Asthma Control In Subjects Research Articles

Caregiver Perceptions of Change in Pediatric Asthma Control During the COVID-19 Pandemic.

Although several indicators suggest that pediatric asthma control in the United States improved early in the pandemic, other indicators suggest not. Missing are reports from caregivers of the experiences of their children with asthma early in the pandemic. Using the PP-ACT and other measures that we specifically constructed for our research, we conducted a cross-sectional national survey of US caregivers of children with asthma (N=595) to examine perceived change in their child's asthma control and changes in reports of ED visits and use of emergency relief medicine and controller medicine pre-pandemic (January to March 2020) versus early-pandemic (June to September 2020). Caregivers fell into three groups: most caregivers perceived that their child's asthma control was improved (50.3%) or unchanged (41.2%), and few reported worse control (8.5%). Surprisingly, all three groups of caregivers reported similar frequencies of early-pandemic and pre-pandemic ED visits and use of emergency relief medicine. Also surprising, caregivers who perceived their child's asthma as more controlled (compared with the other two groups) reported more frequent ED visits and use of emergency relief medicine, yet also more use of controller medicine at both early-pandemic and pre-pandemic. The mismatch between caregivers' perceptions of their child's early-pandemic asthma control and their reports of ED visits and use of emergency relief medicine suggests that caregivers may rely on a gist (a global evaluation that can include nonbiomedical evidence) when estimating their child's asthma control. Caregivers and their families could benefit from help from clinicians in understanding the discrepancy between subjective asthma control and asthma control indicators and in understanding what well-controlled asthma looks and feels like.

A comparative study evaluating C-reactive protein, sputum eosinophils and forced expiratory volume in one second in obese and nonobese asthmatics.

After completing the asthma control test (ACT), the CRP, FEV1 and sputum eosinophils of sixty asthmatics were compared to find the association of them in obese and nonobese asthmatics and contrasted with their ACT. The data were analysed using IBM SPSS V20.0, Mann-Whitney U test (non-parametric test), Pearson's correlation coefficient and Fisher's exact test. We found significant differences for CRP (P = 0.001) and sputum eosinophils (P = 0.001) between obese and nonobese asthmatics, both higher in obese asthmatics and with a significant association with body mass index (BMI) (P < 0.05). The FEV1 levels were independent of the BMI levels of asthmatics. There was a significant correlation between the CRP and sputum eosin-ophils (0.52, P = 0.001) for all asthmatics. There was no significant correlation between FEV1 and sputum eosinophils (nonobese P = 0.120, obese P = 0.388) and between FEV1 and CRP (obese P = 0.423, nonobese P = 0.358) in both obese and nonobese asthmatics. Obesity had an association (P = 0.001) with ACT scores (≤ 19). Sputum eosinophils and CRP were raised in obese asthmatics and had a positive association with BMI. Obese asthmatics had a poorer subjective asthma control than nonobese asthmatics despite FEV1 being independent of the BMI levels. Measuring the systemic inflammatory markers could help in additional interventions in reducing systemic inflammation and thus possibly facilitating better symptom control.

Exposure to Violence, Psychosocial Stress, and Asthma.

Over the last two decades, chronic psychosocial stress has been linked to asthma. Exposure to violence is a common stressor for people living in urban settings, particularly in the U.S, and has received increased attention in the asthma literature in recent years. Improving our understanding of whether and how exposure to chronic stressors causes or worsens asthma could help us gain insights into disease pathogenesis, design public health policies, and develop new therapies. In this review, we assess the evidence linking violence or stress to asthma, describe recent insights on potential mechanisms, and discuss challenges and future directions. To date, experimental and observational studies suggest a causal association between chronic stress and worse asthma control, and a growing body of literature suggests that pre- or post-natal chronic stress may lead to new-onset asthma. Such evidence supports conducting randomized controlled trials of stress-reduction interventions to improve asthma control in subjects with high chronic stress. On the other hand, additional studies are needed to better understand if the specific stressor of violence exposure leads to asthma or worse asthma outcomes. Longitudinal studies with assessment of co-exposures and coping mechanisms are key to not only better understand the independent effects of violence or stress on asthma but also to identify factors that could ameliorate or worsen such effects. At this time, preliminary evidence supports prospective studies of whether and how chronic stress affects asthma or treatment responses through changes in DNA methylation or gene expression in cells relevant to disease pathogenesis.

