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Biomedical subjects

I Town

Publications and source records attributed to I Town.

16 recordsLinked to original sources
PubMed2006

Predictive value of respiratory symptoms and bronchial hyperresponsiveness to diagnose asthma in New Zealand.

Respiratory symptoms are often used as the only diagnostic criteria for asthma in epidemiological surveys and the clinical diagnosis of asthma relies primarily on a detailed history. The aim of this study is to predict the diagnostic value of 11 different respiratory symptoms to diagnose asthma, and to determine if bronchial hyperresponsiveness (BHR) improves the predictive value of these respiratory symptoms. A random sample of 1257 subjects aged 20-44 years old in 3 different areas of New Zealand were selected between March 1991 and December 1992 to answer the European Community Respiratory Health Survey questionnaire on respiratory symptoms. Of these, 784 underwent bronchial challenge with methacholine. The prevalence of current doctor diagnosed asthma (DDA) defined as asthma confirmed by a physician and an asthma attack in the last 12 months was 8.3%. Wheezing with dyspnoea is the single best predictor of diagnosed asthma with a sensitivity of 82%, a specificity of 90% and a Youden's index of 0.72. Wheezing alone is more sensitive (94%) but less specific (76%), with a Youden's index of 0.70. The addition of BHR to asthma symptoms decreases sensitivity and increases specificity with a small increase in Youden's index to 0.75. In New Zealand adults, a history of wheezing with BHR best predicts a diagnosis of asthma but wheezing alone or with dyspnoea are the two best symptoms for predicting asthma.

Adult↗
PubMed2001

Community-acquired pneumonia in Christchurch and Waikato 1999-2000: microbiology and epidemiology.

AIMS: To prospectively record current epidemiology and microbiology of community-acquired pneumonia in two New Zealand centres. METHODS: Between July 1999 and 2000 all adults admitted to Christchurch and Waikato Hospitals with community-acquired pneumonia were screened for study inclusion. All those enrolled had their medical history, clinical variables, inpatient management and clinical outcomes recorded and standardised microbial diagnostic testing carried out. RESULTS: 474 participants were enrolled with a mean age of 64 years and a microbial diagnosis was made in 197 cases (42%). Streptococcus pneumoniae (14%), Haemophilus influenzae (10%) and Influenza A virus (7%), Legionella spp (4%) and Mycoplasma pneumoniae (3%) were the most commonly isolated organisms. An 'atypical' organism was diagnosed in 8% of cases compared to 30% and 23% in previous Christchurch and Waikato studies respectively. Fourteen of the 67 S pneumoniae isolates (21%) had reduced susceptibility to penicillin, all with a MIC < or = 2 microg/mL, a level of reduced susceptibility not associated with worse patient outcomes. Clinical outcome included a mean hospital stay of 6.7 days and a 6 week mortality of 6%. CONCLUSION: Although S pneumoniae was the most commonly isolated organism in this study there have been significant changes in the prevalence of atypical organisms since previous surveys. Ongoing surveillance of antibiotic resistance and variations in the prevalence of organisms causing community-acquired pneumonia is required to guide clinicians' empiric antibiotic use.

Adult↗
PubMed2001

The use of the Hospital Anxiety and Depression Scale (HADS) in patients with chronic obstructive pulmonary disease: a pilot study.

