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Biomedical subjects

Michael S Blaiss

Publications and source records attributed to Michael S Blaiss.

At least 19 recordsLinked to original sources
PubMed2006

Allergic fungal sinusitis in children.

BACKGROUND: Allergic fungal sinusitis (AFS) has been characterized in adults presenting with chronic sinusitis. Rare reports allude to a similar disease in children. OBJECTIVE: To characterize the features of AFS in children. METHODS: Children referred to otolaryngology clinics at Arkansas and LeBonheur Children's Hospitals for chronic sinusitis during a 12-year period were studied. This retrospective analysis reviews the following: clinical presentation, laboratory evaluations, radiographic and pathologic findings, and surgical intervention. Twenty patients (age range, 7-18 years; mean age, 12.5 years; median age, 16 years) met previously published criteria for AFS. Thirteen patients were male and 7 were female. Thirteen were African American and 7 were white. RESULTS: Presentation at diagnosis included the following: atopy (n = 20), nasal symptoms (n = 20), recurrent sinusitis (n = 18), nasal polyps (n = 18), recurrent headaches (n = 12), asthma (n = 11), proptosis (n = 10), and ocular symptoms (n = 10). All had radiographic evidence of sinusitis and allergy to fungal organisms. IgE levels were elevated in 8 of 9 patients, and 10 of 15 patients had eosinophilia. Surgical specimens demonstrated allergic mucin (n = 11), Charcot-Leyden crystals (n = 2), hyphae or fungal debris (n = 9), and fungal growth (n = 17). All patients underwent endoscopic sinus surgery, with 11 requiring multiple surgical procedures. Postoperatively, 19 patients received intranasal and oral steroids, and all had nasal saline washes. Eleven patients (9 who had undergone multiple surgical procedures) were treated with immunotherapy. Relapse was seen in 55% of patients at 1 year of follow-up. CONCLUSION: AFS presents with a higher incidence of proptosis in children when compared with adults. Typically, AFS occurs in atopic children with refractory sinus disease, requiring a high index of suspicion for evaluation and aggressive treatment.

Adolescent↗
PubMed2006

What are the best estimates of pediatric asthma control?

PURPOSE OF REVIEW: To evaluate asthma outcome measures in the face of the variable nature of asthma. The outcome measures are divided into objective and subjective clinical measures, humanistic measures such as quality of life, and costs of asthma control. RECENT FINDINGS: Objective measures of asthma include those traditionally used such as spirometry, peak expiratory flow rate, and airway hyperresponsiveness. Recently, more attention has been geared towards markers of inflammation including exhaled nitric oxide and sputum eosinophils. Subjective measures of asthma control include patient-derived parameters such as number of wheezing episodes, nocturnal symptoms, exercise-induced symptoms, short-acting beta-agonist use, steroid bursts, emergency-department visits, and hospitalizations. Asthma-related quality of life is related to asthma morbidity, and patients with better baseline quality of life have improved outcomes. Asthma-related costs include direct costs mostly comprised of hospitalizations and emergency-room visits, and indirect costs including school absenteeism. SUMMARY: There is no ideal outcome measure for evaluating pediatric asthma control, but each of these outcome measures must be used together to evaluate a patient at each outpatient visit. Patient-centered measures of asthma control must also be further incorporated into office visits for improved asthma management.

Asthma↗
PubMed2006

Selecting the optimal oral antihistamine for patients with allergic rhinitis.

