Self-reported Asthma Symptoms Research Articles

Association between living habits, indoor humidity, ventilation and asthma among residents in the tropical regions of China.

Asthma is a major public health problem that affects both children and adults, and its prevalence varies among people with different climatic characteristics and living habits. However, few studies have investigated the prevalence and risk factors for asthma among tropical residents in China. Therefore, this study aims to investigate the correlation between individuals' living environment and daily habits in Hainan Province, and the occurrence of asthma. This cross-sectional study collected data from 1021 participants in three regions of the Hainan Province. A questionnaire derived from the European Community Respiratory Health Survey was used to collect data on demographics, living habits, self-reported asthma, and respiratory system-related symptoms. Logistic regression was used for univariate and multivariate analyses to screen for relative risk factors associated with asthma. Among the 1,021 subjects investigated, the prevalence rate of self-reported asthma was 18.6%. Significant risk factors for asthma include hair dyeing, longer living time in Hainan, higher BMI, and living in a damp and musty room. Protective factors included fruit intake, years of higher education, and indoor timing of natural ventilation. Higher frequency of hair dyeing, higher body mass index (BMI), longer living in Hainan, lower frequency of fruit intake, fewer years of education, a damp and musty room, and no indoor timing natural ventilation were associated with an increased risk of asthma.

Exposures to Organophosphate Esters and Respiratory Morbidity among School-Aged Children with Asthma.

Organophosphate esters (OPEs) are an emerging class of chemicals used in a variety of consumer products as flame retardants, plasticizers, and additives. While prior epidemiologic studies suggest that OPEs may impact respiratory health, results remain inconclusive. We examined associations between urinary biomarkers of OPEs and symptoms of respiratory morbidity in a panel study of 147 predominantly Black school-aged children with asthma living in Baltimore City, Maryland. The study consisted of up to four seasonal, week-long, in-home visits where urine samples and self-reported asthma symptoms were collected on days 4 and 7 (nsamples = 438). We quantified concentrations of nine urinary OPE biomarkers: bis(2-chloroethyl) phosphate (BCEtp), bis(1-chloro-2-propyl) phosphate (BCPP), bis(1,3-dichloro-2-propyl) phosphate (BDCIPP), di-n-butyl phosphate (DBuP), di-benzyl phosphate (DBzP), di-o-cresylphosphate (DOCP), di-p-cresylphosphate (DPCP), di-(2-propylheptyl) phthalate (DPHP), and 2,3,4,5-tetrabromo benzoic acid (TBBA). We estimated prevalence odds ratios (POR) of respiratory morbidity symptoms using logistic regression with generalized estimating equations to account for our repeated measure design. We assessed BDCIPP and DPHP as continuous (log2) concentrations and dichotomized exposure of BCEtP, DBuP, and DPCP (detect vs non-detect) based on their lower detection frequencies. We adjusted models for season, visit day, age, gender, caregiver education, health insurance type, exposure to household smoking, atopy, and PM2.5. Higher DPHP concentrations were significantly associated with odds of daytime symptoms (POR: 1.26; 95% CI: 1.04-1.53; p = 0.02) where daytime symptoms consisted of trouble breathing due to asthma, reporting bother caused by asthma, and/or limitation in activities due to asthma. DBuP detection was associated with use of rescue medication on the day of sample collection (POR: 2.36; 95% CI: 1.05-5.29; p = 0.04). We also observed several consistent, albeit non-significant (p > 0.05), positive associations for BCEtP and DPCP and respiratory morbidity measures. This is the first study to evaluate the relationship between OPE biomarkers and respiratory morbidity symptoms in children with asthma, and findings suggest that further studies are warranted to confirm whether these associations are causal.

