Young Asthmatics Research Articles

Disparities in the Circumstances of Asthma Deaths in Maryland

The reasons for significant disparities in asthma mortality are unclear. Maryland vital statistics and medical examiner data were used to examine timing, location, and circumstances of asthma deaths. We found that unexplained deaths increased substantially over the past 10 years and that young, male, and black asthmatics were more likely to die before hospital admission. Factors contributing to disparities included better availability of anti-inflammatory medications among whites versus blacks, and a higher incidence of positive toxicology screens among males versus females. Disparities in asthma mortality might be reduced through efforts to optimize asthma treatment and reduce illicit drug use.

Vocational and working career of asthmatic adolescents is only slightly affected

The aim of this study was to investigate whether teenagers and adolescents (10-22 years) with asthma or asymptomatic bronchial hyperresponsiveness, were more likely to experience vocational or professional career limitations in the future, as compared to non-asthmatic contemporaries. Data were used from a 14-year follow-up study in general practice, investigating the relationship between respiratory health in childhood and adolescence. At follow-up, the respiratory health status and information about career limitations were obtained. There were no statistical significant differences between asthmatics (n=52) and non-asthmatics (n=154) in the proportion currently employed subjects, or contract type. Most examined career limitations were infrequently reported in both groups, but seemed to occur slightly more frequent among asthmatics. Asthmatics seemed to have an increased risk for limitations in daily activities both attributable to their respiratory health (OR=2.6, 95% CI [1.0; 7.0]) and all-cause (OR=1.8, 95% CI [0.9; 3.3]), and for absence from work all-cause (OR=1.7, 95% CI [0.9; 3.3]). However, the differences were in most cases in the magnitude of only a few days per year. Neither lung function nor bronchial hyperresponsiveness did predict absence from work, or limitations in daily activities. Asthmatic young adults seem to experience somewhat more limitations in their vocational and professional careers. Nonetheless, the majority of the young asthmatics seem to be only slightly limited in their careers. In non-asthmatic young adults the presence of asymptomatic bronchial hyperresponsiveness does not seem to lead to career limitations.

Effects of aging on sensation of dyspnea and health-related quality of life in elderly asthmatics

As the awareness of sensory stimuli is often impaired in older subjects, it has been hypothesized that the aging process may influence the perception of dyspnea. This study aimed at evaluating the aging-related difference in perception of spontaneously occurring dyspnea in adult asthmatics and at whether any such aging-related differences have an effect on the health-related quality of life (HRQOL). 18 elderly asthmatics (EA) aged >65 years and 20 young asthmatics (YA) (age range 16-44 years) were recruited. In all subjects, 12-month asthma symptom score and respiratory function were recorded. Dyspnea was measured at rest by the Visual Analog Scale (VAS) and HRQOL by the St. George's Respiratory Questionnaire (SGRQ). Although the groups did not differ for FEV1% predicted, the EA showed lower VAS scores (9.9+/-19.8 mm vs 19.5+/-17.0, p<0.05). As regards HRQOL, only the "Symptom" section of SGRQ showed lesser impairment in EA. Aging is associated with blunted sensation of dyspnea. This only partly attenuates the disease-related impairment in quality of life, and other factors are presumed to counterbalance this effect.

