Inhalers and climate change: A sustainable approach to severe asthma management.

Initial asthma management often relies on a one-size-fits-all approach; however, the heterogeneity of treatment-naive, uncontrolled asthma remains insufficiently characterized. Specifically, the complex relationships among symptom burden, type 2 (T2) inflammation, and pulmonary function in this population are poorly understood. We sought to identify distinct clinical phenotypes in treatment-naive adults via multidimensional analysis and evaluate the association between symptom scores and T2 inflammation. This single-center, retrospective study analyzed 171 treatment-naive adults with uncontrolled asthma (5-item Asthma Control Questionnaire [ACQ-5] score ≥ 1.5). We performed k-means clustering using 20 variables, including demographics, symptoms, T2 biomarkers (blood eosinophils and fractional exhaled nitric oxide), and lung function (FEV1 and forced expiratory flow at 25% to 75% of forced vital capacity). Logistic regression assessed the ability of ACQ-5 scores to predict T2-high status (blood eosinophils ≥ 300/μL and fractional exhaled nitric oxide > 50 ppb). Cluster analysis identified 3 phenotypes: relative T2-low/preserved function (32.7%); severe T2/obstructive (29.2%); and (3) T2-moderate/small airway dysfunction predominant (38.0%). The prevalence of T2-high status varied significantly (30.4%, 64.0%, and 50.8%, respectively; P = .002). ACQ-5 scores showed limited ability to discriminate T2-high status (area under the curve 0.615). Multivariable modeling provided only modest improvement (area under the curve 0.644). In this study population, treatment-naive uncontrolled asthma comprises 3 clinically distinct phenotypes with divergent inflammatory and functional profiles. Symptom burden alone appeared to be a limited predictor of T2-high inflammation. These exploratory findings suggest that incorporating objective biomarkers and functional assessments into initial care may help tailor therapeutic strategies for patients with small airway dysfunction or discordant symptom-inflammation profiles. Further validation in larger cohorts is required.

The review examines the application of machine learning (ML) and large language models (LLMs) to asthma management. We sought to identify clinically relevant applications, and particularly those that harness electronic health record data. We review methodological challenges and future directions for translating these tools into meaningful improvements in asthma care. ML applied to electronic health record data has been utilized across several domains of asthma management: predicting medication response to inhaled corticosteroids and biologics, improving inhaler adherence through digital inhaler systems, and predicting exacerbation risk with moderate-to-high accuracy. Tools for patient education include clinician-guided chatbots, as well as publicly available LLMs. Limitations include accuracy, hallucinations, and patient health literacy. ML and LLMs offer promising pathways towards personalized, data-driven asthma management. However, harnessing this potential will require rigorous external validation, transparent model design, equitable implementation, and adaptive clinician oversight. Collaboration among clinicians, data scientists, and policymakers will be essential to implement these tools for patient-centered asthma care.

Inhaled corticosteroid (ICS) use in pregnancy has shown associations with decreased offspring asthma in childhood, whereas exacerbations in pregnancy may increase the risk. However, these findings have not been tested in population-based cohorts with rigorous assessment of confounding structures. The aim was to describe asthma exacerbations and ICS utilisation during pregnancy and to assess causal pathways between pregnancy exacerbations, ICS use and offspring asthma. Register-based cohort study of pregnancies in New South Wales (NSW), Australia and Sweden. Maternal monthly asthma exacerbations (hospital visits and/or oral corticosteroid (OCS) dispensings) and ICS dispensing rates were calculated 12 months prepregnancy to 12 months post partum. Among mothers with asthma (35 194 NSW, 102 248 Sweden), Hazard Ratios (HR)s were calculated for pregnancy exacerbations or ICS use and offspring asthma adjusting for confounders including asthma severity. Associations between paternal exposures and offspring asthma and sibling analyses assessed the likelihood of unmeasured confounding. Maternal asthma prevalence was 8.6% in NSW and 7.1% in Sweden. While ICS use was maintained over the course of pregnancy, a postpartum decline was observed, accompanied by a rise in OCS use. Adjusted HRs for offspring asthma were 1.47 (95% CI 1.32 to 1.64, NSW) and 1.30 (95% CI 1.24 to 1.36, Sweden) following maternal exacerbations, and 1.37 (95% CI 1.26 to 1.49, NSW) and 1.23 (95% CI 1.19 to 1.27, Sweden) following maternal ICS use. Paternal exposures were also associated with offspring asthma, while associations in sibling analyses were not significant. Observed associations between maternal exacerbations, ICS use and offspring asthma appear to be due to unmeasured confounding. Management of maternal asthma remains a priority in pregnancy and post partum.

