Brett Toelle - Academia.edu (original) (raw)

Papers by Brett Toelle

Research paper thumbnail of E-044: Association between Exposure to Traffic-related Air Pollution and Respiratory Health in Sydney, Australia

Research paper thumbnail of ABS78: A pilot study of Physician Asthma Care Education program in Australia

Primary Care Respiratory Journal, 2006

Research paper thumbnail of Respiratory Health before and after the Opening of a Road Traffic Tunnel: A Planned Evaluation

PLoS ONE, 2012

Objective: The construction of a new road tunnel in Sydney, Australia, and concomitant reduction ... more Objective: The construction of a new road tunnel in Sydney, Australia, and concomitant reduction in traffic on a major road presented the opportunity to study the effects of this traffic intervention on respiratory health.

Research paper thumbnail of Telomere length in early childhood: Early life risk factors and association with carotid intima-media thickness in later childhood

European journal of preventive cardiology, Jan 24, 2015

Reduced telomere length is a measure of biological aging that is predictive of cardiac events in ... more Reduced telomere length is a measure of biological aging that is predictive of cardiac events in adults, and has been mechanistically implicated in the onset and progression of atherosclerosis. We sought to describe the early life factors associated with leukocyte telomere length in early childhood, and to determine whether telomere length measured during early childhood is associated with arterial wall thickening later in childhood. A longitudinal birth cohort recruited antenatally in Sydney from 1997 to 1999. Leukocyte telomere length was measured in 331 children at age 3.6 years (SD 1.0); of whom 268 children without diabetes had carotid intima-media thickness assessed by ultrasound at age 8 years. Male sex, younger paternal age and higher maternal body mass index were associated with shorter telomere length in early childhood, which in turn was associated with greater carotid intima-media thickness at age 8 years (standardised β = -0.159, P = 0.01). There was a graded associatio...

Research paper thumbnail of Absence of back to school peaks in human rhinovirus detections and respiratory symptoms in a cohort of children with asthma

Journal of Medical Virology, 2015

Much of what is known about the seasonality of human rhinovirus (hRV) infections has been learned... more Much of what is known about the seasonality of human rhinovirus (hRV) infections has been learned from the study of acute asthma exacerbations presenting to emergency care, including those among children at the start of the school term. Much less is known about the patterns of hRVs in the community. In this study, viruses and day-to-day symptoms of asthma and colds were monitored twice weekly in 67 children with asthma aged 5-12 years, over a 15 month period in Sydney, Australia. Overall hRV was detected in 314/1232 (25.5%) of nasal wash samples and 142/1231 (11.5%) of exhaled breath samples; of these, 231 and 24 respectively were genotyped. HRVs were detected with similar prevalence rate throughout the year, including no peak in hRV prevalence following return to school. No peaks were seen in asthma and cold symptoms using twice-weekly diary records. However, over the same period in the community, there were peaks in asthma emergency visits both at a large local hospital and in state-wide hospitalizations, following both return to school (February) and in late autumn (May) in children of the same age. This study suggests that hRV infections are common throughout the year among children, and differences in virus prevalence alone may not account for peaks in asthma symptoms. J. Med. Virol. 9999:1-10, 2015. © 2015 Wiley Periodicals, Inc.

Research paper thumbnail of Exasperations" of asthma: a qualitative study of patient language about worsening asthma

The Medical journal of Australia

To identify expressions used by patients to describe worsening asthma; to examine the relevance o... more To identify expressions used by patients to describe worsening asthma; to examine the relevance of the word "exacerbation" to patients' experience; and to investigate whether their language is influenced by the severity of the episode and/or the target audience such as family members, friends and work colleagues. Qualitative study carried out from 1 January to 30 December 2004 among community volunteers to a research institute. Semistructured face-to-face interviews were used to elicit descriptions of episodes of worsening asthma, and further questioning was used to examine language used with family, employer and doctor. 25 people with asthma, aged 22-75 years. Themes identified by open coding about patient language for worsening asthma. 12 participants were not familiar with "exacerbation" and only three would use it themselves. "Attack" was the only specific term spontaneously volunteered (20 participants), but it was used for anything from mild t...

