The aim of this study was to compare the self-reported health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF) with the HRQL of a large community sample, to assess the extent to which the HRQL of the children and adolescents with chronic illness changes over time, and to examine the consistency of changes in different HRQL domains. One hundred and twenty three young people aged 10–16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Children rated their HRQL using the Child Health Questionnaire (CHQ) and three disease-specific measures at baseline, 6, 12, 18 and 24 months post-baseline. In several areas, the HRQL of children with chronic illness was significantly worse than that of children in the community sample. Over the 2 years of the study, although children with asthma and diabetes did not report significant changes in CHQ scores rating their physical health, they reported significant improvements in scores rating the extent to which health problems interfered with physical and family activities. CHQ scores describing their physical health reported by children with CF declined significantly but there was no significant change in scores rating interference with physical and family activities.

Objectives: The present study aims to describe the use of health services by children with asthma, and examine disease-specific, parental and sociodemographic variables associated with different levels of health-service utilization. Methods: Parents of 135 children attending an emergency room (ER) completed questionnaires measuring the children's asthma symptoms, and sociodemographic and psychological variables. Parents were contacted monthly for 6 months to document the number of planned and unplanned visits to hospital and community health-care services for asthma. Results: At least one further unplanned visit to the ER was made by 37% of children, while 62% made at least one unplanned visit to a general practitioner (GP). Fifty-five per cent made planned review visits to a GP, 30% to paediatricians and 5% to hospital clinics. After controlling for the level of asthma symptoms, parental anxiety and parental perceptions of children's vulnerability were associated with unplanned GP visits (P=0.05 and P=0.01, respectively); a planned review visit and the child being admitted to hospital for the index attack were associated with unplanned ER visits (P=0.05 and P=0.004, respectively). Conclusions: Children with asthma more frequently attend GP services than hospital services for both planned and unplanned asthma management. Different variables predict the unplanned use of GP and ER services. Understanding these differences is imperative if children and families are to make the most effective use of health services.

This study examined the relationship between asthma management strategies used by parents and parental perception of children's vulnerability to illness. Home interviews were conducted with 101 parents of children previously hospitalized with asthma. The child vulnerability scale (CVS) was employed to assess parents' perception of their children's vulnerability to illness. The asthma severity index (ASI) was used to measure the frequency and intensity of asthma symptoms experienced by children in the preceding 12 months. Five markers of parental asthma management were assessed: (i) school absences; (ii) visits to the general practitioner (GP); (iii) visits to the emergency room (ER); (iv) hospitalizations; and (v) whether children are using a regular preventer. After controlling for the frequency and intensity of children's asthma symptoms, parents who perceived that their children were more vulnerable to medical illness were significantly more likely to keep their children home from school (P = 0.01), were more likely to take their children to the GP for acute asthma care (P = 0.02), and were more likely to be giving their children regular preventer medication (P = 0.02). In contrast, the use of tertiary pediatric care services was not significantly associated with parental perceptions of their children's vulnerability. The results suggest that parental attitudes and beliefs about the vulnerability of their children to illness were associated with greater use of GP services by parents and more frequent school absences for children. The use of hospital services by parents appeared to be more strongly associated with the actual level of children's asthma symptoms than their vulnerability to illness. Pediatr Pulmonol. 2000; 29:88–93. © 2000 Wiley-Liss, Inc.

BACKGROUNDAcute asthma attacks are frequent causes of attendance at hospital Emergency Departments (EDs) and a subgroup of these patients repeatedly present for such treatment.AIMSThis study sought to characterise patients who were repeat attenders at EDs, to assist the targetting of appropriate future interventions aimed at reducing avoidable presentation.METHODSA cross-sectional survey was undertaken of patients presenting with an asthma attack to the EDs of six teaching hospitals in Adelaide, South Australia between 14 May and 30 June 1994. Patients were interviewed within six weeks of their attendance about aspects of their asthma history, severity, medications, self-management, attitudes and environment. Repeat attenders, defined as two or more visits over the course of the preceding year, were compared with those who reportedly attended on one occasion only, using logistic regression analyses.RESULTSSixty-two per cent of 272 patients aged under 15 years and 40% of 165 patients aged 15 years or more reported having attended two or more times over the course of the preceding year. Among adults, the variables independently associated with repeat attendance principally related to asthma severity. Among children, repeat attendance was associated with parental attitudinal variables relating to appraisal of their child's asthma severity, management of asthma attacks and parental worry.CONCLUSIONSThe factors underlying repeated presentations at EDs differ between adults and children and interventions to minimise avoidable presentation will require different emphasis for these patient subgroups.