Allergic rhinitis (AR) is now recognised as a global health problem that affects 10-30% of adults and up to 40% of children. Each year, millions of patients seek treatment from their healthcare provider. However, the prevalence of AR maybe significantly underestimated because of misdiagnosis, under diagnosis and failure of patients to seek medical attention. In addition to the classical symptoms such as sneezing, nasal pruritus, congestion and rhinorrhoea, it is now recognised that AR has a significant impact on quality of life (QOL). This condition can lead to sleep disturbance as a result of nasal congestion, which leads to significant impairment in daily activities such as work and school. Traditionally, AR has been subdivided into seasonal AR (SAR) or perennial AR (PAR). SAR symptoms usually appear during a specific season in which aeroallergens are present in the outdoor air such as tree and grass pollen in the spring and summer and weed pollens in the autumn (fall); and PAR symptoms are present year-round and are triggered by dust mite, animal dander, indoor molds and cockroaches. Oral histamine H(1)-receptor antagonists (H(1) antihistamines) are one of the most commonly prescribed medications for the treatment of AR. There are several oral H(1) antihistamines available and it is important to know the pharmacology, such as administration interval, onset of action, metabolism and conditions that require administration adjustments. When prescribing oral H(1) antihistamines, the healthcare provider must take into account the clinical efficacy and weigh this against the risk of adverse effects from the agent. In addition to the clinical efficacy, potential for improvement in QOL with a particular treatment should also be considered.

Administration, Oral↗
PubMed2005

Outcomes in pediatric asthma.

Pediatric asthma is one of the most common chronic conditions seen in children throughout the world. Even with our better understanding of the pathology of pediatric asthma and improved pharmaceutical management for this disorder, we are still far from reaching the goals of optimal asthma outcomes as outlined by the National Heart, Lung, and Blood Institute of the National Institutes of Health. What we mean by outcomes is the change in the patient's current and future health due to the care given. The outcomes in pediatric asthma can be divided into three categories: clinical, humanistic, and economic. This article provides information regarding the different components of outcomes in pediatric asthma and how one can use outcomes to improve asthma control for the child.

Asthma↗
PubMed2005

Asthma disease management: a critical analysis.

OBJECTIVE: To examine how effective a number of asthma disease management (DM) programs have been and whether they have been shown to improve patient outcomes cost-effectively. DATA SOURCES: Articles and meta-analyses from peer-reviewed journals or conference abstracts from 1991 to November 2003 were reviewed by searching MEDLINE and the external World Wide Web to provide examples of data. Terms used for searches included outcomes, intervention, specialist, self-management, asthma, pediatric, and cost-effectiveness. STUDY SELECTION: Observational studies that reported data on DM programs, comparisons of general and specialty care, or asthma self-management outcomes were selected for review. RESULTS: Recently, several studies have demonstrated the short-term benefit of asthma DM programs. These studies found that educational intervention programs produce measurable clinical and economic benefits in the intervention group; however, only a small percentage of patients remain compliant. In addition, the benefit of specialty care in asthma has been shown in other studies. CONCLUSIONS: Although long-term studies are needed to evaluate DM-mediated clinical and cost benefits compared with specialty care, any program that helps improve patient compliance will result in clinical and economic benefits.

Asthma↗
PubMed2004

The utility of the Health Plan Employer Data and Information Set (HEDIS) asthma measure to predict asthma-related outcomes.

BACKGROUND: The Health Plan Employer Data and Information Set (HEDIS) measures are used extensively to measure quality of care. OBJECTIVE: To evaluate selected aspects of the HEDIS measure of appropriate use of asthma medications. METHODS: Claims data were analyzed for commercial health plan members who met HEDIS criteria for persistent asthma in 1999. The use of asthma medications was evaluated in the subsequent year with stratification by controller medication and a measure of adherence (days' supply). Multivariate logistic regressions were used to evaluate the association among long-term controller therapy for persistent asthma, adherence to therapy, and asthma-related hospitalizations or emergency department (ED) visits, controlling for demographic, preindex utilization, and other confounding characteristics. RESULTS: Of the 49,637 persistent asthma patients, approximately 35.7% were using 1 class of long-term controller medications, 18.4% were using more than 1 class, and 45.9% were not using such medication. More than 25% of the persistent asthma patients did not use any asthma medication in the subsequent year. Patients with low adherence to controller medication had a significantly higher risk (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.42-2.08) of ED visit or hospitalization relative to patients not using any controllers compared with persons with moderate (OR, 0.84; 95% CI, 0.57-1.23) or high (OR, 0.70; 95% CI, 0.34-1.44) adherence. Patients receiving a high days' supply of inhaled corticosteroids had the lowest risk of ED visit or hospitalization (OR, 0.37; 95% CI, 0.05-2.69). CONCLUSIONS: Our findings suggest that refinements to the HEDIS measure method for identifying patients with persistent asthma may be needed.

