Revisiting asthma control: how should it best be defined?

Impact evaluation of environmental factors on respiratory function of asthma patients living in urban territory

BACKGROUND

Environmental pollution, local climatic conditions and their association with the prevalence and exacerbation of asthma are topics of intense current medical investigation.

MATERIALS AND METHODS

Air pollution in the area of Vladivostock was estimated both by the index of emission volumes of "air gaseous components" (nitrogen oxide and nitrogen dioxide, formaldehyde, hydrogen sulfide, carbon monoxide) in urban atmosphere and by mass spectrometric analysis of precipitates in snow samples. A total of 172 local asthma patients (101 controlled-asthma patients-CAP and 71 non-controlled asthma patients - nCAP) were evaluated with the use of spirometry and body plethysmography. Airway obstruction reversibility was evaluated with the use of an inhaled bronchodilator. Using discriminant analysis the association of environmental parameters with clinical indices of asthma patients is explored and thresholds of impact are established.

RESULTS

CAP presented high sensitivity to large-size suspended air particles and to several of the studied climatic parameters. Discriminant analysis showed high values of Wilks' lambda index (α = 0.69-0.81), which implies limited influence of environmental factors on the respiratory parameters of CAP. nCAP were more sensitive and susceptible to the majority of the environmental factors studied, including air suspended toxic metals particles (Cr, Zn and Ni). Air suspended particles showed higher tendency for pathogenicity in nCAP population than in the CAP, with a wider range of particle sizes being involved. Dust fractions ranging from 0 to 1 μm and from 50 to 100 μm were additionally implicated compared to CAP group. Considerably lowest thresholds levels of impact are calculated for nCAP.

Fuzzy rule-based expert system for evaluating level of asthma control

Asthma control is a final goal of asthma therapy process. Despite outstanding progress in discovering various variables affecting asthma control levels, disregarding some of them by physicians and variables' inherent uncertainty are the major causes of underestimating of asthma control levels and as a result asthma morbidity and mortality. In this paper, we provide an intelligent fuzzy system as a solution for this problem. Inputs of this system are composed of 14 variables organized in five modules of respiratory symptoms severity, bronchial obstruction, asthma instability, current treatment, and quality of life. Output of this system is degree of asthma control defined in the score (0-10). Evaluation of performance of this system by 42 asthmatic patients at asthma, allergy, immunology research center of Emam Khomeini hospital, Tehran, Iran reinforces that the system's results not only correspond with the evaluations of experienced asthma physicians, but represents slight differences in the levels of asthma control between asthmatic patients.

Fuzzy rule-based expert system for assessment severity of asthma

Prescription medicine for asthma at primary stages is based on asthma severity level. Despite major progress in discovering various variables affecting asthma severity levels, disregarding some of these variables by physicians, variables' inherent uncertainty, and assigning patients to limited categories of decision making are the major causes of underestimating asthma severity, and as a result low quality of life in asthmatic patients. In this paper, we provide a solution of intelligence fuzzy system for this problem. Inputs of this system are organized in five modules of respiratory symptoms, bronchial obstruction, asthma instability, quality of life, and asthma severity. Output of this system is degree of asthma severity in score (0-10). Evaluating performance of this system by 28 asthmatic patients reinforces that the system's results not only correspond with evaluations of physicians, but represent the slight differences of asthmatic patients placed in specific category introduced by guidelines.

Measures of asthma control and quality of life: longitudinal data provide practical insights into their relative usefulness in different research contexts

PURPOSE

To further our understanding of the relationships between asthma control and health-related quality of life (HRQOL) and provide insights into the relative usefulness of various measures in different research contexts. We present a conceptual model and test it with longitudinal survey data.

METHODS

Participants recruited via population sampling and hospital Emergency Departments completed questionnaires every 6 months for up to 3 years. Measures included: sleep disturbance, use of short-acting beta agonists (SABA), activity limitation, urgent medical visits, hospital use, Marks' Asthma Quality of Life Questionnaire (AQLQ-M) and the SF-36 Health Survey. Correlation analysis and multi-level models tested predictions from the conceptual model.

RESULTS

A total of 213 people with asthma aged 16-75 years provided 967 observations. Correlations between asthma control and asthma-specific HRQOL were stronger than those between asthma control and generic HRQOL. The asthma control variables explained 54-58% of the variance in asthma-specific HRQOL and 8-25% of the variance in generic HRQOL. Activity limitation was the main contributor to between-person variation, while sleep disturbance and SABA use were the main contributors to within-person variation.

CONCLUSIONS

Sleep disturbance and SABA use may be most useful in evaluating treatment effectiveness, while activity limitation may be better when monitoring the impact of asthma in populations.