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Accuracy of a first diagnosis of asthma in primary health care.

https://arctichealth.org/en/permalink/ahliterature15359
Source
Fam Pract. 2002 Aug;19(4):365-8
Publication Type
Article
Date
Aug-2002
Author
Peter Montnémery
L. Hansson
J. Lanke
L-H Lindholm
P. Nyberg
C-G Löfdahl
E. Adelroth
Author Affiliation
Department of Clinical Neuroscience/Division of Occupational Therapy, PO Box 157, Umeå University, SE-221 00 Lund, Sweden. peter.montnémery@arb.lu.se
Source
Fam Pract. 2002 Aug;19(4):365-8
Date
Aug-2002
Language
English
Publication Type
Article
Keywords
Adult
Asthma - diagnosis - epidemiology
Family Practice
Humans
Prevalence
Primary Health Care
Research Support, Non-U.S. Gov't
Sensitivity and specificity
Sweden - epidemiology
Abstract
BACKGROUND: In a postal questionnaire study, the prevalence of asthma in southern Sweden has been found to be 5.5%. However, the register prevalence of asthma obtained from the medical records in the same municipality and age groups was found to be only 2.1%. OBJECTIVES: The aims of the study were to investigate whether the low register prevalence of asthma was caused by an underdiagnosis of asthma in primary health care and to validate a first diagnosis of asthma set by GPs in primary health care. METHODS: During a period of 3 months in 1997, all patients seeking care in the primary health care units of the municipality of Lund (population 171 877) with upper or lower airway infections, prolonged cough, allergic rhinitis, fatigue or a first positive diagnosis of asthma were recorded ( n = 3025). RESULTS: In the whole group of 3025 patients, 99 patients were found to have received a diagnosis of asthma for the first time during the study period. The diagnosis was verified in 52 of those 68 patients who attended a follow-up and examination by a respiratory physician. Among the remaining 2926 patients, 221 patients were selected randomly to constitute a control group. In this group, three patients were found to have asthma. Thus, the specificity of an asthma diagnosis set in primary health care was 0.99 [95% confidence interval (CI) 0.99-1.00] and the sensitivity was 0.59 (95% CI 0.31-0.81). CONCLUSIONS: The GPs in this study were good at excluding those who did not have asthma (specificity 99%) but less good in correctly diagnosing those who actually had current asthma (sensitivity 59%), which suggests an underdiagnosis of asthma.
PubMed ID
12110556 View in PubMed
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Acute and chronic respiratory symptoms among primary care patients who smoke crack cocaine.

https://arctichealth.org/en/permalink/ahliterature118607
Source
J Urban Health. 2013 Jun;90(3):542-51
Publication Type
Article
Date
Jun-2013
Author
Pamela Leece
Nikhil Rajaram
Susan Woolhouse
Margaret Millson
Author Affiliation
Public Health and Preventive Medicine Residency Program, University of Toronto, Toronto, Ontario, Canada.
