Association of the Asthma Control Test with peak flow measures in a population in Puerto Rico.

OBJECTIVE: The Asthma Control Test (ACT) questionnaire has been widely used and validated in various ethnic groups, showing an adequate correlation with physician assessment of asthma control. We sought to evaluate the relationship between ACT-defined asthma control and peak flow measures in subjects living in Puerto Rico. METHODS: A retrospective evaluation of data collected by a mobile asthma clinic in 2 cities in Puerto Rico was conducted. The participants completed an asthma and rhinitis survey. Self-reported asthmatics answered the age-appropriate Spanish version of the ACT. Peak flows (PEF) were measured. Subjects were skin-tested against the common local aeroallergens. The study was approved by the University of Puerto Rico's IRB. RESULTS: We evaluated data from 70 subjects aged 4 to 68. Of them, 82.85% were 12 years old or older, 64.3% reported having a history of asthma, 57.14% reported that they still suffered from asthma, 81.4% reported that they suffered from rhinitis, and 78.57% were sensitized to at least 1 antigen. The mean ACT score of current asthmatics was 18.97, while that of past asthmatics was 23.83 (p = 6.6e-6). The variability of PEF increased as the ACT score increased. Age had no impact on asthma control (p > 0.25), while the effect of PEF on the control of asthma was tied to gender. Rhinitis was also associated with poor asthma control as defined by the ACT score. No other covariate was found to be statistically significant (p < 0.05). CONCLUSION: Our study supports the use of the ACT to evaluate asthma control in asthmatics living in Puerto Rico. Research into factors associated with poor asthma control, and the importance of rhinitis with regard to such control, is needed.

Allergen sensitivity (mites, insects, and pets) in a Puerto Rican population.

OBJECTIVE: The people of Puerto Rico have one of the highest asthma prevalence and morbidity rates in the U.S.A. Limited information is available on the most common allergy sensitivities among island residents. The aims of the study were to determine the most common inhalant allergen sensitivities among a convenience sample in Puerto Rico and determine as well their relationship to an asthma or a rhinitis diagnosis. METHODS: In August of 2008, we evaluated a cohort of subjects visiting ambulatory clinics offering health screening; the clinics were located in two of the island's biggest cities: Guaynabo in the north and Ponce in the south. Subjects over three years of age (or their parents) visiting the clinics answered a survey on asthma and rhinitis and were skin tested for reactivity to common aeroallergens. RESULTS: The survey included 395 subjects with a mean age of 29 years. Thirty-six percent reported a history of asthma, of whom 83% (30% of the total participants) reported still having asthma, and 76% reported having rhinitis. Sixty-five percent of the subjects were sensitive to at least one antigen. Subjects sensitive to mites were 53% more likely to have suffered from asthma than were non-mite-sensitized subjects (OR = 1.53, p < 0.05) sensitivity to mosquitoes (OR = 2.25, p < 0.02), mites (OR = 2.53, p < 0.00001), feathers (OR = 2.72, p < 0.03), dogs (OR = 3.02, p < 0.01), or cats (OR = 3.42, p < 0.001) increased an individual's likelihood of suffering from rhinitis. CONCLUSION: The most common sensitivities identified were to mites and insects. Mite sensitivity was associated with rhinitis and asthma. Sensitivity to animal dander as well as to mosquitoes was associated to with rhinitis. Further studies are warranted to explore the relevance of allergen sensitivity in terms of asthma and rhinitis prevalence and morbidity among residents of Puerto Rico.

Allergist role in asthma care in Puerto Rico.

INTRODUCTION: Puerto Ricans have one of the highest asthma prevalence and morbidity rates. However, limited information is available on asthma care and attitudes toward asthma treatment among Puerto Ricans living in the island. METHODS: We evaluated a cohort of subjects attending Ambulatory Health Screen Clinic in the two main cities in the north and south of the island during August of 2008. Subjects attending the clinic answered a survey about asthma care and attitudes toward asthma treatment. Approval was obtained from the Medical Sciences IRB and written informed consent obtained from all research subjects before enrollment. RESULTS: According to subject report, asthma care is primarily conducted by primary care physicians including pediatricians (35.8%), general practitioners (31.4%), and family physicians (4.3%). Pulmonary physicians conducted 23.3% of asthma care and allergists conduct 3.6%. Only 65.5 % reported using prescribed asthma medications. Fear of medication side effects (37.7%), lacks of health insurance coverage (26.4%), and medication cost (15.1%) were the most common causes reported for poor compliance. Subjects considered that physicians were one of the best sources (68.1%) for information on asthma, followed by the TV (23.7%) and the web (15.4%). CONCLUSIONS: Most asthma care in Puerto Rico is conducted by primary care providers. Subspecialists have a limited role and particularly allergists. Efforts to increased public and physician awareness of the role of allergists in asthma care in Puerto Rico are warranted.

Episodic laryngeal dyskinesia in an adolescent presenting as acute laryngotracheitis

Se presenta el caso de uma niña de 15 años de edad con manifestaciones clínicas intermitentes de laringotraqueobronquitis aguda y disfonía. Los síntomas mejoraban durante el sueño y por esta razón se sospecho el diagnóstico de discinesia laríngea epsódica de etiología no orgánica. Los exámenes endoscópicos demostraron la aducción de las cuerdas vocales en inspiración con la enferma despierta y la ausencia del trastorno cuando se le practicó la endoscopía con anesthesia general. La espirometría en lazo permitió verificar la obstrucción inspiratoria. La evaluación sicológica fue compatible con un estado de depresión mental. La sicoterpia y logoterapia contribuyeron ulteriormente a mejorar los síntomas. Se reclaca la importancia de sospechar y reconocer la discinesia laríngea epsódica para ofrecer prontamente el tratamiento correcto y evitar realizar pruebas de diagnóstico excesivas, innecesaias y costosas, además de los tratamientos excesivas, innecesarias y costosas, además de los tratamientos inútiles, drásticos y potencialmente iatrógenos tales como la traqueostomía y los corticosteroides a largo plazo