Age and sex distribution of adult asthma admission : a study of the five-year cumulative prevalence

The objective of this study is to describe the age and sex distribution of adult patients (ages 15-59) in Malta, admitted because of severe acute asthma. The study was designed using a retrospective review of all acute adult asthma admissions to determine the 5-year cumulative prevalence of acute asthma admission from 1989 to 1993 to St. Luke’s Hospital, the only acute medical facility serving the whole of the island of Malta. The results of this study showed that the female predominance in adult asthma admission rates reflects a larger number of female patients who require hospital admission rather than higher admission rates per person in females as compared to males.peer-reviewe

Paediatric wheezy admissions at and around school holiday periods

Objective: To study the influence of school holidays on paediatric admissions with wheezing. Design, setting and patients: Retrospective analysis of all admissions due to wheeze in the paediatric age group. Regional hospital catering for all such admissions, subdivided by age group. Outcome measures: Comparison of hospitalisations due to wheezing before, during and after school holiday periods. Results: Summated admissions showed an increase in admissions over the Christmas period for preschool children, and a decrease for school age children. In Easter and at the start of the summer holidays, admissions decreased in all age groups, except for the late school age group which showed increased admissions in April-May. After the summer holidays, a rise in admissions was noted for all ages. Conclusions: Our findings support the multiphenotypic theory for the precipitation of wheezy attacks, with a changeover from a predominantly viral respiratory trigger to a more atopic form of the disease at around 10 years of age. Prophylaxis during school periods is especially important, and advice leading to prophylaxis dose reduction in the benign summer months should be accompanied by advice to restart adequate prophylaxis medication prior to restarting school.peer-reviewe

Predictors of seasonal influenza vaccination in chronic asthma

Background: Guidelines advise annual influenza vaccination in chronic asthma. The aim of this study was to determine uptake of the influenza vaccine in a group of patients (n = 146) with moderate to severe chronic asthma and establish the main predictors of vaccination. Method: Patients attending a hospital asthma clinic were asked to complete a questionnaire in February 2012 (n = 146). These same patients were contacted a year later via telephone (n = 109 responded), and they were asked to complete the same questionnaire. Results: Vaccination rate was 50.3% in winter 2011/12, and 57.8% in 2012/13. Using binary logistic regression, the predictors for vaccination in 2012 were patient advice (Odds ratio [OR] 15.37 p = 0.001), female gender (OR 2.75, p = 0.028), past side effects (OR 0.21, p = 0.001) and comorbidity (OR 0.39, p = 0.013). Stepwise regression resulted in age as predictor (T value = 3.99, p = 0.001). On analyzing the responses from the second questionnaire at one year after attendance to asthma clinic, predictors changed to compliance to medication (OR 9.52, p= 0.001) and previous exacerbations (OR 4.19, p = 0.026). Out of the 56 patients vaccinated in 2011/12, 33 reported asthma exacerbations before 2012, and 29 reported asthma exacerbations after receiving the influenza vaccine. Out of the 46 unvaccinated patients in 2012, 27 had asthma exacerbations before 2012 and 19 patients had exacerbations in 2013. Patients vaccinated in 2011/12 needed 0.59 courses of steroid/patient/year, and 1.23 visits for nebulizer/patient/year while non-vaccinated patients needed 0.18 courses of steroids/patient/year (p = 0.048), and 0.65 visits for nebulized/patient/year (p = 0.012). Patients’ subjective statements broadly confirmed the predictors. 16/69 (23.1%) received the vaccine in winter 2012/13 despite reporting previous side effects. Conclusions: Advice to patient, female gender and patients’ age predicted vaccination, while past side effects to the influenza vaccine, and presence of comorbidities predicted non vaccination. Symptomatic asthma patients are more likely to be vaccinated. One year after the first contact, treatment compliance and previous asthma exacerbations gained statistical significance as predictors of vaccination.peer-reviewe

Predictors of correct technique in patients using pressurized metered dose inhalers

Background: Correct inhaler technique is recommended by guidelines for optimum asthma care. The objective of the study is to determine real life predictors of correct pressurized metered dose inhaler (pMDI) technique in Asthma and COPD patients. Methods: Two hundred eight adult patients aged 18+ from respiratory outpatients (69.2%) and the community on regular pMDI for a diagnosis of Asthma (78.9%) or COPD, were recruited. A questionnaire containing 31 possible predictors was administered and pMDI technique with or without spacer was observed by trained researchers on 12 point steps, of which 4 were considered critical. Results: 23.1% of patients had no errors in inhaler technique and 32.2% had no critical errors. Patients had a median of 10 correct steps (IQR9-11), and 3(IQR2-4) correct critical steps. Using binary logistic regression the predictors of 10 correct steps were, other healthcare professional (pharmacist, nurse, physiotherapist) explained OR 3.73(1.63–8.54, p = 0.001), male gender 2.70(1.35–5.39, p = 0.004), self-score 1–10 1.21(1.05–1.39, p = 0.007), spacer use 0.38(0.19–0.79, p = 0.007), inhaled steroid 3.71(1.34–10.25, p = 0.01), heart disease 0.31(0.13–0.77, p = 0.01), pneumococcal vaccine 2.48(1.0–6.15, p = 0.043), education level 1–4 1.44(1.00–2.06, p = 0.05) and respiratory physician explained 0–7 times, 1.11(0.99–1.26, p = 0.08). Using ordinal logistic regression, predictors for correct critical steps 0–4, were: technique self-score 1–10 1.2(1.05–1.42, p = 0.006), inhaled corticosteroid use 2.78(1.1–7.31, p = 0.03) and education level 1–4 1.41(1.02–1.95, p = 0.03 Times respiratory physician explained inhaler technique 0–7 1.1(0.98–1.24, p = 0.1), married status 1.55(0.85–2.82, p= 0.15), hypercholesterolaemia 0.52(0.25–1.01, p = 0.054) and male gender 1.76(0.97–3.18, p = 0.06). Conclusions: Known predictors of correct pMDI use, such as gender and education level were confirmed, while age and concomitant use of dry powder inhaler were not. Pneumococcal vaccination and awareness of steroid side effects were possible novel positive predictors, while the use of a spacer and co-morbidity with heart disease were found to be negative predictors. Patients’ self-assessment correlated well with actual performance. This information may be useful in defining approaches to optimize inhaler techniques which are so susceptible to human error.peer-reviewe

