Assessment Of Asthma Control Research Articles

Evaluation of Asthma Control Assessment in School-Age Asthmatic Children

Asthma is the most common chronic disease among children. Some 235 million people worldwide suffer from this non-communicable disease but effective medicines are available that can control it. Asthma is said to be under-estimated and under diagnosed in tropical countries including Sudan. Several tools are useful for detecting uncontrolled asthma in children; however, childhood asthma control test is a validated tool for assessing asthma control in pediatric asthma. A cross sectional study conducted over a period of six months (March 2016- September 2016) covering all school age asthmatic children attending the Asthma Clinic in Ahmed Gassim Children Specialized Hospital and Mohammed Elamin Hamid Pediatric Hospital during the period of study. The aim of this study is to assess asthma control in school age asthmatic children at Khartoum using childhood asthma control test (C- ACT) and peak flow meter (PEFR) and to detect associated factors with impaired asthma control. Result: A total of (84) asthmatics children most of them on prophylactic medications, according to ACT were found to be controlled 35 (41.7%), partially controlled 26 (22.2%) and uncontrolled 27 (32.1%). The main triggers as in other countries are infections, environmental factors and exercise. Conclusion: In this study, we realized that none of the children of study group underwent any PEFR measurement in their asthma follow up and none of them has been assessed with ACT before. There was a high percentage of partially controlled and uncontrolled asthma in the selected group.

Telehome Monitoring of Symptoms and Lung Function in Children with Asthma.

Background: The ability to perceive bronchial obstruction is variable in asthma. This is one of the main causes of inaccurate asthma control assessment, on which therapeutic strategies are based. Objective: Primary: To evaluate the ability of physicians to characterize the bronchial obstruction perception profile in asthmatic children using a clinical and spiro-metric telemonitoring device. Secondary: To evaluate its impact on asthma management (control, treatment, respiratory function variability) and the acceptability of this telemonitoring system. Methods: 26 asthmatic children aged 6–18 years equipped with a portable spirometer and a smartphone application were home-monitored remotely for 3 months. Clinical and spiro-metric data were automatically transmitted to a secure internet platform. By analyzing these data, three physicians blindly and independently classified the patients according to their perception profile. The impact of telemonitoring on the quantitative data was assessed at the beginning (T0) and end (T3 months) of telemonitoring, using matched statistical tests. Results: Patients could initially be classified according to their perception profile, with a concordance between the three observers of 64% (kappa coefficient: 0.55, 95%CI [0.39; 0.71]). After discussion among the observers, consensus was reached for all patients but one. There was a significant >40% decrease in FEV1 and PEF variability, with good acceptance of the device. Conclusions: Clinical and spiro-metric tele-home monitoring is applicable and can help define the perception profile of bronchial obstruction in asthmatic children. The device was generally well accepted.

Asthma Control and Medication Reliance Among Asthmatics in a General Practice Setting - A Questionnaire Based Study.

The main goal of asthma treatment is to obtain and maintain reasonable control of symptoms with current evidence-based protocols. Asthma is one of the chronic diseases, that, if not well controlled, can lead to the development of serious complications involving not only the respiratory, but the cardiovascular system. In this study, we aimed to determine how well intermittent asthma and mild persistent asthma are controlled among patients aged 15 years and above in a general practice setting using Asthma Control Test (ACT) questionnaire. Furthermore, we used a SABA Reliance Questionnaire (SRQ) to understand whether these patients rely heavily on their prescribed short-acting beta agonist (SABA) medication. This is an audit questionnaire-based study conducted in our primary health care setting in New Zealand from February to May 2021. Forty-three physician-diagnosed intermittent asthma and mild persistent asthma patients aged 15 years and above volunteered to take part in this study. They completed two questionnaires - the ACT to assess asthma control and the SRQ to assess patients’ reliance on SABA reliever inhalers. Overall, 43 patients responded; asthma was well-controlled in 23 patients (53.5%), partially controlled in 15 (34.9%), and uncontrolled in five (11.6%). The total of patients who showed a high reliance on SABA was 31 (72.1%). When comparing SABA reliance with asthma control, 23 (53.5%) patients reported well-controlled asthma; however, 13 (56.5%) of these patients showed a high reliance on SABA. Furthermore, 15 (34.9%) of the patients had partially controlled asthma, and 14 (93.3%) of them also relied highly on their SABA inhalers. We concluded that intermittent asthma and mild persistent asthma remains inadequately controlled in general practice, with the majority of patients showing a high reliance on SABA.

