Histone Deacetylases and Their Role in Asthma

To determine the relationship between patient education and the risk of underdiagnosis and undertreatment of asthma, a cross-sectional study of 500 (250 males and 250 females) adult attendees between 16 and 44 years of age was undertaken at five primary health care (PHC) centers in Al-Ain, United Arab Emirates. We used an Arabic translation of the European Community Respiratory Health Survey Screening Questionnaire. Asthmatics with higher levels of education had a significantly higher risk of underdiagnosis and undertreatment than asthmatics with less education. Doctors at PHC centers failed to diagnose 34.6% of the asthmatics with lower levels of education and 77.6% of the patients with higher levels of education. Eighty-five percent of the asthmatics with lower levels of education and 46.6% of the asthmatics with higher levels of education recognized that they had asthma. Thirty-eight percent of the asthmatics with lower levels of education and 83% of the asthmatics with higher levels of education were undertreated. It was found that 19% of the asthmatics with lower levels of education and 3% of the asthmatics with higher level of education were on prophylactic medication for asthma. We concluded that education level was related to underdiagnosis and undertreatment of asthma among adults between 16 and 44 years of age. People with higher levels of education have a higher risk of underdiagnosis and undertreatment than do those with lower levels of education. The factors that might be associated with these findings need to be explored in further studies.     

上海地区2004年度哮喘患者问卷调查报告

目的探讨目前上海地区哮喘患者对自身疾病和规范化治疗的认识。方法问卷内容涉及哮喘发作的诱因、炎症本质、哮喘诊断和病情的自我监测,以及哮喘药物的使用(包括对常用的吸入药物使用方法的掌握程度),在上海各区县5月份为配合“世界哮喘日”举行的义诊活动中由病人填写。结果198例参与问卷调查的支气管哮喘患者,约半数左右的患者能够正确认识到哮喘炎症的本质。哮喘的自我监测(尤其是使用峰速仪监测病情)很不理想。能够正确掌握吸入技术的患者仅占1/3。三级医院就诊的患者在哮喘炎症本质、病情监测、治疗等多方面的答题情况要优于二级医院就诊的患者,病程长的患者对肺功能的重视程度比较高,但这部分患者对疾病的监测也更容易忽视。文化程度高的患者在哮喘发作避免滥用抗生素方面以及哮喘必须远离过敏原方面的认识程度高,对峰速仪的使用和吸入途径及MD I的掌握程度也较高。结论上海患者对哮喘疾病的认识程度较以前有较大提高,但仍有许多不足之处,哮喘规范化防治工作任重道远,需医患双方进一步努力。     

北京市各级医院呼吸系病专业医师哮喘基本知识问卷调查结果分析

目的了解各级医院呼吸系病专业医师对哮喘基本知识的掌握情况，作为哮喘防治学组制定工作计划的依据。方法采用问卷调查方式，共调查市级或以上医院、市内区级医院和郊区县医院５５家，对象为呼吸内科或内科呼吸专业组的住院医师和主治医师，总计４３６人。结果无论是哮喘的基本概念，还是吸入治疗、抗炎治疗在哮喘治疗中的地位、峰流速仪的使用价值等，各级医院呼吸系病专业医师均存在不同程度的模糊认识，市级或以上医院医师回答问题情况明显优于市内区级医院和郊区县医院。结论哮喘的医师教育问题是一项非常重要的工作，工作的重点应放在基层医院。     

Medication Compliance and Asthma: Overlooking the Trees Because of the Forest

A number of reviews have described medication compliance and asthma. The consensus emerging from the analyses and discussion of the topic is that compliance to treatment regimens is generally poor. The current article describes several trees overlooked in the forest of data generated about compliance and asthma. The paper focuses on neglected issues concerning determinants of compliance, assessment, and changing noncompliant behavior. Based on available data, the conclusion is that it is time for health care personnel and patients to share the blame for the lack of medication compliance in asthma.     

