To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma.
Cross-sectional observational study.
The primary care Optimum Patient Care Research Database and the British ...Thoracic Society Difficult Asthma Registry.
Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)-severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control).
Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group.
748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified.
Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.
This study examined the effectiveness of two tiers of intervention for preventing early reading difficulties among kindergarten children who qualified as at risk of experiencing difficulty in the ...early stages of learning to read. Participating schools were randomly assigned to one of three treatment conditions: Professional Development for classroom teachers which served as a Tier 1 intervention, small group supplemental Intervention for children which served as a Tier 2 intervention, or both Professional Development for teachers and direct intervention for children. Three cohorts of children were followed from the beginning of kindergarten to the beginning of first grade. The first cohort served as a Baseline Cohort. The experimental treatments were instituted for the second cohort (Implementation Cohort). The third cohort served as a Maintenance Cohort which allowed us to evaluate whether effects of PD were still evident in the year following the implementation of the PD program. Data were gathered on both student achievement and classroom language arts instruction for each cohort. Outcomes suggested that all three treatments were very effective in reducing the number of at risk kindergartners who remained at risk for reading difficulties at the end of the school year although differences in the effectiveness of classroom instruction observed for the Baseline Cohort made it difficult to confidently compare the relative effectiveness of the three treatment conditions. However, comparisons between the Baseline and Maintenance Cohorts clearly revealed characteristics of classroom instruction that were associated with reductions in the number of children who qualified as at risk for reading difficulties at the beginning of first grade.
Following the most recent outbreak of Ebola virus disease (EVD), the organized global effort brought new capabilities to postoutbreak clinical monitoring and surveillance. 1 Manifestations of PEVDS ...include abdominal pain, alopecia, anorexia, fatigue, fever, arthralgias, cardiac manifestations, cough/dyspnea, cutaneous/rash, myalgias, hearing loss, blurred vision, headaches, sleep disturbances, uveitis, peripheral dysesthesias or paresthesias, short-term memory problems, erectile dysfunction, lethargy, and mood disorders (depression/anxiety). 15 Limited experiences with lumbar punctures suggest that EBOV-associated CNS findings may include both virus-negative and virus-positive (by reverse transcription polymerase chain reaction) cerebrospinal fluid (CSF) studies with elevated opening pressures. 13 The latter contention remains largely unproven and the key reason for any potential cognitive deficits in both children and adults may be the presence of hemodynamic collapse and cerebral hypoperfusion during the acute clinical phase of Ebola infection. Nonneurologic Manifestations In one study examining nonneurologic complaints, 11% of patients experienced cough; 9% reported chest pain, abdominal pain, or itching; and 7% reported fever, lack of appetite, or sleep-related difficulties. 6 A broad range of upper and lower respiratory complaints was reported as well, including nasal congestion, sneezing, shortness of breath, and chest pain. 6 Finally, nonspecific cutaneous complaints included rash, dry/flaky skin, "fever blisters" or "cold sores," ear pain, hiccups, and scrotal swelling. Early clinical sequelae of Ebola virus disease in Sierra Leone: A cross-sectional study. Necrotizing scleritis, conjunctivitis, and other pathologic findings in the left eye and brain of an Ebola virus-infected rhesus macaque (Macaca mulatta) With apparent recovery and a delayed time of death...
Severe refractory asthma poses a substantial burden in terms of healthcare costs but relatively little is known about the factors which drive these costs. This study uses data from the British ...Thoracic Society Difficult Asthma Registry (n=596) to estimate direct healthcare treatment costs from an National Health Service perspective and examines factors that explain variations in costs. Annual mean treatment costs among severe refractory asthma patients were £2912 (SD £2212) to £4217 (SD £2449). Significant predictors of costs were FEV1% predicted, location of care, maintenance oral corticosteroid treatment and body mass index. Treating individuals with severe refractory asthma presents a substantial cost to the health service.