Research paper thumbnail of ABS78: A pilot study of Physician Asthma Care Education program in Australia

Primary Care Respiratory Journal, 2006

Research paper thumbnail of Prevalence Of Respiratory Symptoms, Illnesses And Spirometric Diagnoses By Age Group And Sex: The Burden Of Lung Disease (BOLD) Study

A50. COPD EPIDEMIOLOGY, 2011

Research paper thumbnail of Assessing the performance of two lung age equations on the Australian population: using data from the cross-sectional BOLD-Australia study

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2014

Lung age, a simple concept for patients to grasp, is frequently used as an aid in smoking cessati... more Lung age, a simple concept for patients to grasp, is frequently used as an aid in smoking cessation programs. Lung age equations should be continuously updated and should be made relevant for target populations. We observed how new lung age equations developed for Australian populations performed when utilizing the Burden of Obstructive Lung Disease (BOLD)-Australia dataset compared to more commonly used equations. Data from a cross-sectional population study of noninstitutionalized Australians aged ≥40 years with analysis restricted to Caucasians <75 years. Lung age calculated using equations developed by Newbury et al. and Morris and Temple was compared with chronological age by smoking status and within smoking status. There were 2,793 participants with a mean age of 57 (±10 SD) years. More than half (52%) ever smoked, and 10.4% were current smokers. Prevalence of chronic obstructive pulmonary disease stage I or higher was 13.4% (95% confidence interval = 12.2, 14.7). For both...

Research paper thumbnail of Prevalence Of COPD And Its Risk Factors In The Australian Bold Study

A50. COPD EPIDEMIOLOGY, 2011

Research paper thumbnail of Lung Function Is Associated with Arterial Stiffness in Children

Background: In older adults, an independent association exists between impaired lung function and... more Background: In older adults, an independent association exists between impaired lung function and cardiovascular disease. This interaction might be related to the effects of aging and/or smoking. In order to explore possible childhood antecedents to this association, we hypothesized that decreased lung function and vascular stiffness might be related, in early life.

Research paper thumbnail of Weighted Road Density and Allergic Disease in Children at High Risk of Developing Asthma

PLoS ONE, 2014

Evidence for an association between traffic-related air pollution and allergic disease is inconsi... more Evidence for an association between traffic-related air pollution and allergic disease is inconsistent, possibly because the adverse effects may be limited to susceptible subgroups and these have not been identified. This study examined children in the Childhood Asthma Prevention Study (CAPS), potentially susceptible to air pollution effects because of a family history of asthma. We examined cross-sectional associations at age eight years between road density within 75 m and 50 m of home address weighted by road type (traffic density), as a proxy for traffic-related air pollution, on the following allergic and respiratory outcomes: skin prick tests (SPTs), total and specific serum IgE, pre- and post-bronchodilator lung function, airway hyperresponsiveness, exhaled NO, and reported asthma and rhinitis. Weighted road density was positively associated with allergic sensitisation and allergic rhinitis. Adjusted relative risk (RR) for house dust mite (HDM) positive SPT was 1.25 (95% CI: 1.06-1.48), for detectable house dust mite-specific IgE was 1.19 (95% CI: 1.01-1.41) and for allergic rhinitis was 1.30 (95% CI: 1.03-1.63) per 100 m local road or 33.3 m motorway within 50 m of home. Associations were also seen with small decrements of peak and mid-expiratory flows and increased risk of asthma, current wheeze and rhinitis in atopic children. Associations between road density and allergic disease were found in a potentially susceptible subgroup of children at high risk of developing atopy and asthma.

Research paper thumbnail of Written individualised management plans for asthma in children and adults

Protocols, 1996

Non-adherence to treatment advice is a common phenomenon in asthma and may account for a signific... more Non-adherence to treatment advice is a common phenomenon in asthma and may account for a significant proportion of the morbidity. Comprehensive care that includes asthma education, written self-management plan and regular review has been shown to improve asthma outcomes, but the contribution of these components has not been established. To determine whether the provision of a written asthma self-management plan increases adherence and improves outcome. A search was carried out on the Cochrane Airways Group trials register. There was no language restriction. The search of the databases used the following terms: action plan OR self OR self-care OR self-manag* OR educ* AND adher* OR comply OR compli*. Authors of included studies were contacted for any unpublished or on-going studies and bibliographies of all included studies and reviews were searched for further studies. Only randomised controlled trials (RCTs) in patients with asthma were considered. Participants must have been assigned to receive an individualised written asthma management plan (symptom or peak flow based) about the actions required for regular asthma management and/or the actions to take in the event of an asthma exacerbation. Study quality was assessed and data abstracted by two reviewers independently. Six trials met the inclusion criteria. The written management plans were either peak flow or symptom based, which were compared against each other or compared to no written management plan. Reported outcomes included: hospitalisation, emergency department visits, oral corticosteroid use, lung function, days lost from school/work, unscheduled doctor visits and respiratory tract infections. There was no consistent evidence that written plans produced better patient outcomes than no written plan. For some outcomes, there appeared to an advantage of one type of plan over the other, but there was no consistency - one type of plan was not consistently more effective than another. The available trials are too small and the results too inconsistent to form any firm conclusions as to the contribution of written self management plans in the known beneficial effects of a comprehensive asthma care programmes.

