Childhood Asthma Management Pre- and Post-Incident Asthma Hospitalization

Many hospitalizations for asthma could potentially be avoided with appropriate management. The aim of this study was to analyze data on disease management of a paediatric population with a hospitalization for asthma. The study population comprised 6–17 year old subjects belonging to three local health units of the Lombardy Region, northern Italy. Regional administrative databases were used to collect data on: the number of children with an incident hospitalization for asthma during the 2004–2006 period, anti-asthma therapy, specialist visit referrals, and claims for spirometry, released in the 12 months before and after hospitalization. Each patient’s asthma management profile was compared with GINA guideline recommendations. Among the 183 hospitalized subjects, 101 (55%) received therapy before hospitalization and 82 (45%) did not. 10% did not receive any therapy either before or after hospital admission and in 13% the therapy was discontinued afterward. Based on GINA guidelines, asthma management adhered to recommendations only for 55% of subjects. Results may suggest that for half of hospitalized subjects, inaccurate diagnosis, under-treatment/scarce compliance with asthma guidelines by physicians, and/or scarce compliance to therapy by patients/their parents occurred. In all these cases, hospitalization would be a proxy indicator of preventable poor control of disease, rather than a proxy indicator of severity.     

Childhood Asthma and Mental Retardation

Four hundred consecutive outpatients seen at the Children''s Psychiatric Research Institute, London, Ont., were investigated to determine whether there is a negative correlation between childhood asthma and mental retardation. Of these, 380 were mentally retarded and 20 were of normal intelligence. Only two cases of childhood asthma were found. One of these had an I.Q. of 108 and the other 78, so that no case of asthma was found in the mentally retarded group. On the basis of a reported prevalence rate for asthma of 1.76%, one would expect six or seven cases among the 400. By contrast, among the approximately 800 parents there were 11 cases of chronic asthma, a figure which is approximately the expected number.     

Effect of Salbutamol on Spirometry and Blood-gas Tensions in Bronchial Asthma

A new bronchodilator drug, salbutamol, reduced airway obstruction in 37 patients with bronchial asthma but did not lead to a significant fall in lowered arterial oxygen tension. This drug, unlike other bronchodilators, appears to have little or no effect on the cardiovascular system, and it is suggested that it does not therefore lead to an intensification of the ventilation/perfusion disturbance in the lung leading to a worsening of hypoxaemia.     

Effect of Controlled Oxygen Therapy on Arterial Blood Gases in Acute Respiratory Failure

Seven patients in acute exacerbation of chronic respiratory failure were given 24·5% and later 28% oxygen through Ventimasks. The mean increases in arterial PO₂ were 11 and 21 mm. Hg while breathing 24·5% and 28% oxygen respectively compared with control values while breathing air. Associated increases in arterial PCO₂ were 4 and 8 mm. Hg, respectively. In five of the patients these increases in inspired oxygen concentration resulted in useful increases in tissue oxygen supply without significant deterioration in ventilation, but in two patients arterial PCO₂ rose excessively and artificial ventilation was required.     

Arterial Blood Pressure and Modernization in Brazil

The relationship between individual modernization and elevated arterial blood pressure was examined in a study in urban Brazil. We hypothesized that elevated blood pressure would result from the discrepancy between an individual's style of life and his or her economic resources; specifically, we suggested that when modern life-style acquisition exceeded economic resources, a circumstance referred to as "life-style stress," blood pressure would be elevated. This factor was related to diastolic, but not systolic, blood pressure, independently of a variety of biologic, dietary, and sociocultural confounding factors. The perceived change associated with life events also predicted diastolic, but not systolic, blood pressure. Other predictors of diastolic blood pressure were calcium intake, fat intake, race, age, and the body mass index. We argue that sociocultural risk factors emerge in the modernization process as a result of social structural imbalances generated by economic development and represent independent risk factors for elevated arterial blood pressure.