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Hodgson, David Brian. "Investigating new treatment options for refractory asthma." Thesis, University of Nottingham, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.664300.
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Patients with difficult to manage asthma and chronic cough are commonly seen by respiratory physicians in the NHS. This thesis describes three randomised trials which explore new treatment options for these difficult groups. Non-invasive markers of airway inflammation and function were measured before each trial to help determine likely responders. In the first study, 30 patients with asthma and eosinophilic inflammation were given two weeks of prednisolone and then randomised to receive either ciclesonide 360mcg or placebo twice daily for 8 weeks. Though the between- group differences were not significant several patients had changed their usual maintenance dose of prednisolone during the trial. When these patients were removed from the analysis there was a significant improvement sputum eosinophils with ciclesonide. There was no significant change in the marker of small airway inflammation, so it is possible that this effect was due to a general reduction in airway inflammation from the higher dose of inhaled steroids, rather than specifically targeting the small airways. In the second study, 28 patients with refractory asthma were given azithromycin 250mg or placebo three times weekly for six weeks in a randomised, cross-over design. Though significant improvements in airway hyper-responsiveness, asthma control and sputum neutrophils were seen with azithromycin, these changes were not significant when compared to placebo.
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Khan, Md Sanaur Rahman School of Women?s & Children?s Health UNSW. "Improving the management of childhood asthma." Awarded by:University of New South Wales. School of Women?s and Children?s Health, 2003. http://handle.unsw.edu.au/1959.4/19256.
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Objectives: To improve the management of childhood asthma. Subjects & Setting: Children admitted with asthma from 1st January 2000 to 31st December 2000; and children discharged with asthma from Emergency Department (ED) of Sydney Children?s Hospital (SCH) between 16th October 2000 and 28th February 2002. Methods: There were two major studies addressing aspects of asthma management, namely the retrospective in-patient study and the prospective ED presentation study. Each of these was subdivided in two different studies to address different research questions. In the first retrospective study, a priori criteria for theoretical "time ready for discharge" (TRD) for asthmatic admissions were defined based on frequency of use of salbutamol. In the second retrospective study, we followed 361 children for 1 year from the date of their discharge, to find out whether those who received asthma education, written asthma action plan, and preventer medications at the time of discharge and whose follow?up was arranged prior to discharge, represented to the ED or were readmitted. The prospective study, which also addressed two different research questions, was a randomised-controlled trial in which parents of 310 children who had been discharged from ED with asthma, received written asthma materials only or received telephone consultation in addition to written materials. Background severity and control of asthma were assessed in baseline study from parent?s reported symptom frequency and medication uses. Outcome measures: readmission and representation to the ED, regular use of preventer medications, possession and use of written asthma action plan, and asthma symptom measures. Results: (1) 116 (27.7%) children were discharged before our theoretical TRD and only 2 child who were discharged after achieving TRD, developed symptoms which required oxygenation and more frequent doses of salbutamol. Both readmission and representation to ED within one week of discharge were uncommon. (2) 121 children represented within 1 year of their discharge, of whom 68 children were readmitted. Both receiving asthma education during admission and arranging follow-up prior to discharge were associated with a decreased likelihood of representation as well as readmission (P > 0.001). (3) In RCT, the baseline study showed that 14% of children were not receiving appropriate preventer therapy despite indications; and a further 34% had frequent symptoms despite receiving preventer therapy. 62% of the parents reported of having written asthma action plan but less than 50% of them reported using it regularly. At follow up we observed both possession and use of written asthma action plan (p = 0.002) as well as regular use of preventer medications (p = 0.001) were improved in the intervention group compared with the control group. Conclusions: Discharge on 3-hourly rather than 4-hourly doses of salbutamol appears safe and shortens length of stay by an average of 5.5 hrs. Both asthma education and follow-up at the time discharge appear to reduce readmission and representation to ED. Telephone consultation can increase the regular use of preventer medications and written asthma action plan.
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Lau, Ming-wai, and 劉明偉. "Effectiveness of pharmacist interventions in the self management of asthma in the community setting : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193784.
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Background: Asthma is a global health problem affecting people of all ages. Despite huge progress on the management of asthma in recent decades, suboptimal health outcomes associated with under-management is still commonly encountered. Self management was shown to be a both clinically and cost effective approach to improve asthma outcomes in some studies. The role of pharmacists in promoting self management of asthma was explored in individual studies but limited review was conducted to assess its effectiveness.
Objective: To investigate the effectiveness of pharmacist interventions on the self management of asthma patients in the community setting and to examine if the benefits, if any, could be realized by implementing such interventions in Hong Kong.
Methods: A systematic search was conducted on Medline, Embase, Pubmed and Cochrane Library without time limit to identify studies assessing the clinical, humanistic and economic outcomes of pharmacist-led self management interventions towards adolescent or adult patients with asthma compared to usual care. Risk of bias of studies was appraised using a tool adapted from the Effective Practice of Organization of Care version of the Cochrane Risk of Bias Tool.
Results: The search yielded 504 studies of which eight studies were eligible for inclusion. The included studies involved 1674 patients, were published between 2001 and 2008 and were originated from seven countries. Discrepancies of findings were noted in the majority of outcome measures reviewed. Significant benefits of pharmacist interventions included improvement of inhalation technique and reduction of rescue medication use although no significant effect was observed with regard to forced expiratory volume in one second and days lost from work or school.
Conclusions: The evidence of pharmacist interventions on the self management of asthma remains inconsistent, probably attributable to variable quality of studies and heterogeneous assessment methods and outcome measures. Future research should aim to produce randomized, controlled studies incorporating allocation concealment with a follow-up period of over one year. Nevertheless, pharmacist-led asthma self management initiatives could be implemented at the general outpatient clinic setting in Hong Kong to further improve the quality of primary care.published_or_final_version
Public Health
Master
Master of Public Health
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Ställberg, Björn. "Asthma in Primary Care : Severity, Treatment and Level of Control." Doctoral thesis, Uppsala universitet, Allmänmedicin och klinisk epidemiologi, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9332.
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Aims. The overall aim was to examine the severity, treatment and level of control in patients with asthma in primary care in Sweden. The specific aims were to assess what matters to asthma patients, evaluate symptoms, medication and identify factors related to asthma severity, compare the extent of asthma control in 2001 and 2005, and investigate the development of asthma and degree of asthma control in adolescents and young adults who had reported asthma six years earlier. Methods. The first study was a telephone interview of a representative sample of Swedish asthmatics. In the second study a random sample of 1,136 patients answered two questionnaires. A classification of the asthma severity similar to that in the GINA guidelines was made. In the third study two surveys were performed, in 2001 and in 2005, with a random sample of 1,012 and 224 asthma patients, respectively, and a classification of asthma control similar to the recent GINA guidelines was made. In the fourth study 71 individuals who reported physician-diagnosed asthma in a population-based survey in 1997 and were defined as current asthmatics, were reinvestigated in 2003 with a skin prick test, methacholine challenge test, eucapnic voluntary hyperventilation test and measurement of exhaled nitric oxide. Results. Common situations causing symptoms of asthma were physical exertion and contact with pets. Nocturnal symptoms were frequent. In primary care 35% of the women and 24% of the men were classified as having severe asthma. Female sex, increasing age, not filling the asthma prescription owing to cost, daily smoking, and pollen allergy increased the odds of having severe asthma. In 2001, 37% had achieved asthma control, as compared with 40% in 2005. Uncontrolled asthma was more common in women and smokers. In the 2003 study of adolescents and young adults with asthma six years earlier, the definition of current asthma was fulfilled by 50 of the 71 subjects and one third had achieved asthma control. Conclusions. The majority of the asthmatics reported a large number of symptoms and limitations in their daily living. Many asthma patients in primary care have insufficient asthma control. One reason for lack of control might be undertreatment with inhaled corticosteroids.
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Byrne, Karen. "Efficacy of yoga practices in treatment of asthma : a systematic review /." Thesis, View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B38030627.
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McCants, Kellie M. "Factors affecting treatment regimen adherence in children and adolescents with asthma." Connect to this title online, 2003. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1041866923.
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Thesis (Ph. D.)--Ohio State University, 2004.Title from first page of PDF file. Document formatted into pages; contains xv, 134 p.; also includes graphics Includes bibliographical references (p. 101-108). Available online via OhioLINK's ETD Center
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Erasmus, Esther W. "Insights into the psychobiology of personality of individuals living with chronic asthma to inform treatment planning." Pretoria : [s.n.], 2007. http://upetd.up.ac.za/thesis/available/etd-06292007-163159.
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Ilicak, Selin. "Children's adjustment to asthma or diabetes and treatment adherence." Thesis, Oxford Brookes University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.515232.
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This thesis had two main aims. Firstly, to develop separate questionnaires for children with asthma and children with diabetes and their parents, which assess children's adjustment to the illness and treatment adherence. Secondly, to test the hypothesis of an association between children's adjustment and treatment adherence. The essence of asthma and diabetes treatment is self-care and consequently children with asthma or diabetes have to learn to cope with the long-term demands and responsibilities of complying with a strict and complex treatment regimen. It is currently recognized that a major problem in paediatrics is poor treatment adherence, which can result in serious health consequences. This led to a shift in paediatric medicine, from focusing only on the physical treatment of the illness to exploring the psychological impact of the illness and how it affects children's socio-emotional adjustment. However, there is a shortage of adjustment and treatment adherence measures; existing ones have major limitations. Thus, the new questionnaires aimed at assessing both children's adjustment and treatment adherence. Four interlinked studies utilising qualitative and quantitative methods were carried out. Study 1 and study 3 were parallel but separate studies and involved interviewing a group of 15 children with asthma and 15 children with diabetes, their parents and paediatric nurses about the children's experiences and feelings in a range of contexts. The interviews showed that there were commonalities in stressors across children but differences in adjustment and treatment adherence levels. On the basis of these interviews separate questionnaires for children with asthma (study 2) and children with diabetes (study 4) and their parents were developed and administered to a sample of 60 children and their parents. The new questionnaires proved to be reliable and valid and confirmed the hypothesis of a significant relation between children's adjustment and treatment adherence. The development of a new assessment tool involves several steps: This work represents the first steps in developing a new assessment tool. As with any new assessment instrument, further development will be required to examine its validity and reliability.
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Bolcas, Paige. "Pathogenesis and Treatment Strategies for Difficult-to-Treat Asthma." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1561393922642685.
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Williams, Julie M. "Coping with asthma : investigation and intervention using the self-regulation model." Thesis, University of St Andrews, 1995. http://hdl.handle.net/10023/2800.
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The Self-Regulation Model (Leventhal, Nerenz & Steele, 1984) highlights the roles of patients' illness representations, coping, emotional reactions and appraisal of coping in the progression of chronic disease. This thesis incorporates previous literature on adherence, panic-fear and selfmanagement interventions into the model in order to (a) investigate coping with asthma and (b) develop an intervention aimed at improving asthmatic control. New measures of asthmatic control and illness representations of the consequences of having asthma were developed in order to operationalise the model. A cross-sectional study investigated factors influencing asthmatic control in a sample of 35 adult asthma sufferers recruited through a single general practice. Coping was poor, adherence being low and less than 50% of participants reporting current Peak Flow monitoring or medical contact during the previous 12 months. Good coping appeared to be a response to poor asthmatic control, rather than prophylactic. Good asthmatic control was associated with low perceived consequences, recent medical contact, moderate panic-fear and low general avoidance coping. These results imply that asthmatic control may be improved by encouraging sufferers to maintain regular contact with outpatient services and to implement prophylactic coping. Since epidemiological and clinical evidence suggested asthmatic control to be poor in young adults, an intervention was developed to improve asthmatic control in this group by modifying illness representations, coping and panic-fear. The intervention was evaluated in a randomised controlled study of 50 student asthma sufferers identified initially through an epidemiological screening of 2,979 students. It led to increased Preventer medication use and Peak Flow monitoring and decreased distress over the condition. However, the coping process changed and asthmatic control improved even in the control group, perhaps because self-monitoring of asthmatic control for the study constituted a change in coping. This unanticipated result was entirely compatible with the Self-Regulation Model. The thesis dearly demonstrates value of the Self-Regulation Model in understanding asthma self-management and developing clinical interventions.