Study objectives: To develop a practical screening tool that could identify adult patients highly likely to attend a hospital emergency department (ED) in a 1-year period.Design: Retrospective case-control study of patients who did and did not attend a hospital ED for asthma in the past year.Setting: Adelaide, South Australia.Participants: One hundred sixty-five adults attending an ED for asthma were compared with 260 adults with asthma from a community survey who had not attended an ED in the previous par.Measurements and results: The following variables were independently related to ED attendance: having been woken from sleep by asthma in past month; having been admitted to hospital because of asthma in the past year; having seen more than one general practitioner for asthma in the last 12 months; a moderate or severe self-rating of asthma in the last month; and having taken oral steroid medication for asthma in past month. A risk screening questionnaire using the weighted responses to these five variables with a cutoff score of 30/100 demonstrated a sensitivity of 90% and specificity of 88%.Conclusions: These findings agree with those of previous studies that markers of asthma severity and discontinuity of care are risk factors for adverse asthma outcomes. Validation of the risk screening questionnaire is required in a prospective study.

Medical Journal of AustraliaVolume 162, Issue 8 p. 443-443 Letter Salmeterol xinafoate in children Colin F Robertson, Colin F Robertson Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorCraig Mellis, Craig Mellis Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorRima Staugas, Rima Staugas Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorAlan F Isles, Alan F Isles Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorLouis I Landau, Louis I Landau Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this author Colin F Robertson, Colin F Robertson Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorCraig Mellis, Craig Mellis Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorRima Staugas, Rima Staugas Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorAlan F Isles, Alan F Isles Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorLouis I Landau, Louis I Landau Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this author First published: 01 April 1995 https://doi.org/10.5694/j.1326-5377.1995.tb139988.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume162, Issue8April 1995Pages 443-443 RelatedInformation

Since asthma is the most common chronic illness in childhood, many of the problems associated with this condition will impact on the child's education. Because of widespread concerns regarding the management of asthma in schools, a subcommittee of the Thoracic Society of Australia and New Zealand, Asthma Special Interest Group, was convened to draw up national guidelines for school staff in order to provide optimal management of asthma in the school setting. We used current medial literature and the clinical experience of the authors who have dealt with children and adolescents suffering from asthma in the hospital, community and school environment. A number of issues had been identified, including: the availability of an asthma first aid kit; correct use of bronchodilator aerosols by puffer and spacer devices; and clear instructions as to when to notify parents and when to call an ambulance to the school.(ABSTRACT TRUNCATED AT 250 WORDS)