A Cross Sectional Study of Respiratory and Allergy Status in Dairy Workers

ABSTRACT Introduction Workers on dairy farms face exposures to organic dusts and endotoxin. At the same time, a number of studies of farmers have reported a lower prevalence of asthma in farmworkers compared to persons without farm contact. The “hygiene hypothesis” suggests that early life exposures on farms could be protective against allergic disease and asthma. Such protective relationships are less well studied in adult farm workers. Methods A cross-sectional analysis of respiratory function and allergy status was performed in a sample of dairy farm workers (n = 42) and community controls (n = 40). Measures of respiratory status (spirometry, exhaled nitric oxide FeNO, self-reported symptoms) and levels of total and bovine-specific IgE were compared between the groups. Results Prevalence of self-reported asthma and most respiratory symptoms was similar in the two groups, with the exception of increased report of dyspnea among dairy workers. In the dairy workers, level of lung function was not reduced and FeNO was not increased. In unadjusted and adjusted models, dairy work was not associated with reduced lung function or increased airway inflammation. Mean IgE levels did not differ significantly between workers and controls, but elevated bovine-specific IgE was detected only among dairy workers, with an apparent association between elevated bovine IgE and increased FeNO. Conclusion While dairy workers did not demonstrate increased asthma prevalence compared to controls, sensitization to bovine antigen in several workers appeared to be associated with airway inflammation. Occupational health programs for dairy workers should consider the risk of animal allergy as part of respiratory health protection efforts.

Self-reported prevalence of asthma symptoms in adults living in a port city.

Air pollution is a worldwide health problem, and exposure to the pollution can cause damage to the human body, especially to the respiratory and cardiovascular systems. Asthma is the third most common chronic disease in Brazil, presenting high prevalence in some areas. The aim of this study was to evaluate the self-report the prevalence of asthma symptoms in Santos city, Brazil, and its associated factors in the adult population (between 18 and 59 years old). A cross-sectional study was applied in two different areas of the city. The participants of this study were selected by zip code estimated on a random sample. The ECHRS and a demographic questionnaire were used to collect data. Associations between categorical variables were tested using Pearson's chi-square test or Fisher's exact test. Single and multiple logistic regression models were applied to evaluate the risk factors for asthma. Georeferencing was implemented to distribute the cases. The highest prevalence of asthma was found in Ponta da Praia neighborhood (16.4%; p=0.019), as well as waking up with a coughing crisis in the last 12 months (26.4%; p <0.001). The risk factors for asthma were the following: living next Santos Port area (OR: 2.90; 95%CI 1.13-7.44); and the presence of O3 (OR = 2.63; 95%CI 0.86-7.96). This pioneering study demonstrated that living near the port area increases the chances of adults having self-reported asthma symptoms.

Development and content validation of a self-completed, electronic Pediatric Asthma Symptom Diary

BackgroundChildhood asthma is an important unmet need. To date, patient-reported outcome measures (PROMs) for children with asthma have used a combination of caregiver or proxy-reported and self-reported measures. No comprehensive measure is available to assess the severity and impact of daytime and nighttime asthma symptoms and rescue medication use for self-completion by children aged 6–11 years. This study aimed to develop a novel, interactive, electronic Pediatric Asthma Symptom Diary (ePASD) measuring self-reported key symptom severity and proximal impacts of asthma in young children with varying reading ability and disease severity, consistent with US Food and Drug Administration (FDA) PRO guidance and the International Society for Health Economics and Outcomes Research (ISPOR) good research practices.MethodsA targeted literature review and clinician interviews were undertaken to characterize symptoms and impacts experienced by children with mild-to-severe asthma. Concept elicitation interviews (CEIs) were conducted with 44 children and their caregivers (30 US; 14 UK). Following item and digital application development, the ePASD was assessed for relevance, understanding, and interpretability through cognitive debriefing interviews (CDIs) with 21 US children. Face validity/translatability assessments were also performed.ResultsKey measurement concepts included cough, wheeze, difficulty breathing, chest tightness/discomfort, nighttime awakening, and daytime activity limitations. Concept saturation was reached during CEIs for primary asthma-related daytime and nighttime symptoms and core impacts. Most CDI participants found the ePASD items clear, understandable, and comprehensive. Standardized training is anticipated to facilitate reliable child self-report.ConclusionThe ePASD, a novel PROM for children aged 6–11 years with asthma, uses an innovative multimedia approach and has been developed in accordance with FDA PRO guidance and ISPOR good research practices, directly capturing the child’s self-reported asthma symptoms, impacts on daily activities and nighttime awakening, and rescue medication use.

