Use Of Asthma Drugs Research Articles

Carious lesions recurrence in children with developmental disabilities: a longitudinal study.

This study investigated the factors associated with new carious lesions in one-to five-year-old children with developmental disabilities. This was a retrospective cohort that evaluated 64 dental charts of individuals with caries or fillings in their first dental appointment. The dependent variable was the occurrence of a new carious lesion or restoration. Gender, age, mother's education, sugar consumption, oral hygiene, mouth breathing, reports of xerostomia, gingival status, use of psychotropic drugs, use of asthma drugs, history of asthma, bronchitis, reflux or seizures and having at least one sibling were covariates. Cox proportional hazards regression model was used to estimate the raw and adjusted hazard ratios with their respective 95% confidence interval. The average time that individuals remained free of dental caries/restoration was 79.49 months (95%CI: 64.37 to 92.61). Increase in sucrose consumption increased the rate of caries recurrence (HR = 1.16; 95%CI: 1.04 to 1.30). Individuals who had poor oral hygiene had higher rate of new dental caries (HR = 3.88; 95%CI: 1.22 to 12.37) compared to those with good oral hygiene. The presence of mouth breathing decreased the rate of recurrence of the disease when compared to the nasal breathing (HR = 0.32; 95%CI: 0.15 to 0.70). Oral health-related behaviors and nasal respiration influenced the rate of dental caries recurrence in individuals with developmental disabilities.

Photodegradation mechanism and influencing factors of asthma drug salmeterol under UV irradiation

With serious air pollution, heavy use of asthma drugs caused the accumulation in environmental water, which might pose a potential risk on the organisms. In this study, the ultraviolet photodegradation of asthma drug salmeterol (SX) and influencing factors were studied, meanwhile, the possible photolysis pathway and toxicity trends during the photolysis process were further discussed. The results showed that the photolysis of SX conformed to the pseudo-first order kinetic reaction and 1O2 dominated the photolysis process with contribution of 41.7 %. As the temperature, pH value and HCO3− concentration increased, SX photolysis rate accelerated. The presence of NO3− could also promote the SX photolysis rate but with to Cl2− the increase of NO3− concentration, the promotion reduced via OH quenching and stronger optical shielding. When Cl− concentration increased to 0.1 mM, the promotion effect of Cl− turned to inhibition due to the transformation of Cl to Cl2−. Moreover, the photolysis of SX was inhibited by the Fulvic acid (FA) through optical screening effect and free radical scavenging. Based on the nine intermediates predicted by UPLC-Q-TOF, three possible transformation pathways were proposed. Luminous intensity test of photobacterium phoshoreum T3 spp indicated the toxicity of the final reaction system was reduced through the ultraviolet irradiation.

Use of asthma drugs and prevalence of molar incisor hypomineralization.

BackgroundAsthma and molar incisor hypomineralization (MIH) are common diseases among children and have been suspected to be associated with each other.AimTo examine the association between asthma or the use of asthma drugs and the prevalence of MIH.DesignIn a population‐based cross‐sectional study, we recorded MIH in 9‐year‐old children in Aalborg Municipality, Denmark, born in the year 2000. We used a unique 10‐digit civil personal number to link data on MIH to population‐based medical register data. The exposure was inhaled asthma medication from birth date until date of dental examination. The outcome was the overall prevalence of MIH according to use of asthma medication. Odds ratios (OR) of having MIH were adjusted for gender, use of antibiotics and amoxicillin, maternal smoking, pre‐ and perinatal complication, and hospital admissions.ResultsWe examined 1837 children, of which 542 (29.5%) had one or more molar(s) with MIH. The adjusted odds ratio of having MIH was 0.95 (95% CI: 0.60‐1.51) among children with prescriptions of inhaled asthma medication.ConclusionIn this study, where the results have been adjusted for confounding, we found no association between use of inhaled asthma medication and the prevalence of MIH.

