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Loewenthal L, Busby J, McDowell R, Brown T, Burhan H, Chaudhuri R, Dennison P, Dodd JW, Doe S, Faruqi S, Gore R, Idris E, Jackson DJ, Patel M, Pantin T, Pavord I, Pfeffer PE, Price DB, Rupani H, Siddiqui S, Heaney LG, Menzies-Gow A. Impact of sex on severe asthma: a cross-sectional retrospective analysis of UK primary and specialist care. Thorax 2024; 79:403-411. [PMID: 38124220 DOI: 10.1136/thorax-2023-220512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION After puberty, females are more likely to develop asthma and in a more severe form than males. The associations between asthma and sex are complex with multiple intrinsic and external factors. AIM To evaluate the sex differences in the characteristics and treatment of patients with severe asthma (SA) in a real-world setting. METHODS Demographic, clinical and treatment characteristics for patients with SA in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD) were retrospectively analysed by sex using univariable and multivariable logistic regression analyses adjusted for year, age and hospital/practice. RESULTS 3679 (60.9% female) patients from UKSAR and 18 369 patients (67.9% female) from OPCRD with SA were included. Females were more likely to be symptomatic with increased Asthma Control Questionnaire-6 (UKSAR adjusted OR (aOR) 1.14, 95% CI 1.09 to 1.18) and Royal College of Physicians-3 Question scores (OPCRD aOR 1.29, 95% CI 1.13 to 1.47). However, they had a higher forced expiratory volume in 1 second per cent (FEV1%) predicted (UKSAR 68.7% vs 64.8%, p<0.001) with no significant difference in peak expiratory flow. Type 2 biomarkers IgE (UKSAR 129 IU/mL vs 208 IU/mL, p<0.001) and FeNO (UKSAR 36ppb vs 46ppb, p<0.001) were lower in females with no significant difference in blood eosinophils or biological therapy. Females were less likely to be on maintenance oral corticosteroids (UKSAR aOR 0.86, 95% CI 0.75 to 0.99) but more likely to be obese (UKSAR aOR 1.67, 95% CI 145 to 1.93; OPCRD SA aOR 1.46, 95% CI 1.34 to 1.58). CONCLUSIONS Females had increased symptoms and were more likely to be obese despite higher FEV1% predicted and lower type 2 biomarkers with consistent and clinically important differences across both datasets.
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Affiliation(s)
- Lola Loewenthal
- National Lung and Heart Institute, Imperial College London, London, UK
- Department of Asthma and Allergy, Department of Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - John Busby
- Centre for Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
| | - Ronald McDowell
- Queen's University Belfast, Belfast, UK
- Ulster University, Coleraine, UK
| | - Thomas Brown
- Respiratory Medicine, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Hassan Burhan
- Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rekha Chaudhuri
- Respiratory Medicine, Gartnavel General Hospital, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - Paddy Dennison
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton University Hospitals NHS Trust, Southampton, UK
| | - James William Dodd
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Westbury on Trym, UK
| | - Simon Doe
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Shoaib Faruqi
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - David Joshua Jackson
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Mitesh Patel
- University Hospitals Plymouth, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Thomas Pantin
- Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ian Pavord
- NIHR Respiratory BRC, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | | | - David B Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Hitasha Rupani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton, Southampton, UK
| | - Salman Siddiqui
- National Lung and Heart Institute, Imperial College London, London, UK
| | - Liam G Heaney
- Centre of Infection and Immunity, Queen's University Belfast, Belfast, UK
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George M, Camargo CA, Burnette A, Chen Y, Pawar A, Molony C, Auclair M, Wells MA, Ferro TJ. Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record Analysis. J Asthma Allergy 2023; 16:567-577. [PMID: 37200709 PMCID: PMC10187653 DOI: 10.2147/jaa.s383817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/31/2023] [Indexed: 05/20/2023] Open
Abstract
Purpose The identification of risk factors associated with uncontrolled moderate-to-severe asthma is important to improve asthma outcomes. Aim of this study was to identify risk factors for uncontrolled asthma in United States cohort using electronic health record (EHR)-derived data. Patients and Methods In this retrospective real-world study, de-identified data of adolescent and adult patients (≥12 years old) with moderate-to-severe asthma, based on asthma medications within 12 months prior to asthma-related visit (index date), were extracted from the Optum® Humedica EHR. The baseline period was 12 months prior to the index date. Uncontrolled asthma was defined as ≥2 outpatient oral corticosteroid bursts for asthma or ≥2 emergency department visits or ≥1 inpatient visit for asthma. A Cox proportional hazard model was applied. Results There were 402,403 patients in the EHR between January 1, 2012, and December 31, 2018, who met the inclusion criteria and were analyzed. African American (AA) race (hazard ratio [HR]: 2.08), Medicaid insurance (HR: 1.71), Hispanic ethnicity (HR: 1.34), age of 12 to <18 years (HR 1.20), body mass index of ≥35 kg/m2 (HR: 1.20), and female sex (HR 1.19) were identified as risk factors associated with uncontrolled asthma (P < 0.001). Comorbidities characterized by type 2 inflammation, including a blood eosinophil count of ≥300 cells/μL (as compared with eosinophil <150 cells/μL; HR: 1.40, P < 0.001) and food allergy (HR: 1.31), were associated with a significantly higher risk of uncontrolled asthma; pneumonia was also a comorbidity associated with an increased risk (HR: 1.35) of uncontrolled asthma. Conversely, allergic rhinitis (HR: 0.84) was associated with a significantly lower risk of uncontrolled asthma. Conclusion This large study demonstrates multiple risk factors for uncontrolled asthma. Of note, AA and Hispanic individuals with Medicaid insurance are at a significantly higher risk of uncontrolled asthma versus their White, non-Hispanic counterparts with commercial insurance.
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Affiliation(s)
- Maureen George
- Office of Research and Scholarship, Columbia University School of Nursing, New York, NY, USA
- Correspondence: Maureen George, Office of Research and Scholarship, Columbia University School of Nursing, New York, NY, 10032, USA, Tel +1 212-305-1175, Email
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Autumn Burnette
- Division of Allergy and Immunology, Howard University Hospital, Howard University College of Medicine, Washington, DC, USA
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3
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Farooq S, Khatri S. Life Course of Asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:43-76. [PMID: 37464116 DOI: 10.1007/978-3-031-32259-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Asthma is a heterogeneous chronic airway disease that can vary over a lifetime. Although broad categories of asthma by severity and type have been constructed, there remains a tremendous opportunity to discover an approach to managing asthma with additional factors in mind. Many in the field have suggested and are pursuing a novel paradigm shift in how asthma might be better managed, considering the life course of exposures, management priorities, and predicted trajectory of lung function growth. This approach will require a more holistic view of prenatal, postnatal, adolescence, hormonal and gender aspects, and the aging process. In addition, the environment, externally and internally, including in one's genetic code and epigenetic changes, are factors that affect how asthma progresses or becomes more stable in individuals. This chapter focuses on the various influences that may, to differing degrees, affect people with asthma, which can develop at any time in their lives. Shifting the paradigm of thought and strategies for care and advocating for public policies and health delivery that focus on this philosophy is paramount to advance asthma care for all.
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Affiliation(s)
- Sobia Farooq
- National Heart, Lung, and Blood Institute, CMO Division of Lung Diseases, Bethesda, MD, USA
| | - Sumita Khatri
- National Heart, Lung, and Blood Institute, CMO Division of Lung Diseases, Bethesda, MD, USA.
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4
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Sex Plays a Multifaceted Role in Asthma Pathogenesis. Biomolecules 2022; 12:biom12050650. [PMID: 35625578 PMCID: PMC9138801 DOI: 10.3390/biom12050650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Sex is considered an important risk factor for asthma onset and exacerbation. The prevalence of asthma is higher in boys than in girls during childhood, which shows a reverse trend after puberty—it becomes higher in adult females than in adult males. In addition, asthma severity, characterized by the rate of hospitalization and relapse after discharge from the emergency department, is higher in female patients. Basic research indicates that female sex hormones enhance type 2 adaptive immune responses, and male sex hormones negatively regulate type 2 innate immune responses. However, whether hormone replacement therapy in postmenopausal women increases the risk of current asthma and asthma onset remains controversial in clinical settings. Recently, sex has also been shown to influence the pathophysiology of asthma in its relationship with genetic or other environmental factors, which modulate asthmatic immune responses in the airway mucosa. In this narrative review, we highlight the role of sex in the continuity of the asthmatic immune response from sensing allergens to Th2 cell activation based on our own data. In addition, we elucidate the interactive role of sex with genetic or environmental factors in asthma exacerbation in women.
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Pelà G, Goldoni M, Solinas E, Cavalli C, Tagliaferri S, Ranzieri S, Frizzelli A, Marchi L, Mori PA, Majori M, Aiello M, Corradi M, Chetta A. Sex-Related Differences in Long-COVID-19 Syndrome. J Womens Health (Larchmt) 2022; 31:620-630. [PMID: 35333613 DOI: 10.1089/jwh.2021.0411] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Sex differences have been demonstrated in the acute phase of COVID-19. Women (F) were found to be less prone to develop a severe disease than men (M), but few studies have assessed sex-differences in Long-COVID-19 syndrome. Methods: The aim of this prospective/retrospective study was to characterize the long-term consequences of this infection based on sex. For this purpose, we enrolled 223 patients (89 F and 134 M) who were infected by SARS-CoV-2. In the acute phase of the illness, F reported the following symptoms more frequently than M: weakness, dysgeusia, anosmia, thoracic pain, palpitations, diarrhea, and myalgia-all without significant differences in breathlessness, cough, and sleep disturbance. Results: After a mean follow-up time of 5 months after the acute phase, F were significantly more likely than M to report dyspnea, weakness, thoracic pain, palpitations, and sleep disturbance but not myalgia and cough. At the multivariate logistic regression, women were statistically significantly likely to experience persistent symptoms such as dyspnea, fatigue, chest pain, and palpitations. On the contrary, myalgia, cough, and sleep disturbance were not influenced by sex. Conclusion: We demonstrated that F were more symptomatic than M not only in the acute phase but also at follow-up. Sex was found to be an important determinant of Long-COVID-19 syndrome because it is a significant predictor of persistent symptoms in F, such as dyspnea, fatigue, chest pain, and palpitations. Our results suggest the need for long-term follow-up of these patients from a sex perspective to implement early preventive and personalized therapeutic strategies.
