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ABSTRACT: The people of Puerto Rico have one of the highest asthma prevalence and morbidity rates in the U.S.A. Limited information is available on the most common allergy sensitivities among island residents. The aims of the study were to determine the most common inhalant allergen sensitivities among a convenience sample in Puerto Rico and determine as well their relationship to an asthma or a rhinitis diagnosis.
In August of 2008, we evaluated a cohort of subjects visiting ambulatory clinics offering health screening; the clinics were located in two of the island's biggest cities: Guaynabo in the north and Ponce in the south. Subjects over three years of age (or their parents) visiting the clinics answered a survey on asthma and rhinitis and were skin tested for reactivity to common aeroallergens.
The survey included 395 subjects with a mean age of 29 years. Thirty-six percent reported a history of asthma, of whom 83% (30% of the total participants) reported still having asthma, and 76% reported having rhinitis. Sixty-five percent of the subjects were sensitive to at least one antigen. Subjects sensitive to mites were 53% more likely to have suffered from asthma than were non-mite-sensitized subjects (OR = 1.53, p < 0.05) sensitivity to mosquitoes (OR = 2.25, p < 0.02), mites (OR = 2.53, p < 0.00001), feathers (OR = 2.72, p < 0.03), dogs (OR = 3.02, p < 0.01), or cats (OR = 3.42, p < 0.001) increased an individual's likelihood of suffering from rhinitis.
The most common sensitivities identified were to mites and insects. Mite sensitivity was associated with rhinitis and asthma. Sensitivity to animal dander as well as to mosquitoes was associated to with rhinitis. Further studies are warranted to explore the relevance of allergen sensitivity in terms of asthma and rhinitis prevalence and morbidity among residents of Puerto Rico.
Puerto Rico health sciences journal 03/2012; 31(1):24-8. · 0.56 Impact Factor
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Joshua Galanter,
Shweta Choudhry,
Celeste Eng, Sylvette Nazario,
José R Rodríguez-Santana,
Jesús Casal,
Alfonso Torres-Palacios,
Jorge Salas,
Rocio Chapela,
H Geoffrey Watson,
Kelley Meade,
Michael LeNoir,
William Rodríguez-Cintrón,
Pedro C Avila,
Esteban González Burchard
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ABSTRACT: Independent replication of genetic associations in complex diseases, particularly in whole-genome association studies, is critical to confirm the association.
A whole-genome association study identified ORMDL3 as a promising candidate gene for asthma in white populations. Here, we attempted to confirm the role of ORMDL3 genetic variants in asthma in three ethnically diverse populations: Mexican, Puerto Rican, and African American.
We used family-based analyses to test for association between seven candidate single-nucleotide polymorphisms (SNPs) in and around the ORMDL3 gene and asthma and related phenotypes in 701 Puerto Rican and Mexican parent-child trios. We also evaluated these seven SNPs and an additional ORMDL3 SNP in 264 African American subjects with asthma and 176 healthy control subjects.
We found significant associations between two SNPs within ORMDL3 (rs4378650 and rs12603332) and asthma in Mexicans and African Americans (P = 0.028 and 0.001 for rs4378650 and P = 0.021 and 0.001 for rs12603332, respectively), and a trend toward association in Puerto Ricans (P = 0.076 and 0.080 for SNPs rs4378650 and rs12603332, respectively). These associations became stronger among Mexican and Puerto Rican subjects with asthma with IgE levels greater than 100 IU/ml. We did not find any association between ORMDL3 SNPs and baseline lung function or response to the bronchodilator albuterol.
Our results confirm that the ORMDL3 locus is a risk factor for asthma in ethnically diverse populations. However, inconsistent SNP-level results suggest that further studies will be needed to determine the mechanism by which ORMDL3 predisposes to asthma.
