High frequency of emergency room visits of asthmatic children on misty or foggy nights.

STUDY OBJECTIVES: To examine whether or not the presence of mist or fog affects respiratory conditions in asthmatic children. DESIGN: A retrospective study. PREPARATION AND METHODS: There were 754 visits by children with asthma to the emergency room at night (between 18:00 p.m. and 9:00 a.m.) during a two-year period. Meteorological data were checked at a local fire station and regional meteorological observatory. We evaluated the relation between meteorological data and the number of emergency room visits of asthmatic children. RESULTS: The mean number of asthmatic children who visited the emergency room was higher on misty or foggy nights than on clear nights (1.2 +/- 1.2 people/night vs. 0.8 +/- 0.9 people/night, p<0.0001). Mist and fog had an increased odds ratio (OR) of emergency room visits of asthmatic children (1.74, p<0.001). In addition, increased OR was found for high atmospheric temperature (4.39, p<0.0001). Multivariate analysis showed mist and fog (p<0.0001), average atmospheric temperature (p<0.0001), and day-to-day change of temperature (p<0.05) were related to the number of asthmatic children (n=731, r=0.428, p<0.0001). CONCLUSIONS: Our results suggest that the presence of mist and fog causes the exacerbation of asthma in children. It is not clear which is related to the high frequency of emergency room visits of asthmatic children, airborne water droplets or the meteorological condition that causes mist or fog, but the prophylaxis for exacerbation may decrease the frequency of emergency room visits.     

Airborne Water Droplets in Mist or Fog 05 Affect Nocturnal Attacks in Asthmatic Children

Our study objectives were to evaluate whether or not airborne water droplets in mist or fog affect the occurrence of nocturnal attacks of asthmatic children using a retrospective study. This study included 971 visits by children with bronchial asthma to the emergency department at nighttime (from 18:00 to 09:00) during a 3-year period (04 1, 1998–03 31, 2001). Meteorological data were checked at a local fire station and regional meteorological observatory. We divided nighttime into five 3-hour periods to evaluate the relationship between chronological changes in the frequency of the emergency department visits of asthmatic children and of meteorological conditions. In four of five periods of nighttime, multivariate analysis showed that mist or fog, average atmospheric temperature, and barometric pressure were related to the number of emergency department visits (n = 1096, r = 0.165–0.263, p<0.0001). We divided the year into four seasons to eliminate differences between atmospheric temperature and barometric pressure on clear nights and on misty or foggy nights; we also found the mean number of emergency department visits was higher on misty or foggy nights than on clear nights in each seasonal period (p<0.01). In addition, average atmospheric temperature on misty or foggy nights with the emergency department visits was higher than that on misty or foggy nights without any visits (p<0.01). Asthmatic children frequently visited the emergency department on misty or foggy nights, especially during midnight to dawn periods with high atmospheric temperature. Because a higher atmospheric temperature on misty or foggy nights indicates a larger saturated amount of airborne water droplets, our results suggest that mist and fog, in particular a saturated amount of airborne water droplets, may be a stimulus for bronchoconstriction.     

Airborne water droplets in mist or fog may affect nocturnal attacks in asthmatic children.

Our study objectives were to evaluate whether or not airborne water droplets in mist or fog affect the occurrence of nocturnal attacks of asthmatic children using a retrospective study. This study included 971 visits by children with bronchial asthma to the emergency department at nighttime (from 18:00 to 09:00) during a 3-year period (April 1, 1998-March 31, 2001). Meteorological data were checked at a local fire station and regional meteorological observatory. We divided nighttime into five 3-hour periods to evaluate the relationship between chronological changes in the frequency of the emergency department visits of asthmatic children and of meteorological conditions. In four of five periods of nighttime, multivariate analysis showed that mist or fog, average atmospheric temperature, and barometric pressure were related to the number of emergency department visits (n=1096, r=0.165-0.263, p<0.0001). We divided the year into four seasons to eliminate differences between atmospheric temperature and barometric pressure on clear nights and on misty or foggy nights; we also found the mean number of emergency department visits was higher on misty or foggy nights than on clear nights in each seasonal period (p<0.01). In addition, average atmospheric temperature on misty or foggy nights with the emergency department visits was higher than that on misty or foggy nights without any visits (p<0.01). Asthmatic children frequently visited the emergency department on misty or foggy nights, especially during midnight to dawn periods with high atmospheric temperature. Because a higher atmospheric temperature on misty or foggy nights indicates a larger saturated amount of airborne water droplets, our results suggest that mist and fog, in particular a saturated amount of airborne water droplets, may be a stimulus for bronchoconstriction.     

