Outpatient Asthma Research Articles

Medicaid Accountable Care Organizations and Disparities in Pediatric Asthma Care.

Nearly 6 million children in the US have asthma, and over one-third of US children are insured by Medicaid. Although 23 state Medicaid programs have experimented with accountable care organizations (ACOs), little is known about ACOs' effects on longstanding insurance-based disparities in pediatric asthma care and outcomes. To determine associations between Massachusetts Medicaid ACO implementation in March 2018 and changes in care quality and use for children with asthma. Using data from the Massachusetts All Payer Claims Database from January 1, 2014, to December 31, 2020, we determined child-years with asthma and used difference-in-differences (DiD) estimates to compare asthma quality of care and emergency department (ED) or hospital use for child-years with Medicaid vs private insurance for 3 year periods before and after ACO implementation for children aged 2 to 17 years. Regression models accounted for demographic and community characteristics and health status. Data analysis was conducted between January 2022 and June 2024. Massachusetts Medicaid ACO implementation. Primary outcomes were binary measures in a calendar year of (1) any routine outpatient asthma visit, (2) asthma medication ratio (AMR) greater than 0.5, and (3) any ED or hospital use with asthma. To determine the statistical significance of differences in descriptive statistics between groups, χ2 and t tests were used. Among 376 509 child-year observations, 268 338 (71.27%) were insured by Medicaid and 73 633 (19.56%) had persistent asthma. There was no significant change in rates of routine asthma visits for Medicaid-insured child-years vs privately insured child-years post-ACO implementation (DiD, -0.4 percentage points [pp]; 95% CI, -1.4 to 0.6 pp). There was an increase in the proportion with AMR greater than 0.5 for Medicaid-insured child-years vs privately insured in the postimplementation period (DiD, 3.7 pp; 95% CI, 2.0-5.4 pp), with absolute declines in both groups postimplementation. There was an increase in any ED or hospital use for Medicaid-insured child-years vs privately insured postimplementation (DiD, 2.1 pp; 95% CI, 1.2-3.0 pp), an 8% increase from the preperiod Medicaid use rate. Introduction of Massachusetts Medicaid ACOs was associated with persistent insurance-based disparities in routine asthma visit rates; a narrowing in disparities in appropriate AMR rates due to reductions in appropriate rates among those with private insurance; and worsening disparities in any ED or hospital use for Medicaid-insured children with asthma compared to children with private insurance. Continued study of changes in pediatric asthma care delivery is warranted in relation to major Medicaid financing and delivery system reforms.

Impact of Air Pollutants on Lung Function and Inflammatory Response in Asthma in Shanghai

Objective Air pollution is a leading public health issue. This study investigated the effect of air quality and pollutants on pulmonary function and inflammation in patients with asthma in Shanghai.Methods The study monitored 27 asthma outpatients for a year, collecting data on weather, patient self-management [daily asthma diary, peak expiratory flow (PEF) monitoring, medication usage], spirometry and serum markers. To explore the potential mechanisms of any effects, asthmatic mice induced by ovalbumin (OVA) were exposed to PM2.5.Results Statistical and correlational analyses revealed that air pollutants have both acute and chronic effects on asthma. Acute exposure showed a correlation between PEF and levels of ozone (O3) and nitrogen dioxide (NO2). Chronic exposure indicated that interleukin-5 (IL-5) and interleukin-13 (IL-13) levels correlated with PM2.5 and PM10 concentrations. In asthmatic mouse models, exposure to PM2.5 increased cytokine levels and worsened lung function. Additionally, PM2.5 exposure inhibited cell proliferation by blocking the NF-κB and ERK phosphorylation pathways.Conclusion Ambient air pollutants exacerbate asthma by worsening lung function and enhancing Th2-mediated inflammation. Specifically, PM2.5 significantly contributes to these adverse effects. Further research is needed to elucidate the mechanisms by which PM2.5 impacts asthma.

