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As the power source for vocalization, the lower respiratory tract plays a key role in voice production. This is particularly true with sustained singing, where continued high ventilatory demands are present. Changes in pulmonary function that are insignificant with normal speech have been shown to lead to performance impairment. The purpose of this study was to examine and characterize this problem in a large group of singers. Systematic evaluation of a defined population, along with inhalational and singing challenge, was the design. The demographic characteristics, history, pulmonary function, and response to treatment were evaluated in 20 professional or serious amateur singers with voice problems, who did not have causal laryngeal pathology, whose history and evaluation suggested increased airway reactivity, and who responded to anti-asthma therapy. An additional patient was challenged by the exercise of singing in the office, with pulmonary function measurements before and after. This group of serious singers demonstrated vocalization complaints referable to bronchodilator responsive airway obstruction. They responded to treatment for asthma, with improvement in their performance-related difficulties. An additional subject demonstrated a small decline in expiratory flow rates with only 20 minutes of singing in the office. This was readily reversed by an inhaled bronchodilator. Singers who present with complaints of impaired vocalization, such as vocal fatigue, decreased control, and excessive muscular tension, should be evaluated for increased airway reactivity as a possible cause of their complaints.
Allergy Asthma Proc
PMID:Airway reactivity induced reversible voice dysfunction in singers. 906 29

The objective of this study was to validate the Asthma Symptom Checklist (ASC) so that it could be reliably used to assess the subjective symptomatology of asthma attacks in our context. Subjective symptomatology of asthma was examined in a group of 100 adult Spanish outpatients (57 women, 43 men; 17-69 years of age) with asthma. All of them completed the modified version of the ASC as well as questionnaires of depression, anxiety, and self-management of asthma (self-efficacy expectancies and health care utilization). Data about duration and severity of asthma, as well as dyspnea and %FEV1, were also recorded. The highest reliability Cronbach alpha indexes were for the panic-fear and fatigue scales. The oblique rotation of the ASC revealed five correlated factors (53% of the total variance explained): 1) panic-fear, 2) airways obstruction, 3) airways obstruction and panic-fear, 4) fatigue and irritability, 5) hyperventilation. The structure of factors was revalidated using orthogonal (varimax) rotation. Construct validity was examined by Person product-moment coefficient correlations, ANOVAs (asthma severity x ASC scores), and t-tests (sex by ASC scores). Panic-fear showed the best construct validity, as it was related to the severity of the asthma and the use of high-cost health care resources. There were no differences in ASC scores either on the basis of the asthma severity or on the sex of patients. The ASC factors represent stable components of subjective symptomatology of asthma attacks, especially with regard to the panic-fear and the hyperventilation subscales; however, the structure of the checklist as a whole was not identical to those reported in other studies. Correlations of the ASC with clinical variables related to asthma severity support the construct validity of the instrument and confirm its utility to evaluate the subjective symptomatology of asthma attacks in outpatients.
J Asthma 1997
PMID:Subjective symptomatology of asthma: validation of the asthma symptom checklist in an outpatient Spanish population. 942 97

The Japan Asthma Death Investigation Committee sent questionnaires to hospitals with more than 100 beds, and studied the clinical characteristics of 313 reported cases who died of asthma between 1992 and 1994. Forty percent of them were at the age between 60 and 79. Deaths of young adults in the twenties tended to increase. One third of the deaths was due to asphyxia. More than half of the patients were classified infectious or mixed type of asthma and 43.9% were graded as severe asthma. The main causes of the fatal asthma attacks were respiratory infections, fatigue and stress. Insufficient education, low compliance, delay in treatment with corticosteroids and other drugs, delay in emergency treatment, past histories of life-threatening attacks and hospitalization due to severe attacks were suggested to be risk factors of adult asthma death. Pulmonary emphysema showed relatively high frequency as a complication.
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PMID:[Trends of asthma death among adults in Japan 1992-1994. Analysis of 313 cases reported questionnaires sent to hospitals with more than 100 beds]. 952 64

