Effect of beta-adrenoreceptor stimulants on exercise-induced asthma.

Exercise-induced asthma can be prevented or minimized by beta-adrenoreceptor stimulating drugs, which may elicit bronchodilation before exercise has begun or may enhance thebronchodilating effect of more prolonged exercise. Recently introduced beta-adrenoreceptor stimulants have longer durations of action than isoproterenol, are effective following oral administration, and are selective for beta-adrenoreceptors.

History of exercise-induced asthma.

Strenuous exercise prolonged for several minutes can cause airway obstruction in asthmatic subjects. Initial obstruction becomes most extreme 5-10 min after the completion of exercise and usually remits within a few minutes but may recur 3-6 h later. The response to exercise depends upon the type of exercise. Swimming is less likely to cause exercise-induced asthma than running. Recent exercise or pretreatment with a bronchodilator or cromolyn can inhibit exercise-induced asthma. Nasal breathing or inhalation of warm, fully humidified air during exercise can minimize exercise-induced asthma. Local changes in osmolarity or cooling of mast cells probably causes release of mediators that cause airway obstruction.

You Can Control Asthma: evaluation of an asthma education program for hospitalized inner-city children.

A self-management education program was designed for staff nurses to offer children while they received medical care for asthma in the hospital. The program uses videotapes, written activity books and nurse discussion with the patient. Evaluation was conducted to assess program feasibility and impact. Pre- and post-tests of 40 children age 6-12 years revealed that the children had statistically significant increases in knowledge of and expected response to early warning signs of acute asthma, and in their sense of personal control (Health Locus of Control). Parents reported an increased use of asthma self-management techniques for acute episodes of asthma. Medical record review for a 15 month pre- and post-period indicated reductions in emergency room use. Inpatient hospital based education offers a critical opportunity to introduce asthma management skills, especially to children not reached by more traditional programs.

Mortality from asthma in children 1979-1984.

Deaths from asthma in children less than 15 years of age in the USA increased from 63 in 1979 to 111 in 1983 and then decreased slightly to 106 in 1984. Rates of death from asthma have been higher among boys than girls, probably due to higher prevalence of asthma among boys. Increases in rates of death from asthma have occurred in most age groups because of much higher rates of death and greater increases in rates of death among blacks than whites. Prevalence of asthma is not sufficiently greater among blacks to account for rates of death 3 to 5 times as great as those for white children. Increases in deaths due to asthma have occurred in 47 states, and deaths have occurred in metropolitan children of both races in approximate proportion to their distribution to metropolitan areas. At least 46% of deaths from asthma in children and adolescents less than 20 years of age have occurred at hospitals. Reviews of deaths from asthma have implicated delays in implementation of appropriate therapy, including adrenal corticosteroids, psychosocial dysfunction that has interfered with compliance with recommended management, and underestimation of the seriousness of airway obstruction. Some deaths have been sudden and unavoidable.

Mortality from asthma, 1979-1984.

Review of data from the National Center for Health Statistics to characterize deaths from asthma disclosed increases in rates of death from 1.2 per 100,000 in 1979 to 1.5 in 1983 and 1984. For black subjects, rates of death from asthma increased from 1.8 in 1979 to 2.5 in 1984; for white subjects, from 1.1 in 1979 to 1.4 in 1984. Age-adjusted rates of death from asthma increased from 1.9 in 1979 to 2.8 in 1983 and 2.6 in 1984 for black subjects, and from 0.8 to 1979 to 1.0 in 1984 for white subjects. Rates for other minority groups have been lower than rates for white subjects. A modest increase in prevalence of asthma among black subjects is insufficient to account for their much higher rate of death from asthma. Increases in rates of death have occurred in both metropolitan and nonmetropolitan areas in all regions of the country and in all but a few states. At least half the deaths from asthma have occurred at hospitals: this proportion did not change from 1979 to 1984. Increases in deaths from asthma have occurred in several other countries as well. Other reviews of deaths from asthma have implicated undertreatment and delays in treatment with bronchodilators and adrenal corticosteroids as factors contributing to death. High rates of death among black subjects suggest underutilization or lack of accessibility of health care. The large proportion of deaths that have occurred at hospitals suggests delays or other inadequacies of treatment at hospitals.

Evaluation of a sound-slide program for patient education.

PIP: A comparative study was undertaken to assess the effectiveness of a synchronized sound-slide program in allergy patient education. All asthmatic children were assigned alternately to experimental and control groups at the completion of their initial workups at the allergy clinic of a New Orleans hospital. The experimental group received a slide show on the etiology and control of the particular allergies suffered by the children. The control group received the same information in lecture form. Immediate testing by questionnaire and follow-up visits to the home were used to assess assimilation of the information. Mean scores increased for both groups immediately after instruction. The slide show was found to be as effective a method of presenting the information, freeing the doctors for counseling on different aspects of the allergy program and more specific problems.^ieng

Decreases in asthma mortality in the United States.

