Validation of a life quality (LQ) test for asthma.

BACKGROUND: The American College of Allergy, Asthma, and Immunology (ACAAI) developed a questionnaire, the Life Quality (LQ) Test, for use in its Nationwide Asthma Screening Program. The test is intended as a tool to help individuals with breathing problems determine if they have asthma or, for those already diagnosed with asthma, if their asthma is under control. We attempted to assess whether the LQ Test was a valid tool for use in the screening program. OBJECTIVE: The objective of this study was to validate the LQ Test by determining whether a high score on the LQ Test is a positive predictor of a clinical diagnosis of asthma. METHODS: The 20-question LQ Test was prospectively distributed and self-administered to new patients on their first visit to an asthma and allergy clinic. Total LQ scores were recorded for each patient as the sum of all positive 'yes' responses to the test. All patients were subsequently diagnosed by an allergist as having asthma or not having asthma. The LQ Test also was administered to a group of individual patients who were seen in a dental office. This group of patients, who had no known breathing problems, served as a control. RESULTS: The clinic patients who were subsequently diagnosed with asthma had the highest average LQ score (9.31), 3.9 times higher than the average score for clinic patients diagnosed as not having asthma (2.39), and 8 times higher than the average score for the control group (1.15). CONCLUSION: Higher LQ scores correlate with a higher probability of a positive diagnosis, initially making the LQ Test questionnaire a valid tool to help predict which individuals are more likely to be diagnosed with asthma.

A multicenter, placebo-controlled study of twice daily triamcinolone acetonide (800 microg per day) for the treatment of patients with mild-to-moderate asthma.

BACKGROUND: National and international guidelines recommend the use of inhaled antiinflammatory medications in patients with all but the mildest forms of asthma. Twice daily dosing may increase compliance with therapy. OBJECTIVE: We sought to evaluate the safety and efficacy of 400 microg twice daily triamcinolone acetonide (TAA) compared with placebo in adult patients with mild-to-moderate asthma who were poorly controlled by beta2-agonist therapy. METHODS: We performed a multicenter, randomized, double-blind, placebo-controlled study, including a screening visit, a 7- to 21-day pretreatment baseline phase, and a 6-week double-blind treatment phase. Efficacy was measured by weekly spirometry and daily diary recordings of peak flow rates, asthma symptom scores, and albuterol use. Eligible patients used albuterol four or more times per day, had total asthma symptom scores of 15 or greater (possible total, 60) over 5 of 7 baseline days, and had FEV1 measurements of 60% of predicted value or greater. RESULTS: One hundred twenty-one patients were randomized to treatment. TAA was superior to placebo for all efficacy measures, with significant improvements in asthma symptoms, albuterol use, morning and evening peak flow rates, and forced vital capacity evident at Treatment Week 1. Significant improvements in other pulmonary function measurements were observed after 2 or more weeks. All efficacy variables improved progressively throughout the study. CONCLUSIONS: Twice daily TAA (400 microg) decreased asthma symptoms and improved lung function in patients with mild-to-moderate asthma compared with placebo. Therapeutic benefit was evident within 1 week and increased throughout treatment.

Once-daily cetirizine effective in the treatment of seasonal allergic rhinitis in children aged 6 to 11 years: a randomized, double-blind, placebo-controlled study.

Cetirizine (once daily), a highly selective H1-antagonist, is efficacious for treating seasonal allergic rhinitis (SAR), perennial allergic rhinitis, and chronic idiopathic urticaria. A 4-week, randomized, double-blind, placebo-controlled trial investigated the safety and efficacy of cetirizine syrup (5 or 10 mg daily) in 209 children ages 6 to 11 years with SAR. Parents assisted patients in recording symptom severity (sneezing, nasal discharge, itchy eyes, itchy nose or mouth, conjunctivitis, nasal congestion) daily. A total symptom severity (TSS) score was derived from all symptoms, excluding nasal congestion. At baseline, TSS was comparable for all groups (range 6.8-7.0). Cetirizine 10 mg produced a significantly greater mean TSS reduction (3.2) than placebo (P < 0.05) over the treatment period. Cetirizine 5 mg once daily produced mean reductions in weekly symptom scores of 2.4; this did not differ statistically from placebo. Furthermore, cetirizine 10 mg significantly improved symptoms of itchy eyes, nose, or mouth. The most commonly reported adverse reactions to both cetirizine and placebo were headache, pharyngitis, and abdominal pain, which did not occur with an incidence statistically different from that of placebo. Once-daily cetirizine is safe for treating SAR in children ages 6-11 years. Once-daily cetirizine 10 mg provides effective improvement in symptoms and is well tolerated.