Long-term exposure to ambient air pollution and asthma symptom score in the CONSTANCES cohort

BackgroundThe asthma symptom score allows to consider asthma as a continuum and to investigate its risk factors. One previous study has investigated the association between asthma score and air pollution...

Parent-child conflict and physical health trajectories among youth with asthma

ObjectiveTo investigate the role of caregiver- and youth-reports of parent-child conflict on trajectories of asthma-related health outcomes over 2 years. MethodsIn a sample of 193 youth with asthma (42.7% female; M age = 12.78) and their primary caregivers, we used a multi-method and multi-informant approach to assess self-reported parent-child conflict from youth and caregivers at both the daily and global levels at baseline. Next, we annually assessed subjective (i.e., youth self-reported asthma symptoms) and clinical (i.e., peak flow) asthma health outcomes for 2 years. ResultsLatent growth curve models revealed an effect of baseline youth-reported global family conflict on peak flow trajectories such that youth who reported greater parent-child conflict at baseline experienced less of an increase in peak flow over time than youth who reported less parent-child conflict at baseline (standardized β = −0.27, p = .003). ConclusionsYouth with asthma who perceive greater overall conflict with their caregivers experience less improvement in peak flow as they age. The research and clinical implications of these findings are discussed.

Organophosphate Ester (OPE) Exposures and Asthma Morbidity Among Urban School-Aged Children in Baltimore City, Maryland

BACKGROUND AND AIM: OPEs are used as flame retardants and plasticizers in many consumer products. Studies suggest OPEs may be linked with respiratory outcomes among children. We aimed to examine associations between OPEs and asthma morbidity among 179 mostly Black children (93%), aged 5-12 years with asthma enrolled in a panel study between 2009-2013¬ in Baltimore City. METHODS: The panel study included up to four seasonal, week-long in-home visits. We collected urine samples on visit-days 4 and 7 (n = 618 samples). We quantified concentrations of 9 OPE metabolites: bis(2-chloroethyl)phosphate(BCEtp), bis(1-chloro-2-propyl)phosphate(BCPP), bis(1-chloro-2-propyl)phosphate(BDCPP), di-benzylphosphate(DBuP), di-benzylphosphate(DBzP), di-o-cresylphosphate(DOCP), di-p-cresylphosphate(DPCP), diphenyl-phosphate(DPHP), and 2,3,4,5-tetrabromobenzoic acid(TBBA). At each visit, participants self-reported asthma symptoms. We calculated Spearman’s rank (continuous) and tetrachoric (binary) correlation coefficients to assess variability of concentrations on days 4 and 7 and intraclass correlation coefficients (ICCs) to assess variability by visit. We assessed associations between metabolite concentrations and asthma symptoms using logistic regression models with generalized estimating equations. We examined BDCPP and DPHP as continuous variables; dichotomized BCEtP, DBuP, and DPCP; and excluded others not frequently detected. We adjusted models for season, visit-day, age, race, sex, BMI, caregiver education, and household income. RESULTS:Detection frequencies were 95% for BDCPP and DPHP, 4.6-31.1% for BCEtP, DBuP and DPCP, respectively and 3% for all other metabolites. OPE concentrations on days 4 and 7 were moderately correlated (rho=0.3-0.6) with low reproducibility across visits (ICC=0.2-0.4). In adjusted models, higher DPHP concentrations were associated with greater odds of self-reported difficulty breathing (odds ratio [OR]: 2.0; 95%CI:1.1-3.6), activity limitation due to asthma (OR:1.6; 95%CI:1.0-2.8), and being bothered by asthma (OR:1.9; 95%CI:1.2-3.2). No associations were observed with other OPEs. CONCLUSIONS:In this predominantly pediatric Black cohort, higher DPHP concentrations were consistently associated with asthma symptoms. We did not observe consistent patterns of association between other OPE metabolites and asthma morbidity. KEYWORDS: Biomarkers of exposure, Respiratory outcomes, Children's environmental health, Environmental disparities, Environmental epidemiology

