Helene J Krouse

Wayne State University, Detroit, Michigan, United States

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Publications (42)49.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Allergic Rhinitis. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed address the evaluation of patients with allergic rhinitis, including performing and interpretation of diagnostic testing and assessment and documentation of chronic conditions and comorbidities. It will then focus on the recommendations to guide the evaluation and treatment of patients with allergic rhinitis, to determine the most appropriate interventions to improve symptoms and quality of life for patients with allergic rhinitis. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
    Otolaryngology Head and Neck Surgery 02/2015; 152(2):197-206. DOI:10.1177/0194599814562166 · 1.72 Impact Factor
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    ABSTRACT: Objective Allergic rhinitis (AR) is one of the most common diseases affecting adults. It is the most common chronic disease in children in the United States today and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5 billion in direct health expenditures annually. It can impair quality of life and, through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually. Not surprisingly, myriad diagnostic tests and treatments are used in managing this disorder, yet there is considerable variation in their use. This clinical practice guideline was undertaken to optimize the care of patients with AR by addressing quality improvement opportunities through an evaluation of the available evidence and an assessment of the harm-benefit balance of various diagnostic and management options.
    Otolaryngology Head and Neck Surgery 02/2015; 152(1 Suppl):S1-S43. DOI:10.1177/0194599814561600 · 1.72 Impact Factor
  • Helene J Krouse
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    ABSTRACT: Background Environmental control measures refer to using 1 or more interventions aimed at avoiding, reducing, or eliminating allergens and irritants in the environment to improve symptoms of allergic rhinitis. Although avoiding known allergens is highly effective, completely eliminating an allergen from one's environment is often impractical or even impossible. Methods The purpose of this work is to review evidence on the efficacy of various environmental control measures aimed at preventing the development of new sensitizations, reducing the progression of allergic rhinitis, and improving its symptoms and quality of life. ResultsCurrent literature examining the protective effects of specific measures such as breastfeeding and early pet exposure against the development of allergic diseases including allergic rhinitis has been inconclusive. Environmental measures such as frequently washing cats and dogs, encasing bedding within impermeable covers, air filtration, and chemicals can effectively reduce levels of allergens in the home. Although environmental control measures reduce allergen exposure levels, significant alleviation in symptoms or improvement in quality of life in patients with allergic rhinitis have not been shown. Conclusion An evidence-based approach can assist health providers in educating patients and helping them to make informed decisions in selecting the most appropriate and cost-effective environmental control strategies to manage their disease. The greatest benefits can be achieved from using a multifaceted environmental approach aimed at routinely and systematically reducing exposure to allergens over time. (C) 2014 ARS-AAOA, LLC.
    International Forum of Allergy and Rhinology 09/2014; 4 Suppl 2(S2):S32-4. DOI:10.1002/alr.21383 · 2.37 Impact Factor
  • Helene J Krouse, John H Krouse
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    ABSTRACT: : Allergic rhinitis (AR) is an immune hypersensitivity response of the nasal mucosa affecting children and adults. Patients with a genetic predisposition become sensitized to certain allergens over time with repeated exposures. This article will discuss AR from diagnosis through treatment.
    The Nurse practitioner 02/2014; DOI:10.1097/01.NPR.0000444647.43315.8c
  • John H Krouse, Helene J Krouse
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    ABSTRACT: Pulmonary function testing is an important diagnostic modality in the workup of patients suspected of having asthma. It is also valuable for monitoring response to treatment in patients initiated and sustained on asthma therapy, and for assessing patients with symptoms suggestive of an asthma exacerbation. Spirometry is the most useful test in patients suspected of having asthma, and can easily be performed and interpreted in the otolaryngology office with readily available, inexpensive equipment. Pulmonary function testing should be considered for use in all otolaryngology patients with significant rhinitis and in those suspected of having lower respiratory disease.
