[Persistence rate for clinic visit in children with asthma after initiating controller therapy].

OBJECT: To investigate the actual condition of the persistence rate for clinic visit in children with asthma requiring controller medication. METHODS: Seventy-three asthma children (0 to 15 years of age) who initiated controller medication were enrolled this study. Patients and their parents were educated about this disease (mechanism of asthma, airway inflammation, and necessity of asthma medication) and instructed to visit clinics regularly every 30 days. We prospectively monitored visit rate of the patients for 180 days. RESULTS: Mean persistence rate for clinic visit of all patients was gradually decreased, 90.4% on the 30 day, 82.2% on the 60 day, 78.1% on the 90 day, 67.1% on the 120 day and 38.4% on the 180 day, respectively. The persistence rate on the 180 day of 2 to 5 years old patients was significantly lower than that of < 2 years old patients and the rate on the 60 days or more after in 6 to 15 years old patients was lower than that of < 2 years old patients. It was also significantly lower in patients with moderate and severe persistent asthma than in mild persistent patients. CONCLUSION: Despite of the investigation in the setting of asthma specialty clinic, the persistence rate for clinic visit was decreased with time, especially in 6 to 15 years old or moderate to severe asthmatic patients. In order to improve the situation, it is necessary to analyze the cause of poor adherence and make a concrete action plan.

[Potential risk factors aggravating airway allergy--aspects of involvement of airtight housing and passive smoking].

OBJECTIVES: The involvement of tightly insulated housing conditions and passive smoking in atopic sensitization, a major risk factor for airway allergy, was examined with nonsmoking adult women and school-age children. SUBJECTS AND METHODS: The subjects were 382 nonsmoking healthy adult women (housewives) who underwent medical examinations for prevention of adult diseases conducted in a district of Osaka from 1995 to 1997, and 214 elementary school-children 9-12 years old living in an urban district of Osaka who underwent medical examinations at a health center in April, 2000 to prevent allergic diseases. We also examined the correlation between tightly insulated housing conditions and the amount of passive smoking based on family smoking habits with 170 children under 12 years old who had been under the care of a hospital pediatrics department between December, 1993 and May, 1994. A questionnaire was administered to all subjects to survey the housing structure (concrete/wooden housing), family smoking habits and visible mold proliferation in the kitchen in relation to airtight housing conditions, passive smoking and exposure to inhalant allergens. Atopic sensitization was assessed by positivity for serum house dust mite-specific IgE, and passive smoking was defined as a urinary cotinine level of more than 6 ng/mgCr. RESULTS: 1. Among the three factors, indoor mold proliferation and family smoking habits were positively and synergistically related with atopic sensitization to house dust mites. 2. Airtight conditions of concrete housing showed a promotional effect on passive smoking for housewives, but a suppressive effect for school-age children. 3. Taking into account the above results, the promotional effects of passive smoking on atopic sensitization appeared predominantly in the concrete housing-residence group of housewives and the wooden housing-residence group of school-age children. 4. Effects of visible mold proliferation in the kitchen on atopic sensitization appeared predominantly in wooden housing-residence group of housewives. CONCLUSIONS: The results suggest that involvement of the three factors in atopic sensitization is due to increased exposure to indoor inhalant allergens or enhanced IgE-antibody production (adjuvant effects of tobacco smoke) and the extent of their inpact varies depending on the individual life styles of the housewives and school-age children.