Asthma Education Program Research Articles

Suboptimal Control of Asthma Among Diverse Patients: A US Mixed Methods Focus Group Study.

PurposeThe US National Asthma Education and Prevention Program updates and Global Initiative for Asthma report encourage considering the patient perspective to improve asthma control. The objective of the present study was to collect data about the perceptions, experiences, and concerns of adult patients and caregivers of children with asthma regarding rescue, maintenance, and oral corticosteroid treatments.Patients and MethodsIn-person focus groups were conducted in three cities across the US. Participants also completed patient-reported outcome measures assessing asthma control and experiences.ResultsFocus groups were conducted in demographically and clinically diverse adults with asthma (five groups, n=34), caregivers of children with asthma (five groups, n=35), and adults with a dual diagnosis of asthma and chronic obstructive pulmonary disease (one group, n=5). Only 28% of patients were well-controlled by Asthma Control Test/Asthma Control Test-Caregiver Report and 18% by Asthma Impairment and Risk Questionnaire. Forty-four percent of participants reported not following their prescribed medical plan. Four key themes emerged from the focus groups: (1) asthma symptom control and monitoring are often inadequate; (2) treatments are often used incorrectly; (3) communication between health care professionals and patients or caregivers is often ineffective; and (4) concerns related to treatment and desires to improve treatment.ConclusionControl of asthma symptoms is suboptimal in the vast majority of patients and both patients and caregivers do not feel sufficiently informed about asthma. Health care providers should be encouraged to engage patients and caregivers in shared decision making for managing asthma and selecting treatments that integrate patient values, preferences, and lifestyles.

The Impact of Theoretical and Practical Guidance Regarding Metered Dose Inhaler Technique on Asthma Patients

Published on:August 2022Journal of Young Pharmacists, 2022; 14(3):327-332Original Article | doi:10.5530/jyp.2022.14.64 Authors: Sara Shahid1,2,*, Fahad Ahmed3, Gul Shahnaz1, Muhammad Saqlain1, Muhammad Ans4, Anosh Sana1, Abdul Nazer Ali5, Ahmad Kamal Ariffin Abdul Jamil6, Asma Fareed Khan7,8, Saba Naeem9, Shakeel Ahmad9, Aiman Mahmood4,9, Qandeel Rafi9, Asifa Anwar2, Rabeel Khan2, Naeem Mubarak2 1Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, PAKISTAN. 2Department of Pharmacy Practice, Lahore Pharmacy College, Lahore Medical and Dental College, University of Health Sciences, Lahore, PAKISTAN.3Faculty of Pharmacy, University of Sargodha, Sargodha, PAKISTAN.4University College of Pharmacy, University of the Punjab, Lahore, PAKISTAN.5Department of Pharmacy Practice, Geethanjali College of Pharmacy, Hyderabad, Telangana, INDIA.6Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, UniSZA, Besut, Terengganu, MALAYSIA.7Disciplines of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, MALAYSIA. 8Children’s Hospital & University of Child Health Sciences, Lahore, PAKISTAN. 9Department of Pharmaceutics, Lahore Pharmacy College, Lahore Medical and Dental College, University of Health Sciences, Lahore, PAKISTAN. Abstract: Background: Asthma is rapidly increasing globally. Inhalation therapy is the backbone for asthma management due to localized delivery and rapid onset of action. Currently, metered dose inhalers (MDIs) are the most widely prescribed and dispensed inhaler devices worldwide due to the advantage of portability, multiple dose delivery and better efficacy. Objectives: The current study aimed to access the effect of educational intervention on asthma patients’ competency regarding pressurized metered dose inhaler (pMDI) technique. Methods: Asthma patients were recruited from Pakistan Institute of Medical Sciences (PIMS) Islamabad, Pakistan. Inhaler technique steps based upon “National Asthma Education and Preventive Program” (NAEPP) criteria was set as evaluating tool to evaluate competency of asthma patients regarding MDI appropriate technique. Intervention involved educating study subjects (asthma patients) practically through placebo inhaler and theoretically through inhaler technique directed literature brochures. Pre intervention and post intervention inhaler technique competency was accessed and evaluated statistically. Results: Among 207 asthma patients, majority were never instructed by healthcare professional regarding inhaler technique (78.8%). However, most of the patients were observed to have inadequate inhaler technique (76.3%) at baseline. As the result of educational intervention, the competency of patients regarding inhaler technique was significantly enhanced from 11.6% pre-intervention to 34.8% post-intervention (p<0.001), statistically analyzed by McNemar testing. Conclusion: Originally, inhaler technique competency of majority of asthma patients was observed to be inappropriate. However, educational intervention proved to be effective in substantially enhancing the competency of study subjects regarding MDI technique. Keywords: Asthma, Inhalation therapy, Metered-dose inhalers, Educational intervention, National Asthma Education and Preventive Program.