American Journal of Respiratory and Critical Care Medicine 07/2008; 177(11):1194-200. · 11.08 Impact Factor
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Mariam Naqvi,
Shannon Thyne,
Shweta Choudhry,
Hui-ju Tsai,
Daniel Navarro,
Richard A Castro, Sylvette Nazario,
Jose R Rodriguez-Santana,
Jesus Casal,
Alfonso Torres,
Rocio Chapela,
H Geoffrey Watson,
Kelley Meade,
Michael LeNoir,
Pedro C Avila,
William Rodriguez-Cintron,
Esteban González Burchard
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ABSTRACT: Socioeconomic and environmental differences do not fully explain differences in asthma prevalence, morbidity, and mortality among Puerto Ricans, African Americans, and Mexican Americans. Differences in response to albuterol may be a factor. We compared bronchodilator responsiveness between these three populations. All groups demonstrated below expected responsiveness. Puerto Ricans of all ages and African American children with moderate-to-severe asthma demonstrated the lowest responsiveness overall. Among subjects with moderate-to-severe asthma, children were even less likely than adults to show the expected bronchodilator response. We conclude that ethnic-specific differences in bronchodilator drug responsiveness exist between Mexicans, Puerto Ricans, and African Americans with asthma. This may be of importance in asthma management.
Journal of Asthma 11/2007; 44(8):639-48. · 1.52 Impact Factor
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Mariam Naqvi,
Shweta Choudhry,
Hui-Ju Tsai,
Shannon Thyne,
Daniel Navarro, Sylvette Nazario,
Jose R Rodriguez-Santana,
Jesus Casal,
Alfonso Torres,
Rocio Chapela,
H Geoffrey Watson,
Kelley Meade,
William Rodriguez-Cintron,
Michael Lenoir,
Pedro C Avila,
Esteban González Burchard
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ABSTRACT: High levels of IgE are associated with asthma. Whether higher levels of IgE are associated with more severe asthma is still unclear.
To determine whether IgE is associated with asthma severity among Latino and African American subjects with asthma.
We assessed lung function and asthma severity among African American, Mexican, and Puerto Rican patients with asthma with high IgE levels (> or =100 IU/mL; n = 492) and compared these values to those of patients with asthma with low IgE levels (<100 IU/mL; n = 247). We also examined IgE as a continuous variable among these groups.
Patients with asthma with high IgE had a lower mean FEV(1) (87.6 +/- 17.1, percent of predicted) than patients with asthma with low IgE (91.5 +/- 17.0; P = .031). Regardless of race and ethnicity, baseline FEV(1), forced expiratory flow, and FEV(1)/forced vital capacity were lower among subjects with high IgE than among subjects with low IgE (P = .031, P < .0001, P = .0001, respectively). In addition, 54.7% of patients with asthma with high IgE had been previously hospitalized, compared with 44.1% of patients with asthma with low IgE (odds ratio, 1.33; 95% CI, 1.04-1.71).
Higher IgE is associated with lower baseline lung function and more severe asthma among these populations.
Among patients with asthma from 3 ethnically distinct groups, total IgE levels are inversely correlated with baseline lung function and asthma severity.
Journal of Allergy and Clinical Immunology 07/2007; 120(1):137-43. · 11.00 Impact Factor
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Yuhjung J Tsai,
Shweta Choudhry,
Jennifer Kho,
Kenneth Beckman,
Hui-Ju Tsai,
Daniel Navarro,
Henry Matallana,
Richard A Castro,
Craig M Lilly, Sylvette Nazario, [......],
Jesus Casal,
Alfonso Torres,
Jorge Salas,
Rocio Chapela,
H George Watson,
Kelley Meade,
Pedro C Avila,
William Rodriguez-Cintron,
Michael LeNoir,
Esteban González Burchard
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ABSTRACT: The prostanoid DP receptor (PTGDR) gene on chromosome 14q22.1 has been identified as an asthma susceptibility gene. A haplotype with decreased transcription factor binding and transcription efficiency was associated with decreased asthma susceptibility in African American and white subjects. The significance of PTGDR gene variants in asthma has yet to be determined in Latinos, the largest US minority population, nor has the association been replicated in other populations.
To determine the role of PTGDR gene variants in asthma susceptibility and asthma-related traits among the Mexican, Puerto Rican, and African American populations.
