Asthma

1. Safety net practice-based research network

1.1. METHOD: asthma kits, educational materials, peak flow meters for patients, training for staff, templates for practice-level systems

2. Exposure

2.1. Individual level

2.1.1. Proximity to central roads

2.1.1.1. proximity to truck traffic related to asthma prevalence

2.1.2. Season

2.1.2.1. Altitude

2.1.2.2. Temperature

2.1.2.3. humidity

2.1.2.4. weather

2.1.2.5. rainfall

2.1.2.6. most hospital admissions during WINTER

2.1.3. Exposure to farm milk and stables increases resistance to asthma

2.1.3.1. associated with hygiene hypothesis

2.2. Population level

2.2.1. Air Pollution

2.2.1.1. Nitrogen Dioxide (NO2)

2.2.1.1.1. had been found to be the most associated

2.2.1.2. Sulphur Dioxide (SO2)

2.2.1.3. Carbon monoxide (CO)

2.2.1.4. particulate matter less than 2.5 microns in diameter

2.2.1.5. Ozone (O3)

2.2.2. Pollen

3. Intervention

3.1. Personal asthma management

3.1.1. self-monitoring

3.1.1.1. The Cochrane Central Register of Controlled Trials (CENTRAL) Issue 4, 2008

3.1.1.2. mobile phone self-monitoing yields same results as paper-based, and not effective

3.2. At school

3.2.1. Controling school bus operations

3.3. Increasing Compliance

3.3.1. Address reasons for noncompliance

3.3.2. Attitudes of mothers

3.3.3. Can be measured with a CHRONIC DISEASE COMPLIANCE INSTRUMENT

3.4. Media Alerts

3.4.1. can be effective in changing activities outdoors

3.5. Hospital

3.5.1. Train asthma nurse specialists: socially appropriate asthma care (patient's education, motivation, cultural beliefs)

3.5.1.1. MEASUREMENT: hospital re-admissions; absences from school/work

3.5.2. Establishment of individualized asthma self-management plans

3.6. Community

3.6.1. Compliance to National Asthma Education and Prevention Program guidelines for clinical care

3.6.1.1. MEASUREMENT: asthma severity in the community

3.6.2. Role of community health workers: fostering communication between patient and health team; educating patient and parent; conducting home visits

3.6.3. Asthma Resource Center

3.6.3.1. MEASUREMENT: Questionnaire

3.6.3.2. METHOD: Randomized Controlled Trial

3.6.4. "Asthma Control Test" created for non-asthma specialists to treat a wide variety of asthma cases. The guidelines are based on asthma situation is Saudi Arabia

3.6.5. Air Quality Health Index developed in China from an already existing Air Health Index in Canada based on WHO standards

3.6.6. intervention involving masters-level training

3.6.6.1. empowering families and equipping them with asthma-management skills

3.6.6.1.1. shown to be highly effective

3.7. Omalizumab

3.7.1. MEASUREMENT: Exacerbations, Need for other medications

3.7.2. METHOD: randomized double-blind, placebo-controlled, parallel-group trial

3.8. Microbial Manipulation

3.8.1. METHOD: feeding of probiotics

3.9. Educational Programmes

3.9.1. METHOD: controlled clinical trials

3.9.2. Showed improved lung function, reduced absence in school, reduce in number of hospital visits, reduced number of possible disturbed nights

3.10. 12 week Disease Management Program

3.10.1. Treatment guidelines for long-term disease control; self-management education

3.11. Asthama Drug Fund

3.11.1. International Union Against Tuberculosis and Lung Disease: save governments millions in costs

3.12. High quality generic drugs

3.12.1. proper distribution, upgrading equipment and local levels, regular training and monitoring of performances of health workers

4. Indoor

4.1. Descriptive

4.1.1. Endotoxins and asthma in school children

4.1.1.1. Levels of endotoxins were inversely related to the occurrence of asthma in children.

4.1.1.2. exposure to endotoxins may have crucial role in development of tolerance against asthma

