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- Arvidsson, Monica, 1955, et al.
(författare)
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Early and late phase asthmatic response in lower airways of cat-allergic asthmatic patients - a comparison between experimental and environmental allergen challenge
- 2007
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Ingår i: Allergy. - 0105-4538. ; 62:5, s. 488-94
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Tidskriftsartikel (refereegranskat)abstract
- Background: Standardized experimental allergen challenges are usually adopted to investigate the effect of allergen exposure on the lower airways. Environmental (natural) allergen challenges are used less often, mainly because of difficulties in standardizing the method, safety reasons and costs. The aim of this study was to investigate the relationship between an experimental and an environmental bronchial challenge. For this reason a natural challenge model was developed. Methods: Sixty-two patients with a history of cat allergen-induced symptoms involving the lower airways, positive skin prick test, positive in vitro specific IgE to cat allergen and bronchial hyper-responsiveness were included. All 62 patients underwent an experimental challenge in the laboratory followed by an environmental allergen challenge. Results: All 62 patients developed an early asthmatic response [>/=20% fall in forced expiratory volume in 1 s (FEV(1))] in the experimental challenge and 60% (37/62) during the environmental challenge. A late asthmatic response (>/=15% fall in FEV(1) within 3-24 h) was seen in 56% (35/62) of the patients after the experimental challenge. Following the environmental challenge 47% (29/62) of the patients developed a late response. Thirty-four per cent (21/62) of the patients developed a late response in both challenge models and 31% (19/62) did not develop a late response in any model. Thus, there was consistency in 65% (40/62) of the patients in both challenge models. Conclusion: We found consistency in the pattern of response to inhaled allergen between the two challenge models and we believe that experimental bronchial challenge is likely to reflect the development of relevant inflammation in the lower airways after low-dose allergen exposure in the environment.
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| 2. |
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| 3. |
- Löwhagen, Olle, 1938
(författare)
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[Asthma--a disease difficult to define. Patients can receive correct treatment by means of differential diagnosis criteria]. Astma - en svårdefinierad sjukdom
- 2005
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Ingår i: Läkartidningen.. ; 102:50
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Tidskriftsartikel (refereegranskat)abstract
- Asthma is a well defined disease in international consensus reports. However, in clinical praxis patients are often presenting asthma-like symptoms that are not explained by asthma and not by chronic obstructive pulmonary disease (COPD), the later being reported as the most common differential diagnosis. In an asthma and allergy clinic the most common differential diagnoses are asthma-like disorders, of which sensory hyperreactivity (SHR) can be identified by a capsaicin inhalation test. This review presents aspects on the investigation of adult patients with airway symptoms based on 20 years of clinical studies. It is pointed out that a careful asthma investigation strictly following diagnostic criteria is the first step. After this further diagnostic steps may be taken, especially as sensory mechanisms are often involved. Sensory hyperreactivity may also be present in patients with "classical" asthma sometimes explaining the lack of effect of asthma medication.
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| 4. |
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| 5. |
- Sundberg, Rosita, 1944, et al.
(författare)
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A randomized controlled study of a computerized limited education program among young adults with asthma
- 2005
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Ingår i: Respir Med. ; 99:3
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to assess the effectiveness of a computerized limited asthma education program, designed to suit young people. The study was conducted with 97 young adults (18-25 years) with asthma, 48 were randomized to the intervention group and 49 to the control group, and they were followed for 12 months. The intervention group completed an interactive computer program of 30-min duration providing information about asthma, mechanisms, trigger factors, allergies and medication use, which was followed by a 30-min discussion with a specialized asthma nurse. The control group followed the routine schedule for asthma outpatients. The outcomes of the study were number of hospital admissions, emergency visits, asthma symptoms, knowledge about asthma, lung function and quality of life. No effect was found regarding admission to hospital, emergency visits, prevalence of respiratory symptoms, knowledge of asthma or quality of life. However, forced exhaled volume in 1s (FEV(1)) increased significantly, mainly among the atopic subjects. In conclusion, an intervention with a limited asthma education program did not show an effect on asthma symptoms, asthma knowledge or quality of life parameters.
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| 6. |
- Ternesten-Hasséus, Ewa, 1956, et al.
