Jon G Ayres
Research interests
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InterestsAir pollution and health; respiratory disease and environmental and occupational exposures; COPD
Publications
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5.53Impact points
Reduced lung function due to biomass smoke exposure in young adults in rural Nepal.
The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 05/2012;
This study aimed to assess the effects of biomass smoke exposure on lung function in a Nepalese population addressing some of these methodological issues from previous studies.We carried out a cross-sectional study of adults in a population exposed to biomass smoke and a non-exposed population in Ne... [more] This study aimed to assess the effects of biomass smoke exposure on lung function in a Nepalese population addressing some of these methodological issues from previous studies.We carried out a cross-sectional study of adults in a population exposed to biomass smoke and a non-exposed population in Nepal. Questionnaire and lung function data were acquired along with direct measures of indoor and outdoor air quality.Ventilatory function (FEV1, FVC, FEF25-75) was significantly reduced in the population using biomass across all age groups compared to the non-biomass using population, even in the youngest (16-25) age group [mean FEV1 (95% CI) 2.65 (2.57-2.73) vs. 2.83 (2.74-2.91), p=0.004]. Airflow obstruction was twice as common among biomass users compared to liquefied petroleum gas users (8.1% vs. 3.6%, p<0.001) with similar patterns for males (7.4% vs. 3.3%, p=0.022) and females (10.8% vs. 3.8%, p<0.001) based on lower limit of normal. Smoking was a major risk factor for airflow obstruction but biomass exposure added to the risk.Exposure to biomass smoke is associated with deficits in lung function, an effect which can be detected as early as late teenage years. Biomass smoke and cigarette smoke have additive adverse effects on airflow obstruction in this setting.
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5.53Impact points
Ten principles for clean air.
The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 03/2012; 39(3):525-8.
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5.53Impact points
Indoor air pollution and the lung in low and medium income countries.
The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 02/2012;
Over half the world's population, most from developing countries, use solid fuel for domestic purposes and are exposed to very high concentrations of harmful air pollutants with potential health effects such as respiratory problems, cardiovascular, infant mortality and ocular problems. The evide... [more] Over half the world's population, most from developing countries, use solid fuel for domestic purposes and are exposed to very high concentrations of harmful air pollutants with potential health effects such as respiratory problems, cardiovascular, infant mortality and ocular problems. The evidence also suggests that, although the total percentage of people using solid fuel is coming down, the absolute number is currently increasing. Exposure to smoke from solid fuel burning increases the risk of chronic obstructive pulmonary diseases (COPD) and lung cancer in adults and acute lower respiratory tract infection/pneumonia in children. Despite heterogeneity among different studies the association between COPD and exposure to smoke produced by burning different types of solid fuel is consistent. However, there is strong evidence that while coal burning is a risk for lung cancer, exposure to other biomass fuel smoke is less so. There is some evidence that reduction of smoke exposure using improve cook stoves reduces the risk of COPD and possibly acute lower respiratory infection in children so approaches to reduce biomass smoke exposure are likely to result in reductions in the global burden of respiratory disease.
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2.89Impact points
Contribution of solid fuel, gas combustion, or tobacco smoke to indoor air pollutant concentrations in Irish and Scottish homes.
