Advances In Management Of Asthma Research Articles

Examining Influenza Vaccination Patterns Among Young Adults with Asthma: Insights into Knowledge, Attitudes, and Practices.

Asthma is a major chronic disease of all ages, globally. Exacerbations are a significant problem for asthmatic patients. Despite advances in asthma management and efforts to identify asthma triggers, viral infections of the respiratory tract remain the most frequent triggers of asthma exacerbations. This study explored knowledge, attitudes, and practices (KAP) of asthmatic patients towards receiving the influenza vaccine. This cross-sectional study enrolled 397 adult asthmatic patients visiting the outpatient respiratory clinics of three Jordanian medical facilities. The research included 66.4% females, with a median age of 32 years. The results showed that 42.4% of enrolled asthmatics had never received the flu vaccine and only 51.1% reported that they intended to take the vaccine in the current year. Most of those who had been vaccinated at least once in their lifetime reported that the side effects were mild (61.8%). Variables that decreased refusal/hesitancy towards receiving the flu vaccine in the current year included having well-controlled asthma (RRR = 0.193, 95% Cl (0.053-0.698), p =0.012), and high knowledge about asthma and flu (RRR= 0.916, 95% Cl (0.847-0.990), p =0.028, respectively). A small number of the participants adhered to vaccinating against the flu which is due to lack of knowledge about the asthma, flu, and the vaccine. To address this challenge, we propose targeted health education campaigns, collaboration with healthcare providers, and utilization of digital platforms.

New approaches in childhood asthma treatment.

This review aims to summarize the most recent advances in asthma management, focusing on novel approaches to pediatric asthma. In recent years, the therapeutic tools for pediatric asthma have expanded significantly for both the nonsevere and severe forms. The use of anti-inflammatory treatment, even for the mildest cases, and the withdrawal of symptomatic bronchodilation as monotherapy have been included in the most recent guidelines. Also, different biological therapies have revolutionized the therapeutical approach for severe uncontrolled asthma in children and adolescents. With the expanding landscape of novel therapeutic approaches for pediatric asthma, further evidence is needed to help clinicians choose the best option for patients, particularly those with severe asthma. The identification of novel predictive biomarkers may also help pediatricians in selecting children and adolescents for innovative therapies.

Defining Treatment Response for Clinical Trials of Pediatric Acute Asthma

An agreed-upon definition of treatment response for clinical trials of pediatric acute asthma does not exist, limiting meaningful comparisons among therapeutic interventions and advances in asthma management. To develop a consensus definition of treatment response for clinical trials of pediatric acute asthma. A multidisciplinary panel of 22 experts participated in a Web-based modified Delphi process to achieve consensus on a definition of treatment response. Round 1 consisted of closed- and open-ended questions in which panelists ranked measures of treatment response developed by literature review, suggested additional measures, and explained their responses. In rounds 2 and 3, panelists reviewed summary statistics of the panel's rating from prior rounds and reconsidered their rankings. In round 3, pairwise ranking was performed to determine the ranked importance of components. Consensus was defined as 70% or greater agreement among panelists choosing Likert-scale values of 1 to 6 (extremely unimportant to extremely important) and an interquartile range less than2. Drawing on results from the expert panel, we developed a definition of treatment response that includes Clinical Severity Score, need for additional therapies, and hospitalization. Clinical Severity Score encompassed most ranked criteria (eg, respiratory distress, wheeze) for a treatment response definition. Panelists recommended that a valid and pragmatic severity score be used consistently across institutions. Panelists also achieved consensus on the top 10 criteria that appropriately classify need for hospitalization. This consensus definition of treatment response can be used in clinical trials of children with acute asthma to standardize outcome measurement and report meaningful outcomes.

Proposed Strategies to Improve Adult Asthma Management in Egypt: Expert Review and Recommendations.