All people are not born equally. The World Conference in Special Education which was held in Salamanca in 1994, sought to make inclusive education the norm. The aspiration is arguably noble. However, ...it would appear that defining the meaning of inclusive education poses difficulties. Over twenty five years have elapsed since the conference. This thesis reviews the support for primary children with dyslexia from the perspective of inclusion and offers the opportunity to explore the perception of teachers, parents and past pupils around inclusion and segregation. The literature review initially considers the theme of special education in five jurisdictions. The special education theme is then narrowed, focusing specifically on the area of dyslexia. Finally, the documentary evidence relating to the Republic of Ireland (ROI) Northern Ireland (NI) becomes the sole focal point where the policy of inclusion and the support of primary school children with dyslexia are carefully studied. The literature review provided the impetus for a comparative study using an online survey and a comparative case study involving participants from the Republic of Ireland and Northern Ireland. The survey and the comparative case study employed in this research generated considerable data which was analysed qualitatively. In addition, the survey produced large amounts of statistics which were used as a means of triangulation. Eight thematic nodes from the survey expanded into an additional four thematic nodes from the comparative case study. The survey was conducted with 174 participating teachers and the comparative case study consisted of 21 semi structured interviews involving teachers, parents and past pupils. When the entire data was carefully analysed, twelve recommendations emerged. It would appear that the quality of teaching support for primary children in both the ROI and NI lacks a coordinated approach, where it is up to individual boards of management and boards of governors to organise and train school staff specifically in the area of special education. Only 53.5 per cent of the participants in the survey had received any training in the support of children with dyslexia. The detection of children with dyslexia appeared haphazard with only 28 per cent of participants reporting that their school used dyslexia screening tests. The findings from the case study illustrate the contrast in support which is available to primary children with dyslexia. In the ROI, children with a diagnosis of severe dyslexia who meet the required criteria have the option of attending either one of four special schools or twenty special units for children with a specific disability including dyslexia. The policy of the department of education and skills in the ROI encourages primary schools not to withdraw children from their classrooms wherever possible which is in contrast to the existence of four schools and twenty units where children are removed from their mainstream peers for up to two years and in exceptional circumstances this can be extended up to three years. Withdrawing children was the norm in NI and the findings from this research suggest that perhaps children prefer to be withdrawn.
Refractory asthma represents a significant unmet clinical need. Data from a national online registry audited clinical outcome in 349 adults with refractory asthma from four UK specialist centres in ...the British Thoracic Society Difficult Asthma Network. At follow-up, lung function improved, with a reduction in important healthcare outcomes, specifically hospital admission, unscheduled healthcare visits and rescue courses of oral steroids. The most frequent therapeutic intervention was maintenance oral corticosteroids and most steroid sparing agents (apart from omalizumab) demonstrated minimal steroid sparing benefit. A significant unmet clinical need remains in this group, specifically a requirement for therapies which reduce systemic steroid exposure.
After puberty, females are more likely to develop asthma and in a more severe form than males. The associations between asthma and sex are complex with multiple intrinsic and external factors.
To ...evaluate the sex differences in the characteristics and treatment of patients with severe asthma (SA) in a real-world setting.
Demographic, clinical and treatment characteristics for patients with SA in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD) were retrospectively analysed by sex using univariable and multivariable logistic regression analyses adjusted for year, age and hospital/practice.
3679 (60.9% female) patients from UKSAR and 18 369 patients (67.9% female) from OPCRD with SA were included. Females were more likely to be symptomatic with increased Asthma Control Questionnaire-6 (UKSAR adjusted OR (aOR) 1.14, 95% CI 1.09 to 1.18) and Royal College of Physicians-3 Question scores (OPCRD aOR 1.29, 95% CI 1.13 to 1.47). However, they had a higher forced expiratory volume in 1 second per cent (FEV
%) predicted (UKSAR 68.7% vs 64.8%, p<0.001) with no significant difference in peak expiratory flow. Type 2 biomarkers IgE (UKSAR 129 IU/mL vs 208 IU/mL, p<0.001) and FeNO (UKSAR 36ppb vs 46ppb, p<0.001) were lower in females with no significant difference in blood eosinophils or biological therapy. Females were less likely to be on maintenance oral corticosteroids (UKSAR aOR 0.86, 95% CI 0.75 to 0.99) but more likely to be obese (UKSAR aOR 1.67, 95% CI 145 to 1.93; OPCRD SA aOR 1.46, 95% CI 1.34 to 1.58).
Females had increased symptoms and were more likely to be obese despite higher FEV
% predicted and lower type 2 biomarkers with consistent and clinically important differences across both datasets.
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