Association between asthma control and healthcare costs: Results from a German linked data study.

Background: This study aimed to evaluate differences in healthcare resource utilization and cost among patients with controlled and uncontrolled asthma.Methods: Claims data from a German sickness fund was linked to patient survey data. Outpatient physicians enrolled patients and assessed asthma control using the ACTTM questionnaire. All-cause and asthma-specific healthcare resource use (HCRU)/costs were compared descriptively and based on multivariable models using a continuous ACTTM score.Results: Overall, 492 asthma patients were included (mean age: 53.8, 73.8% female). The mean/median ACTTM score was 19.9/20.7, with 183 patients (37.2%) classified as having uncontrolled asthma (mean ACTTM score<20) Patients with uncontrolled asthma had significantly more hospitalizations (p = .035) and medication prescriptions (p < .001), which resulted in higher total healthcare costs for asthma-related (€1785 vs. €1615; p = .004) and all-cause care (€4695 vs. €4117; p = .009). While controlling for baseline characteristics, multivariable models confirmed a negative association between asthma control and total all-cause healthcare costs (p = .008), total asthma-related costs (p = .008), and costs of medication prescriptions (p = .001). However, no significant association was found for all-cause (p = .062) and asthma-related hospitalization costs (p = .576).Conclusion: Considering continuous patient care, improving asthma control is not only desirable from a clinical perspective, but could also be an effective approach to reduce asthma-related HCRU and cost burden.

Severe asthma treatment patterns: A multicenter observational study in the Gulf region

BackgroundWhile crucial to the assessment and improvement of asthma control, insights on treatment practices in patients with severe diseases across Gulf nations are lacking. This observational study describes the treatment patterns of adolescents and adults with severe asthma across four countries of the Gulf region and evaluates current levels of asthma control; quality of life (QoL); exacerbation frequency; and the application of cellular, protein, and respiratory biomarkers in assessing asthma severity and inflammation. MethodsPatients (aged >12 years, body weight ≥40 kg) with clinician-diagnosed, severe asthma (guided by the 2018 Global Initiative for Asthma definition) were included in this cross-sectional, multicenter, observational study conducted in the four Gulf countries of Kuwait, Oman, Qatar, and the United Arab Emirates. Data on demographics, treatment patterns, and laboratory parameters (blood eosinophil count [BEC], levels of serum immunoglobulin E [IgE], and fractional exhaled nitric oxide [FeNO]) were extracted from the medical records of patients during a 12-month retrospective period and transcribed onto case report forms. At the Enrollment visit, patients assessed their asthma control and QoL with the self-administered Asthma Control Questionnaire (ACQ) and a standardized version of the Asthma Quality of Life Questionnaire (AQLQ(S)), respectively. ResultsAmong the 243 patients analyzed, (mean [standard deviation (SD)] age, 48.4 [13.9] years; female, 67.5%), the inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) combination was the most prescribed asthma medication (n = 240; 98.8%). Most patients were classified as “uncontrolled,” (n = 173; 71.2%) and the majority (n = 206; 84.8%) experienced ≥1 exacerbation(s) in the preceding 12 months. The mean (SD) ACQ score was 2.1 (1.2), which indicated uncontrolled asthma, and the mean (SD) total AQLQ(S) score was 4.7 (1.4), suggesting “some limitation” in overall QoL. BECs during the 12-month period were elevated in most patients (>300 cells/μL [n = 183; 41.7%], 150–300 cells/μL [n = 138; 31.4%], <150 cells/μL [n = 118; 26.9%]), suggesting an eosinophilic asthma phenotype, although no standardized threshold by which to define eosinophilia has yet been confirmed. This study revealed that the biomarkers BEC, serum IgE, and FeNO concentrations were obtained inconsistently by the participating centers. ConclusionsDespite recommended ICS/LABA therapy being prescribed to most patients for their severe disease, the majority experienced uncontrolled asthma and exhibited elevated BECs. These findings indicate the need for enhanced treatment strategies to improve and sustain asthma control in the Gulf region.

