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Rationale: Air pollution caused by wildfire smoke is linked to adverse health outcomes, especially for people living with asthma. Objectives: To evaluate whether government rebates for high-efficiency particulate air (HEPA) filters, which reduce concentrations of smoke particles indoors, are cost effective in managing asthma and preventing exacerbations in British Columbia (BC), Canada. Methods: We used a Markov model to analyze health states for asthma control, exacerbation severity, and death over a retrospective time horizon of 5 years (2018-2022). Concentrations of wildfire smoke-derived particulate matter with an aerodynamic diameter ⩽2.5 μm (PM 2.5 ) from the Canadian Optimized Statistical Smoke Exposure Model and relevant literature informed the model. The base-case analysis assumed continuous use of a HEPA filter. Costs and quality-adjusted life-years (QALYs) resulting from varying rebates were computed for each Health Service Delivery Area (HSDA). Measurements and Main Results: In the base-case analysis, HEPA filter use resulted in increased costs of $83.34 (SE, $1.03) and increased QALYs of 0.0011 (SE, 0.0001) per person. The average incremental cost-effectiveness ratio among BC HSDAs was $74,652/QALY (SE, $3,517), with incremental cost-effectiveness ratios ranging from $40,509 to $89,206 per QALY in HSDAs. Across the province, the intervention was projected to prevent 4,418 exacerbations requiring systemic corticosteroids, 643 emergency department visits, and 425 hospitalizations during the 5-year time horizon. A full rebate was cost effective in 1 of the 16 HSDAs across BC. The probability of cost-effectiveness ranged from 0.1% to 74.8% across HSDAs. A $100 rebate was cost effective in most HSDAs. Conclusions: The cost-effectiveness of HEPA filters in managing wildfire smoke-related asthma issues in BC varies by region. Government rebates up to two-thirds of the filter cost are generally cost effective, with a full rebate being cost effective only in Kootenay Boundary.

Objective To evaluate the association between maternal asthma (MA) and obstetric complications, while considering subdivided total serum immunoglobulin E (IgE) levels. Methods Data of the participants enrolled in the Japan Environment and Children's Study between 2011 and 2014 were analyzed. In total, 77,131 women with singleton live births at and after 22 weeks of gestation were included. MA was defined based on a self-administered questionnaire. Women with MA were stratified based on the quartile of total serum IgE levels during pregnancy as follows: low IgE levels ( 331.00 IU/mL). The adjusted odds ratios (aORs) for preterm births (PTB), small for gestational age (SGA) infants, gestational diabetes mellitus, and hypertensive disorders of pregnancy (HDP) were calculated using multivariable logistic regression, while considering women without MA as reference and maternal socioeconomic factors as confounders. Results The aORs for SGA infants and HDP in women with MA and high total serum IgE levels were 1.26 (95% confidence interval [CI], 1.05-1.50) and 1.33 (95% CI, 1.06-1.66), respectively. The aOR for SGA infants among women with MA and moderate total serum IgE levels was 0.85 (95% CI, 0.73-0.99). The aOR for PTB among women with MA and low total serum IgE levels was 1.26 (95% CI, 1.04-1.52). Conclusions for Practice MA with subdivided total serum IgE levels was associated with obstetric complications. Total serum IgE level may be a potential prognostic marker to predict obstetric complications in pregnancies with MA., Author(s): Tsuyoshi Murata [sup.1] [sup.2] , Hyo Kyozuka [sup.1] [sup.2] , Toma Fukuda [sup.1] [sup.2] , Shun Yasuda [sup.1] [sup.2] , Akiko Yamaguchi [sup.1] [sup.2] , Akiko Sato [sup.1] , [...]

PURPOSE The Assessment of Burden of Chronic Conditions (ABCC) tool was developed to improve care by facilitating shared decision making and self-management. It assesses and visualizes the experienced burden of 1 or multiple chronic conditions and integrates it in daily care. The aim of this study is to evaluate whether the ABCC scale is valid and reliable in people with chronic obstructive pulmonary disease (COPD), asthma, or type 2 diabetes (T2D). METHODS The Saint George Respiratory Questionnaire (SGRQ), the Standardized Asthma Quality of Life Questionnaire (AQLQ-S), and the Audit of Diabetes Dependent Quality of Life Questionnaire (ADDQoL19) were compared with the ABCC scale to assess convergent validity. The internal consistency was evaluated using Cronbach's [alpha]. Test-retest reliability was evaluated at a 2-week interval. RESULTS A total of 65 people with COPD, 62 with asthma, and 60 with T2D were included. The ABCC scale correlated, in accordance with hypotheses, with the SGRQ (75% of correlations [greater than or equal to] 0.7), AQLQ-S (100%), and ADDQoL19 (75%). The ABCC scale was internally consistent with a Cronbach's [alpha] of 0.90, 0.92, and 0.91 for the total score for people with COPD, asthma, and T2D, respectively. The ABCC scale had a good test-retest reliability with an intraclass correlation coefficient of 0.95, 0.93, and 0.95 for people with COPD, asthma, and T2D, respectively. CONCLUSIONS The ABCC scale is a valid and reliable questionnaire that can be used within the ABCC tool for people with COPD, asthma, or T2D. Future research should indicate whether this applies to people with multimorbidity, and what the effects and experiences are upon clinical use. Key words: asthma; diabetes mellitus; patient reported outcome measures; pulmonary disease, chronic obstructive; vaildation study https://doi.org/10.1370/afm.2954, INTRODUCTION Chronic conditions impose an enormous impact on health care in general and especially on the people living with them. (1,2) Effective disease management is essential in care for people [...]

