Asthma Emergency Research Articles

Short-term nitrogen dioxide exposure and asthma emergency hospital admissions in children: a case-crossover study in England

Short-term nitrogen dioxide exposure and asthma emergency hospital admissions in children: a case-crossover study in England

Community Interventions for Childhood Asthma ED Visits and Hospitalizations: A Systematic Review.

Structural and social determinants of childhood asthma inequities manifest within geographic communities that are often segregated. Childhood asthma disproportionately affects Black, Hispanic, and low-income populations. Community interventions have the potential to improve inequities in emergency healthcare. This systematic review was conducted to assess the effectiveness of childhood asthma community interventions and provide a conceptual model to inform implementation of future community interventions. Publications from PubMed, ScienceDirect, CINAHL, Cochrane Library, Web of Science, and hand searched references were examined from 2010 to 2021. Community intervention studies among children with asthma were included. Main outcomes were emergency department visits and hospitalizations. Community interventions exclusively focusing on schools or hospitals were excluded. Two reviewers independently assessed eligibility for final inclusion. Emergency healthcare findings were extracted in addition to co-benefits (eg, fewer missed school days and caregiver workdays). Out of 1856 records, 26 publications met the inclusion criteria. Community interventions were categorized by care coordination (n = 8), policy and environmental changes (eg, smoke-free legislature, traffic reduction models, and green housing) (n = 8), home-based (n = 6), and community-based health services (n = 4). Selected studies indicated that community interventions significantly reduced childhood asthma emergency department visits and hospitalizations through increased caregiver self-efficacy, home environmental trigger reduction, and increased access to healthcare. Because of heterogeneity among studies, we were unable to conduct a meta-analysis. Findings show significant associations between community interventions and the reduction of emergency healthcare, suggesting a protective effect for severe cases of childhood asthma.

Age-dependent rebound in asthma exacerbations after COVID-19 lockdown.

BackgroundVirus mitigation measures enacted early in the coronavirus infectious disease 2019 (COVID-19) pandemic suppressed common respiratory viruses and reduced the number of obstructive lung disease exacerbations. However, many localities began to ease these precautions in the year 2021, leading to a resurgence of non-COVID viruses. How asthma and chronic obstructive pulmonary disease (COPD) activity responded to this upswing in viral abundance is unclear.ObjectiveOur aim was to examine how viral resurgence during the relaxation of COVID-19 restrictions affected asthma and COPD exacerbations.MethodsWe analyzed electronic medical records for emergency department (ED) respiratory virus positivity, asthma visits, and COPD visits. We compared the 52-week interval before the COVID-19 restrictions (the pre-lockdown period [March 22, 2019–March 19, 2020]), the 52-week period immediately following enactment of the restrictions (the lockdown period [March 20, 2020–March 18, 2021]), and the 52-week period thereafter (the post-lockdown period [March 19, 2021–March 18, 2022]). We used MetaCYCLE to analyze seasonal trends in our data.ResultsThe post-lockdown period was marked by a 400% increase in viral positivity compared with during the lockdown period. Asthma- and COPD-related ED visits each rose 37% compared with during the lockdown, with the rebound in asthma ED visits concentrated in individuals younger than 20 years. Interestingly, after the lockdown period, asthma ED visits overcorrected in children younger than 5 years, rising 81% compared with before the lockdown. Seasonal rhythms in asthma and COPD exacerbations were suppressed during the lockdown and recovered after the lockdown.ConclusionsCOVID-19 precautions had the unexpected effect of magnifying early-childhood asthma activity once common respiratory viruses recurred. These results may have implications for the future use of virus mitigation strategies in young children.

