Symptom perception and asthma control

Objectives: Asthma control is the goal of asthma management. The perception of asthma symptoms represents a cornerstone aspect in this issue. The visual analogue scale (VAS) has been proposed as a useful tool for assessing respiratory symptoms perception. The present cross-sectional real-life study investigated whether VAS assessment of asthma symptoms perception could predict asthma control level. Methods: This cross-sectional study included a total of 370 (153 males, mean age 39.9 years) patients with asthma. Perception of asthma symptoms was assessed by VAS; clinical examination, lung function, fraction of exhaled nitric oxide (FeNO) measurement, Asthma Control Test (ACT) and Hospital Anxiety Depression Scale questionnaires were also evaluated. Results: Asthma was well controlled in 47% of patients. Considering most of the evaluated parameters, there were significant differences among patients with well-controlled, partly controlled and uncontrolled asthma. VAS values were significantly (p < 0.001) different considering the asthma control level. VAS score were significantly related with ACT scores (p < 0.001). A VAS <6 was able to reliably predict uncontrolled asthma (area under the curve: 0.74; odds ratio: 5.16). Conclusion: The present real-life study demonstrates that asthma symptoms assessment by VAS might be useful for approximately predicting uncontrolled asthma in particular conditions, such as at home or at the general practitioner’s office.     

Clinical evaluation of tulobuterol aerosol in childhood asthma

An open clinical trial was performed to assess the efficacy and safety of 400 micrograms tulobuterol aerosol given four times daily in childhood bronchial asthma. A total of 54 children were enrolled with bronchial asthma shown to be reversible by an increase of forced expiratory volume in 1 s (FEV1) of more than 15% following 200 micrograms of salbutamol. Tulobuterol was administered for 3 weeks and regular use of salbutamol was continued for 12 patients during the 7-day lead-in period and six patients took theophylline throughout the study; other drugs were discontinued. The mean FEV1, mean adjusted FEV1, mean peak expiratory flow rate (PEFR) and mean forced vital capacity (FVC) were significantly increased (P less than 0.001) following treatment. Mean FEV1 increases ranged from 9.2% to 14.0%, with 24.5-43.4% of patients showing clinically significant increases of at least 15%. Globally, there was improvement in 46 patients (85%). Headache and nervous system complaints were the most common side-effects. Although this was an uncontrolled study, the indications are that tulobuterol aerosol is effective and safe for use in children with asthma.     

Symptom perception: a concept exploration

The topic of this paper is a concept analysis of symptom perception using the theoretical phase of the Schwartz-Barcott Hybrid Model. The purpose of this paper is to explore symptom perception and related concepts and formulate a working definition. Sources of information include symptom perception and related concepts models and studies using the concepts as well as sources pertaining to related measurement tools. The conclusion of this exploration reveals several overlapping concepts. These concepts are synthesized into a working definition of symptom perception.     

Symptom assessment and management in children with asthma

Asthma is the most prevalent and costly chronic childhood disease worldwide, unexpected flare-ups and exacerbation of which threaten the safety and quality of life of children and their families. As the capacity for self-management among children is limited by their developmental level, much of the weight of asthma management falls on the shoulders of caregivers. This article outlines the impact of asthma, and guidelines for diagnosis and management of asthma, and symptom self-monitoring and management in children. It is aimed at facilitating self-monitoring to improve assessments of the severity of the condition in order to prevent deterioration and improve the quality of life of children and their families.     

Symptom perception and respiratory sensation: clinical applications

This article has described symptom perception and its relation to asthma management. Underestimation of airway obstruction in persons with asthma is a common and serious problem that is linked to fatalities in persons with asthma. Strategies to identify and manage the poor perceiver have been suggested.     

Symptom evaluation in cancer care

Abstract

Introduction: Distress is an important problem in palliative care. However, current models of clinical practice emphasise symptom-focused assessment of need, raising problems with integrating complex, and potentially conflicting, assessments of experience. An alternative perspective views distress as the result of the disruptive impact of illness on people's efforts to continue living their daily lives. We explored whether this account of distress may offer new insights into models of clinical care.

Subjects and methods: Qualitative, phenomenographic analysis of interviews with a purposive sample of 19 adults with advanced cancer (eight men, 11 at high risk of depression) to explore experiences of distress in the context of on-going efforts of daily living.

Results: Distress resulted from threats to aspects of themselves which mattered most to people. By achieving a balance between these disruptive effects and individual supportive capacity, most people were able to maintain continuity of daily life. Distress was identified by some as a productive emotion driving change. However, exhaustion undermined this self-capacity leading to fracturing of daily life, profound distress, and the need for external help to restore daily living. This is summarised in our self-integrity model (SIM).

Conclusions: Understanding distress in the context of the effort of daily life, rather than individual symptoms, may support a holistic assessment of need; the assessment process itself acting as a support for self-agency. A clinical trial of symptom-based versus SIM-informed assessment of need could support development of an individual-focused, holistic assessment of need.     

Biometeorological triggers in childhood asthma

The relationship between child asthma admissions and biometeorological factors was investigated over a 16-month period. No relationship was found with many commonly suspected precipitants such as temperature, humidity and wind. There was however a strong association with rainfall (P much less than 0.001). Associations occurred with low barometric pressure and counts of coloured basidiospores and green algae, but no significant relationship was found with grass pollen.     

Self-management plans in childhood asthma

Current literature supports the use of self-management plans in childhood asthma. The aim of this article is to describe the purpose of such plans. It gives step-by-step advice on how to prepare an individualized management plan and discusses important considerations on how they can best be implemented in clinical practice.     