BACKGROUND: Rates of death from asthma in the United States increased from 1978 until 1988 and have tended to stabilize since then. OBJECTIVE: To identify and evaluate recent trends in asthma mortality in the United States. METHODS: Graphing and tabulation of data from the National Center for Health Statistics identifying asthma (ICD 493) as the underlying cause of death in the 50 United States and the District of Columbia with rates of death from asthma by age, race, and sex and age-adjusted rates of death by race. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989 and 2.1 in 1994 through 1996 but decreased to 2.0 in 1997. Rates decreased for black females and males and for white females in 1997. Age-adjusted rates of death from asthma decreased in 1997 for both blacks and whites. Deaths from asthma in children less than 15 years of age decreased from 191 in 1996 to 154 in 1997, the greatest decrease in any single year since 1971. CONCLUSION: Decreases in deaths from asthma in the United States in 1997 have followed stabilization of asthma mortality rates since 1988, although changes in a single year cannot establish a trend. Improved management is the most likely explanation of reversal of previous increases in asthma mortality.

Changing asthma mortality and sales of inhaled bronchodilators and anti-asthmatic drugs.

BACKGROUND: Increasing rates of death from asthma in the United States have stabilized somewhat since 1988. Case-control studies have suggested possible adverse effects of inhaled beta-adrenergic agonists that may have contributed to mortality. OBJECTIVE: To examine possible relationships between changing asthma mortality and sales of inhaled antiasthmatic drugs. METHODS: The National Center for Health Statistics supplied numbers and rates of death from asthma (ICD 493) by year. The Bureau of the Census supplied population data. IMS America provided estimates of total hospital and drugstore sales of inhaled beta-adrenergic agonists, cromolyn sodium, and inhaled corticosteroids by year and annual sales of AeroChambers and InspirEase kits. I calculated sales of the antiasthmatic drugs as puffs per person in the general population or doses per person for cromolyn sodium, defining a dose as a 20-mg capsule or vial or 2 mg by metered dose inhaler. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989, then decreased to 1.9 in 1990 before increasing again to 2.0 in 1991. Rates of death for blacks 5 through 34 years of age increased from 0.9 in 1980 to 1.3 in 1990 and decreased to 1.2 in 1991. Estimated total hospital and drugstore sales of beta-adrenergic metered dose inhalers increased from 10.3 puffs per person in the general population in 1976 to 31.0 in 1991; those for inhaled corticosteroids, from 0.44 puffs per person in 1976 to 5.44 in 1991. Sales of cromolyn increased from 0.047 doses per person in 1978 to 0.91 in 1991. Sales of AeroChambers and InspirEase kits have also increased. CONCLUSIONS: Since 1988 there has been some moderation in increases in rates of death from asthma while progressive increases in sales of inhaled antiasthmatic drugs have continued. These data are consistent with the likelihood that previous increases in rates of death from asthma were partly due to undertreatment.

Changing asthma mortality.

BACKGROUND: Rates of death from asthma in the United States have increased progressively since 1978. OBJECTIVE: To identify recent trends in asthma mortality. METHODS: The National Center for Health Statistics supplied asthma mortality data (ICD 493), and the Bureau of the Census supplied population data that permitted calculation and graphing of mortality data by age group, race, sex, and region and calculation and tabulation of mortality rates by state. The Departments of Health and Vital Statistics of Australia, Canada, Great Britain, and New Zealand provided data that permitted calculation and graphing of rates of death from asthma (ICD 493) in those countries. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 in 1977 and 1978 to 2.0 in 1989, fell to 1.9 in 1990 and then increased again to 2.0 in 1991. Rates have been much higher for blacks than whites; age-adjusted rates for blacks increased from 1.5 in 1977 and 1978 to 3.5 in 1991; those for whites, from 0.5 in 1977 to 1.2 in 1991. Rates of death from asthma have increased with age and across time have increased in almost all age groups. The greatest proportional increase has occurred at 10 to 14 years of age with rates of 0.1 in 1979, 0.5 in 1987, and 0.4 in 1991. Rates of death at 5 through 34 years of age have increased for both blacks and whites in all regions of the country. Increases in rates of death from asthma have also occurred in other countries, but rates have been falling in New Zealand since the peak of 8.1 in 1980 and in Australia since the peak of 5.7 in 1989. CONCLUSIONS: The recent plateau in increases in rates of death from asthma in the United States may suggest effectiveness of improved management of asthma that may have followed increased awareness of the importance of optimal management.

