Asthma death among adults in Japan 1995-1997. Analysis of 295 cases reported questionnaires sent to hospitals with more than 100 beds. Asthma Death Investigation Committee]

To clarify recent trends in adult asthma mortality, the Asthma Death Investigation Committee of Japan studied the clinical characteristics of 295 patients who died of asthma between 1995 and 1997. Males were slightly more than females among the death cases. Approximately half of the patients ranged in age from 60 to 79 years. Tendency to increase of death among young male adults continued. One third of the patient deaths involved the asphyxic type, while status asthmaticus was the cause death in 21.9%. Half of the asthmatics died in hospitals or emergency rooms, and places where the fatal attacks occurred were mainly patients' houses. The main cause fatal asthma attacks was respiratory infection, followed by fatigue, stress, and discontinuation of medication. Most of the patients were classified moderate or severe type of asthma 1 month before death. Histories of life-threatening attacks and hospitalization due to severe attacks, irregular visits to the hospital, low compliance, and insufficiency of corticosteroid treatment were suggested as the main risk factors in adult asthma deaths.     

Increased risk of asthma attacks and emergency visits among asthma patients with allergic rhinitis: a subgroup analysis of the improving asthma control trial

BACKGROUND: Inadequately controlled allergic rhinitis (AR) in asthmatic patients can contribute towards increased asthma exacerbations and poorer symptom control, which may increase medical resource use. We assessed asthma-related medical resource use and attacks in asthmatic patients who did and did not have concomitant AR and were adding montelukast or salmeterol to baseline treatment with inhaled fluticasone. METHODS: A post hoc resource use analysis of a 52-week, double-blind multicentre clinical trial (Investigation of Montelukast as a Partner Agent for Complementary Therapy) [corrected] including 1490 adults with chronic asthma, aged 15-72 years, with FEV(1) 50-90% of predicted and > or =12% increase in FEV(1) after salbutamol administration, treated with either montelukast 10 mg daily or salmeterol 50 microg twice daily in addition to fluticasone 200 microg, was undertaken. Asthma-related medical resource use included medical visits (defined as either an unscheduled visit [to a general practitioner, a specialist or a non-medical provider] or a specialist visit), emergency room visits and hospitalizations during follow-up. Asthma attacks were defined as the worsening of asthma requiring unscheduled visit, emergency visit, hospitalization or oral/intravenous/intramuscular corticosteroids. RESULTS: A self-reported history of concomitant AR was identified in 60% of the patients (n=893). Univariate analysis suggests that significantly more patients with concomitant AR experienced emergency room visits (3.6% vs. 1.7%, P=0.029) and asthma attacks (21.3% vs. 17.1%, P=0.046). Multivariate analysis adjusting for treatment group, age and baseline asthma severity confirmed these results since the presence of concomitant AR in patients with asthma increases the likelihood of emergency room visit (odds ratio (OR)=2.35, 95% confidence interval (CI)=1.12-4.80) and asthma attack (OR=1.35, 95% CI=1.03-1.77). Patients with asthma alone compared with patients with both conditions did not differ in terms of unscheduled or specialist visits and hospitalizations. CONCLUSIONS: Presence of self-reported concomitant AR in patients with asthma resulted in a higher rate of asthma attacks and more emergency room visits compared with asthma patients without concomitant AR.     

Relation between serum eosinophil cationic protein (ECP) level and asthma attack in children]

Serum eosinophil cationic protein (sECP) levels were measured in 339 patients with childhood asthma, and the clinical courses of these patients were followed for 57 weeks. While considering the history and characteristics of each patient, we examined the correlation between asthma attack frequency and sECP, blood eosinophil count, and serum total IgE (tIgE) to determine their usefulness in predicting asthma attacks. Among patients with no other allergic diseases, sECP levels in patients who had no asthma attacks two weeks before or after the measurement were significantly lower than those of patients who had attacks during the same four-week period. Among patients who had attacks, those patients with no attack for a year after the measurement were also found to have low sECP levels. Similarly, even among patients with asthma attacks and high sECP levels, there were cases where attacks were well controlled using nebulizer treatments with DSCG or BDP. The incident rate of attacks for patients with other allergic diseases and a low sECP was low. Yet, there was no common trend in patients with high sECP levels. Moreover, this study detected a significant correlation between sECP level and blood eosinophil count as well as between sECP level and serum tIgE. The most significant correlation with asthma attack frequency was sECP level. Thus, sECP level seems to reflect the allergy activity level, especially two weeks prior to and after the measurement. For patients without other allergic diseases, asthma attack prediction during the two weeks period after the measurement of sECP also seems possible. Therefore, periodic measurement of sECP level is useful in objectively monitoring the improvement of symptoms and establishing the treatment plan, including treatment with DSCG or BDP.     