Misunderstanding of Asthma Controller Medications: Association with Nonadherence

Objective.?Nonadherence to regular inhaled anti-inflammatory medication use is a frequent contributor to poor control of persistent asthma and may result from misunderstanding of the preventive role of such medications. This study's aims are to 1) test the hypothesis that misunderstanding is associated with decreased adherence to its daily use and 2) identify factors associated with increased risk of misunderstanding. Study Design.?A sample of parents of children with asthma insured by Medicaid and enrolled in managed care programs in Northern California, Washington, and Massachusetts were interviewed by telephone. This analysis focused on the subset that reported having an inhaled anti-inflammatory medication and whose medication use and symptom frequency in the 2 weeks before the interview suggested persistent asthma. Misunderstanding of the role of inhaled anti-inflammatory medication was defined as identifying it as being for treatment of symptoms after they begin and not for prevention of symptoms before they start. Results.?A total of 1663 parents of children with asthma (63% response rate) were interviewed. Of those, 571 subjects (34%) reported use of an inhaled anti-inflammatory medication and met our criteria for persistent asthma. Among those with persistent asthma, 23% (131 parents) misunderstood the role of their child's inhaled anti-inflammatory. Misunderstanding of inhaled anti-inflammatory medication was associated with decreased adherence to its daily use (odds ratio [OR] 0.18, 95% confidence interval [CI], 0.11–0.29). The risk for misunderstanding was lower if the patient had seen a specialist (OR 0.42, 95% CI, 0.24–0.75) or had graduated high school (OR = 0.54, 95% CI, 0.34–0.84). Conclusion.?Misunderstanding of the role of inhaled anti-inflammatory medication is associated with reduced adherence to its daily use.     

Misunderstanding of Asthma Controller Medications: Association with Nonadherence

Objective. Nonadherence to regular inhaled anti-inflammatory medication use is a frequent contributor to poor control of persistent asthma and may result from misunderstanding of the preventive role of such medications. This study's aims are to 1) test the hypothesis that misunderstanding is associated with decreased adherence to its daily use and 2) identify factors associated with increased risk of misunderstanding. Study Design. A sample of parents of children with asthma insured by Medicaid and enrolled in managed care programs in Northern California, Washington, and Massachusetts were interviewed by telephone. This analysis focused on the subset that reported having an inhaled anti-inflammatory medication and whose medication use and symptom frequency in the 2 weeks before the interview suggested persistent asthma. Misunderstanding of the role of inhaled anti-inflammatory medication was defined as identifying it as being for treatment of symptoms after they begin and not for prevention of symptoms before they start. Results. A total of 1663 parents of children with asthma (63% response rate) were interviewed. Of those, 571 subjects (34%) reported use of an inhaled anti-inflammatory medication and met our criteria for persistent asthma. Among those with persistent asthma, 23% (131 parents) misunderstood the role of their child's inhaled anti-inflammatory. Misunderstanding of inhaled anti-inflammatory medication was associated with decreased adherence to its daily use (odds ratio [OR] 0.18, 95% confidence interval [CI], 0.11-0.29). The risk for misunderstanding was lower if the patient had seen a specialist (OR 0.42, 95% CI, 0.24-0.75) or had graduated high school (OR = 0.54, 95% CI, 0.34-0.84). Conclusion. Misunderstanding of the role of inhaled anti-inflammatory medication is associated with reduced adherence to its daily use.     

Persistent Asthma: Patient Characteristics, Courses of Asthma, and Utility of Salmeterol

Applications of National Asthma and Education and Prevention Program (NAEPP) guidelines for the diagnosis and management of asthma may reduce the morbidity of this disorder. Medical records and questionnaires from a series of 177 outer-city adolescents and adults with persistent asthma were audited according to NAEPP guidelines and for utility of salmeterol (Serevent®). Allergic sensitivity and exposure to indoor allergens house-dust mite (66% of patients), fungi (42%), cat (20%) and/or dog (14%) were of dominant importance to persistent asthma. Patients who continued salmeterol over 1 year had reduced severity of disease, improved forced expiratory flow at 25%-75% of vital capacity, and reduced usage of systemic, but not inhaled, corticosteroid.     