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Affiliation(s)
- Giovanna Pelà
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of General and Specialistic Medicine, University-Hospital of Parma, Parma, Italy
| | - Matteo Goldoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Emila Solinas
- Interventional Cardiology Unit, University-Hospital of Parma, Parma, Italy
| | - Chiara Cavalli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sara Tagliaferri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Annalisa Frizzelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Cardio-Thoracic and Vascular, Respiratory Disease and Lung Function Unit, University-Hospital of Parma, Parma, Italy
| | - Laura Marchi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pier Anselmo Mori
- Department of Cardio-Thoracic and Vascular, Pulmonology and Endoscopic Unit, University-Hospital of Parma, Parma, Italy
| | - Maria Majori
- Department of Cardio-Thoracic and Vascular, Pulmonology and Endoscopic Unit, University-Hospital of Parma, Parma, Italy
| | - Marina Aiello
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Cardio-Thoracic and Vascular, Respiratory Disease and Lung Function Unit, University-Hospital of Parma, Parma, Italy
| | - Massimo Corradi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alfredo Chetta
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Cardio-Thoracic and Vascular, Respiratory Disease and Lung Function Unit, University-Hospital of Parma, Parma, Italy
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6
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Borges RC, Alith MB, Nascimento OA, Jardim JR. Gender differences in the perception of asthma respiratory symptoms in five Latin American countries. J Asthma 2021; 59:1030-1040. [PMID: 33902380 DOI: 10.1080/02770903.2021.1922914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVES To determine the differences between sexes in perceptions of asthma symptoms, asthma control, daily activities, and symptom exacerbation in Latin American countries. METHODS This cross-sectional study was performed using data from the Latin America Asthma Insight and Management (LA-AIM) study (n = 2167) carried out in Argentina, Brazil, Mexico, Venezuela, and Puerto Rico. Face-to-face interviews were conducted, and patients orally completed a 53-question survey assessing five main domains of asthma: symptoms, impact on daily activities, disease control, exacerbation, and treatment/medication. RESULTS Of the 2167 participants, 762 (35.2%) were males and 1405 (64.8%) were females. Male participants smoked more than females, but history of rhinitis and allergies was more common in females (p < 0.05). Women aged 18-40 years had a higher proportion of uncontrolled asthma compared to men of the same age (37.8% and 30.0%, respectively). A higher proportion of symptomatic females reported more frequent symptoms (daytime cough, shortness of breath, breathlessness/wheezing, sputum, tightness in the chest, etc.) than males (p < 0.05). Females also experienced more limitations in sports/recreational activities, normal physical exertion, social activities, sleep, and daily activities. Females consulted with health professionals more often than males (67.8% and 59.6%, respectively; p < 0.05). Asthma caused a feeling of lack of control over life in 42.6% of females and 31.4% of males. CONCLUSION In Latin America, females report more asthma symptoms, poorer asthma control, more impact on their daily activities, and more visits with health professionals than males.
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Affiliation(s)
- Rodrigo C Borges
- Hospital Universitário da Universidade de São Paulo (USP), São Paulo, Brazil
| | - Marcela B Alith
- Hospital Universitário da Universidade de São Paulo (USP), São Paulo, Brazil.,Centro de Reabilitação Pulmonar da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil
| | - Oliver A Nascimento
- Centro de Reabilitação Pulmonar da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil.,Respiratory Division of EPM/Unifesp, São Paulo, Brazil
| | - José R Jardim
- Centro de Reabilitação Pulmonar da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil.,Respiratory Division of EPM/Unifesp, São Paulo, Brazil
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7
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Jacobs LG, Gourna Paleoudis E, Lesky-Di Bari D, Nyirenda T, Friedman T, Gupta A, Rasouli L, Zetkulic M, Balani B, Ogedegbe C, Bawa H, Berrol L, Qureshi N, Aschner JL. Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection. PLoS One 2020; 15:e0243882. [PMID: 33306721 PMCID: PMC7732078 DOI: 10.1371/journal.pone.0243882] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023] Open
Abstract
Background Characterizing the prevalence and persistence of symptoms associated with COVID-19 infection following hospitalization and their impact is essential to planning post-acute community-based clinical services. This study seeks to identify persistent COVID-19 symptoms in patients 35 days post-hospitalization and their impact on quality of life, health, physical, mental, and psychosocial function. Methods and findings This prospective cohort study used the PROMIS® Instruments to identify symptoms and quality of life parameters in consecutively enrolled patients between March 22 and April 16, 2020, in New Jersey. The 183 patients (median age 57 years; 61.5% male, 54.1% white) reported persistent symptoms at 35 days, including fatigue (55.0%), dyspnea (45.3%), muscular pain (51%), associated with a lower odds rating general health (41.5%, OR 0.093 [95% CI: 0.026, 0.329], p = 0.0002), quality of life (39.8%; OR 0.116 [95% CI: 0.038, 0.364], p = 0.0002), physical health (38.7%, OR 0.055 [95% CI: 0.016, 0.193], p <0.0001), mental health (43.7%, OR 0.093 [95% CI: 0.021, 0.418], p = 0.0019) and social active role (38.7%, OR 0.095 [95% CI: 0.031, 0.291], p<0.0001), as very good/excellent, particularly adults aged 65 to 75 years (OR 8·666 [95% CI: 2·216, 33·884], p = 0·0019). Conclusions COVID-19 symptoms commonly persist to 35 days, impacting quality of life, health, physical and mental function. Early post-acute evaluation of symptoms and their impact on function is necessary to plan community-based services.
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Affiliation(s)
- Laurie G. Jacobs
- Department of Internal Medicine, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
- * E-mail:
| | - Elli Gourna Paleoudis
- Office of Research Administration, Hackensack Meridian Health, Edison, New Jersey, United States of America
| | - Dineen Lesky-Di Bari
- Department of Research, Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Themba Nyirenda
- Office of Research Administration, Hackensack Meridian Health, Edison, New Jersey, United States of America
| | - Tamara Friedman
- Office of Research Administration, Hackensack Meridian Health, Edison, New Jersey, United States of America
| | - Anjali Gupta
- Department of Internal Medicine, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Lily Rasouli
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Marygrace Zetkulic
- Department of Internal Medicine, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Bindu Balani
- Department of Internal Medicine, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
- Division of Infectious Disease, Department of Internal Medicine, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Chinwe Ogedegbe
- Department of Emergency Medicine, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
- Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Harinder Bawa
- Department of Internal Medicine, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
- Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Lauren Berrol
- Department of Anesthesiology, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Nabiha Qureshi
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, New Jersey, United States of America
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
- Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center, Hackensack, New Jersey, United States of America
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8
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Selberg S, Hedman L, Jansson SA, Backman H, Stridsman C. Asthma control and acute healthcare visits among young adults with asthma-A population-based study. J Adv Nurs 2019; 75:3525-3534. [PMID: 31441107 DOI: 10.1111/jan.14174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 07/04/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
AIMS To study asthma control and acute healthcare visits among young adults with asthma. BACKGROUND Despite the access to effective treatment and nursing interventions, poor asthma control is still common among individuals with asthma. However, studies describing clinical characteristics among young adults with asthma are rare. DESIGN A population-based cohort study. METHODS In 2015, as a part of the OLIN paediatric cohort I (recruited in 1996 at age 7-8 years), N = 2,291 young adults (27-28 years) completed a postal questionnaire survey including questions on asthma and respiratory symptoms. Of these, N = 280 (12%) were identified as having current asthma and were further studied. RESULTS Of those with current asthma, women reported respiratory symptoms and smoking to a greater extent than men. Approximately one-fourth had uncontrolled asthma and acute healthcare visits due to asthma was reported by 15% of women and 8% of men. Uncontrolled asthma was associated with smoking, lower educational level, use of reliever treatment most days, and acute healthcare visits. Acute healthcare visits due to asthma were associated with periodic use of regular controller treatment also after adjustment for uncontrolled asthma. CONCLUSION The result indicate poor adherence to asthma treatment which may lead to decreased asthma control and acute healthcare visits. IMPACT Most young adults with asthma are diagnosed and treated in primary care, ideally in a team with a nurse. The main findings highlight the need for evidenced-based nursing interventions, contributing to a more efficient asthma management in primary care.
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Affiliation(s)
- Stina Selberg
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden
| | - Linnea Hedman
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden.,The OLIN Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Sven-Arne Jansson
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden.,The OLIN Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Helena Backman
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden.,The OLIN Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
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9
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Sessa M, Mascolo A, D'Agostino B, Casciotta A, D'Agostino V, Michele FD, Polverino M, Spaziano G, Andersen MP, Kragholm K, Rossi F, Torp-Pedersen C, Capuano A. Relationship Between Gender and the Effectiveness of Montelukast: An Italian/Danish Register-Based Retrospective Cohort Study. Front Pharmacol 2018; 9:844. [PMID: 30116192 PMCID: PMC6083053 DOI: 10.3389/fphar.2018.00844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/13/2018] [Indexed: 11/13/2022] Open
Abstract
Rationale: Gender-related differences in asthma prevalence, pathophysiology and clinical features induced by sex steroids have been investigated, however, how gender influences response to asthma treatments in routine clinical practice have not yet been elucidated fully. This aspect is crucial for montelukast considering the jeopardization of asthmatic patients that benefit from this treatment and the existence of evidence of gender differences in leukotriene levels. Therefore, to fulfill this medical need, we investigated the role of gender on a set of montelukast' effectiveness surrogates in adults and pediatric patients with asthma. Methods: The study settings were Napoli 2 Local Health Unit (southern Italy) and the entire Danish territory. The study population was composed of adult and pediatric patients with asthma. Cumulative incidence curves, unadjusted and adjusted Cox regression were used as statistical models to compare aforementioned outcomes between genders. Results: Adult Italian male users of montelukast had a statistically lower persistence in montelukast treatment compared to female users. In the adjusted analyses, they had a higher hazard of montelukast' withdrawal (Hazard Ratio [HR] 1.07; 95% Confidence Interval [CI] 1.01-1.14), add-on/switch to a long-term treatment for asthma following montelukast withdrawal (HR 1.72; 95%CI 1.39-2.12), and rescue therapy with short-acting β2 agonist (HR 1.24; 95%CI 1.04-1.47). In the adult Danish cohort, we also found that male users had higher a hazard of rescue therapy with oral corticosteroids (HR 1.10; 95%CI 1.04-1.16). In the pediatric cohorts, no statistically significant differences were observed between genders for aforementioned outcomes. Conclusions: In adults, male gender was associated with increased hazards of montelukast discontinuation, add-on/switch to a long-term treatment for asthma following montelukast withdrawal, and rescue therapy with oral corticosteroids or short-acting β2 agonist when compared to the female gender. As expected, these associations were reversed or absent in pediatric patients.
