Feasibility of a Peer-Led Asthma and Smoking Prevention Project in Australian Schools with High Indigenous Youth.

BACKGROUND: The high global burden of asthma and tobacco smoking among Indigenous people may potentially be reduced by appropriate interventions that target prevention of tobacco smoke uptake and improved asthma management. The latter includes targeted treatment based on airway inflammation. We undertook a feasibility study in two Darwin schools with a high proportion of Indigenous youth to determine the feasibility of an innovative, peer-led, school-based education program called the Asthma and Smoking Prevention Project (ASPP). A subset of children with reported persistent respiratory symptoms were also clinically evaluated to determine the lower airway inflammatory profile and optimize asthma management. METHODS: The ASPP is founded on an evidence-based three-step program and targets improving asthma management and preventing the uptake of tobacco smoking. The program uses a student-centered approach in which senior students (peer leaders) deliver the ASPP to Grade 7 students using activities, videos, and games. Students completed questionnaires related to asthma and smoking at baseline and 3 months after program delivery. Students with respiratory symptoms at 3 months were invited for a comprehensive clinical evaluation and tests including sputum induction. RESULTS: The ASPP was well received. Of the 203 students involved, 56 (28%) were Indigenous and 70% completed baseline and follow-up questionnaires. Self-reported asthma was high (19%), 10% of students reported smoking and 63% reported exposure to tobacco at home. Of the 22 students who were clinically evaluated, 41% were Indigenous. Clinically important airway inflammation was high; 23% had Fractional Exhaled Nitric Oxide Levels ≥35 ppb, 88% had airway neutrophilia (>15%), and 29% had airway eosinophilia (>2.5%). Optimization of medication and management was required in 59% of students. CONCLUSION: Our study has demonstrated the implementation of the ASPP was well received by the schools as well as by the students. The high prevalence of clinically important airway inflammation and suboptimal asthma management highlights the need for a community-based study on persistent respiratory symptoms in adolescents to reduce the burden of chronic lung disease particularly for Indigenous Australians.

Comparison of rectal and tympanic thermometry during exercise.

BACKGROUND: Heat-related deaths are among the most preventable injuries in athletics. We sought to examine two methods of monitoring body temperature during exercise as a means of preventing heat-related illnesses. METHODS: Ten adult subjects exercised in hot, humid conditions while body temperature was monitored by rectal (Tre) and tympanic (Tty) thermometry. RESULTS: Our results indicate that increase in Tty was significantly greater than increase in Tre during exercise. However, rectal temperatures continued to increase after exercise cessation and peak temperatures were not significantly different. Temperature readings of the two devices during exercise had a strong correlation. There was a poor correlation between the two methods of measurement in the recovery phase. CONCLUSIONS: Tympanic thermometry is reliable for monitoring changes in body temperature during exercise. This could be valuable for monitoring individuals during long exercise in an effort to prevent heat exhaustion or heat stoke.

Paradoxical Vocal-Cord Dysfunction: Management in Athletes.

OBJECTIVE: To describe a treatment strategy for paradoxical vocal-cord dysfunction (PVCD) as it applies to an athletic population. BACKGROUND: Paradoxical vocal-cord dysfunction has been identified as a cause of dyspnea and stridor in athletes. The basic element of PVCD is an inappropriate closure of the vocal cords during respiration, resulting in airway obstruction. This condition is familiar to speech-language pathologists and otolaryngologists yet remains poorly understood in the sports medicine community. Treatment strategies are even less understood. A therapeutic exercise program designed to promote diaphragmatic breathing may allow an athlete to gain control during episodes of dyspnea. Elimination of contributing or concomitant conditions is critical to resolution of the condition. DESCRIPTION: The treatment of PVCD requires an understanding of the pathoanatomy of the condition. The focus of the exercise program is on relaxation of the larynx and conscious activation of the diaphragm and abdominal muscles during respiration. The athlete must have a sense of laryngeal control while performing the exercises. In addition, the patient and practitioner must realize the amount of neuromuscular reeducation required to change breathing patterns. CLINICAL ADVANTAGES: This therapy may allow the athlete to gain control over episodic dyspnea, participate in athletic activities with fewer complications, and, perhaps, reduce or eliminate medications prescribed to treat suspected bronchospasm.