Asthma education among caregivers is an integral part of asthma management. The study validates the Hindi version of the Newcastle Asthma Knowledge Questionnaire (NAKQ). This was a pilot study conducted among 100 parents of children between 7 and 15 years with bronchial asthma. The original English NAKQ tool was forward and back translated into Hindi. A face-to-face interview was conducted to administer the tool. Exploratory factor analysis (EFA) and confirmatory factor analysis were carried out to understand the factor structure, construct, validity, and reliability of the questionnaire. The Cronbach's alpha value was 0.641. The Hindi NAKQ was factorable as demonstrated by a significant Bartlett's test of sphericity. The EFA revealed a four-factor solution explaining 22.5% of the variance. The construct validity showed that items 4, 7, 14, and 17 had poor correlation (of the total 31 items) with the overall scale score (<0.2), and therefore, the items were deleted. Using the four factors with all 27 items, a statistical model was generated with a good fit, as indicated by a root mean square error of approximation (RMSEA) value of 0.0546, which was close to the acceptable cutoff of 0.06. The Hindi-translated version of NAKQ tool is reliable and valid to be administered among the Indian participants.

Exercise training is a crucial non-pharmacological approach in asthma management, yet asthmatic patients are not routinely referred to these programs. Recognizing that significant benefits can be achieved even with highly accessible, standardized exercise programs, the aim of our study was to investigate the effectiveness of a standardized, low-cost, and easily implementable home-based exercise program, supported by weekly supervision, in women with asthma. Thirty female patients with asthma were randomized into training and control groups. Patients in the training group participated in supervised exercise sessions with a physiotherapist once a week for 8 weeks and performed the prescribed exercise program at home 3 days per week. The control group received general physical activity recommendations via an educational booklet. Primary outcomes were respiratory function assessed using spirometry and functional capacity assessed using the 6-minute walk test (6MWT). Secondary outcomes included asthma control assessed using the Asthma Control Test, dyspnea assessed using the modified Medical Research Council dyspnea scale (mMRC), health-related quality of life assessed using the St. George's Respiratory Questionnaire (SGRQ), and lower extremity muscle strength assessed using the 30-second sit-to-stand test (30-s STST). The training group showed statistically significant improvements in peak expiratory flow parameter of spirometry (PEF%), 6MWT, activity subscore of SGRQ, and 30-s STST values compared with the control group (p < 0.05). This study demonstrates that a standardized, accessible, and sustainable home-based exercise program, supplemented by minimal supervision, was associated with significantly greater improvements compared to general physical activity recommendations in enhancing key outcomes in asthma management. This approach offers a valuable, low-cost alternative for reducing sedentary behavior and improving clinical outcomes, particularly in settings where access to complex or technologically advanced rehabilitation centers is limited. These findings may be particularly relevant for women with asthma, who often face greater barriers to physical activity and experience a higher symptom burden. This trial registration was prospectively registered at ClinicalTrials.gov, ID number: NCT04088669.

BackgroundPharmacists can play a key role in asthma management through patient education, inhaler technique assessment, and promoting evidence-based care. This study assessed Palestinian pharmacists’ general asthma knowledge, asthma pharmaceutical care knowledge, attitudes, practices, and perceived barriers to asthma management.MethodsA cross-sectional study was conducted from March to June 2025 in Palestine. Data were collected using a self-administered online questionnaire (convenience/volunteer-response sampling; response rate not determinable). General asthma knowledge was scored by awarding 1 point per correct response (range 0–17) and categorized as poor (0–8), fair (9–11), and knowledgeable (12–17). Data were analyzed using SPSS, bivariate associations were tested using chi-square test, or Fisher’s exact test, and multivariable linear regression was used to identify independent predictors. A p-value of < 0.05 was considered statistically significant.ResultsA total of 402 participants (137 male and 265 female) participated in this study. Overall, 57.2% were classified as knowledgeable in general asthma knowledge. Pharmacists working in hospital settings showed a significantly higher asthma knowledge in comparison with those working in community pharmacies (β = 0.110, p = 0.032). However, the model explained minimal variance (R² = 0.037) and was not statistically significant overall (overall model p = 0.144). No pharmacists’ characteristics were significantly associated with asthma pharmaceutical care knowledge (R² = 0.027; overall model p = 0.378) or attitudes and practices (R² = 0.014; overall model p = 0.850).ConclusionPharmacists demonstrated mixed asthma knowledge with gaps relevant to updated guideline-based care, alongside practice barriers and clinically important practice gaps. Given the very low R² values, observed associations should be interpreted cautiously. Structured continuing professional development and targeted training may improve pharmacists’ uptake of updated recommendations and strengthen asthma pharmaceutical services.

