Tesis: "Asthma control"

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Goodman, Neil. "Electrostatic allergen control". Thesis, University of Southampton, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249630.

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5

Eilayyan, Owis. "Maximizing the effects of asthma interventions: predictors of perceived asthma control over time". Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=114582.

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Background: Asthma is a common chronic disease that causes substantial morbidity and reduced quality of life when poorly controlled. Identifying clinical and psychosocial characteristics that influence long-term asthma control can help to match asthma management programs to the individuals' needs. Objective: Study1: To estimate the extent to which symptom status, beliefs about medications, self-efficacy, emotional function, and health care utilization predict perceived asthma control perceived asthma control over a 16 months period of time among a primary care population. Study2: To estimate the extent to which symptom status, physical, mental, and social function, and healthcare utilization predict perceived asthma control over a 6 month period of time among individuals receiving care at a respiratory specialty clinic. Methods: Study 1 and 2 are secondary analysis of data from two longitudinal studies that examined health outcomes of asthma. The first study recruited the participants from primary clinics, while the second one recruited the participants from a specialty clinic at a Montreal territory hospital. Evaluations on measures of symptom status, beliefs about medications, self-efficacy, physical, mental, and social function, and healthcare utilization were evaluated over 2 time points. Path analysis models were used to estimate the predictors of perceived asthma control in both studies, which were modeled based on the Wilson & Cleary and ICF models. The first study's path model hypothesized that symptoms, self-efficacy, beliefs about medications, emotional function, physical activity, and healthcare utilization are predictors of perceived asthma control. The second study's path model hypothesized that FEV1, symptom, mental health, physical and social function, role emotional, and healthcare utilization are predictors of perceived asthma control. Results: Study1: the path model indicated asthma symptom (B= 0.35, p= 0.00) and physical activity (B= 0.24, p= 0.01) had a significant positive total effect on perceived asthma control, while emotional function (B= 0.08, p= 0.05) and self-efficacy (B= 0.07, p= 0.02) were significant predictors indirectly through physical activity. The model explained 24% of perceived asthma control. Overall, the model fit the data well (Χ2 = 15.98, df = 10, P-value = 0.1, RMSEA = 0.045, and CFI = 0.98). Study 2: the path model indicated that FEV (B= 0.12, p= 0.01), asthma symptom (B= 0.42, p= 0.001), and social function (B= 0.37, p= 0.02) had a significant positive total effect on perceived asthma control. The model explained 34% of perceived asthma control. Overall, the model fit the data well (Χ2= 39.83, df = 27, P-value = 0.053, RMSEA = 0.065, and CFI = 0.95). Conclusion: FEV1, asthma symptom, physical activity, emotional function, social function, and self-efficacy can be used to identify patients likely to have poor perceived asthma control in the future, and should be considered when planning patient management. Identifying these predictors is important to help the care team tailor interventions that will allow individuals to optimally manage their asthma, to prevent exacerbations, to prevent other respiratory-related chronic disease, and to maximise quality of life.
Contexte: L'asthme entraîne une morbidité importante et réduit la qualité de vie lorsqu'elle est mal contrôlée. L'identification des caractéristiques cliniques et psychosociales qui influent sur contrôle de l'asthme à long terme peut aider à faire concorder les programmes de gestion de l'asthme aux besoins des individus. Objectif: Étude 1: Estimer la mesure dans laquelle le statut des symptômes, les croyances concernant les médicaments, l'auto-efficacité, l'émotion, et l'utilisation des soins de santé permettent de prédire le contrôle de l'asthme perçu sur une période de 16 mois dans une population des soins primaires. Étude 2: Estimer la mesure dans laquelle le statut des symptômes physiques et mentaux, les fonctions sociales, et l'utilisation des soins de santé permettent de prédire le contrôle de l'asthme perçu sur une période de 6 mois chez les personnes recevant des soins dans une clinique spécialisée en pneumologie.Méthodes: Les études 1 et 2 sont des analyses secondaires des données provenant de deux études longitudinales qui ont examiné les effets de l'asthme sur la santé. La première étude a recruté les participants de cliniques de soins primaires, tandis que la seconde a recruté les participants à partir d'une clinique spécialisée dans un hôpital à Montréal. Les évaluations sur les mesures de l'état de symptôme, les croyances concernant les médicaments, l'auto-efficacité, physique, mental, et les fonctions sociales, et l'utilisation des soins de santé ont été évaluées à 2 points dans le temps. Des modèles d'analyse de pistes causales ont été utilisés pour estimer les facteurs prédictifs de le contrôle de l'asthme perçu dans les deux études. Les modèles utilisés se basent sur les modèles Wilson & Cleary et modèles ICF. Le modèle de piste pour la première étude a émis l'hypothèse que les symptômes, les auto-efficacités, les croyances au sujet des médicaments, l'émotion, l'activité physique, et l'utilisation des soins de santé sont des facteurs prédictifs du contrôle de l'asthme perçu. Le modèle de piste pour la deuxième étude a émis l'hypothèse que le VEMS, les symptômes, la santé mentale, les fonctions physiques et sociales, le rôle émotionnel, et l'utilisation des soins de santé sont des facteurs prédictifs du contrôle de l'asthme perçu. Résultats: Étude 1: le modèle de piste causale a indiqué que les symptômes de l'asthme (B = 0,35, p = 0,00) et l'activité physique (B = 0,24, p = 0,01) ont eu un effet positif important sur la le contrôle de l'asthme perçu totale, tandis que la fonction émotive (B = 0,08, p = 0,05) et l'auto-efficacité (B = 0,07, p = 0,02) étaient des prédicteurs significatifs indirectement au moyen de l'activité physique. Le modèle explique 24% de la le contrôle de l'asthme perçu. Les statistiques d'ajustement indiquent un bon ajustement du modèle (= 15,98 Χ2, df = 10, P-value = 0,1, RMSEA = 0,045, et la FCI = 0,98). Étude 2: le modèle de piste causale a indiqué que le VEMS (B = 0,12, p = 0,01), les symptômes d'asthme (B = 0,42, p = 0,001), et la fonction sociale (B = 0,37, p = 0,02) a eu un effet positif important sur la le contrôle de l'asthme perçu totale. Le modèle explique 34% de la le contrôle de l'asthme perçu. Les statistiques d'ajustement indiquent un bon ajustement du modèle (= 39,83 Χ2, df = 27, P-value = 0,053, RMSEA = 0,065, et la FCI = 0,95). Conclusion: Le VEMS, les symptômes de l'asthme, l'activité physique, la fonction émotive, la fonction sociale, et l'auto-efficacité peuvent être utilisés pour identifier les patients susceptibles d'avoir une mauvaise le contrôle de l'asthme perçu dans l'avenir, et devrait être considéré lors de la planification de gestion des patients. L'identification de ces prédicteurs est une étape importante pour aider les équipes d'interventions à administrer des soins sur mesure afin de contrôler l'asthme et les exacerbations des patients de façon optimale, mais également de prévenir les maladies chroniques associées, et de maximiser la qualité de vie.

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Cameron, Euan John. "Effects of azithromycin on asthma control, airway inflammation and bacterial colonisation in smokers with asthma : a randomised control trial". Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4575/.