Impact of benralizumab on asthma control, asthma-related quality of life and lung function in patients with poorly controlled eosinophilic asthma: A systematic review and meta-analysis

BACKGROUND: Benralizumab is a monoclonal antibody to the alpha subunit of the IL-5 receptor used in the management of severe, eosinophilic asthma. Although Benralizumab has been shown to significantly reduce asthma exacerbation rates in several Randomized Controlled Trials (RCTs), its impact on subjective asthma control, asthma-related quality of life and lung function is less clear. The purpose of this meta-analysis is to analyze the combined effect of Benralizumab on Asthma Control Questionnaire (ACQ) scores, Asthma Quality of Life Questionnaire (AQLQ) scores and pre-bronchodilator (pre-BD) FEV1 values in severe asthmatics with eosinophilia.METHODS: A comprehensive search of selected databases was performed to include randomized, phase 3 placebo-controlled clinical trials that compared the impact of Benralizumab on ACQ6 scores, AQLQ scores and pre-BD FEV1 values in severe asthmatics with eosinophilia. Random effect models were produced to compare the combined effect of Benralizumab treatment in comparison to placebo.RESULTS: Overall, Benralizumab treatment in asthmatic patients with eosinophilia resulted in significantly improved ACQ6 scores, AQLQ scores and pre-BD FEV1 values in comparison to placebo (Mean Difference: −0.24,95%CI: −0.32, −0.16, p-value: <0.00001); (Mean Difference: 0.23, 95%CI: 0.14, 0.32, p-value: <0.00001); (Mean Difference: 0.11, 95% CI 0.08, 0.15, p-value: <0.00004), respectively.CONCLUSIONS: Our meta-analysis demonstrates that treatment with Benralizumab in patients with severe asthma associated with eosinophilia significantly improves asthma control, asthma-related quality of life and lung function. We believe these findings can provide evidenced-based recommendations for the use of Benralizumab in asthmatic patients with eosinophilia.

Obesity-asthma phenotype: Effect of weight gain on asthma control in adults.

The obesity-asthma phenotype has become an increasingly common situation in our clinical practice. The mechanisms behind poor asthma control in subjects who are obese remain unclear. We aimed to determine the effect of obesity on asthma control in a group of adult patients Method: Subjects who had been diagnosed as having asthma and who were admitted to our clinic were included to this study. Body mass index (BMI) and asthma control status of the patients were evaluated. BMI values at the time of diagnosis were also collected from the patient files, and the difference between basal and current BMI values were calculated. The effect of obesity and weight gain on asthma control was investigated. The study population was composed of 218 patients (29 men, 189 women), with a mean (standard deviation) age of 52.01 ± 11.6 years. Fifty-four percent of the patients were obese, 27.5% were overweight, and 18.3% were of normal weight. The baseline and current BMI values were higher in women than in the men. BMI increased with the increase in age or disease duration. Asthma control was poor in the patients who were obese and overweight despite optimal treatment. Moreover, asthma control was worse in patients who gained weight during the follow-up period. In our study, we found a significant relationship between obesity and asthma control. In addition, weight gain and being nonatopic also was found to worsen asthma control. In light of our finding that weight gain led to a decrease in asthma control, we suggest that weight loss may improve the course of asthma.

Vitamin D3 for uncontrolled childhood asthma: A pilot study.