We determined whether single nucleotide polymorphisms (SNPs) and haplotypes in PTGDR were associated with asthma and asthma-related traits by family-based and cross-sectional cohort analyses in 336 Puerto Rican and 273 Mexican asthmatic trios and by case-control analysis among African American subjects with asthma and healthy controls (n = 352).
We identified 13 SNPs in the PTGDR gene, and 6 were further analyzed. There was no significant association between PTGDR variants and asthma by family-based or case-control analyses. SNPs -441C and -197C and haplotype TTT showed marginal association with asthma-related traits in Mexican subjects. SNP -441 genotype TT (P = .05) and haplotype TTT (P = .02) were associated with increased IgE levels in African Americans.
We conclude that the PTGDR gene is not a significant risk factor for asthma among Puerto Ricans, Mexicans, or African Americans.
Asthma candidate genes provide insights to pathophysiology and potentially new therapeutic targets, although the PTGDR gene was not found to be a significant risk factor for asthma in 3 populations.
Journal of Allergy and Clinical Immunology 01/2007; 118(6):1242-8. · 11.00 Impact Factor
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Shweta Choudhry,
Esteban González Burchard,
Luisa N Borrell,
Hua Tang,
Ivan Gomez,
Mariam Naqvi, Sylvette Nazario,
Alphonso Torres,
Jesus Casal,
Juan Carlos Martinez-Cruzado,
Elad Ziv,
Pedro C Avila,
William Rodriguez-Cintron,
Neil J Risch
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ABSTRACT: Puerto Ricans, an admixed population of African, European, and Native American ancestries, have the highest asthma prevalence, morbidity, and mortality rates of any United States' population. Although socioeconomic status (SES) is negatively correlated with asthma incidence in most populations, no such relationship has been identified among Puerto Ricans. We hypothesized that, in this admixed population, the association between SES and asthma may interact with genetic ancestry.
We analyzed 135 Puerto Rican subjects with asthma and 156 control subjects recruited from six different recruitment centers in Puerto Rico. Individual ancestry for each subject was estimated using 44 ancestry informative markers. SES was assigned using the census tracts' median family income. Analyses of SES were based on the SES of the clinic site from which the subjects were recruited and on a subset of individuals on whom home address-based SES was available.
In the two (independent) analyses, we found a significant interaction between SES, ancestry, and asthma disease status. At lower SES, European ancestry was associated with increased risk of asthma, whereas African ancestry was associated with decreased risk. The opposite was true for their higher SES counterparts.
The observed interaction may help to explain the unique pattern of risk for asthma in Puerto Ricans and the lack of association with SES observed in previous studies when not accounting for varying proportions of ancestry.
American Journal of Respiratory and Critical Care Medicine 12/2006; 174(10):1088-93. · 11.08 Impact Factor
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Shweta Choudhry,
Natasha E Coyle,
Hua Tang,
Keyan Salari,
Denise Lind,
Suzanne L Clark,
Hui-Ju Tsai,
Mariam Naqvi,
Angie Phong,
Ngim Ung, [......],
Richard Castro,
Natalie C Battle,
Eliseo J Perez-Stable,
Pui-Yan Kwok,
Dean Sheppard,
Mark D Shriver,
William Rodriguez-Cintron,
Neil Risch,
Elad Ziv,
Esteban Gonzàlez Burchard
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ABSTRACT: In the United States, asthma prevalence and mortality are the highest among Puerto Ricans and the lowest among Mexicans. Case-control association studies are a powerful strategy for identifying genes of modest effect in complex diseases. However, studies of complex disorders in admixed populations such as Latinos may be confounded by population stratification. We used ancestry informative markers (AIMs) to identify and correct for population stratification among Mexican and Puerto Rican subjects participating in case-control studies of asthma. Three hundred and sixty-two subjects with asthma (Mexican: 181, Puerto Rican: 181) and 359 ethnically matched controls (Mexican: 181, Puerto Rican: 178) were genotyped for 44 AIMs. We observed a greater than expected degree of association between pairs of AIMs on different chromosomes in Mexicans (P < 0.00001) and Puerto Ricans (P < 0.00002) providing evidence for population substructure and/or recent admixture. To assess the effect of population stratification on association studies of asthma, we measured differences in genetic background of cases and controls by comparing allele frequencies of the 44 AIMs. Among Puerto Ricans but not in Mexicans, we observed a significant overall difference in allele frequencies between cases and controls (P = 0.0002); of 44 AIMs tested, 8 (18%) were significantly associated with asthma. However, after adjustment for individual ancestry, only two of these markers remained significantly associated with the disease. Our findings suggest that empirical assessment of the effects of stratification is critical to appropriately interpret the results of case-control studies in admixed populations.