Rhinitis is a significant cause of widespread morbidity, medical treatment costs, reduced work productivity and lost school days. Although sometimes mistakenly viewed as a trivial disease, symptoms of allergic and non-allergic rhinitis may significantly impact a patient's quality of life, by causing fatigue, headache, cognitive impairment and other systemic symptoms. In addition, many antihistamines commonly used for treatment can themselves cause performance impairment that may contribute to fatal automobile accidents, work place accidents, decreased work productivity and in children, impaired school performance. Appropriate management of rhinitis may be an important component in effective management of coexisting or complicating respiratory conditions, such as asthma, sinusitis, or chronic otitis media. Rhinitis may be caused by allergic, non-allergic, infectious, hormonal, occupational, and other factors. Defining the causes of rhinitis in an individual is important because different rhinitis syndromes may require different therapeutic approaches for optimal management, an important consideration as more treatment options become available. This Executive Summary reviews key points about diagnosis and management of rhinitis contained in the comprehensive document, Diagnosis and Management of Rhinitis: Complete Guidelines of Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology, and Joint Task Force Algorithm and Annotations for Diagnosis and Management of Rhinitis. These documents represent a consensus opinion of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology, a national panel co-sponsored by the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council on Allergy, Asthma and Immunology.
Ann Allergy Asthma Immunol 1998 Nov
PMID:Executive Summary of Joint Task Force Practice Parameters on Diagnosis and Management of Rhinitis. 986 24

With unfortunate high frequency, clinicians consider allergic rhinitis to be more of a nuisance than an illness. When in fact, allergic rhinitis is not only a very common disease process, affecting up to a cumulative frequency of 42% of the U.S. population by age 40, but can lead to significant short-term and long-term medical complications. Poorly controlled symptoms of allergic rhinitis may contribute to sleep loss, secondary daytime fatigue, learning impairment, decreased overall cognitive functioning, decreased long-term productivity and decreased quality of life. Additionally, poorly controlled allergic rhinitis may also contribute to the development of other related disease processes including acute and chronic sinusitis, recurrence of nasal polyps, otitis media/otitis media with effusion, hearing impairment, abnormal craniofacial development, sleep apnea and related complications, aggravation of underlying asthma, and increased propensity to develop asthma. Treatment of allergic rhinitis with sedating antihistamine therapy may result in negative neuropsychiatric effects that contribute to some of these complications. Sedating antihistamines may also be dangerous to use in certain other settings such as driving or operating potentially dangerous machinery. In contrast nonsedating antihistamines have been demonstrated to result in improved performance in allergic rhinitis.
Allergy Asthma Proc
PMID:Complications of allergic rhinitis. 1047 18

To clarify recent trends in adult asthma mortality, the Asthma Death Investigation Committee of Japan studied the clinical characteristics of 295 patients who died of asthma between 1995 and 1997. Males were slightly more than females among the death cases. Approximately half of the patients ranged in age from 60 to 79 years. Tendency to increase of death among young male adults continued. One third of the patient deaths involved the asphyxic type, while status asthmaticus was the cause death in 21.9%. Half of the asthmatics died in hospitals or emergency rooms, and places where the fatal attacks occurred were mainly patients' houses. The main cause fatal asthma attacks was respiratory infection, followed by fatigue, stress, and discontinuation of medication. Most of the patients were classified moderate or severe type of asthma 1 month before death. Histories of life-threatening attacks and hospitalization due to severe attacks, irregular visits to the hospital, low compliance, and insufficiency of corticosteroid treatment were suggested as the main risk factors in adult asthma deaths.
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PMID:[Asthma death among adults in Japan 1995-1997. Analysis of 295 cases reported questionnaires sent to hospitals with more than 100 beds. Asthma Death Investigation Committee]. 1091 89

The aim of this study was to compare the degree of inflammation present in acute sinusitis, allergic rhinitis, chronic Fatigue Syndrome (CFS), and non-CFS control subjects by measuring cytokine concentrations in nasal lavage fluids. The concentrations of total protein (TP; Lowry assay), nerve growth factor (NGF), tumor necrosis factor (TNF) alpha, and interleukin (IL)-8 were measured by ELISA in nasal lavage fluids from acute sinusitis (n = 13), active allergic rhinitis (n = 16), CFS (n = 95), and non-CFS (n = 89) subjects. CFS and non-CFS groups were subdivided further using allergy skin test and rhinitis score results. Acute sinusitis subjects had significantly higher TP (p = 0.011, ANOVA), TNF-alpha (p = 0.00071), and IL-8 (p = 0.0000027) concentrations and IL-8/TP ratios (p = 0.0030) than the other three patient groups. There were no differences based on skin test or rhinitis score severity within either the CFS or non-CFS groups. The mucopurulent discharge of acute sinusitis contained significantly higher TNF-alpha and IL-8. Neutrophils were a likely source for these cytokines. There were no differences between CFS and non-CFS subjects, making it unlikely that the rhinitis of CFS has an inflammatory component.
Allergy Asthma Proc
PMID:Cytokines in nasal lavage fluids from acute sinusitis, allergic rhinitis, and chronic fatigue syndrome subjects. 1212 6

