Asthma Control Test Questionnaire Research Articles

Improving Asthma Control Test completion rates across a multi-site pediatric pulmonary clinic network: a quality improvement initiative

Objective Assessing asthma control is an essential part of the outpatient management of children with asthma and can be performed through validated questionnaires such as the Asthma Control Test (ACT). Systematic approaches to incorporating the ACT in outpatient visits are often lacking, contributing to inconsistent completion rates. We conducted a quality improvement initiative to increase the proportion of visits where the ACT is completed for children with asthma in our multi-site pediatric pulmonary clinic network. Methods We developed an intervention of sending the ACT questionnaire to patients and caregivers through the electronic patient portal to complete prior to their visits. This strategy was first piloted at one clinic beginning in July 2020 and then expanded to 5 other clinics in the network in October 2020. Our outcome measure was average monthly proportion of visits with a completed ACT, tracked using statistical process control charts. The process measure was method of ACT completion tracked using run charts. Results At the pilot clinic, average monthly completion rate rose within 3 months of the intervention from 27% to 72% and was sustained more than 22 months. Completion across all clinics increased from 57% pre-intervention to 76% post-intervention. Importantly, the intervention did not rely on clinic staff to administer the questionnaire and did not interfere with existing clinic flow. Conclusion An intervention of delivering the ACT electronically to patients and caregivers for completion prior to visits led to a rapid and sustained improvement in ACT completion rates across a large, pediatric pulmonary clinic network.

The effect of motivational interviewing techniques on the knowledge level of asthma control among mothers of children with allergic asthma

PurposeThis study aims to evaluate the effect of education given with motivational interviewing techniques on mothers of children with allergic asthma aged 4–11 years on asthma control and knowledge level. MethodsThe research was designed according to the CONSORT checklist with a randomized controlled design. 76 participants were randomly assigned to either an intervention (n = 38) or control group (n = 38). The intervention group received asthma education utilizing motivational interviewing techniques from a pediatric nurse. The control group received no further education. The Childhood Asthma Control Test and Asthma Knowledge Level Questionnaire were used to collect data. The control group received only education at the time of discharge. ResultsThe mothers' asthma control and asthma knowledge scores in the experimental group were significantly higher than in the control group (p < 0.001). In the experimental group, asthma control scores increased from 14.29 ± 4.27 to 21.37 ± 1.57 after education. The mean score of the asthma knowledge score increased from 54.74 ± 10.89 to 73.47 ± 7.17 after intervention. ConclusionsThe study showed that education using motivational interviewing techniques for mothers of children with allergic asthma increased their knowledge and positively affected asthma control. Implications to practiceEducation is important in improving mothers' knowledge about allergic asthma. Asthma education using motivational interviewing techniques should be provided when their children are newly diagnosed. Education practices should be implemented as a policy in hospitals and pediatric clinics, and nurses should be supported in ensuring the implementation of education practices.

The relationship between changes in peak expiratory flow and asthma exacerbations in asthmatic children

BackgroundAsthma is one of the most common chronic airway diseases in children. Preventing asthma exacerbation is one of the objectives of all asthma action plans. In patients with poor perception, it is difficult to identify acute asthma exacerbations by clinical asthma score, asthma control test or asthma control questionnaire. The aim of this study is to analyze whether children with asthma have changes in peak expiratory flow(PEF)before an acute asthma exacerbation and to evaluate the relationship between PEF and asthma exacerbation.MethodsBasic information (including sex, age, atopy, etc.) and clinical information of asthmatic children who registered in the Electronic China Children’s Asthma Action Plan (e-CCAAP) from 1 September 2017 to 31 August 2021 were collected. Subjects with 14 consecutive days of PEF measurements were eligible. Subjects in this study were divided into an exacerbation group and a control group. We analyzed the relationship between changes in PEF% pred and the presence of asthma symptoms.ResultA total of 194 children with asthma who met the inclusion criteria were included, including 144 males (74.2%) and 50 females (25.8%), with a male-to-female ratio of 2.88:1. The mean age of the subjects was 9.51 ± 2.5 years. There were no significant differences in sex, age, allergy history or baseline PEF between the two groups. In children with and without a history of allergy, there was no significant difference between the variation in PEF at 14 days. Patients who only had a reduced in PEF but no symptoms of asthma exacerbation had the greatest reduction in PEF compared to the other groups. The most common cause of acute exacerbations of asthma is upper respiratory tract infection. Among the causes of acute exacerbations of asthma, the variation in PEF caused by air pollution was significantly higher than that of other causes (P < 0.05). In acute exacerbations, the decrease in PEF was significantly greater in the exacerbation group than in the control group. In children with asthma symptoms, there was a decrease in PEF approximately 1.34 days before the onset of symptoms.ConclusionChildren with asthma show a decrease in PEF 1.34 days before the onset of asthma symptoms. We recommend that asthmatic children who show a decrease in PEF should step-up asthma therapy. The most common cause of acute exacerbations of asthma was upper respiratory tract infections, and the variation in PEF caused by air pollution was significantly higher than that caused by other factors.

