Objective. To determine if poor compliance with asthma treatment is independently associated with exacerbations requiring emergency room visits in adult patients seen at Kalafong Hospital, a secondary regional- and teaching hospital affiliated to the University of Pretoria. Methods. A matched case-control study was undertaken - matched on age and gender, between December 2003 and May 2005. Known asthma patients with exacerbations presenting at the hospital's emergency unit were chosen as cases. Controls were stable asthma patients recruited from the outpatient departments. A structured questionnaire was used to interview patients concerning their possible exposure to certain triggers and risk factors. Univariate and multivariate analysis with conditional logistic regression was done to determine any significant exposures. Participants were between 18 ¬65 years of age. Results. Three hundred and fifty-six patients were evaluated. Fifty cases and 100 controls were enrolled. Cases were shown to be more non-compliant than controls (OR = 2.18; 95% CI 1.09 to 4.38, p = 0.03). Missing follow-up doctor appointments for the last six months was statistically significant with an OR of 2.39 (95% CI 1.08 to 5.27) and p = 0.03. Cases had more bacterial respiratory infections than controls (OR = 5.00; 95% CI 1.57 to 15.94, p = 0.01). More controls (50%) were exposed to dust- and environmental pollution than cases (38%) (OR = 0.60; 95% CI 0.29 to 1.23, p = 0.16). There was also an interaction between non-compliance and dust- and environmental pollution. Conclusion. Non-compliance and bacterial respiratory infections were strong predictors of exacerbations in adult asthma patients at Kalafong Hospital. / Dissertation (MPh)--University of Pretoria, 2008. / School of Health Systems and Public Health (SHSPH) / MPh / Unrestricted

The Self-Regulation Model (Leventhal, Nerenz & Steele, 1984) highlights the roles of patients' illness representations, coping, emotional reactions and appraisal of coping in the progression of chronic disease. This thesis incorporates previous literature on adherence, panic-fear and selfmanagement interventions into the model in order to (a) investigate coping with asthma and (b) develop an intervention aimed at improving asthmatic control. New measures of asthmatic control and illness representations of the consequences of having asthma were developed in order to operationalise the model. A cross-sectional study investigated factors influencing asthmatic control in a sample of 35 adult asthma sufferers recruited through a single general practice. Coping was poor, adherence being low and less than 50% of participants reporting current Peak Flow monitoring or medical contact during the previous 12 months. Good coping appeared to be a response to poor asthmatic control, rather than prophylactic. Good asthmatic control was associated with low perceived consequences, recent medical contact, moderate panic-fear and low general avoidance coping. These results imply that asthmatic control may be improved by encouraging sufferers to maintain regular contact with outpatient services and to implement prophylactic coping. Since epidemiological and clinical evidence suggested asthmatic control to be poor in young adults, an intervention was developed to improve asthmatic control in this group by modifying illness representations, coping and panic-fear. The intervention was evaluated in a randomised controlled study of 50 student asthma sufferers identified initially through an epidemiological screening of 2,979 students. It led to increased Preventer medication use and Peak Flow monitoring and decreased distress over the condition. However, the coping process changed and asthmatic control improved even in the control group, perhaps because self-monitoring of asthmatic control for the study constituted a change in coping. This unanticipated result was entirely compatible with the Self-Regulation Model. The thesis dearly demonstrates value of the Self-Regulation Model in understanding asthma self-management and developing clinical interventions.

Thesis (M.S.)--Boston University / The purpose of this study is to explore the social factors which are present in the children and adults with a diagnosis of bronchial asthma and to learn the role of the social worker in the treatment of these cases. The writer hopes to find out the ways in which the medical social worker can help the asthmatic patient benefit from the medical treatment he is receiving. The writer sets forth the following questions to be answered: 1) What are the reasons for referral to the socia~ service department? 2) What are the factors in the environment which seem to be impeding treatment? 3) What methods are ; used by the social worker in trying to remove the obstacles? 4) To what extent is it possible to achieve these objectives?