Risk factors for severe adult-onset asthma: a multi-factor approach

BackgroundThe aim was to identify risk factors for severe adult-onset asthma.MethodsWe used data from a population-based sample (Adult Asthma in Finland) of 1350 patients with adult-onset asthma (age range 31–93 years) from Finnish national registers. Severe asthma was defined as self-reported severe asthma and asthma symptoms causing much harm and regular impairment and ≥ 1 oral corticosteroid course/year or regular oral corticosteroids or waking up in the night due to asthma symptoms/wheezing ≥ a few times/month. Sixteen covariates covering several domains (personal characteristics, education, lifestyle, early-life factors, asthma characteristics and multiple morbidities) were selected based on the literature and were studied in association with severe asthma using logistic regressions.ResultsThe study population included 100 (7.4%) individuals with severe asthma. In a univariate analysis, severe asthma was associated with male sex, age, a low education level, no professional training, ever smoking, ≥ 2 siblings, ≥ 1 chronic comorbidity and non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD) (p < 0.05), and trends for association (p < 0.2) were observed for severe childhood infection, the presence of chronic rhinosinusitis with nasal polyps, and being the 1st child. The 10 variables (being a 1st child was removed due to multicollinearity) were thus entered in a multivariate regression model, and severe asthma was significantly associated with male sex (OR [95% CI] = 1.96 [1.16–3.30]), ever smoking (1.98 [1.11–3.52]), chronic comorbidities (2.68 [1.35–5.31]), NERD (3.29 [1.75–6.19]), and ≥ 2 siblings (2.51 [1.17–5.41]). There was a dose–response effect of the total sum of these five factors on severe asthma (OR [95% CI] = 2.30 [1.81–2.93] for each one-unit increase in the score).ConclusionsMale sex, smoking, NERD, comorbidities, and ≥ 2 siblings were independent risk factors for self-reported severe asthma. The effects of these factors seem to be cumulative; each additional risk factor gradually increases the risk of severe asthma.

Characterization of Asthma Trajectories from Infancy to Young Adulthood

Development of asthma is complicated by the multidimensional nature of the disease. To identify and characterize trajectories of asthma from infancy to young adulthood, and their associations with lung function and inflammatory and respiratory markers in adolescence and young adulthood. A latent class analysis was performed in a population-based cohort (N= 4089). Parental and self-reported symptoms of asthma were used to investigate asthma development. We characterized background factors, allergic comorbidity, and IgE sensitization and investigated associations with asthma markers. A 4-class solution of asthma trajectories was identified: never/infrequent (n= 3291 [80.4%]), early-onset transient (n= 307 [7.5%]), adolescent-onset (n= 261 [6.4%]), and persistent asthma (n= 230 [5.6%]). Uncontrolled asthma was equally prevalent in the adolescent-onset and persistent asthma trajectory groups, at both age 16 (41.7% vs 42.4%; P= .90) and 24 years (53.7% vs 52.4%; P= .81). The persistent asthma trajectory group had a higher proportion of eosinophil counts greater than or equal to 0.3 (109 cells/L) at age 24 years compared with the adolescent-onset trajectory group (31.0% vs 18.5%; P < .01). The adolescent-onset and persistent asthma trajectory groups had equal burdens of asthma control in adolescence and young adulthood. However, the persistent asthma trajectory group showed more signs of type 2 inflammation than the adolescent-onset trajectory group. This unbiased approach highlights the need of identifying patients with adolescent asthma to optimize care, because they suffer the same lack of asthma control as those with persistent asthma.

