Development and validation of a model to predict the 10-year risk of general practitioner-recorded COPD

There is increasing interest in the earlier detection of, and intervention in, patients at highest risk of developing chronic obstructive pulmonary disease (COPD).status: publishe

Report 'Effects of air pollution on allergy'

In the last decade the prevalence of asthma and allergy is increasing. Epidemiological studies have frequently shown that allergic diseases and asthma are more prevalent in children living in areas with relative high traffic intensity. To study whether the urban air pollution adversely affects the allergic responses to pollen and house dust mite, the present study was performed in allergic and non-allergic children living in the city of Utrecht (Zuilen and Ondiep). 119 Schoolchildren were selected and they were divided into 4 groups: children without allergy, and children allergic for pollen, for house dust mite or for both pollen and house dust mite. Besides the completing a diary, the higher and lower respiratory tract of children were investigated using non-invasive sampling procedures. The results show that the levels of air pollution in the region Zuilen/Ondiep, measured in the study, are normal for urban regions and below the current standards. Between the groups with different ethnic origin differences in prevalence of allergic sensitisation were observed. Children sensitised to pollen, house dust mite or to both allergens, do not show an increased prevalence of complaints during exposure to pollen or increased levels of airpollution. This is objectified by the results obtained in the study measuring biomarkers in exhaled air and nasal lavage. In conclusion, children allergic for airway-allergens (based on positive skin test) have significant more respiratory complaints than children who were negative in this test. However, during this study air pollution did neither facilitate a stronger allergic reaction nor did it result in more respiratory complaints in school children living in the regions Zuilen and Ondiep

Report 'Effects of air pollution on allergy'

In the last decade the prevalence of asthma and allergy is increasing. Epidemiological studies have frequently shown that allergic diseases and asthma are more prevalent in children living in areas with relative high traffic intensity. To study whether the urban air pollution adversely affects the allergic responses to pollen and house dust mite, the present study was performed in allergic and non-allergic children living in the city of Utrecht (Zuilen and Ondiep). 119 Schoolchildren were selected and they were divided into 4 groups: children without allergy, and children allergic for pollen, for house dust mite or for both pollen and house dust mite. Besides the completing a diary, the higher and lower respiratory tract of children were investigated using non-invasive sampling procedures. The results show that the levels of air pollution in the region Zuilen/Ondiep, measured in the study, are normal for urban regions and below the current standards. Between the groups with different ethnic origin differences in prevalence of allergic sensitisation were observed. Children sensitised to pollen, house dust mite or to both allergens, do not show an increased prevalence of complaints during exposure to pollen or increased levels of airpollution. This is objectified by the results obtained in the study measuring biomarkers in exhaled air and nasal lavage. In conclusion, children allergic for airway-allergens (based on positive skin test) have significant more respiratory complaints than children who were negative in this test. However, during this study air pollution did neither facilitate a stronger allergic reaction nor did it result in more respiratory complaints in school children living in the regions Zuilen and Ondiep.VWSDirectie Preventie Onderzoek en Gezondhei

Characteristics of effective self-management interventions in patients with COPD: individual patient data meta-analysis

It is unknown whether heterogeneity in effects of self-management interventions in patients with chronic obstructive pulmonary disease (COPD) can be explained by differences in programme characteristics. This study aimed to identify which characteristics of COPD self-management interventions are most effective. Systematic search in electronic databases identified randomised trials on self-management interventions conducted between 1985 and 2013. Individual patient data were requested for meta-analysis by generalised mixed effects models. 14 randomised trials were included (67% of eligible), representing 3282 patients (75% of eligible). Univariable analyses showed favourable effects on some outcomes for more planned contacts and longer duration of interventions, interventions with peer contact, without log keeping, without problem solving, and without support allocation. After adjusting for other programme characteristics in multivariable analyses, only the effects of duration on all-cause hospitalisation remained. Each month increase in intervention duration reduced risk of all-cause hospitalisation (time to event hazard ratios 0.98, 95% CI 0.97–0.99; risk ratio (RR) after 6 months follow-up 0.96, 95% CI 0.92–0.99; RR after 12 months follow-up 0.98, 95% CI 0.96–1.00). Our results showed that longer duration of self-management interventions conferred a reduction in all-cause hospitalisations in COPD patients. Other characteristics are not consistently associated with differential effects of self-management interventions across clinically relevant outcomes