Joint associations of air pollutants during pregnancy, infancy, and childhood with childhood persistent asthma: Nationwide database study in Japan

The joint effect of air pollutants at relatively low levels requires further investigation. Here, a database study was performed to evaluate the effects of exposure to mixtures of air pollutants during pregnancy, infancy, and childhood on childhood persistent asthma. We used the Japan Medical Data Center database, which provides access to family linkages and healthcare provider addresses, and included child-mother dyads in which the child was born between January 2010 and January 2017. The exposure of interest was ground-level air pollutants, and the primary outcome was childhood persistent asthma at 45 years of age, as defined based on outpatient and inpatient asthma disease codes and/or asthma medication dispensing claims. The weighted quantile sum (WQS) regression was used to evaluate the effects of air pollutant mixtures on 52,526 child-mother dyads from 1149 of 1907 municipalities (60.3 %) in Japan. The WQS regression models showed that with every 10th percentile increase in the WQS index, ground-level air pollutants during pregnancy, infancy, and childhood increased the risk of childhood persistent asthma by an odds ratio of 1.04 (95 % CI: 1.02–1.05; p<0.001), 1.02 (95 % CI: 1.01–1.03; p<0.001), and 1.03 (95 % CI: 1.01–1.04; p<0.001), respectively. Moreover, particulate matter with an aerodynamic diameter ≤ 2.5 µm was assigned the highest weight across all three exposure periods. Relatively high weights were assigned to suspended particulate matter and photochemical oxidants during pregnancy, carbon monoxide during infancy, and photochemical oxidants during childhood. Our study showed that a mixture of low-level air pollutants has a detrimental association with childhood persistent asthma.

Assessment of acute asthma in children: do parents and healthcare providers speak the same language?

Objective Education and self-management plans enhance parents’ self-efficacy in managing their child’s asthma symptoms. By understanding how parents recognize and interpret acute asthma symptoms, we can compile patient information using terms that are familiar to parents. Method Semi-structured interviews were carried out with 27 parents of children with asthma aged 2–12 years. The interviewees were selected from three groups: parents of children admitted for acute asthma, parents of children receiving outpatient asthma care, and parents who had access to a self-management plan. Parents were invited to report symptoms they would associate with acute asthma. Subsequently, parents were queried about their recognition of symptoms from a predefined list and asked to explain how they would assess these symptoms in case their child would experience an attack of acute asthma. Results The most frequently reported symptoms for acute asthma were shortness of breath (77.8%) and coughing (63%). Other signs such as retractions, nasal flaring, and wheezing were reported by less than 25% of the parents. All parents recognized shortness of breath, wheezing and gasping for breath from a predefined list of medical terms. Retractions and nasal flaring were recognized by 81.5% and 66.7% of the parents, respectively. Recognizing the medical terms did not necessarily translate into parents being able to explain how to assess these symptoms. Conclusion Parents and healthcare professionals do not always speak the same language concerning symptoms of acute asthma. This may hamper timely recognition and adequate self-management, highlighting the necessity to adjust current medical information about acute asthma.

Asthma–COPD overlap syndrome among smoker subjects with asthma: A cross-sectional study

This study aimed to assess the prevalence of asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) in asthmatic outpatients with smoking exposure (smokers or ex-smokers with ≥10 pack-year history) and to evaluate quality of life (QoL) and adherence among the study sample. This cross-sectional study was conducted at outpatient respiratory clinics in governmental hospitals in Jordan. Asthmatic outpatients were interviewed to assess their spirometric readings, patients’ adherence, and patients’ QoL [using the Mini Asthma QoL questionnaire (MiniAQLQ)]. The prevalence of ACOS was found to be 33% among asthmatic smoker patients in the outpatient setting (n = 65 out of 200 subjects with asthma-diagnosed patients recruited into the study). For subjects with ACOS, 47.7% of them were older than 60 years old. Smoking history for more than 30 years was prevalent among most subjects with ACOS (67.7%). The MiniAQLQ average score was found to be low (mean ± SD = 3.23 ± 1.01, score out of 7) and similarly for patients’ adherence to their treatment modalities (mean ±SD = 1.76 ± 1.2, score out of 6). A significant positive relationship between adherence to treatment and QoL was found among subjects with ACOS (correlation coefficient = 0.171, p-value = 0.018). In conclusion, a moderate prevalence of ACOS was estimated among asthmatic smoker patients. Low levels of QoL and adherence to treatment were significantly correlated.

