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Aim: To identify the level of non-pharmacological care received by middle-aged adults with current asthma in Australia and to identify its association with clinical measures. Methods: The Tasmanian Longitudinal Health Study (TAHS) is a population-based cohort first studied in 1968 (n = 8583). In 2010, when participants were aged 49 years, a stratified sample enriched for asthma and bronchitis underwent clinical assessments including respiratory questionnaires and lung function testing (n = 836). Current asthma was defined as self-reported asthma symptoms and/or healthcare utilization in the last 12 months. Multivariable linear regression and log-binomial models were used to assess the relevant associations. Results: Of the entire TAHS cohort, 15.6% (95% CI 13.4–18.2%) had current asthma. Of these, 37.9% (95% CI 30.5–45.9%) had seen a general practitioner for their asthma and 16.5% (95% CI 11.5–23.1%) had discussed their asthma with a pharmacist in the last 12 months. Written asthma action plans (AAPs) were reported by 17.9% (95% CI 12.9–23.2%), verbal AAPs by 53.8% (95% CI 45.9–61.6%) and doctor-assessments of inhaler technique by 42.7% (95% CI 35.2–50.5%). Adults with asthma of greater severity were more likely to have received verbal AAPs (p-trend =0.02). In contrast, adults with lower spirometry were more likely to have received verbal AAPs (p = 0.04), written AAPs (p = 0.001) and education on inhaler technique (p = 0.04). Conclusion: Despite an established evidence base and recommendations in local and international guidelines, non-pharmacological asthma management remains sub-optimal in the middle-aged adult asthma population. [ABSTRACT FROM AUTHOR]

Objective: Atopy is associated with asthma, but cross-sectional studies suggest this association may be weaker in older adults. It remains unclear if atopy predicts asthma later in adult life. We aimed to investigate whether atopy in young adults predicted asthma 20 years later and to quantify the contemporaneous relationship of atopy and asthma as adults age. Methods: Participants of the European Community Respiratory Health Survey (ECRHS) in Melbourne aged 20-44 years were followed for 20 years and completed questionnaires, skin prick tests (SPT) and allergen specific immunoglobulin E measurement at a baseline and two subsequent surveys. Using logistic regression and generalized estimating equations, we tested if atopy at baseline predicted current asthma later in life and estimated the association between current atopy measured at each survey and current asthma, while adjusting for potential confounders. Results: The analysis included 220 participants: 50.9% male. Mean (SD) age at baseline was 35.7 (5.7) years. Asthma and atopy prevalence remained stable over 20 years. Baseline atopy (SPT) was associated with current asthma (OR 9.74, 95%CI 4.22, 22.5) over 20 years, and current atopy (SPT) with concurrent asthma (3.12; 1.70, 5.74). Conclusions: Atopy remains strongly associated with current asthma in 40 to 64 year-old adults, both prospectively and contemporaneously, but the prospective association is stronger. [ABSTRACT FROM AUTHOR]

Background: Perinatal events can influence the development of asthma in childhood but current evidence is contradictory concerning the effects on life-time asthma risk. Objective: To assess the relationship between birth characteristics and asthma from childhood to adulthood. Methodology: All available birth records for the Tasmanian Longitudinal Health Study (TAHS) cohort, born in 1961 were obtained from the Tasmanian State Archives and Tasmanian hospitals. Low birth weight (LBW) was defined as less than 2500 grams. Preterm birth was defined as delivery before 37 weeks' gestation. Small for gestational age (SGA) was defined as a birth weight below the 10th percentile for a given gestational age. Multivariate logistic and cox regression were used to examine associations between birth characteristics and lifetime risk of current and incident asthma, adjusting for confounders. Results: The prevalence of LBW was 5.2%, SGA was 13.8% and preterm was 3.3%. LBW (OR = 1.65, 95%CI 1.12,2.44) and preterm birth (OR = 1.81, 95%CI 0.99, 3.31) were both associated with an increased risk of current asthma between the ages of 7 to 43 years. There was no association between SGA and current asthma risk. However, SGA was associated with incident asthma (HR = 1.32, 95%CI 1.00, 1.74), and there was an interaction with sex (p value = 0.08), with males having a greater risk of incident asthma (HR = 1.70, 95%CI 1.16–2.49) than females (HR = 1.04, 95%CI 0.70–1.54). Conclusions: Preterm birth and LBW were associated with an increased risk of current asthma into middle-age. These findings are the first to demonstrate the continuing impact of these characteristics on asthma risk into middle-age. [ABSTRACT FROM AUTHOR]

Purpose: To assess misclassification in adults reporting childhood asthma. Methods: The Tasmanian Asthma Survey commenced in 1968 when 8,583 7-year-old children attending school in Tasmania (participants) were studied. In 1991–1993, a stratified sample of 1,494 participants was studied. Their recall of childhood asthma was compared to their parents' prospectively gathered report. Results: Where participants had childhood asthma, those with current asthma, severe eczema, or hay fever were less likely to misclassify while females were more likely to misclassify. Where participants had no childhood asthma, misclassification was associated with current asthma, hay fever, or allergies. Conclusions: Retrospective self-assessment of childhood asthma is unreliable. [ABSTRACT FROM AUTHOR]

Adjustment for psychosocial and family problems is common in epidemiological research. Recursive partitioning algorithms, such as CHi Square Automatic Interaction Detection (CHAID), can be used to explore complex interactions between these factors and predictor and outcome variables. We investigated the nature of interactions between asthma management variables and psychosocial problems and how these interactions changed the risk of asthma mortality; 50 cases of asthma death and 201 emergency department controls were recruited. A validated questionnaire was used to collect data. An extended version of CHAID was used to identify statistically significant ( p = 0.05) interactions controlling for asthma severity. Family problems were associated with increased risk of mortality for patients aged > 31 years (OR = 6.5; 95% CI 2.6–16.1) but not for younger patients. Males were at increased risk overall, but females with family problems (OR = 4.3; 95% CI 1.7–10.7) were at greater risk then males (OR = 3.1; 95% CI 1.2–7.9) with family problems. Alcohol use increased risk of mortality for individuals with verbal instructions (OR = 5.4; 95% CI 1.5–19.5) or without a written action plan (OR = 4.4; 95% CI 1.0–19.4). Individuals with severe asthma and who reported having lung function tests were at increased risk for mortality if family (OR = 8.2; 95% CI 1.6–41.6) or financial problems (OR = 11.5; 95% CI 2.0–65.9) were present. This analysis highlights some important interactions and the magnitude of additional risk for mortality associated with psychosocial or family problems. Psychosocial problems need to be identified and addressed as part of asthma management, because even with best practice, these problems place patients at an increased risk of dying. [ABSTRACT FROM AUTHOR]