Evidence for 2 clusters among patients with noneosinophilic asthma

BackgroundAlthough asthma is often seen as an eosinophilic disease associated with atopy, patients with noneosinophilic asthma represent a substantial part of the population with asthma. ObjectiveTo apply an unsupervised clustering method in a cohort of 588 patients with noneosinophilic asthma (sputum eosinophils < 3%) recruited from an asthma clinic of a secondary care center. MethodsOur cluster analysis of the whole cohort identified 2 subgroups as cluster 1 (n = 417) and cluster 2 (n = 171). ResultsCluster 1 comprised a predominantly female group with late disease onset, a low proportion of atopy (24%), and a substantial smoking history (53%). In this cluster, treatment burden was low (<50% of inhaled corticosteroid users); asthma control and quality of life were poor, with median Asthma Control Test, Asthma Control Questionnaire, and Asthma Quality of Life scores of 16, 1.7, and 4.5, respectively, whereas lung function was preserved with a median postbronchodilation forced expiratory volume in 1 second of 93% predicted. Cluster 2 was a predominantly male group, almost exclusively comprising patients with atopy (99%) with early disease onset and a moderate treatment burden (median inhaled corticosteroids dose 800 µg/d equivalent beclomethasone). In cluster 2, asthma was partially controlled, with median Asthma Control Test and Asthma Control Questionnaire scores reaching 18 and 1.3, respectively, and lung function well preserved with a median postbronchodilation of 95% predicted. Although systemic and airway neutrophilic inflammation was the dominant pattern in cluster 1, cluster 2 essentially comprised paucigranulocytic asthma with moderately elevated fraction exhaled nitric oxide. ConclusionNoneosinophilic asthma splits into 2 clusters distinguishing by disease onset, atopic status, smoking history, systemic and airway inflammation, and disease control and quality of life.

PENGARUH EDUKASI FARMASI TERHADAP TINGKAT KONTROL ASMA DI POLI PARU RUMAH SAKIT BHAYANGKARA KEDIRI

Asthma control level is one of the indicators to assess the success of asthma therapy. The provision of pharmaceutical education is crucial in changing respondents' attitudes in controlling and preventing recurrent asthma exacerbations. The type of research used is pre-experimental (One group pre-post-test design) which will be conducted through pre-testing first, then giving the intervention, and then providing a post-test to determine the changes that occur before and after the intervention. Data collection is done through interviews and filling out the Asthma Control Test questionnaire. In this study, a sample of 35 respondents was used. The research analysis was conducted using the Wilcoxon test. The demographic data results showed that the majority of respondents were female, 21 respondents (60%), aged 36-45 years, 14 respondents (40%), with high school education, 14 respondents (40%), occupation as a homemaker, 13 respondents (37.1%), and a history of asthma for more than 10 years, 13 respondents (37.1%). Out of 35 respondents, before receiving pharmaceutical education, there were 7 respondents (20%) well-controlled, 13 respondents (37.1%) partially controlled, and 15 respondents (42.9%) uncontrolled. The questionnaire results after providing education showed 12 respondents (34.3%) well-controlled, 17 respondents (48.6%) partially controlled, and 6 respondents (17.1%) uncontrolled. The statistical test results showed that there is an influence of pharmaceutical education on asthma control level with a significance value of 0.003.

