Asthma Program Research Articles

Picturing asthma in Turkey: results from the Turkish adult asthma registry

Introduction National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. Methods Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. Results The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3–5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. Conclusion The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee

The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.

Short-acting Beta-agonist (SABA) Use By Race and Neighborhood Socioeconomic Status (nSES) Among Participants Enrolled In A Digital Health Program For Asthma

Short-acting Beta-agonist (SABA) Use By Race and Neighborhood Socioeconomic Status (nSES) Among Participants Enrolled In A Digital Health Program For Asthma

Early life miRNA programming of asthma and allergic diseases

Early life miRNA programming of asthma and allergic diseases

Progress to be made in asthma management

Progress to be made in asthma management

Asthma control in Kazakhstan: need for urgent action

BackgroundAsthma control, patients’ awareness level and adherence to treatment in Kazakhstan have never been studied. The aim of this study was to verify the prevalence of controlled, poorly controlled and uncontrolled asthma in a large sample of three largest cities of Kazakhstan.MethodsWe recruited 600 (median age 54 (interquartile range (IQR) 22) years, 64% females) patients with diagnosis confirmed earlier in the outpatient facilities in Almaty, Astana and Shymkent in 2020–2021. We offered a structured questionnaire on asthma control and risk factors as of GINA and performed spirometry. We report the prevalence of asthma control, knowledge and skills and pharmacological treatment with 95% confidence interval (CI) and the association of selected predictors with asthma control.ResultsWith the median of 9 (IQR 13) years of diagnosis, 40% of patients had comorbid COPD and 42% had allergic rhinitis, whereas 32% lived with pets. Asthma was well-controlled in only 12.3% (95% CI 9.7–15.0), partly controlled in 29.8% (95% CI 26.2–33.5) and uncontrolled in 57.8% (95% CI 53.9–61.8) patients. ACQ-5 score (range 0–5.8, median 2) equaled 0.2 (IQR 0.85) in well-controlled asthma patients, 1.4 (IQR 1) in partly controlled and 2.8 (IQR 1.4) in uncontrolled asthma patients. Knowledge and skills levels were very low. Only 54% were on inhaled corticosteroids (52.2% of them used budesonide/formoterol and 39.5% used fluticasone/salmeterol). 39% used steroids per os or parenterally within a period of 12 months (51% of patients with uncontrolled asthma).ConclusionAsthma control, knowledge and skills levels of asthma patients in the largest cities of Kazakhstan remain unacceptably low, whereas pharmacological treatment is far from optimal. Urgent action should be taken to support doctors’ training, and we call to launch a national asthma program to coordinate asthma care in Kazakhstan.

PCR20 Diversity of Patient Support Programs for Severe Asthma Treated with Biologic Therapies – A Systematic Literature Review

PCR20 Diversity of Patient Support Programs for Severe Asthma Treated with Biologic Therapies – A Systematic Literature Review

Adherence to treatment guidelines and good asthma control in Finland

ABSTRACT Background Asthma program in Finland decreased asthma-related mortality and expenses of care on national level, but there is lack of data on adherence to treatment guidelines and disease control on individual level. We aimed to assess adherence to guidelines and disease control among Finnish adult asthmatics. Methods Questionnaires were sent in Finland to 2000 randomly selected recipients aged 18–80 years, who had bought medication for obstructive airways disease during the previous 12 months. The questionnaire included questions on asthma medication, exacerbations, self-management and follow-up. Asthma symptom control was assessed by the Asthma Control Test (ACT). Results A high proportion (82.4%) of the 541 responders with physician-diagnosed asthma reported regular use of asthma medication and 97.1% of them used inhaled corticosteroids. Almost all (97.0%) of the asthmatics were taught how to use their inhaler and 78.4% had an asthma self-management plan, but only 35.7% reported regular annual follow-up visits. According to symptoms, 60.0% had their asthma well-controlled (ACT score ≥20). On the other hand, 29.2% had a course of oral corticosteroid and 21.8% had an asthma-related unscheduled health care visit during the previous year, but only 2.6% reported a hospitalization. Asthma control was better in those not using regular asthma medication. Conclusions The guidelines are well adopted in Finnish adult asthma care except for regular follow-up visits. Majority of patients had good symptom control and hospitalizations were rare. Better asthma control among those not using regular asthma medication implies they are not undertreated but have a mild disease.