Long-term effects of asthma medication on asthma symptoms: an application of the targeted maximum likelihood estimation

BackgroundLong-term effectiveness of asthma control medication has been shown in clinical trials but results from observational studies with children and adolescents are lacking. Marginal structural models estimated using targeted maximum likelihood methods are a novel statistiscal approach for such studies as it allows to account for time-varying confounders and time-varying treatment. Therefore, we aimed to calculate the long-term risk of reporting asthma symptoms in relation to control medication use in a real-life setting from childhood to adulthood applying targeted maximum likelihood estimation.MethodsIn the prospective cohort study SOLAR (Study on Occupational Allergy Risks) we followed a German subsample of 121 asthmatic children (9–11 years old) of the ISAAC II cohort (International Study of Asthma and Allergies in Childhood) until the age of 19 to 24. We obtained self-reported questionnaire data on asthma control medication use at baseline (1995–1996) and first follow-up (2002–2003) as well as self-reported asthma symptoms at baseline, first and second follow-up (2007–2009). Three hypothetical treatment scenarios were defined: early sustained intervention, early unsustained intervention and no treatment at all. We performed longitudinal targeted maximum likelihood estimation combined with Super Learner algorithm to estimate the relative risk (RR) to report asthma symptoms at SOLAR I and SOLAR II in relation to the different hypothetical scenarios.ResultsA hypothetical intervention of early sustained treatment was associated with a statistically significant risk increment of asthma symptoms at second follow-up when compared to no treatment at all (RR: 1.51, 95% CI: 1.19–1.83) or early unsustained intervention (RR:1.38, 95% CI: 1.11–1.65).ConclusionsWhile we could confirm the tagerted maximum likelihood estimation to be a usable and robust statistical tool, we did not observe a beneficial effect of asthma control medication on asthma symptoms. Because of potential due to the small sample size, lack of data on disease severity and reverse causation our results should, however, be interpreted with caution.

Allergic disease and risk of stress in pregnant women: a PreventADALL study.

BackgroundMaternal stress during pregnancy may negatively affect the health of mother and child. We therefore aimed to identify the proportion of women reporting high maternal stress in mid and late pregnancy and explore whether symptoms of maternal allergic disease are associated with perceived maternal stress in late pregnancy.MethodThe population-based Preventing Atopic Dermatitis and Allergy in Children (PreventADALL) study enrolled 2697 pregnant women at their 18-week routine ultrasound examination in Norway and Sweden. Information about sociodemographic factors, symptoms and doctor-diagnosed asthma, allergic rhinitis, atopic dermatitis, food allergy, and anaphylaxis and stress using the 14-item perceived stress scale (PSS) was collected at 18 weeks (mid) and 34 weeks (late) pregnancy. High stress was defined as a PSS score ≥29. Scores were analysed using multivariate logistic and linear regression.ResultsAmong the 2164 women with complete PSS data, 17% reported asthma, 20% atopic dermatitis, 23% allergic rhinitis, 12% food allergy and 2% anaphylaxis. The proportion of women reporting high stress decreased from 15% at mid to 13% at late pregnancy (p<0.01). The adjusted odds ratio for high stress in late pregnancy was 2.25 (95% CI 1.41–3.58) for self-reported symptoms of asthma, 1.46 (95% CI 1.02–2.10) for allergic rhinitis and 2.25 (95% CI 1.32–3.82) for food allergy. A multivariate linear regression model confirmed that symptoms of asthma (β coefficient 2.11; 0.71–3.51), atopic dermatitis (β coefficient 1.76; 0.62–2.89) and food allergy (β coefficient 2.24; 0.63–3.84) were independently associated with increased PSS score.ConclusionAllergic disease symptoms in pregnancy were associated with increased stress, highlighting the importance of optimal disease control in pregnancy.

