Journal of Asthma (J Asthma )

Publisher: Taylor & Francis

Description

Providing an authoritative open forum on asthma and related conditions, this highly regarded journal brings timely reports of relevant advances in areas from molecular biology to government legislation to those involved in the research, clinical, and educational aspects of asthma management. MULTIDISCIPLINARY... The Journal discusses asthma from the perspectives of clinical immunology allergy pulmonary physiology psychosomatics pharmacology and other asthma-related clinical health trends PRACTICAL The Journal offers valuable guidelines for the basic understanding of emergency and long-term care environmental counseling preventative measures patient education and psychological support AND MUCH MORE!

  • Impact factor
    1.85
  • 5-year impact
    1.75
  • Cited half-life
    5.10
  • Immediacy index
    0.20
  • Eigenfactor
    0.01
  • Article influence
    0.52
  • Website
    Journal of Asthma website
  • Other titles
    Journal of asthma (Online), Journal of asthma
  • ISSN
    1532-4303
  • OCLC
    48876396
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Taylor & Francis

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    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 month embargo for STM, Behavioural Science and Public Health Journals
    • 18 month embargo for SSH journals
  • Conditions
    • Some individual journals may have policies prohibiting pre-print archiving
    • Pre-print on authors own website, Institutional or Subject Repository
    • Post-print on authors own website, Institutional or Subject Repository
    • Publisher's version/PDF cannot be used
    • On a non-profit server
    • Published source must be acknowledged
    • Must link to publisher version
    • Set statements to accompany deposits (see policy)
    • Publisher will deposit to PMC on behalf of NIH authors.
    • STM: Science, Technology and Medicine
    • SSH: Social Science and Humanities
    • 'Taylor & Francis (Psychology Press)' is an imprint of 'Taylor & Francis'
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Information on sCD200 (OX-2), 25-Hydroxyvitamin-D(25(OH)D), homocysteine (hcy), eosinophil cationic peptid (ECP), d-dimer (DD), CXCL8, fractional exhale nitric oxide concentrations (FeNO) status all together among patients with allergy in mediterranean region in comparison of climatic conditions have not been well established yet. Blood samples were taken on May and June during the highest air pollination. Hence, this study was undertaken to compare these serum biomolecules’ levels in allergic patients and matched controls, to evaluate disease characteristics. The study participants (n=129) included 25 healthy individuals (controls) and 104 allergic patients. Consecutive patients with allergic disease (Group II,III,IV,V) above the age of 18 years, managed. In the control group there was a significant positive correlation between ECP and BMI. Positive correlations between ECP, IgE and OX-2 were detected in group IV. For group V patients, positive correlations between age and IgE and between BMI and 25(OH)D were also detected. Statistical analysis showed positive correlation between basophil, eosinophil and OX-2 and negative correlation between ECP and age in group V. In conclusion, these data suggest that the measurement of hcy, 25(OH)D and OX-2 might be a useful biomarker to get additional information to conventional clinical measures.
    Journal of Asthma 08/2014;
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    ABSTRACT: Abstract Background. There is a critical need for additional validation studies of questionnaires designed to assess the level of control of asthma in pediatric patients. Objective. To validate the Spanish version of the Childhood Asthma Control Test (cACT) in children aged between 4 and 11 years with physician-diagnosed asthma Methods. In a prospective cohort validation study, asthmatic children aged between 4 and 11 years and their parents, attended both a baseline and a follow-up visit 2 to 6 weeks later. In these two visits, they completed the information required to assess the criterion validity, construct validity, test-retest reliability, sensitivity to change, internal consistency, and usability of the cACT. Results. At baseline, cACT scores were significantly different between patients with controlled, partly controlled, and uncontrolled asthma [24.0 (23.0-26.0), 18.0 (18.0-22.0), and 17.5 (13.0-20.0) respectively, p<0.001], and also between patients for whom this visit resulted in a step-up, no change, or step-down in therapy [18.0 (15.0-21.0), 24.0 (23.0-24.0), and 26.0 (23.5-26.0) respectively, p<0.001]. The score of the cACT correlated positively and significantly with the score of the Pediatric Asthma Caregivers Quality of life Questionnaire - PACQLQ (Spearman's rho = 0.50, p<0.001).The intraclass correlation coefficient of the measurements in patients with no change in clinical status was 0.849 (95% CI: 0.752-0.908). There were statistical significant differences between baseline and follow-up cACT scores in patients with an improvement in clinical status [19.0 (18.0-22.0) vs. 24.5 (24.0-25.0), p<0.001]. Cronbach's α was 0.8276 for the questionnaire as a whole. Conclusion. The Spanish version of the cACT has adequate criterion validity, adequate construct validity, adequate sensitivity to change, good internal consistency, good test-retest reliability, and excellent usability when administered to asthmatic children aged between 4 and 11 years.