Placebo-controlled, double-blind study of the efficacy and safety of triamcinolone acetonide aerosol nasal inhaler in pediatric patients with seasonal allergic rhinitis.

Triamcinolone acetonide (TAA) aerosol nasal inhaler has been shown to effectively relieve the symptoms of seasonal allergic rhinitis in adults and adolescents. We conducted a study to evaluate the efficacy and safety of once-daily administration of TAA aerosol nasal inhaler in pediatric patients aged 6 to 11 years with grass seasonal allergic rhinitis. This multicenter, randomized, double-blind, placebo-controlled, parallel-group study enrolled 116 children who were treated with either TAA aerosol nasal inhaler (220 micrograms/d) or placebo once daily for 2 weeks. Patients evaluated the severity of rhinitis symptoms (nasal stuffiness, discharge, sneezing, and itching) daily according to a four-point scale (0 = absent, 1 = mild, 2 = moderate, and 3 = severe). Patients' and physicians' global evaluations of overall treatment efficacy were assessed at the end of the 2-week treatment period. Patients treated with TAA aerosol nasal inhaler had significantly greater reductions in all nasal symptom scores overall and in virtually all symptoms at the end of week 1 and week 2 compared with those in the placebo group. Both patients' and physicians' global evaluations of efficacy favored TAA aerosol nasal inhaler over placebo. This study demonstrated that once-daily administration of 220 micrograms of TAA aerosol nasal inhaler was well tolerated and effectively reduced the symptoms of seasonal allergic rhinitis in pediatric patients.

Evaluation of individualized asthma self-management programs.

We compared the effectiveness of personalized asthma self-management recommendations with that of a group self-management program. We assigned each of 34 asthma patients randomly to one of three conditions: individualized asthma self-management, group asthma self-management, and control. We derived individualized self-management recommendations from patient recordings of asthma occurrence, asthma precipitants, and peak expiratory flow rate made during a 3-month period. The group program we used was the Wheezers Anonymous program. As compared to a control group of patients who received no self-management training, the patients in both the individualized and group condition evidenced improvement of pulmonary function, as measured daily with a home peak flow meter. The improvement was equivalent for patients in the two conditions. Patients in the individualized condition also exhibited a drop in frequency of asthma attacks, but patients in the group condition did not. We concluded that individualized asthma self-management is effective in reducing symptoms of asthma.

Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease.

OBJECTIVES: This study sought to establish the validity, reproducibility and responsiveness of the Seattle Angina Questionnaire, a 19-item self-administered questionnaire measuring five dimensions of coronary artery disease: physical limitation, anginal stability, anginal frequency, treatment satisfaction and disease perception. BACKGROUND: Assessing the functional status of patients is becoming increasingly important in both clinical research and quality assurance programs. No current functional status measure quantifies all of the important domains affected by coronary artery disease. METHODS: Cross-sectional or serial administration of the Seattle Angina Questionnaire was carried out in four groups of patients: 70 undergoing exercise treadmill testing, 58 undergoing coronary angioplasty, 160 with initially stable coronary artery disease and an additional 84 with coronary artery disease. Evidence of validity was sought by comparing the questionnaire's five scales with the duration of exercise treadmill tests, physician diagnoses, nitroglycerin refills and other validated instruments. Reproducibility and responsiveness were assessed by comparing serial responses over a 3-month interval. RESULTS: All five scales correlated significantly with other measures of diagnosis and patient function (r = 0.31 to 0.70, p < or = 0.001). Questionnaire responses of patients with stable coronary artery disease did not change over 3 months. The questionnaire was sensitive to both dramatic clinical change, as seen after successful coronary angioplasty, and to more subtle clinical change, as seen among outpatients with initially stable coronary artery disease. CONCLUSIONS: The Seattle Angina Questionnaire is a valid and reliable instrument that measures five clinically important dimensions of health in patients with coronary artery disease. It is sensitive to clinical change and should be a valuable measure of outcome in cardiovascular research.

Monitoring the quality of life in patients with coronary artery disease.