Research paper thumbnail of Rhinoviruses significantly affect day-to-day respiratory symptoms of children with asthma

Journal of Allergy and Clinical Immunology, 2014

Viruses are frequently associated with acute exacerbations of asthma, but the extent to which the... more Viruses are frequently associated with acute exacerbations of asthma, but the extent to which they contribute to the level of day-to-day symptom control is less clear. We sought to explore the relationship between viral infections, host and environmental factors, and respiratory symptoms in children. Sixty-seven asthmatic children collected samples twice weekly for an average of 10 weeks. These included nasal wash fluid and exhaled breath for PCR-based detection of viral RNA, lung function measurements, and records of medication use and asthma and respiratory symptoms in the previous 3 days. Atopy, mite allergen exposure, and vitamin D levels were also measured. Mixed-model regression analyses were performed. Human rhinoviruses (hRVs) were detected in 25.5% of 1232 nasal samples and 11.5% of breath samples. Non-hRV viruses were detected in less than 3% of samples. hRV in nasal samples was associated with asthma symptoms (cough and phlegm: odds ratio = 2.0; 95% CI = 1.4-2.86, P = .0001; wheeze and chest tightness: odds ratio = 2.34, 95% CI = 1.55-3.52, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001) and with cold symptoms, as reported concurrently with sampling and 3 to 4 days later. No differences were found between the 3 hRV genotypes (hRV-A, hRV-B, and hRV-C) in symptom risk. A history of inhaled corticosteroid use, but not atopic status, mite allergen exposure, or vitamin D levels, modified the association between viruses and asthma symptoms. The detection of nasal hRV was associated with a significantly increased risk of day-to-day asthma symptoms in children. Host, virus genotype, and environmental factors each had only a small or no effect on the relationship of viral infections to asthma symptoms.

Research paper thumbnail of Paediatric Asthma Education And Communication In General Practice: What Do Doctors And Parents Say?

D39. PSYCHOSOCIAL DETERMINANTS OF LUNG HEALTH, 2010

Page 1. / Thematic Poster Session / Wednesday, May 19/8:15 AM-4:00 PM / D39 PSYCHOSOCIAL DETERMIN... more Page 1. / Thematic Poster Session / Wednesday, May 19/8:15 AM-4:00 PM / D39 PSYCHOSOCIAL DETERMINANTS OF LUNG HEALTH Area C, Hall G (First Level), Morial Convention Center Paediatric Asthma Education And ...

Research paper thumbnail of Translation Of Evidence-Based Asthma Interventions: Physician Asthma Care Education (PACE) Program In The United States And Australia

B15. CLINICAL OUTCOMES RESEARCH METHODOLOGY, 2012

Physician Asthma Care Education (PACE) is a programme developed in the USA to improve paediatric ... more Physician Asthma Care Education (PACE) is a programme developed in the USA to improve paediatric asthma outcomes. To examine translation of PACE to Australia. The RE-AIM framework was used to assess translation. Demographic characteristics and findings regarding clinical asthma outcomes from PACE randomised clinical trials in both countries were examined. Qualitative content analysis was used to examine fidelity to intervention components. Both iterations of PACE reached similar target audiences (general practice physicians and paediatric patients with asthma); however, in the USA, more children with persistent disease were enrolled. In both countries, participation comprised approximately 10% of eligible physicians and 25% of patients. In both countries, PACE deployed well-known local physicians and behavioural scientists as facilitators. Sponsorship of the programme was provided by professional associations and government agencies. Fidelity to essential programme elements was observed, but PACE Australia workshops included additional components. Similar outcomes included improvements in clinician confidence in developing short-term and long-term care plans, prescribing inhaled corticosteroids, and providing written management instructions to patients. No additional time was spent in the patient visit compared with controls. US PACE realised reductions in symptoms and healthcare use, results that could not be confirmed in Australia because of limitations in follow-up time and sample sizes. US PACE is maintained through a National Heart, Lung, and Blood Institute website. Development of maintenance strategies for PACE Australia is underway. Based on criteria of the RE-AIM framework, the US version of PACE has been successfully translated for use in Australia.

Research paper thumbnail of Continuing the debate about measuring asthma in population studies

Thorax, 2001

The reasons for measuring atopy and airway hyperresponsiveness (AHR) and the methods of validatin... more The reasons for measuring atopy and airway hyperresponsiveness (AHR) and the methods of validating measurements of asthma in population studies continue to be debated. The debate has centred around standards against which to validate asthma measurements but the absence of a "gold standard" makes the criterion validation of measurements difficult. Questionnaires will always be useful but cannot be validated against a doctor diagnosis because of self-selection and recall biases. In practice, measurements should be selected on the merits of what they measure rather than being regarded as validated or non-validated alternatives. The measurement of AHR is invaluable because it is reliable, not influenced by variations in symptom perception or diagnostic trends, and is closely related to the underlying mechanisms of asthma. The value of AHR lies in its high specificity (rate of true negatives) and low sensitivity (rate of false positives) against asthma symptoms which gives additional information about symptomatic subjects. Atopy is also a useful test and, in quantifying its association with asthma, we should not place any currency on ecological evidence. Atopy is a strong risk factor for asthma in the presence of regionally specific allergens and ecological analyses that ignore these eVects are diversionary rather than productive. For preventing asthma, we need to identify the group at greatest risk of developing it, measure the risk factors with precision, and develop interventions that are eVective in changing environmental exposures and homogenous outcomes. This is the only approach that has the potential to lead to significant public health benefits. (Thorax 2001;56:406-411)