Assessment of Asthma Knowledge of Parents of Children with Bronchial Asthma

Introduction: Understanding bronchial asthma plays a crucial role in the management and control of this chronic disease. While good asthma knowledge of the parents helps in better control of the disease in their children, it remains variable among the parents. Materials and Methods: This cross-sectional observational study was conducted in the outpatient asthma clinic of a tertiary center. New Castle Asthma Knowledge Questionnaire (NAKQ) were filled out by the caregivers of children (between 7 and 15 years, diagnosed as per global initiative for asthma guidelines) with bronchial asthma, after obtaining the proper consent. The validated Hindi version of the NAKQ questionnaire had a total of 31 questions regarding knowledge, acute asthma attacks, maintenance management, and misconceptions. Results: Eighty-five parents responded to the NAKQ questionnaire during this 1-year duration. 58 (68.24%) were fathers, and 27 (31.76%) were mothers, filling out the questionnaires. The knowledge score of the respondents enrolled in the study ranged from 10 to 18, the median knowledge score was 14, and the mean knowledge score of respondents was 14.02 ± 1.93. Conclusion: The mean knowledge score of the parents of bronchial asthma patients was found to be low in our setting as compared to other studies where a similar questionnaire was used.

Implementing paediatric patient-reported outcome measures in outpatient asthma clinics: a feasibility assessment study

ObjectiveImplementation of patient-reported outcome measures (PROMs) is limited in paediatric routine clinical care. The KidsPRO programme has been codesigned to facilitate the implementation of PROMs in paediatric healthcare settings. Therefore,...

Physical Health-Related Quality of Life in Relation to Mediterranean Diet Adherence in a Sample of Greek Asthma Patients: A Pilot Study.

The role of nutrition in the management of asthma in obese patients is of increasing interest due to their limited response to inhaled corticosteroids. Some studies note that through diet and lifestyle, there can be an improvement in asthma control. The aim of the present study was to investigate the adherence to the Mediterranean Diet and its association with asthma severity and quality of life in patients with bronchial asthma. This is a cross-sectional study of 85 patients (70.6% female), with a mean age of 57 years, from the General University Hospital of Larissa and, more specifically, patients of the outpatient asthma clinic. Data were collected with the use of specific questionnaires. In relation to BMI, 12.9% of participants were of a normal weight, 45.9% were overweight, 25.9% were obese level I, 5.9% were obese level II, and 9.4% were in the morbidly obese range. Based on the Med Diet Score (ranging from 21 to 35), most participants (85.9%) reported moderate adherence to the Mediterranean Diet. Further analysis examined the correlations of the PCS-12 score with the frequency of consumption of each of the 11 food categories, as well as all demographic and health behavior variables. The ranked correlations indicated a significant relationship between PCS-12 score and Med Diet adherence and the consumption of alcoholic beverages (r = 0.437, p < 0.05), in accordance with the Mediterranean Diet suggestions, as well as a negative relationship with BMI score (r = -0.454, p < 0.010). Moreover, significant correlations were also present between the physical quality of life and AQLQ score and work type, as well as gender, age, and marital status. The results of our study showed a high rate of obesity in patients with asthma at the General University Hospital of Larissa and moderate adherence to the Mediterranean Diet. Increased BMI and alcoholic beverage consumption in asthma patients were significant predictors of lower physical health-related quality of life. In conclusion, personal and society-level interventions are required to effectively address obesity and poor diet in patients with asthma.

