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Biomedical subjects

M J Abramson

Publications and source records attributed to M J Abramson.

At least 37 records · Page 2Linked to original sources
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↗
PubMed2001

Respiratory disorders and allergies in tea packers.

The aim of this study was to determine whether respiratory symptoms or cross-shift declines in lung function were related to occupational exposure to tea dust. A cross-sectional epidemiological study was conducted at a tea-packing plant. Subjects completed a questionnaire, spirometry before and after a full work shift, skin prick testing and venipuncture. Among the 83% of the workers at the site who participated, the prevalences of asthma, wheezing, hay fever and atopy were similar to the general population. Work-related nasal symptoms were more commonly reported by blenders and operators. There were six (3.2%) subjects with a cross-shift decline in the forced expiratory volume in 1 s of > 10%. Specific immunoglobulin E antibodies to black or chamomile tea were observed in 10 (5.6%) employees. As there was little evidence of specific allergic sensitization to the tea varieties tested, the excess of work-related respiratory and nasal symptoms probably represented non-specific irritation.

Adult↗
PubMed2001

Are asthma medications and management related to deaths from asthma?

There is controversy about the role of beta-agonists in asthma mortality, and the impact of asthma management plans remains unclear. We compared blood beta-agonist levels in patients dying from asthma with those in controls, and estimated the risks associated with specific classes of medication and patterns of management. We identified 89 asthma deaths and recruited 322 patients presenting to hospitals with acute asthma. A questionnaire was administered to the next of kin in 51 cases, and to 202 controls. Blood drawn from 35 cases and 229 controls was assayed for salbutamol. Smoking, drinking, and family problems were significantly more likely among the cases of asthma death than among the controls. The two groups were reasonably well matched with regard to markers of chronic asthma severity. Cases of asthma death were significantly less likely than controls to use a peak flow meter. Written action plans were associated with a 70% reduction in the risk of death. Use of nebulized bronchodilators or oral steroids was significantly more likely in cases of asthma death. Mean blood salbutamol concentrations were 2.5 times higher in cases of asthma. The use of oral steroids for an attack of asthma reduced the risk of death by 90%. More widespread adoption of written asthma management plans, with less reliance on beta-agonists and closer medical supervision, should reduce asthma mortality.

Adrenergic beta-Agonists↗
PubMed2000

The epidemic of asthma: too much allergen or not enough infection?

Asthma has generally been thought to result from exposure to allergens in infancy leading to atopy, and eventually to airway hyperresponsiveness. There is now evidence that implicates absence of childhood infections as a factor in development of asthma. Childhood infections seem to be important in normal maturation of the immune system, with asthma a manifestation of a persistent "immature" immune system.

Adolescent↗
PubMed2000

Allergen immunotherapy for asthma.

BACKGROUND: Allergen specific immunotherapy has long been a controversial treatment for asthma. Although beneficial effects upon clinically relevant outcomes have been demonstrated in randomised controlled trials, there remains a risk of severe and sometimes fatal anaphylaxis. The recommendations of professional bodies have ranged from cautious acceptance to outright dismissal. With increasing interest in new allergen preparations and new methods of delivery, it was time to conduct a systematic review of allergen specific immunotherapy for asthma. OBJECTIVES: Allergen specific immunotherapy involves injecting an extract of the allergen under the skin. It is also known as hyposensitisation or desensitisation, and carries a risk of potentially fatal anaphylaxis. The objective of this review was to assess the effects of allergen specific immunotherapy for asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register up to 1997, Dissertation Abstracts, WorldCat and ArticleFirst. SELECTION CRITERIA: Randomised trials using various forms of allergen specific immunotherapy to treat asthma. DATA COLLECTION AND ANALYSIS: Eligibility of studies for inclusion was decided by three reviewers independently. Quality assessment of studies was performed by two reviewers independently. MAIN RESULTS: Fifty-four trials were included. There were 25 trials of immunotherapy for house mite allergy; 13 pollen allergy trials; eight animal dander allergy trials; two Cladosporium mould allergy and six trials looking at multiple allergens. Concealment of allocation was assessed as clearly adequate in only 11 of these trials. Significant heterogeneity was present in a number of comparisons. Overall, there was a significant reduction in asthma symptoms and medication following immunotherapy. There was also a significant improvement in asthma symptom scores (standardised mean difference -0.52, 95% confidence interval -0.70 to -0.35). People receiving immunotherapy were less likely to report a worsening of asthma symptoms than those randomised to placebo (odds ratio 0.27, 95% confidence interval 0.21 to 0.35). People randomised to immunotherapy were less likely to require medication than those randomised to placebo (odds ratio 0.28, 95% confidence interval 0.19 to 0.42). Allergen immunotherapy reduced allergen specific bronchial hyper-reactivity, with some reduction in non-specific bronchial hyper-reactivity as well. There was no consistent effect on lung function. REVIEWER'S CONCLUSIONS: Immunotherapy may reduce asthma symptoms and use of asthma medications, but the size of the benefit compared to other therapies is not known. The possibility of adverse effects (such as anaphylaxis) must be considered.

