The Journal of asthma : official journal of the Association for the Care of Asthma
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A total of 48 patients presenting to the emergency department as acute asthma exacerbation were prospectively studied. Rhinolaryngoscopy was conducted with simultaneous flow measurements and spirometry performed before and after the procedure. ⋯ One additional patient had inspiratory and expiratory closure of the vocal cords. The previously unreported high incidence of anterior two-thirds closure (10.4%) of the vocal cords suggests that the upper airway has a role to play in a significant number of patients presenting with symptoms of asthma exacerbation.
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We sought to determine socioeconomic and demographic factors that predict frequent emergency department (ED) use among asthmatics in Southeastern Pennsylvania. ⋯ Frequent ED use is associated with demographic factors, geographic factors, and markers of severity of illness. While care guidelines recommend prompt referral to a primary care physician to prevent ED visits, given the level of primary care use in this population, frequent primary care attendance alone may not prevent asthma-related ED visits.
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Asthma education programs are reportedly effective for children and adolescents. Urban and minority children continue to have poor asthma outcomes and limited access to asthma education programs. The purpose of this study was to determine whether a library-based asthma education program, the Columbus Ohio Partnership for Inner-City Asthma Education (COPICAE), offered to urban and minority children (with their parents) could improve asthma-related outcomes and reduce billing claims for asthma-related hospital visits. ⋯ Parents also found the information from the asthma education classes to be "beneficial." Total asthma-related billing claims for children who completed 6 hours of asthma education decreased 63.2%, while those for age and zip code matched controls increased 0.7%. Inner-city and minority children (with their parents) who attended 6 hours of asthma education offered in a public library showed improvements in asthma-related outcomes over a 24-month period and decreased billing claims for asthma-related hospital visits. Parents found 6 hours of asthma education to be beneficial in gaining basic knowledge about asthma and improving their child's illness control and self-esteem in living with asthma.
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Short-term bronchodilator responsiveness to an inhaled ss 2 adrenergic agonist was assessed by changes in forced expiratory volume in 1 second (FEV(1)) in nonsmoking adults with controlled asthma (mild disease, 20 patients; moderate disease, 20 patients; severe disease, 18 patients). Responsiveness correlated significantly with age and with percent of predicted FEV(1) (%FEV(1)) except in patients with severe asthma, who showed significantly less responsiveness than others. Thus, responsiveness is closely associated with degree of airflow limitation in patients with controlled asthma and is significantly influenced by severity of disease and by aging.
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Chronic obstructive pulmonary disease (COPD) is often misdiagnosed as asthma, leading to inappropriate treatment and suboptimal patient outcomes. As part of a prospective study of patients with a history consistent with obstructive lung disease, we compared prior diagnostic labels with a study diagnosis based on spirometric results. We enrolled persons 40 years of age or older with prior diagnoses or medications consistent with obstructive lung disease. ⋯ Among subjects with a spirometry-based study diagnosis of COPD, 121 (51.5%) reported a prior diagnosis of asthma without concurrent CBE diagnosis, 89 (37.9%) reported a prior diagnosis of CBE, and 25 (10.6%) reported no prior diagnosis of obstructive lung disease. Despite the availability of consensus guideline diagnostic recommendations, diagnostic confusion between COPD and asthma appears common. Increased awareness of the differences between the two conditions is needed to promote optimal patient management and treatment.