Total serum IgE and specific IgE levels in 10-15 year old children with respiratory symptoms and healthy controls in Sicily and Malta

Introduction: The RESPIRA study (EU Funded-Italia-Malta) was performed in the district of Gela (Southern Sicily) and Malta in 2012/3 in 10-15 years old schoolchildren (n=2,047) by means of standard respiratory questionnaires (ISAAC),and clinical exam of case and control subjects. Aims and Objectives: To measure total serum IgE levels in cases (n=127, males=45) and controls (n=142, Males=64), specific IgEs in cases (n=90, Males=53), and controls (n=82, Males=38). Materials and Methods: Cases reported wheeze and/or use of asthma medications in the last 12 months, while controls answered negatively to both and rhinitis. Results: Total Serum IgE (n=269) was raised (>144 IU/l) in 70/127 cases vs 25/142 controls (p=.0001). In males 30/76 of cases vs 11/64 controls (p=.005), while in females cases 15/51 vs 14/78, (p=.14). Positive specific IgE (>0.34 U/ml) was noted for at least one allergen in 54/90 cases vs 30/82 controls (p=.002). House dust mite (HDM) was positive in 27/90 cases vs 12/82 controls (p=.0001), Parietaria positive 12/90 cases vs 2/82 controls (p=.011), cat 22/90 vs 13/82 controls (p=.19), while in male subgroup 14/53 of cases were positive vs 4/38 controls (p=.06). Dog 9/90 cases vs 8/82 controls (NS). Olive positive in 13/90 cases vs 8/82 controls (NS). Alternaria positive in 6/90 cases vs 2/82 controls (NS). Goldenrod Solidago Virgaurea positive in 2/90 cases vs 1/82 controls, and Cladosporium 0/90 cases, 1/82 controls. Conclusion: Positive Total serum IgE and specific IgE to HDM and Parietaria in all patients and cat in males only were higher in cases than in controls.peer-reviewe

Association between the concentration and the elemental composition of outdoor PM2. 5 and respiratory diseases in schoolchildren : a multicenter study in the Mediterranean area

Asthma is a worldwide health problem and its prevalence has been increasing in many countries, especially in young children [1]. Asthma prevalence is particularly high in industrialized countries, even though a change in trend was noticed in the most recent years [2]. Multiple genetic factors increase the risk of developing asthma, whilst environmental conditions play a fundamental role in the expression of its symptoms [3]. In fact, the avoidance of air pollution has been suggested as a nonpharmacological intervention for the prevention of asthma exacerbations in the latest Global Initiative for Asthma (GINA) Guidelines [1]. Exposure to outdoor air pollution increases asthma symptoms, and asthmatic children are at increased risk of adverse effects from poor air quality [4,5]. The World Health Organization (WHO) stated that a high level of outdoor pollutant concentration is a determinant of worsening asthma symptoms in both children and adults [6]. In particular, high airborne particulate matter (PM) concentration has been associated with worsening of symptoms, especially in sensitive children [7], and the prevalence of allergic respiratory diseases is higher in urban areas and still on the rise [8]. Children vulnerability to atmospheric pollution was attributed to their high breath rate and to both physiological and anatomical immaturity [9]. A number of studies have demonstrated an association between respiratory symptoms, the diagnosis of asthma, and proximity of residences to industrial settlements such as oil refineries, petrochemical plants [10–12], and power plants [13,14]. Thus, living in urban environments or in proximity to industrial complexes may worsen respiratory health in children. The aim of the study was to assess the potential role of residing in different areas which had varying levels of pollution on current allergic respiratory diseases in schoolchildren. Thus, by means of a multicenter cross-sectional study, we evaluated children living in areas close to petrochemical and power plants in a southern Mediterranean area, comparing them with those living in rural and urban areas of Sicily and Malta. We used a modified ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire to collect data on individual characteristics and respiratory and allergic symptoms. We also evaluated children exposure to a set of elements measured in outdoor PM with aerodynamic diameter <2.5 µm (PM2.5) through a semi-ecological approach.peer-reviewe

The interplay of landscape composition and configuration: new pathways to manage functional biodiversity and agroecosystem services across Europe

Managing agricultural landscapes to support biodiversity and ecosystem services is a key aim of a sustainable agriculture. However, how the spatial arrangement of crop fields and other habitats in landscapes impacts arthropods and their functions is poorly known. Synthesising data from 49 studies (1515 landscapes) across Europe, we examined effects of landscape composition (% habitats) and configuration (edge density) on arthropods in fields and their margins, pest control, pollination and yields. Configuration effects interacted with the proportions of crop and non‐crop habitats, and species’ dietary, dispersal and overwintering traits led to contrasting responses to landscape variables. Overall, however, in landscapes with high edge density, 70% of pollinator and 44% of natural enemy species reached highest abundances and pollination and pest control improved 1.7‐ and 1.4‐fold respectively. Arable‐dominated landscapes with high edge densities achieved high yields. This suggests that enhancing edge density in European agroecosystems can promote functional biodiversity and yield‐enhancing ecosystem services