13 research outputs found
A telehealth integrated asthma-COPD service for primary care: a proposal for a pilot feasibility study in Crete, Greece
<p>Abstract</p> <p>Background</p> <p>Chronic obstructive pulmonary disease (COPD) and asthma are considered underdiagnosed and misdiagnosed chronic diseases. In The Netherlands, a COPD-asthma telemedicine service has been developed to increase GPs' ability to diagnose and manage COPD and asthma. A telemedicine COPD-asthma service may benefit Greece as it is a country, partly due to its geography, that does not have easy access to pulmonologists.</p> <p>Findings</p> <p>Therefore, a pilot feasibility study has been designed in Greece in order to establish this telemedicine service. Ten rural practices, in the island of Crete, with an average population of 2000 patients per practice will pilot the project supported by three pulmonologists. This paper presents the translated interfaces, the flowcharts and the steps that are considered as necessary for this feasibility study in Crete, Greece.</p
Quantification of atopy, lung function and airway hypersensitivity in adults
<p>Abstract</p> <p>Background</p> <p>Studies in children have shown that concentration of specific serum IgE (sIgE) and size of skin tests to inhalant allergens better predict wheezing and reduced lung function than the information on presence or absence of atopy. However, very few studies in adults have investigated the relationship of quantitative atopy with lung function and airway hyperresponsiveness (AHR).</p> <p>Objective</p> <p>To determine the association between lung function and AHR and quantitative atopy in a large sample of adults from the UK.</p> <p>Methods</p> <p>FEV<sub>1</sub> and FVC (% predicted) were measured using spirometry and airway responsiveness by methacholine challenge (5-breath dosimeter protocol) in 983 subjects (random sample of 800 parents of children enrolled in a population-based birth cohort enriched with 183 patients with physician-diagnosed asthma). Atopic status was assessed by skin prick tests (SPT) and measurement of sIgE (common inhalant allergens). We also measured indoor allergen exposure in subjects' homes.</p> <p>Results</p> <p>Spirometry was completed by 792 subjects and 626 underwent methacholine challenge, with 100 (16.0%) having AHR (dose-response slope>25). Using sIgE as a continuous variable in a multiple linear regression analysis, we found that increasing levels of sIgE to mite, cat and dog were significantly associated with lower FEV<sub>1</sub> (mite p = 0.001, cat p = 0.0001, dog p = 2.95 × 10<sup>-8</sup>). Similar findings were observed when using the size of wheal on skin testing as a continuous variable, with significantly poorer lung function with increasing skin test size (mite p = 8.23 × 10<sup>-8</sup>, cat p = 3.93 × 10<sup>-10</sup>, dog p = 3.03 × 10<sup>-15</sup>, grass p = 2.95 × 10<sup>-9</sup>). The association between quantitative atopy with lung function and AHR remained unchanged when we repeated the analyses amongst subjects defined as sensitised using standard definitions (sIgE>0.35 kUa/l, SPT-3 mm>negative control).</p> <p>Conclusions</p> <p>In the studied population, lung function decreased and AHR increased with increasing sIgE levels or SPT wheal diameter to inhalant allergens, suggesting that atopy may not be a dichotomous outcome influencing lung function and AHR.</p
Temporal changes in the prevalence of childhood asthma and allergies in urban and rural areas of Cyprus: results from two cross sectional studies
<p>Abstract</p> <p>Background</p> <p>The prevalence of childhood asthma and allergies in Cyprus was significantly higher in urban compared to rural areas back in the year 2000, against a background of an overall low prevalence (e.g. current wheeze 6.9%) by comparison to northern European countries. In this study we aimed to assess temporal changes in the prevalence of asthma and allergies in Cyprus after an 8-year interval and to examine whether any differential changes have occurred in urban and rural parts of the island.</p> <p>Methods</p> <p>During the academic years 1999-2000 and 2007-2008, the parents of 7-8 year old children residing in the same set of urban and rural areas completed the ISAAC core questionnaire. In addition to providing prevalence estimates of allergic diseases in 2000 and 2008, changes between the two periods were expressed as odds ratios estimated in multiple logistic regression models adjusting for survey participants' characteristics.