Association of pet-keeping in home with self-reported asthma and asthma-related symptoms in 11611 school children from China

Objective We conducted a cross-sectional study to investigate the associations between domestic pets and respiratory health in children. Methods We randomly recruited 11,611 school children from Zhongshan, a southern city in China. Information about the respiratory symptoms and disease history of the recruited children, the status of domestic pets, and other related risk factors were collected from March to July 2016. Results We identified cat-keeping at home increases the risk of persistent cough (OR, 1.77; 95%CI, 1.03–3.05); poultry-keeping at home increases the risk of current asthma (OR, 3.87; 95%CI, 1.08–13.92) and allergic rhinitis (OR, 1.84; 95%CI, 1.01–3.37); sleeping with pets increases the risk of persistent phlegm (OR, 5.04; 95%CI, 1.05–24.28), doctor-diagnosed asthma (OR, 3.35; 95%CI, 1.31–8.57) and current asthma (OR, 4.94; 95%CI, 1.05–23.31) in children. Conclusions Cat-keeping and molds on the wall of the house had the multiplicative and additive interaction in doctor-diagnosed asthma. In conclusion, pet-keeping increased the risk of respiratory symptoms in children.

Potential effects of E-cigarettes and vaping on pediatric asthma.

Asthma is the most common chronic disease in childhood and exposure to tobacco smoke has been long recognized as a risk factor for its onset as well as for exacerbations and poor disease control. Since the early 2000s, electronic cigarettes have been marketed worldwide as a non-harmful electronic alternative to combustible cigarettes and as a device likely to help stop smoking, and their use is continuously rising, particularly among adolescents. However, several studies have shown that vape contains many different well-known toxicants, causing significant cytotoxic and pro-inflammatory effects on the airways in-vitro and in animal models. In humans, a variety of harmful lung effects related to vaping, ranging from bronchoconstriction to severe respiratory distress has been already reported. To investigate the potential effects of vaping in pediatric asthma, we searched relevant published studies in the MEDLINE/PubMed database by combining the adequate Medical Subject Headings terms and key words. At the end of our study selection process, five cross-sectional studies focusing on electronic cigarettes use in adolescents and self-reported asthma and/or other respiratory symptoms, one study focusing on the effects of electronic cigarettes second-hand exposure and one case report were retrieved. These preliminary data support a likely detrimental effect of vaping in asthmatic adolescents. Currently available evidence supports that electronic cigarettes are a potential threat to respiratory health, particularly in adolescents with asthma. High-quality studies on larger population assessing the long-term effects of vape exposure, are urgently needed.

New Concepts and Technological Resources in Patient Education and Asthma Self-Management.

Asthma is a chronic disease that is associated with significant morbidity and mortality. In general, the use of technology resources or electronic health (e-health) has been shown to have beneficial effects on patients with asthma. E-health can impact a broad section of patients and can be cost-effective and associated with high patient satisfaction. E-health may enable remote delivery of care, as well as timely access to health care, which are some of the common challenges faced by patients with asthma. Web-based asthma self-management systems have been found to improve quality of life, self-reported asthma symptoms, lung function, reduction in asthma symptoms/exacerbations, and self-reported adherence for adults. Social media is commonly being used as a platform to disseminate information on asthma to increase public awareness. It can facilitate asthma self-management in a patient friendly manner and has shown to improve asthma control test scores as well as self-esteem. Text massages reminders can increase awareness regarding asthma treatment and control, thus potentially can improve adherence to medications and asthma outcome. Mobile health applications can support asthma self-management, improve a patient's quality of life, promote medication adherence, and potentially reduce the overall costs for asthma care. Inhaler trackers have shown to be beneficial to asthma outcome in various populations by improving adherence to asthma medications. Barriers such as physician financial reimbursement as well as licensing for rendering tele-healthcare services are important concerns. Other limitations of using technology resources in health care are related to liability, professionalism, and ethical issues such as breach of patient confidentiality and privacy. Additionally, there may be less face-to-face interaction and care of the patient when e-health is used.

