PubMed Health⌕ Search

Biomedical subjects

E H Walters

Publications and source records attributed to E H Walters.

At least 55 records · Page 3Linked to original sources
PubMed2002

Reported adverse food reactions overestimate true food allergy in the community.

OBJECTIVE: To determine the extent to which perceived adverse food reactions were associated with IgE mediated food allergy, as defined by skin prick testing (SPT). DESIGN: A cohort epidemiological study. Participants underwent SPT to five common food allergens (cow's milk, peanut mix, egg white, shrimp and whole grain wheat mix) and were asked whether they had ever suffered any food 'illness/trouble', and if so to list such food(s). A positive SPT was defined as wheal diameter of > or =3 mm. Cohen's kappa (kappa) was used to assess the agreement between SPT and self-reported reactions to food(s) which contained the allergen of interest. SETTING: Randomly selected adults who took part in the follow-up of the European Community Respiratory Health Survey (ECRHS) in 1998. SUBJECTS: The subjects were 457 adults aged 26-50 y. RESULTS: Fifty-eight (13%) adults were sensitised to at least one food allergen whilst 99 adults (22%) reported illness to food(s) nearly always. However, only seven subjects who reported illness to a food also had a positive SPT to the same food. The prevalence of adverse food reactions associated with IgE mediated allergy in the adult general population would be less than 1.5% (7/457). The agreement between SPT and self-reported illness to food(s) was poor for cow's milk (kappa=0) and wheat (kappa=0), slight for shrimp (kappa=0.16) and egg white (kappa=0.09) and fair for peanut mix (kappa=0.37). CONCLUSIONS: There was little agreement between self-reported perceived illness to food(s) known to contain the food allergen of interest, and positive SPT, suggesting that most reactions are not due to IgE mediated food allergy.

Adult↗
PubMed2002

Mouldy houses influence symptoms of asthma among atopic individuals.

BACKGROUND: The influence of current levels of indoor fungi on asthma is a controversial issue that needs to be resolved in order to advise patients appropriately. OBJECTIVE: To assess the seasonal variation in indoor fungal levels and the impact of these levels on asthma among mould-sensitized individuals. METHODS: Thirty-five young adults with current asthma and sensitization to fungi were visited four times over 1 year. At each home visit a questionnaire was administered and samples of dust and air were collected. Participants also recorded information on symptoms, peak expiratory flows (PEF) and medication use. Dust samples were analysed for house dust mite allergen (Der p 1) and total fungal biomass (ergosterol). Total and genus-specific fungal propagules were identified in air samples. Seasonal variation in allergen levels and significant independent effects of fungal levels on peak flow variability (PFV) were identified by repeated measures analysis of variance. RESULTS: Significant seasonal variations were observed in viable airborne fungi, ergosterol levels in the floor dust and PFV. PFV correlated significantly with symptom scores and the dose of reliever medication. PFV was also significantly associated with smoking and visible mould. The association between visible mould and PFV was independent of season, smoking and the dose of reliever medication. However, there was no association between total fungi, specific fungi or ergosterol and PFV. Der p 1 levels had no significant influence on asthma, even in HDM-sensitized individuals. CONCLUSIONS: Mouldy homes adversely influence asthma in asthmatics sensitized to fungi.

Air Pollution, Indoor↗
PubMed2002

Wheeze not current asthma affects quality of life in young adults with asthma.

BACKGROUND: A study was undertaken to investigate quality of life in asthma, defined by differing criteria, to see which may be most appropriate in epidemiological studies. METHODS: The 426 adults were participants in the follow up phase of the European Community Respiratory Health Survey (ECRHS) in Melbourne. As part of the laboratory visit, participants completed the SF-36 quality of life questionnaire, a detailed respiratory questionnaire, and underwent lung function testing. RESULTS: Both the physical component summary and the mental component summary scores were significantly worse in those with wheeze in the previous 12 months than in those without wheeze. Only the mental component summary score was significantly worse in those with current asthma than in those without. In contrast, in those with current asthma or bronchial hyperreactivity only, neither of the summary scales was significantly different between cases and controls. CONCLUSIONS: Quality of life is severely impaired in individuals with wheeze in the previous 12 months while individuals with current asthma or bronchial hyperreactivity alone did not appear to have significantly reduced quality of life.

