The role of age at asthma diagnosis in the development of triggers of asthma episodes

Evaluation of a Spanish language version of the Asthma Trigger Inventory

Background: Perceptions of asthma triggers provide important guidance for patients' disease management. A psychometrically valid instrument, the Asthma Trigger Inventory (ATI), is available in English and German language versions, however, a version in Spanish as major world language has been missing.Method: A Spanish-language version of the ATI was evaluated in 339 adult patients with asthma, 223 of these in Peru and 107 in the USA. Principal Component analysis (PCA) with Varimax rotation was used to identify coherent trigger domains across and within samples. Resulting subscales were evaluated for internal consistency.Results: PCA suggested differences in factor structures between sites. Whereas the USA sample largely replicated original factors for animal allergens, pollen allergens, physical activity, air pollution/irritants, infections, and psychology, the initial analysis of the Peru sample suggested substantial overlap of air pollution/irritant, infection, and allergen items. Subsequent analysis of an expanded research form of the ATI for the Peru site culminated in extraction of five factors related to psychology, climate/temperature, combined pollen and animal allergens, physical activity, and infection. Internal consistencies were in an acceptable to excellent range (α = 0.74 to 0.94). Additional free trigger responses confirmed the importance of climate variables for patients in Peru. Psychological triggers were reported by 26% (Peru) and 31% (USA) of patients.Conclusion: Coherent trigger domains are readily identified and measured reliably by a Spanish-language ATI version. However, factor structures vary between samples from different Hispanic/Latino cultural and geographic domains. Culturally adapted versions of this instrument are therefore required for Hispanic/Latino population studies.

Role of age at asthma diagnosis in the asthma-obesity relationship

OBJECTIVE

To determine whether age at asthma diagnosis has an impact on the previously described relationship between asthma and obesity.

METHODS

Data were provided from Cycle 1.1 (2000⁄2001) of the Canadian Community Health Survey, a nationally representative health survey that included 6871 participants (2464 males and 4407 females) with asthma. Body mass index was used to categorize participants as normal weight (18.5 kg/m2 to 24.9 kg/m2), overweight (25 kg/m2 to 29.9 kg/m2) or obese (30 kg/m2 or greater). Multivariate logistic regression analyses were used to estimate the odds of overweight and obesity by self-reported age at asthma diagnosis, after accounting for current age and other covariables.

RESULTS

In fully adjusted models, males diagnosed with asthma during adolescence (12 to 20 years of age) were at elevated odds of obesity (OR 1.58; 95% CI 1.03 to 2.43) compared with asthmatic patients diagnosed during childhood (0 to 11 years of age). Women diagnosed with asthma in mid life (21 to 44 years of age) and later life (45 to 64 years of age) were 43% (OR 1.43; 95% CI 1.08 to 1.90) and 56% (OR 1.56; 95% CI 1.00 to 2.44) more likely to be obese than those diagnosed in childhood, respectively.

CONCLUSIONS

The impact of age at asthma diagnosis on the asthma-obesity relationship differed between males and females. However, the identification of high-risk groups of asthmatic patients may strengthen primary prevention strategies for obesity and related comorbidities at multiple levels of influence.

Laugh yourself into a healthier person: a cross cultural analysis of the effects of varying levels of laughter on health

This cross-cultural study explored along with various personality factors the relationship between laughter and disease prevalence. Previous studies have only determined the effect of laughter on various health dimensions, whereas, this study quantified the level of laughter that was beneficial or detrimental to health. There were a total of 730 participants between the ages of eighteen and thirty-nine years. 366 participants were from Aurangabad, India (AUR), and 364 participants were from Mississauga, Canada (MISS). The participants were provided a survey assessing demographics, laughter, lifestyle, subjective well-being, life satisfaction, emotional well-being and health dimensions. In AUR, a beneficial effect of laughter was mediated through moderate levels (level two) of laughter, whereas both low (level one) and high (level three) levels had no effect. Similarly, in MISS, the beneficial effect was mediated through level two, but a negative effect was also seen at level three. This could be attributable to a higher prevalence of bronchial asthma in western countries. Laughter was associated with emotional well-being in MISS and life satisfaction in AUR, providing cross cultural models to describe the interactions between laughter and disease. This study validated the correlation between emotional well-being and life satisfaction, with a stronger correlation seen in MISS, suggesting that individualists rely more on their emotional well-being to judge their life satisfaction. In conclusion, there is a benefit to clinicians to incorporate laughter history into their general medical history taking. Future research should consider developing mechanisms to explain the effects of level two, determine specific systemic effects and obtain more samples to generalize the cross cultural differences.

The relationship between age of asthma onset and cardiovascular disease in Canadians

PURPOSE

To quantify the association between cardiovascular disease (CVD) and asthma in Canadian adults and to determine whether age of asthma onset is a moderator of this association.

METHODS

We used a sample of 74 342 participants with a mean age of 56.4 +/- 12.5 from cycle 1.1 of the Canadian Community Health Survey. Asthma age of onset was categorized into early-onset (0-20 years) and adult-onset (21-54 years). Three major outcomes were used to estimate the relationship between asthma and CVD, namely: high blood pressure, heart disease, and stroke.