Effectiveness of a community-driven, asthma intervention: project asthma in-home response

Objectives: Project Asthma In-home Response (AIR) is a multilevel, home-based intervention to address childhood asthma. This study aims to assess the effectiveness of the community-driven, multilevel Project AIR intervention. We hypothesize that children participating in the Project AIR intervention will have reduced asthma-related emergency room visits, hospitalizations, and asthma exacerbations. Methods: Seventy-Five participants of an in-home asthma intervention were surveyed at the onset of intervention and six months after the intervention. Results: The mean age of clients in the sample population was ten years. Most clients in the sample population were 11–15 years old (34.7%), followed by 6–10 years old (29.3%) and 3–5 years (26.0%). Participation in the Project AIR intervention resulted in significant reductions in asthma attacks (p-value 0.0003), asthma-related emergency room visits (p-value > 0.0001), and asthma-related hospitalizations (p-value 0.008).Conclusion: The results of this study support that in-home environmental asthma programs are an efficient method of treating asthma in a smaller metro area. Our findings reinforce prior studies in larger metropolitan areas such as New York and Boston.

Road traffic density and recurrent asthma emergency department visits among Medicaid enrollees in New York State 2005–2015

BackgroundEnvironmental exposures such as traffic may contribute to asthma morbidity including recurrent emergency department (ED) visits. However, these associations are often confounded by socioeconomic status and health care access.ObjectiveThis study aims to assess the association between traffic density and recurrence of asthma ED visits in the primarily low income Medicaid population in New York State (NYS) between 2005 and 2015.MethodsThe primary outcome of interest was a recurrent asthma ED visit within 1-year of index visit. Traffic densities (weighted for truck traffic) were spatially linked based on home addresses. Bivariate and multivariate logistic regression analyses were conducted to identify factors predicting recurrent asthma ED visits.ResultsIn a multivariate model, Medicaid recipients living within 300-m of a high traffic density area were at a statistically significant risk of a recurrent asthma ED visit compared to those in a low traffic density area (OR = 1.31; 95% CI:1.24,1.38). Additionally, we evaluated effect measure modification for risk of recurrent asthma visits associated with traffic exposure by socio-demographic factors. The highest risk was found for those exposed to high traffic and being male (OR = 1.87; 95% CI:1.46,2.39), receiving cash assistance (OR = 2.11; 95% CI:1.65,2.72), receiving supplemental security income (OR = 2.21; 95% CI:1.66,2.96) and being in the 18.44 age group (OR = 1.59;95% CI 1.48,1.70) was associated with the highest risk of recurrent asthma ED visit. Black non-Hispanics (OR = 2.35; 95% CI:1.70,3.24), Hispanics (OR = 2.13; 95% CI:1.49,3.04) and those with race listed as “Other” (OR = 1.89 95% CI:1.13,3.16) in high traffic areas had higher risk of recurrent asthma ED visits as compared to White non-Hispanics in low traffic areas.ConclusionWe observed significant persistent disparities in asthma morbidity related to traffic exposure and race/ethnicity in a low-income population. Our findings suggest that even within a primarily low-income study population, socioeconomic differences persist. These differences in susceptibility in the extremely low-income group may not be apparent in health studies that use Medicaid enrollment as a proxy for low SES.

The Impact of Payment Reforms on the Safety Net: Examining Effects of the New Jersey Delivery System Reform Incentive Payment Program on Quality of Care Among Medicaid Beneficiaries.

The Medicaid Delivery System Reform Incentive Payment (DSRIP) program has been among the most widely adopted value-based payment strategies to drive improved population health management among safety net populations. Using comprehensive claims data from New Jersey and difference-in-differences modeling, the authors examine the impact of DSRIP pay-for-performance disease management programs on outcomes related to targeted chronic conditions. The authors find DSRIP reduced asthma hospitalizations and emergency department visits, pneumonia readmissions, and improved alcohol and drug treatment. Positive program-specific findings are encouraging for future DSRIP-like initiatives and demonstrate provider ability to successfully adapt to payment reforms.