Indoor air. 10/2011;
Abstract There are limited data describing pollutant levels inside homes that burn solid fuel within developed country settings with most studies describing test conditions or the effect of interventions. This study recruited homes in Ireland and Scotland where open combustion processes take place.... [more] Abstract There are limited data describing pollutant levels inside homes that burn solid fuel within developed country settings with most studies describing test conditions or the effect of interventions. This study recruited homes in Ireland and Scotland where open combustion processes take place. Open combustion was classified as coal, peat, or wood fuel burning, use of a gas cooker or stove, or where there is at least one resident smoker. Twenty-four-hour data on airborne concentrations of particulate matter <2.5 μm in size (PM(2.5) ), carbon monoxide (CO), endotoxin in inhalable dust and carbon dioxide (CO(2) ), together with 2-3 week averaged concentrations of nitrogen dioxide (NO(2) ) were collected in 100 houses during the winter and spring of 2009-2010. The geometric mean of the 24-h time-weighted-average (TWA) PM(2.5) concentration was highest in homes with resident smokers (99 μg/m(3) - much higher than the WHO 24-h guidance value of 25 μg/m(3) ). Lower geometric mean 24-h TWA levels were found in homes that burned coal (7 μg/m(3) ) or wood (6 μg/m(3) ) and in homes with gas cookers (7 μg/m(3) ). In peat-burning homes, the average 24-h PM(2.5) level recorded was 11 μg/m(3) . Airborne endotoxin, CO, CO(2) , and NO(2) concentrations were generally within indoor air quality guidance levels. PRACTICAL IMPLICATIONS: Little is known about indoor air quality (IAQ) in homes that burn solid or fossil-derived fuels in economically developed countries. Recent legislative changes have moved to improve IAQ at work and in enclosed public places, but there remains a real need to begin the process of quantifying the health burden that arises from indoor air pollution within domestic environments. This study demonstrates that homes in Scotland and Ireland that burn solid fuels or gas for heating and cooking have concentrations of air pollutants generally within guideline levels. Homes where combustion of cigarettes takes place have much poorer air quality.
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2.22Impact points
A survey of schoolchildren's exposure to secondhand smoke in Malaysia.
BMC public health. 08/2011; 11:634.
There is a lack of data describing the exposure of Malaysian schoolchildren to Secondhand Smoke (SHS). The aim of this study is to identify factors influencing schoolchildren's exposures to SHS in Malaysia. This cross-sectional study was carried out to measure salivary cotinine concentrations am... [more] There is a lack of data describing the exposure of Malaysian schoolchildren to Secondhand Smoke (SHS). The aim of this study is to identify factors influencing schoolchildren's exposures to SHS in Malaysia. This cross-sectional study was carried out to measure salivary cotinine concentrations among 1064 schoolchildren (10-11 years) attending 24 schools in Malaysia following recent partial smoke-free restrictions. Parents completed questionnaires and schoolchildren provided saliva samples for cotinine assay. The geometric mean (GM) salivary cotinine concentrations for 947 non-smoking schoolchildren stratified by household residents' smoking behaviour were: for children living with non-smoking parents 0.32 ng/ml (95% CI 0.28-0.37) (n = 446); for children living with a smoker father 0.65 ng/ml (95% CI 0.57-0.72) (n = 432); for children living with two smoking parents 1.12 ng/ml (95% CI 0.29-4.40) (n = 3); for children who live with an extended family member who smokes 0.62 ng/ml (95% CI 0.42-0.89) (n = 33) and for children living with two smokers (father and extended family member) 0.71 ng/ml (95% CI 0.40-0.97) (n = 44). Parental-reported SHS exposures showed poor agreement with children's self-reported SHS exposures. Multiple linear regression demonstrated that cotinine levels were positively associated with living with one or more smokers, urban residence, occupation of father (Armed forces), parental-reported exposure to SHS and education of the father (Diploma/Technical certificate). This is the first study to characterise exposures to SHS using salivary cotinine concentrations among schoolchildren in Malaysia and also the first study documenting SHS exposure using salivary cotinine as a biomarker in a South-East Asian population of schoolchildren. Compared to other populations of similarly aged schoolchildren, Malaysian children have higher salivary cotinine concentrations. The partial nature of smoke-free restrictions in Malaysia is likely to contribute to these findings. Enforcement of existing legislation to reduce exposure in public place settings and interventions to reduce exposure at home, especially to implement effective home smoking restriction practices are required.
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3.73Impact points
The effect of inspired air conditions on exercise-induced bronchoconstriction and urinary CC16 levels in athletes.