Irritable bowel syndrome in young and elderly patients with stable asthma

Background. It has been speculated that asthma and irritable bowel syndrome may share common pathophysiological processes. Aim. To estimate the prevalence of irritable bowel syndrome in young and elderly patients with stable asthma. Patients and methods. Sixty-five young (age < 60 years) and 66 elderly (age ≥ 60 years) stable asthmatics, and 119 age-matched healthy volunteers were enrolled. In all participants, presence of irritable bowel syndrome, quality of life and psychological status were evaluated. Results. The prevalence of irritable bowel syndrome in asthmatic group was higher than that in the control group (27.5% versus 16.8%; odds ratio, 1.8 [1.0–3.4]; p = 0.04). The prevalence of irritable bowel syndrome was significantly higher in young asthmatics than in age-matched healthy controls (36.9% versus 20.3%; odds ratio, 2.2 [1.0–5.1]; p = 0.04) and than in elderly asthmatics (36.9% versus 18.2%; odds ratio, 0.3 [0.1–0.8]; p = 0.01). Logistic regression analysis identified the younger age (odds ratio, 2.1 [1.1–3.8]; p = 0.01), and the presence of asthma (odds ratio, 1.9 [1.0–3.5]; p = 0.03) as independent risk factors for irritable bowel syndrome in all participants after adjusting for gender. We also found impaired quality of life to be associated with the presence of irritable bowel syndrome and asthma in all participants after adjusting for age and gender. Conclusion. The prevalence of irritable bowel syndrome appears to be significantly higher in young asthmatics, but not in elderly asthmatics, compared to age-matched healthy counterparts. Potential pathogenic mechanisms of higher irritable bowel syndrome prevalence in young asthmatics need to be explained by further studies.

Comorbidity and medication load in adult asthmatics

ObjectiveTo examine comorbidity and the medication load among asthmatics.DesignA self-administered postal inquiry.SettingA national register-based random sample of 6000 subjects aged 16 years or older entitled to special reimbursement for anti-asthmatic medication in Finland.SubjectsA total of 4690 subjects with clinically diagnosed asthma.Main outcome measuresReporting of doctor-diagnosed chronic diseases and the number of prescription medicines used by asthmatics.ResultsTwo-thirds of the subjects (n=2952, 63%) reported other diseases in addition to other chronic pulmonary diseases and allergies. Musculoskeletal and cardiovascular disorders were the most common, increasing with age. Allergies were most frequent among the young asthmatics. Nearly all the subjects (n=4444, 95%) took at least one anti-asthmatic medicine, and two out of every three (n=3051, 65%) received other prescription medicines, most commonly cardiovascular drugs or analgesics. Some 41% (n=1938) of all the asthmatics and as many as 21% of the young adults (n=269) were taking at least five prescription medicines concomitantly. The total medication load increased with age.ConclusionThe load of comorbidity and prescribed medication is heavy in adult asthmatics of all ages. Thus asthmatic patients should best be treated by GPs, while pulmonary specialists work as consultants and take care of the most severe cases.

Enhanced Lung Function and Prevention of Peroxidative Damage by Vitamin E Supplementation in Childhood Asthma

This study was designed to assess the effects of vitamin E supplementation on the lung function and lipid peroxidation status of asthmatic children. Fifteen asthmatics (ten male and five female) aged between 6 and 13years, all in a stable state, were recruited from the paediatric out-patient respiratory clinic of the Lagos University Teaching Hospital, Idi-Araba (LUTH). Three millilitres of blood was drawn from the antecubital vein of each of the 15 patients before vitamin supplementation for assessment of plasma lipid peroxidation products. Lung function tests were performed on each subject before vitamin supplementation. After all measurements have been made, each patient received vitamin E (Teva Pharmaceuticals, Tel-Aviv, Israel) supplementation at a dose of 100 I.U./day for 6 weeks. Thereafter, all previous measurements were repeated on each patient. Mean SBP after vitamin E supplementation reduced slightly (0.73%) from 97.0mmHg to 96.3mmHg. The DBP increased by (7.76%) from 58.0mmHg to 62.5mmHg. Pulse pressure reduced from 39mmHg to 33mmHg(15.39%). The MAP changed from 71.0mmHg to 73.07 mmHg (0.03%). These changes were not significant. However, after vitamin E supplementation the plasma MDA concentration was significantly reduced by 34.8% from 66.0+2.3 nmol/L to 43.0+2.9 nmol/L. FEV1 increased significantly from 1.24 ± 0.06 L to 1.39 ± 0.02 L after vitamin E supplementation. The PEFR and FVC increased slightly by 8.43% and 3.53% respectively. From the results, we therefore concluded that vitamin E supplementation may improve lung function and also supresses peroxidative damage in young asthmatics. KEY WORDS: Vitamin E, lung function, childhood asthma. Nigerian Journal of Health and Biomedical Sciences Vol.4(1) 2005: 57-60

