Allergen sensitivity and asthma severity at an inner city asthma center.

The objective of this study was to examine the relationship of allergen sensitivity to asthma symptoms among inner-city asthmatics seen at our Brooklyn, NY, asthma center. We hypothesized that asthma severity would increase for adults and children with increased cockroach and dust mite allergen sensitivity. Data were gathered from retrospective chart review for all patients who were treated at the center with a diagnosis of asthma and had undergone skin-prick testing (SPT) for allergen sensitivity during 1998 (pediatric, n = 79; adult, n = 29). Asthma severity (determined by National Heart, Lung and Blood Institute [NHLBI] asthma severity class) was examined in relation to allergen sensitivity. Allergen sensitivity was measured by percent positive to skin-prick testing as well as by relative mean diameter of skin prick test wheals. For adults, mite sensitivity prevalence was 61% and cockroach sensitivity prevalence was 41%. For children, mite sensitivity prevalence was 49%; cockroach sensitivity prevalence was 42%. For adults, asthma severity correlated significantly with sensitivity to Cladosporium, tree, and grass as measured by percent positive skin tests and by increasing mean diameter of skin test wheals. There was a significant correlation with severity for adult dust mite sensitivity only as measured by increasing mean wheal diameter. Ragweed sensitivity showed a significant correlation with severity only as measured by percent positive skin tests. There was a significant positive association for adults between increasing asthma severity and total number of allergen sensitivities per subject. There was no significant correlation for children between asthma severity and total number of allergen sensitivities per subject. Among children, no specific allergen sensitization showed a significant positive association with asthma severity. By both measures of allergen sensitization, there was a significant negative association for children between Cladosporium and asthma severity. Among our inner-city asthmatic population significant correlation between mite sensitivity and asthma severity was found only in adults. No significant association was seen with cockroach. However, outdoor allergen sensitivity (Cladosporidium, tree, ragweed, and grass) significantly correlated with asthma for adults in this inner city population.     

Associations between asthma trigger reports,mental health conditions,and asthma morbidity among world trade center rescue and recovery workers

Aim: There is limited information regarding asthma triggers in World Trade Center (WTC) rescue and recovery workers (RRW) or how mental health conditions affect the perception of triggers. Methods: We included 372 WTC workers with asthma. The Asthma Trigger Inventory (ATI) assessed triggers along five domains: psychological, allergens, physical activity, infection, and pollution. We administered the Structured Clinical Interview to diagnose post-traumatic stress disorder (PTSD), major depression and panic disorder (PD). The Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (AQLQ) measured asthma control and quality of life, respectively. Linear regression models were fitted to examine the association of ATI total and subdomain scores with mental health conditions as well as the percent of ACQ and AQLQ variance explained by ATI subscales. Results: The most common triggers were air pollution (75%) and general allergens (68%). PTSD was significantly associated with psychological triggers (partial r²=0.05, p?<?0.01), physical activity (partial r²=0.03, p?<?0.01) and air pollution (partial r²=0.02, p?=?0.04) subscales while PD was significantly associated with air pollution (partial r²=0.03, p?=?0.03) and general allergens (partial r²=0.02, p?=?0.03). ATI subscales explained a large percentage of variance in asthma control (r²=0.37, p?<?0.01) and quality of life scores (r²=0.40, p?<?0.01). Psychological subscale scores explained the largest portion of the total variability in ACQ (partial r²= 0.11, p?=?0.72) and AQLQ (partial r²=0.14, p?=?0.64) scores. Conclusion: RRW with mental health conditions reported more asthma triggers and these triggers were associated with asthma morbidity. These data can help support interventions in RRW with asthma.     

Basophil "releasability" in patients with asthma

This study was based on the premise that mediator release plays a role in the pathogenesis of allergen-induced as well as nonallergen-induced asthma. We studied histamine release from human basophils obtained from patients with asthma and from control subjects. These cells were challenged with several different stimuli: goat anti-human IgE-Fc, C5-peptide, N-formyl-methionyl-leucyl-phenylalanine (f-met peptide), Ca++ ionophore A23187, hyperosmolar mannitol, and D2O. Release induced by any one stimulus was unrelated to the response to any other stimulus. The basophils of patients with asthma and control subjects responded similarly to most stimuli: they were significantly less responsive to C5-peptide and f-met peptide, and significantly more responsive to D2O. The results suggest that there is a parameter of releasibility that must be defined for each separate stimulus, and that patients with asthma can be differentiated from normal persons by the response of their basophils to selected stimuli.     

The interrelationship among bronchial hyperresponsiveness, the diagnosis of asthma, and asthma symptoms

Bronchial hyperresponsiveness (BHR) to inhaled histamine has often been cited as the gold standard in asthma diagnosis, but recently this has been questioned. This report assesses the relationship of BHR to asthma symptoms and asthma diagnosis in a large community-based sample of children. A total of 2,053 children 7 to 10 yr of age were randomly sampled from Auckland primary schools and assessed by a questionnaire and histamine inhalation challenge. In all, 14.3% had had asthma diagnosed, 29.6% reported having had one of the four respiratory symptoms in in the previous 12 months, and 15.9% had BHR (PD20 less than or equal to 7.8 mumol histamine). After a cumulative dose of 3.9 mumol histamine, the percent change in FEV1 from postsaline FEV1 was unimodally distributed, with those in whom asthma had been diagnosed dominating the severe end of the spectrum. However, 53% of those with BHR had no asthma diagnosis, and 41% had no current asthma symptoms. On the other hand, 48% of all subjects with diagnosed asthma and 42% of children with diagnosed asthma and current symptoms did not have BHR. Although severity of BHR tended to increase with wheezing frequency, all grades of severity (including no BHR) were found for any given frequency of wheeze. An existing diagnosis of asthma identified symptomatic children more accurately than did BHR, regardless of the criteria used for BHR or for "symptomatic" and irrespective of ethnic group. In conclusion, BHR is related to, but not identical to, clinical asthma. Bronchial challenge testing is an important tool of respiratory research, but cannot reliably or precisely separate asthmatics from nonasthmatics in the general community.     

