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Background The determinants linked to the short- and long-term improvement in lung function in patients with severe eosinophilic asthma (SEA) on biological treatment (BioT) remain elusive. Objective We sought to identify the predictors of early and late lung function improvement in patients with SEA after BioT. Methods 140 adult patients with SEA who received mepolizumab, dupilumab, or reslizumab were followed up for 6 months to evaluate improvement in forced expiratory volume in one second (FEV.sub.1). Logistic regression was used to determine the association between potential prognostic factors and improved lung function at 1 and 6 months of treatment. Results More than a third of patients with SEA using BioT showed early and sustained improvements in FEV.sub.1 after 1 month. A significant association was found between low baseline FEV.sub.1 and high blood eosinophil count and sustained FEV.sub.1 improvement after 1 month (0.54 [0.37-0.79] and 1.88 [1.28-2.97] odds ratios and 95% confidence interval, respectively). Meanwhile, among patients who did not experience FEV.sub.1 improvement after 1 month, 39% exhibited improvement at 6 months follow-up. A high ACT score measured at this visit was the most reliable predictor of late response after 6 months of treatment (OR and 95% CI 1.75 [1.09-2.98]). Conclusion Factors predicting the efficacy of biological agents that improve lung function in SEA vary according to the stage of response., Author(s): Duong Duc Pham [sup.1], Ji-Hyang Lee [sup.1], Hyouk-Soo Kwon [sup.1], Woo-Jung Song [sup.1], You Sook Cho [sup.1], Hyunkyoung Kim [sup.1], Jae-Woo Kwon [sup.2], So-Young Park [sup.3], Sujeong Kim [sup.4], [...]

Asthma is still a major cause of morbidity and mortality. Patients who use hospital services frequently tend to have more severe asthma and lack formal support. Attitudes to self-management also tend to differ and qualitative studies of frequent attenders have identified differing views of the appropriateness of service use between patients and their physicians. We undertook a qualitative study of patients with severe asthma admitted and not admitted to hospital in a 12-month period in the UK. The aim of the study was to investigate the relationship between perception of life events, psychosocial factors, coping and asthma admission in these two groups of patients. We interviewed 50 patients (aged 16 and over) admitted to two large teaching hospitals in London with asthma exacerbations, 25 patients with similar levels of asthma severity (step 3 or higher of the British Thoracic Society guidelines) sampled in General Practice and 19 general practitioners (GPs). Data were analysed using an adapted framework analysis. Patients admitted to hospital reported high levels of psychosocial problems and life events but tended to make few connections between these and their asthma attacks or their ability to manage their asthma. Patients reporting frequent hospital use tended to value professionals working in hospitals while reporting poor relationships with GPs; views that appeared related to delays in seeking help from primary care. Among GPs, knowledge of patients having attended hospital was generally poor, although they appeared more aware of those who were high users of General Practice (whether they were high attenders at hospital or not). GPs perceived stressful life events in patients with asthma to compound existing dispositions and be related to poor control and poor adherence. These findings suggest that vulnerable patient groups often face poor material circumstances and chaotic lives, impacting on their capacity to manage their illness and on their ability to derive benefit from primary care. Policy interventions aimed at reducing 'unnecessary' admissions will need to be tailored to the psychosocial circumstances and health beliefs of vulnerable patient groups. Keywords: UK; Asthma; Psychosocial; Chronic illness; Primary care; Use of health services

Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its c hronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process-clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings. Keywords: Australia; Asthma; Self-management model; Community pharmacists; Illness behaviour

The paper reviews the existing research related to asthma disparities and frames the results of this research within a conceptual model modified from the Institute of Medicine model in order to explain asthma health disparities in Latino children in the USA. The model of pediatric asthma disparity presented is based on the conceptualization of health disparities as the result of a complex interaction of factors related to four main domains: the individual and family, the environment or context in which the child lives, the health-care system, and provider characteristics. Asthma disparities are discussed as they are reflected in the process of care (access and quality of treatment) and outcome prevalence, morbidity, severity) experienced by Latino children. The potential mechanisms that may account for the asthma disparities documented as reflected by the conceptual model proposed are discussed. Finally, several suggestions for future research examining determinants that account for asthma disparities are examined. Keywords: Cultural beliefs; Health-care system; Health disparities; Latino; Asthma; Treatment; Children; USA

Objective: To identify the resources used and the costs incurred by people with asthma for health care and non-health care products and services to manage asthma. Methods: A prospective, longitudinal study, using self-reported and administrative data, commenced in 2001 in New South Wales (NSW). Data sources included two six-monthly surveys, hospital admission data from NSW Health, and pharmaceutical benefits and Medicare data. A cohort of 245 people with asthma, aged between 5-75 years, was recruited from the general population and from hospital emergency departments. The study measured the use and cost of health care services and products, including alternative therapies and home modifications. Costs to both the health care system and individuals were measured. Results: General practitioner visits and asthma medications were the items of health care most commonly used. Medications were also the largest component of individual costs for health care in terms of the average payment and the number of people facing an out-of-pocket cost, although home equipment and modifications were the most expensive individual items. The distribution of individual costs was highly skewed, ranging from $0 to $4,882 per person per annum (median $89). Admitted hospital care was the largest component of the cost to the health care system. Conclusion: While individual costs were not large for the majority, some people faced substantial costs, with the highest of these being for non-health care items. Implications: Asthma management policies may need to incorporate schemes to alleviate the impact of costs for the minority experiencing significant out-of-pocket expenses.

