From the female perspective: Long-term effects on quality of life of a program for women with asthma.

BACKGROUND: Although, among adults, asthma predominates in women, the role of sex and gender in asthma has only recently been studied. Moreover, only one study has focused on the management of asthma by women, reporting that 1 year subsequent to an intervention addressing sex and gender role factors, women's asthma status was improved. OBJECTIVE: Data from a 2-year postintervention follow-up were assessed to determine whether there were longer-term effects on the asthma status and quality of life (QoL) of the participants. METHODS: A randomized controlled design was used in which female patients with asthma, who were receiving services at the University of Michigan Health System, Ann Arbor, Michigan (2002-2006), were assigned to either a control group or a female-oriented intervention group that focused on management challenges related to sex and gender role factors. Data were collected at baseline and 2 years' postintervention (2008) by telephone interview and review of medical records. Measures included asthma-related QoL, health care and medication use for asthma, level of self-regulation, self-confidence in managing the condition, sex and gender role-related asthma problems, and days of missed work or school because of asthma. Data were analyzed using both generalized estimating equations logistic regression and log-linear regression. RESULTS: The mean (SD) age of the 808 women participating in the study was 48.2 (13.1) years in the intervention group and 48.7 (14.3) years in the control group, and the percentage of minority participants was 15.8% and 16.3%, respectively. Despite randomization, women in the intervention group had more persistent asthma at baseline. At 2 years' postrandomization, the only significant difference in health care use was associated with scheduled office visits; no other significant health care use differences were evident. However, the women in the intervention group had a significantly greater decrease of asthma symptoms with sexual activity (P = 0.01) and greater reduction in days of work/school missed for asthma in winter months (P = 0.03), were better able to self-regulate (P = 0.01), were more confident in managing their asthma (P = 0.01), and had higher levels of asthma-related QoL (P = 0.02). They also had a greater reduction in the use of short-acting bronchodilators (ie, rescue medications) than did women in the control group (P < or = 0.05). CONCLUSION: An intervention that focuses on female-specific aspects of asthma management may result in improved QoL and health status for women with asthma, as was evident 2 years' postintervention in this study.

Overweight women and management of asthma.

PURPOSE: We sought to describe clinical and psychosocial characteristics of overweight women with asthma. METHODS: Telephone interview and medical record review involving 808 women with asthma participating in a randomized study to identify those who were overweight. We assessed the relationship of their weight to asthma symptoms, health care use, quality of life, self-esteem, need for social support, and demographic characteristics. Regression analyses were used to investigate relationships between overweight and asthma. FINDINGS: Sixty-eight percent of the women in the study were overweight or obese. Demographic characteristics associated with overweight in women with asthma included being minority (p=.000), having a lower education level (p=.000), and a lower household income (p=.024). Overweight was associated with greater health care use, comorbidities (acid reflux, urinary incontinence), and persistent disease (p=.001). Overweight women exhibited lower self-esteem (p=.002) and lower perceived quality of life (p=.000). CONCLUSION: Overweight females with asthma experience significant challenges because of their weight, more persistent and severe disease, specific comorbidities, and lower rates of obtaining psychosocial resources. Clinical consultations and interventions should account for the influence of overweight on asthma control and health status in female patients.

Predictors of habitual snoring and obstructive sleep apnea risk in patients with asthma.

BACKGROUND: A high prevalence of obstructive sleep apnea (OSA) symptoms was reported in patients with asthma. Our goal was to evaluate factors associated with habitual snoring and OSA risk in these patients. METHODS: Patients with asthma were surveyed at specialty clinics with the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) and questions about the frequency of asthma symptoms (National Asthma Education and Prevention Program guidelines), followed by medical record review. SA-SDQ scores >or= 36 for men and >or= 32 for women defined high OSA risk. Logistic regression was used to model associations with habitual snoring and high OSA risk. RESULTS: Among 244 patients, 37% snored habitually and 40% demonstrated high OSA risk. Independent predictors of habitual snoring included gastroesophageal reflux disease (GERD) [odds ratio (OR), 2.19; 95% confidence interval (CI), 1.19 to 4.02] and use of an inhaled corticosteroid (ICS) [OR, 2.66; 95% CI, 1.05 to 6.72]. High OSA risk was predicted by asthma severity step (OR, 1.59; 95% CI, 1.23 to 2.06), GERD (OR, 2.70; 95% CI, 1.51 to 4.83), and ICS use (OR, 4.05; 95% CI, 1.56 to 10.53). Linear, dose-dependent relationships of ICS with habitual snoring and high OSA risk were seen (p = 0.004 and p = 0.0006, respectively). Women demonstrated a 2.11 times greater odds for high OSA risk (95% CI, 1.10 to 4.09) when controlling for the above covariates. CONCLUSIONS: Symptoms of OSA in patients with asthma are predicted by asthma severity, coexistent GERD, and use of an ICS in a dose-dependent fashion. The well-recognized male gender predominance for OSA symptoms is not apparent in these patients. Further exploration of these relationships may help to explain the increased prevalence of OSA in asthma and provide new insights into the reported female predominance of asthma morbidity.