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Smokers with asthma represent an important sub-group of asthmatics displaying both reduced response to inhaled and oral corticosteroids as well as demonstrating accelerated decline in lung function and increased use of health care services. Clinical and laboratory studies have suggested that macrolide antibiotics may exhibit anti-inflammatory properties in a variety of airways disease including asthma. The anti-inflammatory properties of macrolides have been recognised for almost 50 years. Indirect evidence from both pre-clinical and clinical studies suggests that the mechanism of action may be of particular benefit in smokers with asthma. A proof of concept study was designed to test the hypothesis that the macrolide antibiotic azithromycin improves measures of asthma control, airway inflammation and bacterial colonisation in smokers with asthma. Azithromycin was chosen for its convenience of once daily dosing and its oral tolerability in addition to its more limited interactions. Seventy-seven adults with allergic asthma were recruited to a 12-week parallel group randomised controlled trial comparing the effects on asthma control, airway inflammation and bacterial colonisation of oral azithromycin 250 mg daily with matched placebo. The primary outcome measure was peak expiratory flow at the final study visit. Secondary outcome measures included spirometry, asthma control questionnaire [ACQ] score, asthma quality of life questionnaire [AQLQ], Leicester cough questionnaire [LCQ] score, provocation concentration to methacholine PC20, and inflammatory markers: exhaled nitric oxide, sputum differential cell counts, sputum supernatant and serum inflammatory markers such as interleukin-1β [IL-1β], IL-2, -4, -5, -6, -10, TNF-α, IFN-γ, GM-CSF, Leukotriene B4, and high sensitivity C-reactive protein. Microbiological culture and PCR of sputum was also performed to assess for any changes associated with treatment. At 12 weeks, the change in PEF at the final study visit, as compared with baseline, did not differ significantly between the azithromycin and placebo treatment groups [mean difference azithromycin-placebo -10.3L/min, 95% CI -47.1 to 26.4, p=0.58]. No statistically significant difference was observed between the azithromycin and placebo groups in each of the measures of spirometry, ACQ, AQLQ, LCQ, PC20, or evening PEF. The LCQ-psychological domain did reach statistical significance, [mean difference azithromycin-placebo -0.46, 95%CI -0.9 to 0.02 p=0.04], however this indicates a deterioration in the treatment group. No change was seen in exhaled nitric oxide. The total cell counts recovered from sputum were similar following treatment with azithromycin compared to placebo. In addition, differential cell counts remained unchanged and lymphocyte proliferation assays did not demonstrate any statistically significant changes following 12 weeks of treatment with azithromycin when compared to placebo. There was no substantial difference in any of the measured sputum supernatant or plasma cytokines. Peripheral blood monocyte stimulation was performed, with supernatant being measured against a panel of cytokines. There was again no substantial difference in any of the measured panel of cytokines collected from the monocyte stimulation assays when the azithromycin group was compared to placebo. There was no correlation between changes in ACQ, AQLQ, LCQ, PC20, sputum macrophage count, sputum neutrophil count, sputum eosinophil count, and PEF. Adverse event rates were similar in patients taking azithromycin compared with placebo. A total of 4 patients were lost to follow up [1 in the azithromycin group, 3 in the placebo group]. One patient died of a cardiovascular cause. This occurred following completion of the study but within the pre-specified regulatory reporting period. In conclusion there were no clinically important improvements in a range of clinical indices of asthma control, airway inflammation or bacterial colonisation following 12 weeks treatment with azithromycin when compared with placebo in smokers with asthma. The lack of any evidence of clinical benefit of azithromycin in smokers with asthma is a new finding and extends the current knowledge base and evidence for the use of macrolides in asthma. There exists no firm evidence to suggest the widespread use of macrolides in asthma and the current study suggests that no benefit will be observed in the sub-group of asthmatics whom are current smokers.

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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 Philosophy
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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Neffen, Hugo, Carlos Fritscher, Francisco Cuevas Schacht, Gur Levy, Pascual Chiarella, Joan B. Soriano y Daniel Mechali. "Asthma control in Latin America: the Asthma Insights and Reality in Latin America (AIRLA) survey". Pan American Health Organization, 2005. http://hdl.handle.net/10757/625754.

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Objectives. The aims of this survey were (1) to assess the quality of asthma treatment and control in Latin America, (2) to determine how closely asthma management guidelines are being followed, and (3) to assess perception, knowledge and attitudes related to asthma in Latin America. Methods. We surveyed a household sample of 2 184 adults or parents of children with asthma in 2003 in 11 countries in Latin America. Respondents were asked about healthcare utilization, symptom severity, activity limitations and medication use. Results. Daytime asthma symptoms were reported by 56% of the respondents, and 51 % reported being awakened by their asthma at night. More than half of those surveyed had been hospitalized, attended a hospital emergency service or made unscheduled emergency visits to other healthcare facilities for asthma during the previous year. Patient perception of asthma control did not match symptom severity, even in patients with severe persistent asthma, 44.7% of whom regarded their disease as being well or completely controlled. Only 2.4% (2.3% adults and 2.6% children) met all criteria for asthma control. Although 37% reported treatment with prescription medications, only 6% were using inhaled corticosteroids. Most adults (79%) and children (68%) in this survey reported that asthma symptoms limited their activities. Absence from school and work was reported by 58% of the children and 31% of adults, respectively. Conclusions. Asthma control in Latin America falls short of goals in international guidelines, and in many aspects asthma care and control in Latin America suffer from the same shortcomings as in other areas of the world.
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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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Cox, Karen R. (Karen Rose). "Effects of a self-care deficit nursing theory-designed nursing system on symptom control in children with asthma". free to MU campus, to others for purchase, 2001. http://wwwlib.umi.com/cr/mo/fullcit?p3036817.

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12

Aboussafy, David 1969. "Stress, coping, self-efficacy and asthma control : clinic, diary and laboratory studies". Thesis, McGill University, 1999. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=35553.

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Asthma has not declined in morbidity and mortality despite significant advances in medical treatment. A literature review was conducted and a program of research was devised with the goal of improving understanding of why many appropriately treated and educated asthmatics are unable to gain adequate control of their asthma. A review of the literature found that psychological stress was a poorly understood trigger for asthmatic symptoms and a possible factor in poor asthma control. A clinic visit study of adult asthmatics found: (1) life event stress was associated with asthma quality of life but not ventilatory function, (2) asthma self-efficacy was strongly related to asthma quality of life and ventilatory function, (3) style of coping with stress appeared to buffer the effects of stress on asthma, and (4) evidence for a stress-responsive asthmatic subgroup. A subsequent longitudinal daily diary study found: (1) concurrent stress and daily asthma symptoms were strongly associated, (2) daily bronchodilator use appeared to be determined by pre-diary beliefs about disease severity and controllability, (3) stress could precede (within one day) increases in asthma symptoms and decreases in airflow, and (4) clinically significant decreases in peak flow were often preceded by large increases in perceived stress. A laboratory study found: (1) exposure of asthmatics to specific passive and asthma-related stressors resulted in decreased airflow and that these decreases are associated with a concurrent increase in vagal (parasympathetic) tone, (2) an active stressor that resulted in increased sympathetic arousal did not result in decreased airflow, (3) relaxation resulted in parasympathetic arousal and decreased airflow, and (4) asthma self-efficacy was associated with parasympathetic reactivity. In sum, the program of research has generated findings that help explain how stress, coping and self-efficacy contribute to asthma control led to concrete suggestions to improve c

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13

Harrison, Selena. "The control of sensory nerve function in guinea-pig airways". Thesis, King's College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312823.

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Harris, Katherine Marie. "The impact of suboptimal asthma control and adherence to medication on health-related outcomes for children with asthma". Thesis, Queen Mary, University of London, 2018. http://qmro.qmul.ac.uk/xmlui/handle/123456789/53581.

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Asthma is the most common long-term condition in children in the United Kingdom (UK). Asthma-related hospitalisations and mortality are disproportionally higher in the UK, compared with other European countries, however the reasons for this disparity remain unclear. A putative explanation is that that prevalence of suboptimal asthma control in children in the UK is higher than in continental Europe. If this is indeed correct, then the drivers of suboptimal control, such as poor adherence to therapy resulting from poor understanding of the role of preventer medication (inhaled corticosteroids (ICS)) in UK children would be of significant clinical interest. Therefore, in this thesis, I sought to first identify the levels of asthma control and medication adherence in a non-random sample of London secondary school children. Then, I used focus groups to further highlight the barriers to good medication adherence, and generate insights into potential solutions. To achieve these aims, I developed and implemented an online questionnaire to be delivered in schools, which included the validated Asthma Control Test (ACT). Methods: This thesis is divided into three main sections. The first and second sections include original data from an observational research study, which collected data about asthma control, from 24 London secondary schools between December 2014 and March 2016. The aim of the first section was to assess current levels of asthma control and medication adherence among children with asthma in London secondary schools. Data were collected using an online questionnaire, which included the validated ACT to measure asthma control, as well as additional questions about knowledge, healthcare use, medication use, school attendance, lifestyle and emotion and behaviour, using the validated Me and My School (M&MS) questionnaire. The second section of this thesis includes data generated from six focus groups, conducted in four London secondary schools with 56 students. In order to generate data to inform future interventions, discussions focused on the barriers to medication adherence among teenagers, and how these barriers could be addressed. The third section comprises a systematic review of school-based self-management interventions for children with asthma. The review uses a mixed-methods approach, and includes both quantitative and qualitative study data. A process evaluation is also included, to identify intervention elements that are associated with implementation success. Results: 766 children with asthma from 24 schools were surveyed. Almost half of the students (45.7%; n = 350) had poor asthma control by ACT score. Adherence with asthma medication was low, regardless of asthma control (56.2% self-reported forgetting to use their ICS "preventer" inhaler; 29% self-reported not using their SABA "reliever" inhaler when they needed it, at least some of the time). Health care involvement was relatively high, with at least one unplanned GP visit, due to asthma in the previous four weeks, reported by 28.1% of students; at least one unplanned hospital visit was self-reported by 15.7% of students; and at least one unplanned school nurse visit due to asthma was self-reported by 16% of students. At least one whole school absence was reported by 20.9% of students. Unplanned medical care and school absences were higher among children with poor asthma control, according to the ACT. Themes from focus groups suggested that social stigma, fear of embarrassment, forgetfulness, and incorrect attitudes towards medication were all contributory factors to poor medication adherence. Communications with healthcare professionals were also identified as key unmet needs of teenagers with asthma. The findings from the meta-analyses, included in the systematic review of school-based self-management interventions, showed that such interventions were effective in improving several outcomes, largely related to healthcare use. These included hospitalisations, emergency department (ED) visits, and health-related quality of life. There was no evidence that school-based interventions improved school absences, experiences of day and night time symptoms, or the use of medication. The findings from the analysis of the process evaluation studies showed that a theoretical framework is important in the development of a successful intervention. Conclusions: First, in a large non-random sample of secondary school children with asthma, the proportion of children with suboptimal control is worryingly high, and this is associated with general poor adherence to prescribed therapy asthma. Second, focus groups identified practical and social barriers to good adherence, that should be addressed in future studies. Third, previous studies suggest that school based interventions are effective in reducing incidences of unplanned and urgent healthcare use. The systematic review included studies that included relatively hard-to-reach populations, suggesting that such interventions may be effective across diverse populations, including those considered hard-to-reach. The findings in this thesis informed the development of a school-based self-management intervention, to be piloted in London secondary schools, and an NIHR-funded global research group award on improving asthma control in African children.