4.1.2. Cockroach allergy and morbidity among inner-city children with asthma

4.1.2.1. exposure to cockroach allergen does not necessarily translate to a reaction in the patient

4.1.2.2. cockroach allergen is a marker for poor housekeeping

4.1.2.3. lowering exposure is very important in asthma management and control

4.1.3. Indoor air pollution and childhood asthma

4.1.3.1. Young children spend most of their time indoors

4.1.3.2. Children with parents who smoke indoors were more likely to develop pulmonary complications

4.1.3.3. Study design

4.1.3.3.1. 3 test groups

4.2. Intervention

4.2.1. Breath-Easy Home

4.2.1.1. Strategies

4.2.1.1.1. moisture-reduction features

4.2.1.1.2. enhanced ventilation system

4.2.1.1.3. minimized dust and off-gassing

4.2.1.2. Conclusions

4.2.1.2.1. large increase of asthma-free days

4.2.1.2.2. emergency visits decreased from 62% to 21%

4.2.1.2.3. Exposure to mold, rodents and moisture were reduced significantly

4.2.2. Home-based environmental intervention

4.2.2.1. Strategy

4.2.2.1.1. Educaton

4.2.2.1.2. Remediation of exposure to allergens and tobacco smoke

4.2.2.2. Conclusions

4.2.2.2.1. Decrease in allergens

4.2.2.2.2. Reduced complications

4.2.2.2.3. Fewer days with symptoms in the intervention group as compared to the control group

5. Outdoor

6. Tools for Measurement

6.1. Geographical Information Systems

6.1.1. Adult asthma and traffic exposure at residential address, workplace address, and self-reported daily time outdoor in traffic: A two-stage case-control study.

6.1.1.1. Roads (total time spent in traffic)

6.1.2. Use of a total traffic count metric to investigate the impact of roadways on asthma severity: a case-control study.

6.1.2.1. Used to create models for cases(attended emergency departments more than once) and controls (Attended emergency departments only once) and was compared to the length of roads for each area

6.1.3. Examining associations between childhood asthma and traffic flow using a geographic information system.

6.1.3.1. exposure to traffic and its density in different areas

6.1.3.2. Used census data to obtain unemployed, childhood poverty, urban/rural conditions for each “block” in the area based on GIS

6.1.4. Comparative effectiveness of asthma interventions within a practice based research network

6.1.4.1. housing density, neighborhood quality of life, pollution sources, transportation and built environment elements, race/ethnicity, and household income

6.2. Use of Spirometers and other equipments

6.2.1. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial

6.2.1.1. Home environmental inspection (house hold dust samples through vacuuming, housing condition, water damage, evidence of infestation)

6.2.1.2. Air pollution in children’s room was evaluated using equipment

6.2.1.3. Behavioral and physical interventions through using air filters, allergen-proof mattresses, and extermination of infestations

6.2.1.4. Pricking of skin for allergen testing

6.2.1.5. Spirometers were used to measure human lung capacity

6.2.2. Effect of urbanisation on asthma, allergy and airways inflammation in a developing country setting.

6.2.2.1. NOx concentrations

6.2.3. Indoor air pollution on nurseries and primary schools: impact on childhood asthma-- study protocol.

6.2.4. Effects of an Ambient Air Pollution Intervention and Environmental Tobacco Smoke on Children's Respiratory Health in Hong Kong

6.2.4.1. SO2 using UV fluorescent analyzers

6.2.4.2. NO2 using dual channel chemiluminescent analyzers

6.2.4.3. Total suspended particles using high volume samplers

6.2.5. Temporal association between hospital admissions for asthma in Birmingham and ambient levels of sulphur dioxide and smoke

6.2.5.1. Used british standard black smoke method to calculate particulate pollution: The British Standard definition for black smoke (BS 1747) is based on a non-gravimetric reflectance method in which air is sampled through a filter and the resulting blackening measured. A conversion from black smoke to mass equivalent was established in the United Kingdom in the 1960s, based on domestic coal smoke emissions, as that was the main source of emissions at that time.