Asthma improvement in patients treated with dupilumab for severe atopic dermatitis.

Atopic dermatitis (AD) is considered a systemic type 2 immune driven disease, and it is associated to many atopic comorbidities including asthma. The aim of our study was to prospectively evaluate the respiratory outcomes in patients with persistent allergic asthma treated with dupilumab due to severe AD (sAD). We enrolled eligible patients with sAD for dupilumab treatment from September 2018 to December 2020. We then selected the subgroup of patients sensitized to perennial allergens. Dupilumab's efficacy and safety on AD and comorbid asthma were assessed at baseline, one month, four months, and then every 4 months up to one year. A total of 437 patients with sAD were enrolled for dupilumab treatment due to sAD, and 273 reached 48 weeks of therapy. Respiratory outcomes were evaluated in the 85 asthmatic patients with positivity only to perennial allergens. Our patients showed statistically and clinically significant improvement in asthma control (Asthma Control Test and Asthma Control Questionnaire) and airway obstruction parameters (FEV1), in addition to the expected AD-related skin outcomes. Specifically, a significant improvement was achieved at the fourth month of dupilumab therapy, and this trend was maintained up to twelve months, regardless of asthma severity. Our results showed the overall improvement of the clinical picture that dupilumab offers for patients with severe AD and persistent allergic asthma of any severity, highlighting the importance of a global multidisciplinary approach of type 2 driven disease.

The Prevalence and Impact of Allergic Rhinitis on Asthma Exacerbations in Asthmatic Adult Patients in the Qassim Region of Saudi Arabia: A Cross-Sectional Study.

Objective We aim to evaluate the prevalence and impact of allergic rhinitis comorbidity in asthmatic patients in the Qassim region and identify whether rhinitis affects asthma control. Methods This is an observational cross-sectional study on asthmatic adults who live in the Qassim region of Saudi Arabia. An online questionnaire was distributed through social media. The questionnaire is composed of the validated Arabic versions of the Score for Allergic Rhinitis (SFAR) questionnaire, the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines, and the Asthma Control Test (ACT) questionnaire. Results The total number of participants was 380; however, after 98 were excluded, 282 asthmatic patients were includedin this study. Of them, 33% had allergic rhinitis. Females constitute 67% of the study participants, while males comprise 33%. The findings of the study indicate that there is a significant association between allergic rhinitis and asthma control in the Qassim region. Symptoms such as runny nose, sneezing, and nasal obstruction are significantly associated with poor asthma control (p = 0.006). Having a knownfamily history of asthma, eczema, or allergic rhinitis is significantly associated with worse asthma control (0.004). Conclusion In summary, this study found a high prevalence of rhinitis symptoms comorbidity in asthmatic patients in the Qassim region. Overall, the study established the existence of a relationship between allergic rhinitis and asthmatic control. Symptoms such as a runny nose, sneezing, and nasal obstruction are significantly associated with allergic rhinitis and asthmatic symptoms. However, there is no significant association between nose problems that occur in specific seasons or months and allergic rhinitis and asthmatic symptoms, suggesting that seasonality may not have a strong impact on asthma control. House dust mite allergies have a borderline significant association with allergic rhinitis and asthmatic symptoms. Having a family history of asthma, eczema, or allergic rhinitis is associated with allergic rhinitis and asthmatic symptoms, thereby indicating a significant impact on asthma control.

Time effect of dupilumab to treat severe uncontrolled asthma in adolescents: A pilot study.

Dupilumab is a new biological drug approved for the treatment of type 2 inflammatory diseases, such as asthma. Dupilumab is a fully humanized monoclonal antibody that acts against both interleukin-4 and interleukin-13 receptors. This study evaluated the time--dependent effect of dupilumab on asthma exacerbations and quality of life in adolescents with uncontrolled severe asthma. Five adolescents suffering from uncontrolled severe asthma and treated with dupilumab were recruited. All subjects were evaluated for 4, 12, and 24 weeks after the first dose of dupilumab. Outcome measures included lung function, fractional exhaled nitric oxide, asthma control and quality of life assessed by validated questionnaires (Asthma Control Test and Asthma Control Questionnaire). The quality of life improved quickly after 4 weeks of treatment and 80% of adolescents halved the dose of inhaled corticosteroids necessary to control asthma symptoms. These results were still maintained for 24 weeks after start of the therapy. None of the patients had any asthma exacerbation during the study period. Results of this study demonstrated that dupilumab was quickly effective to reduce asthma exacerbation and ameliorate quality of life in severe asthmatic adolescents.