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Affiliation(s)
- Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Annamaria Mascolo
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Bruno D'Agostino
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Antonio Casciotta
- Local Health Unit Napoli Second, Department of Pharmaceutical, Naples, Italy
| | - Vincenzo D'Agostino
- Local Health Unit Napoli Second, Department of Pharmaceutical, Naples, Italy
| | | | - Mario Polverino
- Department of Pneumology and Endoscopic Unit, Ospedale Scarlato, Scafati, Italy
| | - Giuseppe Spaziano
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Kristian Kragholm
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Francesco Rossi
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.,Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Annalisa Capuano
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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Rosychuk RJ, Ospina M, Zhang J, Leigh R, Cave A, Rowe BH. Sex differences in outcomes after discharge from Alberta emergency departments for asthma: A large population-based study. J Asthma 2017; 55:817-825. [PMID: 28872981 DOI: 10.1080/02770903.2017.1373805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Asthma exacerbations frequently result in emergency department (ED) visits. While sex differences have been identified in some asthma studies, there is a paucity of literature on sex differences in the ED setting, especially population-based ones. This study examines sex differences in important outcomes of patients discharged from EDs for acute asthma in Alberta, Canada. METHODS Alberta residents aged from 2 to 55 years discharged from EDs with a primary diagnosis of asthma during 1999-2011 were identified from administrative databases from a single-payer health care system for the entire geographic region of Alberta. Multivariable Cox regression models analyzed time to first follow-up physician or specialist visit, and logistic regression models analyzed the binary outcome of ED return within 30 days for asthma. RESULTS There were 115,853 discharged patients analyzed (40.4% and 59.1% female in pediatric and adult groups, respectively). Approximately 26% of patients revisited the ED during 1999-2011 and 5.1% did so within 30 days. Women had higher odds of a 30-day ED return after ED discharge than men (unadjusted odds ratio [uOR] = 1.26; 95% confidence interval [CI] 1.17-1.36). Time to first non-ED physician follow-up was shorter for girls (unadjusted hazard ratio [uHR] = 1.05; 95%CI 1.03-1.07) and women (uHR = 1.62; 95%CI 1.59-1.64) than for boys and men, respectively. Significant interactions between sex and age, socio-economic status, area of residence, and comorbidities were identified and changed the effect of sex on outcomes. CONCLUSIONS In conclusion, women return to EDs within 30 days of discharge for acute asthma more often than men. Time to first non-ED physician follow-up for children and adults differed by sex. Multiple factors likely contribute to these differences; however, identifying these differences is critical to understand the influence of sex on health behaviors and outcomes.
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Affiliation(s)
- Rhonda J Rosychuk
- a Department of Pediatrics , University of Alberta, Edmonton Clinic Health Academy (ECHA) , Edmonton , Alberta , Canada.,b Women & Children's Health Research Institute, Edmonton Clinic Health Academy (ECHA) , Edmonton , Alberta , Canada
| | - Maria Ospina
- c Department of Obstetrics & Gynecology , University of Alberta, Lois Hole Hospital For Women, Robbins Pavilion Royal Alexandra Hospital , Edmonton , Alberta , Canada
| | - Jingbin Zhang
- d R.A. Malatest & Associates Ltd. , Edmonton , Alberta , Canada
| | - Richard Leigh
- e Departments of Medicine and Physiology and Pharmacology , University of Calgary , Calgary , Alberta , Canada
| | - Andrew Cave
- f Department of Family Medicine , University of Alberta, University Terrace, University of Alberta , Edmonton , Alberta , Canada
| | - Brian H Rowe
- g Department of Emergency Medicine , University of Alberta, University of Alberta Hospital , Edmonton , Alberta Canada.,h Alberta Health Services , Edmonton , Alberta , Canada.,i School of Public Health , University of Alberta, Edmonton Clinic Health Academy (ECHA) , Edmonton , Alberta , Canada
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Abstract
Asthma is a common chronic disease that affects over 300 million people worldwide, resulting in a considerable socio-economic burden. Literature data suggest that asthma has a higher incidence in females, particularly at certain stages of pubertal development. Moreover, women seem to experience more asthma symptoms than men and to use more rescue medications, resulting in a reduced quality of life. Although several mechanisms have been proposed to explain these differences, there are not yet final data available in the literature on the role of gender in the pathogenesis of asthma and different behavior in females. Some study suggested a more prevalent hyper-responsiveness in women than in men. Nevertheless, in the literature definitive data on a possible different response to drugs used for asthma between males and females are not described. Understanding the mechanisms that underlie these gender differences in clinical history of asthma patients could give inspiration to new areas of research to obtain a more specific diagnostic and therapeutic approach gender-oriented.
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Raherison C, Bourdin A, Bonniaud P, Deslée G, Garcia G, Leroyer C, Taillé C, De Blic J, Dubus JC, Tillié-Leblond I, Chanez P. Updated guidelines (2015) for management and monitoring of adult and adolescent asthmatic patients (from 12 years and older) of the Société de Pneumologie de Langue Française (SPLF) (Full length text). Rev Mal Respir 2016; 33:279-325. [PMID: 27147308 DOI: 10.1016/j.rmr.2016.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Raherison
- Inserm U1219, ISPED, service des maladies respiratoires, pôle cardio-thoracique, CHU de Bordeaux, université de Bordeaux, 33000 Bordeaux, France.
| | - A Bourdin
- Inserm U1046, département de pneumologie et addictologie, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, université Montpellier 1, 34000 Montpellier, France
| | - P Bonniaud
- Inserm U866, service de pneumologie et soins intensifs respiratoires, CHU de Bourgogne, université de Bourgogne, 21079 Dijon, France
| | - G Deslée
- Service de pneumologie, CHU Maison-Blanche, université de Reims - Champagne-Ardennes, 51000 Reims, France
| | - G Garcia
- Inserm, UMRS 999, service de pneumologie, département hospitalo-universitaire (DHU) thorax innovation, hôpital de Bicêtre, Centre national de référence de l'hypertension pulmonaire sévère, faculté de médecine, université Paris-Sud, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - C Leroyer
- Département de médecine interne et de pneumologie, CHU de la Cavale-Blanche, université de Bretagne Occidentale, 29000 Brest, France
| | - C Taillé
- Service de pneumologie, département hospitalo-universitaire FIRE, centre de compétence des maladies pulmonaires rares, hôpital Bichat, université Paris-Diderot, AP-HP, 75018 Paris, France
| | - J De Blic
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants-Malades, 75743 Paris, France
| | - J-C Dubus
- Unité de pneumologie et médecine infantile, hôpital Nord, 13000 Marseille, France
| | - I Tillié-Leblond
- Service de pneumo-allergologie, CHRU de Lille, 59000 Lille, France
| | - P Chanez
- UMR 7333 Inserm U 1067, service de pneumologie, hôpital Nord, université Aix Marseille, AP-HM, 13000 Marseille, France
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Hasegawa K, Cydulka RK, Sullivan AF, Langdorf MI, Nonas SA, Nowak RM, Wang NE, Camargo CA. Improved management of acute asthma among pregnant women presenting to the ED. Chest 2015; 147:406-414. [PMID: 25358070 DOI: 10.1378/chest.14-1874] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A multicenter study in the late 1990s demonstrated suboptimal emergency asthma care for pregnant women in US EDs. After a decade, follow-up data are lacking. We aimed to examine changes in emergency asthma care of pregnant women since the 1990s. METHODS We combined data from four multicenter observational studies of ED patients with acute asthma performed in 1996 to 2001 (three studies) and 2011 to 2012 (one study). We restricted the data so that comparisons were based on the same 48 EDs in both time periods. We identified all pregnant patients aged 18 to 44 years with acute asthma. Primary outcomes were treatment with systemic corticosteroids in the ED and, among those sent home, at ED discharge. RESULTS Of 4,895 ED patients with acute asthma, the analytic cohort comprised 125 pregnant women. Between the two time periods, there were no significant changes in patient demographics, chronic asthma severity, or initial peak expiratory flow. In contrast, ED systemic corticosteroid treatment increased significantly from 51% to 78% across the time periods (OR, 3.11; 95% CI, 1.27-7.60; P = .01); systemic corticosteroids at discharge increased from 42% to 63% (OR, 2.49; 95% CI, 0.97-6.37; P = .054). In the adjusted analyses, pregnant women in recent years were more likely to receive systemic corticosteroids, both in the ED (OR, 4.76; 95% CI, 1.63-13.9; P = .004) and at discharge (OR, 3.18; 95% CI, 1.05-9.61; P = .04). CONCLUSIONS Between the two time periods, emergency asthma care in pregnant women significantly improved. However, with one in three pregnant women being discharged home without systemic corticosteroids, further improvement is warranted.
