Asthma morbidity in Australia: an epidemiological study.

OBJECTIVE: To examine the prevalence and management of asthma in adults and children in a population sample in eastern Australia. SETTING: A random sample of children from 33 primary schools in Sydney, Melbourne, Brisbane, and the Upper Hunter Valley (New South Wales), and their parents. DESIGN: A cross-sectional analytic survey of 8753 primary school children aged between 5 and 12 years, and their parents (n = 13,945 adults). Asthma prevalence and management practices were determined by parental responses to a questionnaire, and spirometry was performed in children with "probable asthma". RESULTS: Of 8753 children whose parents responded, the prevalence of current wheeze was 19.5% and diagnosed asthma was 17.1%. Of the children with "probable asthma", 30% had their lung function measured in the previous year, and 6% possessed both a peak flow meter and an action plan for their asthma. Undertreatment was likely, as preventive asthma medications (inhaled corticosteroids or sodium cromoglycate) were used regularly by only 25.5% of these children and by 44.3% of children who had asthma symptoms more than twice per week. Children with the diagnosis of asthma reported higher rates of preventive medication use and ventilatory function measurement than children with frequent symptoms without the diagnosis. In the 13,945 adults, the reported prevalence of asthma was 7%, of whom 39% were using preventive medications, 34% had their ventilatory function assessed in the previous year, and 7% had both a peak flow meter and an asthma action plan. CONCLUSIONS: The study illustrated the gap between the current level of asthma management in the community and the standards set by the Thoracic Society of Australia and New Zealand. Undertreatment and suboptimal management of asthma remain important problems in Australia.     

A South Australian population survey of the ownership of asthma action plans

OBJECTIVE: To examine the relationships between ownership of written asthma action plans, asthma morbidity, use of devices, and patients' perceptions of their asthma management. DESIGN AND SETTING: A random population survey (in 1996) of the South Australian population aged 15 years or over, using interviewers to administer a questionnaire. PARTICIPANTS: People who reported that they had current, doctor-diagnosed asthma. MAIN OUTCOME MEASURES: Prevalence of written asthma action plans; night-time awakenings from asthma; ownership of peak flow meters; and people's perceptions of their asthma management. RESULTS: The ownership of asthma action plans by people with self-reported asthma was 33% and has declined since 1995 (42%; P < 0.001). Fifteen per cent were awakened weekly or more frequently by asthma symptoms. These people were more likely to have a peak flow meter and a written action plan, but less likely to consider they had been provided with enough information about their asthma, to feel comfortable managing their asthma, or to find it easy to see their doctor. Having a written asthma action plan was associated with regular corticosteroid use, understanding asthma, having enough information and owning a peak flow meter. CONCLUSIONS: Ownership of asthma action plans in South Australia is suboptimal. Before we develop new strategies to improve asthma outcomes, we must determine whether there is a need to target people with less severe asthma and/or improve the use of guidelines by health professionals.     

Prevalence of asthma and asthma action plans in South Australia: population surveys from 1990 to 2001

OBJECTIVES: To assess trends in the prevalence of self-reported doctor-diagnosed asthma, associated asthma related morbidity, and the uptake of written asthma action plans in South Australia, 1990-2001. DESIGN, SETTING AND PARTICIPANTS: Surveys by telephone interview of the South Australian population between 1990 and 2001, and interview of participants in their own homes by trained health interviewers. MAIN OUTCOME MEASURES: Asthma prevalence, percentage of patients with written action plans, and asthma associated morbidity. RESULTS: The reported prevalence of doctor-diagnosed asthma has increased from 8% (95% CI, 6.4%-9.6%) in 1990 to 12.8% (95% CI, 11.4%-14.2%) in 2001. Morbidity, as measured by wakening at night (daily or weekly) and days lost from normal activities because of asthma, has remained constant over the decade. The percentage of patients with written asthma action plans increased to a peak of 42.3% (95% CI, 40.3%-44.3%) in 1995, but then declined to 22.2% (95% CI, 20.7%-23.7%) in 2001. CONCLUSIONS: The prevalence of asthma has increased while morbidity has remained constant, indicating that the burden of asthma has increased. The associated decline in the percentage of patients with asthma action plans in recent years is cause for concern.     