Human Genetics 01/2006; 118(5):652-64. · 5.07 Impact Factor
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Shweta Choudhry,
Pedro C Avila, Sylvette Nazario,
Ngim Ung,
Jennifer Kho,
Jose R Rodriguez-Santana,
Jesus Casal,
Hui-Ju Tsai,
Alfonso Torres,
Elad Ziv, [......],
Henry Matallana,
Richard A Castro,
Moises Selman,
Scott T Weiss,
Jean G Ford,
Jeffrey M Drazen,
William Rodriguez-Cintron,
Rocio Chapela,
Edwin K Silverman,
Esteban González Burchard
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ABSTRACT: A recent family-based genomewide screen revealed linkage between the 5q31 region and the diagnosis of asthma, but only in those exposed to environmental tobacco smoke (ETS). Among the candidate genes in this region is CD14.
To determine whether polymorphisms in the CD14 gene are related to this gene-by-environment interaction in Latinos, we used both family-based and cross-sectional cohort analysis to test for interactions between CD14 genotypes/haplotypes, exposure to ETS, and asthma-related phenotypes in 659 Mexican and Puerto Rican families.
We identified 21 single nucleotide polymorphisms (SNPs) in the CD14 gene by sequencing 72 Puerto Ricans, Mexicans, and African Americans with asthma. Three SNPs, -810, -159, and +1437, were further genotyped in families with asthma. Among all subjects with asthma exposed to ETS, without regard to ethnicity, CD14 +1437 genotypes were associated with asthma severity. SNP +1437 GG or GC genotypes were significantly associated with lower baseline FEV1 using both family-based (p = 0.0009) and cross-sectional cohort (p = 0.03) analyses. Subjects with asthma with the GG or GC genotypes who were exposed to ETS had mean baseline FEV1 (% predicted) values 8.6% lower than subjects not exposed to ETS (p = 0.03). As previously observed in whites, we found an interaction between plasma IgE levels, SNP -159 genotypes, and ETS exposure (p = 0.0002). The lowest IgE levels were in those subjects with the TT genotype and who were exposed to ETS regardless of ethnicity.
Our data suggest a gene-by-environment interaction between CD14 genotypes and ETS, which affects pulmonary function and IgE levels among Latinos with asthma.
American Journal of Respiratory and Critical Care Medicine 08/2005; 172(2):173-82. · 11.08 Impact Factor
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Keyan Salari,
Shweta Choudhry,
Hua Tang,
Mariam Naqvi,
Denise Lind,
Pedro C Avila,
Natasha E Coyle,
Ngim Ung, Sylvette Nazario,
Jesus Casal, [......],
Ivan Gomez,
Henry Matallana,
Eliseo J Pérez-Stable,
Mark D Shriver,
Pui-Yan Kwok,
Dean Sheppard,
William Rodriguez-Cintron,
Neil J Risch,
Esteban González Burchard,
Elad Ziv
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ABSTRACT: Genetic association studies in admixed populations may be biased if individual ancestry varies within the population and the phenotype of interest is associated with ancestry. However, recently admixed populations also offer potential benefits in association studies since markers informative for ancestry may be in linkage disequilibrium across large distances. In particular, the enhanced LD in admixed populations may be used to identify alleles that underlie a genetically determined difference in a phenotype between two ancestral populations. Asthma is known to have different prevalence and severity among ancestrally distinct populations. We investigated several asthma-related phenotypes in two ancestrally admixed populations: Mexican Americans and Puerto Ricans. We used ancestry informative markers to estimate the individual ancestry of 181 Mexican American asthmatics and 181 Puerto Rican asthmatics and tested whether individual ancestry is associated with any of these phenotypes independently of known environmental factors. We found an association between higher European ancestry and more severe asthma as measured by both forced expiratory volume at 1 second (r=-0.21, p=0.005) and by a clinical assessment of severity among Mexican Americans (OR: 1.55; 95% CI 1.25 to 1.93). We found no significant associations between ancestry and severity or drug responsiveness among Puerto Ricans. These results suggest that asthma severity may be influenced by genetic factors differentiating Europeans and Native Americans in Mexican Americans, although differing results for Puerto Ricans require further investigation.