AIMS: To investigate the use of the Hospital Anxiety and Depression Scale (HADS) with recuperating chronic obstructive pulmonary disease (COPD) patients. To study prevalence rates and changes in clinically relevant anxiety and depression during rehabilitation. METHODS: Consecutive patients admitted to a non acute respiratory ward over a twelve week period were asked to complete a HADS questionnaire on three occasions. Nurses recorded basic demographic information on admission. Additional demographic, medical and psychiatric data were obtained by retrospective review of medical records. RESULTS: Of 93 consecutive inpatients, 79 (85%) completed the admission HADS. 72 patients were eligible to complete the day three HADS and 60 the discharge HADS. Clinically relevant anxiety (HADS score of > or =8) was indicated in 39 patients (50%) and depression in 22 (28%). HADS anxiety (p=0.05) and total scores (anxiety+depression) (p=0.03) decreased between admission and discharge. A larger proportion of patients scored within the normal or mild psychopathology range by discharge. More severe COPD (FEV1% predicted) correlated with higher HADS anxiety scores (r=-0.39, p<0.001) and HADS depression scores (r=-0.34, p<0.005). Patients with a recorded history of anxiety (p<0.0001) and depression (p<0.02) had higher WADS scores. Females (n=37) when compared to males (n=42), recorded significantly higher HADS anxiety scores throughout (p<0.005). CONCLUSIONS: Clinically relevant anxiety, indicated by higher HADS scores, was more common in patients with severe COPD, a past history of anxiety or depression and females. Anxiety and total mood improved during inpatient rehabilitation. The use of this instrument with New Zealand COPD patients may improve identification and treatment of anxious and depressed patients.

Age Distribution↗
PubMed1999

The prevalence of asthma symptoms, bronchial hyperresponsiveness and atopy in New Zealand adults.

AIMS: To examine the prevalence of asthma symptoms, bronchial hyperresponsiveness (BHR) and atopy in a random population sample of New Zealand adults. METHODS: A random sample of 2004 adults, aged 20-44 years, in Hawkes Bay, Wellington and Christchurch, were selected from respondents to a one-page respiratory screening questionnaire and invited to take part in further testing. Subjects attending the testing centres' laboratories underwent a detailed respiratory symptom questionnaire, Phazet testing to eleven common allergens, blood samples for total and specific IgE, and measurement of bronchial hyperresponsiveness. Subjects who did not wish to participate were encouraged to complete the questionnaire by telephone. RESULTS: A participation rate of 67% (1257 of 1877 eligibles) was achieved. We found a high prevalence for all measures of asthma in the previous 12 months: wheezing was reported by 28.5%, waking with shortness of breath by 7.7%, a physician diagnosis of asthma by 15.9% and asthma medications were used by 8.5%. Bronchial hyperresponsiveness was found in 24.9%, atopy in 34.8% and elevated serum IgE levels in 30.5%. Asthma symptoms (in the past 12 months) and atopy decreased with increasing age, whereas bronchial hyperresponsiveness increased with age. Females reported higher prevalences of waking with coughing (45.9%), nasal allergies (43.5%) and skin allergies (48.8%) compared to males (30.5%, 31.9% and 37.0%, respectively). There were no significant regional differences. CONCLUSIONS: Asthma symptoms, bronchial hyperresponsiveness and atopy are all common in adult New Zealanders. Their prevalence is associated with age, gender and current smoking but there are no significant regional differences between Hawkes Bay, Wellington and Christchurch.

Adult↗
PubMed1997

Rapid assay of plasma brain natriuretic peptide in the assessment of acute dyspnoea.