Several challenges face asthma management in Egypt, including the high percentage of uncontrolled patients, inadequate compliance, and overuse of short-acting beta-agonists (SABAs) leading to increased asthma-related morbidity and mortality. In this regard, the recent Global Initiative for Asthma (GINA) recommendations included inhaled corticosteroids containing therapy for mild asthma. Local healthcare systems and healthcare professionals (HCPs) often experience practical challenges when implementing global guidelines. The present expert review aims to outline the development of local guidelines and health policies that integrate global advances in asthma management while addressing unmet needs and challenges in Egypt. A steering committee of health policymakers and respiratory experts from the principal healthcare sectors in Egypt came together in March 2021 to develop a consent and national guideline for local asthma management, codifying the current challenges and the required elements for adequate control. The recommendations were either evidence-based or consensus-based from the clinical expertise and perspectives of the committee. The committee identified vital challenges facing all chronic airway diseases with initial focus on asthma management in Egypt in diagnosis, data collection, policymaking, patients' awareness, and physicians' attitudes. In general, the committee stated that globally adapted management protocols necessitate addressing from diverse perspectives through policymakers, HCPs, and patients. Accordingly, it is vital to provide relevant education for the patient and HCPs. The recommendations emphasize key elements concerning baseline assessment, diagnosis, treatment strategy with regular review of patient progress, and compliance toward the introduced reforms. Full integration of these recommendations into local practice allows physicians to sustain adequate management while reducing preventable exacerbations and unnecessary burdens. The proposed strategies outline efficient patient-centered management that approaches asthma as an inflammatory condition, encouraging health promotion and patients' compliance.

Diagnosis and treatment of adult asthma patients in Serbia: a 2022 experts group position statement

ABSTRACT Introduction Asthma is the most common non-communicable chronic lung condition across all ages. Epidemiological data indicate that many asthma patients in Serbia remain undiagnosed and untreated. The implementation of recent global advances in asthma management is limited due to the lack of a systematic approach, drug availability and regulatory affairs. In addition, the global coronavirus disease pandemic has posed a significant challenge, particularly in resource-limited settings. Areas covered In this paper, we propose an algorithm for treating adult asthma patients in Serbia. We performed PubMed database search on published asthma clinical trials and guidelines from 1 January 2015 to 10 March 2020. The consensus process incorporated a modified Delphi method that included two rounds of e-mail questionnaires and three rounds of national asthma expert meetings. We focus on 1) objective diagnosis of asthma, 2) the implementation of up-to-date therapeutic options, and 3) the identification and referral of severe asthma patients to newly established severe asthma centers. Expert opinion Regional specificities and variations in healthcare systems require the adaptation of evidence-based knowledge. Practical, clinically oriented algorithms designed to overcome local barriers in healthcare delivery may facilitate timely and adequate asthma diagnosis and the local implementation of current advances in asthma management.

Recent Advances in Long-Term Management of Asthma.

Asthma is one of the most common chronic diseases of childhood with significant morbidity. Management of asthma has evolved from inhaled corticosteroids to personalized therapy in recent years. This article summarizes the recent advances in the management of asthma. The severity of asthma is assessed retrospectively by the level of treatment required to control asthma symptoms.Recently, there has been an emphasis on not to use short-acting beta-2 agonist (SABA) alone, even for intermittent or mild asthma. Single maintenance and reliever therapy (MART) is increasingly being recommended. Asthma therapy should be personalized based on phenotype (clinical presentations) and endotypes (distinct mechanistic pathways) of asthma and by a continuous cycle of assessment of asthma control and risk assessment, treatment, and reviewing the response in children on treatment. Various add-on therapy like tiotropium and biological monoclonal antibodies have been approved for use in a subset of children with severe asthma. Before considering biologicals, it is vital to have a proper diagnosis, good compliance and inhaler technique, and treatment of comorbidities.

Multi-Omics Profiling Approach to Asthma: An Evolving Paradigm.