Optimizing pediatric asthma education using virtual platforms during the COVID-19 pandemic

BackgroundWe compared patient and caregiver knowledge and confidence for managing asthma, and participant experiences when comprehensive asthma education was delivered in person versus in the virtual setting.MethodsWe performed a multi-methods study using structured surveys and qualitative interviews to solicit feedback from patients and caregivers following participation in a comprehensive asthma education session between April 2018 and October 2021. We compared participant knowledge and confidence for managing asthma as well as user experience when the education was attended in-person or virtually. Quantitative responses were summarized descriptively, and qualitative feedback was analyzed for major themes.ResultsOf 100 caregivers/patients who completed post education satisfaction surveys and interviews, 52 attended in person and 48 virtually, with the mean age of patients being 6.7 years (range: 1.2–17.0). Participant reported gains in knowledge and confidence for asthma management were not different between groups and 65.2% preferred attending virtual asthma education. The majority of participants described virtual education as a safer modality that was more convenient and accessible.ConclusionsWe demonstrated the successful implementation of a novel, virtual asthma education program for patients and caregivers of children with asthma. Both virtual and in-person delivered asthma education were equally effective for improving perceived knowledge and confidence for asthma self-management and virtual education was considered safer, more convenient and accessible. Virtual asthma education offers an attractive and effective option for improving the reach of quality asthma education programs and may allow more children/patients to benefit.

The Impact of an Educational Intervention on the Skill of Community Pharmacists in the Use of a Pressurized Metered-dose Inhaler: A Covert Simulated Patient Approach in Pakistan

Introduction: Metered-dose inhalers are the most widely prescribed and dispensed inhaler devices worldwide for the management of asthma. The present study aimed to access the impact of educational intervention on the competency of community pharmacists of Islamabad, Pakistan regarding the pressurized metered-dose inhaler (MDI) technique. Materials and Methods: The intervention involved educating pharmacists practically through placebo inhalers and theoretically through literature brochures; based upon the “National Asthma Education and Preventive Program” inhaler technique. A total of 100 pharmacists were recruited from the rural and urban sectors of Islamabad. A covert simulated patient approach was used to evaluate the inhaler technique of pharmacists. Type of pharmacy, education status of pharmacists and the influence of already received training on the use of inhaler devices were the factors that demonstrated a significant positive association with the competency of pharmacists. Results: McNemar test was applied for pre and post-intervention intragroup comparisons to further access categorical variables. A p-values &lt;0.05 were considered statistically significant. The competency of pharmacists increased significantly from 24% before intervention to 33% after intervention (p&lt;0.001). Conclusion: Originally, the inhaler technique competency of the majority of pharmacy professionals was observed to be inappropriate. However, the educational intervention proved to be effective in substantially enhancing the skill of community pharmacists regarding the MDI technique.

