Viability-Resolved Metagenomics Reveals Antagonistic Colonization Dynamics of Staphylococcus epidermidis Strains on Preterm Infant Skin.

Preterm infants are at increased risk of infections caused by coagulase-negative staphylococci (CoNS) that colonize skin. Technical barriers in sequencing low-microbial-biomass skin swabs from preterm infants hinder attempts to gain a strain-level understanding of CoNS colonization dynamics within their developing skin microbiome. Here, the microbiome of five skin sites and available stool was studied from four preterm infants hospitalized over their first 2 months of life. We used propidium monoazide treatment of samples to enrich for the viable microbiome and metagenomic shotgun sequencing to resolve species and strains. The microbiome of different skin sites overlapped with each other, was dominated by the CoNS species Staphylococcus epidermidis and Staphylococcus capitis, and was distinct from stool. Species diversity on skin increased over time despite antibiotic exposure. Evidence of antagonism between the most common S. epidermidis strains, ST2 and ST59, included negative relationships for species correlation networks and in situ replication rates and that ST2 colonized skin earlier but was often replaced by ST59 over time. Experiments done with reference isolates showed that ST2 produced more biofilm than ST59 on plastic surfaces, which was reduced in mixed culture. We also discovered that a rare S. epidermidis strain, ST5, grew rapidly in stool in association with Stenotrophomonas maltophilia from a suspected episode of infection. Viability treatment of samples and moderate throughput shotgun sequencing provides strain-level information about CoNS colonization dynamics of preterm infant skin that ultimately might be exploited to prevent infections. IMPORTANCE The skin is a habitat for microbes that commonly infect preterm infants, but the use of sequencing for fine-scale study of the microbial communities of skin that develop in these infants has been limited by technical barriers. We treated skin swabs of preterm infants with a photoreactive dye that eliminates DNA from nonviable microbes and then sequenced the remaining DNA. We found that two strains of the most common species, Staphylococcus epidermidis, showed an antagonistic relationship on skin by cooccurring with different species, replicating fastest in different samples, and dominating skin sites at different times. Representatives of these strains also differed in their ability to stick to plastic surfaces-an important pathogenicity trait of this species. Our study shows the feasibility of gaining detailed information about strain colonization dynamics from this difficult-to-sequence body site of preterm infants, which might be used to guide novel approaches to prevent infections.

Prevalence of female sexual dysfunction among women attending college presenting for gynecological care at a university student health center.

Objective: To estimate the prevalence of female sexual dysfunction (FSD) among women attending college (18-29 years of age) presenting for routine gynecological care at a university-based student health center. Participants: Location: University affiliated women's health care clinic. Methods: Study design: Descriptive, cross sectional study. Primary endpoint: Estimated prevalence of FSD in the 18-29-year- old population. A subanalysis between those with and without recent sexual activity was performed. Logistic Regression was performed to identify potential predictors of FSD among those affected. Results: Of 310 women, FSFI was estimated as ranging from 35.5% (not sexually active) to 42.3% (sexually active). Those of younger age (18-21), with prior mental health diagnosis, and self-reported problems with arousal were at increased risk for FSD. Conclusion: Screening for FSD in the 18-29-year-old population is justified and recommended.

Letter to the Editor.

J. Fish.

Mindfulness Interventions Delivered by Technology Without Facilitator Involvement: What Research Exists and What Are the Clinical Outcomes?

New cost-effective psychological interventions are needed to contribute to treatment options for psychiatric and physical health conditions. This systematic review aims to investigate the current literature on one potentially cost-effective form of mindfulness-based therapy, those delivered through technological platforms without any mindfulness facilitator input beyond the initial design of the programme. Three electronic databases (Ovid Medline, PsychINFO and Embase) were searched for relevant keywords, titles, medical subject headings (MeSH) and abstracts using search terms derived from a combination of two subjects: 'mindfulness' and 'technology'. Overall, ten studies were identified. The majority of studies were web-based and similar in structure and content to face-to-face mindfulness-based stress reduction courses. Clinical outcomes of stress (n = 5), depression (n = 6) and anxiety (n = 4) were reported along with mindfulness (n = 4), the supposed mediator of effects. All eight studies that measured significance found at least some significant effects (p < .05). The highest reported effect sizes were large (stress d = 1.57, depression d = .95, both ps > .005). However, methodological issues (e.g. selection bias, lack of control group and follow-up) which reflect the early nature of the work mean these largest effects are likely to be representative of maximal rather than average effects. Whilst there are important differences in the construction, length and delivery of interventions, it is difficult to draw firm conclusions about the most effective models. Suggestions of key characteristics are made though, needing further investigation preferably in standardised interventions. Given the existing research and the speed at which technology is making new platforms and tools available, it seems important that further research explores two parallel lines: first, refinement and thorough evaluation of already established technology-based mindfulness programmes and second, exploration of novel approaches to mindfulness training that combine the latest technological advances with the knowledge and skills of experienced meditation teachers.