Source
J Urban Health. 2013 Jun;90(3):542-51
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Adult
Asthma - diagnosis - epidemiology - etiology
Confounding Factors (Epidemiology)
Crack Cocaine
Female
Health Surveys
Humans
Male
Middle Aged
Ontario - epidemiology
Pilot Projects
Prevalence
Primary Health Care
Pulmonary Disease, Chronic Obstructive - diagnosis - epidemiology - etiology
Smoking - adverse effects - epidemiology
Substance-Related Disorders - complications
Abstract
Among inner-city populations in Canada, the use of crack cocaine by inhalation is prevalent. Crack smoking is associated with acute respiratory symptoms and complications, but less is known about chronic respiratory problems related to crack smoking. There is also a gap in the literature addressing the management of respiratory disease in primary health care among people who smoke crack. The purpose of our study was to assess the prevalence of acute and chronic respiratory symptoms among patients who smoke crack and access primary care. We conducted a pilot study among 20 patients who currently smoke crack (used within the past 30 days) and who access the "drop-in clinic" at an inner-city primary health care center. Participants completed a 20- to 30-min interviewer-administered survey and provided consent for a chart review. We collected information on respiratory-related symptoms, diagnoses, tests, medications, and specialist visits. Data were analyzed using frequency tabulations in SPSS (version 19.0). In the survey, 95 % (19/20) of the participants reported having at least one respiratory symptom in the past week. Thirteen (13/19, 68.4 %) reported these symptoms as bothersome. Chart review indicated that 12/20 (60 %) had a diagnosis of either asthma or chronic obstructive pulmonary disease (COPD), and four participants (4/20, 20 %) had a diagnosis of both asthma and COPD. Majority of the participants had been prescribed an inhaled medication (survey 16/20, 80 %; chart 12/20, 60 %). We found that 100 % (20/20) of the participants currently smoked tobacco, and 16/20 (80 %) had smoked both tobacco and marijuana prior to smoking crack. Our study suggests that respiratory symptoms and diagnoses of asthma and COPD are prevalent among a group of patients attending an inner-city clinic in Toronto and who also smoke crack. The high prevalence of smoking tobacco and marijuana among our participants is a major confounder for attributing respiratory symptoms to crack smoking alone. This novel pilot study can inform future research evaluating the primary health care management of respiratory disease among crack smokers, with the aim of improving health and health care delivery.
Notes
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PubMed ID
23188552 View in PubMed
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Acute asthma: observations regarding the management of a pediatric emergency room.

https://arctichealth.org/en/permalink/ahliterature230989
Source
Pediatrics. 1989 Apr;83(4):507-12
Publication Type
Article
Date
Apr-1989
Author
G J Canny
J. Reisman
R. Healy
C. Schwartz
C. Petrou
A S Rebuck
H. Levison
Author Affiliation
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Source
Pediatrics. 1989 Apr;83(4):507-12
Date
Apr-1989
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Asthma - diagnosis - epidemiology - therapy
Child
Child, Preschool
Emergency Service, Hospital - standards - utilization
Female
Humans
Infant
Infant, Newborn
Male
Ontario
Recurrence
Retrospective Studies
Seasons
Abstract
Because inadequate assessment and inappropriate treatment of acute asthma have been implicated as contributing factors in morbidity and even deaths, the management of acute asthma, as practiced in an emergency room, were reviewed. The study population comprised 1,864 children (mean age 5.6 years; 65% boys) who attended the emergency room with acute asthma on 3,358 occasions during a 16-month period. Visits occurred more commonly in winter and usually in the evenings; 93% were self-referred and the mean duration of symptoms was 41 hours. Most acute episodes were associated with infection. Although chest auscultation, heart rate, and respiratory rate were recorded during the majority of visits, evidence that pulsus paradoxus had been measured could be found for only 1% of visits. Results of lung function and blood gas values were rarely recorded, but chest radiographs were obtained in 18% of visits. Drugs used in the emergency room included beta 2-agonists (93% of visits), theophylline (16%), and systemic steroids (4%), but no child received anticholinergic therapy. In 26% of patient visits, admission to hospital occurred; one patient died. The erratic fashion in which asthma severity appears to have been assessed and the failure to document whether lung function had been measured are causes for concern. The surprisingly high hospitalization rate may have been avoided if bronchodilators and corticosteroids had not been underused in the emergency room.
PubMed ID
2927989 View in PubMed
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Adult-onset asthma and occupational exposures.