A Study of the Relationship Among Self-Reported Noncompliance,Symptomatology, and Psychological Variables in Patients with Asthma

We examined the association among self-reported noncompliance and clinical status, symptomatology, functional activity, and psychological variables in asthma. Eighty-five asthmatics, who were hospitalized (H group), outpatients previously hospitalized (OH group), or outpatients not previously hospitalized (O group) completed questionnaires. Compliance was assessed during a structured interview. The higher prevalence of self-reported noncompliance in H group and OH group, compared to O group, was not explained by differences in respiratory function. Self-reported noncompliance was related to symptoms and emotional distress associated with disease and treatment, but not to functional or emotional status. A patient subgroup that catalogued itself as non-compliant may also be at risk for hospitalization, and was characterized by emotional distress associated with disease and treatment.     

A Study of the Relationship Among Self-Reported Noncompliance, Symptomatology, and Psychological Variables in Patients with Asthma

We examined the association among self-reported noncompliance and clinical status, symptomatology, functional activity, and psychological variables in asthma. Eighty-five asthmatics, who were hospitalized (H group), outpatients previously hospitalized (OH group), or outpatients not previously hospitalized (O group) completed questionnaires. Compliance was assessed during a structured interview. The higher prevalence of self-reported noncompliance in H group and OH group, compared to O group, was not explained by differences in respiratory function. Self-reported noncompliance was related to symptoms and emotional distress associated with disease and treatment, but not to functional or emotional status. A patient subgroup that catalogued itself as non-compliant may also be at risk for hospitalization, and was characterized by emotional distress associated with disease and treatment.     

Asthma Knowledge and Medication Compliance Among Parents of Asthmatic Children in Nanjing, China

Asthma knowledge and medication compliance among parents of 150 asthmatic children in Nanjing were assessed using a self-administered questionnaire. The results showed that 54.7% of parents had poor knowledge of asthma and its management. Parental compliance with medication was also suboptimal as only 43.3% of parents reported adherence with prescribed anti-asthmatic medication for their children. Reasons for non-compliance included fear of medication side-effects and tolerance, and forgetting to give the child's medication. Education and occupation were found to be associated with asthma knowledge, however there was no association between age or income with knowledge. Income was associated with compliance with asthma medication, however no association was found between parents' age, education, occupation, or asthma knowledge with compliance. This study has identified the need for accurate and up-to-date information on asthma for parents of asthmatic children as well as programs aimed at teaching parents skills in managing their child's asthma. There is also the need for strategies aimed at improving communication between the health provider and parents of asthmatic children.     

Asthma Knowledge and Medication Compliance Among Parents of Asthmatic Children in Nanjing,China

Asthma knowledge and medication compliance among parents of 150 asthmatic children in Nanjing were assessed using a self-administered questionnaire. The results showed that 54.7% of parents had poor knowledge of asthma and its management. Parental compliance with medication was also suboptimal as only 43.3% of parents reported adherence with prescribed anti-asthmatic medication for their children. Reasons for non-compliance included fear of medication side-effects and tolerance, and forgetting to give the child's medication. Education and occupation were found to be associated with asthma knowledge, however there was no association between age or income with knowledge. Income was associated with compliance with asthma medication, however no association was found between parents’ age, education, occupation, or asthma knowledge with compliance. This study has identified the need for accurate and up-to-date information on asthma for parents of asthmatic children as well as programs aimed at teaching parents skills in managing their child's asthma. There is also the need for strategies aimed at improving communication between the health provider and parents of asthmatic children.     