Nocturnal Wheeze Measurement in Young Asthmatics

Nocturnal exacerbation is one of the criteria for defining asthma severity. The aim of this study was to look at the relationship between subjective complaints of nocturnal asthma symptoms, objectively recorded wheezing, and spirometry values. Continuous overnight recording and analysis of respiratory sounds were performed in the homes of 12 young asthmatic patients (7 male), aged 7–18 years, who reported symptoms when seen in clinic. Patients kept an asthma symptom diary for 1 week. They had spirometry the evening before and the morning after the nighttime study. Wheezing was identified and quantified by an FFT-based computer algorithm. Seven patients reported nocturnal asthma symptoms the next morning. Three patients had sustained wheezing episodes lasting 21, 25, and 36 minutes, respectively. They all had a morning FEV1 ≤ 51% predicted, whereas none of the 10 without wheezing had a morning FEV1 ≤ 51% predicted. Two of them reported nocturnal asthma and one did not. There was a significant relationship between night-time wheezing and lower FEV1 the next morning by both parametric (unpaired t-test, p = 0.004) and nonparametric (Mann-Whitney, p = 0.009) tests, and between night-time wheezing and larger diurnal variation in FEV1 (p = 0.038, p = 0.036, respectively). There was no significant relationship between subjective complaints of nocturnal asthma and objective measurement of wheezing or the FEV1 the evening before the nocturnal study. Night-time wheeze was associated with a morning FEV1 ≤ 51% predicted and more pronounced diurnal variation of FEV1. Recalled nocturnal symptoms may not necessarily reflect wheezing and may reflect chest tightness or other sensations. Computerized acoustic monitoring provides objective evaluation of night-time wheezing.

AIR POLLUTION AND LUNG FUNCTION AMONG SUSCEPTIBLE ADULT SUBJECTS: A PANEL STUDY

ISEE-82 Aims: We conducted a time-series panel study to analyse pulmonary function changes in relation to daily fluctuations in concentrations of selected ambient pollutants among subjects with chronic obstructive pulmonary disease (COPD), asthma, and ischemic heart disease (IHD). Methods: Twenty-nine patients (11 COPD, 11 asthmatics and 7 IHD) underwent repeated lung function tests (measuring FVC, FEV1, and FEF25-75) in two subsequent surveys in spring and winter 1999. Daily concentrations of PM10-2.5 and PM2.5 were gravimetrically determined from dust samples collected by means of dichotomous samplers at two urban locations. The amount of selected metals (cadmium, chrome, iron, nickel, lead, platinum, vanadium, and zinc) in the PM samples was determined by atomic absorption spectrometry (AAS). We obtained average daily concentrations of nitrogen dioxide (NO2), carbon monoxide (CO), sulphur dioxide (SO2), and ozone (O3) from the Rome air-quality monitoring network. The relationships between outdoor 24-h concentrations of air pollutants and lung function parameters were analysed by cross-sectional time-series regression fixed-effect models, adjusting for temperature, relative humidity, season, and day of the week or β-2 agonist use (among asthmatics). Results: In the COPD panel (171 spirometries), we observed a decrease of pulmonary function (FVC, FEV1) associated with an increase in PM2.5 concentrations (lag 1, lag 2, cumulative exposure over 48 h and 72 h) and a decrease in FEV1 correlated with an increase in previous 24 h ambient NO2 levels. Outdoor concentrations of Fe, Zn and Pb were negatively related to lung function indexes. Among the asthmatics (108 spirometries), increasing concentrations of both PM10-2.5 and NO2 were followed by decreases of FEV1 with a 48-h delay, while ambient levels of CO and O3 did not apparently influence the respiratory function of these patients. No association between average ambient concentrations of any air pollutant and lung function was observed among IHD cases (170 spirometries). Conclusions: The short-term negative impact of exposure to air pollutants on respiratory volume and flow was limited to individuals with already impaired respiratory function. Fine particles, and the associated transition metals, seem responsible for the observed effects among COPD cases, while the respiratory function of our relatively young and mild asthmatics worsens when ambient levels of NO2 and coarse particulate increase.

