[Show abstract][Hide abstract] ABSTRACT: Background: The importance of smoking in bronchial asthma has been thoroughly investigated. Although a high smoking rate has been recognized in Japan, there have been few studies of the relationship between active smoking and bronchial asthma, and little analysis of the gender difference in this relationship. The aims of this study were to examine the contribution of active smoking to asthma and to clarify any gender difference. Methods: For 8 weeks from September through October 2000, a smoking questionnaire survey was performed on adult patients with bronchial asthma, and their attending physicians, in Niigata Prefecture, Japan. The questionnaire surveyed asthma control, asthma-related emergencies and satisfaction in daily life. The attending physicians were questioned about patient profiles and medications. Patients were classified into three groups: non-smokers (NS), ex-smokers (ES) and current smokers (CS). For examination of gender differences, the CS group was compared with the NS group, due to variable duration of smoking and of cessation of smoking in the ES group. Results: Complete data were received from 2947 cases. Of the male patients, 340 (23.0%) were in the CS group, 325 (22.0%) were in the NS group and 812 were in the ES group. Of the female patients, 109 (7.4%) were in the CS group, 1132 (77.4%) were in the NS group, and 229 (7.4%) were in the ES group. The male CS group had more severe asthma-related symptoms in the morning and at night, more sputum and cough in the morning, and more severe sleep disturbance than the male NS group. In the female patients, these differences were not detected. A logistic and multiple regression analysis confirmed these significant differences between male and female asthma patients. Conclusions: The gender differences in the susceptibility of asthma to smoking suggests the need for gender-specific strategies for smoking cessation, although further investigation is required.
Allergology International 12/2005; 54(3):401-410. DOI:10.2332/allergolint.54.401 · 2.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prevention of deaths due to asthma is one of the most important issues in asthma management. However, there are few epidemiological studies of asthma deaths in Japan.
Over an 8-week period in Niigata Prefecture, Japan, a questionnaire on asthma control and emergency episodes was administered to adult asthmatic patients. A questionnaire was also given to the patients' physicians to obtain further clinical information. Patients who became unconscious during episodes of asthma, or who required intubation and ventilation, were allocated to a near-fatal asthma group (NFA). Patients who did not fulfill these criteria were allocated to the non-NFA group. The NFA group was divided into two subgroups, based on the date of their last NFA episode (old NFA>or= 5 years and recent NFA<4 years).
Characteristic features of the NFA group included severe disease (23.1%vs 7.6%) with more aggressive patient management, including inhaled corticosteroid use (84.3%vs 72.0%). Multiple regression analysis confirmed that aspirin-intolerant asthma (AIA) was strongly associated with NFA. There was no difference in the incidence of AIA between the recent and old NFA patients. This suggests the incidence of AIA in NFA did not improve over time.
A history of AIA may be a useful indicator of potential NFA and allow preventative methods to be introduced. It is therefore important to obtain a history of AIA and to be aware of the risk of NSAID administration to these patients.
[Show abstract][Hide abstract] ABSTRACT: Objective : Although inhaled steroids are strongly recommended in several guidelines for the management of bronchial asthma, the actual clinical situation requires clarification. This study presents the current status of adult bronchial asthma by questionnaire-based analysis, and suggests an improved method of assessment for asthma management compared with the guideline strategy. Methodology : Questionnaires were completed by asthmatic patients and their physicians in participating institutions within Niigata Prefecture from September to October 1998. The 3,347 responses were then analyzed. Results : The rate of peak-flow meter per user was only 30.8%. Attacks that were more than moderate were found in less than 10% of subjects, while asthma related symptoms--including coughing--were found in more than 50% of subjects. Emergent events were often existed (unconsciousness attacks; 6.8%, respirator management; 5.9%, aspirin induced attacks; 8.6%, respectively). Although inhaled steroid use reached 62.0%, sustained-release theophylline was used by 76.9% of subjects. Conclusion : Despite satisfactory results in asthma attack control, there is still room for improvement of the peak-flow meter and inhaled steroid use, as well as for alleviating asthma-related symptoms and preventing death related risk factors. Sustained-release theophylline was positioned as a fundamental medication and requires reevaluation as a long-term controller the same as inhaled steroids.