RESULTS

Multiple logistic regression models revealed that asthmatics were 43% (OR = 1.43, CI = 1.19-1.72) more likely to have heart disease, and 36% (OR = 1.36, CI = 1.21-1.53) more likely to have high blood pressure than non-asthmatics. There were no consistent results for age of onset with high blood pressure, heart disease, or stroke.

CONCLUSION

Using a population-based dataset we confirmed that asthmatics are at increased odds of cardiovascular disease compared to non-asthmatics; furthermore, age of asthma onset did not appear to moderate this relationship. Future research should focus on determining whether asthma severity or allergic/non-allergic phenotypes have a differential effect on the asthma-CVD relationship.

The asthma trigger inventory: validation of a questionnaire for perceived triggers of asthma

BACKGROUND

Asthma patients' perceptions of triggers have been explored in a largely unstructured fashion in the past. We therefore developed and validated a questionnaire of commonly perceived asthma triggers.

METHODS

Two hundred forty-seven primary care patients with asthma filled in an asthma trigger survey together with questionnaires on demographics, asthma-relevant information, perceived control of asthma, and general health status. Factor structure of the item pool and psychometric properties of trigger subscales were evaluated. We also investigated the relationship between allergen or psychological trigger reports and allergy skin test response or respiratory impedance during emotional film viewing, respectively.

RESULTS

Principal component analysis yielded six factors that were thematically associated with psychology, animal allergens, pollen allergens, physical activity, infection, and air pollution/irritants. Subscales showed good internal consistencies and low to moderately positive intercorrelations. Psychological triggers were consistently associated with less favorable health status, a reduced perception of asthma control, and greater medical treatment utilization. Animal allergen scores correlated positively with skin test responses to animal allergens. Respiratory impedance increases during emotional film clips were positively correlated with the psychological trigger subscale.

CONCLUSION

The questionnaire is a reliable measure of commonly perceived asthma triggers. Aspects of patients' trigger reports reflect actual reactivity to specific trigger factors.

Kissing selectively decreases allergen-specific IgE production in atopic patients

OBJECTIVE

Stress enhanced allergic skin wheal responses and allergen-specific IgE production. In contrast, mothers' kissing caused relaxation in infants, and kissing by lovers or spouses to atopic patients reduced allergic skin wheal responses. I studied the effect of kissing on production of allergen-specific IgE and cytokines in atopic patients.

METHODS

Twenty-four patients with mild atopic eczema and 24 patients with mild allergic rhinitis kissed with lovers or spouses freely for 30 min while listening to soft music. Just before and immediately after kissing, blood mononuclear cells were separated cultured for allergen, and production of allergen-specific immunoglobulin and cytokine was measured.

RESULTS

Kissing selectively decreased allergen-specific IgE production with skewing cytokine pattern toward Th1 type.

CONCLUSION

Kissing may alleviate allergic symptoms by decrease in allergen-specific IgE production.

Can subjective asthma symptoms be learned?

OBJECTIVE

We investigated whether perception of subjective asthma symptoms can be brought under control of biomedically irrelevant cues in the environment, i.e., whether subjective asthma symptoms can be learned in response to harmless stimuli.

METHODS

Twenty patients with asthma and 20 healthy participants were presented with two placebo-inhalers presented as new chemicals for diagnosing asthma. One inhaler was coupled three times with rebreathing 5% CO2 in oxygen, the other inhaler was coupled three times with rebreathing oxygen. In the subsequent test phase, both inhalers were coupled once with oxygen. We assessed airway resistance and subjective symptoms throughout the study.

RESULTS

Both groups expected and reported more symptoms with the inhaler that was previously associated with the CO2 trials compared with trials with the inhaler that was used on trials without CO2 without concomitant effects on respiratory resistance. The learning effects were most pronounced in a subgroup of patients reporting symptoms of hyperventilation during asthma exacerbations in daily life.

CONCLUSIONS

Subjective respiratory symptoms can be learned in response to harmless stimuli and a substantial proportion of patients with asthma might be especially vulnerable to this phenomenon. Because asthma patients rely mainly on perceived symptoms for their medication use, it is likely that they will take reliever medication based on expected symptoms instead of real exacerbations of respiratory dysfunction.

Laughter-associated asthma

This study was conducted to assess the prevalence of laughter-induced asthma, and to study any associations with asthma-related triggers and measures of disease activity, using a questionnaire-based survey of asthma subjects in both the community and on presentation to hospital. A total of 105 subjects participated, and 44 (41.9%) reported laughter-associated asthma. Exercise and laughter were strongly associated as triggers (p < 0.006), as well as molds and grass pollen (p = 0.03). It seems to be associated with poor asthma control as well, since hospital admissions are also more frequent in this group (p = 0.043). Laughter-induced asthma is strongly associated with exercise as a trigger; the mechanism remains uncertain, but better understanding of this problem may assist in controlling difficult asthma.