Asthma in the elderly: Results from TENOR

Rationale Previous studies indicate elderly asthmatics are treated less appropriately, resulting in worse outcomes, than younger asthmatics. A comparison of elderly and younger patients in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study was made to determine if elderly asthmatic patients differ from younger asthmatics in healthcare utilization (HCU) and outcomes. Methods 566 elderly patients (≥65 y) were compared to 2,912 younger patients (18-64 y) with respect to FEV 1, HCU, medication use, quality of life (QoL), and self-reported asthma control and management at Month 12. Results Elderly TENOR asthmatics had decreased %-predicted FEV 1 (p<0.0001), but lower HCU (emergency room visits (p<0.05), steroid bursts (p<0.05), unscheduled office visits (p<0.0001)) in the previous three months compared to younger asthmatics. Inhaled corticosteroid use and QoL were similar between the two groups. While elderly patients reported fewer problems controlling their asthma (p<0.0001), communication with physicians was worse (p=0.02), and they were less likely to receive instruction both during (p=0.07) and in the absence of an asthma attack (p<0.0001). Conclusions Elderly patients in TENOR appear to do as well or better than younger patients (as measured by HCU, QoL, corticosteroid use, and asthma control) in spite of lower FEV 1. The severe or difficult-to-treat elderly patients in TENOR may receive more aggressive care than elderly asthmatics in general, as suggested by a higher use of oral corticosteroids in elderly TENOR patients compared to previous studies. If so, this may have contributed to better outcomes. However, communication between physicians and elderly asthmatics may need improvement.

Breathing counts: A community-focused empowerment model of asthma health education

Rationale The Breathing Counts Program aims to increase the health and wellness of underserved asthmatic children and their families. Breathing Counts is centrally located in Bayview Hunters Point–a predominately African-American, disenfranchised neighborhood in southeast San Francisco with many surrounding environmental toxins, a lack of continuous and accessible health care, and a disproportionately high asthma rate. Breathing Counts strives to provide residents with reliable and acceptable health education and referrals as essential components of their asthma management. Methods School-based education provides culturally- and age-appropriate curricula to young asthmatics attending local public and private schools. Community Health Workers conduct outreach through community health fairs, parent advisory meetings, and door-to-door outreach at homes and local businesses. Lastly, one-to-one training empowers adult community members to serve as local asthma experts. Results Each year, Breathing Counts reaches approximately 10,000 local residents, who become more knowledgeable about a serious, yet manageable condition that may affect them or someone close to them. Staff has been able to integrate within the public school system–augmenting existing services at approximately 10 schools in the neighborhood–as well as the housing authority–collaborating to effectively combat asthma allergens in low-income housing. Conclusions Breathing Counts is fostered by a high amount of trust among local residents, strong ties with other community organizations, and a continuum of services with the educational, medical, social, and political systems. In the near future, Breathing Counts hopes to offer more services to afford local asthmatics increased opportunities for enhanced health education, social support, and empowerment.

Funhaler spacer: improving adherence without compromising delivery

A novel asthma spacer device, the “Funhaler”, incorporates incentive toys which are isolated from the main inspiratory circuit by a valve. Here we show that its use does not compromise...