    Journal of Asthma 05/2014;
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    ABSTRACT: Abstract Objective: This study uses 32 years of longitudinal job history to analyze the long-term effect of exposure to specific workplace conditions on the risk of contracting asthma or chronic lung disease later in life. Our approach allows for the estimation of occupational respiratory risks even in the absence of direct environmental monitoring. Methods: We employ a novel methodology utilizing data from the National Longitudinal Survey of Youth 1979 (NLSY79), and ratings of job exposures from the Occupational Information Network (O*NET), which are based on 70 years of empirical data compiled by the U.S. Department of Labor. A series of multivariable logistic regression analyses are performed to determine how long-term exposure to a particular occupational O*NET indicator (e.g., working in extremely hot or cold environment) is related to asthma and COPD risk. Results: The risk of contracting COPD was significantly associated with long-term work in very hot or cold temperatures (OR=1.50, CI:1.07-2.10), performing physically demanding activities (OR=1.65, CI:1.20-2.28), working outdoors exposed to weather (OR=1.45, CI:1.06-1.99), and workplace exposure to contaminants (OR=1.42, CI:1.05-1.96). In general, the effects of exposure were greater for COPD than for asthma. With respect to contracting asthma, only exposure to work in very hot or cold temperatures (OR=1.35, CI:1.08-1.70) and performing physically demanding activities (OR=1.23, CI:1.00-1.52) were statistically significant. Conclusions: Use of O*NET job descriptors as surrogate measures of workplace exposures can provide a useful way of analyzing the risk of occupationally-related respiratory disease in situations where direct exposure measurement is not feasible.
    Journal of Asthma 05/2014;
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    ABSTRACT: Abstract Introduction: The Nijmegen Questionnaire-NQ has previously been used for screening the hyperventilation syndrome (HVS) in asthmatics. However, no validity study has been reported so far. Objective: To examine the validity and reliability of the NQ in asthma patients and identify the prevalence of HVS. Methods: The NQ (n = 162) was examined for translation, construct, cross-sectional and discriminant validity as well as for internal consistency and test-retest reliability. Results: Principal component analysis and exploratory factor analysis revealed a single factor solution with 11 items and 58.6% of explained variability. These 11 NQ items showed high internal consistency (Cronbach alpha = 0.92) and test-retest reliability (IR = 0.98). Higher NQ scores were found in the following subgroups: women vs. men (p < 0.01); participants with moderate vs. mild asthma (p < 0.001) or uncontrolled vs. controlled asthma (p < 0.001), and participants with breath-hold time-BHT <30 vs. ≥30 sec (p < 0.01) or end-tidal CO2-ETCO2 ≤35 vs. >35 mmHg (p < 0.001). A cut-off score of > 17 discriminated the participants with regard to the presence of HVS. The NQ showed 92.73% sensitivity and 91.59% specificity. The total NQ score was found significantly correlated with ETCO2 (r = -0.68), RR (r = 0.66) and BHT (r = -0.65). The prevalence of HVS was found 34%. Conclusion: The NQ is a valid and reliable questionnaire for screening HVS in patients with stable mild to moderate asthma.
