Premenstrual asthma and leukotriene variations in the menstrual cycle.

BACKGROUND: Several authors have reported an increase in leukotriene C4 in the premenstrual phase in women with severe premenstrual asthma, indicating that antileukotrienes could be used in treatment. OBJECTIVE: To analyse the role of leukotrienes in premenstrual asthma. METHODS: A questionnaire on respiratory symptoms and peak flow during one complete menstrual cycle was given to women of fertile age to define them as asthmatics who suffered from premenstrual asthma or not. Premenstrual asthma (PMA) was defined as a clinical or functional deterioration (≥20%) in the premenstrual phase compared with the preovulatory phase. Blood samples to measure leukotriene C4 were taken during the preovulatory and premenstrual phases. RESULTS: Blood samples were taken in 62 asthmatic women, 34 of whom (54.3%) presented PMA criteria, all with a premenstrual deterioration of between 20 and 40%. There was no difference in leukotriene C4 levels between the preovulatory and premenstrual phases in the women who suffered from PMA (1.50ng/mL vs. 1.31ng/mL; p=0.32) and those who did not (1.40ng/mL vs. 1.29ng/mL; p=0.62). Neither were there any differences in leukotriene levels between women with or without PMA. The results were similar for each category of asthma severity. CONCLUSIONS: Our data show that leukotriene C4 does not appear to be involved in the pathogenesis of premenstrual asthma, or support the use of anti-leukotrienes in the specific treatment of premenstrual asthma, at least in women with a moderate premenstrual deterioration. No differences appeared in any of the categories of asthma severity.

Variability in the prevalence of premenstrual asthma.

Our aim is to analyse the differences in the prevalence of premenstrual asthma (PMA) according to a set of criteria, the relationship between them and the influence of asthma severity. The answer "Yes" to "Does your asthma get worse before menstruation?" was considered subjective PMA. A daily respiratory symptoms register of fertile asthmatic females was taken during two consecutive menstrual cycles. For the semi-objective diagnosis, an exacerbation of > or =20% was required in the symptoms register. Objective diagnosis was a premenstrual worsening of > or =20% of peak flow. We selected 103 patients. Subjective premenstrual deterioration was perceived in 43.7%. The semi-objective deterioration of symptoms in the first cycle occurred in 44.7%, and in 22.3% in both cycles. A total of 54.3% of females with semi-objective criteria in the first cycle perceived a subjective deterioration of symptoms, versus 35.1% of those without semi-objective criteria (p = 0.05). PMA was present at all levels of asthma severity, with no clear link to the degree of severity. The detection of PMA prevalence, the subjective perception of this deterioration and its presence at all levels of asthma severity lead us to urge research into possible premenstrual deterioration in all fertile asthmatic females.

Benefits at 3 yrs of an asthma education programme coupled with regular reinforcement.

The benefits at 3 yrs of an asthma self-management education programme coupled with educational reinforcement were assessed at follow-up visits in 63 adults with chronic asthma. Changes in asthma-related morbidity parameters, lung function and use of different classes of drugs before intervention and after 1, 2 and 3 yrs of the asthma education programme were compared using Friedman one-way analysis of variance. Improvements in the number of days off work or school, general practitioner consultations, admissions to emergency services, hospital admissions and nocturnal awakenings, as well as increases in forced expiratory volume in one second (FEV1), were significant. Comparison of data obtained at 1 yr and 2-3 yrs showed significant differences in the number of asthma-associated sleep disruptions, days off work or school and unscheduled visits to the general practitioner, as well as FEV1, but significant differences between the data obtained at 2 and 3 yrs were not observed. The percentage of patients using oral steroids had decreased significantly at 3 yrs. In adults with chronic asthma, an asthma self-management education programme coupled with educational reinforcement was effective at decreasing asthma morbidity, improving lung function and decreasing consumption of oral steroids.

[Prescription habits in a primary health care district: approach to an indication-prescription study]. / Hábitos de prescripción en un distrito de atención primaria de salud. Aproximación a un estudio de indicación-prescripción.

OBJECTIVE: To analyse the profile of medical prescription and prescription habits in the most common illnesses in a Primary Health Care district. DESIGN: Descriptive crossover study. SETTING: Algeciras-La Línea (Cádiz) Primary Care district. MEASUREMENTS AND MAIN RESULTS: A randomised sample of clinical histories stratified by months was selected. This included 338 Paediatrics cases (< 8 years old) and 665 general medical cases (> 8). The therapeutic groups most commonly prescribed for the children were R (45.7%) and J (27.1%) The therapeutic groups most used among the > 8 group were C (17.9%), R (14.8%), N (14.7%) and A (14.3%). Hypertension was the most common chronic pathology in this group (8.9%), treated most often by ACEIs (44.9%). CONCLUSIONS: 1) In our ambit, the most widespread pathology signified the greatest consumption of therapeutic groups. 2) The indication-prescription analysis detected prescription habits that need to be watched: the use of antibiotics and expectorants/mucolytics in ARI and the use of fixed-dose combinations which are hard to justify. Prescription habits in Hypertension treatment and Hyperlipidaemia also merit a consensus analysis.