Asthma is a chronic inflammatory disorder of the airways characterized by airflow obstruction, bronchial hyperreactivity, and underlying inflammation. Two common reasons asthmatics fail standard therapy are incorrect diagnosis and failure to recognize underlying contributing factors. A correct diagnosis of asthma is of great importance to military practitioners since misdiagnosis or uncontrolled asthma affects an individual's operational readiness or determines whether one can receive a medical waiver to enlist in military service. This article presents four cases of patients with dyspnea that have conditions which mimic asthma or complicate asthma management: vocal cord dysfunction misdiagnosed as asthma, respiratory bronchiolitis interstitial lung disease mistaken as asthma, difficult-to-control asthma because of bronchiectasis and allergic bronchopulmonary aspergillosis, and difficult and fatal asthma. Asthma is contrasted to other respiratory disorders, and an outlined approach to asthma diagnosis and management is presented using the Global Initiative for Asthma guidelines.

Purpose Comorbidities associated with chronic obstructive pulmonary disease (COPD) affect quality of life and increase mortality. Asthma-COPD overlap (ACO) may express a different profile of comorbidities compared to COPD alone. It is unclear how recent changes in GOLD recommendations affect the profile of comorbidities in COPD and ACO. Methods Eight hundred and thirty-four patients with COPD were recruited from 67 Hungarian secondary care outpatient clinics, 469 of them had ACO. Comorbidities were defined by respiratory specialists based on medical history, patient report, and medications. COPD grades were defined according to the old 2016 and the new 2017 GOLD document. Comorbidities were compared along COPD ABCD groups determined by the old and new GOLD. Results 66 and 72% of the COPD patients in groups C and D (GOLD 2016) were recategorized to groups A and B (GOLD 2017), respectively. There was no difference in the prevalence of disorders along the 2016 GOLD categories except for osteoporosis in ACO (p = 0.01). When the patients were categorized according to the 2017 GOLD criteria, the prevalence of osteoporosis (p = 0.01) was different among the four groups in all COPD patients. Subgroup analysis of non-ACO COPD patients revealed inter-group differences for cardiac arrhythmia (p < 0.01). No alteration was seen in the prevalence of coronary artery disease, hypertension, diabetes, or the total number of comorbidities. Conclusion A significant number of patients are recategorized according to the GOLD 2017 criteria. This change only marginally affects the profile of comorbidities; still this needs to be considered when assessing the patients in daily practice., Author(s): András Bikov [sup.1] , Alpár Horváth [sup.2] [sup.3] , Gábor Tomisa [sup.2] [sup.3] , Liza Bártfai [sup.4] , Zoltán Bártfai [sup.5] Author Affiliations: (Aff1) 0000 0001 0942 9821, grid.11804.3c, [...]

Attentional biases have been observed in populations with psychological disorders, but have been under-investigated in populations with physical illnesses. This study investigated potential attentional biases in asthma as a function of mood. Asthma (N = 45), and healthy (N = 39) participants were randomly allocated to a depressed or a neutral mood state induction. They completed a visual probe task that measured participants' reaction times to health-threat and neutral pictures and words. Compared to the healthy controls, the asthma group showed attentional bias towards health-threat pictures in depressed mood, and avoidance of health-threat pictures in neutral mood. Attentional biases were found in a group with a physical illness as a function of induced mood. It is suggested that attentional processes in people with physical illness may be important in relation to symptom perception and illness management., Author(s): Iana Alexeeva [sup.1] , Maryanne Martin [sup.1] Author Affiliations: (Aff1) 0000 0004 1936 8948, grid.4991.5, Medical Sciences Division, Department of Experimental Psychology, University of Oxford, , Anna Watts Building, [...]