Asthma is a complex multifactorial and heterogeneous respiratory disease. Although genetics is a strong risk factor of asthma, external and internal exposures and their interactions with genetic factors also play important roles in the pathophysiology of asthma. Over the past decades, the application of high-throughput omics approaches has emerged and been applied to the field of asthma research for screening biomarkers such as genes, transcript, proteins, and metabolites in an unbiased fashion. Leveraging large-scale studies representative of diverse population-based omics data and integrating with clinical data has led to better profiling of asthma risk. Yet, to date, no omic-driven endotypes have been translated into clinical practice and management of asthma. In this article, we provide an overview of the current status of omics studies of asthma, namely, genomics, transcriptomics, epigenomics, proteomics, exposomics, and metabolomics. The current development of the multi-omics integrations of asthma is also briefly discussed. Biomarker discovery following multi-omics profiling could be challenging but useful for better disease phenotyping and endotyping that can translate into advances in asthma management and clinical care, ultimately leading to successful precision medicine approaches.

Human Eosinophils Express a Distinct Gene Expression Program in Response to IL-3 Compared with Common β-Chain Cytokines IL-5 and GM-CSF.

Despite recent advances in asthma management with anti-IL-5 therapies, many patients have eosinophilic asthma that remains poorly controlled. IL-3 shares a common β subunit receptor with both IL-5 and GM-CSF but, through α-subunit-specific properties, uniquely influences eosinophil biology and may serve as a potential therapeutic target. We aimed to globally characterize the transcriptomic profiles of GM-CSF, IL-3, and IL-5 stimulation on human circulating eosinophils and identify differences in gene expression using advanced statistical modeling. Human eosinophils were isolated from the peripheral blood of healthy volunteers and stimulated with either GM-CSF, IL-3, or IL-5 for 48 h. RNA was then extracted and bulk sequencing performed. DESeq analysis identified differentially expressed genes and weighted gene coexpression network analysis independently defined modules of genes that are highly coexpressed. GM-CSF, IL-3, and IL-5 commonly upregulated 252 genes and downregulated 553 genes, producing a proinflammatory and survival phenotype that was predominantly mediated through TWEAK signaling. IL-3 stimulation yielded the most numbers of differentially expressed genes that were also highly coexpressed (n = 119). These genes were enriched in pathways involving JAK/STAT signaling. GM-CSF and IL-5 stimulation demonstrated redundancy in eosinophil gene expression. In conclusion, IL-3 produces a distinct eosinophil gene expression program among the β-chain receptor cytokines. IL-3-upregulated genes may provide a foundation for research into therapeutics for patients with eosinophilic asthma who do not respond to anti-IL-5 therapies.

Eligibility of monoclonal antibody-based therapy for patients with severe asthma: a Canadian cross-sectional perspective

BackgroundBased on immunologic phenotypes underlying asthma, use of monoclonal antibody based therapies is becoming the new standard of care for severe, corticosteroid refractory clinical symptoms. Patients may qualify for one or more of these targeted treatments, based on clinical characteristics and approved indications. However, the statistics are not well characterized, particularly in the Canadian population.MethodsThe objective of this observational study was to identify and describe the proportion of patients with severe asthma who were eligible for targeting IgE, IL-5, or both pathways of immunomodulation. We reviewed a cross-sectional cohort of patients in a Canadian Allergy and Immunology referral practice. We also compared demographic and clinical characteristics of each group.ResultsOf the 128 patients with severe asthma, 84 (66%) were eligible for omalizumab, 100 (78%) for mepolizumab, 52 (41%) for reslizumab, and 68 (53%) for benralizumab. Overlap in treatment eligibility varied; 68 (53%) patients were eligible for both omalizumab and mepolizumab, 47 (37%) were eligible for omalizumab and benralizumab, and 37 (29%) were eligible for all four medications. Patient demographics and clinical characteristics were similar, and levels of serum biomarkers varied based on locally approved prescribing criteria.ConclusionIn this severe asthma population from a Canadian Allergist’s practice, one-third of individuals qualified for all currently available biologics. 41–78% were eligible for at least one mAb. Patients were most likely to be eligible for mepolizumab. Objective assessments to determine asthma phenotype, along with further characterization of safety profiles will lead to further advances in asthma management.