    Otolaryngologic Clinics of North America 02/2014; 47(1):33-7. DOI:10.1016/j.otc.2013.09.009 · 1.34 Impact Factor
  • Diane Sobecki-Ryniak, Helene J Krouse
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    ABSTRACT: The purpose of this literature review is to explore the historical progression of treatment and its impact on care requisites in patients with head and neck cancer. Head and neck cancers are some of the most visible types of cancer. Patients often experience difficulties in self-care because of problems adapting to and coping with the diagnosis and disease management. Evaluation of the literature from the 1960s to present indicated a shift from coping with disfigurement to focusing on dysfunction and rehabilitative self-care. The process of assisting patients with self-care activities occurs from the time of diagnosis through post-treatment and beyond. Adapting to and coping with changes in physical appearance and function begins with the cognitive decision to initiate treatment modalities specific to the cancer site. Current knowledge of the manifestations of head and neck cancer provides the healthcare team with a better understanding of the disease trajectory and how best to assist patients in adapting to and coping with changes affecting their quality of life.
    Clinical Journal of Oncology Nursing 12/2013; 17(6):659-63. DOI:10.1188/13.CJON.659-663
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    ABSTRACT: The Geospatial Determinants of Health Outcomes Consortium (GeoDHOC) study investigated ambient air quality across the international border between Detroit, Michigan, USA and Windsor, Ontario, Canada and its association with acute asthma events in 5- to 89-year-old residents of these cities. NO2, SO2, and volatile organic compounds (VOCs) were measured at 100 sites, and particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) at 50 sites during two 2-week sampling periods in 2008 and 2009. Acute asthma event rates across neighborhoods in each city were calculated using emergency room visits and hospitalizations and standardized to the overall age and gender distribution of the population in the two cities combined. Results demonstrate that intra-urban air quality variations are related to adverse respiratory events in both cities. Annual 2008 asthma rates exhibited statistically significant positive correlations with total VOCs and total benzene, toluene, ethylbenzene and xylene (BTEX) at 5-digit zip code scale spatial resolution in Detroit. In Windsor, NO2, VOCs, and PM10 concentrations correlated positively with 2008 asthma rates at a similar 3-digit postal forward sortation area scale. The study is limited by its coarse temporal resolution (comparing relatively short term air quality measurements to annual asthma health data) and interpretation of findings is complicated by contrasts in population demographics and health-care delivery systems in Detroit and Windsor.Journal of Exposure Science and Environmental Epidemiology advance online publication, 13 November 2013; doi:10.1038/jes.2013.78.
    Journal of Exposure Science and Environmental Epidemiology 11/2013; 24(4). DOI:10.1038/jes.2013.78 · 3.05 Impact Factor
  • Karen Wykowski, Helene J Krouse
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    ABSTRACT: The prevalence of obesity in the United States has more than doubled from 1980 to 2008. Obesity leads to a multitude of comorbidities, most notably diabetes and cardiovascular diseases, resulting in more than $147 billion annually in healthcare costs. Bariatric surgery is becoming a common weight loss option for morbidly obese individuals. Studies in this review examine patients who have undergone laparoscopic adjustable gastric banding or Roux-en-Y gastric bypass surgery. Patients initially lose large amounts of weight postoperatively; unfortunately, around 30% of these individuals begin to regain weight 18-24 months after surgery. The purpose of this article is to analyze the current literature to ascertain which self-care variables are predictors of successful long-term weight loss after bariatric surgery. The studies analyzed in this review found that patients who undergo a surgical weight loss intervention lose more weight faster than patients who do not have a surgical weight loss intervention. However, patients reported feeling unprepared for the extreme psychosocial and lifestyle changes after bariatric surgery. Findings from these studies point to the need for future research in the area of postsurgical psychosocial support for successful long-term weight loss maintenance.
    Gastroenterology nursing: the official journal of the Society of Gastroenterology Nurses and Associates 03/2013; 36(2):129-35. DOI:10.1097/SGA.0b013e3182891295 · 0.56 Impact Factor
  • John H Krouse, Helene J Krouse
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    ABSTRACT: Patients with rhinitis and rhinosinusitis are commonly treated in otolaryngologists' offices. Many of these patients have concurrent lower respiratory diseases such as asthma. The simultaneous presence of upper and lower airway diseases occurs frequently, and has resulted in the unified airway model, which describes the close relationships between these inflammatory diseases. Understanding the coexistence of respiratory illnesses has implications for the diagnosis and management of both upper and lower airway conditions. It is important for otolaryngologists and otolaryngology nurses to be aware of these common comorbid processes, and to evaluate for the presence of asthma in all patients with upper airway conditions such as rhinitis and rhinosinusitis. This paper will discuss the epidemiology, pathophysiology, mechanisms, and diagnosis and treatment considerations in patients with unified airway diseases.