Assessment of Control of Bronchial Asthma in Children Using Childhood Asthma Control Test

The use of Childhood Asthma Control Test (C-ACT) has been advised for monitoring asthma control by the Global Initiative for Asthma (GINA) guidelines. To validate the tool C-ACT for the assessment of control of asthma and to examine the correlation between C-ACT score and lung function assessed by forced expiratory volume in one second (FEV1). This was a prospective observational study conducted between January 2010 to January 2011. Children diagnosed to have bronchial asthma and aged 5 to 14 years, were enrolled in the study. Asthma severity and control status were classified according to the National Asthma Education and Prevention Programme (NAEPP) and GINA guidelines, respectively. Patients were followed-up at three and six months and C-ACT and spirometric measurements were obtained. Significant positive correlations were found between C-ACT score and FEV1 at enrollment (r = 0.772) (p < 0.001), three months (r = 0.815) (p < 0.001) and at six months follow-up (r = 0.908) (p < 0.001). Baseline C-ACT score was useful for predicting the levels of control of asthma upto three months (0.004), but not at six months follow-up (0.787). A cut-off C-ACT value of > or = 19 had a sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) 98.5%, 89.1%, 94.9%, 96.6%, 0.717, respectively for the control of asthma. C-ACT is a simple and feasible tool to assess and predict the levels of control in children with bronchial asthma upto three months.

Comparison of three alternatives for the management of moderate asthma in children aged 6–11 years: a cost-utility analysis

Background Recent asthma guidelines for children 6–11 years with persistent asthma advocate three alternatives: SMART (budesonide/formoterol 80/4.5 mcg qd plus additional doses as needed), fixed combination of budesonide/formoterol, and fixed-dose budesonide. Concerns have arisen as to which of the proposed alternatives has the best possible cost-effectiveness profile. This study aimed to assess the health and economic consequences of SMART, fixed combination, and fixed-dose budesonide therapy in children 6–11 years old with persistent asthma. Methods A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with persistent asthma. Total costs and QALYs of SMART, fixed combination, and fixed-dose budesonide therapy were calculated over a time horizon of 6 years. Multiple sensitivity analyses were conducted. Results The mean QALY per patient was 0.57 and 0.56 QALYs per patient per year of SMART and fixed combination and 0,52 with fixed-dose budesonide. The total mean of discounted costs per patient per cycle were US$111 for SMART, US$133 for fixed combination, and US$67 for fixed-dose budesonide. The net monetary benefit of SMART was US$12,549, US$12278 for fixed combination, and US$11,380 for fixed-dose budesonide Conclusion Our study showed that SMART was more cost-effective than fixed combination and fixed-dose budesonide. These findings complement and support the GINA 2021 and National Asthma Education and Prevention Program asthma guideline recommendations for use of inhaled corticosteroids–formoterol in children 6–11 years old with persistent asthma.

Does kinesiophobia limit physical activity and quality of life in asthmatic patients?

Kinesiophobia has been studied in musculoskeletal and neurological diseases. The aim of this descriptive study was to assess the level of kinesiophobia in stable asthmatic patients, and to determine whether it is an obstacle to physical activity and quality of life. A total of 62 asthmatic patients and 50 healthy control subjects were assessed using the tampa kinesiophobia scale (TSK) for kinesiophobia, International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity levels, and Asthma Quality of Life Questionnaire (AQLQ) for quality of life. A high degree of kinesiophobia was determined in 54.8% of the asthmatic patients. The TSK scores were significantly higher ( P < 0.001), and the AQLQ scores were lower in the asthma group than in the control group ( P < 0.001). The IPAQ-SF level and AQLQ score were lower ( P < 0.001 for both) in the asthmatic group with a high kinesiophobia score. The TSK score was significantly associated with IPAQ-SF score ( r = -0.889; P < 0.001) and AQLQ score ( r = -0.820; P < 0.001) in asthmatic patients. According to linear regression analysis, kinesiophobia explained 84.40% of QoL and physical activity. Patients with a stable asthma were observed to have a high level of kinesiophobia compared with healthy subjects. High kinesiophobia levels may increase the disease burden by negatively affecting participation in physical activity and quality of life. While developing asthma education programs for asthma patients, it should be remembered that even in the stable period, kinesiophobia can develop. Preventive and therapeutic programs should include precautions to improve quality of life and physical activity against the effects of kinesiophobia.