Partnering to Improve Pediatric Asthma Quality.

Partnering to Improve Pediatric Asthma Quality.

Evaluating construct validity of the Asthma Impairment and Risk Questionnaire using a 3-month exacerbation recall

BackgroundRecurrent assessment of asthma control is essential to evaluating disease stability and intervention impacts. An assessment that can be administered between annual clinic visits is needed. The Asthma Impairment and Risk Questionnaire (AIRQ) is a cross-sectionally validated, 10-item, yes or no, composite control tool evaluating previous 2-week symptoms and previous 12-month exacerbations. ObjectiveTo evaluate the construct validity of the AIRQ using a 3-month recall period for exacerbation-based risk questions and retaining the 2-week recall for symptom-based impairment items. MethodsAt baseline, patients completed the AIRQ with 12-month recall exacerbation items, Asthma Control Test (ACT), St. George's Respiratory Questionnaire (SGRQ), and global self-assessments of asthma risk, control, and symptom severity. Patient-reported exacerbations were captured monthly. The AIRQ with 3-month recall exacerbation items, ACT, and global self-assessments was administered at months 3, 6, and 9, and SGRQ at month 6. ResultsA total of 1112 patients aged 12 years or older were enrolled (mean [SD] age, 43.9 [19.5] years). The AIRQ and each administration of the AIRQ with 3-month recall exacerbation items classified asthma control similarly to an ACT plus exacerbation validation standard. For both AIRQ versions, SGRQ scores were higher with worsening asthma control (P < .001). At months 3, 6, and 9, worse AIRQ control levels were associated with higher proportions of patients with 1 or more and 2 or more exacerbations in the previous 3 months and patient global self-assessments indicating greater asthma morbidity (all P < .001). ConclusionThe AIRQ using exacerbation risk items with a 3-month recall period exhibits construct validity for classifying current asthma control and can be administered between annual AIRQ assessments.

The Evaluation of Asthma Control and its Predictors in Patients Attending a Tertiary Clinic in Lagos, Nigeria.

There is a high rate of poorly controlled asthma in Nigeria. The determination of the level of asthma control and associated factors in asthma patients attending clinics is important to identify those patients at risk of exacerbations. The objective of this study is to evaluate the level of asthma control of patients attending respiratory clinic in Lagos using the Asthma Control Test (ACT) and pre-forced expiratory volume in first second (PREFEV1). This was a cross-sectional descriptive study. The ACT questionnaire and PREFEV1 were used to assess asthma control of patients attending a tertiary pulmonary clinic in Lagos. Two hundred patients were recruited over the period of one year between 2016 and 2017. The participants comprised of 96 (48.0%) females and 104 (52.0%) males with mean and standard deviation (SD) of 40.57± 15.86 years. The mean score with standard deviation of the ACT score was 18.64 +4.64. Half of the participants had good asthma control (>20) based on the ACT score. The mean pre FEV1 was 2.14 +0.93 for 200 participants and the post FEV1 of 189 was 2.25+ 0.91. Only76 (37.5%) participants had normal FEV1. About one third of the participants 60(30%) had obstructive ventilatory pattern, 9(5%) had restrictive ventilatory pattern, 73(37%) had mixed ventilator pattern and 58(29%) had normal ventilatory pattern. Allergic rhinitis was reported in 99 (49.5%) and likelihood of GERD in 63 (31.5%). There was a significant positive relationship between the ACT and FEV1 and a significant negative relationship between the GSAS score and ACT (p= <0.0001 and p= <0.0001 respectively). The level of asthma control using ACT questionnaire was average among asthma patients attending the clinic. However, the use of pre FEV1 which is an objective tool for assessing asthma control was significantly lower among these patients. The use of Lung function test should be employed in respiratory clinics for objective assessment of patients' asthma control in other to achieve the goals of asthma treatment.

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.

Spatial analysis of tobacco outlet density on secondhand smoke exposure and asthma health among children in Baltimore City

RationaleTobacco outlets are concentrated in low-income neighbourhoods; higher tobacco outlet density is associated with increased smoking prevalence. Secondhand smoke (SHS) exposure has significant detrimental effects on childhood asthma. We hypothesised...