Insights, attitudes, and perceptions about asthma and its treatment: a multinational survey of patients from Europe and Canada.

BACKGROUND: Asthma surveys completed within the past 10 years in the Americas and the Asia-Pacific region have shown significant underassessment of asthma severity in addition to undertreatment of asthma and have suggested the need to improve long-term asthma management. In this study, we examined the frequency of asthma symptoms and severe episodes, patients' perceived asthma control, and use of asthma medications in Europe and Canada. METHODS: The Asthma Insight and Management survey (54 questions) was conducted in Europe (Germany, Italy, Spain and the United Kingdom) and Canada from June 14 through July 28, 2010. Telephone interviews were conducted with randomly screened patients or parents of adolescents (aged 12-17 years) with asthma; patients younger than 12 years of age were excluded from the survey. Responses were reported separately for each country and in total for all five countries. RESULTS: Seventy-five thousand three hundered thirty-five households were screened, and 2003 patients were interviewed. The survey respondents represented a wide range of severity. Overall, 26 % of patients reported symptoms daily or most days over the past 4 weeks, but most patients (81 %) perceived their asthma to be well or completely controlled. Over the past year, 41 % of patients had episodes of frequent/severe symptoms, and 50 % reported acute treatment (e.g. hospitalization, emergency visit, unscheduled physician visit) for asthma. Across countries, 52 % of patients reported taking controller medication every day over the past year, 27 % reported not taking any controller medication, and 14 % reported stopping controller treatment for 3 months or longer the last time they stopped. Many patients considered asthma well controlled if each year they had only two urgent doctor visits (50 %), three or four exacerbations (60 %), and/or one emergency room visit (41 %). DISCUSSION: This is the largest survey of patients with asthma in Europe and Canada in more than a decade. CONCLUSION: In 2010, many surveyed patients in Europe and Canada reported features indicating uncontrolled asthma, yet the majority believed they were well controlled, indicating that they had low expectations of long-term asthma management. Use of controller medications was substantially less than recommended in treatment guidelines.

Taking Aim at Asthma Around the World: Global Results of the Asthma Insight and Management Survey in the Asia-Pacific Region, Latin America, Europe, Canada, and the United States.

BACKGROUND: Asthma, a worldwide health problem, can be controlled if properly diagnosed and managed. Multinational surveys conducted in patients with asthma from 1998 to 2003 indicated that asthma was inadequately controlled. The Asthma Insight and Management (AIM) study represents the largest survey conducted on patients with asthma since 2003. OBJECTIVE: The objective of this study was to assess findings from the United States (US), Europe and Canada (EUCAN), Latin America (LA), and the Asia-Pacific (AP) region surveys to identify differences and similarities with earlier surveys on patients with asthma. METHODS: The US, EUCAN, LA, and AP AIM surveys conducted from 2009 to 2011 all used a common set of questions. Responses to these are reported as proportions of patients with asthma for each country individually, and as totals for all regions. Results are presented as mean/median proportions for US, EUCAN, LA, and AP survey populations individually. Global medians and the range of regional response values are also described. RESULTS: A total of 10,302 patients or parents of adolescents with asthma were interviewed. Approximately one-quarter reported daytime symptoms daily or on most days over the previous 4 weeks. Globally, a median of 67% (range, 27%-88%) of patients perceived their asthma as completely and/or well controlled, but a median of only 9% (range, 0%-29%) of patients had well-controlled asthma using criteria from asthma guidelines. A majority (≥60%) of patients felt that quick-relief medication could be used daily if needed, contrary to guideline recommendations. CONCLUSIONS: Patients exhibited a lack of knowledge and conviction for treatment recommendations and guidelines that was relatively uniform across the regions, similar to earlier survey findings. These results reveal an ongoing need for improvement in asthma care and education in most populations.

Negative impact of asthma on patients in different age groups.