Monitoring the outcomes of treatment and quantifying patients' functional status have assumed a prominent role in both clinical trials and quality assurance programs. Because patients with coronary artery disease (CAD) may have comorbid illnesses, and because generic health status questionnaires may not focus on symptoms and impairments unique to coronary disease, a generic measure of health status may not be sufficient to detect important changes in patients' CAD. The responsiveness to clinical change of the Seattle Angina Questionnaire (SAQ), a disease-specific measure for CAD, was compared with that of the Short Form-36, a generic measure of health status. Both questionnaires were serially administered, 3 months apart, to 45 patients undergoing coronary angioplasty and to 130 patients with stable CAD. Most scales of both questionnaires improved significantly after coronary angioplasty. The responsiveness statistics of the SAQ exceeded those of the Short Form-36. Among 130 patients with initially stable angina, 33 deteriorated, 79 remained stable, and 18 improved over 3 months of observation. Mean SAQ scores changed significantly and appropriately in each of these groups. In contrast, none of the Short Form-36 scales detected these more subtle changes. Although useful in assessing overall function, a generic health status measure, such as the Short Form-36, may not be responsive enough to detect important clinical changes in patients' CAD. A disease-specific instrument, such as the SAQ, can be an important and relevant outcome measure in clinical trials or quality assurance programs.

Evaluation of biological efficiency of free-grazing beef cows under semidesert conditions.

Effects of cow BW, hip height, and estimated genetic potentials (EBV) for weaning weight direct and milk on cow productivity, fecal OM output, OM intake, and efficiency (kilograms of calf BW/kilogram of OM intake by the cow) were evaluated with 44 free-grazing crossbred cows under semidesert conditions. Calf BW were measured during early, mid-, and late lactation. Data were collected in four periods: Period 1 = late spring (early lactation), Period 2 = late summer (mid-lactation), Period 3 = mid-autumn (late lactation), and Period 4 = mid-winter (nonlactation). Calf BW increased linearly with cow BW (P < .01) in Periods 1, 2, and 3. Fecal OM output and OM intake increased with cow BW in Periods 2 (P < .01) and 4 (P < .01), and on average (P < .02). Overall efficiency decreased with increasing cow BW (P < .04). Taller cows excreted more fecal OM and had greater OM intake throughout the study (P < .02 to P < .11). Overall efficiency decreased with increasing cow hip height (P < .05). Weaning weight direct EBV of cows was related linearly to cow BW (P < .01 to P < .07) and to calf BW (P < .01 to P < .07). Calf weight in all periods increased linearly with milk EBV (P < .001). Overall, fecal OM output, OM intake, and efficiency were not affected by milk EBV.

The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire.

The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire (KASE-AQ) is a paper-and-pencil instrument that was developed to allow physicians, behavioral scientists, and other health care personnel to assess asthma patients' knowledge regarding asthma, their attitudes about their asthma (including their willingness to cooperate with the physician in managing asthma), and their self-efficacy regarding their perceived ability to control the disorder. The KASE-AQ assesses changes in these patient variables following a particular intervention. The KASE-AQ proved to be reliable and internally consistent, and a factor analysis revealed presence of three subscales in the questionnaire (knowledge, attitude, and self-efficacy about asthma). Following asthma education and self-management training, experimental group subjects showed significant improvements in knowledge, attitude, and self-efficacy. Waiting-list control subjects showed similar improvements following training. Both groups' scores at 3-month follow-up remained significantly higher than their baseline scores on all 3 variables.

Fluticasone propionate aqueous nasal spray is safe and effective for children with seasonal allergic rhinitis.