Relationship of Illness Perception with Asthma Symptoms Control in Adolescents

Asthma has a high prevalence in Indonesia. Good self-management is necessary for therapy and greatly affects the level of asthma control symptoms. The patient's perception plays an important role in the success of asthma therapy, especially among students, because education affects a person's mindset and perception of disease conditions. The purpose was to determine the relationship between illness perception and control of asthma symptoms in adolescents. The method was cross-sectional and was conducted from November 2019 to January 2020. The variables were asthma control and illness perception. This research was conducted on a campus in Surabaya city. Respondents were asked to fill out the Illness Perception Questionnaire (IPQ) and asthma control test (ACT) questionnaire and analyze by calculating each answer point. This study used a chi-square test to analyze the relationship between ACT and Illness perception. This study involved 75 respondents. Of most of the respondents, 58 people have their asthma partially controlled. Most respondents experienced shortness of breath and wheezing symptoms, and most understood that they were related to their asthma. There was a relationship between asthma control scores and illness perception (p&gt;0.05) on the timeline (p=0.03), personal control (p=0.03), and causal representation (p=0.01). Illness perception can affect asthma symptoms. Asthma will be experienced for a long time, and respondents will better adjust their lifestyle and have confidence that it was controlled. Material factors were also considered. If their asthma was controlled, it was hoped not to affect their finances.

Asthma control test (ACT): comparison with the accurate use of inhalers for the treatment among patients with asthma

Background: Asthma is a heterogeneous disease characterized by chronic inflammation of the respiratory tract. Pharmacological therapies that are often given by inhalation are Dry Powder Inhaler (DPI) and Metered-Dose Inhaler (MDI). According to the GLOBAL INITIATIVE FOR ASTHMA Asthma Control Test (ACT) is a questionnaire that can be used to measure the level of asthma controlPurpose: To determine the relationship between the correct use of inhalers and the results of the Asthma Control Test (ACT) in asthma patientsMethod: The design of this study was an analytic survey with a cross-sectional approach. The parameter used were asthma control test questionnaires taken from primary data in the form of a survey. There were 126 total samples of respondents who met the inclusion criteria, namely asthma patients who used inhalers and underwent at least 3 months of treatment.Results: Spearman correlation test was obtained p = 0.000 which means that there is a significant relationship between the accuracy of inhaler use and the results of the asthma control test and a strong positive correlation coefficient of r = 0.667 and, for the 95% confidence interval in this study, it was obtained (95%CI = 3.09-3.83).Conclusion: There is a relationship between the correct use of inhalers and the results of the asthma control test (ACT) in asthma patients.

Bronchodilator response does not associate with asthma control or symptom burden among patients with poorly controlled asthma

PurposeThe purpose of this study was to determine how four different definitions of bronchodilator response (BDR) relate to asthma control and asthma symptom burden in a large population of participants with poorly controlled asthma. ProceduresWe examined the baseline change in FEV1 and FVC in response to albuterol among 931 participants with poorly controlled asthma pooled from three clinical trials conducted by the American Lung Association - Airways Clinical Research Centers. We defined BDR based on four definitions and analyzed the association of each with asthma control as measured by the Asthma Control Test or Asthma Control Questionnaire, and asthma symptom burden as measured by the Asthma Symptom Utility Index. Main findingsA BDR was seen in 31–42% of all participants, depending on the definition used. There was good agreement among responses (kappa coefficient 0.73 to 0.87), but only 56% of participants met all four definitions for BDR. A BDR was more common in men than women, in Blacks compared to Whites, in non-smokers compared to smokers, and in non-obese compared to obese participants. Among those with poorly controlled asthma, 35% had a BDR compared to 25% of those with well controlled asthma, and among those with a high symptom burden, 34% had a BDR compared to 28% of those with a low symptom burden. After adjusting for age, sex, height, race, obesity and baseline lung function, none of the four definitions was associated with asthma control or symptom burden. ConclusionA BDR is not associated with asthma control or symptoms in people with poorly controlled asthma, regardless of the definition of BDR used. These findings question the clinical utility of a BDR in assessing asthma control and symptoms.