Asthmatic patients' poor awareness of inadequate disease control: a pharmacy-based survey.

BACKGROUND: Many asthmatic patients fail to perceive their level of disease control. OBJECTIVE: To investigate whether patients' ability to identify asthma control varied with personal characteristics or factors related to disease management. METHODS: Asthmatic patients were consecutively recruited at 348 pharmacies. They completed a questionnaire (regarding personal characteristics and asthma management) linked to pharmacies records of dispensed medications. The Asthma Control Test questionnaire includes 4 dimensions of asthma control (activity limitations, dyspnea, nocturnal awakenings, and rescue medication use) and assesses patients' perception of control ("How would you rate your asthma control during the past 14 days?"). Analyses were restricted to patients with inadequate control. Patients' perception of control was compared across the other dimensions of the questionnaire. The correlates of patients' failure to perceive inadequate asthma control were investigated. RESULTS: Seven hundred eighteen (68.5%) of the 1,048 patients with inadequate asthma control and documented perception of control considered themselves to be "completely" or "well" controlled. Patients' perception of control did not vary with each dimension of inadequate control. High rates of failure to perceive poor control were observed in patients with at least weekly dyspneas (60%) or nocturnal symptoms (60%). Failure to perceive inadequate control was more likely in patients aged 41 to 50 years (odds ratio, 1.51; 95% confidence interval, 1.05-2.15). No significant effect of factors related to asthma management was observed. CONCLUSIONS: Patients with most uncontrolled asthma have difficulty in properly perceiving their level of disease control regardless of their personal characteristics or disease management. The reasons for this poor perception should be investigated. Education programs should be created that focus on knowledge of asthma miscontrol criteria.     

Asthma and the risk of panic attacks among adults in the community

OBJECTIVE: The study was designed to determine the association between self-reported asthma and the risk, persistence and severity of panic attacks among adults in the community. METHOD: Data were drawn from waves 1 and 2 of the Baltimore site of the Epidemiologic Catchment Area (ECA) Study (N = 2768), which included self-report information on asthma, treatment for asthma and panic attacks in 1981 and 1982. Multiple logistic regression analyses were used to calculate odds ratios comparing the prevalence of panic attack at baseline and follow-up by asthma status at baseline. Linear regression analyses were used to examine the relationship between self-reported asthma status and the number of panic symptoms during a panic attack. RESULTS: Self-report asthma was associated with significantly increased likelihood of having panic attacks at baseline (1981) (12.1% v. 7.3%, P < 0.05) and of having panic attacks at both baseline and follow-up (15.9% v. 7.3%, P < 0.05), compared to those without asthma at baseline. Adults receiving treatment for asthma at baseline had an increased risk of incident panic attacks at follow-up (OR = 2.65 (1.11, 6.34)) and at baseline and follow-up (OR = 5.88 (2.21, 15.62)), though untreated asthma did not appear to increase risk of incident panic at follow-up. Similarly, the risk of panic at follow-up was not increased among those with asthma at baseline who did not report asthma at follow-up, compared with those without asthma at baseline. Treated asthma was associated with having more panic symptoms during panic attacks, compared to those without asthma (P < 0.001). CONCLUSION: These findings are consistent with and extend previous results suggesting that self-reported asthma is associated with an increased risk of panic attacks among adults in the general population, and that there is a consistent relation between severity and persistence of asthma and panic attacks. The lack of association between remitted asthma and panic attack may reveal a need for further research to determine whether asthma may be a causal risk factor for panic attacks, or whether a third factor (genetic or environmental) may be associated with increased risk of the cooccurrence of asthma and panic attacks. Replication of these results using alternative methodology with corroborative data on asthma and panic attacks is needed next.     