Comparison of the efficacy and safety of beclometasone dipropionate suspension for nebulization and beclometasone dipropionate via a metered-dose inhaler in paediatric patients with moderate to severe exacerbation of asthma

Nebulization simplifies the administration of effective inhaled medications to young asthmatics who experience hand-to-lung co-ordination problems and inspiratory difficulties associated with metered-dose and dry-powder inhalers, respectively. The objective of this double-blind, double-dummy, multicentre, randomized, parallel-group study was to compare the efficacy and safety of corticosteroids given by nebulization or metered-dose inhalation in paediatric patients with exacerbation of asthma. Following a 24-h run-in period, 151 patients, aged 6–16 years, with moderate to severe exacerbation of asthma were randomized to one of two treatment groups for 4 weeks: beclometasone dipropionate (BDP) suspension for nebulization 1600 μg day −1 b.i.d. given via a nebulizer ( n=75), or BDP spray 800 μg day −1 b.i.d. given via a metered-dose inhaler (MDI) plus spacer (BDP MDI) ( n=76). Superimposable and statistically significant improvements over baseline were noted at study end for the two treatment groups in the various efficacy parameters evaluated (pulmonary function tests, asthma symptoms scores, and the use of rescue salbutamol). The primary efficacy endpoint was the morning pulmonary expiratory flow rate (PEFR). In the BDP nebulization group, mean morning PEFR increased statistically significantly from 233·2 ± 86·31 min −1 to 322·0 ± 101·81 min −1, while in the BDP MDI group the increase was from 222·9 ± 87·31 min −1 to 314·9 ± 96·61 min −1. Moreover, an additional 4-week treatment period at half doses, completed by 26 patients, demonstrated that improvements were maintained or further enhanced. The two treatments were equally well tolerated. A total of 25 and 26 patients i nthe BDP nebulization and BDP MDI groups, respectively, reported adverse events during the treatment period, and these were generally mild. In conclusion, the results of this study demonstrate that BDP suspension for nebulization 1600 μg day −1 given via a nebulizer and BDP spray 800 μg day −1 given via an MDI plus spacer are equally effective, with an acceptable safety and tolerability profile, when used in paediatric patients with moderate to severe asthma exacerbation.

Use of anti-inflammatory therapy and asthma mortality in Japan.

Asthma treatment guidelines were introduced in Japan in the 1990s, insisting as elsewhere, on the importance of anti-inflammatory therapy. The present study assessed whether use of anti-inflammatory medications was associated with a decrease in asthma mortality in Japan, the first country to use leukotriene receptor antagonists. A population-based ecological study was conducted, spanning the period 1987-1999, among people aged 5-34 yrs in Japan. The association between the yearly rate of asthma death and sales of inhaled corticosteroids and leukotriene receptor antagonists was estimated using Poisson regression. The yearly asthma death rate was stable at 6-7 deaths per million before the introduction of leukotriene receptor antagonists in 1995 and decreased by 23% thereafter, reaching 3.5 per million in 1999. The rate of asthma death was found to decrease with increasing use of both leukotriene receptor antagonists and inhaled corticosteroids. The rate ratio of asthma death was 0.96 per 1 million 25-day treatment courses of inhaled corticosteroids and 0.80 for every 1 million 25-day treatment courses of leukotriene receptor antagonists, consumed per year in Japan. The increasing use of inhaled corticosteroids and leukotriene receptor antagonists may have contributed to the significant reduction in asthma mortality among young asthmatics in Japan.