Chinese herbal medicine formula for acute asthma: A multi-center, randomized, double-blind, proof-of-concept trial.

Despite advances in asthma management, exacerbations constitute a significant health economic burden. To observe the efficacy and safety of Chinese herbal medicine formula entitled PingchuanYiqi (PCYQ) granule, on acute asthma and to explore its possible mechanism. This proof-of-concept study consisted of a randomized, double-blind, placebo-controlled trial in patients with acute asthma (n = 300). Participants with acute mild-to-moderate asthma recruited from seven centers in China were randomly assigned to receive PCYQ or placebo. The primary outcomes were PEF (L/min) and total asthma symptom scores. Furthermore, a panel of cytokines including serum IL-4, IL-5, IL-6, IL-8, IL-1β, IL-17A, IFN-α, IFN-β, IFN-γ, CRP, CCL-5, IP-10, and PGD2 levels was detected using ELISA. The PCYQ (n = 139) significantly improved the morning PEF on day 4 (349.73 ± 93.92 vs. 313.56 ± 92.91 L/min, P = 0.004) and day 7 (360.42 ± 94.39 vs. 329.52 ± 95.97 L/min, P = 0.023), and the evening PEF on day 4 (352.65 ± 95.47 vs. 320.58 ± 95.30 L/min, P = 0.012) and day 7 (360.42 ± 94.39 vs. 336.86 ± 95.59 L/min, P = 0.029) in comparison with the placebo (n = 143). The PCYQ also improved the clinical symptoms scores and reduced the puffs of short-acting β2-agonist (all P < 0.05). Furthermore, the PCYQ statistically reduced IL-5, IL-8, IL-1β and PGD2 in serum. The PCYQ as the Chinese herbal medicine formula significantly improves lung function and symptoms of acute asthma, and reduces SABA dosage possibly via decrease of inflammatory biomarkers such as IL-5, IL-8, IL-1β and PGD2. ISRCTN61674768 (http://www.isrctn.com/).

Recent Advances in Asthma Management

The treatment of asthma has improved greatly during the last two decades, and deaths from the disease have decreased.1 Despite these advances, many asthma patients fail to achieve optimal asthma control as defined by international guidelines.2,3 Severe asthma is associated with high risk of exacerbations and death.4 Definitions of severe asthma vary but, according to European Respiratory Society (ERS)/American Thoracic Society (ATS) and Global Initiative for Asthma (GINA) guidelines, severe asthma is asthma that requires treatment with high doses of inhaled corticosteroids plus a second controller, and/or systemic corticosteroids, to prevent it from becoming uncontrolled, or remains uncontrolled despite this therapy.2,5 In an expert interview, Professor Barnes discusses the latest advances in the management of both mild and severe asthma.

Burden of bacterial exacerbation in bronchial asthma in Assiut University Hospitals, Egypt