Acute changes in bronchoconstriction influences exhaled nitric oxide level

In previous studies the exhaled nitric oxide (NO) level of asthma patients was investigated only in association with bronchial inflammation, and whether the degree of bronchoconstriction itself influences the exhaled NO level has never been investigated. We therefore evaluated the effect of inhalation of a bronchoconstrictor (methacholine) or a bronchodilator (salbutamol) on the exhaled NO level of healthy volunteers and asthma patients. The exhaled NO level of the healthy volunteers decreased after methacholine inhalation. The exhaled NO level of patients with mild or moderate persistent asthma, who had no asthma attacks on the day of measurement, increased after salbutamol inhalation, and the exhaled NO level of asthma patients during asthma attacks increased after salbutamol inhalation followed by intravenous drip infusion of aminophylline. It is suspected that large amounts of NO are trapped in the lung distal to the constricted airway, contributing little to the exhaled NO level at the mouth. However, we expect that the trapped NO is exhaled at a larger fraction after the dilatation of the constricted small airway, thereby increasing the exhaled NO level at the mouth. In conclusion, the results of this study suggest that acute changes in bronchoconstriction themselves influence the exhaled NO level independently of the change in NO synthase activity associated with airway inflammation.     

Further investigation into the recent increase in asthma death rates: a review of 41 asthma deaths in Oregon in 1982

Vital statistics indicate increasing mortality from asthma since 1978 in the United States, England and Wales, Australia, and New Zealand. In Oregon and Washington, combined asthma mortality increased by 87% between 1977 and 1983. We reviewed the records of all patients (N = 41) (1) who died in hospitals or nursing homes in Oregon in 1982 and (2) whose death certificates listed asthma as the cause. Patients were 34 to 90 years old and half had been smokers. We found that most young patients who died clearly had asthma and died suddenly during severe attacks. Patients aged 55 and over frequently had bronchitis, emphysema, or chronic obstructive pulmonary disease rather than uncomplicated asthma, and were treated less aggressively than young patients. Their cause of death was often due to multisystem disease rather than reversible airflow obstruction. Reported statistics probably overestimate the true asthma mortality rate in the older population in Oregon.     

Which patients benefit from adding theophylline to beta 2-agonist treatment in severe acute asthma?

The aim of this investigation was to study whether certain patients benefit from adding theophylline to the beta 2-agonist treatment of acute asthma. The study group comprised 101 patients who were taking oral theophylline. The patients received inhaled salbutamol (albuterol) (0.15 mg/kg x 2) (n = 53) or IV salbutamol (5 micrograms/kg) (n = 48). Aminophylline (3 mg/kg) was infused intravenously 60 minutes after the start of the salbutamol treatment. The mean increase in peak flow (PEF) after the aminophylline infusion was 22 +/- 33 L/min or 4% +/- 6% of the predicted value (mean +/- SD). A change in PEF correlated negatively to plasma theophylline before treatment (P less than .01) and positively to a change in plasma-theophylline after treatment (P less than .05). All patients with an increase in PEF of more than 10% of the predicted value (n = 14) after the theophylline infusion had plasma-theophylline levels before treatment of below 7.5 mg/L (41 mumol/L). No significant difference in the change in PEF after the theophylline infusion was found between patients who had received inhaled or intravenous salbutamol. This investigation could indicate that IV theophylline as an additive to beta 2-agonist treatment should be reserved for patients who are either not taking theophylline or who have only taken a low dose before arriving for the emergency treatment of acute asthma.     

