Fatal asthma; is it still an epidemic?

Juan Carlos Ivancevich Tuesday, 03 January 2017 22:41
Logo of waoj BioMed Central search submit a manuscript register this article World Allergy Organization Journal

Abstract

Background

Asthma mortality has declined since the 1980s. Nevertheless the World Health Organization (WHO) identified asthma as responsible for 225.000 deaths worldwide in 2005, and 430.000 fatal cases are expected by 2030. Some unexpected and concentrated fatal asthma events all occurred between 2013 and 2015 in Veneto, a North Eastern region of Italy, which prompted a more in-depth investigation of characteristics and risk factors.

Methods

A web search including key words related to fatal asthma in Italy between 2013 and 2015 has been performed. Concerning the cases that occurred in Veneto, subjects’ clinical records have been evaluated and details about concomitant weather conditions, pollutants and pollen count have been collected.

Results

Twenty-three cases of asthma deaths were found in Italy; 16 of them (69%) occurred in the Veneto Region. A prevalence of male and young age was observed. Most of patients were atopic, died in the night-time hours and during the weekends. The possible risk factors identified were the sensitization to alternaria, previous near fatal asthma attacks and the incorrect treatment of the disease. Weather condition did not appear to be related to the fatal exacerbations, whereas among the pollutants only ozone was detected over the accepted limits. Smoking habits, possible drug abuse and concomitant complementary therapies might be regarded as further risk factors.

Discussion

Although not free from potential biases, our web search and further investigations highlight an increasing asthma mortality trend, similarly to what other observatories report. The analysis of available clinical data suggests that the lack of treatment more than a severe asthma phenotype characterizes the fatal events.

Conclusions

Asthma mortality still represents a critical issue in the management of the disease, particularly in youngsters. Once more the inadequate treatment and the lack of adherence seem to be not only related to the uncontrolled asthma but also to asthma mortality.

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Prenatal exposure to selenium may protect against wheezing in children by the age of 3

Juan Carlos Ivancevich Sunday, 18 December 2016 16:21

Early View
Immunity, Inflammation and Disease

Browse  Early View Articles 

Original Research


Authors: Nour Baïz, Julie Chastang, Gladys Ibanez, Isabella Annesi-Maesano

Abstract

Introduction

It has been suggested that human in utero exposure to heavy metals such as selenium can reduce the prevalence of childhood asthma and allergic diseases. However, data on this topic are scarce. The objective of the present study was to assess the putative associations between maternal selenium level during pregnancy and the risk of asthma, wheezing, allergic rhinitis, and atopic dermatitis in children from the EDEN birth cohort by the age of 1 and 3 years.

Methods

Plasma selenium concentrations were measured in maternal blood during mid-pregnancy (24–28 weeks of gestation) in 861 mothers. Cohort children were followed up from birth to 3 years using health questionnaires filled out by the parents for asthma, wheezing, allergic rhinitis, and atopic dermatitis. Maternal plasma selenium was related to the childhood outcomes by the age of 1 and 3 years.

Results

Our results showed a significant negative association between a high maternal plasma selenium level during pregnancy and the risk of wheezing in the child by the age of 1 and 3 years. However, maternal plasma selenium during pregnancy was not associated with the prevalence of asthma, allergic rhinitis or atopic dermatitis.

Conclusions

The results of this study suggest that the level of fetal exposure to maternal selenium could have an influence on the risk of wheezing in infancy and potentially on the risk of developing asthma later in life.

Abstract
Introduction
Materials and Methods
Results
Discussion
Conclusion
Acknowledgments
Conflict of Interest

References
Related Content

Procedural and short-term safety of bronchial thermoplasty in clinical practice: evidence from a national registry and Hospital Episode Statistics.

Juan Carlos Ivancevich Tuesday, 13 December 2016 13:10
J Asthma. 2016 Dec 1:0. [Epub ahead of print]
 

Abstract

OBJECTIVE: Bronchial thermoplasty (BT) is a novel treatment for severe asthma. Its mode of action and ideal target patient group remain poorly defined, though clinical trials provided some evidence on efficacy and safety. This study presents procedural and short-term safety evidence from routine UK clinical practice.

METHODS: Patient characteristics and safety outcomes (procedural complications, 30-day readmission and A&E attendance, length of stay) were assessed using two independent data sources, the British Thoracic Society UK Difficult Asthma Registry (DAR) and Hospital Episodes Statistics (HES) database. A matched cohort (with records in both) was used to estimate safety outcome event rates and compare them with clinical trials.

RESULTS: Between June 2011 and January 2015, 215 procedure records (83 patients, of whom 68 were treated in England) were available from DAR and 203 (85 patients) from HES. 152 procedures matched (59 patients; 6 centres), and of these, 11.2% reported a procedural complication, 11.8% resulted in emergency respiratory readmission and 0.7% in respiratory A&E attendance within 30 days (20.4% had at least one event); 46.1% involved a post-procedure stay. Compared with published clinical trials which found lower hospitalisation rates, BT patients in routine clinical practice were, on average, older, had worse baseline FEV1 and lower AQLQ scores.

CONCLUSIONS: A higher proportion of patients experienced adverse events compared with clinical trials. The greater severity of disease amongst patients treated in clinical practice may explain the observed rate of post-procedural stay and readmission. Continued data collection will allow long-term safety and efficacy to be studied.