Chest tightness is relieved with the use of asthma drugs except bronchodilators

Objective: Many patients with a chief complaint of chest tightness are examined in medical facilities, and a lack of diagnosis is not uncommon. We have reported that these patients often include those with chest tightness relieved with bronchodilator use (CTRB) and those with chest tightness relieved with the use of asthma drugs except bronchodilators (CTRAEB). The purpose of this study was to demonstrate the clinical characteristics of the patients with CTRAEB and compare them with data from patients with CTRB. Methods: Patients with CTRB (n = 13) and CTRAEB (n = 7) underwent a bronchodilator test, assessments of airway responsiveness to methacholine, bronchial biopsy, and bronchial lavage under fiberoptic bronchoscopy before receiving treatment. In all, 10 healthy subjects, 11 bronchial biopsy control patients, and 10 asthmatic patients were recruited for comparison. Results: Inhalation of a short-acting ß2-agonist (SABA) increased the forced expiratory volume in one second (FEV1) by 5.1% ± 4.0% in patients with CTRB and by 1.3% ± 3.5% in patients with CTRAEB, and the difference was statistically significant (p = 0.0449). The bronchial biopsy specimens from the patients with CTRB and CTRAEB exhibited significant increases in T cells (p < .05) compared with those of the control subjects. The bronchial responsiveness to methacholine was increased in only a minor portion of patients with CTRB and CTRAEB. Conclusions: We hypothesized that the clinical condition of patients with CTRAEB involves chest tightness arising from inflammation alone, and this chest tightness is mostly associated with airway T cells, without constriction of the airways. There is little to distinguish CTRAEB from CTRB aside from the response to bronchodilator treatment.This clinical trial is registered at www.umin.ac.jp (UMIN13994, 13998, and 16741).

Developmental defects of enamel in first permanent molars associated with use of asthma drugs in preschool aged children: A retrospective case-control study.

To investigate the association between the occurrences of developmental defects of enamel (DDE), in first permanent molars, and bronchodilators and/or corticosteroid intake for asthma-like episodic treatment at preschool age, in 6-12year old children. Children of the case group (n=70) were followed in the Paediatric Pulmonary Unit and the Unit of Allergology, Asthma and Inflammation at 'Aghia Sofia' Children's Hospital, Athens, Greece and had used asthma drugs during their first 4years of life. The control group (n=70) consisted of healthy children who visited the Postgraduate Paediatric Dental Clinic, University of Athens. Information regarding demographic data, medical history, pregnancy, birth weight, duration of breastfeeding, mother's smoking habits and antibiotic use at preschool age was obtained through a structured questionnaire. Details concerning asthma drugs used were extracted from medical records. The children in both groups underwent an oral examination under standard clinical conditions and all surfaces of first permanent molars were assessed for enamel defects using the modified DDE Index. Chi square statistics, Mann-Whitney U test, Spearman correlation coefficient and logistic regression analysis were used for statistical analysis of the data (p≤0.05). DDE were present in 24 children (34.3%) in the case group and only in 6 (8.6%) in the control, with the difference between the two groups being statistically significant (p<0.001), while the estimated odds ratio was 5.56. Among the children with DDE in the case group, 41.6% had at least one hypoplastic molar with loss of enamel. The type of asthma drug, age at treatment onset and duration of drug use were not significantly associated with the severity or extent of DDE. Among the possible influential factors, gender was the only statistical significant factor. Children treated with asthma drugs for asthma-like episodes at a preschool age showed an overall increased risk for developing enamel defects in their first permanent molars. Severe hypoplastic lesions with loss of enamel was a frequent finding among affected molars.

Parasympathetic Activity and Bronchial Hyperresponsiveness in Athletes.