Asthma Smarts Education: Increased Disease Knowledge and Reduced School Nurse Visits.

Worldwide, asthma is one of the most prevalent chronic diseases. Lack of asthma knowledge can lead to exacerbations, emergency room visits, absenteeism, and decreased quality of life. Asthma prevalence in Milwaukee Public Schools (MPS) is often 20% or higher, and among children ages 5 to 17, asthma is a leading cause of missed school days. A community collaboration created an asthma education program tailored to MPS needs. The purpose of this study was to evaluate the efficacy of brief, school-based asthma education for students with asthma in grades three to five. A prospective cohort study of students with asthma in third to fifth grades was developed to assess asthma knowledge improvements via survey (n = 2,066) before and after implementing three 30-minute Asthma Smarts lessons delivered one week apart. Additionally, MPS data was analyzed to explore impact on asthma-related school nursing visits (n = 110). Improvement upon post-testing was shown for all questions in each implementation year with highly significant results (all P &lt; 0.0001). Students that participated in Asthma Smarts made fewer asthma-related visits to the school nurse with a significant difference in the mean number of visits pre and post program (P &lt; 0.001). This project demonstrates potential for mutually beneficial partnerships addressing gaps in school-based nursing services, and successful support for students with asthma.

Asthma education and its impact on pediatric asthma severity: a prospective cohort study

Objective Asthma education has been shown to improve asthma control. Our goal was to evaluate the efficacy of asthma education on the frequency of utilization of health-care services, lung function results, degree of asthma severity, and quality of life (QOL) level in children with asthma. Methods A single-arm prospective interventional trial was conducted in a tertiary facility. Thirty children with asthma and their parents were recruited for the research. Following an assessment of the participants’ and caregivers’ knowledge about asthma using an asthma knowledge questionnaire, degree of asthma control using asthma control test, inhaler technique using standardized inhaler technique checklists, and QOL using pediatric asthma QOL questionnaires, they participated in a three-month education program in the form of monthly live interactive sessions followed by weekly phone interviews. Measures taken before and after the intervention were compared. Results The educational intervention improved asthma control dramatically including daytime asthma symptoms, night awakenings, and frequency of use of short-acting beta2- adrenergic receptor agonists. Furthermore, the number of emergency department visits and hospitalizations fell considerably after the intervention (p < 0.001 for all). Asthma education was also linked to better inhalation technique and lung function (p < 0.001). Furthermore, all quality-of-life measures increased (p < 0.001 for all). Conclusions Implementing an asthma education program that included both children with asthma and their parents improved asthma control levels, lung function measures, and overall quality of life. Furthermore, it increased asthma awareness, decreased the use of health-care resources, and reduced asthma severity, resulting in better asthma management.

Perceptions towards childhood asthma and barriers to its management among patients, caregivers and healthcare providers: a qualitative study from Ethiopia

BackgroundThe management of asthma, which is one of the major causes of childhood morbidity and mortality has been affected by non-adherence to recommended treatment regimens with severe consequences. The aim of the present study was therefore to explore the perceptions of the children with asthma, their caregivers and their healthcare providers towards asthma and barriers to long term childhood asthma management in an institutional setting in Addis Ababa, Ethiopia.MethodsA qualitative descriptive design was followed for the present study that used individual interviews as a data collection method. The study participants were 23 pairs of children with asthma that had treatment follow-ups in two tertiary hospitals and their caregivers and eight healthcare providers who cared for these children. The data was analyzed using thematic analysis approach.ResultsThe study findings revealed that the children’s reported adherence to the recommended treatment regimens was low and they along with their caregivers were facing physical, emotional and social burdens related to asthma. Some of the influencing factors affecting childhood asthma management were found to be the low-level implementation of the asthma management guidelines by the healthcare providers, limited awareness about asthma and its management by the children and their caregivers, use of traditional home remedies and religious healing on a complementary and alternative basis and inadequate education received from healthcare professionals. Further identified barriers to the adherence of especially inhaled corticosteroids appear to be the low necessity beliefs towards chronic administration of treatment regimens and concerns related with difficulty of administration, fear of side effects and general negative attitude towards it, in addition to their low availability and affordability.ConclusionsLow awareness of the biomedical treatment regimens and use of traditional home remedies and religious healing by the children with asthma and their caregivers, the low-level implementation of the asthma management guidelines as well as low access to medications may among other things contribute to the low adherence of the children to their recommended regimens. The findings support the need for implementation of asthma management guidelines, institution of strong asthma care and education programs that are sensitive to local and individual patients’ and caregiver perceptions and experiences including emotional distress, the need to institute chronic care approach and ways to address patients’ medication access issues.

