Prevention of exercise-induced asthma by a fixed combination of disodium cromoglycate plus reproterol compared with montelukast in young patients.

BACKGROUND: The leukotriene inhibitor montelukast has been recommended against exercise-induced asthma (EIA), however, single-dose agents might be favourable in several aspects. OBJECTIVE: To compare the protective effects against EIA of a single inhalation of the combination disodium cromoglycate (DSCG, CAS 16110-51-3) and reproterol (REP, CAS 54063-54-6) with 3 days oral treatment of montelukast (MON, CAS 158966-92-8). METHODS: Open-label, cross-over, single-centre trial. Twenty-four 6 to 18-year-old children and adolescents, with reversible and stable airway obstruction, baseline FEV1 > or = 70%, predicted and proven EIA (i.e. a maximum decrease of FEV1 by > or = 20% compared with baseline) were treated with MON, orally for 3 days in the evening, or one single inhalation of DSCG/REP 20 min before the exercise challenge. The treatment sequence was randomised. The exercise test on a treadmill was performed under standardised conditions. RESULTS: 24 patients completed both periods. Both treatments clearly provided protection against EIA; however, protection of DSCG/REP was more pronounced than that of MON. This difference was statistically significant even if the data were adjusted for the increase in FEV1 between inhalation of DSCG/REP and challenge (DSCG/REP(adjusted). The nadir FEV1 level after exercise following prophylaxis with DSCG/REP was even higher than the pre-inhalation FEV1 value. From these data, protection indices of 66%, 81%, and 113% for MON, DSCG/REP(adjusted), and DSCG/REP(unadjusted), respectively, were estimated. CONCLUSIONS: Inhalation of DSCG/REP before exercise provides significantly better protection against EIA than three days treatment with MON.

Disease severity, mental health, and quality of life of children and adolescents with asthma.

Asthma has been found related to a higher risk of psychological problems. Inconsistent results have been reported with respect to the quality of life of children with asthma. So there may be a complex relationship between asthma severity, quality of life, and psychological factors. The aim of this study was to examine the impact of asthma severity and emotional/behavioral problems on the quality of life of children and adolescents and on their need for support. Eighty-one children and adolescents (7-18 years old, 62 boys, 19 girls) with asthma participating in different intervention and rehabilitation programs completed the Ulm Inventory for Children, an instrument for assessing health-related quality of life. Psychological problems were rated using the Child Behavior Checklist (CBCL). Caregivers judged the patients' need for support due to asthma and due to psychosocial problems. Asthma severity was rated according to the GINA classification. The participants showed elevated caregiver-reported emotional and behavioral symptoms compared with the normative sample (mean CBCL total score T=63). Quality of life and the need for social support were significantly correlated with psychological symptoms. Asthma severity was neither correlated with quality of life nor with emotional/behavioral symptoms, but it was associated with the need for support due to asthma. Therefore, in our study, comorbid emotional and behavioral symptoms rather than disease severity predicted quality of life of children and adolescents with asthma. Treatment should be adjusted to the special needs of children with asthma and comorbid mental health problems.

Outcomes of a Web-based patient education program for asthmatic children and adolescents.

BACKGROUND: Asthma is the most common chronic disease among children in Germany. Approaches to reduce the burden of asthma include patient education to improve self-management skills. STUDY OBJECTIVES: We determined whether a continuous Internet-based education program (IEP) as an add-on to a standardized patient management program (SPMP) improves health outcomes of asthma patients at a favorable benefit-cost ratio. PATIENTS AND METHODS: A total of 438 asthmatic patients aged 8 to 16 years in 36 study centers were enrolled during a 6-month period. We performed a prospective cost-benefit analysis alongside a nonrandomized trial. At baseline and at 6 months and 12 months, health service utilization data were collected. INTERVENTIONS: Study participants were assigned to a control group and two intervention groups. Patients in both intervention groups participated in an SPMP. Additionally, patients in one intervention group received the IEP. RESULTS: Utilization of various health-care services decreased significantly in both intervention groups. From a payer perspective, the benefit-cost ratio of the traditional education program was 0.55. Adding the IEP improved the ratio (0.79). For patients with moderate or severe asthma, the benefit-cost ratios were 1.07 and 1.42 (with IEP), respectively. CONCLUSIONS: The IEP offers the potential to decrease the burden of disease and to realize incremental morbidity cost savings. Subgroup analysis demonstrated that within 1 year, the savings exceed the intervention costs in patients with moderate or severe asthma.

[Corticophobia in asthma]. / Kortikophobie beim Asthma bronchiale.

BACKGROUND: Steroid phobia is regarded as a common phenomenon in the management of asthma, eventually contributing to poor compliance in these patients. The aim of this survey was to examine asthma patients (adults and children with their parents) and general practitioners (GPs) if inhaled corticosteroids are a matter of concern. METHODS: The physicians were asked what they assume, their patients would answer. To accomplish this, 407 physicians (202 GPs without subspecialty, 103 internists, 102 pediatricians) and 346 patients (245 adults, 101 children, 109 parents) were questioned using a structured questionnaire. RESULTS: In contrast to patients, physicians rated inhaled corticosteroids as the medication the patients wanted primarily to get rid of (in parenthesis physician answers): adult asthmatics 17% (55%), children 19%, parents 26% (55%). The answer "side effects" to the question "What do you dislike most in your asthma medication?" was given as follows: physicians 58%, adult asthmatics 42%, children 10%, parents 14%, and pediatricians 46%. Major lack of knowledge regarding the use and function of asthma medication was excluded in these patients as well as in the children's parents. The request for further information regarding their disease varied: adult asthmatics 57%, children 66%, parents 90%. CONCLUSION: Our survey indicates that physicians may overestimate patients' concern to use inhaled corticosteroids in asthma therapy. For patients rejecting corticosteroid therapy other antiinflammatory treatment options must be considered as an alternative individually.