Asthma treatment and outcomes for children in the emergency department and hospital

Objective: To describe and compare the treatment of acute asthma exacerbations in children given in the emergency department (ED) and admitted to acute care floor in the hospital or intensive care unit (ICU). Methods: A retrospective chart review of visits for acute exacerbation of asthma treated at Phoenix Children's Hospital between January 1, 2014 and December 31, 2016. Results: A total of 287 asthma exacerbation cases were identified including 106 (37%) ED visits, 134 (47%) hospital floor and 47 (16%) ICU admissions. A history of a previous ED visit (ED 88%, Floor 60% and ICU 68%; p < 0.0001) and prior pulmonology inpatient consultation (ED 30%, Floor 19% and ICU 15%; p = 0.05) varied significantly. Pulmonology inpatient consultations were performed more frequently in the ICU than on the hospital floor (54% versus 8%; p < 0.0001). Although overall 145 (51%) of the cases were already on inhaled corticosteroids (ICS) at the time of visit with no differences across locations, ICS initiation/step-up was greater in the ICU (72%) than on the hospital floor (54%) and ED (2%) (p < 0.0001). A recommendation given to the family for follow-up with pulmonology was more frequent for patients who had been admitted to the ICU (68%) as compared to those only admitted to the floor (31%) or ED (4%) (p < 0.0001). Readmission rates were similar for patients previously admitted to the hospital (Floor 42%; ICU 40%), but significantly higher for previous ED visits (77%) (p < 0.0001). Conclusions: Physicians in the ED have an opportunity to provide preventative care in the acute care setting and should be encouraged to initiate treatment with ICS. Consideration should be given to develop a program or clinical pathway focused on long-term asthma management and maintenance to reduce readmissions and long hospital stays.     

Influenza-Like Illness Responsible for Severe Exacerbations in Asthmatic Children During H1N1 Pandemic: A Survey Before Vaccination

Background. Asthma seems to be the more prevalent underlying condition in patients hospitalized for H1N1-related flu. Methods. A prospective survey was conducted during the early phase of H1N1 pandemic in France in asthmatic children before vaccination to assess whether severe exacerbations in childhood asthma are associated with influenza-like illness (ILI, the definition of H1N1-related flu in a pandemic). Eight pediatricians in primary care distributed in three localities (Paris, south suburb, and west suburb) conducted the survey (4 weeks/locality from week 36 to 47). At each visit, the pediatrician filled a questionnaire entering the information regarding asthma treatment, severe exacerbation (at least 3 days' use of systemic corticosteroids), and ILI (temperature ≥37.8°C, cough, and/or sore throat, in the absence of a known cause other than influenza) during the past 3 weeks. Results. The survey included 1155 asthmatic children (mean age [SD]: 7.5 years [4.1]); almost all visits were scheduled (99%). A severe exacerbation was recorded in 121 children [10.5%; 95% confidence interval (CI): 8.7–12.2%], which was concomitant with ILI in 20 children (16.5%; 95% CI: 9.9–23.2%), whereas 1034 children did not exhibit any exacerbation. In these latter children, 40 ILI were observed (3.9%; 95% CI: 2.7–5.0%), which constituted a significantly lesser percentage as compared with children with both exacerbation and ILI (p < .0001). This result remained significant in each locality. Overall, 60/1155 (5.2%; 95% CI: 3.9–6.5%) asthmatic children had an ILI. Conclusions. Our survey shows that severe exacerbation and ILI are strongly associated during the H1N1 pandemic in asthmatic children.     