Journal of Paediatrics and Child HealthVolume 29, Issue 2 p. 101-103 Management of acute asthma R. L. HENRY, Corresponding Author R. L. HENRYAssoc. Prof. R. L. Henry, Department of Paediatrics, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, NSW 2310, Australia.Search for more papers by this authorC. F. ROBERTSON, C. F. ROBERTSONSearch for more papers by this authorI. ASHER, I. ASHERSearch for more papers by this authorD. M. COOPER, D. M. COOPERSearch for more papers by this authorP. COOPER, P. COOPERSearch for more papers by this authorK. P. DAWSON, K. P. DAWSONSearch for more papers by this authorP. FRANCIS, P. FRANCISSearch for more papers by this authorG. GEELHOED, G. GEELHOEDSearch for more papers by this authorJ. D. GILLIES, J. D. GILLIESSearch for more papers by this authorA. F. ISLES, A. F. ISLESSearch for more papers by this authorA. KEMP, A. KEMPSearch for more papers by this authorL. I. LANDAU, L. I. LANDAUSearch for more papers by this authorA. J. MARTIN, A. J. MARTINSearch for more papers by this authorB. MASTERS, B. MASTERSSearch for more papers by this authorC. M. MELLIS, C. M. MELLISSearch for more papers by this authorE. A. MITCHELL, E. A. MITCHELLSearch for more papers by this authorJ. MORTON, J. MORTONSearch for more papers by this authorA. OLINSKY, A. OLINSKYSearch for more papers by this authorP. D. PHELAN, P. D. PHELANSearch for more papers by this authorP. D. SLY, P. D. SLYSearch for more papers by this authorP. LE SOUEF, P. LE SOUEFSearch for more papers by this authorR. STAUGAS, R. STAUGASSearch for more papers by this authorP. P. VAN ASPEREN, P. P. VAN ASPERENSearch for more papers by this author R. L. HENRY, Corresponding Author R. L. HENRYAssoc. Prof. R. L. Henry, Department of Paediatrics, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, NSW 2310, Australia.Search for more papers by this authorC. F. ROBERTSON, C. F. ROBERTSONSearch for more papers by this authorI. ASHER, I. ASHERSearch for more papers by this authorD. M. COOPER, D. M. COOPERSearch for more papers by this authorP. COOPER, P. COOPERSearch for more papers by this authorK. P. DAWSON, K. P. DAWSONSearch for more papers by this authorP. FRANCIS, P. FRANCISSearch for more papers by this authorG. GEELHOED, G. GEELHOEDSearch for more papers by this authorJ. D. GILLIES, J. D. GILLIESSearch for more papers by this authorA. F. ISLES, A. F. ISLESSearch for more papers by this authorA. KEMP, A. KEMPSearch for more papers by this authorL. I. LANDAU, L. I. LANDAUSearch for more papers by this authorA. J. MARTIN, A. J. MARTINSearch for more papers by this authorB. MASTERS, B. MASTERSSearch for more papers by this authorC. M. MELLIS, C. M. MELLISSearch for more papers by this authorE. A. MITCHELL, E. A. MITCHELLSearch for more papers by this authorJ. MORTON, J. MORTONSearch for more papers by this authorA. OLINSKY, A. OLINSKYSearch for more papers by this authorP. D. PHELAN, P. D. PHELANSearch for more papers by this authorP. D. SLY, P. D. SLYSearch for more papers by this authorP. LE SOUEF, P. LE SOUEFSearch for more papers by this authorR. STAUGAS, R. STAUGASSearch for more papers by this authorP. P. VAN ASPEREN, P. P. VAN ASPERENSearch for more papers by this author First published: April 1993 https://doi.org/10.1111/j.1440-1754.1993.tb00459.xCitations: 21 Prepared by Australian and New Zealand respiratory paediatricians following a meeting in Perth, Western Australia in May 1991. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume29, Issue2April 1993Pages 101-103 RelatedInformation

ABSTRACT Abstract In June 1990 a meeting of Paediatric Respiratory Physicians was held near Adelaide. The guidelines for assessing and treating asthma as prepared by the Thoracic Society of Australia and New Zealand for the management of patients with asthma was considered. Although not explicitly stated, these guidelines were designed for adult asthmatics. There was complete agreement that a companion statement was needed to take into account differences between the management of children and adults. This document fulfils that role. Further recommendations are found in a statement prepared by Australian and New Zealand respiratory paediatricians following a workshop in June 1989. This present statement should be read in association with the previous documents. 1,2

