Estudio primario

No clasificado

Vocal cord dysfunction: a frequently forgotten entity.

Año 2012
Revista Case reports in pulmonology
Enlaces Pubmed , DOI , PMC

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Vocal cord dysfunction (VCD) is a disorder characterized by unintentional paradoxical adduction of the vocal cords, resulting in episodic shortness of breath, wheezing and stridor. Due to its clinical presentation, this entity is frequently mistaken for asthma. The diagnosis of VCD is made by direct observation of the upper airway by rhinolaryngoscopy, but due to the variable nature of this disorder the diagnosis can sometimes be challenging. We report the case of a 41-year old female referred to our Allergology clinics with the diagnosis of asthma. Thorough investigation revealed VCD as the cause of symptoms.

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Estudio primario

No clasificado

Comparison of salbutamol Rotahaler with conventional pressurized aerosol.

Año 1977
Autores Hetzel MR , Clark TJ
Revista Clinical allergy
Enlaces Pubmed , DOI

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Salbutamol in a powder aerosol from the Rotahaler insufflator was compared, with equal doses of the conventional pressurized aerosol by dose-response curves and in a 1 month open trial, in the treatment of asthma patients with good inhalation technique. Results were not significantly different in either study. A further group of asthma patients, who were known to be incapable of using pressurized aerosols effectively, were shown to benefit from treatment with the Rotahaler. This device should increase the value of the sympathomimetic drugs to the minority of asthma patients who cannot use conventional aerosols correctly.

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Estudio primario

No clasificado

Efficacy and safety of subcutaneous immunotherapy with a biologically standardized extract of Ambrosia artemisiifolia pollen: a double-blind, placebo-controlled study.

Año 2004
Revista Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
Enlaces Pubmed , DOI

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BACKGROUND:

The allergological relevance of Ambrosia in Europe is growing but the efficacy of the injective immunotherapy for this allergen has been documented only in Northern America.

OBJECTIVE:

We sought to study the safety and efficacy of injective immunotherapy in European patients sensitized to Ambrosia artemisiifolia.

METHODS:

Thirty-two patients (18 M/14 F, mean age 36.78, range 23-60 years) suffering from rhinoconjunctivitis and/or asthma and sensitized to Ambrosia were enrolled and randomized in a double-blind, placebo-controlled (DBPC) study lasting 1 year. A maintenance dose corresponding to 7.2 microg of Amb a 1 was administered at 4-week intervals after the build-up. During the second and the third year, all patients were under active therapy in an open fashion. Symptom and medication scores, skin reactivity to Ambrosia (parallel line biological assay), and pollen counts were assessed throughout the trial.

RESULTS:

Twenty-three patients completed the trial. No severe adverse event was observed. During the DBPC phase, actively treated patients showed an improvement in asthmatic symptoms (P=0.02) and drug (P=0.0068) scores days with asthmatic symptoms (P=0.003), days with rhinitis symptoms (P=0.05), and days with intake of drugs (P=0.0058), as compared to before therapy. No improvement for any of these parameters was detected in the placebo group. Moreover, the number of days with rhinitis and asthma was significantly higher in the placebo as compared to the active group (P=0.048 and P<0.0001, respectively). Patients who switched from placebo to active therapy improved in rhinoconjunctivitis, asthma, and drug intake. The skin reactivity decreased significantly (12.2-fold, P=0.0001) in the active group whereas a slight increase (1.07-fold, P=0.87) was observed in the placebo group after the DBPC phase. After switching to active therapy, patients previously under placebo showed a significant decrease of this parameter (4.78-fold, P=0.002).

CONCLUSION:

Injective immunotherapy is safe and clinically effective in European patients sensitized to Ambrosia.

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Estudio primario

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Pregnancy outcome of asthmatic patients: a population-based study.

Año 2005
Revista The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
Enlaces Pubmed , DOI

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OBJECTIVE:

To investigate pregnancy outcome of asthmatic patients.

METHODS:

A retrospective population-based study comparing all singleton pregnancies in women with and without asthma was conducted. Patients lacking prenatal care (less than three visits in prenatal care facilities) were excluded from the study. Deliveries occurred during the years 1988-2002. Stratified analysis, using a multiple logistic regression model was performed to control for confounders.