Allergens↗
PubMed2000

Dietary marine fatty acids (fish oil) for asthma.

BACKGROUND: Epidemiological studies suggest that a diet high in marine fatty acids (fish oil) may have beneficial effects on inflammatory conditions such as rheumatoid arthritis and possibly asthma. OBJECTIVES: 1. To determine the effect of marine n-3 fatty acid (fish oil) supplementation in asthma. 2. To determine the effect of a diet high in fish oil in asthma. SEARCH STRATEGY: The Cochrane Airways Review Group register was search using the terms: marine fatty acids OR diet OR nutrition OR fish oil OR eicosapentaenoic acid OR EPA. Bibliographies of retrieved trials were searched and fish oil manufacturers contacted. SELECTION CRITERIA: Randomised controlled trials in patients with asthma more than two years of age were included. The study duration had to be in excess of 4 weeks. Double blind trials were preferred, but single-blind and open trials were also reviewed for possible inclusion. Three reviewers read each paper, blind to its identity. Decisions concerning inclusion were made by simple majority. Quality assessment was performed by all three reviewers independently. DATA COLLECTION AND ANALYSIS: The only comparison possible was between marine n-3 fatty acid supplementation and placebo. There were insufficient trials to examine dietary manipulation alone. MAIN RESULTS: Eight randomised controlled trials conducted between 1986 and 1998 satisfied the inclusion criteria. Six were of parallel design and two were cross-over studies. Seven compared fish oil with placebo whilst one compared high dose vs low dose marine n-3 fatty acid supplementation. None of the included studies reported asthma exacerbations, health status or hospital admissions. There was no consistent effect on any of the analyzable outcomes: FEV1, peak flow rate, asthma symptoms, asthma medication use or bronchial hyper reactivity. The single study performed in children also combined dietary manipulation with fish oil supplementation and showed improved peak flow and reduced asthma medication use. There were no adverse events associated with fish oil supplements. REVIEWER'S CONCLUSIONS: There is little evidence to recommend that people with asthma supplement or modify their dietary intake of marine n-3 fatty acids (fish oil) in order to improve their asthma control. Equally, there is no evidence that they are at risk if they do so.

Adult↗
PubMed2000

Asthma is more prevalent in rural New South Wales than metropolitan Victoria, Australia.

OBJECTIVE: The aim of this study was to compare the prevalence of adult respiratory symptoms and conditions in a rural setting with a metropolitan setting. METHODOLOGY: We used cross-sectional population surveys of respiratory health using the European Respiratory Health Survey screening questionnaire. A random sample of 4455 eligible young adults aged 20-44 years, from electoral rolls in south-eastern metropolitan Melbourne, Victoria, and 4521 from rural south-western New South Wales were surveyed. RESULTS: Response rates of 72% (n=3194) and 69% (n=3121) were achieved in Melbourne and the Riverina, respectively. Respondents from the Riverina reported significantly higher prevalences of nocturnal dyspnoea (P<0.01), chronic bronchitis (P=0.03), an asthma attack in the previous 12 months (P<0.001), ever having had asthma (P<0.001) and doctor-diagnosed asthma (P<0.001) compared to those from Melbourne. However, among those with 'asthma attacks in the last 12 months', Melbourne respondents experienced a higher frequency of attacks (P<0.05). Riverina respondents reported a higher prevalence of smoking (P<0.05) and smoked more cigarettes on average (P<0.001) than Melbourne respondents. However, annoyance from air pollution was higher in Melbourne than in the Riverina. CONCLUSIONS: These results suggest that asthma is more prevalent in rural southern New South Wales than in Melbourne but follows a different pattern of exacerbations.

