The Journal of asthma : official journal of the Association for the Care of Asthma
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Allergen-specific sublingual immunotherapy is now recognized to be an efficacious and well-tolerated treatment for allergic rhinitis. Emerging treatment strategies are also aimed at the primary treatment of allergic asthma, particularly allergy to house dust mites. ⋯ An improved understanding should allow the development of more effective treatment programs and widen the potential use of this form of immunotherapy. This review discusses the possible mechanism of action of sublingual immunotherapy, including data from animal and clinical studies, while comparing this with the current understanding of subcutaneous immunotherapy.
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Asthma disproportionately affects minorities, but not enough is known about morbidity and specialist access in asthmatic minority children. ⋯ Urban minority children with asthma average 1 asthma symptom daily, 1 exacerbation monthly, and 7 missed school days, 6 missed parental work days, 3 ED visits, and 1 hospitalization yearly; most receive their usual asthma care in EDs and have no asthma care plan or asthma specialist. Urban minority asthmatic children need interventions to reduce morbidity and improve access to specialists and asthma care plans, especially among the poor and African-Americans.
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Methacholine challenge (MCC) is an important diagnostic tool for asthma, especially in patients in whom routine pulmonary function testing (PFT) is normal or equivocal. The basis for a positive test per American Thoracic Society (ATS) guidelines is a methacholine concentration < or = 16 mg/mL that causes a 20% decrease in forced expiratory volume in 1 second (FEV(1)) (termed the PC20 for FEV(1)). There is little information in the medical literature that utilizes other flow rates during MCC, including small airway function parameters such as the forced expiratory flow rate 25-75% (FEF(25-75)). We question whether the FEF(25-75) may be a useful parameter to monitor during MCC and whether it may be predictive of a positive MCC. ⋯ The FEF(25-75) and its decline during a MCC appear to be useful information and potentially predictive of a positive MCC. We suggest that the forced expiratory flow rate 25-75% (FEF(25-75)) be considered as an adjunct to the FEV(1) to define a positive study.
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Randomized Controlled Trial
Self-management plans for asthma control and predictors of patient compliance.
To evaluate the impact of peak flow or symptom-based self-management plans on asthma control and patients' quality of life and to determine the main psychosocial factors that affect compliance with these plans. ⋯ Introduction of self-management plans improved illness control and quality of life in asthma patients. Use of the PFM and the presence of higher RIELCS and lower BDI scores can be used to predict compliance with the action plans.
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Lack of discussion regarding actual asthma medication use by physicians with caregivers of children with asthma may result in low caregiver and physician concordance about prescribed asthma medications. ⋯ Caregiver and PCP concordance was significantly associated with increased number of PCP visits suggesting that increased exposure to a health care provider may increase agreement between a child's PCP and caregiver regarding prescribed asthma medications. However, there may be other important factors including increased emergency department visits that may also be associated with subsequent pediatric primary care visits for asthma.