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Capstick, Toby Gareth David. "The effectiveness of pharmacist interventions in improving asthma control and quality of life in patients with difficult asthma". Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/13962.

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Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates < 80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.

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Patel, P. P., M. M. Mittal y Sergyi Ipolitovich Sazhyn. "Level of asthma control in school-age children with exercise-induced asthma phenotype and difference type of acetylator". Thesis, ВДНЗ України «Буковинський державний медичний університет», 2016. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/11420.

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Capstick, Toby G. D. "The Effectiveness of Pharmacist Interventions in Improving Asthma Control and Quality of Life in Patients with Difficult Asthma". Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/13962.

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Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates <80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.
The Pharmaceutical Trust for Educational and Charitable Objects (PTECO) (now known as Pharmacy Research UK).

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18

Croft, Elizabeth. "Children's representations of asthma : developmental changes and influences on knowledge, asthma control, management and perceptions of quality of life". Thesis, Open University, 1996. http://oro.open.ac.uk/57617/.

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A between and within group design using a semi-structured interview was used to explore the content of children's illness representations of their asthma and the influence of these representations on knowledge, asthma management , asthma control and perceived quality of life. A sample of 41 asthmatic children and their parents were recruited from GP practices. Children were divided into two age groups 8-11 years and 12-16 years. Test-retest reliability was performed on a sample from each age group. Children were found to have similar illness representations across the age groups although developmental patterns were found in the beliefs children offered about the cause of their asthma, and in the way in which illness representations influenced outcome. For the younger children, causal attributions appear to be more influential in outcome than the constellation of illness representations that were tested Older children appeared to be beginning to approximate more adult patterns of holding a set of beliefs that influenced outcome. A major issue in the study was the variable reliability of the measures used Stability over time for the younger children was attributed to greater parental influence. The instability of measures over time for older children was considered to reflect developmental influences. Some support was found for the proposed self-regulatory function of illness representations although the complexity of findings highlights the need for longitudinal research to track developmental changes in children's illness representations. The implications for future research and clinical practice are discussed.

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Sazhyn, S. I. "Is pediatric asthma caregiver's quality of life questionnaire a useful test for asthma control assessment in school-age children?" Thesis, БДМУ, 2020. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/17674.

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20

Clayton, Robert Alan. "The effect of hypoxia on airway smooth muscle function". Thesis, University of Glasgow, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.244358.

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Akiki, Zeina. "Biological Markers For Chronic Obstructive Pulmonary Disease And Asthma". Thesis, Université Paris-Saclay (ComUE), 2016. http://www.theses.fr/2016SACLS081/document.

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L’étude des marqueurs biologiques dans la broncho-pneumopathie chronique obstructive (BPCO) et l'asthme, deux maladies respiratoires chroniques affectant des millions de personnes dans le monde, pourrait améliorer leur diagnostic, leur traitement et leur prévention.Cette thèse comprend deux parties. La première visait à évaluer l'association entre un marqueur spécifique des poumons, la protéine surfactant D (SP-D) sérique, et la BPCO, et à trouver un seuil de SP-D capable de discriminer les patients BPCO des témoins. Elle a été réalisée dans le cadre d’une étude cas-témoin au Liban incluant des patients BPCO (n=90), des asthmatiques (n=124) et des témoins (n=180). La deuxième partie visait à évaluer les associations chez les adultes des marqueurs de l’inflammation systémique (protéine C-réactive ultra-sensible, hs-CRP (n=252), et des cytokines (n=283)) et des marqueurs de dommages dus au stress oxydant (8-isoprostanes 8-IsoPs (n=258) du condensat de l’air exhalé) avec les phénotypes de l’asthme.Elle a été réalisée dans le cadre de l'étude épidémiologique longitudinale Française des facteurs génétiques et environnementaux de l'asthme (EGEA).Les résultats ont montré que les niveaux de SP-D sériques étaient associés positivement avec la BPCO et des seuils des niveaux de SP-D chez ces patients ont été identifiés avec d'excellentes valeurs discriminantes. Dans EGEA, aucune association n'a été trouvée entre les niveaux de hs-CRP sériques et le contrôle de l’asthme. Des profils de cytokines sériques (identifiés par analyse en composante principale) avec des niveaux élevés d’interleukine(IL)-1Ra et d’IL-10 ont été associés avec moins de crises d'asthme et un risque plus faible d'un mauvais contrôle de l'asthme sept ans plus tard. Les résultats des analyses préliminaires sur les associations entre les niveaux de 8-IsoPs et les phénotypes de l'asthme sont également présentés.Globalement, ces résultats ont montré l'utilité d'étudier les marqueurs biologiques en lien avec la BPCO et l'asthme
Studying the biological markers in chronic obstructive pulmonary disease (COPD) and asthma, two chronic respiratory diseases affecting millions of individuals around the world, could improve their diagnosis, their treatment and their prevention.This thesis includes two parts. The first aimed to assess the association between a lung-specific biomarker, serum Surfactant Protein D (SP-D), and COPD, and to find cut-off points able to discriminate COPD patients from controls using SP-D levels. It was performed in a case-control study in Lebanon including COPD (n=90) and asthma patients (n=124) and controls (n=180). The second part aimed to assess the cross-sectional and longitudinal associations in adults for systemic inflammatory biomarkers (high sensitivity C reactive protein hs-CRP (n=252) and cytokines (n=283) as well as biomarkers of damage due to oxidative stress (8-Isoprostanes 8-IsoPs (n=258) from the exhaled breath condensate) and asthma outcomes.It was performed in the French longitudinal epidemiological study on the genetics and environmental factors of asthma (EGEA).Results showed that serum SP-D levels were positively associated with COPD and thresholds for SP-D levels in these patients were identified with excellent discriminant values. In EGEA, no association was found between serum hs-CRP levels and asthma control. Serum cytokine profiles (identified by principal component analysis) with high levels of interleukin (IL)-1Ra and IL-10 were associated with less asthma attacks and lower risk of poor asthma control in adults seven years later. The results of the preliminary analyses on the associations between the levels of 8-IsoPs and asthma outcomes are also presented.Overall, these results have shown the usefulness of studying the biological markers related to COPD and asthma

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22

Kuznetsov, Nikita Aleksandrovich. "Postural Sway Complexity in Healthy Older Adults and Individuals with Asthma". University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1378112671.

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Aboussafy, David. "Stress, coping, self-efficacy and asthma control, clinic, diary and laboratory studies". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/NQ64491.pdf.

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Cooper, Susan Elizabeth. "Clinical trials to investigate the effect of breathing exercises on asthma control". Thesis, University of Nottingham, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.537620.

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Ruz, S. Abu. "Factors influencing adherence and disease control in patients with asthma and diabetes". Thesis, Queen's University Belfast, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273144.

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Blyth, Thomas Peter. "Risk factors for life-threatening asthma in childhood : a case-control study". Thesis, University of Cambridge, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.611488.

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Oliveira, Suelen Goecks. "Validação do questionário Childhood Asthma Control Test (c-ACT) para o Brasil". Pontifícia Universidade Católica do Rio Grande do Sul, 2015. http://hdl.handle.net/10923/7292.