    Journal of Asthma 05/2014;
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    ABSTRACT: Abstract Non-uniform distribution of inspired gas within the lung, termed ventilation heterogeneity, is present in patients with even mild asthma. Current evidence strongly supports ventilation heterogeneity as a fundamental derangement of lung function in asthma that contributes per se to hypoxemia and airway hyperresponsiveness. An extreme example of ventilation heterogeneity is the identification by hyperpolarized gas MRI of lung regions with no ventilation, termed filling defects. Lung filling defects in patients with asthma can persist over time, increase in size with methacholine-induced bronchospasm, and more likely are caused by obstruction of the peripheral and not the proximal airways. Ventilation heterogeneity can be quantified in the conducting and acinar lung zones with the multiple gas washout method, and in the acinar zone does not fully resolve following bronchodilator treatment in patients with asthma. In prospective studies the degree of ventilation heterogeneity at baseline predicts airway hyperresponsiveness and response to corticosteroid dose titration. An important unanswered question is the relationship of airways inflammation to ventilation heterogeneity. In consideration of the importance of ventilation heterogeneity in its pathobiology, asthma is more a focal disorder with regional pathology akin to regional ileitis and not the generalized disorder of the airways as it has been viewed in the past.
    Journal of Asthma 05/2014;
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    ABSTRACT: Abstract Objective: Regular physical activity (PA) is an important component of pediatric asthma management. No studies have examined how in-school asthma management influences PA from children's perspectives. The aim of this study was to explore children's perceptions of the impact of in-school asthma management on PA. Methods: Qualitative interviews with 23 inner-city minority children with asthma (ages 8-10 yrs; 12 girls, 11 boys) were conducted in 10 Bronx, New York elementary schools. Sampling continued until saturation was reached. Interviews were recorded, transcribed and independently coded for common themes. Results: Interviews produced five themes representing students' perceptions about 1) asthma symptoms during in-school PA; 2) methods to control asthma episodes during school PA; 3) methods to prevent asthma episodes during school; 4) limited accessibility of asthma medications; and 5) negative feelings about asthma and medication use. The majority of students experienced asthma symptoms while performing PA during school. Primary methods of managing asthma symptoms were sitting out during activity, drinking water, and visiting the nurse. Students lacked awareness or adherence to action plans to prevent or control asthma. Students reported limited access to medication during school and feelings of embarrassment and/or concerns of teasing when medicating in front of others. Conclusions: Our results indicate inappropriate in-school management of asthma symptoms, poor asthma control, lack of accessible medication, and stigma around publicly using asthma medication. Thus, students often missed or were withheld from PA. Interventions to improve in-school asthma care must consider ways to address these issues.
    Journal of Asthma 05/2014;
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    ABSTRACT: Abstract Background Bronchial hyperresponsiveness in a military population has been evaluated by direct and indirect challenge methods. We hypothesized that negative methacholine challenge testing was not sufficient to exclude significant bronchial hyperresponsiveness in a symptomatic military population with exertional dyspnea. The purpose of our study was to identify bronchial hyperresponsiveness in symptomatic military recruits and active duty personnel with normal baseline spirometry and negative pharmacologic bronchoprovocation testing. Methods We performed a retrospective single center electronic chart review of symptomatic service members with a negative methacholine challenge test (MCT) who completed a subsequent exercise challenge test (ECT). Results Exercise challenge testing was positive in 45 (26.4%) of 171 subjects (98 recruits). Subjects with a positive ECT had lower baseline FEV1, FVC, and FEV1/FVC than those with a negative ECT, and these differences were statistically significant. The mean drop in FEV1 with exercise challenge positive patients was 17.9 + 9.2%, and the mean drop in FEV1 with methacholine challenge testing was significantly greater in exercise challenge positive patients (-9.5 + 5.5 vs. -7.6 +5.5, p = 0.042). Exercise-induced bronchoconstriction (EIB) was observed in 41% of all recruits who subsequently did not complete training. Only 1 recruit subject of 28 with EIB completed training. Conclusions Methacholine challenge is an inadequate screening test to detect bronchial hyperresponsiveness in a symptomatic military population. In military recruits EIB is associated with training failure.