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Smith, Nerida Ann. "The effects of intervention on medication compliance and asthma control in children with asthma." Thesis, The University of Sydney, 1987. http://hdl.handle.net/2123/1613.
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Asthma can be a chronic disorder requiring regular medications if the symptoms are persistent. The regimen is often complex, involving a number of drugs and a variety or routes of administration. Although drug therapy may not alter the natural history of asthma it can improve lung function enabling those with asthma to lead as near a normal life as possible. Thus medication compliance is an important factor in the managemnt of asthma. (Note : Special enclosures (Publication reprints) at end of thesis have been removed for digital submission, with permission of author)
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Smith, Nerida Ann. "The effects of intervention on medication compliance and asthma control in children with asthma." University of Sydney, 1987. http://hdl.handle.net/2123/1613.
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Doctor of PhilosophyAsthma can be a chronic disorder requiring regular medications if the symptoms are persistent. The regimen is often complex, involving a number of drugs and a variety or routes of administration. Although drug therapy may not alter the natural history of asthma it can improve lung function enabling those with asthma to lead as near a normal life as possible. Thus medication compliance is an important factor in the managemnt of asthma. (Note : Special enclosures (Publication reprints) at end of thesis have been removed for digital submission, with permission of author)
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Edmonds, Marcia. "Inhaled corticosteroids in the emergency department treatment of acute asthma." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ60425.pdf.
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Mondoñedo, Jarred R. "Anesthetic delivery system for treatment of status asthmaticus." Thesis, Boston University, 2013. https://hdl.handle.net/2144/21220.
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Thesis (M.Sc.Eng.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Status asthmaticus (SA) is a severe, acute exacerbation of asthma that is refractory to traditional therapies using standard bronchodilators such as β-agonists and corticosteroids. Inhaled volatile anesthetics are currently used as a rescue therapy for SA due to their potent bronchodilator effects. However, it is unclear whether these agents act in vivo via 1) direct action on airway smooth muscle (ASM); 2) systemic re-circulation; or 3) autonomic reflexes from the central nervous system. Treatment with these agents can also lead to negative side effects, notably hypotension and arrhythmias, especially during prolonged pediatric use. The goals of this thesis were to compare direct versus systemic effects of these inhaled anesthetic agents, and to determine whether sufficient bronchodilation can be achieved via direct diffusion from the airway lumen to the ASM. We designed and developed a computer-actuated, ventilator-valve system to control the serial composition of the inspired gas. Using this system, we delivered inhaled anesthetic agents either a) to the anatomic dead space selectively (direct), or b) continuously throughout inspiration (systemic) in three mongrel canines (20-25 kg) with methacholine-induced bronchoconstriction. Measurements of lung resistance (RL), elastance (EL), and anatomic dead space (VD) demonstrated that isoflurane and sevoflurane result in bronchodilation for both delivery regimes. This suggests that the mechanism of action for these agents is at least partly via direct effects. Fluctuations in VD were not directly coupled with those for RL or EL. Furthermore, there may exist a limit to maximal bronchodilation using inhaled anesthetics, with isoflurane being more potent. In summary, this study illustrates the feasibility of using a targeted anesthetic delivery to treat severe, acute bronchoconstriction. Such a delivery system has the potential to define a rapidly translatable treatment paradigm for SA while increasing patient safety.
2031-01-01
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Baraket, Melissa. "Comparison of the effects of low dose and high dose inhaled corticosteroid treatment of mild to moderate asthma in adults." Connect to full text, 2007. http://hdl.handle.net/2123/4855.
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Thesis (Ph. D.)--University of Sydney, 2008.Title from title screen (viewed May 8, 2009) Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Discipline of Pharmacology, Faculty of Medicine. Degree awarded 2008; thesis submitted 2007. Includes bibliography. Also available in print form.
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Wright-Jegede, Narue Jaynelle. "Parental Perception of Physician Cultural Sensitivity and Adherence to Asthma Treatment." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7905.
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In the United States, asthma remains a major cause of frequent urgent care visits, hospitalizations, and preventable deaths among children. Nationwide, the chronic disease continues to fall disproportionately on minorities, mostly residing in urban localities. When a child is diagnosed with asthma, the parents are typically tasked with managing the child's condition. Establishing a collaborative partnership between parents and their child's primary physician is significant for improving asthma self-management among youth. Using the theory of reasoned action as a theoretical framework, this mixed-methods study examined whether a relationship exists between parental perceptions of physician cultural sensitivity and parental care in asthma treatment adherence. Phenomenology was used to explore the real-world experiences of study five ethnic minority parents and one guardian grandparent of asthmatic children aged 0–17 who shared similar perspectives. Descriptive surveys were used in combination with in-depth interviews to develop an understanding of parental perceptions on physician cultural sensitivity related to asthma treatment adherence. Overall, 108 minority parents were eligible to complete the survey. The study findings revealed that parents who feel recognized, valued, and respected by their child's physician were more likely to be engaged in shared decision-making about treatment. The findings support the potential for positive social change in terms of modifying the health care behaviors of minority parents with asthmatic children, increasing parental self-efficacy in managing their child's asthma, and improving the cultural sensitivity of physicians who serve the needs of diverse minority families.
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Clearie, Karine Leila. "Airway challenges in different clinical phenotypes and their relationship to markers of disease and treatment." Thesis, University of Dundee, 2010. https://discovery.dundee.ac.uk/en/studentTheses/ebd2ee79-ad92-419b-a159-fc83f6a7a4b3.
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Asthma is a chronic disease, which affects over 300 million people worldwide.Despite the introduction of both national and international guidelines, asthma control remains poor. The aim of this thesis is therefore to explore possible new strategies for improving the management of asthma. The first strategy to be explored is ‘titrating asthma treatment to suppress underlying airway inflammation’. The benefits of such a strategy have already been demonstrated,however, the lack of an adequate ‘inflammometer’ have limited its application to the research/ hospital setting. Mannitol challenge appears to be the most promising candidate, as it is portable and relatively cheap. The aim of the first study in this thesis is therefore to trial the use of mannitol challenge in a community setting. The selection of an appropriate ‘inflammometer’ is not limited to the clinical setting, it is equally important in research. This is particularly true when determining therapeutic equivalence between inhaled steroids. The aim of the second study in this thesis is therefore to determine which inflammatory outcomes demonstrate sufficient assay sensitivity, as part of a cross-over trial, to detect dose response effects on airway and systemic markers The second strategy to be examined in this thesis is tailoring asthma therapy according to asthmatic phenotype. Two groups of asthmatics that differ significantly from traditional ‘inflammatory asthma’ have been selected. Asthmatic smokers are known to develop relative resistance to the beneficial effects of inhaled steroids. A recent post hoc analysis of the GOAL trial has suggested that smokers may gain greater benefit from the addition of a long-acting beta-2 agonist vs. doubling the dose of inhaled steroid. The third study in this thesis therefore aims to examine this in a prospective fashion. Another group of individuals in whom the traditional approach to asthma management and diagnosis may not be appropriate is elite athletes. In has been well documented that the mechanism of bronchospasm in athletes involves the drying/ cooling of airways. However, even within this category there are athletes to which this mechanism of action is unlikely to apply.Elite swimmers, for example, exercise in a warm, humidified environment. It therefore seems unlikely that tests designed to reproduce hyperosmolar shifts will have the same diagnostic sensitivity as they do in cold weather or track athletes. The aim of the fourth and fifth studies included in this thesis is therefore to compare various diagnostic tests in swimmers to determine which are the most sensitive.
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Van, Der Touw Thomas. "Cardiorespiratory effects of manual tidal expiratory chest wall compression during mechanical ventilation and pulmonary hyperinflation." Thesis, The University of Sydney, 1998. https://hdl.handle.net/2123/27602.
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This thesis examines and compares the cardiorespiratory effects of manual expiratory rib cage compression (MERC), which is used as an emergency expiratory assistance technique during positive pressure ventilation for acute severe asthma, and a potential alternative form of expiratory assistance (manual expiratory abdominal compression, MEAC).
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Mansell, Ingrid Joan. "Whole body vibration training effects on asthma specific pulmonary variables." Thesis, Nelson Mandela Metropolitan University, 2008. http://hdl.handle.net/10948/d1020953.
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The aim of the study was to determine and document evidence of the comparative effect of a 12- week whole body vibration training programme, exercise training programme and sedentary control group on the anthropometric profile, aerobic capacity, lung volumes and hence, the pulmonary capacity in people with asthma. The study used a descriptive, exploratory, quasi-experimental research approach employing randomised pairing to classify participants into either the whole body vibration therapy or exercise training group. Accidental and snowball sampling was used to identify and obtain a base of volunteers. A three-group pre-test/post-test design was employed to gain insight into statistical differences that might be apparent between the whole body vibration therapy group, the exercise group and the control group, and which could potentially be attributed to participation in the whole body vibration exercise programme. Randomised pairing for participant selection was selected because of the potential effects varying pulmonary variables might have had on the reliability of the study. A Physical Activity Selection Criteria Questionnaire was completed by participants to ascertain baseline physical activity readiness and as a means of determining selection criteria for their allocation to the whole body vibration training group, the experimental exercise group or the true control group. The pre-test/post-test assessment made use of a combination evaluation that incorporated an anthropometric profile assessment of height, weight, biceps, triceps, subscapular and suprailliac skinfolds, waist and hip circumference and posture, an aerobic capacity evaluation that incorporated aspects of both the YMCA and Astrand and Rhyming Physical Work Capacity (PWC) evaluation on a cycle ergometer and, lastly, a pulmonary variable assessment that made use of both the Datospir Peak-10 peak flow meter and the Spirovit SP-100AT spirometry unit integrated into the Cardiovit AT-6 model for all spirometry measurements. Participants were required to complete either the whole-body vibration or the exercise training programme a minimum of twice a week and a maximum of four times over the same period. The duration of the intervention programmes was approximately 30 minutes and consisted of three sections including a warm-up comprising flexibility exercises, whole body strength training exercises, and a cool-down which, in turn, consisted of massage exercises or replicated flexibility exercises. The main difference between the whole body vibration and exercise training group thus lay in the exclusion of the use of vibration for those participants assigned to the exercise training programme. Analysis of data was performed using descriptive and inferential statistics with the help of a qualified statistician. The identified variables were tested at a 95 percent level of probability (p<0.05) as recommended by Thomas and Nelson (1996:117). Descriptive data, in the form of a statistical mean, standard deviation, minimum, median and maximum values, obtained during this study were reported in the form of a t-score for selected anthropometric and pulmonary variables. The 12-week intervention programme, on analysis of the results, produced statistically insignificant improvements in the variables of anthropometric profile, aerobic capacity and lung volumes identified as determinants of, and factors influencing, the cardiorespiratory fitness level of participants with asthma and hence, the subsequent severity of this chronic condition. However, slight mean increases for the whole body vibration training group were evident for certain variables identified in this study. Based on the results, the inference could be made that whole body vibration therapy and exercise were both effective modes of training to improve the cardiorespiratory fitness level of people with asthma, but the results of the study did not show sufficient practical or statistical significance to verify the assumption that whole body vibration training was a method superior to conventional exercise training. Hence, the significance of whole body vibration training on the pulmonary variables of people with asthma could not be determined. The researcher recommends that future studies be undertaken to verify whether whole body vibration training incorporating larger participant groups could produce significant improvements in pulmonary variables in people with asthma.