Not available / text

The aim of the study was to determine and document evidence of the comparative effect of a 12- week whole body vibration training programme, exercise training programme and sedentary control group on the anthropometric profile, aerobic capacity, lung volumes and hence, the pulmonary capacity in people with asthma. The study used a descriptive, exploratory, quasi-experimental research approach employing randomised pairing to classify participants into either the whole body vibration therapy or exercise training group. Accidental and snowball sampling was used to identify and obtain a base of volunteers. A three-group pre-test/post-test design was employed to gain insight into statistical differences that might be apparent between the whole body vibration therapy group, the exercise group and the control group, and which could potentially be attributed to participation in the whole body vibration exercise programme. Randomised pairing for participant selection was selected because of the potential effects varying pulmonary variables might have had on the reliability of the study. A Physical Activity Selection Criteria Questionnaire was completed by participants to ascertain baseline physical activity readiness and as a means of determining selection criteria for their allocation to the whole body vibration training group, the experimental exercise group or the true control group. The pre-test/post-test assessment made use of a combination evaluation that incorporated an anthropometric profile assessment of height, weight, biceps, triceps, subscapular and suprailliac skinfolds, waist and hip circumference and posture, an aerobic capacity evaluation that incorporated aspects of both the YMCA and Astrand and Rhyming Physical Work Capacity (PWC) evaluation on a cycle ergometer and, lastly, a pulmonary variable assessment that made use of both the Datospir Peak-10 peak flow meter and the Spirovit SP-100AT spirometry unit integrated into the Cardiovit AT-6 model for all spirometry measurements. Participants were required to complete either the whole-body vibration or the exercise training programme a minimum of twice a week and a maximum of four times over the same period. The duration of the intervention programmes was approximately 30 minutes and consisted of three sections including a warm-up comprising flexibility exercises, whole body strength training exercises, and a cool-down which, in turn, consisted of massage exercises or replicated flexibility exercises. The main difference between the whole body vibration and exercise training group thus lay in the exclusion of the use of vibration for those participants assigned to the exercise training programme. Analysis of data was performed using descriptive and inferential statistics with the help of a qualified statistician. The identified variables were tested at a 95 percent level of probability (p<0.05) as recommended by Thomas and Nelson (1996:117). Descriptive data, in the form of a statistical mean, standard deviation, minimum, median and maximum values, obtained during this study were reported in the form of a t-score for selected anthropometric and pulmonary variables. The 12-week intervention programme, on analysis of the results, produced statistically insignificant improvements in the variables of anthropometric profile, aerobic capacity and lung volumes identified as determinants of, and factors influencing, the cardiorespiratory fitness level of participants with asthma and hence, the subsequent severity of this chronic condition. However, slight mean increases for the whole body vibration training group were evident for certain variables identified in this study. Based on the results, the inference could be made that whole body vibration therapy and exercise were both effective modes of training to improve the cardiorespiratory fitness level of people with asthma, but the results of the study did not show sufficient practical or statistical significance to verify the assumption that whole body vibration training was a method superior to conventional exercise training. Hence, the significance of whole body vibration training on the pulmonary variables of people with asthma could not be determined. The researcher recommends that future studies be undertaken to verify whether whole body vibration training incorporating larger participant groups could produce significant improvements in pulmonary variables in people with asthma.