Comparison of COPD primary care in England, Scotland, Wales, and Northern Ireland

Currently the National Asthma and COPD audit programme (NACAP) only undertakes audit of COPD primary care in Wales due to its near complete data coverage. We aimed to determine if the quality of COPD primary care in the other UK nations is comparable with Wales. We found that English, Scottish, and Northern Irish practices were significantly worse than Welsh practices at recording coded lung function parameters used in COPD diagnosis (ORs: 0.51 [0.43–0.59], 0.29 [0.23–0.36], 0.42 [0.31–0.58], respectively) and referring appropriate patients for pulmonary rehabilitation (ORs: 0.10 [0.09–0.11], 0.12 [0.11–0.14], 0.22 [0.19–0.25], respectively). Completing national audits of primary care in Wales only may have led to improvements in care, or at least improvements in the recording of care in Wales that are not occurring elsewhere in the UK. This highlights the potential importance of audit in improving care quality and accurate recording of that care.

Outdoor air pollution exposure and the risk of asthma and wheezing in the offspring.

According to the "fetal origin of disease" hypothesis, air pollution exposure in pregnancy may play an important role in stimulating the early programming of asthma and allergies. However, previous studies reported inconsistent findings. The aim of this meta-analysis was to provide higher grade evidence and quantitatively analyze the link between prenatal exposure to outdoor air pollutants and childhood asthma and wheezing. Databases (Web of Science and PubMed) were extensively searched for articles published from the start of the database to September 15, 2021. Either random-effect model or fixed-effect model was used to estimate the disease-specific relative risks (RR) with the corresponding 95% confidence intervals (CIs) to estimate the association. Newcastle-Ottawa Quality Score (NOS) was used to assess the quality of studies. This study finally included 13 cohort studies, and the findings showed that NO2 and SO2 exposure during entire pregnancy was significantly associated with wheezing (RR = 1.032, 95% CI: 1.000, 1.066) and asthma (RR = 1.114, 95% CI: 1.066, 1.164), respectively. Further analyses showed that PM2.5 were positively associated with asthma in the second (RR = 1.194, 95% CI: 1.143, 1.247) and third trimester (RR = 1.050, 95% CI: 1.007, 1.094), while NO2 (RR = 1.060, 95% CI: 1.021, 1.101) and SO2 (RR = 1.067, 95% CI: 1.013, 1.123) were shown positively associated with asthma only in the second trimester. The relationship between wheezing and outdoor air pollutants was not significant in any of the pregnancy subgroups. This study suggests that prenatal exposure of outdoor air pollution may increase the asthma and wheezing risk in the offspring and that the second trimester may be a sensitive period for air pollution exposure. But the interpretation of the causal association is hampered by limited number of studies on dose response.

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.

An asthma collaboration to reduce childhood asthma disparities on the Navajo Nation: Trial protocol for the Community Asthma Program

Navajo children disproportionately experience poor asthma outcomes. Following a one-year community engagement period with key stakeholders from the Navajo Nation, the Community Asthma Program (CAP) was created using evidenced based programs with the goal of reducing asthma disparities among Navajo children. CAP is being evaluated with a six-year, multi-site step-wedge design in three Navajo communities: Tuba City, Chinle and Fort Defiance, Arizona. The primary outcome is asthma exacerbations defined as use of systemic oral corticosteroids, asthma hospitalizations, asthma related ED visits, and ICU admissions. Asthma exacerbations will be measured using data from the electronic medical records of the three community health care centers. Secondary outcomes include will changes in asthma-related events and asthma control. The RE-AIM (Reach and representativeness, 2)Effectiveness, 3) Adoption, 4) Implementation, and 5) Maintenance) framework is being used to guide the implementation evaluation which includes iterative collection and analysis of process data to identify facilitators and barriers, describe relevant organizational contexts, and inform strategies for dissemination. The CAP intervention requires community engagement and participation, building community capacity, incorporating evidenced-based guidelines and practices while ensuring program strategies actively involve Navajo community members during all steps of the intervention. The outcome of this trial will allow us to determine the effectiveness of a multi-component, community-focused intervention to improve asthma in a tribal community.