RESULTS:

During the study period 139 168 singleton deliveries occurred, of which 1.4% in asthmatic patients (n = 963). Using a multivariate analysis, with backward elimination, the following complications were significantly associated with maternal asthma: diabetes mellitus (OR = 1.8, 95%CI 1.5-2.0, p < 0.001), fertility treatments (OR = 1.6, 95%CI 1.3-2.1, p < 0.001), intrauterine growth restriction (IUGR) (OR = 1.5, 95%CI 1.1-1.9, p = 0.004), hypertensive disorders (OR = 1.5, 95%CI 1.2-1.7, p < 0.001) and premature rupture of membranes (OR = 1.2, 95%CI 1.1-1.5, p = 0.013). Higher rates of cesarean deliveries were found among asthmatic patients as compared to the controls (17.1% vs. 11.4%, p < 0.001). This association persisted even after controlling for possible confounders such as failure to progress in labor, mal-presentations, IUGR, etc. No significant differences regarding low Apgar scores (less than 7) at 1 and 5 minutes were noted between the groups (3.9% vs. 4.4%, p = 0.268 and 0.4% vs. 0.6%, p = 0.187, respectively). Likewise, the perinatal mortality rate was similar among patients with and without asthma (1.3% vs. 1.3%, p = 0.798).

CONCLUSION:

Pregnant women with asthma are at an increased risk for adverse maternal outcome. This association persists after controlling for variables considered to co-exist with maternal asthma. However, perinatal outcome is favorable. Careful surveillance is required in pregnancies of asthmatic patients, for early detection of possible complications.

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Revisión sistemática

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Association between biomarker-quantified antioxidant status during pregnancy and infancy and allergic disease during early childhood: A systematic review.

Año 2011
Revista Nutrition reviews
Enlaces Pubmed , DOI

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Recent findings suggest a significant association between the antioxidant status of pregnant women and of their children during the first years of life and the development of allergic disease during childhood. The aim of this review was to identify all studies that estimated the effect of intake of antioxidants in pregnant women and their children on the development of allergic disease during early childhood. A systematic review was conducted of epidemiological studies featuring original peer-reviewed data on the association between dietary antioxidant status and allergic disease during childhood. A systematic search was performed following the Meta-analysis of Observational Studies in Epidemiology Guidelines. A comprehensive search of the literature yielded 225 studies, 18 of which were selected for the extraction of results and were related to antioxidant status and allergic disease. The systematic review included five prospective cohort studies, four cross-sectional studies, and nine case-control studies. Eight studies reported an important association between antioxidant status and asthma onset during childhood. Similarly, wheezing and eczema were studied as an outcome in six and in five studies, respectively. Recent observational studies suggest that a higher intake of antioxidant vitamins, zinc, and selenium during pregnancy and childhood reduces the likelihood of childhood asthma, wheezing, and eczema.

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Revisión sistemática

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Autoanticuerpos tisulares y factor reumatoideo en la infección crónica por virus de la hepatitis C

Traducción oficial
Año 2008
Revista Acta bioquím. clín. latinoam
Enlaces Virtual Health Library

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El objetivo de este estudio fue determinar la prevalencia de autoanticuerpos titulares y de factor reumatoideo (FR) en la infección crónica por Virus de la Hepatitis C (VHC) y su relación con el genotipo viral y tratamiento antiviral. Este estudio incluyó a 21 pacientes infectados con VHC y 24 sujetos sanos. Los autoanticuerpos: antinucleares (ANA), anti-músculo liso (ASMA), anti-mitocondriales (AMA) y anti-microsomales de hígado y riñón-1 (LKM-1) fueron investigados por inmunofluorescencia indirecta y el FR por aglutinación de látex. ANA fueron detectados en el 43% de pacientes y en el 4% de controles (p<0,05). ASMA, AMA Y LKM-1 no se detectaron en pacientes ni en controles. El FR estuvo presente en el 48% de los pacientes, pero en ninguno de los controles. En pacientes ANA (+) y/o FR (+), el nivel de la enzima alanina-aminotransferasa fue similar al nivel detectado en pacientes ANA y FR negativos. Además, la presencia de ANA o FR no estuvo asociada con el genotipo viral o tratamiento antiviral. En conclusión, una alta prevalencia de ANA y FR a títulos bajos pueden ser detectados en la infección crónica por VHC. Estas manifestaciones autoinmunes no están relacionadas con signos bioquímicos de daño hepático, ni genotipo viral o tratamiento antiviral.

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Revisión sistemática

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A Systematic Review of the Interplay Between Social Determinants and Environmental Exposures for Early-Life Outcomes.

Año 2016
Revista Current environmental health reports
Enlaces Pubmed , DOI

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PURPOSE OF REVIEW:

Early-life social and environmental exposures have independent effects on many child health outcomes. Increasingly, investigators have suggested that these exposures, which commonly co-occur, may have synergistic effects and have thus begun to evaluate if environmental and social factors jointly contribute to child health. This systematic review summarizes findings and methodological approaches across studies examining the interplay between environmental and social exposures in relation to commonly assessed childhood health outcomes: asthma, cognition and behavior, perinatal outcomes, and obesity.