Journal of applied physiology (Bethesda, Md. : 1985). 07/2011;
Injury to the airway epithelium has been proposed as a key susceptibility factor for exercise-induced bronchoconstriction (EIB). Our goals were to establish whether airway epithelial cell injury occurs during EIB in athletes and whether inhalation of warm humid air inhibits this injury. Twenty one y... [more] Injury to the airway epithelium has been proposed as a key susceptibility factor for exercise-induced bronchoconstriction (EIB). Our goals were to establish whether airway epithelial cell injury occurs during EIB in athletes and whether inhalation of warm humid air inhibits this injury. Twenty one young male athletes (ten with a history of EIB) performed two 8 min exercise tests near maximal aerobic capacity in cold dry (4°C, 37% relative humidity) and warm humid air (25°C, 94% relative humidity) on separate days. Post-exercise changes in urinary CC16 were used as a biomarker of airway epithelial cell perturbation and injury. Bronchoconstriction occurred in eight athletes in the cold dry environment and was completely blocked by inhalation of warm humid air (maximal fall in forced expiratory volume in one sec: 18.1 ± 2.1 (SD) % in cold dry vs 1.7 ± 0.8 % warm humid air, P<0.01). Exercise caused an increase in urinary excretion of CC16 in all subjects (P<0.001), but this rise in CC16 was blunted following inhalation of warm humid air (median CC16 increase pre- to post-challenge in athletes with EIB: cold dry 1.91 ng.μmol(-1) vs warm humid 0.35 ng.μmol(-1), P=0.017; athletes without EIB: cold dry 1.68 ng.μmol(-1) vs warm humid 0.48 ng.μmol(-1), P=0.002). The results indicate that exercise hyperpnea transiently disrupts the airway epithelium of all athletes (not only in those with EIB) and that inhalation of warm moist air limits airway epithelial cell perturbation and injury.
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10.69Impact points
Vocal cord dysfunction and severe asthma: considering the total airway.
American journal of respiratory and critical care medicine. 07/2011; 184(1):2-3.
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1.12Impact points
High prevalence of skin symptoms among bakery workers.
Occupational medicine (Oxford, England). 06/2011; 61(4):280-2.
Occupational skin disease is common and bakery workers are at increased risk of hand dermatitis. To explore the frequency of, and to identify risk factors for, skin symptoms in a small bakery. A cross-sectional survey of workers in a small bakery in Scotland, using a self-completed questionnaire reg... [more] Occupational skin disease is common and bakery workers are at increased risk of hand dermatitis. To explore the frequency of, and to identify risk factors for, skin symptoms in a small bakery. A cross-sectional survey of workers in a small bakery in Scotland, using a self-completed questionnaire regarding skin symptoms over the last 12 months. Additionally, data on self-reported atopy status, glove use and daily hand washing frequencies were obtained. Workers were classed as being at low, medium or high risk of occupational skin disease based on their job titles. The overall response rate was 85% (52 women, 41 men) with a mean age of 41 (range 17-72). Eleven per cent of bakers, confectioners and packers and 31% of cleaners, cooks and food production workers reported at least one skin symptom. Thirty-three per cent of symptomatic low-risk workers, 50% of symptomatic medium-risk workers and 75% of symptomatic high-risk workers stated their symptoms usually improved away from work. While washing hands more frequently than 20 times a day had an increased risk of skin symptoms, this was not significant [OR 3.5 (95% CI 0.9-13.2)]. There was a high prevalence of skin symptoms among these bakery workers which was more than double that previously reported in UK bakeries. Frequent washing of hands as a risk factor for skin symptoms may warrant further investigation in bakery workers.
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47.05Impact points
Leukotriene antagonists as first-line or add-on asthma-controller therapy.
The New England journal of medicine. 05/2011; 364(18):1695-707.