The Role of Social Determinants of Health in the Use of Telemedicine for Asthma in Children

Asthma is the most common chronic health condition among children in the United States. The adverse impacts of social determinants of health often manifest in unmet health-related social needs, potentially contributing to worse asthma outcomes. With the onset and rapid spread of coronavirus disease 2019 (COVID-19) and the identification of asthma as a potential risk factor for more severe disease, our asthma program quickly pivoted to a remote-access telemedicine asthma population management platform to best meet the needs of our most at-risk patients. Our practice provides care to a large proportion of Black and Latino/a/e children in urban areas insured by the State Medicaid Program and impacted by unmet social needs. As we pivoted to telemedicine, we consistently reached a greater number of patients and families than prepandemic and observed decreased emergency department visits and hospitalizations. About 1 in 5 families received resource touch points spanning categories of transportation, food and supplies, clothing, utilities, and rent. Overall, families reported positive experiences with telemedicine, including the ability to connect remotely with our social work and resource teams. Telemedicine may be an effective strategy for addressing both the medical and the social needs of children with asthma at risk for worse outcomes.

Implementation of a Pediatric Population Health Asthma Program in Academic Medical Center-Affiliated Urban and Suburban Practices.

A tiered pediatric Asthma Population Health Management Program (APHMP), based on evidence-based practices, that differentially targets populations for intervention based on rising risk for high utilization and disease complications was implemented at 6 urban and suburban practices affiliated with an academic medical center. In addition to standard pediatric asthma care, APHMP adds regular administration of the asthma control test (ACT), provider education on performance variation, and monitoring through the electronic health record-based asthma registry. As patients' use of acute health care services and complications increases, APHMP integrates multidisciplinary interventions, including an asthma coach who conducts environmental assessments in addition to addressing social needs, into their primary care. A retrospective cohort study method was used to assess population-level effects on asthma event rates and practice- and provider-level variation from 2017 to 2019. Consistent with well-documented health disparities in pediatric asthma, the analysis demonstrated that patients who were male (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.02-1.43), 4-8 years old (OR = 4.91, 95% CI = 3.27-7.37), Spanish speaking (OR = 1.67, 95% CI = 1.54-1.81), from low-income neighborhoods (OR = 1.56, 95% CI = 1.53-2.46), and with ACT <20 (OR = 2.88, 95% CI = 1.97-4.21) had higher odds of having asthma events. Six percent of patients studied were found to be at risk for high health care utilization and disease complications. Study limitations include the absence of a control group, the mixed model data collection approach, and the effects of seasonal variation on asthma events. Future directions include analyzing disease management program outcomes of incorporating an asthma coach into a patient's primary care team and addressing provider-level variation in asthma event rates.

COVID-19 on the Navajo Nation: experiences of Diné families of children with asthma

Objective The first case of COVID-19 on the Navajo Nation (NN) was found on March 17, 2020. Even with strong public health efforts, NN saw the highest per capita infection rate in the US during May of 2020 with 2450/100,000. To determine the impact of COVID-19 on families of children with asthma on the NN, families participating in the NHLBI funded Community Asthma Program were contacted to see if they would share their experiences. Methods Sixty-six of 193 families (34%) were interviewed. Results: The average age of the child with asthma was 13.5 (SD = 3.9) and 33% were female. Most Diné children with asthma in our study did not contract COVID-19. However, the pandemic had a significant impact on them and their families. Many family members contracted COVID-19, some children lost family members, and half of interviewed parents reported a decline in their child’s mental health. Twenty-five percent of families sought the help of a traditional healer. Many accessed medical care through telehealth and most were able to obtain asthma medications when needed. Conclusions: Despite significant challenges, our research indicated resilience among Navajo families.

Applying dissemination and implementation research methods to translate a school-based asthma program

Our school-based asthma program has reduced asthma exacerbations for youth with health disparities in the Denver metropolitan area, due partly to addressing social determinants of health, such as access to health care and medications. Dissemination and implementation (D&I) science approaches accelerate the translation of evidence-based programs into routine practice. D&I methods are being applied more commonly to improve health equity. The purpose of this publication was to give an overview of D&I research methods, using our school-based asthma program as an example. To successfully scale out our program across the state of Colorado, we are applying a D&I framework that guides the adaptation of our existing implementation approach to better meet our stakeholders' local context-the Exploration, Preparation, Implementation, Sustainment framework. In a pragmatic trial design, we will evaluate the outcomes of implementing the program across 5 Colorado regions, with attention to health equity, using a second commonly used D&I framework-Reach, Effectiveness, Adoption, Implementation, and Maintenance. Our central hypothesis is that our program will have broad and equitable reach to eligible students (primary outcome) and will reduce asthma attacks and symptoms. This D&I approach accelerates dissemination of our program and is an applicable process for translating other effective allergy/asthma programs to address asthma and allergy-related disparities.

