Thirty-one adult patients with asthma caused by house-dust mites (HDM) were included in this placebo-controlled, double-blind study to evaluate the efficacy and safety of specific immunotherapy (SIT) with biologically standardized extracts of HDM. The specific diagnosis was confirmed by skin prick tests, specific IgE, and bronchial provocation tests with HDM allergens. The patients were randomized to receive active treatment with extracts of either Dermatophagoides pteronyssinus (Dpt) or D. farinae (Dfa) (Alutard SQ, ALK, Denmark) or placebo injections. Twenty-three patients completed the study. After 1 year of treatment, we found a clinically important and significant reduction in both asthma medicine consumption (inhaled steroids 38% and beta 2-agonists 46%) and symptom score (57%) in the actively treated group, but not the placebo group. These findings were confirmed by a significant decrease in skin and bronchial sensitivity to HDM in the active group. Additionally, there was a significant difference in the patients' scores for effect in favor of the actively treated group. Total IgE and specific IgE to HDM showed no significant changes before and after treatment for either group. Spirometric lung-function measurements showed a significant increase in forced expiratory volume in 1 s (FEV1) from 85% before to 89% of predicted values after treatment for the actively treated group. Peak-flow measurements at home showed no significant changes during the study. It is concluded that allergen SIT is an effective treatment in adult patients suffering from asthma due to HDM.
INTRODUCTION: The aim of this study was to evaluate adult patients examined in general practice on suspicion of having asthma. MATERIALS AND METHODS: A total of 46 patients suspected of having asthma underwent a second specialist investigation, which demonstrated that 28 of them had asthma. Through interviews of patients and a questionnaire completed by the primary physician, information on diagnostic strategy, general practice diagnosis, suggested treatments and patients' knowledge about asthma was determined. RESULTS: In 65% of the patients investigated for possible asthma in general practice, the specialist examination did not provide any major suggestions for changes, while one in every three patients would have benefited from a secondary specialist examination. The largest group was 7 of 18 patients who did not have asthma but who suffered from chronic or recurrent symptoms. Also, one in four of the patients with a final diagnosis of asthma would have benefited from a specialist examination because of uncertain diagnosis, disease severity and/or the possibility of allergen-specific treatment. The medical treatments suggested by the general practitioners followed modern treatment principles. Just over half of the patients with a final specialist diagnosis of asthma were familiar with the basic disease mechanisms, but only 7% of them would change their therapy in relation to disease severity without first contacting their physicians. CONCLUSION: Patients with chronic or recurrent symptoms should be referred to specialists more often, and patients who could potentially benefit from allergen-specific treatment, such as allergen prevention, should be evaluated by an allergy specialist. There is a need for increased patient education.
A telephone survey was conducted of all the 71 Danish hospitals with the capacity to receive acutely ill medical patients. The purpose was to register treatment regimes used in acute asthma and exacerbations in chronic obstructive pulmonary disease (COPD). The house officer on duty was interviewed and questioned about the use of nebulizers, oxygen therapy, bronchodilators, steroids, theophyllins and monitoring of the patient's condition. The physician survey was supplemented by a smaller survey among emergency room nurses about nebulizing systems. The answers showed inadequate knowledge of nebulizing systems. There was a noticeable variation in the dosing of oxygen and in the dosing of bronchodilators and steroids. beta 2-agonist treatment by nebulizer differed with a factor 14 in dose. The majority of the physicians had no specific parameters for monitoring severity of disease. CONCLUSION: There is a need for improvement of the knowledge of nebulizing systems, including specific knowledge of the appropriate use of propellant gasflow and time of nebulizing for optimum performance of the used nebulizer. Divergent answers from the nurses and the physicians show the need for interdisciplinary instruction. The noticeable variation in treatment in this Danish survey displays a need for quality control in terms of concise guidelines for medical therapy in acute exacerbations of asthma and COPD and guidelines for monitoring of the response to the treatment. A suggestion for a treatment regime is proposed.