Assessing the Impact of Different Spirometric Equations on Asthma Severity and Control Among Children in Jordan: A Retrospective Study

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Impact of the COVID-19 pandemic in children with allergic asthma

Higher BMI is associated with worse asthma control and quality of life but not asthma severity

Advances in pediatric asthma in 2009: Gaining control of childhood asthma

Asthma is the most commonly encountered chronic disease in children. Periodic assessment of asthma severity and control is an integral part of asthma management, but patients with uncontrolled asthma don’t...

Objective: To evaluate the extent of documentation of asthma control and severity and associated characteristics among pediatric asthma patients in office-based settings. Methods: This cross-sectional study utilized data from the 2012–2015 National Ambulatory Medical Care Survey (NAMCS). Patients aged 6–17 years with a diagnosis of asthma were included. Weighted descriptive analysis examined the extent of documentation and uncontrolled asthma; while logistic regression evaluated associated characteristics. Results: Overall, there were 2.47 million (95% confidence interval, 95% CI: 2.04–2.90) average annual visits with asthma as a primary diagnosis. Asthma control and severity was documented in only 36.1% and 33.8% of the visits, respectively. An established patient (odds ratio, OR = 3.81), Hispanic ethnicity (OR = 2.10), chronic sinusitis (OR = 5.59), and visits in the Northeast (OR = 2.12) and Midwest (OR = 2.25) regions had higher odds of documented asthma control status, whereas undocumented asthma severity (OR = 0.02), and visits in spring (OR = 0.34), had lower odds. Osteopathic doctors (OR = 0.18), visits in the Northeast region (OR = 0.23), chronic sinusitis (OR = 0.08), and undocumented asthma control status (OR = 0.03) had lower odds of documented asthma severity, whereas visits in spring (OR = 3.88) and autumn (OR = 3.32) had higher odds. Moderate/severe persistent asthma (OR = 15.35) had higher odds of uncontrolled asthma (as compared to intermittent asthma), while visits in the summer (OR = 0.14) had lower odds. Conclusion: The findings of this study suggest a critical need to increase the documentation of asthma severity and control to improve quality of asthma care in children.

Background: Spirometry is the single most important test for the evaluation of respiratory function. The results are interpreted by comparing measured data with predicted values previously obtained from a reference population. Reference equations for spirometry have been discussed previously. The aim of this study was to compare reference values based on National Health and Nutrition Assessment Survey (NHANES III), European Community of Steel and Coal (ECSC), and Global Lung Initiative (GLI) equations in an elderly sample population. Methods: Subjects from the Geriatric Study on Health Effects of Air Quality in elder care centres who met the inclusion criteria were enrolled. Spirometry was performed according to international guidelines. The forced vital capacity, forced expiratory volume in 1 s, and FEV1/FVC ratio were reported as percentages of the predicted value, and the lower limit of normality was calculated. Results: Out of 260 elderly patients, 69.6% were women; the mean age was 83.0 ± 6.46 years with an age range of 65– 95 years. The lowest %FVC and %FEV1 values were obtained using the GLI reference equations. However, when NHANES III equations were used, the FEV1/FVC ratio was higher than ratios obtained from GLI and ECSC equations. The prevalence of airway obstruction was highest using ECSC equations, while GLI equations demonstrated more restrictive defects. Conclusions: The present study showed meaningful differences in the reference values, and consequently, in the results obtained using NHANES III, ECSC, and GLI reference equations. The spirometry interpretation was also influenced by the reference equations used.

Background:Severity of airflow obstruction in chronic obstructive pulmonary disease (COPD) is based on forced expiratory volume in one second expressed as percentage predicted (FEV1%predicted) derived from reference equations for spirometry results.Aims:To establish how switching to new spirometric reference equations would affect severity staging of airflow obstruction in the Dutch primary care COPD patient population.Methods:Spirometry tests of 3,370 adults aged ≥40 years with obstruction (postbronchodilator FEV1/forced vital capacity (FVC) <0.70) were analysed. The presence and severity of obstruction were defined using Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Postbronchodilator FEV1%predicted was calculated using three reference equations: corrected European Community of Steel and Coal (ECSC) (currently recommended in Dutch primary care), Swanney et al., and Global Lung Initiative (GLI). Discordances between severity classifications based on these equations were analysed.Results:We studied 1,297 (38.5%) females and 2,073 males. Application of contemporary reference equations (i.e. Swanney and GLI) changed the GOLD severity stages obtained with the ECSC equations, mostly into milder stages. Severity of airflow obstruction was staged differently in 14.0% and 6.3%, respectively, when the Swanney et al. and GLI reference equations were applied.Conclusions:Compared with the (corrected) ECSC equations, switching to more contemporary reference equations would result in lower FEV1 predicted values and affect interpretation of spirometry by reclassifying 6–14% of primary care COPD patients into different (mostly milder) severity stages. If and how this will affect GPs' treatment choices in individual patients with COPD requires further investigation.