https://arctichealth.org/en/permalink/ahliterature15626
Source
Scand J Work Environ Health. 1999 Oct;25(5):430-5
Publication Type
Article
Date
Oct-1999
Author
K. Torén
B. Järvholm
J. Brisman
S. Hagberg
B A Hermansson
L. Lillienberg
Author Affiliation
Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. Kjell.Toren@ymk.gu.se
Source
Scand J Work Environ Health. 1999 Oct;25(5):430-5
Date
Oct-1999
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Age of Onset
Air Pollutants, Occupational - adverse effects - classification
Asthma - diagnosis - epidemiology - etiology
Comparative Study
Confidence Intervals
Cross-Sectional Studies
Dust - adverse effects - analysis
Female
Humans
Incidence
Logistic Models
Male
Middle Aged
Occupational Exposure - adverse effects - analysis - statistics & numerical data
Odds Ratio
Population Surveillance
Research Support, Non-U.S. Gov't
Retrospective Studies
Risk factors
Sampling Studies
Sex Distribution
Sweden - epidemiology
Abstract
OBJECTIVES: This study examined certain occupational exposures and the risk for adult-onset asthma. METHODS: A nested case-referent study of adult-onset asthma was performed on a random population sample (N=15813), aged 21 to 51 years. Cases for the study included 2 groups: subjects reporting "physician-diagnosed" asthma (N=251) and a broader "asthma" group (N=362). The "asthma" group consisted of subjects with "physician-diagnosed" asthma (N=251) and subjects reporting asthma-like symptoms without having "physician-diagnosed" asthma (N=111). The referents (N=2044) were randomly selected from the whole population sample. The case-referent sample was investigated with a comprehensive questionnaire about occupational exposures, asthma, respiratory symptoms, smoking, and atopy. Odds ratios were calculated with stratification for gender, year of diagnosis, and birth year. RESULTS: The highest odds ratio for "physician-diagnosed" asthma was associated with exposure to flour dust [odds ratio (OR) 2.8, 95% confidence interval (95% CI) 1.5-5.2] and the occupational handling of resin-based paints (isocyanates) (OR 3.0, 95% CI 1.6-5.9). Exposure to welding fumes, textile dust, and work with glues containing acrylates was also associated with an increased odds ratio for "physician-diagnosed" asthma. Including persons with asthma-like symptoms (ie, the asthma group) showed similar results. CONCLUSION: This population-based case-referent study from Sweden indicates that occupational exposure to acrylate-based compounds and welding fumes is associated with increased risk for adult-onset asthma.
PubMed ID
10569463 View in PubMed
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Age-specific incidence of allergic and non-allergic asthma.

https://arctichealth.org/en/permalink/ahliterature307361
Source
BMC Pulm Med. 2020 Jan 10; 20(1):9
Publication Type
Journal Article
Date
Jan-10-2020
Author
Johanna Pakkasela
Pinja Ilmarinen
Jasmin Honkamäki
Leena E Tuomisto
Heidi Andersén
Päivi Piirilä
Hanna Hisinger-Mölkänen
Anssi Sovijärvi
Helena Backman
Bo Lundbäck
Eva Rönmark
Hannu Kankaanranta
Lauri Lehtimäki
Author Affiliation
Department of Respiratory Medicine, Tampere University Hospital, FIN-33521, Tampere, Finland. johanna.pakkasela@tuni.fi.
Source
BMC Pulm Med. 2020 Jan 10; 20(1):9
Date
Jan-10-2020
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Asthma - diagnosis - epidemiology
Child
Child, Preschool
Female
Finland - epidemiology
Humans
Incidence
Infant
Infant, Newborn
Male
Middle Aged
Prevalence
Rhinitis, Allergic - diagnosis - epidemiology
Surveys and Questionnaires
Young Adult
Abstract
Onset of allergic asthma has a strong association with childhood but only a few studies have analyzed incidence of asthma from childhood to late adulthood in relation to allergy. The purpose of the study was to assess age-specific incidence of allergic and non-allergic asthma.
Questionnaires were sent to 8000 randomly selected recipients aged 20-69?years in Finland in 2016. The response rate was 52.3% (n?=?4173). The questionnaire included questions on e.g. atopic status, asthma and age at asthma diagnosis. Asthma was classified allergic if also a physician-diagnosed allergic rhinitis was reported.