A high prevalence of asthma and bronchial hyperresponsiveness (BHR) is reported in swimmers and cross-country skiers. It has been suggested that increased parasympathetic nervous activity is involved in asthma development in endurance athletes. We aimed to assess the associations of BHR to parasympathetic activity in healthy and asthmatic swimmers and cross-country skiers and healthy nonathletes. Parasympathetic activity was measured by pupillometry and heart rate variability at the onset of exercise with the cardiac vagal index calculated in 28 cross-country skiers (♂18/♀10), 29 swimmers (♂17/♀12), and 30 healthy nonathlete controls (♂14/♀16) on two different days. All subjects performed a methacholine bronchial challenge with the provocation dose causing 20% decrease in the forced expiratory volume in 1 s calculated (PD20met). Data were analyzed by robust regression analysis and presented as β coefficients with 95% confidence intervals (CI). PD20met was negatively associated with cardiac vagal index (-13.9, 95% CI = -26.8 to -1.0) in all subjects. When adjusted to the type of sport, this association was stronger in swimmers (-8.3, 95% CI = -13.0 to -3.6) as compared with controls and nonsignificant in cross-country skiers. Percent pupil constriction was significantly associated with PD20met in swimmers (-9.4, 95% CI = -15.4 to -3.4) only after adjusting for the type of sport. Fourteen swimmers (48%) and 16 cross-country skiers (57%) had doctor-diagnosed asthma in combination with current BHR and/or current use of asthma drugs. Seventy-two percent swimmers, 44% cross-country skiers, and 39% controls had a PD20met ≤8 μmol (P = 0.015). Fourteen swimmers had a PD20met ≤2 μmol as compared with one cross-country skier (P < 0.001). Parasympathetic activity measured in the heart is more closely related to BHR as compared with parasympathetic activity measured in the pupils. The type of sport influences BHR severity and its relationship to parasympathetic activity.

Factors associated with concordance between parental-reported use and dispensed asthma drugs in adolescents: findings from the BAMSE birth cohort.

Pharmacological treatment is important in asthma care, but there are methodological challenges in measuring how drugs are used by patients. The aim of this study was to investigate the concordance between register data on dispensed drugs and parental-reported use of asthma drugs in adolescents. A cross-sectional study comparing data on dispensed drugs from the Swedish Prescribed Drug Register with data on parental-reported use of asthma drugs among 3 316 adolescents (age 11-14 years) in a population-based birth cohort in Sweden. Sensitivity, specificity, and positive predicted value for different time windows (3, 6, 12, 18, and 24 months) for dispensing in the register were computed. Logistic regression was used to explore factors associated with concordance. The prevalence of parental-reported use of asthma drugs in the past year was 10.7% (n = 356) compared with 8.1% (n = 269) for dispensed drugs according to the register (p ≤ 0.001). The sensitivity increased with an extended time window in the register, whereas the specificity remained high up to 18 months. Although 90% of the adolescents with asthma had parental-reported use of asthma drugs, 30% of them had no such drugs dispensed in the preceding 18 months. The highest concordance was seen for adolescents with severe asthma (OR 4.6, CI 1.2-17.6). An 18-month window is preferable when using dispensing data to study the use of asthma drugs. Still, many adolescents with reported drug use had not purchased any asthma drug in this period. The concordance between parental-reported use and dispensed drugs is higher for adolescents with severe asthma.

Risk factors for the development of oesophageal adenocarcinoma in Barrett's oesophagus: a UK primary care retrospective nested case-control study.

Oesophageal adenocarcinoma (OAC) incidence is rising rapidly and prognosis remains poor. Endoscopic surveillance of Barrett's oesophagus (BO) remains controversial. A nested case-control study was undertaken to evaluate risk factors for progression of BO to OAC, potentially guiding surveillance efforts. The Health Improvement Network database includes general practitioner consultations from 5 million UK subjects. BO subjects with 1-year minimum of follow up were followed until development of OAC or end of time on database. Demographic variables (age, gender, smoking, body mass index) and data on medication considered negatively (aspirin/nonsteroidal anti-inflammatory drugs/proton pump inhibitors) or positively associated (lower oesophageal sphincter-relaxing and asthma drugs) with OAC development were studied. Cox regression analysis-derived hazard ratios with 95% confidence intervals estimated the relative risk for OAC progression. A total of 3749 BO subjects were studied: 55 developed OAC during 17,743 patient years of follow up, a progression rate of 0.3% per annum. There was 96.7% of the cohort who took proton-pump inhibitors, with no association observed. Increasing age (1.03, 95% CI 1.01-1.05, p = 0.005), male gender (3.06, 95% CI 1.50-6.24, p = 0.002), and having ever smoked (2.36, 95% CI 1.13-4.93, p = 0.023) were associated with progression to OAC, (although smoking lost association on multivariate analysis). Increasing number of drugs used for asthma (2.91, 95% CI 1.10-7.68, p= 0.0314) was also associated. In this nested case-control study of BO, male gender, increasing age, and increasing use of asthma drugs were associated with progression to OAC.