Most randomized trials of treatment for asthma study highly selected patients under idealized conditions. We conducted two parallel, multicenter, pragmatic trials to evaluate the real-world effectiveness of a leukotriene-receptor antagonist (LTRA) as compared with either an inhaled glucocorticoid fo... [more] Most randomized trials of treatment for asthma study highly selected patients under idealized conditions. We conducted two parallel, multicenter, pragmatic trials to evaluate the real-world effectiveness of a leukotriene-receptor antagonist (LTRA) as compared with either an inhaled glucocorticoid for first-line asthma-controller therapy or a long-acting beta(2)-agonist (LABA) as add-on therapy in patients already receiving inhaled glucocorticoid therapy. Eligible primary care patients 12 to 80 years of age had impaired asthma-related quality of life (Mini Asthma Quality of Life Questionnaire [MiniAQLQ] score ≤6) or inadequate asthma control (Asthma Control Questionnaire [ACQ] score ≥1). We randomly assigned patients to 2 years of open-label therapy, under the care of their usual physician, with LTRA (148 patients) or an inhaled glucocorticoid (158 patients) in the first-line controller therapy trial and LTRA (170 patients) or LABA (182 patients) added to an inhaled glucocorticoid in the add-on therapy trial. Mean MiniAQLQ scores increased by 0.8 to 1.0 point over a period of 2 years in both trials. At 2 months, differences in the MiniAQLQ scores between the two treatment groups met our definition of equivalence (95% confidence interval [CI] for an adjusted mean difference, -0.3 to 0.3). At 2 years, mean MiniAQLQ scores approached equivalence, with an adjusted mean difference between treatment groups of -0.11 (95% CI, -0.35 to 0.13) in the first-line controller therapy trial and of -0.11 (95% CI, -0.32 to 0.11) in the add-on therapy trial. Exacerbation rates and ACQ scores did not differ significantly between the two groups. Study results at 2 months suggest that LTRA was equivalent to an inhaled glucocorticoid as first-line controller therapy and to LABA as add-on therapy for diverse primary care patients. Equivalence was not proved at 2 years. The interpretation of results of pragmatic research may be limited by the crossover between treatment groups and lack of a placebo group. (Funded by the National Coordinating Centre for Health Technology Assessment U.K. and others; Controlled Clinical Trials number, ISRCTN99132811.).
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2.41Impact points
Temporal variations of atmospheric aerosol in four European urban areas.
Environmental science and pollution research international. 03/2011; 18(7):1202-12.
The concentrations of PM(10) mass, PM(2.5) mass and particle number were continuously measured for 18 months in urban background locations across Europe to determine the spatial and temporal variability of particulate matter. Daily PM(10) and PM(2.5) samples were continuously collected from October ... [more] The concentrations of PM(10) mass, PM(2.5) mass and particle number were continuously measured for 18 months in urban background locations across Europe to determine the spatial and temporal variability of particulate matter. Daily PM(10) and PM(2.5) samples were continuously collected from October 2002 to April 2004 in background areas in Helsinki, Athens, Amsterdam and Birmingham. Particle mass was determined using analytical microbalances with precision of 1 μg. Pre- and post-reflectance measurements were taken using smoke-stain reflectometers. One-minute measurements of particle number were obtained using condensation particle counters. The 18-month mean PM(10) and PM(2.5) mass concentrations ranged from 15.4 μg/m(3) in Helsinki to 56.7 μg/m(3) in Athens and from 9.0 μg/m(3) in Helsinki to 25.0 μg/m(3) in Athens, respectively. Particle number concentrations ranged from 10,091 part/cm(3) in Helsinki to 24,180 part/cm(3) in Athens with highest levels being measured in winter. Fine particles accounted for more than 60% of PM(10) with the exception of Athens where PM(2.5) comprised 43% of PM(10). Higher PM mass and number concentrations were measured in winter as compared to summer in all urban areas at a significance level p < 0.05. Significant quantitative and qualitative differences for particle mass across the four urban areas in Europe were observed. These were due to strong local and regional characteristics of particulate pollution sources which contribute to the heterogeneity of health responses. In addition, these findings also bear on the ability of different countries to comply with existing directives and the effectiveness of mitigation policies.
