Mismatch between asthma symptoms and spirometry: implications for managing asthma in children.

Spirometry was performed on 894 children (5-19) in Connecticut in whom clinical assessment had found intermittent asthma in 30% and mild, moderate and severe persistent asthma in 32%, 33% and 5% respectively. Worsening spirometric parameters were associated with more severe clinical disease. But spirometric assessment showed greater disease severity than clinical asessment in 36% and concordance between spirometric results and clinical symptoms was poor, 0.2 after adjustment for bias and prevalence. Asthma morbidity is known to be reduced by appropriate treatment and the authors suggest that spirometry results may be a better guide for therapy decisions than symptomatology.

Schifano ED et al. J Pediatr. 2014 Aug 28. pii: S0022-3476(14)00650-7. doi: 10.1016/j.jpeds.2014.07.026. [Epub ahead of print]

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Grandmother’s smoking when pregnant with the mother and asthma in the grandchild: the Norwegian Mother and Child Cohort Study.

The Norwegian Mother and Child Cohort Study includes about 100,000 mothers and children. The grandmother’s smoking when pregnant with the mother was examined in relation to asthma outcomes in the grandchild. For 23.5% of children, mothers stated their own mothers had smoked when pregnant with them. Asthma was reported in 5.7% of 53,169 children with follow up data at age 36 months, and 5.1% of 25,394 children with data at age 7. There was prescription registry data on dispensed asthma drugs for 4.8% of 45,607 children with data available at age 7. There was positive association between grandmother’s smoking when pregnant and asthma in all 3 groups of grandchildren, independent of mother’s smoking status. Because of few information about the socioeconomic status and asthma status of the grandmothers, unmeasured confounding factors may be present.

Magnus MC et al. Thorax. 2015 Jan 8. pii: thoraxjnl-2014-206438.

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The reliability and utility of spirometry performed on people with asthma in community pharmacies.

Australian researchers assessed data from 2593 spirometry sessions performed by community pharmacists for 892 asthmatics within 2 large asthma intervention trials. There were 3 acceptable tests in 68.5% of sessions and at least one acceptable test in 96% of sessions. Acceptability was defined as meting ATS/ERS guideline criteria. Around 40% had results indicating obstruction. As a result of the service FEV1 and FEV1/FVC increased significantly in study participants as did asthma control. Those who were referred to GPs had significantly worse spirometry results. The authors concluded that spirometry by pharmacists can be reliable, and could be useful for community asthma review.

Burton DL et al. J Asthma. 2015 Jan 7:1-27

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Efficacy and effectiveness of seasonal and pandemic A (H1N1) 2009 influenza vaccines in low and middle income countries: a systematic review and meta-analysis.

Influenza vaccination is recommended in low and middle income countries (LICs and MICs) for at-risk populations. A search in 3 medical databases for English, French, Spanish or Portuguese papers on effectiveness and efficacy of flu vaccine in these countries from 1960- 2011 yielded 41 studies. In MICs, flu vaccine showed pooled efficacy 72% and 81% for 1 and 2 year follow up in children and 43% and 58% pooled efficacy for live attenuated and inactivated vaccine respectively in the elderly. Inactivated vaccine reduced cardiovascular outcomes in at-risk patients. Effectiveness was similar to that in high income countries. Data for LICs and other at risk groups in MICs were limited.

Breteler JK et al. Vaccine. 2013 Oct 25;31(45):5168-77. doi: 10.1016/j.vaccine.2013.08.056. Epub 2013 Sep 5.

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