Higher mortality of adults with asthma: a 15 year follow-up of apopulation-based cohort.
Allergy. 2018 Feb 20;:
Authors: Lemmetyinen RE, Karjalainen JV, But A, Renkonen RLO, Pekkanen JR, Toppila-Salmi SK, Haukka JK
BACKGROUND: Higher all-cause mortality in asthmatics has been shown previously. Polysensitization is associated with higher morbidity among asthmatic children, and allergic rhinitis and/or allergic conjunctivitis (AR/AC) is associated with higher morbidity in adult asthmatics. Little is known about the effect of AR/AC and other factors on mortality among adult asthmatics. The aim was to study mortality and its risk factors in adults with and without asthma.
METHODS: We randomly selected 1648 asthmatics with age over 30 years from national registers and matched the asthma sample with one or two controls. Baseline information was obtained by a questionnaire in 1997, and the study population was linked with the death certificate information of Statistics Finland from 1997 to 2013. Overall and cause-specific survival between the groups was compared in several adjusted models.
RESULTS: During a mean follow-up period of 15.6 years, 221 deaths among 1052 asthma patients and 335 deaths among 1889 non-asthmatics were observed. Cardiovascular diseases were the main cause of death in both groups. Asthma was associated with increased all-cause mortality (adjusted HR 1.25; 95% CI 1.05-1.49, P=0.011); as well as mortality from chronic obstructive pulmonary disease (HR 12.0, 4.18-34.2, P<0.001) and malignant neoplasms of respiratory organs (HR 2.33, 1.25-4.42, P=0.008). Among asthmatics, smoking was associated with increased all-cause mortality and self-reported AR/AC was associated with decreased mortality. Among non-asthmatics, smoking and obesity were associated with increased all-cause mortality, whereas female gender showed an association with a decreased risk.
CONCLUSIONS: Increased mortality among adult asthmatics was largely explained by the development of COPD, malignant respiratory tract neoplasms and cardiovascular diseases. Smoking cessation is important for reduction of total mortality in both asthmatic and non-asthmatic adults. AR/AC was associated with decreased mortality only in asthmatics. Thus, studies in other populations of larger size are needed to explore further the nature of this association. This article is protected by copyright. All rights reserved.
PMID: 29461632 [PubMed - as supplied by publisher]
Serum vitamin D profile of Nigerian children with asthma: Association with asthma severity and control.
Pediatr Pulmonol. 2018 Feb 20;:
Authors: Omole KO, Kuti BP, Oyelami OA, Adegbola AJ, Omole JO
OBJECTIVE: Childhood asthma is a chronic inflammatory airway disorder with increasing prevalence even in Africa. Vitamin D, with anti-inflammatory and immune-modulatory properties, may have effects on the severity and level of symptoms control in childhood asthma. We aimed to assess the serum vitamin D levels in children with asthma as related to disease severity and control in a tropical region.
METHODS: A hospital based comparative cross sectional study was conducted in western Nigeria. Serum vitamin D (25-OH-D) levels of all the children, assayed using high-performance liquid chromatography (HPLC), were compared to the various disease severity and levels of asthma control as well as between the asthmatic and non-asthmatic children.
RESULTS: A total of 206 children (103 asthmatics and 103 non-asthmatics) were recruited with a mean (SD) age of 6.6 (3.7) years. The majority (82.5%) of the children with asthma had mild intermittent form, 63.1% had well controlled symptoms while 33.0% and 3.9% had partly controlled and uncontrolled symptoms, respectively. None of the children were deficient in vitamin D. The mean (SD) serum vitamin D levels of the children with asthma (49.2 [7.2] ng/mL) was significantly lower than those without asthma (51.2 [6.9] ng/mL, P = 0.043). Varying degrees of asthma severity and levels of symptoms control were not affected by serum vitamin D levels.
CONCLUSION: Children with asthma in Nigeria had marginally but significantly lower mean serum vitamin D levels when compared with their counterparts without asthma. However, serum vitamin D level does not seem to be associated with childhood asthma severity and control in these children with normal serum vitamin D levels.