Prescribing patterns for childhood asthma treatment in general practice

The treatment preferences of 109 general practitioners (GPs) for childhood asthma were determined. Availability and adherence to clinical practice guidelines (CPG) for the treatment of childhood asthma was also assessed. Ninety eight (90%), 60 (55%) and 33 (30%) GPs considered nocturnal symptoms > 2 times/week, exercise induced wheeze and cough respectively as indications for preventer therapy. An oral preparation was preferred for relief medication [72 (66%) for 2-5 years, 60 (55%) for > 5 years]. An inhaled preparation was however preferred for preventer medication [60 (55%) for 2-5 years, 85 (78%) for > 5 years]. The oral form was more likely prescribed for asthmatic children 2-5 years (p < 0.001). Corticosteroids and ketotifen were the commonest inhaled and oral preventer treatment prescribed respectively. Only 36(33%) GPs have a CPG copy for reference. Children with asthma symptoms that require preventer therapy may not always be identified in general practice. The oral route remains important for asthma medication especially in young children. The accessibility to the CPG among GPs is disappointing.     

Risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use.

OBJECTIVE--To examine the relationship between patterns of use of inhaled beclomethasone dipropionate and the risk of fatal and near-fatal asthma. DESIGN--Nested case-control analysis of a historical cohort; a further analysis. SETTING--The 12,301 residents of Saskatchewan aged 5 to 54 years who were dispensed 10 or more asthma drugs from 1978 to 1987. PATIENTS--The 129 persons who experienced asthma death (n = 44) and near-death (n = 85) and their 655 controls matched as to age and date of entry into the cohort, with the additional matching criteria of at least one hospitalization for asthma in the prior 2 years, region of residence, and having received social assistance. MAIN OUTCOME--Life-threatening attacks of asthma defined as death due to asthma or the occurrence of hypercarbia, intubation, and mechanical ventilation during an acute attack of asthma. RESULTS--After accounting for the risk associated with use of other medications and adjustment for markers of risk of adverse events related to asthma, subjects who had been dispensed, on average, one or more metered-dose inhalers of beclomethasone per month over a 1-year period had a significantly lower risk of fatal and near-fatal asthma (odds ratio, 0.1; 95% confidence interval, 0.02 to 0.6). CONCLUSION--These data support recent guidelines from several countries that recommend the use of inhaled corticosteroids in moderate and severe asthma.     

白三烯受体拮抗剂孟鲁司特治疗咳嗽变异性哮喘的疗效观察

目的评价白三烯受体拮抗剂孟鲁司特治疗咳嗽变异性哮喘的疗效。方法共有21例咳嗽变异性哮喘病人进入此项前瞻性、开放临床研究,所有病人均给予口服孟鲁司特10mg,每日1次,疗程2周。观察病人咳嗽频率评分、夜间咳醒次数、24小时短效β2受体激动剂使用次数、最大呼气流速(PEF)以及症状缓解时间。结果咳嗽频率评分及β2激动剂使用次数有显著改善。夜间咳醒次数也有明显改善。治疗后第1、2周末,清晨PEF及晚间PEF均有显著改善。病人症状缓解时间1～10天,平均3.7±2.1天。不良事件发生率为4.8%。结论白三烯受体拮抗剂孟鲁司特治疗咳嗽变异性哮喘疗效确切,安全性好。     

Utilization of the "Smokescreen" smoking-cessation programme by general practitioners and their patients

General practitioners have been encouraged to be more active in helping their patients to stop smoking. A number of research studies overseas and in Australia has reported that they can be effective in this form of health promotion. The "Smokescreen" programme is an intensive, structured antismoking intervention that was developed for use by general practitioners in Australia. To monitor the effect of this programme, general practitioners who had attended workshops on the use of the programme were contacted 12 months later to find out what use they had made of the programme, and how effective it had been. Only 18 of the 38 doctors who initially agreed to cooperate in the study had recruited smokers to the programme and had kept records of their progress. These 18 doctors had recruited 121 smokers in the 12-month period: only 7% (approximately) of all their patients who smoked. Of these, 29 (24%) patients reported that they had stopped smoking. Reasons that were given by doctors for their inability to use the programme as fully as they had hoped included the difficulty in recruiting smokers, a lack of time, and a low rate of return by the patients for follow-up visits. These results suggest that while general practitioners should be encouraged to give brief antismoking advice, general practice may not be a suitable location for more-intensive antismoking programmes. Limited health-promotional funds may be deployed better in general community awareness and mass-media programmes.     