Adult↗
PubMed2004

Allergic rhinitis and impairment issues in schoolchildren: a consensus report.

BACKGROUND: Allergic rhinitis (AR) can have substantial negative impact on children. Most notably, it can impede learning during the school-age years. Other consequences include adverse behavioral and psychosocial effects, poor quality of life, and potential impact on serious comorbidities, such as asthma. CONSENSUS PANEL: In February 2004, in a conference sponsored by Aventis Pharmaceuticals, a multidisciplinary group convened to review relevant clinical data for the purposes of developing consensus recommendations for the management of AR in children. The consensus panel consisted of academic, school health, and medical providers, who were identified based on previous work and publications. CONSENSUS FINDS: The focus of discussions was to assess the degree of impact of AR in schoolchildren and, based on this information, to determine how to improve screening, diagnosis, prevention, and treatment, to help ensure quality of life and maximal school performance in this population. The group considered the most critical factor in successful management ot be communication and collaboration among parents, educators, and healthcare professionals. Knowledge of the common signs and symptoms of AR in children can help to ensure early diagnosis, appropriate intervention, and clinically favorable outcomes. Importantly, both uncontrolled symptoms of AR, as well as adverse effects from medications, can diminish cognitive function and learning. When choosing treatment for children with AR, consideration must be given to the side effects of medications. All first-generation and some second-generation antihistamines can be associated with adverse effects on cognitive function and learning, as a result of their sedative properties. Treatment with non-sedating second-generation antihistamine has been shown to improve learning potential and is an ideal choice for treatment in this population. CONCLUSION: Existing data indicate that further studies using objective measures of impairment in children taking antihistamine medications should be conducted to evaluate the impact of disease and treatment.

Absenteeism↗
PubMed2004

Managing asthma during pregnancy. The whys and hows of aggressive control.

Asthma occurs in about 4% of pregnancies and can worsen during pregnancy. Aggressive treatment is needed because failure to control asthma during pregnancy can lead to poor outcomes for both mother and child. At the same time, the risk-benefit profile of various asthma medications should be considered to avoid any adverse effects. In this article, Dr Blaiss discusses the foundations for management of asthma during pregnancy: environmental control, pharmacotherapy, and allergen immunotherapy.

Acute Disease↗
PubMed2003

Management of rhinitis and asthma in pregnancy.

OBJECTIVES: To objectively critique recent available data on the proper management of allergy and asthma during pregnancy, with an emphasis on understanding the risk and benefit of medications used during pregnancy for these disorders. DATA SOURCES: Data for this article were obtained from a MEDLINE search of literature from 1975 until the present published in English. STUDY SELECTION: It was the expert opinion of the author to select and synthesize recently published articles and reviews on this broad subject. RESULTS: Asthma is estimated to affect up to 4% of pregnancies, whereas rhinitis complicates up to 20%. The cornerstones of management are environmental avoidance procedures, pharmacologic treatment, and allergen immunotherapy. Pharmaceutical treatment for allergic rhinitis should start with the first-generation antihistamines, chlorpheniramine and tripelennamine. In pregnant women, who cannot tolerate first-generation antihistamines, use of a second-generation agent, either loratadine or cetirizine, should be considered. Though data are lacking, intranasal corticosteroids appear to be safe during pregnancy. For pregnant women with persistent asthma, the use of inhaled cromolyn should be the first-line therapy, followed by inhaled budesonide if symptoms worsen. Other agents such as salmeterol, leukotriene modifiers, and newer inhaled corticosteroids may be considered in women who exhibited a good response to these agents before pregnancy. Immunotherapy is the only disease-modifying treatment for allergic rhinitis and asthma. It can be continued during pregnancy. CONCLUSIONS: Understanding the important differences in treatment for the pregnant patient is vital for all physicians caring for these patients. Proper medical management needs to take into consideration possible adverse effects of different agents used in asthma and rhinitis.