Socioeconomic status and the quality of prescribing asthma drugs in Sweden

Introduction: Socioeconomic status (SES) is strongly associated with morbidity as well as with health care utilization and expenditure. The association between SES and quality of prescribing of asthma drugs is less studied. Objectives: The aim of this study was to examine the association between socioeconomic factors, i.e. education, income and country of birth, and the prevalence, incidence and adherence to guidelines for antiasthmatic drugs. Methods: This registry study includes all Swedish citizens aged 25–44 years who redeemed at least one prescription of an antiasthmatic drug during 2010. Incidence and prevalence was calculated. The adherence to guidelines was studied using two defined quality indicators. Heavy users were also assessed. Results: Incidence for antiasthmatic drugs was 18.4 per 1000 person-years and the prevalence 50.9 per 1000 inhabitants. Previously untreated patients who redeemed fixed combination ranged from 45% to 49%. Patients who purchase long-acting beta-2-adrenoceptor agonists (LABA) without inhaled corticosteroid ranged from 43% to 59%. Six percent of the population was classified as heavy users. Conclusion: The study showed a high incidence and prevalence of asthma drug use with a poor adherence to guidelines for rational drug prescribing. Fixed combination as first line asthma treatment as well as purchasing LABA without concomitant ICS was more common in patients born outside Scandinavia. Heavy users of short-acting bronchodilators were associated with male sex, high age, low income levels and low levels of education.

Does drug compliance change in asthmatic patients during pregnancy?

Background: Pregnant women with asthma are recommended to maintain optimal therapeutic management during pregnancy. Uncontrolled, symptomatic asthma may increase the risk of adverse peri-natal outcomes; thus adequate regular anti-asthmatic treatment must be given to provide optimal asthma control during pregnancy. However, doubts about the safety of asthmatic drugs can affect pregnant asthmatic patients’ drug compliance. The aim of this study was to assess behavioral differences in drug compliance among pregnant asthmatic patients. Methods: Thirty two asthmatic and 121 healthy pregnant women were enrolled in the study. Structured face-to-face interviews were conducted after delivery. The interviews included disease characteristics, drug compliance and patients’ own perspective for asthma status prior to and during pregnancy. In addition, medical and pregnancy history, pregnancy complications and outcomes, and newborn characteristics were recorded. Results: In our study group the rates of hospitalization, emergency room visits and systemic steroid use in the year before pregnancy were 13%, 46.9% and 18.8%, respectively. The rate of regular asthma medication use was only 32% at that period and increased to 44% during pregnancy. However, hospitalization, emergency room visits, systemic steroid usage rates remained unchanged and according to patients’ own evaluations, 44% of asthmatics pointed out that their asthma had worsened during pregnancy. No statistically significant difference was detected in terms of pregnancy/labour complication between asthmatic and non-asthmatics. Conclusions: Contrary to some previous studies, in our study regular use of asthma drugs increased during pregnancy. The uncontrolled condition of their asthma before and during pregnancy and the idea that their asthma worsened during pregnancy might force the patients to use medication more regularly.

Does drug compliance change in asthmatic patients during pregnancy?

BackgroundPregnant women with asthma are recommended to maintain optimal therapeutic management during pregnancy. Uncontrolled, symptomatic asthma may increase the risk of adverse peri-natal outcomes; thus adequate regular anti-asthmatic treatment must be given to provide optimal asthma control during pregnancy. However, doubts about the safety of asthmatic drugs can affect pregnant asthmatic patients’ drug compliance. The aim of this study was to assess behavioral differences in drug compliance among pregnant asthmatic patients.MethodsThirty two asthmatic and 121 healthy pregnant women were enrolled in the study. Structured face-to-face interviews were conducted after delivery. The interviews included disease characteristics, drug compliance and patients’ own perspective for asthma status prior to and during pregnancy. In addition, medical and pregnancy history, pregnancy complications and outcomes, and newborn characteristics were recorded.ResultsIn our study group the rates of hospitalization, emergency room visits and systemic steroid use in the year before pregnancy were 13%, 46.9% and 18.8%, respectively. The rate of regular asthma medication use was only 32% at that period and increased to 44% during pregnancy. However, hospitalization, emergency room visits, systemic steroid usage rates remained unchanged and according to patients’ own evaluations, 44% of asthmatics pointed out that their asthma had worsened during pregnancy. No statistically significant difference was detected in terms of pregnancy/labour complication between asthmatic and non-asthmatics.ConclusionsContrary to some previous studies, in our study regular use of asthma drugs increased during pregnancy. The uncontrolled condition of their asthma before and during pregnancy and the idea that their asthma worsened during pregnancy might force the patients to use medication more regularly.