Beta-adrenergic drugs in the management of asthma in athletes.

beta-Adrenergic drugs are effective as bronchodilators and as inhibitors of exercise-induced asthma. Inhalation is the route of choice, but technique determines adequacy of delivery of the drug to the lower airways. The duration of bronchodilation can differ from the duration of inhibition of exercise-induced asthma. Albuterol aerosol usually prevents exercise-induced asthma for 4 to 6 hr, but metaproterenol aerosol affords protection to most asthmatics for less than 2 hr. Albuterol aerosol is the drug of choice for prevention of exercise-induced asthma. When a beta-adrenergic drug alone does not afford adequate protection, addition of theophylline, cromolyn, or an inhaled corticosteroid may enhance protection.

Current theories of the pathophysiology of asthma.

Release of chemical mediators from sensitized mast cells is of established importance in allergic asthma and can account for most of the pathology and recognized changes in physiology. There is still uncertainty regarding specific modes of action of most of the drugs effective in the treatment of asthma. Changes in respiratory mucosal permeability induced directly or indirectly by viruses may initiate atopic sensitization in genetically predisposed subjects. Increased bronchial irritability accounts for much of the bronchoconstriction in both allergic and nonallergic asthma. Leukotrienes cause the bronchoconstriction in patients with aspirin sensitivity, but the factors that differentiate these patients from subjects who tolerate aspirin remain unknown. Asthmatics are characterized by a substantial increase in the number of alpha-adrenergic receptors and a more modest decrease in the number of beta-adrenergic receptors as well as increased sensitivity to cholinergic stimulation. Both mediator release and bronchial irritability may be important causes of exercise induced asthma.

Mortality from asthma.

Since 1979 there has been a progressive increase in rates of death from asthma in the United States. This increase in mortality has been most extreme among blacks. It has occurred in all regions of the U.S. as well as some other countries. The problem requires further study to identify the cause.

Changing prevalence of allergic rhinitis and asthma.

OBJECTIVE: This review will enable the reader to discuss prevalence, risk factors, and prognosis of allergic rhinitis and asthma. DATA SOURCES: MEDLINE (PubMed) search using the terms allergic rhinitis, asthma, prevalence, risk factors. STUDY SELECTION: Human studies published in the English language since 1978, especially studies of relatively large populations in the United States, Great Britain, Australia, and New Zealand, with cross referencing to earlier relevant studies. RESULTS: Current prevalence of allergic rhinitis at 16 years of age in cohorts of British children born in 1958 and 1970 increased from 12% in the earlier cohort to 23% and in the later cohort. Local surveys of allergic rhinitis at approximately 18 years of age in the United States in 1962 to 1965 disclosed prevalence of 15% to 28%, while the national survey of 1976 to 1980 disclosed a prevalence of 26%. Thus, it is uncertain whether prevalence of allergic rhinitis has changed in the United States based on these limited data. Data from several sources indicate worldwide increases in prevalence of asthma. Annual Health Interview surveys indicate increases in prevalence of asthma in the United States from 3.1% in 1980 to 5.4% in 1994, but prevalence among impoverished inner city children has been much higher. Combined prevalence of diagnosed and undiagnosed asthma among inner city children has been 26% and 27% at 9 to 12 years of age in Detroit and San Diego. Positive family history and allergy are important risk factors for allergic rhinitis and asthma. Prognosis is guarded; allergic rhinitis resolves in only 10% to 20% of children within 10 years, and at least 25% of young adults who have had asthma during early childhood are symptomatic as adults. CONCLUSION: Increases in prevalence remain unexplained, but avoidance of recognized allergens should reduce the prevalence of allergic rhinitis and asthma.

Regional distribution of deaths from asthma.

Data from the National Center for Health Statistics indicate rates of death from asthma at 5-34 years of age in the USA in 1980 were .166 per 100,000 general population for whites and .914 for blacks. Rates for blacks were higher in the Northeast (1.313) and North Central Region (1.179) than in the West (.905) and South (.659). The rate for whites was higher in the West (.263) than in the Northeast (.180), South (.149), or North Central Region (.108). During 1981-84 rates remained higher for blacks in the Northeast and North Central Regions than other regions and higher for whites in the West than elsewhere. Most deaths from asthma at 5-34 years of age from 1979-84 in the USA occurred at hospitals (70% of blacks, 77% of whites for the 40 states reporting this detail on death certificates). Rates of discharge from hospitals after admission for the treatment of asthma at 5-34 years of age have also been much higher for blacks than for whites from 1979-86. These rates have been highest in the Northeast and North Central Region for both blacks and whites. Accordingly, neither failure to reach a hospital nor lack of hospitalization can account for regional and racial differences in asthma mortality rates. Median household incomes have been lower for blacks than whites, and unemployment rates have been higher for blacks than whites. From 1980-84 unemployment rates for blacks were highest in the North Central Region. Economic factors may account in part for racial and regional differences in mortality from asthma.