Genetic Epidemiology 08/2005; 29(1):76-86. · 3.44 Impact Factor
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Shweta Choudhry,
Ngim Ung,
Pedro C Avila,
Elad Ziv, Sylvette Nazario,
Jesus Casal,
Alfonso Torres,
Jennifer D Gorman,
Keyan Salari,
Jose R Rodriguez-Santana, [......],
Moises Selman,
Rocio Chapela,
Dean Sheppard,
Scott T Weiss,
Jean G Ford,
Homer A Boushey,
Jeffrey M Drazen,
William Rodriguez-Cintron,
Edwin K Silverman,
Esteban González Burchard
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ABSTRACT: In the United States, Puerto Ricans and Mexicans have the highest and lowest asthma prevalence, morbidity, and mortality, respectively. Ethnic-specific differences in the response to drug treatment may contribute to differences in disease outcomes. Genetic variants at the beta(2)-adrenergic receptor (beta(2)AR) may modify asthma severity and albuterol responsiveness. We tested the association of beta(2)AR genotypes with asthma severity and bronchodilator response to albuterol in Puerto Ricans and Mexicans with asthma.
We used both family-based and cross-sectional tests of association with 8 beta(2)AR single nucleotide polymorphisms in 684 Puerto Rican and Mexican families. Regression analyses were used to determine the interaction between genotype, asthma severity, and bronchodilator drug responsiveness.
Among Puerto Ricans with asthma, the arginine (Arg) 16 allele was associated with greater bronchodilator response using both family-based and cross-sectional tests (p = 0.00001-0.01). We found a strong interaction of baseline FEV(1) with the Arg16Glycine (Gly) polymorphism in predicting bronchodilator response. Among Puerto Ricans with asthma with baseline FEV(1) < 80% of predicted, but not in those with FEV(1) > 80%, there was a very strong association between the Arg16 genotype and greater bronchodilator responsiveness. No association was observed between Arg16Gly genotypes and drug responsiveness among Mexicans with asthma.
Ethnic-specific pharmacogenetic differences exist between Arg16Gly genotypes, asthma severity, and bronchodilator response in Puerto Ricans and Mexicans with asthma. These findings underscore the need for additional research on racial/ethnic differences in asthma morbidity and drug responsiveness.
American Journal of Respiratory and Critical Care Medicine 03/2005; 171(6):563-70. · 11.08 Impact Factor
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ABSTRACT: We conducted a survey to determine parent-reported asthma prevalence, morbidity, and healthcare utilization among 3527 children attending public schools (n = 2849) and private schools (n = 678) in San Juan, Puerto Rico. Schools were randomly selected from each of 12 geographic regions of the San Juan metropolitan area. Parents of children age 4-7 years old completed a 12-item questionnaire on asthma diagnosis, respiratory symptoms and morbidity, and healthcare utilization. Parents of children in public schools and private schools reported similar rates of a physician having previously diagnosed asthma in their children (43.2% vs. 39.4%); however, significantly more children in public schools were reported to still have asthma at the time of the survey (32.6% vs. 23.7%). Children attending public schools vs. private schools were reported to have missed significantly more school and to have had more hospitalizations and emergency department visits. Among children reported to still have asthma, significantly more children visited an emergency department, were hospitalized, and missed more school days due to respiratory symptoms in the past year. The high prevalence of parent-reported asthma, respiratory symptoms, and healthcare utilization among Puerto Rican children in San Juan calls for further studies using objective methods for ascertaining asthma and asthma-related morbidity. Differences in healthcare utilization between children attending public vs. private schools suggest that socioeconomic factors play a role in asthma management in Puerto Rico.