Ng, Chor Fung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 130-144). / Abstracts in English and Chinese. / ABSTRACT (ENGLISH VERSION) --- p.i / ABSTRACT (CHINESE VERSION) --- p.iv / ACKNOWLEDGEMENTS --- p.vi / TABLE OF CONTENTS --- p.viii / LIST OF TABLES AND FIGURES --- p.xii / ABBREVIATIONS --- p.xiv / Chapter CHAPTER 1. --- GENERAL INTRODUCTION --- p.1 / Chapter 1.1 --- Definition of asthma --- p.1 / Chapter 1.2 --- Asthma epidemiology --- p.2 / Chapter 1.3 --- Pathogenesis of Asthma --- p.3 / Chapter 1.3.1 --- Gene-environment interaction --- p.3 / Chapter 1.3.2 --- Allergens and atopic sensitization --- p.4 / Chapter 1.3.3 --- Other environmental factors --- p.5 / Chapter 1.4 --- House dust mite (HDM) --- p.5 / Chapter 1.4.1 --- Characteristics of HDM allergens --- p.5 / Chapter 1.4.2 --- HDM and asthma --- p.6 / Chapter 1.5 --- Pathophysiology of asthma --- p.8 / Chapter 1.5.1 --- Airway inflammation --- p.8 / Chapter 1.5.1.1 --- Cellular mechanism --- p.8 / Chapter 1.5.1.2 --- Characteristics of chronic inflammation --- p.9 / Chapter 1.5.1.3 --- Inflammatory cells in airway inflammation --- p.10 / Chapter 1.5.1.3.1 --- Mast cell --- p.10 / Chapter 1.5.1.3.2 --- Macrophages --- p.11 / Chapter 1.5.1.3.3 --- T lymphocytes --- p.12 / Chapter 1.5.1.3.4 --- Eosinophils --- p.12 / Chapter 1.5.1.3.5 --- Epithelial cells --- p.13 / Chapter 1.5.1.4 --- Cytokines in asthma --- p.14 / Chapter 1.5.1.4.1 --- Inflammatory cytokines --- p.14 / Chapter 1.5.1.4.1.1 --- Interleukin-4 --- p.14 / Chapter 1.5.1.4.1.2 --- Interleukin-5 --- p.14 / Chapter 1 5.1.4.1.3 --- Interleukin-6 --- p.15 / Chapter 1.5.1.4.1.4 --- Granulocyte Monocyte Colony Stimulating Factor (GM-CSF) --- p.15 / Chapter 1.5.1.4.1.5 --- Tumor Necrosis Factor-α (TNF-α) --- p.16 / Chapter 1.5.1.4.2 --- Anti-inflammatory cytokines --- p.17 / Chapter 1.5.1.4.2.1 --- Interleukin-10 --- p.17 / Chapter 1.5.1.4.2.2 --- Interferon-γ(IFN-γ) --- p.17 / Chapter 1.5.2 --- Airway hyperresponsiveness (AHR) --- p.18 / Chapter 1.5.3 --- A irway remodeling --- p.19 / Chapter 1.6 --- Asthma therapy --- p.21 / Chapter 1.6.1 --- β2-agonists --- p.21 / Chapter 1.6.2 --- Cromolyn and nedocromil --- p.21 / Chapter 1.6.3 --- Theophylline --- p.22 / Chapter 1.6.4 --- Leukotriene modifiers --- p.22 / Chapter 1.6.5 --- Corticosteroids --- p.23 / Chapter 1.7 --- Traditional Chinese Medicine --- p.24 / Chapter 1.7.1 --- Introduction --- p.24 / Chapter 1.7.2 --- Traditional Chinese Medicine (TCM) --- p.24 / Chapter 1.7.3 --- "Chinese herbal formula, CU Formula 2 (CUF2) and Kuan Dong Hua" --- p.26 / Chapter 1.8 --- Objectives of our studies --- p.28 / Chapter CHAPTER 2. --- ESTABLISHMENT OF A HDM-INDUCED ASTHMATIC ANIMAL MODEL IN SD RATS --- p.32 / Chapter 2.1 --- Introduction --- p.32 / Chapter 2.2 --- Materials and methods --- p.33 / Chapter 2.2.1 --- Buffers and solutions --- p.33 / Chapter 2.2.2 --- Animals --- p.33 / Chapter 2.2.3 --- Preparation of aluminum hydroxide gel --- p.34 / Chapter 2.2.4 --- HDMAllergen --- p.34 / Chapter 2.2.5 --- Sensitization Procedure --- p.35 / Chapter 2.2.6 --- Intratracheal instillation challenge --- p.35 / Chapter 2.2.7 --- Bronchoalveolar lavage (BAL) and BAL Cell counting --- p.36 / Chapter 2.2.8 --- Lung Histopathological Analysis --- p.37 / Chapter 2.2.9 --- Measurement of cytokine and chemokine by Enzyme-Linked Immunosorbent Assay (ELISA) --- p.39 / Chapter 2.2.10 --- Statistical Analysis --- p.40 / Chapter 2.3 --- Results --- p.41 / Chapter 2.3.1 --- Cellular Analysis of BALF --- p.41 / Chapter 2.3.2 --- Histopathology --- p.42 / Chapter 2.3.3 --- Cytokine and chemokine --- p.43 / Chapter 2.4 --- Discussion --- p.44 / Chapter CHAPTER 3. --- IMMUNOMODULATORY EFFECT OF CUF2 AND KUAN DONG HUA IN A RAT MODEL OF HDM-INDUCED ASTHMA --- p.65 / Chapter 3.1 --- Introduction --- p.65 / Chapter 3.2 --- Materials and methods --- p.67 / Chapter 3.2.1 --- Herbal materials and extraction method --- p.67 / Chapter 3.2.2 --- "Antigen sensitization, challenge, and treatment" --- p.68 / Chapter 3.2.3 --- Bronchoalveolar lavage and cell differential counts --- p.69 / Chapter 3.2.4 --- Histological Studies --- p.69 / Chapter 3.2.5 --- Measurement of BALF cytokines and chemokines --- p.70 / Chapter 3.2.6 --- "Body weight, thymus index and spleen index" --- p.70 / Chapter 3.2.7 --- Statistical analysis --- p.70 / Chapter 3.3 --- Results --- p.71 / Chapter 3.3.1 --- Effect of herbs and DXA on total cells and eosinophils in BALF --- p.71 / Chapter 3.3.2 --- Effect of herb and DXA on lung histology --- p.72 / Chapter 3.3.3 --- Effect of herbs and DXA on cytokine and chemokine level in BALF --- p.73 / Chapter 3.3.4 --- "Effect of herb and DXA on body weight, thymus index and spleen index" --- p.75 / Chapter 3.4 --- Discussion --- p.77 / Chapter CHAPTER 4. --- IMMUNOMODULATORY EFFECT OF KUAN DONG HUA ON HUMAN MAST CELLS (HMC-1) --- p.109 / Chapter 4.1 --- Introduction --- p.109 / Chapter 4.2 --- Materials and methods --- p.110 / Chapter 4.2.1 --- Reagents --- p.110 / Chapter 4.2.2 --- Cell line and Cell Culture --- p.111 / Chapter 4.2.3 --- Herb and extraction procedure --- p.111 / Chapter 4.2.4 --- Cell Viability Assay --- p.112 / Chapter 4.2.5 --- Assay of cytokine secretion --- p.113 / Chapter 4.2.6 --- Quantitative Analysis of cytokines --- p.113 / Chapter 4.2.7 --- Bacterial endotoxin contamination --- p.114 / Chapter 4.2.8 --- Statistical analysis --- p.115 / Chapter 4.3 --- Results --- p.116 / Chapter 4.3.1 --- Effect of Kuan Dong Hua on cell viability of HMC-I --- p.116 / Chapter 4.3.2 --- Effect of Kuan Dong Hua on cytokine release from HMC-I --- p.116 / Chapter 4.3.3 --- Effect of endotoxin contamination in the extract --- p.117 / Chapter 4.4 --- Discussion --- p.118 / Chapter CHAPTER 5. --- GENERAL CONCLUSION --- p.125 / Chapter 5.1 --- Conclusion --- p.125 / Chapter 5.2 --- Limitations of this study and Future work --- p.128 / REFERENCES --- p.130 / APPENDICES --- p.145 / Appendix A. Wright-Giemsa Stain for cytospin preparations --- p.145 / Appendix B. Hematoxylin & eosin (H&E) staining --- p.145 / Appendix C. Congo Red staining --- p.146 / Appendix D. Periodic acid-Schiff (PAS) staining --- p.146

