Asthma Screening Research Articles

Evaluation and Application of the Work-Related Asthma Screening Questionnaire—Long Version (WRASQ-L)

BackgroundThe Work-related Asthma (WRA) Screening Questionnaire (Long-Version)(WRASQ-L)TM is a screening questionnaire that could improve recognition of WRA. ObjectiveTo conduct a definitive evaluation of the WRASQ-LTM to justify its implementation in clinical settings. MethodsEmployed adults aged 18-75 years with asthma confirmed by objective measures and the ability to take time off work were eligible. Participants completed the WRASQ-LTM then monitored their peak expiratory flow at and away from work or completed a specific inhalation challenge test. Data were classified as WRA or non-WRA by two asthma specialists, blinded to WRASQ-LTM answers. Sensitivity (SN), specificity (SP), positive and negative predictive values (PPV and NPV, respectively) and Youden’s index were calculated for cut-offs of a positive screen. ResultsOf 106 participants (47.1±7.1 years (mean ± SD); 60 (57%) female), 14 (17%) were classified as WRA and were significantly younger in age than non-WRA participants (p=0.043). The questionnaire has high SN and NPV (90.9% and 93.1%, respectively), but low PPV and SP (32.1% and 26.0%, respectively). ConclusionsThe WRASQ-LTM has high SN and NPV. High SN is of primary interest to ensure that few false negative screens are missed and those with potential WRA are identified and continue to specialist care. The SN indicates utility of the questionnaire in clinical settings. Further benefits of the tool include its potential to prompt for education on the symptom-workplace relationship, workplace exposures, personal protective equipment use, and collect exposure and occupational history.

Associations Between Pesticide Chemical Exposure Students with Respiratory Infections and Asthma Symptoms in Iraq

Background: There are relationships between pesticide chemical exposures (PCE) found in schools, and not enough research has been done on schoolchildren's allergies and respiratory health. In order to provide objective assessments of the PMECs that young students are exposed to in the classroom and to establish a link between schoolchildren's respiratory infections and asthma and exposure to major air pollutants found in classrooms, a survey was carried out in a sizable sample of primary school classrooms in Iraq. Methods: Children from a randomly chosen sample were the subjects of a cross-sectional study that also included a case-control analysis of public schools in Karbala. A total of 500 pupils from six junior primary schools in Karbala (mean age 10 years, SD 65.7) took part (97% participation rate). Results: The study included a physician visit with skin prick testing for common allergens, an exercise-induced asthma (EIA) screening test, and a parent-completed standardized health questionnaire. Out of 500 youngsters, 10 (2%) had a persistent respiratory condition. Although not very large, the baseline difference in mean age was statistically significant. Conclusion: Children in Iraq who were exposed to pesticides had long-term respiratory problems and illnesses.

Causal effects of genetically determined blood metabolites on asthma: a bidirectional Mendelian randomization study

Objective The observational association between blood metabolites and asthma has been extensively studied. However, it is still unclear whether this association is causal. In this study, we aimed to investigate the causal relationship between blood metabolites and asthma using a bidirectional Mendelian randomization (MR) analysis. Additionally, we aimed to explore the potential mechanisms underlying this relationship. Methods The study design involved the use of genetic instruments as instrumental variables (IVs) to fulfill the assumptions of MR analysis. The data on 1,091 metabolites and 309 metabolite ratios were obtained from the Canadian Longitudinal Study on Aging (CLSA), while the data on asthma were obtained from the Integrative Epidemiology Unit (IEU) Open GWAS Project. Utilizing the inverse variance-weighted (IVW) method as the primary MR analysis approach, sensitivity tests were conducted to assess the reliability of the findings, which involved employing Cochran’s Q and the MR-Egger intercept. Furthermore, Bayesian weighted MR was used to further test the robustness of the results. Additionally, pathway analysis was conducted to explore the metabolic explanations underlying asthma. Result In our study, a comprehensive MR Analysis identified 10 metabolites and 6 metabolite ratios significantly associated with the development of asthma (FDR < 0.05). The metabolites included glycerophosphocholines(GPCs), glycerophosphoethanolamines(GPEs), and an unknown metabolite. Of these, 1-arachidonoyl-GPC, 1-myristoyl-2-arachidonoyl-GPC, 1-palmitoyl-2-arachidonoyl-GPC, and 1-(1-enyl-palmitoyl)-2-arachidonoyl-GPC were associated with an increased risk of asthma, whereas 1,2-dilinoleoyl-GPC, 1-palmitoyl-2-linoleoyl-GPC, 1,2-dilinoleoyl-GPE, 1 − oleoyl − 2 − linoleoyl − GPE, 1-palmitoyl-2-linoleoyl-GPE, and X-21470 were found to have a protective effect. No heterogeneity and pleiotropy were observed in the significant metabolites (p > 0.05), and each metabolite exhibited a consistent effect direction across all five methods. BWMR analysis results confirmed the significance and direction of effects across exposures, except for Cholesterol to linoleoyl-arachidonoyl-glycerol ratio(p = 0.673). Pathway analysis suggests that glycerophospholipid metabolism may potentially be a mechanism underlying the development of asthma. Conclusion Our MR findings suggest that the identified metabolites and pathways can serve as biomarkers for clinical asthma screening and prevention, while also providing new insights for future mechanistic exploration and drug target selection.