Does Exogenous Melatonin Improve Day Sleep or Night Alertness in Emergency Physicians Working Night Shifts?

Study Objective: To determine whether exogenous melatonin improves day sleep or night alertness in emergency physicians working night shifts. Methods: In a double-blind, placebo-controlled crossover trial, emergency physicians were given 10 mg sublingual melatonin or placebo each morning during one string of nights and the other substance during another string of nights of equal duration. During day-sleep periods, subjective sleep data were recorded. During night shifts, alertness was assessed with the use of the Stanford Sleepiness Scale. Key outcome comparisons were visual analog scale scores for gestalt night alertness and for gestalt day sleep for the entire string of nights. Results: We analyzed data from 18 subjects. Melatonin improved gestalt day sleep (P=.3) and gestalt night alertness (P=.03) but in neither case was the improvement statistically significant. Of 13 secondary comparisons, 9 showed a benefit of melatonin over placebo; none showed a benefit of placebo over melatonin. Conclusion: Exogenous melatonin may be of modest benefit to emergency physicians working night shifts. [Jorgensen KM, Witting MD: Does exogenous melatonin improve day sleep or night awareness in emergency physicians working night shifts? Ann Emerg Med June 1998;31:699-704.]     

Beliefs about Medications in Asthmatic Children Presenting to Emergency Department and Their Parents

Objective. The aim of our study was to assess the relationship of beliefs about medications questionnaire (BMQ) scores of asthmatic children presenting to the emergency department and their parents with asthma severity parameters. Methods. Eighty children with asthma presenting to the emergency department with acute asthma findings and their mothers were enrolled in the study. BMQ was applied to all parents and children older than 7 years of age. Asthma severity clinical score was recorded. Results. The mean age of children (39 males, 41 females) was 49.1 ± 42.8 months. Parent necessity and concerns scores were significantly correlated with their counterparts in children (r = 0.74 and r = 0.60, respectively). Difference between necessity and concerns scores was correlated between parents and children (r = 0.60, p = .002). Child’s necessity score was significantly correlated with respiratory severity score (r = ?0.43, p = .036). Conclusion. BMQ necessity and concerns scores of asthmatic children in the emergency department and their parents are correlated with asthma severity. Although not assessed in this study, this result may be attributed to the relationship of necessity and concerns with drug adherence. Therefore, increasing the knowledge about asthma medications in asthmatic children and their parents may contribute to asthma control and decrease their emergency visits with acute asthma findings.     

Asthma control and need for future asthma controller therapy among inner-city Hispanic asthmatic children engaged in a pediatric asthma disease management program (the Breathmobile program,Mobile Asthma Care for Kids Network)

Objective: To determine whether significant numbers of asthmatic children with initially rated intermittent asthma later suffer poor asthma control and require the addition of controller medications. Methods: Inner-city Hispanic children were followed prospectively in an asthma-specific disease management system (Breathmobile) for a period of 2 years. Clinical asthma symptoms, morbidity treatment, and demographic data were collected at each visit. Treatment was based upon National Heart, Lung, and Blood Institute (NHLBI) Expert Panel Report 3 asthma guidelines. Primary outcome was percentage of patients with intermittent asthma who had not well or poorly controlled asthma during subsequent visits and required controller agents. Secondary outcomes were factors associated with the maintenance of asthma control. Results: About 30.9% of the patients with initial rating of intermittent asthma had not well controlled and poorly controlled asthma during subsequent visits and required the addition of controller agents. Factors associated with good asthma control were compliance, no previous emergency room visits and previous visit during spring season. Conclusion: Asthmatic children with intermittent asthma often lose asthma control and require controller therapy. This justifies asthma guideline recommendations to assess asthma control at follow-up visits and adjust therapy accordingly.     

Epidemiological aspects of respiratory symptoms treated in the emergency room of a tertiary care hospital

OBJECTIVE:

To evaluate the prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients, describing the major clinical syndromes diagnosed and the outcomes of the patients.