OBJECTIVE: To evaluate the impact of asthma on patients in Brazil, by age group (12-17 years, 18-40 years, and ≥ 41 years). METHODS: From a survey conducted in Latin America in 2011, we obtained data on 400 patients diagnosed with asthma and residing in one of four Brazilian state capitals (São Paulo, Rio de Janeiro, Curitiba, and Salvador). The data had been collected using a standardized questionnaire in face-to-face interviews. For the patients who were minors, the parents/guardians had completed the questionnaire. The questions addressed asthma control, number of hospitalizations, number of emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. We stratified the data by the selected age groups. RESULTS: The proportions of patients who responded in the affirmative to the following questions were significantly higher in the 12- to 17-year age group than in the other two groups: "Have you had at least one episode of severe asthma that prevented you from playing/exercising in the last 12 months?" (p = 0.012); "Have you been absent from school/work in the last 12 months?" (p < 0.001); "Have you discontinued your asthma relief or control medication in the last 12 months?" (p = 0.008). In addition, 30.2% of the patients in the 12- to 17-year age group reported that normal physical exertion was very limiting (p = 0.010 vs. the other groups), whereas 14% of the patients in the ≥ 41-year age group described social activities as very limiting (p = 0.011 vs. the other groups). CONCLUSIONS: In this sample, asthma had a greater impact on the patients between 12 and 17 years of age, which might be attributable to poor treatment compliance.

OBJETIVO: Avaliar o impacto da asma em pacientes segundo as faixas etárias de 12-17 anos, 18-40 anos e ≥ 41 anos no Brasil. MÉTODOS: Os dados de 400 pacientes com asma diagnosticada por um médico e residentes de quatro capitais estaduais brasileiras (São Paulo, Rio de Janeiro, Curitiba e Salvador) foram obtidos em um inquérito realizado em países da América Latina em 2011. Os dados foram coletados por meio de um questionário padronizado em entrevista presencial com os pacientes ou com os pais/responsáveis daqueles < 18 anos. As questões abordavam controle da asma, número de hospitalizações, número de consultas de urgência, absenteísmo na escola/trabalho e impactos da asma na qualidade de vida, sono e lazer. Os dados foram estratificados pelas faixas etárias selecionadas. RESULTADOS: Em comparação com os grupos de pacientes adultos, houve uma proporção significativamente maior no grupo 12-17 anos em relação a ter ao menos um episódio de asma grave que impediu o paciente a continuar a jogar ou a se exercitar nos últimos 12 meses (p = 0,012), absenteísmo escolar/trabalho nos últimos 12 meses (p < 0,001), e interrupção de medicação para controle ou prevenção da asma nos últimos 12 meses (p = 0,008). Além disso, 30,2% dos pacientes na faixa etária 12-17 anos relataram que esforços físicos normais eram atividades muito limitantes (p = 0,010 vs. outros grupos), enquanto 14% dos pacientes do grupo ≥ 41 anos descreveram as atividades sociais como muito limitantes (p = 0,011 vs. outros grupos). CONCLUSÕES: Nessa amostra, o impacto da asma foi maior nos pacientes com idade entre 12 e 17 anos do que nos adultos, e isso pode ser atribuído à baixa aderência ao tratamento.

Negative impact of asthma on patients in different age groups / Impacto negativo da asma em diferentes faixas etárias

Objective: To evaluate the impact of asthma on patients in Brazil, by age group (12-17 years, 18-40 years, and ≥ 41 years). Methods: From a survey conducted in Latin America in 2011, we obtained data on 400 patients diagnosed with asthma and residing in one of four Brazilian state capitals (São Paulo, Rio de Janeiro, Curitiba, and Salvador). The data had been collected using a standardized questionnaire in face-to-face interviews. For the patients who were minors, the parents/guardians had completed the questionnaire. The questions addressed asthma control, number of hospitalizations, number of emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. We stratified the data by the selected age groups. Results: The proportions of patients who responded in the affirmative to the following questions were significantly higher in the 12- to 17-year age group than in the other two groups: "Have you had at least one episode of severe asthma that prevented you from playing/exercising in the last 12 months?" (p = 0.012); "Have you been absent from school/work in the last 12 months?" (p < 0.001); "Have you discontinued your asthma relief or control medication in the last 12 months?" (p = 0.008). In addition, 30.2% of the patients in the 12- to 17-year age group reported that normal physical exertion was very limiting (p = 0.010 vs. the other groups), whereas 14% of the patients in the ≥ 41-year age group described social activities as very limiting (p = 0.011 vs. the other groups). Conclusions: In this sample, asthma had a greater impact on the patients between 12 and 17 years of age, which might be attributable to poor treatment compliance. .

