Despite advancements in asthma treatment and diagnosis, asthma still remains the number 1 cause for hospitalizations in school-aged children. This usability study aimed to develop a child-friendly interactive narrative, Okay with Asthma v2.0, based on the Biopsychosocial Family Model using feedback from children. This fun and kid-friendly program encourages children to manage their own asthma with the help of peers, families, communities, and health care services. With these support structures, children can identify and avoid triggers, monitor their asthma, manage their condition with medications based on an action plan, and learn to live happily with asthma.

Despite advancements in asthma treatment and diagnosis, asthma still remains the number 1 cause for hospitalizations in school-aged children. This usability study aimed to develop a child-friendly interactive narrative, Okay with Asthma v2.0, based on the Biopsychosocial Family Model using feedback from children. This fun and kid-friendly program encourages children to manage their own asthma with the help of peers, families, communities, and health care services. With these support structures, children can identify and avoid triggers, monitor their asthma, manage their condition with medications based on an action plan, and learn to live happily with asthma.

No description available.

Aim: To determine whether the addition of nebulised ipratropium to the therapy of acute asthma leads to a cost-effective reduction in the mean duration of admission and time to maximum peak expiratory flow rate (PEFR). Method: Patients with an admission diagnosis of acute asthma were studied in a double-blind, placebo-controlled trial in which they received a standard therapeutic regimen of continuous intravenous aminophylline, 4-hourly fenoterol nebulisation, intravenous methylprednisolone 125mg 12-hourly, and, every four hours, either nebulised saline placebo or ipratropium bromide 500mcg in 3ml saline. Data on age, gender, initial and maximum PEFR, time to maximum PEFR, and duration of hospital stay was collected from the hospital record after discharge. Statistical techniques: 2-way contingency tables for categorical variables, 1-way ANOVA for treatment effects, and life-table analysis of the time till discharge. Results: Records of 279 of the 400 patients entered in the study were suitable for analysis after excluding re-admissions, non-asthmatics and incomplete records. Baseline comparisons of age and severity on presentation showed no significant differences. The trial group did not differ significantly from the control group with respect to either time to PEFR (respectively 21.11 hours (SD 14.3) versus 22.89 (SD 15.82)) or duration of admission (5.02 (SD 3.65) versus 5.38 (SD 3.13) 6-hour units). In a sub-group of patients (n=155) demonstrating more than 100% improvement in PEFR, the time to maximum PEFR was significantly shorter in the ipratropium group (20.35 hours SD 12.4) versus 25.20 hours (SD 17.0); p= 0.045). Conclusion: The addition of ipratropium bromide to a standard treatment regimen for acute asthma reduced the time to achieve maximum PEFR in a sub-group of patients with markedly reversible airflow limitation. Overall, however, the addition did not prove cost-effective.

The author participated in an international survey organised by the British Medical Research Council (MRC) epidemiological unit in Cardiff, Wales which set out to compare the prevalence of asthma in several countries. The motivation for participating in this study was that very little previous prevalence data for asthma is available for coloured or white children in South Africa. A protocol designed by the British MRC Epidaemiology Unit was followed. One thousand one hundred and seventy four white children aged 12 years attending a random selection of primary schools in the Southern Suburbs of Cape Town were studied. A standard MRC questionnaire on asthma was completed by parents. The subjects then underwent an exercise challenge test (ECT) which involved running on the level for six minutes. During the ECT, we measured the forced expiratory volume in 1 second (FEVl) before and after the exercise. A fall in post exercise FEVl of 15% or greater was regarded as evidence of bronchoconstriction and considered diagnostic of asthma. This method is thought to identify 70-90% of asthmatics (Anderson 1985, Lee et al 1989, Pierson 1988). Using this criterion, 52 (4.4%) of the children had asthma. The prevalence of 4.4% in this study is higher than 3.1% reported in a previous study of black children in Guguletu (Van Niekerk et al, Clinical Allergy 1979). However, the age spectrum of children was different in that study. Terblanche et al (1990) report the prevalence of exercise induced bronchoconstriction (EIB) in white and coloured children to be 5.87% and 4.05% respectively. The level of FEVl reduction for a diagnosis of EIB approved for this study was lower than usually accepted. Using conventional criteria for a diagnosis of EIB, Burr et al (1989) reported a prevalence of 7.7% in Cardiff, Wales. This study confirms that exercise induced asthma is a common problem in 12-year old white children in Cape Town.