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7.04Impact points
Costs of occupational asthma in the UK.
Thorax. 02/2011; 66(2):128-33.
To estimate the social costs of occupational asthma in the UK. A desk-top approach using cost-of-illness methodology was employed, defining direct and indirect lifetime costs for six scenarios: a male and a female worker each exposed to isocyanates, latex and biocides (eg, glutaraldehyde) or flour. ... [more] To estimate the social costs of occupational asthma in the UK. A desk-top approach using cost-of-illness methodology was employed, defining direct and indirect lifetime costs for six scenarios: a male and a female worker each exposed to isocyanates, latex and biocides (eg, glutaraldehyde) or flour. The numbers of new cases annually in each industry were estimated from Survey of Work-related and Occupational Respiratory Disease (SWORD) data. The main outcome measure was the current value total working lifetime costs of new cases annually for each scenario. Assuming 209 new cases of occupational asthma in the six scenarios in the year 2003, the present value total lifetime costs were estimated to be £25.3-27.3 million (2004 prices). Grossing up for all estimated cases of occupational asthma in the UK in 2003, this came to £70-100 million. About 49% of these costs were borne by the individual, 48% by the state and 3% by the employer. The cost to society of occupational asthma in the UK is high. Given that the number of newly diagnosed cases is likely to be underestimated by at least one-third, these costs may be as large as £95-135 million. Each year a new stream of lifetime costs will be added as a newly diagnosed cohort is identified. Approaches to reduce the burden of occupational asthma have a strong economic justification. However, the economic burden falls on the state and the individual, not on the employer. The incentive for employers to act is thus weak.
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3.64Impact points
Reconstructing past occupational exposures: how reliable are women's reports of their partner's occupation?
Occupational and environmental medicine. 11/2010; 68(6):452-6.
Most of the evidence on agreement between self- and proxy-reported occupational data comes from interview-based studies. The authors aimed to examine agreement between women's reports of their partner's occupation and their partner's own description using questionnaire-based data collect... [more] Most of the evidence on agreement between self- and proxy-reported occupational data comes from interview-based studies. The authors aimed to examine agreement between women's reports of their partner's occupation and their partner's own description using questionnaire-based data collected as a part of the prospective, population-based Avon Longitudinal Study of Parents and Children. Information on present occupation was self-reported by women's partners and proxy-reported by women through questionnaires administered at 8 and 21 months after the birth of a child. Job titles were coded to the Standard Occupational Classification (SOC2000) using software developed by the University of Warwick (Computer-Assisted Structured Coding Tool). The accuracy of proxy-report was expressed as percentage agreement and kappa coefficients for four-, three- and two-digit SOC2000 codes obtained in automatic and semiautomatic (manually improved) coding modes. Data from 6016 couples at 8 months and 5232 couples at 21 months postnatally were included in the analyses. The agreement between men's self-reported occupation and women's report of their partner's occupation in fully automatic coding mode at four-, three- and two-digit code level was 65%, 71% and 77% at 8 months and 68%, 73% and 76% at 21 months. The accuracy of agreement was slightly improved by semiautomatic coding of occupations: 73%/73%, 78%/77% and 83%/80% at 8/21 months respectively. While this suggests that women's description of their partners' occupation can be used as a valuable tool in epidemiological research where data from partners are not available, this study revealed no agreement between these young women and their partners at the two-digit level of SOC2000 coding in approximately one in five cases. Proxy reporting of occupation introduces a statistically significant degree of error in classification. The effects of occupational misclassification by proxy reporting in retrospective occupational epidemiological studies based on questionnaire data should be considered.
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6.19Impact points
The global burden of air pollution on mortality: the need to include exposure to household biomass fuel-derived particulates.
Environmental health perspectives. 10/2010; 118(10):A424; author reply A424-5.
