National asthma observational survey of severe asthmatics in Israel: the no-air study.

BACKGROUND: Asthma is considered a global public health issue requiring a significant medical expenditure as a result of its high prevalence and the low rate of disease control. OBJECTIVE: This is the first nationwide survey of severe asthma patients carried out in Israel. In this study we aimed to assess health resources utilization, compliance with treatment and disease-control in a subgroup of patients with severe asthma in Israel. MATERIAL AND METHOD: One hundred and twenty-three patients with a diagnosis of asthma for more then one year, as well as a hospitalization during the last 12 months due to asthma exacerbation or maintenance systemic steroids therapy, were included in this non-interventional observational study. RESULTS: Asthma was uncontrolled in 43.9%, partly controlled in 50.4% and well controlled in only 5.7%. The majority of the patients (83%) were compliant with drug treatment. CONCLUSION: The fact that 83% of the asthma patients included in this study were compliant with their asthma therapy was not manifested in asthma control. Therefore concrete tools are required for achieving and maintaining asthma control, especially in the treatment of the most severe asthmatic patients.

A computerized surveillance system for asthma.

PURPOSE: Asthma is a chronic inflammatory airways disease characterized by acute exacerbations interspaced by symptom-free periods. Its management imposes a substantial burden on healthcare services, as well as personal suffering and significant financial tolls. The aim of this paper is to demonstrate links between routinely used computerized databases and to establish an automatic mechanism for monitoring asthma patients. DESIGN/METHODOLOGY/APPROACH: The study population was all adult subscribers to a major health maintenance organization (HMO) in Southern Israel (230,000 adults, age 20-65 years). Relevant data for this retrospective analysis (2000 to 2004) were extracted from several computerized databases routinely used in the service: pharmacy; administrative; and each person's personal computerized medical file in the primary care clinic. FINDINGS: Based on data from 72 regional primary care clinics, during the study period, 11,054 adults were treated simultaneously by beta2 agonists and steroids--assumed to be asthmatics. In contrast, asthma diagnosis was recorded in only 4,061 personal files. The intersection between two databases yielded 2,569 persons recorded in both. These findings attest to the feasibility of developing computerized automatic surveillance systems for monitoring asthma patients with certain algorithms to assure service quality. RESEARCH LIMITATIONS/IMPLICATIONS: Data extracted from the various databases were unequal quality, a factor that imposed data management difficulties. PRACTICAL IMPLICATIONS: Similar surveillance systems can be developed relatively easily by using comparable algorithms for monitoring different chronic diseases or introducing management indices to secure quality of services. ORIGINALITY/VALUE: The paper focuses on developing an automatic asthma monitoring model, using information from routinely used computerized HMO DBs.

Pulmonary function correlates with arterial stiffness in asthmatic patients.

BACKGROUND: At the population level, asthma has been associated with chronic systemic inflammation as well as adverse cardiovascular outcomes. OBJECTIVES: The aim of this study was to investigate peripheral vascular hemodynamic variables of arterial stiffness (AS) and their relationship to pulmonary function tests in asthmatic patients. METHODS: Young asthmatic patients from the tertiary center for pulmonary diseases at the Barzilai Medical Center underwent pulmonary function evaluation and non-invasive radial artery hemodynamic profiling, pre- and post-exercise. Results were compared to age matched, non-asthmatic controls. RESULTS: 23 young asthmatics and 41 controls, completed all evaluation points. Pulmonary flow parameters were significantly reduced in the asthma group at all points. There were no differences between groups in BMI, blood pressure, pulse rate or measurements of AS at baseline or after bronchodilation. The % predicted forced expiratory volume in the first second at baseline (FEV1%) in asthmatics was positively correlated with the small arteries elasticity index (SAEI) and negatively correlated with the systemic vascular resistance (SVR) in these patients. These correlations were not observed in non-asthmatic controls. In multifactorial regression FEV1 remained the major factor associated with measurements of AS in asthmatic patients, while gender was the only significant factor in non-asthmatic controls. CONCLUSIONS: Significant correlations between measurements of AS and FEV1 in young asthmatics, suggest the presence of a common systemic, most likely inflammatory pathway involving both the cardiovascular and respiratory systems.