Ambulatory long-term subcutaneous salbutamol infusion in chronic severe asthma

Although most patients with asthma improve with currently available drugs, there appears to be a subset of patients with asthma resistant to intensive treatment, including large doses of systemic corticosteroids. In 10 patients with asthma difficult to treat, a double-blind, placebo-controlled, crossover study was performed to evaluate whether long-term, continuous subcutaneous infusion of large doses of salbutamol, in addition to steroids, could improve pulmonary function, compared with intermittent nebulization of salbutamol. Four weeks of administration of large doses (greater than 14 mg/day) of beta 2-agonists were well tolerated, elicited a significant decrease of corticosteroid consumption (p less than 0.01), and were associated with an improvement in pulmonary function (p less than 0.01), compared with run in or the placebo administration period. Mean morning and evening peak expiratory flow rates were similar during all periods, and the variability between morning and evening peak expiratory flow rates was only slightly and nonsignificantly reduced during the period when salbutamol was administered subcutaneously. Both nebulized and subcutaneous salbutamol elicited similar metabolic and muscular side effects, but these untoward reactions never caused any patient to stop the treatment. Local infection at the injection site was observed in two of 10 patients with continuous subcutaneous infusion. Tachyphylaxis to beta 2-agonist, as measured by the reversibility of FEV1 to inhaled salbutamol 12 hours after the end of each period, did not occur. In conclusion, large doses of beta 2-agonist administered to patients with severe, chronic, and steroid-dependent asthma were able to improve respiratory function and to decrease corticosteroids requirements.     

Twelve months, treatment with inhaled salmeterol in asthmatic patients

Salmeterol is a new beta 2-receptor agonist with a prolonged duration of action after inhalation, exceeding 12 h in most patients. We have performed a 12-month open follow-up study on 11 patients with reversible asthma. All patients were given salmeterol inhalations (50 micrograms twice daily). Additional asthma treatment included inhaled corticosteroids in all patients, and oral slow-release theophylline or beta 2-receptor agonists in a minority of patients (3 and 1, respectively). Before salmeterol treatment was initiated and after 3, 6, 9 and 12 months of salmeterol treatment, a cumulative dose-response curve to inhaled salbutamol (100, 300 and 900 micrograms) was performed, and FEV1 measured. We also evaluated the effect of each salbutamol dose on finger tremor, systemic blood pressure and heart rate. Blood tests, including white blood count and electrolytes, were taken at each visit. After salmeterol treatment was initiated, morning FEV1, measured before the morning asthma medication, was significantly improved (p < 0.05). The responsiveness to inhaled salbutamol was not decreased during salmeterol treatment, except in one patient with asthma worsening over the study year. Baseline finger tremor measured before salbutamol dose-response curves, was significantly lower at the 12-month visit than before treatment was initiated (p < 0.05). Effects of salbutamol on systemic blood pressure, heart rate or finger tremor was not significantly changed during salmeterol treatment. We found a successive and significant decrease in blood eosinophils (p < 0.05) during the 12 months of salmeterol treatment, when the patient with asthma worsening was excluded in the analysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Serum eosinophil cationic protein (ECP) and major basic protein (MBP) levels in patients prepared for asthma attack]

Serum ECP levels, serum MBP levels and blood eosinophil counts (Eo) were studied in patients prepared for asthma attack. Five severely asthmatic children were studied. Samples were taken just before their 33 times of home stay loading test. Serum ECP levels were significantly higher in the patients who suffered asthma attacks during their home-stay period than in those who did not. In addition, serum ECP levels were higher in the patients whose asthma attack started less than 12 hours after they returned home. However, there was no significant correlation either in serum MBP levels or peripheral eosinophil counts between these groups. These findings suggested that serum ECP levels increased in patients prepared for asthma attack.     

The relationship between historical aspirin-induced asthma and severity of asthma induced during oral aspirin challenges