INTRODUCTION: Fluticasone propionate aqueous nasal spray, a new topical corticosteroid preparation, is effective when given as 200 micrograms once daily in patients (> 12 years of age) with seasonal allergic rhinitis. STUDY OBJECTIVE: To evaluate the efficacy and safety of fluticasone proprionate aqueous nasal spray in children aged 4 to 11 years with seasonal allergic rhinitis. STUDY DESIGN: Multicenter, randomized, double-blind, placebo-controlled, parallel-group. PATIENTS: Two hundred fifty children aged 4 to 11 years with moderate-to-severe nasal symptoms, a positive skin test reaction to a late-summer or autumn allergen, a history of seasonal allergic rhinitis, and documentation of an unsatisfactory response to conventional treatment. INTERVENTIONS: Children were randomly assigned to receive fluticasone propionate, either 100 micrograms or 200 micrograms, or placebo, given by intranasal spray once daily in the morning for 14 days. MEASUREMENTS AND RESULTS: Severity of nasal symptoms (obstruction, rhinorrhea, itching, and sneezing) was recorded on visual analog scales by investigators at weekly visits and by patients (or adult guardian) daily in the evening. According to investigator and patient ratings, both fluticasone propionate 100 micrograms/d and 200 micrograms/d lowered total nasal symptom scores when compared with placebo. Both dosages of fluticasone propionate were more effective than placebo on the basis of investigator-rated overall clinical evaluation of efficacy at the end of treatment, with significant improvement (as opposed to moderate or mild improvement, no change or worsening) noted in 21% to 29% of the active-treatment groups vs 9% in the placebo group. There were no significant differences between the two fluticasone propionate dosages in any efficacy measurement. Morning plasma cortisol concentrations and frequency of drug-related adverse events were similar in the fluticasone propionate and placebo groups. CONCLUSION: In children as young as 4 years, 100 micrograms of fluticasone propionate aqueous nasal spray given once daily is as effective as 200 micrograms given once daily, the usual adult dose for the treatment of seasonal allergic rhinitis. Both fluticasone propionate dosages were well tolerated and neither dosage appears to interfere with the hypothalamic-pituitary-adrenal axis in children.

A life activities questionnaire for childhood asthma.

The paper describes the development and testing of a paper-and-pencil instrument, the Life Activities Questionnaire for Childhood Asthma, that can be applied to assess activity restriction in children with asthma. It describes how items for the instrument were selected to ensure the validity of the developed instrument. The method by which the reliability of the questionnaire was established is also discussed. The result is a valid and reliable instrument that should have wide applicability in measuring activity restriction because of childhood asthma. The developed instrument has potential use in clinical settings, research, and policy making.

The effect of grazing location and oronasal treatment with bull urine on reproductive performance and serum prolactin concentrations of beef heifers.

Grazing location and biostimulatory treatments were imposed on 55 Brangus and crossbred heifers in a 2x2x2 factorial arrangement. Grazing locations (postweaning) were semi-desert rangeland with supplementation or irrigated small grains pasture. Biostimulatory treatment involved either weekly oronasal application of bull urine or no treatment (control). The duration of bull urine treatments was 8 weeks. Grazing location affected heifer weights from February through August (P<0.01). Rate of weight gain on irrigated pasture exceeded native range (P<0.01). Cyclicity was similar between the location groups before the treatment period. Post-treatment cyclicity rates of heifers were 25 and 78% for native range and irrigated pasture, respectively (P<.01). Twenty-five percent of cyclic heifers grazing native range went into anestrus during this treatment period, while no loss of cyclicity was observed in the heifers on irrigated pasture (P<0.10). Heifers maintained on irrigated pasture exhibited more standing estrus following synchronization (P<0.10), higher pregnancy rates following breeding (P<0.05), heavier fall weights (P<0.01), higher body condition scores (P<0.01), and greater pelvic widths (P<0.05) than those on native range. Cyclic heifers grazing native range had prolactin levels twice those of irrigated pasture heifers. Serum growth hormone levels were not consistently affected by treatments. Heifers which became pregnant while grazing irrigated pasture had much lower prolactin concentrations in serum collected in January than the noncyclic heifers.

Maternal performance of Hereford, Brangus, and reciprocal crossbred cows under semidesert conditions.

Maternal performance of 134 Hereford (H), Brangus (B), and reciprocal crossbred (H x B and B x H) cows from 2 to 7 yr of age was evaluated under semidesert conditions in this study. Calves produced by 2- and 3-yr-old cows were sired by Brangus and Hereford bulls. Calves produced by 4- to 7-yr-old cows were sired by Charolais bulls. Breed of sire and breed of dam of cow affected kilograms of weaning weight, 205-d weight, weaning weight as a percentage of cow weight, and 205-d weight as a percentage of cow weight produced annually. Brangus (either as sire or dam of cow) was superior to Hereford in all cases. Observed maternal heterosis on 2- to 3-yr-old cows was 23.0, 20.1, 30.0, 29.1, 23.9, and 23.0% for calf birth date, weaning percentage, weaning weight per year, 205-d weight per year, weaning weight as a percentage of cow weight per year, and 205-d weight as a percentage of cow weight per year, respectively (P less than .01). Observed maternal heterosis from mature cows was 19.8, 12.8, 21.0, 18.7, 17.4, and 15.4% for calf birth date, weaning percentage, weaning weight per year, 205-d weight per year, weaning weight as a percentage of cow weight per year, and 205-d weight as a percentage of cow weight per year, respectively (P less than .01). Results indicate large heterotic effects on annual cow productivity and an adaptive advantage for cows with Brangus sires and(or) dams under semidesert conditions.

