ABSTRACT
Late diagnostics and inadequate follow-up of an asthma patient could have been avoided by use of accessible initiatives. Several differential diagnoses to dyspnoea and oppression of the chest exist and in this case a spirometry would have established the asthma diagnosis. Increasing specialization causes necessity to focus on differential diagnosis from nearby specialities. After hospitalization with asthma, the patient should be followed closely until asthma control is achieved and the necessary education is given so that inhalation technique and adherence is optimized.
Subject(s)
Asthma/complications , Asthma/diagnosis , Acute Coronary Syndrome/diagnosis , Asthma/drug therapy , Critical Illness , Delayed Diagnosis , Diagnosis, Differential , Disease Progression , Female , Humans , Middle Aged , SpirometryABSTRACT
In epidemiological studies, increased indoor temperature--producing a lower relative humidity--is associated with low house dust mite (HDM) load. Twenty-eight dwellings were allocated for either intervention (12/15 completed) or control (11/13 completed). In the intervention group, participants were asked to increase the bedroom temperature by at least 3 degrees C compared to the self-assessed temperature of the previous winter. Dust samples were repeatedly collected from mattress and floor, and bedroom temperature and relative humidity were recorded hourly throughout one year. Dust was analysed for allergen (Der f 1 + Der p 1 + Der m 1 = Der 1) by ELISA and HDMs were counted. Changes in mite and in mite allergen concentration were the same in the control and intervention groups, and measured temperatures did not differ during intervention period in the groups (18 degrees C and 19 degrees C). Groups turned out not to be comparable with respect to initial (self-assessed) bedroom temperature (lowest in the intervention group). There was a significant seasonal variation, with doubled Der 1 concentrations in dust collected in July-November compared to January-May samples. No effect was obtained on mites or mite allergens, but this may be due either to a general lack of effect of increase in bedroom temperature, or to an insufficient increase in temperature in our intervention group. Seasonal variations in HDM and HDM allergens must be accounted for when data on exposure are interpreted.
Subject(s)
Allergens/analysis , Dust , Pyroglyphidae/growth & development , Adolescent , Adult , Aged , Animals , Environmental Exposure , Enzyme-Linked Immunosorbent Assay , Female , Household Articles , Humans , Humidity , Male , Middle Aged , Seasons , TemperatureABSTRACT
BACKGROUND: The decay of house-dust mite allergens is important for the outcome of avoidance measures for house-dust mite-allergic patients. OBJECTIVE: To quantify the stability of Der f 1 from mattress dust when exposed to domestic conditions. METHODS: Three samples of mattress dust were individually homogenized and divided into 64 subsamples. Mites were killed by freezing for 48 hours at -30 degrees C. The subsamples were exposed in eight homes, three storerooms, and one greenhouse, where temperature and relative humidity were recorded. Der f 1 was determined in extracts of subsamples (enzyme-linked immunoadsorbent assay) at 0, 3, 12, and 24 months. RESULTS: In the three samples of mattress dust, the initial concentrations of Der f 1 (mean +/- standard deviation; STD) were: 169 (12), 3.9 (0.4), and 31 (2.6) microg/g, respectively. Median half-life of Der f 1 in the mattress dust samples was 10 years in the exposure homes, 18 years in the store rooms, and 1.0 year in the greenhouse. No correlations among preserved Der f 1 and temperature, relative humidity, and absolute humidity in homes were found (Spearman rank correlation test). CONCLUSION: Natural decay of Der f 1, with an estimated half-life of 10 years at housing conditions, has no practical consequence in reducing allergen exposure. Therefore, avoidance measures should include an active removal of the allergens.
Subject(s)
Air Pollution, Indoor , Allergens/metabolism , Glycoproteins/metabolism , Mites/immunology , Animals , Antigens, Dermatophagoides , TemperatureABSTRACT
The purpose of this study was to identify the level of house dust mites (HDMs) and their allergens in mattresses, not selected on their owners atopic status, and to find associated factors. Dust was collected from 68 mattresses. The recruitment was population-based and conducted during the screening phase of a HDM intervention study. The visited persons declared to have had a "cold" bedroom the previous winter. HDMs were counted and dust was analysed by ELISA for Der 1 (= Der f 1+ Der p 1+ Der m 1). Multiple regression analysis was carried out to find housing conditions associated with high HDM levels. Type of housing, mattress age and self-assessed winter bedroom-temperature explained 47% of Der 1. Median concentrations were 3.77 microg Der 1/g and 1 HDM/0.1 g dust. Both immunochemically and microscopically Dermatophagoides farinae was dominant; D. pteronyssinus less frequent but important; and D. microceras insignificant. In 62% of these suburban homes the mattress dust exceeded 2 microg Der 1/g; and measurement of both Der f 1 and Der p 1 was necessary and sufficient to evaluate HDM allergen exposure. The association with a high HDM level was highest and most consistent for one-family houses.