Symptoms, severity and asthma control in 5-14 y-old Lebanon school children

BACKGROUND: This study addressed symptoms' profile, severity and determinants of asthma control in school-aged patients (5-14 y) across Lebanon. METHODS: It is a cross-sectional study, applied on school children with physician-diagnosed asthma (PDA), divided into two groups: those who were on controllers (C+) and those who were not (NC). RESULTS: Out of 5544 children, 275 (4.96%) had PDA. The C+ group (32.7%) had higher mother's education than the NC group (45.9%) (p = 0.037). NC children were more frequently found in public versus private schools (p = 0.0001). Higher frequencies of regular visits to the doctor were noted in the C+ compared to NC group. In C+ group, 90% were on reliever and controller, and 10% just on one controller. A trend for more severity in the C+ group was noted compared to the NC group. An impact of asthma on daily activities was reported by 40% in the C+ group versus 34% in the NC group. CONCLUSION: Treatment of PDA in 5-14 y school children was quite adapted according to the recommendations. However, total control was reported in low percentages of patients reflecting universal discrepancy between evidence base medicine and real life.     

Deaths from asthma in Victoria: a 12-month survey

The circumstances surrounding the death of all patients who died from asthma in the State of Victoria over a 12-month period from May 1, 1986 were investigated. Data were collected using an interviewer-administered questionnaire as soon as practicable after registration of the death. In 168 cases asthma was considered to be the cause of death and adequate data were obtained in 163; 75 of these were male (74 over 60 years of age). Thirteen per cent had a history of trivial or mild asthma, 22% of moderate and 65% of severe asthma. Thirty-four per cent had not been limited at all or only by active sport, while 39% had had no previous hospital admission for asthma. In only 18% had there been a previous admission to an intensive care unit. Forty-seven per cent were taking inhaled beclomethasone or sodium cromoglycate regularly and 27% were taking corticosteroids by mouth regularly. Death occurred outside hospital in 150 of 163 subjects. In the final attack 58% had a sudden onset and collapsed within minutes, 20% were found dead and 27% had an acute progression of an established attack. Twenty-nine per cent of the deaths were assessed as preventable: preventable factors included inadequate assessment or therapy of prior asthma (35%), poor compliance with therapy (33%) and delay in seeking help (43%). As a significant number of subjects in this survey could not be classified as "high risk", it is important that clinicians ensure that all patients are aware of optimal maintenance management and have a clear individualized plan of what to do in the event of deteriorating asthma.     

Back for more: a qualitative study of emergency department reattendance for asthma

OBJECTIVE: To explore the reasons why individuals recurrently present with asthma to hospital emergency departments. DESIGN: A predominantly qualitative study in which participants were interviewed in-depth about their asthma. Data on medication use, respiratory health and asthma knowledge were also collected, and asthma severity was determined from medical records. SETTING: A tertiary teaching hospital and a suburban hospital emergency department (ED) from 1 March to 30 April 2000, and a rural hospital ED from 1 July to 31 August 2000. PARTICIPANTS: The participation rate was 32% of an initial 195 ED attendees (183 of whom were eligible) aged 18-70 years: 32 had presented to an ED for asthma care on more than one occasion over the preceding 12 months (reattendees), and 29 were non-reattendees. RESULTS: Two-thirds (22/32) of reattendees had chronic severe asthma and presentation to ED was deemed appropriate for 18 of these, indicated by recurrent severe asthma attacks despite seeking prior medical intervention. Reasons for re-presentation identified in a third of all reattendees included poor asthma knowledge, and financial and other barriers to medication use. CONCLUSIONS: We identified potentially preventable issues in about a third of patients (most of whom had mild to moderate asthma) who recurrently presented to EDs for treatment. The remainder of the participants sought emergency asthma treatment appropriately after failing to respond to medical care, and this was frequently in accordance with their asthma management plans.     

Effects of intervention on medication compliance in children with asthma

We have assessed the effects of intervention on medication compliance in asthmatic children. The intervention comprised both written information about the medications and behavioural strategies effected by the physician. Children were assigned at random to either control (received no intervention) or test (received the intervention) groups. Compliance was assessed by questionnaire. The mean compliance for the test (78.0%; n = 93) and for the control (54.5%; n = 103) groups differed significantly (P less than 0.001; Mann-Whitney U-test). The test group had a better knowledge of asthma and of the medications, and was more satisfied with the physician and with the regimen than was the control group. These variables were also related to good compliance. This study demonstrates that a programme of intervention can significantly improve medication compliance and can be accompanied by increases in the knowledge of, and satisfaction with, treatment.     

