Does treatment of paradoxical vocal fold movement disorder decrease asthma medication use?

Background and AimPreterm birth is associated with increased risk of asthmatic symptoms in childhood, but it seems uncertain whether this association persists into adulthood. We have investigated the association between...

Objective. The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma—in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children. Methods. A literature search using electronic search engines (i.e., Medline, International Pharmaceutical s (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms “asthma,” “children,” and “medicines” (and derivatives of these keywords) was conducted. Results. The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child’s self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, “off-label” prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications. Conclusion. These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.

Five-fold increase in use of inhaled corticosteroids over 18 years in the general adult population in West Sweden

For more than 70 years, the coexistence of asthma and paranasal rhinosinusitis has been noted in the medical literature. Causal relationships have been proposed but not proved. To date, limited evidence exists suggesting that asthma improves after surgical correction of rhinosinusitis. To determine whether asthma control improved after first-time functional endoscopic sinus surgery (FESS). A retrospective medical record analysis was performed on 13 patients with chronic bronchial asthma who underwent FESS for medically refractory chronic rhinosinusitis. Patients received comprehensive asthma care before and after FESS (mean, 19.3 and 33.1 months, respectively). Outcomes analyzed included pre- and post-FESS individual and group mean asthma symptom scores, medication use scores, pulmonary function test results, and emergency department visits or hospital admissions for asthma. Patient medical records were obtained from a private allergy-immunology practice affiliated with a medical school. The surgical procedure was performed at a tertiary care teaching hospital by a single ear, nose, and throat surgeon (R.L.). Following FESS, there was no statistically significant change in group mean asthma symptom scores, asthma medication use scores, pulmonary function test results, and the number of emergency department visits or hospital admissions. Only a few patients demonstrated statistically significant improvement after FESS in asthma symptom scores (1 patient), medication use scores (1 patient), or pulmonary function test results (2 patients). The data do not support the hypothesis that first-time FESS for medically refractory chronic rhinosinusitis in adult patients with chronic asthma leads to reduced postoperative asthma symptoms or asthma medication use or improved pulmonary function. Based on this limited study, a reexamination of the benefits of sinus surgery to coexisting asthma is in order.

Paradoxical Vocal Fold Movement Disorder is where the larynx exhibits paradoxical vocal cords closure during respiration, creating partial airway obstruction. Causes of vocal fold movement disorder are multifactorial, and patients describe tightness of throat, difficulty getting air in, have stridor, and do not respond to inhalers. We propose using transnasal laryngoscopy examination, which will show narrowing of vocal cords on inspiration, and The Pittsburgh Vocal Cord Dysfunction Index with a cutoff score of ≥4 to distinguish vocal fold movement disorder from asthma and other causes of stridor. Management of paradoxical vocal fold movement disorder involves a combination of pharmacological, psychological, psychiatric, and speech training. Paradoxical vocal fold movement disorder is a very treatable cause of stridor, so long as it is identified and other organic causes are excluded.

Introductionasthma tends to be more severe with worse symptoms in Africa due to late diagnosis and delayed initiation of treatment. To identify patient and treatment-related factors which influence the appropriate use of asthma medications.Methodsthe study was institution based cross-sectional design. Patients were invited to provide information regarding the use of their asthma medications and factors potentially associated with appropriate use of these medications. A stepwise multivariate logistic regression analysis was used to evaluate the most important factor at a 0.05 level of significance.Resultsrespondents with better knowledge of their asthma medications were more likely to use them appropriately (OR 5.82 [CI 95% 2.25-15.04]) as were those with positive attitudes and beliefs towards asthma and asthma medications (OR 3.88 [CI 95% 1.44-10.44]).Conclusionpatients need to understand the importance of adhering to the prescribed regimen for their asthma medications even in the absence of overt symptoms in order to optimize clinical outcome.

Asthma is a chronic respiratory condition exacerbated by exposure to particulate air pollution. Smoke from landscape fires has been associated with increased mortality, asthma-related admissions to emergency and other hospital departments, and uptake in primary care services. With climate change and more frequent landscape fires, healthcare systems must prepare for disaster, including surges in asthma medication demand. Past reviews have not resolved the direction and magnitude of the association between PM2.5 exposure during landscape fires and asthma medication use. The aim of this review was to investigate the relationship between exposure to landscape fire smoke and the use of asthma medications. We conducted a systematic review of PubMed, Scopus, and Web of Science, identifying peer-reviewed articles that examined asthma medication usage following environmental exposure to landscape fire smoke. After a full-text review, we identified twelve articles, three from Canada, three from the USA and six from Australia, with five being retrospective cohort studies. Despite differences in study design, outcome and exposure assessment, the included studies reported a consistent increase in asthma medication use after exposure to wildfires. There is consistent evidence that exposure to wildfire smoke is associated with an increase in the use of reliever medications, particularly salbutamol. Increases in other asthma management medications were also consistently identified. Increases in demand for asthma medications after exposure to wildfire smoke highlight the urgent need to address the growing frequency and intensity of wildfires driven by climate change.