Research paper thumbnail of The association of comorbid anxiety and depression with asthma-related quality of life and symptom perception in adults

Respirology, 2008

There are limited data on the association and interaction between anxiety and depression comorbid... more There are limited data on the association and interaction between anxiety and depression comorbidity and asthma-related quality of life (AQOL) and symptom perception. This study evaluated these associations in patients subsequent to an emergency department (ED) visit for asthma. This was a cross-sectional study of 110 (38 male) adult asthma patients (mean age 42 years), who had visited an ED in the previous 18 months. Participants completed the hospital anxiety and depression scale, measures of AQOL and the asthma symptom checklist. Depression symptoms independently showed a significant negative association with AQOL after controlling for depression/anxiety, age, gender, smoking status and ED visits in the previous 12 months (ED-12). Overall, anxiety and depression symptoms accounted for 28.3% of the variance in AQOL. Greater anxiety was associated with increased perception of asthma-specific panic-fear and hyperventilation symptoms during an asthma attack, irrespective of depression status. Categorical analyses of groups of patients, differentiated by psychometric properties on the hospital anxiety and depression scale (anxiety vs normal, anxiety and depression vs normal depression) confirmed most results. However, for the anxiety group there was a significant association with the AQOL domains of emotional functioning and response to environmental stimuli, after controlling for depression symptoms. The negative association of depression symptom scores with AQOL and of anxiety with increased panic-fear and hyperventilation symptoms suggests a potential role for interventions addressing this psychological comorbidity, in order to improve AQOL.

Research paper thumbnail of Asthma management and outcomes in Australia: A nation-wide telephone interview survey

Respirology, 2007

Asthma is a high-burden disease for which effective treatment is available. In Australia, there h... more Asthma is a high-burden disease for which effective treatment is available. In Australia, there has been a public health campaign directed at increasing the implementation of effective management with the aim of improving asthma outcomes. The aim of this study was to assess the burden of asthma and describe current asthma management in Australia. A computer-assisted telephone interview survey was conducted in 2003/04 among randomly selected participants. Current asthma was defined as self-reported asthma, confirmed by doctor, which was still present and/or associated with symptoms in the last 12 months. From 46,855 eligible telephone numbers dialled there were 14,271 (30.5%) responses to the screening questionnaire. Among 1734 respondents with current asthma, 1205 (69.5%) completed the detailed questionnaire. Among these, 24.2% of adults and 14.3% children had symptoms during the day or night on most days; 11.3% of adults and 6.0% of children avoided exercise because of asthma symptoms during exercise and 19.4% of adults and 29.7% of children had sought urgent medical care because of an exacerbation of asthma during the preceding year. Among adults with asthma, only 35.6% with daily symptoms and 41.4% with symptoms on most days were taking inhaled steroids. Only 31.1% of adults with daily symptoms had a written asthma action plan. Compared with similar international studies, this study revealed a lower prevalence of frequent asthma symptoms and a higher prevalence of use of inhaled steroids among people with asthma. However, there remains ample scope for improvement in management of patients with frequent symptoms.

Research paper thumbnail of Anxiety, panic and adult asthma: A cognitive-behavioral perspective

Respiratory Medicine, 2007

A review of previous research suggests increased probability of the prevalence of anxiety disorde... more A review of previous research suggests increased probability of the prevalence of anxiety disorders, and particularly panic disorder and panic attacks in patients with asthma, as compared to a normal population. Research also indicates significant levels of co-morbidity between asthma and anxiety as measured on dimensional scales of anxiety and panic. Clinical anxiety and panic manifestations affect symptom perception and asthma management through the effects of anxiety symptoms such as hyperventilation, and indirectly through self-management behavior and physician response. However, there is limited data on the impact of anxiety co-morbidity on asthma quality of life. Some studies indicate that individuals with co-morbid asthma and anxiety or panic report worse asthma quality of life both in general and in relation to their symptomatology, being limited in their daily activities, in response to environmental stimuli and in regard to feelings of emotional distress. Cognitive-behavioral therapy (CBT) is an effective and empirically supported treatment of choice for anxiety disorders and panic attacks. However, standard CBT protocols for anxiety and panic may need to be specifically targeted at improving asthma outcomes. Also, asthma research literature is lacking in randomized controlled trials applying CBT to patients with co-morbid asthma and clinical anxiety manifestations. Trials evaluating CBT interventions in individuals with clinical anxiety manifestations and asthma may provide evidence of these interventions as an effective adjunct to improve asthma management and control.