BackgroundThere is limited information available on patients with asthma in hospitals in China. We investigated their clinical and phenotypic characteristics and management.MethodsThe China Asthma Data Registry Project (CHART) study is a multicentre, hospital-based, prospective, observational study in which patients were recruited from outpatient clinics. This analysis used baseline cross-sectional data from patients with asthma (≥12 years) enrolled at 58 tertiary hospitals in China between 25 March 2018 and 11 July 2019.ResultsA total of 20 683 patients with asthma (56.2% female, 15.0% patients with active tobacco use) were enrolled. Overall, 22.8% had uncontrolled asthma, 39.5% had partially controlled asthma. Furthermore, 45.3% experienced ≥1 exacerbation annually, including 31.7% who required hospitalisation, with only 21.4% having previously used inhaled corticosteroids (ICSs) in the past year. Cough (80.0%) was the most common symptom, followed by wheezing (70.7%), with 14.6% having cough-predominant asthma and 11.4% having cough-variant asthma. Multivariate logistic regression revealed that cough severity independently predicted poor control, irrespective of airflow limitation or inflammatory status. The association was stronger in ICS users than in nonusers across all cough severity metrics: a visual analogue scale (VAS) score ≥40 (aOR 3.88–5.47 versus 2.49–2.94), a cough evaluation test (CET) score ≥12 (aOR 11.15–20.91 versus 3.97–5.55), and a Leicester Cough Questionnaire (LCQ) score <15 (aOR 6.15–13.66 versus 2.45–3.18).ConclusionsWe found significant suboptimal control, a high prevalence of cough-related phenotypes, frequent exacerbations and hospital admissions in patients with asthma attending hospitals. This underscores the need to prioritise the assessment and treatment of cough in asthma.

Biological targeted drugs play an important role in the treatment of severe bronchial asthma. According to the Global Initiative for Asthma (GINA) 2025 Report and the Chinese Guidelines for the Diagnosis and Management of Bronchial Asthma (2024 Edition), for patients with poorly controlled symptoms despite treatment with high-dose inhaled corticosteroids (ICS) combined with long-acting β2-agonists (LABAs), approved biological targeted agents are recommended as add-on therapy. In addition, some of these agents are also indicated for allergic and immune-mediated conditions, including chronic spontaneous urticaria, atopic dermatitis, chronic rhinosinusitis with nasal polyps, and allergic rhinitis. However, in clinical practice, the precise selection of biological targeted drugs remains challenging in patients with severe asthma complicated by comorbidities. Although biologics can substantially improve the prognosis of some patients with severe asthma, a notable proportion still show a suboptimal initial response. Therefore, switching between biologics has become a common clinical strategy. Here, we report a patient with severe asthma complicated with chronic spontaneous urticaria who received three different biological agents sequentially. By analyzing the evolution of clinical characteristics and the adjustment made to the therapeutic regimens, we ultimately identified an effective treatment strategy. This case is intended to provide a reference for the selection of biologics and individualized treatment in patients with severe asthma and concomitant comorbidities.

Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of type 2 inflammation with potential for personalized asthma management. However, the longitudinal patterns of FeNO and their association with childhood asthma control remain insufficiently characterized. This cohort study enrolled children with newly diagnosed asthma from Shanghai Children's Medical Center. Participants underwent baseline assessments and serial FeNO measurements at diagnosis and at 3-month intervals over 12 months. Asthma control was assessed at 12 months using Global Initiative for Asthma (GINA) criteria. Longitudinal trajectories of FeNO were identified using group-based trajectory modeling (GBTM). Associations of time-specific FeNO levels and FeNO trajectory group with uncontrolled asthma at 12 months were analyzed using logistic regression. Among 142 children (mean age 6.92 ± 2.08 years; 71.1% male), 125 (88.0%) achieved controlled asthma and 17 (12.0%) had uncontrolled asthma at 12 months. Elevated FeNO at 3 and 12 months was significantly associated with increased odds of uncontrolled asthma after adjusting for covariates. Longitudinal FeNO levels showed two distinct trajectories: low-stable (80.3% of participants) and high-rising (19.7%). Compared with the low-stable group, the high-rising group had significantly older age, later wheezing onset, higher serum total immunoglobulin E (IgE) and eosinophil percentages (all p < 0.05). Children in the high-rising trajectory group had higher odds of uncontrolled asthma (OR = 5.86; 95% CI: 1.28-29.57; p = 0.025). Elevated FeNO levels during follow-up and a high-rising FeNO trajectory are associated with uncontrolled asthma at 12 months in children with newly diagnosed asthma. Longitudinal FeNO monitoring may help identify children at increased risk of poor asthma control and support more individualized asthma management.