    Journal of Asthma 05/2014;
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    ABSTRACT: Abstract Objective: To investigate the function of interleukin-33 (IL-33) in the asthmatic airway remodeling and the relationship between IL-33 and asthma severity. Methods: IL-33 levels, sputum eosinophils percentage (EOS%), pulmonary function and total immunoglobulin (IgE) were measured for 45 patients with asthma and 40 non-allergic controls. Asthma severity was assessed. The expressions of IL-33 and reticular basement membrane (RBM) on bronchial biopsy specimens from 8 asthma patients and 8 non-allergic controls were observed after hematoxylin-eosin staining(HE) and immunohistochemical staining. In vitro experiments, real-time polymerase chain reactions and western blotting analysis were used to identify the specific effects of IL-33 administration. Results: Serum IL-33 levels in patients with asthma were higher than those in non-allergic controls. Moreover, in asthmatic patients, serum IL-33 levels were negatively correlated to forced expiratory volume in one second (FEV1, % predicted), and positively correlated to asthma severity. Increased expression of IL-33 and RBM thickening were observed on bronchial biopsy specimens obtained from patients with asthma. Serum IL-33 levels were positively correlated to basement membrane thickness. The production of fibronectin1 and type I collagen in human lung fibroblasts (HLF-1) increased at 24 h after IL-33 treatment in vitro. Pre-treatment with anti-ST2 antibody or fluticasone propionate (FP) suppressed the production of fibronectin1 and types I collagen induced by IL-33. Conclusions: IL-33 is a marker of asthma severity, and may contribute to airway remodeling in asthma by acting on human lung fibroblasts.
    Journal of Asthma 05/2014;
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    ABSTRACT: Abstract Objective: Asthma is an inflammatory airway disease, characterized by airway eosinophilia, in which CCL11 (eotaxin) plays a crucial role. The aim of study is to determine the elevation of CCL11 levels in bronchoalveolar lavage fluid (BALF), blood, exhaled breath condensate (EBC) and sputum in asthma patients and to identify which medium yields the most significant change in CCL11 level. Methods: The databases of PubMed, Embase and Cochrane Centre Register of Controlled Trials were systematically searched from inception to September 2013. Controlled clinical trials that focused on CCL11 concentrations in asthma patients and controls, and their correlations with other asthma indicators were obtained. Data were analysed using Stata 12.0. Results: Thirty studies were included in this investigation. CCL11 levels in blood, EBC and sputum were significantly higher in asthma patients than in healthy subjects. Sputum CCL11 concentrations were significantly elevated in unstable asthma patients versus stable asthma patients and in uncontrolled asthma patients versus partially controlled asthma patients. CCL11 levels in sputum and blood were negatively correlated with the lung function as measured by FEV1%predicted, and were positively correlated with BALF, EBC and sputum eosinophil counts. Similarly, CCL11 concentrations were positively correlated with eosinophil cationic protein in EBC, blood and sputum as well as with interleukin-5 in sputum and fractional exhaled nitric oxide in EBC. Steroid treatment had no significant effect on CCL11 levels. Conclusions: CCL11 is a potentially useful biomarker for the diagnosis and assessment of asthma severity and control, especially in sputum. CCL11 is crucial in eosinophil chemoattraction and activation in asthma pathogenesis. Further studies using anti-CCL11 approaches are needed to confirm a role for CCL11 in asthma pathogenesis particularly in patients with more severe disease.
    Journal of Asthma 05/2014;
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    ABSTRACT: Abstract Introduction: Reduced vitamin-D levels in patients with asthma has been associated with impaired lung function, increased airway hyper-responsiveness and reduced glucocorticoid responsiveness. Nationwide studies revealed a considerable prevalence of vitamin-D deficiency (VDD) in Jordanian women. Objective: A case-control study was conducted to determine the relationship between serum vitamin A and D levels and asthma among women in North of Jordan. Methods: 68 asthmatics, age range between 14-65 years and 77 healthy women, age range between 19-51 years were enrolled. Asthma severity was classified using Global Initiative for Asthma (GINA) guidelines and Asthma Control Test (ACT) questionnaire. Serum vitamin-A and 25-hydroxyvitamin-D (25(OH)D3) levels were measured using high performance liquid chromatography (HPLC) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods, respectively. Results: The prevalence of VDD (<15 ng/ml) was higher but not statistically significant for women with asthma compared to controls (95.6% vs. 87.0%; p=0.070). Severity of VDD correlated with number of asthma medications (p=0.020). 25(OH)-D3 serum levels directly correlated with asthma control level using ACT score (p=0.012) and GINA classification (p=0.046). After adjusting for age, the odds of having VDD for asthmatic women were 35.9 times higher than that for women with no asthma. There was no difference in serum vitamin-A level between healthy and asthmatic women (p=0.214) and none had vitamin-A deficiency (<200 µg/dl). Conclusions: VDD is prevalent in women with asthma in northern Jordan. The severity of VDD correlated with poor asthma control and need for more medications to control asthma. There was no association between vitamin-A and asthma.