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Affiliation(s)
- Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Rita K Cydulka
- Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University, School of Medicine, Cleveland, OH
| | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mark I Langdorf
- Department of Emergency Medicine, University of California Irvine Medical Center, Orange, CA
| | - Stephanie A Nonas
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University Hospital, Portland, OR
| | - Richard M Nowak
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI
| | - Nancy E Wang
- Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Rowe BH, Villa-Roel C, Majumdar SR, Abu-Laban RB, Aaron SD, Stiell IG, Johnson J, Senthilselvan A. Rates and correlates of relapse following ED discharge for acute asthma: a Canadian 20-site prospective cohort study. Chest 2015; 147:140-149. [PMID: 25340825 DOI: 10.1378/chest.14-0843] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Acute asthma is a common ED presentation. In a prospective, multicenter cohort study, we determined the frequency and factors associated with asthma relapse following discharge from the ED. METHODS Adults aged 18 to 55 years who were treated for acute asthma and discharged from 20 Canadian EDs underwent a structured ED interview and a follow-up telephone interview 4 weeks later. Standardized antiinflammatory treatment was offered at discharge. Multivariable analyses were performed. RESULTS Of 807 enrolled patients, 58% were women, and the median age was 30 years. Relapse occurred in 144 patients (18%) within 4 weeks of ED discharge. Factors independently associated with relapse occurrence were female sex (women, 22% vs men, 12%; adjusted OR [aOR], 1.9; 95% CI, 1.2-3.0); symptom duration of ≥ 24 h prior to ED visit (long duration, 19% vs short duration, 13%; aOR, 1.7; 95% CI, 1.3-2.3); ever using oral corticosteroids (ever use, 21% vs never use, 12%; aOR, 1.5; 95% CI, 1.1- 2.0); current use of an inhaled corticosteroid ([ICS]/long-acting β-agonist combination product (combination product, 25% vs ICS monotherapy,15%; aOR, 1.9; 95% CI, 1.1-3.2); and owning a spacer device (owning one, 24% vs not owning one, 15%; aOR, 1.6; 95% CI, 1.3-1.9). CONCLUSIONS Despite receiving guideline-concordant antiinflammatory treatments at ED discharge, almost one in five patients relapsed within 4 weeks. Female sex, prolonged symptoms, treatment-related factors, and markers of prior asthma severity were significantly associated with relapse. These results may help physicians target more aggressive interventions for patients at high risk of relapse.
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Affiliation(s)
- Brian H Rowe
- Department of Emergency Medicine; School of Public Health.
| | | | | | - Riyad B Abu-Laban
- University of Alberta, Edmonton, AB; the Department of Emergency Medicine
| | - Shawn D Aaron
- University of British Columbia, Vancouver, BC; and the Department of Medicine
| | - Ian G Stiell
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
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Haahtela T, Burbach GJ, Bachert C, Bindslev-Jensen C, Bonini S, Bousquet J, Bousquet-Rouanet L, Bousquet PJ, Bresciani M, Bruno A, Canonica GW, Darsow U, Demoly P, Durham SR, Fokkens WJ, Giavi S, Gjomarkaj M, Gramiccioni C, Kowalski ML, Losonczy G, Orosz M, Papadopoulos NG, Stingl G, Todo-Bom A, von Mutius E, Köhli A, Wöhrl S, Järvenpää S, Kautiainen H, Petman L, Selroos O, Zuberbier T, Heinzerling LM. Clinical relevance is associated with allergen-specific wheal size in skin prick testing. Clin Exp Allergy 2014; 44:407-16. [PMID: 24283409 PMCID: PMC4215109 DOI: 10.1111/cea.12240] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 11/30/2022]
Abstract
Background Within a large prospective study, the Global Asthma and Allergy European Network (GA2LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings. Objective To improve clinical interpretation of SPT results for inhalant allergens by providing quantitative decision points. Methods The GA2LEN SPT study with 3068 valid data sets was used to investigate the relationship between SPT results and patient-reported clinical relevance for each of the 18 inhalant allergens as well as SPT wheal size and physician-diagnosed allergy (rhinitis, asthma, atopic dermatitis, food allergy). The effects of age, gender, and geographical area on SPT results were assessed. For each allergen, the wheal size in mm with an 80% positive predictive value (PPV) for being clinically relevant was calculated. Results Depending on the allergen, from 40% (blatella) to 87–89% (grass, mites) of the positive SPT reactions (wheal size ≥ 3 mm) were associated with patient-reported clinical symptoms when exposed to the respective allergen. The risk of allergic symptoms increased significantly with larger wheal sizes for 17 of the 18 allergens tested. Children with positive SPT reactions had a smaller risk of sensitizations being clinically relevant compared with adults. The 80% PPV varied from 3 to 10 mm depending on the allergen. Conclusion These ‘reading keys’ for 18 inhalant allergens can help interpret SPT results with respect to their clinical significance. A SPT form with the standard allergens including mm decision points for each allergen is offered for clinical use.
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Affiliation(s)
- T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
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Hasegawa K, Sullivan AF, Tsugawa Y, Turner SJ, Massaro S, Clark S, Tsai CL, Camargo CA. Comparison of US emergency department acute asthma care quality: 1997-2001 and 2011-2012. J Allergy Clin Immunol 2014; 135:73-80. [PMID: 25263233 DOI: 10.1016/j.jaci.2014.08.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/03/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND It remains unclear whether the quality of acute asthma care in US emergency departments (EDs) has improved over time. OBJECTIVES We investigated changes in concordance of ED asthma care with 2007 National Institutes of Health guidelines, identified ED characteristics predictive of concordance, and tested whether higher concordance was associated with lower risk of hospitalization. METHODS We performed chart reviews in ED patients aged 18 to 54 years with asthma exacerbations in 48 EDs during 2 time periods: 1997-2001 (2 prior studies) and 2011-2012 (new study). Concordance with guideline recommendations was evaluated by using item-by-item quality measures and composite concordance scores at the patient and ED levels; these scores ranged from 0 to 100. RESULTS The analytic cohort comprised 4039 patients (2119 from 1997-2001 vs 1920 from 2011-2012). Over these 16 years, emergency asthma care became more concordant with level A recommendations at both the patient and ED levels (both P < .001). By contrast, concordance with non-level A recommendations (peak expiratory flow measurement and timeliness) decreased at both the patient (median score, 75 [interquartile range, 50-100] to 50 [interquartile range, 33-75], P < .001) and ED (mean score, 67 [SD, 7] to 50 [SD, 16], P < .001) levels. Multivariable analysis demonstrated ED concordance was lower in Southern and Western EDs compared with Midwestern EDs. After adjusting for severity, guideline-concordant care was associated with lower risk of hospitalization (odds ratio, 0.37; 95% CI, 0.26-0.53). CONCLUSIONS Between 1997 and 2012, we observed changes in the quality of emergency asthma care that differed by level of guideline recommendation and substantial interhospital and geographic variations. Greater concordance with guideline-recommended management might reduce unnecessary hospitalizations.
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Affiliation(s)
- Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
| | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Yusuke Tsugawa
- Harvard Interfaculty Initiative in Health Policy, Cambridge, Mass
| | | | | | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College, New York, NY
| | - Chu-Lin Tsai
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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Hasegawa K, Brenner BE, Clark S, Camargo CA. Emergency department visits for acute asthma by adults who ran out of their inhaled medications. Allergy Asthma Proc 2014; 35:42-50. [PMID: 24801458 DOI: 10.2500/aap.2014.35.3747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study was designed to determine the percentage of asthma-related emergency department (ED) visits made by patients who recently ran out of their inhaled short-acting beta-agonists or inhaled corticosteroids and to characterize this understudied patient population. A secondary analysis was performed of data from four ED-based multicenter studies of acute asthma during 1996-1998 (n = 64 EDs). In each study, consecutive adult patients, aged 18-54 years, with acute asthma underwent a structured interview that assessed running out of inhaled medications. The analytic cohort comprised 1095 adults. Overall, 324 patients (30%; 95% confidence interval [CI], 27-32%) ran out of either of their inhaled beta-agonists or inhaled corticosteroids during the week before their index ED visit; 311 (28%; 95% CI, 26-31%) ran out of inhaled beta-agonists per se. Among a subset of 518 patients on inhaled corticosteroids, 55 patients (11%; 95% CI, 8-14%) ran out of inhaled corticosteroids. In the multivariable model, predictors of running out of an asthma medication were male sex, non-Hispanic black race, Hispanic ethnicity, no insurance, lower household income, and use of EDs as the preferred source of asthma prescriptions (all p < 0.05). Among patients who ran out of medications, 49% (95% CI, 43-55%) ran out of inhaled beta-agonists and 72% (95% CI, 58-84%) ran out of inhaled corticosteroids, before onset of their acute asthma symptoms. In 1095 adult ED patients with acute asthma, we found that 30% ran out of their inhaled asthma medications before the ED visit. Asthma patients who ran out of medications had sociodemographic characteristics that may help with identification of preventable ED visits. Multifaceted strategies needed to ensure optimal use of inhaled medications are warranted.
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Affiliation(s)
- Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Tanaka T, Asai M, Yanagita Y, Nishinakagawa T, Miyamoto N, Kotaki K, Yano Y, Kozu R, Honda S, Senjyu H. Longitudinal study of respiratory function and symptoms in a non-smoking group of long-term officially-acknowledged victims of pollution-related illness. BMC Public Health 2013; 13:766. [PMID: 24090071 PMCID: PMC3765588 DOI: 10.1186/1471-2458-13-766] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 08/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Air pollution is known to be a leading cause of respiratory symptoms. Many cross-sectional studies reported that air pollution caused respiratory disease in Japanese individuals in the 1960s. Japan has laws regulating air pollution levels and providing compensation for victims of pollution-related respiratory disease. However, long-term changes in respiratory function and symptoms in individuals who were exposed to air pollution in the 1960s have not been well studied. This study aimed to investigate longitudinal respiratory function and symptoms in older, non-smoking, long-term officially-acknowledged victims of pollution-related illness. METHODS The study included 563 officially-acknowledged victims of pollution-related illness living in Kurashiki, Okayama who were aged ≥ 65 years in 2009. Data were retrospectively collected from yearly respiratory symptom questionnaires and spirometry examinations conducted from 2000 to 2009. RESULTS Respiratory function declined significantly from 2000 to 2009 (p < 0.01), but the mean annual changes were relatively small. The change in mean vital capacity was -40.5 ml/year in males and -32.7 ml/year in females, and the change in mean forced expiratory volume in 1 second was -27.6 ml/year in males and -23.9 ml/year in females. Dyspnea was the only symptom that worsened significantly from 2000 to 2009 in both sexes (males: p < 0.05, females: p < 0.01). CONCLUSIONS Our results suggest that the high concentrations of air pollutants around 1970 resulted in a decrease in respiratory function and an increase in respiratory symptoms in the study population. From 2000 to 2009, the mean annual changes in respiratory function were within the normal range, even though the severity of dyspnea worsened. The changes in respiratory function and symptoms over the study period were probably due to aging. The laws governing air pollution levels and providing compensation for officially-acknowledged victims of pollution-related illness in Japan may be effective for respiratory disease cause by pollution.
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Affiliation(s)
- Takako Tanaka
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8520, Japan.