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Conlin, Tim. "Prevention of exercise-induced asthma in an outdoor environment following bronchodialator use in asthmatic children." Virtual Press, 1996. http://liblink.bsu.edu/uhtbin/catkey/1020158.
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The purpose of this study was to determine if exercise-induced asthma (EIA) could be prevented in an outdoor environment in asthmatic children attending a summer camp 3 hours after their usual dose of medication. Most studies that test for ETA are done in a controlled environment which may make results not applicable to asthmatic children who spend a lot of their time outside. The relationship of aerobic fitness and level of activity to the severity of EIA were also examined. A total of 25 subjects (10.9+0.9 yrs, M±SD) were tested. Subjects were instructed to run around a grass field circular course (0.1 mile) for 5 minutes. The subjects could stop at any time. Baseline measurements of heart rate, respiratory rate and peak flow were determined before the test and at 1, 5, and 10 minutes following the end of the run. A fall in peak flow of >10% from baseline was considered positive for EIA. A total of 14 subjects experienced EIA following the run. There were no significant differences between the group who experienced EIA and those who did not in terms of heart rate, respiratory rate, or distance run. There was a significant difference between peak flow recordings as expected. Aerobic fitness and physical activity were not related to the severity of EIA. The results of this study suggests that additional medications may be needed to prevent EIA in these children in order to allow participation in activities which may produce EIA. Moreover, 3 hours may be beyond the protection time limit for some asthmatic children.School of Physical Education
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Spears, Mark. "Reduced corticosteroid sensitivity in smokers with asthma : potential mechanisms and treatment." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/1100/.
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Smokers with asthma display reduced responses to both inhaled and oral corticosteroids with associated increased symptoms, accelerated decline in lung function and increased use of health care services. Little work has been undertaken to address the possible causes of this reduced response and to find effective replacement therapies. Therefore this thesis was carried out with the aim of identifying potential mechanisms and new therapies for this group. The oral bronchodilator theophylline has been suggested as a treatment for corticosteroid insensitivity due to its ability to increase HDAC activity in-vitro. I undertook an exploratory proof of concept clinical trial based on the hypothesis that low dose theophylline would restore corticosteroid sensitivity in smokers with asthma through theophylline induced recovery of HDAC activity. Low dose oral theophylline added to inhaled corticosteroid increased pre-bronchodilator lung function and reduced symptoms of asthma whilst low dose theophylline given alone reduced symptoms but had no effect on pre-bronchodilator lung function. This research provides a foundation for future studies designed to examine the efficacy of theophylline in smokers with asthma. Agonists of the nuclear hormone receptor peroxisome proliferator activated receptor-γ (PPARγ) have been demonstrated to be effective at reducing inflammation in both in-vitro and animal models of asthma. Therefore to examine the hypothesis that PPARγ stimulation would reduce the inflammation present in smokers with asthma I undertook an exploratory, proof of concept clinical trial using the PPARγ agonist rosiglitazone. Treatment with rosiglitazone was associated with a trend to improvement in FEV1 and improvement in a marker of small airway lung function and as such may provide an alternative treatment for small airways obstruction in conditions such as asthma and chronic obstructive airways disease. This trial will enable powering of future confirmatory studies. Altered cytokine profiles, specifically the combination of increased interleukin (IL)-2 and 4, are observed in asthmatic subjects with corticosteroid insensitivity. Based on this work I examined the hypothesis that the altered response to corticosteroids in smokers with asthma was associated with an altered cytokine milieu including raised levels of IL-2 and 4. Smokers with asthma, characterised as corticosteroid resistant by oral corticosteroid trial, demonstrated significantly raised sputum supernatant IL-6 levels and raised levels of a number of other sputum cytokines compared to non smokers with asthma. This altered phenotype suggests cigarette smoking in asthma may be associated with a deviation to Th1 mediated inflammation and could provide an explanation for the reduced corticosteroid response of smokers with asthma. The cell type/s responsible for both this shift in immunological phenotype and production of increased levels of sputum cytokines is unclear and will require further study. Previous in-vitro and in-vivo research has identified altered histone acetylation patterns in subjects with relative corticosteroid resistance. Therefore I examined the hypothesis that smokers with asthma displayed reduced responses to corticosteroids as a result of a cigarette smoke induced reduction in histone de-acetylase (HDAC) activity. Smokers with asthma provided sputum macrophages and blood for peripheral blood borne monocytes to examine total HDAC activity. Sputum and blood macrophage total HDAC activity was equivalent in smokers and non-smokers with asthma. Therefore reduced blood total HDAC activity does not appear to explain the altered corticosteroid response in this group. However the number of sputum macrophages obtained may have been too low to allow conclusive examination of this endpoint. Another consideration is that contamination of the sample due to the technique used may be altering the signal obtained. Further work either through modification of sputum induction techniques to increase macrophage number or bronchoscopic sampling is required to conclusively address the role of alveolar macrophage HDAC activity in the reduced corticosteroid response displayed by smokers with asthma. Exhaled nitric oxide has been exploited as a useful exploratory and confirmatory endpoint in asthma. However exhaled nitric oxide, measured using standard flow rates and methodology, is unhelpful in smokers with asthma as cigarette smoking is associated with a marked reduction in exhaled nitric oxide levels in the majority of subjects. Recent research has demonstrated that measurement of exhaled nitric oxide at multiple flow rates followed by mathematical modelling reveals increased levels of alveolar nitric oxide that were unaltered by current smoking. Therefore to examine the hypothesis that smokers with asthma display altered levels of alveolar nitric oxide and flow independent parameters compared to non-smokers with asthma I carried out a cross-sectional study. Alveolar nitric oxide, determined by linear modelling, was significantly reduced in smokers with asthma compared to non smokers with asthma. The concentrations observed were within the range for normal subjects and therefore this method does not overcome the problems inherent in measuring exhaled nitric oxide at standard flows. The use of non-linear modelling did demonstrate parity between smokers and non-smokers with asthma for alveolar nitric oxide. Nitric oxide flux was lower in smokers with asthma when derived by both linear and non-linear modelling and displayed sensitivity to oral corticosteroids. Therefore nitric oxide flux is worthy of further investigation as an exploratory endpoint in smokers with asthma. In conclusion treatment of smokers with asthma with low dose theophylline alone, the combination of low dose theophylline and inhaled corticosteroid and the PPARγ agonist rosiglitazone was associated with clinical improvements and further clinical trials to assess the role for these treatments in the management of smokers with asthma are justified. Smokers with asthma display an altered sputum cytokine profile with raised levels of the proinflammatory cytokine IL-6, equivalent blood total HDAC activity and reduced alveolar nitric oxide compared to non-smokers with asthma. Sputum HDAC activity requires further development before it can be confidently employed as a method of assessing total pulmonary HDAC activity.
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Dickinson, John. "Prevalence, diagnosis and treatment of exercise induced asthma in elite athletes." Thesis, Brunel University, 2006. http://bura.brunel.ac.uk/handle/2438/6530.
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An acute asthmatic episode can occur following exercise and is termed exercise induced asthma (EIA). The purpose of this thesis was to investigate the prevalence, diagnosis, and treatment of EIA in elite British athletes. The addition of objective pulmonary function assessment to the criteria an athlete must submit to use inhaled 02-agonists at Olympic Games may result in a change in the prevalence of asthma within elite athletes. The purpose of study 1 was to compare the prevalence of asthma at the 2000 and 2004 Olympic Games in the Great British Olympic team (Team GB). The asthma prevalence of Team GB reported in 2000 (21.2%) was similar to the asthma prevalence reported in 2004 (20.7%). 13 out of 62 (21.0%) athletes, from 2004 Team GB with a previous diagnosis of asthma failed to present evidence of EIA. The overall asthma prevalence of Team GB remained unchanged between 2000 and 2004. Mid-expiratory airflow measurements may improve the diagnosis of EIA in elite athletes. Study 2 investigated the response of Forced Expiratory Flow at 50% vital capacity (FEFso) following eucapnic voluntary hyperpnoea (EVH) and exercise challenge, in elite athletes, as an adjunct to Forced Expiratory Volume in one second (FEVI). 66 male and 50 female athletes were tested for EIA. Sixty athletes demonstrated a fall in FEVI >10% leading to the diagnosis of EIA. Using the FEF50 criteria (1FEF50 >-26%) led to 21 (35%) asthmatic athletes receiving false negative diagnosis. The addition of FEF50 failed to enhance the diagnosis of EIA in elite athletes. It is unclear, between exercise and EVH challenges as to which one provides the greatest sensitivity and most suitable method of EIA diagnosis in elite athletes. Study 3 investigated the response of elite winter athletes to EVH and two exercise challenges (laboratory-based [LB] and sport-specific [SS]). 14 athletes from the British Short-track Speed Skating and Biathlon teams volunteered for the study. Ten athletes presented with a positive response to EVH (71%); of these, only 3 (21%) had a positive response to the SS challenge. No athletes had a positive test to the LB challenge. Our results suggest that the EVH challenge is more sensitive, compared with either LB or SS exercise challenge, to diagnose EIA in elite winter athletes. A limited number of studies exist examining the optimal pharmacotherapy for elite athletes with EIA. The purpose of study 4 was to examine the effects of fluticasone propionate and salmeterol in the control of EIA in athletes. Eight athletes were prescribed 200mcg fluticasone propionate (FLU), 50mcg Salmeterol (SAL), 250mcg fluticasone propionate and salmeterol in combination (FXS) or placebo (PLA), in a randomised double blind design. No significant (p=0.07) differences were observed in the FEV1 change (zFEV1) following EVH challenge between the 4 treatments. Baseline eNO for both FXS (20.3 +/- 8.2ppb) and FLU (19.7 +/- 9.2 ppb) were significantly (p=0.02) lower than SAL (39.3 +/- 26.7ppb) or PLA (46.3 +/- 26.8ppb). Four athletes were prescribed FLU, 2 athletes were prescribed FXS and 2 athletes were prescribed SAL. The results of this study demonstrate the heterogeneity of response in elite athletes with EIA to the three medication regimes employed. Therefore, suggesting differences in the pathogenesis of EIA in this population. This thesis is the first to investigate EIA within elite British athletes. The prevalence of asthma within elite athletes is greater than that of the British general population. Optimal EIA diagnostic methods should include EVH challenges using FEV1 as the criterion measurement. Treatment for athletes with EIA should be taken on an individual basis due to the heterogeneity of response to medications that attenuate EIA in elite athletes.
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McCants, Kellie Michele. "Factors Affecting Treatment Regimen Adherence in Children and Adolescents with Asthma." The Ohio State University, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=osu1041866923.
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Sicouri, Gemma. "Understanding and treating anxiety disorders in children with asthma." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17269.