Tropical high altitude and severe asthma in adults: house dust mite sensitization and phenotypic distribution

Background There is a lack of information on house dust mite (HDM) sensitization and phenotype distribution in patients with severe asthma (SA) living permanently at high-altitude (HA) in tropical regions, which may be different. Objective The aim of this study was to characterize adults with SA in a tropical high altitude city (2,640 m): Bogotá, Colombia. Material and Methods This observational cross-sectional study included severe asthmatic outpatients (n = 129) referred to the ASMAIRE program of the Fundación Neumológica Colombiana in Bogotá (2,640 m). Clinical history, spirometry, total IgE, blood eosinophils, and skin prick test (SPT), including HDM allergens, were performed. Phenotype definitions: Allergic/atopic (AA): IgE ≥100 IU/mL and/or at least one positive SPT; eosinophilic (EOS): blood eosinophils ≥300 cells/µL; type 2-high: AA and/or EOS phenotype; type 2-low: non-AA/non-EOS phenotype (IgE <100 IU/mL, negative SPT, and blood eosinophils <300 cells/µL). Results A total of 129 adults with SA were included, 79.8% female. Phenotype distribution: AA: 61.2%; EOS: 37.2%; type 2-high: 72.1%; type 2-low: 27.9%. Among AA patients, HDM sensitization was present in 87% and 34.9% were non-eosinophilic. There was a significant overlap between the phenotypes. Conclusions In contrast to non-tropical high-altitude regions, we found a high frequency of HDM sensitization in patients with AA phenotype living in a tropical high-altitude city. We also found a discrete lower frequency of EOS phenotype with no other significant differences in the phenotypic distribution compared to that described at low altitudes. We propose that tropical location may modify the effect of high altitude on HDM concentrations and allergenicity.

Get SMART: Teaching Pediatric Residents the 2020 Focused Asthma Updates' Recommendations for Symptom-Based Medication Increases.

The 2020 Focused Asthma Updates introduced a paradigm shift in the treatment of asthma that includes symptom-based adjustments to outpatient asthma treatment that vary by age and severity. The length and complexity of the updates have made them challenging to adopt. We implemented an educational session among pediatric residents to increase their familiarity with, comprehension of, and plans to adopt two evidence-based recommendations introduced in the 2020 Updates for symptom-based therapy. Facilitators led groups of four to six pediatric residents in cased-based discussions during a 30-minute, ambulatory care-based session. One week prior, participants and facilitators received synopses of the 2007 Guidelines for the Diagnosis and Management of Asthma and the 2020 Updates. Facilitators also received a guide and scripts explaining new concepts, providing supporting data, and highlighting learning objectives. Retrospective pre/post surveys assessed participants' familiarity with, comprehension of, and planned adoption of recommendations for intermittent steroids and single maintenance and reliever therapy (SMART) before and after the conference. The surveys also assessed prior exposure to the 2020 Updates and reflections on the educational session. There were 26 participants. Ratings of familiarity, comprehension, and adoption plans regarding the recommendations significantly improved (ps < .001, Wilcoxon signed rank test). The case-based approach was well received, and the material was deemed relevant. This educational session significantly increased pediatric residents' familiarity with, comprehension of, and plans to adopt two new evidence-based treatments. Dissemination of this educational session may improve outpatient asthma management.