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Melero Moreno C, López-Viña A, García-Salmones Martín M, Cisneros Serrano C, Jareño Esteban J, Ramirez Prieto MT. Factors Related With the Higher Percentage of Hospitalizations Due to Asthma Amongst Women: The FRIAM Study. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Factors related with the higher percentage of hospitalizations due to asthma amongst women: the FRIAM study. Arch Bronconeumol 2012; 48:234-9. [PMID: 22475519 DOI: 10.1016/j.arbres.2012.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 02/03/2012] [Accepted: 02/12/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The reason why there is a higher hospitalization rate due to asthma exacerbations amongst women is unclear. The objective of this study is to explore the possible causes that may explain this fact. METHODS A multi-center, prospective study including asthma patients hospitalized in the pulmonary medicine departments during a two-year period. By means of a questionnaire, the following data were collected: demographic characteristics and treatment compliance, anxiety-depression, hyperventilation and asthma control, both prior to and during the hospitalization. RESULTS 183 patients were included, 115 (62.84%) of whom were women. The women were older (52.4 ± 18.3/43.4 ± 18.7; P=.02), were more frequently prescribed inhaled corticosteroids (63.2%/47.1%; P=.03) and had a higher rate of hyperventilation syndrome (57.3/35.9; P=.02) and a longer mean hospital stay (7.3 ± 3.4/5.9 ± 3.6; P=.02). The percentage of smokers among the women was lower (21.2%/38.8%; p=0.01) and the FEV(1) was lower at admittance (58.2% ± 15.9/67.5% ± 17.4; P=.03). In the 40 to 60-year-old age range, an association was demonstrated between being female and the 'previous hospitalizations' variable (OR, 16.1; 95% CI, 1.6-156.7); sex and obesity were also independently associated (OR, 4.8; 95% CI, 1.06-22). CONCLUSIONS In this cohort, the rate of hospitalization for asthma was higher in women than in men. Being a woman between the ages of 40 and 60 is associated with previous hospitalizations and is a risk factor for asthma-related hospitalization. This situation could partially be explained by the hormonal changes during menopause, where polyposis and obesity are independent risk factors.
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Chhabra SK, Chhabra P. Gender differences in perception of dyspnea, assessment of control, and quality of life in asthma. J Asthma 2011; 48:609-15. [PMID: 21679098 DOI: 10.3109/02770903.2011.587577] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is limited information on the inter-relationship between gender, perception of dyspnoea and health-related quality of life (HRQoL) in asthma. METHODS In a cross-sectional study in an out-patient setting, 85 patients with bronchial asthma, 41 males and 44 females, underwent spirometry and were administered the following instruments to measure asthma control, HRQoL and dyspnoea : (a) Asthma control questionnaire (ACQ), (b) Asthma Quality of Life questionnaire (AQLQ), (c) Baseline dyspnoea index (BDI) questionnaire and Oxygen Cost Diagram (OCD). RESULTS Overall, male patients had greater airways obstruction but reported similar level of asthma control as females. Among patients with mild persistent asthma, females had a poorer level of control. The BDI and the OCD scores were significantly lower in female patients indicating greater dyspnoea and they also had a poorer quality of life especially in the symptoms and emotional domains of the AQLQ. After adjusting for the severity of airways obstruction in multivariate analysis, female gender and a poorer quality of life were independent predictors of increased perception of dyspnoea. CONCLUSIONS Female patients with asthma are likely to have a greater perception of dyspnoea, report a poorer control and have a poorer quality of life as compared to males. Female gender and a poorer quality of life are independent predictors of increased perception of dyspnoea in asthmatics.
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Affiliation(s)
- Sunil K Chhabra
- Department of Cardiorespiratory Physiology, Vallabhbhai Patel Chest Institute, Clinical Research Centre, University of Delhi, Delhi 110007, India.
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Abstract
PURPOSE OF REVIEW asthma is a common chronic disease with significant clinical impact worldwide. Sex-related disparities in asthma epidemiology and morbidity exist but debate continues regarding the mechanisms for these differences. There is a need to review the recent findings for asthma care providers and to highlight areas in need of additional research. RECENT FINDINGS recent data illustrate striking sex-related differences in asthma epidemiology and disease expression. Studies show an increased incidence of asthma in women. Data demonstrate that asthmatic women have a poorer quality of life and increased utilization of healthcare compared to their male counterparts despite similar medical treatment and baseline pulmonary function. Research continues to explore hypotheses for these differences including the potential influences of the female sex hormones, altered perception of airflow obstruction, increased bronchial hyper-responsiveness, and medication compliance and technique. However, no single explanation has been able to fully explain the disparities. SUMMARY women are more likely to be diagnosed with asthma and suffer greater morbidity than men. The physiologic mechanisms for these differences are not well understood. Understanding sex-related differences in asthma and providing patients with education geared toward these disparities are important in establishing effective, individualized asthma management strategies for all patients.
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Prevalence of lifetime asthma and current asthma attacks in U.S. working adults: an analysis of the 1997-2004 National Health Interview Survey data. J Occup Environ Med 2009; 51:1066-74. [PMID: 19730397 DOI: 10.1097/jom.0b013e3181b3510a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate national prevalences of lifetime asthma and asthma attacks among workers by age, sex, race, occupation and industry, and estimate population attributable fraction to employment for asthma attacks in the United States. METHODS The 1997-2004 National Health Interview Survey data for currently working adults aged > or = 18 years were analyzed. RESULTS Lifetime asthma prevalence was 9.2%; the social services religious and membership organizations industry and the health service occupation had the highest asthma prevalence. Asthma attack prevalence among workers with asthma was 35.4%; the primary metal industry and the health assessment and treating occupation had the highest attack prevalence. Approximately, 5.9% of cases reporting an asthma attack were attributed to employment when considering industries and 3.8% when considering occupations. CONCLUSIONS Future studies and intervention strategies should address the higher prevalence of asthma in certain industries and occupations.
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Rowe BH, Villa-Roel C, Sivilotti MLA, Lang E, Borgundvaag B, Worster A, Walker A, Ross S. Relapse after emergency department discharge for acute asthma. Acad Emerg Med 2008; 15:709-17. [PMID: 18637082 DOI: 10.1111/j.1553-2712.2008.00176.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives were to determine patient and treatment-response factors associated with relapse after emergency department (ED) treatment for acute asthma. METHODS Subjects aged 18-55 years who were treated for acute asthma in 20 Canadian EDs prospectively underwent a structured ED interview and telephone contact 2 weeks later. RESULTS Of 695 enrolled patients, 604 (86.9%) were discharged from the ED; follow-up was available in 529 (87.5%); 63% were female and the median age was 29 years. Most patients were discharged on oral (70.8%) and inhaled (60.1%) corticosteroids (CS); 2-week treatment adherences were 93.3 and 80.9%, respectively. Relapse occurred in 9.2% at 1 week (95% confidence interval [CI] = 7.1% to 12.0%) and 13.9% (95% CI = 11% to 17%) at 2 weeks. In multivariable modeling, factors associated with relapse were ethnicity (risk ratio [RR] white = 0.66; 95% CI = 0.52 to 0.83); female gender (RR = 1.57; 95% CI = 1.14 to 2.09); any ED visits in the past 2 years (RR = 1.47; 95% CI = 1.18 to 1.80); ever admitted for asthma treatment (RR = 1.83; 95% CI = 1.09 to 2.84); use of combined inhaled CS plus long-acting beta(2)-agonists (RR = 1.39; 95% CI = 1.07 to 1.78) and of oral CS (RR = 1.35; 95% CI = 1.12 to 1.59) at the time of ED presentation. CONCLUSIONS Ethnicity (white), female gender, prior ED visits and admissions for asthma, and recent treatments (especially oral CS) were associated with asthma relapse, which remains relatively common. Future research is required to target this high-risk group.
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Affiliation(s)
- Brian H Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
BACKGROUND AND OBJECTIVE The hospitalization of asthma patients accounts for substantial costs in any health-care system. However, the utilization of medical resources and the cost of hospitalizing asthma patients in Thailand have never been evaluated. This study aimed to evaluate the utilization of health-care resources and itemize the cost of hospitalizing asthma patients in a regional hospital in north-east Thailand. METHODS A cross-sectional, retrospective study was conducted at Surin Hospital, a 697-bed, regional hospital in north-east Thailand. The study included 183 adults (> or =15 years of age) who were admitted with acute asthma. Demographic data, resource-utilization parameters and itemized costs were recorded. RESULTS The average hospital cost was 5,809.3 +/- 6,587.4 Thai Baht (US $134.5 +/- 152.5) per patient (range, 740-57,980 Thai Baht or US $17.1-1,342.1). Medications were the primary hospital expense (47.2%), followed by hospital charges (13.5%), nursing care (13.0%) and respiratory therapy (12.2%). Fifteen per cent of patients accounted for 45% of total hospital costs. Significant predictors of increased total hospital cost were: (i) age > or =60 years; (ii) presence of comorbid conditions; (iii) admission to the intensive care unit; and/or (iv) prolonged hospital stay. CONCLUSION Despite the low unit costs for inpatient care in Thailand, the cost of hospitalizing asthma patients (especially the elderly) constitutes a substantial burden to the health-care system.
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Matos APSD, Machado ACC. Influência das variáveis biopsicossociais na qualidade de vida em asmáticos. PSICOLOGIA: TEORIA E PESQUISA 2007. [DOI: 10.1590/s0102-37722007000200004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A asma brônquica é uma doença complexa e interfere com a qualidade de vida desses doentes. Pretendemos, com a presente investigação, estudar a relação das variáveis sócio-demográficas (género, idade e grau de instrução), clínicas (gravidade da doença, duração e tipo clínico) e psicológicas (cognições, emoções e comportamentos) com a qualidade de vida do doente asmático. Cinqüenta doentes asmáticos do Departamento de Pneumologia e Imunoalergologia dos Hospitais da Universidade de Coimbra preencheram cinco questionários de auto-resposta que avaliavam as variáveis psicológicas em estudo. Os dados clínicos relativamente à doença foram igualmente recolhidos.Os nossos resultados revelam-nos que a qualidade de vida se relaciona com um conjunto de variáveis que podemos denominar biopsicossociais (e.g., uma menor qualidade de vida relaciona-se com uma maior idade, menor escolaridade, uma atitude mais negativa face à asma, designada "estigma", cognições disfuncionais e comportamentos/emoções-problema relacionados com a asma). Implicações ao nível do tratamento são apresentadas.