Full textAbstract:
The aim of this thesis was to provide research to understand and treat anxiety in children with asthma. Specifically, the aims were to: (1) investigate the parent and cognitive factors associated with anxiety in children with asthma; and (2) evaluate a cognitive behavioural treatment (CBT) specifically developed for children in this population. The rationale behind this research was the identification of a higher prevalence of anxiety disorders in children with asthma compared to healthy children, yet very little understanding about the factors which may underlie this relationship. This poor understanding has translated into a lack of evidence-based treatments for this population. The research comprises of five empirical studies, including a meta-analysis, two cross-sectional empirical studies, a case series analysis of treatment and a qualitative study. The findings of this thesis highlight that some parenting behaviours, namely parental control, and child cognitions, namely avoidant coping, whilst understandable in the context of a chronic illness, may – in fact – also confer risk for anxiety in these children. The results also showed promise for the efficacy of a group CBT intervention for a small number of participants with asthma and a comorbid anxiety disorder, however critically a large number of eligible participants declined to take part. It appears that a number of barriers to treatment engagement exist, which relate specifically to parent beliefs and understanding about the link between asthma and anxiety. Additional research is needed with larger samples in order to further explicate the role of parent and cognitive factors in the development and maintenance of anxiety in children with asthma, and establish CBT as an evidence-based treatment for this population.
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Dunder, T. (Teija). "Environment and atopy and asthma in childhood:the effect of dietary fats, common infections and asthma treatment practises on morbidity rates." Doctoral thesis, University of Oulu, 2008. http://urn.fi/urn:isbn:9789514287510.
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Abstract
Despite the common recommendations of the criteria for the diagnosis of asthma there is still a wide variation within different regions in diagnoses, use of medications and hospitalisation rates especially among young children. This thesis elucidates the role of spesified environmental risk factors associated with the development of atopic diseases in childhood.
In two prospective follow-up surveys we found that allergies and asthma associate with the consumption of margarines, butter and fish and that the common infection of childhood, RS-virus infection, does not increase asthma morbidity in adolescence. In a randomised set-up we were able to verify that the common childhood infections do not protect from allergies and asthma. In a retrospective survey we found that hospitalisation rates can reflect medication practices in different regions.
Our results indicate that consumption of fat in the diet can be one triggering factor for allergies but common childhood infections are merely markers of susceptibility to allergies and asthma rather than the cause of it.
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Basu, Kaninika. "The effect of genetic variation on asthma severity and treatment in childhood." Thesis, University of Dundee, 2010. https://discovery.dundee.ac.uk/en/studentTheses/cae1bb7b-0f37-4554-99af-d4a231d1dabd.
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1. I have described a population of children and young adults with asthma in primary and secondary care, in terms of relevant history, medication use and exacerbations. 2. My thesis presents observations reported for the first time that asthmatic children and young adults homozygous for the Arg16 allele on the ß2 adrenergic receptor gene (ADRB2), on frequent doses of on demand short-acting ß2-agonists are at greater risk of asthma exacerbations.I have shown an increase in the risk of exacerbations per copy of Arg16 allele in children and young adults with asthma on the regular long-acting ß2-agonist salmeterol. 4. I have shown that there is an increase in risk of exacerbations per copy of Arg16 allele in children and young adults with asthma on frequent (once daily or more) as required doses of inhaled salbutamol. This effect is not observed on participants with asthma who are not exposed to ß2-agonist on a daily basis. 5. I have shown that the Arg16Arg variant status may be associated with worse airway obstruction, as measured by the FEV1/FVC ratio.6. I have shown that the individuals with FLG null alleles have a significantly increased risk of exacerbations requiring hospital admissions, courses of oral steroids, or experiencing school absences
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Kilian, Pieter Johannes. "The treatment of asthma : a managed pharmaceutical care approach / Pieter Johannes Kilian." Thesis, North-West University, 2005. http://hdl.handle.net/10394/1610.
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Malkovych, N. M. "Nebuliser therapy for prevention and treatment of viral-induced bronchial asthma exacerbation." Thesis, БДМУ, 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/17101.
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Vathenen, Arumugam Santhire. "The effect of beta agonists and corticosteroids on bronchial reactivity in asthma." Thesis, University of Southampton, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.278555.
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Petraitytė, Asta. "Utilization and costs of drugs for asthma and chronic obstructive pulmonary disease treatment in Lithuania on 2006-2009 year." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2010. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2010~D_20100621_092657-27689.
Full textAbstract:
Objective: To evaluate the utilization and cost of drugs for the treatment of asthma and COPD in Lithuania in 2006-2009.
Methodology: The data on the sales of drugs for asthma and COPD for the year 2006-2009 was obtained from SoftDent, JSC, database. The utilization of the R03 group (drugs for obstructive airway diseases) of the Anatomical Therapeutic Chemical (ATC) classification was analysed. The utilization was expressed as DDD/1000 inhabitants per day. The pharmacoeconomical analysis was performed implementing cost-minimisation and reference pricing methodologies.
Results: The total use of drugs for asthma and COPD increased from 23,70 DDD/1000 inhabitants/day in 2006 to 28,67 DDD/1000 inhabitants/day in 2009. The most significant increase is found in the use of inhaled corticosteroid/long-acting β2-agonist combinations. The costs for drugs for the treatment of asthma and COPD increased from 59,71 million Litas in 2006 to 80,12 million Litas in 2008 and decreased to 79,25 million Litas in 2009. The use of drugs of the ATC group R03 is about 2 times higher in Norway, Denmark and Finland and about 1,6 times lower in Estonia. The pharmacoeconomical analysis shows marked savings if the lowest of the second lowest prices of one DDD were implemented as the reference price. The most considerable saving is found to be for inhaled corticosteroid/long-acting β2-agonist combinations – using the lowest basic price of one DDD as the reference price, total 18,04 million Litas would... [to full text]Tikslas: Įvertinti vaistų, vartojamų astmai ir lėtinei obstrukcinei plaučių ligai (LOPL) gydyti suvartojimą ir išlaidas Lietuvoje 2006-2009 metais. Metodika: Duomenys apie vaistų, vartojamų astmai ir LOPL gydyti pardavimus 2006-2009 metais gauti iš UAB SoftDent duomenų bazės. Analizuojami vaistai yra klasifikuojami R03 grupėje (vaistai obstrukcinėms plaučių ligoms) pagal Anatominę Terapinę Cheminę (ATC) klasifikaciją. Vaistų suvartojimas išreikštas DDD skaičiumi, tenkančiu tūkstančiui gyventojų per vieną dieną. Farmakoekonominė analizė atlikta taikant kaštų mažinimo ir referentinės kainos metodus. Rezultatai: Bendras vaistų astmai ir LOPL gydyti suvartojimas Lietuvoje išaugo nuo 23,70 DDD/1000 gyventojų per dieną 2006 metais iki 28,67 DDD/1000 gyventojų per dieną 2009 metais. Didžiausias suvartojimo augimas nustatytas inhaliuojamų gliukokortikosteroidų/ilgo veikimo β2-agonistų kombinuotų preparatų grupėje. Išlaidos vaistų, vartojamų astmai ir LOPL gydyti augo nuo 59,71 mln. Litų 2006 metais iki 80,12 mln. Litų 2008 metais ir 2009 metais sumažėjo iki 79,25 mln. Litų. Vaistų, klasifikuojamų R03 grupėje pagal ATC klasifikaciją, suvartojimas Lietuvoje yra apie 2 kartus mažesnis nei Norvegijoje, Danijoje ir Suomijoje ir apie 1,6 karto didesnis nei Estijoje. Farmakoekonominė analizė pateikia ženklius galimo taupymo pavyzdžius, jei mažiausia ar antra mažiausia vieno DDD kaina būtų taikoma kaip referentinė kaina. Reikšmingiausi farmakoekonominės analizės rezultatai nustatyti... [toliau žr. visą tekstą]
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Brar, J. S., and N. K. Bogutska. "Anxiety, alexithymia and attitude to the disease in children with severe bronchial asthma." Thesis, “BIMCO Journal” Abstract book, 2018. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/14303.
Full textAbstract:
The study of psychological characteristics of the children with bronchial asthma (BA) is extremely relevant in determining
the severity of the course of the disease. The purpose of the study was to examine associations between BA severity and
personal psychological characteristics.
Levels of state (SA), trait (TA) and school anxiety (ScA) with self-reported State Trait Anxiety Inventory (Spielberger and
Hanin), School Anxiety Inventory (Phillips) were examined, a Bekhterev institute personality questionnaire (LOBI) was used in
order to diagnose the types of attitudes to BA, an adapted Toronto Alexithymia Scale (by G. Taylor) was used to detect
alexithymia. The first clinical group was formed by 32 children with severe BA, and the II group of comparison included 30
children with moderate BA (GINA).
High TA scores were observed in 26.6±1.7% of patients with severe BA versus 9.1±6.1% of children in control group
(OR=4,0; 95%CI:0,75-21,2). High SA scores were revealed in 25±8.2% versus 22.7±8.3% of patients with severe and nonsevere
BA correspondingly (p>0.05). The patients’ TA levels were associated with more severe children’s fears (r=0.3;
p<0.03) and the presence of early warning signs of the BA attack (r=0.3; p <0.04). The experience of child’s social stress was
associated with night attacks (r = 0.27; p <0.04). The higher level of ScA correlated with a child’s negative attitude to the
need of daily medicines use (r=0.3; p<0.03) and higher scores of the bronchial lability (r=0.36; p<0.01). The high level of SA
was a predictor of the lower efficacy of control treatment with inhaled corticosteroids (r=-0.6; p<0.02). The mean scores of
the Toronto Alexithymia Scale were 71.2±2.1 versus 70.3±2.7 in groups of comparison (p>0.05), however, the presence of
alexithymia correlated with the number of asthma attacks per year (r=0.36; p<0.05), the negative attitude toward
hospitalization (r=0.37; p<0.04) and the need of daily intake of drugs (r=0.26; p<0.05). The neurasthenic and / or sensitized
type of attitude to the disease was more often noted in children with severe asthma (OR=5.3; 95% CI:1.3-24.7), and euphoric
/ anosognosic types of attitudes were associated with lower levels of disease control and non-compliance to basic therapy.
Thus, there was a tendency to higher TA, ScA and presence of the neurasthenic and / or sensitized type of attitude to the
disease in children with severe BA.
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Arora, G. K., and N. K. Bogutska. "Comparative analysis of the asthma phenotypes with and without exercise induced bronchoconstriction in school age children (results of cluster analysis)." Thesis, “BIMCO Journal” Abstract book, 2018. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/14306.
Full textAbstract:
Well known association between bronchial asthma (BA) and exercise induced bronchoconstriction (EIB) was revealed long
ago, but the exact mechanisms of this association are not fully defined.
Patients with persistent moderate and severe BA were included in alternative clinical groups: in particular, 30 children
with EIB BA phenotype and 30 patients without EIB BA were examined. EIB was diagnosed in case of the presence of
bronchospasm after exercise in the patient’s history and spirometric index of bronchospasm after a dosed physical activity of
at least 15%. According to the main characteristics (sex, age and place of residence) the groups were comparable.
Hierarchical probabilistic approach and cluster analysis (CA) with the K-means method were used for statistical analysis.
While analyzing the clinical and paraclinical characteristics of the phenotypes of BA with and without EIB in school-age
children, it was found that a severe variant of the disease, allergic burden only after father's pedigree, the total number of
points of clinical manifestations of exacerbation of BA higher than 15 before treatment, complaints of chest tightness during
the last exacerbation, higher than 4% eosinophil count and more than 1.0 G/l absolute T lymphocyte content in the peripheral
blood, and the need for constant use of short-acting beta-agonists in the remission period statistically significantly increased
the chances of diagnosing BA with EIB. The bronchial lability index more than 25% most significantly increased the chances of
detecting the BA phenotype with EIB, this diagnostic marker was characterized by significant reproducibility and validity
(80%), while bronchial nonspecific hyperresponsiveness test to histamine (PC20H) of inhalation less than 0.8 mg/ml histamine
concentration, which caused 20% FEV1 fall, also most significantly increased the chances of diagnosing of BA with EIB in
children of school age. CA of a whole cohort of patients indicated a significant clinical similarity of BA phenotypes with and
without EIB in children, because the first and second clusters were formed of 56% and 44% and 43% and 57% of children with
phenotypes with and without EIB correspondingly.