A Cost-Effectiveness Analysis of a Community Health Worker Led Asthma Education Program in South Texas

PurposeThis paper examines the cost-effectiveness of an asthma-related education program.Materials and MethodsUsing a pre and post approach, the paper calculates first changes in cost due to variations in outcome (from baseline to follow-up). We also estimate cost-effectiveness ratios for each of the eight outcomes (numbers of asthma attacks, hospital, and ER visits, and physical and emotional health, and activity levels of both children and family members).ResultsThe intervention saved the household around $36 per day. Cost-effectiveness ratios ranged between less than $2.2 for children and family members’ physical and emotional health, and activity levels to between $4.1 and $82.8 for asthma attacks and hospital visits. Cost-benefit results showed minimal benefit due to conservative estimates. We could not quantify the economic value of physical and emotional health improvement seen based on the measures.ConclusionCost savings and ratios suggest that such a program could reduce health disparities due to improved knowledge, decreasing exposure to asthma triggers, enhancing health outcomes, and improving the quality of life of the children with asthma and their whole family.

Patients with Severe Uncontrolled Asthma: Perception of Asthma Control and its Management.

IntroductionThe aim of our observational study was to understand how patients with uncontrolled severe asthma perceive asthma control, and to assess their views on the role of healthcare professionals (HCPs) and other stakeholders in asthma management.MethodsIn total, 200 patients with uncontrolled, severe asthma living in Canada, France, Germany, Italy, Spain, the UK, or the USA registered on the Carenity asthma community responded to a patient survey.ResultsWhile 62% of respondents indicated they knew a lot about asthma, they were not entirely satisfied with its control. The two most helpful tools considered important in long-term asthma control were centered on learning, with tips on asthma control (76%), as well as information on asthma and its causes (67%). Although asthma education programs were accessible to less than half (44%) of the respondents, 72% said they would find them useful. In the previous year, most patients (78%) consulted a specialist; however, while 54% of respondents participated in shared decision-making (SDM) concerning their treatment, less than one-third (29%) felt their opinion had been considered, and only 27% said it helped their HCPs to develop an informed action plan. However, 48% believed that SDM would help them feel more confident in achieving long-term control. Most respondents consulted emergency room doctors or nurse practitioners because of their uncontrolled severe asthma, finding them persuasive sources of information. Additionally, patient advocacy organizations (PAGs) were considered as a preferred (12%) or persuasive (6%) source by only a few patients.ConclusionMost people with uncontrolled severe asthma were well informed about their disease. However, better information on asthma management would be useful for patients, with HCPs involved in this process. SDM was welcomed by respondents, but, to be successful, the patients’ opinions should be taken into consideration when forming an asthma management action plan.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41030-022-00190-z.