Objetivo: Avaliar o impacto da asma em pacientes segundo as faixas etárias de 12-17 anos, 18-40 anos e ≥ 41 anos no Brasil. Métodos: Os dados de 400 pacientes com asma diagnosticada por um médico e residentes de quatro capitais estaduais brasileiras (São Paulo, Rio de Janeiro, Curitiba e Salvador) foram obtidos em um inquérito realizado em países da América Latina em 2011. Os dados foram coletados por meio de um questionário padronizado em entrevista presencial com os pacientes ou com os pais/responsáveis daqueles < 18 anos. As questões abordavam controle da asma, número de hospitalizações, número de consultas de urgência, absenteísmo na escola/trabalho e impactos da asma na qualidade de vida, sono e lazer. Os dados foram estratificados pelas faixas etárias selecionadas. Resultados: Em comparação com os grupos de pacientes adultos, houve uma proporção significativamente maior no grupo 12-17 anos em relação a ter ao menos um episódio de asma grave que impediu o paciente a continuar a jogar ou a se exercitar nos últimos 12 meses (p = 0,012), absenteísmo escolar/trabalho nos últimos 12 meses (p < 0,001), e interrupção de medicação para controle ou prevenção da asma nos últimos 12 meses (p = 0,008). Além disso, 30,2% dos pacientes na faixa etária 12-17 anos relataram que esforços físicos normais eram atividades muito limitantes (p = 0,010 vs. outros grupos), enquanto 14% dos pacientes do grupo ≥ 41 anos descreveram as atividades sociais como muito limitantes (p = 0,011 vs. outros grupos). Conclusões: Nessa amostra, o impacto da asma foi maior nos pacientes com idade entre 12 e 17 anos do que nos adultos, e isso pode ser atribuído à baixa aderência ao tratamento. .

Gender differences in the perception of asthma and respiratory symptoms in a population sample of asthma patients in four Brazilian cities / Diferenças entre os sexos na percepção de asma e sintomas respiratórios em uma amostra populacional em quatro cidades brasileiras

OBJECTIVE: To evaluate the impact of asthma, by gender, in a population sample of asthma patients in Brazil. METHODS: We conducted face-to-face interviews with 400 subjects (> 12 years of age) included in a national probability telephone sample of asthma patients in the Brazilian state capitals of São Paulo, Rio de Janeiro, Curitiba, and Salvador. Each of those 400 subjects completed a 53-item questionnaire that addressed five asthma domains: symptoms; impact of asthma on quality of life; perception of asthma control; exacerbations; and treatment/medication. RESULTS: Of the 400 patients interviewed, 272 (68%) were female. In relation to respiratory symptoms, the proportion of women reporting extremely bothersome symptoms (cough with sputum, tightness in the chest, cough/shortness of breath/tightness in the chest during exercise, nocturnal shortness of breath, and nocturnal cough) was greater than was that of men. Daytime symptoms, such as cough, shortness of breath, wheezing, and tightness in the chest, were more common among women than among men. Women also more often reported that their asthma interfered with normal physical exertion, social activities, sleep, and life in general. Regarding the impact of asthma on quality of life, the proportion of subjects who reported that asthma caused them to feel that they had no control over their lives and affected the way that they felt about themselves was also greater among women than among men. CONCLUSIONS: Among women, asthma tends to be more symptomatic, as well as having a more pronounced effect on activities of daily living and on quality of life. .

OBJETIVO: Avaliar o impacto da asma em relação ao sexo em uma amostra populacional de pacientes asmáticos no Brasil. MÉTODOS: Foram entrevistados pessoalmente 400 pacientes asmáticos com idade > 12 anos de uma amostra probabilística nacional por contato telefônico nas cidades de São Paulo, Rio de Janeiro, Curitiba e Salvador. Os indivíduos responderam um questionário de 53 questões relacionadas com cinco domínios da asma: sintomas; impacto da asma na vida; percepção do controle da asma; exacerbações; tratamento e medicação. RESULTADOS: Dos 400 pacientes entrevistados, 272 (68%) eram do sexo feminino. Em relação aos sintomas respiratórios, uma maior proporção de mulheres relatou se sentir extremamente incomodada com seus sintomas (tosse com secreção, sensação de aperto no peito, tosse/falta de ar/sensação de aperto no peito durante exercícios, falta de ar noturna e tosse noturna) do que os homens. Sintomas diurnos, como tosse, falta de ar, chiado e sensação de aperto no peito, foram mais comuns nas mulheres que nos homens. Além disso, a asma interferiu mais frequentemente nos esforços físicos normais, atividades sociais, durante o sono e na vida em geral nas mulheres. Sobre o impacto da asma na qualidade de vida, as mulheres relataram mais frequentemente que os homens que a asma causava uma sensação de falta de controle sobre a própria vida e que eram afetadas na forma como se sentiam em relação a si mesmas. CONCLUSÕES: As mulheres asmáticas apresentam mais sintomas e são mais afetadas em suas atividades diárias e ...

Level of asthma control and its relationship with medication use in asthma patients in Brazil.