Automated asthma detection in a 1326-subject cohort using a one-dimensional attractive-and-repulsive center-symmetric local binary pattern technique with cough sounds

Asthma is a common disease. The clinical diagnosis is usually confirmed on a pulmonary function test, which is not always readily accessible. We aimed to develop a computationally lightweight handcrafted machine learning model for asthma detection based on cough sounds recorded using mobile phones. Toward this aim, we proposed a novel feature extractor based on a one-dimensional version of the published attractive-and-repulsive center-symmetric local binary pattern (1D-ARCSLBP), which we tested on a new cough sound dataset. We prospectively recorded cough sounds from 511 asthmatics and 815 non-asthmatic subjects (comprising mostly healthy volunteers), which yielded 1875 one-second cough sound segments for analysis. Our model comprised four steps: (i) preprocessing, in which speech signals and stop times (silent zones between coughs) were removed, leaving behind analyzable cough sound segments; (ii) feature extraction, in which tunable q-factor wavelet transformation was used to perform multilevel signal decomposition into wavelet subbands, allowing 1D-ARCSLBP to extract local low- and high-level features; (iii) feature selection, in which neighborhood component analysis was used to select the most discriminative features; and (iv) classification, in which a standard shallow cubic support vector machine was deployed to calculate binary classification results (asthma versus non-asthma) using tenfold and leave-one-subject-out cross-validations. Our model attained 98.24% and 96.91% accuracy rates with tenfold and leave-one-subject-out cross-validation strategies, respectively, and obtained a low-time complexity. The excellent results confirmed the feature extraction capability of 1D-ARCSLBP and the feasibility of the model being developed into a real-world application for asthma screening.

РАННЯЯ ДИАГНОСТИКА ПОЗДНЕЙ БРОНХИАЛЬНОЙ АСТМЫ У КОМОРБИДНЫХ ПАЦИЕНТОВ

Abstract. Introduction. Underdiagnosis of late-onset bronchial asthma and improvement of methods for its early detection is an important trend in medicine, which is associated with the increasing number of adult patients with variable respiratory symptoms, allergologic history, and comorbid background. It seems reasonable to improve the early diagnosis of late-onset asthma in comorbid patients using screening scales. Aim. To assess the risk of late-onset bronchial asthma in comorbid patients, using the Adult Epidemiologic Asthma Scale (A2) and the European Community Respiratory Health Survey (ECRHS) questionnaire. Material and Methods. Eighty patients aged 59.9±11.6 (–51.3% of them being female patients) were examined. Group 1: Comorbid patients with the established asthma; group 2: Comorbid patients without asthma. Asthma risk factors, respiratory symptoms, frequency of comorbid conditions, and blood eosinophil count were evaluated. Additionally, questionnaires including A2 and ECRHS scales were used in asthma screening. The diagnostic significance of questionnaires for early detection of late-onset asthma was assessed using ROC analysis. Results and Discussion: The patients examined were comparable in age, sex, and adherence to smoking. Over 63% of the group 1 patients had hereditary history of asthma and sensitization to allergens in contrast to the group 2 patients (0%). Patients in both groups frequently reported choking (group 1: 100%, group 2: 85.1%), cough (100% and 57.4%, respectively), and wheezing (69.7% and 38.3%, respectively). Among comorbidities, the frequency of which was comparable between the groups (p&gt;0.05), arterial hypertension (group 1: 66.7%, group 2: 59.6%) and obesity (60.6% and 42.6%, respectively) were predominant. Over 35% of patients in each group had chronic heart failure. There was a trend toward more frequent development of diabetes mellitus in patients with asthma (30.3% and 12.8%; p=0.054). The sum of A2 and ECRHS scale scores exceeded 4 in all patients with asthma. In group 2, “Probable asthma” was reported by 46.8% of patients in the A2 questionnaire and by 27.7% on the ECRHS scale. According to ROC-analysis, “Probable asthma” in the group 2 patients on A2 scale was recorded at the sum of scores &gt; 6 (100% sensitivity and 82.9% specificity) and &gt; 4 scores (87.8% sensitivity and 87.2% specificity) for ECRHS questionnaire. Conclusions. High diagnostic value of A2 and ECRHS questionnaires was determined in comorbid patients with respiratory symptoms without asthma. In 30% of cases, the questionnaire results established “Probable asthma” in this category of patients.

