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Australia has a high prevalence of asthma amongst its population. Literature shows rural asthma patients have a higher need to access emergency healthcare due to asthma-related emergencies than those living in metropolitan areas, and that underutilisation of ambulance resources is evident in rural areas. This study aims to explore the barriers preventing patients from accessing emergency healthcare resources during an asthma-related emergency in rural New South Wales (NSW). A qualitative interpretative design comprising 12 semi-structured interviews was conducted between May and July 2021. Participants had accessed emergency healthcare in rural NSW during a moderate to severe asthma exacerbation in NSW within the last five years. Interviews were recorded and transcribed verbatim to allow thematic analysis, which produced four overarching themes. This paper explores two of those themes due to the depth and range of the data. The impact of healthcare logistics, including access and availability of emergency healthcare resources, response times, environmental concerns, and issues with transport home from the hospital, were identified as barriers. Additionally, financial cost, the presumed cost to healthcare workers and societal cost were also found to influence participants’ decisions to access emergency healthcare. Overall, multiple factors were identified as potential barriers to asthma patients in rural NSW accessing emergency healthcare. Introducing improved mapping systems and mobile/radio reception, in addition to better staff resourcing in rural locations may help reduce the reluctance of asthma patients to access healthcare due to logistical concerns and fear of being a burden on the emergency healthcare system. [ABSTRACT FROM AUTHOR]

According to the international guidelines of COPD (GOLD) and asthma (GINA) diagnosis and treatment of both diseases necessitate spirometry in the private practice as well as in hospital setting. However today, spirometry is not sufficiently used in Switzerland. This paper intends to give an easy overview how spirometry is performed and spirometric values can be interpreted. [ABSTRACT FROM AUTHOR]

According to the international guidelines of COPD (GOLD) and asthma (GINA) diagnosis and treatment of both diseases necessitate spirometry in the private practice as well as in hospital setting. However today, spirometry is not sufficiently used in Switzerland. This paper intends to give an easy overview how spirometry is performed and spirometric values can be interpreted. [ABSTRACT FROM AUTHOR]

Summary: In France, an annual seasonal influenza vaccination has been recommended since 2000 for patients suffering from chronic respiratory diseases, including asthma. Each year, a free influenza vaccination voucher is sent by the French Public Health Insurance authorities to patients with chronic respiratory disease, including severe asthma. In November 2006, this measure was extended to all asthmatic patients, irrespective of asthma severity. The present paper examines the 2006–2007 influenza vaccination coverage rate in 433 asthmatic children aged six to 17 years (mean age: 9.5 years; male: 61%) who consulted a pediatric pulmonologist between March and September 2007 in eight hospitals throughout France. The influenza vaccination coverage rate was 15.7% for the 2006–2007 season (13.9% for the 2005–2006 season and 10.9% for the 2004–2005 season). General practitioners vaccinated 72.1% of the children. Lack of information (42%) was the most frequently reported reason for non-vaccination. Free vouchers (received by 39.6% of the children) significantly increased the vaccination coverage rate (31% versus 5.9%; p <0.001). In France, in 2006–2007, the influenza vaccination coverage rate in asthmatic children was far below the national public health objective to achieve for the year 2008 (at least 75%). Concerted action is needed to improve the influenza vaccination coverage rate in asthmatic children. [Copyright &y& Elsevier]

Abstract: Asthma morbidity and mortality have increased over the last ten years in most countries. In some countries now, it apears that asthma prevalence has reached a plateau. The increased prevalence, especially in children, should be explained by environnemental factors, since obviously our genes have not changed. In this paper, we will review the recent data concerning asthma prevalence, mortality, socio-economic impact and both environnemental and genetic risk factors. [Copyright &y& Elsevier]

Abstract: Recurrent respiratory tract infections are a common reason for visits to primary care practitioners or hospital physicians. They are placed at the junction of several medical specialities: paediatrics, ENT, pneumology, allergology, immunology, infectiology. The great diversity of the laboratory tests requested and on the other hand the proposed treatments, are the consequences of the diversity of the patients encountered and the paucity of the evidence based-medicine studies in this setting. The dilemma is how to identify the child for which recurrent respiratory tract infections are the witness of underlying condition, without performing repeated medical examinations, laboratory tests and treatments for normal children for which immunologic development occurs normally. The essential tools are the history analysis, physical examination and few laboratory tests. The other questions are how to include, for these patients, influenza and pneumococcal vaccines in the immunization program and how to assess the benefit/risk ratio and the cost of surgical treatments. This paper presents the thought of an expert group trying to define the situations where biological tests or treatments are useful. [Copyright &y& Elsevier]

Abstract: If it can be confirmed that variations in the level of nitric oxide (NO) in expired air tells us something about the different physiological processes in which this molecule is involved (bronchomotor, vasomotor, immunoregulation), then we will have available a non-invasive technique that would be useful in conditions as varied as asthma, sickle cell anemia, mucoviscidosis and pulmonary arterial hypertension. This technique can be used routinely to the analysis of the concentration of NO in a single expired breath. However, analysis of the concentration of NO in several expired breaths, which is possible from the age of 8–9 years, also makes it possible, using a method that is now standardized, to determine the bronchial production of NO and its alveolar concentration, thus providing a method for differentiating the respective contribution of these two compartments. Other techniques now being developed should soon allow us to calculate even more precisely events during normal ventilation, which will then allow us to make these measurements in babies, in young children, and in patients on artificial ventilation. The aim of this present paper is to discuss the theoretical basis and the techniques of these different approaches. [Copyright &y& Elsevier]

During the last two decades, quality of life (QOL) has been perceived as an innovative indicator of patients’ self-perceived health status, allowing integration of a qualitative approach in medical decision-making. This is evident from the number of publications related to this topic: during the three decades between 1973 and 2002, 1124 papers dealing with QOL in asthma were cited in Medline, 85% having been published during the last 15 years and 65% during the last 5 years. A number of reasons can be given for the interest in this subject: the limitations of traditional indicators of health outcomes, the evolution of the relationship between patients and physicians, the rationalisation of health care expenditures, the increasing importance of health care interventions, and also the desire to keep up with the fashion. The medical community at large has been trying to define QOL, how to measure it, looking at the available instruments and how to use them; this is also true for allergy. Of the 1124 publications cited above, only 41 (3.5%) were written in French. We point out that QOL is a measurable concept, that it is based on a subjective approach and that it has numerous applications. Nevertheless, for a wider use in France, especially in allergy, decision makers must make it a key issue before clinicians are going to understand QOL and make full use of questionnaires used to measure it. [Copyright &y& Elsevier]

The increase in asthma prevalence over the past 20 years could be due to modification of exposure to environmental factors (environmental theory) or to the lost of protective factors (hygienist theory). Among environmental factors this paper reviewed the controversial role of exposure to house dust mite (HDM). If exposure to HDM is deleterious in asthmatics known to be sensitised to this allergen, the effect of HDM exposure on asthma incidence has been challenged recently, based on longitudinal studies showing no correlation between level of exposure to HDM and asthma incidence. Exposure to animal dander may have protective effects. This review has shown that, even if some studies have shown potential protective effect of early exposure, the protection seems to be better in families with a low risk of atopy; almost all studies tend to show a deleterious effect of current exposure; exposure to dog dander may be more protective than cat. These studies cannot give definite conclusions to change current advices of early eviction of HDM and animal dander, especially in families with a high risk of atopy. The deleterious effect of passive smoking on asthma prevalence and severity is undisputable and our efforts should concentrate on obtaining effective eviction of passive smoking. [Copyright &y& Elsevier]