Research paper thumbnail of E-044: Association between Exposure to Traffic-related Air Pollution and Respiratory Health in Sydney, Australia

Research paper thumbnail of ABS78: A pilot study of Physician Asthma Care Education program in Australia

Primary Care Respiratory Journal, 2006

Research paper thumbnail of Respiratory Health before and after the Opening of a Road Traffic Tunnel: A Planned Evaluation

PLoS ONE, 2012

Objective: The construction of a new road tunnel in Sydney, Australia, and concomitant reduction ... more Objective: The construction of a new road tunnel in Sydney, Australia, and concomitant reduction in traffic on a major road presented the opportunity to study the effects of this traffic intervention on respiratory health.

Research paper thumbnail of Telomere length in early childhood: Early life risk factors and association with carotid intima-media thickness in later childhood

European journal of preventive cardiology, Jan 24, 2015

Reduced telomere length is a measure of biological aging that is predictive of cardiac events in ... more Reduced telomere length is a measure of biological aging that is predictive of cardiac events in adults, and has been mechanistically implicated in the onset and progression of atherosclerosis. We sought to describe the early life factors associated with leukocyte telomere length in early childhood, and to determine whether telomere length measured during early childhood is associated with arterial wall thickening later in childhood. A longitudinal birth cohort recruited antenatally in Sydney from 1997 to 1999. Leukocyte telomere length was measured in 331 children at age 3.6 years (SD 1.0); of whom 268 children without diabetes had carotid intima-media thickness assessed by ultrasound at age 8 years. Male sex, younger paternal age and higher maternal body mass index were associated with shorter telomere length in early childhood, which in turn was associated with greater carotid intima-media thickness at age 8 years (standardised β = -0.159, P = 0.01). There was a graded associatio...

Research paper thumbnail of Absence of back to school peaks in human rhinovirus detections and respiratory symptoms in a cohort of children with asthma

Journal of Medical Virology, 2015

Much of what is known about the seasonality of human rhinovirus (hRV) infections has been learned... more Much of what is known about the seasonality of human rhinovirus (hRV) infections has been learned from the study of acute asthma exacerbations presenting to emergency care, including those among children at the start of the school term. Much less is known about the patterns of hRVs in the community. In this study, viruses and day-to-day symptoms of asthma and colds were monitored twice weekly in 67 children with asthma aged 5-12 years, over a 15 month period in Sydney, Australia. Overall hRV was detected in 314/1232 (25.5%) of nasal wash samples and 142/1231 (11.5%) of exhaled breath samples; of these, 231 and 24 respectively were genotyped. HRVs were detected with similar prevalence rate throughout the year, including no peak in hRV prevalence following return to school. No peaks were seen in asthma and cold symptoms using twice-weekly diary records. However, over the same period in the community, there were peaks in asthma emergency visits both at a large local hospital and in state-wide hospitalizations, following both return to school (February) and in late autumn (May) in children of the same age. This study suggests that hRV infections are common throughout the year among children, and differences in virus prevalence alone may not account for peaks in asthma symptoms. J. Med. Virol. 9999:1-10, 2015. © 2015 Wiley Periodicals, Inc.

Research paper thumbnail of Exasperations" of asthma: a qualitative study of patient language about worsening asthma

The Medical journal of Australia

To identify expressions used by patients to describe worsening asthma; to examine the relevance o... more To identify expressions used by patients to describe worsening asthma; to examine the relevance of the word "exacerbation" to patients' experience; and to investigate whether their language is influenced by the severity of the episode and/or the target audience such as family members, friends and work colleagues. Qualitative study carried out from 1 January to 30 December 2004 among community volunteers to a research institute. Semistructured face-to-face interviews were used to elicit descriptions of episodes of worsening asthma, and further questioning was used to examine language used with family, employer and doctor. 25 people with asthma, aged 22-75 years. Themes identified by open coding about patient language for worsening asthma. 12 participants were not familiar with "exacerbation" and only three would use it themselves. "Attack" was the only specific term spontaneously volunteered (20 participants), but it was used for anything from mild t...

Research paper thumbnail of ABS78: A pilot study of Physician Asthma Care Education program in Australia

Primary Care Respiratory Journal, 2006

Research paper thumbnail of Prevalence Of Respiratory Symptoms, Illnesses And Spirometric Diagnoses By Age Group And Sex: The Burden Of Lung Disease (BOLD) Study

A50. COPD EPIDEMIOLOGY, 2011

Research paper thumbnail of Assessing the performance of two lung age equations on the Australian population: using data from the cross-sectional BOLD-Australia study

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2014

Lung age, a simple concept for patients to grasp, is frequently used as an aid in smoking cessati... more Lung age, a simple concept for patients to grasp, is frequently used as an aid in smoking cessation programs. Lung age equations should be continuously updated and should be made relevant for target populations. We observed how new lung age equations developed for Australian populations performed when utilizing the Burden of Obstructive Lung Disease (BOLD)-Australia dataset compared to more commonly used equations. Data from a cross-sectional population study of noninstitutionalized Australians aged ≥40 years with analysis restricted to Caucasians <75 years. Lung age calculated using equations developed by Newbury et al. and Morris and Temple was compared with chronological age by smoking status and within smoking status. There were 2,793 participants with a mean age of 57 (±10 SD) years. More than half (52%) ever smoked, and 10.4% were current smokers. Prevalence of chronic obstructive pulmonary disease stage I or higher was 13.4% (95% confidence interval = 12.2, 14.7). For both...