BackgroundAsthma is one of the most common chronic respiratory diseases. Despite advances in asthma management, acute exacerbations continue to occur and impose considerable morbidity and mortality on patients and constitute a major burden on healthcare resources.ObjectiveThis study aimed to determine the associations between bacterial infections and adult asthma exacerbations, together with detection of antibiotic resistance patterns in clinical practice.Patients and methodsSputa were collected from 60 adult asthmatic patients recruited from both Internal Medicine Department and Chest Disease Department and their critical care units during exacerbation attacks. Patients underwent thorough clinical examination, laboratory investigations, and pulmonary function tests. Bacterial isolates were identified using the standard diagnostic methods. Susceptibilities of the isolated bacterial strains were determined using disk diffusion method.ResultsSignificant bacterial growth was detected in 47 (78%) patients. Single etiological agent was detected among 44 (73%) patients, whereas mixed infection was found in three (5%) patients. A total of 52 bacterial strains were isolated from our asthmatic patients. The predominant bacterial strains were as follows in decreasing order: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae, Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa. Gram-negative bacilli constituted 52% (27 isolates) of the total bacterial isolates during the exacerbation attacks. Non-multidrug-resistant bacteria were 15 (30%) in number, 22 (44%) bacterial isolates were multidrug resistant, six (12%) bacterial isolates were extensively drug resistant, and seven (14%) isolates were pandrug resistant.ConclusionAcute exacerbation of asthma was associated with infection in most patients. Gram-negative bacteria and S. pneumoniae form a relevant part of the microbial pattern of exacerbation of asthma. Antibiotic resistance among bacterial strains remains a challenge for the management of asthma exacerbations in clinical settings.

Asthma exacerbations: Origin, effect, and prevention

Asthma is the most common chronic respiratory disease, affecting up to 10% of adults and 30% of children in the Western world. Despite advances in asthma management, acute exacerbations continue to occur and impose considerable morbidity on patients and constitute a major burden on health care resources. Respiratory tract viruses have emerged as the most frequent triggers for exacerbations in both children and adults; however, the mechanisms underlying these remain poorly understood. More recently, it has become increasingly clear that interactions might exist between viruses and other triggers, increasing the likelihood of an exacerbation. In this article we begin with an overview of the health, economic, and social burden that exacerbations of asthma carry with them. This is followed by a review of the pathogenesis of asthma exacerbations, highlighting the various triggers responsible and multiple interactions that exist between them. The final section first addresses what preventative measures are currently available for asthma exacerbations and subsequently examines which of the new treatments in development might lessen the burden of exacerbations in the future.

Extended‐stay hospitalization for childhood asthma in Japan

While recent advances in asthma management have enabled adequate control to be frequently achieved in outpatient settings, children whose asthma remains poorly controlled despite outpatient treatment are often referred to extended-stay hospitals. The aim of the present study was to examine trends concerning extended-stay hospitalization and to evaluate the present status of this approach. A retrospective study was conducted to assess changes in the number of admissions among 408 children with extended stays at Kamiamakusa General Hospital between 1989 and 2005. Medical and laboratory data of 236 patients admitted since 1994 were obtained from clinical records. The number of children with extended-stay hospitalizations since 2000 declined dramatically compared with the early 1990s, while the percentage of patients with complications of childhood asthma, such as severe atopic dermatitis, school absenteeism, and obesity, have increased significantly in the recent past. Practical benefits of extended-stay hospitalization were demonstrated by significant improvement of exercise performance and measurement of pulmonary function parameters and serum IgE concentrations by time of discharge. In addition to improvement in asthmatic symptoms, maintenance drug requirements and frequency of school absenteeism were reduced. The medical mission of extended-stay hospitalizations is currently limited due to the availability of improved pharmacotherapy. Some patients, however, with exceptionally severe asthma or psychological problems that interact with their medical condition still fare poorly under outpatient care and could benefit from group care. Further study is needed to identify the components of long-term programs essential to produce change.

New treatments for chronic obstructive pulmonary disease and viable formulation/device options for inhalation therapy

Chronic obstructive pulmonary disease (COPD) is an increasingly important cause of morbidity and mortality, pathological features of which are pulmonary inflammation and irreversible airflow obstruction. Current therapies for COPD are aimed at improvement of clinical symptoms and reduction of inflammation in the respiratory systems. There is a pressing need for the development of new COPD medication, particularly as no existing treatment has been shown to reduce disease progression. In spite of a better understanding of the underlying disease process, there have been limited advances in the drug therapy of COPD, in contrast to the enormous advances in asthma management. Several new therapeutic targets and strategies have been proposed, and new drug candidates, including bronchodilators, protease inhibitors anti-inflammatory drugs and mediator antagonists, are now in clinical development for COPD treatment. New dry powder inhaler (DPI) systems for inhaled COPD therapy have also been developed to maximize drug concentrations in the airway systems, while minimizing systemic exposure and associated toxicity. This article aims to review recent developments in COPD drugs and the delivery systems for inhalation therapy, with particular emphasis on device options and formulations of DPI systems.