Adult↗
PubMed2000

A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video.

The Buteyko Breathing Technique (BBT) is promoted as a drug-free asthma therapy. It is based on the premise that raising blood PaCO2 through hypoventilation can treat asthma. Our study was designed to examine whether the Buteyko Breathing Technique, as taught by a video, is an efficacious asthma therapy. Thirty-six adult subjects with mild to moderate asthma were randomized to receive either a BBT or placebo video to watch at home twice per day for 4 weeks. Asthma-related quality of life, peak expiratory flow (PEF), symptoms, and asthma medication intake were assessed both before and after intervention. Our results demonstrated a significant improvement in quality of life among those assigned to the BBT compared with placebo (p = 0.043), as well as a significant reduction in inhaled bronchodilator intake (p = 0.008). We conclude that the BBT may be effective in improving the quality of life and reducing the intake of inhaled reliever medication in patients with asthma. These results warrant further investigation.

Adult↗
PubMed1999

Comparison of patients with asthma managed in general practice and in a hospital clinic.

OBJECTIVES: To compare knowledge and attitudes about asthma, self-management skills and impact of asthma on quality of life between patients managed in general practice (GP) and in a hospital clinic. DESIGN: Cross-sectional survey with six months' follow-up. PATIENTS AND SETTING: 105 adults with asthma: 61 from the Alfred Hospital Asthma and Allergy Clinic, Melbourne, and 44 from nearby general practices, in 1994-1995. MAIN OUTCOME MEASURES: Patient sociodemographic and clinical characteristics; patient knowledge, attitudes and beliefs about asthma; self-management skills; and impact of asthma on quality of life. RESULTS: GP patients were more educated (P = 0.04) and more likely to smoke (P = 0.04) and to have mild asthma (P = 0.04) than hospital patients; they were less likely to use theophylline (P = 0.006) and to have exercise limitation (P = 0.03), and had fewer previous hospital admissions (P = 0.01). Impact of asthma on quality of life was greater in the hospital group than in the GP group. At baseline, the GP group were less likely to have written asthma action plans (P = 0.018), and were less able to manage rapid onset attacks than the hospital group (P = 0.02). More subjects in the hospital group than the GP group felt their asthma was severe (P = 0.02) and were optimistic about their asthma improving (P = 0.03). GP patients increased their knowledge about asthma significantly (P = 0.002) over six months. CONCLUSIONS: Patients with asthma managed in general practice and in hospital differ in clinical parameters, quality of life and attitudes to asthma. Future educational initiatives should take such differences into account.

Adult↗
PubMed1999

Increased risk of allergy in children due to formaldehyde exposure in homes.

BACKGROUND: Formaldehyde levels were measured in 80 houses in the Latrobe Valley, Victoria, Australia. An association between exposure to formaldehyde and sensitization to common aeroallergens has been suggested from animal trials, but no epidemiologic studies have tested this hypothesis. METHODS: A total of 148 children 7-14 years of age were included in the study, 53 of whom were asthmatic. Formaldehyde measurements were performed on four occasions between March 1994 and February 1995 with passive samplers. A respiratory questionnaire was completed, and skin prick tests were performed. RESULTS: The median indoor formaldehyde level was 15.8 microg/ m3(12.6ppb), with a maximum of 139 microg/m3 (111 ppb). There was an association between formaldehyde exposure and atopy, and the adjusted odds ratio was 1.40 (0.98-2.00, 95% CI) with an increase in bedroom formaldehyde levels of 10 microg/m3. Furthermore, more severe allergic sensitization was demonstrated with increasing formaldehyde exposure. On the other hand, there was no significant increase in the adjusted risk of asthma or respiratory symptoms with formaldehyde exposure. However, among children suffering from respiratory symptoms, more frequent symptoms were noted in those exposed to higher formaldehyde levels. CONCLUSIONS: Low-level exposure to indoor formaldehyde may increase the risk of allergic sensitization to common aeroallergens in children.

Adolescent↗
PubMed1999

Mutational analysis of the high affinity immunoglobulin E receptor beta subunit gene in asthma.