Evaluating the Impact of Pharmacist Counselling for Asthmatic Children at Karbala Teaching Hospital for Children: An Interventional Prospective Study (Conference Paper )#

Asthma is one of the most common chronic, non-communicable diseases affecting children worldwide. The estimated prevalence of pediatric asthma in Iraq is 15.8%. Physiologic, inflammatory and structural factors contribute to the development of asthma. Assessment and monitoring of asthma control can be done by a validated children asthma control test (CACT). Management of asthma must address three components which are an appropriate management plan, the most appropriate medication if necessary, and the use of safe and effective medication. The management plan should consider patient counseling and education about the definition of asthma, signs, and symptoms, the pathophysiology of asthma, common triggers for asthma and how can avoid them, what are the rescue medication and the controller one, proper inhaler techniques, and how to monitor asthma control. Patient education accounts for 90% of success and this can be achieved by an active collaboration among health care providers. This is a prospective interventional study that aims at evaluating pharmacist counseling for asthmatic children. The study involved 105 participants whose consent was taken and underwent a face-to-face interview about asthma counseling and inhaler technique for those who use it. Ninety-two eligible participants remained. Their CACT was recorded at the first visit and then followed up weekly for one month either by phone or physical to assess asthma control. In the fourth week, a CACT was recorded and compared to the first one before intervention. There was a significant improvement in CACT after providing the counselling and weekly follow up.

Role of FEF25-75 in managing children with newly-diagnosed asthma in clinical practice.

BackgroundReversible bronchial obstruction characterizes asthma. Spirometry is the gold standard to assess airflow, and FEV1 is the most reliable parameter in this regard. However, many children with asthma have FEV1 within the normal range despite uncontrolled asthma and worsening. Therefore, FEF25-75 has been proposed as a valuable marker of early airflow impairment. This study aimed at investigating FEF25-75 in a cohort of children with newly diagnosed asthma.Methods381 children (122 females, mean age 11.6 years) were consecutively visited and had a new asthma diagnosis. In addition, Spirometry, type-2 phenotyping, asthma control assessment, and ACT were performed.Results72 (18.9%) asthmatic children had impaired FEF25-75, such as <65% of predicted. Low FEF25-75 was associated with lower FVC and FEV1/FVC values (OR 1.11 and 1.32, respectively). Children with normal FEV1 but impaired FEF25-75 had more frequently uncontrolled asthma (15.8% vs. 32.4%) than children with both parameters within the normal range.ConclusionsFEF25-75 deserves adequate and careful consideration in children with asthma, and the presence of impaired FEF25-75 values suggests a more compelling approach. (www.actabiomedica.it)

Neuropeptide Y and Asthma Clinical Course

Background: The spectrum of clinical manifestations and pathogenetic mechanisms of bronchial asthma (BA) is very wide. Given the complex pathogenesis and syndromic nature of BA, it is not surprising that there is no single universal biomarker. The objective of this study was to evaluate levels of neuropeptide Y (NPY) and its association with levels of leptin, adiponectin, oxidative damage, antioxidant status, spirometry parameters, and asthma control in BA patients. Methods and Results: Overall, 140 patients [35(25%) men and 105(75%) women; mean age of 57.0±9.34 years] with moderate asthma participated in the study. According to body mass index, all patients were divided into three groups. The asthma diagnosis was based on the integral assessment of symptoms, medical history, health status, and spirometry values according to the Global Strategy for Asthma Management and Prevention. (GINA, 2017 REPORT). The Asthma Control Test (АСТ) was used to assess asthma control. NPY was measured in blood serum in EIA. The NPY level was significantly higher in overweight patients and patients with obesity than in patients with normal body weight. The NPY level significantly correlated with leptin (r=0.44; P&lt;0.05), adiponectin (r=-0.24; P&lt;0.05), ImanOx (r=-0.40; P&lt;0.05), PerOx (r=0.58; P&lt;0.05), ACT (r=-0.41; P&lt;0.05), VC (r=-0.31; P&lt;0.05), FEV1 (r=-0.41; P&lt;0.05), FEF25% (r=-0.26; P&lt;0.05), FVC (r=-0.23; P&lt;0.05), Tiffno index (r=-0.36; P&lt;0.05), FEF50% (r=-0.22; P&lt;0.05), and PEF (r=-0.23; P&lt;0.05) Conclusion: The severity of the asthma clinical course is associated with different factors, including oxidative stress, levels of leptin, adiponectin and NPY. NPY seems to be associated with worse asthma control and higher levels of leptin and oxidative damage.