Targeting small airways in asthma: the new challenge of inhaled corticosteroid treatment

The small airways have long been considered to be important in asthma. The presence of inflammation in small airways has been well established in studies of post mortem tissue 1. Inflammation even extends to peribronchial tissues seen in transbronchial biopsy studies 2. In this issue of the European Respiratory Journal , the study by Cohen et al. 3 underscores the increasing interest in targeting treatment to the small airways with currently available fine-particle aerosols with median diameters of ∼1 μm. The study also highlights the as yet unproven potential of aerosol treatment in targeting the small airways and the complexities of such research. Cohen et al. 3 found that 5 weeks of ciclesonide treatment, a small-particle inhaled corticosteroid, improved alveolar exhaled nitric oxide, airway hyperresponsiveness and spirometry but not closing volume. They also found that the expiratory lung volume measured using high-resolution computed tomography (HRCT), after methacholine challenge, was smaller in the ciclesonide-treated group compared with the placebo group. However, the question as to whether ciclesonide is better than larger-particle aerosols for treating small airways in asthma remains unanswered. Establishing the clinical significance of small airways disease is a priority if advances in asthma management are to occur; however, this has been difficult because of the challenges in measurement. Assessment of small airways continues to be a complex undertaking and includes techniques such as transbronchial biopsy, gas washout tests 4, 5, frequency dependence of compliance, intrabronchial pressure measurements 6, forced oscillation technique (FOT) …

Inhaled Glucocorticosteroid and Long-Acting ??2-Adrenoceptor Agonist Single-Inhaler Combination for Both Maintenance and Rescue Therapy

Despite aggressive fixed-dose (FD) combination therapy with inhaled glucocorticosteroids (ICS) and long acting beta(2)-adrenoceptor agonists (LABA), many patients with asthma remain suboptimally controlled, based on the need for rescue therapy and rates of severe exacerbations. The strategy of adjustable maintenance dosing (AMD) involves adjustment of the maintenance dose, (using a single combination [budesonide/formoterol] inhaler, Symbicort((R))) in response to variability of asthma control over time. The AMD strategy, like the FD approach, involves the use of a short-acting beta(2)-adrenoceptor agonist (SABA) for rapid relief of bronchospasm. The dose-response characteristics of budesonide/formoterol make the AMD strategy a feasible option that cannot be exploited with the combination of salmeterol/fluticasone propionate (Advair((R))). Several studies suggest that the AMD strategy is superior to a FD approach in terms of overall asthma control.Budesonide/formoterol in a single inhaler is as effective as albuterol (salbutamol) for relief of acute asthma episodes, a feature that makes it possible to use this combination for both maintenance and reliever therapy without the need for the use of a SABA. The single-inhaler strategy has been shown to be safe and more efficacious than FD therapy. In particular, the COSMOS study has demonstrated that exacerbation burden is reduced more effectively when the combination (budesonide/formoterol) single inhaler is used for both maintenance and relief compared with FD therapy with salmeterol/fluticasone and albuterol for rescue in patients with moderate-to-severe asthma. These findings suggest that we will have to reconsider our definition of reliever therapy for patients that require long-term therapy with combination ICS and LABA.The concept of single-inhaler therapy represents a paradigm shift in asthma management that has been validated in several large studies involving thousands of patients. The single-inhaler strategy represents one of the most significant advances in asthma management in many years, and one that appears ideal for adoption in primary care.

All I need is the air that I breath: outdoor air quality and asthma.