BACKGROUND: Historical aspirin- or nonsteroidal anti-inflammatory drug (NSAID)-induced reactions might provide predictive information about the severity of reactions in patients with aspirin-exacerbated respiratory disease (AERD) undergoing oral aspirin challenge (OAC). OBJECTIVE: We sought to assess the relationship between historical aspirin- or NSAID-induced bronchial reactions and the severity of bronchial reactions during OAC in patients with AERD. METHODS: Data regarding the provoking doses, treatments, and treatment settings of historical aspirin/NSAID-induced reactions were recorded, analyzed, and compared with the provoking doses, maintenance regimens, and observed decreases in FEV(1) that occurred during OAC in 210 consecutive patients referred with suspected AERD. RESULTS: Of 147 patients who reported seeking acute medical care for their historical aspirin/NSAID-induced asthma attacks, 101 (69%) were treated in an emergency department and released, and 46 (31%) required hospitalization. During OAC in these 147 subjects, 23 (16%) had a 20% to 29% decrease and 14 (10%) had a 30% or greater decrease in FEV(1) values from baseline. Of the 46 patients previously hospitalized for aspirin/NSAID-induced asthma attacks, 9 (20%) had a 20% to 29% decrease and 6 (13%) had a 30% or greater decrease in FEV(1) during OAC. By contrast, of the 63 patients who treated their prior aspirin/NSAID-induced reactions at home, 5 (8%) had a 20% to 29% decrease and 5 (8%) had a 30% or greater decrease in FEV(1) during OAC (P = not significant for both). CONCLUSION: The severity of the historical aspirin/NSAID-induced asthma attack was not predictive of asthma severity during OAC. CLINICAL IMPLICATIONS: These data provide further reassurance regarding the safety of outpatient aspirin desensitization.     

Demographic characteristics of patients experiencing near-fatal and fatal asthma: results of a regional survey of 400 asthma specialists [see comment]

BACKGROUND: Case-control studies now describe a growing number of younger patients with varying levels of asthma severity who experience near-fatal or fatal asthma unexpectedly at home, en route to the hospital, or in public places. OBJECTIVE: To collect case reports and analyze the demographic characteristics and patient profiles that may help identify predisposing factors which trigger near-fatal and fatal asthma episodes. METHODS: In order to gather case reports and analyze the demographics and clinical characteristics of patients experiencing near-fatal and fatal asthma, a questionnaire on near-fatal and fatal asthma was distributed to 400 regional asthma specialists. RESULTS: Forty physicians reported 25 cases of near-fatal asthma and 20 cases of fatal asthma. Twenty-five patients (13 males and 12 females) with a mean age of 29.4 years experienced near-fatal asthma. The time of onset of the near-fatal event was sudden (less than 3 hours) in 60% of cases and 76% of the episodes occurred at home or en route to the hospital. All 25 patients were using short acting inhaled beta agonists and 88% were reportedly using inhaled corticosteroids on a daily basis. Good to excellent compliance was noted in 60% of patients. Six patients were using a peak flow meter prior to their near-fatal attack. Predisposing psychosocial factors for life threatening asthma were noted in 44% of patients. Twenty patients, (4 males and 16 females) with a mean age of 21.7 years experienced fatal asthma. The time of onset of the fatal event was sudden (less than 3 hours) in 80% of cases and all but one patient died at home, en route to the hospital, or in a public place. All 20 patients were using short acting inhaled beta agonists, 80% were reportedly on daily inhaled corticosteroids and six patients were on oral corticosteroids. Good to excellent compliance was noted in 60% of patients. Only two patients were using a peak flow meter immediately prior to their fatal attack. Predisposing psychosocial factors for life threatening asthma were noted in 45% of decedent patients. Risk factors for fatal asthma included running in cold weather, over relying on home nebulizers, and a delay in seeking care on long holiday weekends. CONCLUSIONS: While approximately 50% of the patients in this survey had moderate to severe asthma tainted by adverse psychosocial factors, nearly half of near-fatal and fatal attacks occurred suddenly and unexpectedly, outside the hospital in stable, younger, atopic, reportedly compliant patients utilizing inhaled corticosteroids on a daily basis. This regional survey supports the need for additional studies and the establishment of a national case registry to collect case reports and analyze the demographics and clinical characteristics of patients experiencing near-fatal and fatal asthma in order to further define the risk factors and develop preventative protocols for patients at risk for near-fatal or fatal asthma.     

Incidence of episodes of acute asthma and acute bronchitis in general practice 1976-87.