Agreement between self-reported asthma symptoms and exhaled nitric oxide levels: impact on inhaled corticosteroid prescribing in general practice. An observational study

BackgroundThe National Review of Asthma Deaths UK highlighted that 46% of deaths could be avoided and recommended that all sufferers receive a structured asthma annual review which assess asthma control. In primary care this is commonly achieved using symptom-based questionnaires such as the Asthma Control Test (ACT). A newer method of assessing asthma control is Fractional Exhaled Nitric Oxide (FeNO) testing, which is currently recommended for the diagnosis of asthma, but not for monitoring of asthma control. The study aim was to assess the correlation between self-reported symptoms as measured by the ACT and FeNO testing and the subsequent impact of FeNO testing on prescribing of asthma medication.MethodsA retrospective review of 65 patients who had received both ACT and FeNO testing as part of their asthma annual review. A spearman correlation was used to estimate the correlation between ACT scores and FENO levels. A χ2 test was used to compare prompting frequency of the measures and Kendalls τ statistic was made to estimate their concordance and influence on subsequent ICS medication prescription.ResultsThe mean age of the participants was 41 years (4–93 years). There was no statistically significant correlation between ACT and FeNO (ρ = 0.195, p = 0.120). The median FeNO was 26 ppb (range 8–279 ppb), and the ACT score 20 (range 5 to 25 points). Furthermore, FeNO more frequently prompts a change in medication than ACT, 66% versus 42% (p = 0.005). A low concordance between the measures was found (Kendall’s τ statistic − 0.321).ConclusionFeNO should be considered for monitoring of control in asthma. To balance the cost of implementing this technology into primary care a risk stratified approach could be applied to testing.

Prevalence and risk factors of asthma symptoms in Saudi university students in Najran, southern border region of Saudi Arabia

Background: Asthma prevalence in adults is globally increasing with variations between and within countries. Data are lacking regarding the prevalence of asthma among adults in Najran area , the southern region of Saudi Arabia. Objectives: The study aimed at estimating the prevalence and risk factors for asthma symptoms in Najran University students. Materials and Methods: A cross-sectional study was performed in Najran University Saudi students during the academic year 2017–2018. A modified translated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was distributed to Najran University Saudi students, males and females aged 18 and above living in Najran for more than 1 year. Samples were taken using multistage random sampling. Results: A total of 418 participants (269 males and 149 females) with a mean age of 21.05 ± 1.56 were included in the study. The prevalence of asthma depending on the wheezing symptom in the past 12 months was 27% and physician-diagnosed asthma was 13.6%. Most of the asthmatic subjects (>85%) have intermittent symptoms. The first-degree family history, active tobacco smoking, allergic rhinitis (AR), dust, and smoke are the major risk factors for asthma symptoms. Conclusions: The study revealed a high prevalence of self-reported asthma symptoms among adults in Najran University associated with a high prevalence of AR, which needs particular attention by the health stakeholders.

Non-pharmacological management of adult asthma in Australia: cross-sectional analysis of a population-based cohort study