OBJECTIVE: To assess asthma patients in Brazil in terms of the level of asthma control, compliance with maintenance treatment, and the use of rescue medication. METHODS: We used data from a Latin American survey of a total of 400 asthma patients in four Brazilian state capitals, all of whom completed a questionnaire regarding asthma control and treatment. RESULTS: In that sample, the prevalence of asthma was 8.8%. Among the 400 patients studied, asthma was classified, in accordance with the Global Initiative for Asthma criteria, as controlled, partially controlled, and uncontrolled in 37 (9.3%), 226 (56.5%), and 137 (34.3%), respectively. In those three groups, the proportion of patients on maintenance therapy in the past four weeks was 5.4%, 19.9%, and 41.6%, respectively. The use of rescue medication was significantly more common in the uncontrolled asthma group (86.9%; p < 0.001). CONCLUSIONS: Our findings suggest that, in accordance with the established international criteria, asthma is uncontrolled in the vast majority of asthma patients in Brazil. Maintenance medications are still underutilized in Brazil, and patients with partially controlled or uncontrolled asthma are more likely to use rescue medications and oral corticosteroids.

Level of asthma control and its relationship with medication use in asthma patients in Brazil / Nível de controle da asma e sua relação com o uso de medicação em asmáticos no Brasil

OBJECTIVE: To assess asthma patients in Brazil in terms of the level of asthma control, compliance with maintenance treatment, and the use of rescue medication. METHODS: We used data from a Latin American survey of a total of 400 asthma patients in four Brazilian state capitals, all of whom completed a questionnaire regarding asthma control and treatment. RESULTS: In that sample, the prevalence of asthma was 8.8%. Among the 400 patients studied, asthma was classified, in accordance with the Global Initiative for Asthma criteria, as controlled, partially controlled, and uncontrolled in 37 (9.3%), 226 (56.5%), and 137 (34.3%), respectively. In those three groups, the proportion of patients on maintenance therapy in the past four weeks was 5.4%, 19.9%, and 41.6%, respectively. The use of rescue medication was significantly more common in the uncontrolled asthma group (86.9%; p < 0.001). CONCLUSIONS: Our findings suggest that, in accordance with the established international criteria, asthma is uncontrolled in the vast majority of asthma patients in Brazil. Maintenance medications are still underutilized in Brazil, and patients with partially controlled or uncontrolled asthma are more likely to use rescue medications and oral corticosteroids. .

OBJETIVO: Avaliar pacientes asmáticos no Brasil em relação ao grau de controle da asma, a aderência ao tratamento de manutenção e o uso de medicação de alivio em pacientes asmáticos. MÉTODOS: Foram utilizados os dados de um inquérito latino-americano, obtidos em quatro capitais brasileiras, de 400 pacientes com asma através de um questionário sobre o controle e o tratamento da doença. RESULTADOS: A prevalência de asma nesta amostra foi de 8,8%. Dos 400 pacientes estudados, 37 (9,3%), 226 (56,5%) e 137 (34,3%), respectivamente, foram classificados, segundo critérios da Global Initiative for Asthma, como tendo asma controlada, parcialmente controlada e não controlada. A proporção de pacientes em terapia de manutenção nas últimas quatro semanas naqueles três grupos, respectivamente, foi de 5,4%, 19,9% e 41,6%. O uso de medicação de alivio foi significativamente mais comum nos pacientes com asma não controlada (86,9%; p < 0,001). CONCLUSÕES: Nossos achados sugerem que a grande maioria dos pacientes com asma no Brasil não apresenta sua doença controlada segundo critérios internacionais. As medicações de manutenção ainda são subutilizadas no Brasil, e o uso de medicações de alívio e corticoide oral é mais frequente em pacientes com asma parcialmente controlada ou não controlada. .

Gender differences in the perception of asthma and respiratory symptoms in a population sample of asthma patients in four Brazilian cities.

OBJECTIVE: To evaluate the impact of asthma, by gender, in a population sample of asthma patients in Brazil. METHODS: We conducted face-to-face interviews with 400 subjects (> 12 years of age) included in a national probability telephone sample of asthma patients in the Brazilian state capitals of São Paulo, Rio de Janeiro, Curitiba, and Salvador. Each of those 400 subjects completed a 53-item questionnaire that addressed five asthma domains: symptoms; impact of asthma on quality of life; perception of asthma control; exacerbations; and treatment/medication. RESULTS: Of the 400 patients interviewed, 272 (68%) were female. In relation to respiratory symptoms, the proportion of women reporting extremely bothersome symptoms (cough with sputum, tightness in the chest, cough/shortness of breath/tightness in the chest during exercise, nocturnal shortness of breath, and nocturnal cough) was greater than was that of men. Daytime symptoms, such as cough, shortness of breath, wheezing, and tightness in the chest, were more common among women than among men. Women also more often reported that their asthma interfered with normal physical exertion, social activities, sleep, and life in general. Regarding the impact of asthma on quality of life, the proportion of subjects who reported that asthma caused them to feel that they had no control over their lives and affected the way that they felt about themselves was also greater among women than among men. CONCLUSIONS: Among women, asthma tends to be more symptomatic, as well as having a more pronounced effect on activities of daily living and on quality of life.