</p> <p>Results</p> <p>The prevalence of current wheeze was higher in 2008 (8.7%, 95% confidence interval 7.5%-9.9%, n = 2216) than the previously recorded figure in 2000 (6.9%, 95% CI 6.2%-7.6%, OR = 1.25, 95% CI: 1.02-1.53, n = 4944). Significant increases were also seen in the prevalence of lifetime asthma (11.3% vs. 17.4%, OR = 1.59, CI: 1.36-1.86), eczema (6.8% vs. 13.5%, OR = 1.91, CI: 1.59-2.29) and allergic rhinoconjuctivitis (2.6% vs. 5.2%, OR = 1.82, CI: 1.39-2.41). The prevalence of current wheeze nearly doubled between 2000 and 2008 in rural areas (5.4% vs. 9.7%, OR 1.81, CI: 1.24-2.64) while no significant change was observed in urban areas (7.5% vs. 8.4%, OR 1.08, CI: 0.84-1.37); p value for effect modification = 0.04. Rises in asthma and rhinitis prevalence, but not eczema were also more pronounced in rural compared to urban areas.</p> <p>Conclusions</p> <p>The prevalence of allergic diseases in Cyprus is still on the rise; recent increases appear more pronounced among children living in rural areas possibly indicating recent environmental and lifestyle changes in these communities</p
Investigating International Time Trends in the Incidence and Prevalence of Atopic Eczema 1990-2010: A Systematic Review of Epidemiological Studies
The prevalence of atopic eczema has been found to have increased greatly in some parts of the world. Building on a systematic review of global disease trends in asthma, our objective was to study trends in incidence and prevalence of atopic eczema. Disease trends are important for health service planning and for generating hypotheses regarding the aetiology of chronic disorders. We conducted a systematic search for high quality reports of cohort, repeated cross-sectional and routine healthcare database-based studies in seven electronic databases. Studies were required to report on at least two measures of the incidence and/or prevalence of atopic eczema between 1990 and 2010 and needed to use comparable methods at all assessment points. We retrieved 2,464 citations, from which we included 69 reports. Assessing global trends was complicated by the use of a range of outcome measures across studies and possible changes in diagnostic criteria over time. Notwithstanding these difficulties, there was evidence suggesting that the prevalence of atopic eczema was increasing in Africa, eastern Asia, western Europe and parts of northern Europe (i.e. the UK). No clear trends were identified in other regions. There was inadequate study coverage worldwide, particularly for repeated measures of atopic eczema incidence. Further epidemiological work is needed to investigate trends in what is now one of the most common long-term disorders globally. A range of relevant measures of incidence and prevalence, careful use of definitions and description of diagnostic criteria, improved study design, more comprehensive reporting and appropriate interpretation of these data are all essential to ensure that this important field of epidemiological enquiry progresses in a scientifically robust manner
The role of timely intervention in middle lobe syndrome in children
Study objectives: Middle lobe syndrome (MLS) in children is
characterized by a spectrum of clinical and radiographic presentations,
from persistent or recurrent atelectasis to pneumonitis and
bronchiectasis of the right middle lobe (RML) and/or lingula. This study
was undertaken to evaluate the effect of early intervention, including
fiberoptic bronchoscopy (FOB), in the development of bronchiectasis in
MLS.
Design: Children with atelectasis of the RML and/or lingula persisting
for > 1 month or recurring two or more times despite conventional
treatment underwent high-resolution CT (HRCT) scanning and FOB.
Appropriate treatment and follow-up were provided, and the effect of the
duration of symptoms on clinical outcome and the development of
bronchiectasis was investigated. The patient cohort was retrospectively
reviewed.
Patients: We evaluated 55 children with MLS. The median age at
diagnosis, duration of symptoms, and duration of clinical deterioration
before diagnosis were 5.5 years (range, 3 months to 12 years), 14.5
months (range, 3 to 48 months), and 8 months (range, 3 to 36 months),
respectively.
Measurements and results: FOB revealed marked obstruction in two
children (ie, a foreign body and an endobronchial tumor) and positive
findings for a culture of BAL fluid in 49.1% of patients. The remaining
53 patients were followed up for a median duration of 24 months (range,
5 to 96 months). The clinical outcome was “cure” in 60.4% of
patients, “improvement” in 32.1% of patients, and “no change”
in the remaining patients. Bronchiectasis was documented prior to FOB by
HRCT scan in 15 patients (27.3%). The duration of the deterioration of
symptoms prior to presentation positively correlated with the
development of bronchiectasis (p = 0.03) and an unfavorable clinical
outcome (ie, improvement or no change) [p = 0.02]; a positive
correlation was also found between the duration of symptoms and the
development of bronchiectasis (p = 0.04).
Conclusions: Timely medical intervention in patients with MLS that
includes FOB with BAL prevents bronchiectasis that may be responsible
for an ultimately unfavorable outcome