Asthma management in eastern Australia, 1990 and 1993

Comino, Elizabeth; Mitchell, Charles; Bauman, Adrian; Henry, Richard L.; Robertson, Colin F.; Abramson, Michael J.; Ruffin, Richard E.; Landau, Lou

doi:10.5694/j.1326-5377.1996.tb122087.x

Cited by 53 publications

(33 citation statements)

References 11 publications

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“…19 Our study's increased prevalence is similar to the 33% in Yocum and colleagues' epidemiological study, 6 and is higher than the rate of 23.2% in Brown and colleagues' local adult study. 5 A history of poorly controlled asthma is significant as it is an independent risk factor for death from anaphylaxis.…”

Section: Discussionsupporting

confidence: 81%

Paediatric emergency department anaphylaxis: different patterns from adults

Braganza

Acworth²,

McKinnon³

et al. 2005

Archives of Disease in Childhood

236

222

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Background and Aims: Data on acute paediatric anaphylaxis presentations to the emergency department (ED) are limited. All allergic presentations to one Australian paediatric ED were studied to determine epidemiological, clinical, and outcome data. Methods: Retrospective, case based study of patients under 16 years attending one metropolitan, paediatric teaching hospital ED in Australia over three years. The medical records of patients presenting with generalised allergic reactions and anaphylaxis satisfying relevant ICD-9-CM diagnostic codes were studied. The incidence, age, sex ratio, co-morbidities, likely aetiology, clinical features, management, and disposal were determined. Results: A total of 526 children with generalised allergic reactions, and 57 with anaphylaxis were included in the study. This represented incidences of 9.3:1000 ED presentations for generalised allergic reactions and 1:1000 for anaphylaxis. There were no fatalities. In anaphylaxis cases, a cause was recognised in 68.4%. Cutaneous features were present in 82.5%. A past history of asthma was reported in 36.8%. Adrenaline was used in 39.3% of severe anaphylaxis cases. The ED alone definitively cared for 97.8% of all patients. Follow up was inadequate in cases of anaphylaxis. Conclusions: This is the first reported incidence figure for paediatric anaphylaxis ED presentations in Australia, and is less than that reported in adults in the same local population. However, the incidence of generalised allergic reactions of 9.3:1000 was greater than in the adults. Virtually all paediatric allergic cases may be managed in the ED alone, provided that the importance of specialist follow up, particularly for severe anaphylaxis, is recognised.

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Section: Discussionsupporting

confidence: 81%

Paediatric emergency department anaphylaxis: different patterns from adults

Braganza

Acworth²,

McKinnon³

et al. 2005

Archives of Disease in Childhood

236

222

View full text Add to dashboard Cite

show abstract

“…Our results may be subject to bias because of the increasing awareness of both asthma and wheezing in the community and could be influenced by parental recall or acceptance of these labels, access to health services, and physician attitudes. We expect that the last sentence of our written questionnaire and the fact that there were no questions on recurrent or persistent cough have significantly limited false positive answers 9. This is supported by the fact that the majority of physician diagnosed asthmatic subjects were also recurrent wheezers.…”

Section: Discussionmentioning

confidence: 83%

Prevalence of asthma among schoolchildren in Patras, Greece: three surveys over 20 years

Anthracopoulos¹

2001

Thorax

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Background-Beta-2 adrenoceptor agonists have been associated with sudden death in asthma patients but the cause and underlying mechanism are unclear. Animal experiments indicate that the combination of hypoxia and 2 agonists may result in detrimental cardiovascular effects. A study was undertaken to investigate the eVect of hypoxia on the systemic vascular eVects of salbutamol in patients with asthma who are hypoxic by assessing forearm blood flow (FBF) as a measure of peripheral vasodilatation. Methods-Eight men with mild asthma underwentthefollowingtreatments:normoxia + placebo (NP), normoxia + salbutamol (NS), hypoxia + placebo (HP), and hypoxia + salbutamol (HS). The period of mask breathing started at t=0 minutes, lasted for 60 minutes, and at 30 minutes 800 µg salbutamol was inhaled. The experiment was completed 30 minutes after the inhalation (t=60 minutes). For the hypoxia treatment the SpO 2 level was 82%. DiVerences between treatments were sought using factorial ANOVA on percentage change from the pretreatment value. Results-There were no significant diVerences in blood pressure and potassium levels between the treatments. After 60 minutes the increase in FBF was 13% (95% CI -12 to 39) more for HP treatment than for NP, 21% (95% CI -5 to 46) more for NS than for NP, and 32% (95% CI 7 to 58) more for HS than for HP (p=0.016). The inhalation of salbutamol during hypoxia resulted in a significant increase in FBF of 45% (95% CI 20 to 71) compared with NP (p=0.001). Conclusion-Patients with asthma who are hypoxic and inhale 2 agonists have serious systemic vascular side eVects which may be an additional explanation for the association between asthma treatment and sudden death. (Thorax 2001;56:567-569)

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“…In eastern Australia 21.7% of children reported having a written asthma action plan in 1993, an increase from 16.7% in 1990 19. Here, at trial end, 44% of intervention children had a written asthma action plan, less than the 70% used to estimate sample sizes.…”

Section: Discussionmentioning

confidence: 91%

Proactive asthma care in childhood: general practice based randomised controlled trial

Glasgow

2003

BMJ

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Objectives To assess the feasibility and effectiveness of a general practice based, proactive system of asthma care in children. Design Randomised controlled trial with cluster sampling by general practice. Setting General practices in the northern region of the Australian Capital Territory. Participants 174 children with moderate to severe asthma who attended 24 general practitioners. Intervention System of structured asthma care (the 3+ visit plan), with participating families reminded to attend the general practitioner. Main outcome measures Process measures: rates for asthma consultations with general practitioner, written asthma plans, completion of the 3+ visit plan; clinical measures: rates for emergency department visits for asthma, days absent from school, symptom-free days, symptoms over the past year, activity limitation over the past year, and asthma drug use over the past year; spirometric lung function measures before and after cold air challenge. Results Intervention group children had significantly more asthma related consultations (odds ratio for three or more asthma related consultations 3.8 (95% confidence interval 1.9 to 7.6; P = 0.0001), written asthma plans (2.2 (1.2 to 4.1); P = 0.01), and completed 3+ visit plans (24.2 (5.7 to 103.2); P = 0.0001) than control children and a mean reduction in measurements of forced expiratory volume in one second after cold air challenge of 2.6% (1.7 to 3.5); P = 0.0001) less than control children. The number needed to treat (benefit) for one additional written asthma action plan was 5 (3 to 41) children. Intervention group children had lower emergency department attendance rates for asthma (odds ratio 0.4 (0.2 to 1.04); P = 0.06) and less speech limiting wheeze (0.2 (0.1 to 0.4); P = 0.0001) than control children and were more likely to use a spacer (2.8 (1.6 to 4.7); P = 0.0001). No differences occurred in number of days absent from school or symptom-free day scores. Conclusions Proactive care with active recall for children with moderate to severe asthma is feasible in general practice and seems to be beneficial.

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Asthma management in eastern Australia, 1990 and 1993

Cited by 53 publications

References 11 publications

Paediatric emergency department anaphylaxis: different patterns from adults

Paediatric emergency department anaphylaxis: different patterns from adults

Prevalence of asthma among schoolchildren in Patras, Greece: three surveys over 20 years

Proactive asthma care in childhood: general practice based randomised controlled trial

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