Paediatric Severe Asthma Biologics Service: From Hospital to Home

To assess whether biologics could be given safely at home in children with severe asthma, including measuring spirometry and quality of life.Children with severe asthma who had received omalizumab or mepolizumab and were willing to administer medication by supervised video calls in London, England, during the coronavirus disease 2019 pandemic from April to July 2020.In the study, children were identified who previously received at least 3 doses of biologics in the clinic or hospital setting safely with no reactions, were deemed suitable by a multidisciplinary team, and had no previous experience with home medication administration. Patients and their caretakers were trained for 1 to 2 hours, after which clinical nurse specialists virtually observed them during home medication administration. Patients and their families were given a home spirometer that measured forced expiratory volume in 1 second and forced vital capacity (FVC) to track asthma status. They were then managed every 2 to 4 weeks, with video calls to assist with medication dosing, assess asthma control, determine if oral corticosteroids (OCSs) were required or unscheduled health care visits, and determine general well-being the preceding 4 weeks.A total of 16 of 23 patients with a median age of 14.5 years (6 to 18 years) fulfilled the criteria for homecare and consented. A total of 14 adolescents independently completed home administration, and 2 required community nursing to administer the medication. Seven patients who did not participate in home administration served as the control group. Video calls with medication dosing were completed on 75 occasions. The drug was administered improperly on 2 of 75 occasions. Spirometry was used before each virtual appointment to assess asthma control. Patients and parents felt confident with video monitoring at the time of injection and felt relieved that they did not have to travel to the hospital for drug administration. Overall, patients felt monitoring devices were easy to use. Both Asthma Control Test and mini Pediatric Asthma Quality of Life Questionnaire scores improved within the first 3 months during home administration.Home administration of biologics with virtual monitoring is feasible and acceptable for patients and their families.Mepolizumab and omalizumab are available for home infusion for children ≥12. There is concern over which patients will be the “right” patient for this treatment method. Indeed, during the height of the coronavirus disease 2019 pandemic, home infusion options would have been beneficial. Although the number of patients with home infusions is small in this study, it does suggest a valuable combination of parameters to follow at home with a portable forced expiratory volume in 1 second meter and asthma control tests. Video supervision and telehealth is a practical option, ensures safety and support for families, and reinforces asthma medication adherence. Telehealth administration of biologics could reduce severe asthma attacks, increase patient satisfaction and convenience, and decrease the burden of coming to the hospital/clinic for the severe child with asthma.

Community Health Workers in Home Visits and Asthma Outcomes

The authors demonstrate that a Centers for Medicare and Medicaid Services (CMS) funded Community Asthma Initiative transition from a mixed nurse-community health worker model to a nurse supervised community health worker model could engender enhanced outcomes for hospitalizations and missed school and parent and/or guardian missed workdays.In the study, researchers included 389 patients were enrolled under the CMS grant from 2013–2015 at Boston Children’s Hospital and 733 Medicaid patients enrolled from 2005–2012 (comparison group).The 2 groups were compared at baseline, 6 months, and 12 months post enrollment for 5 asthma outcome measures: emergency department visits, hospitalizations, physical activity limitations, missed school days, and parent and/or guardian missed workdays. These measures were analyzed as dichotomous variables by using logistic regression, with the numbers of occurrences as continuous variables. A 13 question survey composed of activity and emotional health subscales was used to assess quality of life changes.The CMS group demonstrated more improvement in asthma outcomes, compared with the comparison group. They had a greater odds of decreased hospitalization (odds ratio: 3.13 [95% confidence interval: 1.49 to 6.59]), missed school days (odds ratio: 1.91 [95% confidence interval: 1.09 to 3.36]), and parent and/or guardian missed workdays (odds ratio: 2.72 [95% confidence interval: 1.15 to 6.41]). One year post enrollment, the CMS group experienced enhancement in all measured QoL parameters (all P values were <.01)The transition of the Community Asthma Initiative to a nurse supervised community health worker model for home visits resulted in positive impacts on asthma outcomes and quality of life.In the study, the authors highlight that home visits by nurse supervised community health workers can benefit pediatric asthma control and quality of life. The study is limited by fact that patient data were from 2 different time frames and the lack of spirometry testing to provide a more precise assessment of asthma control. The data supports that community engagement and home visits can be effective strategies to contain health care use and costs.

