Effect of an Education Programme for South Asians with Asthma and Their Clinicians: A Cluster Randomised Controlled Trial (OEDIPUS).

Background: People with asthma from ethnic minority groups experience significant morbidity. Culturally-specific interventions to reduce asthma morbidity are rare. We tested the hypothesis that a culturally-specific education programme, adapted from promising theory-based interventions developed in the USA, would reduce unscheduled care for South Asians with asthma in the UK.

Tuberculosis: a missed opportunity for early diagnosis at the front line?

Introduction: The incidence of tuberculosis (TB) has increased over the last two decades. Many patients with TB preferentially access healthcare via the emergency department (ED) prediagnosis, presenting an early opportunity for diagnosis.

Methods: We looked at the number of patients who presented to ED in the 3 months prior to TB notification, and their outcomes.

Ethnic variation in inflammatory profile in tuberculosis.

Distinct phylogenetic lineages of Mycobacterium tuberculosis (MTB) cause disease in patients of particular genetic ancestry, and elicit different patterns of cytokine and chemokine secretion when cultured with human macrophages in vitro. Circulating and antigen-stimulated concentrations of these inflammatory mediators might therefore be expected to vary significantly between tuberculosis patients of different ethnic origin. Studies to characterise such variation, and to determine whether it relates to host or bacillary factors, have not been conducted.

Vitamin D accelerates resolution of inflammatory responses during tuberculosis treatment.

Calcidiol, the major circulating metabolite of vitamin D, supports induction of pleiotropic antimicrobial responses in vitro. Vitamin D supplementation elevates circulating calcidiol concentrations, and thus has a potential role in the prevention and treatment of infection. The immunomodulatory effects of administering vitamin D to humans with an infectious disease have not previously been reported.

High-dose vitamin D(3) during intensive-phase antimicrobial treatment of pulmonary tuberculosis: a double-blind randomised controlled trial.

Background: Vitamin D was used to treat tuberculosis in the pre-antibiotic era, and its metabolites induce antimycobacterial immunity in vitro. Clinical trials investigating the effect of adjunctive vitamin D on sputum culture conversion are absent.

Methods: We undertook a multicentre randomised controlled trial of adjunctive vitamin D in adults with sputum smear-positive pulmonary tuberculosis in London, UK.

Influence of a single oral dose of vitamin D(2) on serum 25-hydroxyvitamin D concentrations in tuberculosis patients.

Setting: Newham Chest Clinic, London, UK.

Objective: To determine the safety and efficacy of the administration of bolus-dose vitamin D(2) in elevating serum 25-hydroxyvitamin D (25[OH]D) concentrations in tuberculosis (TB) patients.

Design: A multi-ethnic cohort of TB patients was randomised to receive a single oral dose of 2.

Neutrophil-mediated innate immune resistance to mycobacteria.

Neutrophils contain antimicrobial peptides with antituberculous activity, but their contribution to immune resistance to tuberculosis (TB) infection has not been previously investigated to our knowledge. We determined differential white cell counts in peripheral blood of 189 adults who had come into contact with patients diagnosed with active TB in London, United Kingdom, and evaluated them for evidence of TB infection and capacity to restrict mycobacterial growth in whole-blood assays. Risk of TB infection was inversely and independently associated with peripheral blood neutrophil count in contacts of patients diagnosed with pulmonary TB.

A single dose of vitamin D enhances immunity to mycobacteria.

Rationale: Vitamin D was used to treat tuberculosis (TB) in the preantibiotic era. Prospective studies to evaluate the effect of vitamin D supplementation on antimycobacterial immunity have not previously been performed.

Objectives: To determine the effect of vitamin D supplementation on antimycobacterial immunity and vitamin D status.

Delay in starting treatment for tuberculosis in east London.

In the United Kingdom there is little information about the delay between the onset of symptoms in patients with tuberculosis and the time it takes for them to be correctly diagnosed and treatment started. We have examined the duration and possible causes of such delay in our own district. The records of 93 patients were examined.

Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study.

Objective: To explore reasons for increased risk of hospital admission among south Asian patients with asthma.

Design: Qualitative interview study using modified critical incident technique and framework analysis.

Setting: Newham, east London, a deprived area with a large mixed south Asian population.

Factors influencing the distribution of tuberculosis cases in an inner London borough.

The incidence of tuberculosis (TB) has increased throughout London, especially in inner city boroughs. Ethnicity, poverty, and the success of TB control measures all affect the distribution of cases between boroughs. This study was conducted to see which factors affect the distribution of cases between electoral wards within an inner London borough.

Bone density in asthmatic patients taking inhaled corticosteroids: comparison of budesonide and beclomethasone dipropionate.

We assessed bone mineral density (BMD) in 20 asthmatics who had been taking inhaled budesonide (BUD) (median daily dose 800 micrograms) for over a year, 13 of whom had taken previous courses of systemic steroids. Their results were compared with those of 20 patients receiving inhaled high-dose beclomethasone dipropionate (BDP) (median daily dose 1,000 micrograms), all of whom had received previous courses of systemic corticosteroids, and with those of 17 mild asthmatics who had never taken either inhaled or systemic steroids. Mean (standard deviation) (SD)) BMD in the patients taking BUD was 139.

Oilseed rape and bronchial reactivity.

Objectives: To investigate atopy and changes in symptoms, peak flow rate, and bronchial reactivity in people complaining of symptoms during the oilseed rape flowering season.

Methods: 37 people who had given positive answers to questions about the presence of symptoms in relation to the flowering season of oilseed rape and 24 controls with no such symptoms were studied, although not all took part in all parts of the study. All had been previously identified in a cross sectional survey of a random sample of a rural population.

Rates of change in peak expiratory flow and in diurnal variation in peak flow in patients recovering from acute severe asthma.

1. The rates of change in mean peak expiratory flow and in diurnal variation in peak flow were compared in 14 patients recovering from acute severe asthma. 2.

Spontaneous sternal fractures in four patients with chronic airflow obstruction taking corticosteroids.

Four patients with chronic airflow obstruction developed spontaneous sternal fractures. All had received repeated courses of high dose corticosteroids and three were receiving long term treatment with low dose corticosteroids. It is important to consider sternal fracture in the differential diagnosis when patients with chronic airflow obstruction present with chest pain.

Bone density in asthmatic patients taking high dose inhaled beclomethasone dipropionate and intermittent systemic corticosteroids.

Background: Asthmatic patients taking low to moderate doses of inhaled topical corticosteroids have been shown to have lower bone density than those taking bronchodilators only. There is little information on bone density in asthmatic patients taking high dose inhaled corticosteroids.

Methods: Bone mass was studied in three age matched groups of asthmatic patients.

Changes in spirometry during consecutive admissions for infective pulmonary exacerbations in adolescent and adult cystic fibrosis.

Changes in spirometry during consecutive admissions for treatment of pulmonary infective exacerbations were studied in 45 patients (24 males, 21 females) with cystic fibrosis (CF) who had required five or more such admissions. Over the overall study period there was a mean (SD) decline in FEV1 of -112.1 (188.

Cardio-respiratory responses to exercise following treatment of acute severe asthma.

Asthmatic patients are encouraged to adopt a normal and active life-style. However, following treatment of acute severe asthma, patients may ask for advice about taking exercise. Serial measurements of the cardio-respiratory responses to continuous work load exercise, were made in asthmatic patients convalescing following hospital treatment of an acute exacerbation.