Suicidal ideation and suicide attempts among asthma

Juan Carlos Ivancevich Friday, 16 December 2016 13:01

Abstract

BACKGROUND:

The present study aimed to investigate the mental health status in patients with asthma and assess the effects of asthma on suicidal ideation and attempts using a representative sample from Korea.

METHODS:

Individual-level data were obtained from 228,744 participants (6372 with asthma and 222,372 without asthma) of the 2013 Korean Community Health Survey. Demographic characteristics, socioeconomic status, physical health status, and mental health status were compared between patients with asthma and population without asthma. Multivariable logistic regression was performed to investigate the independent effects of the asthma on suicidal ideation and attempts.

RESULTS:

A depressed mood for 2 or more continuous weeks was reported by 12.0% of subjects with asthma and 5.7% of controls (p < 0.001). Suicidal thoughts were reported by 21.4% of patients with asthma and 9.8% of controls (p < 0.001). Suicidal attempts were reported by 1.0% of the patients with asthma and 0.4% of controls (p < 0.001). Following adjustment for age, sex, income, education, job, marital status, smoking, alcohol, exercise, and presence of diabetes mellitus, hypertension, stroke, arthritis, and depression, the ORs for suicidal ideation with asthma were 1.53 (95% CI 1.42-1.65) and that for suicidal attempts was 1.32 (95% CI 1.01-1.73).

CONCLUSIONS:

We found that asthma increased the risk for suicidal ideation and attempts, even controlling for the effects of socioeconomic status, physical health status, comorbid chronic medical diseases, and depressive mood. Our finding suggests that asthma per se may be an independent risk factor for suicidality.

Formats:

Article PubReader ePub (beta) PDF (762K) Citation

The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial

Juan Carlos Ivancevich Monday, 12 December 2016 13:55

Original Paper

Sara Ahmed1,2,3,4, BPhysio, MSc (Rehab), PhD Pierre Ernst5, FRCPC, MD Susan J Bartlett1,3, PhD Marie-France Valois3, MSc Tasneem Zaihra1,2,4,6, PhD Guy Paré7, PhD Roland Grad8, MSc, FCFP, MDCM Owis Eilayyan1,2,4, MSc Robert Perreault9, FRCPC, MD Robyn Tamblyn3,10, PhD 

1Division of Clinical Epidemiology, McGill University Health Center, McGill University, Montreal, QC, Canada 2School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada3Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada4Centre de recherche interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montreal, QC, Canada5Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada6The College at Brockport, Department of Mathematics, State University of New York, Brockport,, NY, United States7Department of Information Technology, HEC Montreal, Montreal, QC, Canada8Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada9Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada10Biostatistics and Occupational Health and the Clinical and Health Informatics Research Group, Department of Epidemiology, McGill University, Montreal, QC, Canada

ABSTRACT

Background: Whether Web-based technologies can improve disease self-management is uncertain. My Asthma Portal (MAP) is a Web-based self-management support system that couples evidence-based behavioral change components (self-monitoring of symptoms, physical activity, and medication adherence) with real-time monitoring, feedback, and support from a nurse case manager.

Objective: The aim of this study was to compare the impact of access to a Web-based asthma self-management patient portal linked to a case-management system (MAP) over 6 months compared with usual care on asthma control and quality of life.

Methods: A multicenter, parallel, 2-arm, pilot, randomized controlled trial was conducted with 100 adults with confirmed diagnosis of asthma from 2 specialty clinics. Asthma control was measured using an algorithm based on overuse of fast-acting bronchodilators and emergency department visits, and asthma-related quality of life was assessed using the Mini-Asthma Quality of Life Questionnaire (MAQLQ). Secondary mediating outcomes included asthma symptoms, depressive symptoms, self-efficacy, and beliefs about medication. Process evaluations were also included.

Results: A total of 49 individuals were randomized to MAP and 51 to usual care. Compared with usual care, participants in the intervention group reported significantly higher asthma quality of life (mean change 0.61, 95% CI 0.03 to 1.19), and the change in asthma quality of life for the intervention group between baseline and 3 months (mean change 0.66, 95% CI 0.35 to 0.98) was not seen in the control group. No significant differences in asthma quality of life were found between the intervention and control groups at 6 (mean change 0.46, 95% CI –0.12 to 1.05) and 9 months (mean change 0.39, 95% CI –0.2 to 0.98). For poor control status, there was no significant effect of group, time, or group by time. For all self-reported measures, the intervention group had a significantly higher proportion of individuals, demonstrating a minimal clinically meaningful improvement compared with the usual care group.

Conclusions: This study supported the use of MAP to enhance asthma quality of life but not asthma control as measured by an administrative database. Implementation of MAP beyond 6 months with tailored protocols for monitoring symptoms and health behaviors as individuals’ knowledge and self-management skills improve may result in long-term gains in asthma control.

ClinicalTrial: International Standard Randomized Controlled Trial Number (ISRCTN): 34326236; http://www.isrctn.com/ISRCTN34326236 (Archived by Webcite at http://www.webcitation.org/6mGxoI1R7).

J Med Internet Res 2016;18(12):e313

doi:10.2196/jmir.5866

 

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