Adult↗
PubMed2002

Airway inflammation, basement membrane thickening and bronchial hyperresponsiveness in asthma.

BACKGROUND: There are few data in asthma relating airway physiology, inflammation and remodelling and the relative effects of inhaled corticosteroid (ICS) treatment on these parameters. A study of the relationships between spirometric indices, airway inflammation, airway remodelling, and bronchial hyperreactivity (BHR) before and after treatment with high dose inhaled fluticasone propionate (FP 750 microg bd) was performed in a group of patients with relatively mild but symptomatic asthma. METHODS: A double blind, randomised, placebo controlled, parallel group study of inhaled FP was performed in 35 asthmatic patients. Bronchoalveolar lavage (BAL) and airway biopsy studies were carried out at baseline and after 3 and 12 months of treatment. Twenty two normal healthy non-asthmatic subjects acted as controls. RESULTS: BAL fluid eosinophils, mast cells, and epithelial cells were significantly higher in asthmatic patients than in controls at baseline (p<0.01). Subepithelial reticular basement membrane (rbm) thickness was variable, but overall was increased in asthmatic patients compared with controls (p<0.01). Multiple regression analysis explained 40% of the variability in BHR, 21% related to rbm thickness, 11% to BAL epithelial cells, and 8% to BAL eosinophils. The longitudinal data corroborated the cross sectional model. Forced expiratory volume in 1 second improved after 3 months of treatment with FP with no further improvement at 12 months. PD(20) improved throughout the study. BAL inflammatory cells decreased following 3 months of treatment with no further improvement at 12 months (p<0.05 v placebo). Rbm thickness decreased in the FP group, but only after 12 months of treatment (mean change -1.9, 95% CI -3 to -0.7 microm; p<0.01 v. baseline, p<0.05 v. placebo). A third of the improvement in BHR with FP was associated with early changes in inflammation, but the more progressive and larger improvement was associated with the later improvement in airway remodelling. CONCLUSION: Physiology, airway inflammation and remodelling in asthma are interrelated and improve with ICS. Changes are not temporally concordant, with prolonged treatment necessary for maximal benefit in remodelling and PD(20). Determining the appropriate dose of inhaled steroids only by reference to symptoms and lung function, as specified in current international guidelines, and even against indices of inflammation may be over simplistic. The results of this study support the need for early and long term intervention with ICS, even in patients with relatively mild asthma.

Administration, Topical↗
PubMed2002

beta-Actin and GAPDH housekeeping gene expression in asthmatic airways is variable and not suitable for normalising mRNA levels.

BACKGROUND: The use of reverse transcription-polymerase chain reaction (RT-PCR) to measure mRNA levels has led to the common use of beta-actin and GAPDH housekeeping genes as denominators for comparison of samples. Expression of these genes is assumed to remain constant, so normalising for variations in processing and signal quantitation. However, it is well documented that beta-actin and GAPDH expression is upregulated with proliferation, activation, and differentiation. We hypothesised that airway samples which differ in their cellular profiles and activation status have different levels of expression of GAPDH and beta-actin. METHODS: The mRNA for beta-actin, GAPDH, and interleukin (IL)-2 was measured in bronchoalveolar lavage (BAL) fluid cells and endobronchial biopsy tissue by competitive RT-PCR in a cross sectional study of 26 normal controls and 92 asthmatic subjects. RESULTS: For both BAL fluid cells and biopsy tissue, asthmatics overall had reduced expression of GAPDH and beta-actin mRNA. In asthmatic subjects not using inhaled corticosteroids (ICS), GAPDH mRNA levels in both BAL fluid and biopsy tissue, and beta-actin mRNA in BAL fluid cells were 10 times lower than samples from both normal controls and from asthmatic subjects using ICS. beta-Actin mRNA in biopsy specimens showed the same pattern of expression, but asthmatic subjects not using ICS were not significantly different from those receiving ICS treatment. IL-2 mRNA levels did not differ between the subject or treatment groups but, when expressed as a ratio with beta-actin, significant differences were seen. CONCLUSIONS: beta-Actin and GAPDH used as denominators of gene expression quantitation in asthma research can cause confounding. Housekeeping genes need careful validation before their use in such quantitative mRNA assays.

Actins↗
PubMed2002

European Community Respiratory Health Survey calibration project of dosimeter driving pressures.