Asthma and allergy screening in elite soccer athletes: Is it worth it?

Asthma and allergy screening in elite soccer athletes: Is it worth it?

The anthropometric determinants of peak expiratory flow rate among children in Dar Es Salaam, Tanzania

BackgroundPeak expiratory flow rate (PEFR) is an important tool for assessing lung function, which can be affected by environmental and physical factors such as altitude, nutrition, genetics, age, height, and weight. Conducting a study to assess the correlation between peak expiratory flow rate and anthropometric measurements in Tanzanian schoolchildren is crucial to derive a population-specific prediction formula and further simplify respiratory health assessment.MethodsThis cross-sectional study was conducted in a single center private primary and secondary school in Dar es Salaam, Tanzania using data from an asthma screening camp. Variables of interest were height, weight, Body Mass Index (BMI) and PEFR. Independent t-test was performed to identify any differences in mean flow rate values between different ethnicities and genders. Correlation coefficients (r) were used to observe the relationship between PEFR and anthropometric measurements. A prediction equation by gender was generated using linear regression analysis. Statistical significance was set at the 5% level. All statistical data was analyzed using SPSS version 25.0.ResultsThe study involved 260 participants with a mean age of 9.5 years. Males were 51.2% and 65% of participants were of Asian ethnicity. PEFR was not observed to differ across the different ethnic groups and genders. Height was found to have the strongest correlation coefficient of 0.745, while BMI had the weakest correlation coefficient of 0.366. The strongest correlation was found with height for females (r = 0.787), while the weakest was with body mass index for boys (r = 0.203). The derived prediction equation for males was PEFR = 279.169 (Height of Student in meters) —134.12, while the predictive equation for females was PEFR = 318.32 (Height of Student in meters) —195.69.ConclusionThis study found a strong correlation between PEFR and anthropometric characteristics in school children from Dar es Salaam, Tanzania. A prediction equation by gender for PEFR was developed based on anthropometric characteristics. This equation may be applied in population-based studies or situations where peak flow meters are not readily available. Further research is needed to explore how well this prediction formula performs in other Tanzanian settings and to determine other factors that may affect lung function in this population.

Asthma heterogeneity among Asian American children: The California Health Interview Survey

BackgroundThe Asian American (AsA) population is heterogenous and rapidly growing; however, little is known regarding childhood asthma burden among AsA ethnic groups. The relation between obesity and asthma in AsA ethnic groups also remains unclear. ObjectiveTo evaluate asthma prevalence and the relation of obesity to asthma risk among children in 7 AsA ethnic groups. MethodsWe analyzed data from the California Health Interview Survey from 2011 to 2020. AsA ethnicities were self-reported. Body mass index z-scores, calculated from self-reported height/weight, were used to categorize children by obesity status, based on body mass index-for-age growth charts. Prevalence of self-reported lifetime doctor-diagnosed asthma and asthma attack in the last 12 months was calculated. We performed multivariable logistic regressions adjusting for age and sex. ResultsOf 34,146 survey respondents, 12.2% non-Hispanic White and 12.5% AsA children reported lifetime asthma. Among AsA ethnic groups, however, lifetime asthma ranged from 5.1% (Korean American) to 21.5% (Filipino American). Non-Hispanic White children and AsA children had a similar lifetime asthma prevalence (adjusted odds ratio [aOR], 1.05; 95% CI, 0.71-1.55; P = .81), but prevalence was lower in Korean American children (aOR, 0.37; 95% CI, 0.19-0.73; P = .004) and higher in Filipino American children (aOR, 1.97; 95% CI, 1.22-3.17; P = .006). The lifetime asthma prevalence of different AsA ethnic groups persisted even when stratified by obesity status. ConclusionChildhood lifetime asthma prevalence varied among AsA ethnic groups, with lowest prevalence in Korean American children and highest prevalence in Filipino American. Further characterization of asthma burden among AsA ethnic groups may help guide asthma screening and prevention measures and offer new insights into asthma pathogenesis.