Thus, the results of CA of the cohort of pediatric patients with alternative phenotypes of the disease due to exercise
induced bronchoconstriction showed a significant similarity between two clinical subclusters and the difference existed mainly
due to markers of atopic reactivity.
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Van, Patrick P. T. "Comparison of nebulised vs MDI-spacer delivered beta-2 agonist therapy in patients with asthma in the community." Thesis, The University of Sydney, 2001. https://hdl.handle.net/2123/27750.
Full textAbstract:
Objective: The aim of this study was to determine whether asthma symptoms and beta-2
agonist usage were any different between community patients using a nebuliser or a metereddose
inhaler with a spacer (MDI—spacer) to deliver beta-2 agonist for the relief of symptoms.
Design and setting: A randomised intervention versus control group study in a
community pharmacy.
Participants: 48 patients with asthma over 2 years of age; 34 completed the study.
Intervention: Subjects with a repeat prescription for salbutamol nebules were randomised
to switch to MDI—spacer with patient counselling and pamphlets or to continue nebuliser for
beta-2 agonist delivery over a 3-month period.
Main outcome measures: The primary outcome measures were asthma symptom scores
and usage of beta-2 agonist. In addition, introduction or change in preventer use and
respiratory infection over the 3-month period were recorded.
Results: There was no significant difference between the control and intervention patients
in terms of asthma symptom scores at any of the time periods nor was there any significant
change in score within either group over the 3-month period (Chi—Square p>0.05). The
average cost of beta-2 agonist therapy (not including the cost of the nebuliser which was
$195.00) for the 14 control patients maintained on nebuliser therapy for the 3 months was
$59.94, whereas for the 20 intervention patients, the average cost of beta-2 agonist therapy
(including the cost of the spacer +/- mask, which only needs to be purchased once) was
$39.03. The cost of the spacer and mask were $19.95 and $7.95 respectively. The annual
estimated cost for 20 patients maintained on nebuliser therapy (not including the cost of the
nebuliser) is $4,795 versus $1,925 on MDI-spacer therapy (including the cost of the spacer
+/- mask).
Conclusion: We found that MDI-spacer was as effective as nebuliser delivered beta-2
agonist therapy in community practice.
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Smith, Andrew D., and n/a. "Exhaled nitric oxide measurements in the diagnosis and management of asthma." University of Otago. Dunedin School of Medicine, 2007. http://adt.otago.ac.nz./public/adt-NZDU20070924.133734.
Full textAbstract:
Introduction: The enzyme, inducible nitric oxide synthase (iNOS), is upregulated in the airway epithelium in patients with allergic asthma resulting increased nitric oxide production. The concentration of nitric oxide in exhaled air (FENO) correlates with the degree of eosinophilic airway inflammation and has been proposed as a new breath test to assist in the management of asthma.
Key Aims: To determine the predictive accuracy of FENO compared with conventional testing in the diagnosis of asthma.
To assess the performance characteristics of FENO to predict steroid responsiveness compared with the conventional approach in patients presenting with non-specific respiratory symptoms.
To assess the role of FENO compared with conventional guidelines-based approach as a guide to adjusting inhaled corticosteroid therapy in patients with chronic persistent asthma.
Methods: Consecutive patients referred with chronic undiagnosed respiratory symptoms were enrolled. Comparisons were made between FENO, induced sputum analysis and other conventional tests (including peak flow variation, spirometry, response to oral steroid challenge) for predicting the presence of asthma in the first study, and for predicting response to four weeks inhaled fluticasone treatment in the second study.
In the third study, 110 subjects with chronic persistent asthma were enrolled into a single-blind placebo-controlled study during which subjects were randomly allocated to have their corticosteroid (fluticasone) dose adjusted on the basis of either FENO measurements or an algorithm based on conventional guidelines. The main outcomes were the frequency of asthma exacerbations and the mean daily dose of inhaled corticosteroid.
Results: In the first study, 17 of 47 consecutive patients were diagnosed with asthma. Sensitivities for the conventional tests (0-47%) were lower than for FENO (88%) and sputum eosinophils (86%), with overall significantly greater diagnostic accuracy for FENO and sputum eosinophils.
Fifty-two consecutive subjects completed the second study. When compared to the conventional tests, the predictive powers for FENO were consistently greater than for almost all other baseline measurements used to predict steroid responsiveness, with an optimum cut point of 47 ppb.
In the third study, the exacerbation rates were 0.49 (95% C.I. 0.20, 0.78) per patient per year in the FENO group and 0.90 (95% C.I. 0.31, 1.49) in the control group, representing a nonsignificant reduction of 45.6 percent (95% C.I. -78.5, 54.5%) in the FENO group. The final mean daily doses of fluticasone were significantly lower in for the FENO group compared with the conventional group (370 [mu]g/day (95% C.I. 263, 477) vs 641 [mu]g/day (95% C.I. 526, 756) respectively; p=0.003). There were no significant differences in other markers of asthma control, use of oral prednisone, pulmonary function, or levels of airway inflammation (sputum eosinophils).
Conclusions: FENO is comparable to induced sputum analysis and superior to the conventional methods currently used including peak flows and spirometry as a dignositic for asthma and as a predictor of steroid responsiveness in patients with chronic respiratory symptoms. FENO measurements as a guide to adjusting inhaled corticosteroid therapy compared to the conventional guidelines based approach results in significantly lower maintenance doses being achieved without compromising asthma control. The results of this thesis provide evidence to support the use of FENO measurements in routine clinical practice as a tool to improve the overall management and diagnosis of asthma.
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Gaddam, Surender. "The impact of asthma self-management education programs on the health outcomes: A meta-analysis (systemic review) of randomized controlled trials." CSUSB ScholarWorks, 2003. https://scholarworks.lib.csusb.edu/etd-project/2312.
Full textAbstract:
An attempt has been made in this study to critically appraise, systematically review and gather together the results obtained in individual trials and examine the strength of evidence supporting the component for Education for a Partnership in Asthma Care of the National Asthma Education and Prevention Program (NAEPP) to test whether health outcomes are influenced by education and self-management programs.
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Hernández, Pombo María Gimena. "Treatment safety, adherence and health-related quality of life in patients with asthma." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/666784.
Full textAbstract:
L'objectiu general d'aquesta tesi doctoral va ser avaluar la qualitat de vida relacionada amb la salut (QVRS) en pacients amb asma i els factors sociodemogràfics i clínics que contribueïxen al seu deteriorament. També, avaluar la seguretat dels broncodilatadors d'acció llarga (BAL) combinats amb corticosteroides inhalats (CI) i els determinants de l'adherència al tractament.
L’evidència obtinguda en estudis observacionals (recerca sistemàtica en MEDLINE i EMBASE, període 1990-2013, incloent 19 estudis amb graandàries mostrals entre 50 i 514.216), mostren que el tractament combinat de LABA i CI no està associat a un major risc d'esdeveniments adversos greus, en comparació amb només CI. Els principals dèficits identificats van ser la mancança de disseny prospectiu, de població pediàtrica i de inclusió de la mortalitat com a resultat primari. Una revisió sistemàtica dels estudis observacionals sobre els determinants de l'adherència als inhaladors per a l‘asma va identificar 51 estudis (cerca realitzada a EMBASE, Medline, PsychInfo i PsychArticles de 1990 a 2014) que van examinar principalment els factors relacionats amb el pacient, i van trobar associacions consistents entre l’adherència i creences més arralades en la necessitat dels inhaladors, i possiblement amb una edat més avançada. Es va detectar la necessitat d'una amplia adopció d'estàndards conceptuals i metodològics comuns.
El projecte titulat “Assessment of the Safety of LABAs in asthma in routine care by combining health care data bases and direct patient-follow-up” (ASTRO-LAB) va ser un estudi prospectiu longitudinal (n = 908 pacients). Els pacients es van reclutar en els centres d’atenció primària a França i el Regne Unit. Els criteris d'inclusió eren: individus de 6 a 40 anys d'edat amb asma persistent, definit com més de 6 mesos de prescripció de CI i/o BAL durant els 12 mesos previs al seu reclutament. L'anàlisi dels 290 pacients que van completar l'EQ-5D-5L en l'enquesta basal per internet va demostrar un efecte sostre acceptable, una bona validesa de constructe i una alta fiabilitat, donant suport a la idoneitat d'aquesta nova versió del EQ-5D per avaluar la QVRS en pacients amb asma.
Finalment, vam comparar els pacients francesos (n = 222) amb les normes de referència EQ-5D procedents de França per estimar l'impacte de l'asma en la QVRS del pacient. L'asma persistent té un impacte moderadament negatiu en els pacients d'ambdós sexes, i les dones més joves van ser identificades com un grup d'alt risc que mereix més recerca. Hem identificat el control de l'asma com a principal factor associat de la reducció de la QVRS en els pacients, independentment del seu gènere, el que suggereix que l'impacte de l‘asma en la QVRS es podria mitigar aconseguint un bon control dels símptomes.El objetivo general de esta tesis doctoral fue evaluar la calidad de vida relacionada con la salud (CVRS) en pacientes con asma y los factores sociodemográficos y clínicos que contribuyen a su deterioro. Asimismo, evaluar la seguridad de los broncodilatadores de acción larga (BAL) combinados con corticosteroides inhalados (CI) y los determinantes de la adherencia al tratamiento. La evidencia obtenida en los estudios observacionales (búsqueda sistemática en MEDLINE y EMBASE, período 1990-2013, incluyó 19 estudios de tamaños muestrales entre 50 y 514.216) demuestra que el tratamiento combinado de BAL y CI no se asocia con un mayor riesgo de eventos adversos graves, en comparación con el tratamiento sólo con CI. Los principales déficits identificados fueron la falta de diseño prospectivo, de población pediátrica y de mortalidad como resultado primario. La revisión sistemática de estudios observacionales sobre determinantes de la adherencia a los inhaladores para el asma identificó 51 estudios (búsqueda realizada en EMBASE, Medline, PsychInfo y PsychArticles entre 1990 y 2014) que examinaron principalmente los factores relacionados con el paciente y encontraron una relación consistente entre la adherencia y las creencias más arraigadas en la necesidad de inhaladores, y posiblemente con una edad más avanzada. Se detectó la necesidad de una adopción más amplia de estándares conceptuales y metodológicos comunes. El proyecto titulado “Assessment of the Safety of LABAs in asthma in routine care by combining health care data bases and direct patient-follow-up” (ASTRO-LAB) fue un estudio longitudinal prospectivo (n = 908 pacientes). Los pacientes fueron reclutados en centros de atención primaria en Francia y Reino Unido. Los criterios de inclusión fueron: individuos cuyas edades estaban comprendidas entre los 6 y 40 años con asma persistente, definido como más de 6 meses de prescripción de CI y/o BAL durante los 12 meses anteriores al reclutamiento. El análisis de los 290 pacientes que completaron el EQ-5D-5L en la encuesta basal por internet demostró un efecto techo aceptable, una buena validez de constructo y una alta fiabilidad, lo cual apoya la idoneidad de esta nueva versión del EQ-5D para evaluar la CVRS en pacientes con asma. Finalmente, comparamos los pacientes franceses (n = 222) con las normas de referencia del EQ-5D en Francia para estimar el impacto del asma en la CVRS de los pacientes. El asma persistente tiene un impacto en la CVRS moderadamente negativo en pacientes de ambos sexos, y las mujeres más jóvenes fueron identificadas como un grupo de alto riesgo que merece más investigación. Identificamos el control del asma como el principal factor asociado al deterioro de la CVRS en los pacientes, independientemente de su sexo, lo que sugiere que el impacto del asma en la CVRS se podría mitigar logrando un buen control de los síntomas.