Two potential sources of systematic variation in output from Mefar dosimeters, the system used in the European Community Respiratory Health Survey (ECRHS) study have been evaluated: individual nebulizer characteristics and dosimeter driving pressure. Output variation from 366 new nebulizers produced in two batches for the second ECRHS were evaluated, using a solute tracer method, at a fixed driving pressure. The relationship between dosimeter driving pressure was then characterized and between-centre variation in dosimeter driving pressure was evaluated in an Internet-based survey. A systematic difference between nebulizers manufactured in the two batches was identified. Batch one had a mean+/-SD output of 7.0+/-0.8 mg x s(-1) and batch two, 6.3+/-0.7 mg x s(-1) (p<0.005). There was a wide range of driving pressures generated by Mefar dosimeters as set, ranging between 70-245 kPa, with most outside the quoted manufacturer's specification of 180+/-5%. Nebulizer output was confirmed as linearly related to dosimeter driving pressure (coefficient of determination (R2)=0.99, output=0.0377 x driving pressure-0.4151). The range in driving pressures observed was estimated as consistent with a variation of about one doubling in the provocative dose causing a 20% fall in forced expiratory volume in one second. Systematic variation has been identified that constitutes potentially significant confounders for between-centre comparisons of airway responsiveness in the European Community Respiratory Health Survey, with the dosimeter driving pressure representing the most serious issue. This work confirms the need for appropriate quality control of both nebulizer output and dosimeter driving pressure, in laboratories undertaking field measurements of airway responsiveness. In particular, appropriate data on driving pressures need to be collected and factored into between-centre comparisons. Comprehensive collection of such data to optimize quality control is practicable and has been instigated by the organizing committee for the European Community Respiratory Health Survey II.

Aerosols↗
PubMed2002

Increased soluble CD14 in bronchoalveolar lavage fluid of stable lung transplant recipients.

Macrophages, neutrophils and infection have been implicated in the genesis of the bronchiolitis obliterans syndrome (BOS) post lung transplantation. sCD14 is a soluble form of a shed-cell surface protein. It is capable of promoting cytokine-induced inflammation and it's presence in clinically stable lung transplant recipients (LTR) might be important as an early marker of BOS. Bronchalveolar lavage (BAL) and blood samples were taken from 26 stable LTR, at or near their best forced expiratory volume in one second who were free from infection. sCD14 levels were measured via enzyme-linked immunosorbent assay. Cell counts were performed on unfiltered BAL. LTR neutrophil count, BAL sCD14 and serum sCD14 levels were higher than controls (median 3.8% versus 1.3%, p<0.05; 11.5 ng x mL(-1) versus 6 ng x mL(-1), p<0.001; 6.2 microg x mL(-1) versus 2.4 microg x mL(-1), p<0.05, respectively). BAL albumin and sCD14 correlated (regression coefficient: 0.77, p<0.001). In this hypothesis-generating, cross-sectional study, the authors have described for the first time soluble CD14 levels in the bronchoalveolar lavage and serum of stable lung transplant recipients, and show that these are elevated compared to controls. This is a practicable candidate marker system, which can be tested for a predictive role in bronchiolitis obliterans syndrome following lung transplantation. The origin of this cellular protein and its temporal relationship to the development of the bronchiolitis obliterans syndrome remains to be elucidated in more definitive longitudinal studies, which should include other measurements potentially relevant to the innate immune system, such as bronchoalveolar lavage endotoxin levels.

Adult↗
PubMed2001

Reduced airway distensibility, fixed airflow limitation, and airway wall remodeling in asthma.

The airways of individuals with asthma are less distensible than normal and it has been assumed that this may be due to airway remodeling associated with chronic inflammation, although there are currently no available data directly relating these two aspects of asthma. We have therefore carried out a study of the relationship between airway distensibility (DeltaVD) and subepithelial reticular basement membrane (RBM) thickening as an index of airway remodeling, in a group of patients with relatively mild but symptomatic asthma. Our methods included a cross-sectional study of DeltaVD in patients with mild to moderate atopic asthma, with matched airway biopsy for structural components. We confirmed that DeltaVD was lower in patients with asthma than in normal individuals (19.8 +/- 1.1 versus 24.1 +/- 1.5; p < 0.05) and that RBM thickness was increased in patients with asthma (9.1 +/- 2.2 versus 7.7 +/- 1.2 microm; p < 0.01). There was a negative correlation between DeltaVD and RBM thickness in asthma (r = -0.37, p = 0.03) and positive correlations between percent predicted postbronchodilator large and small airway function (for percent predicted FEV(1 )versus DeltaVD, r = 0.59, p < 0.001). We conclude that, cross-sectionally, DeltaVD was related to airway remodeling (RBM thickening) and airflow limitation (percent predicted large and small airway function). Our findings support the hypothesis that DeltaVD is a physiologic test that is reflective of airway remodeling.