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Introduction: Children’s own perceptions and accounts of their asthma diagnosis have proved to be reliable and relevant to disease control.Objective: The aim is to validate the Brazilian Portuguese version of the Childhood Asthma Control Test (c-ACT) in children aged between 4 and 11 years.Methods: The investigation was divided into two stages: The first stage comprised the translation and linguistic adaptation of the instrument, while the second consisted of testing the psychometric properties of validity and reliability.Results: A total of 105 participants were included, aged between 4 and 11 years. Validity: all correlations between the total score and items on the questionnaire were significant and obtained values of r = > 0. 3. There was no correlation between the total score of the questionnaire and lung function. The controlled asthma group showed significantly higher c-ACT scores than those of the uncontrolled asthma group (controlled 22±2. 9 VS uncontrolled 16. 3±5. 3 p <0. 001). Reliability: The Alfa de Cronbach coefficient for the total c-ACT score was 0. 677 (CI95% 0. 573-0763). In the assessment of sensitivity to change, the effect size was 0. 8 and the intraclass correlation coefficient was 0. 598. No floor or ceiling effects were observed in the sample studied.Completed: The Brazilian version of the Childhood Asthma Control Test proved to be valid and reliable.
Introdução: Atualmente a percepção e os relatos da própria criança sobre seu diagnóstico de asma tem se demonstrado confiável e relevante para o manejo da doença.Objetivo: Validar a versão Português para o Brasil do Childhood Asthma Control Test em jovens com idade entre 4 a 11 anos.Métodos: O estudo foi dividido em duas etapas: a primeira o processo de tradução, adaptação linguística do instrumento. A segunda etapa foi realizada a análise das propriedades psicométricas validade e a confiabilidade.Resultados: Foram incluídas 105 participantes, com idades entre 4 a 11 anos. Validade: todas as correlações entre o escore total e os itens do questionário foram significativas e com valores r = > 0,3. Não houve correlações entre o escore total do questionário e a função pulmonar. O grupo com asma controlada apresenta valores significativamente superiores no c-ACT ao compararmos com o grupo com asma não controlada (controlada 22±2,9 VS não controlada 16,3±5,3 p < 0,001). Confiabilidade: o coeficiente de Alfa de Cronbach do escore total do c-ACT foi de 0,677 (IC95% 0,573-0763). Na avaliação da sensibilidade às mudanças o tamanho do efeito foi 0,8 e o coeficiente de correlação intraclasse foi de 0,598. Não foram observados os efeitos teto e chão na amostra estudada.Conclusão: A versão em Português para o Brasil do questionário Childhood Asthma Control Test demonstrou-se uma versão válida e confiável.

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Ortiz-Rivera, Maria Calixta. "Asthma Determinants, Health Care Utilization, and Control Among Women in Puerto Rico". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2040.

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Active asthma and asthma-related health care utilization are higher among adult females than they are among adult males in Puerto Rico. The purpose of this study was to examine the determinants of the risk of active asthma and associated health care utilization and asthma control among women in Puerto Rico. Guided by the Andersen behavioral model, the study included data from the Asthma Call-Back Survey (ACBS) during 2011 and 2012 in Puerto Rico. The associations between active asthma and behavioral, demographic, and environmental factors were assessed using logistic regression. The relationship between asthma-related health care utilization and predisposing, enabling, and need factors was examined using multiple linear regression. The association between achieved level of asthma control and asthma-related healthcare utilization was investigated using multinomial logistic regression. Results of the logistic regression indicated that being out of work, being in a middle income category, and being obese significantly increased the odds of active asthma. Being self-employed and being in the income category of $15,000-$25,000 significantly predicted the frequency of emergency room visits (ERVs). Results of the multinomial logistic regression indicated that physician urgent visit and ERV were significantly associated with poorly controlled asthma symptoms. The positive social change implication of these findings is that the identified risk factors can be used to develop asthma management plans to prevent and control asthma attacks in at-risk populations and reduce asthma-related health care utilization cost

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29

Moody, Julie Anne Moody. "Determining Caregiver Understanding of Childhood Asthma Control and Preferred Mode of Communication in a School based Health Center". Xavier University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1524760698798185.

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Júnior, Sérvulo Azevedo Dias. "Efeitos clínicos, funcionais e em citocinas circulantes da redução do peso em pacientes asmáticos obesos". Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5150/tde-27022013-163029/.

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INTRODUÇÃO: A asma grave acomete menos de 10% dos asmáticos, mas tem um impacto desproporcional sobre a utilização de recursos de saúde, contribuindo para, pelo menos, metade dos custos diretos e indiretos da doença. A proporção de indivíduos obesos ou com sobrepeso é elevada em pacientes com asma grave. Na verdade, a obesidade é um fator de risco para a asma, está associada com a gravidade da doença, com pior resposta a corticosteroides e pior controle clínico. Estudos sobre os efeitos da perda de peso em pacientes com asma ainda são escassos. OBJETIVOS: Avaliar o impacto da perda de peso com medidas clínicas em pacientes com asma grave e obesidade. MÉTODOS: Este é um estudo prospectivo randomizado aberto com dois grupos paralelos. Os participantes eram obesos e com asma grave e que, depois de um período de run-in de três meses, não estavam controlados de acordo com critérios da GINA. Os pacientes elegíveis foram randomizados em uma proporção de 2:1 (perda de peso: controle). Todos os participantes passaram por consultas bimensais no ambulatório de asma e foram acompanhados por seis meses. O desfecho primário foi o nível de controle da asma seis meses após o início do programa de redução de peso medido pelo Questionário de Controle da Asma (ACQ). Os desfechos secundários incluíram o Teste de Controle da Asma (ACT), resultados de função pulmonar, o Questionário Respiratório de St. George (SGRQ), a mudança na reatividade brônquica à metacolina, o uso diário de medicação de alívio para asma, percentagem de dias livres de sintomas, número de visitas ao pronto-socorro e exacerbações, marcadores de inflamação das vias aéreas medidos pelo escarro induzido e pelo óxido nítrico exalado (FeNO). IgE, proteína C reactiva, eotaxina, leptina e Transforming Growth Factor beta 1 (TGF 1) também foram medidos. RESULTADOS: Trinta e três foram randomizados. O grupo era composto predominantemente de mulheres com obstrução moderada, aprisionamento de ar, aumento da resistência das vias aéreas e marcada eosinofilia no escarro. O aumento dos níveis séricos de IgE foram consistentes com uma predominância de asma atópica. Dos 22 pacientes randomizados para submeterem-se a tratamento para a obesidade, 12 atingiram a meta de perda de peso de, pelo menos, 10% do peso corporal. A redução de peso no grupo de tratamento foi associada com melhor controle da asma medido pelo ACQ, ACT e SGRQ. Houve aumento de dias sem sintomas, menor uso de medicação de resgate e menos visitas ao serviço de emergência durante o período de estudo. Não houve diferença no número de exacerbações. A capacidade vital forçada (CVF) aumentou significativamente no grupo de tratamento e permaneceu inalterada no grupo de controle. As outras medidas da função pulmonar não mostraram diferenças entre os grupos. A hiperreatividade das vias aéreas, níveis de óxido nítrico exalado e celularidade do escarro induzido não se alterou ao longo do estudo. Os níveis de leptina diminuíram em ambos os grupos. Os níveis séricos de IgE, proteína C-reactiva, eotaxina, e TGF-1 não se alteraram. CONCLUSÃO: Nosso estudo adiciona informações à controvérsia sobre o impacto da obesidade e seu tratamento no controle da asma. Nossos resultados sugerem que a redução de peso em pacientes obesos com asma grave melhore os resultados de asma por mecanismos não relacionados com a inflamação das vias aéreas e que o controle da asma pobre em pessoas obesas é, pelo menos em parte, o resultado de fatores relacionados com a obesidade. A abordagem terapêutica para pacientes obesos com dificuldade de tratar a asma deve ser destinada à redução de peso, bem como à intensificação do tratamento anti-inflamatório
INTRODUTION: Severe asthma affects less than 10% of asthmatics, but has a disproportionate impact on the use of health resources, contributing to at least half of the direct and indirect costs of the disease. The proportion of obese or overweight individuals is elevated in patients with severe asthma. In fact, obesity is a risk factor for asthma, is associated with the severity of the disease, a poor response to corticosteroids and worse clinical control. Studies on the effects of weight loss in patients with asthma are still scarce. OBJECTIVES: Assess the impact of weight loss with a medical weight loss program in patients with severe asthma associated with obesity. METHODS: This is a prospective open study with two randomized parallel groups. The participants were obese and with severe asthma and, after a three month run-in period, were not controlled according to GINA criteria. Eligible patients were randomized in a 2:1 ratio (weight loss:control). All participants attended bimonthly consultations in the asthma clinic and were followed for six months. The primary outcome measure was the level of asthma control 6 months after initiation of the weight reduction program quantified by using the Asthma Control Questionnaire (ACQ). Secondary clinical outcomes included the Asthma Control Test (ACT), lung function results, score on the St. Georges Respiratory Questionnaire (SGRQ), change in metacholine reactivity, daily use of asthma reliever medication, percentage of asthma symptom free days, number of visits to emergency room and exacerbations, markers of airway cellular inflammation measured in induced sputum and with exhaled nitric oxide (FeNO). IgE, C reactive protein, leptin, eotaxin and Transforming Growth Factor beta 1 (TGF1) levels in serum were also measured. RESULTS: Thirty-three patients were randomized. The group consisted predominantly of women with moderate airflow obstruction, air trapping, increased airway resistance and marked eosinophilia in the sputum. The increased serum levels of IgE were consistent with a predominance of atopic asthma. Of the 22 patients randomized to undergo treatment for obesity, 12 achieved the weight loss goal of at least 10% of body weight. The reduction in weight in the treatment group was associated with improvement in the control as measured by ACQ, ACT and SGRQ. There was increase of symptom-free days, less use of rescue medication and fewer visits to the emergency room during the study period. There were no differences in the number of exacerbations. The forced vital capacity (FVC) increased significantly in the treatment group and remained unchanged in the control group. The other measures of the pulmonary function showed no differences between groups. The airway hyperresponsiveness, exhaled nitric oxide levels and induced sputum cellularity did not change throughout the study. Leptin levels decreased in both groups. Serum levels of IgE, C-reactive protein, eotaxin, and TGF-1 did not change. CONCLUSION: Our study adds information to the controversy about the impact of obesity and its treatment on asthma control. Our results suggest that weight reduction in obese patients with severe asthma improves asthma outcomes by mechanisms not related to airway inflammation and that poor asthma control in people who are obese is at least in part the result of obesity-related factors. The therapeutic approach for obese patients with difficult-to-treat asthma should therefore be aimed at weight reduction as well as on intensifying antiinflammatory treatment

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Bakhireva, Ludmila N. "Asthma control in pregnancy and selected drug therapy in relation to perinatal outcomes". Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 2007. http://wwwlib.umi.com/cr/ucsd/fullcit?p3258326.

