Impact of disease severity on quality of life in adults with asthma.

Health-related quality of life is increasingly used as an outcome measure in asthma. The aim of this study was to define the relationship between asthma symptoms, lung function and health related quality of life in a community based sample of people with asthma ranging from no recent asthma to severe persistent asthma. We recruited subjects at the age of 42 years from a well-described community cohort, the Melbourne Epidemiological Study of Childhood Asthma, to define this association. 161 subjects completed a respiratory symptom survey, the Asthma Quality of Life Questionnaire and had lung function testing. According to the previous surveys and when applicable in agreement with GINA, subjects were classified into 4 groups: no recent asthma, sporadic asthma, intermittent asthma and persistent asthma, with the persistent asthma group further categorised by wheezing frequency and lung function. 55 had no recent asthma, 31 had sporadic asthma, 39 had intermittent asthma and 36 had persistent asthma. There was clear evidence of lower total scores with increased asthma severity, with median scores of 6.8 for the sporadic asthma group, 6.4 for the intermittent and 5.5 for the persistent asthma group compared to 6.9 in those with no recent asthma. All domain scores within the intermittent and persistent asthma groups were lower than scores for the no recent asthma group (p < 0.01). Those with persistent asthma and low FEV1% had the lowest quality of life scores (4.6). Analysis of this population cohort highlights that health related quality of life in patients with asthma strongly depends on symptom frequency and lung function and underlines the necessity of adequate treatment.

Factors affecting clinical outcome in gastrostomy-fed children with cystic fibrosis.

In order to assess the effects of gastrostomy feeding on nutritional status, respiratory function, and survival in children with cystic fibrosis (CF), we studied all patients undergoing gastrostomy between 1989-1997 at the Royal Children's Hospital, Melbourne. Clinical information was collected from medical records, including serial measurements of weight-for-age standard deviation scores (WAZ) and forced expired volume in 1 sec (FEV1) (percent predicted). Measurements were compared for 2 years before and 2 years after gastrostomy placement. Data on gastroesophageal reflux (GER), adherence to the gastrostomy feeding program, and sputum culture were also assessed. Of 37 children (22 male; mean age, 11.6 +/- 4.8 years; range, 3-20), 11 died during the study period (7 female, 4 male). Female patients were more likely to die within 2 years of gastrostomy placement (OR = 3.9; 95% CI, 0.72-23.2; P = 0.07). Mortality was significantly associated with a WAZ score < -2 (OR = 10.7; 95% CI, 1.07-466.6; P = 0.02) and predicted FEV1 < 50% (OR = 10.8; 95% CI, 1.07-512.9; P = 0.02) at time of gastrostomy. Patients with clinical evidence of GER (n = 11) had significantly lower weight gain after gastrostomy (delta WAZ, -0.32 +/- 0.26 vs. 0.03 +/- 0.39; P = 0.03). In conclusion, the presence of advanced lung disease, GER, and female gender were factors associated with a poor clinical outcome after gastrostomy placement.

Adverse effects of smoking on respiratory function in young adults born weighing less than 1000 grams.

OBJECTIVE: To determine whether active smoking has an adverse impact on respiratory function of young adults of extremely low birth weight (ELBW; birth weight <1000 g). METHODS: This was a cohort study of 60 consecutive ELBW survivors who were born during 1977-1980 at Royal Women's Hospital, Melbourne, Australia. Respiratory function was measured on 44 (73%) of the subjects at a mean age of 20.2 years (standard deviation: 1.0 year). Respiratory function had also been measured on 42 of the 44 subjects at 8 years of age. Respiratory function was compared between the 14 smokers and the 30 nonsmokers. RESULTS: Several respiratory function variables reflecting airflow (the forced expired volume in 1 second [FEV(1)]/forced vital capacity [FVC] ratio; flow rates at 75%, 50%, and 25% of vital capacity; and mid-expiratory flow from 25% to 75% of vital capacity) were significantly diminished in smokers. The proportion with a clinically important reduction in the FEV(1)/FVC ratio (<75%) was significantly higher in smokers (64%) than in nonsmokers (20%). There was a significantly larger decrease in the FEV(1)/FVC ratio between ages 8 and 20 years in the smokers (mean change: -8.2%; 95% confidence interval: -14.1% to -2.4%) CONCLUSIONS: Active smoking by young adult survivors of ELBW is associated with reduced respiratory function.

Chest physiotherapy in infants with cystic fibrosis: to tip or not? A five-year study.