    ORL-head and neck nursing: official journal of the Society of Otorhinolaryngology and Head-Neck Nurses 01/2013; 31(4):6-10.
  • Wanda Gibson-Scipio, Helene J Krouse
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    ABSTRACT: Objective: Caregiver goals, an integral part of a partnership for asthma management, have been found to influence asthma outcomes in children. These goals are likely to change during the transitional period of adolescence to address the needs of teenagers as they mature and assume greater responsibilities for their own care. Little is known about the goals, beliefs, and concerns of caregivers as they begin to shift responsibilities for asthma management to teens. This study sought to identify the asthma management goals, beliefs and concerns of primarily African American caregivers of urban middle and older adolescents. Methods: Fourteen caregivers of urban African American adolescents aged 14 to 18 years with asthma participated in a focus group session. An iterative process was used to identify themes from the session related to asthma management goals, concerns, and beliefs of caregivers. Results: Caregivers identified goals that related to supporting their teens’ progress towards independent asthma self-management. They described significant concerns related to the teens’ ability to implement asthma self-management, especially in school settings. Caregivers also revealed beliefs that represented knowledge deficits related to asthma medications and factors that improved or worsened asthma. Most caregivers identified grave concerns about school policies regarding asthma medication administration and the lack of knowledge and support provided by teachers and staff for their teen. Conclusion: Caregivers are an invaluable resource in the care of adolescents with asthma. An opportunity exists to improve caregiver understanding of asthma medications and to provide support through improvements in asthma care for adolescents in school based settings.
    Journal of Asthma 12/2012; DOI:10.3109/02770903.2012.759964 · 1.83 Impact Factor
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    Atmospheric Environment 01/2012; DOI:10.1016/j.atmosenv.2011.10.010 · 3.06 Impact Factor
  • Helene J Krouse
    Ear, nose, & throat journal 10/2011; 90(10):468-9. · 0.88 Impact Factor
  • Jenna Babcock, Helene J Krouse
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    ABSTRACT: To evaluate if wrist actigraphy, a measurement of movement, is an effective tool for assessing sleep/wake patterns and use in clinical practice in persons with asthma. Data from three individuals with asthma were utilized to develop three case scenarios. The case scenarios illustrated the use of actigraphy as the measurement tool for sleep patterns as they relate to individuals with varying degrees of asthma control. The person with poorly controlled asthma had less total sleep time and lower sleep efficiency than the person with well-controlled asthma. The actigraph provided useful information on sleep patterns such as daytime napping, nighttime sleep, and sleep efficiency in persons with varying degrees of asthma control. Nighttime asthma symptoms are often hard for the nurse practitioner (NP) to assess as they are often subjectively reported by patients. The use of actigraph in the clinical setting can provide useful, objective information on the sleep/wake cycles of persons with asthma to aid the NP in providing optimal management of the disease.
    Journal of the American Academy of Nurse Practitioners 05/2010; 22(5):270-7. DOI:10.1111/j.1745-7599.2010.00505.x · 0.87 Impact Factor
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    ABSTRACT: As part of a larger research project initiated by the Geospatial Determinants of Health Outcomes Consortium (GeoDHOC), an air quality study was conducted in an international airshed encompassing Detroit, Michigan, USA, and Windsor, Ontario, Canada. Active and passive samplers were used to measure nitrogen dioxide (NO2), sulfur dioxide (SO2), 26 volatile organic compounds (VOCs), 23 polycyclic aromatic hydrocarbons (PAHs) and pesticides, and three size fractions of particulate matter (PM) over a two-week period in September, 2008. Measurements of NO2 and 14 VOCs were found to be acceptable at 98 out of 100 passive monitoring sites. PAH and PM measurements were acceptable at 38 out of 50 active sites.Mean concentrations for all analytes except for PM2.5–10 were higher in Detroit than Windsor by a factor of up to 1.8. Strong statistical correlations were found among benzene, toluene, ethylbenzene, and xylene (BTEX), as well as between NO2 and PM in Detroit. In Windsor, the strongest correlations were between NO2 and total VOCs, as well as total PAHs and total VOCs. Differences in the degree of correlation observed in Detroit and Windsor are attributable to differences in the volume and composition of emissions within the two cities. Spatial variability was evaluated using a combination of statistical (coefficient of variation) and geostatistical (standardized variogram slope) metrics together with concentration maps. Greater spatial variability was observed for total VOCs and total BTEX in Detroit, while greater variability of NO2, total PAHs, and PM was found in Windsor. Results of this study suggest that statistical correlations between NO2 and other contaminants may not provide sufficient justification for the indiscriminant use of NO2 as a proxy for those contaminants if smaller scale features are to be reproduced.