PMID: 29461019 [PubMed - as supplied by publisher]
Medication adherence in pediatric asthma: A systematic review of the literature.
Pediatr Pulmonol. 2018 Feb 20;:
Authors: Gray WN, Netz M, McConville A, Fedele D, Wagoner ST, Schaefer MR
OBJECTIVE: To provide a systematic review of correlates of adherence to inhaled corticosteroids (ICS) in pediatric asthma across the individual, family, community, and healthcare system domains.
METHODS: Articles assessing medication adherence in pediatric asthma published from 1997 to 2016 were identified using PsychINFO, Medline, and CINAHL. Search terms included asthma, compliance, self-management, adherence, child, and youth. Search results were limited to articles: 1) published in the US; 2) using a pediatric population (0-25 years old); and 3) presenting original data related to ICS adherence. Correlates of adherence were categorized according to the domains of the Pediatric Self-Management Model. Each article was evaluated for study quality.
RESULTS: Seventy-nine articles were included in the review. Family-level correlates were most commonly reported (N = 51) and included socioeconomic status, race/ethnicity, health behaviors, and asthma knowledge. Individual-level correlates were second-most common (N = 37), with age being the most frequently identified negative correlate of adherence. Health care system correlates (N = 24) included enhanced asthma care and patient-provider communication. Few studies (N = 10) examined community correlates of adherence. Overall study quality was moderate, with few quantitative articles (26.38%) and qualitative articles (21.4%) referencing a theoretical basis for their studies.
CONCLUSIONS: All Pediatric Self-Management Model domains were correlated with youth adherence, which suggests medication adherence is influenced across multiple systems; however, most studies assessed adherence correlates within a single domain. Future research is needed that cuts across multiple domains to advance understanding of determinants of adherence.
PMID: 29461017 [PubMed - as supplied by publisher]
Prescribing of asthma drugs for children 2004-2015.
Tidsskr Nor Laegeforen. 2018 Feb 19;:
Authors: Mikalsen IB, Karlstad Ø, Furu K, Øymar K
BAKGRUNN: Astma kan være vanskelig å diagnostisere hos barn. For barn under skolealder finnes det få tilgjengelige objektive diagnostiske undersøkelser, og retningslinjene for diagnose og behandling er basert på sykehistorie og klinisk undersøkelse. Dette kan gi rom for varierende behandlingspraksis.
KUNNSKAPSGRUNNLAG: Data fra Reseptregisteret ble brukt til å studere forskrivning av legemidler mot astma til barn i aldersgruppene 0-4 år og 5-9 år fordelt på fylker fra 2004-15.
RESULTAT: Det var stor variasjon mellom fylkene i andelen per 1 000 barn som fikk forskrevet legemidler mot astma i perioden 2012-14 (aldersgruppen 0-4 år: median: 104/1 000; ekstremverdier: 64-147, aldersgruppen 5-9 år: 68/1000; 46-86). Inhalasjonssteroider var hyppigst forskrevet, og det var her variasjonen mellom fylkene var størst i begge aldersgruppene (aldersgruppen 0-4 år: 85/1 000; 42-116, aldersgruppen 5-9 år: 51/1 000; 31-70). De fleste fikk kun en eller få forskrivninger med inhalasjonssteroider over en treårsperiode. Endring i forskrivningen av inhalasjonssteroider fra 2004 til 2015 varierte betydelig mellom fylkene, mest for aldersgruppen 0-4 år.
FORTOLKNING: Stor forskjell i forskrivning av legemidler mot astma fylkene imellom, høy andel sporadisk bruk og endring over tid, særlig i den yngste aldersgruppen, kan tyde på en unaturlig variasjon i behandlingen som ikke kan forklares av forskjeller i astmaforekomst. Uklare retningslinjer som ikke er tilstrekkelig innarbeidet i klinisk praksis kan være én årsak.
PMID: 29460600 [PubMed - as supplied by publisher]
How are children with asthma treated?
Tidsskr Nor Laegeforen. 2018 Feb 19;:
Authors: Aasen TOB
PMID: 29460566 [PubMed - as supplied by publisher]