An evaluation of outpatient pediatric asthma prescribing patterns in the United States

Pediatric asthma is often under-diagnosed and under-treated, resulting in a lack of concentration, difficulty sleeping, and tiredness. The Global Initiative for Asthma (GINA) guidelines recommended that children should be prescribed maintenance inhalers along with rescue inhalers. Concurrent use of rescue and maintenance inhalers were considered appropriate use for this study. The aim of the study was to determine the prevalence of inappropriate prescribing patterns against various patient and prescriber demographic factors. A total of 2,264 patients meeting the inclusion criteria for ICD 10 codes, J45.20 - J45.52 and age less than 18 were extracted from the 2018 National Ambulatory Medical Care Survey (NAMCS), which captures ambulatory services offered in physicians’ offices directly engaged in patient care. This data is collected by the National Center of Health Statistics (NCHS), a division of the CDC. The data were analyzed using descriptive analysis, two-tailed t-tests, and ANOVA with an alpha significance level at 0.05. The majority of the pediatric patient population was in the age range of 17-18 years old. Overall, more patients were prescribed inappropriately (68.3%) as compared to appropriate prescribing (31.7%). Inappropriate prescribing was seen more for patients with Medicaid (24.8%) and self-payment (38.2%) as compared to other types of payment (p= 0.052). General practice/ family physicians (35.1%) and nurse practitioners (20.9%) prescribed more inappropriately as compared to other prescribers. (p= 0.001). Patients from the Southern region of the U.S. were prescribed more inappropriately compared to the other regions in the U.S. (p= 0.205). This study concluded that a significant number of pediatric asthma patients across all demographics were not appropriately prescribed inhalers, thus not adhering to GINA guidelines. Appropriate prescribing and adhering to guidelines would prevent morbidity, mortality and improve the patient's quality of life, thereby saving healthcare costs.

Glucocorticoid Receptor Polymorphism A3669G Is Associated with Airflow Obstruction in Mild-to-Severe Asthma

Background: Glucocorticoids (GCs) represent the mainstay therapy for asthmatics. A subset of severe asthmatics fails to respond to steroid-based therapies, leading to important healthcare costs. Single nucleotide polymorphisms (SNPs) of glucocorticoid receptor genes were associated with a response to GC. We evaluate the possible relation of BclI and A3669G SNPs to clinical, biological and functional characteristics of asthmatics. Methods: We recruited 172 mild-to-severe asthmatic outpatients referring to the Severe Asthma and Rare Lung Disease Unit at San Luigi University Hospital. Clinical data were obtained at recruitment when spirometry tests and peripheral blood sampling were performed. Patients were genotyped for BclI and A3669G through the pyrosequencing assay results. Results: Patients with the A3669G AG genotype were younger, allergic and had higher IgE levels compared to AA genotype (p &lt; 0.05). Moreover, asthmatics with the AA genotype had a lower post-bronchodilator FEV1/FVC ratio than the GG genotype (p &lt; 0.05), and a higher RV/TLC ratio than the AG genotype (p &lt; 0.05). Conclusions: The A3669G AG genotype might be related to type-2 allergic asthma; in particular, allele A of A3669G SNP was associated with GC response in our asthmatics. In conclusion, this observational cross-sectional study suggests a possible role of A3669G SNP as a predictor of asthma severity and phenotype.

Effect of Pharmacist-Led Interventions on Medication Adherence among Vietnamese Patients with Asthma: A Randomized Controlled Trial.

Medication adherence in asthmatic patients enhances the effectiveness of treatments, but some studies in low and middle-income countries still show some limitations. Our study aimed to determine if pharmacist-led interventions could increase medication adherence, improve treatment effectiveness, and relieve symptom severity in outpatients with asthma. We conducted a randomized, controlled trial on 247 asthmatic outpatients (aged ≥ 16) with a 1:1 ratio randomization at the hospitalization time and repeated after 1-month discharge. The primary outcome was to detect the difference in medication adherence between groups. Adherence was assessed by the general medication adherence scale (GMAS). Data collected by questionnaire was coded and entered into SPSS_20 for statistical analysis; Results: 247 patients (123 intervention, 124 control) were enrolled (61.1% male). After intervention, the adherence rate was higher among the intervention group than the control group (94.3% vs. 82.8%, p = 0.001). Patient behavior and knowledge were enhanced in the intervention group (p < 0.05). Asthma symptoms were relieved in the intervention group (p = 0.014). Pharmacist-led interventions on adherence rate were higher with OR: 3.550, 95% CI: 1.378-9.143, p = 0.009. pharmaceutical intervention could improve medication adherence, treatment efficacy, and the outcome should not be taken for granted; further research should be carried out in this regard.