Predictors of Treatment Adherence Among Asthma Patients in the Emergency Department

This study examined predictors of treatment adherence among 120 adult patients with asthma at two emergency departments (EDs). Structured medical chart reviews were performed for characteristics hypothesized to be associated with treatment adherence difficulties. Sixty percent of subjects had evidence of nonadherence with asthma treatment. Several variables were associated with nonadherence including younger age, more utilization of ED services (more ED visits, using the ED for medication refills), certain treatment characteristics (receiving more medications in the ED, not being prescribed prednisone at discharge), and not keeping post-discharge follow-up appointments. Further research should be directed at enhancing self-management skills and decreasing inappropriate ED use among nonadherent patients.     

Predictors of Treatment Adherence Among Asthma Patients in the Emergency Department

This study examined predictors of treatment adherence among 120 adult patients with asthma at two emergency departments (EDs). Structured medical chart reviews were performed for characteristics hypothesized to be associated with treatment adherence difficulties. Sixty percent of subjects had evidence of nonadherence with asthma treatment. Several variables were associated with nonadherence including younger age, more utilization of ED services (more ED visits, using the ED for medication refills), certain treatment characteristics (receiving more medications in the ED, not being prescribed prednisone at discharge), and not keeping post-discharge follow-up appointments. Further research should be directed at enhancing self-management skills and decreasing inappropriate ED use among nonadherent patients.     

Beliefs That Support the Behavior of People with Asthma: A Qualitative Investigation

Differences between patients' knowledge and behavior in relation to asthma may account for continuing morbidity in the face of professional and public asthma education campaigns. We conducted a qualitative study of beliefs that support asthma-related behavior, obtaining data from interviews with 70 adult patients. Analysis identified four clear subgroups, or “streams,” of adults with asthma: an “anonymous” stream, who doubt that they have asthma and manage symptoms outside the organized health system; an “isolated” stream, who feel dependent on bronchodilators and do not understand the potential of preventive therapy; a “suboptimal” stream, who are confident that they are managing their asthma effectively but who are excessively reliant on bronchodilators; and an “optimal stream,” who have high expectations of outcomes and participate actively in a partnership with a doctor. Characteristics of the doctor and the doctor-patient relationship are important elements in altering asthma-related behavior in ways that may facilitate the best health outcomes.     

The Complexity of Treatment Adherence in Adults with Asthma: Challenges and Opportunities

The therapeutic program for persons with asthma includes recommendations for altering the environment and a drug regimen designed to alleviate symptoms, minimize exacerbations, and improve quality of life. Unfortunately, patients can have difficulty adhering to these recommendations, which contributes to treatment failure and increased costs. This paper provides a comprehensive review of the challenge of adherence in adults with asthma, including the costs and benefits, optimal adherence levels, assessment methods commonly used in research and practice, factors believed to predict poor adherence, and tested and untested strategies for improving adherence. Opportunities for further research are discussed throughout the paper.     

Access to Spacers and Peak Flow Meters Among Medicaid Patients with Asthma

Asthma morbidity and mortality have increased at alarming rates. Morbidity is significantly higher among minorities and low-income populations. The purpose of this study was to survey pharmacies licensed to provide both asthma medications and durable medical equipment (DME) to evaluate their acceptance of Medicaid as payment for spacers and peak flow meters in patients with Medicaid. Twenty-four pharmacies were identified and completed a telephone survey. Only 64% of the pharmacies licensed to accept Medicaid for DME provide this service. We postulate that improving DME licensing and claims reimbursement will impact medication compliance, as well as asthma morbidity and mortality.     

Access to Spacers and Peak Flow Meters Among Medicaid Patients with Asthma

Asthma morbidity and mortality have increased at alarming rates. Morbidity is significantly higher among minorities and low-income populations. The purpose of this study was to survey pharmacies licensed to provide both asthma medications and durable medical equipment (DME) to evaluate their acceptance of Medicaid as payment for spacers and peak flow meters in patients with Medicaid. Twenty-four pharmacies were identified and completed a telephone survey. Only 64% of the pharmacies licensed to accept Medicaid for DME provide this service. We postulate that improving DME licensing and claims reimbursement will impact medication compliance, as well as asthma morbidity and mortality.