    Atmospheric Research 03/2010; 46(9-44):1162-1174. DOI:10.1016/j.atmosenv.2009.12.030 · 2.42 Impact Factor
  • Journal of Allergy and Clinical Immunology 02/2010; 125(2). DOI:10.1016/j.jaci.2009.12.810 · 11.25 Impact Factor
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    ABSTRACT: This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness. The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology-head and neck surgery, pediatrics, and consumers. The panel made strong recommendations that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL. The panel made recommendations that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL; 2) the clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as options that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti-reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate/counsel patients with hoarseness about control/preventive measures. DISCLAIMER: This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
    Otolaryngology Head and Neck Surgery 09/2009; 141(3 Suppl 2):S1-S31. DOI:10.1016/j.otohns.2009.06.744 · 1.72 Impact Factor
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    ABSTRACT: An air quality study has been carried out in Windsor, Ontario, Canada and Detroit, Michigan, USA as part of a pilot research study undertaken by the Geospatial Determinants of Health Outcomes Consortium (GeoDHOC), a multidisciplinary, international effort aimed at understanding the health effects of air pollution in urban environments. Exposure to volatile organic compounds has long been associated with adverse health conditions such as atrophy of skeletal muscles, loss of coordination, neurological damage, dizziness, throat, nose, and eye irritation, nervous system depression, liver damage, and respiratory symptoms. Twenty-six species of ambient volatile organic compounds (VOCs) were monitored during a 2-week period in September, 2008 at 100 sites across Windsor and Detroit, using 3M # 3500 Organic Vapour Monitors. Ten species with highest concentrations were selected for further investigation; Toluene (mean concentration =4.14 mum/m3), (m+p)-Xylene (2.30 mum/m3), Hexane (1.87 mum/m3), Benzene (1.37 mum/m3), 1,2,4-Trimethylbenzene (0.87 mum/m3), Dichloromethane (0.77 mum/m3), Ethylbenzene (0.68 mum/m3), o-Xylene (0.63 mum/m3), n-Decane (0.42 mum/m3), and 1,3,5-Trimethylbenzene (0.39 mum/m3). Comparison to a similar investigation in Sarnia, Ontario in October 2005 revealed that the mean concentrations of VOCs were higher in Windsor-Detroit for all species by a significant margin (31-958%), indicating substantial impact of local industrial and vehicular emissions in the Windsor
  • John H Krouse, Helene J Krouse, James J Janisse
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    ABSTRACT: Nocturnal symptoms are common in asthma patients and have the potential for considerable clinical effects due to a lack of sleep and persistent daytime symptoms of somnolence and activity impairment. The primary objective of this investigation was to determine the effect of a 14-day course of once-daily evening administration of mometasone furoate 400 microg administered via a dry powder inhaler (MF-DPI 400 microg qd pm) on the overnight decline in pulmonary function observed in patients with nocturnal asthma. Eligible enrollees were between the ages of 18 and 60 years and had established mild to moderate asthma, with an improvement in forced expiratory volume in 1 second (FEV(1)) of >15% after administration of inhaled salbutamol (albuterol) 200 microg. All enrolled patients had a history of nocturnal asthma. Enrollees were randomized to receive MF-DPI 400 microg qd pm or placebo administered between 6 pm and 8 pm for 14 days. The primary outcome evaluated in the study was reduction in nocturnal decline in evening (8 pm) to morning (6 am) FEV(1) values. Secondary outcomes included reduction in nocturnal decline in evening to morning peak expiratory flow rate (PEFR), polysomnographic indices of sleep, and psychometric indices (Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire [NRQLQ], 36-item Short Form of the Medical Outcomes Survey [SF-36], and Asthma Quality of Life Questionnaire [AQLQ]). A total of 20 patients were randomized and completed all phases of the study. No significant differences were observed between treatment groups in the primary outcome of nocturnal decline in FEV(1) from pretreatment to end of treatment. Likewise, there was no significant difference between treatment groups in polysomnographic indices of sleep or quality-of-life assessments. However, there was a trend toward improvement in the activity scale of the AQLQ assessment in the MF-DPI 400 microg qd pm treatment group. No significant treatment effect on nocturnal pulmonary function, sleep indices or quality of life was observed with 14-day administration of MF-DPI 400 microg qd pm. These findings are limited by the small sample size and the short treatment period evaluated. Future studies are warranted to study the effects of MF-DPI therapy in patients with nocturnal asthma.