Low power laser therapy in treatment of bronchial asthma

Modern concept of acupuncture is based on the fact there are designated locations on the surface of human body, which are related to integrative systems of an organism by means of sensory nerves, correlating and synchronizing organ functioning, depending on external and internal conditions, by means of nervous and neurohumoral regulation of metabolic and regenerative processes, including also mobilisation of immunological, protective and antistress reactions. Apart from standard needle acupuncture, other methods of stimulating acupuncture points are also applied. Due to invention of low power lasers, irradiation laser acupuncture has been introduced into routine medical practice, characterised by painless and aseptic technique and outstanding clinical results. The investigation was aimed at defining therapeutic effects of low power laser irradiation by stimulating acupuncture points or local treatment of asthma. A prospective analysis included 50 patients treated at the Institute of Pulmonary Diseases in Sremska Kamenica during 2000, 2001 and 2002. Together with conservative treatment of present disease, these patients were treated with laser stimulation of acupuncture points in duration of ten days. During treatment changes of functional respiratory parameters were recorded. Results were compared with those in the control group. The control group consisted of the same number of patients and differed from the examination group only by not using laser stimulation. Patients with bronchial asthma presented with significant improvement (p < 0000,5) of all estimated lung function parameters just 30 minutes after laser stimulation. Improvements achieved on the third and the tenth day of treatment were significantly higher (p < 0.001 to p < 0.00005) in the examination group in comparison with the control group. Further investigation confirmed that improvement of measured lung function parameters was significantly higher in younger patients, in patients whose disease lasted shorter, as well as in women. Patients with asthma, who were treated every three months for a one year period, presented with significantly lower frequency and intensity of attacks. The mechanism of laser stimulation activity in treatment of bronchial asthma is explained in detail, correlating our results to those obtained by other authors. A ten-day course of low-power laser stimulation of acupuncture points in patients with bronchial asthma improves both the lung function and gas exchange parameters. Positive effects of laser treatment in patients with bronchial asthma are achieved in a short time and they last long, for several weeks, even months. Successive laser stimulation in asthmatics prolongs periods of remission and decreases the severity of asthmatic attacks. Better positive effects of laser stimulation are achieved in younger asthmatics, in those with shorter disease history and in female patients. There is a negative correlation between effects of laser stimulation and patients' age and disease history. However, these characteristics do not affect response rate and speed but positive laser stimulation effects are achieved in a shorter period in female asthmatics.

Recurrent wheezing in infants and young children and bronchial hyperresponsiveness: a perspective.

Epidemiological studies report a 50% incidence of at least one wheezing episode in young children. If we can argue that 10% of children have asthma sometime during their pediatric years, it still leaves a significant percentage of children with an unexplained cause for their wheezing. Other recognized phenotypes of recurrent wheezing include young children exposed to excessive environmental tobacco smoke (ETS), while other infants wheeze recurrently following a significant episode of bronchiolitis. Bronchial hyperresponsiveness (BHR) is a universally recognized phenomenon of asthma, but its presence in young children with recurrent wheezing is not as well studied. Currently available studies demonstrates that BHR is also seen in young pediatric asthmatics, paralleling what is well recognized in adolescent or adult asthma. In those children with post-bronchiolitis wheezing, BHR appears to be present to a degree; while infants and young children exposed to ETS have increased BHR, as a group. If exaggerated BHR in recurrent wheezing children without asthma has the same inherent disadvantage as it does in asthmatic children, additional studies looking directly at this issue in a longitudinal fashion need to be designed. A hypothesis of BHR in non-asthmatic children is presented that could be studied prospectively.

Lung Function Decline in Bronchial Asthma

We evaluated the longitudinal changes in lung function and the factors associated with FEV(1) changes over time in a sample of asthmatic subjects. FEV(1) measures were recorded every 3 months over a 5-year follow-up period. To compare all subjects independently of body size, FEV(1) values were normalized for the subject's height at the third power. We evaluated the possible effect of age, baseline FEV(1), disease duration, and FEV(1) variability on the rate of change of FEV(1). We studied 142 subjects with asthma diagnosed on the basis of validated clinical and functional criteria. FEV(1) showed a linear decay with aging in each subject. For a subject 1.65 m in height, the median overall FEV(1) decay was 40.9 mL/yr. FEV(1) decay slopes were significantly influenced by age and sex, being steeper in younger male subjects. A significant interaction was found between age and baseline FEV(1): the FEV(1) decay was significantly higher among younger asthmatics with a poorer baseline functional condition. A longer disease duration was associated with a lower FEV(1) slope. FEV(1) variability was strongly associated with an increased rate of FEV(1) decline. FEV(1) decline in patients with bronchial asthma is significantly influenced by baseline FEV(1), disease duration, and FEV(1) variability. Moreover, the rate of FEV(1) decline seems to increase in younger subjects only when the baseline function is poorer.