OBJETIVO: Avaliar o impacto da asma em relação ao sexo em uma amostra populacional de pacientes asmáticos no Brasil. MÉTODOS: Foram entrevistados pessoalmente 400 pacientes asmáticos com idade > 12 anos de uma amostra probabilística nacional por contato telefônico nas cidades de São Paulo, Rio de Janeiro, Curitiba e Salvador. Os indivíduos responderam um questionário de 53 questões relacionadas com cinco domínios da asma: sintomas; impacto da asma na vida; percepção do controle da asma; exacerbações; tratamento e medicação. RESULTADOS: Dos 400 pacientes entrevistados, 272 (68%) eram do sexo feminino. Em relação aos sintomas respiratórios, uma maior proporção de mulheres relatou se sentir extremamente incomodada com seus sintomas (tosse com secreção, sensação de aperto no peito, tosse/falta de ar/sensação de aperto no peito durante exercícios, falta de ar noturna e tosse noturna) do que os homens. Sintomas diurnos, como tosse, falta de ar, chiado e sensação de aperto no peito, foram mais comuns nas mulheres que nos homens. Além disso, a asma interferiu mais frequentemente nos esforços físicos normais, atividades sociais, durante o sono e na vida em geral nas mulheres. Sobre o impacto da asma na qualidade de vida, as mulheres relataram mais frequentemente que os homens que a asma causava uma sensação de falta de controle sobre a própria vida e que eram afetadas na forma como se sentiam em relação a si mesmas. CONCLUSÕES: As mulheres asmáticas apresentam mais sintomas e são mais afetadas em suas atividades diárias e qualidade de vida.

Level of asthma control and its impact on activities of daily living in asthma patients in Brazil.

OBJECTIVE: To evaluate the impact of asthma on activities of daily living and on health status in patients with controlled, partially controlled, or uncontrolled asthma in Brazil. METHODS: We used data related to 400 patients in four Brazilian cities (São Paulo, Rio de Janeiro, Salvador, and Curitiba), obtained in a survey conducted throughout Latin America in 2011. All study subjects were > 12 years of age and completed a standardized questionnaire in face-to-face interviews. The questions addressed asthma control, hospitalizations, emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. The level of asthma control was determined in accordance with the Global Initiative for Asthma criteria. RESULTS: Among the 400 respondents, asthma was controlled in 37 (9.3%), partially controlled in 226 (56.5%), and uncontrolled in 137 (34.2%). The numbers of patients with uncontrolled or partially controlled asthma who visited the emergency room, who were hospitalized, and who missed school/work were higher than were those of patients with controlled asthma (p = 0.001, p = 0.05, and p = 0.01, respectively). Among those with uncontrolled asthma, the impact of the disease on activities of daily living, sleep, social activities, and normal physical exertion was greater than it was among those with controlled or partially controlled asthma (p < 0.001). CONCLUSIONS: In Brazil, asthma treatment should be monitored more closely in order to increase treatment adherence and, consequently, the level of asthma control, which can improve patient quality of life and minimize the negative impact of the disease.

Insights, attitudes, and perceptions about asthma and its treatment: findings from a multinational survey of patients from Latin America.

BACKGROUND: In 2011 the Latin America Asthma Insight and Management (LA AIM) survey explored the realities of living with asthma. We investigated perception, knowledge, and attitudes related to asthma among Latin American asthma patients. METHODS: Asthma patients aged ≥12 years from four Latin American countries (Argentina, Brazil, Mexico, Venezuela) and the Commonwealth of Puerto Rico responded to questions during face-to-face interviews. A sample size of 2,169 patients (approximately 400 patients/location) provided an accurate representation of asthma patients' opinions. Questions probed respondents' views on topics such as levels of asthma control, frequency and duration of exacerbations, and current and recent use of asthma medications. RESULTS: A total of 2,169 adults or parents of children with asthma participated in the LA AIM survey. At least 20% of respondents experienced symptoms every day or night or most days or nights. Although 60% reported their disease as well or completely controlled, only 8% met guideline criteria for well-controlled asthma. 47% of respondents reported episodes when their asthma symptoms were more frequent or severe than normal, and 44% reported seeking acute care for asthma in the past year. Asthma patients in Latin America overestimated their degree of asthma control. CONCLUSIONS: The LA AIM survey demonstrated the discrepancy between patient perception of asthma control and guideline-mandated criteria. Additional education is required to teach patients that, by more closely following asthma management strategies outlined by current guidelines more patients can achieve adequate asthma control.