Journal of Paediatrics and Child HealthVolume 26, Issue 2 p. 72-74 Childhood asthma: Application of the international view of management in Australia and New Zealand* R. HENRY, Corresponding Author R. HENRYDepartment of Paediatrics, University of Newcastle, Mater Misericordiae Hospital, Waratah, NSW 2298, Australia.Search for more papers by this authorL. LANDAU, L. LANDAUSearch for more papers by this authorC. MELLIS, C. MELLISSearch for more papers by this authorP. VAN ASPEREN, P. VAN ASPERENSearch for more papers by this authorJ. MORTON, J. MORTONSearch for more papers by this authorP. COOPER, P. COOPERSearch for more papers by this authorD. COOPER, D. COOPERSearch for more papers by this authorA. KEMP, A. KEMPSearch for more papers by this authorC. ROBERTSON, C. ROBERTSONSearch for more papers by this authorP. PHELAN, P. PHELANSearch for more papers by this authorP. SLY, P. SLYSearch for more papers by this authorR. STAUGAS, R. STAUGASSearch for more papers by this authorJ. MARTIN, J. MARTINSearch for more papers by this authorA. ISLES, A. ISLESSearch for more papers by this authorB. MASTERS, B. MASTERSSearch for more papers by this authorP. LeSOUEF, P. LeSOUEFSearch for more papers by this authorJ. HOBDAY, J. HOBDAYSearch for more papers by this authorE. MITCHELL, E. MITCHELLSearch for more papers by this authorI. ASHER, I. ASHERSearch for more papers by this authorK. DAWSON, K. DAWSONSearch for more papers by this author R. HENRY, Corresponding Author R. HENRYDepartment of Paediatrics, University of Newcastle, Mater Misericordiae Hospital, Waratah, NSW 2298, Australia.Search for more papers by this authorL. LANDAU, L. LANDAUSearch for more papers by this authorC. MELLIS, C. MELLISSearch for more papers by this authorP. VAN ASPEREN, P. VAN ASPERENSearch for more papers by this authorJ. MORTON, J. MORTONSearch for more papers by this authorP. COOPER, P. COOPERSearch for more papers by this authorD. COOPER, D. COOPERSearch for more papers by this authorA. KEMP, A. KEMPSearch for more papers by this authorC. ROBERTSON, C. ROBERTSONSearch for more papers by this authorP. PHELAN, P. PHELANSearch for more papers by this authorP. SLY, P. SLYSearch for more papers by this authorR. STAUGAS, R. STAUGASSearch for more papers by this authorJ. MARTIN, J. MARTINSearch for more papers by this authorA. ISLES, A. ISLESSearch for more papers by this authorB. MASTERS, B. MASTERSSearch for more papers by this authorP. LeSOUEF, P. LeSOUEFSearch for more papers by this authorJ. HOBDAY, J. HOBDAYSearch for more papers by this authorE. MITCHELL, E. MITCHELLSearch for more papers by this authorI. ASHER, I. ASHERSearch for more papers by this authorK. DAWSON, K. DAWSONSearch for more papers by this author First published: April 1990 https://doi.org/10.1111/j.1440-1754.1990.tb02389.xCitations: 21 † *A statement prepared by Australian and New Zealand paediatric respiratory physicians following a workshop in the Hunter Valley, New South Wales, Australia in June 1989. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Reference 1 Warner J. O., Gotz M., Landau L. L., Levison H., Milner A. D., Pedersen S., Silverman M. Management of asthma: a consensus statement. Arch. Dis. Child. 1989; 64: 1065–79. 10.1136/adc.64.7.1065 CASPubMedWeb of Science®Google Scholar Citing Literature Volume26, Issue2April 1990Pages 72-74 ReferencesRelatedInformation

Tracheal aspirates from 46 children were examined for the presence of fat-filled macrophages. They had no history suggestive of gastro-oesophageal reflux. The number of positive results from this group (46%) was compared with the number of positive results (73%) in a group of 40 children with proven gastro-oesophageal reflux. The difference in proportion of positive results between the two groups was statistically significant (P less than 0.05). In addition, subgroups of subjects, negative for gastro-oesophageal reflux and lower respiratory tract disease, were compared with children who had both conditions. A slightly greater difference, although at a similar level of significance, was found. The fact that 42% of subjects without lower respiratory tract disease or gastro-oesophageal reflux had tracheal aspirates positive for fat-filled macrophages would, however, suggest that this test is of limited clinical value and may need better quantitation before it can be recommended for widespread clinical use.

Reports of important pulmonary complications, including bronchiectasis, have been reported after Mycoplasma pneumoniae infection.'-4Two reports56 have noted more subtle pulmonary function abnormalities, several years after mycoplasma infection, in children.Haemophilus influenzae has been implicated as a secon- dary invader following initial Mycoplasma pneumoniae infection in two reports."The complications so far recorded may therefore be manifestations of secondary infection.This report describes five children with proved Mycoplasma pneumoniae infection whose illness was pro- longed and in whom secondary bacterial infection was possible.Case reports