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2.02Impact points
Efficacy and safety of ciclesonide in patients with severe asthma: a 12-week, double-blind, randomized, parallel-group study with long-term (1-year) follow-up.
Expert opinion on pharmacotherapy. 10/2010; 11(17):2791-803.
To investigate the efficacy and safety of ciclesonide in patients with severe asthma over a 1-year period. Patients aged 18 - 75 years with persistent asthma were enrolled in a 12-week, double-blind, randomized study and treated with ciclesonide 320 or 640 μg twice daily (b.i.d.) with the option of ... [more] To investigate the efficacy and safety of ciclesonide in patients with severe asthma over a 1-year period. Patients aged 18 - 75 years with persistent asthma were enrolled in a 12-week, double-blind, randomized study and treated with ciclesonide 320 or 640 μg twice daily (b.i.d.) with the option of continuing in a 40-week extension phase (EP). Change in morning peak expiratory flow (PEF) from baseline to 12 weeks and safety over 1 year. 365 patients were randomized and 275 continued into the EP. During 12 weeks' treatment, morning peak expiratory flow significantly increased by 16 l/min (p < 0.001) and 14 l/min (p = 0.001) in the 320 and 640 μg b.i.d. groups, respectively. Both doses significantly reduced total asthma symptom scores by 0.29 (p < 0.0001). In both groups, the incidence of adverse effects (AEs) was low and mean cortisol levels in serum and urine were not suppressed during the EP. Ciclesonide 320 μg b.i.d. sustained lung function and asthma symptoms in patients with severe asthma over 12 weeks' treatment, and maintained lung function during a 40-week EP; ciclesonide 640 μg b.i.d. did not provide additional benefits. Long-term use of ciclesonide was not associated with increased local AEs or negative effects on cortisol levels.
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47.05Impact points
Smoke-free legislation and hospitalizations for childhood asthma.
The New England journal of medicine. 09/2010; 363(12):1139-45.
Previous studies have shown that after the adoption of comprehensive smoke-free legislation, there is a reduction in respiratory symptoms among workers in bars. However, it is not known whether respiratory disease is also reduced among people who do not have occupational exposure to environmental to... [more] Previous studies have shown that after the adoption of comprehensive smoke-free legislation, there is a reduction in respiratory symptoms among workers in bars. However, it is not known whether respiratory disease is also reduced among people who do not have occupational exposure to environmental tobacco smoke. The aim of our study was to determine whether the ban on smoking in public places in Scotland, which was initiated in March 2006, influenced the rate of hospital admissions for childhood asthma. Routine hospital administrative data were used to identify all hospital admissions for asthma in Scotland from January 2000 through October 2009 among children younger than 15 years of age. A negative binomial regression model was fitted, with adjustment for age group, sex, quintile of socioeconomic status, urban or rural residence, month, and year. Tests for interactions were also performed. Before the legislation was implemented, admissions for asthma were increasing at a mean rate of 5.2% per year (95% confidence interval [CI], 3.9 to 6.6). After implementation of the legislation, there was a mean reduction in the rate of admissions of 18.2% per year relative to the rate on March 26, 2006 (95% CI, 14.7 to 21.8; P<0.001). The reduction was apparent among both preschool and school-age children. There were no significant interactions between hospital admissions for asthma and age group, sex, urban or rural residence, region, or quintile of socioeconomic status. In Scotland, passage of smoke-free legislation in 2006 was associated with a subsequent reduction in the rate of respiratory disease in populations other than those with occupational exposure to environmental tobacco smoke. (Funded by NHS Health Scotland.)
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7.04Impact points
Acute exposure to biomass smoke causes oxygen desaturation in adult women.
Thorax. 09/2010; 66(8):724-5.
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6.38Impact points
Projections of the effects of climate change on allergic asthma: the contribution of aerobiology.
Allergy. 09/2010; 65(9):1073-81.