Observational and mechanistic data suggest a role for vitamin D in childhood asthma. However, subsequent interventional trials have been inconsistent. We aimed to assess the effect of 15 weeks of vitamin D3 supplementation compared with placebo (PL) in Irish children with asthma. We conducted a double-blind, randomized, PL-controlled trial of vitamin D supplementation (2000 IU/day) in 44 urban, Caucasian children at high latitude. Assessments were completed at baseline and after 15 weeks of supplementation. Outcome measures were lung function, subjective asthma control and biochemical parameters of total vitamin D, allergy, immunity, airway inflammation, and systemic inflammation. Finally, parents/guardians completed a weekly diary during the trial. There was no significant difference in baseline 25(OH)D levels, but there was a significant increase in median 25(OH)D in the vitamin D3 group (57.5-105 nmol/l) compared with the PL group (52.5-57.5 nmol/l) (p < 0.0001). There was no significant difference between groups regarding subjective asthma control. Compared with PL, there was a significant decrease in school days missed due to asthma (1 vs. 5 days, p = 0.04) and alkaline phosphatase (-3.4 vs. +16; p = 0.037) in the vitamin D3 group, but there were no beneficial effects regarding several other secondary end-points. However, there were non-significant, advantageous changes in the PL group compared with the vitamin D3 group in subjective asthma control and lung function, particularly percentage of predicted forced expiratory volume in 1 s (+2.5 vs. -4; p = 0.06). Vitamin D3 supplementation led to a significant increase in serum 25(OH)D and decreased school days missed (p = 0.04), but no other advantageous changes in asthma parameters compared with PL. The potential adverse effect of vitamin D deficiency on growth and the potential negative effect of high serum 25(OH)D on pulmonary function warrant further investigation.

Effect of smoking abstinence and reduction in asthmatic smokers switching to electronic cigarettes: evidence for harm reversal.

Electronic cigarettes (e-cigs) are marketed as safer alternatives to tobacco cigarettes and have shown to reduce their consumption. Here we report for the first time the effects of e-cigs on subjective and objective asthma parameters as well as tolerability in asthmatic smokers who quit or reduced their tobacco consumption by switching to these products. We retrospectively reviewed changes in spirometry data, airway hyper-responsiveness (AHR), asthma exacerbations and subjective asthma control in smoking asthmatics who switched to regular e-cig use. Measurements were taken prior to switching (baseline) and at two consecutive visits (Follow-up/1 at 6 (±1) and Follow-up/2 at 12 (±2) months). Eighteen smoking asthmatics (10 single users, eight dual users) were identified. Overall there were significant improvements in spirometry data, asthma control and AHR. These positive outcomes were noted in single and dual users. Reduction in exacerbation rates was reported, but was not significant. No severe adverse events were noted. This small retrospective study indicates that regular use of e-cigs to substitute smoking is associated with objective and subjective improvements in asthma outcomes. Considering that e-cig use is reportedly less harmful than conventional smoking and can lead to reduced cigarette consumption with subsequent improvements in asthma outcomes, this study shows that e-cigs can be a valid option for asthmatic patients who cannot quit smoking by other methods.

Effect of β2 -adrenergic receptor gene Arg16Gly polymorphisms on response to long-acting β2-agonist in Chinese Han asthmatic patients

&#x0D; &#x0D; &#x0D; &#x0D; Background: To evaluate the effect of variation of the Arg16Gly polymorphism of the β2-adrenergic receptor gene on clinical response to salmeterol administered with fluticasone propionate in Chinese Han asthmatic patients.&#x0D; Methods: Moderate persistent asthmatic patients (n = 62) currently receiving short-acting β2-agonists were administered twice-daily therapy with salmeterol/fluticasone propionate 50/250 μg in a single inhaler for 12 weeks, followed by a 2-to-4-day run-out period. Using direct DNA sequencing, five single nucleotide polymorphisms (SNPs) in the promoter and coding block regions of β2-adrenergic receptor gene were determined in 62 subjects and haplotypes were combined.&#x0D; Results: There was sustained and significant improvement (p &lt; 0.001) over baseline in all measures of asthma control in subjects receiving salmeterol and fluticasone, regardless of Arg16Gly genotype. However, there was no significant difference in the improvement among three genotypes (p &gt; 0.05). Responses to salmeterol did not appear to be modified by haplotype pairs (p &gt; 0.05). During the run-out period, all subjects had similar decreases in measures of asthma control, with no differences between genotypes (p &gt; 0.05).&#x0D; Conclusions: Response to salmeterol does not vary with Arg16Gly polymorphisms after chronic dosing with inhaled corticosteroids in Chinese Han asthmatic patients.&#x0D; &#x0D; &#x0D; &#x0D;