AIM: Recognition of heart failure may be difficult in patients presenting with acute dyspnoea, particularly in the presence of chronic airways obstruction or obesity. In a previous study of patients with acute dyspnoea, we showed that the measurement of plasma brain natriuretic peptide (BNP)-a hormone secreted in increased amounts by the failing heart-accurately distinguishes heart failure from primary lung disorder. The aim of the present study was to develop a rapid assay for BNP and evaluate its diagnostic use in patients acutely hospitalised for increasing dyspnoea of any cause. METHODS: A rapid assay for plasma BNP, providing results within 24 h of blood collection, was developed without loss of precision. The results of the rapid and previously established BNP assays were highly correlated (r = 0.9). To determine the diagnostic value of the rapid assay, measurements were undertaken on the day of admission in 123 breathless patients (mean age 68.3, range 23 to 90 years) and related to conventional diagnostic assessments and final outcome. RESULTS: In patients diagnosed and treated urgently for clinical heart failure, plasma BNP was significantly higher (115 (SE 13) pmol/L, n = 39) than in those without clinical heart failure (33 (5) pmol/L, n = 84, p < 0.001). Using a cut-off of 50 pmol/L for the presence of heart failure, there was discordance between BNP level and clinical diagnosis in 21 of 123 cases. Reassessment after independent analysis of discordant cases increased the difference in BNP level in the presence (123 (13) pmol/L, n = 43) or absence (24 (1.5) pmol/L, n = 80) of heart failure. Using two way analysis of variance, no further improvement in discrimination was found when chest radiographs were used together with the BNP data. CONCLUSION: Rapid BNP assays are practicable and provide accurate information on cardiac status-superior to chest radiographs in many cases-early in the course of the patient's presentation with acute dyspnoea.

Acute Disease↗
PubMed1997

House dust mite allergen levels in public places in New Zealand.

BACKGROUND: House dust mite allergens are a risk factor for asthma in New Zealand, and levels in domestic dwellings have been found to be high compared with levels in most other countries. Studies in other countries have demonstrated lower levels of Dermatophagoides pteronyssinus allergens in public places compared with levels in domestic dwellings. OBJECTIVES: The purpose of this study was to measure reservoir Der p 1 levels in public places in New Zealand and to examine determinants of these levels. METHODS: Reservoir dust was obtained in the two centers (Christchurch and Wellington) from hotels, hospitals, rest homes, churches, primary schools, childcare centers, cinemas, bank head offices, and airplanes; samples were also obtained from ski lodges. Single measurements of temperature and relative humidity were taken with thermohygrometers and an average humidity over 2 weeks was estimated with use of waxed wooden sticks. Information was collected on building construction, type of heating, and frequency of cleaning. Der p 1 levels (micrograms per gram of fine dust) for floor (n = 202), bed (n = 65), and seat (n = 24) samples in public places were expressed as geometric means (95% confidence intervals). RESULTS: Der p 1 levels in public places were significantly lower than domestic levels in both Wellington and Christchurch. Both floor and bed levels were higher in hotels than in other public places. After controlling for potential confounders, floor Der p 1 levels were higher with carpeted floors (p < 0.0001) and lower with recent cleaning (p = 0.02) and bed Der p 1 levels were higher with timber wall construction (p = 0.03). Other building, heating, or cleaning characteristics did not show significant association with allergen levels. CONCLUSION: Der p 1 levels were much lower in public places than in domestic dwellings with floor levels primarily affected by floor covering.

Allergens↗
PubMed1997

Occupational asthma in New Zealanders: a population based study.

OBJECTIVES: To examine the effect of occupation on respiratory symptoms in a randomly selected adult population aged 20-44 years. METHODS: It is based on the phase II sampling of the New Zealand part of the European Community respiratory health survey. 1609 people (63.9% response rate) completed a detailed respiratory questionnaire. Of those responding, 1174 (73%) underwent skin tests and 1126 (70%) attended to undergo methacholine bronchial challenge. Current occupation was recorded and a previous occupation was also recorded if it had led to respiratory problems. 21 occupational groups were used for analysis for the five definitions of asthma wheezing in the previous 12 months; symptoms related to asthma; bronchial hyperresponsiveness (BHR); BHR with wheezing in the previous 12 months; and BHR with symptoms related to asthma. RESULTS: Prevalence odds ratios (ORs) were significantly increased for farmers and farm workers (OR 4.16, 95% confidence interval (95% CI) 1.33 to 13.1 for the combination of wheezing and BHR). Increased risks of prevalence of asthma were also found for laboratory technicians, food processors (other than bakers), chemical workers, and plastic and rubber workers. Workers had also been divided into high and low risk exposure categories according to relevant publications. The prevalence of wheezing was greater in the high risk group (OR 1.57, 95% CI 0.83 to 2.95) than in the low risk group. Atopy was associated with asthma, but the prevalence of atopy did not differ significantly between occupational exposure groups. The attributable risk of wheezing that occurred after the age of 15 years and that was estimated to be due to occupational exposure (based on the defined high risk group) was 1.9%, but this increased to 3.1% when farmers and food processors (other than bakers) were also included in the high risk group. CONCLUSIONS: This population based study has identified certain occupations significantly associated with combinations of asthmatic symptoms and BHR.