Clinical effectiveness of conventional influenza vaccination in asthmatic children.

Influenza immunization rates among young asthmatics remain unsatisfactory due to persistent concern about the impact of influenza and the benefits of the vaccine. We assessed the effectiveness of the conventional inactivated trivalent sub-unit influenza vaccine in reducing acute respiratory disease in asthmatic children. We conducted a two-season retrospective cohort study covering the 1995-6 and 1996-7 influenza outbreaks in 22 computerized primary care practices in The Netherlands. In total, 349 patients aged between 0 and 12 years meeting clinical asthma-criteria were included; 14 children were lost to follow-up in the second season. The occurrence of physician-diagnosed acute respiratory disease episodes including influenza-like illness, pneumonia. bronchitis, bronchiolitis, asthma exacerbation and acute otitis media in vaccinated and unvaccinated children were compared after adjustments for age, prior health care and medication use. The occurrence of acute respiratory disease in unvaccinated children was 28% and 24% in the 1995-6 and 1996-7 season, respectively, and was highest in children under 6 years of age (43%). The overall pooled clinical vaccine effectiveness was 27% (95% confidence interval -7 to 51%, P = 0.11) after adjustments. A statistically higher vaccine protectiveness of 55% (95% CI 20-75%, P = 0.01) was observed among asthmatics under 6 years of age compared with -5% in older children (95% CI -81 to 39%). The occurrence of acute respiratory disease among asthmatic children during influenza epidemics is very high, notably in the youngest. Influenza vaccination may reduce morbidity in asthmatic infants and pre-school children. However, larger, preferably experimental, studies are needed to establish the benefits of vaccination, notably in older asthmatic children.

Investigation of growth prognosis in asthmatic children

The objective of the present study was the ascertainment of correct data related to growth prognosis in asthmatic children. For this purpose, 210 young asthmatics including 153 males and 57 females ranging in age from 1.7 to 18.9 years were evaluated. Data were specified for the parameters: chronological age (CA); bone age (KA); height age (LA); height (KH); severity of illness; target adult height (GZG) and predicted adult height (PEG). Among this group, 5.9 % of the boys and 3.5 % of the girls, were found to be of small stature (KH < - 2 s). This corresponds to about 2.5 and 1.5 times the average in a normal distribution. Children with the highest severity of illness showed the strongest negative deviation for the KH-SDS values (boys - 0.59 plus minus 1.1, girls - 0.97 plus minus 0.8). This proved to be statistically significant for females. Development of CA, KA and LA continued unremarkably until the age of 4 years. From age 5, partially a significant growth retardation of KA and LA could be observed in both sexes. To age 16, KA values and, after that LA values, were more strongly affected. Comparison of the GZG and PEG average values within the degree of severity groups made it clear that the PEG values for both sexes, independent of the severity of illness, were without exception, smaller than the GZG. The differences of both parameters proved to be statistically significant for the group with the most severe symptoms of the boys (180.8 plus minus 6.5 cm to 175.8 plus minus 6.2 cm, p < 0.01) and for the entire groups of both sexes (boys 180.2 plus minus 5.3 cm to 178.6 plus minus 7.3 cm, p < 0.05, girls 167.7 plus minus 4.4 cm to 165.8 plus minus 6.8 cm, p < 0.05). However, a separate comparison of GZG and PEG average values, respectively, among the severity groups showed no significant differences. The results argue for a growth-inhibiting influence from bronchial asthma. The cause has to be severity of illness but direct effects of the atopy on skeletal development is also taken in consideration. Confirmation of these findings requires investigation of a larger group of asthmatics and clarification of the pathophysiological processes in the growing skeletons of atopic children.