The general aim of this doctoral thesis was to evaluate the health-related quality of life (HRQoL) in patients with asthma, and the socio-demographic and clinical factors which contributed to its impairment. Also, to assess the safety of long-acting beta-agonists (LABAs) combined with inhaled corticosteroids (ICs), and the determinants of treatment adherence. Evidence from observational studies (systematic search in MEDLINE and EMBASE, period 1990-2013, including 19 studies with sample sizes from 50 to 514,216) shows that the combined treatment of LABAs and ICs is not associated with a higher risk of serious adverse events, compared to ICs alone. Major gaps identified were: prospective design, paediatric population and inclusion of mortality as a primary outcome. The systematic review of observational studies on determinants of asthma inhaler adherence identified 51 studies (search performed in EMBASE, Medline, PsychInfo and PsychArticles from 1990 to 2014) which mainly examined patient-related factors and found consistent links between adherence and stronger beliefs in inhaler necessity, and possibly with older age. The need of a broader adoption of common conceptual and methodological standards was detected. The project entitled “Assessment of the Safety of LABAs in asthma in routine care by combining health care data bases and direct patient-follow-up” (ASTRO-LAB) was a prospective longitudinal study (n= 908 patients). Patients were enrolled in primary care in France and United Kingdom by their general practitioner. Inclusion criteria were: subjects aged 6-40 years old, with persistent asthma, defined as more than 6 months of prescribed ICs and/or LABAs during 12 months before inclusion. Analysis of the 290 patients who completed the EQ-5D-5L in the baseline online survey demonstrated acceptable ceiling effect, good construct validity, and high reliability, supporting the adequacy of this new EQ-5D version for assessing HRQoL in asthma patients. Finally, French patients (n= 222) were compared with the EQ-5D reference norms from France to estimate the impact of asthma on patients' HRQoL. Persistent asthma has a moderately negative HRQoL impact on patients of both genders, and the youngest women have been identified as a high risk group which merits further research. We identified asthma control as the major factor associated to impaired HRQoL in patients, regardless of their gender, suggesting that asthma HRQoL impact could be alleviated by achieving a good symptom control.
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Miah, Afjal Hussain. "The design, synthesis and optimisaion of CCR4 antagonists for the treatment of asthma." Thesis, University of Strathclyde, 2015. http://digitool.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=28799.
Full textAbstract:
The 7-transmembrane chemokine receptor, CCR4 is differentially expressed on T helper type 2 (TH2) cells; together with its endogenous ligands, CCL17 and CCL22, it promotes activation and recruitment of TH2 cells into the lungs. Infiltration of TH2 cells into the airways is an important characteristic of allergic asthma, so inhibition of CCR4 binding to its endogenous ligands might provide a potential therapeutic target for treating the disease. In order to identify a potential back-up to the clinical development candidate, N-(3-((3-(5-chlorothiophene-2-sulfonamido)-4-methoxy-1H-indazol-1-yl)methyl)benzyl)-2-hydroxy-2-methylpropanamide (6), a library of 2,3-dichlorobenzene sulfonamides were designed. Synthesis and evaluation of the 'hits' in the primary antagonist assay (GTPγS) led to the identification of three novel templates with good potency and ligand efficiency (LE). The benzimidazolone template, exemplified by 88 (2,3-dichloro-N-(6-methoxy-2-oxo-2,3-dihydro-1H-benzo[d]imidazol-5-yl) benzenesulfonamide), demonstrated a good PK profile (low clearance, moderate to high oral bioavailability) in both rat and dog, and had better potency in the human whole blood (hWB) assay compared to the other two series, and hence was explored further. Investigation of substituents of the benzimidazolone series, and incorporation of nitrogen into the core led to the discovery of 239 (2,3-dichloro-N-(6-methoxy-2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-5-yl)benzenesulfonamide), which had a pA2 value of 6.0 in the hWB assay and a much improved LE (0.43) compared to indazole 6 (LE = 0.30). The azabenzimidazolone 239 provides a new starting point for further lead optimisation to develop a novel allosteric CCR4 antagonist from which a potential oral asthma drug could emerge. A phenylpyrazole sulfonamide (N-(2-(1H-pyrazol-1-yl)phenyl)phenylsulfonamide) was also identified, where X-ray diffraction studies showed that one of the nitrogens of the pyrazole ring forms an intramolecular hydrogen bond with the sulfonamide NH and promotes a conformation that was thought to be preferred in the active site. A SAR study around the phenylpyrazole core provided pyridine analogue 115 (N-(3-(1H-pyrazol-1-yl)pyridin-2-yl)-5-chlorothiophene-2-sulfonamide) with very good potency, high LE (0.47) and excellent physicochemical properties (chromlogD7.4 = 2.7, MW = 340, solubility = 133 μg/mL). Pyridylpyrazole 115 also represent good starting points for a lead optimisation programme. In addition, a novel series of 2,8-diazaspiro[4.5]decan-8-yl)pyrimidin-4-amine inhibitors, were identified using computational modelling studies, which bind to a different allosteric region on the CCR4 receptor compared to indazole 6. Evaluation of SAR led to identification of several analogues that exhibited hWB activity superior or comparable to that of 6. The most potent compound, 282 (N-(2,4-dichlorobenzyl)-2-(2-(pyrrolidin-2-ylmethyl)-2,8-diazaspiro[4.5]decan-8-yl)pyrimidin-4-amine, hWB pA2 = 6.7) demonstrated anti-inflammatory activity in acute in vivo murine allergic inflammation models. After an ovalbumin challenge in mice, compound 282 showed not only significant reduction in eosinophil and lymphocyte infiltration into the bronchoalveolar lavage (BAL) fluid but also displayed a profound effect on airway hyperreactivity, returning the levels back to the control line. The in vivo results indicate that targeting CCR4 with a small molecule allosteric antagonist could be a potential novel way of treating allergic diseases such as asthma. Interestingly, representative compounds from the spiro-pyrimidine series were found to induce receptor internalisation of CCR4 in HUT78 cell with approximately 50% reduction of cell surface receptor. It is suggested that in vivo activity of 282 might be due to its ability to induce internalisation of the receptor.
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Lundquist, Gabriel, and Samuel Holmström. "Digital Treatment of Asthma Patients in Swedish Primary Care : A Business Model Study." Thesis, KTH, Skolan för industriell teknik och management (ITM), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-279628.
Full textAbstract:
The cost of healthcare has been steadily increasing over the last decades and is becoming an increasing liability on the public finances. Much of these resources are directed to the primary care, and more specifically to the treatment of chronic diseases within the primary care. Digital healthcare, which has been highlighted as a potential way of increasing the efficiency within the primary care, has so far been unable to provide continuous care to patients with chronic diseases. New digital business models are needed to properly treat these patient groups. This study has evaluated the feasibility of a new digital business model for the treatment of the chronic disease of Asthma. The feasibility of business models was evaluated qualitatively from a patient, payer and provider perspective. Parameters for evaluating feasibility from the three perspectives were determined through policy reports as well as expert and practitioner interviews. Patient journeys, with their corresponding business models, were developed iteratively together in a series of interviews with practitioners from diverse disciplinary backgrounds. The evaluation of the business model’s feasibility for treating patients with asthma was done on a basis of clinical studies, clinician interviews, five patient interviews as well as financial calculations on provided care from the perspective of the provider and the payer. The study found that business models based on fee-per-action reimbursement, which are dominating in digital healthcare currently, are feasible for treating patients with mild asthma, but not for patients with severe asthma. For patients with severe asthma, business models based on capitation reimbursement are feasible, while the care can be provided 100% digitally by the inclusion of a bluetooth spirometer. A capitation based business model would provide better care for patients with severe asthma, to a lower cost to the payer (the healthcare region) and would be financially viable for the provider of healthcare. Our findings indicate that while asthmacare can be treated digitally with good patient outcomes as well as cost-efficiency, providers need to establish a physical presence in order to adopt a financially viable business model.Sjukvårdens kostnader har stadigt ökat de senaste decennierna och har blivit en allt större belastning på de offentliga utgifterna. Mycket av dessa kostnader kommer från primärvården, och framförallt till insatser mot kroniska sjukdomar. Digital sjukvård, som ofta lyfts som ett möjligt verktyg för att minska vårdens kostnader, har hittills inte använts för att ge kontinuerlig vård till kroniker på bred skala. Nya digital affärsmodeller behövs för att behandla dessa patientgrupper. Denna studie har undersökt genomförbarheten av att behandla den kroniska diagnosen astma med digitala affärsmodeller. Genomförbarheten av de olika affärsmodeller utvärderades kvalitativt utifrån tre intressenters perspektiv: patienten, beställaren och vårdgivaren. Relevanta utvärderingsparametrar fastställdes genom myndighetsrapporter samt intervjuer med experter och praktiker. Patientresor, med tillhörande affärsmodell, utvecklades iterativt i intervjuer med praktiker från olika fält. Genomförbarheten av affärsmodellerna utvärderas slutligen med hjälp av resultat från kliniska studier, intervjuer med kliniker, intervjuer med patienter samt finansiella beräkningar på levererad vård utifrån beställaren och vårdgivarens perspektiv. Vi fann att digital affärsmodeller som får sin ersättning via utomlänspatientavgift är genomförbara för att leverera vård till patienter med mild astma, men inte till patienter med svår astma. För patienter med svår astma är digital affärsmodeller som bygger på kapiteringsersättning genomförbara. Kapiteringsersättning bygger på att vårdgivaren har fysisk närvaro, men vi fann att vården kan hanteras 100% digitalt till goda resultat för patienten, beställaren och vårdgivaren.
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McGlade, Jacqueline Patricia. "Suppression of the asthmatic phenotype in mice by UVB irradiation." University of Western Australia. School of Paediatrics and Child Health, 2008. http://theses.library.uwa.edu.au/adt-WU2009.0086.
Full textAbstract:
Background: Exposure of skin to UVB radiation (290-320 nm) modulates the immune system, with most studies showing a suppression of Th1-driven immune responses. Investigations into the effects of UVB exposure on allergic respiratory responses have been limited. This study investigated the systemic effects of UVB on Th2-associated immune responses using two different murine models of allergic respiratory inflammation. The mechanism of immune regulation was also examined. Methods and Results: Two murine models of asthma were used: the papain model and the ovalbumin (OVA) model using papain and OVA, respectively, as the allergens. In the papain model, C57BL/6, histamine receptor-1 knockout (H1RKO) and histamine receptor-2 knockout (H2RKO) mice were exposed to a single 4 kJ/m2 dose of UVB (twice a minimal oedemal dose) on shaved dorsal skin three days prior to intranasal sensitisation with papain, a cysteine protease homologue of the house dust mite (Dermatophagoides pteronyssinus) allergen Der p 1. Sensitisation and boost each consisted of five daily intranasal doses of 1 µg papain whilst the challenge consisted of three daily intranasal doses of 100 µg papain. Asthmatic symptoms were assessed 24 h after the final challenge dose. H1RKO mice demonstrated enhanced papain-specific inflammatory responses in the lung-draining lymph nodes (LDLNs) whilst the responses of H2RKO mice closely mimicked those of C57BL/6 mice. UVB irradiation three days before sensitisation reduced in vitro papain-specific proliferation of LDLN cells from C57BL/6 and H1RKO mice but not H2RKO mice 24 h after challenge. The regulatory effect of UVB was transferred by adoptive transfer of 5 x 106 unfractionated LDLN cells from UVB-irradiated, papain-sensitised and -challenged C57BL/6 and H1RKO donor mice into naïve recipients of the corresponding strain that were ii subsequently sensitised and challenged with papain. Additionally, UVB exposure suppressed papain-induced IL-5 and IL-10 production in vitro by LDLN cells from H1RKO mice but not from C57BL/6 mice or H2RKO mice. The results of this study demonstrate systemic immunomodulation of responses to intranasally delivered antigen by UVB irradiation and the induction of regulatory cells in the LDLN following UVB exposure. Furthermore, these results implicate a role for the H2R in UVB-induced suppression of antigen-specific responses in the draining lymph nodes.