Asthma is a chronic obstructive pulmonary disease (COPD) which affects 1 in every 12 Americans. Symptoms common to asthmatics include dyspnea, increased mucous production and airway hyperresponsiveness. While research over the past few decades has mostly established the immunological basis behind asthma, there have not been radical changes in the treatment modalities. It is believed that in many COPDs, alveolar macrophages play a critical role in disease progression. While evolutionarily, alveolar macrophages played a significant part in protecting the individual from harmful allergens, in asthma there may be an inappropriate activation of the alveolar macrophages to proteases such as cockroach allergen (CRA). Studies show that children living in inner cities with cockroach infestation are more likely to develop asthma than those that reside in rural areas with less exposure to cockroach allergens. In exposed individuals, when the alveolar macrophages come in contact with CRA, an immune cascade is initiated which sensitizes the child. Subsequent exposure to such an antigen will induce asthma like symptoms. One possible way of reducing such a response is to reduce the number of alveolar macrophages thus avoiding the pathalogical effects. Clodronate liposomes are liposomes that are encapsulated with bisphosphonate clodronate. When a macrophage phagocytoses such a liposome, the result is cellular suicide or apoptosis. In this study, we sensitized a murine model of CRA asthma and then monitored the impact of depleted alveolar macrophages using intratracheal administration of clodronate liposomes. We then studied the effect of this depletion on the recruitment of inflammatory cells such as neutrophils and eosinophils which are primary cellular contributors to the asthmatic response. Our studies show that while clodronate liposomes are effective in alveolar macrophage depletion, the subsequent inflammation through neutrophil recruitment interferes with the study of the delicate milieu of cells in the respiratory epithelium of this murine model.

Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Medicine Johannesburg, August 2013 / Asthma control is a central focus of the updated version of the GINA Guidelines, in which clinicians are encouraged to concentrate on assessment of control, defined by symptoms, lung function and the presence or history of exacerbations. Control is of critical importance in asthma and is now more important than the actual level of severity. Measures of asthma control do not necessarily perform well and all of them need to be looked at as a whole as studies have shown. Many factors have been found to be associated with poor asthma control ranging from concomitant rhinitis and co morbidities to poor compliance with medications or inappropriate inhaler technique in addition to home or environmental factors. Several factors around the home of asthmatic patients contribute to poor asthma control which includes parental smoking or smoking by other relatives within the home, biomass fuel exposure, exposure to aeroallergens and animal danders which all leads to failure in achieving control despite adequate drug therapy. This cross sectional study was conducted in 115 asthmatics children with the aim of determining the level of asthma control and home circumstances that contributes to poor asthma control. Most patients were males and blacks with 55.65% of patients having controlled asthma. Use of biomass fuel was uncommon in this study and none of the home circumstances was found to be associated with poor asthma control in this study. Day time and nocturnal asthma symptoms were significantly associated with poor asthma control. Good adherence to medications was found to be associated with asthma control similar association was not seen with good inhaler technique. The higher the FEV1 percent predicted the better the asthma control. Day time and nocturnal asthma symptoms were associated with FEV1. Results from this study need confirmation in a representative population study. Further longitudinal study is required to see if home circumstances may affect asthma control in patients that had controlled asthma.

No description available.

