Emad A. Koshak

Do eosinophil counts correlate differently with asthma severity by symptoms versus peak flow rate

BACKGROUND Discrepancy in asthmatic assessment by symptoms and peak flow rate (PFR) is a frequent dilemma. Currently, total peripheral eosinophil count (TPEC) is under study for asthma evaluation. OBJECTIVES To explore the correlation between TPEC and asthma severity assessed by symptoms alone versus symptoms and PFR. METHOD Adults asthmatics were selected from the Asthma Clinic. Severity assessment was based on two methods: symptoms alone or symptoms and PFR. Expiratory PFR was recorded by a Wright peak flow meter. Severity levels included mild intermittent, mild persistent, moderate persistent, and severe persistent. Total peripheral eosinophil count was performed on a Celldyn-3500 counter. Data was analyzed for statistical significance. RESULTS Sixty asthmatics aged 15 to 70 years (mean = 34 years), of which 68.3% were female, were studied. Severity levels differed between the two assessment methods in 45% of the cases and showed a predominance of the moderate persistent type. Total peripheral eosinophil count ranged between 22 and 2470 cells/mm3 (mean = 520 +/- SD = 393) and eosinophilia was found in 50% of the cases. Total peripheral eosinophil count showed a high positive correlation with increased asthma severity level assessed by history alone (r = 0.460, P < .001); more than by history and PFR (r = 0.328, P < .05). CONCLUSION The discrepancy between symptoms and PFR is confirmed by these results. A reliable objective parameter in asthma assessment is a continuous challenge. This study advocates the possible supplementation of TPEC as another objective parameter that might help in selecting the appropriate severity level in asthmatics.

Asthma care: Structural foundations at primary health care at Al-Qassim region, Saudi Arabia

BACKGROUND: Proper structural foundations for asthma care at primary health care centers [PHCCs], are of essential importance, regarding its management. OBJECTIVE: To assess the adherence of PHCCs to the recommended structural foundation for asthma care. MATERIALS AND METHODS: 35 PHCCs were selected in a cluster random fashion. A questionnaire for structural standards was designed, based on the Saudi national protocol for the management of asthma (SNPMA). A physician and a nurse, each from PHCC, were trained for data collection. Structural facilities deficiency was arbitrarily classified into: least deficient (>75%), moderate to severe deficient (25-75%) and most deficient ( RESULTS: The total population registered, was 131190 [urban: 85701 (65.4%), rural: 45489 (34.6%)]. Total registered asthmatics was 4093 [urban: 2585 (63.1%), rural: 1508 (36.9%)]. The asthma prevalence rate did not differ significantly between urban (3%) and rural (3.3%) areas . Structural facilities distribution for asthma care, did not significantly vary among urban and rural PHCCs and none of them fulfilled 100% of the desired standards. The least deficient, were the availability of asthma register and salbutamol, in its various forms. The moderately to severely deficient were the SNPMA, peak flow meter (PFM), nebulizer system, Theophylline and systemic corticosteroid. However, they were most deficient in trained doctors and nurses, record charts for Peak flow meter, spacer, educational material and inhalers of corticosteroid or cromoglycate. CONCLUSION: Proper structural foundations for asthma care at PHCCs, at AL-Qassim region, were below the desired national standards. They were most deficient in trained doctors and nurses, record charts for PFM, spacers, educational material and anti-inflammatory inhalers. Future health directorate strategies have to provide such beneficial interventions for proper asthma care.

The Link between Uncontrolled Asthma and Sensitization to InhalantAllergens: Evidence from Jeddah, Saudi Arabia

Background: For optimal asthma control, current guidelines recommend the assessment of allergy phenotype. This study investigates the relationship between asthma control and sensitization to inhalant allergens. Methods: A cross-sectional study was conducted over a one year period since January 2011. Asthmatics were sequentially selected from allergy clinic at King Abdulaziz University Hospital in Jeddah. Evaluation of asthma control was based on GINA guideline. Assessment of the sensitization towards inhalant allergens was measured in-vivo by wheal size and number of positive reactions on the standard skin prick test (SPT). SPSS was used to analyse any statistical correlation. Results: A total of 110 asthmatics with a mean age of 34 ± 14 years were included, 63.6% being females. Asthma was predominantly uncontrolled in 68 cases (61.8%), partly controlled in 26 cases (23.6%) and controlled in 16 cases (14.5%). SPT to common inhalant allergens was positive in 76 asthmatics (77.6%); of which 54 (55.1%) were uncontrolled, 13 (13.3%) partly controlled and only 9 (9.2%) were controlled asthmatics. The predominant allergens were Dermatophagoides pteronyssinus in 57 cases (54.8%), Dermatophagoides farinae in 49 cases (47.1%), cat epithelia in 35 cases (33.7%) and cockroach in 23 cases (22.1%). Uncontrolled asthma was correlated significantly with positive SPT (p=0.038). Conclusions: More than half of the uncontrolled asthmatics population is sensitized to indoor inhalant allergens. This clinically favours the assessment of allergic status in any asthmatic, whose symptoms are not controlled. This is one of the early studies exploring the potential link between asthma control and sensitization to inhalant allergens.