METHODS:

A cross-sectional study conducted in the emergency room of a tertiary care university hospital. Between November of 2008 and November of 2009, we reviewed the total number of emergency room visits per day. Children and adults who presented with at least one respiratory symptom were included in the study. The electronic medical records were reviewed, and the major characteristics of the patients were recorded.

RESULTS:

During the study period, there were 37,059 emergency room visits, of which 11,953 (32.3%) were motivated by respiratory symptoms. The prevalence of emergency room visits due to respiratory symptoms was 28.7% and 38.9% among adults and children, respectively. In adults, the rates of hospitalization and mortality were 21.2% and 2.7%, respectively, compared with 11.9% and 0.3%, respectively, in children. Among the adults, the time from symptom onset to emergency room visit correlated positively with the need for hospitalization (p < 0.0001), the length of the hospital stay (p < 0.0001), and the mortality rate (p = 0.028).

CONCLUSIONS:

We found a high prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients. Our results could inform decisions regarding the planning of prevention measures. Further epidemiological studies are needed in order to clarify the risk factors for severe respiratory symptoms.     

Urban Minority Children with Asthma: Substantial Morbidity,Compromised Quality and Access to Specialists,and the Importance of Poverty and Specialty Care

Background. Asthma disproportionately affects minorities, but not enough is known about morbidity and specialist access in asthmatic minority children. Objective. To examine asthma morbidity and access to specialty care in urban minority children. Methods. A consecutive series was recruited in 2004–2007 of urban minority children 2 to 18 years old seen for asthma in four emergency departments (EDs) or admitted to a children's hospital. Outcomes assessed included asthma symptom and attack frequency; missed school and parental work; asthma ED visits and hospitalizations; severity of illness; and asthma specialty care. Results. Of 648 children assessed, 220 were eligible. The mean age was 7 years; 68% were poor, 83% had Medicaid, 84% were African-American, and 16% were Latino. Sixty-eight percent of children were not in excellent/very good health, 73% had persistent asthma (moderate/severe = 52%), and only 44% had asthma care plans. The mean number of asthma attacks in the past year was 12, and of monthly daytime and nighttime asthma symptoms, is 12 and 12, respectively. The mean annual number of asthma doctor visits was 6; of ED asthma visits, 3; hospitalizations, 1; missed school days, 7; and missed parent work days, 6. Eighty-three percent of children have no asthma specialist, and 62% use EDs as the usual asthma care source. Poor children were less likely than the non-poor to have asthma specialists (13 vs. 26%; p < 0.03). African-Americans were more likely than Latinos to use EDs for usual asthma care (68% vs. 44%; p < 0.01). In multivariable analyses, poverty was associated with greater odds and having an asthma care plan with lower odds of an asthma attack in the past year; poverty also was associated with half the odds of having an asthma specialist. African-American children were significantly more likely to report the ED as the usual source of asthma care, and having an asthma specialist and male gender were associated with greater odds of having an asthma care plan. Conclusions. Urban minority children with asthma average 1 asthma symptom daily, 1 exacerbation monthly, and 7 missed school days, 6 missed parental work days, 3 ED visits, and 1 hospitalization yearly; most receive their usual asthma care in EDs and have no asthma care plan or asthma specialist. Urban minority asthmatic children need interventions to reduce morbidity and improve access to specialists and asthma care plans, especially among the poor and African-Americans.     

The Regional Asthma Disease Management Program (RADMP) for low income underserved children in rural western North Carolina: a National Asthma Control Initiative Demonstration Project

Background: A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI). Methods: This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management. Results: Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month pre-intervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p?<?0.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25–75 increased by 7.2%, 13.2% and 21.1%, respectively (all p?<?0.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882?021. Conclusion: The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.     