Assessment of health-related quality of life among outpatients with asthma at Hue University of Medicine and Pharmacy Hospital

Background: Asthma is either a chronic respiratory disease or a serious global health problem that is common in all ages at a high rate. It seriously affects not only the physical health but also the health-related quality of life (HRQoL) of patients. Objectives: (1) To determine HRQoL score among asthmatic outpatients at Hue University of Medicine and Pharmacy Hospital; (2) To assess factors associated with HRQoL among asthmatic outpatients at Hue University of Medicine and Pharmacy Hospital. Subjects and methods: A descriptive cross-sectional study was conducted on 102 asthmatic outpatients at Hue University of Medicine and Pharmacy Hospital by using a self-administered questionnaire. Results: The male-to-female patient ratio was 1.68/1. The mean age of study participants was 59.2 ± 15.39 (26-95). A large number of patients were unemployed (55.9%) and had a low education level (54.9%). Participants with comorbidities and time of being diagnosed with asthma over 10 years accounted for the highest percentage, 69.6%, and 48.0% respectively, but most patients were not hospitalized due to an acute asthma attack within the past year (88.2%). The most common type of inhaler being used was DPI or the combination of MDI and DPI (35.3%) whereas the prevalence of patients only using the Metered-Dose Inhalers (MDI) was 29.4%. There were 40.2% of patients who were severely affected. The mean value of the total HRQoL score was 4.27 ± 0.747. The domain that most impacted HRQoL was “Activity limitations” whereas “Symptoms” affected the least. Men had higher HRQoL than women (6.441 times); The participants who did not have asthma-related family history were likely to have better HRQoL than others (3.3 times); The patients who used MDI or DPI alone had higher HRQoL scores than the group used the combination of two devices (2.788 times). Conclusions: Asthma remarkably affected asthmatic patients’ quality of life. The factors associated with HRQoL were gender, family history of asthma, and the type of inhaler. Key words: sthma, health-related quality of life, outpatients, Hue University of Medicine and Pharmacy Hospital.

Real-world effects of once-daily inhaled steroid (fluticasone furoate) combined with long-acting beta-2 agonist (vilanterol) and long-acting muscarinic antagonist (umeclidinium) on lung function tests of asthma patients in Japan.

Background: The Japanese drug use system allowed the once-daily use of inhaled corticosteroid fluticasone furoate (FF) combined with a long-acting beta-2 agonist vilanterol (VI) and a long-acting muscarinic antagonist umeclidinium (UMEC) against asthma on 18 February 2021. We investigated the real-world effects of these drugs (FF/UMEC/VI) mainly on lung function tests. Methods: This was an open-label, uncontrolled, within-group time-series (before-after) study. Prior asthma treatment (inhaled corticosteroid with/without a long-acting beta-2 agonist with/without a long-acting muscarinic antagonist) was switched to FF/UMEC/VI 200/62.5/25μg. Subjects were evaluated by lung function tests prior to, and 1-2months after, initiation of FF/UMEC/VI 200/62.5/25μg. Patients were asked questions regarding the asthma control test and preference for drugs. Results: Overall, 114 asthma outpatients (97% Japanese) were enrolled from February 2021 to April 2022: 104 subjects completed the study. Forced expiratory volume in 1s, peak flow, and asthma control test score of FF/UMEC/VI 200/62.5/25μg-treated subjects were significantly increased (p < 0.001, p < 0.001, and p < 0.01, respectively). In contrast with FF/VI 200/25μg, instantaneous flow at 25% of the forced vital capacity and expiratory reserve volume were significantly increased by FF/UMEC/VI 200/62.5/25μg (p < 0.01, p < 0.05, respectively). Sixty-six percent of subjects declared they wanted to continue FF/UMEC/VI 200/62.5/25μg in the future. Adverse effects, mainly local, were seen in 30% of patients, but no serious adverse effects were seen. Conclusion: Once-daily FF/UMEC/VI 200/62.5/25μg was effective against asthma without serious adverse events. This is the first report that demonstrated FF/UMEC/VI dilated peripheral airways using lung function tests. This evidence on drug effects may improve our understanding of pulmonary physiology and the pathophysiology of asthma.