1-Year Prospective Study of the Relationship of Serial Exhaled Nitric Oxide Level and Asthma Control.

Previous studies found that the fractional nitric oxide concentration in exhaled breath (FeNO) levels in healthy Chinese adults was higher than in White adults. More understanding of serial changes of FeNO levels with asthma control in a real-life clinical setting would be important to explore the utility of this biomarker in routine asthma management. This study assessed the FeNO levels of Chinese asthma subjects with different levels of asthma control and the serial changes with respect to the changes in asthma control over 1 year. A 12-month prospective study (subjects recruited between November 2019 and January 2021) with serial measurement of FeNO levels at baseline, 4, 8 and 12 months. Asthma control was assessed by the Global Initiative for Asthma classification, Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ). Altogether, 136 subjects (mean age 51.51±15.09 years, 46[33.8%] male) had successful baseline FeNO measurements. At baseline, the FeNO levels did not show a statistically significant difference for controlled, partly controlled and uncontrolled asthma according to GINA classification, ACT and ACQ. FeNO levels decreased with improving asthma control and stayed at similar levels with unchanged or worsening asthma control for all subjects. For subjects with baseline blood eosinophil levels ≥300 cells/µL(n=59), FeNO levels decreased with improving asthma control, stayed similar without change for asthma control and increased with worsening asthma control. Receiver operating characteristic (ROC) analysis with the highest area under curve (AUC) for changes in FeNO levels for improving asthma control was between ≤ -10 to -25 ppb at various time points in the 12-month study. Changes in FeNO levels over time were associated with changes in clinical asthma control, particularly in those with higher blood eosinophil count and are likely more useful than a single time point measurement in managing asthma.

The effect of nose clip on exercise-induced bronchoconstriction in adolescents.

Oral breathing is considered to increase hyper-responsiveness of the airways. Data on the need for nose clip (NC) during exercise challenge test (ECT) in children and adolescents is scarce. Ouraim was to evaluate the role of NC during ECT in children and adolescents. A prospective, cohort study; children referred for ECT were evaluated on two separate visits, with and without a NC. Demographic, clinical data and measurements of lung functions were recorded. Allergy and asthma control were evaluated by Total Nasal Symptoms Score (TNSS) and Asthma Control Test (ACT) questionnaires. Sixty children and adolescents (mean age 16.7 ± 1.1 years, 38% Female,) performed ECT with NC and 48 (80%) completed visit 2 (ECT without NC), 8.7 ± 7.9 days after visit 1. Following exercise, 29/48 patients (60.4%) with NC had a decline of ≥12% in forced expiratory volume in the first second (FEV1 ) (positive ECT) compared to only 16/48 (33.3%) positive tests without NC (p = 0.0008). Test result was changed in 14 patients from positive ECT (with NC) to negative ECT (no NC) and in only one patient from negative to positive. The use of NC resulted in greater FEV1 decline (median 16.3% predicted, IQR 6.0-19.1% predicted vs. median 4.5% predicted, IQR 1.6-18.4% predicted, p = 0.0001), and better FEV1 increase after bronchodil at or inhalation compared to ECT without NC. Higher TNSS scores did not predict higher probability to positive ECT. The use of NC during ECT increases detection rate of exercise induced bronchoconstriction during ECT in the pediatric population. These findings strengthen the recommendation of nasal blockage during ECT in children and adolescents.