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Heatlie, Heath Forbes. "Variations in primary care prescribing : a pharmacoepidemiological study." Thesis, Keele University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.366442.
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Mohamed, A. A., and N. K. Bogutska. "Parental psychological characteristics in families of school-age children with severe and moderate persistent bronchial asthma." Thesis, “BIMCO Journal” Abstract book, 2018. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/14304.
Full textAbstract:
In children with any chronic disease the risk of psychological disadaptation disorders is significantly higher in comparison
with healthy ones. In order to improve the verification of the severity of the course of bronchial asthma (BA) we investigated
the psychological parameters of the patients’ families.
The I group was formed by 32 children of school age with severe BA, and the II group included 30 children with moderate
persistent BA. Psychological examination of parents was carried out using Parental Attitudes Questionnaire (A. Varga, V.
Stolin), family relationships were investigated using Parental Attitude Research Instrument (PARI) by E.S. Schaefer and R.Q.
Bell adapted by T.V. Neshcheret.
The lower mother’s educational level was poorly correlated with the more severe course of the child’s BA (r=0.30,
p<0.02), and the lower general level of education of the family - with a lower degree of disease control (r=0.29, p<0.05). Low
/ satisfactory children school educational achievements associated with severe BA (OR=2.0; 95%CI:0.9-7.8). According to
PARI questionnaire of the families in group of severe BA there were more frequent: problematic aspect of mother's relation to
family role (83.3±7.6% vs. 53.3±12.9%, p<0.05); excessive emotional distance with a child (16.7±7.6% vs. 0, p>0.26);
excessive concentration on a child (12,5±6,8% vs. 0, p>0,15). Low scores on the scale of the socially desirable parental
relationship with the maximum cooperation was noted in 40.9±10.5% in families of children with severe BA vs. 14.3±9.4% in
controls (p<0.1) There was a significant difference in the proportion of children in whom parents revealed significant
behavioral changes after diagnosis of BA (53.8 vs. 23.6%, OR=3.8; 95%CI:1.0-14.8), which prevailed in the group with severe
BA. There was a direct correlation between the existing behavioral changes in children with more severe course (r=0.33,
p<0.03) and the lower level of control of BA (r=0.35, p<0.03).
Thus, excessive emotional distance in mother-child relationships and problematic aspects of mother's role in family life, as
well as changes in the child’s behavior were revealed in families of patients with severe BA, which associated with more
pronounced manifestations of the disease. Excessive mother’s concentration in the child correlated with the less pronounced
characteristics of child’s BA.
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Latter, Macy Little. "The Use of Osteopathic Manipulation in a Clinic and Home Setting to Address Pulmonary Distress as Related to Asthma in Southwest Virginia." Diss., Virginia Tech, 2009. http://hdl.handle.net/10919/26189.
Full textAbstract:
Osteopathic Manipulative Therapy (OMT) is underutilized in addressing lung function and symptoms in asthma patients. The objective of this study was to determine if a single session of OMT can improve lung function and symptoms in patients suffering from asthma, and if patients can be taught a self-administered home OMT protocol to control their symptoms, in order to develop a protocol by which physicians can apply OMT to address lung disease in patients. This was a purposive randomized controlled quasi-experimental study which took place in family practice, pulmonology, and asthma specialist offices in southwest Virginia. The intervention was a ten-minute semi-individualized OMT protocol and a self administered home OMT education session.
Variable baseline, within-subject study design was utilized, allowing each person to serve as his or her own control. Pre and posttest measurements included: participant spirometry FEV1, FVC, and PEF; thoracic excursion upper and lower rib cage motion; and a five-question rating scale to determine current asthma symptoms.
A ten-minute OMT session included an individualized thoracic and rib screening and treatment, suboccipital release, diaphragm release, and thoracic pump. Comparison between pre- and post-OMT lung function and symptoms portrayed change. For the second part of the study, the participants were divided into two groups with group two receiving a ten-minute home OMT education session and a handout of the home OMT techniques. All participants returned two weeks later for a follow up lung function assessment.
Statistically significant (p<.05) improvements after initial OMT were documented for 8 of 10 measurements. Only two spirometry values, FEV1 and PEF, did not significantly improve. The group who participated in the home OMT education session had statistically significant improvements in 3 of 10 measurements, including the upper and lower thoracic excursion measurements and the overall asthma symptoms rating.
With a simple, easy to repeat, 10 minute semi-individualized OMT session, researchers demonstrated improved lung function and symptoms in this group of participants in Southwest Virginia. The addition of a home OMT education session was demonstrated to be at least partially beneficial. Future studies should expand on this pilot study with the researchers recommending using a larger patient population including patients with lower pre-treatment spirometry values in order to accurately monitor potential for change.Ph. D.
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Davidson, Deborah Nicole. "Chemical and spectroscopic studies of chromone derivatives." Thesis, Rhodes University, 1992. http://hdl.handle.net/10962/d1006857.
Full textAbstract:
Various chromone derivatives have been used in asthma therapy, and their biological activity is apparently related to certain chemical features which include conformation and acidity. In the present study, substituent effects on conformation and acidity have been explored in chromone systems with potential biological activity. A range of variously substituted symmetrical chromone-2-carboxamides (including a series of N,N-dimethylchromone-2-carboxamides) have been prepared via chromone-2-carboxylic acids, which, in turn, were prepared from the corresponding o-hydroxyacetophenones. The N,N-dimethylchromone-2-carboxamides were prepared by reacting the appropriate chromone-2-carbonyl chlorides with dimethylammonium chloride in pyridine, in an approach which resolved various problems encountered in the preparation of these compounds. Substituent effects on the conformation of chromone-2-carboxamides have been explored using dynamic NMR spectroscopy, and the observed splitting of the N-alkyl signals has been attributed to slow site-exchange of the N-alkyl substituents. Dynamic NMR frequency separations and coalescence temperatures have been used to calculate rotational energy barriers, and substituent effects on these rotational energy barriers have been analysed. The possible implication of ring-opening of chromones in chromone pharmacology has also been examined. A range of 3-(2-hydroxybenzoyl)acrylamides has been prepared via the dimethylamine-mediated ring-opening of N,N-dimethylchromone-2-carboxamides and the E-double-bond configuration of the ring-opened products has been unambiguously established by single crystal analysis of the parent system. The configuration and conformation of the crystal structure of the parent system have been shown, using IR and NMR spectroscopic, and molecular graphics techniques, to be maintained in solution and to characterise the whole series. ¹H and ¹³C NMR spectroscopy have also been used to study the dimethylamine-mediated ring-opening of disodium cromoglycate. The kinetics of the dimethylamine-mediated ring-opening of N,N-dimethylchromone-2-carboxamides have been studied using UV spectroscopy. These reactions have been shown to follow third-order kinetics overall and a mechanism accommodating the observed third-order kinetics has been proposed. Substituent effects have been further investigated by the potentiometric determination of the pKa (pK [subscript a]) values for a series of chromone-2-carboxylic acids. The relationship between acidity and the observed rate constants has been explored and has verified that the observed rate constants are sensitive to the influence of meta-substituents on the stability of the phenoxide ion "leaving group" rather than C-2 electrophilicity.
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Krigsman, Kristin. "Refill Adherence to Long-Term Drug Treatment with a Focus on Asthma/COPD Medication." Doctoral thesis, Uppsala University, Department of Pharmacy, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8094.
Full textAbstract:
Most patients are non-adherent with their medication sometimes, i.e. that they do not always use their medicines as prescribed. This might result in both under- and overuse and can lead to therapy failure, resulting in both unnecessary suffering and high costs. Therefore, medication adherence should be as high as possible.
The aims of this thesis were to investigate the refill adherence to long-term drug treatment, especially for patients with asthma and chronic obstructive pulmonary disease (COPD), and to study treatment gaps for patients with undersupply and drug costs for patients with oversupply. Further aims were to compare different methods for assessing refill adherence and analyse whether the same patient has the same refill adherence pattern to two different chronic drug treatments, i.e. diabetes and asthma/COPD.
The thesis shows that satisfactory refill adherence (80-120% of the prescribed dose) was 57% for repeat prescriptions with long-term drug treatment; undersupply was 21% and oversupply 22%. Patients with undersupply were without drugs more than half of the prescribed treatment time and the median oversupply for 90-100 days dispensation interval was 28 days. Patients who were exempt from charges had significantly higher oversupply than non-exempt patients and that leads to unnecessary cost for society. The level of satisfactory refill adherence for repeat prescriptions dispensed for asthma/COPD was on average 30%. The same low level was displayed for the elderly, where undersupply was more common than oversupply.
Assessments of refill adherence during a one-year period gave the same results irrespective of whether the repeat prescriptions were from an individual pharmacy record database or were manually collected at a pharmacy.
Patients with concomitant use of diabetes and asthma/COPD drugs do not have the same dispensation pattern for both drug types.
The introduction of patient profiles as a new approach to complement the calculated refill adherence needs to be further studied in larger and more divergent populations. In the future, the new national pharmacy record database in Sweden has opened up for larger studies and will be valuable when studying patterns of drug utilization.
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Irvine, Mark William. "The design and synthesis of novel phosphodiesterase 4 inhibitors for the treatment of asthma." Thesis, University of the West of Scotland, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.441083.
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Flores, Chiari Nydia. "Cost of Treatment of Asthma Attacks in a Tertiary Level Healthcare Hospital in Panama." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4671.
Full textAbstract:
Asthma is a chronic respiratory disease characterized by inflammation of the airway and the presence of recurrent attacks (exacerbations) of breathlessness, wheezing, cough, chest tightness, or some combination of these symptoms. In the US, about 53% of people with asthma had an asthma attack in 2008, and 57% of these, were children. One in ten children (10%) had asthma in 2009, and boys were more likely than girls to have asthma. Internationally, the prevalence of asthma varies widely in different countries, but the disparity is narrowing due to rising prevalence in low and middle income countries. Unfortunately, we do not have statistics for asthma in the Republic of Panama, neither epidemiological data nor costs, which is the reason why this research is needed.
The Panamanian Social Security Fund (CSS) provides protection to workers, their immediate families and the pensioned. By the end of 2010, the total insured population was 2,862,202 (83% of the total population of Panama). Of the total insured population 58% were dependent. Of this, 1,205,607 (42%) were children. On the basis of this information, we decided to develop the research study using information from the CSS, specifically in the Hospital de Especialidades Pediatricas (HEPOTH). It is the only tertiary level of healthcare children's hospital of the CSS.
A quantitative-descriptive design was used to develop this study. Data was collected from medical records of patients diagnosed with asthma in the HEPOTH from January to June 2012. We reviewed the medical records of each care area by month, and numbered each clinical record of children diagnosed with asthma in crisis and randomly selected 10% of the medical records from a minimum of 2000 records. Information on treatment costs was also obtained. Once all the information was collected, it was typed in the digital data log created for this study and the responses were code converted and the information was entered into a database. The data were exported to IBM SPSS Statistics 21.