Adult↗
PubMed1997

Chronic bronchitis, shortness of breath, and airway obstruction by occupation in New Zealand.

The objectives of this study were to measure the population prevalence of symptoms of chronic obstructive lung disease and mild airway obstruction and to compare these between occupational groups. There were 1,609 subjects (63.9% response rate) who completed a respiratory questionnaire. Of these, 1,132 (70.4%) underwent pulmonary function testing (FEV1 and FVC). Twenty-one categories of current occupation were used for analysis. Four definitions of chronic obstructive pulmonary disease (COPD) were used: (1) chronic bronchitis, (2) chronic bronchitis with airway obstruction, (3) shortness of breath, and (4) shortness of breath with airway obstruction. For chronic bronchitis, adjusted prevalence odds ratios were significantly elevated for food processors other than bakers (OR = 2.83; 95% CI, 1.27 to 6.29) and chemical processors (OR = 18.84; 3.71 to 95.64). The combination of chronic bronchitis and mild airway obstruction (FEV1/FVC < 0.75) was associated with bakers (OR = 25.5; 3.86 to 168.53) and spray painters (OR = 14.40; 2.85-72.69). Shortness of breath was associated with hairdressers (OR = 2.75; 0.80 to 9.42) and bakers (OR = 6.72; 0.57 to 79.66), and nursing was associated with lower levels of shortness of breath (OR = 0.42; 0.16 to 1.15). Working ever with vapors, gases, dust, or fumes was significantly associated with chronic bronchitis and airway obstruction (OR = 3.13; 1.07 to 9.12). This population-based study has identified certain occupations with increased prevalence of chronic bronchitis and COPD.

Adult↗
PubMed1995

Prevalence of childhood asthma symptoms in an industrial suburb of Christchurch.

AIM: In response to community concern about the possible respiratory effects of emissions from a fertiliser plant, a study was carried out to determine whether the prevalence of asthma symptoms in 5-8 yr old children in an industrial suburb of Christchurch (Hornby) was the same as in the rest of Christchurch. METHODS: A sample of 646 children aged 5-8 years in Hornby was compared with 1183 6-7 year old children randomly selected from schools throughout the Christchurch metropolitan area. The Christchurch sample was part of the International Study of Asthma and Allergies in Childhood (ISAAC) carried out during 1993. ISAAC questionnaires on respiratory symptoms with some additional questions about smoking and pets were answered by the caregivers of the children sampled. RESULTS: Response rates were 97% in Hornby and 94% in Christchurch. Of the sample, 29% (Hornby) and 27% (Christchurch) had 'wheeze in the last 12 months' while 45% of Hornby and 44% of Christchurch children had 'ever wheezed', 28% had 'ever had asthma'. Significantly more children in Hornby (44%) were exposed to passive smoking compared to Christchurch (29%). Indoor pets were present in 73% and 67% of homes, respectively. CONCLUSION: There was no evidence of an increase in asthma symptoms reported in children in the industrial area of Hornby.

Air Pollution↗
PubMed1994

Plasma brain natriuretic peptide in assessment of acute dyspnoea.