Prevalence and associations among metabolically unhealthy obesity, asthma exacerbations, and emergency department use

BackgroundHelper type 1 T cell polarization and monocyte cell activation influence forced expiratory volume in 1 second/forced vital capacity and are affected by body mass index (BMI), insulin resistance, and serum lipoproteins. No study has assessed the impact of metabolic syndrome components on asthma symptom control. ObjectiveTo determine the prevalence of patients with metabolically unhealthy obesity (MUO) and asthma. Our secondary objective was to compare the strength of associations among asthma outcomes in patients with obesity measured by BMI, waist circumference, and MUO. MethodsA cross-sectional analysis of the combined 2011 to 2016 cycles of the National Health and Nutrition Examination Survey was performed among persons with asthma. Metabolically unhealthy obesity was defined as a BMI of at least 30 kg/m2 and one of the following: increased waist circumference, insulin resistance, low physical activity, hyperlipidemia, or hypertension. Multiple logistic regression models were computed to assess asthma exacerbations and emergency department use for asthma in patients with MUO compared with unhealthy obesity. ResultsAmong respondents with MUO, 50.09% (n = 543; N = 17,011,880) had asthma compared with 7.91% in those with metabolically healthy obesity (n = 77; N = 2,685,858). Persons with MUO were significantly more likely to report the use of an emergency department for their asthma symptoms within the past 12 months (odds ratio, 3.53; 95% confidence interval, 1.54-8.09; P < .05). Persons with elevated waist circumference were more likely to report asthma exacerbations (odds ratio, 1.58; 95% confidence interval, 1.09-2.26). No significant difference existed in reported asthma exacerbations or emergency department use in patients measured by BMI. ConclusionMUO is associated with increased emergency department use for asthma and is better at predicting exacerbations and emergency department use than BMI alone.

Spatial autocorrelation may bias the risk estimation: An application of eigenvector spatial filtering on the risk of air pollutant on asthma

Air pollutants are major risk factors for respiratory diseases, particularly asthma, socially and spatially correlated. Many existing environment-asthma-related studies, however, have evaluated the impact of crude trends at the largest district level, which accounts only for temporal effects and may produce biased results with spatial autocorrelation. This study aimed to investigate how the spatial autocorrelation affects the air pollution effect estimations (sulfur dioxide [SO2], nitrogen dioxide [NO2], carbon monoxide [CO], and particulate matter [PM10]) on daily asthma emergency department (ED) visits in two metropolitan areas in Korea (Seoul Metropolitan Area [SMA] and Busan Metropolitan City, Ulsan Metropolitan City, Gyeongsangnamdo [BUG]). We applied eigenvector spatial filter (ESF) to the spatio-temporal model to remove spatial autocorrelation and distributed lag nonlinear model (DLNM) to explore nonlinear patterns between air pollutant concentration and lagged days on the three models including aggregated model (a temporal model), spatial model without ESF, and spatial model with ESF (both are spatio-temporal models). The effect of SO2 was not statistically significant for asthma ED visits in the aggregated model for SMA (cumulative relative risks [CRR] = 0.99, confidence intervals [CI]: 0.93–1.05), while the effect was statistically significant in the spatial model with ESF (CRR = 1.10, CI: 1.08–1.12). NO2 and CO were positively correlated to asthma ED visits in the spatial model without ESF (CRR = 0.84, CI: 0.81–0.86; 0.91, 0.89–0.94, respectively), but the spatial model with ESF showed significant risks (CRR = 1.21, CI: 1.18–1.24; 1.13, 1.11–1.16). Moreover, the spatial model with ESF successfully removed spatial autocorrelation (P-values for Moran's I 0.83–0.98) and demonstrated the highest model fit (McFadden's pseudo R2 0.42–0.43 for SMA and 0.26–0.27 for BUG) among the three models. Our findings demonstrate how ESF can be introduced into spatial correlation to remove bias and construct more reliable models.