Vitamin D has an immunomodulatory effect on innate and adaptive immunity within the body, which partially explains its links to inflammation-induced epithelial changes seen in asthma. Various evidence suggest a potential link between vitamin D deficiency and asthma control and severity. This study aimed to determine the vitamin D levels in asthmatic children and their association with asthma severity and control. A cross-sectional prospective study was conducted on 72 children with persistent asthma aged 5 to 18 years old in a tertiary hospital in Kelantan. Asthma severity was assessed using the Global Initiative for Asthma (GINA) guidelines based on treatment given. Asthma control was evaluated using both parent/patient self-administered Asthma Control Test (ACT) or Children's Asthma Control Test (c-ACT) scores accordingly to their age and asthma control GINA classification. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured, with <52 nmol/L defined as deficient and 52-73 nmol/L as insufficient. Of the 72 children with persistent asthma, 40.3% had vitamin D deficient and 38.9% had vitamin D insufficient with a mean 25(OH)D level of 58.74 nmol/L. Being female, older age group and higher body mass index (BMI) were associated with vitamin D deficiency (p =<0.05). Lower vitamin D levels were significantly associated with increased asthma severity (p =0.020). There was no significant association between vitamin D levels and asthma control based on GINA classification (p =0.470) and c-ACT/ACT scores (p =0.052). High prevalence of vitamin D deficient and insufficient was found among children with persistent asthma. Vitamin D deficiency was significantly associated with increased asthma severity. This group of children needs further evaluation for intervention. We recommend routine assessments of vitamin D levels among children with moderate to severe asthma.

Reasons for inadequate asthma control in children: an important contribution from the “French 6 Cities Study”

Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: A systematic review

The recent multi-ethnic global lung initiative 2012 (GLI2012) reference values don't reflect contemporary adult's North African spirometry

Purpose: Assessment of the severity and clinical course of asthma is important for effective disease control. Cognitive and physical impairments occur due to the aging process, which may impact on asthma control. We aimed to evaluate the impact of cognitive function on the assessment of asthma control in older asthmatics as a prospective interventional trial. Methods: A total of 50 mild to moderate asthmatics over 60 years of age were enrolled. Three questionnaires were used: the asthma control test (ACT), the asthma-specific quality of life, and the Korean version of the Short Form of the Geriatric Depression Scale. The Seoul neuropsychological screening battery-dementia version (SNSB-D), Korean version of the Mini-Mental Status Examination, and the Seoul instrumental activities of daily living scale were applied for neuropsychological assessment. Results: The mean patient age was 67.0±4.9 years, and 30 patients (60.0%) were female. The sensitivity and specificity of the ACT for determining well-controlled asthma were 91.7% and 39.5%, respectively. Regarding neuropsychological assessment, 22 patients (44%) had mild cognitive impairment, 4 (8.7%) had dementia, and 17 (34%) had depression. Total SNSB-D score was significantly higher in patients with an ACT score of ≥20 (P=0.015). The ACT scores were significantly associated with SNSB-D results in analyses adjusted for age, sex, education duration, lung function, and depression (P=0.004). Conclusion: We found significant positive correlations between cognitive functions, as measured by SNSB-D, and asthma control status, as measured by ACT scores, in older patients with asthma. Therefore, cognitive impairment may be associated with poor asthma control in older asthmatics. (Allergy Asthma Respir Dis 2017:5:34-40)

BackgroundSpirometry is the single most important test for the evaluation of respiratory function. The results are interpreted by comparing measured data with predicted values previously obtained from a reference population. Reference equations for spirometry have been discussed previously. The aim of this study was to compare reference values based on National Health and Nutrition Assessment Survey (NHANES III), European Community of Steel and Coal (ECSC), and Global Lung Initiative (GLI) equations in an elderly sample population.MethodsSubjects from the Geriatric Study on Health Effects of Air Quality in elder care centres who met the inclusion criteria were enrolled. Spirometry was performed according to international guidelines. The forced vital capacity, forced expiratory volume in 1 s, and FEV1/FVC ratio were reported as percentages of the predicted value, and the lower limit of normality was calculated.ResultsOut of 260 elderly patients, 69.6% were women; the mean age was 83.0 ± 6.46 years with an age range of 65–95 years. The lowest %FVC and %FEV1 values were obtained using the GLI reference equations. However, when NHANES III equations were used, the FEV1/FVC ratio was higher than ratios obtained from GLI and ECSC equations. The prevalence of airway obstruction was highest using ECSC equations, while GLI equations demonstrated more restrictive defects.ConclusionsThe present study showed meaningful differences in the reference values, and consequently, in the results obtained using NHANES III, ECSC, and GLI reference equations. The spirometry interpretation was also influenced by the reference equations used.

Use of the composite asthma severity index in a pediatric subspecialty clinic