In severe or chronic asthma, there is an increase in airway smooth muscle cell (ASMC) mass as well as an increase in connective tissue proteins in the smooth muscle layer of airways. Transforming growth factor-beta (TGF-beta) exists in three isoforms in mammals and is a potent regulator of connective tissue protein synthesis. Using immunohistochemistry, we had previously demonstrated that ASMCs contain large quantities of TGF-beta1-3. In this study, we demonstrate that bovine ASMC-derived TGF-beta associates with the TGF-beta latency binding protein-1 (LTBP-1) expressed by the same cells. The TGF-beta associated with LTBP-1 localizes TGF-beta extracellularly. Furthermore, plasmin, a serine protease, regulates the secretion of a biologically active form of TGF-beta by ASMCs as well as the release of extracellular TGF-beta. The biologically active TGF-beta released by plasmin induces ASMCs to synthesize collagen I in an autocrine manner. The autocrine induction of collagen expression by ASMCs may contribute to the irreversible fibrosis and remodeling seen in the airways of some asthmatics.

OBJECTIVES: This study examines the socio-economic gradient in utilization and the risk factors associated with hospitalization for four pediatric ambulatory care sensitive conditions (dental conditions, asthma, gastroenteritis, and bacterial pneumonia). Dental conditions, where much care is provided by dentists and insurance coverage varies among different population segments, present special issues. METHODS: A population registry, provider registry, physician ambulatory claims, and hospital discharge abstracts from 28 398 children born in 2003-2006 in urban centres in Manitoba, Canada were the main data sources. Physician visits and hospitalizations were compared across neighbourhood income groupings using rank correlations and logistic regressions. RESULTS: Very strong relationships between neighbourhood income and utilization were highlighted. Additional variables--family on income assistance, mother's age at first birth, breastfeeding--helped predict the probability of hospitalization. Despite the complete insurance coverage (including visits to dentists and physicians and for hospitalizations) provided, receiving income assistance was associated with higher probabilities of hospitalization. CONCLUSIONS: We found a socio-economic gradient in utilization for pediatric ambulatory care sensitive conditions, with higher rates of ambulatory visits and hospitalizations in the poorest neighbourhoods. Insurance coverage which varies between different segments of the population complicates matters. Providing funding for dental care for Manitobans on income assistance has not prevented physician visits or intensive treatment in high-cost facilities, specifically treatment under general anesthesia. When services from one type of provider (dentist) are not universally insured but those from another type (physician) are, using rates of hospitalization to indicate problems in the organization of care seems particularly difficult. KEY WORDS: Pediatric dental conditions; early childhood caries; physician visits; hospitalizations; birth cohorts; socio-economic gradient OBJECTIFS : Notre etude porte sur le gradient socioeconomique du recours a l'hospitalisation et sur les facteurs de risque associes pour quatre conditions pediatriques propices aux soins ambulatoires (problemes dentaires, asthme, gastroenterite et pneumonie bacterienne). Les problemes dentaires presentent des enjeux particuliers, car la plupart sont traites par des dentistes, et la couverture d'assurance de ces soins varie selon le segment demographique. METHODE : Nos donnees provenaient principalement d'un registre de population, d'un registre des fournisseurs, des demandes de paiement des medecins pour consultations en medecine ambulatoire et du registre des sorties des hopitaux de 28 398 enfants nes entre 2003 et 2006 dans les centres urbains du Manitoba, au Canada. Nous avons compare les visites chez le medecin et les hospitalisations pour differents groupes de revenu selon le quartier a l'aide de correlations des rangs et de regressions logistiques. RESULTATS : Des liens tres solides sont apparus entre le revenu selon le quartier et le recours a l'hospitalisation. D'autres variables--le fait pour la famille de toucher une aide au revenu, l'age de la mere a la premiere naissance, l'allaitement maternel - ont aide a predire la probabilite d'hospitalisation. Malgre la couverture d'assurance complete assortie a l'aide au revenu (y compris les visites chez le dentiste et le medecin et les hospitalisations), le fait de toucher une telle aide etait associe a des probabilites d'hospitalisation superieures. CONCLUSIONS : Nous avons constate la presence d'un gradient socioeconomique dans le recours a l'hospitalisation pour les conditions pediatriques propices aux soins ambulatoires, avec des taux de visites sur pied et d'hospitalisation plus eleves dans les quartiers les plus pauvres. La couverture d'assurance, qui varie selon le segment demographique, complique encore les choses. Le financement des soins dentaires des Manitobains prestataires de l'aide au revenu n'a pas empeche les visites chez le medecin ni les traitements intensifs dans des installations a cout eleve, plus precisement les traitements sous anesthesie generale. En l'absence d'une couverture universelle des services d'une categorie de fournisseurs (les dentistes) alors qu'une telle couverture existe pour les services d'une autre categorie de fournisseurs (les medecins), il semble particulierement difficile d'utiliser les taux d'hospitalisation pour reperer des problemes dans l'organisation des soins. MOTS CLES : problemes dentaires pediatriques; caries du jeune enfant; visites chez le medecin; hospitalisations; cohortes de naissance; gradient socioeconomique, Appropriate care in primary care physicians' offices is presumed to prevent expensive hospitalizations for untreated conditions. (1) 'Timely and effective outpatient care can help to reduce the risks of hospitalization [...]