[The quality of antibacterial prescription in a primary care district. Its evolution in 1994-1995]. / La calidad de la prescripción de antibacterianos en un distrito de atención primaria. Evolución 1994-1995.

OBJECTIVES: To analyse the profile and quality of antibacterials (ABs) prescription in a primary care (PC) district during 1994 and 1995. DESIGN: A longitudinal, descriptive and retrospective study. SETTING: PC doctors from the PC district Bahía de Cádiz (Cádiz). MEASUREMENTS AND MAIN RESULTS: The prescriptions for ABs belonging to the following groups were studied: JO1 (systemic antibiotics), JO3 (systemic chemotherapy drugs), GO4A (antiseptics and drugs for urinary infection) and RO5C1 (expectorants, with mucolytic drugs included with anti-infection ones). The unit of measurement was the daily defined dose (DDD). DDD per 1,000 inhabitants per day (DID) and the DDD percentage of each AB versus the total were used as quantitative indicators. The qualitative indicators were: origins of use of ABs in PC and %DDD of non-justified associations (NJA) (RO5C1 group). CONCLUSIONS: The prescription profile of ABs in the area is similar to, and somewhat more favorable than, that described in the literature for similar areas. In the reconverted network there was a more rational prescription than in the non-reconverted network for the two years of the study. In both types of network a light improvement in the indicators studied was observed from 1994 to 1995.

[Study of the use of antiulcer and hypolipemic drugs in the Primary Care District of Jerez (Cádiz)]. / Estudio de utilización de antiulcerosos e hipolipemiantes en el Distrito de Atención Primaria de Jerez (Cádiz).

OBJECTIVES: To identify the prescription profile for anti-ulcerous and hypolipemic drugs during the three-year period 1994-1996 in the Jerez Primary Care district, and the differences in prescription between the reformed (Health Centres) and the unreformed networks (non-hospital clinics). DESIGN: Longitudinal, retrospective study, out of a complete sample. SETTING: Primary Care. PARTICIPANTS: Total number of general medical consultations. MEASUREMENTS AND MAIN RESULTS: The first quarter of each year was studied. Dose per 1,000 inhabitants per day (DID) was the indicator. Consumption of anti-ulcer drugs grew from 11.43 DID in 1994 to 15 in 1996 (31.23%). In the reformed network, consumption grew from 10.25 to 13.26 DID (29.37%); and in the non-reformed, from 12.56 to 16.72 DID (33.12%). Hypolipemic use went up from 8 DID in 1994 to 10.32 in 1996 (29%). CONCLUSIONS: Anti-ulcer and hypolipemic drug use increased over the study period. Both consumption and increases were lower in Health Centres. Increase in statin use led to a light decline in fibrate use in the reformed network, but not in non-hospital clinics.

Asthma self-management education program by home monitoring of peak expiratory flow.

A prospective controlled trial of home monitoring of peak expiratory flow rate (PEFR) was conducted to determine the usefulness of an objective measure of lung function in association with an education program and a medication self-management plan in reducing morbidity in adult patients with asthma. Thirty-five patients managed themselves, using peak flow readings as the basis for the therapeutic plan coupled with educational intervention, whereas 35 control patients used symptoms and spirometric data for following physicians' treatment plans. After a 6-mo study period, patients in the experimental group showed statistically significant improvements in morbidity parameters (days lost from work, acute asthma attacks, days on antibiotic therapy, physician consultations, and emergency room admissions for asthma), increases in FVC, FEV1, and FEV1/FVC, mean PEFR and mean morning PEFR, decrease in percentage of the mean PEFR amplitude, and a reduction in the use of inhaled beta-agonists, oral theophylline, and oral prednisone. Although improvements in some of these parameters were also found in the control group, they did not reach the levels of significance obtained in the experimental group. The personal use of an objective measure of lung function in association with a medication self-management plan leads to improvement in the patient's condition.

[2 cases of bilateral diaphragmatic paralysis]. / Dos casos de parálisis diafragmática bilateral.

Bilateral diaphragmatic paralysis is characterized by severe dyspnea in decubitus, with or without known respiratory or cardiac disorders. In both patients clinical diagnosis was confirmed by measuring the transdiaphragmatic pressure which was approximately zero. The first patient, previous to the clinical onset, had an episode of gastroenteritis and later developed a pneumonia; in the second patient, clinical manifestations started after neck surgery and both the clinical and functional disorders recovered within the following eight months.