Tree canopy, pediatric asthma, and social vulnerability: An ecological study in Connecticut

Despite a variety of health benefits associated with trees, previous findings on links between tree canopy and asthma have been mixed. Little is known about the association of tree canopy with asthma emergency department (ED) visits and hospitalizations at the neighborhood level. This study examines associations between tree canopy and pediatric asthma ED visit/hospitalization rates among the Connecticut population at the census tract level and investigates the moderating effect of social vulnerability on these associations. Using data of the combined pediatric asthma ED visits and hospitalizations (from 2010 to 2014), tree canopy coverage, and area-based social vulnerability, we applied multivariate negative binomial regression models, controlling for confounders including ozone and road density. Results show that every 10-percentage point increase in tree canopy cover was expected to bring a 4% decrease in asthma ED visit/hospitalization rates. Further, every 10-percentage point increase in social vulnerability index was associated with an 18% increase in asthma ED visit/hospitalization rates. We also found a nonlinear association, indicating a U-shape effect of tree canopy on pediatric asthma ED visit/hospitalization rates. The levels of social vulnerability moderated the association between the nonlinear effect of tree canopy and asthma ED visit/hospitalization rates (β = -5.629, p =.004). Findings suggests that tree canopy may help reduce pediatric asthma ED visits and hospitalizations. Particularly, the benefits of tree canopy in decreasing pediatric asthma ED visits and hospitalizations would be more effective in more socially vulnerable areas.

ZIP Code-Level Estimation of Air Quality and Health Risk Due to Particulate Matter Pollution in New York City.

Exposure to PM2.5 is associated with hundreds of premature mortalities every year in New York City (NYC). Current air quality and health impact assessment tools provide county-wide estimates but are inadequate for assessing health benefits at neighborhood scales, especially for evaluating policy options related to energy efficiency or climate goals. We developed a new ZIP Code-Level Air Pollution Policy Assessment (ZAPPA) tool for NYC by integrating two reduced form models—Community Air Quality Tools (C-TOOLS) and the Co-Benefits Risk Assessment Health Impacts Screening and Mapping Tool (COBRA)—that propagate emissions changes to estimate air pollution exposures and health benefits. ZAPPA leverages custom higher resolution inputs for emissions, health incidences, and population. It, then, enables rapid policy evaluation with localized ZIP code tabulation area (ZCTA)-level analysis of potential health and monetary benefits stemming from air quality management decisions. We evaluated the modeled 2016 PM2.5 values against observed values at EPA and NYCCAS monitors, finding good model performance (FAC2, 1; NMSE, 0.05). We, then, applied ZAPPA to assess PM2.5 reduction-related health benefits from five illustrative policy scenarios in NYC focused on (1) commercial cooking, (2) residential and commercial building fuel regulations, (3) fleet electrification, (4) congestion pricing in Manhattan, and (5) these four combined as a “citywide sustainable policy implementation” scenario. The citywide scenario estimates an average reduction in PM2.5 of 0.9 μg/m3. This change translates to avoiding 210–475 deaths, 340 asthma emergency department visits, and monetized health benefits worth $2B to $5B annually, with significant variation across NYC’s 192 ZCTAs. ZCTA-level assessments can help prioritize interventions in neighborhoods that would see the most health benefits from air pollution reduction. ZAPPA can provide quantitative insights on health and monetary benefits for future sustainability policy development in NYC.

Follow-Up After Asthma Emergency Department Visits and Its Relationship With Subsequent Asthma-Related Utilization.