6.2.6. Policy and System Change and Community Coalitions: Outcomes From Allies Against Asthma

6.2.6.1. Data sources used to document changes included the online tracking system employed by coalitions to document their activities, published articles by coalition staff and conveners reporting their work,11 annual coalition reports to the national program office and the funder, key informant interviews with stakeholders (n = 97) in the coalitions' communities (conducted by a contract organization), and periodic group interviews with coalition staff, members, and leaders (n = 116).

6.2.7. Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study.

6.2.7.1. Immunoglobin E (IgE) Serum samples were shipped following cold-chain standards to the Institute for Immunological Research at the University of Cartagena where all laboratory analyses took place. For each sample, total IgE (tIgE) and allergen-specific IgE antibody (sIgE) assays against Dermatophagoides pteronyssinus and Blomia tropicalis were performed using ImmunoCap system (Phadia) and following the technical instructions of the manufacturer.

6.2.8. Can Guideline-defined Asthma Control Be Achieved? The Gaining Optimal Asthma Control Study

6.2.8.1. Use of salmeterol/fluticasone propionate (salmeterol/fluticasone; Seretide/Advair; GlaxoSmithKline, Middlesex, UK) with fluticasone propionate (fluticasone; Flixotide/Flovent; GlaxoSmithKline) in making measures of asthma control

6.2.8.1.1. Measured through the following asthma outcomes: PEF, rescue medication use, symptoms, night-time awakenings, exacerbations, emergency visits, and adverse events

6.2.9. Quality of asthma management in an urban community in Delhi, India

6.2.9.1. Used spirometers to diagnose bronchial asthma based on the Global Initiative for Asthma (GINA)

6.2.10. Indoor air pollution on nurseries and primary schools: impact on childhood asthma-- study protocol.

6.2.10.1. IgE serum samples

6.2.10.2. spirometry

6.3. Use of questionnaires, interviews, etc.

6.3.1. Adult asthma and traffic exposure at residential address, workplace address, and self-reported daily time outdoor in traffic: A two-stage case-control study.

6.3.2. Effects of an Ambient Air Pollution Intervention and Environmental Tobacco Smoke on Children's Respiratory Health in Hong Kong

6.3.2.1. self-completed questionnaire

6.3.3. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial

6.3.3.1. - Questionnaires about demographic, medical, psychological, and environmental factors

6.3.3.2. - Outcomes measured through clinical visits and symptoms present

6.3.4. Asthma control in Latin America: the Asthma Insights and Reality in Latin America (AIRLA) survey

6.3.4.1. Interviews and survey

6.3.5. Policy and System Change and Community Coalitions: Outcomes From Allies Against Asthma

6.3.5.1. Questionnaires(symptoms) used to assess (face-to-face)

6.3.5.2. Used cohort design to compare those exposed to coalition activities and those not exposed

6.3.6. High School Students with Asthma: Attitudes about School Health, Absenteeism, and Its Impact On Academic Achievement.

6.3.6.1. Survey to assess health services in school

6.3.6.2. Survey to measure level of asthma sickness

6.3.7. Temporal changes in the prevalence of childhood asthma and allergies in urban and rural areas of Cyprus: results from two cross sectional studies

6.3.7.1. ISAAC Core questionnaire for assessing asthma and allergy symptoms

6.3.8. Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study.

6.3.8.1. Cross-section population based study (survey)

6.3.9. Effect of urbanisation on asthma, allergy and airways inflammation in a developing country setting.

6.3.9.1. Questionnaires on asthma and allergy symptoms

6.3.10. Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials

6.3.10.1. Structured interviews

6.3.10.1.1. Both physical and emotional health should be measured.

6.3.10.1.2. Items must reflect areas of function that are important to patients with asthma.

6.3.10.1.3. Summary scores amenable to statistical analysis must be provided.

6.3.10.1.4. The questionnaire should be responsive to clinically important changes, even if the changes are small.

6.3.10.1.5. The questionnaire should be valid-that is, measure subjective aspects of health state.

6.3.10.1.6. Considerations of cost and efficiency dictate that the questionnaire be short.

6.3.10.1.7. The questionnaire should be capable of being administered by an interviewer or being self administered.

6.3.11. Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults(reveiw)

6.3.11.1. The Cochrane Airways Group Specialised Register of Trials

6.3.11.2. MEDLINE (1966 to February 2009). Topic search strategy combined with the RCT search filter as outlined in the Airways Group module.