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Tsai CL, Clark S, Cydulka RK, Rowe BH, Camargo CA. Factors associated with hospital admission among emergency department patients with chronic obstructive pulmonary disease exacerbation. Acad Emerg Med 2007; 14:6-14. [PMID: 17119187 DOI: 10.1197/j.aem.2006.07.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
UNLABELLED OBJECTIVES To determine the patient factors associated with hospital admission among adults who present to the emergency department (ED) with acute exacerbations of chronic obstructive pulmonary disease (COPD) and to determine whether admissions were concordant with recommendations in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. METHODS The authors performed a prospective multicenter cohort study involving 29 EDs in the United States and Canada. By using a standard protocol, consecutive ED patients with COPD exacerbation were interviewed, and their charts were reviewed. Predictors of admission were determined by multivariate logistic regression. RESULTS Of 384 patients, 233 (61%; 95% confidence interval = 56% to 66%) were admitted. Multivariate analysis showed that a higher likelihood of admission was associated with older age, female gender, more pack-years of smoking, recent use of inhaled corticosteroid, self-reported activity limitation in the past 24 hours, higher respiratory rate at ED presentation, and a concomitant diagnosis of pneumonia. Patients who reported the ED as their usual site for problem COPD care, or who had mixed COPD and asthma, were less likely to be admitted. The authors confirmed five of the seven testable indications for hospital admission in the GOLD guidelines. CONCLUSIONS Several patient factors were independently associated with hospital admission among ED patients with COPD exacerbations. Overall, concordance with admission recommendations in the GOLD guidelines was high. The authors also identified a few novel predictors of admission (female gender, ED as the usual site for problem COPD care, mixed diagnosis of COPD and asthma, recent use of inhaled corticosteroid) that require replication in future studies.
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Affiliation(s)
- Chu-Lin Tsai
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
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Baibergenova A, Thabane L, Akhtar-Danesh N, Levine M, Gafni A. Patient characteristics associated with nocturnal emergency department visits for asthma. J Asthma 2006; 43:469-75. [PMID: 16952867 DOI: 10.1080/02770900600758382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVES To identify patient characteristics associated with nocturnal emergency department (ED) visits for asthma. METHODS Asthmatic patients 18 to 55 years of age who visited Ontario EDs between April 1, 2003 and March 31, 2004, were identified through an administrative clinical database. Patients' time of ED presentation was analyzed for circadian pattern using histogram and polynomial regression. Risk of nocturnal visit (presentation at the ED between midnight and 8 AM) was modeled through generalized estimating equations with patient age, gender, and asthma severity level as covariates. The effect of nocturnal visit on return rate to the ED within 14 days after the initial visit was determined through Cox regression. RESULTS During study period there were 31,490 ED visits for asthma made by 23,253 patients. Their time of ED visits displayed a distinct circadian pattern with peak between 7 and 8 PM, and trough at 5 AM. Approximately 22% of visits (6,868) occurred at night. Men had higher odds of presenting at night than women (OR 1.61; 1.49-1.73). Patients with mild asthma were significantly less likely to visit the ED at night than patients with moderate or severe asthma. Nocturnal presentation was not associated with higher odds of subsequent returns to the ED (HR 1.00; 0.89-1.14). CONCLUSION Higher odds of nocturnal visits in men suggest the existence of gender-differences in health-seeking behavior in asthmatics. Although nocturnal visits are associated with more severe asthma, they do not lead to higher return rates.
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Affiliation(s)
- Akerke Baibergenova
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
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Parshall MB, Doherty GS. Predictors of emergency department visit disposition for patients with chronic obstructive pulmonary disease. Heart Lung 2006; 35:342-50. [PMID: 16963366 DOI: 10.1016/j.hrtlng.2006.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Revised: 01/30/2006] [Accepted: 02/06/2006] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVES The study objective was to validate among patients with chronic obstructive pulmonary disease (COPD) clinical predictors of emergency department (ED) disposition (admission vs discharge) found in a previous study. We hypothesized that the initial heart rate (HR) at presentation and the number of nebulizer treatments would predict visit disposition adequately and that existing triage criteria would not. METHODS In this correlational study, all ED visits to a university medical center related to a diagnosis of COPD over a 2-year period were identified and reviewed retrospectively (N = 114 patients and 226 visits). Associations of clinical predictors with visit disposition was by contingency table or receiver operating characteristic curve analysis. RESULTS The overall admission rate was 60.2%. An initial HR slightly greater than normal limits (HR >/= 106 vs HR </= 105 beats/min) predicted visit disposition; receiver operating characteristic area under curve (95% confidence interval) = .67 (.60-.73); sensitivity = .61 (.52-.69); and specificity = .68 (.57-.77). Likelihood ratios for positive and negative tests were 1.93 and 0.57, corresponding to posterior probabilities of admission = .74 and .46, respectively. Triage classification did not adequately predict visit disposition. Patients receiving three or more nebulized bronchodilator treatments were more likely to be admitted than those receiving fewer treatments, but this predictor had low sensitivity and was no more discriminating than the initial HR. Women were more likely than men to be admitted, odds ratio = 2.66 (1.54-4.61), but there were few clinically meaningful differences between sexes. CONCLUSIONS The initial HR on arrival predicted disposition of ED visits for patients with COPD with operating characteristics that were superior to the existing triage criteria. Triage of patients with COPD could be improved simply, and at no additional expense, by recognizing that almost any degree of tachycardia in a patient with COPD substantially increases the likelihood of admission.
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Affiliation(s)
- Mark B Parshall
- University of New Mexico College of Nursing, Albuquerque, New Mexico
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Lee JH, Haselkorn T, Chipps BE, Miller DP, Wenzel SE. Gender differences in IgE-mediated allergic asthma in the epidemiology and natural history of asthma: Outcomes and Treatment Regimens (TENOR) study. J Asthma 2006; 43:179-84. [PMID: 16754518 DOI: 10.1080/02770900600566405] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The TENOR study consists of a large cohort of subjects with severe or difficult-to-treat asthma. The objective of this analysis was to evaluate demographic and clinical characteristics of subjects 12 years of age or older with immunoglobulin E (IgE)-mediated allergic asthma (skin test positive with an IgE level = 30 to =700 IU/mL), and specifically, to assess gender differences in this cohort. METHODS A total of 4,756 subjects were enrolled by 283 US study sites between January and October 2001. Of those subjects 12 years or older at baseline with an IgE measure and who were skin tested (n = 2,843), 1,783 (63%) were skin test positive and had an IgE level between = 30 to = 700 IU/mL. RESULTS Compared to males, females reported significantly greater healthcare utilization (steroid bursts in previous 3 months: 50% vs 42%, p < 0.001; unscheduled office visits in previous 3 months: 50% vs 36%, p < 0.0001; missed 1+ days of work/school in previous 2 weeks: 14% vs 10%, p < 0.01). Females also reported significantly more asthma control problems and lower asthma-related quality of life (4.6 +/- 1.3 vs 5.2 +/- 1.2; p < 0.0001); the difference was clinically meaningful. Asthma triggers and allergic comorbidities, such as allergic rhinitis and atopic dermatitis, were more common in female subjects. Despite their overall worse health outcomes, female subjects demonstrated better lung function, had similar treatment patterns, and showed no differences in physician-assessed asthma severity when compared with males. CONCLUSIONS The reasons for these gender differences in subjects with IgE-mediated allergic asthma are complex, but results from this analysis suggest that detailed evaluations of asthma patients, including symptom-related questions and asthma-related healthcare utilization, are needed to accurately assess asthma severity and control.
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Affiliation(s)
- June H Lee
- Genentech, Inc., South San Francisco, California 94080, USA.
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Baibergenova A, Thabane L, Akhtar-Danesh N, Levine M, Gafni A, Leeb K. Sex differences in hospital admissions from emergency departments in asthmatic adults: a population-based study. Ann Allergy Asthma Immunol 2006; 96:666-72. [PMID: 16729778 DOI: 10.1016/s1081-1206(10)61063-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Women represent the majority of adult patients hospitalized for asthma. Analyzing the course of emergency department (ED) visits before hospital admission can help understanding of the mechanisms behind the excess of hospitalizations in women. OBJECTIVE To investigate sex differences in hospital admission rates in adult patients with asthma visiting EDs in Ontario. METHODS Asthmatic patients 18 to 55 years old who visited Ontario EDs between April 1, 2003, and March 31, 2004, were identified using the Canadian Institute for Health Information's National Ambulatory Care Reporting System. The generalized estimating equations for binary outcome were used to model rates of hospital admission with sex, age, and triage (severity) score as covariates. Analysis was further stratified by the ED volume. RESULTS Women represented 62.2% of all ED visits. They were on average older than men, but both groups had similar distributions of triage scores. Female patients accounted for more hospital admissions than male patients (7.4% vs 4.5%). After adjusting for age and triage score, women were more likely to be admitted than men (odds ratio, 1.64; 95% confidence interval, 1.41-1.90). The interaction found between sex and triage level indicates that hospitalized women may have less severe asthma than hospitalized men. Analysis by ED volume did not significantly alter the results. CONCLUSION The higher admission rates in women may be related to sex differences in the subjective perception of dyspnea, management of asthma by ED physician, or inadequate ambulatory care strategies in women and thus merit further investigation.
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Affiliation(s)
- Akerke Baibergenova
- McMaster University, Faculty of Health Sciences, Department of Clinical Epidemiology and Biostatistics, Centre for Evaluation of Medicines, St Joseph's Healthcare, Hamilton, Ontario, Canada.