The prevalence of physician-diagnosed asthma and allergic rhinitis were 11.2 and 17.8%, respectively. Of the 445 responders with physician-diagnosed asthma, 52% were classified as allergic and 48% as non-allergic. Median ages at diagnosis of allergic and non-allergic asthma were 19 and 35?years, respectively. Among subjects with asthma diagnosis at ages 0-9, 10-19, 20-29, 30-39, 40-49, 50-59 and 60-69?years, 70, 62, 58, 53, 38, 19 and 33%, respectively, were allergic. For non-allergic asthma, the incidence rate was lowest in children and young adults (0.7/1000/year). It increased after middle age and was highest in older age groups (2.4/1000/year in 50-59?years old).
The incidence of allergic asthma is highest in early childhood and steadily decreases with advancing age, while the incidence of non-allergic asthma is low until it peaks in late adulthood. After approximately 40?years of age, most of the new cases of asthma are non-allergic.
PubMed ID
31924190 View in PubMed
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Allergen extract vs. component sensitization and airway inflammation, responsiveness and new-onset respiratory disease.

https://arctichealth.org/en/permalink/ahliterature287899
Source
Clin Exp Allergy. 2016 May;46(5):730-40
Publication Type
Article
Date
May-2016
Author
A. Patelis
M. Gunnbjornsdottir
K. Alving
M P Borres
M. Högman
C. Janson
A. Malinovschi
Source
Clin Exp Allergy. 2016 May;46(5):730-40
Date
May-2016
Language
English
Publication Type
Article
Keywords
Adult
Allergens - immunology
Animals
Asthma - diagnosis - epidemiology - immunology - metabolism
Biomarkers
Bronchial Provocation Tests
Cats
Exhalation
Female
Follow-Up Studies
Health Surveys
Humans
Immunization
Immunoglobulin E - immunology
Inflammation - diagnosis - epidemiology - immunology - metabolism
Inhalation Exposure
Male
Methacholine Chloride
Middle Aged
Nitric oxide
Respiratory Tract Diseases - diagnosis - epidemiology - immunology - metabolism
Rhinitis - diagnosis - epidemiology - immunology - metabolism
Sweden - epidemiology
Abstract
The absence of IgE sensitization to allergen components in the presence of sensitization to the corresponding extract has been reported, but its clinical importance has not been studied.
To evaluate the clinical significance of IgE sensitization to three aeroallergen extracts and the corresponding components in relation to the development of respiratory disease.
A total of 467 adults participated in the European Community Respiratory Health Survey (ECRHS) II and 302 in ECRHS III, 12 years later. IgE sensitization to allergen extract and components, exhaled nitric oxide (FeNO) and bronchial responsiveness to methacholine were measured in ECRHS II. Rhinitis and asthma symptoms were questionnaire-assessed in both ECRHS II and III.
A good overall correlation was found between IgE sensitization to extract and components for cat (r = 0.83), timothy (r = 0.96) and birch (r = 0.95). However, a substantial proportion of subjects tested IgE positive for cat and timothy allergen extracts but negative for the corresponding components (48% and 21%, respectively). Subjects sensitized to both cat extract and components had higher FeNO (P = 0.008) and more bronchial responsiveness (P = 0.002) than subjects sensitized only to the extract. Further, subjects sensitized to cat components were more likely to develop asthma (P = 0.005) and rhinitis (P = 0.007) than subjects sensitized only to cat extract.
Measurement of IgE sensitization to cat allergen components would seem to have a higher clinical value than extract-based measurement, as it related better to airway inflammation and responsiveness and had a higher prognostic value for the development of asthma and rhinitis over a 12-year period.