The average cost of asthma attacks in Panama is estimated at $205.52. We were able to confirm that there are variations in this average by gender, age, geographic area of residence, season, severity, whether treated in the emergency department or hospitalization, and the type of treatment received. It was also possible to obtain secondary information about the epidemiology of asthma that allowed us to confirm that our statistics matched international statistics.
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Short, Philip. "Evaluation of beta-blockers for the treatment of asthma and chronic obstructive pulmonary disease." Thesis, University of Dundee, 2014. https://discovery.dundee.ac.uk/en/studentTheses/2ec04592-d4c9-44da-9175-d92be119bf36.
Full textAbstract:
Beta-blockers are avoided in asthma and chronic obstructive pulmonary disease (COPD) due to the potential risk of drug induced bronchospasm. Despite these concerns, beta-adrenoceptor antagonism has recently been associated with potential therapeutics benefits in asthma. Furthermore the use of beta-blockers in COPD patients may potentially result in improved survival due to optimisation of treatment in those with concurrent cardiovascular disease. This thesis evaluates the role of beta-blocker use in asthma and COPD. The introduction outlines the pharmacological principles associated with the human beta-adrenoceptor and its therapeutic application in the management of asthma and COPD through established treatment strategies including inhaled beta-agonists. The historical literature documenting concerns with beta-blocker use in asthma and COPD is reviewed and critiqued. Finally the hypothesis, on which this thesis is based, that betablockers may have a therapeutic role in the asthma and COPD is discussed. Proof of concept studies and preliminary work suggesting potential putative effects of betablocker use in asthma, data highlighting the burden of cardiovascular disease in COPD patients and the potential role of beta-blockers are discussed. New data from two randomised double-blind placebo controlled trials evaluating betablocker use in asthma and an observational study investigating the effects of betablocker use on mortality in COPD are presented. The first randomised controlled trial, addresses the safety of beta-blocker use in asthma. Using the non-selective beta-blocker propranolol, the study investigated the safety of acute exposure to propranolol in asthmatics, sequentially challenged with histamine to mimic an asthma exacerbation and evaluated the role of intravenous hydrocortisone in potentiating salbutamol reversibility. The results of this study showed there was no significance difference in salbutamol recovery measured by change in FEV1 (ml) post histamine challenge following intravenous hydrocortisone verses placebo (mean difference 0.04 (95%CI - 0.07 to 0.15), p=0.417). The study also investigates the degree of bronchoconstriction attributable to oral propranolol in mild-to-moderate asthmatics and uses impulse oscillometry as an alternative method of assessing pulmonary function to conventional spirometry. Following 10 or 20mg of oral propranolol, a mean fall in FEV1 of 4.7% was observed (95%CI 1.8 to 7.5), p=0.008. Impulse oscillometry showed a greater response to propranolol with an increase of 31.3% (95%CI 15.6 to 47), p= 0.04, 2 hours post propranolol dosing. The second randomised controlled trial within this thesis, describes the first placebocontrolled trial to assess the effects of chronic dosing with oral propranolol as add-on to inhaled corticosteroids in patients with stable persistent asthma. The study investigated the hypothesis of potential therapeutic benefits of chronic beta-blocker use in asthma by improvements in airway hyper-responsiveness. This study evaluates the effects of oral propranolol on both methacholine and histamine bronchial challenges, in addition to spirometry, impulse oscillometry and inflammatory surrogates including exhaled nitric oxide. Furthermore the effects on asthma control and quality of life post chronic betablockade are described. Finally the safety and tolerability of acute cardio-selective beta-blockade with esmolol is compared to acute propranolol dosing and the protective effects of tiotropium are evaluated. The main result of this study showed chronic propranolol dosing did not affect airway hyper-responsiveness, with no significant difference observed in methacholine challenge PC20 following chronic propranolol exposure compared to placebo, geometric mean mg/ml: 2.57 (95%CI 1.13 to 5.85) versus 2.50 (95%CI 1.14 to 5.50), -i.e. a mean doubling dilution difference (DDD) of 0.04 (95%CI -0.56 to 0.63), p=0.89. Furthermore following chronic beta-blocker dosing, FEV1 showed a fall with propranolol versus placebo amounting to a 4.3% (95%CI -0.6 to 9.2) p=0.08. The final study within this thesis is a large observational cohort study using a disease specific dataset of COPD patients. By means of data linkage using pharmacy prescriptions, hospital admissions and mortality data, the potential effects of betablocker use on COPD exacerbations and mortality is examined. This study suggested a potential survival benefit with beta-blocker use amounting to a 22% reduction in mortality (HR 0.78 (95%CI 0.67 to 0.92). The discussion of this thesis evaluates the results of each study and describes their relevance in the management of patients with asthma and COPD.
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Garas, M. N. "Treatment efficacy of children suffered from late-onset bronchial asthma depending on phenotypic heterogenity." Thesis, БДМУ, 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/13058.
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Kennedy, Wendy Ann. "Cost-efficacy vs. cost-effectiveness, the case of inhaled corticosteroids in the treatment of asthma." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0025/NQ48776.pdf.
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Camateros, Pierre. "The genetic control of airway responsiveness and the effect of resiquimod treatment on allergic asthma." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=92166.
Full textAbstract:
Asthma is a heterogeneous airway disease caused by a mixture of genetic and environmental factors which result in improper immune responses to innocuous antigens. Toll-like receptors (TLR) are pathogen associated pattern recognition receptors which form homo- or heterodimers which bind specific ligands leading to activation and modulation of immune responses. The present study examined the effect of resiquimod, a synthetic toll-like receptor 7 ligand, on the development of allergic asthma pathology in animal models. Resiquimod treatment of ovalbumin sensitized mice prevented the subsequent development of airway hyperresponsiveness and inflammation, increased plasma IgE levels, and both TH1 and TH2 cytokine production. This effect was independent of the Mapkapk2 gene but was ineffective in Myd88 knockout mice.A defining feature of asthmatic airways is airway wall remodelling which is characterized by an increase in airway smooth muscle mass, goblet cell hyperplasia, and the deposition of extra-cellular matrix components. The effects of resiquimod treatment on the development of airway remodelling were examined in Brown Norway rats. Resiquimod treatment prevented the increase in airway smooth muscle mass and goblet cell hyperplasia observed in control animals. These effects were associated with a reduction in the number of proliferating airway cells and were preceded by an abrogation of the allergic inflammatory reaction.
Employing gene expression microarray analysis, the transcriptome of resiquimod treated, and untreated asthmatic A/J and C57BL/6 mice, was characterized. Asthma induction resulted in the up-regulation of genes involved with the control of cell cycle progression, the complement and coagulation cascades, and chemokine signalling, findings which are consistent with previous reports. Treatment with resiquimod resulted in the normalization of asthma induced genes related to airway remodelling and chemokine signalling. Additionally, treatment resulted in the induction of cell adhesion genes, and genes involved in natural killer (NK) cell-mediated cytotoxicity. Furthermore, NK cell recruitment to the lungs and livers of resiquimod treated mice was demonstrated, though treatment efficacy was not dependent on these cells.
The difference in asthma susceptibility between A/J and C57BL/6 mice was further explored at the genetic level. Specifically, airway responsiveness, a predisposing factor for the development of asthma in humans, was assessed using a panel of 33 recombinant congenic strains of mice derived from A/J and C57BL/6 parental strains. A genotype-phenotype association analysis was then performed and identified 16 chromosomal regions as significantly associated with airway responsiveness. Of these 16 regions, 8 are novel while the remainder have previously been linked with airway responsiveness. Several likely candidates have been identified from these 16 regions, but further study will be required in order to determine if these genes have any causal relationship with airway responsiveness.
Overall, the data presented in this thesis demonstrate and characterize the protective effect of resiquimod treatment against both the acute and chronic pathological changes associated with the development of asthma. Furthermore, genetic factors which are associated with a predisposition to the development of asthma and with asthma pathology have been described at the genetic and transcriptional levels, respectively. Taken together, these findings further our understanding of the molecular basis of asthma pathology and will aid in the development of new therapeutic strategies.
L'asthme est une maladie des voies respiratoires causée par une combinaison de facteurs génétiques et environnementaux qui entraîne une réponse immunitaire inappropriée contre des antigènes bénins. Les TLRs (récepteurs ressemblant à Toll) sont des récepteurs qui reconnaissent des motifs dérivés de pathogènes qui forment des homo- ou hétérodimères se liant à des ligands spécifiques qui amènent à l'activation et la modulation de diverses réponses immunitaires. La présente étude a examiné l'effet du composé resiquimod, un ligand synthétique de TLR-7, dans le développement pathologique de l'asthme allergique dans des modèles animaux. Chez les souris sensibilisées avec l'ovalbumine, le traitement avec resiquimod a prévenu le développement subséquent de l'hyperréactivité et l'inflammation des voies aériennes, l'augmentation des niveaux d'IgE, ainsi que la production de cytokines de type TH1 et TH2. Cet effet est indépendant du gène Mapkapk2 mais requiert la présence du gène Myd88.
Une caractéristique des voies aériennes asthmatiques est le remodelage de la paroi des voies respiratoires. Les effets du traitement avec resiquimod sur le remodelage des voies respiratoires ont été examinés chez les rats brun norvégien. Ce traitement a prévenu l'augmentation de la masse des muscles lisses des voies respiratoires ainsi que l'hyperplasie des cellules caliciformes chez les témoins. Ces effets étaient précédée par l'élimination de la réaction inflammatoire allergique.
Le transcriptome de souris A/J et C57BL/6 traité et non-traité avec resiquimod fut analysé en utilisant des puces à ADN pour l'analyse de l'expression des gènes. Le déclenchement de l'asthme a provoqué l'induction de gènes impliqués dans le contrôle de la progression du cycle cellulaire, la cascade du complément et de la coagulation, et la signalisation des chimiokines. Ces résultats sont conformes avec les études antérieures. Le traitement avec resiquimod a entrainé la normalisation des gènes induits par l'asthme liés au remodelage des voies respiratoires et la signalisation des voies chimiokines. Par ailleurs, le traitement a résulté en l'induction de gènes reliés à l'adhésion cellulaire et des gènes impliqués dans la cytotoxicité médiée par les cellules tueuses naturelles (NK). De plus, le recrutement des cellules NK dans les poumons et le foie a été démontré chez des souris traitées avec resiquimod. Cependant, l'efficacité du traitement n'était pas dépendante des cellules NK.
La différence dans la susceptibilité de l'asthme entre les souris A/J et C57BL/6 fut exploré davantage au niveau génétique. Plus spécifiquement, la réactivité des voies respiratoires fut évalué à l'aide d'un panneau de 33 souches de souris congéniques recombinantes qui était dérivé de souris parentales A/J et C57BL/6. Une analyse de l'association entre le génotype et le phénotype fut ensuite effectuée et 16 régions chromosomiques qui sont associées de façon significative à la réactivité des voies respiratoires ont été définies. De ces 16 régions, 8 sont nouvelles alors que les autres ont déjà été lié à la réactivité des voies respiratoires. De ces 16 régions, plusieurs candidats potentiels furent identifiés. Cependant, des recherches additionnelles seront requises afin de déterminer si ces gènes ont une relation de cause à effet avec la réactivité des voies respiratoires.
En conclusion, les données présentées dans cette thèse démontrent et caractérisent l'effet protecteur apporté par le traitement avec resiquimod contre les changements pathologiques associés à l'asthme chronique et aigu. Par ailleurs, les facteurs génétiques qui sont associés à une prédisposition du développement de l'asthme et de la pathologie de l'asthme ont été décrits au niveau génétique et transcriptionnel, de façon respective. Prises ensemble, ces découvertes avancent notre compréhension au point de vue moléculaire de la pathologie de l'asthme et aideront au développement de nouvelles stratégies thérapeutiques.