The incidence of episodes of acute asthma and acute bronchitis was analysed for an 11-year period and studied in relation to epidemiological data on viral illness and virus isolation data. Between 1976 and 1987, the weekly returns service estimates of the incidence of acute asthmatic episodes in England and Wales increased from 10.2 to 27.1 per 100,000 patients per week (all ages). The increase was most marked in children up to the age of 14 years. Acute bronchitis attack rates (all ages) increased from 78.7 to 111.9 per 100,000 patients over the same period. Because of this rise in rates of acute bronchitis, it is unlikely that labelling shifts contributed to the increase in reported episodes of asthma. These data support the belief that the rise in the prevalence of asthma is real, and also that in the United Kingdom this rise may even be underestimated by partial concealment in the rates of acute bronchitis. In 1987, if 10% of attacks of acute bronchitis were attacks of asthma, this would represent a 41% underestimation of asthma attack rates. Rates for other respiratory illnesses showed a fall over the same period, apart from the common cold which showed an increase. The winter increase in acute bronchitis coincided with viruses with strong seasonal patterns (respiratory syncytial virus, parainfluenza viruses 1 and 2 and influenza A and B), but there was no evidence that these viruses were related to the overall increase in acute asthma attacks over this 11 year period.(ABSTRACT TRUNCATED AT 250 WORDS)     

Non-compliance in asthmatic children: a study of theophylline levels in a pediatric emergency room population.

Sub-therapeutic theophylline levels due to patient (parent) non-compliance is a significant cause of outpatient treatment failure in childhood asthma. In a study of 50 known asthmatic children with acute asthmatic episodes, 98% had sub-therapeutic theophylline levels less than 10 mcg/ml with 75.5% due to inadequate patient (parent) compliance.     

Comparison of efficacy and safety between flunisolide/AeroChamber and budesonide/turbuhaler in patients with moderate asthma. AER-MD-04 Study Group.

BACKGROUND: There is a limited body of evidence comparing the clinical effects of different inhaled corticosteroids in the treatment of asthma. This study compared the safety and efficacy of inhaled flunisolide and budesonide, both with unique delivery systems that may affect clinical response. OBJECTIVE: This multicenter study was carried out to compare the efficacy and safety of flunisolide, administered via AeroChamber, with budesonide, administered via Turbuhaler, in the treatment of moderate asthma. METHODS: Patients with moderate asthma, defined as an FEV1 of 40% to 85% of predicted, underwent a 2-week run-in period during which beclomethasone, 750 microg twice daily by MDI, was administered, along with salbutamol prn. Patients (n = 176) were then randomized into two groups. One group received flunisolide administered via AeroChamber, 750 microg (3 puffs), twice daily. The second group received budesonide administered via Turbuhaler, 600 microg (3 puffs), twice daily. All patients took salbutamol prn. RESULTS: At the end of the 6-week treatment period, there were no significant differences (P > .05 for all comparisons) in efficacy between the groups as evaluated by any efficacy parameter. The treatment groups also did not differ significantly in the number of adverse events or in the incidence of oropharyngeal Candida infection. CONCLUSION: Flunisolide administered by AeroChamber and budesonide administered via Turbuhaler demonstrate similar efficacy and safety in the treatment of moderate asthma.     

Salmeterol in two different doses in the treatment of nocturnal bronchial asthma poorly controlled by other therapies

This study compared the efficacy of inhaled salmeterol (SM) 50 μmg twice a day with SM 100 μmg once a day (at night) and placebo in patients with poorly controlled nocturnal asthma despite treatment with corticosteroids, oral long-acting bronchodilators, or both. This was a two-center, double-blind, randomized, crossover study with three treatment periods, each of 3 weeks' duration. The first treatment period was preceded by two 1-week run-in periods, and the last treatment period was followed by a 2-week follow-up period. In the three treatment periods, patients received either SM 50 μmg twice a day, SM 100 μmg nightly, or placebo, in randomized order. Salbutamol metered-dose inhaler was given as relief medication. Of the 41 randomized patients, 38 were evaluable for more than one treatment period. Efficacy and safety were determined by daily record card data: morning and evening peak expiratory flow rates (PEFR), daytime and nighttime asthma symptom scores, and rescue salbutamol use. At clinic visits, FEV₁ and FVC were measured, and the physicians' and the patients' respective assessments of the study mediation were noted. The study showed that the two doses, SM 50 μmg twice a day and SM 100 μmg nightly, were equally effective in controlling nocturnal asthma symptoms and were significantly better than placebo. SM was well tolerated, and no unexpected problems were revealed. The adverse events reported during this study were related either to the patient's underlying disease or to an intercurrent respiratory infection.     