A Multi-Mode Education Program to Enhance Asthma Care by Pharmacists

Objective. To provide optimal asthma care, community pharmacists must have advanced, contemporary knowledge, and the skills to translate that knowledge into practice. The development and evaluation of an innovative multi-mode education program to enhance pharmacists' clinical knowledge and practical skills is described.Methods. The online education modules were collaboratively developed alongside asthma and pharmacy organizations. The education program was comprised of five evidence-based education modules delivered online and a skills review conducted either in-person with real-time feedback (urban pharmacists) or via video upload and scheduled video-conference feedback (regional and remote pharmacists). A mixed methods approach was used to evaluate the feedback obtained from pharmacists to assess the content, efficacy, and applicability of the education.Results. Ninety-seven pharmacists opted into the program and successfully completed all education requirements. A larger proportion of pharmacists did not pass trial protocol-based education modules on their first attempts compared to the number that passed the asthma and medication knowledge-based modules. Prior to skills review, the proportion of pharmacists demonstrating device technique competency was suboptimal. Pharmacists rated the education modules highly in both quantitative and qualitative evaluations and reported that the program adequately prepared them to better deliver care to asthma patients.Conclusion. We developed, implemented, and evaluated a novel multi-mode asthma education program for community pharmacists that supports knowledge and practical skill development in this crucial area of patient care. The education program was well received by pharmacists. This form of education could be used more broadly in international collaborative trials.

Asthma guidelines: comparison of the National Heart, Lung, and Blood Institute Expert Panel Report 4 with Global Initiative for Asthma 2021.

Asthma continues to be a prevalent respiratory disease that affects lives within the United States and worldwide. Clinical asthma guidelines based on scientific evidence on testing and therapeutic interventions are needed to control this disease better. To meet this need, the NAEPP (National Asthma Education and Prevention Program) and GINA (Global Initiative for Asthma) were formed to assist with best practice diagnosis and treatments for asthma. This paper reviews the subtle differences and similarities between the most recent recommendations put forth by NAEPP 2020 and GINA 2021, mainly examining the six selected topics, as well as methodology, guidance on emerging topics, and implementation. In December 2020, the National Asthma Education and Prevention Program Coordinating Committee released their focused update on fraction of exhaled nitric oxide, indoor allergen mitigation, inhaled corticosteroids, long-acting muscarinic antagonists, allergen immunotherapy, and bronchial thermoplasty. The Global Initiative for Asthma comprehensive document is published annually as a framework for all nations. Therefore, it is timely to consider the National Asthma Education and Prevention Program Coordinating Committee 2020 in relation to the GINA 2021. The comparison provides a better understanding of evidence-based recommendations for asthma. The NAEPP 2020 and GINA 2021 will equip providers with the knowledge to provide their patients with the best and most updated asthma care.

Implementation of an internet-based asthma patient education program in primary care: results of a single-arm trial

Objective: Asthma education programs (AEPs) for patients are known to be important to provide skills to effectively manage the disease. We developed an electronic AEP (eAEP) and assessed the extent to which patients with asthma in primary care are capable to use the eAEP and whether asthma knowledge improved after eAEP. Methods: A single-arm pilot study was performed between November 2019 and December 2020 in 12 general practices in Upper Bavaria, Germany. Asthma knowledge was assessed by the Asthma Knowledge Test (AKT) at baseline, 2 weeks after completion of the eAEP, as well as after 3 and 6 months. AKT sum scores at baseline and follow-up were compared with each other using the Wilcoxon test. Results: In total, 72 patients with asthma were included, of whom all participated in the 2-week follow-up, while data on the 3- and 6-month follow-up was available in 62 and 51 patients, respectively. The eAEP was well accepted and positively evaluated by participants. The mean AKT score significantly (p < .001) increased from 22.8 ± 11.0 at baseline to 44.6 ± 8.3 two weeks after completion of the eAEP. After 3 months, the mean score was still 41.8 ± 7.6, and after 6 months it was 40.2 ± 9.3 (p < .001 each compared to baseline). Conclusions: The internet-based asthma education program was well accepted by primary care patients and resulted in a major increase of asthma knowledge. Thus, it has the potential to be an important adjunct in the treatment of patients with asthma in general practice.

SMART - is it practical in the United States?