Acute asthma attacks in childhood

The diagnosis of an acute asthmatic attack in a child is made on a clinical basis. The severity of the exacerbation can be assessed by physical examination and measurement of the transcutaneous oxygenation saturation. A blood gas analysis can be helpful in this assessment. A child with a severe asthma exacerbation should be promptly referred to an emergency department of a hospital. Oxygen should be given to keep the oxygen saturation above 92% and short-acting, selective beta-2 agonists should be administered. Beta-2 agonists can be delivered by intermittent nebulization, continuous nebulization or by metered dose inhaler (MDI) with a spacer They can also be given intravenously in patients who are unresponsive to escalating therapy. The early administration of systemic corticosteroids is essential for the management of acute asthma in children. When tolerated, systemic corticoseroids can be given orally but inhaled corticosteroids are not recommended. Oxygen delivery, beta-2 agonists and steroid therapy are the mainstay of emergency treatment. Hypovolemia should be corrected either intravenously or orally. Administration of multiple doses of ipratropium bromide has been shown to decrease the hospitalization rate in children and adolescents with severe asthma. Clinical response to initial treatment is the main criterion for hospital admission. Patients with failure to respond to treatment should be transferred to an intensive care unit. A critical aspect of management of the acute asthma attack in a child is the prevention of similar attacks in the future.     

Clusterin in atopic and non-atopic childhood asthma

Abstract

Several biomarkers have been studied to diagnose or to detect the phenotype of asthma. Clusterin is a sensitive cellular biosensor of oxidative stress and has been studied as a biomarker for inflammatory diseases. We aimed to study serum clusterin level in atopic versus non-atopic childhood asthma and its relation to disease severity. This case-control study included 160 children; 120 stable asthmatic children and 40 apparently healthy children. Asthmatic children were further subdivided into atopic and non-atopic. All children were subjected to medical history taking, clinical examination, and laboratory investigations including complete blood count, serum IgE, serum clusterin level and spirometry before and after bronchodilator therapy. In comparison to controls, patients had significantly higher eosinophils count which was higher in atopic than non-atopic group, also serum IgE level was higher in the atopic asthmatics (118.1?±?16.2?U/ml) than in both the non-atopic asthmatics (81.2?±?6.1?U/ml) and the controls (76.3?±?11.6?U/ml). There was statistical significant difference in serum levels of Clusterin which were highest in the atopic group (182.5?±?33.5?ng/l), followed by the non-atopic patients (127.5?±?32.5?ng/l) and lowest in the controls (46.09?±?7.01?ng/l). Moreover, the higher the severity of asthma, the higher was the level of serum clusterin. In conclusion serum level of clusterin was higher in atopic than non-atopic asthmatic children and it increases significantly with increased severity of the disease.     

Symptom evaluation using observational assessment

Symptom management is the cornerstone of hospice and palliative care and begins with a comprehensive assessment. Patient self-report remains the gold standard to determine symptom presence and intensity along with its impact on functional status and quality of life. However, patients often lose the ability to communicate over the course of a progressive illness whether transiently from the development of delirium or an ICU stay with mechanical ventilation or more permanently as a consequence of a cerebrovascular event or progressive neurodegenerative disorder (e.g. dementia).     

Differences between adult and childhood asthma

During the last 2 decades, we have gained new insights into the pathogenesis of asthma; consequently, new therapeutic agents and approaches to therapy have emerged. Nevertheless, significant gaps remain in our understanding of this disease. Important new treatment issues affect childhood (the usual time of asthma onset), and researchers have recently described increases in asthma incidence in children. Yet, most clinical studies have been performed with adults, and our knowledge about major determinants of childhood asthma remains incomplete. Major challenges in pediatric asthma include methods of easily assessing lung function and noninvasive methods of assessing asthma's inflammatory nature. Research that addresses the mechanisms responsible for disease onset is also critical to decrease the prevalence of asthma. What we know about adult asthma cannot be used in the treatment of children without further study, but it is now clear that effective treatment should begin during childhood. (J Allergy Clin Immunol 2000;106:S153-7.)     

Nutritional supplements and plasma antioxidants in childhood asthma

Objective

This study investigated the relationship of plasma antioxidants to airway inflammation and systemic oxidative stress in children suffering from atopic asthma with consideration of the intake of nutritional supplements.

Subjects and research methods

A total of 35 asthmatic children (AG) and 21 healthy controls (CG) participated in this study. Plasma levels of vitamins A and E, β-carotene, coenzyme Q10 and malondialdehyde (MDA) were analyzed with high-performance liquid chromatography (HPLC); the total antioxidant capacity (TAC) was measured photometrically, and selenium was determined by atomic absorption spectroscopy (AAS). The volume of fractionated exhaled nitric oxide (FeNO) was measured with the NIOX nitric oxide monitoring system.

Results

The plasma antioxidants vitamins A and E, selenium, and coenzyme Q10 but not β-carotene were significantly (p < 0.05) lower in asthmatics than in controls. Further, asthmatic children had significantly reduced plasma concentrations of TAC (p < 0.01), significantly enhanced levels of MDA (p < 0.001), and exhaled a significantly (p < 0.001) higher mean volume of FeNO than healthy children. Regular intake of supplements had a significant positive influence on plasma vitamin E (p < 0.01), selenium (p < 0.01), TAC (p < 0.05), MDA (p < 0.01), and FeNO (p < 0.01) in asthmatics but not in controls. Additionally, significant negative associations of vitamin E and MDA (AG: p < 0.01; CG: p < 0.05), and vitamin E and FeNO (AG: p < 0.05; CG: p > 0.05) were identified.

Conclusion

These results indicate that nutritional supplements beneficially modulate plasma antioxidants and thus might have a positive influence on systemic redox balance and subsequently, pulmonary inflammation in asthmatic children.