Nebulized Fluticasone Propionate vs. Budesonide as Adjunctive Treatment in Children with Asthma Exacerbation

Objectives: To compare the effects of nebulized fluticasone propionate (FP) and nebulized budesonide (BUD) in addition to inhaled salbutamol in children with mild asthma exacerbation. Methods: The study was a multicenter, randomized, single-blind, parallel group design. One hundred and sixty-eight children, aged 4–15 years, were randomly allocated to receive either nebulized FP (250 mcg) or nebulized BUD (500 mcg) twice daily for 10 days. On presentation, at the end of treatment, and after a 7-day follow-up, clinical assessment and pulmonary function measurements were performed. Daytime and nighttime asthma symptom scores, the use of rescue salbutamol, and morning/evening peak expiratory flow (PEF) values were recorded at home during the treatment period. Morning cortisol concentration (51 children) and overnight urinary cortisol excretion (30 children) were also measured in six centers at the start and at the end of the treatment. Results: Improvement of morning PEF was significantly higher in patients treated with FP (p = 0.032). The percentage of symptom-free nights was significantly higher in the BUD group (p = 0.006), but no difference was found in symptom-free days. No intergroup difference was detected in the percentage of days/nights free from rescue medication and in pulmonary function tests performed in outpatient settings. There was no evidence of hypothalamo-pituitary-adrenal axis suppression. Conclusions: A short course of nebulized FP has the same effects as a double dose of nebulized BUD, when either drug is added to bronchodilator therapy in children with mild asthma exacerbation.     

Asthma emergency care: National guidelines summary

The increasing global incidence of asthma and the availability of national guidelines for asthma treatment present an opportunity for emergency care providers to improve the delivery of care to patients. Despite the fact that the National Heart, Lung, and Blood Institute (NHLBI) published national guidelines in 1991 and an updated report in 1997, up to 49% of asthma patients continue to suffer from chronic and acute symptoms.(1) One of the 6 NHLBI goals in asthma care is to minimize the need for emergency department visits or hospitalizations.(2) Ironically, 32% of asthmatic children visited the emergency room, whereas 41% of all asthmatics sought urgent care from the emergency room, clinic, or hospital for acute exacerbation in the same year that the Expert Panel Report 2 (EPR2) was published, 6 years after publication of the Global Initiative for Asthma.(3) More than 5000 people die each year of asthma(1) and there were almost 2 million emergency room visits for asthma in 1995(3); these events often occur as a result of inadequate or inappropriate medical care. Prevention of acute exacerbations or deterioration is the ultimate goal of asthma-therapy, as outlined by the NHBLI guidelines. However, during an acute exacerbation, prompt action is required for stabilization to potentially prevent hospitalization, intubation, and unnecessary mortality. The most recent National Institutes of Health (NIH)/NHLBI guidelines regarding asthma emergency care are summarized in this article.     

Environmental factors affecting seasonality of ambulance emergency service visits for exacerbations of asthma and COPD

Objective: The aim of this study was to assess the association of severe exacerbations of asthma and Chronic Obstructive Pulmonary Disease (COPD) requiring ambulance emergency service (AES) visits with meteorological parameters and influenza outbreaks. Methods: The records of patients calling the AES in 2007 and 2008 in the urban area of Lodz due to dyspnea were analyzed. Information on 25 daily reported meteorological parameters was obtained from the local meteorological service and data on influenza outbreaks obtained from the national surveillance service. Results: During the winter months, a significantly higher mean daily number of AES visits for both COPD and asthma were noticed when compared to the summer. Interestingly, the number of daily AES visits correlated with several weather parameters, and the multiple regression analysis confirmed a negative correlation with minimum temperature, mean temperature and the dew point for both diseases (R?=?0.526; p?<?0.01; R?=?0.577; p?<?0.01 and R?=?0.589; p?<?0.01). Furthermore, the increased number of AES visits also correlated with a new number of cases of influenza infections as reported by local influenza surveillance system (rs?=?77.6%; p?<?0.001 and rs?=?80.8%; p?<?0.001 for asthma and COPD, respectively). Conclusion: Seasonality of AES visits for asthma and COPD are similar and seems to be related to specific weather conditions and to influenza outbreaks.     