Adult↗
PubMed2001

Increased human cytomegalovirus (HCMV) DNA load in peripheral blood leukocytes after lung transplantation correlates with HCMV pneumonitis.

BACKGROUND: Human cytomegalovirus (HCMV) reactivation and disease remain relatively common in lung transplant recipients (LTR) despite the use of ganciclovir prophylaxis protocols for all HCMV at-risk patients. The specific aims of this study were to (1) describe the HCMV DNA viral load in the peripheral blood leukocytes (PBL) of a cohort of LTR during the first 6 months after lung transplantation; (2) prospectively determine whether HCMV DNA viral load predicts episodes of HCMV pneumonitis in LTR; and (3) study the effect of ganciclovir on HCMV viral load. METHODS: Competitive polymerase chain reaction using an internal standard and fluorometric detection were used to quantitate HCMV DNA in the PBL of a cohort of 26 LTR monthly for the first 6 months after transplantation (145 samples). All patients were treated with standard triple immunosuppression, and ganciclovir prophylaxis was given to all at-risk LTR (donor or recipient HCMV seropositive) for at least 8 weeks after transplantation. RESULTS: Thirteen episodes of histopathologically proven HCMV pneumonitis in nine subjects occurred during follow-up with a wide intra- and intersubject variation in the HCMV DNA PBL levels. HCMV detection had a sensitivity of 92% and specificity of 76% for HCMV pneumonitis (negative likelihood ratio, 9.5), whereas greater than 10-fold increases in HCMV DNA load had a specificity of 93% and sensitivity of 67% (positive likelihood ratio, 11). HCMV DNA detection had an adjusted odds ratio for HCMV pneumonitis of 107 (95% confidence interval, 14-821; P<0.005). In those with detectable HCMV DNA in PBL (n=44), HCMV DNA levels were 4.4 (95% confidence interval, 1.2-16.8) times higher in those with HCMV pneumonitis than in those without HCMV pneumonitis. Although ganciclovir treatment was very effective in treating HCMV pneumonitis and suppressing HCMV DNA levels, thrice weekly ganciclovir prophylaxis only partially controlled HCMV DNA levels and did not eliminate HCMV pneumonitis risk as three patients developed HCMV pneumonitis while on this regimen. CONCLUSIONS: HCMV DNA detection, absolute levels, and relative change from baseline in the PBL of LTR correlate with HCMV pneumonitis episodes and may be a useful intermediate outcome measure of the efficacy of ganciclovir prophylaxis and treatment strategies.

Adult↗
PubMed2001

Effect of a long-acting beta2-agonist over three months on airway wall vascular remodeling in asthma.

There are few data regarding the potential effects of antiasthma treatment on indices of airway remodeling, such as the increased subepithelial airway vascularity in patients with asthma. We studied 45 symptomatic subjects with asthma who were receiving treatment with low dose inhaled corticosteroids (ICS) (range 200-500 microg twice a day) and 28 normal subjects without asthma as a control population. Subjects underwent bronchoscopy with airway biopsy and subjects with asthma were then randomized to receive supplementary inhaled salmeterol 50 microg twice a day, fluticasone propionate 100 microg twice a day, or placebo for 3 mo in addition to their baseline ICS. Biopsy of the airway was then repeated. The biopsies were analyzed for vascular structures in the subepithelial lamina propria. Sufficient biopsy material was available for analysis of vascularity in 34 of the subjects with asthma and 28 of the normal subjects. We confirmed that airways of subjects with asthma had a significant increase in the number of vessels/mm2 of lamina propria compared with airways of normal subjects (524 +/- 137 vessels/mm2, n = 34 versus 425 +/- 130 vessels/mm2, n = 28; p = 0.004). There was a decrease in the density of vessels of lamina propria after treatment only in the salmeterol group compared with baseline (before, 535 +/- 153 vessels/mm2 versus after, 400 +/- 142 vessels/mm2; n = 12; p = 0.04). There was no significant change within the fluticasone (n = 11) or placebo (n = 11) treatment groups, but also no significant differences between the groups. Notably, no treatment was associated with increased airway wall vascularity. The demonstrated fall in vessel number within the salmeterol-treated group may suggest an advantageous effect of long-acting beta2-agonists on this manifestation of airway remodeling over the 3-mo time scale of this study, which is complementary to the action of ICS on airway vascularity.