    Journal of Asthma 04/2014;
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    ABSTRACT: Abstract Background: Vaccination against influenza A(H1N1)pdm09 in Japan started in October 2009. Children with asthma are considered a high-risk group and are recommended to preferentially receive the vaccine. Objective: To identify the clinical effects of vaccination in Japanese children with and without asthma. Methods: We conducted a cross-sectional, questionnaire-based survey to compare vaccination rates, vaccine effectiveness against physician-diagnosed influenza A infection (PDIA), and consecutive asthma exacerbations between children with and without asthma. Results: Of the 460 children included in this study, those with asthma had higher vaccination rates (46.5%, 67/144) than those without asthma (30.4%, 96/316). Influenza A infections were diagnosed in 28 of 163 vaccinated children (17.2%) compared to 164 of 297 unvaccinated children (55.2%, p < 0.001). Comparison of positive influenza diagnosis rates between vaccinated and unvaccinated children with and without asthma showed that unvaccinated children with asthma had an elevated odds ratio (13.235; 95% confidence interval [CI], 5.564-32.134) and that treatment for asthma exacerbations was needed in a larger proportion of unvaccinated children. Vaccine effectiveness against PDIA was 87% (95% CI, 78-93%) overall, 92% (95% CI, 81-96%) in children with asthma and 81% (95% CI, 63-91%) in children without asthma, respectively. Conclusions: The administration of an inactivated, split-virus, non-adjuvanted monovalent A(H1N1)pdm09 vaccine during the pandemic period reduced the number of physician-diagnosed influenza A infections and asthma exacerbations in children with asthma. Therefore, we strongly recommend that high-risk children with a history of asthma receive vaccines during pandemics.
    Journal of Asthma 04/2014;
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    ABSTRACT: Abstract Objective. The evaluation sought to determine if a comprehensive, school-based asthma management program in a small, rural school district helped students improve asthma control. Methods. To determine if students in the asthma program demonstrated better asthma control than students in a comparison school district, the evaluation team used a quasi-experimental, cross-sectional design and administered questionnaires assessing asthma control (which included FEV1 measurement) to 456 students with asthma in the intervention and comparison districts. Data were analyzed for differences in asthma control between students in the two districts. To determine if students in the intervention experienced increased asthma control between baseline and follow-up, the evaluation team used a one-group retrospective design. Program records for 323 students were analyzed for differences in percent of predicted forced expiratory volume in one second (FEV1) between baseline and follow-up. Results. Students with asthma in the intervention district exhibited significantly better asthma control than students with asthma in the comparison district. Percent of predicted FEV1 did not change significantly between baseline and follow-up for the intervention participants; however, post hoc analyses revealed students with poorly-controlled asthma at baseline had significantly higher FEV1 scores at follow-up, and students with well-controlled asthma at baseline had significantly lower FEV1 scores at follow-up. Conclusions. Findings suggest the comprehensive school-based program led to improvements in asthma control for students with poorly controlled asthma at baseline, and school-based programs need mechanisms for tracking students with initially well-controlled asthma in order to ensure they maintain control.
    Journal of Asthma 04/2014;
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    ABSTRACT: Abstract Objective. To explore, in depth, the literature for evidence supporting asthma interventions delivered within primary schools and to identify any 'gaps' in this research area. Methods. A literature search using electronic search engines (i.e., Medline, PubMed, Education Resources Information Center (ERIC), International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Informit) and the search terms "asthma," "asthma intervention," and "school based asthma education program" (and derivatives of these keywords) was conducted. Results. Twenty-three articles met the inclusion criteria; of these eight were Randomised Controlled Trials. There was much variety in the type, content, delivery and outcome measures in these 23 studies. The most common intervention type was asthma education delivery. Most studies demonstrated improvement in clinical and humanistic markers, for example asthma symptoms medication use (decrease in reliever medication use or decrease in the need for rescue oral steroid), inhaler use technique and spacer use competency, lung function and quality of life. Relatively few studies explored the effect of the intervention on academic outcomes. Most studies did not report on the sustainability or cost effectiveness of the intervention tested. Another drawback in the literature was the lack of details about the intervention and inconsistency in instruments selected for measuring outcomes. Conclusion. School-based asthma interventions regardless of their heterogeneity have positive clinical, humanistic, health economical and academic outcomes.