Impact of a mobile-app assisted self-management educational intervention on the scores of asthma control test (ACT) questionnaire among young asthmatic patients

BackgroundMobile phone apps have reached almost all sectors of everyday modern human life, including health promotion and patient education intervention. Regarding asthma self-management programs, apps are considered to be a potential learning medium for patients with asthma, especially young patients, due to their effectiveness in improving patients’ knowledge and, consequently, the level of asthma control. ObjectiveThe aim of this study was to evaluate the effectiveness of the AsmaDroid® mobile app, as compared with conventional educational methods, as a self-management educational intervention tool for improving asthma control among young patients. MethodsTo determine the app's effectiveness, the study involved 140 participants from various backgrounds and applied a quasi-experimental method using a two-group pretest and posttest with a control group design. Specifically, the treatment groups received the AsmaDroid® app as a learning medium, while the control groups used conventional methods (e.g., books, posters, videos, and social media). Before and after a 4-week intervention period, all the participants of both groups were asked to complete the Asthma Control Test (ACT) questionnaire. ResultsThe results of this study revealed a significant difference of +1.4 (p < 0.0001) in the pretest and posttest scores of the ACT questionnaire from the intervention group, while no difference was found in the control group. ConclusionsTherefore, this study concluded that mobile app-assisted self-management educational intervention significantly improved the scores of the ACT questionnaire among young asthmatic patients.

Assessing the Pharmacist's Role in Counseling Asthmatic Adults Using the Correct Inhaler Technique and Its Effect on Asthma Control, Adherence, and Quality of Life.

This study was designed to assess inhaler technique skills, asthma control level, adherence, and quality of life scores amongst asthmatic patients living in Amman, Jordan, investigating the role of pharmacist's educational intervention. This single-blinded randomized parallel-group active-controlled study was conducted at the Jordan University Hospital (JUH) clinic in 2019. Patients were assessed at baseline and follow-up (after three months) on their inhaler technique (based on validated published checklists), asthma control based on the asthma control test (ACT) questionnaire, adherence to treatment, and quality of life (QoL). Patients in the active group were counseled on correct inhaler technique and administration skills, orally and using inhaler adhesive labels delivered by the clinical pharmacist. Asthma patients (n = 157; active, n = 79, and control, n = 78) were recruited into the study and grouped based on the controller inhaler they were using (Turbohaler (TH) and Accuhaler (ACC). There was no statistically significant difference between both groups at baseline for inhaler technique, adherence, ACT, and QoL. At follow-up, 93.7% of the active group patients used their inhalers correctly, while only 16.7% of the control group used them correctly (P-value <0.001). Also, the ACT mean score was significantly higher for the active group (21.21±5.27) versus the control group (15.92±7.31; P-value <0.001). The QoL mean score was significantly improved for the active group compared with the control group (active = 63.85±24.78, Control = 38.746±3.23, P-value <0.001). Improvement in adherence for the active group was noticed compared with the control group but did not reach a significant level (P-value=0.691). Through a practical educational intervention, pharmacists were found to significantly improve patients' asthma inhaler technique, ACT scores, and QoL scores for patients with asthma.

Use of digital measurement of medication adherence and lung function to guide the management of uncontrolled asthma (INCA Sun): a multicentre, single-blinded, randomised clinical trial