In recent years, developing insight into the pathophysiology of asthma and advances in asthma management have been substantial. Despite these advancements, asthma remains a significant health problem in the paediatric population. In the USA, the prevalence of asthma in children under 18 years of age is estimated at 7% [US Environmental Health Protection Agency. Publication # EPA-100-r-018. Washington, DC, 2000]. Prevalence rates in various subpopulations, particularly African and Hispanic Americans, are much higher. Certain inner-city census tracts have estimated prevalence rates of 20 to 25% [ Crain EF Weiss KP, Stein REK. Pediatric 1994; 94: 356-362]. Many of these subpopulations experience alarmingly disparate and apparently increasing morbidity and mortality associated with asthma. Similar trends in prevalence and morbidity have been observed in urban populations outside the USA as well [Sears MR. Lancet 1997; 350: 1015-1020]. There is considerable controversy as to the scientific basis for these observed trends. While the identification of a single factor or even a closely related group of factors appears unlikely, there is considerable speculation about the role of environmental factors, particularly outdoor air quality. In the USA, the National Ambient Air Quality Standards (NAAQs) offer specific standards for air quality. These standards are applied to certain criteria pollutants, including ozone, particulate matter (both PM(10) and PM(2.5)), sulfur dioxide, nitrogen dioxide, lead and carbon monoxide [ Committee on Environmental Health, AAP. In: Handbook of Pediatric Environmental Health. Elk Grove Village, IL, 1999; 181-191]. The NAAQs were recently revised for both ozone and particulate matter based on data that suggested health risks existed at levels below those set forth in the previous standards. Monitoring data reveals that urban populations are more likely to be exposed to elevated levels of these pollutants [Dickey JH. Disease Monitor 2000; 46(9): 566-589]. Children are uniquely predisposed to the potential harmful effects of these pollutants. This predisposition is related to unique physiologic, anatomic and behavioural characteristics of the infant, child and adolescent. There is compelling evidence that an interplay of genetic predisposition and environmental exposure to a number of chemical and infectious agents may be operative in both the inception and persistence of the clinical asthma phenotype. The relative role of the criteria air pollutants in this interplay is the subject of considerable study. The potential value of intervention by regulatory agencies or by behavioural modification among individuals or communities should be explored. At the very least, the current data offers implications for situational strategies of asthma management based on local monitoring data.

Improving Patient Outcomes with Tools for Asthma Self-Monitoring

Despite recent advances in the therapeutic management of asthma, the prevalence, morbidity and mortality of this chronic disease continue to increase in most countries. The financial burden associated with asthma has received increasing scrutiny in the medical literature over the past two decades. In 1990, a study in the US demonstrated that all chronic disease conditions accounted for $US425 billion in medical care costs. These chronic conditions accounted for 96% of home care visits, 80% of hospital days, 69% of hospital admissions, 66% of doctor and 55% of emergency department visits, and 55% of pharmacy prescriptions. This has led to an increased demand for improved outpatient management of asthma, and patients are now monitoring their asthma and gathering data in the ambulatory setting. Self-monitoring tools for patients with diabetes mellitus and hypertension have grown in recent years, but technological advances for self-monitoring of patients with asthma have been slow over the past several decades.

State of the art: therapeutic controversies in severe acute asthma.

This is a transcript of the 1999 SAEM State-of-the-Art session on "Therapeutic Controversies in Severe Acute Asthma," presented at the 1999 SAEM annual meeting in Boston. The aim of this session was to address some of the current controversies in the management of acute asthma exacerbations, a major issue in emergency medicine. Despite many recent advances in asthma management, morbidity and mortality remain high. While many of us have strong feelings on how asthma patients should be treated, many of our assertions are not based on good science, and there are numerous areas of controversy. This discussion focuses on the controversy over beta agonist treatment for acute asthma, the physiology of corticosteroids in asthma, and the emergency use of leukotriene-modifying agents.