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Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2007.
Title from first page of PDF file (viewed May 29, 2007). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 117-127).

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32

Hothersall, Eleanor Jane. "Effect of atorvastatin on asthma control and airway inflammation : a randomised controlled trial". Thesis, University of Glasgow, 2008. http://theses.gla.ac.uk/360/.

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Background Statins are inhibitors of the rate-limiting enzyme, 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase, in cholesterol biosynthesis. As such, they have been widely used in clinical practice as cholesterol lowering agents to reduce morbidity and mortality from coronary artery disease. There is evidence from clinical studies and in vitro experiments that statins have additional anti-inflammatory properties in atherosclerotic disease, which are unrelated to their lipid lowering activity. Clinical studies have previously suggested that statins might show a beneficial clinical effect in inflammatory diseases, such as rheumatoid arthritis and multiple sclerosis. Furthermore, preliminary data obtained in models of pulmonary inflammation suggest that the effects manifest in rheumatoid patients can be achieved also in asthma. A proof of concept study was designed to test the hypothesis that atorvastatin improves asthma control and airway inflammation in adults with asthma. Methods Fifty four adults with allergic asthma were recruited to a 22-week crossover randomised controlled trial comparing the effect on asthma control and airway inflammation of oral atorvastatin 40 mg daily with that of a matched placebo. Each treatment was administered for 8 weeks separated by a 6-week washout period. The primary outcome was morning peak expiratory flow. Secondary outcomes included spirometry, asthma control questionnaire (ACQ) score, asthma quality of life questionnaire (AQLQ), provocation concentration to methacholine (PC20) and inflammatory markers: exhaled nitric oxide, sputum differential cell count, sputum supernatant and serum inflammatory markers such as interleukin-6 (IL-6), IL-5, IL-8, sICAM-1, TNF-α, leukotriene B4 (LTB4) and high sensitivity C-reactive protein (hsCRP), and blood lymphocyte proliferation. Results At 8 weeks, the change in mean morning PEF, as compared with baseline, did not differ between the atorvastatin and placebo treatment periods [mean difference -0.5 L/min, 95% CI -10.6 to 9.6, p=0.921]. No statistically significant effect of atorvastatin was seen in evening PEF, or methacholine responsiveness (PC20). Out of all spirometry results, only post-salbutamol FVC showed a statistically significant result, which was slightly lower in the atorvastatin group [treatment difference -0.1L, 95% CI -0.2 to 0.0, p=0.037]. There was also no change in ACQ or AQLQ. No change was seen in exhaled nitric oxide. The total cell counts recovered from sputum were similar after atorvastatin compared to after placebo treatment. After 8 weeks, the mean absolute and relative sputum macrophage count was significantly reduced after atorvastatin compared to placebo [mean absolute difference -44.9x104 cells, 95% CI -80.1 to -9.7, p=0.029]. There was a reciprocal increase in the relative proportion of sputum neutrophils [mean proportion difference 13.1%, 95% CI 1.8 to 24.4, p=0.025], but there were no significant changes in the absolute count of these cells or the counts and proportions of the other sputum cell phenotypes under atorvastatin treatment. The sputum concentrations of inflammatory cytokines and mediators were similar after atorvastatin compared to after placebo treatment other than LTB4 which was significantly reduced [mean difference -88.1 pg/mL, 95% CI -156.4 to -19.9, p=0.014]. No significant difference was seen in the concentration of any serum marker of inflammation between atorvastatin and placebo treatment periods. The change in hsCRP was of borderline significance [mean difference -0.65 mg/L, 95% CI -1.38 to 0.09, p=0.082], but there were no changes in sICAM-1, TNF-α, IL-5, IL-6 and IL-8. There was no significant difference in lymphocyte proliferation. The biochemical effects of atorvastatin therapy were reflected in significant reduction in concentration of serum lipids; cholesterol (mean difference -1.71 mmol/l, 95% CI -1.94 to -1.48 p<0.0001), and HDL-cholesterol (mean difference -0.14 mmol/l, 95% CI -0.26 to -0.02 p=0.026), but not triglycerides. There were significant, albeit modest, increases in mean bilirubin, AST and ALT. There was no difference in compliance, assessed by number of tablets returned and by biochemical results. There was no correlation between changes in LTB4 or IL-8 and sputum macrophage count, sputum neutrophil count, or PEF. The only correlation observed between the variables that were compared was between sputum macrophages and neutrophils. Adverse event rates were similar in patients taking atorvastatin compared with placebo. Equal numbers of patients were lost to follow-up in both arms of the study. One patient died of unrelated causes while taking the placebo medication. Conclusions There were no clinically important improvements in a range of clinical indices of asthma control after eight weeks of treatment with atorvastatin despite expected changes in serum lipids. There were however changes in airway inflammation and in particular, a reduction in the absolute sputum macrophage count after atorvastatin compared to placebo and an associated reduction in sputum LTB4 and a trend towards lower CRP. The lack of any evidence of clinical benefit of atorvastatin in allergic asthma confirms and extends the findings of a smaller randomised placebo controlled crossover trial of simvastatin in 16 subjects with asthma, which showed no change in clinical outcomes or inflammatory markers. It is unlikely that altering duration of treatment, washout period or type of statin used would have changed the outcome of the study. However, as all patients were receiving inhaled corticosteroid as part of their asthma therapy, it is possible that this may have masked any modest anti-inflammatory effects of the statin. Baseline asthma inflammation may also have been too low to show any significant improvement. Despite the postulated anti-inflammatory actions of statins, it seems that they may not be appropriate for the inflammatory phenotype associated with atopic asthma. The reduction in alveolar macrophage count found in patients with allergic asthma may however have relevance to the treatment of chronic lung diseases such as COPD in which alveolar macrophage function has been implicated in the pathogenesis.

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33

Ilchenco, M. y L. A. Ivanova. "Features of bronchial asthma course and control in schoolchildren with excess body weight". Thesis, Abstract Book XVI International Congress of Medical Sciences.-Sofia. Bulgaria, 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/13166.

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James, Christine. "HEPA Filtration Emproves Asthma Control in Children Exposed to Traffic-related Airborne Pollutants". University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin152241466911486.

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Lisspers, Karin. "Organisation of Asthma in Primary Care, Quality of Life and Sex-related Aspects in Asthma Outcomes". Doctoral thesis, Uppsala universitet, Allmänmedicin och klinisk epidemiologi, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9315.

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Objectives: To investigate the organisation of asthma care in primary care and evaluate outcomes for patients attending primary care centres with and without asthma clinics. Other objectives were to study the association between quality of life and asthma control in patients in primary care and to analyse sex differences regarding asthma outcomes related to menopausal status. Material and methods: Cross-sectional surveys and a patient record study. Results: Of all the primary health care centres, 77% had a spirometer and 53% an asthma clinic. At centres with asthma clinics 77% of the patients reported sufficient knowledge of asthma as compared with 65% at centres without asthma clinics (p<0.001). With more time allocated for the nurse, 44% of patients achieved asthma control as compared with 27% at asthma clinics with less time (p<0.003). Patients using short-acting beta-2 agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding also held for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (5.26 versus 5.64) and reported emergency consultations during the last six months (4.85 versus 5.71). Premenopausal women had significantly lower total MiniAQLQ scores than men in the same age group (5.44 versus 5.89, p<0.001), while no difference was found between postmenopausal women and men of similar ages. The adjusted odds for premenopausal women for asthma exacerbations was 2.0 (95%CI 1.22-3.43) as compared with men in the same age group. No differences were found when comparing postmenopausal women with men of similar ages. Conclusions: Half the primary health care centres had an asthma clinic and the majority had access to a spirometer. Patients at primary health care centres with asthma clinics reported better knowledge of their disease, and asthma control is more often achieved if the nurse is allocated more time. Achieving asthma control is associated with better quality of life in patients in primary care. Premenopausal women had lower quality of life and less often asthma control then men of the same ages, while no corresponding difference was found between postmenopausal women and men of similar ages.