The clinical value of using digital tools to assess adherence and lung function in uncontrolled asthma is not known. We aimed to compare treatment decisions guided by digitally acquired data on adherence, inhaler technique, and peak flow with existing methods. A 32-week prospective, multicentre, single-blinded, parallel, randomly controlled trial was done in ten severe asthma clinics across Ireland, Northern Ireland, and England. Participants were 18 years or older, had uncontrolled asthma, asthma control test (ACT) score of 19 or less, despite treatment with high-dose inhaled corticosteroids, and had at least one severe exacerbation in the past year despite high-dose inhaled corticosteroids. Patients were randomly assigned in a 1:1 ratio to the active group or the control group, by means of a computer-generated randomisation sequence of permuted blocks of varying sizes (2, 4, and 6) stratified by fractional exhaled nitric oxide (FeNO) concentration and recruitment site. In the control group, participants were masked to their adherence and errors in inhaler technique data. A statistician masked to study allocation did the statistical analysis. After a 1-week run-in period, both groups attended three nurse-led education visits over 8 weeks (day 7, week 4, and week 8) and three physician-led treatment adjustment visits at weeks 8, 20, and 32. In the active group, treatment adjustments during the physician visits were informed by digital data on inhaler adherence, twice daily digital peak expiratory flow (ePEF), patient-reported asthma control, and exacerbation history. Treatment was adjusted in the control group on the basis of pharmacy refill rates (a measure of adherence), asthma control by ACT questionnaire, and history of exacerbations and visual management of inhaler technique. Both groups used a digitally enabled Inhaler Compliance Assessment (INCA) and PEF. The primary outcomes were asthma medication burden measured as proportion of patients who required a net increase in treatment at the end of 32 weeks and adherence rate measured in the last 12 weeks by area under the curve in the intention-to-treat population. The safety analyses included all patients who consented for the trial. The trial is registered with ClinicalTrials.gov, NCT02307669 and is complete. Between Oct 25, 2015, and Jan 26, 2020, of 425 patients assessed for eligibility, 220 consented to participate in the study, 213 were randomly assigned (n=108 in the active group; n=105 in the control group) and 200 completed the study (n=102 in the active group; n=98 in the control group). In the intention-to-treat analysis at week 32, 14 (14%) active and 31 (32%) control patients had a net increase in treatment compared with baseline (odds ratio [OR] 0·31 [95% CI 0·15-0·64], p=0·0015) and 11 (11%) active and 21 (21%) controls required add-on biological therapy (0·42 [0·19-0·95], p=0·038) adjusted for study site, age, sex, and baseline FeNO. Three (16%) of 19 active and 11 (44%) of 25 control patients increased their medication from fluticasone propionate 500 μg daily to 1000 μg daily (500 μg twice a day; adjusted OR 0·23 [0·06-0·87], p=0·026). 26 (31%) of 83 active and 13 (18%) of 73 controls reduced their medication from fluticasone propionate 1000 μg once daily to 500 μg once daily (adjusted OR 2·43 [1·13-5·20], p=0·022. Week 20-32 actual mean adherence was 64·9% (SD 23·5) in the active group and 55·5% (26·8) in the control group (between-group difference 11·1% [95% CI 4·4-17·9], p=0·0012). A total of 29 serious adverse events were recorded (16 [55%] in the active group, and 13 [45%] in the control group), 11 of which were confirmed as respiratory. None of the adverse events reported were causally linked to the study intervention, to the use of salmeterol-fluticasone inhalers, or the use of the digital PEF or INCA. Evidence-based care informed by digital data led to a modest improvement in medication adherence and a significantly lower treatment burden. Health Research Board of Ireland, Medical Research Council, INTEREG Europe, and an investigator-initiated project grant from GlaxoSmithKline.

Association of eosinophil-derived neurotoxin levels with asthma control status in patients with aspirin-exacerbated respiratory disease.

The long-term goals of asthma treatment are to achieve well control of symptoms and to minimize the future risk of asthma exacerbation. Identifying biomarkers for uncontrolled asthma is important for improving the asthma outcome. This study aimed to investigate the association of the levels of eosinophil-derived neurotoxin (EDN) with asthma control status in specific asthma phenotype, aspirin-exacerbated respiratory disease (AERD), and aspirin-tolerant asthma (ATA). A total of 136 adult asthmatics, including 47 asthmatics with AERD and 89 asthmatics with ATA, were enrolled. Plasma, sputum, and urine were collected at enrollment and the levels of EDN were measured by the K-EDN ELISA kit. Urinary leukotriene E4 (LTE4 ) level was measured using liquid chromatography-mass spectrometry (LC-MS)/MS methods. Asthma control status was evaluated according to the GINA guideline, asthma control test and asthma control questionnaire scores. In the total study subjects, sputum levels of EDN as well as of urine and plasma EDN showed significantly higher levels in patients with uncontrolled asthma than in those with well-controlled or partly-controlled asthma (ANOVA, p<0.001); in patients with AERD, the sputum EDN levels showed significant correlations with ACT, ACQ, and AQLQ scores (p=0.010, r=-0.536, p=0.001, r=0.665, and p<0.001, r=-0.691, respectively), while no differences were noted in patients with ATA. Sputum EDN level was the only significant factor for ACT, ACQ, and AQLQ scores in patients with AERD (p=0.001, p<0.001, and p<0.001, respectively) in the multivariate analysis adjusting for age, sex, peripheral eosinophil count, and urine LTE4 . The ROC curve analysis demonstrated that sputum EDN can predict uncontrolled asthma with 80% sensitivity and 88.2% specificity for ACT≤19 (area under the ROC curve [AUC]=0.824, p=0.019); 71.4% sensitivity and 86.7% specificity for ACQ≥1.5 (AUC=0.752, p=0.049) only in AERD patients. The level of sputum EDN may be a potential biomarker for identifying the asthma control status in patients with AERD.