Thesis (D.P.H.)--University of Hawaii at Manoa, 1996. / Includes bibliographical references (leaves 83-108). / Microfiche. / vii, 108 leaves, bound 29 cm

Optimal management of a chronic disease, like asthma, requires the active participation of patients. To achieve this, patients require education about asthma. Many of the recommended components of asthma care and management might not be effective without adequate patient education. Pharmacists in community, hospital and clinic practice are well placed to provide continued information and reinforcement of key messages, in order to improve compliance with medication and the outcomes of asthma management plans. Pharmacists may be able to increase medication adherence with patient counselling and monitoring systems and by facilitating communication with physicians. However, regardless of this, it remains uncertain whether pharmacist-patient interactions improve patient outcomes, and in spite of recommendations for teamwork and a multidisciplinary approach in the education of asthma patients, medical doctors and nurses are still largely responsible for carrying out the greatest part of patient education. The objectives of this study were therefore to determine the impact of pharmaceutical care services at a primary health care level on the management and well-being of asthmatic patients; to determine the effect of complex or multi-faceted pharmaceutical interventions, in patients with asthma, on lung function, asthma knowledge, attitudes and perceived self-management efficacy, asthma related quality of life and asthma control; and to determine the extent to which pharmacotherapeutic interventions, with regards to medication changes and dosage changes, are accepted and implemented by doctors. A randomised-control study was conducted at a primary health care clinic in the Eastern Cape. A total of 120 patients were allocated to two groups of sixty patients each (a Control Group and an Intervention Group). Baseline values were measured and follow-up interviews and post-intervention data collection were conducted three months afterwards for each group. Patients in the Control Group were attended to by the clinic staff as usual. Patients in the Intervention Group were educated on their disease by a pharmacist. The use of a customised 500ml plastic bottle as a spacer was suggested and each patient’s medication was evaluated against the Standard Treatment Guidelines for the management of asthma in adults at the primary health care level and where necessary, prescribing recommendations were made. Following assessment of the medication regimens of the patients in the Intervention Group, a total of 49 prescribing recommendations were made, of which 73 percent were accepted by both the doctor and patient. After educating the patients in the Intervention Group on inhaler technique, a significant improvement in technique was observed at the 3-month follow-up assessment (p<0.05). Using a short form of the Asthma Quality of Life Questionnaire (AQLQ(S)), a significant improvement post-intervention in mean total quality of life score (p<0.05) and mean average quality of life score (p<0.05) in the Intervention Group, were demonstrated. An improvement in mean activity limitation score in the Intervention Group post-intervention was also recorded for the activity limitation subscale of the AQLQ(S) (p<0.05). On measuring changes in asthma related knowledge, attitudes and self-efficacy, using a questionnaire (KASE-AQ), a significant improvement in mean knowledge score in the Intervention Group after the intervention (p<0.05) was also shown. With regards to lung function, both vital capacity (percent FVC) and expiratory flow volumes (percent FEV1) improved significantly in the Intervention Group (p<0.05). This study therefore demonstrated that multi-faceted pharmacist interventions, including medication assessment, asthma education, education on inhaler technique and the provision of medication aids in the form of spacers, can significantly improve the management of asthma patients and improve their well-being and quality of life.

An attempt has been made in this study to critically appraise, systematically review and gather together the results obtained in individual trials and examine the strength of evidence supporting the component for Education for a Partnership in Asthma Care of the National Asthma Education and Prevention Program (NAEPP) to test whether health outcomes are influenced by education and self-management programs.

Indiana University-Purdue University Indianapolis (IUPUI) / Asthma, a chronic inflammatory disease of the airways, affects nearly 25 million Americans. The vast majority of these patients suffer from exercise-induced bronchoconstriction (EIB), a complication of asthma. Although traditionally treated pharmacologically, nutritional strategies provide a promising alternative for managing EIB as the prevalence of asthma may be due in part to changes in diet. Our objective was to determine the effects of novel nutritional strategies on hyperpnea-induced bronchoconstriction (HIB) in asthmatic individuals. HIB uses rapid breathing to identify EIB in a research or clinical setting. Fish oil, a combination of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docsahexaenoic acid (DHA), has been shown to be effective in suppressing EIB. However, its use in combination with other nutritional supplements, the optimal fish oil formula, and its effect on smooth muscle contractility have not been fully explored. An in vivo study (study 1) was conducted in individuals with both asthma and HIB to determine whether a combination of fish oil and vitamin C was more effective than either one alone in alleviating HIB. Pulmonary function was significantly improved with both fish oil and the combination treatment but not with vitamin C alone. In study 2, individuals with both asthma and HIB were supplemented with DHA alone since the optimal formula for fish oil has yet to be ascertained; previous in vitro studies have suggested DHA may be the more potent omega-3 fatty acid in fish oil. However, no significant changes in pulmonary function or airway inflammation were seen with DHA supplementation. For study 3, canine airway smooth muscle tissue was treated with fish oil to determine the in vitro effect of fish oil on smooth muscle contractility. Acute treatment with fish oil relaxed smooth muscle strips that had been contracted with 5-hydroxytryptamine. These minor relaxations in smooth muscle tension with fish oil may represent significant changes at the level of the smaller airways. These studies have confirmed that fish oil represents a viable treatment modality for asthmatic individuals with EIB and suggest that fish oil may influence airway smooth muscle contractility.