(författare)
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Inhalation method determines outcome of capsaicin inhalation in patients with chronic cough due to sensory hyperreactivity
- 2006
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Ingår i: Pulm Pharmacol Ther. ; 19:3, s. 172-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: For patients with idiopathic chronic cough, a subgroup is recognised with respiratory symptoms induced by scents and chemicals. The diagnosis of sensory hyperreactivity (SHR) has been suggested for this group of patients and can be made using a capsaicin inhalation test. The aim of the present study was to compare the results of inhaling capsaicin by tidal breathing with those obtained by the dosimeter method regarding repeatability, agreement, and ability to distinguish patients with SHR from healthy controls. METHODS: A total of 15 patients with chronic cough due to SHR and 15 healthy control subjects underwent a randomised cross-over protocol and were provoked in a double-blind, randomised fashion with vehicle and two concentrations of inhaled capsaicin, using either the tidal breathing or dosimeter method, in a total of four challenges opportunities, two with each method. RESULTS: Patients coughed more and showed more respiratory symptoms than healthy controls with each dose of capsaicin. Compared with tidal breathing, inhalation of capsaicin with the dosimeter method caused a significantly greater number of coughs and respiratory symptoms in both patients and controls. Among the patients, the mean number of coughs after inhalation of 1mL of capsaicin 0.4mumol/L from the first provocation with tidal breathing was 12 (95% CI: 7; 17) and after inhalation from the first provocation with the dosimeter method 32 (95% CI: 19; 46) (P<0.05). Both methods showed good repeatability and similar ability to distinguish patients with SHR from healthy control subjects. CONCLUSIONS: For patients with SHR, capsaicin cough sensitivity is increased and repeatable. The dosimeter method caused more coughs and other respiratory symptoms than the tidal breathing method, indicating that the methods cannot be used interchangeably. Knowledge of the type of inhalation device used, the particle size, the airflow rate and the inspiratory flow rate are essential when comparing different studies of capsaicin-induced cough.
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| 7. |
- Ternesten-Hasséus, Ewa, 1956, et al.
(författare)
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Quality of life and capsaicin sensitivity in patients with airway symptoms induced by chemicals and scents: a longitudinal study
- 2007
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Ingår i: Environ Health Perspect. - : Environmental Health Perspectives. - 0091-6765. ; 115:3, s. 425-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: It is common in asthma and allergy clinics to see patients presenting with upper and lower airway symptoms that are induced by chemicals and scents and not explained by allergic or asthmatic reactions. Previous studies have shown that these patients often have increased cough sensitivity to inhaled capsaicin; such sensitivity is known to reflect the airway sensory reactivity. The aim of this study was to evaluate the duration of symptoms induced by chemicals and scents and to measure health-related quality of life (HRQL) in patients with chemically induced airway symptoms. We also wished to determine and compare repeatability of the cough response to capsaicin inhalation, and to evaluate the patients' airway sensory reactivity in a long-term perspective. PARTICIPANTS: Seventeen patients with a history of at least 12 months of airway symptoms induced by chemicals and scents were followed over 5 years with repeated questionnaires, measurements of HRQL, and capsaicin inhalation tests. RESULTS: The symptoms persisted and did not change significantly over time, and the patients had a reduced HRQL that did not change during the 5-year period. The capsaicin sensitivity was increased at the start of the study, the cough sensitivity was long-lasting, and the repeatability of the capsaicin inhalation test was considered to be good in a long-term perspective. CONCLUSIONS: Upper and lower airway symptoms induced by chemicals and scents represent an entity of chronic diseases, different from asthma or chronic obstructive pulmonary disease, with persistent symptoms, a reduced HRQL, and unchanged sensory hyperreactivity.
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| 8. |
- Torén, Kjell, 1952, et al.
(författare)
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Self-reported asthma was biased in relation to disease severity while reported year of asthma onset was accurate
- 2006
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Ingår i: J Clin Epidemiol.. ; 59:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: The aims of the study were to assess the accuracy of self-reported asthma and notified year of asthma onset. METHODS: The study was performed on a sample of 365 subjects, 18-60 years old, with clinically diagnosed onset of asthma between 1983 and 1986. All subjects were investigated 10 years later, in 1996, with a respiratory questionnaire about the items of asthma and year of onset. The material was analyzed with logistic regression models. RESULTS: Of the 289 subjects who returned the questionnaire, asthma was reconfirmed in 251 subjects. In a logistic regression model, asthma severity was significantly associated with confirmation of asthma. The median difference between the "true" year of onset and the reported year 10 years later, the recall period was zero, with a 10th to 90th interpercentile range of -2 to 6 years. The recall period was not associated with asthma severity, bronchial hyperresponsiveness, smoking, atopy, or sex. CONCLUSION: Self-reported asthma is biased in relation to disease severity, meaning that subjects with mild disease were less prone to report their asthma. Reported year of asthma onset among adults seems to be rather accurate, with no obvious dependent misclassifications.
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