Development and equivalence of new faces for inclusion in the Childhood Asthma Control Test (C-ACT) response scale

BackgroundAccurate symptom monitoring is vital when managing pediatric asthma, providing an opportunity to improve control and relieve associated burden. The CHILDHOOD ASTHMA CONTROL TEST (C-ACT) has been validated for asthma control assessment in children; however, there are concerns that response option images used in the C-ACT are not culturally universal and could be misinterpreted. This cross-sectional, qualitative study developed and evaluated alternative response option images using interviews with children with asthma aged 4–11 years (and their parents/caregivers) in the United States, Spain, Poland, and Argentina. Interviews were conducted in two stages (with expert input) to evaluate the appropriateness, understanding and qualitative equivalence of the alternative images (both on paper and electronically). This included comparing the new images with the original C-ACT response scale, to provide context for equivalence results.ResultsAlternative response option images included scale A (simple faces), scale B (circles of decreasing size), and scale C (squares of decreasing quantity). In Stage 1, most children logically ranked images using scales A, B and C (66.7%, 79.0% and 70.6%, respectively). However, some children ranked the images in scales B (26.7%) and C (58.3%) in reverse order. Slightly more children could interpret the images within the context of their asthma in scale B (68.4%) than A (55.6%) and C (47.5%). Based on Stage 1 results, experts recommended scales A (with slight modifications) and B be investigated further. In Stage 2, similar proportions of children logically ranked the images used in modified scales A (69.7%) and B (75.7%). However, a majority of children ranked the images in scale B in the reverse order (60.0%). Slightly more children were able to interpret the images in the context of their asthma using scale B (57.6%) than modified scale A (48.5%). Children and parents/caregivers preferred modified scale A over scale B (78.8% and 90.9%, respectively). Compared with the original C-ACT, most children selected the same response option on items using both scales, supporting equivalency. Following review of Stage 2 results, all five experts agreed modified scale A was the optimal response scale.ConclusionsThis study developed alternative response option images for use in the C-ACT and provides qualitative evidence of the equivalency of these response options to the originals.

Differing perceptions of asthma control and treatment effectiveness by patients with severe asthma and treating subspecialists in the United States

Objective For patients with severe asthma (SA), overestimation of asthma control may lead to poorer outcomes. The objective of this study was to assess concurrent patient and specialist assessments of asthma control and treatment effectiveness among a large US cohort of SA patients. Methods CHRONICLE is an ongoing observational study of patients with SA treated by US subspecialists. Asthma control was assessed using the patient-completed Asthma Control Test™ (ACT™) and specialist clinical assessment of control. Treatment effectiveness was measured using the Global Evaluation of Treatment Effectiveness (GETE) completed by patients and specialists. Results 1109 patients who completed online surveys at enrollment were included. 14%, 28%, 25%, and 33% of patients had ACT™ scores of 5–9, 10–15, 16–19, and 20–25, respectively. Compared with 67% of patients with uncontrolled asthma by ACT™, 44% were uncontrolled by specialist assessment. 54% of patients who were uncontrolled according to the ACT™ were rated as controlled by specialists, demonstrating overestimation of asthma control. Based on ACT™ score, asthma control was more frequent among patients treated with biologics compared to other treatments. Using the GETE, 90% of patients reported treatment effectiveness compared with 71% of specialists. Patient and specialist treatment effectiveness categorizations agreed 73% of the time. Conclusion Specialists commonly overestimated asthma control relative to ACT™ scores. Patients reported treatment effectiveness more frequently than specialists. These findings emphasize the importance of validated instruments to assess asthma control and reduce potential treatment gaps associated with patient-specialist discordance. Clinical trial registration ClinicalTrials.gov Identifier: NCT03373045.