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Ostrom NK. Women with asthma: a review of potential variables and preferred medical management. Ann Allergy Asthma Immunol 2006; 96:655-65. [PMID: 16729777 DOI: 10.1016/s1081-1206(10)61062-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To summarize the potential variables that contribute to the increased risk of asthma in women, outline therapeutic strategies that address these variables, and review current treatment recommendations for both pregnant and nonpregnant women with asthma. DATA SOURCES Literature searches (MEDLINE and cross-references) were performed using the keywords asthma and women in combination with the terms compliance, depression, emergency department, hormones, menstruation, mortality, National Asthma Education and Prevention Program, osteoporosis, pregnancy, prevalence, smoking, and treatment. Searches were limited to human studies with data published before 2005. STUDY SELECTION The author selected relevant articles for inclusion in this review. RESULTS Fluctuations in sex hormones, menstruation, pregnancy, obesity, depression, medication nonadherence, and smoking may contribute to increased asthma symptoms or severity in women. Asthma control may be improved if physicians address conditions and behaviors associated with asthma variability and severity in women. Notably, asthma must be managed aggressively in pregnant women, because uncontrolled asthma can lead to perinatal complications. Asthma treatment in women is optimized through patient and physician adherence to national guideline recommendations, including provision of patient education and asthma action plans. CONCLUSIONS Multiple variables throughout the female life cycle may influence asthma control. Successful asthma management requires an ongoing partnership between the patient and her physician to address physiologic (eg, sex hormones, pregnancy, obesity, depression) and nonphysiologic (eg, smoking, medication nonadherence) factors that may contribute to decreased asthma control.
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Affiliation(s)
- Nancy K Ostrom
- Allergy and Asthma Medical Group and Research Center, San Diego, California 92123, USA.
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Abstract
In addition to preventing maternal and fetal hypoxia, the goals of treating acute asthma exacerbation during pregnancy mirror those in the nongravid patient: rapid reversal of airflow obstruction with aerosolized bronchodilators,reduction of likelihood of recurrence by the addition of corticosteroids, and ongoing assessment of mother and fetus. Disposition decisions are multifaceted and must take into account the health and well-being of the pregnant patient and that of her fetus. Discharge planning includes prescription of scheduled 3-2 agonist treatments until symptoms resolve, intensification of daily treatment as needed, prescriptions for systemic and ICSs, as well provision of patient education, a personalized action plan, and close follow-up.
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Affiliation(s)
- Rita K Cydulka
- MetroHealth Emergency Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA.
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van de Ven MOM, van den Eijnden RJJM, Engels RCME. Atopic diseases and related risk factors among Dutch adolescents. Eur J Public Health 2006; 16:549-58. [PMID: 16524943 DOI: 10.1093/eurpub/ckl022] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of the present study was to gain insight into the prevalence of asthma, allergic rhinitis, and eczema among Dutch early adolescents, and to study the impact of several social demographic and individual risk factors. METHODS Cross-sectional survey study using the self-report questionnaires of the International Study of Asthma and Allergies in Childhood (ISAAC). In January 2003, 10 087 12- to 14-year-old students from 33 secondary schools in four regions of the Netherlands participated in this study. RESULTS Of all participants, 52.6% reported that they had an allergic disease at least once in their lifetime. The 12 months prevalence of wheezing, rhinitis, and itchy rash was 12.3%, 28.3%, and 13.5%, respectively. Several social demographic and individual factors (gender, age, education levels, ethnicity, body mass index, and residential area) were significantly associated with the atopic symptoms and diseases. CONCLUSION This study showed that allergic conditions are common in the Netherlands. Several social demographic and individual risk factors were related to the atopic diseases and symptoms.
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Schatz M, Clark S, Camargo CA. Sex Differences in the Presentation and Course of Asthma Hospitalizations. Chest 2006; 129:50-5. [PMID: 16424412 DOI: 10.1378/chest.129.1.50] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To distinguish between differences in prevalence, asthma severity, and treatment to explain sex-related differences in hospitalized asthma patients. DESIGN Medical record review. SETTING Thirty US hospitals as part of the University HealthSystem Consortium Asthma Clinical Benchmarking Project. PATIENTS A random sample of patients aged 2 to 54 years and admitted to the hospital for acute asthma from 1999 to 2000. MEASUREMENTS Demographics, medical history, initial oxygen saturation, initial peak expiratory flow (adults), initial pulmonary index (children), emergency department course, length of hospital stay, and discharge plans. RESULTS The cohort included 606 pediatric (aged 2 to 17 years) and 680 adult (aged 18 to 54 years) inpatients. The sex ratio varied significantly by age: 40% were girls 2 to 17 years of age, and 68% were women 18 to 54 years of age p < 0.001). Among children, girls did not differ from boys according to asthma history, pulmonary index scores, or hospital length of stay. Among adults, women were more likely to have a primary care provider (90% vs 73%, p < 0.001) but did not differ according to asthma history or recent medication use. Women had a higher mean initial PEF compared to men (43% of predicted vs 36% of predicted, p < 0.001) and higher median initial oxygen saturation (95% vs 93%, p = 0.002) but did not differ by hospital length of stay. No sex differences in discharge regimens were identified in children or adults. CONCLUSIONS Among US inpatients with acute asthma, male children are more common than female children, while women are more common in adults. The results in children are probably explained by prevalence differences, since no sex differences were seen in markers of asthma severity or treatment. In adults, increased symptoms in response to a given level of airway obstruction in women may contribute to the female predominance in asthma hospitalizations.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser-Permanente Medical Care Program, 7060 Clairemont Mesa Blvd., San Diego, CA 92111, USA.
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Watson L, Vestbo J, Postma DS, Decramer M, Rennard S, Kiri VA, Vermeire PA, Soriano JB. Gender differences in the management and experience of Chronic Obstructive Pulmonary Disease. Respir Med 2005; 98:1207-13. [PMID: 15588042 DOI: 10.1016/j.rmed.2004.05.004] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Whether women receive the same medical care for COPD as men and if they are at risk of different outcomes as a result, is not known. The Confronting COPD International Survey was performed in the USA, Canada, France, Italy, Germany, The Netherlands, Spain and the UK in 2000 with 3265 COPD participants. Forty-one per cent were women; mean age in women and men was 61.2 (SD 10.5) and 64.4 (11.0) years, mean pack-years of smoking 36 (29) and 46 (35) years, respectively. After adjusting for age, pack-years, country and severe dyspnea (MRC scores 5 and 4), women were less likely to have had spirometry (OR 0.84, 95% C.I. 0.72-0.98) but more likely to get smoking cessation advice (OR 1.57, 1.33-1.86). Despite significantly lower pack-years of smoking, women were more likely to report severe dyspnea than men (OR 1.30, 1.10-1.54), with similar cough (OR 1.08, 0.92-1.27) and less sputum (OR 0.84, 0.72-0.98). There were no differences in the risk of hospitalisation or emergency room visit. This study indicates that gender differences in COPD care and outcomes exist.
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Affiliation(s)
- Louise Watson
- Department of Worldwide Epidemiology, GlaxoSmithKline, Greenford, UK.
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Schatz M, Clark S, Emond JA, Schreiber D, Camargo CA. Sex differences among children 2-13 years of age presenting at the emergency department with acute asthma. Pediatr Pulmonol 2004; 37:523-9. [PMID: 15114553 DOI: 10.1002/ppul.20018] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hospitalization rates for asthma have been reported to be higher in males than females in children under age 15, but it is not clear whether this disparity reflects gender differences in prevalence, severity, or treatment. We performed a prospective cohort study as part of the Emergency Medicine Network. Patients aged 2-13 years who presented to the emergency department (ED) with acute asthma underwent a structured interview in the ED and another by telephone 2 weeks later. Of 1,602 patients, 61% (95% CI, 59-64%) were boys. Girls were slightly older than boys, although no material differences existed in acute presentation, chronic asthma characteristics, ED treatment, or ED course. There was no difference in admission rates for boys or girls (20% vs. 22%; P = 0.48). This finding persisted when adjusting for other factors in a multivariate logistic regression model. No sex differences were observed for relapse or ongoing exacerbation on univariate or multivariate analysis. These data suggest that asthma is not inherently more severe in boys with asthma compared to girls, and that the increased rate of hospitalizations in boys under age 13 is due to differences in prevalence, not severity.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser-Permanente Medical Care Program, San Diego, California 92111, USA.
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Gwynn RC. Risk factors for asthma in US adults: results from the 2000 Behavioral Risk Factor Surveillance System. J Asthma 2004; 41:91-8. [PMID: 15046383 DOI: 10.1081/jas-120026066] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Identifying populations at risk for having asthma is an essential step toward appropriately allocating resources and reducing the burden of this disease. To date, the impact of demographic and social factors on asthma prevalence has not been assessed in a nationally representative sample of U.S. adults. METHODS We conducted weighted analyses using data from a random digit-dialed telephone survey of non-institutionalized persons > or = 18 years of age in 50 states, Puerto Rico, and the District of Columbia to assess risk factors for asthma prevalence. RESULTS We found that women were more likely than men to report current asthma [odds/ratio (OR): 1.91, 95% confidence interval (CI): 1.77-2.06]; adults aged 35-64 and >65 were less likely than adults aged 18-34 to report current asthma (OR: 0.79, 95% CI: 0.73-0.85 and OR: 0.65, 95% CI: 0.58-0.72, respectively); persons from the lower socioeconomic status (SES) were more likely to report current asthma than those in other SES (OR: 1.36, 95% CI: 1.25-1.49); overweight and obese people were more likely to report current asthma than were those of normal weight (OR: 1.10, 95% CI: 1.02-1.20 and OR: 1.65, 95% CI: 1.51-1.80, respectively); and current and former smokers were more likely than never smokers to report current asthma (OR: 1.28, 95% CI: 1.18-1.39 and OR: 1.36, 95% CI: 1.24-1.48, respectively). CONCLUSIONS While several important sociodemographic risk factors were associated with increased asthma prevalence in U.S. adults, the impact of generally modifiable risk factors such as elevated body mass index and cigarette smoking is of specific concern. These findings further underscore the need to target and diminish these risk factors among U.S. adults.
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Affiliation(s)
- R Charon Gwynn
- Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Abstract
All patients with asthma are at risk of having exacerbations. Hospitalizations and emergency department (ED) visits account for a large proportion of the health-care cost burden of asthma, and avoidance or proper management of acute asthma (AA) episodes represent an area with the potential for large reductions in health-care costs. The severity of exacerbations may range from mild to life threatening, and mortality is most often associated with failure to appreciate the severity of the exacerbation, resulting in inadequate emergency treatment and delay in referring to hospital. This review describes the epidemiology, costs, pathophysiology, mortality, and management of adult AA in the ED and in the ICU.
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Affiliation(s)
- Gustavo J Rodrigo
- Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay.