Climate change is unequivocal and represents a possible threat for patients affected by allergic conditions. It has already had an impact on living organisms, including plants and fungi with current scenarios projecting further effects by the end of the century. Over the last three decades, studies ... [more] Climate change is unequivocal and represents a possible threat for patients affected by allergic conditions. It has already had an impact on living organisms, including plants and fungi with current scenarios projecting further effects by the end of the century. Over the last three decades, studies have shown changes in production, dispersion and allergen content of pollen and spores, which may be region- and species-specific. In addition, these changes may have been influenced by urban air pollutants interacting directly with pollen. Data suggest an increasing effect of aeroallergens on allergic patients over this period, which may also imply a greater likelihood of the development of an allergic respiratory disease in sensitized subjects and exacerbation of symptomatic patients. There are a number of limitations that make predictions uncertain, and further and specifically designed studies are needed to clarify current effects and future scenarios. We recommend: More stress on pollen/spore exposure in the diagnosis and treatment guidelines of respiratory and allergic diseases; collection of aerobiological data in a structured way at the European level; creation, promotion and support of multidisciplinary research teams in this area; lobbying the European Union and other funders to finance this research.
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3.64Impact points
Outdoor air pollution is associated with rapid decline of lung function in alpha-1-antitrypsin deficiency.
Occupational and environmental medicine. 08/2010; 67(8):556-61.
Outdoor air pollutants are associated with respiratory morbidity and mortality, but little longitudinal work has been undertaken in this area in chronic obstructive pulmonary disease (COPD). Patients with alpha-1-antitrypsin deficiency (AATD) typically exhibit faster decline of lung function than su... [more] Outdoor air pollutants are associated with respiratory morbidity and mortality, but little longitudinal work has been undertaken in this area in chronic obstructive pulmonary disease (COPD). Patients with alpha-1-antitrypsin deficiency (AATD) typically exhibit faster decline of lung function than subjects with usual COPD and thus represent a group in whom studies of factors influencing decline may be more easily clarified. Decline of FEV(1) and KCO in subjects of the PiZZ genotype from the UK AATD registry were studied. Pollution levels (PM(10), ozone, sulphur dioxide, nitrogen dioxide) during the exposure window were extracted from GIS maps, matching the measurement to each patient's home address. Clinical predictors of decline were sought using generalised estimating equations, and pollutants added to these subsequently. Single pollutant models were used due to multicollinearity. In the FEV(1) decline analysis, higher baseline FEV(1) was associated with rapid decline of FEV(1) (p<0.001). High PM(10) exposure predicted more rapid decline of FEV(1) (p=0.024). In a similar analysis for KCO decline, higher baseline KCO predicted rapid decline (p<0.001) as did higher exposure to ozone (p=0.018). High PM(10) exposure also showed a trend towards this effect (p=0.056). Exposure to ozone and PM(10) predicts decline of lung function in AATD.
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2.61Impact points
Cost effectiveness of leukotriene receptor antagonists versus long-acting beta-2 agonists as add-on therapy to inhaled corticosteroids for asthma: a pragmatic trial.
PharmacoEconomics. 07/2010; 28(7):597-608.