The breathless adolescent asthmatic athlete

This article concerns physical activity and sports in asthmatic adolescents. Exercise-induced asthma (EIA) is found in 8-10% of the normal child population and in ∼35% of children with current asthma, as reported in a population-based birth cohort study. The mechanisms of EIA are related to markedly increased ventilation during exercise, which causes increased heat and water loss through respiration, leading to bronchial constriction. In athletes and especially in endurance athletes, the repeated daily physical activity during training will, over time, cause epithelial damage and increase inflammation in the respiratory mucosa. With increased exposure to environmental agents, such as as cold air in skiers and chlorine compounds in swimmers, the athlete may contract symptoms and signs of asthma and bronchial hyperresponsiveness, either worsening existing asthma or causing symptoms in a previous healthy adolescent athlete. There are several causes of breathlessness in adolescents, including EIA, vocal cord dysfunction, poor physical fitness and others, which are important to consider in the diagnostic procedure. The asthmatic athlete should follow the same guidelines for treating their asthma as an ordinary asthmatic patient, with careful consideration of the special diagnostic rules given for the use of asthma drugs in sports, especially for inhaled β(2)-agonists.

Factors Associated with the Appropriate Use of Asthma Drugs

When used properly, asthma drugs can reduce asthma-related morbidity and mortality. To assess the use of asthma drugs, and to identify factors associated with appropriateness of use among patients 12 to 45 years of age. Asthmatic patients were interviewed about their asthma drug(s) use and the factors potentially associated with appropriateness of use according to the 2003 Canadian Asthma Consensus Conference guidelines. To determine the factors associated with the appropriate use of asthma drugs, a multivariate logistic regression model was built using a stepwise procedure, and ORs and associated 95% CIs were calculated. Of the 349 study participants, 43 (12.3%) reported appropriate use of their asthma drugs. Respondents who were more likely to report appropriate use were patients with sound knowledge of their asthma drugs (OR 2.61 [95% CI 1.29 to 5.29]), those in good, very good or excellent self-perceived health (OR 3.37 [95% CI 1.31 to 8.71]), those who had consulted a specialist during the preceding year (OR 2.28 [95% CI 1.05 to 4.97]) and those who declared themselves short of drugs due to a lack of money (OR 2.78 [95% CI 1.26 to 6.17]). Results of the present study suggested that recommendations in the current guidelines regarding the appropriate use of asthma medications are being poorly implemented. Educational interventions with the aim of improving quality of care and knowledge about asthma drugs should be offered.

Assessment of Pediatric asthma drug use in three European countries; a TEDDY study

Asthma drugs are amongst the most frequently used drugs in childhood, but international comparisons on type and indication of use are lacking. The aim of this study was to describe asthma drug use in children with and without asthma in the Netherlands (NL), Italy (IT), and the United Kingdom (UK). We conducted a retrospective analysis of outpatient medical records of children 0–18 years from 1 January 2000 until 31 December 2005. For all children, prescription rates of asthma drugs were studied by country, age, asthma diagnosis, and off-label status. One-year prevalence rates were calculated per 100 children per patient-year (PY). The cohort consisted of 671,831 children of whom 49,442 had been diagnosed with asthma at any time during follow-up. ß2-mimetics and inhaled steroids were the most frequently prescribed asthma drug classes in NL (4.9 and 4.1/100 PY), the UK (8.7 and 5.3/100 PY) and IT (7.2 and 16.2/100 PY), respectively. Xanthines, anticholinergics, leukotriene receptor antagonists, and anti-allergics were prescribed in less than one child per 100 per year. In patients without asthma, ß2-mimetics were used most frequently. Country differences were highest for steroids, (Italy highest), and for ß2-mimetics (the UK highest). Off-label use was low, and most pronounced for ß2-mimetics in children <18 months (IT) and combined ß2-mimetics + anticholinergics in children <6 years (NL). Conclusion: This study shows that among all asthma drugs, ß2-mimetics and inhaled steroids are most often used, also in children without asthma, and with large variability between countries. Linking multi-country databases allows us to study country specific pediatric drug use in a systematic manner without being hampered by methodological differences. This study underlines the potency of healthcare databases in rapidly providing data on pediatric drug use and possibly safety.