Research paper thumbnail of Prevalence Of COPD And Its Risk Factors In The Australian Bold Study

A50. COPD EPIDEMIOLOGY, 2011

Research paper thumbnail of Lung Function Is Associated with Arterial Stiffness in Children

Background: In older adults, an independent association exists between impaired lung function and... more Background: In older adults, an independent association exists between impaired lung function and cardiovascular disease. This interaction might be related to the effects of aging and/or smoking. In order to explore possible childhood antecedents to this association, we hypothesized that decreased lung function and vascular stiffness might be related, in early life.

Research paper thumbnail of Weighted Road Density and Allergic Disease in Children at High Risk of Developing Asthma

PLoS ONE, 2014

Evidence for an association between traffic-related air pollution and allergic disease is inconsi... more Evidence for an association between traffic-related air pollution and allergic disease is inconsistent, possibly because the adverse effects may be limited to susceptible subgroups and these have not been identified. This study examined children in the Childhood Asthma Prevention Study (CAPS), potentially susceptible to air pollution effects because of a family history of asthma. We examined cross-sectional associations at age eight years between road density within 75 m and 50 m of home address weighted by road type (traffic density), as a proxy for traffic-related air pollution, on the following allergic and respiratory outcomes: skin prick tests (SPTs), total and specific serum IgE, pre- and post-bronchodilator lung function, airway hyperresponsiveness, exhaled NO, and reported asthma and rhinitis. Weighted road density was positively associated with allergic sensitisation and allergic rhinitis. Adjusted relative risk (RR) for house dust mite (HDM) positive SPT was 1.25 (95% CI: 1.06-1.48), for detectable house dust mite-specific IgE was 1.19 (95% CI: 1.01-1.41) and for allergic rhinitis was 1.30 (95% CI: 1.03-1.63) per 100 m local road or 33.3 m motorway within 50 m of home. Associations were also seen with small decrements of peak and mid-expiratory flows and increased risk of asthma, current wheeze and rhinitis in atopic children. Associations between road density and allergic disease were found in a potentially susceptible subgroup of children at high risk of developing atopy and asthma.

Research paper thumbnail of Written individualised management plans for asthma in children and adults

Protocols, 1996

Non-adherence to treatment advice is a common phenomenon in asthma and may account for a signific... more Non-adherence to treatment advice is a common phenomenon in asthma and may account for a significant proportion of the morbidity. Comprehensive care that includes asthma education, written self-management plan and regular review has been shown to improve asthma outcomes, but the contribution of these components has not been established. To determine whether the provision of a written asthma self-management plan increases adherence and improves outcome. A search was carried out on the Cochrane Airways Group trials register. There was no language restriction. The search of the databases used the following terms: action plan OR self OR self-care OR self-manag* OR educ* AND adher* OR comply OR compli*. Authors of included studies were contacted for any unpublished or on-going studies and bibliographies of all included studies and reviews were searched for further studies. Only randomised controlled trials (RCTs) in patients with asthma were considered. Participants must have been assigned to receive an individualised written asthma management plan (symptom or peak flow based) about the actions required for regular asthma management and/or the actions to take in the event of an asthma exacerbation. Study quality was assessed and data abstracted by two reviewers independently. Six trials met the inclusion criteria. The written management plans were either peak flow or symptom based, which were compared against each other or compared to no written management plan. Reported outcomes included: hospitalisation, emergency department visits, oral corticosteroid use, lung function, days lost from school/work, unscheduled doctor visits and respiratory tract infections. There was no consistent evidence that written plans produced better patient outcomes than no written plan. For some outcomes, there appeared to an advantage of one type of plan over the other, but there was no consistency - one type of plan was not consistently more effective than another. The available trials are too small and the results too inconsistent to form any firm conclusions as to the contribution of written self management plans in the known beneficial effects of a comprehensive asthma care programmes.