Thesis (Ph.D.)--Boston University. / This study used the procedures of classical conditioning to investigate the possibility of producing asthmatic bronchospasm as a conditioned response. In order to carry out this study equipment was developed which permitted the experimental operations to be carried out while disguising the purpose of the experiment from the subjects. In the experiment, bronchospasm, induced by inhaled acetyl beta methacholine chloride, and shown to be highly similar to the condition of the lungs in asthma, was paired with auditory or visual stimuli. Similarly, Isuprel-induced relief of bronchospasm was paired with another exteroceptive stimulus in an attempt to condition the end of the attack. Subjects, on the average, received ten to fifteen conditioning trials depending on their cooperation and availability. Of four subjects who completed the necessary trials evidence for conditioning appeared in two. Magnitude of the conditioned responses is not great, producing, on the average, reduction of about 8% of the vital capacity in five minutes. Both of these subjects show conditioning to the experimental situation; one of the two, conditioning to the exteroceptive stimuli presented by the experimenter. The fact that conditioning did not automatically result from the experimental procedure and the complexity of the conditioning process apparent from detailed examination of the individual cases, led to discussion concerning the nature of conditioning, with special emphasis on the new area of interoceptive conditioning. The author takes the viewpoint that a central emotional-expectancy is an important aspect of conditioned visceral responses, and rejects connectionism between an external stimulus and a response. In addition, one peculiarity of the conditioning done in this experiment is noted. The unconditioned stimulus, rather than acting on the sensory nervous system, produces direct local change in the lungs. The resulting lack of representation of the UCS in the central nervous system is discussed in the reference to classical Pavlovian theory. The writer sees the application of interoceptive conditioning techniques as a fruitful method for further exploration of psychosomatic disorders. [TRUNCATED]

Asthma is a chronic disease of the lungs and respiratory passages. Hallmarks of asthma exacerbation, commonly referred to as an “asthma attack,” are bronchoconstriction, inflammation, and airway remodeling. Millions of people worldwide have asthma, with both children and adults affected by the disease. Asthma prevalence in the United States has been increasing on a yearly basis, and thus asthma is a serious health threat to people of all ages. Asthma can be controlled with short term bronchodilatory drugs and inhaled corticosteroids for long-term inflammation management. Pediatric asthma is particularly taxing, however, as it can cause numerous absences from school, frequent hospitalizations, and can be difficult for children to manage without close supervision. Many of these pediatric patients present in emergency departments, and are given oral or IV steroids to treat the asthma exacerbation. We specifically want to assess the effect of early administration of these steroids on the patient outcomes of admission rate and length of stay. We hypothesize that patients given steroids sooner rather than later are less likely to be admitted to inpatient status and will have a shorter stay in the emergency department. To test our hypotheses, we conducted a retrospective study in which we gathered pediatric patient data from August, 2011, to April, 2012. We included patients that presented with asthma exacerbation and recorded a number of metrics and variables for each patient, including time of steroid administration, admission status, and total length of stay in the emergency department. Steroid administration time was separated into two categories: administration pre or post-30 minutes of triage, and administration pre or post-60 minutes of triage. This data was logged, reviewed, and finally analyzed for statistical significance. Results of the study showed that there is no statistically significant association between time of steroid administration on admission rates. To assess the relationship of steroid administration time and length of stay in the emergency department, patients with the same admission status were compared against one another in order to eliminate potential confounding (i.e. length of stay for admitted patients who received steroids within 30 minutes was compared to that of admitted patients receiving steroids post-30 minutes, and so on). Overall, those patients receiving steroids tended to have a shorter mean length of stay in the emergency department. This finding was statistically significant for only one subset of the patient sample, however: discharged patients who received their steroids pre-60 minutes as opposed to post-60 minutes. While the data that we analyzed did not depict many statistically significant associations, it did reveal trends in outcomes that are associated with timing of steroid administration. With further study and an expanded sample size, these associations may prove to be of significance. From a clinical perspective, such findings could impact emergency asthma care, with early steroid administration becoming more of a priority in treatment protocols.