A randomized trial of a self-regulation intervention for women with asthma.

BACKGROUND: Women with asthma have greater mortality and morbidity than men in the United States. To date, there has been no rigorous evaluation of an intervention focused on the particular problems in asthma management faced by women. This study was a randomized clinical trial of a self-regulation, telephone counseling intervention emphasizing women's concerns, and sex and gender role factors in their management of asthma. METHODS: A total of 808 women with diagnosed asthma were randomly assigned to the intervention group or a usual-care control group, including conventional asthma education. Interviews and medical record data were collected to assess psychosocial factors, and the behavioral factors of functioning, quality of life, symptoms, and health-care use at baseline and the subsequent 1 year. Generalized estimating equations, identity link, logit link, and log link were employed to analyze the data. RESULTS: Compared to control subjects, the women receiving treatment had greater annual reductions in the average number of nights with asthma symptoms (p = 0.04), days of missed work/school (p = 0.03), emergency department visits (p = 0.04), unscheduled office visits (p = 0.01), and scheduled office visits (p = 0.04). They had greater recognition of asthma symptoms during the menstrual cycle (p = 0.0003), had decreased asthma symptoms with sexual activity (p = 0.008), and had greater improvement in quality of life (p = 0.0005), self-regulation (p = 0.03), and self-confidence to manage asthma (p = 0.001). CONCLUSION: The intervention improved women's clinical status, functioning, quality of life, and health-care use. A program with a focus on asthma management problems particular to women can significantly assist female asthma patients.

Correlates of daytime sleepiness in patients with asthma.

BACKGROUND AND PURPOSE: Patients with asthma often complain of daytime sleepiness, which is usually attributed to a direct effect of asthma on nocturnal sleep quality. We investigated this and other potential explanations for daytime sleepiness among asthmatics. PATIENTS AND METHODS: One hundred fifteen adult asthmatics were assessed for perceived daytime sleepiness (one question item), subjective sleepiness (Epworth Sleepiness Scale score, ESS), obstructive sleep apnea risk (Sleep Apnea scale score within Sleep Disorders Questionnaire, SA-SDQ), asthma severity step, relevant comorbid conditions, and current asthma medications. RESULTS: Among all subjects, 55% perceived excessive daytime sleepiness and 47% had ESS>10. Most subjects reported snoring (n=99, or 86%) and many snored habitually (n=44, 38%). The ESS correlated with SA-SDQ (P<0.0001), male gender (P=0.01), and asthma severity step (P=0.04). In a multiple regression model, the ESS was independently associated with SA-SDQ (P=0.0003) and male gender (P=0.02), but not with asthma severity step (P=0.51). There were no correlations between ESS and age, body mass index (BMI), forced expiratory volume in one second as percent of predicted value (FEV(1)%), comorbidities, or medication used to treat asthma. CONCLUSIONS: Sleepiness is common in asthmatics and may reflect occult obstructive sleep apnea more often than effects of asthma itself, other comorbid conditions, or asthma medications.

Applied medical informatics for the chest physician: information you can use!--Part 3.

In this third and last part in our series on applied medical informatics (AMI), we will examine the following: (1) a concise wrap-up of the practice steps necessary to achieve the benefits from AMI in your practice; (2) an introduction to the patient health-care record and why it is important to physicians; and (3) a look at some of the latest developments in AMI that are of interest to the chest physician.

Applied medical informatics for the chest physician: information you can USE!--Part 2.

In part 2 of this series on applied medical informatics for the chest physician, we will examine in detail the key reasons for the current low adoption and effective use of the electronic medical record.

Applied medical informatics for the chest physician: information you can use!

The world of applied medical informatics is changing rapidly. This is the first of a three-part series of articles on applied medical informatics that will bring the practicing chest physician up to date on the structure, function, benefits, and drawbacks of the electronic medical record and all of its components, including the virtual ICU and the daily practice of medicine.

The electronic medical record, safety, and critical care.

The goal of this article is to introduce the elements of the Electronic Medical Record as they pertain to critical care medicine including order communications and decision support.