Asthma is the most common chronic disease in childhood, imposing a huge burden on the patient, their family and society. It is a worldwide disease with variable expression between countries and between different populations in a country. There is evidence that its prevalence has increased considerably over the last two decades and is still increasing, despite there being some indications that the increase in prevalence may have plateaued in some countries in the last few years. Better understanding of the natural course of asthma and improved asthma control can lead to a decreased burden on the patient, their family and society. The burden of asthma consists mainly of a decreased quality of life for the patient and their family, as well as high costs for society; the healthcare expenditures for asthma in developed countries are 1-2% of the total healthcare costs.
"The symptoms include chest tightness, coughing and wheezing, and in severe cases shortness of breath and low blood oxygen . In addition, the prevalence of asthma is increasing in recent decades, accompanied by the rise of the cost of asthma care as well   . One of many problems in asthma managements is that a lot of patients with asthma are not properly diagnosed or misdiagnosed as other respiratory diseases such as common cold, acute bronchitis, or chronic obstructive pulmonary disease  . "
[Show abstract][Hide abstract] ABSTRACT: Asthma is a disorder characterized by chronic airway inflammation, airway hypersensitivity to a variety of stimuli, and airway obstruction that is at least partially or even completely reversible. To make correct diagnosis of asthma, diagnosis must be based on typical symptoms of asthma and identification of airway hyper responsiveness (AHR) or variable airway obstruction. In some cases, additionally we need to use bronchial provocation test using nonspecific stimuli, such as methacholine or histamine, what is useful for the determination of AHR. However, it is somewhat invasive in nature and it is not available in primary-care clinics or even in many general hospitals. Bronchodilator response (BDR) to short-acting β2-agonists is a valuable test to evaluate variable airway obstruction, which is only useful in patients with reduced lung function at the time of visit. Developed integrated software suite is user friendly tool which considers all this parameters to assist clinicians in the analysis and interpretation of pulmonary function tests data to better detect, diagnose, and treat asthma conditions. A total sum of 72 patient reports with previously diagnosed asthma by clinicians was tested with this tool. The software has performed the classification of asthma in the same way as doctors in 65 (90.27%) cases.
MIPRO, 2013 Proceedings of the 36th International Convention, Opatija, Croatia, 21-25 May, 2013, Opatija, Croatia; 05/2013
"The prevalence of childhood asthma is high in the UK: approximately one in five children are diagnosed by a doctor, making it one of the most common chronic childhood conditions (Kaur et al., 1998; Patel et al., 2008). Asthma can limit a child's daily life, social activities and may result in missed school days which then impacts on parents working life (Sennhauser et al., 2005). Children with asthma require more contact with doctors than non-sufferers, and may require medication and hospitalization. "
[Show abstract][Hide abstract] ABSTRACT: STUDY QUESTION: Is asthma more common in children born after subfertility and assisted reproduction technologies (ART)? SUMMARY ANSWER: Yes. Asthma, wheezing in the last year and anti-asthmatic medication were all more common in children born after a prolonged time to conception (TTC). This was driven specifically by an increase in children born after ART. WHAT IS KNOWN ALREADY: Few studies have investigated any association between ART and asthma in subsequent children, and findings to date have been mixed. A large registry-based study found an increase in asthma medication in ART children but suggests underlying infertility is the putative risk factor. Little is known about asthma in children after unplanned or mistimed conceptions. STUDY DESIGN, SIZE, DURATION: The Millennium Cohort Study is a UK-wide, prospective study of 18 818 children recruited at 9 months of age. Follow-up is ongoing. This study analyses data from follow-up surveys at 5 and 7 years of age (response rates of 79 and 70%, respectively). PARTICIPANTS/MATERIALS, SETTING, METHODS: Singleton children whose natural mothers provided follow-up data were included. Mothers reported whether their pregnancy was planned; planners provided TTC and details of any ART. The population was divided into 'unplanned' (unplanned and unhappy), 'mistimed' (unplanned but happy), 'planned' (planned, TTC < 12 months), 'untreated subfertile' (planned, TTC >12 months), 'ovulation induced' (received clomiphene citrate) and 'ART' (IVF or ICSI). The primary analysis used the planned children as the comparison group; secondary analysis compared the treatment groups to the children born to untreated subfertile parents. Outcomes were parent report of asthma and wheezing at 5 and 7 years, derived from validated questions in the International Study of Asthma and Allergies in Childhood, plus use of anti-asthmatic medications. A total of 13 041 (72%) children with full data on asthma and confounders were included at 5 years of age, and 11 585 (64%) at 7 years. MAIN RESULTS AND THE ROLE OF CHANCE: Compared with planned children, those born to subfertile parents were significantly more likely to experience asthma, wheezing and to be taking anti-asthmatics at 5 years of age [adjusted odds ratio (OR): 1.39 (95% confidence interval (CI): 1.07, 1.80), OR: 1.27 (1.00, 1.63) and OR: 1.90 (1.32,2.74), respectively]. This association was mainly related to an increase among children born after ART (adjusted OR: 2.65 (1.48, 4.76), OR: 1.97, (1.10, 3.53) and OR: 4.67 (2.20, 9.94) for asthma, wheezing and taking anti-asthmatics, respectively). The association was also present, though reduced, at the age of 7 years. LIMITATIONS, REASONS FOR CAUTION: The number of singletons born after ART was relatively small (n = 104), and as such the findings should be interpreted with caution. However, data on a wide range of possible confounding and mediating factors were available and analysed. The data were weighted for non-response to minimize selection bias. WIDER IMPLICATIONS OF THE FINDINGS: The findings add to the growing body of evidence suggesting an association between subfertility, ART and asthma in children. Further work is needed to establish causality and elucidate the underlying mechanism. These findings are generalizable to singletons only, and further work on multiples is needed. STUDY FUNDING/COMPETING INTEREST(S): This study was funded by a Medical Research Council project grant. No competing interests.
Human Reproduction 12/2012; 28(2). DOI:10.1093/humrep/des398 · 4.57 Impact Factor
"A recent study in the Netherlands showed that ethnic minority children have poorer asthma control and more complaints than their Dutch peers . This reflects a significant, avoidable burden of illness, because asthma prevalence is as high as 5% to 10% among children in Western societies , and ethnic diversity has increased among young Western populations [6,7]. "
[Show abstract][Hide abstract] ABSTRACT: Asthma outcomes are generally worse for ethnic minority children. Cultural competence training is an instrument for improving healthcare for ethnic minority patients. To develop effective training, we explored the mechanisms in paediatric asthma care for ethnic minority patients that lead to deficiencies in the care process.
We conducted semi-structured interviews on care for ethnic minority children with asthma (aged 4-10 years) with paediatricians (n = 13) and nurses (n = 3) in three hospitals. Interviews were analysed qualitatively with a framework method, using a cultural competence model.
Respondents mentioned patient non-adherence as the central problem in asthma care. They related non-adherence in children from ethnic minority backgrounds to social context factors, difficulties in understanding the chronic nature of asthma, and parents' language barriers. Reactions reported by respondents to patients' non-adherence included retrieving additional information, providing biomedical information, occasionally providing referrals for social context issues, and using informal interpreters.
This study provides keys to improve the quality of specialist paediatric asthma care to ethnic minority children, mainly related to non-adherence. Care providers do not consciously recognise all the mechanisms that lead to deficiencies in culturally competent asthma care they provide to ethnic minority children (e.g. communicating mainly from a biomedical perspective and using mostly informal interpreters). Therefore, the learning objectives of cultural competence training should reflect issues that care providers are aware of as well as issues they are unaware of.
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