PubMed ID
26243058 View in PubMed
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Allergic diseases and asthma in the family predict the persistence and onset-age of asthma: a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature268440
Source
Respir Res. 2014;15:152
Publication Type
Article
Date
2014
Author
Elina M S Paaso
Maritta S Jaakkola
Aino K Rantala
Timo T Hugg
Jouni J K Jaakkola
Source
Respir Res. 2014;15:152
Date
2014
Language
English
Publication Type
Article
Keywords
Age of Onset
Asthma - diagnosis - epidemiology - genetics
Child
Child, Preschool
Female
Finland - epidemiology
Genetic Predisposition to Disease
Heredity
Humans
Hypersensitivity - diagnosis - epidemiology - genetics
Infant
Longitudinal Studies
Male
Odds Ratio
Pedigree
Phenotype
Prognosis
Prospective Studies
Risk assessment
Risk factors
Time Factors
Abstract
Family history of asthma and other allergic diseases have been linked to the risk of childhood asthma previously, but little is known about their effect on the age-of-onset and persistency of asthma until young adulthood.
We assessed the effect of the family history of asthma and allergic diseases on persistent vs. transient, and early- vs. late-onset persistent asthma in The Espoo Cohort Study 1991-2011, a population-based cohort study of 1623 subjects (follow-up rate 63.2%). The determinants were any family history (any parent or sibling); maternal; paternal; siblings only; parents only; and both siblings and parents. Analyses were conducted separately for asthma and allergic diseases while taking the other disease into account as a confounding factor. The outcomes were persistent, transient, early-onset persistent (
Notes
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Erratum In: Respir Res. 2015;16:3625849811
PubMed ID
25427760 View in PubMed
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Allergic disorders and immediate skin test reactivity in Finnish adolescents.

https://arctichealth.org/en/permalink/ahliterature245620
Source
Allergy. 1980 Jul;35(5):433-41
Publication Type
Article
Date
Jul-1980
Author
T. Haahtela
M. Heiskala
I. Suoniemi
Source
Allergy. 1980 Jul;35(5):433-41
Date
Jul-1980
Language
English
Publication Type
Article
Keywords
Adolescent
Allergens - diagnostic use
Asthma - diagnosis - epidemiology
Dermatitis, Atopic - diagnosis - epidemiology
Female
Finland
Humans
Male
Physical Exertion
Respiratory Tract Infections - immunology
Rhinitis - diagnosis - epidemiology
Skin Tests
Smoking
Abstract
We studied the prevalence of allergic disorders in an unselected group of 708 adolescents aged 15-17 years. All subjects were physically examined and interviewed by the authors. The prevalence of past or present asthma was 5.7% in boys and 3.1% in girls. The figures for hay fever were 14% and 8%, and for atopic dermatitis (including allergic urticaria) 25% and 30%, respectively. In 24% of all symptomatic subjects, the condition had not been active during the year preceding the study. The sex difference in the prevalence of hay fever was significant. It is associated with higher immediate skin test reactivity in boys. A progressive increase in the frequency of allergic disorders was observed with increasing number of positive skin reactions in both boys and girls. Respiratory allergy was closely related to a positive skin test: 87% of the asthmatics and 83% of all those with allergic rhinitis exhibited at least one positive skin reaction. For atopic dermatitis the association was less pronounced. Nineteen per cent of the population studied had a positive symptom history and a positive skin test to pollens, animal epithelia or dusts indicating a clinically significant relationship. However, 39% of the 346 subjects with a positive skin test, including some with a large number of positive reactions, were completely asymptomatic.
PubMed ID
7446872 View in PubMed
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An investigation of the increase in preschool-age asthma in Manitoba, Canada.

https://arctichealth.org/en/permalink/ahliterature225097
Source
Health Rep. 1992;4(4):379-402
Publication Type
Article
Date
1992
Author
H. Johansen
M. Dutta
Y. Mao
K. Chagani
I. Sladecek
Author Affiliation
Canadian Centre for Health Information, Ottawa, Ontario.