阿斯美对老年哮喘患者中枢驱动力的作用

目的 探讨阿斯美对老年哮喘患者呼吸中枢驱动力（P0.1）和气道阻力的作用.方法 应用西德耶格生产的呼吸中枢驱动检测仪（MasterScreen）,检测老年哮喘患者静息态下和经阿斯美治疗前、后呼吸中枢驱动和气道阻力的变化.结果 （1）哮喘组患者P0.1较正常人高且有显著性差异（p＜0.01）,FEV1.0、PEF较正常人明显减低（p＜0.05）.（2）老年哮喘患者中枢驱动力P0.1与FEV1.0、PEF、R4Hz、R8Hz、R16Hz密切相关而与MIP、MEP无明显相关关系.（3）经阿斯美治疗后老年哮喘患者中枢驱动力P0.1和气道阻力均较前减低,肺功能指标有显著改善.结论 老年哮喘患者呼吸中枢驱动力（P0.1）与呼吸功能指标FEV1.0、PEF和气道阻力指标R4Hz、R8Hz、R16Hz密切相关.经阿斯美治疗后老年哮喘患者中枢驱动力和气道阻力有显著改善作用,这对提高其呼吸中枢驱动能力,改善呼吸功能以达预防呼吸衰竭提高生活质量方面具有一定的临床意义.     

"三位一体"支气管哮喘教育管理模式对支气管哮喘患者病情控制水平的影响

目的 评价"三位一体"支气管哮喘教育管理模式对支气管哮喘患者病情控制水平的影响.方法 由经过培训的北京市6所大型教学医院的呼吸科医生,以面对面的方式连续不加选择地问卷调查各自医院门诊成年支气管哮喘患者病情控制水平,比较以"三位一体"(哮喘专病门诊、哮喘宣教中心、哮喘患者协会)模式系统教育管理的支气管哮喘患者(教育组)与未进行"三位一体"系统教育管理的支气管哮喘患者(对照组)的问卷调查结果.结果 教育组患者100例,对照组患者427例.教育组支气管哮喘控制测试(ACT)评分达20分以上的占85%,显著高于对照组的37%(χ2=74.345,P<0.01);过去1年中教育组因支气管哮喘加重住院、急诊就诊、误工的分别占4%、18%、20%(10/49),显著低于对照组的23%、32%、55%(76/137)(χ2值分别为19.431、7.515、17.853,P值均小于0.01).结论 "三位一体"支气管哮喘教育管理模式可显著提高患者的病情控制水平.     

“胸痛中心”对主动脉夹层患者诊疗及预后的影响

目的:分析胸痛中心(CPC)管理模式对急诊科主动脉夹层(AD)患者诊疗及预后的影响。方法:对比九江市第一人民医院CPC成立前后4年急诊科接诊的AD患者的诊疗时间、误诊漏诊率、院内夹层破裂发生率、院内死亡率及半年内死亡率,并对可能影响AD患者存活出院和半年后存活的相关因素进行Logistic回归分析。结果:入选186例AD患者,其中CPC成立前94例,CPC成立后92例。CPC成立后AD患者从就诊至主动脉血管造影(CTA)出报告的间隔时间、急诊处置时间、误诊率、院内夹层破裂发生率、院内死亡率及出院后半年内死亡率均显著低于CPC成立前(均P 0. 05)。Logistic回归分析显示CPC管理模式是AD患者存活出院(OR=8. 627,P=0. 001)及出院患者半年后存活(OR=3. 137,P=0. 045)的独立预测因子。结论:CPC管理模式可显著缩短AD患者的诊疗时间,降低误诊率,减少院内夹层破裂的发生率,明显改善患者预后,具有显著的经济效益和社会效益。     

The healthy worker effect in asthma: work may cause asthma, but asthma may also influence work

Despite the increasing attention to the relationship between asthma and work exposures, occupational asthma remains underrecognized and its population burden underestimated. This may be due, in part, to the fact that traditional approaches to studying asthma in populations cannot adequately take into account the healthy worker effect (HWE). The HWE is the potential bias caused by the phenomenon that sicker individuals may choose work environments in which exposures are low; they may be excluded from being hired; or once hired, they may seek transfer to less exposed jobs or leave work. This article demonstrates that population- and workplace-based asthma studies are particularly subject to HWE bias, which leads to underestimates of relative risks. Our objective is to describe the HWE as it relates to asthma research, and to discuss the significance of taking HWE bias into account in designing and interpreting asthma studies. We also discuss the importance of understanding HWE bias for public health practitioners and for clinicians. Finally, we emphasize the timeliness of this review in light of the many longitudinal "child to young adult" asthma cohort studies currently underway. These prospective studies will soon provide an ideal opportunity to examine the impact of early workplace environments on asthma in young adults. We urge occupational and childhood asthma epidemiologists collaborate to ensure that this opportunity is not lost.