Animals↗
PubMed2003

First do no harm: managing antihistamine impairment in patients with allergic rhinitis.

Antihistamines are effective medications that have been used for decades in the management of allergic rhinitis; however, they may be administered or selected in an inappropriate fashion and may be the source of drug-related morbidity. Our objective is to present relevant background information and an expert consensus statement on the use of antihistamines in treatment of allergic rhinitis. In July 2002, 14 experts in allergy, clinical immunology, pharmacology, and impairment assessment were invited to participate in a roundtable conference to present current concepts and develop a consensus statement on the clinical management of allergic rhinitis with antihistamines. Many of the antihistamines used to treat allergic rhinitis, as well as the disease itself, may produce sedation, impairment, and reduced quality of life. Allergic rhinitis is more appropriately managed with the relatively nonimpairing second-generation antihistamines (eg, loratadine, desloratadine, cetirizine, and fexofenadine), because older agents (eg, diphenhydramine, chlorpheniramine, and brompheniramine) produce sedation and impairment and worsen sleep architecture. Although there is some debate surrounding the varying degrees of efficacy of second-generation antihistamines, it is known that some agents may produce varying levels of drowsiness or impairment, especially at higher than recommended doses. The differences with regard to safety among the second-generation antihistamines are smaller than are the differences between the first and second generations. A nonsedating, nonimpairing (even at higher than recommended doses), second-generation antihistamine is preferred for all patients, particularly those with a higher risk for the development of adverse effects. We recommend that primary care and specialist physicians, nurse practitioners, physician assistants, pharmacists, and all other health professionals involved in the diagnosis and treatment of allergic rhinitis follow this consensus document and share this information with patients for whom antihistamine therapy is recommended. In addition, further epidemiologic studies on the effects of antihistamines should be performed.

Diagnosis, Differential↗
PubMed2002

Cost-effectiveness of H1-antihistamines.

In the health care arena, assessment of a medication's clinical efficacy is no longer enough. It is important to confirm the medication's cost-effectiveness and the improvement in quality of life it provides in relationship to other options in therapy. H1-antagonists are widely used in the treatment of many atopic disorders, especially allergic rhinitis. This review has pointed out cost-effectiveness and quality-of-life studies comparing the different H1-antagonists among themselves, and with other treatments used in allergic rhinitis, such as intranasal corticosteroids and allergen immunotherapy. Cost-effective analyses among H1-antagonists in other allergic diseases, such as atopic dermatitis, urticaria and angioedema, and asthma, are lacking at this time.

Cost-Benefit Analysis↗
PubMedDate not supplied

Expanding choices in intranasal steroid therapy: summary of a roundtable meeting.

Intranasal steroids (INSs) are recommended as first-line treatment for allergic rhinitis (AR) and a wealth of data exist supporting them as safe and effective. Our goal was to develop a consensus to help physicians choose between INSs by focusing on clinical profiles and patient preferences and providing expert advice on choosing the appropriate INS for each patient. Experts from specialties that manage patients with AR attended a roundtable meeting to discuss INS therapy. Besides comparisons with other pharmacologic agents, they examined the effects of INS on nasal anatomy, patient preferences for INS, and benefits of product selection based on patient profile. The literature on INSs in AR was reviewed, examining properties of the various drugs, delivery devices, formulations, and patient preference data. Nasal anatomy and physiology must be considered to optimize INS deposition in the nose. Teaching patients proper technique for using INS devices is important to prevent nasal injury and may help concentrate drug effect on affected tissues. INS therapies differ somewhat in biological properties and specific formulation; however, all are considered safe and effective treatment for AR. Patients exhibit different clinical profiles, which play a role in INS selection. Patients can clearly identify sensory characteristics of INS and therefore establish product preference. Patient preference also can guide physicians in choosing the appropriate agent for each patient. Control of AR requires a systematic approach to treatment selection and follow-up. Treatment selection should be matched with clinical profile and patient preferences.

Administration, Intranasal↗