    Clinical Drug Investigation 02/2009; 29(1):51-8. DOI:10.2165/0044011-200929010-00005 · 1.70 Impact Factor
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    ABSTRACT: This guideline provides evidence-based recommendations on managing cerumen impaction, defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. We recognize that the term "impaction" suggests that the ear canal is completely obstructed with cerumen and that our definition of cerumen impaction does not require a complete obstruction. However, cerumen impaction is the preferred term since it is consistently used in clinical practice and in the published literature to describe symptomatic cerumen or cerumen that prevents assessment of the ear. This guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction. The primary purpose of this guideline is to improve diagnostic accuracy for cerumen impaction, promote appropriate intervention in patients with cerumen impaction, highlight the need for evaluation and intervention in special populations, promote appropriate therapeutic options with outcomes assessment, and improve counseling and education for prevention of cerumen impaction. In creating this guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of audiology, family medicine, geriatrics, internal medicine, nursing, otolaryngology-head and neck surgery, and pediatrics. The panel made a strong recommendation that 1) clinicians should treat cerumen impaction that causes symptoms expressed by the patient or prevents clinical examination when warranted. The panel made recommendations that 1) clinicians should diagnose cerumen impaction when an accumulation of cerumen is associated with symptoms, or prevents needed assessment of the ear (the external auditory canal or tympanic membrane), or both; 2) clinicians should assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as one or more of the following: nonintact tympanic membrane, ear canal stenosis, exostoses, diabetes mellitus, immunocompromised state, or anticoagulant therapy; 3) the clinician should examine patients with hearing aids for the presence of cerumen impaction during a healthcare encounter (examination more frequently than every three months, however, is not deemed necessary); 4) clinicians should treat the patient with cerumen impaction with an appropriate intervention, which may include one or more of the following: cerumenolytic agents, irrigation, or manual removal other than irrigation; and 5) clinicians should assess patients at the conclusion of in-office treatment of cerumen impaction and document the resolution of impaction. If the impaction is not resolved, the clinician should prescribe additional treatment. If full or partial symptoms persist despite resolution of impaction, alternative diagnoses should be considered. The panel offered as an option that 1) clinicians may observe patients with nonimpacted cerumen that is asymptomatic and does not prevent the clinician from adequately assessing the patient when an evaluation is needed; 2) clinicians may distinguish and promptly evaluate the need for intervention in the patient who may not be able to express symptoms but presents with cerumen obstructing the ear canal; 3) the clinician may treat the patient with cerumen impaction with cerumenolytic agents, irrigation, or manual removal other than irrigation; and 4) clinicians may educate/counsel patients with cerumen impaction/excessive cerumen regarding control measures. DISCLAIMER: This clinical practice guideline is not intended as a sole source of guidance in managing cerumen impaction. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
    Otolaryngology Head and Neck Surgery 09/2008; 139(3 Suppl 2):S1-S21. DOI:10.1016/j.otohns.2008.06.026 · 1.72 Impact Factor
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    ABSTRACT: This study evaluated the sleep/wake cycle of individuals with asthma in relation to asthma control, daytime sleepiness, and daytime activity. Ten persons with mild to moderate persistent asthma monitored their sleep quality and daytime wakefulness for 7 consecutive days using 24-hours wrist actigraphy. Degree of asthma control strongly correlated with sleep quality. Individuals whose asthma was not well controlled took longer to fall asleep, awoke more often, and spent more time awake during the night compared to those with well controlled asthma. Poor asthma control, use of rescue medications, and asthma symptoms were associated with daytime sleepiness and limitations in physical activity and emotional function. Forty percent of subjects reported clinically significant daytime sleepiness. Evaluating asthma throughout a 24-hour cycle provides valuable information on variations in the sleep/wake cycle associated with asthma control, use of rescue medications, and asthma symptoms.
    Journal of Asthma 07/2008; 45(5):389-95. DOI:10.1080/02770900801971800 · 1.83 Impact Factor