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Abreu, Fernanda Cruvinel de. "A medida da Fração Exalada do Óxido Nítrico (FeNO) como marcador do nível de controle da asma". Universidade Federal de Goiás, 2016. http://repositorio.bc.ufg.br/tede/handle/tede/6610.

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The main goal of asthma treatment is to achieve and maintain clinical control of the disease. The exhaled fraction nitric oxide (FeNO) level is considered a biomarker of airways inflammation and its important to conduct researches involving this measured and its relationship in evaluation of asthma control.Objective: To determine whether the FeNO level can be used to discriminate between patients with controlled, partially controlled and uncontrolled asthma. Materials and methods: The FeNO level and asthma control were evaluated in a retrospective and analytic cross– sectional study through data collected from asthmatic patients who were assessed by clinical history, asthma control, physical examination, spirometry, and FeNO level. Asthma control was determined by the criteria of the Global Initiative for Asthma, and classified as controlled asthma, partially controlled asthma, and uncontrolled asthma. The FeNO values were classified as low (<25 ppb) or intermediate/high (≥25 ppb), based on the American Thoracic Society recommendations. Results: The symptoms of 81 asthmatic patients were classified as controlled (34 [42%] patients), partially controlled (27 [33,3%] patients), and uncontrolled (20 [24.7%] patients). The FeNO level discriminated between the uncontrolled and controlled groups (p = 0,01) and between the uncontrolled and partially controlled groups (p = 0,01), but not between the controlled and partially controlled groups (p = 0,98). An FeNO level >30 ppb was associated with uncontrolled asthma (p < 0,01) with an area under the receiver operating characteristic curve of 0,78 (95% confidence interval, 0,65-0,89). Conclusions: The FeNO level aided the identification of uncontrolled asthma. This measurement may can be helpful in determining asthma control.
O principal objetivo do tratamento da asma é alcançar e manter o controle clínico da doença. A medida da Fração Exalada do Óxido Nítrico (FeNO) é considerada um biomarcador da inflamação das vias aéreas sendo de extrema importância a realização de pesquisas envolvendo essa medida e a avaliação do nível de controle da asma. Objetivo: Verificar se a medida da FeNO discrimina pacientes com asma controlada, parcialmente controlada e não controlada. Materiais e métodos: Realizou-se um estudo restrospectivo, transversal analítico por meio da coleta de dados de pacientes asmáticos que foram avaliados em relação a sua história clínica, nível de controle da asma, exame físico, espirometria e FeNO. O nível de controle da asma foi determinado conforme critério da Global Initiative for Asthma (GINA), classificados como controlados, parcialmente controlados e não controlados. Os valores da FeNO foram classificados em baixo ou intermediário/alto (baixo <25 ppb e intermediário/elevado ≥ 25 ppb), de acordo com as recomendações da American Thoracic Society (ATS). Resultados: Foram incluídos 81 pacientes asmáticos classificados em controlados 34 (42%), parcialmente controlados 27 (33,3%) e não controlados 20 (24,7%). A medida da FeNO discriminou o grupo não controlado dos grupos controlado (p = 0,01) e parcialmente controlado (p = 0,01), mas não discriminou os grupos controlado e parcialmente controlado (p = 0,98). FENO >30 estava associado a asma não controlada (p <0,01) com área sob a curva ROC de 0,78 (Intervalo de Confiança 95%, 0.65- 0.89).Conclusão: A FeNO foi capaz de identificar asmáticos não controlados. Isso sugere que sua medida pode ser útil na determinação do controle da asma

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37

Smith, Sheree Margaret Stewart. "A critical analysis of the relationship between health promoting behaviours, an individual's health risk, asthma severity and control, and patient centred asthma education in the emergency department". Thesis, Queensland University of Technology, 2006. https://eprints.qut.edu.au/16921/1/Sheree_Smith_Thesis.pdf.

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Asthma affects over 2.2 million people in Australia. Asthma morbidity is increasing while mortality is decreasing. People with asthma experience shortness of breath as their airways narrow and become inflamed. After an episode of acute asthma many patients experience a relapse requiring further emergency department care. Numerous studies have been undertaken to identify the determinants of asthma morbidity and these studies have primarily used asthma oriented and co-morbidity scales such as anxiety and depression indices. Other studies in this area have indicated psychosocial factors such as coping, asthma attitudes and beliefs that may be linked to people with asthma who are non-compliant or adherent to treatment. Currently, there is no research available that has examined the link between general health promoting behaviours, an individual’s risk behaviour assessment and a brief asthma education encounter that is patient-centred. This study provides a description of the health promoting and risk taking behaviours of people who attend the emergency department with acute asthma. Secondly, it examines the effectiveness of patient-centred education compared with standard education. One hundred and forty-six people with acute asthma who attended the emergency departments of the Princess Alexandra and Mater Adult Public Hospitals were enrolled in this study. Participants self-reported health promoting and risk taking behaviours by completing the questionnaire that contained the Health Promoting Lifestyle Profile (HPLPII) and the Health Risk Appraisal (HRA) instruments. The Hospital Anxiety and Depression Scale (HADS) was also incorporated into the questionnaire to ascertain levels of anxiety and depression in this acute asthma group of people. The asthma education curriculum had the same topics for both the standard education and the patient-centred groups. However, the patient-centred group were able to prioritise the order of the topics according to their identified need. Secondly, the patient-centred group were asked two questions to ascertain the most important issue and asthma issue for them at that point in time. Both groups of participants were educated using the Asthma Foundation Leaflet “Asthma - Basic Facts” during the individual education session. There were 56% females and 44% males with a mean age (+SD) of 34 (13.8) years with 70.3% reported year 12 or above education and 49% of participants earned less that $20,000. Nearly half of the participants were admitted to a hospital ward following emergency department assessment and care. A large proportion of the participants had either moderate or severe asthma. The health behaviour findings from this study suggest people with acute asthma follow preventive health recommendations and safety guidelines more so than the wider community. However, they did not self-initiate home based health actions such as breast self-examination. At the time of attendance to the emergency department with acute asthma there were no statistical difference between the patient-centred education and standard format education groups for age, gender, education, income, asthma control and previous emergency department attendances. The patient-centred education group had fewer re-attendances in the four months after the education intervention when compared with prior emergency department attendances than the control group (p=0.057; p=0.486). In conclusion, people with acute asthma report undertaking a number of preventive health behaviours and actions according to national guidelines and safety recommendations. They report a lack of self-initiated home based health behaviours. Further research is required to investigate the impact on the National Asthma Council’s recommendations of the importance of asthma action plans on people who follow preventive health guidelines and who lack self-initiative abilities. In terms of asthma education, patient-centred education when compared to standard format education may be useful in reducing further emergency department attendances for acute asthma. More research is required to identify other key education issues for people with acute asthma.

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38

Smith, Sheree Margaret Stewart. "A critical analysis of the relationship between health promoting behaviours, an individual's health risk, asthma severity and control, and patient centred asthma education in the emergency department". Queensland University of Technology, 2006. http://eprints.qut.edu.au/16921/.

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Asthma affects over 2.2 million people in Australia. Asthma morbidity is increasing while mortality is decreasing. People with asthma experience shortness of breath as their airways narrow and become inflamed. After an episode of acute asthma many patients experience a relapse requiring further emergency department care. Numerous studies have been undertaken to identify the determinants of asthma morbidity and these studies have primarily used asthma oriented and co-morbidity scales such as anxiety and depression indices. Other studies in this area have indicated psychosocial factors such as coping, asthma attitudes and beliefs that may be linked to people with asthma who are non-compliant or adherent to treatment. Currently, there is no research available that has examined the link between general health promoting behaviours, an individual’s risk behaviour assessment and a brief asthma education encounter that is patient-centred. This study provides a description of the health promoting and risk taking behaviours of people who attend the emergency department with acute asthma. Secondly, it examines the effectiveness of patient-centred education compared with standard education. One hundred and forty-six people with acute asthma who attended the emergency departments of the Princess Alexandra and Mater Adult Public Hospitals were enrolled in this study. Participants self-reported health promoting and risk taking behaviours by completing the questionnaire that contained the Health Promoting Lifestyle Profile (HPLPII) and the Health Risk Appraisal (HRA) instruments. The Hospital Anxiety and Depression Scale (HADS) was also incorporated into the questionnaire to ascertain levels of anxiety and depression in this acute asthma group of people. The asthma education curriculum had the same topics for both the standard education and the patient-centred groups. However, the patient-centred group were able to prioritise the order of the topics according to their identified need. Secondly, the patient-centred group were asked two questions to ascertain the most important issue and asthma issue for them at that point in time. Both groups of participants were educated using the Asthma Foundation Leaflet “Asthma - Basic Facts” during the individual education session. There were 56% females and 44% males with a mean age (+SD) of 34 (13.8) years with 70.3% reported year 12 or above education and 49% of participants earned less that $20,000. Nearly half of the participants were admitted to a hospital ward following emergency department assessment and care. A large proportion of the participants had either moderate or severe asthma. The health behaviour findings from this study suggest people with acute asthma follow preventive health recommendations and safety guidelines more so than the wider community. However, they did not self-initiate home based health actions such as breast self-examination. At the time of attendance to the emergency department with acute asthma there were no statistical difference between the patient-centred education and standard format education groups for age, gender, education, income, asthma control and previous emergency department attendances. The patient-centred education group had fewer re-attendances in the four months after the education intervention when compared with prior emergency department attendances than the control group (p=0.057; p=0.486). In conclusion, people with acute asthma report undertaking a number of preventive health behaviours and actions according to national guidelines and safety recommendations. They report a lack of self-initiated home based health behaviours. Further research is required to investigate the impact on the National Asthma Council’s recommendations of the importance of asthma action plans on people who follow preventive health guidelines and who lack self-initiative abilities. In terms of asthma education, patient-centred education when compared to standard format education may be useful in reducing further emergency department attendances for acute asthma. More research is required to identify other key education issues for people with acute asthma.