    Journal of Asthma 04/2014;
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    ABSTRACT: Abstract Background. Monitoring peak expiratory flow (PEF) values is one option as part of asthma action plans per national guidelines. PEF assessment is also recommended in emergency department and hospitalized patients. Incorrect use of peak flow meters (PFM) has obvious implications for appropriate decisions by patients and clinicians. Methods. We searched the English literature via PubMed and SCOPUS using the following search terms: PEF maneuver; incorrect use of PFM. When pertinent articles were found, we assessed publications cited in those papers. All studies related to incorrect use of PFM in patients with asthma were included. Results. Nine studies have reported errors in performing the PEF maneuver, including 3 pediatric and 6 adult studies. Errors were found at most steps of the maneuver, and inability to perform all steps correctly was common in these investigations. Examples of errors included failure to inhale fully or give maximum effort on exhalation, accelerating air with the tongue and buccal musculature, and performing only one attempt versus three. Gender differences in correct use of PFM are suggested by 3 adult studies. One study described falsifying PEF values by manipulating the PFM indicator, and another investigation assessed the PEF maneuver in 2 positions in bed versus the correct posture of standing. Conclusion. Many pediatric and adult patients do not use PFM correctly. Clinicians should regularly observe patients use PFM to detect errors and help ensure correct use and accurate PEF measurements.
    Journal of Asthma 04/2014;
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    ABSTRACT: Abstract Objective: Increases in asthma and obesity over the past three decades have led to speculation about a causal link between the two diseases. However, investigations of the relationship between body mass index (BMI) and fractional exhaled nitric oxide (FeNO) - a marker of eosinophilic airway inflammation - have produced mixed results. The purpose of this study was to evaluate the relationship between BMI, asthma and FeNO in a sample of U.S. adults using data from the National Health and Nutrition Examination Surveys (NHANES) for 2007-2010. Methods: We assessed the relationship between FeNO and BMI in subjects with and without asthma using categorical and continuous models for BMI. All models controlled for age, gender, ethnicity, household income-to-poverty ratio, atopy and current smoking. Results: Adjusted asthma prevalence was positively associated with BMI, and subjects with asthma had higher adjusted FeNO levels than subjects without asthma. However no association between FeNO and BMI was observed in either those with (̂β = 0.002, p = 0.74) or without (̂β = 0.0014, p = 0.51) asthma after adjusting for covariates. Conclusions: Our results suggest that in the U.S. adult population, BMI is not associated with eosinophilic airway inflammation.
    Journal of Asthma 04/2014;
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    ABSTRACT: Abstract Objective: Asthma is a common chronic disease with various phenotypes and therapeutic responses. Unlike other diseases, current anti-inflammatory treatment with corticosteroids does not include any reference to biological measures which may vary among different asthma phenotypes. Morbidity from uncontrolled asthma suggests a need for specific targeted treatment approaches such as biologic medications. In half of asthmatics, chronic airway inflammation may be driven by T helper (Th)-2 cells, which release pro-inflammatory cytokines, such as interleukin (IL)-4, IL-5 and IL-13, contributing to eosinophil inflammation and IgE production. Earlier studies of cytokine-targeted biologic therapy on non-phenotyped asthma patients were generally not clinically effective. Methods: Literature published from 1958-2013 was identified through PubMed using the search terms which included asthma and therapy. A total of 32 studies were reviewed covering both pediatric and adult asthmatics and includeFd double-blind randomized placebo-controlled trials testing efficacy of biologic agents to treat asthma. Results: More recent approaches to personalized medicine with expression profiling studies, genetic analysis and clinical biomarkers of Th2 inflammation have allowed identification of asthma phenotypes including a Th2 "high" phenotype. Studies targeting IgE, IL-5, IL-13 and the IL4 receptor alpha chain have shown some efficacy in phenotyped patients. For those without evidence of Th2 inflammation, no specific therapies have been identified. Conclusions: In recent years, the identification of Type-2 cytokine "high" asthma in numerous studies has predicted the clinical response to the Th2 associated therapies. It is not yet clear whether all Type 2 high asthma will respond similarly to IL-4, 5 and 13 approaches.