Percepción de mejoría en los pacientes con asma

The objective of this study was to investigate the ability of patients with stable asthma to recognize improvement in bronchial obstruction with treatment. We enrolled 75 stable asthmatics (44 women and 31 men, mean age 43 17 years) who reported baseline dyspnea on a modified Borg scale. Acute bronchodilation of 15% was provoked in the laboratory, after which the patients were asked if there was a change in dyspnea. Our results were as follows. 1) Overall, 19 asthmatics (25%) failed to perceive improvement in dyspnea with bronchodilation. 2) The mean change in dyspnea was 1.17 1.11, although the change was greater in patients with more severe asthma (0.60 0.5 for mild asthmatics, 1.05 1.07 for moderate asthmatics and 1.93 1.4 for severe asthmatics; p < 0.0001). 3) Perception of improvement was significantly related to level of the patient's emotional balance (anxiety-depression), quality of life, education, socioeconomic level, age, age of onset, severity, baseline dyspnea and obstruction, thoracic pressure and number of visits to the doctor in the preceding year. 4) The variables entered into the stepwise regression model were baseline dyspnea, depression, thoracic pressure and age. 5) Generally, young asthmatics whose disease appeared at a younger age and who also had less ventilatory obstruction and greater quality of life, showed a tendency to underestimate the beneficial effect of bronchodilator treatment. Moreover, when asthma was severe, non-perceptive individuals had significantly more admissions to intensive care units due to asthma exacerbation.In conclusion, 25% of our asthmatics are unable to recognize whether their bronchia dilate as a result of treatment, meaning that they would delay the start of rescue medication during an exacerbation. Such patients should be identified in order to establish therapeutic guidelines in function of objective home criteria (peak-flow monitoring).

Actitudes ante el tabaquismo y características del hábito de un grupo de asmáticos jóvenes comparado con un grupo sin asma

To compare the attitudes toward smoking and smoking patterns of young male asthmatics with the attitudes and habits of a group previously studied non-asthmatic men. Volunteers responded individually to as anonymous questionnaire. Responses were received from 488 asthmatics men (55.83%) of the sample, with 11 not responding) and 386 non-asthmatics (44.16%, with 27 not responding). The mean age of subjects was 19.91 +/- 2.76 yr. Smoking asthmatics numbered 154 (31.56%) non-asthmatic smokers numbered 207 (53.6%) (p < 0.001). Eighteen asthmatics (3.68%) and 6 (1.55%) non-asthmatics were ex-smokers. The mean age of initiation was 15.20 +/- 2.42 for asthmatics and 15.08 +/- 2.41 for non-asthmatics. Smoking was established at a mean age of 16.56 +/- 2.04 yr for asthmatics and 16.47 +/- 2.18 yr for non-asthmatics. Sixty-two percent of asthmatics smoked fewer than 10 cigarettes/day whereas 55% of non-asthmatics smoked between 11 and 20 cigarettes/day. The mean Fagerström score were 2.59 +/- 2.2 for asthmatics and 4.66 +/- 2.2 for non-asthmatics (p < 0.001). Fifty-four percent of asthmatics and 47% non-asthmatics were considering quitting. Sixty-five percent of asthmatics and 44% of non-asthmatics had previously tried to quit (p < 0.01) and mean duration of abstinence was 4.6 +/- 3.8 months and 3.8 +/- 4.6, respectively (p < 0.05). No differences were found in the reason for starting to smoke. We found that the companions and friends of asthmatics smoked less than did the friend and acquaintances of non-asthmatics (p < 0.001), although that differences was not found for relatives, the friends, relatives and companions of smoking asthmatics smoked more than did those of non-smoking asthmatics. The prevalence of smoking is lower among asthmatics than among non-asthmatics and asthmatics smoke fewer cigarettes/day and have a lower level of addiction. There are no differences in age of or reasons for starting to smoke. Asthmatics have fewer smoking friends than do non-asthmatics and non-smoking asthmatics have fever still. the desire to quit smoking is high in both groups.