北京市城区门诊哮喘患者控制现状及疾病认知程度的调查分析

目的 了解北京市城区近年来哮喘患者的控制现状和对疾病的认知程度,评估近年来推广哮喘规范化治疗的效果.方法 选择2007年6-12月在卫生部中日友好医院、北京大学第一医院和北京市天坛医院呼吸内科门诊就诊的哮喘患者,采用医师与患者面对面的方法 进行问卷调查.结果 共完成问卷360份.90.3%(325例)的患者享有医疗保障.在过去1年中,因哮喘住院者占12.2%(44例),急诊就医者占25.6%(92例);因哮喘请假误工的在职患者占29.6%(65/220),请假误学的学生占26.9%(7/26);87.8%(316例)曾进行过肺功能的检查,29.2%(105例)使用过峰流速仪监测病情;68.6%(247例)长期吸入糖皮质激素治疗哮喘,30.6%(110例)达到哮喘控制.结论 北京市哮喘患者的总体控制水平有明显改善,患者对疾病的认知程度对其疾病控制水平有明显影响.     

The cost of asthma in New South Wales

OBJECTIVE: To determine the economic cost of asthma to the New South Wales community. DESIGN: Direct costs (both health-care and non-health-care) plus indirect costs (loss of productivity) were estimated from various sources to assess retrospectively the dollar costs of asthma. Intangible costs (such as quality of life) were not included. SETTING: Estimates of costs were made at all levels of medical care of asthma patients, including inpatient and outpatient hospitalisations, emergency department visits, and visits to general practitioners and specialist physicians, plus costs of pharmaceuticals, nebulisers and home peak-flow monitoring devices. The cost of time lost by the patient attending for medical visits and loss of productivity due to absence from employment as a result of asthma were also included. RESULTS: The total cost of asthma in New South Wales was $209 million in 1989. This was made up of $142 million in direct health-care costs, $19 million in direct non-health-care costs and $48 million in indirect costs. CONCLUSION: Although we believe that our estimate is an underestimate of the true dollar cost of this disease to the community, it represents $769 per asthmatic person per year, assuming a current prevalence rate for asthma in New South Wales of 6%. The cost effectiveness of any new treatment of asthma should be estimated to ensure that the economic cost to the community does not rise unnecessarily.     

社区支气管哮喘患儿发病相关因素调查分析

目的:了解社区儿童支气管哮喘发病的相关因素,以及治疗用药情况,作为进一步制定对哮喘患儿健康教育、疾病防治工作的依据。方法:采用普查的方式对社区0～16岁儿童进行哮喘筛查,共筛查出42例哮喘患儿。结果:该社区中儿童哮喘的发病率约为1.3%,以春季最多见,占47.6%(20例);哮喘患儿首次出现喘息的年龄<3岁者69.0%(29例);近12个月内有过发作占78.6%(33例);诱发因素以呼吸道感染最多见,占66.7%(28例);家族中有哮喘及其他过敏史者为38.1%(16例);患儿有湿疹和/或过敏性鼻炎等过敏史者占28.6%(12例)。正确规范用药的患儿只有4例(9.5%),无1例病人记录哮喘日记与使用峰流速仪。治疗上100%患儿均使用过抗生素。结论:哮喘发病与年龄、季节、家族史及个人过敏史等多种因素密切相关。哮喘患儿的用药和管理存在不少问题,应加强宣传和交流,提高哮喘的防治水平。     

Sub-optimal asthma control in teenagers in the midland region of Ireland

Background

Internationally, many children with asthma are not attaining achievable asthma control.

Aims

To examine the prevalence of asthma in teenagers in four midland counties, their asthma control and the barriers, if any, to gaining control of asthma.

Methodology

International Study of Asthma and Allergies in Children (ISAAC) methodology was used in a survey of Junior Cycle Year 2 second-level students.

Results

The prevalence of “wheeze ever” was 49.8%, “wheeze in the last 12 months” was 32.6% and “asthma ever” was 23.5%. Of teenagers with current asthma, 96% had evidence of sub-optimal asthma control during the previous year. For the majority of the teenagers with asthma, treatment was not guideline concordant; infrequent lung function testing, insufficient review after acute care and poor use of written asthma action plans. Barriers included lack of awareness of need for treatment.

Conclusions

If asthma guidelines are implemented fully, these children may experience better health.     