There is controversy about the need for postural drainage physiotherapy in asymptomatic infants with cystic fibrosis (CF). We aimed to compare the effectiveness of standard postural drainage chest physiotherapy (SPT) with a modified physiotherapy regimen without head-down tilt (MPT) in young infants with CF. Twenty newly diagnosed infants with CF (mean age, 2.1 months; range, 1-4) were randomized to SPT or MPT. Parents kept a detailed symptom and treatment diary for the following 12 months. Serial chest radiographs, taken at diagnosis, 12 months, 2(1/2) years, and 5 years after diagnosis, were assessed using the Brasfield score. Pulmonary function tests were compared between groups after 5 years. Of the 20 infants, 16 (80%) completed the review at 12 months, and 14 (70%) at 2(1/2) and 5 years. Patients receiving SPT had more days with upper respiratory tract symptoms than those on MPT (70 +/- 32.8 vs. 37 +/- 24.9 days; P = 0.04) and required longer courses of antibiotics (23 +/- 28.5 vs. 14 +/- 11.2 days; P = 0.05). Chest x-ray scores were similar at diagnosis but were worse at 2(1/2) years for those receiving SPT (P = 0.03). Forced vital capacity and forced expired volume in 1 sec (FEV(1)) at 5-6 years was lower for SPT than for MPT (P < 0.05). In conclusion, MPT was associated with fewer respiratory complications than SPT in infants with CF.

Major haemoptysis in children with cystic fibrosis: a 20-year retrospective study.

BACKGROUND: Major haemoptysis occurs in approximately 1% of children with cystic fibrosis (CF). This report describes management and follow-up of these children at a tertiary centre in Australia. METHODS: Retrospective review of medical records from 1980-1999. RESULTS: Fifty-one children (45% female) had major haemoptysis (102 episodes). Mean age at first episode was 15 years (range 7-19) and mean FEV(1) was 56% predicted (range 14-98). Massive life-threatening haemoptysis was not confined to those with severe lung disease (FEV1 < 50% predicted). Bronchial artery embolisation (BAE) was more likely to be the initial treatment for those with massive haemoptysis and chronic recurrent bleeding tended to be treated conservatively (P = 0.01). Overall, 52 BAE were performed in 28 children with an immediate success rate of 98%; 13 children (46%) had repeated BAE. Four patients died as a direct result of severe haemoptysis. Mean follow-up was 54 months (range 0.5-183). Median survival time (Kaplan-Meier estimate) after first haemoptysis was 70 months, with a significantly longer survival for male patients independent of age (RR 3.8; 95% CI 1.7-8.8; P = 0.001). Median survival time following initial treatment with BAE was longer (103 months) compared to conservative treatment (52 months, P = 0.09). CONCLUSIONS: Massive haemoptysis was unrelated to the severity of lung disease and was more likely to be treated with embolisation. BAE was highly effective, however, 46% of the children required re-embolisation at some time, which is similar to the recurrence risk for major hemoptysis treated conservatively on longer term follow-up.

Bronchial artery embolization for hemoptysis in young patients with cystic fibrosis.

PURPOSE: To review the authors' 15-year experience with bronchial artery embolization (BAE) for treatment of hemoptysis in young patients with cystic fibrosis. MATERIALS AND METHODS: By searching the 1985-1999 radiology database, the authors identified 23 young patients who had been referred to the radiology department for angiography. Twenty of these patients underwent BAE. The 23 medical records were retrospectively reviewed with regard to embolization agents used, embolization success rates, number of repeat embolizations, survival times, and causes of death. RESULTS: BAE was performed on 38 occasions in 20 patients. The mean age of patients at first BAE was 15 years (age range, 7-19 years). The majority (n = 34 [89%]) of BAEs were performed by using polyvinyl alcohol. The immediate success rate after BAE (ie, no recurrent bleeding within 24 hours) was 95% (36 of 38 BAEs). Eleven (55%) patients required more than one BAE, and the median time between first and second embolizations was 4 months (range, 5 days to 61 months). Three patients died as a consequence of severe hemoptysis during induction of anesthesia with intermittent positive pressure ventilation in preparation for BAE. The median survival duration after the first BAE (Kaplan-Meier estimate) was 84 months (average follow-up, 61 months; range, 5 days to 169 months). CONCLUSION: BAE had a high success rate for short-term control of bleeding; however, more than half the patients required repeat embolization during the long-term follow-up.

The Melbourne Asthma Study: 1964-1999.

A group of children with a past history of wheezing was randomly selected from the Melbourne community at the age of 7 years in 1964, and a further group of children with severe wheezing was selected from the same birth cohort at the age of 10 years. These subjects have been followed prospectively at 7-year intervals, with the last review in 1999, when their average age was 42 years. Eighty-seven percent of the original cohort who were still alive participated in the 1999 review. This study showed that the majority of children who had only a few episodes of wheezing associated with symptoms of a respiratory infection had a benign course, with many ceasing to wheeze by adult life. Most who continued with symptoms into adult life were little troubled by them. Conversely, those children with asthma mostly continued with significant wheezing into adult life, and the more troubled they were in childhood, the more likely symptoms continued. There was a loss in lung function by the age of 14 years in those with severe asthma, but the loss did not progress in adult life. The childhood asthma had been treated before the availability of inhaled steroids. There was no significant loss of lung function in those with milder symptoms.