Safety and efficacy of allergen immunotherapy in the treatment of allergic rhinitis and asthma in real life.

BACKGROUND: Subcutaneous allergen immunotherapy is effective in treating allergic airway disease. Disadvantages include immediate local and systemic adverse reactions and poor compliance. OBJECTIVES: To obtain real-life efficacy and safety data through a prospective observational study of SIT in the allergist's office. METHODS: We prospectively collected data from all patients with a diagnosis of allergic rhinitis and/or asthma and a specific immunoglobulin E-mediated sensitization to one or more aeroallergens who began SIT during the 2 year period 1 January 2005 to 31 December 2006. As part of the routine immunotherapy care patients were asked to complete a disease activity questionnaire before and yearly during the treatment. The primary outcome measure was the combined rhinitis and asthma symptoms scores. Data from patients completing at least 1 year of immunotherapy were analyzed. RESULTS: Altogether, 133 enrolled patients with a mean age of 22.7 years completed at least 1 year of SIT. The allergic rhinitis and asthma disease activity score decreased from a mean of 8.1 to 3.3 (rhinitis) and from 4.8 to 2.4 (asthma) on a 10 cm visual analogue scale after 1 year of SIT (P < 0.001 for all comparisons). Rhinitis medication use in all patients and asthma medication use in asthmatics decreased significantly. Mild local adverse reactions were almost universal. There were 11 patients (8%) who developed 14 immediate systemic, mild to moderate reactions. All reactions were successfully treated in the clinic; none required additional observation or hospitalization. CONCLUSIONS: In the hands of experienced allergists subcutaneous allergy immunotherapy is a safe and efficacious option for patients with allergic rhinitis and asthma.

Single-dose quinolone treatment in acute gastroenteritis.

BACKGROUND: Acute diarrhea is a common disease worldwide and in Israel, a Mediterranean country. Acute bacterial gastroenteritis (ABGE) is the leading cause of severe diarrhea in Israel in summer and early autumn. Although there are some reports showing some benefit from empiric antibiotic therapy in acute gastroenteritis, most are old reports using nondefinitive diagnostic criteria and using 5-day antibiotic regimens. AIMS: 1. To examine the efficiency of antibiotic therapy in relatively severe ABGE in general. 2. To check the efficiency of the different types of quinolones in the treatment of ABGE. 3. To compare various therapy regimens. METHODS: All patients admitted to the Barzilai Medical Center emergency room during the period June to October in 2002-2004 who were defined by protocol as having relatively severe gastroenteritis and required hospitalization in the Department of Internal Medicine were included in the study. All were randomized either to a supportive treatment only group (STG) or to the antibiotic treatment group (ATG) of ofloxacin or levofloxacin with a single dose or BID for 5 days in addition to STGs. All patients were interviewed a week later about their medical history and duration of symptomatology. RESULTS: One hundred thirty-nine patients were found eligible for the study in the above-mentioned period. Abdominal pain resolved 1.3 days earlier in the ATG in comparison to the STG whereas vomiting and diarrhea disappeared 1.0 and 0.8 days earlier, respectively, in the ATG versus the STG. In terms of fever abatement there was no difference between the regimens and no significant difference in symptomatology disappearance between various types of quinolones used or between the single antibiotic dose regimen and the 5-day antibiotic regimen groups. CONCLUSIONS: 1. Antibiotic therapy was found to shorten duration of symptoms in patients with relatively severe gastroenteritis. 2. Single-dose therapy is as effective and certainly significantly more cost effective in comparison to the 5-day antibiotic treatment regimen.