Asthma and Technology in Emerging African American Adults (The ATHENA Project): Protocol for a Trial Using the Multiphase Optimization Strategy Framework.

BackgroundAsthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However, intensive face-to-face interventions are often difficult to implement in this population.ObjectiveThe purpose of this study is to develop an effective mobile asthma management intervention to improve control among AAEAs.MethodsWe will assess the ability of multiple technologic components to assist and improve traditional asthma education. The first component is the Motivational Enhancement System for asthma management. It is a mobile 4-session intervention using supported self-regulation and motivational interviewing. Personalized content is based on each participant’s activity level, daily experiences, and goals. The second component is supportive accountability. It is administered by asthma nurses using targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through a motivational interviewing–based framework. The third component is SMS text messaging. It provides reminders for asthma education, medication adherence, and physical activity. The fourth component is physical activity tracking. It uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test intervention components and combinations of components to identify the most effective mobile intervention. The MOST framework is an innovative, and cost- and time-effective framework that uses engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy, using a clinically significant improvement in asthma. Participants (N=180) will be randomized to 1 of 6 intervention arms. Participants will be recruited from multiple sites of the American Lung Association-Airway Clinical Research Centers network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, and 3, 6, and 12 months.ResultsAt study completion, we will have an empirically supported optimized mobile asthma management intervention to improve asthma control for AAEAs. We hypothesize that postintervention (3, 6, and 12 months), participants with uncontrolled asthma will show a clinically significant improvement in asthma control. We also hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbation (secondary outcomes) will be observed.ConclusionsAAEAs are disproportionately impacted by asthma, but have been underrepresented in research. Mobile asthma management interventions may help improve asthma control and allow people to live healthier lives. During this project, we will use an innovative strategy to develop an optimized mobile asthma management intervention using the most effective combination of nurse-delivered asthma education, a smartphone app, and text messaging.International Registered Report Identifier (IRRID)PRR1-10.2196/37946

Allergic rhinitis co-morbidity on asthma outcomes in city school children

Background School based asthma programs have demonstrated that preventive asthma therapy administered in school reduces asthma morbidity. The burden of co-morbid allergic disease on asthma outcomes in a large school based asthma cohort has been unexplored. Objective Evaluate the prevalence of allergic rhinitis (AR) in historically minoritized school children with persistent asthma, and determine if AR is an independent risk factor for asthma morbidity. Methods We evaluated the prevalence of AR in children enrolled in 3 NIH funded school based asthma programs in Rochester, NY. We used linear regression and multivariate analyses to compare asthma outcomes for children whose caregivers did and did not report AR. Results We used data from 1,029 children with asthma (mean age 7.4, 60.4% Black, 29.5% Hispanic, 72.8% insured with Medicaid). 63% of children reported AR. Children with AR had significantly fewer symptom free days over 2 weeks compared to children without AR (7.2 vs. 8.3, p < 0.001). Children with AR also had more daytime symptoms, (4.7 vs. 3.7, p < 0.001), more rescue medication use (4.5 vs. 3.4, p < 0.01), and more activity limitation due to asthma (3.6 vs. 2.5, p < 0.001). Only 44% of children with AR reported allergy medication use. Conclusions Among a large school-based cohort of minoritized children with asthma, we found that the majority of children have comorbid allergic rhinitis, which was associated with increased asthma morbidity. Inadequate recognition and treatment for allergic rhinitis likely represents substantial preventable morbidity for this group.

Using Telemedicine to Care for the Asthma Patient.

Purpose of ReviewTo review the data supporting the use of telemedicine (TM) and to provide practical guidance for practitioners to optimize the care of their asthmatic patients.Recent FindingsPrevious to the pandemic, TM was little used in various aspects of asthma care. Since the pandemic, TM has been increasingly used in new ways to care for asthma patients at various locations. In addition to direct-to-consumer visits for asthma care, other forms of telehealth visits have been increasing such as facilitated visits, asynchronous, remote patient monitoring, e-consults, and mHealth. Moreover, patient and provider satisfaction with the use of TM has been increasing and is comparable at times with face-to-face visits. In this review, best practices for starting a telemedicine asthma service with patients at home, distant clinic sites, and various other locations, including school-based asthma programs, are reviewed.SummaryTM is a valuable adjunct to face-to-face visits for asthma care. Following the recommended best practices can strengthen the implementation of a telemedicine asthma program (TMAP) into clinical practice. Providers must be vigilant in keeping current with the various nuances required for asthma telemedicine care in preparation for the post-pandemic environment.

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...