Insights into asthma prevalence in Oregon

Short and long term treatment of asthma with intravenous nutrients

Background

Asthma is an increasing problem in this country and others. Although medications for the treatment of asthma abound and are improving, there are inherent risks and side effects with all of them. Intravenous magnesium has been employed in the treatment of acute asthma, but its use has not become universal, nor has it been studied for the treatment of chronic asthma. It is known to be a safe drug with minimal side effects. In this study, the author investigates the use of magnesium and other nutrients in the treatment of both acute and chronic asthma.

Methods

In this non-blinded outcome study, following informed consent, forty-three (43) randomly selected volunteer patients with both acute and chronic asthma were treated with IV infusions described herein. All patients were observed with spirometry 10 minutes post-infusion; two sub-groups of patients were also observed after multiple infusions over a short period of time (less than one month) and a longer period of time (average 5.8 months). Pulmonary function was analyzed by spirometric testing with pre- and post-infusion spirometric measurements with the pre/post group. For longer term (Trend) patients, baseline spirometry measurements were compared to spirometry measurements after patients had received multiple infusions over a period of time. Eight (8) patients were measured for both pre/post and Trend data.

Results

The 38 pre-infusion/post-infusion patients with acute and chronic asthma demonstrated an overall average improvement (percentage improvement in percent predicted) of 45%. The 13 patients measured for improvement over time (Trend data, average duration 5.82 months), demonstrated an overall average improvement (percentage improvement in percent predicted) of 57%. Of the 13 patients in the multiple infusion group, 9 patients who received longer-term therapy (average duration of 12.58 months) for chronic asthma demonstrated an overall average improvement of 95% (percentage improvement in percent predicted).

Conclusion

The use of intravenous treatment with multiple nutrients, including magnesium, for acute and chronic asthma may be of considerable benefit. Pulmonary function improved progressively the longer patients received treatment.

Health and safety hazards in Northwest agriculture: setting an occupational research agenda

BACKGROUND

Agriculture is among the most hazardous occupations in the United States. Research can provide new insights about disease and injury and serve as the foundation for occupational health and safety policies. The determination of research priorities can be problematic. Public participation approaches offer opportunities to identify and integrate various perspectives.

METHODS

The agenda process was modeled on the NIOSH National Occupational Research Agenda. Center staff contacted representatives of producer groups, labor, health care, academia, and public agencies to participate in telephone interviews and a daylong workshop.

RESULTS

Twelve research priorities were identified: musculoskeletal disorders; respiratory disease; skin disease; traumatic injuries; chemical exposures; special populations at risk; social and economic foundations of workplace safety; risk communication barriers; diagnostic approaches; hazard control technology; intervention effectiveness; and surveillance research methods.

CONCLUSIONS

The agenda process engaged stakeholders in priority setting. The resulting document is a useful guide for occupational safety and health in agriculture.

A longitudinal study of the prevalence of asthma in a community population of school-age children

OBJECTIVE

Using a unique county-wide resource that links all health care providers' medical records to assess current and "ever" prevalence of physician-diagnosed asthma. To describe the age and sex rates and temporal trends in new asthma diagnoses and associations with race and socio-economic status.

STUDY DESIGN

A longitudinal retrospective evaluation of a population-based cohort of school children using linked medical and school records.

RESULTS

Overall, 17.6% of children in grades kindergarten through 12 had a physician diagnosis of asthma and 12.9% had an asthma-related visit within the past 2 years. An additional 19.7% had visits for reactive airway disease or recurrent wheezing or bronchospasm with no diagnosis of asthma. Children provided with free and reduced-cost lunches had lower cumulative and incident asthma rates from birth through their current school age. Race was not related to rates of physician-diagnosed asthma. There was a significant temporal increase in rates of new asthma diagnoses.

CONCLUSIONS

In this community, 1 in 3 children have had a physician-documented recurrent wheezing-type illness, and 1 in 6 were diagnosed with asthma. Diagnoses rates were directly related to socioeconomic status.

Autoimmune disease in first-degree relatives of patients with multiple sclerosis. A UK survey

Previous studies examining an association with other autoimmune diseases have suggested the existence of a generalized autoimmune diathesis in patients with multiple sclerosis. We investigated the prevalence of autoimmune disease in first-degree relatives of probands with multiple sclerosis using a case-control method. The results show an excess of autoimmune disease within these families, but no significant association was seen with non-autoimmune diseases. The higher risk in multiplex than simplex families suggests an effect of genetic loading. While the increase in risk applies to each autoimmune disease, autoimmune thyroid disease (and Graves' disease in particular) contributes disproportionately to the excess risk. There was no increase in autoimmune disease within patients with multiple sclerosis themselves when compared with the index controls or population data. We conclude that autoimmune disease is more common in first-degree relatives of patients with multiple sclerosis and hypothesize that common genetic susceptibility factors for autoimmunity co-exist with additional disease specific genetic or environmental factors, which determine clinical phenotype in the individual.

Epidemiology of asthma: the year in review

Asthma is a worldwide problem, with more than 17 million persons in the United States estimated to have asthma, and there is evidence that the prevalence is increasing. This article reviews the latest epidemiologic evidence for an increase in asthma prevalence and morbidity, and the evidence that environment plays a significant role in this disease. This review focuses on five specific areas: prevalence, incidence, natural history, environmental factors, and morbidity and mortality.

The natural history of asthma in adults: the problem of irreversibility

Asthma is common, affecting 5% to 10% of adults; asthma is progressive, leading to irreversible obstruction in 80% of elderly patients; and asthma is complex, often complicated by coexisting lung diseases. This loss of lung function results from 4 independent pathologic conditions: (1) airway remodeling, especially in the small airways, from the lymphocytic-eosinophilic inflammation that characterizes asthma; (2) bronchiectasis; (3) postinfectious pulmonary fibrosis; and (4) emphysema and chronic bronchitis from tobacco smoke. Deterioration in lung function develops faster in nonallergic patients with intrinsic asthma during the period shortly after onset of asthma and in older patients. About 4% of patients die of asthma, and most are elderly. Death most often results from complications of irreversible obstruction or cardiotoxicity of bronchodilator therapy. More research is needed to improve therapy for preventing remodeling of small airways, to confirm the frequency of bronchiectasis and postinfectious fibrosis and to determine their causes, and to develop diagnostic criteria to identify these complications. Meanwhile, clinicians treating adult asthmatic patients need to be aggressive in preventing the damage from cigarette smoke; in immunizing for influenza and pneumococcus infection and identifying and treating respiratory infections, particularly at times of acute exacerbations; in diagnosing and managing bronchiectasis; and in objectively confirming the efficacy of asthma therapy to prevent illness from overtreatment with glucocorticoids and bronchodilators.