Asthma severity, atopic status, allergen exposure and quality of life in elderly persons.

BACKGROUND: Although asthma can be associated with significant airflow obstruction in those over the age of 65, it is often underdiagnosed and undertreated. OBJECTIVE: To describe severity of asthma, allergy skin test sensitivities, indoor allergen exposures, and the impact on quality of life (QOL) and health status in elderly persons with asthma. METHODS: A cross-sectional data analysis with 80 elderly persons with asthma recruited from medical, geriatric, and allergy/immunology tertiary care centers. Asthma severity was determined by symptoms and measurements of lung function. House dust specimens were collected from mattresses and bedroom carpets and analyzed separately for the major allergens of house dust, using monoclonal antibody-based immunoenzymetric assays. QOL was measured using Juniper's Asthma Quality of Life Questionnaire. Health status was measured using the Short Form Health Survey Medical Outcome Questionnaire which included Ferrans and Powers' Quality of Life Index subscales. RESULTS: Two-thirds of participants had either moderate or severe persistent asthma. Skin tests to a battery of common airborne allergens were positive to at least one allergen in 56 of the 75 participants tested (74.7%). Reservoir dust allergen levels were often high enough to place participants at risk of symptoms or at risk of developing sensitization. Increased asthma severity was associated with significantly lower QOL and a trend toward decreased health status. CONCLUSIONS: Asthma is a significant chronic problem in the elderly. Atopy was common. Asthma severity impacts on these participants' QOL and health status. Results support interventions aimed at identifying allergens precipitating attacks and reducing them in the home.

Genetics of asthma and allergies.

This article is a literature review focusing on the underlying concepts of human genetics related to asthma and allergies. Asthma is classified as a complex genetic disorder with genetic susceptibility and an appropriate environmental stimulus necessary for the expression of disease. Intermediate phenotypes of asthma, which are used to study the disease, include the total IgE levels, the specific immune response, and end organ response. Because gene products cause the inflammation in asthma and allergies, the molecular cell biology of these events is reviewed. Although no one gene is implicated in causing asthma, candidate genes involved in the multiple phenotypic expressions of asthma are described.

Moving health care education into the community.

The A+ Asthma Club, an educational program developed for elementary school children in inner-city schools, is offered through a series of six sessions during school hours with an additional three booster sessions. This article describes how the program was designed, its theoretical basis, the curriculum and its staffing.

Adherence issues in clinical practice.

To combat the millions of days of restricted activity and the billions of dollars spent in respiratory clinical practice, national health objectives are targeting people with asthma. Research data depict nurses and other health care providers as encountering patients with asthma and allergies who do not adhere to their medical and nursing care management plans. The skills and success with which these professional caregivers are able to assist these patients depends on an understanding of how to measure and evaluate compliance and adherence issues. In turn, this implementation of effective strategies for optimal patient outcomes can be actualized. Patient-related, practice-related, and health care provider-related factors must be considered to ensure that patients get the best chance to succeed and to be compliant. Achieving adherence with regimens not only reduces health care expenditures but ultimately results in patients' reaching their highest level of wellness.

Controlling allergies by assessing risks in the home.

Nurses and other health care providers will encounter children with allergies and asthma in virtually all practice sites. The skills with which they are able to assist these children and their families will depend on their understanding of the precipitating allergens and the most economical, feasible, and effective ways to reduce exposure to them.

Mite allergen control with acaricide fails.

BACKGROUND: We compared the effects of an acaricide, benzyl benzoate, with the effects of baking soda control applied to bedroom and living room carpets on house dust mite allergen levels, lung function, and medication use in 12 adult patients with asthma for 12 months. METHODS: This was a randomized, double-blind, placebo-controlled study. Patients were enrolled from the allergy clinic of a large tertiary care center in a metropolitan area. All patients had positive dust mite puncture test results. Six patients used benzyl benzoate, and six used baking soda. Other aggressive mite control measures were implemented uniformly in each group. Subjects were to make two carpet applications, at baseline and at 6 months according to the manufacturer's recommendations. Dust samples were collected in bedroom and living room carpets at 0, 3, 6, 9, and 12 months; and quantities of Der p I and Der f I allergens were determined. Spirometry was done every 3 months, and peak flow rates were recorded for 10 days after each dust sampling. RESULTS: There were no significant differences in mean allergen levels between the two groups over time at either site. There were no significant changes in lung function or medication use for either group. CONCLUSIONS: Benzyl benzoate powder applications may not be effective when done according to manufacturer's instructions. Further studies are necessary to test effectiveness when applied more frequently and for longer periods.

Allergen avoidance in the treatment of dust-mite allergy and asthma.

House-dust-mite allergen is one of the primary causes of asthma. In many instances, asthma is an immunoglobulin gamma E mediated atopy (i.e., allergen-specific hypersensitivity) that leads to non-specific bronchial hyper-reactivity and subsequent symptom manifestations. These symptoms may range from an annoying cough to full-blown respiratory failure. Allergen-avoidance measures should be a primary mode of treatment for atopic asthmatics. This article focuses on the dust-mite allergen and its relationship to asthma. It details specific avoidance measures that should be implemented by the majority of asthmatics. Studies are cited that support the aggressive use of these measures to decrease allergen exposure, and to subsequently prevent or significantly reduce asthma symptoms. When health care providers have a better understanding of avoidance measures and the rationale underlying their use, these measures are more likely to be valued and given greater emphasis in education and treatment plans. Renewed emphasis on an immunomodulatory approach to asthma treatment may help to reverse the rise in asthma morbidity and mortality rates.

Effective education of adults with asthma who are allergic to dust mites.

The effects of supplementary computer instruction in house dust mite-avoidance measures on adherence to implementing measures, on home dust mite-allergen levels, and on symptomatology were investigated in 52 adult patients with mite-associated asthma. Twenty-six patients received conventional instruction (counseling and written instruction) and the other 26 patients received conventional plus 22 minutes of interactive computer-assisted instruction. Instructions were aimed at mite-avoidance measures. Pre- and postinstruction dust samples were collected, and adherence was monitored. All patients kept symptom diaries twice a day. Patients' progress was followed for 12 weeks, and all patients completed the study. Adherence, number of observed and self-reported mite-avoidance measures implemented after visit, was higher for the computer group (p = 0.023). The computer-instructed group achieved significantly lower levels of mite allergen in bedroom carpets (p = 0.004) with mean levels of mite allergen declining from 6.5 +/- 7.6 to 2.2 +/- 4.3 micrograms/gm of dust (two-site monoclonal antibody assays), whereas levels for the conventional-instructed group did not change. Moreover, by study weeks 9 and 10, the computer-instructed group was significantly less symptomatic (p = 0.033). Mean symptom scores for this group decreased from 12.4 to 7.7, compared with 16.4 to 14.3. Conventional instruction supplemented with computer instruction is suggested in mite education.

Computer-assisted reinforcement of instruction: effects on adherence in adult atopic asthmatics.

A randomized comparison group pretest-posttest experimental design was used to determine computer-assisted instruction effects on adherence to implementing house dust mite avoidance measures in adult atopic asthmatics. Fifty-two subjects were randomly assigned to comparison and experimental groups. The comparison group received traditional instruction in avoidance measures while the experimental group received traditional instruction supplemented by identical information provided by computer-assisted reinforcement of instruction. Adherence was measured by subjects' self-ratings and investigators' observations. Data were collected during two home visits 12 weeks apart. The computer group had significantly (p less than .05) greater adherence scores than the comparison group. The results indicate that computer-assisted reinforcement of instruction is an effective method of increasing self-care behaviors about allergen avoidance activities.