The 2020 focused updates to the asthma management guidelines by the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group advocate for inhaled corticosteroid (ICS)-formoterol combinations as single maintenance and reliever therapy (SMART) for patients with persistent asthma. We review the rationale, the evidence supporting SMART use in asthma, and barriers limiting its wide adoption in the United States. A growing body of evidence supports the use of SMART over the conventional use of controller medicaments with an as-needed short-acting β2 agonist for rescue therapy for the purpose of reducing the risk of asthma exacerbation and maintaining asthma control in adolescents and adults with persistent disease. Lack of US Food and Drug Administration approval, inconsistent insurance coverage, and limited options of ICS-formoterol combination available for use as SMART represent obstacles to wider integration of SMART in clinical practice. SMART represents a paradigm shift in asthma management. By identifying and addressing the current and anticipated barriers to implementing SMART, its adoption by providers is likely to increase in the United States.

Stakeholders’ views of supporting asthma management in schools with a school-based asthma programme for primary school children: a qualitative study in Malaysia

ObjectiveThe WHO Global School Health Initiative aimed to improve child and community health through health promotion programmes in schools, though most focus on preventing communicable disease. Despite WHO recommendations, no...

Relaxation Effect of Extract Ethanol Curcuma Longa on Isolated Guine Pig Trachea

Aims: Asthma is a chronic obstructive pulmonary disease which is a world health problem that is not only infected in developed countries but also in developing countries. According to the National Asthma Education and Prevention Program (NAEPP), asthma can be defined as a chronic inflammatory disorder that occurs in the airways, which involves inflammatory cells. curcumin reduces allergic airway inflammation in mice through inhibition of a specific pathway aimed at investigating the anti-inflammatory effect of curcumin in acute allergic asthma and its underlying mechanisms in mice.&#x0D; Study Design: This study is experimental study.&#x0D; Methodology: The experimental animals were divided into 2 groups, each group consisting of 4 animals. Group 1 gave theophline as a positive control group and group 2 was given extracts with concentrations (1 mg / ml, 2 mg / ml, 3 mg / ml, 4 mg / ml, 5 mg / ml, 6 mg / ml, 7 mg / ml and 8 mg / ml). These animals are acclimatized for 1 (one) week with the aim of homogenizing their food and life with the same conditions so that they are considered eligible for research.&#x0D; Results: The ethanol extract of curcuma longa has no different ability from atropine sulfate 1 x 10-6 M in reducing the smooth muscle contraction of isolated guinea pig tracheal induced by acetylcholine, the strength of acetylcholine without incubation contraction compared to acetylcholine with EETH incubation showed statistically different results (p&lt;0.05).&#x0D; Conclusion: The mechanism of the relaxing effect of curcuma longa on isolated mouse smooth muscle is mediated through inhibition of the PDE enzyme.

Effectiveness of a Home- and School-Based Asthma Educational Program for Head Start Children With Asthma: A Randomized Clinical Trial