A relationship between distance from major roads and the prevalence of allergic disorders and general symptoms among junior high school students was assessed, separating the effects of distance of residence and school from the roads. Study subjects were 5,652 students aged 12 to 15 years. This study used diagnostic criteria from the International Study of Asthma and Allergies in Childhood. The questionnaire also asked about symptoms of headache, stomachache, tiredness, and cough and the shortest distance from residence to major roads. Distance from school to the nearest major road was measured on a map. Adjustment was made for gender, grade, the number of older siblings, smoking in the household, and maternal history of allergy. A shorter distance between residence and major roads was associated with an increased prevalence of headache, stomachache, tiredness, and cough. There was a marginally significant positive association between residence facing major roads and the prevalence of allergic rhinoconjunctivitis. Residence within 100 m of major roads showed a tendency for a positive relationship with the prevalence of wheeze and atopic dermatitis. There was no apparent relationship between distance of school from major roads and allergic disorders or the general symptoms. The findings suggest that proximity of residence, not school, to major roads may be associated with an increased prevalence of allergic disorders, headache, stomachache, and tiredness among Japanese adolescents. Further investigations with more precise and detailed exposure and health outcome measurements are needed to corroborate the relationship between traffic related factors and allergic disorders and general symptoms.
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PMID:Relationship between distance from major roads and adolescent health in Japan. 1246 76

An individualised asthma programme directed at behavioural change was evaluated in asthmatic subjects who reported complaints and impairment, despite adequate medical treatment. Mild-to-moderate asthma patients (n=23) were randomly assigned to a programme or waiting list condition. Outcome measures were: McMaster Asthma Quality of Life Questionnaire, Asthma Symptom Checklist, Negative Emotionality Scale, Knowledge, Attitude and Self-Efficacy Asthma Questionnaire, Adherence Scale, and peak flow measurements. Both groups were evaluated at three consecutive moments, each separated by 3 months; the programme was delivered between the first two evaluations. At onset the patient received a workbook containing information, exercises and homework assignments. Psycho-education, behavioural and cognitive techniques were introduced during six 1-h individual sessions. Compared with controls the programme group reported less symptoms (obstruction, fatigue), better quality of life (activity, symptoms, emotions), decreased negative affectivity, and increased adherence, immediately after finishing the programme and at 3 months follow-up. All three cognitive variables (knowledge, attitude towards asthma, self-efficacy) and day and night peak flow ratings improved in the programme group but not in the waiting list group. Participation in an individualised programme resulted in improvement of asthma morbidity, and asthma-related behaviour and cognitions, in subjects reporting symptoms and impairment despite adequate medical therapy.
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PMID:Evaluation of an individualised asthma programme directed at behavioural change. 1257 Jan 18

Recent data suggested that daytime somnolence in patients with allergic rhinitis was secondary to disrupted sleep caused by nasal congestion. Medications, which decreased congestion, would be expected to improve sleep and daytime somnolence. Previously, we showed that nasal steroids improved all three symptoms. Presently, we have not performed objective sleep testing to determine if there is a correlation between subjective improvement of congestion, sleep, and daytime somnolence. The objective of this 8-week, double-blind, placebo-controlled study was to determine if topical nasal fluticasone is effective at decreasing subjective congestion and daytime somnolence and improving sleep and if this improvement correlated with a change in overnight sleep testing (polysomnography). We recruited 32 subjects with perennial allergic rhinitis and randomized them in a double-blinded, cross-over fashion, to receive placebo or fluticasone (50 micrograms a spray), 2 sprays each side everyday, using Balaam's design. Questionnaires, quality of life instruments, daily diary, Epworth Sleepiness Scale, and an overnight sleep test with polysomnograms were used as tools. The last 2 weeks of each 4-week treatment period were summarized, scored, and compared by PROC MIXED in SAS. Correlations between arousals on sleep tests and subjective tests were performed. Fluticasone improved subjective sleep when compared with placebo (p = 0.04); however, there was no difference in the apnea/hypopnea index in those that were treated. Daytime sleepiness and fatigue were decreased by > 10% in the treated group; however, this was not statistically significant. However, fluticasone used at approved doses improves subjective sleep in patients with perennial allergic rhinitis without a change in the apnea/hypopnea index.
Allergy Asthma Proc
PMID:The effect of topical nasal fluticasone on objective sleep testing and the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis. 1263 78


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