Plasma fibronectin in asthmatic patients and its relation to asthma attack

This study investigated the relation between asthma attacks and levels of plasma fibronectin (FN) and serum eosinophilic cationic protein (ECP) in patients with bronchial asthma in order to clarify the role of FN in the airway inflammation of bronchial asthma. Plasma levels of FN were significantly higher (P < 0.025) in patients with bronchial asthma than in healthy controls. They were also significantly higher (P < 0.05) in non-atopic asthmatics than in atopic asthmatics. Furthermore, plasma FN was lower during the attack than the non-attack stage (P < 0.025), and a significant increase of plasma FN was noted (P < 0.05) in asthmatics who had more severe and more frequent attacks. Serum levels of ECP were significantly higher during the attack than the non-attack stage (P < 0.005). An increase of plasma FN in the non-attack stage after attacks showed a significant correlation (P < 0.05) with a decrease of serum ECP. These observations clearly indicate that the decrease in plasma FN associated with attacks is closely related to aggravation of airway inflammation, and that the increase in plasma FN in the non-attack stage reflects chronic airway inflammation. These results suggest that the fluctuation in plasma levels of FN may be one of the factors affecting allergic inflammation and attacks in bronchial asthma.     

Specific immunotherapy with SQ standardized grass allergen tablets in asthmatics with rhinoconjunctivitis

BACKGROUND: The best way to prevent allergy symptoms is to treat the allergic condition. Specific immunotherapy with grass allergen tablets 75,000 SQ-T (Grazax, Phleum pratense, ALK-Abelló) is safe and efficacious in rhinoconjunctivitis patients. As rhinoconjunctivitis often co-exists with asthma, we aimed to confirm safety and efficacy in grass allergic subjects with asthma and rhinoconjunctivitis. METHODS: A randomized, double-blind, placebo-controlled, multicentre trial was performed 10-14 weeks prior to and during the grass pollen season 2004. About 114 subjects were randomized 2 : 1 to grass allergen tablets or placebo. The primary end points were average asthma medication and symptom scores during the grass pollen season, and secondary variables were average rhinoconjunctivitis symptom and medication scores during the grass pollen season. Additionally, number of well days was defined post hoc. RESULTS: Differences in asthma medication and symptom scores between the treatment groups were negligible. The mean difference in asthma medication score was below 0.1 and 0.3 for asthma symptom score [a single inhalation of salbutamol (200 microg) was scored 2]. No serious adverse events were reported. A reduction in rhinoconjunctivitis symptom score of 37% (P = 0.004) and a 41% (P = 0.036) reduction in medication score was found in the grass pollen season for subjects treated with the grass allergen tablet compared with placebo. Well days increased by 54% (P = 0.002). CONCLUSIONS: Self-administration of the grass allergen tablet was safe. The treatment did not impair asthma control and confirmed considerable symptom prevention and reduced medication use. It addresses the allergic condition and represents a baseline treatment for grass pollen allergy.     

A controlled study of education for improving compliance with cromolyn sodium (Intal): the importance of physician-patient communication

The effectiveness of an educational program to increase compliance with cromolyn sodium was assessed in 31 children and adolescents 6 to 17 years of age. Patients were randomly assigned to an education or noneducation group. A standard education program regarding asthma and asthma medications was provided to the education group during four monthly visits. At each visit, all patients were assessed in terms of knowledge of asthma and medications, asthma-related symptoms, and pulmonary function. Patients were also asked to self-rate their compliance. The education program increased the patients' knowledge of cromolyn, and appeared to result in increased cromolyn compliance. Post-hoc analyses, however, suggested that increased compliance did not correspond to improved medical status unless the quality of management (by physician and parents) of the child's asthma was taken into account. These results suggest that inadequate management of asthma in children may be a more serious problem than patient noncompliance.