Validation of an outpatient questionnaire for bronchopulmonary dysplasia control.

Despite bronchopulmonary dysplasia (BPD) being a common morbidity of preterm birth, there is no validated objective tool to assess outpatient respiratory symptom control for clinical and research purposes. Data were obtained from 1049 preterm infants and children seen in outpatient BPD clinics of 13 US tertiary care centers from 2018 to 2022. A new standardized instrument was modified from an asthma control test questionnaire and administered at the time of clinic visits. External measures of acute care use were also collected. The questionnaire for BPD control was validated in the entire population and selected subgroups using standard methodology for internal reliability, construct validity, and discriminative properties. Based on the scores from BPD control questionnaire, the majority of caregivers (86.2%) felt their child's symptoms were under control, which did not differ by BPD severity (p = 0.30) or a history of pulmonary hypertension (p = 0.42). Across the entire population and selected subgroups, the BPD control questionnaire was internally reliable, suggestive of construct validity (albeit correlation coefficients were -0.2 to -0.4.), and discriminated control well. Control categories (controlled, partially controlled, and uncontrolled) were also predictive of sick visits, emergency department visits, and hospital readmissions. Our study provides a tool for assessing respiratory control in children with BPD for clinical care and research studies. Further work is needed to identify modifiable predictors of disease control and link scores from the BPD control questionnaire to other measures of respiratory health such as lung function testing.

Asthma control among adolescents in the inner provinces of South Africa: Perception v. reality

Proper asthma control can lessen the negative effects of asthma in adolescents, such that they can lead a normal and physically activelife. The study aimed to compare self-reported asthma control and actual test scores among adolescents in the inner provinces (Gauteng and North West) of South Africa. The asthma control test (ACT) questionnaire was administered to 123 of adolescents who had reported doctor-diagnosed asthma during the cross-sectional study. There was a statistically significant difference between self-reported asthma control and actual test scores among study participants (p=0.003). Out of the 90 study participants who claimed that their asthma was controlled, only 25 (27.78%) were correctly classified as ‘controlled’ according to the ACT. A high percentage (72.22%) of adolescents misclassified their asthma as ‘controlled’, whereas it was not. There is a lack of studies on asthma control in Africa.

Different clinical characteristics of current smokers and former smokers with asthma: a cross-sectional study of adult asthma patients in China

Smoking is a trigger for asthma, which has led to an increase in asthma incidence in China. In smokers, asthma management starts with smoking cessation. Data on predictors of smoking cessation in Chinese patients with asthma are scarce. The objective of this study was to find the differences in clinical characteristics between current smokers and former smokers with asthma in order to identify factors associated with smoking cessation. Eligible adults with diagnosed asthma and smoking from the hospital outpatient clinics (n = 2312) were enrolled and underwent a clinical evaluation, asthma control test (ACT), and pulmonary function test. Information on demographic and sociological data, lung function, laboratory tests, ACT and asthma control questionnaire (ACQ) scores was recorded. Patients were divided into a current smokers group and a former smokers group based on whether they had quit smoking. Logistic regression analysis was used to analyze the factors associated with smoking cessation. Of all patients with asthma, 34.6% were smokers and 65.4% were former smokers, and the mean age was 54.5 ± 11.5 years. Compared with current smokers, the former smokers were older, had longer duration of asthma, had higher ICS dose, had more partially controlled and uncontrolled asthma, had more pack-years, had smoked for longer, and had worse asthma control. The logistic regression model showed that smoking cessation was positively correlated with age, female sex, pack-years, years of smoking, partially controlled asthma, uncontrolled asthma, and body mass index (BMI), but was negatively correlated with ACT, FEV1, FEV1%predicted, and widowed status. More than 30% of asthma patients in the study were still smoking. Among those who quit smoking, many quit late, often not realizing they need to quit until they have significant breathing difficulties. The related factors of smoking cessation identified in this study indicate that there are still differences between continuing smokers and former smokers, and these factors should be focused on in asthma smoking cessation interventions to improve the prognosis of patients with asthma.