Despite its high prevalence and the discovery of hundreds of genetic associations, the genetic determinants and heterogeneous manifestations of asthma remain incompletely understood. Incorporating polygenic risk scores (PRS) into asthma research offers a powerful approach to quantify inherited susceptibility, refine risk profiles, and advance mechanistic understanding of disease development. For this study, we leveraged whole-genome sequencing (WGS) data from two family-based cohorts of childhood asthma - the Genetics of Asthma in Costa Rica Study (GACRS) and the Childhood Asthma Management Program (CAMP) - to examine the transmission profiles of externally derived asthma PRS and their associations with clinical phenotypes in children with asthma. To further elucidate molecular mechanisms, we integrated large-scale external genome-wide association study (GWAS) summary statistics and genetic prediction models of protein abundance in a two-step proteome-wide association study (PWAS) of asthma. Our findings provide robust evidence supporting the validity of externally derived asthma PRS (asthma PRS association p-valuep= 10−24[GACRS and CAMP trios combined] for the Global Biobank Meta-analysis Initiative [GBMI]) and reveal consistent associations with spirometry measures and atopy markers across both studies, as 13 of 21 traits (62%) were significantly associated with the GBMI-PRS in the meta-analysis after multiple-testing correction. Moreover, the results of the integrative proteomic analysis implicate IL-1 signaling in the etiology of asthma, reinforcing the candidacy of IL1R1 antagonists for drug repurposing.

Short-acting β2-agonist (SABA) overuse is associated with increased asthma exacerbations and mortality, yet its impact on cardiovascular disease remains unclear. We investigate the association between SABA overuse and the risk of major adverse cardiovascular events (MACE) in patients with asthma. Between 2011 and 2019, patients with asthma were identified from the Taiwan asthma pay-for-performance database. SABA overuse was defined as using ≥3 canisters annually, compared with acceptable use (0-2 canisters/year). Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. The primary outcome was 1-year MACE. Secondary outcomes included MACE component (non-fatal myocardial infarction, haemorrhagic stroke, ischaemic stroke) and mortality. Among 231 970 patients, 28 500 had SABA overuse and 203 470 had acceptable use. In the IPTW-weighted cohort, 1-year MACE incidence was higher in the overuse group (2.82 vs 0.99 per 100 person-years; adjusted HR (aHR) 1.25, 95% CI 1.12 to 1.39). SABA overuse significantly increased the risk of non-fatal MI (aHR: 1.28, 95% CI 1.09 to 1.50), ischaemic stroke (aHR: 1.26, 95% CI 1.08 to 1.46) and mortality (aHR: 1.40, 95% CI 1.24 to 1.58). Haemorrhagic stroke risk was not significantly increased. A non-linear dose-response was observed, with MACE risk peaking at 6-8 canisters annually. SABA overuse (≥3 canisters/year) is associated with increased risks of MACE and mortality in patients with asthma. These findings emphasise the importance of monitoring SABA use and assessing cardiovascular risk in asthma management.