Adrenergic beta-Agonists↗
PubMed2001

Current indoor allergen levels of fungi and cats, but not house dust mites, influence allergy and asthma in adults with high dust mite exposure.

We assessed the influence of current indoor levels of fungi, house dust mite allergen (Der p 1), and cat allergen (Fel d 1) on sensitization and asthma in adults. A total of 485 adults answered a questionnaire and had skin prick tests and lung function tests. Dust and air samples were collected from their bedrooms. The dust was analyzed for Der p 1, Fel d 1, and fungal biomass (ergosterol). Fungal propagules were measured in air samples. Current asthma was defined as having wheezed during the past 12 mo plus bronchial hyperreactivity (BHR) to methacholine. High exposure to total airborne fungi was associated with increased BHR, but perhaps paradoxically with a lower risk of being sensitized to fungi. Ergosterol levels in floor dust were a risk factor both for being sensitized to fungi and having wheezed within the last year. High Fel d 1 levels in floor dust were found to increase the risk of being sensitized to cats and in beds to increase the risk of current asthma. Although Der p 1 levels in homes were high, people exposed to high Der p 1 levels in floor dust were less likely to be sensitized to house dust mites or to have wheezed within the past year. Current indoor levels of fungi and Fel d 1, but not Der p 1, influenced sensitization and asthma in adults with high dust mite exposure.

Adult↗
PubMed2001

Idiopathic pulmonary fibrosis: in need of focused and systematic management.

Idiopathic pulmonary fibrosis (IPF) is an increasingly recognised, serious lung disease. A recent International Consensus Statement has redefined the term "idiopathic pulmonary fibrosis", restricting its use to the entity previously described as "usual interstitial pneumonia" and reclassifying some of the more benign inerstitial lung diseases formerly included under IPF. There is insufficient quality evidence for the effectiveness of current medical therapies for IPF. Lung transplantation provides a potential surgical therapeutic option for selected individuals with IPF, but referral for transplant needs to be made as early as possible. Multidisciplinary clinics specialising in interstitial lung disease have a potential role in determining which patients may benefit from novel and existing medical therapies and which patients should be referred for lung transplantation.

Adult↗
PubMed2001

Bronchoalveolar lavage macrophage and lymphocyte phenotypes in lung transplant recipients.

Recent publications have demonstrated potentially pathologic changes in bronchoalveolar lavage (BAL) from clinically stable lung transplant recipients (SLTRs), but there are few available data on alveolar macrophages (AMs). We formulated the hypothesis that changes in BAL AM and lymphocyte phenotypes would be apparent even in SLTRs.A cross-sectional study using a standardized 3 x 60 ml BAL, investigating lymphocyte and AM phenotypes in 19 SLTRs, 5 subjects with bronchiolitis obliterans syndrome (BOS) and 18 normal control volunteers. BAL lymphocyte and AM markers were assessed using flow cytometry. We confirmed a significant elevation of neutrophils in all lung transplant recipients with a more marked elevation in the BOS subjects. Flow-cytometric analysis showed increased numbers of natural killer (NK; CD56/CD16-positive) cells, increased CD11b- and CD11c-positive CD3 lymphocytes, increased CD8-positive lymphocytes and increased HLA-DR expression in CD8 cells from the lung transplant recipients, when compared with normals (p <.005). In contrast, the expression of a number of AM surface markers, associated with a range of host defense functions against bacteria, fungi and viruses (CD11a, CD11b, CD11c, HLA-DR, CD14), was lower in both SLTRs and those with BOS (p <.05). These novel findings are consistent with complex lymphocyte and macrophage changes that may result from clinically silent infection, partially suppressed rejection, or both.

Adult↗
PubMed2001

The rising prevalence of asthma in young Melbourne adults is associated with improvement in treatment.