Research paper thumbnail of Rhinoviruses significantly affect day-to-day respiratory symptoms of children with asthma

Journal of Allergy and Clinical Immunology, 2014

Viruses are frequently associated with acute exacerbations of asthma, but the extent to which the... more Viruses are frequently associated with acute exacerbations of asthma, but the extent to which they contribute to the level of day-to-day symptom control is less clear. We sought to explore the relationship between viral infections, host and environmental factors, and respiratory symptoms in children. Sixty-seven asthmatic children collected samples twice weekly for an average of 10 weeks. These included nasal wash fluid and exhaled breath for PCR-based detection of viral RNA, lung function measurements, and records of medication use and asthma and respiratory symptoms in the previous 3 days. Atopy, mite allergen exposure, and vitamin D levels were also measured. Mixed-model regression analyses were performed. Human rhinoviruses (hRVs) were detected in 25.5% of 1232 nasal samples and 11.5% of breath samples. Non-hRV viruses were detected in less than 3% of samples. hRV in nasal samples was associated with asthma symptoms (cough and phlegm: odds ratio = 2.0; 95% CI = 1.4-2.86, P = .0001; wheeze and chest tightness: odds ratio = 2.34, 95% CI = 1.55-3.52, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001) and with cold symptoms, as reported concurrently with sampling and 3 to 4 days later. No differences were found between the 3 hRV genotypes (hRV-A, hRV-B, and hRV-C) in symptom risk. A history of inhaled corticosteroid use, but not atopic status, mite allergen exposure, or vitamin D levels, modified the association between viruses and asthma symptoms. The detection of nasal hRV was associated with a significantly increased risk of day-to-day asthma symptoms in children. Host, virus genotype, and environmental factors each had only a small or no effect on the relationship of viral infections to asthma symptoms.

Research paper thumbnail of Paediatric Asthma Education And Communication In General Practice: What Do Doctors And Parents Say?

D39. PSYCHOSOCIAL DETERMINANTS OF LUNG HEALTH, 2010

Page 1. / Thematic Poster Session / Wednesday, May 19/8:15 AM-4:00 PM / D39 PSYCHOSOCIAL DETERMIN... more Page 1. / Thematic Poster Session / Wednesday, May 19/8:15 AM-4:00 PM / D39 PSYCHOSOCIAL DETERMINANTS OF LUNG HEALTH Area C, Hall G (First Level), Morial Convention Center Paediatric Asthma Education And ...

Research paper thumbnail of Translation Of Evidence-Based Asthma Interventions: Physician Asthma Care Education (PACE) Program In The United States And Australia

B15. CLINICAL OUTCOMES RESEARCH METHODOLOGY, 2012

Physician Asthma Care Education (PACE) is a programme developed in the USA to improve paediatric ... more Physician Asthma Care Education (PACE) is a programme developed in the USA to improve paediatric asthma outcomes. To examine translation of PACE to Australia. The RE-AIM framework was used to assess translation. Demographic characteristics and findings regarding clinical asthma outcomes from PACE randomised clinical trials in both countries were examined. Qualitative content analysis was used to examine fidelity to intervention components. Both iterations of PACE reached similar target audiences (general practice physicians and paediatric patients with asthma); however, in the USA, more children with persistent disease were enrolled. In both countries, participation comprised approximately 10% of eligible physicians and 25% of patients. In both countries, PACE deployed well-known local physicians and behavioural scientists as facilitators. Sponsorship of the programme was provided by professional associations and government agencies. Fidelity to essential programme elements was observed, but PACE Australia workshops included additional components. Similar outcomes included improvements in clinician confidence in developing short-term and long-term care plans, prescribing inhaled corticosteroids, and providing written management instructions to patients. No additional time was spent in the patient visit compared with controls. US PACE realised reductions in symptoms and healthcare use, results that could not be confirmed in Australia because of limitations in follow-up time and sample sizes. US PACE is maintained through a National Heart, Lung, and Blood Institute website. Development of maintenance strategies for PACE Australia is underway. Based on criteria of the RE-AIM framework, the US version of PACE has been successfully translated for use in Australia.

Research paper thumbnail of Continuing the debate about measuring asthma in population studies

Thorax, 2001

The reasons for measuring atopy and airway hyperresponsiveness (AHR) and the methods of validatin... more The reasons for measuring atopy and airway hyperresponsiveness (AHR) and the methods of validating measurements of asthma in population studies continue to be debated. The debate has centred around standards against which to validate asthma measurements but the absence of a "gold standard" makes the criterion validation of measurements difficult. Questionnaires will always be useful but cannot be validated against a doctor diagnosis because of self-selection and recall biases. In practice, measurements should be selected on the merits of what they measure rather than being regarded as validated or non-validated alternatives. The measurement of AHR is invaluable because it is reliable, not influenced by variations in symptom perception or diagnostic trends, and is closely related to the underlying mechanisms of asthma. The value of AHR lies in its high specificity (rate of true negatives) and low sensitivity (rate of false positives) against asthma symptoms which gives additional information about symptomatic subjects. Atopy is also a useful test and, in quantifying its association with asthma, we should not place any currency on ecological evidence. Atopy is a strong risk factor for asthma in the presence of regionally specific allergens and ecological analyses that ignore these eVects are diversionary rather than productive. For preventing asthma, we need to identify the group at greatest risk of developing it, measure the risk factors with precision, and develop interventions that are eVective in changing environmental exposures and homogenous outcomes. This is the only approach that has the potential to lead to significant public health benefits. (Thorax 2001;56:406-411)