Although asthma and obesity are independently associated with neurodevelopmental disorders, whether their co-occurrence is associated with a higher burden of these disorders remains unclear. Using NHIS data from children and adolescents aged 10-17 years with complete BMI and neurodevelopmental data, 42,444 participants were stratified into four categories according to their asthma and obesity status: obesity-related asthma (OA), asthma without obesity (NOA), obesity without asthma (ONA), and neither condition (NC). Compared with the NC group, the adjusted odds ratios for attention-deficit/hyperactivity disorder, learning disability, autism spectrum disorder, and developmental delay were, respectively, 1.84 (95% CI 1.57-2.14), 1.87 (95% CI 1.57-2.22), 2.20 (95% CI 1.57-3.07), and 2.29 (95% CI 1.79-2.94) in the OA group; 1.56 (95% CI 1.40-1.74), 1.51 (95% CI 1.34-1.69), 1.12 (95% CI 0.87-1.43), and 1.50 (95% CI 1.26-1.79) in the NOA group; 1.23 (95% CI 1.10-1.38), 1.32 (95% CI 1.17-1.48), 1.53 (95% CI 1.21-1.93), and 1.31 (95% CI 1.10-1.56) in the ONA group. This study demonstrated a significant association between obesity-related asthma and neurodevelopmental disorders in children. The co-occurrence of obesity and asthma is associated with stronger associations than either condition alone. Our study showed that there was a significant association between obesity-related asthma and neurodevelopmental disorders in children. Our study also suggested that the co-occurrence of obesity and asthma is associated with stronger associations than either condition alone. Our study filled the research gap regarding the association between obesity-related asthma and childhood neurodevelopmental disorders. Our findings highlight the need for further longitudinal studies to examine whether integrated management of obesity and asthma is related to neurodevelopmental outcomes in children. These findings may help identify children with co-occurring obesity and asthma as a subgroup warranting closer developmental assessment.

Advancing in precision asthma management: The Treat-to-Target by Treatable Traits (T4) framework.

How to monitor response to biologics in children with severe asthma.

One of the optimal asthma management goals is to improve patients' quality of life. Limited Saudi studies assessed quality of life (QoL) among vulnerable groups like schoolchildren. This study conducted quantitative and qualitative approaches to examine asthma-related QoL in Saudi adolescent students. A mixed-approach study was conducted among guardians of Saudi schoolchildren with confirmed asthma disease during May and November 2025. Based on in-depth asthma QoL interviews, a qualitative approach was completed, and quantitative methods were applied for comprehensiveness. Both approaches were influenced by the reliable and verified Arabic PedsQL Asthma Module. MAXQDA was used to assess guardians' comprehensive responses, and the PedsQL Asthma Module scale was used to categorize and analyze the conclusion responses.Qualitative and quantitative analyses include 46 interviews. As some feelings of anxiety and worry among children were shown to be linked with asthmatic symptoms and complications, it appears that this nervousness impacts guardians and might affect their QoL. Some found asthma to be challenging to manage, leading to anxiety and fear of complications. The quantitative approach revealed a substantial effect size of high asthma QoL compared to moderate to poor QoL (Hedges' g = - 0.690, p 0.001). Conclusion: This study shows that Saudi asthmatic adolescents have moderate QoL, but clinical and school-based care gaps exist. QoL is driven by asthma symptoms and management, which may create worry in children and parents. Furthermore, environmental differences in Saudi Arabia may affect asthmatic students'respiratory health. These issues should be addressed to improve asthmatic adolescents'QoL.

ABSTRACT Background Clinical remission is an emerging goal in severe asthma (SA) management. While tezepelumab demonstrates broad efficacy, its real-world impact on remission—specifically in the context of small airway dysfunction (SAD)—remains incompletely defined. Methods This prospective, multicentre study enrolled 39 adults with SA treated with tezepelumab for 12 months. Clinical remission was defined by SANI criteria: complete oral corticosteroid (OCS) withdrawal, zero severe exacesrbations, Asthma Control Test score ≥20, and stable/improved FEV1. SAD remission required normalization of oscillometric parameters. Results At baseline, 44% of patients exhibited SAD. Tezepelumab eliminated severe exacerbations and achieved complete OCS withdrawal in 100% of evaluable patients. At 12 months, 77.4% of the overall evaluable cohort and 80.0% of those with baseline SAD achieved clinical remission. However, SAD remission was not observed; these patients maintained persistent oscillometric abnormalities despite reaching all clinical goals. Conclusion Tezepelumab enables high rates of clinical remission regardless of baseline small airway status. In the SAD phenotype, symptomatic and inflammatory recovery dissociates from physiological SAD remission. Persistent mechanical abnormalities highlight the necessity of oscillometry to identify hidden residual disease in patients who otherwise appear to be in remission.