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39

Temam, Sofia. "Déterminants sociaux et asthme : approche épidémiologique". Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLS110/document.

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L’objectif général de la thèse était d’étudier le rôle des déterminants sociaux dans l’asthme avec un intérêt particulier pour des aspects méthodologiques de caractérisation du contexte social de résidence.La première partie de la thèse visait à étudier l’hypothèse d’une association entre le niveau socioéconomique (NSE) et la pollution de l’air qui est un facteur de risque important de l’asthme. Nous avons étudié spécifiquement l’association entre le NSE évalué à un niveau individuel (niveau d’études et catégorie socioprofessionnelle) et contextuel (taux de chômage du quartier de résidence) en lien avec l’exposition au dioxyde d’azote (NO2), un marqueur du trafic routier, dans 16 villes d’Europe occidentale (n=5692, 3 cohortes). Dans les analyses stratifiées par ville, nous avons observé que le NSE individuel n’était généralement pas associé au NO2, alors que l’indicateur contextuel était associé positivement et significativement au NO2 dans la majorité des villes.La deuxième partie de la thèse visait à mieux comprendre l’association entre le NSE et le contrôle de l’asthme, objectif majeur de la prise en charge thérapeutique. Ce travail a d’abord porté sur des aspects méthodologiques d’évaluation du contexte social de résidence dans la cohorte E3N (Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale). La comparaison de trois indices de désavantage (n=63888) a mis en évidence l’intérêt de l’indice FDep (French Deprivation Index) pour caractériser le contexte de résidence de cette cohorte spécifique de femmes âgées avec un NSE relativement élevé comparé à celles de la population générale française. Ce travail a ensuite porté sur l’étude de l’association entre le NSE, individuel et contextuel, et le contrôle de l’asthme dans l’étude Asthma-E3N, une étude cas-témoin sur la santé respiratoire, nichée dans la cohorte E3N. Parmi les 2258 femmes avec un asthme actuel, les femmes avec un niveau d’études moyen (OR= 1.2 (1.0 ; 1.6)) ou bas (1.9 (1.4 ; 2.6)) avaient significativement un moins bon contrôle de leur asthme que celles avec un niveau d’études élevé (≥Bac+3). Les femmes qui résidaient dans les quartiers les plus désavantagés avaient plus fréquemment un asthme non contrôlé, quel que soit leur niveau d’études.Ces résultats montrent l’importance de prendre en compte le niveau socioéconomique au niveau individuel et contextuel dans l’étude des facteurs de risque de l’asthme
The general aim of the thesis was to study the role of social determinants in asthma with a particular focus on methodological aspects to characterize neighborhood social context.The first part of the thesis aimed to investigate the hypothesis of a differential exposure to air pollution, an important risk factor for asthma. Specifically, we studied the association between socioeconomic position (SEP) assessed at individual-level (educational level and occupational status) and neighborhood-level (unemployment rate) and exposure to nitrogen dioxide (NO2), a marker of traffic exhaust, in 16 western European cities. In stratified analyses, including 5692 participants from three European cohorts, association between individual SEP and NO2 were generally weak and inconsistent in direction. The neighborhood unemployment rate was positively and significantly associated with NO2 in most of the cities studied.The second part of the thesis aimed to better understand the association between socioeconomic position and asthma control, the main target of asthma management. We first focused on methodological aspects to characterize neighborhood social context in the E3N cohort. We compared three indices of deprivation and showed that the French Deprivation Index was the most appropriate to measure neighborhood social context in this specific cohort composed of elderly women with higher socioeconomic profile than the elderly women in the general French population. We then investigated the association between SEP, at individual- and area-level, and asthma control in Asthma-E3N, a case-control study on asthma nested in the E3N cohort. Including 2258 women with current asthma, the analysis showed that women with medium and low educational level had more often uncontrolled asthma than women with high educational level. Women living in deprived neighborhood had more often uncontrolled asthma independently of their educational level

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40

Schuckard, Eeuwe. "Functional Asthma Severity and Impulsive Behaviour in 6 and 7 Year-old Children". Thesis, University of Canterbury. College of Education, 2007. http://hdl.handle.net/10092/1705.

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There is evidence that children with asthma exhibit more externalizing behaviour problems than other children. Impulsive behaviours can mark the onset and severity of externalizing behaviour problems. The present paper reports an exploratory examination of relationships between functional asthma severity and impulsivity in 6 and 7 year old children with asthma (N = 16). Participants with varying functional asthma severity were recruited at age 5 from a larger community study (the Children’s Learning Study). Parents completed items from three subscales of the Connors’ Parent Rating Scale-Revised (CPRS-R), the Hyperactive-Impulsive, Conners’ Global Index: Restless-Impulsive and the DSM-IV Hyperactive-Impulsive subscales. Children completed the Two Choice Paradigm (TCP), a computer program measuring delay aversion type impulsive behaviours. Mean (SD) CPRS-R Hyperactive-Impulsive, Conners’ Global Index: Restless-Impulsive and DSM-IV Hyperactive-Impulsive subscale scores were 59 (11), 56 (10) and 59 (10) respectively. There was no correlation between functional asthma severity and delay aversion or CPRS-R subscale scores and there was no evidence of a trend for such a relationship. Preliminary investigations conducted with a small sample of 6-7 year-old children with asthma thus suggest that functional asthma severity is not related to impulsivity.

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41

Bime, Christian, Joe K. Gerald, Christine Y. Wei, Janet T. Holbrook, William G. Teague, Robert A. Wise y Lynn B. Gerald. "Measurement characteristics of the childhood Asthma-Control Test and a shortened, child-only version". NATURE PUBLISHING GROUP, 2016. http://hdl.handle.net/10150/622153.

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The childhood Asthma-Control Test (C-ACT) is validated for assessing asthma control in paediatric asthma. Among children aged 4-11 years, the C-ACT requires the simultaneous presence of both parent and child. There is an unmet need for a tool that can be used to assess asthma control in children when parents or caregivers are not present such as in the school setting. We assessed the psychometric properties and estimated the minimally important difference (MID) of the C-ACT and a modified version, comprising only the child responses (C-ACTc). Asthma patients aged 6-11 years (n = 161) from a previously completed multicenter randomised trial were included. Demographic information, spirometry and questionnaire scores were obtained at baseline and during follow-up. Participants or their guardians kept a daily asthma diary. Internal consistency reliabilities of the C-ACT and C-ACTc were 0.76 and 0.67 (Cronbach's a), respectively. Test-retest reliabilities of the C-ACT and C-ACTc were 0.72 and 0.66 (intra-class correlation), respectively. Significant correlations were noted between C-ACT scores and ACQ scores (Spearman's correlation r = -0.56, 95% CI (-0.66, -0.44), P<0.001). The strength of the correlation between C-ACTc scores and ACQ scores was weaker (Spearman's correlation r = -0.46, 95% CI (-0.58, -0.33), P<0.001). We estimated the MID for the C-ACT and C-ACTc to be 2 points and 1 point, respectively. Among asthma patients aged 6-11 years, the C-ACT had good psychometric properties. The psychometric properties of a shortened child-only version (C-ACTc), although acceptable, are not as strong.

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42

Oliveira, Suelen Goecks. "Valida??o do question?rio Childhood Asthma Control Test (c-ACT) para o Brasil". Pontif?cia Universidade Cat?lica do Rio Grande do Sul, 2015. http://tede2.pucrs.br/tede2/handle/tede/6019.