Aim: To identify the level of non-pharmacological care received by middle-aged adults with current asthma in Australia and to identify its association with clinical measures. Methods: The Tasmanian Longitudinal Health Study (TAHS) is a population-based cohort first studied in 1968 (n = 8583). In 2010, when participants were aged 49 years, a stratified sample enriched for asthma and bronchitis underwent clinical assessments including respiratory questionnaires and lung function testing (n = 836). Current asthma was defined as self-reported asthma symptoms and/or healthcare utilization in the last 12 months. Multivariable linear regression and log-binomial models were used to assess the relevant associations. Results: Of the entire TAHS cohort, 15.6% (95% CI 13.4–18.2%) had current asthma. Of these, 37.9% (95% CI 30.5–45.9%) had seen a general practitioner for their asthma and 16.5% (95% CI 11.5–23.1%) had discussed their asthma with a pharmacist in the last 12 months. Written asthma action plans (AAPs) were reported by 17.9% (95% CI 12.9–23.2%), verbal AAPs by 53.8% (95% CI 45.9–61.6%) and doctor-assessments of inhaler technique by 42.7% (95% CI 35.2–50.5%). Adults with asthma of greater severity were more likely to have received verbal AAPs (p-trend =0.02). In contrast, adults with lower spirometry were more likely to have received verbal AAPs (p = 0.04), written AAPs (p = 0.001) and education on inhaler technique (p = 0.04). Conclusion: Despite an established evidence base and recommendations in local and international guidelines, non-pharmacological asthma management remains sub-optimal in the middle-aged adult asthma population.

Social, Environmental and Behavioral Determinants of Asthma Symptoms in Brazilian Middle School Students-A National School Health Survey (Pense 2012).

Biological and psychosocial factors are recognized contributors to the worldwide burden of asthma. However, the relationship between psychosocial factors and asthma symptoms among students in low- and middle-income countries remains underexplored. We aimed to identify socioeconomic, environmental, psychosocial, family-related and lifestyle factors associated with the self-reporting of asthma symptoms in Brazilian adolescents. This is a cross-sectional study using data from the 2012 PeNSE survey (n = 109,104). We analyzed the following variables: socioeconomic conditions, demographic characteristics, lifestyle, family context and dynamics, psychosocial indicators, smoking, and exposure to violence. Our outcome variable was the self-report of asthma symptoms in the past 12 months. The prevalence of wheezing was 22.7% (21.5–23.9). After adjusting for sex, age and the variables from higher hierarchical levels, exposure to violence (feeling unsafe at school, being frequently bullied, being exposed to fights with firearms) and physical aggression by an adult in the family were the environmental factors that showed the strongest associations with self-reporting of asthma symptoms. For psychosocial indicators of mental health and social integration, feelings of loneliness and sleeping problems were the strongest factors, and among individual behavioral factors, the largest associations were found for tobacco consumption. Our findings were consistent with previous studies, showing an association between self-reported asthma symptoms and socio-economic status, family context and dynamics, psychosocial indicators of mental health, exposure to violence and social integration, as well as a sedentary lifestyle and tobacco use.

Prevalence and trend of COPD from 1995-1997 to 2006-2008: The HUNT study, Norway.

COPD is a major cause of morbidity and mortality across the world and new estimates of prevalence and trend are of great importance. We aimed to estimate the prevalence and trend of COPD from 1995-1997 to 2006-2008 in Norwegian adults ≥40 years from the Nord-Trøndelag Health Study. COPD was assessed using a fixed-ratio and lower limit of normal (LLN) criteria. Pre-bronchodilator spirometry was performed during 1995-1997 (n = 7158) and 2006-2008 (n = 8788). The prevalence of COPD was weighted using the inverse probability of selection and predicted probability of response. The prevalence of pre-bronchodilator COPD was 16.7% in 1995-1997 and 14.8% in 2006-2008 using fixed-ratio criteria, and 10.4% in 1995-1997 and 7.3% in 2006-2008 using LLN criteria. The prevalence of LLN COPD was higher among men (13.0% in 1995-1997, 7.7% in 2006-2008) than women (8.0% in 1995-1997, 6.9% in 2006-2008). From 1995-1997 to 2006-2008, the prevalence decreased among men but remained relatively stable among women. Over the 11-year period, the cumulative incidence of pre-bronchodilator COPD using LLN criteria was 3.3% and 2.7% among men and women respectively. The prevalence of self-reported asthma and respiratory symptoms increased. The prevalence declined in men but not in women from 1995-1997 to 2006-2008, and was consistently higher among men than women.