Penggolongan Obat Berdasarkan Peresepan Obat Asma Di Instalasi Rawat Jalan RSUD Dr Agoesdjam Ketapang

Asthma was included in the top ten causes of morbidity and mortality in Indonesia. The priority of asthma treatment so far is to control symptoms. Therefore, the classification of drugs based on asthma drug prescribing is very necessary. This study aims to determine the characteristics and classes of drug prescribing in outpatient asthma patients at RSUD Dr. Agoesdjam Ketapang in 2020. This research method was carried out in December 2021-January 2022 with a retrospective descriptive method, data obtained from medical record cards of outpatient asthma patients at RSUD Dr. Agoesdjam Ketapang in 2020. The data obtained are presented in the form of percentages, average values and tables. The results showed that of the 61 outpatient asthma patient medical records analyzed by the percentage data, the majority of patients were women (59%) and at the age of 42-49 years (31%). The most widely prescribed drug group was beta-2 agonist (48%) with the most common dosage form being inhalers (51%) and the route of drug use was inhalation (51%). The conclusion is that the use of drugs in asthma patients in the outpatient installation of RSUD Dr. The majority of Agoesdjam Ketapang are women. The majority occurred at the age of 42-49 years, the most widely used drug class was the beta-2 agonist group with the inhaler dosage form and the inhalation route was the most widely used.

Assessment of knowledge, attitudes and practical skills in using inhalers for asthmatic outpatients

Background: Asthma is a chronic inflammatory disorder of the airways with increasing prevalence worldwide, becoming a burden for the healthcare system. Currently, inhaled therapy is the mainstay of asthma treatment. Factors associated with the incorrect use of inhalers were lack of knowledge or false beliefs. Incorrect inhalation techniques are the most common reasons that lead to uncontrolled asthma and treatment failure. Objectives: (1) To survey the knowledge and attitude of asthmatic outpatients towards asthma disease, treatment medicines and inhaler use. (2) To assess the patient’s practical skills in inhalation technique. Materials and methods: A descriptive cross-sectional study was conducted on asthmatic outpatients treated at Hue University of Medicine and Pharmacy hospital from March 2022 to April 2022. Results and conclusions: A total of 102 asthmatic patients were enrolled in the study. The proportion of males accounted for 62.7%. The mean age of patients was 59.2 ± 15.4. Regarding knowledge assessment, 31.4% of the patients had good knowledge of diseases and inhalers. Regarding that attitude, 24.5% of patients had a good attitude towards the disease and inhalers. The percentage of patients showing good practical skills in metered dose inhaler use (MDI) and dry powder inhaler (DPI) - Turbuhaler was 54.5%, DPI - Accuhaler was 66.7%. Key words: bronchial asthma, inhalers, metered dose inhaler, dry powder inhaler

The effect of fine-particle size and extrafine particle size inhaled corticosteroid in reducing airway resistance in asthmatic patients

