Predictive value of specific IgE for the development of asthma in children younger than 5 years presenting with persistent coughing in general practice

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common cause of consultations in Primary Care and accounts for as many as 1 in 8 medical admissions. Objectives: The main aims of this audit are accurate diagnosis of COPD, control of symptoms and thereby promoting quality of care, to evaluate current medications and to encourage patients to stop smoking. Methods: initial search of the practice population revealed 82 patients who were potentially suffering from COPD (Age 43-86 years). With support of Respiratory Specialist nurse, all these patients had spirometry and reversibility tests for confirmation of their diagnosis. 47 patients were confirmed of suffering from COPD. All these patients were given St George's Respiratory Questionnaire (SGRQ) to assess the symptoms, their current medications were assessed and smoking cessation advice was given. These patients were subsequently followed up in further two audit cycles with carbon monoxide monitoring in last audit. Results: In January 1999, only 48% (N=23) of COPD patients were using B2 agonists on regular basis, this increased to 97% (N=36) in March 2000 and 92% (N=34) in January 2001. Usage of anticholinergic increased from 20% (N=10) to 51% (N=19) in same period. Percentage of patients on inhaled corticosteriods came down from 70% (N=34) to 53% (N=21) for the above period. Those who were on high doses of inhaled corticosteroids (.800mcg daily) also reduced from 44% (N=15) to only 8% (N=3). 50% (N=26) of COPD patients were smoking in January 1999 and this reduced to 24% (N=9) in January 2001. The carbon monoxide monitoring in these patients revealed that 67% (N=20) of these patients showed carbon monoxide traces between 0-3%. Quality of Life Questionnaire (SGRQ) of these patients revealed that percentage of patients feeling better was increased from 35% (N=17) to 57% (N=21) for the above period. Conclusion:Smoking cessation is the cornerstone of COPD management. Accurate diagnosis and frequent assessment of medication improves the outcome. The use of inhaled corticosteriods should be reserved for more severe COPD patients. Aim: To longitudinally describe the relation between indoor and lifestyle factors and the subsequent development of specific IgE to inhalant-allergens. Methods: Coughing children, aged 1-5, were tested for IgE-antibodies to mite, dog and cat by RAST. All children with all RASTs <0.2 IU/ml were retested after 30 months. The results of the second RAST were dichotomized in IgE-positive (RAST 0.5 IU/ml) or IgEnegative. The parents completed questionnaires during the first and second RAST. The results of the second RAST were compared to items on smoking by the parents, pets at home, breastfeeding, siblings, floor covering, moulds and dampness. Adjusted odds ratios (ORs) for becoming IgE-positive in relation to lifestyle and environmental factors were calculated. Results: After 2 years, 33 of 317 originally IgE-negative children had become IgE-positive (22/169 boys, 11/148 girls). Associated with a decreased risk of allergy was havin...