Comparative clinical evaluation of ketotifen and montelukast sodium in asthmatic Iraqi patients

Asthma is a common and chronic inflammatory condition of the airways whose cause is not completely understood. Although many classes of drugs are used for management of asthma, the response is variable due to multifactor reasons. This study was designed to evaluate the outcome of using ketotifen or montelukast sodium in Iraqi asthmatic patients. Single blinded randomized clinical trial was utilized, in which 100 asthmatic patients were recruited from Al-Karama hospital and randomized into two groups; 1st group (50 patients, treated with ketotifen for 4weeks) and 2nd group (50 patients treated with montelukast sodium for 4weeks). Asthma symptom score and wheezing were recorded at the beginning (first visit) and at the end of the study (after one month). Pulmonary function tests (PFTs) were performed by spirometry, and the patients’ use of asthma drugs and their symptoms were evaluated at each visit. The result showed that asthma symptom, chest wheezing, and PFT values were significantly improved in the two groups at the end of the study compared to first visit (p<0.05). All symptoms were significantly lower and PFT values were higher in the 2nd group compared to 1st group (p<0.05). In conclusion, both ketotifen and montelukast sodium showed significant changes in asthma symptoms and PFT after one month of treatment, but the changes were more significant with montelukast group (2nd group) compared with ketotifen group (1st group) and this indicate that montelukast was more effective than ketotifen in treatment of asthmatic patients.

Association between use of asthma drugs and prevalence of demarcated opacities in permanent first molars in 6‐to‐8‐year‐old Danish children

Demarcated opacities in permanent first molars are common developmental tooth defects, characterized by areas with insufficient mineralization of the enamel. The defects present clinically as a continuum from creamy-white demarcated opacities, yellowish-brown demarcated opacities to macroscopic loss of tooth substance. The etiology is sparsely elucidated, but asthma drugs have been suspected to increase the prevalence. The aim of this study was to examine the prevalence of demarcated opacities in permanent first molars among 6-to-8-year-old children with prescriptions and without prescriptions for asthma drugs. In a cross-sectional study in two Danish municipalities, all children aged 6-8 years (n = 891) were included. A total of 745 (83.6%) went through a dental examination during which demarcated opacities and tooth substance loss due to these were recorded. The analyses were restricted to 647 children in whom all four permanent first molars had erupted. Data on use of asthma drugs from birth until the time of the dental examination were obtained from a population-based pharmaco-epidemiological prescription database. Among 47 children with prescriptions for both inhaled beta(2)-agonists and inhaled corticosteroids before the age of 3 years, 15 (31.9%) had demarcated opacities of any type, and six children (12.8%) had opacity-related loss of tooth substance. Among 264 children with no prescriptions for either inhaled or oral asthma drugs from birth until the date of the dental examination, 96 (36.4%) had demarcated opacities of any type, and 13 (4.9%) had opacity-related loss of tooth substance. The odds ratio (OR) of any demarcated opacity, and of opacity-related loss of tooth substance in children with prescriptions for both inhaled beta(2)-agonists and inhaled corticosteroids before the age of 3 years was 0.82 (95% CI: 0.39-1.65), and 2.42 (95% CI: 0.70-7.43). Children with prescriptions for inhaled asthma drugs before the age of 3 years did not have an overall increased risk of demarcated opacities in first permanent molar but they seemed to have an increased risk of the severe demarcated opacities, i.e. opacities resulting in macroscopic loss of tooth substance, and possibly a need for restorative care.