BackgroundWheezing may lead to asthma and reduced pulmonary function in later life. The study aims to identify wheezing trajectories and investigate their relation with pulmonary function and asthma-related outcomes at 22 years of age. MethodsIndividuals from a population-based cohort in Brazil (1993 Pelotas Birth Cohort) with post-bronchodilator pulmonary function data at 22 years (3350) were included in the study. From parentally reported (4 and 11 years) and self-reported (15, 18 and 22 years) history of wheezing in the last 12 months, we used a group-based trajectory modelling approach to derive wheezing trajectories. ResultsFour trajectories were identified: never/infrequent, transient-early, late-onset and persistent wheeze. After adjustments, wheezing trajectories remained associated with lower post-bronchodilator values of pulmonary function. Individuals in the persistent wheeze trajectory had a markedly poorer pulmonary function and also showed greater odds of asthma-related outcomes compared to other trajectories groups. Those following this trajectory had on average −109 ml (95% CI: −188; −35), −1.80 percentage points (95% CI: −2.73; −0.87) and −316 ml/s (95% CI: −482; −150) lower FEV1, FEV1/FVC ratio and FEF25–75% respectively; higher odds of self-reported medical diagnosis of allergy (OR 6.18; 95% CI: 3.59; 10.61) and asthma (OR 12.88; 95% CI: 8.91; 18.61) and asthma medication use (OR 9.42; 95% CI: 5.27; 16.87) compared to the never/infrequent group. ConclusionsWheezing trajectories, especially the persistent wheeze trajectory, were related to lower pulmonary function values and increased risk of asthma and allergy diagnosis in early adulthood.

Absence of changes in airway responsiveness during the menstrual cycle

Asthma related medication use and exacerbations in children and adolescents with type 1 diabetes.

To investigate the impact of adenotonsillectomy on asthma in the pediatric population. Retrospective chart review. All children who underwent adenotonsillectomy at our institution from 2002-2007 were identified from a medical records database. Of the 560 charts reviewed, 93 of the patients had the diagnosis of asthma from a pediatric pulmonologist. Outcome measures of asthma control were analyzed one year preoperatively and one year postoperatively and included: hospital visits, systemic steroid use, asthma medication use, and asthma control test scores. There was a statistically significant improvement in postoperative asthma severity in all measures including mean hospital visits, systemic steroid administration, asthma medication use, and childhood asthma control test scores (p<0.01). This study suggests that adenotonsillectomy, which provides improvement in the upper airway of children, may in turn lead to improvement of the lower airways of children, especially those with bronchial asthma.

IntroductionTaking care of children with asthma, especially those who cannot take their medications according to treatment regimens, can be burdensome for parents and lead to additional parenting stress. Understanding the care process of parents with asthmatic children and helping parents better manage their children's asthma medication use is critical to health care providers. This study aimed to explore how parental factors, namely parental expectation, parental perceived performance, parental confirmation, parental satisfaction, and parenting stress impact parents' intention to adhere to asthma medications (PIAAM) for their children.MethodsA cross‐sectional online Qualtrics survey was administered to parents of children aged between 2 and 12 who were visiting participating asthma/pediatric clinics. The survey assessed the above‐mentioned factors adapted from the expectation confirmation theory (ECT), along with parents' health literacy, number of asthma medications used by the children, and socio‐demographic characteristics of both parents and children. Spearman's correlation, multiple regression, and path analyses were conducted to determine the relationship between model variables with parents' and children's characteristics.ResultsThe findings from a total of 261 surveys indicated that PIAAM was significantly correlated with all parental factors (P &lt; 0.05). Path analyses indicated an indirect effect of parenting stress on PIAAM. Multiple regression and path analyses both suggested that parental expectation (β = 0.369, P &lt; 0.05) and number of asthma medications (β = 0.659, P &lt; 0.05) were significant predictors for PIAAM after controlling for other covariates.ConclusionsReducing parenting stress can enhance parental expectation of asthma medications, and hence improve PIAAM. Understanding parents' perspectives may enable health care providers to provide better care for children with asthma.

New-Onset Asthma in Adults: What Does the Trigger History Tell Us?

Background and AimsContinuing care of asthmatic children is traditionally provided in outpatients settings. This study evaluated the effectiveness of both asthma and upper airway cough syndrome assessment by questionnaire and...

Recent evidence suggests a role for hormonal factors in the aetiology of asthma. Data from a large study of women selected from the general population were used to relate treatment with oral hormonal contraceptives (OCP) and postmenopausal hormone replacement therapy (HRT) to the following asthma indicators: self-reported asthma, wheezing, cough at exertion, and use of medication for asthma. The study sample comprised 1536 premenopausal and 3016 postmenopausal women who participated in the third round of the Copenhagen City Heart Study in 1991-4. A total of 377 women were taking OCP (24.5% of premenopausal women) and 458 were on HRT (15.2% of postmenopausal women). In premenopausal women 4.8% reported having asthma. The prevalence of self-reported asthma, wheeze, use of asthma medication, and cough at exertion was not significantly related to use of OCP. In postmenopausal women the prevalence of self-reported asthma was 6.2%. A weak but consistent association was observed between HRT and self-reported asthma (OR 1.42 (95% CI 0.95 to 2.12)), wheeze (OR 1.29 (95% CI 1.02 to 1.64)), cough at exertion (OR 1.34 (95% CI 1.01 to 1.77)), and use of asthma medication (OR 1.45 (95% CI 0.97 to 2.18)). In this study of the general population no relationship was found between the use of OCP and asthma. Although an association was observed between HRT and asthma and asthma-like symptoms, this was relatively weak and it is concluded that there is no necessity to change present prescription practice.