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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES
Introduction: Children?s own perceptions and accounts of their asthma diagnosis have proved to be reliable and relevant to disease control. Objective: The aim is to validate the Brazilian Portuguese version of the Childhood Asthma Control Test (c-ACT) in children aged between 4 and 11 years. Methods: The investigation was divided into two stages: The first stage comprised the translation and linguistic adaptation of the instrument, while the second consisted of testing the psychometric properties of validity and reliability. Results: A total of 105 participants were included, aged between 4 and 11 years. Validity: all correlations between the total score and items on the questionnaire were significant and obtained values of r = > 0.3. There was no correlation between the total score of the questionnaire and lung function. The controlled asthma group showed significantly higher c-ACT scores than those of the uncontrolled asthma group (controlled 22?2.9 VS uncontrolled 16.3?5.3 p <0.001). Reliability: The Alfa de Cronbach coefficient for the total c-ACT score was 0.677 (CI95% 0.573-0763). In the assessment of sensitivity to change, the effect size was 0.8 and the intraclass correlation coefficient was 0.598. No floor or ceiling effects were observed in the sample studied. Completed: The Brazilian version of the Childhood Asthma Control Test proved to be valid and reliable.
Introdu??o: Atualmente a percep??o e os relatos da pr?pria crian?a sobre seu diagn?stico de asma tem se demonstrado confi?vel e relevante para o manejo da doen?a. Objetivo: Validar a vers?o Portugu?s para o Brasil do Childhood Asthma Control Test em jovens com idade entre 4 a 11 anos. M?todos: O estudo foi dividido em duas etapas: a primeira o processo de tradu??o, adapta??o lingu?stica do instrumento. A segunda etapa foi realizada a an?lise das propriedades psicom?tricas validade e a confiabilidade. Resultados: Foram inclu?das 105 participantes, com idades entre 4 a 11 anos. Validade: todas as correla??es entre o escore total e os itens do question?rio foram significativas e com valores r = > 0,3. N?o houve correla??es entre o escore total do question?rio e a fun??o pulmonar. O grupo com asma controlada apresenta valores significativamente superiores no c-ACT ao compararmos com o grupo com asma n?o controlada (controlada 22?2,9 VS n?o controlada 16,3?5,3 p < 0,001). Confiabilidade: o coeficiente de Alfa de Cronbach do escore total do c-ACT foi de 0,677 (IC95% 0,573-0763). Na avalia??o da sensibilidade ?s mudan?as o tamanho do efeito foi 0,8 e o coeficiente de correla??o intraclasse foi de 0,598. N?o foram observados os efeitos teto e ch?o na amostra estudada. Conclus?o: A vers?o em Portugu?s para o Brasil do question?rio Childhood Asthma Control Test demonstrou-se uma vers?o v?lida e confi?vel.

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43

Santino, Thayla Amorim. "Tradução, adaptação transcultural e avaliação psicométrica do Pediatric Asthma Control and Communication Instrument - PACCI". PROGRAMA DE PÓS-GRADUAÇÃO EM FISIOTERAPIA, 2018. https://repositorio.ufrn.br/jspui/handle/123456789/25535.

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Introdução: No Brasil, observa-se uma prevalência de cerca de 20 milhões de indivíduos com asma sendo observada principalmente na infância e adolescência e a ocorrência de seus sintomas está intimamente relacionada com a falta de controle da doença. Objetivo: Traduzir, adaptar transculturalmente e analisar as propriedades psicométricas do questionário Pediatric Asthma Control and Communication Instrument (PACCI) para o uso na população brasileira. Materiais e métodos: A tradução e adaptação transcultural envolveram procedimentos de tradução, tradução reversa, comitê multiprofissional de especialistas e pré-teste em uma amostra representante da nova população. As propriedades psicométricas foram avaliadas a partir da administração da versão adaptada do questionário em uma amostra de 103 crianças e adolescentes com diagnóstico clínico de asma e seus pais/responsáveis. Foram avaliadas a condição socioeconômica (Critério de Classificação Econômica Brasil); controle clínico (Childhood Asthma Control Test (c-ACT) e Asthma Control Test (ACT)); qualidade de vida do cuidador (Pediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ)) e função pulmonar (espirometria). Foram investigadas validade (conteúdo, construto e concorrente), confiabilidade e determinado o ponto de corte. Resultados: O comitê multiprofissional de especialistas indicou que os itens do questionário se apresentaram claros e compressíveis, com concordância variando entre 0,78 e 1,00. No pré-teste, os pais/responsáveis apresentaram boa compreensão dos itens (concordância acima de 0,90). A consistência interna foi de 0,80. A estrutura interna do questionário foi avaliada por meio da análise fatorial exploratória (KMO= 0,81 e teste de esfericidade de Barlett, p=0,00), considerando a extração de 4 fatores pré-determinados e rotação ortogonal (varimax). Foram identificados os fatores: controle clínico, riscos, percepção do estado da asma e severidade. O fator controle da asma apresentou correlação significativa com o c-ACT/ACT e com o PACQLQ. Para o fator controle, o índice de problema e a soma do escore indicaram que uma pontuação de 1 e 4 pontos foram indicativos de asma não controlada, respectivamente. Conclusão: A versão brasileira do questionário PACCI demonstrou ser capaz de fornecer medidas válidas e confiáveis na avaliação do controle clínico da asma de crianças e adolescentes.
Introduction: In Brazil, a prevalence of about 20 million individuals with asthma is observed mainly in childhood and adolescence, and the occurrence of its symptoms is closely related to the lack of control of the disease. Objectives: To perform a translation, cross-cultural adaptation, and evaluation of psychometric properties of the Pediatric Asthma Control and Communication Instrument (PACCI) for use in the Brazilian population. Methods: The translation and cross-cultural adaptation involved the translation, backtranslation, multiprofessional committee of experts and pre-test in a representative sample of the new population. The psychometric properties were evaluated through the administration of the adapted version of the questionnaire in a sample of 103 children and adolescents with clinical diagnosis of asthma and their parents/caregivers. The socioeconomic condition was evaluated (Brazil Economic Classification Criteria); clinical control (Childhood Asthma Control Test (c-ACT) and Asthma Control Test (ACT)); caregiver’s quality of life(Pediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ)), and pulmonary function (spirometry). We investigated the validity (content, construct and concurrent), reliability and the cutoff. Results: The multiprofessional committee of experts indicated that the items of the questionnaire were clear and compressible, with agreement ranging from 0.78 to 1.00. In the pre-test, parents/caregivers presented a good understanding of the items (agreement above 0.90). The internal consistency was 0.80. The internal structure of the questionnaire was evaluated through exploratory factorial analysis (KMO=0.81 and Bartlett’s sphericicity test, p<0,001), considering the extraction of 4 pre-determined factors and orthogonal rotation (varimax).The following factors were identified: clinical control, risks, perception of asthma status and severity. The factor asthma control showed a significant correlation with c-ACT/ACT, PACQLQ. For the control factor, the problem index and the sum of the score indicated that a score of 1 and 4 points were indicative of uncontrolled asthma, respectively. Conclusion: The Brazilian version of the questionnaire PACCI showed to be able to provide valid and reliable measures to assess the clinical control of asthma in children and adolescents.
2019-05-19

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44

Marusyk, U. I. "The modern opportunities for increasing the control of bronchial asthma in school-age children". Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18410.

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Sazhyn, S. I. "Achievement of asthma control in children depending on the phenotype of the disease onset". Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19158.

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Takeda, Tomoshi. "Relationship between Small Airway Function and Health Status, Dyspnea and Disease Control in Asthma". Kyoto University, 2010. http://hdl.handle.net/2433/120545.

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Tan, Jessica S. "Nonadherence and Inability to Afford Medications is Associated with Poor Asthma Control in Older Adults". University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1427883052.

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48

Scott, Mark George Hunter. "Control of cyclic AMP-mediated and ÃŸâ‚‚ adrenergic receptor gene expression in cultured human airway smooth muscle cells". Thesis, University of Nottingham, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324123.

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Mohamed, Nashila. "Association of the home environment and asthma in Kenyan school children : a case-control study". Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=56629.

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Among participants in a community-based prevalence survey of asthma in Nairobi school children, a case-control study was conducted to investigate the association of home environment factors with asthma. The prevalence survey was conducted among children in Grade four (age 9-11 years) in five schools, selected to represent a wide range of socioeconomic status (SES). Asthma was defined as a history of wheeze, or doctor diagnosed asthma, or a decline of FEV1 of $ ge$10% at 5 or 10 minutes post exercise.
Of the 409 children studied, 77 cases and 77 age and gender matched controls were identified, and visits made to their homes to carry out visual inspection and questionnaire administration. Assessment included: house construction material, cooking fuel, air pollution in or around the house, child's bedding material, presence of rugs, carpets, sofas, or pets; evidence of damp damage, and nutritional information including salt intake.
The following factors were significantly associated with asthma: damp damage in the child's sleeping area (odds ratio (OR): 4.38; 95% confidence interval (CI) $ {$2.11, 9.11$ }$), air pollution in the home (OR: 2.97; 95% CI $ {$1.40, 6.32$ }$), presence of rugs or carpets in child's bedroom (OR: 2.92; 95% CI $ {$1.35, 6.34$ }$).

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50

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.

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Resumen

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.

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