BackgroundAsthma is a heterogeneous disease with well-documented sex differences in prevalence. However, the sex-specific and pubertal effects of inhaled corticosteroids on endogenous steroid metabolites and their relationship with asthma-related clinical outcomes remain poorly understood.MethodsTargeted whole-blood plasma profiling of the steroid biosynthesis pathway was generated by Precion Inc. (NC, USA). Sixteen metabolites from the steroid biosynthesis pathway were quantified at baseline and end-of-trial in children with asthma from the Childhood Asthma Management Program (CAMP; n = 1,041), aged 5–12 years. Linear mixed models and generalized linear models were used to evaluate sex-specific longitudinal and endpoint responses of steroid metabolites and clinical outcomes with inhaled corticosteroid (ICS) use, adjusting for age, sex, race, height, and body mass index.ResultsICS use in males was associated with significantly lower cortisol and cortisone levels at Year 4 (end of trial). In females, cortisol and cortisone showed more stable trajectories with ICS use, which resulted in a non-significant reduction at year 4. Males receiving ICS showed suggestive positive longitudinal associations for 17α-hydroxyprogesterone, estrone, and testosterone, while females showed a suggestive positive trajectory for androstenedione. ICS exposure modified the associations between metabolites and clinical outcomes (FEV1, FVC, eosinophils, and airway hyperresponsiveness) in a pathway- and sex-specific manner. Overall, ICS attenuated longitudinal associations between endogenous steroids and clinical outcomes, particularly in females, while selected relationships from the androgen–lung function associations were preserved at the end of the trial.ConclusionWe identify sex-specific differences in ICS-associated metabolite profiles and clinical outcomes, supporting the need for further investigation into sex-informed approaches to corticosteroid use in pediatric asthma.Trial registration:Clinicaltrials.gov: NCT00000575; registered 1999-10-27

Asthma is the most common pulmonary condition encountered during pregnancy. Based on our clinical experience as a pulmonologist and an internal medicine specialist, we frequently manage pregnant women with asthma, often without prior referral from an obstetrician. This study aimed to evaluate obstetricians' clinical approaches to asthma management during pregnancy using a structured questionnaire. A 12-item questionnaire was developed and distributed electronically to obstetricians nationwide. Participation was voluntary, and respondents were assured of full anonymity. The survey was administered via e-mail through a secure online platform. Among the participants, 26 (61.9%) were specialists, while 16 (38.1%) held academic titles as associate professors or professors. Regarding consultation practices, 23 obstetricians (54.8%) reported consistently consulting a pulmonologist from the early stages of pregnancy, 10 (23.8%) did so frequently, 8 (19.0%) occasionally, and 1 (2.4%) stated that they never sought consultation. In terms of delivery preferences for asthmatic patients, 32 respondents (76.2%) favored vaginal delivery, while 10 (23.8%) preferred cesarean section. Among those who opted for cesarean delivery, 41 (97.6%) reported a preference for regional anesthesia, and only 1 (2.4%) indicated the use of general anesthesia. Asthmatic pregnant patients should be reassured both by obstetricians and by the pulmonologists or internists involved in their care that the majority of medications used in asthma management are classified as Category B and are generally considered safe during pregnancy. Physicians should remain aware of their dual responsibility, both ethical and legal, when making therapeutic decisions during this sensitive period. This study was registered by the scientific board of Fatih Sultan Mehmet Education and Research Hospital (FSM EAH-KAEK 2023/71).

PurposeIn 2010, the Global Strategy for Asthma Management and Prevention recommended reducing the reliance on treating acute asthma exacerbations with short-acting β2 agonists (SABAs) given potential adverse effects. However, more than a decade later, SABAs, particularly nebulised salbutamol, remain at the forefront of acute asthma care. This study examined the physiological effects of nebulised salbutamol in patients experiencing moderate to severe asthma exacerbations.MethodsA six month, prospective and retrospective observational study was undertaken involving prehospital asthma patients treated with nebulised salbutamol. Data were analysed using descriptive and inferential statistics, including paired comparisons and exploratory subgroup analyses, to identify relevant trends and variability.ResultsAmong 176 eligible patients, reductions were observed in heart rate (mean −3 beats/min) and respiratory rate (mean −5 breaths/min), with modest improvement in peripheral oxygen saturation (+2%). Capillary blood glucose (CBG) analysis was conducted on a small prospective subgroup (n=8). A mean increase of +0.375 mmol/L was observed. When one clinically atypical outlier was excluded (n=7), the increase reached statistical significance. Albeit interpretation is limited by the small sample size.ConclusionAdministration of ≥5mg nebulised salbutamol in acute asthma exacerbations was transiently associated with improved peripheral oxygen saturation and respiratory parameter changes during the prehospital treatment period. No clinically significant increase in heart rate was observed overall. A small rise in CBG was observed in a small prospectively monitored subgroup. However, the clinical significance of this finding remains uncertain. Larger, adequately powered prospective studies are required to confirm these findings. The present findings are insufficient to recommend changes to current glucose monitoring practices in non-diabetic patients.