Pediatric Pulmonology 06/2004; 37(5):453-60. · 2.53 Impact Factor
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Esteban González Burchard,
Pedro C Avila, Sylvette Nazario,
Jesus Casal,
Alfonso Torres,
Jose R Rodriguez-Santana,
Monica Toscano,
Jody Senter Sylvia,
MariaElena Alioto,
Michael Salazar, [......],
Richard Castro,
Moises Selman,
Rocio Chapela,
Dean Sheppard,
Scott T Weiss,
Jean G Ford,
Homer A Boushey,
William Rodriguez-Cintron,
Jeffrey M Drazen,
Edwin K Silverman
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ABSTRACT: In the United States, Puerto Ricans and Mexicans have the highest and lowest asthma prevalence, morbidity, and mortality, respectively. To determine whether ethnicity-specific differences in therapeutic response, clinical response, and/or genetic factors contribute to differences in asthma outcomes, we compared asthma-related clinical characteristics among 684 Mexican and Puerto Rican individuals with asthma recruited from San Francisco, New York City, Puerto Rico, and Mexico City. Puerto Ricans with asthma had reduced lung function, greater morbidity, and longer asthma duration than did Mexicans with asthma. Bronchodilator responsiveness, measured as percentage change from baseline FEV1, was significantly lower among Puerto Ricans with asthma than among Mexicans with asthma. Puerto Ricans with asthma had on average 7.3% (95% confidence interval [CI], 4.6 to 9.9; p < 0.001) lower bronchodilator reversibility in FEV1, higher risk of an emergency department visit in the previous year (odds ratio, 2.63; 95% CI, 1.6 to 4.3; p < 0.001), and of previous hospitalization for asthma (odds ratio, 1.94; 95% CI, 1.2 to 3.2; p = 0.009) than Mexicans. Subgroup analysis corroborated that Puerto Ricans with asthma had more severe disease than did Mexicans on the basis of lung function measurements, responsiveness to beta2-adrenergic agonists, and health care use. We conclude that Puerto Ricans with asthma respond less to albuterol than do Mexicans with asthma. These findings underscore the need for additional research on racial/ethnic differences in asthma morbidity and response to therapy.
American Journal of Respiratory and Critical Care Medicine 02/2004; 169(3):386-92. · 11.08 Impact Factor
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Denise L Lind,
Shweta Choudhry,
Ngim Ung,
Elad Ziv,
Pedro C Avila,
Keyan Salari,
Connie Ha,
Elizabeth G Lovins,
Natasha E Coyle, Sylvette Nazario, [......],
Moises Selman,
Homer A Boushey,
Scott T Weiss,
Rocio Chapela,
Jean G Ford,
William Rodriguez-Cintron,
Edwin K Silverman,
Dean Sheppard,
Pui-Yan Kwok,
Esteban González Burchard
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ABSTRACT: A recent study identified the ADAM33 gene as a promising candidate contributing to asthma. In Puerto Rican and Mexican populations, we have genotyped six single nucleotide polymorphisms (SNPs) that were used in the Genetics of Asthma in Latino Americans Study. We chose to study these two populations because in the United States, Puerto Ricans have the highest asthma prevalence, morbidity, and mortality and Mexicans the lowest. We used the transmission disequilibrium test to analyze associations between the ADAM33 gene variants and asthma, asthma severity, bronchodilator responsiveness, and total IgE levels using single SNPs, two to six SNP combinations, and specific haplotypes in 583 trios (proband with asthma and both biological parents). We also genotyped matched control samples to allow case-control analyses. None of the transmission disequilibrium test or case-control results showed significant association in either population. We found no evidence for association of single SNPs with asthma severity, bronchodilator response, or IgE levels in Mexicans or in the combined population. Two SNPs showed a modest association in Puerto Ricans, insignificant when the number of comparisons was taken into account. We conclude that the ADAM33 gene is not an important risk factor for asthma or for asthma-associated phenotypes in Mexicans or in Puerto Ricans.