Attendance for general practitioner (GP) care of childhood asthma varies widely in New Zealand (NZ). There is little current research to account for the variations, although groups such as Maori and Pacific peoples have traditionally faced barriers to accessing GP care. This paper aims to describe and account for attendance levels for GP asthma care among 6-9 year-olds with moderate to severe asthma in Auckland, NZ. During 2002, randomly selected schools identified all 6-9 year-olds with possible breathing problems. Completion of a questionnaire by each parent/guardian indicated which children had moderate to severe asthma, and what characteristics influenced their access to GP asthma care. A multilevel, negative binomial regression model (NBRM) was fitted to account for the number of reported GP visits for asthma, with adjustment for clustering within schools. Twenty-six schools (89.7 percent) identified 931 children with possible breathing problems. Useable questionnaires were returned to schools by 455 children (48.9 percent). Results indicated 209 children with moderate to severe asthma, almost one in every three reportedly making 5 or more GP visits for asthma in the previous year. Maori, Pacific and Asian children were disproportionately represented among these 'high attendees'. Low attendees (0-2 visits) were mainly NZ Europeans. The NBRM (n = 155) showed that expected visits were increased by perceived need, ill-health, asthma severity and, in particular, Maori and Pacific child ethnicity. It may be that Maori and Pacific children no longer face significant barriers to accessing GP asthma care. However, more likely is that barriers apply only to accessing routine, preventative care, leading to poor asthma control, exacerbations requiring acute care, and paradoxically an increase in GP visits. That barriers may increase total numbers of visits challenges the assumption, for all health systems, that access can be defined in terms of barriers that must be overcome to obtain health care. Keywords: Health services utilisation; Primary health care; Children; Asthma; Ethnicity

Case report on sublingual hematoma formation in a 56-year-old man, allergic to penicillin and has history of asthma is reported. It is suggested that surgeon should be well versed and necessary complications should be explained to the clinicians.

Several behavioral medicine interventions (eg, relaxation training and written emotional expression) have been proposed as effective supplemental treatments for individuals with chronic illnesses such as asthma. Whether these treatments are feasible or effective in a manual-based, self-administered format is unclear, and few studies have examined the effectiveness of such treatments presented in a complementary format. We examined the feasibility and effectiveness of a 4-week stress management treatment compared with a matched placebo intervention in young adults with asthma. Both groups considered the workbooks credible treatment interventions and completed them conscientiously. The treatment group showed significant improvement in measures of lung function compared with the placebo group, but analysis revealed no differences in measures of perceived stress. These findings provide initial support for the feasibility of self-administered manual-based interventions and some evidence that they can produce health benefits in individuals with asthma and, perhaps, other chronic conditions. Index Terms: asthma, clinical trial, manual, workbook, writing, For more than a decade, researchers have examined the use of stress-management interventions (1) as supplementary treatments for people with chronic and life-threatening illnesses. These interventions, proposed in an attempt [...]

This article investigates potential mediators of the beneficial effects of structured writing about stress on symptomatology in asthma and rheumatoid arthritis patients. Results indicate that potential mediators such as sleep quality, affect, and medication use did not influence the health benefits gained from structured writing.

Background: In 1991, an intervention trial of the efficacy of an asthma self-management plan was carried out in partnership with a rural Maori community. The program relied on Maori community health workers and other health professionals working in partnership, was delivered through clinics in traditional Maori community centres and Maori processes were followed throughout. The plan was shown to be effective in reducing asthma morbidity. Objective: To assess whether the long-term benefits of the program extend beyond reduced asthma morbidity and the extent to which any additional benefits may be related to the partnership approach employed by the program. Method: Forty-seven (68%) of the original program participants were surveyed in August 1997. Participants were questioned on the program's impact in areas such as cultural development, health service access and lifestyle. Results: In addition to the improvements in asthma morbidity, the program was found to have four key benefits: cultural affirmation; improved access to other health services; a greater sense of control for participants; and positive impacts on the extended family. Conclusions: The program's benefits extended beyond reduced asthma morbidity and were not due simply to the introduction of the asthma self-management plan but also to the partnership approach employed by the program. Implications: The study provides support for providing public health services for indigenous communities that take a partnership approach, utilise community expertise and are delivered in a way that is consistent with each community's cultural processes.