Information is lacking on the relative effectiveness and cost effectiveness--in a real-life primary-care setting--of leukotriene receptor antagonists (LTRAs) and long-acting beta2 adrenergic receptor agonists (beta2 agonists) as add-on therapy for patients whose asthma symptoms are not controlled on... [more] Information is lacking on the relative effectiveness and cost effectiveness--in a real-life primary-care setting--of leukotriene receptor antagonists (LTRAs) and long-acting beta2 adrenergic receptor agonists (beta2 agonists) as add-on therapy for patients whose asthma symptoms are not controlled on low-dose inhaled corticosteroids (ICS). To estimate the cost effectiveness of LTRAs compared with long-acting beta2 agonists as add-on therapy for patients whose asthma symptoms are not controlled on low-dose ICS. An economic evaluation was conducted alongside a 2-year, pragmatic, randomized controlled trial set in 53 primary-care practices in the UK. Patients aged 12-80 years with asthma insufficiently controlled with ICS (n = 361) were randomly assigned to add-on LTRAs (n = 176) or long-acting beta2 agonists (n = 185). The main outcome measures were the incremental cost per point improvement in the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), per point improvement in the Asthma Control Questionnaire (ACQ) and per QALY gained from perspectives of the UK NHS and society. Over 2 years, the societal cost per patient receiving LTRAs was pounds sterling 1157 versus pounds sterling 952 for long-acting beta2 agonists, a (significant, adjusted) increase of pounds sterling 214 (95% CI 2, 411) [year 2005 values]. Patients receiving LTRAs experienced a non-significant incremental gain of 0.009 QALYs (95% CI -0.077, 0.103). The incremental cost per QALY gained from the societal (NHS) perspective was pounds sterling 22,589 (pounds sterling 11,919). Uncertainty around this point estimate suggested that, given a maximum willingness to pay of pounds sterling 30,000 per QALY gained, the probability that LTRAs are a cost-effective alternative to long-acting beta2 agonists as add-on therapy was approximately 52% from both societal and NHS perspectives. On balance, these results marginally favour the repositioning of LTRAs as a cost-effective alternative to long-acting beta2 agonists as add-on therapy to ICS for asthma. However, there is much uncertainty surrounding the incremental cost effectiveness because of similarity of clinical benefit and broad confidence intervals for differences in healthcare costs. UK National Research Register N0547145240; Controlled Clinical Trials ISRCTN99132811.
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7.04Impact points
Case finding for chronic obstructive pulmonary disease: a model for optimising a targeted approach.
Thorax. 06/2010; 65(6):492-8.
Case finding is proposed as an important component of the forthcoming English National Clinical Strategy for chronic obstructive pulmonary disease (COPD) because of accepted widespread underdiagnosis worldwide. However the best method of identification is not known. The extent of undiagnosed clinica... [more] Case finding is proposed as an important component of the forthcoming English National Clinical Strategy for chronic obstructive pulmonary disease (COPD) because of accepted widespread underdiagnosis worldwide. However the best method of identification is not known. The extent of undiagnosed clinically significant COPD in England is described and the effectiveness of an active compared with an opportunistic approach to case finding is evaluated. A cross-sectional analysis was carried out using using Health Survey for England (HSE) 1995-1996 data supplemented with published literature. A model comparing an active approach (mailed questionnaires plus opportunistic identification) with an opportunistic-only approach of case finding among ever smokers aged 40-79 years was evaluated. There were 20 496 participants aged >or=30 years with valid lung function measurements. The main outcome measure was undiagnosed clinically significant COPD (any respiratory symptom with both forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) <0.7 and FEV(1) <80% predicted). 971 (4.7%) had clinically significant COPD, of whom 840 (86.5%) did not report a previous diagnosis. Undiagnosed cases were more likely to be female, and smoked less. 25.3% had severe disease (FEV(1) <50% predicted), 38.5% Medical Research Council (MRC) grade 3 dyspnoea and 44.1% were current smokers. The active case-finding strategy can potentially identify 70% more new cases than opportunistic identification alone (3.8 vs 2.2 per 100 targeted). Treating these new cases could reduce hospitalisations by at least 3300 per year in England and deaths by 2885 over 3 years. There is important undiagnosed clinically significant COPD in the population, and the addition of a systematic case-finding approach may be more effective in identifying these cases. The cost-effectiveness of this approach needs to be tested empirically in a prospective study.
Following (29)
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Peter S Thorne
University of Iowa -
Wolfgang G Kreyling
Helmholtz Zentrum München -
Affandi Omar
Institute for Medical Research -
Martin Raymond Miller
University of Birmingham -
Anne Barbara Knol
RIVM
Topics (1)
