The Association Between Short-Acting ß2-Agonist Over-Prescription, and Patient-Reported Acquisition and Use on Asthma Control and Exacerbations: Data from Australia.

INTRODUCTION: In Australia, short-acting ß2-agonists (SABA) are available both over the counter (OTC) and on prescription. This ease of access may impact SABA use in the Australian population. Our aim was to assess patterns and outcome associations of prescribed, acquired OTC and reported use of SABA by Australians with asthma. METHODS: This was a cross-sectional study, using data derived from primary care electronic medical records (EMRs) and patient completed questionnaires within Optimum Patient Care Research Database Australia (OPCRDA). A total of 720 individuals aged ≥ 12 years with an asthma diagnosis in their EMRs and receiving asthma therapy were included. The annual number of SABA inhalers authorised on prescription, acquired OTC and reported, and the association with self-reported exacerbations and asthma control were investigated. RESULTS: 92.9% (n = 380/409) of individuals issued with SABA prescription were authorised ≥ 3 inhalers annually, although this differed from self-reported usage. Of individuals reporting SABA use (n = 546) in the last 12 months, 37.0% reported using ≥ 3 inhalers. These patients who reported SABA overuse experienced 2.52 (95% confidence interval [CI] 1.73-3.70) times more severe exacerbations and were 4.51 times (95% CI 3.13-6.55) more likely to have poor asthma control than those who reported using 1-2 SABA inhalers. Patients who did not receive SABA on prescription (43.2%; n = 311/720) also experienced 2.71 (95% CI 1.07-7.26) times more severe exacerbations than those prescribed 1-2 inhalers. Of these patients, 38.9% reported using OTC SABA and other prescription medications, 26.4% reported using SABA OTC as their only asthma medication, 13.2% were prescribed other therapies but not SABA OTC and 14.5% were not using any medication. CONCLUSION: Both self-reported SABA overuse and zero SABA prescriptions were associated with poor asthma outcomes. The disconnect between prescribing authorisation, OTC availability and actual use, make it difficult for clinicians to quantify SABA use.

Validation of olfactory threshold testing methods.

In patients with chemosensory complaints, a head-to-head comparison of unilateral olfaction threshold testing with the Phenyl Ethyl Alcohol Smell Threshold Test (PEA) and the OLFACT-RL Odor Threshold Test (OLFACT-RL) was undertaken. The charts of 23 consecutive patients presenting with chemosensory complaints seen at the Smell and Taste Treatment and Research Foundation were reviewed and information extracted per Institutional Review Board guidelines. All patients had undergone olfactory testing with the PEA test and the OLFACT-RL test in accordance with their published administration manuals. Using Spearman correlation coefficients to measure the statistical correlation between tests, we found evidence of a correlation between PEA and OLFACT-RL values on the left side only, overall (r = 0.49, p = 0.0184); in those who had hyposmia and did not have anosmia (r = 0.42, p = 0.0668); in those who did not have burning mouth syndrome (r = 0.46, p = 0.0304); and in those who did not have dysosmia (r = 0.47, p = 0.0553). There is no evidence of a correlation on the right side. The correlation for the left nostril suggests that these tests may be interchangeable. However, lack of correlation with the right nostril requires further investigation.

Alliaceous migraines.

OBJECTIVE: To report a migraineur with osmophobia and trigger to garlic and onion aroma. BACKGROUND: While odors serve as a trigger in 70% of migraineurs, alliaceous aromas have been described only rarely. Furthermore, nor has more than one type of alliaceous odor acted as a trigger in the same individual. Neither has migraine with aura been described as precipitated by such aromas. A patient experiencing migraines with aura, triggered almost exclusively by alliaceous aromas, is described. CASE STUDY: 32-year-old woman; 5 years previously felt nasal pruritis upon eating a red onion dip. Shortly thereafter, the mere aroma of raw onions caused a sensation of her throat closing along with an associated panic attack. Over the intervening years, upon exposure to onions and garlic aroma she experienced a fortification spectra and visual entopia, followed by a bipareital, crushing level 10/10 headache, burning eyes and nose, lacrimation, perioral paresthesias, generalized pruritis, nausea, fatigue, sore throat, dysarthria, confusion, dyspnea, palpitations, presyncopal sensations, hand spasms, tongue soreness, neck pain, phonophobia, and photophobia. These would persist for 1 hour after leaving the aroma. She was unresponsive to medication and would wear a surgical mask when out. The patient also experienced chemosensory complaints: dysosmias every few months; phantosmias of food or cleaning products every month for a minute of level 5/10 intensity; pallinosmia of onion or garlic odor for 30 minutes after exposure; and metallic pallinugeusia after eating with metal utensils. RESULTS: Neurological exam normal except for bilateral positive Hoffman reflexes. CHEMOSENSORY TESTING: Quick Smell Identification Test 3/3 and Brief Smell Identification Test 12/12 were normal. Magnetic resonance imaging and computed tomography with and without contrast normal. Allergy skin test was positive for garlic and onion. Nose plug and counter stimulation with peppermint prevented the onset of headaches and associated symptoms. CONCLUSION: This is the first report of migraines with aura triggered by more than one alliaceous compound in the same individual. Possible mechanisms include odor induced, emotional change, vasomotor instability, trigeminal-induced neurogenic inflammation, and allergic response. In alliaceous and odor-induced migraines, a trial of counter stimulation and nose plugs is warranted.

Effect of two azadirachtin formulations against adults of Sitophilus oryzae and Tribolium confusum on different grain commodities.

The insecticidal effect of two azadirachtin-based insecticides, NeemAzal-T/S and Oikos 32 EC, was examined against adults of the grain beetles Sitophilus oryzae and Tribolium confusum on wheat and maize under different temperature and humidity regimes. The insecticides were applied at three dosages, equivalent to 50, 100, and 200 mg of active ingredient per kg of grain. Adults of the above species were exposed to the treated grains at 20, 25, and 30 degrees C and two relative humidity levels (55 and 75%), and mortality was assessed after 14 days of exposure. All adults were then removed, and the treated substrate remained under the same conditions for 45 more days. After this period, the grains were checked for progeny production. In both species and both commodities, mortality increased with insecticide dosage. For many dosage-formulation combinations, mortality increased with temperature at 55% relative humidity but the reverse was observed at 75% relative humidity. Comparing the two formulations, NeemAzal-T/S was more effective than Oikos 32 EC at all the combinations tested. NeemAzal-T/S was more effective at high relative humidity, but the efficacy of Oikos 32 EC was not much affected by the relative humidity. Survival was high, even at the higher dosages, in some of the temperature-humidity combinations. Progeny production of S. oryzae in the treated grains was considerably higher than that of T. confusum. The results of the present study indicate that further dosage increases and longer exposure times are needed to obtain a complete (100%) adult mortality in all combinations tested. However, the feasibility of using higher azadirachtin dosages (>200 mg/kg grain) is questionable for cost reasons. Consequently, the use of these substances is not comparable to the use of traditional grain protectants, which are usually used at dosages of <5 mg/kg grain. Although azadirachtin-based insecticides can be used with success for protection of stored grain, our study demonstrated that under certain circumstances such an application may not be effective. Abiotic factors (formulation, temperature, and relative humidity) had a more serious impact on the efficacy of these insecticides than did biotic factors (target species and commodity).