To assess the association between follow-up after an asthma-related emergency department (ED) visit and the likelihood of subsequent asthma-related ED utilization. Using data from California Medicaid (2014-2016), and Vermont (2014-2016) and Massachusetts (2013-2015) all-payer claims databases, we identified asthma-related ED visits for patients ages 3 to 21. Follow-up was defined as a visit within 14 days with a primary care provider or an asthma specialist. asthma-related ED revisit after the initial ED visit. Models included logistic regression to assess the relationship between 14-day follow-up and the outcome at 60 and 365 days, and mixed-effects negative binomial regression to assess the relationship between 14-day follow-up and repeated outcome events (# ED revisits/100 child-years). All models accounted for zip-code level clustering. There were 90,267 ED visits, of which 22.6% had 14-day follow-up. Patients with follow-up were younger and more likely to have commercial insurance, complex chronic conditions, and evidence of prior asthma. 14-day follow-up was associated with decreased subsequent asthma-related ED revisits at 60 days (5.7% versus 6.4%, P < .001) and at 365 days (25.0% versus 28.3%, P < 0.001). Similarly, 14-day follow-up was associated with a decrease in the rate of repeated subsequent ED revisits (66.7 versus 77.3 revisits/100 child-years; P < 0.001). We found a protective association between outpatient 14-day follow-up and asthma-related ED revisits. This may reflect improved asthma control as providers follow the NHLBI guideline stepwise approach. Our findings highlight an opportunity for improvement, with only 22.6% of those with asthma-related ED visits having 14-day follow-up.

Adjusting for Social Risk Factors in Pediatric Quality Measures: Adding to the Evidence Base.

Outcome and utilization quality measures are adjusted for patient case-mix including demographic characteristics and comorbid conditions to allow for comparisons between hospitals and health plans. However, controversy exists around whether and how to adjust for social risk factors. To assess an approach to incorporating social risk variables into a pediatric measure of utilization from the Pediatric Quality Measures Program (PQMP). We used data from California Medicaid claims (2015-16) and Massachusetts All Payer Claims Database (2014-2015) to calculate health plan performance using measure specifications from the Pediatric Asthma Emergency Department Use measure. Health plan performance categories were assessed using mixed effect negative binomial models with and without adjustment for social risk factors, with both models adjusting for age, gender and chronic condition category. Mixed effects linear models were then used to compare patient social risk for health plans that changed performance categories to patient social risk for health plans that did not. Of 133 health plans, serving 404,649 pediatric patients with asthma, 7% to 13% changed performance categories after social risk adjustment. Health plans that moved to higher performance categories cared for lower socioeconomic status (SES) patients whereas those that moved to lower performance categories cared for higher SES patients. Adjustment for social risk factors changed performance rankings on the PQMP Pediatric Asthma Emergency Department Use measure for a substantial number of health plans. Some health plans caring for higher risk patients performed more poorly when social risk factors were not included in risk adjustment models. In light of this, social risk factors are incorporated into the National Quality Forum-endorsed measure; whether to incorporate social risk factors into pediatric quality measures will differ depending on the use case.

Efficacy of anti-IL-5 therapy with mepolizumab for severe bronchial asthma and concomitant inflammatory nasal diseases in real clinical practice

BACKGROUND. T2 inflammation underlies non-allergic eosinophilic severe bronchial asthma and chronic rhinosinusitis with nasal polyposis (CRSwNP). Existing targeted anti-IL-5 drugs can improve clinical and functional parameters in patients with a combination of severe asthma and CRSwNP.&#x0D; AIM: to evaluate mepolizumab efficacy in patients with non-allergic severe asthma and concomitant inflammatory nasal diseases (CIND) in real clinical practice.&#x0D; MATERIALS AND METHODS. The study was conducted without a control group, by comparing related populations (before-after analysis) and based on the Sverdlovsk regional register of adult patients with severe asthma and CIND. The primary endpoint was asthma control achievement (ACT questionnaire) and decrease in the proportion of patients with uncontrolled severe asthma. The number of asthma exacerbations, emergency calls and hospitalizations, quality of life according to AQLQ questionnaire, peripheral blood eosinophils level and respiratory function (FEV1, FVC, FEV1/FVC) were also assessed. Dynamics of nasal symptoms was assessed using SNOT22 questionnaire and visual analogue scale (VAS).&#x0D; RESULTS. During 12 months of therapy with mepolizumab, ACT increased from 9 (Q1-Q3: 7-11) to 22 points (Q1-Q3: 21-24) (p0.001). The proportion of patients with uncontrolled asthma decreased from 100% to 10% (p0.001). The number of asthma exacerbations decreased from 3.182.8 per patient per year to 0 (p0.001) and hospitalizations from 0.570.9 per patient per year to 0 (p=0.007). Quality of life according to AQLQ increased from 3.481.05 (95% CI 2.734.24) to 5.590.88 (95% CI 4.966.22) points (p0.001). The number of blood eosinophils decreased from 442 (Q1-Q3: 336-853) to 90 (Q1-Q3: 73-117) cells/l (p0.001). There was increase in FEV1 from 63.9%24.2 (95% CI 46.681.2) to 80.5%18.3 (95% CI 67.493.6) (p=0.015). There was decrease in SNOT22 questionnaire score by 33 points (from 4530 to 2215) (p=0.006) and decrease in VAS score by 5 points (from 8 (Q1-Q3: 5-8) to 3 (Q1-Q3: 3-5)) (p=0.017).&#x0D; CONCLUSIONS. According to the study results, there were asthma control improvement, asthma exacerbations decrease, quality of life improvement according to AQLQ. Statistically significant peripheral blood eosinophils decrease and respiratory function improvement were also revealed. In patients with CIND, significant improvement in nasal breathing was noted, which was confirmed by scores of SNOT22 and VAS questionnaires.