BACKGROUND: Asthma is a common source of morbidity and is now recognized as a national health priority in Australia. Although a number of epidemiologic studies have been conducted in Australia to determine the prevalence of asthma in adults, it is unclear whether the prevalence is changing. OBJECTIVES: To determine the prevalence in 1998 of self-reported asthma and respiratory symptoms among young adults and changes in prevalence between 1990 and 1999. METHODS: Cross-sectional postal survey to 4,455 young adults (aged 20 to 44 years) randomly selected from the electoral rolls of the inner southeastern suburbs of metropolitan Melbourne. The survey instrument was the validated European Community Respiratory Health Survey screening questionnaire, which gathered data on self-reported respiratory symptoms, including whether asthma had been diagnosed. Identically worded questions from similar surveys conducted in 1990, 1992, and 1999 were used to compare changes in prevalence. RESULTS: A response rate of 72% was achieved in 1998 after three mailings and telephone followup. Forty-two percent reported nasal allergies, 26% wheezed within the past 12 months, and 20% ever had asthma. The prevalence of doctor-diagnosed asthma was 18%, whereas 10% reported using asthma medications within the past 12 months. Nine percent of respondents reported an asthma attack within the past 12 months. The prevalence of having ever had asthma, doctor-diagnosed asthma, and using asthma medications had increased significantly since 1990. However, the prevalence of respiratory symptoms did not significantly change over this time. CONCLUSIONS: The prevalence of asthma is likely to be rising, but the symptoms of asthma are being better managed in young Melbourne adults.

Adult↗
PubMed2001

International prevalences of reported food allergies and intolerances. Comparisons arising from the European Community Respiratory Health Survey (ECRHS) 1991-1994.

OBJECTIVE: The aim of this study was to report the prevalence, type and reported symptoms associated with food intolerance. DESIGN: A cross-sectional epidemiological study involving 15 countries using standardized methodology. Participants answered a detailed interviewer-administered questionnaire and took part in blood, lung function and skin prick tests to common aeroallergens. SETTING: Randomly selected adults who took part in the second phase of the European Community Respiratory Health Survey (ECRHS). SUBJECTS: The subjects were 17280 adults aged 20-44 y. RESULTS: Twelve percent of respondents reported food allergy/intolerance (range 4.6% in Spain to 19.1% in Australia). Atopic females who had wheezed in the past 12 months, ever had asthma or were currently taking oral asthma medications were significantly more likely to report food allergy/intolerance. Participants from Scandinavia or Germany were significantly more likely than those from Spain to report food allergy/intolerance. Respondents who reported breathlessness as a food-related symptom were more likely to have wheezed in the past 12 months, to have asthma, use oral asthma medications, be atopic, have bronchial hyperreactivity, be older and reside in Scandinavia. CONCLUSION: Self-reported food allergy/intolerance differed significantly across multiple countries. The reasons for these differences were not explored in this study, but are likely to be largely due to cultural differences.

Adult↗
PubMed2001

The relationships between patients' related variables in asthma: iplications for asthma management.

OBJECTIVE: Understanding patients' personal characteristics is essential for better asthma management. This study assessed the relationships between patients' related variables in asthma and identified key associations relevant to asthma management. METHODOLOGY: Subjects were recruited from the Alfred Hospital Asthma and Allergy Clinic (Melbourne, Victoria, Australia) and general practices. Their clinical and demographic characteristics, asthma knowledge, impact of asthma on their quality of life, their self-management skills and attitudes to asthma were assessed. RESULTS: One hundred and sixty-nine subjects participated in the study. Fifty-seven per cent had one or more previous hospital admissions, 94% had either moderate or severe asthma, and 51% reported nocturnal symptoms in the last 6 weeks. Patients who spoke only English, had been admitted to an intensive care unit, had a peak flow meter, and an asthma action plan had significantly better asthma knowledge than those who did not. The impact of asthma was greatest in patients who had a peak flow meter, used oral steroids, had exercise limitation, and developed asthma between the ages of 31-45 years. Female patients had better self-management skills than males. Patients with asthma-related distress were more likely to use oral steroids or theophylline and to have a history of previous hospital admissions. Patient self-confidence was negatively correlated with age. CONCLUSIONS: There are significant relationships between many of patients' variables related to asthma, including their personal clinical, demographic and psychological characteristics. The findings have implications for optimizing asthma management.

Activities of Daily Living↗