The burden of adult asthma in Finland: impact of disease severity and eosinophil count on health care resource utilization.

Objective: To describe health care resource utilization (HCRU) and associated costs in adult patients referred for specialist asthma care in Southwest Finland, by disease severity and blood eosinophil count (BEC).Methods: This non-interventional, retrospective registry study (GSK ID: HO-17-17558) utilized data from patients >18 years of age on the hospital register of the Hospital District of Southwest Finland. Data extraction was from January 1, 2004 to December 31, 2015; the index date was the first hospital visit within this period with an International Classification of Diseases-10 diagnosis code for asthma or acute severe asthma. Patients were categorized by asthma severity (based on medication use) and BEC (<300 or ≥300 cells/µL). Total and asthma-related HCRU and estimated costs were recorded the year following index and for calendar years 2004-2015.Results: Overall, 14,398 patients were included; 388 had severe asthma at index. BEC was available for 3781 patients; 1434 had a BEC ≥300 cells/µL and 2347 had a BEC <300 cells/µL. A total of 1241 patients had severe asthma; 270 patients had severe eosinophilic asthma (severe asthma and a BEC ≥300 cells/µL). Patients with severe versus non-severe asthma had higher total- and asthma-related outpatient visits, inpatient days, emergency room visits and costs per patient year; those with BEC ≥300 cells/µL versus <300 cells/µL had more outpatient visits. All recorded HCRU and associated costs were highest in patients with severe eosinophilic asthma.Conclusion: This study demonstrated a substantial burden associated with severe and/or eosinophilic asthma for adults in Finland.

The protective effect of rural living against atopy in Mongolia.

BACKGROUND: Farm environment in childhood protects against atopy. We investigated in a population-based study in Mongolia the effects of rural living and migration from rural to urban areas on the risk of atopy. METHODS: The screening study data of 9453 subjects, aged 10-60 years, were used for taking the sample for the clinical study in which 869 subjects were examined. Asthma, allergic rhinoconjunctivitis and sensitization were clinically defined and their risk factors analysed by logistic regression. RESULTS: The risks of allergic rhinoconjunctivitis [adjusted odds ratio (OR) 0.43, 95% confidence interval (CI) 0.19-0.98] and allergic sensitization (OR 0.26, 95% CI 0.13-0.55) were the lowest in subjects living in a village from birth and intermediate in subjects who had relocated from a village to a town (OR for rhinoconjunctivitis 0.68, 95% CI 0.36-1.27, OR for sensitization 0.62, 95% CI 0.35-1.12) compared with subjects living in a town from birth. Simultaneous exposure to herd animals and dung heating decreased the risk of atopy. Keeping animals was a risk-factor for asthma only in Ulaanbaatar city. CONCLUSIONS: Continuing farm exposure after childhood may be important in reducing the risk of atopy.

Prevalence of asthma, allergic rhinoconjunctivitis and allergic sensitization in Mongolia.

BACKGROUND: Studies in countries, such as Mongolia, which are in transition from farming to industrial society permit evaluation of the impact of environmental change on atopic diseases. METHODS: In the screening study, questionnaire data were obtained from 9453 subjects aged 10-60 years. In the clinical study, a subsample of 869 subjects (participation rate 50.0%) was examined. A questionnaire-based interview, clinical examination, skin prick tests, spirometry and bronchodilation test or methacholine challenge test were used to define the clinical diagnoses. The prevalences of atopic diseases were evaluated at the population level using two-phase data and sampling weights. RESULTS: The prevalences of asthma, allergic rhinoconjunctivitis and allergic sensitization with 95% confidence intervals were 1.1% (0.3-2.0%), 9.3% (4.0-14.6%) and 13.6% (7.4-19.9%) in Mongolian villages, 2.4% (1.4-3.5%), 12.9% (8.2-17.7%) and 25.3% (17.1-33.6%) in rural towns and 2.1% (1.3-3.0%), 18.4% (13.3-23.4%) and 31.0% (24.5-37.5%) in Ulaanbaatar city, respectively. The prevalence of allergic rhinoconjunctivitis (P = 0.02) and allergic sensitization (P = 0.003) increased significantly with increasing urbanization. CONCLUSIONS: The prevalences of atopic diseases were low in rural Mongolia and increased with increasing urbanization suggesting that rural living environment protects against atopy.

Ligase chain reaction assay is clinically useful in the discrimination of smear-positive pulmonary tuberculosis from atypical mycobacterioses.

We evaluated the usefulness of the ligase chain reaction (LCR) (Abbott LCx Mycobacterium tuberculosis assay) during the initial diagnosis of tuberculosis. LCx was carried out in parallel with conventional methods for the analysis of clinical samples. Out of 86 patients who were examined clinically, 53 were suspected of having pulmonary tuberculosis, eight had residual X-ray scars from previous tuberculosis and 25 served as asymptomatic controls. Ten bronchoscopy samples and 237 sputum samples were analysed by direct microscopy, culture and LCx. All 11 smear-positive and two of three smear-negative tuberculosis patients had at least one LCx-positive specimen. All samples that were both LCx- and smear-positive were culture-positive for M. tuberculosis. The smear-positive samples from the five patients with atypical mycobacteriosis were LCx-negative. There were three false-positive results: one in a smear-negative sample from a patient with M. malmoense infection and two from two pneumonia patients. All samples from controls and patients with previous tuberculosis were LCx-negative. The sensitivity, specificity and the positive and negative predictive values of LCx in patient analysis were 92.9%, 95.8%, 81.3% and 98.6%, respectively. LCx assay of M. tuberculosis is useful in rapid confirmation of tuberculosis or atypical mycobacteriosis from a smear-positive sample and may aid in diagnosing smear-negative tuberculosis.