Role of ethnicity/language in documented rates of pediatric asthma prescription refills

Objective Medication maintenance is critical in the management of asthma. We investigated the differences in electronic health record (EHR) documentation of medication refills for Spanish- and English-speaking Latino children and non-Hispanic white children by examining rates of albuterol rescue inhaler refills from 2005 to 2017, and and inhaled corticosteroid refills from 2015 to 2017 in a multi-state network of community health centers (CHCs). Methods We used data from the ADVANCE network of CHCs. Our sample consisted of children aged 3–17, with a diagnosis of asthma and either albuterol or inhaled corticosteroid prescriptions (n = 39,162; n = 4,738 children, respectively). Negative binomial regression was used to calculate rates of refills per prescription adjusted for relevant patient-level covariates. Analyses stratified by asthma severity were also conducted. Results English-speaking Latino children had lower rates of albuterol refills compared with non-Hispanic white children (rate ratio [RR] = 0.88, 95% confidence interval [CI]: 0.80–0.98), a trend that persisted among children with moderate/severe persistent asthma severity (RR = 0.85, 95% CI: 0.76–0.95). Spanish-speaking Latino and non-Hispanic white children had similar albuterol refills. Inhaled corticosteroid refill rates were comparable between all groups. Conclusions In a multi-state network, these findings suggest that CHCs deliver equitable asthma care related to prescription refills between their Latino and white patients, but there is still opportunity for providers to ensure that their English-speaking Latino patients have access to necessary emergency asthma medication.

Real-world effectiveness of benralizumab: Results from the ZEPHYR 1 Study

BackgroundReal-world evidence characterizing the clinical outcomes and economic impact on patients with severe eosinophilic asthma treated with benralizumab is limited. ObjectiveTo characterize patients with severe asthma treated with benralizumab and assess its clinical and economic impact in the United States. MethodsA pre-post benralizumab comparison was performed using a large US insurance claims database between November 2016 and November 2019. The primary cohort included patients with asthma aged 12 years or more with 2 or more records of benralizumab. Secondary cohorts included persistent users (6 or more records of benralizumab), patients switching to benralizumab from mepolizumab or omalizumab, and stratified by Medicaid vs non-Medicaid. Exacerbations, concomitant medications, and exacerbation-related health care resource utilization (HCRU) and costs were compared in the 12-month periods pre- and post-benralizumab initiation (index). ResultsOf the 204 patients in the primary cohort, mean age at index was 45.3 years and 68.6% were of female sex. The patients experienced a significant 55% reduction in rates of exacerbations post-benralizumab initiation (3.25 pre-index vs 1.47 post-index per person-year; P < .001), and 41% of the patients had no exacerbations post-benralizumab initiation. The proportion of oral corticosteroid-dependent patients decreased from 82% to 50% (P < .001). Reductions in HCRU were 42%, 46%, and 57% for asthma exacerbation-related inpatient hospitalizations, emergency department, and outpatient visits, respectively (all P < .001). Exacerbation-related costs decreased by $6439 ($13,559 vs $7120; P < .001). Similar results for all outcomes were observed for the persistent cohort, switch cohorts, and Medicaid vs non-Medicaid cohorts. ConclusionPatients with severe asthma treated with benralizumab experienced clinical and economic benefits in the real world, as demonstrated by the reduction in exacerbations and HCRU.