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Abstract
The first step in optimal asthma care is identifying and properly diagnosing patients who have asthma then classifying asthma severity carefully and accurately to ensure proper treatment. Objective monitoring of pulmonary function using spirometry and peak flow monitoring, subjective assessment using symptom identification, and physicians' acceptance of National Asthma Education Program's Expert Panel guidelines are needed to diminish the consequences of undertreatment of asthma. Persistent asthma requires continuous long-term controller therapy. Erratic and insufficient use of medication must be addressed. Clinicians should encourage patients to manage their asthma using routine peak flow monitoring and symptom assessment then intervene according to their asthma action plan. These efforts allow patients to take charge of their asthma instead of the asthma taking charge of them.
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Schatz M, Camargo CA. The relationship of sex to asthma prevalence, health care utilization, and medications in a large managed care organization. Ann Allergy Asthma Immunol 2004; 91:553-8. [PMID: 14700439 DOI: 10.1016/s1081-1206(10)61533-5] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Age-related sex differences in asthma hospitalizations and emergency department (ED) visits have been reported, but relationships of these differences to disease prevalence and outpatient management have not been defined. OBJECTIVE To define the relationships of sex to asthma-related health care utilization and medications, accounting for age-related differences in asthma prevalence. METHODS Computerized data from Southern California Kaiser-Permanente were used to identify asthmatic patients, aged 2 to 64 years, enrolled continuously during 1999 and 2000. Age-specific asthma prevalence in 1999 was calculated to identify ages of male or female predominance. Males and females were compared with regard to asthma-related health care utilization outcomes (outpatient clinic visits, ED visits, and hospitalizations) and medication use (beta-agonists, inhaled steroids, and oral steroids). Hospitalizations, ED visits, and oral steroid use were considered markers of disease severity. RESULTS Of the 60,694 subjects, the female-male prevalence ratio was approximately 35:65 at each age between 2 and 13 years, it was inverse (65:35) between the ages of 23 and 64 years, and prevalences were relatively similar at the ages of 14 to 22 years. In patients aged 2 to 13 years, most utilization and medication variables were significantly greater in males (P < .01). Females aged 14 to 22 years had more outpatient and ED visits and used more oral steroids than males. In patients aged 23 to 64 years, all utilization variables were significantly greater in females, except beta-agonist use and mean inhaled steroid dispensings. CONCLUSIONS Asthma utilization and severity appear greater in males aged 2 to 13 years, somewhat greater in females aged 14 to 22 years, and definitely greater in females aged 23 to 64 years. The mechanisms for these striking sex differences merit further investigation.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser-Permanente Medical Care Program, San Diego, California 92111, USA.
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Thomson CC, Clark S, Camargo CA. Body mass index and asthma severity among adults presenting to the emergency department. Chest 2003; 124:795-802. [PMID: 12970000 DOI: 10.1378/chest.124.3.795] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Among adults presenting to the emergency department (ED) with acute asthma, we sought to determine the prevalence of obesity, and the relation of body mass index (BMI) to asthma severity in this high-risk population. DESIGN Multicenter, prospective cohort study. SETTING Twenty-six North American EDs. PARTICIPANTS Five hundred seventy-two patients aged 18 to 54 years presenting with acute asthma. INTERVENTIONS None. MEASUREMENTS AND RESULTS A standardized interview assessed demographic characteristics, asthma history, and details of the current asthma exacerbation. Data on ED medical management and disposition were obtained by chart review. Three of four asthmatic patients were either overweight (BMI, 25 to 29.9; 30%) or obese (BMI, > or =30; 44%). Normal weight/underweight, overweight, and obese patients did not differ on several markers of chronic asthma severity; obese subjects tended to rate symptoms more severely and to use more inhaled beta-agonists in the 6 h hours prior to ED presentation despite a significantly higher initial percentage of predicted peak expiratory flow (PEF) [44%, 45%, and 51%, respectively; p < 0.05]. The three BMI groups responded similarly to acute therapy in the ED, with all groups demonstrating reversible airway obstruction. The sex distribution by BMI group differed markedly (p < 0.001), with women less often overweight (40% vs 24%) and more often obese (30% vs 52%). Since women were more likely have a higher initial PEF (45% vs 53%, p < 0.001), we stratified by sex to further examine the relation of BMI to asthma severity. The observed BMI-asthma associations were due largely, but not entirely, to confounding by sex. CONCLUSIONS Despite lingering concerns about the veracity of "asthma" among obese individuals, asthma exacerbations among obese and nonobese adults were remarkably similar. Potential differences (eg, in symptom perception, use of inhaled beta-agonists before ED presentation, initial PEF rate) were due, in large part, to confounding by sex.
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Affiliation(s)
- Carey Conley Thomson
- Department of Pulmonary and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Cydulka RK, Rowe BH, Clark S, Emerman CL, Camargo CA. Emergency department management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: the Multicenter Airway Research Collaboration. J Am Geriatr Soc 2003; 51:908-16. [PMID: 12834509 DOI: 10.1046/j.1365-2389.2003.51302.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine adherence of emergency department (ED) management of acute exacerbation of chronic obstructive pulmonary disease (COPD) to current treatment guidelines. DESIGN A prospective cohort study, as part of the Multicenter Airway Research Collaboration. SETTING The study was performed at 29 EDs in 15 U.S. states and three Canadian provinces. PARTICIPANTS ED patients, aged 55 and older, who presented with COPD exacerbation and underwent a structured interview in the ED and another by telephone 2 weeks later. MEASUREMENTS Adherence of ED management of COPD exacerbation to that recommended in current treatment guidelines. RESULTS The cohort consisted of 397 subjects, of whom 224 (56%) reported only COPD and 173 (44%) reported asthma and COPD. The average age was 70. Most (80%) patients had used rescue medications in the 6 hours before seeking emergency care. Only 31% were evaluated using spirometry and 48% using arterial blood gas measurement. ED treatment included inhaled short-acting beta-agonists for 91% of patients, inhaled anticholinergics for 77%, methylxanthines for 0.3%, systemic corticosteroids for 62%, and antibiotics for 28%. More than half the patients required hospitalization. At 2-week follow-up, 43% of patients reported a relapse event or ongoing exacerbation. Overall, adherence to national and international guidelines was low. CONCLUSION Important differences exist between guideline recommendations and actual ED management of COPD exacerbations in older adults. Outcomes after ED treatment are poor and may be related to these shortcomings in quality of care. Better adherence to guideline recommendations when caring for elderly patients with COPD exacerbations may lead to improved clinical outcomes and better resource usage.
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Affiliation(s)
- Rita K Cydulka
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
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Abstract
Asthma is a chronic inflammatory illness with acute exacerbations, which often is encountered in the ED setting. Knowledge of the presentation and treatment of asthma is crucial for any physician treating patients with this disease. Beta-agonist, anticholinergic, and corticosteroid therapy continue to be the mainstay of emergency therapy despite advances in newer medications. Proper attention to long-term treatment of asthma and aggressive treatment of acute exacerbations should help reduce morbidity and mortality.
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Affiliation(s)
- Brian K Adams
- Department of Emergency Medicine, Case Western Reserve University School of Medicine and MetroHealth Medical Center, Room BG3-68, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA
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Wijnhoven HAH, Kriegsman DMW, Snoek FJ, Hesselink AE, de Haan M. Gender differences in health-related quality of life among asthma patients. J Asthma 2003; 40:189-99. [PMID: 12765321 DOI: 10.1081/jas-120017990] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify and explain differences between men and women with asthma regarding health-related quality of life (HRQoL). METHODS A cross-sectional study was performed among 967 asthma patients recruited from general practice. Data were collected by means of a pulmonary function assessment, a face-to-face interview, and a written questionnaire. RESULTS Women with asthma reported lower scores on HRQoL in the age groups 16-34 and 56-75 years but not in the age group 35-55 years. In all age groups, women reported more severe dyspnea but had higher levels of pulmonary function. The poorer HRQoL reported by women could be explained by a more severe dyspnea and a higher level of medication use in women. CONCLUSIONS The finding that women with asthma aged 16-34 and 56-75 years report poorer HRQoL than men is not due to a more severe disease state in terms of pulmonary obstruction but does seem to be related to a more severe subjective disease state in women than in men.
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Affiliation(s)
- Hanneke A H Wijnhoven
- Institute for Research in Extramural Medicine (E.M.G.O. Institute), Vrije Universiteit Medical Centre, Amsterdam, The Netherlands.
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Horak E, Grässl G, Skladal D, Ulmer H. Lung function and symptom perception in children with asthma and their parents. Pediatr Pulmonol 2003; 35:23-8. [PMID: 12461735 DOI: 10.1002/ppul.10218] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A large proportion of children with asthma are managed without recourse to specialized care, and treatment decisions are based solely on symptoms as reported by the children and their parents. We investigated 90 school-age children with the diagnosis of asthma and their accompanying parent to evaluate whether we can obtain better information by using three different means of asking for asthma symptoms: a questionnaire for children (QSR(children)), "smilies," and a visual analogue scale for children (VAS(children)). Furthermore, we analyzed the relationship between these symptom reports and lung function results. Finally, we attempted to determine whether performing a lung function test contributes relevant information toward improving asthma management. Multiple linear regression adjusted for age and gender showed a significant relationship between VAS for children and forced expiratory volume in 1 sec (FEV(1)) (P = 0.047) and maximal expiratory flow at 50% of forced vital capacity (MEF(50)) (P = 0.037). Neither age, gender, QSR for children, "smilies for children" nor all the parents' scores showed a significant association with lung function measurement in the regression model. Subgroup analysis with Spearman's rank correlation coefficients by age group revealed significant correlation in children <10 years between VAS for children, QSR for parents, smilies for parents, and the lung function parameters FEV(1), and MEF(50). Above age 10 years there was no correlation at all, with the accuracy correlation ranging from -0.04 to +0.21. Our data demonstrate that reported symptoms do not reliably correlate with lung function results in asthmatic children and the childrens' parents, and correlation is dependent on the instrument used for symptom evaluation. In children, the VAS, and in parents, the QSR were the most valuable means of obtaining best information on asthma symptoms. This underlines the importance of supplementing information on asthma symptoms with lung function measurements to more reliably assess the severity of asthma.
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Affiliation(s)
- Elisabeth Horak
- University Hospital for Children and Adolescents, University of Innsbruck, Innsbruck, Austria.
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