To evaluate if a multilevel home and preschool asthma educational program is more effective in improving asthma control, compared with a preschool-based program alone. Specifically, because this study was conducted within the Head Start program and targeted at an at risk population, with the study, the researchers examined if their multilevel intervention could address asthma disparities.Eligible participants were caregivers with children aged 2 to 6 years with the confirmed physician-diagnosed of asthma who were also enrolled in one of 14 Head Start programs in Baltimore, Maryland. Participants were recruited from April 1, 2011, to November 31, 2016.Screening forms were provided through Head Start staff, and families who gave permission were contacted by telephone to confirm eligibility and schedule the first home visit. Families were randomly assigned to either the Action for a Better Community (ABC) Plus Head Start education group or the Head Start education alone group by using a 1:1 block randomization scheme. Families were not blinded to their random assignment, but the research assistants who completed assessments were blinded and were different from the intervention staff. The ABC family intervention consisted of 4 30- to 45-minute in-person, at-home asthma management educational sessions and 3 booster calls. Assessment visits were completed by research assistants: in home visits at baseline and 6 months and telephone visits at 3, 9, and 12 months. The primary outcome was the Test for Respiratory and Asthma Control in Kids (TRACK) score to assess the degree of asthma control. Caregiver reports of emergency department visits, hospitalizations, and courses of oral corticosteroids (OCS) in the previous 3 months were collected at each assessment visit. Caregiver health–related quality of life was measured by using the Pediatric Asthma Caregiver’s Quality of Life Questionnaire.A total of 398 families were randomly assigned to either the ABC Plus Head Start educational program (n = 199) or Head Start educational program alone (n = 199). Most participants were Black (379 [95.2%]) and had a family income of less than $40 000 a year (357 [89.7%]). There were no significant group differences on any demographic characteristic. Of those in the intervention group, 144 (72.4%) completed at least 1 home education session, 69 (34.7%) completed all 4 home visits, and 71 (35.8%) completed all the booster telephone calls after the 3-, 6-, and 9-month follow-up surveys. Although there was an overall improvement in TRACK total scores for both groups over time (β = 3.00; 95% confidence interval (CI): 2.47 to 3.54; P < .001), those in the intervention group had clinically significant score differences at 3 months, compared with that of those in the control group (β = 6.26; 95% CI: 1.77 to 10.75; P < .001). There was no significant difference in TRACK scores among groups at months 6, 9, and 12. Participants in the intervention group were significantly less likely to have OCS use at 9 months (β = −0.61; 95% CI: −1.13 to −0.09; P = .02) and hospitalization during the 12-month follow-up period (odds ratio: 0.36; 95% CI: 0.21 to 0.61; P < .001). There was a significant improvement in asthma-related quality of life at 12 months for both groups (β = 0.28; 95% CI: 0.19 to 0.38; P < .001) but no difference between intervention and control groups.The multilevel asthma education intervention decreased several measures including asthma symptom scores at 3 months, OCS use at 9 months, and decreased hospitalizations during the 12-month follow-up period.This educational program revealed modest improvements in asthma control and health care use. It is not entirely clear why TRACK scores only revealed differences at 3 months and OCS use at 9 months; however, the decrease in asthma hospitalization during 12-month follow-up indicates a true significant effect, especially because preschool-aged children have the highest risk for use of health care services. However, it should be noted that health care resources for asthma outcomes was collected via caregiver report and not verified by using medical records, possibly leading to bias. Overall, with this study, the authors highlight how implementation of an asthma educational program by using a community partner was an effective strategy for targeting a population disproportionately affected by health disparities.

Investigating the Outcomes of an Asthma Educational Program and Useful Influence in Public Policy.

The study was conducted to evaluate the effectiveness of an asthma educational program for asthma control, asthma self-management, asthma knowledge, and patient activation. The study analyzes different demographic variables with the purpose of investigating which asthma patients performed better than others. Based on these demographic characteristics, the study provides several recommendations for various stakeholders. The study is based on a positivist approach since its purpose is to investigate the consequences of an asthma educational program with a view to generalizing the results to a larger population. The study targets public and private hospitals which have applied the asthma educational program in collaboration with the Saudi Initiative for Asthma (SINA). Multiple questionnaires were deployed 263 valid responses were received from patients of public and private hospitals using online and offline data collection method. Several parametric and non-parametric tests were carried out in terms of data analysis. The results reveal that patients in the intervention group obtained high scores and were therefore more knowledgeable and able to control their asthma compared to the control group. Overall, patients in the intervention group performed better in terms of asthma control, asthma self-management and knowledge and awareness. There was a high level of patient activation in this group. In the context of demographic features, it was found that patients who are married and are undergraduate degree holders in employment scored high compared to patients who were young, single, post-graduate degree holders that were mainly self-employed. The results of this study can guide policy makers, SINA authorities, and hospitals as to which demographic category of asthma patients require immediate attention. The significance of asthma educational programmes has increased especially through social media platforms as the number of adult patients continues to increase day by day.