Level of asthma control and its impact on activities of daily living in asthma patients in Brazil / Nível de controle da asma e seu impacto nas atividades de vida diária em asmáticos no Brasil

OBJECTIVE: To evaluate the impact of asthma on activities of daily living and on health status in patients with controlled, partially controlled, or uncontrolled asthma in Brazil. METHODS: We used data related to 400 patients in four Brazilian cities (São Paulo, Rio de Janeiro, Salvador, and Curitiba), obtained in a survey conducted throughout Latin America in 2011. All study subjects were > 12 years of age and completed a standardized questionnaire in face-to-face interviews. The questions addressed asthma control, hospitalizations, emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. The level of asthma control was determined in accordance with the Global Initiative for Asthma criteria. RESULTS: Among the 400 respondents, asthma was controlled in 37 (9.3%), partially controlled in 226 (56.5%), and uncontrolled in 137 (34.2%). The numbers of patients with uncontrolled or partially controlled asthma who visited the emergency room, who were hospitalized, and who missed school/work were higher than were those of patients with controlled asthma (p = 0.001, p = 0.05, and p = 0.01, respectively). Among those with uncontrolled asthma, the impact of the disease on activities of daily living, sleep, social activities, and normal physical exertion was greater than it was among those with controlled or partially controlled asthma (p < 0.001). CONCLUSIONS: In Brazil, asthma treatment should be monitored more closely in order to increase treatment adherence and, consequently, the level of asthma control, which can improve patient quality of life and minimize the negative impact of the disease. .

OBJETIVO: Avaliar o impacto da asma nas atividades da vida diária e na saúde em pacientes com asma controlada, parcialmente controlada ou não controlada no Brasil. MÉTODOS: Foram utilizados dados de 400 pacientes de quatro cidades brasileiras (São Paulo, Rio de Janeiro, Curitiba e Salvador) obtidos em um inquérito realizado em países da América Latina em 2011. Todos os indivíduos do estudo tinham idade > 12 anos e responderam a um questionário padronizado por meio de entrevista presencial. As questões abordavam o controle da asma, número de hospitalizações, de consultas de urgência, absenteísmo na escola/trabalho e impacto da asma na qualidade de vida, sono e lazer. O nível de controle da asma foi verificado segundo os critérios da Global Initiative for Asthma. RESULTADOS: Entre 400 entrevistados, a asma estava controlada em 37 (9,3%); parcialmente controlada, em 226 (56,5%); e não controlada, em 137 (34,2%). O número de pacientes com asma não controlada ou parcialmente controlada que apresentaram hospitalizações, visitas ao pronto-socorro e faltas na escola/trabalho foi maior do que o daqueles com asma controlada (p = 0,001, p = 0,05 e p = 0,01, respectivamente). Os participantes com asma não controlada apresentaram um maior impacto da doença em atividades da vida diária, sono, atividades sociais e esforço físico normal do que aqueles com asma parcialmente controlada ou controlada (p < 0,001). CONCLUSÕES: Medidas terapêuticas devem ser mais intensamente adotadas em nosso país para melhorar o controle da asma e estimular a aderência ao tratamento. Isso, seguramente, proporcionará uma melhor qualidade de vida aos pacientes e uma redução do impacto negativo da doença. .

Insights, attitudes and perceptions about asthma and its treatment: findings from a multinational survey of patients from 8 Asia-Pacific countries and Hong Kong.

BACKGROUND AND OBJECTIVE: The Asthma Insight and Management (AIM) survey was conducted in North America, Europe, the Asia-Pacific region and Latin America to characterize patients' insights, attitudes and perceptions about their asthma and its treatment. We report findings from the Asia-Pacific survey. METHODS: Asthma patients (≥12 years) from Australia, China, Hong Kong, India, Malaysia, Singapore, South Korea, Taiwan and Thailand were surveyed. Patients answered 53 questions exploring general health, diagnosis/history, symptoms, exacerbations, patient burden, disease management, medications/treatments and patient's attitudes. The Global Initiative for Asthma guidelines were used to assess asthma control. The survey was conducted by random digit telephone dialling (Australia, China and Hong Kong) or by random face-to-face interviews (India, Malaysia, Singapore, South Korea, Taiwan and Thailand). RESULTS: There were 80 761 households screened. Data from 3630 patients were collected. Wide disparity existed between objective measures of control and patient perception. Reported exacerbations during the previous year ranged from 19% (Hong Kong) to 67% (India). Reported unscheduled urgent/emergency visits to a doctor's office/hospital/clinic in the previous year ranged from 15% (Hong Kong) to 46% (Taiwan). Patients who reported having controlled asthma in the previous month ranged from 27% (South Korea) to 84% (Taiwan). Substantial functional and emotional limitations due to asthma were identified by 13% (South Korea) to 78% (India) of patients. CONCLUSIONS: Asthma has a profound impact on patients' well-being despite the availability of effective treatments and evidence-based management guidelines. Substantial differences across the surveyed countries exist, suggesting unmet, country-specific cultural and educational needs. A large proportion of asthma patients overestimate their level of control.