Allergen Management in Children with Type 2-High Asthma.

Children exposed to various indoor and outdoor allergens are placed at an increased risk of developing asthma in later life, with sensitization in these individuals being a strong predictor of disease morbidity. In addition, aeroallergen exposure influences asthma outcomes through an interplay with adverse determinants of health. The goal of this review is to provide an introductory overview of factors related to aeroallergen exposure in type 2-high childhood asthma. These include the relevance of exposure in asthma exacerbations and severity, and the evidence-base for avoidance and treatment for sensitization to these allergens. This review will focus on both indoor aeroallergens (house dust mite, pet, cockroach, mold, and rodent) and outdoor aeroallergens (pollens and molds). Treatment of aeroallergen sensitization in children with asthma includes avoidance and removal measures, although there is limited evidence of clinical benefit especially with single-strategy approaches. We will also address the interplay of aeroallergens and climate change, adverse social determinants, and the current COVID-19 pandemic, when we have seen a dramatic reduction in asthma exacerbations and emergency department visits among children. While there are many factors that are hypothesized to contribute to this reduction, among them is a reduced exposure to outdoor seasonal aeroallergens.

Equity and the Hazard of Veiled Injustice: A Methodological Reflection on Risk Adjustment.

Equity and the Hazard of Veiled Injustice: A Methodological Reflection on Risk Adjustment.

The German severe asthma patient: Baseline characteristics of patients in the German Severe Asthma Registry, and relationship with exacerbations and control

Introduction.The German Asthma Net Severe Asthma Registry is collecting long-term data from a large cohort of patients aged ≥6 years with severe asthma. This manuscript presents their baseline characteristics, and identifies relationships with exacerbations and/or poor asthma control.Methods.The registry is collecting routine clinical parameters including: demographics and medical history; disease characteristics (Asthma Control Questionnaire [ACQ]-5, forced expiratory volume in 1 s [FEV1]); exacerbations; and biomarkers (eosinophils, immunoglobulin E [IgE], fractional exhaled nitric oxide [FeNO]).Results.These analyses include data from 2011 patients at 72 sites (91.9% adult). Children (6–17 years) were more likely to be male, whereas more adults were female (males: children/adults 62%/41%). Most were receiving inhaled corticosteroid/long-acting β2-agonist combinations (78%/81%); 38.0% of adults were receiving systemic steroids. Asthma control was suboptimal in both groups: 21.5%/13.3% were controlled; 10.4%/49.1% were symptomatic; 33.1%/37.2% received emergency asthma treatment in the previous year. Median blood eosinophil (400/238 cells/μL) and IgE levels (494/186 IU/mL) were higher in children; FeNO was lower (19/35 ppb). Patients with ≥2 exacerbations in the previous year had lower FEV1 (absolute and % predicted) and IgE, and higher ACQ-5, FeNO and blood eosinophil levels (all p < 0.05). There was a weak, negative correlation between ACQ-5 and FEV1% predicted in adults (p < 0.001).Conclusions.These analyses characterise the typical German patient with severe asthma, and provide information on their overall care. Their planned long-term follow-up will assess whether asthma control can be optimised, how best to do so, and most importantly how such optimisation can benefit patients.

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...

Air Pollutant Levels and Asthma Emergency Room Visits in a Highly Populous US Urban County During 2018-19

Air Pollutant Levels and Asthma Emergency Room Visits in a Highly Populous US Urban County During 2018-19