Effect of β2 -adrenergic receptor gene Arg16Gly polymorphisms on response to long-acting β2-agonist in Chinese Han asthmatic patients

BackgroundTo evaluate the effect of variation of the Arg16Gly polymorphism of the β2-adrenergic receptor gene on clinical response to salmeterol administered with fluticasone propionate in Chinese Han asthmatic patients.MethodsModerate persistent asthmatic patients (n = 62) currently receiving short-acting β2-agonists were administered twice-daily therapy with salmeterol/fluticasone propionate 50/250 μg in a single inhaler for 12 weeks, followed by a 2-to-4-day run-out period. Using direct DNA sequencing, five single nucleotide polymorphisms (SNPs) in the promoter and coding block regions of β2-adrenergic receptor gene were determined in 62 subjects and haplotypes were combined.ResultsThere was sustained and significant improvement (p < 0.001) over baseline in all measures of asthma control in subjects receiving salmeterol and fluticasone, regardless of Arg16Gly genotype. However, there was no significant difference in the improvement among three genotypes (p > 0.05). Responses to salmeterol did not appear to be modified by haplotype pairs (p > 0.05). During the run-out period, all subjects had similar decreases in measures of asthma control, with no differences between genotypes (p > 0.05).ConclusionsResponse to salmeterol does not vary with Arg16Gly polymorphisms after chronic dosing with inhaled corticosteroids in Chinese Han asthmatic patients.

Long‐term results of endoscopic sinus surgery–oriented treatment for chronic rhinosinusitis with asthma

The aims of this study were to evaluate the efficacy of functional endoscopic sinus surgery (FESS)-oriented multimodality treatment in chronic rhinosinusitis (CRS) patients with asthma and its impact on asthma. Prospective, nonrandomized cohort. Twenty-seven CRS patients with asthma who underwent FESS with postoperative topical corticosteroid spray were evaluated preoperatively; 25 of them were evaluated 1 year and 3 years postoperatively. CRS was evaluated by visual analogue scale, clinical control of CRS, and objective measurement endoscopy Lund-Kennedy scores. Asthma was assessed by subjective asthma control test and asthma control level, also by objective antiasthma medication use and pulmonary function tests. VAS scores of general symptoms (8.09 ± 0.87 preoperatively) were significantly improved at 1 year (2.94 ± 2.21) and 3 years (3.77 ± 2.16) postoperation (P = .000). No difference in these items was found between 1 year and 3 years (P = .463). Endoscopy Lund-Kennedy scores at 1 year (4.34 ± 3.09) and 3 years (5.80 ± 3.38) postoperatively were significantly better (9.33 ± 2.03 preoperatively, P = .000), and there was no difference between 1 year and 3 years of follow-up (P > .05). Significantly, asthma control level improved postoperatively (P = .025). However, antiasthma drug and pulmonary function showed no significant change postoperatively (P > .05). FESS-oriented multimodality treatment improves CRS with asthma significantly and persistently. Asthma control level improved. Antiasthma medication use and pulmonary function remained stable.