Practice patterns for oral corticosteroid burst therapy in the outpatient management of acute asthma exacerbations.

The use of a short course of oral corticosteroids (OCS), or "steroid burst," is standard practice in the outpatient management of acute severe exacerbations of asthma. Despite published guidelines, the actual practice patterns are unknown. A Web-based survey about typical patterns of OCS administration and total steroid burst dose was administered to pulmonologists (n = 150), allergists (n = 150), primary care physicians (n = 153), and pediatricians (n = 150). No predominant dosing regimen was observed, although a fixed single daily dose was the most commonly prescribed regimen (59%). The majority of physicians treating patients ≥12 years of age prescribed a total burst dose of ≤200 mg and essentially all (99.7%) prescribed ≤600 mg. Among physicians treating younger children, approximately one-quarter prescribed ≤1 mg/kg per day for 3 days (27.8% for children aged 5-11 years of age and 28.1% for children aged <5 years, respectively) and essentially all prescribed ≤2 mg/kg per day for 10 days (99.8% for children aged 5-11 years and 100% for children aged <5 years of age). When prescribing OCS burst therapy for asthma exacerbations, physicians tend to prescribe less than the upper dose recommended in the guidelines; with many physicians prescribing a total steroid burst dose below the lower end of the recommended dose range. Additional study is needed to determine the optimal dose and duration for treating exacerbations of asthma with OCS to minimize both side effects and time to reestablishing asthma control.

Asthma in the elderly: Current understanding and future research needs--a report of a National Institute on Aging (NIA) workshop.

Asthma in the elderly is underdiagnosed and undertreated, and there is a paucity of knowledge on the subject. The National Institute on Aging convened this workshop to identify what is known and what gaps in knowledge remain and suggest research directions needed to improve the understanding and care of asthma in the elderly. Asthma presenting at an advanced age often has similar clinical and physiologic consequences as seen with younger patients, but comorbid illnesses and the psychosocial effects of aging might affect the diagnosis, clinical presentation, and care of asthma in this population. At least 2 phenotypes exist among elderly patients with asthma; those with longstanding asthma have more severe airflow limitation and less complete reversibility than those with late-onset asthma. Many challenges exist in the recognition and treatment of asthma in the elderly. Furthermore, the pathophysiologic mechanisms of asthma in the elderly are likely to be different from those seen in young asthmatic patients, and these differences might influence the clinical course and outcomes of asthma in this population.

Economic burden of impairment in children with severe or difficult-to-treat asthma.

BACKGROUND: The cost associated with asthma impairment in children with severe asthma has not been determined. OBJECTIVE: To assess the asthma cost burden in children with severe or difficult-to-treat asthma based on asthma impairment. METHODS: Children aged 6 to 12 years in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study with available data at baseline (n = 628), month 12 (n = 385), and month 24 (n = 280) corresponding to the National Heart, Lung, and Blood Institute asthma guidelines' impairment domain were included. Children were categorized as either very poorly controlled (VPC), not well controlled (NWC), or well controlled (WC) and assessed cross-sectionally and longitudinally. Mean total asthma costs based on direct (medication usage, unscheduled office visits, emergency department visits, hospitalizations) and indirect (school/work days lost) asthma costs were assessed. RESULTS: Mean annual total asthma costs were more than twice as high in the VPC group compared with NWC and WC groups (baseline: $7,846, $3,526, $3,766.44, respectively; month 12: $7,326, $2,959, $2,043, respectively; month 24: $8,879, $3,308, $1,861, respectively (all P < .001). Indirect costs accounted for approximately half the total asthma costs for VPC asthma patients at each time point. Significantly lower costs were observed for patients whose impairment status improved or temporarily improved from VPC after baseline. CONCLUSION: The economic burden of severe or difficult-to-treat asthma in children is associated with VPC asthma and improvement in asthma control and is associated with reducing cost. Further attention to patients with poorly controlled asthma, through better management strategies or more effective medications, may significantly reduce this burden of illness.