The Journal of asthma : official journal of the Association for the Care of Asthma
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Asthmatics requiring admission to the intensive care unit and/or mechanical ventilation have increased morbidity and mortality. The purpose of this study is to examine morbidity and mortality in patients requiring intubation and mechanical ventilation for asthma over a 10-year period. This study also reviews the clinical features and management of these patients. ⋯ Although these patients had multiple risk factors for mortality from asthma, no deaths in this study were related to complications of mechanical ventilation. This low mortality may be related to changes in management of mechanical ventilation as well as changes in chronic outpatient asthma therapy.
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Asthma that is chronic may influence children's behavioral health and quality of life (QoL) negatively. ⋯ Increased rates of attention deficit symptoms in children with asthma, as reported by mothers, might reflect the negative impact of asthma on neurobehavioral health. Asthmatic children, especially the ones who display attention deficit symptoms, must be considered for further evaluation regarding attention deficit hyperactivity disorder.
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Subjects with bronchial asthmatic symptoms, forced expiratory volume in 1 second (FEV(1)) and FEV(1)/forced vital capacity [FVC] > 80% could show a positive reversibility test with salbutamol in about 25% of the cases. The aim of this study was to evaluate if a limit functional value for spirometry exists where a reversibility test using salbutamol, over this limit, is not necessary to confirm the diagnosis of asthma. Four hundred patients (mean age 31.12 +/- 10.99) with asthmatic symptoms and normal spirometry (mean FEV(1) 96.06 +/- 11.82%, mean FEV(1)/FVC 98.89 +/- 6.03%) were recruited. ⋯ FEV(1) > 121% or FEV(1)/FVC > 110.8% or FEF(25 -75) > 110% were cut-off values identified in this study where no RAO subjects were found over these limits. In conclusion, baseline FEV(1) > 100%, FEV(1)/FVC > 100% and FEF(25 -75) > 70% cannot be considered cut-offs where it is not necessary to perform a reversibility test with a bronchodilator over these limits. It is improbable to find a positive reversibility test using salbutamol in patients with asthmatic symptoms and FEV(1) > 121% or FEV(1)/FVC > 110.8% or FEF(25 -75) > 110% to confirm the diagnosis of asthma.
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Comparative Study
Barotrauma not related to type of positive pressure ventilation during severe asthma exacerbations in children.
Children with impending respiratory failure due to severe asthma may be treated with endotracheal intubation and mechanical ventilation. Barotrauma occurs in a significant number of these children. Non-invasive positive pressure ventilation (NPPV) has been used as an alternative intermediary therapy and potentially prevents intubation. However, the comparative risk of barotrauma associated with the use of NPPV has not been evaluated in this population. ⋯ The use of positive pressure is associated with an increased risk of barotrauma in children with asthma, regardless of the mode of delivery.
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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. ⋯ 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.