重庆地区儿童支气管哮喘急性加重住院危险因素分析

目的分析重庆地区儿童支气管哮喘急性加重住院的危险因素,为制定个体化防治方案,有效控制哮喘提供依据。方法随机选择2009年1月至2009年12月重庆医科大学附属儿童医院呼吸中心及江津区人民医院儿童哮喘急性发作住院患儿共193例,自行设计调查问卷,收集资料进行分析。随机选择门诊随访3个月,接受正规维持治疗的无哮喘发作慢性持续期维持控制治疗的患儿为对照组,分析儿童哮喘急性发作的危险因素。结果呼吸道感染为哮喘急性发作住院的第一独立危险因素,占85.5%(165/193)。未规范使用控制性药物者达71.5%(138/193),包括既往未诊断哮喘102例和已诊断哮喘但未用药的36例,与维持控制治疗组未规范用药(21/110,19.1%)相比有统计学意义(P0.01),为哮喘急性发作第二重要因素。各种过敏原诱发哮喘急性发作也较常见,占9.3%(18/193)。过敏性疾病家族史在急性发作组与维持治疗组间无明显差异(P0.05)。结论呼吸道感染为重庆地区儿童哮喘急性发作的首要危险因素,其次为未及时诊断哮喘、未正规使用哮喘控制药物,各种过敏原诱发哮喘急性发作也需引起重视。     

Diagnostic value of bronchoprovocation challenge with adenosine monophosphate versus exercise testing in early diagnosis of asthma

BackgroundAirway hyperresponsiveness (AHR) is a characteristic feature of bronchial asthma and is diagnosed using direct and indirect bronchoprovocation tests. The diagnosis of AHR is a challenge in symptomatic patients with a normal baseline prebronchodilator spirometry and postbronchodilator spirometry. Exercise-induced asthma or exercise-induced bronchoconstriction (EIB) is a distinct form of AHR. There is no single test that is sufficient to exclude AHR in symptomatic military personnel with normal spirometry. This study was conducted to compare the diagnostic value of indirect bronchoprovocation test using inhaled adenosine monophosphate (AMP) and exercise challenge test (ECT) in the diagnosis of EIB.MethodsA crossover study was conducted with consecutive sampling of patients presenting with symptoms suggestive of asthma and with normal spirometry results who were subjected to both ECT and bronchoprovocation test using inhaled AMP on separate days.ResultsForty participants were recruited (the mean age: 25 yrs, 100% male). The commonest presentation was breathlessness on exercise (55%). With exercise alone, 40% tested positive for AHR, while with AMP alone, the positivity increased to 53%, and the difference was statistically significant (p= 0.03). Exercise alone failed to detect 8 cases that tested positive for AHR by inhaled AMP challenge.ConclusionIndirect bronchoprovocation test using inhaled AMP may be used to diagnose AHR in conditions in which exercise challenge testing is not available or the patient is unable to complete ECT.     

Do patients understand asthma? A community survey of asthma knowledge

Four hundred and twenty-one subjects who attended metropolitan pharmacies in Melbourne that were selected at random were surveyed about the characteristics of, and their knowledge about, their asthma. An unexpectedly-high morbidity was found among 232 persons with asthma, who were aged between 16 years and 75 years. Forty per cent of subjects had been hospitalized at least once for asthma and 15% of subjects were taking maintenance corticosteroid agents by mouth. Twenty per cent of subjects currently were smoking cigarettes (15 cigarettes per day on average). When knowledge of asthma was examined by a questionnaire, the median score of questions that were answered correctly was less than 50% of the total. The best knowledge scores were associated with subjects: who had been exposed in the past to information about asthma; who had attended a private medical specialist; who were non-smokers; and who had achieved the highest levels of schooling. Among the serious misconceptions which were evident in the areas of use of medication were: that sustained-release theophylline agents acted quickly during acute attacks of asthma (62% of subjects); that antihistamine agents should be taken as soon as possible during an asthma emergency (72% of subjects); that six inhalations of beclomethasone were advisable during an asthma emergency (49% of subjects); that systemic corticosteroid agents were effective within 20 minutes of administration (87% of subjects); and that deaths of asthma usually were due to precipitous attacks without time for any intervention (73% of subjects). Only 42% of subjects considered that up to six puffs at once of a beta-agonist aerosol for an asthma emergency may be appropriate. The identification of such misconceptions is quite practical during routine consultations. The correction of such misconceptions may improve the morbidity and mortality that is due to asthma.