A life activities questionnaire for adult asthma.

The development, testing, and applicability of an instrument, the Life Activities Questionnaire for Adult Asthma is described that can be used to assess activity restriction in adults with asthma. It explains how items for the instrument were selected to insure the validity of the developed instrument. The reliability of the questionnaire is also discussed. The result is a valid and reliable paper-and-pencil instrument that should have wide applicability as a component of quality of life measurement. This instrument has potential for functional use in clinical settings, research environments, and policy-making procedures.

Genetic analysis of absolute growth measurements, relative growth rate and restricted selection indices in red Angus cattle.

Performance records on 41,184 Red Angus cattle were analyzed and estimates of parameters calculated for absolute growth rate, relative growth rate and restricted selection indices. Heritability estimates for birth weight, 205-d weight, 365-d weight and postweaning gain were .46 +/- .02, .39 +/- .02, .40 +/- .02 and .36 +/- .02, respectively. Heritability estimates for preweaning, postweaning and postnatal relative growth rates were identical (.33 +/- .02). Heritability estimates for restricted selection indices were .31 +/- .02, .33 +/- .02 and .31 +/- .02 for weaning index, yearling index and postweaning index, respectively. The genetic correlation between preweaning and postweaning absolute growth rate was .15. The genetic correlation between consecutive measurements of relative growth rate (RGR) was -.33. Genetic correlations of birth weight with preweaning RGR and postnatal RGR were -.68 and -.71, respectively. Correlations among measures of relative growth rate using simulated data were similar to correlations of actual data, indicating that these relationships are the result of numerator/denominator relationships and not biological causes. The genetic correlation between weaning and postweaning indices was near zero. Small genetic coefficients of variation for preweaning and postnatal relative growth rates indicate further problems with the expression of growth in this manner. Restricted selection indices exhibited much larger genetic coefficients of variation than measurements of RGR. Genetic standard deviations were 7.8%, 7.2% and 13.7% of the means for weaning, yearling and postweaning indices, respectively.

The Revised Asthma Problem Behavior Checklist.

The Asthma Problem Behavior Checklist (APBC) has proved to be an accurate and invaluable instrument for pinpointing potential behavioral problems in children with the disorder. This article presents the Revised Asthma Problem Behavior Checklist (RAPBC). The value of the RAPBC is that: (a) it has proven reliability when tested with asthmatic adults; (b) the change from a dichotomous yes/no format, used in the APBC, to a 5-point Likert-type answer format adds greater sensitivity to the instrument; and (c) data gathered with the RAPBC compare favorably to information gathered in two previous studies with the APBC. Considering the reliability and validity of the RAPBC, it should prove useful in both clinical and research settings.

The "Asthma Self-Efficacy Scale".

According to Bandura, a person's expectations that a favorable outcome will follow a particular behavior are not sufficient to promote the occurrence of the behavior; the person must also believe that he or she will be effective at performing the behavior. The latter is referred to as self-efficacy. It has become a major focus in assessing patient performance of skills required to manage their illness. The present paper describes the development, testing, and applicability of an instrument for assessing self-efficacy in asthmatic patients. It notes that the Asthma Self-Efficacy Scale is not only a reliable paper-and-pencil instrument, but that it has a wide potential applicability throughout health care settings in measuring self-efficacy in asthmatic patients. The Asthma Self-Efficacy Scale is included.

Development and evaluation of an adult asthma self-management program: Wheezers Anonymous.

The efficacy of an adult asthma self-management program, Wheezers Anonymous (WA), was tested utilizing 79 adult asthmatic patients. Subjects were randomly assigned to a treatment or waiting-list control group. Baseline data gathered included measures of symptom severity, health-care utilization, knowledge of asthma, attitudes about asthma, and self-efficacy. All subjects completed the same measures 1, 2, and 3 months following the WA intervention. Knowledge about asthma increased in the treatment group relative to the waiting-list controls; the number of attacks decreased in the treatment group only, thus demonstrating the efficacy of the WA program.