Recognition of heart failure (HF) may be difficult in patients presenting with acute dyspnoea, particularly in the presence of chronic airways obstruction. Since increased secretion of the cardiac hormones atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) occurs early in the course of HF, we have assessed the value of measuring these hormones in plasma in the diagnosis of suspected HF in 52 elderly patients presenting with acute dyspnoea, and compared values with left-ventricular ejection fraction (LVEF), a standard measure of left-ventricular function, by radionuclide angiography. Patients were enrolled prospectively. On the basis of clinical findings, conventional tests, and response to specific treatment, 20 of the 52 patients were classified as having primary lung disorder (PLD), 12 as HF alone, and 20 as HF with underlying PLD (HF/PLD). Compared with findings in PLD patients, LVEF was significantly depressed in HF and HF/PLD patients (p < 0.001), whereas both plasma ANP and BNP were significantly increased (p < 0.001). Admission plasma BNP concentration more accurately reflected the final diagnosis of HF (93% sensitivity and 90% specificity when BNP > or = 22 pmol/L) than LVEF or plasma ANP concentration. When all patients were considered together, there were strong negative correlations between LVEF and log BNP (r = -0.7, p < 0.001) and log ANP (r = -0.59, p < 0.001). Our finding that plasma BNP is raised in dyspnoeic patients with HF but not in acutely breathless patients with PLD, suggests that rapid BNP assays may assist in the diagnosis of patients with acute dyspnoea.

Acute Disease↗
PubMed1990

The use of water as a diluent for bronchodilator nebuliser solutions.

Inhalation of nebulised water can provoke bronchoconstriction in asthmatic patients. In the first part of this study, a community survey identified that about 20% of patients with home nebulisers currently use water as a diluent. In the second part of this study, the airways effect of the use of water as a diluent for nebulised beta agonist was investigated. Nineteen asthmatic subjects were administered nebulised 2.5 mg salbutamol, diluted with either 2 mL water or physiological saline, and forced expiratory volume in one second (FEV1) was measured at baseline and at regular intervals for 45 minutes after nebulisation. Although there was a trend towards a reduced bronchodilator response with water as diluent, the differences between the two diluents were not significantly different. Paradoxical bronchoconstriction was not observed when salbutamol was diluted with water. We conclude that the common practice of diluting bronchodilator nebuliser solution with water does not result in a significant reduction in the overall bronchodilator response.

Adult↗
PubMed1990

Use of a management plan for treating asthma in an emergency department.

A standardised management protocol has been developed for the assessment and treatment of adults with acute asthma attending an emergency department. The management protocol consists of an assessment sheet for recording essential features of the history and examination findings and a flow diagram with guidelines for initial management that were based on spirometric recordings. The protocol was introduced at Wellington Hospital in 1986. The effect of this intervention was assessed by analysing emergency department records during the three months before and one year after the introduction of the protocol. The use of the assessment sheet improved history taking and led to the increased use of serial measures of airflow obstruction and improved documentation of follow up arrangements. The provision of management guidelines influenced the emphasis of management, including an increased use of corticosteroids intravenously and more frequent use of an additional dose of nebulised bronchodilator. In the light of the initial experience the protocol has been modified and its use either in an emergency department or in general practice is recommended.

Acute Disease↗
PubMed1989

A study of the management of asthma in a hospital emergency department.

We reviewed the medical assessment and treatment of 108 consecutive adult asthmatic patients who attended the Wellington Hospital emergency department for treatment of asthma. Almost 90% of these patients were self referred. Systemic corticosteroids were administered or increased in dose during this asthma attack in only 14% of the 93 patients in whom prior drug therapy was recorded. In the emergency department measurement of either peak expiratory flow or forced expiratory volume in one second was made before treatment in 89% of patients, and after treatment in 77%. About 50% received systemic corticosteroids during their attendance, and of the 66 who were subsequently discharged, 40% were prescribed oral prednisone. Communication with general practitioners concerning patients discharged was poor. We conclude that although the medical assessment and management of severe asthma in this emergency department was of a high standard, there were problems relating to the increased reliance by asthmatic patients on this hospital based service.

Acute Disease↗