BACKGROUND: The gene for the beta subunit of the high affinity receptor for immunoglobulin E (FcepsilonRI-beta) on chromosome 11q13 is linked with clinical asthma and certain mutations have been identified. A study was undertaken to identify DNA variation in the FcepsilonRI-beta gene in a population sample in which linkage between 11q13 and asthma was explained by bronchial hyperreactivity (BHR) but not atopy. METHODS: DNA samples from 71 subjects with asthma, atopy, or BHR were analysed. The complete coding region, some of the introns, and some of the 5' untranscribed region of the FcepsilonRI-beta gene were sequenced. RESULTS: In the subjects studied there were no deviations from the published sequence in any of the seven coding exons of the FcepsilonRI-beta gene. In particular, the three previously reported mutations (Ile181, Leu183, Glu237) were not detected. Two new polymorphisms were discovered, one at position 243 in the 5' untranscribed region and one at position 4390 in intron III. Neither of these variants showed significant association with asthma, atopy, or BHR. CONCLUSIONS: These results suggest that, in the population studied, linkage of asthma and BHR to 11q13 is not explained by mutations in the FcepsilonRI-beta gene. Other mutations in the non-coding region of this gene or in adjacent genes must explain the linkage findings in this study.

Asthma↗
PubMed1998

Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials.

OBJECTIVE: To determine whether intranasal corticosteroids are superior to oral H1 receptor antagonists (antihistamines) in the treatment of allergic rhinitis. DESIGN: Meta-analysis of randomised controlled trials comparing intranasal corticosteroids with oral antihistamines. SETTING: Randomised controlled trials conducted worldwide and published between 1966 and 1997. SUBJECTS: 2267 subjects with allergic rhinitis in 16 randomised controlled trials. MAIN OUTCOME MEASURES: Nasal blockage, nasal discharge, sneezing, nasal itch, postnasal drip, nasal discomfort, total nasal symptoms, nasal resistance, and eye symptoms and global ratings. Outcomes measured on different scales were combined to determine pooled odds ratios (categorical outcomes) or standardised mean differences (continuous outcomes). Assessment of heterogeneity between studies, and subgroup analyses of eye symptoms, were undertaken. RESULTS: Intranasal corticosteroids produced significantly greater relief than oral antihistamines of nasal blockage (standardised mean difference 0.63, 95% confidence interval - 0.73 to - 0.53), nasal discharge (-0.5, - 0.6 to - 0.4), sneezing (- 0.49, - 0.59 to - 0.39), nasal itch (- 0.38,- 0.49 to - 0.21), postnasal drip (- 0.24,- 0.42 to - 0.06), and total nasal symptoms (- 0.42,- 0.53 to - 0.32), and global ratings gave an odds ratio for deterioration of symptoms of 0.26 (0.08 to 0.8). There were no significant differences between treatments for nasal discomfort, nasal resistance, or eye symptoms. The effects on sneezing, total nasal symptoms, and eye symptoms were significantly heterogeneous between studies. Other combined outcomes were homogeneous between studies. Subgroup analysis of the outcome of eye symptoms suggested that the duration of assessment (averaged mean score over the study period versus mean score at end of study period) might have accounted for the heterogeneity. CONCLUSION: The results of this systematic review, together with data on safety and cost effectiveness, support the use of intranasal corticosteroids over oral antihistamines as first line treatment for allergic rhinitis.

Administration, Intranasal↗
PubMed1998

Indoor airborne fungal spores, house dampness and associations with environmental factors and respiratory health in children.

BACKGROUND: Children living in a damp house are more likely to suffer from respiratory symptoms and it has been suggested that exposure to fungi is an important contributing factor. However, more knowledge about underlying mechanisms for the association are needed. OBJECTIVE: To identify associations between measures of house dampness, levels of airborne fungal spores, housing factors and health outcomes in children. METHODS: Eighty households with 148 children between 7 and 14 years of age were recruited in the Latrobe Valley, Victoria, Australia. Some 36% of participating children were asthmatic. Six sampling visits were made to each house between March 1994 and February 1995 on a 2-monthly cycle. Samples for airborne total and viable fungal spores were collected from bedrooms, living rooms, kitchens and outdoors. A detailed dwelling characterization, using a questionnaire and inspection surveys, was carried out. Skin-prick tests were performed with extracts of common aeroallergens and a respiratory questionnaire was completed for each child. RESULTS: Large airborne fungal spore concentrations were recorded in association with: musty odour, water intrusion, high indoor humidity, limited ventilation through open windows, few extractor fans and failure to remove indoor mould growth. Visible mould growth or condensation evidence was associated with large concentrations of Cladosporium spores, but not with large total spore concentrations. Penicillium exposure was a risk factor for asthma, while Aspergillus exposure was a risk factor for atopy. Fungal allergies were more common among children exposed to Cladosporium or Penicillium in winter or to musty odour. Respiratory symptoms were marginally more common with exposure to Cladosporium or total spores in winter. CONCLUSION: Indoor exposure to certain fungal genera in winter was a risk factor for asthma, atopy and respiratory symptoms in children. On the other hand, no significant associations were seen between average viable or total spore concentrations and child health. Actual measurements of fungal spores predict health outcomes better than reported dampness.