Validity of two common asthma-specific quality of life questionnaires: Juniper mini asthma quality of life questionnaire and Sydney asthma quality of life questionnaire

BackgroundThis study explored the psychometric properties (internal consistency, construct validity, discriminative ability) of the Juniper Mini Asthma Quality of Life Questionnaire (Mini AQLQ-J) and the Sydney Asthma Quality of Life Questionnaire (AQLQ-S).MethodsOne hundred fourty-six adults (18–45 years) with asthma requiring regular inhaled corticosteroids were recruited to a trial of written emotional disclosure. Correlational analyses were performed to understand the relationship of the two measures with each other, with symptoms, lung function, asthma control, asthma bother and generic quality of life. Median quality of life scores were compared according to gender, health care usage and levels of asthma severity.ResultsAQLQ-J and AQLQ-S total scores correlated strongly with each other (rho = −0.80) and moderately with the EuroQol Current Health Status Scale (AQLQ-J: rho = 0.35; AQLQ-S: rho = −0.40). Domain score correlations between AQLQ-J and AQLQ-S were mostly moderate (0.50 < rho < 0.80).Both QoL measures were significantly correlated with symptom score. Correlations with the symptom score asthma module (AQLQ-J: rho = −0.69; AQLQ-S: rho = 0.50) were stronger compared with the total symptom score and the symptom score rhinitis module (AQLQ-J: rho = −0.41; AQLQ-S: rho =0.31).Neither QoL measure was significantly correlated with FEV1, % predicted at the total or the domain level.Total scores of both measures were significantly correlated with subjective asthma control (AQLQ-J: rho = 0.68; AQLQ-S: rho = −0.61) and asthma bother (AQLQ-J: rho = −0.73; AQLQ-M: rho = 0.73).Total AQLQ-J score and total AQLQ-S score were significantly associated with perceived asthma severity (AQLQ-J: p=0.004, AQLQ-S: p=0.002) and having visited a GP in the past four months (AQLQ-J: p=0.003, AQLQ-S: p=0.002).ConclusionsThis study provides further evidence for the validity of the AQLQ-J and the AQLQ-S in a British population of adult patients with asthma managed in primary care. Correlations with lung function parameters were weak or absent. Correlations with generic quality of life were moderate, those with asthma symptoms, asthma control and asthma bother were strong. Both measures are able to discriminate between levels of asthma severity and health care usage.

Asthma Control Test (ACT) Versus Intermittent Oscillation System (IOS) Assessment for Control of Asthmatic Children

PURPOSE: In spite of the great development of international guidelines for the diagnosis and the treatment of asthma, there is continuing evidence of poor control of childhood asthma. Aim of this work was to evaluate the subjective asthma control test (ACT) against the objective impulse oscillation system (IOS) measures of the airways resistance in asthmatic children.

Efficacy and safety evaluation of ciclesonide in mild-to-moderate persistent asthma previously treated with inhaled corticosteroids

Inhaled corticosteroids (ICSs) are recommended as first-line treatment for persistent asthma. This study was designed to evaluate the ability of ciclesonide (CIC) in subjects with stable asthma previously receiving another ICS or ICS/long-acting beta(2)-agonist (LABA) to maintain asthma disease control. In this 12-week, multicenter, double-blind, parallel-group study, subjects aged > or =12 years with stable mild-to-moderate persistent asthma were switched at randomization from an ICS or ICS/LABA to CIC, 80 microg twice daily (CIC80 b.i.d.; n = 149); CIC, 160 microg once daily (CIC160 q.d.; n = 150); or placebo (n = 147). Change in forced expiratory volume in 1 second (FEV(1); primary end point), morning peak expiratory flow (PEF), rescue albuterol use, total asthma symptom score, nighttime awakenings, and safety were evaluated. FEV(1) improved from baseline to week 12 after CIC80 b.i.d. treatment (+0.07 L; p = 0.0232), and was maintained after CIC160 q.d. (+0.01 L; p = 0.6217). FEV(1) declined from baseline after placebo (-0.12 L; p < 0.0001) and significantly versus CIC treatments (p < 0.001). At week 12, morning PEF maintained baseline values after CIC80 b.i.d. (-4.43 L/minute; p = 0.1272) and decreased after CIC160 q.d. (-5.77 L/minute; p = 0.0490) and placebo (-12.82 L/minute; p < 0.0001); the difference between CIC80 b.i.d. and placebo was significant (p = 0.035). Baseline albuterol use, total daily asthma score, and nighttime awakenings were maintained after CIC treatments (p > 0.25), but increased after placebo (p < or = 0.002); the difference between CIC80 b.i.d. and placebo was significant (p < 0.02). Incidence of adverse events was similar among treatment groups (range, 52.0-57.9%). In this study, CIC80 b.i.d. maintained asthma control in subjects with stable mild-to-moderate asthma previously treated with ICS or ICS/LABA, was well tolerated, and, in general, was better than CIC160 q.d. in maintaining disease control.