Prevalence and clinical profile of difficult-to-control severe asthma in children: Results from pneumology and allergy hospital units in Spain

BackgroundSevere asthma is often poorly controlled and its prevalence in Spanish children is unknown. The aim was to determine the prevalence of difficult-to-control severe asthma in children, the agreement of asthma control between physicians and Spanish Guidelines for Asthma Management (GEMA), and the health-related quality of life (HRQoL) for children and parents.MethodsObservational, cross-sectional, two-phase, multicentre study. In the first phase, all children who attended pneumology and allergy units during a three-month period were classified according to physicians’ criteria as patients with: asthma, severe asthma, or difficult-to-control severe asthma. Patients aged 6–14 years with severe asthma (difficult-to-control or controlled) were included in the second phase.Results12,376 asthmatic children were screened in the first phase. According to physicians’ criteria, 8.8% (95% CI 8.3–9.3%) had severe asthma. Of these, 24.2% (95% CI, 21.7–26.8%) had difficult-to-control severe asthma. 207 patients with severe asthma (mean age 10.8 ± 2.3 years; 61.4% male; mean of 5.5 ± 3.4 years since asthma diagnosis) were included in the second phase. Compared to the patients with controlled asthma, children with difficult-to-control asthma had a higher number of exacerbations, emergency room or unscheduled primary care visits in the previous year (p < 0.0001, all) and poor HRQoL (p < 0.0001, both children and caregivers). 33.3% of patients with controlled asthma according to physicians’ criteria were poorly controlled according to GEMA.ConclusionsAround one in four asthmatic children with severe disease had difficult-to-control asthma, although one third was underestimated by physicians. Children with difficult-to-control severe asthma had a poor HRQoL that also affected their parents.     

Prevalence,Demographics, and Health Outcomes of Comorbid Asthma and Overweight in Urban Children

Background. Asthma and overweight are epidemic in urban children but the relationship between these conditions is not fully understood. This study presents demographic and risk profiles of comorbidity for overweight asthmatic children, characterizes morbidity by comparing health outcomes among overweight asthmatics and healthy weight asthmatics, and examines socioeconomic factors associated with comorbidity. Objective. To construct a demographic profile of overweight asthmatic children in an urban setting and identify factors that contribute to prevalence. Method. Cross-sectional study of 5250 children in New York City public elementary schools using a parent-report questionnaire on body mass index, socioeconomic status, asthma, and asthma-related outcomes. Results. Prevalence of overweight (body mass index ≥ 85th percentile for age and gender) was 50.9%. The prevalence of overweight and ever being diagnosed with asthma was 10.9%. The prevalence of overweight with current asthma was 6.2%. Overweight current asthmatics had more night symptoms, missed school days, and asthma medication use than healthy weight asthmatics. Almost 50% of overweight current asthmatic children reported emergency department visits for asthma compared with 30% of healthy weight asthmatics. Comorbidity was most prevalent among males, Latinos, and children in low-income households, with the highest prevalence among Puerto Ricans. In multivariate analysis stratified by gender, the most significant factors associated with comorbidity among girls were low income and minority race/ethnicity, while among boys significant factors were parental education and parental history of asthma. Interestingly, there were few underweight children (7.8%) but they had high prevalence of asthma (13.8%). Conclusions. The comorbidity of overweight and asthma has a large impact on urban populations, causing greater disease burden than asthma alone. Overweight asthmatics show more uncontrolled asthma, evidenced by emergency department visits, quick-relief medication use, and days with asthma symptoms. The relationship between socioeconomic factors and the asthma–obesity comorbidity may vary by gender and requires further study to identify successful interventions to reduce disease in children.     

Factors influencing the levels of exhaled carbon monoxide in asthmatic children

Objective: Bronchial asthma is characterised by chronic airway inflammation commonly associated with increased oxidative stress. Exhaled carbon monoxide (eCO) levels could act as markers of both oxidative stress and allergic inflammation. We aimed to study eCO levels in asthmatics and detect the possible factors influencing them. Methods: We studied 241 asthmatic children and 75 healthy children. The differences in eCO levels among various asthmatic phenotypes and the correlations between eCO and other measured parameters (spirometric indices, Asthma Control Test score, exhaled nitric oxide, total IgE, blood eosinophils and marker of oxidative damage of proteins) were analysed. Results: Levels of eCO widely differed according to the selected characteristics of asthma. Asthmatics showed higher eCO concentrations than controls (1.44?±?0.12?ppm vs. 0.91?±?0.11?ppm, p?p?Conclusions: In a population of asthmatic children, eCO levels could be considered as a marker of both allergic inflammation and oxidative stress in the airways. Concomitant AR and asthma control were the most important factors affecting the levels of eCO in asthmatic children. However, our results do not support the use of routine eCO in the clinical practice.     