American Journal of Respiratory and Critical Care Medicine 01/2004; 168(11):1312-6. · 11.08 Impact Factor
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ABSTRACT: To evaluate Smoking Cessation Clinic success rate and attitudes toward smoking among current and quitters enrolled at the clinic.
Telephone survey among a random sample of 61 subjects enrolled at the Smoking Cessation Clinic in the San Juan Veterans Affairs Hospital. The questionnaire was validated and standardized for Hispanic subjects.
Twenty eight percent of the subjects interviewed referred they had quit smoking. Quitters used to smoke more cigarettes than current smokers do. Quitters perceived their general health to be worse than current smoker's perception. Even though Quitters were concerned about weight gain after quitting, it was not a negative outcome for smoking cessation. No association was found between active smoking and use of ethanol, neither socializing with friends nor feeling anxious.
The Smoking Cessation Clinic at the San Juan Veterans Affairs Hospital has a success rate similar to other clinics reported in the literature. Poor health perception and consumption of more than one pack per day predicted smoking cessation. There was no single strong factor associated to smoking cessation. The idiosyncrasy of targeted population should be taken in account when designing smoking cessation program.
Puerto Rico health sciences journal 07/2003; 22(2):173-7. · 0.56 Impact Factor
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ABSTRACT: Puerto Ricans have one of the highest asthma prevalence and morbidity rates. However, limited information is available on asthma care and attitudes toward asthma treatment among Puerto Ricans living in the island.
We evaluated a cohort of subjects attending Ambulatory Health Screen Clinic in the two main cities in the north and south of the island during August of 2008. Subjects attending the clinic answered a survey about asthma care and attitudes toward asthma treatment. Approval was obtained from the Medical Sciences IRB and written informed consent obtained from all research subjects before enrollment.
According to subject report, asthma care is primarily conducted by primary care physicians including pediatricians (35.8%), general practitioners (31.4%), and family physicians (4.3%). Pulmonary physicians conducted 23.3% of asthma care and allergists conduct 3.6%. Only 65.5 % reported using prescribed asthma medications. Fear of medication side effects (37.7%), lacks of health insurance coverage (26.4%), and medication cost (15.1%) were the most common causes reported for poor compliance. Subjects considered that physicians were one of the best sources (68.1%) for information on asthma, followed by the TV (23.7%) and the web (15.4%).
Most asthma care in Puerto Rico is conducted by primary care providers. Subspecialists have a limited role and particularly allergists. Efforts to increased public and physician awareness of the role of allergists in asthma care in Puerto Rico are warranted.
Boletín de la Asociación Médica de Puerto Rico 103(1):18-21.
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Sylvette Nazario
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ABSTRACT: Puerto Ricans have one of the highest asthma prevalence, morbidity and mortality in the world. Genetic, socioeconomic and environmental factors have been hypothesized to account for these elevated figures. The article discusses published articles on asthma among Puerto Ricans.
Boletín de la Asociación Médica de Puerto Rico 100(3):28-31.
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ABSTRACT: Urticaria is a common disorder affecting approximately 15-25% of the population at some point in their life. We can assume that with the advancement of medical therapeutics, which have in turn prolonged the duration of life, the incidence of drug induced urticaria will increase in the geriatric population. Other common causes that need to be considered are allergy, autoimmune conditions and stress. Urticaria is characterized by transient pruritic wheals or erythematous patches on the skin. The signs and symptoms usually resolve in less than 24 hrs, leaving no residual scar or discoloration. Generally, the etiology of urticaria remains unknown in 75-90% of patients. In this article we discuss pathogenesis, clinical presentation, and treatment of urticaria in the elderly. A complete medical evaluation and age appropriate screening should be performed in all elderly patients in a primary care setting. We should also weigh risk versus benefits of each prescribed medication to decrease morbidity and improve the quality of life.
Boletín de la Asociación Médica de Puerto Rico 100(3):32-5.