Effects of Improved Home Heating on Asthma in Community Dwelling Children: Randomised Controlled Trial

Howden-Chapman P, Pierse N, Nicholls S, et al. BMJ. 2008;337(7674):852–855PURPOSE OF THE STUDY. To assess whether nonpolluting, more-effective home heating (heat pump, wood pellet burner, or flued gas) has a positive effect on the health of children with asthma.STUDY POPULATION. A randomized, controlled trial of 409 children, 6 to 12 years of age, with doctor-diagnosed asthma was performed in the household setting in 5 areas in New Zealand.METHODS. Nonpolluting, more-effective home heaters were randomly installed in the intervention houses. Outcome measurements were made during the winter months of 2005 (baseline) and were repeated after the intervention in the winter of 2006. The primary outcome was change in lung function (peak expiratory flow rate and forced expiratory volume in 1 second [FEV1]). The secondary outcomes were reported asthma symptoms, scores for lower respiratory tract symptoms from diaries, daily asthma drug use, health care utilization, and days of missed school. Nitrogen dioxide levels and temperatures were measured in the living room and the child's bedroom.RESULTS. Of 409 households, 349 (85%) remained in the study and were randomly assigned, with 175 assigned to the intervention group and 174 to the control group. After the intervention, lung function tests showed nonsignificant improvement in daily FEV1 (difference in mean FEV1: 130.7 mL [95% confidence interval [CI]: −20.3 to 281.7 mL]; P = .09) and peak expiratory flow rate (difference in mean peak expiratory flow rate: 12.29 l/min [95% CI: −4.57 to 29.15 mL]; P = .15). However, on the basis of parental reports and diaries, children in the intervention group had significant reductions in asthma symptoms and improved well-being, compared with the control group. They had fewer reports of poor health (adjusted odds ratio [OR]: 0.48 [95% CI: 0.31–0.74]; P < .001), less sleep disturbed by wheezing (OR: 0.55 [95% CI: 0.35–0.85]; P < .001), less dry cough at night (OR: 0.52 [95% CI: 0.32–0.83]; P = .01), and reduced scores for lower respiratory tract symptoms (OR: 0.77 [95% CI: 0.73–0.81]; P = .013). The intervention group also had 1.8 fewer days (95% CI: 0.11–3.13 days; P < .04) off school, 0.4 fewer visits (95% CI: 0.11–0.62 visits; P = .01) to a doctor for asthma, and 0.25 fewer visits (95% CI: 0.09–0.32 visits; P = .01) to a pharmacist for asthma than did the control group. Exposure to low temperatures was 50% less in the intervention group (95% CI: 0.49–1.93; P = .001). The mean temperature of the control households was lower than that of the intervention households by 1.10°C (95% CI: 0.54–1.67°C; P < .001) in the living room and 0.57°C (95% CI: 0.05–1.08°C; P = .001) in the child's bedroom. Indoor nitrogen dioxide levels were significantly reduced in the intervention group, compared with the control group, in the living room (geometric mean: 8.5 vs 15.7 μg/m3; P < .001) and the child's bedroom (7.3 vs 10.9 μg/m3; P < .001).CONCLUSIONS. Installing nonpolluting, more-effective heating in the households of children with asthma did not significantly improve lung function but did significantly reduce symptoms of asthma, days off school, health care utilization, and exposure to nitrogen dioxide.REVIEWERS COMMENTS. Asthma is aggravated by the outdoor and indoor environments. Indoor temperatures, damp, mold, and pollutants have been implicated as important factors. This study shows the impact of nonpolluting, home-heating systems on symptoms in children with asthma. In this randomized, controlled trial, significant improvements in frequency and severity of symptoms were noted and there were trends toward improved lung function. These trends toward improved health effects should increase public awareness of this intervention while additional studies are undertaken.