Background Bronchial asthma is characterised by chronic inflammation of both large and small airways. Extra-fine formulation of inhaled corticosteroid (ICS) can achieve a higher peripheral lung deposition leading to improved asthma control. We investigated the effect of extra-fine and fine particle size inhaled ICS with airway resistance and severity of symptoms in asthmatic patients. Methods Prospective interventional study of outpatient asthmatics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Subjects were grouped based on pre-existing inhalers; extra-fine and fine inhaled corticosteroid (ICS)/long acting beta agonist (LABA). Crossover was at week 7 and treatment regime continued for 7 weeks. Subjects were assessed at week 0, 6 and 13 using asthma control test (ACT) score, forced expiratory volume in 1 s (FEV1) and impulse oscillometry (IOS) Inhaler technique was assessed periodically. Results Thirty-four subjects were recruited. Median asthma duration was 20 years. Twenty subjects (58%) in fine ICS/LABA and 14 (42%) in extra-fine ICS/LABA group. Thirty-one subjects were analysed before crossver. There was a significant improvement of FEV1 in the extra-fine ICS/LABA group (1.7 ± 0.47 to 1.88 ± 0.5; p = 0.01). ACT score reduced significantly in extra-fine ICS/LABA group (23 ± 5 to 21 ± 4; p = 0.04) at week 0–6. Week 7–13 showed a significant improvement of ACT score (16.5 ± 3 to 20 ± 3; p = 0.01) and FEV1 (1.71 ± 0.96 to 1.81 ± 1.02: p = 0.01) in extra-fine ICS/LABA. There was no significant difference in (IOS) parameters between the groups. Conclusion There was an improvement of FEV1 and ACT score with extra-fine ICS/LABA with no benefit in airway resistance.

Patterns of bronchodilator therapy in asthmatic outpatients.

Bronchodilators are used to treat asthma symptoms. The administration of this therapy can be given through monotherapy or in combination to achieve the maximum therapeutic effect. This study aimed to examine the prescribing pattern of bronchodilators in asthmatic outpatients. A retrospective study was done by reviewing and analyzing medical records of asthmatic outpatients from January 2019 until December 2020. Data analysis was performed descriptively. In this study, bronchodilators were administered by inhalation 97.4% compared to oral routes 2.6%. Combination bronchodilator therapy showed 54.7% compared to monotherapy by 46.3%. The combination ICS/LABA budesonide/formoterol 160/4.5 mcg was the most widely used 45.7%. The use of a bronchodilator was in accordance with the Global Initiative for Asthma guidelines. The route of drug administration through inhalation is more widely used than oral. Combination bronchodilators were more recommended than bronchodilator monotherapy to control asthma symptoms.

Evaluating Non-IgE-Mediated Allergens’ Immunoreactivity in Patients Formerly Classified as “Intrinsic” Asthmatics with Help of the Leukocyte Adherence Inhibition Test

Background: The ancient concept of “intrinsic” and “extrinsic” asthma has evolved in line with growing scientific knowledge and the use of new clinical diagnostic tools. Objective: The present study aims to evaluate the non-IgE-mediated immunoreactivity against common allergens, in asthmatic patients without evidence of IgE-mediated hypersensitivity against these allergens. Methods: A group of 127 “intrinsic” asthmatic outpatients, were submitted to ex vivo Leukocyte Adherence Inhibition Tests (LAIT) with extracts of Dermatophagoides pteronyssinus, Hevea brasiliensis latex, dog dander, cat dander, cow’s milk proteins, beekeeping pollen and a mixture of fungal extracts. Results: Cascade graphs were assembled according to the distribution of the LAIT results among the range of results of Leukocyte Adherence Inhibition (LAI) inside each group. A column graph was plotted with the mean LAI results for each antigen. The non-parametric Wilcoxon-Mann-Whitney U-test performed between the results of each test was significant only between the results of the LAIT performed with the dog extract and the mixed fungal extract (U = 1,179.5; the z-score was -2.64109; the p-value was 0.0083). All other Wilcoxon-Mann-Whitney U-test calculations between LAIT performed with the other allergens were not significant at p &lt; 0.01. Conclusion: The evidence of non-IgE-mediated immunoreactivity in allergic patients has been reported in the medical literature since the beginning of the 19th century and has been increasing since then. This descriptive article presents the contribution of the LAIT as a tool to quantify the overall non-IgE-mediated cellular/humoral immunoreactivity against common allergens in patients formerly classified inside the “intrinsic” asthma endotype.