Posted by James
Patient experiences identified in these group discussions highlighted areas for improvement in the delivery of asthma education and medical care that are community-oriented and enmeshed with day-to-day living. The discussions revealed a need for patient education that integrates perceptions of illness, concerns about potential medication side effects, the impact of lifestyle adjustments on quality of life, and recognition of and response to asthma symptoms. Workshop participants expressed a desire to learn more about managing their [or their child(ren)'s] asthma. They demonstrated knowledge regarding asthma triggers and the medications needed to control symptoms but were challenged to modify their way of life to avoid triggers or maintain a medication regimen. They creatively crafted ways to manage their asthma that did not entirely compromise their quality of life. Some of their coping strategies also countered the biomedical management model for asthma.
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Posted by James
Two asthma workshops were held that were targeted to the Puerto Rican population in the community. They were held in different locations to accommodate convenience of participants. The workshops were recommended in an earlier participatory research study that explored actual and potential asthma education interventions in ethnic minority communities of western New York State. Questions for the asthma workshops were derived in part from the focus group moderators guide used in the previous study. The workshops allowed participants to learn from each other by sharing their experiences. Twenty-two adults (^18 years of age) who had asthma or were household caretakers of children with asthma participated; one workshop included nine participants, the other 13 participants. Self-reported asthma diagnosis was confirmed by the patient’s medication prescription. The participants were invited through flyers and word of mouth in community centers. Interested parties voluntarily contacted the project director in order to participate. The University at Buffalo’s institutional review board approved this project.
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Posted by James
Study findings reflect the participants’ lay conceptualizations, principal misgivings, coping strategies and basic misconceptions about asthma. These are presented here as themes: 1) deceiving nature of asthma; 2) household environment triggers; 3) lifestyle restrictions; 4) emergency department use; 5) medication use and side effects, and 6) coping strategies (Table 2). These themes are to be viewed as interrelated. A thematic narrative of the findings follows below.
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Posted by James
INTRODUCTION
Asthma is a chronic disease that can be managed with appropriate medication and education. Some disparities in prevalence and related morbidity have been identified among minority populations, particularly children. For example, Puerto Rican children have been documented to have higher prevalence rates of asthma compared to African Americans and non-Hispanic whites. Specifically, data from the National Health Interview Survey found that 83% of Puerto Rican children who reported wheezing in the past year were diagnosed with asthma compared to 71% of African American and 57% of non-Hispanic white children. While asthma prevalence among Hispanic adults in 2002 was lower than among non-Hispanic white adults (5% compared to 7.6%, respectively), prevalence in Puerto Rico was higher than in the 50 United States, and U.S. territories. A study by Ledogar et al. also found that Puerto Ricans had higher rates of asthma than other Hispanic subgroups. Similarly, Puerto Ricans had higher asthma mortality rates compared to African Americans and non-Hispanic whites (40.9 per million, 38.1 per million, and 14.7 per million, respectively. Puerto Ricans also had higher asthma mortality rates than other Hispanic subgroups. Hispanic adults with asthma were more likely than non-Hispanic white adults to present to the emergency room (26%) and 14.5%>, respectively), to have asthma-related urgent care visits (36.9% and 25.8%), to have sleep difficulty (64.7% and 47.4) and to have activity limitations (40.4 and 23.6).
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Posted by James
This study, which consisted predominantly of African-American children, demonstrated that inner-city children are more likely to be overweight com pared with other children. Fifty-three percent of children in this study were that caloric intake is similar in children with or without asthma but that children with asthma are more likely to have exercise-induced bronchospasm. The latter is related to the amount of subcutaneous fat in the bodies of asthmatic children. Exercise-induced bronchospasm may lead to an aversion to exercise, with subsequent risk of overweight and obesity. This is despite the fact that resting energy expenditure, which makes up the largest contribution to total energy expenditure, is greater in children with asthma when compared with children without asthma. These data indicate that increases in overweight and obesity in children with asthma may be related to decreases in physical activity.
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Posted by James
One-hundred-nine children were included in the study. Eleven children were excluded because of unacceptable pulmonary function tests. The demographics and other characteristics are shown in Table 2. Overall, 58 children (53%) were overweight (BMI >85th percentile). Girls were more likely to be overweight (35/61, 57%) compared with boys (24/48, 50%); however, this difference was not statistically significant (p=0.46). Eighteen (17%) children were diagnosed with asthma by a physician, but spirometry parameters were consistent with a diagnosis of asthma in only two of these 18 children. There was not a statistically significant difference between the overweight (8/58, 14%) and lean children (9/51, 18%) with regard to a physician diagnosis of asthma(p=0.412), nor was there a statistically significant association between asthma symptoms and the diagnosis of asthma based on spirometry.
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Posted by James
Spirometry (pre- and postbronchodilator) was assessed using a flow-sensitive spirometer (Renaissance II; Puritann-Bennett, Carlsbad, CA). A respiratory therapist who was experienced in performing spirometry in children conducted all tests, and all tests conformed to the criteria of the American Thoracic Society. All tests were performed between 10 a.m. and 2 p.m. The following parameters were measured: forced vital capacity (FVC), forced expiratory volume in 1 second (FEVi) and forced expiratory flow at midlung volume (FEF25-75). The ratio of FEVi to FVC (FEVi/FVC) was calculated. All values were adjusted for body temperature and barometric pressure. Percent predicted values for FVC,
Table 1. Questionnaires used to elicit symptoms of asthma
1. Wheezing at any time
2. Wheezing with exercise
3. Wheezing while sleeping
4. Cough at night
5. A severe attack of wheezing requiring emergency department visit
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