    Journal of Asthma 04/2014;
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    ABSTRACT: Abstract OBJECTIVE: Asthma, a serious chronic lung disease affecting approximately 26 million Americans, remains clinical and economic burdens on the healthcare system. Although associations between uncontrolled asthma and poor health outcomes is known, the extent of this impact of uncontrolled asthma on economic outcomes in the United States (US) is unknown. We sought to determine the relationship between asthma, asthma control, and economic outcomes in the US. The 2008 to 2010 Medical Expenditure Panel Surveys (MEPS) were used to estimate the impact of uncontrolled asthma (asthma-related emergency department [ED] visit, use of >3 canisters of quick-relief inhaler in past 3 months or asthma attack in past 12 months) on medical expenditures, utilization, and productivity. Estimates were generated using multivariate regression controlling for sociodemographics and comorbidity. Medical expenditures attributable to asthma were up to $4423 greater for those with markers of uncontrolled asthma compared with those who did not have asthma. Frequency of hospital discharges were up to 4.6-fold greater for those with uncontrolled asthma than those without asthma (P < .01), while all others with asthma did not have significantly more discharges. ED visits were up to 1.8-fold greater for those with uncontrolled asthma compared with those without asthma (P < .01). Productivity was significantly (P < .01) decreased (more likely to be unemployed, more days absent from work, more activity limitations) for those with uncontrolled asthma. In recent national data, individuals with asthma and markers of uncontrolled asthma had higher medical expenditures, greater utilization, and decreased productivity.
    Journal of Asthma 04/2014;
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    ABSTRACT: Abstract Objective: Inhaled corticosteroids (ICS) are underutilized among persistent asthmatics. Because of low outpatient follow-up rates after Emergency Department (ED) visits, children are unlikely to be prescribed ICS by their primary care physician after an acute exacerbation. ED physicians have the opportunity to contribute to the delivery of preventive care in the acute care setting. Our objective was to evaluate if quality improvement (QI) methods could improve the rate of ICS initiation at ED discharge. Methods: Within the Pediatric ED (PED) at a tertiary children's hospital, QI methods were used to encourage ICS prescribing at the time of ED discharge. Interventions focused on education at both the attending physician and resident level, process improvements designed to streamline prescribing, and directed provider feedback. This involved multiple plan-do-study-act cycles. Medical records of eligible patients were reviewed monthly to determine ICS prescribing rates. The effect of our interventions on prescribing rate was tracked over time using a run chart. Results: Following our interventions, the ICS initiation rate for children seen in and discharged home from the ED with an acute asthma exacerbation increased from a baseline median rate of 11.25% to a median rate of 79% representing a significant, non-random improvement. The ICS initiation rate has been sustained for 8 months over our goal rate of 75%. Conclusions: This study demonstrates that QI methods can be used to increase inhaled corticosteroid initiation rate at the time of ED discharge and, thus, improve the delivery of preventive asthma care in the acute care setting.
    Journal of Asthma 04/2014;
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    ABSTRACT: Abstract Objective Personality traits have been found to be associated with the management of chronic disease, however there is limited research on these relationships with respect to asthma. Asthma management and asthma control are often suboptimal, representing a barrier to patients achieving good health outcomes. This explorative study aimed to investigate the relationship between correlates of asthma management and personality traits. Methods Participants completed a postal survey comprising validated self-report questionnaires measuring personality traits (neuroticism, extraversion, openness to experiences, agreeableness, conscientiousness), asthma medication adherence, asthma control and perceived control of asthma. Relationships between asthma management factors and personality traits were examined using correlations and regression procedures. Results A total of 77 surveys were returned from 94 enrolled participants. Significant relationships were found between personality traits and (i) adherence to asthma medications, and (ii) perceived control of asthma. Participants who scored high on the conscientiousness dimension of personality demonstrated higher adherence to their asthma medications. Women who scored low on the agreeableness dimension of personality and high on the neuroticism dimension had significantly lower perceived confidence and ability to manage their asthma. No statistically significant associations were found between asthma control and personality traits. Conclusions Three of the five personality traits were found to be related to asthma management. Future research into the role of personality traits and asthma management will assist in the appropriate tailoring of interventional strategies to optimize the health of patients with asthma.
    Journal of Asthma 04/2014;

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