Research paper thumbnail of The association of comorbid anxiety and depression with asthma-related quality of life and symptom perception in adults

Respirology, 2008

There are limited data on the association and interaction between anxiety and depression comorbid... more There are limited data on the association and interaction between anxiety and depression comorbidity and asthma-related quality of life (AQOL) and symptom perception. This study evaluated these associations in patients subsequent to an emergency department (ED) visit for asthma. This was a cross-sectional study of 110 (38 male) adult asthma patients (mean age 42 years), who had visited an ED in the previous 18 months. Participants completed the hospital anxiety and depression scale, measures of AQOL and the asthma symptom checklist. Depression symptoms independently showed a significant negative association with AQOL after controlling for depression/anxiety, age, gender, smoking status and ED visits in the previous 12 months (ED-12). Overall, anxiety and depression symptoms accounted for 28.3% of the variance in AQOL. Greater anxiety was associated with increased perception of asthma-specific panic-fear and hyperventilation symptoms during an asthma attack, irrespective of depression status. Categorical analyses of groups of patients, differentiated by psychometric properties on the hospital anxiety and depression scale (anxiety vs normal, anxiety and depression vs normal depression) confirmed most results. However, for the anxiety group there was a significant association with the AQOL domains of emotional functioning and response to environmental stimuli, after controlling for depression symptoms. The negative association of depression symptom scores with AQOL and of anxiety with increased panic-fear and hyperventilation symptoms suggests a potential role for interventions addressing this psychological comorbidity, in order to improve AQOL.

Research paper thumbnail of Asthma management and outcomes in Australia: A nation-wide telephone interview survey

Respirology, 2007

Asthma is a high-burden disease for which effective treatment is available. In Australia, there h... more Asthma is a high-burden disease for which effective treatment is available. In Australia, there has been a public health campaign directed at increasing the implementation of effective management with the aim of improving asthma outcomes. The aim of this study was to assess the burden of asthma and describe current asthma management in Australia. A computer-assisted telephone interview survey was conducted in 2003/04 among randomly selected participants. Current asthma was defined as self-reported asthma, confirmed by doctor, which was still present and/or associated with symptoms in the last 12 months. From 46,855 eligible telephone numbers dialled there were 14,271 (30.5%) responses to the screening questionnaire. Among 1734 respondents with current asthma, 1205 (69.5%) completed the detailed questionnaire. Among these, 24.2% of adults and 14.3% children had symptoms during the day or night on most days; 11.3% of adults and 6.0% of children avoided exercise because of asthma symptoms during exercise and 19.4% of adults and 29.7% of children had sought urgent medical care because of an exacerbation of asthma during the preceding year. Among adults with asthma, only 35.6% with daily symptoms and 41.4% with symptoms on most days were taking inhaled steroids. Only 31.1% of adults with daily symptoms had a written asthma action plan. Compared with similar international studies, this study revealed a lower prevalence of frequent asthma symptoms and a higher prevalence of use of inhaled steroids among people with asthma. However, there remains ample scope for improvement in management of patients with frequent symptoms.

Research paper thumbnail of Anxiety, panic and adult asthma: A cognitive-behavioral perspective

Respiratory Medicine, 2007

A review of previous research suggests increased probability of the prevalence of anxiety disorde... more A review of previous research suggests increased probability of the prevalence of anxiety disorders, and particularly panic disorder and panic attacks in patients with asthma, as compared to a normal population. Research also indicates significant levels of co-morbidity between asthma and anxiety as measured on dimensional scales of anxiety and panic. Clinical anxiety and panic manifestations affect symptom perception and asthma management through the effects of anxiety symptoms such as hyperventilation, and indirectly through self-management behavior and physician response. However, there is limited data on the impact of anxiety co-morbidity on asthma quality of life. Some studies indicate that individuals with co-morbid asthma and anxiety or panic report worse asthma quality of life both in general and in relation to their symptomatology, being limited in their daily activities, in response to environmental stimuli and in regard to feelings of emotional distress. Cognitive-behavioral therapy (CBT) is an effective and empirically supported treatment of choice for anxiety disorders and panic attacks. However, standard CBT protocols for anxiety and panic may need to be specifically targeted at improving asthma outcomes. Also, asthma research literature is lacking in randomized controlled trials applying CBT to patients with co-morbid asthma and clinical anxiety manifestations. Trials evaluating CBT interventions in individuals with clinical anxiety manifestations and asthma may provide evidence of these interventions as an effective adjunct to improve asthma management and control.