Adolescent↗
PubMed1998

Respiratory symptoms in children and indoor exposure to nitrogen dioxide and gas stoves.

Nitrogen dioxide levels were measured in 80 homes in the Latrobe Valley, Victoria, Australia, using passive samplers. Some 148 children between 7 and 14 yr of age were recruited as study participants, 53 of whom had asthma. Health outcomes for the children were studied using a respiratory questionnaire, skin prick tests, and peak flow measurements. Nitrogen dioxide concentrations were low, with an indoor median of 11.6 microgram/m3 (6.0 ppb), and a maximum of 246 microgram/m3 (128 ppb). Respiratory symptoms were more common in children exposed to a gas stove (odds ratio 2.3 [95% CI 1. 0-5.2], adjusted for parental allergy, parental asthma, and sex). Nitrogen dioxide exposure was a marginal risk factor for respiratory symptoms, with a dose-response association present (p = 0.09). Gas stove exposure was a significant risk factor for respiratory symptoms even after adjusting for nitrogen dioxide levels (odds ratio 2.2 [1.0-4.8]), suggesting an additional risk apart from the average nitrogen dioxide exposure associated with gas stove use. Atopic children tended to have a greater risk of respiratory symptoms compared with nonatopic children with exposure to gas stoves or nitrogen dioxide, but the difference was not significant.

Adolescent↗
PubMed1998

The new asthma genetics and its implications for public health.

OBJECTIVE: To review the genetics of asthma from a public health perspective. DATA SOURCES: Studies of asthma genetics published between 1990 and 1997 were reviewed. STUDY SELECTION: Studies based on random population sampling were preferred. Both linkage and association studies were included, as were genome scans. Studies needed to report results for asthma or the related traits of atopy and bronchial hyperreactivity (BHR). DATA EXTRACTION: The chromosomal locations linked to or candidate genes associated with asthmatic traits were tabulated. DATA SYNTHESIS: A clear majority of studies relied on clinical ascertainment or highly inbred populations. Although there is no consensus about the definition of asthma, phenotypic characterisation of subjects is more complete in recent studies. The high affinity IgE receptor gene on chromosome 11q and a cluster of cytokine genes on chromosome 5q are linked both to atopy and BHR. The T cell receptor gene on chromosome 14q is linked to specific IgE responses, and a region on chromosome 12q is linked both to total IgE levels and asthma. Genome scans have identified other regions of interest on chromosomes 2q, 4, 5p, 6, 7, 11p, 13, 16, 17, 19q, and 21q. CONCLUSIONS: Asthma is a complex polygenic disorder with marked gene-environment interactions. However, it is proving tractable to powerful new genetic approaches arising from the human genome project. At the present state of knowledge, population screening for the asthma genes so far identified cannot be justified. Gene therapy for asthma is an even more remote prospect.

Asthma↗
PubMed1997

Linkage analysis of bronchial hyperreactivity and atopy with chromosome 11q13.

There are two key clinical features of asthma: allergy and bronchial hyperreactivity (BHR). Some pedigree studies of atopy have indicated linkage with the high affinity IgE receptor (Fc epsilon RI-beta) gene on chromosome 11q13, but others failed to confirm this linkage. We examined the genetic linkage of three polymorphic microsatellite markers to atopy and BHR in 120 affected sibling pairs recruited from the general community. We found no linkage to atopy at any of the three 11q13 loci studied. Our findings also do not favour linkage between BHR and loci approximately 8-9 cM either side of the Fc epsilon RI-beta gene.

Adult↗