Effectiveness of inhaled corticosteroids and long-acting β-agonists combinations in real clinical practice: results of a multicenter cross-sectional study in Russian patients with asthma

Asthma management approaches are improving yearly, but the problem of asthma control is still acute. Combinations of inhaled glucocorticosteroids (ICS) and long-acting β2-agonists (LABA) play a crucial role in asthma therapy, but their effectiveness in real practice can be insufficient, and asthma control level in the population remains low. Optimizing the use of these drugs, changing the usual therapy regimens, and implementing upgraded inhalers can improve adherence to treatment and inhalation technique, which affects the effectiveness of the therapy.The study aimed to describe the key characteristics of the patient population getting asthma treatment in real clinical practice and assess factors influencing asthma control, including adherence to therapy.Methods. A single-stage cross-sectional observational study in 124 primary health care centers in 22 cities of the Russian Federation included 3,214 patients &gt; 18 years old, with a clinical diagnosis of asthma for at least 1 year, who were able to perform a spirometry test and fill out the ACQ-5 and TAI-12 questionnaires.Results. Assessment of asthma control with the ACQ-5 questionnaire showed that most patients had uncontrolled asthma (56%). Controlled and partially controlled asthma was diagnosed in 21 and 19% of patients, respectively. 4% of patients had severe uncontrolled asthma. The TAI questionnaire revealed low adherence to therapy in more than half of the patients (53.6%). The rate of patients with controlled asthma and the average annual frequency of exacerbations were significantly lower in subgroups of patients who received therapy with extrafine ICS/LABA and ICS/formoterol in single inhaler regimen, compared with controller therapy using fixed and free combinations of ICS and LABA.Conclusion. The main causes of insufficient asthma control are low adherence to treatment, inhalation errors, monotherapy with ICS, asthma with small airways dysfunction, and adverse events associated with ICS. Prescribing the combinations of ICS/LABA in the form of extra-fine aerosol and using it in the Maintenance and Reliever Therapy (MART) regimen can significantly increase asthma control, reduce the risk of adverse events, and increase patient adherence to treatment. A potential alternative to improve asthma control is administering ICS-LABA combinations once daily.

Assessment of asthma control and lung function in asthmatic children in Sokoto, North Western Nigeria

Objectives: This study aimed at assessing asthma control using Global Initiative for Asthma (GINA) asthma assessment, and determining its relationship with lung function parameters among asthmatic children in Usmanu Danfodiyo University Teaching hospital, Sokoto. Materials and Methods: This was a cross-sectional study among 60 children with asthma diagnosed based on GINA guidelines. It was conducted over a period of 4 months. The GINA asthma control assessment was administered to assess asthma control. Lung function was done using a portable spirometer. Results: Males accounted for 58.3% of the study population with M: F of 1.4:1 and median age of 9.47 years, with majority from urban domicile (91.7%). Well-controlled asthma accounted for 50.0% while 35.0% had partly controlled asthma and 15.0% had poorly controlled asthma. The median FEV1/FVC among the study participants was 0.856 (IQR: 0.170). There was no relationship between asthma control and LF parameters (FEV1: r = 0.044, P = 0.736, FVC: r = 0.010, P = 0.941, FEV1/FVC: r = 0.122, P = 0.352, and PEFR: r = 0.015, P = 0.911). Conclusion: Majority of the study participants had well-controlled asthma and no relationship was found between asthma control and lung function. Thus, serial monitoring of LF in addition to uniformly agreed standardized assessment of asthma control is required to objectively evaluate asthma control in children.

Cross-cultural validation of the Portuguese from Portugal version of the Test for Respiratory and Asthma Control in Kids (TRACK) questionnaire.

Introduction. The Test for Respiratory and Asthma Control in Kids (TRACK) is a tool to assess asthma control in preschool children. This study aims to validate the Portuguese from Portugal version of the TRACK questionnaire. Methods. A prospective cohort study was carried out to assess their psychometric characteristics. Caregivers of 141 children under age 5 with asthma symptoms were enrolled. Results. Internal reliability was close to 0.70 (Cronbach's α). The test-retest reliability was 0.87. TRACK scores were different between well, partially, and non-controlled asthma groups (p less than 0.001). Patients rated as having better control showed an increase in TRACK scores. Conclusions. The Portuguese version of the TRACK questionnaire is accurate and reliable for monitoring asthma control. Its use may help to overcome challenges with the management of this age group.