Asthma, airway inflammation and epithelial damage in elite athletes

In recent years there has been special focus on the increased occurrence of asthma and bronchial responsiveness among top athletes within endurance sports. As early as 1989, an increase in nonspecific bronchial responsiveness after heavy endurance training was found in young competitive swimmers 1. Later, reports were made concerning increased prevalence of asthma and bronchial hyperresponsiveness to metacholine among top cross-country skiers 2, 3. Reports came from Trondheim (Norway) regarding inflammatory changes in bronchial biopsies appearing during a winter season in young competitive cross-country skiers 4, 5. These studies confirmed that both bronchial responsiveness and airway inflammation increased through heavy endurance training 1–5. In the Olympic arena, such reports were confirmed by Voy 6, who reported a prevalence of exercise-induced asthma of 11% among the American summer Olympic athletes of 1984; this increased to >20% among the American participants in the 1996 summer Olympic Games, and was especially high among cyclists and mountain bikers 7. K. Fitch (who supplied some of the data presented in 8) reported that the use of asthma drugs and, in particular, inhaled β2-agonists, was highest in cross-country skiing and speed-skating followed by cycling, Nordic combined (both cross-country skiing and ski jumping) …

Improvement in symptoms and pulmonary function of asthmatic patients due to their treatment according to the Global Strategy for Asthma Management (GINA)

BackgroundGlobal Initiative Strategy for Asthma Management (GINA) is poorly applied in undeveloped and developing countries. The current study examined the effects of applying GINA guidelines on treatment efficacy in asthmatic patients in Iran.MethodsTwenty four asthmatic patients (usual care group) were treated as usual and 26 patients (intervention group) according to the GINA for 2 months. Asthma symptom score, asthma severity, frequency of symptoms/week and wheezing were recorded at the beginning (first visit), one month after treatment (second visit), and at the end of the study (third visit). Pulmonary function tests (PFTs) were performed by spirometry, and the patients' use of asthma drugs and their symptoms were evaluated, at each visit.ResultsAsthma symptoms, frequency of symptoms/week, chest wheezing, and PFT values were significantly improved in the intervention group at the second and third visits compared to first visit (p < 0.001 for all measures). In addition, exercise induced cough and wheeze were significant improved in the third visit compared to the second visit in this group (p < 0.01 for both measures). In the second and third visits all symptoms were significantly lower, and PFT values higher, in the intervention group compared to the usual care group (p < 0.005 to p < 0.001). In the usual care group, there were only small improvements in some parameters in just the second visit (p < 0.01 for all measures). The use of asthma drugs was unchanged in the usual care group and significantly reduced in the intervention group (p < 0.01) by the end of the study.ConclusionAdoption of GINA guidelines improves asthma symptoms and pulmonary function in asthmatic patients in Iran.

Asthma, allergy, the athlete and the Olympics

As the 2008 Summer Olympics in Beijing approach, both the general public and health care professionals are gaining interest in the potential health implications of sport. When asthma and allergy are present in athletes, this may affect their performance and achievements and justify the special attention of health care professionals who specialize in taking care of top athletes. However, the impact of allergy and asthma on sport and exercise goes further than just top athletes. The Editors of Allergy decided that in this issue they would focus the attention of allergy and asthma specialists by presenting a series of articles on the relationship between sport, asthma and allergy in the hope that an increased awareness of these problems would be highlighted not only for sports medicine doctors but also for all practicing allergists. Exercise-induced asthma (EIA) is a general concern for growing children and adolescents. In most international guidelines, one of the main objectives of treating asthma during childhood is for the child to be able to master EIA. Also among athletes, and especially elite athletes, EIA and bronchial hyperresponsiveness (BHR) have become major problems with regard to the correct diagnosis and to treatment. EIA is increasingly common among the top athletes of several different types of sport. Traditionally this has been reported mainly in athletes competing in endurance sports in cold climates, especially among crosscountry skiers (1, 2) and swimmers (3, 4), but also among endurance athletes in summer sports (5). A surprisingly high prevalence of asthma (56%) diagnosed by the reversibility of lung function to inhaled s2-agonists (56%) was reported among professional Canadian football players (6). The prevalence of EIA among top athletes has increased over the past decades. Weiler et al. reported 11% prevalence of EIA among American athletes participating in the 1984 Summer Olympic Games (7) and an increase to a prevalence of more than 20% was noticed among American participants in the 1996 Summer Olympic Games in Atlanta (8).