Source
Health Rep. 1992;4(4):379-402
Date
1992
Language
English
French
Publication Type
Article
Keywords
Abstracting and Indexing as Topic
Air Pollution
Asthma - diagnosis - epidemiology - therapy
Child, Preschool
Female
Health Services - trends - utilization
Hospitalization - statistics & numerical data - trends
Humans
Incidence
Income
Infant
Male
Manitoba - epidemiology
Medical Record Linkage
Prevalence
Risk factors
Seasons
Severity of Illness Index
Abstract
Asthma has long been a major cause of illness and disability among young Canadians. From 1970-71 to 1987-88, hospital admissions for asthma increased significantly among Canadian children under the age of fourteen. Many hypotheses may explain this increase in asthma prevalence. There could be a true increase in the number of people developing symptoms of the disease or increased asthma rates could be an artifact due to changes in detection, diagnosis, treatment, or coding. This study reviews hypotheses put forward to explain the increase in asthma prevalence, and tests some of them in Manitoba for children aged 0-4. Physician claims data and hospital separation data were merged to create unique person oriented medical records. These records were used to estimate the number of children seeking medical services for asthma during a five-year period (1984-85 to 1988-89) and the change in rates over this time period. From 1984-85 to 1988-89, both prevalence and incidence rates for children less than five years of age increased. Prevalence rates showed strong seasonal peaks in the spring and the fall. There is no indication that asthma increased in severity. The hospitalization rate (the number visiting a hospital for asthma divided by the total number seeking medical care for asthma), the average number of hospital admissions per year, and the average number of days spent in a hospital per year did not increase. Levels of ozone (O3) and nitrogen dioxide (NO2) in downtown Winnipeg increased over the study period and asthma prevalence increased twice as fast in Winnipeg as in the rest of the province. For Manitoba, the increase in preschool-aged asthma does not appear to be due to increased use of medical services, a change in ICD coding, an increase in the severity of the cases, or a decrease in income levels. The increases appear to be at least partly due to changes in diagnostic practices. The relationship between asthma and air pollution needs more detailed study as pollution is likely to be an important factor, particularly during the spring. Other areas for further investigation are changes in allergy and virus precursors, maternal smoking, and increased levels of pollens, molds and dust mites.
PubMed ID
1306357 View in PubMed
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Are asthma-like symptoms in elite athletes associated with classical features of asthma?

https://arctichealth.org/en/permalink/ahliterature152734
Source
Br J Sports Med. 2009 Dec;43(14):1131-5
Publication Type
Article
Date
Dec-2009
Author
T K Lund
L. Pedersen
S D Anderson
A. Sverrild
V. Backer
Author Affiliation
Respiratory and Allergy Research Unit, Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen University Hospital, 2400 Copenhagen NV, Denmark. tclund@dadlnet.dk
Source
Br J Sports Med. 2009 Dec;43(14):1131-5
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Asthma - diagnosis - epidemiology - etiology - physiopathology
Breath Tests
Bronchi - drug effects
Bronchial Provocation Tests
Bronchodilator Agents - pharmacology
Cross-Sectional Studies
Denmark - epidemiology
Female
Forced Expiratory Volume - physiology
Humans
Male
Mannitol - pharmacology
Nitric Oxide - analysis
Sports - statistics & numerical data
Sputum - cytology
Vital Capacity - physiology
Young Adult
Abstract
Asthma is frequent in elite athletes and clinical studies in athletes have found increased airway inflammation.
To investigate asthma-like symptoms, airway inflammation, airway reactivity (AR) to mannitol and use of asthma medication in Danish elite athletes.
The study group consisted of 54 elite athletes (19 with doctor-diagnosed asthma), 22 non-athletes with doctor-diagnosed asthma (steroid naive for 4 weeks before the examination) and 35 non-athletes without asthma; all aged 18-35 years. Examinations (1 day): questionnaires, exhaled nitric oxide (eNO) in parts per billion, spirometry, skin prick test, AR to mannitol and blood samples. Induced sputum was done in subjects with asthma.
No significant difference was found in values for eNO, AR and atopy between 42 elite athletes with and 12 without asthma-like symptoms. Elite athletes with doctor-diagnosed asthma had less AR (response dose ratio 0.02 (0.004) vs 0.08 (0.018) p
PubMed ID
19201767 View in PubMed
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187 records – page 1 of 19.