Writing About Emotional Experiences Reduces β-Agonist Use in Patients with Asthma - 3-Month Follow Up of a Randomised Controlled Trial

Rationale: as stress is known to exacerbate asthma symptoms, we examined whether written emotional disclosure (writing about traumatic experiences) could improve lung function in adults with asthma. Writing may facilitate cognitive and emotional processing of stressful events and help to reduce the physiological stress associated with inhibition of emotions. Methods: 138 adults aged between 18 and 45 with a diagnosis of asthma, requiring regular inhaled corticosteroids and able to read and understand English were invited to participate in this double blind randomised controlled trial. Participants were randomly allocated to receive either the written emotional disclosure or non-emotional writing instructions. Participants were asked to write for 20 minutes over 3 consecutive days. Spirometry readings and questionnaires measuring quality of life, asthma symptoms, subjective asthma control and medication use were conducted at baseline, 1 and 3-month follow up. Results: baseline analysis showed no significant differences between the two conditions. Controlling for baseline scores, no significant findings for lung function, quality of life or asthma symptoms were found. At 3-month follow up, participants in the intervention condition reported significantly better subjective control of their asthma (as defined by the Asthma Control Test): OR = 3.01, 95%CL (1.30, 6.94) and reported significantly better objective control of their asthma (defined as using their ?-agonist less than once a day): OR = 2.96, 95%CL (1.38, 6.33). Conclusions: written emotional disclosure may be useful in the management of asthma, improving perceived control of asthma in addition to reducing patients' use of their reliever medication

FLUTICASONE PROPIONATE/SALMETEROL VIA DISKUS IS SUPERIOR TO MONTELUKAST IN OVERALL ASTHMA CONTROL IN SUBJECTS WITH BOTH ASTHMA AND ALLERGIC RHINITIS

PURPOSE: Asthma and seasonal allergic rhinitis often coexist and symptoms manifest concurrently. However, limited data is available regarding the role of fluticasone propionate/salmeterol (FSC) in this population. This study compared the effect of FSC vs montelukast (MON) on asthma control in subjects with active asthma and allergic rhinitis symptoms. In addition, this study was designed to evaluate whether fluticasone propionate aqueous nasal spray (FPANS) was superior to MON for control of allergic rhinitis in the presence of FSC.

Salmeterol response is not affected by β 2-adrenergic receptor genotype in subjects with persistent asthma