RECENT FINDINGS:

Forty-one studies met the search criteria and were reviewed. Of these, 37, 34, and 29 % of studies focused on asthma, cognition/behavior, and perinatal outcomes, respectively. No study focused on obesity. Across all studies reviewed, 72 % observed significant synergistic associations between social and environmental exposures. Air pollution was the most frequently studied environmental exposure, and socioeconomic status was the most commonly studied social factor. The emerging evidence suggests that social and environmental risks may jointly affect child health. Recommendations for future research are discussed, including enhancing characterization of the social environment and broadening the types of environmental risks assessed.

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Revisión sistemática

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Red clover (Trifolium pratense) monograph: a clinical decision support tool.

Año 2002
Revista Journal of herbal pharmacotherapy
Enlaces Pubmed

Sin referencias

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Red clover, a legume resembling soy is used by man as a phytoestrogen. Other uses include asthma, pertussis, cancer and gout. The authors systematically review this herb in terms of pharmacology, efficacy, safety, side effects, standardization, dosing, toxicology as well as other parameters.

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Estudio primario

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Impact of positive and negative beliefs about inhaled corticosteroids on adherence in inner-city asthmatic patients.

Año 2009
Revista Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
Enlaces Pubmed , DOI

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BACKGROUND:

Daily inhaled corticosteroid (ICS) use is the cornerstone of asthma management, although it is often suboptimal, especially in inner-city populations.

OBJECTIVE:

To assess the impact of potentially modifiable medication beliefs on adherence with ICS therapy across time.

METHODS:

Asthma history, medication beliefs, and ICS therapy adherence were determined in a prospective, observational cohort. Medication beliefs were based on self-regulation and self-efficacy theory. Self-reported adherence with ICS therapy was assessed using the Medication Adherence Reporting Scale, a validated 10-item instrument, at baseline and at 1 and 3 months. Repeated-measures multivariable regression identified beliefs independently associated with adherence across time after adjusting for age, sex, race, and asthma severity.

RESULTS:

The 261 patients were low-income minorities with high rates of asthma hospitalization, emergency department visits, intubation, and oral corticosteroid use. Adherence with ICS therapy was stable across time, with 70% of patients saying that they used ICS all or most of the time when asymptomatic. Most patients (82%) thought it was important to use ICS when asymptomatic, although 49% worried about side effects and 37% worried about becoming addicted. Although 82% felt confident in using ICS, 7% felt that their regimen was hard to follow. In multivariable analyses, the odds of adherence increased for those who felt that using ICS when asymptomatic was important (odds ratio [OR], 4.15) and for those who were confident in using ICS (OR, 2.23) and decreased by worries about side effects (OR, 0.52) or feeling the regimen was hard to follow (OR, 0.48).

CONCLUSIONS:

Several positive and negative beliefs about ICS were associated with adherence. Eliciting and addressing these potentially modifiable beliefs may help improve adherence and outcomes.

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Estudio primario

No clasificado

Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age.

Año 2007
Revista The American journal of clinical nutrition
Enlaces Pubmed , DOI , PMC

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BACKGROUND:

Vitamin D deficiency and asthma are common at higher latitudes. Although vitamin D has important immunologic effects, its relation with asthma is unknown.

OBJECTIVE:

We hypothesized that a higher maternal intake of vitamin D during pregnancy is associated with a lower risk of recurrent wheeze in children at 3 y of age.

DESIGN:

The participants were 1194 mother-child pairs in Project Viva-a prospective prebirth cohort study in Massachusetts. We assessed the maternal intake of vitamin D during pregnancy from a validated food-frequency questionnaire. The primary outcome was recurrent wheeze, ie, a positive asthma predictive index (>or=2 wheezing attacks among children with a personal diagnosis of eczema or a parental history of asthma).

RESULTS:

The mean (+/-SD) total vitamin D intake during pregnancy was 548 +/- 167 IU/d. By age 3 y, 186 children (16%) had recurrent wheeze. Compared with mothers in the lowest quartile of daily intake (median: 356 IU), those in the highest quartile (724 IU) had a lower risk of having a child with recurrent wheeze [odds ratio (OR): 0.39; 95% CI.: 0.25, 0.62; P for trend < 0.001]. A 100-IU increase in vitamin D intake was associated with lower risk (OR: 0.81; 95% CI.: 0.74, 0.89), regardless of whether vitamin D was from the diet (OR: 0.81; 95% CI.: 0.69, 0.96) or supplements (OR: 0.82; 95% CI.: 0.73, 0.92). Adjustment for 12 potential confounders, including maternal intake of other dietary factors, did not change the results.

CONCLUSION:

In the northeastern United States, a higher maternal intake of vitamin D during pregnancy may decrease the risk of recurrent wheeze in early childhood.

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