6.3.11.3. OLDMEDLINE (1950 to 65). Topic search strategy combined with the RCT search filter as outlined in the Airways Group module.

6.3.11.4. EMBASE (1980 to February 2009). Topic search strategy combined with the RCT search filter as outlined in the Airways Group module.

6.3.11.5. The list of references in relevant publications.

6.3.11.6. Written communication with the authors of trials included in the review.

6.3.11.7. Studies included in the review underwent quality assessment and entered into Risk of Bias table.Four components were assessed

6.3.11.7.1. Adequate sequence generation.

6.3.11.7.2. Allocation concealment.

6.3.11.7.3. Blinding. Classified

6.3.11.7.4. Free of other bias.

6.3.12. Development and validation of a questionnaire to measure asthma control

6.3.12.1. Asthma Control Questionnaire

6.3.12.1.1. Include symptoms that asthma clinicians consider to be most important for assessing adequacy of asthma control

6.3.12.1.2. Include a measure of a) short-acting b2-agonist use and b) airway calibre

6.3.12.1.3. Be applicable to all adults with asthma (17±70 yrs)

6.3.12.1.4. Be reliable (give reproducible data when the clinical state is stable and be able to discriminate between patients with different levels of asthma control)

6.3.12.1.5. Be responsive (be sensitive to small but clinically important changes in asthma control)

6.3.12.1.6. Be valid (actually measure asthma control).

6.3.12.1.7. Be short and easy to complete

6.3.13. Asthma control in the Asia-Pacific region: The asthma insights and reality in Asia-Pacific study

6.3.13.1. Survey

6.3.13.2. Interviews of about 45-60 minutes in the participant’s homes

6.3.13.3. Questionnaire based on American Thoracic Society Questionnaire

6.3.14. Comparative effectiveness of asthma interventions within a practice based research network

6.3.14.1. Focus group discussions

6.3.14.2. Mini Asthma Quality of Life Questionnaire (Mini-AQLQ) or Mini Pediatric Asthma Quality of Life Questionnaire (Mini-PAQLQ), the Asthma Therapy Assessment Questionnaire (ATAQ) and 2 additional five-point scale questions added by the research team

6.3.15. Global asthma prevalence in adults: findings from the cross-sectional world health survey

6.3.15.1. World health survey through standardized questionnaires(similar to ISAAC and ECRHS surveys)

6.3.16. Quality of asthma management in an urban community in Delhi, India

6.3.16.1. Information on quality of prior treatment, patients’ knowledge about asthma and quality of life was obtained by using three questionnaires administered by one of the authors

6.3.16.2. The two questionnaires, Asthma Knowledge and Asthma Quality of Treatment were developed on the basis of the GINA guidelines

6.3.17. Indoor air pollution on nurseries and primary schools: impact on childhood asthma-- study protocol.

6.3.17.1. Questionnaires

6.3.17.2. Data from hospitals

6.4. hospital admissions

7. Population

7.1. Legislation and Policy

7.1.1. participation of the local and national government

7.2. Social Practice

7.2.1. information dissemination

7.3. Education in level of the community

7.4. Education for health care providers

7.4.1. training for professional

7.5. asthma listed as a significant cause of death

7.5.1. obtained from Center of epidemiology for medical causes of death

8. Other factors affecting Asthma

8.1. Sex

8.1.1. women are more likely to develop asthma than men AFTER puberty. before puberty, it is otherwise

8.2. Age

8.2.1. most severe cases associated with aging

8.3. education

8.3.1. lowest level of education is related to most severa asthma

8.4. Recommendation Compliance

8.4.1. work absences related to asthma greatest in the philippines due to not following international recommendations

8.4.2. work absences lowest in south korea because they follow standards