Recent studies suggest that there might be an association between albuterol use and worsening asthma in patients homozygous for arginine (Arg/Arg) at codon 16 of the beta-receptor. However, it is not known whether similar responses occur in Arg/Arg patients receiving long-acting beta2-agonists. We sought to evaluate the effects of variation in the beta2-adrenergic receptor gene (ADRB2) on clinical response to salmeterol administered with fluticasone propionate. Subjects (n = 183) currently receiving short-acting beta2-agonists were randomized to twice-daily therapy with salmeterol, 50 microg, administered with fluticasone propionate, 100 microg, in a single inhaler or daily therapy with montelukast for 12 weeks, followed by a 2- to 4-day run-out period. There was sustained and significant improvement (P < .001) over baseline in all measures of asthma control in subjects receiving salmeterol, regardless of Arg16Gly genotype. Morning peak expiratory flow in subjects with the Arg/Arg genotype showed 89.0 +/- 16.1 L/min improvement over baseline compared with 93.7 +/- 12.7 L/min for Gly/Gly subjects and 92.5 +/- 11.9 L/min for Arg/Gly subjects. Pairwise changes were similar for Arg/Arg compared with Gly/Gly or Arg/Gly genotypes (estimated differences, 4.7 L/min and 3.5 L/min, respectively). Responses did not appear to be modified by haplotype pairs. During the run-out period, all subjects had predictable and similar decreases in measures of asthma control, with no differences between genotypes. Response to salmeterol does not vary between ADRB2 genotypes after chronic dosing with an inhaled corticosteroid. Analyses from this study indicate that genetic polymorphisms leading to Arg16Gly sequence changes within the beta2-adrenergic receptor do not affect patients' responses to recommended asthma therapy with salmeterol and fluticasone propionate.

Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids

Although inhaled corticosteroids (ICSs) are effective in preventing deterioration in asthma control, at least half of subjects with mild-to-moderate asthma will remain stable when these agents are discontinued. We sought to determine whether noninvasive markers of inflammation predict which individuals maintain asthma control after discontinuation of ICSs. We analyzed data obtained from 164 subjects with mild-to-moderate asthma who participated in a 16-week trial comparing the effects of continued ICS use with the effects of a switch to salmeterol or placebo. In comparison with continued ICS use, a switch to salmeterol or placebo was associated with increased rates of asthma deterioration over 16 weeks (9.3% vs 24.1% and 37.5%, respectively; P = .04 and P < .001, respectively). We found that neither exhaled nitric oxide nor methacholine PC 20 , when measured at randomization or 2 weeks after randomization, were significant predictors of subsequent asthma control in subjects who discontinued ICSs. However, both induced sputum eosinophil counts measured 2 weeks after a switch from ICS to placebo and changes in sputum eosinophil counts from before cessation of ICSs to after a switch to placebo predicted subsequent asthma deterioration (area under the receiver-operating characteristic curve, 0.771 [ P < .001] and 0.825 [ P < .001], respectively). On the basis of a model treatment strategy, we estimate that allocating subjects to ICS therapy on the basis of changes in sputum eosinophil counts after a trial discontinuation could allow 48% of subjects with mild-to-moderate asthma to discontinue ICS therapy without an increased risk of asthma deterioration over a period of at least 14 weeks.

Evaluation of asthma control in subjects participating in a large multi-disease screening project

Evaluation of asthma control in subjects participating in a large multi-disease screening project

Short-acting beta-agonist research: a perspective. 1997.

Asthma mortality increased sharply in New Zealand in 1977, prompting a national investigation into circumstances of asthma deaths. Subsequent observations of improved asthma control in subjects withdrawn from regular beta(2)-agonist treatment raised the question of whether asthma severity and, therefore, mortality could relate to frequent beta-agonist use. A randomized controlled trial of regular inhaled fenoterol versus as-needed bronchodilator use showed worsened asthma control during regular treatment despite concomitant use of inhaled corticosteroids. Assessment of these findings led to delay in the publishing of the American Asthma Guidelines, which were modified to suggest caution in using beta(2)-agonist treatments. Simultaneously, case control studies in New Zealand suggested that prescription of fenoterol was a substantial risk factor for asthma mortality. The causal association was hotly debated, but increasing evidence pointed to an adverse effect of fenoterol on asthma severity and, hence, mortality. This was supported by dramatic decreases in both morbidity and mortality when fenoterol was effectively withdrawn from use in New Zealand. The link between worsening asthma morbidity and mortality, and the use of potent short-acting beta(2)-agonists fulfills the Bradford Hill criteria for attributing causality. Application of evidence from randomized, controlled trials of short-acting beta-agonist use has led to a major shift in therapy in asthma to the recommendation of as-needed use only of short-acting beta-agonists and decreased patient reliance on regular bronchodilator therapy.