Virus and Mycoplasma pneumoniae prevalence in a selected pediatric population with acute asthma exacerbation

Objective: To determine the prevalence of viral and atypical bacteria Mycoplasma pneumoniae infection in children experiencing asthma exacerbation and compare positive and negative subjects with regard to exacerbation severity, need for hospitalization, and treatment. Methods: One hundred sixty-nine asthmatic children aged 2–15 years old who were admitted to emergency rooms in Bogota, Colombia for acute asthma exacerbation were interviewed. Nasopharyngeal aspirates were taken for DNA and RNA extraction. M. pneumoniae and virus were detected by PCR using specific primers. Results: The prevalence of M. pneumoniae and viral infection in the study population was 12.4% and 83.7%, respectively. All subjects positive for M. pneumoniae were also positive for viral infection. Rhinovirus was the most frequently detected viral agent. No significant differences in severity of asthma exacerbations or in need for hospitalization between the virus or M. pneumoniae positive and negative groups were observed. A significantly lower percentage of M. pneumoniae positive subjects had used inhaled steroids over the six months prior to asthma exacerbation compared to M. pneumoniae negative subjects (38.1% vs. 68.2%), suggesting that inhaled corticosteroids may have a protective effect against M. pneumoniae infections. Conclusions: The M. pneumoniae and virus prevalence found in this study were similar to those described in the literature. The 100% co-infection rate observed suggests that viral infection can predispose patients to M. pneumoniae infection, and that this interaction may trigger asthmatic exacerbation. Further studies should be done to confirm the protective effect of inhaled corticosteroids on M. pneumoniae infection in patients with asthma exacerbations.     

Contesting Asthma Medication: Patients’ View of Alternatives

Objective. Several clinical studies have demonstrated the effectiveness of omalizumab in patients with severe allergic asthma but the treatment period has always been relatively short (4–12 months). In the literature, there are a few data about the long-term omalizumab therapy. We aimed to assess the long-term clinical and functional effectiveness of omalizumab treatment in severe allergic asthmatic patients, Methods. Medical records describing the patients’ status before the start of treatment, and also having been registered at the end of 4th, 12th, and 36th months from the commencement of treatment, and at the last visit where the patient was evaluated were used for omalizumab effectiveness assessments. Twenty-six patients (female/male: 21/5) with severe allergic asthma, uncontrolled despite GINA 2006 Step 4 therapy, were included in the study. Effectiveness outcomes included spirometry measurements, level of asthma control measured by asthma control test (ACT), systemic glucocorticosteroid (sGCS) use, emergency room (ER) visits, and hospitalizations for severe exacerbations. In addition, the quality of life was assessed using the quality of life questionnaire AQLQ(S) before, 4, and 36 months after treatment, Results. The mean age was 47.6 ± 13.9 and duration of allergic asthma was 22.7 ± 10.1 years. Serum total IgE levels were 322.0 ± 178.1 IU/mL. Mean duration of omalizumab treatment was 40.81 ± 8.2 months. FEV₁ improved significantly at all control points versus baseline (p < .05). The level of asthma control as evaluated by ACT improved significantly after treatment (p < .05). We determined significantly reduced numbers of exacerbation, emergency visits, hospitalizations, sGCS, and SABA use by the end of 36 months (p < .05). The proportion of patients with improvements larger than 1.5 points in AQLQ(S) total score was 80.7% at the 4th month and 96.1% at the 36th month of treatment, Conclusions. This study showed that long-term therapy with omalizumab for up to 3 years was well tolerated with significant improvement both in symptoms and lung functions. Accordingly, long-term omalizumab treatment may be recommended for responders.