Molecular prevalence of Pneumocystis jirovecii and Cryptosporidium in patients with asthma

Asthma is characterized by chronic airway inflammation. In addition to allergens, microorganisms can affect the clinical course of asthma. It has been shown that some fungi play an important role in the progression of asthma. However, the effects of Pneumocystis jirovecii and Cryptosporidium spp., on the disease are little known.We investigated P. jirovecii and Cryptosporidium spp. in the sputum and stool sample of patients with asthma (n = 40) by microscopy and PCR compared to the healthy group (n = 40).P. jirovecii (12.5 %), and Cryptosporidium spp. (12.5 %) were detected in the sputum samples of only asthmatic patients (p = 0.029 and 0.029 respectively). However, Crpytosporidium spp. was detected equally in stool samples of both groups (p = 0.682).Our results indicate that P. jirovecii and Cryptosporidium spp. should be considered in patients with asthma and molecular screening of these neglected eukaryotes in respiratory tract samples may be beneficial in the clinical management of the disease.

Causal relationship between asthma and inflammatory bowel disease : A two-sample bidirectional mendelian randomization analysis

Background: Based on the findings of current observational studies, asthma and inflammatory bowel disease (including Crohn's disease and ulcerative colitis) are associated; however, their causal association cannot be established due to methodological limitations. Objectives: we use two-sample bidirectional mendelian randomization (MR) to overcome the confounding factors and explore the causal link between asthma and inflammatory bowel disease. Methods: After selecting asthma and IBD-related genome-wide association studies (GWAS) data and screening single nucleotide polymorphisms (SNPs), MR analysis was performed by four methods: inverse variance weighted (IVW), MR-Egger, maximum likelihood, and weighted median (WM), while Cochran's Q test was used to detect heterogeneity and MR-Egger intercept to detect horizontal pleiotropy. Finally, we used the leave-one-out method and funnel plot to perform sensitivity analysis. Results: We screened 57, 59, and 60 SNPs in the association analysis of asthma and IBD, CD, and UC, respectively. The results of MR analysis showed that asthma only increased the risk of CD (IVW: OR = 1.1712, 95% CI = 1.0418-1.3167, P value = 0.0082; maximum likelihood: OR = 1.1739, 95% CI = 1.0428-1.3215, P value = 0.0080). Neither forward nor reverse MR analysis revealed heterogeneity or horizontal pleiotropy. Similarly, we did not find potential directional pleiotropy by funnel plot, and the leave-one-out method did not suggest a significant effect of a single SNP on the overall results. Conclusions: we found a negative correlation between asthma and Crohn's disease, but more research is needed to confirm this.

A cross-country qualitative analysis of teachers’ perceptions of asthma care in sub-Saharan Africa

Asthma is the most common chronic respiratory disease among school-going adolescents worldwide. However, the burden of severe asthma is highest in Sub-Saharan Africa. This study aimed to explore teachers’ perceptions of asthma care across six African countries. We conducted focus group discussions (FGDs) using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and analysed thematically. FGDs were conducted in Kumasi(Ghana), Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda), and Harare (Zimbabwe) between 01 November 2020 and 30 June 2021. We identified two key themes related to asthma care; barriers to asthma care and suggestions to improve the care of adolescents with asthma. Barriers reported by teachers included a lack of knowledge and skills among themselves, adolescents, and caregivers. In addition, some traditional beliefs of teachers on asthma exacerbated challenges with asthma care in schools. Regarding suggestions, most teachers identified a need for all-inclusive asthma training programmes for teachers, adolescents and caregivers, focusing on acute episodes and mitigating triggers. Utilising teachers with personal experiences with asthma to advocate and support these initiatives was suggested. Further suggestions included the need for annual screening to enable early identification of adolescents with asthma and clarify restrictions on teachers administering asthma medications. Teachers across African schools identify multiple barriers to asthma care. Structured school education programs and annual asthma screening are key to addressing some barriers to care.

Maternal apparent temperature during pregnancy on the risk of offspring asthma and wheezing: effect, critical window, and modifiers.

The objective of this study was to explore the impact of maternal AT during pregnancy on childhood asthma and wheezing, as well as the potential effect modifiers in this association. A cross-sectional study was implemented from December 2018 to March 2019 in Jinan to investigate the prevalence of childhood asthma and wheezing among aged 18months to 3years. Then, we conducted a case-control study based on population to explore the association between prenatal different AT exposure levels and childhood asthma and wheezing. The association was assessed by generalized additive models and logistic regression models, and stratified analyses were performed to explore potential effect modifiers. A total of 12,384 vaccinated children participated in screening for asthma and wheezing, 236 cases were screened, as well as 1445 controls were randomized. After adjusting for the covariates, childhood asthma and wheezing were significantly associated with cold exposure in the first trimester, with OR 1.731 (95% CI: 1.117-2.628), and cold exposure and heat exposure in the third trimester, with ORs 1.610 (95% CI: 1.030-2.473) and 2.039 (95% CI: 1.343-3.048). In the third trimester, enhanced impacts were found among girls, children whose distance of residence was close to the nearest main traffic road, and children whose parents have asthma. The study indicates that exposure to extreme AT during the first and third trimesters could increase the risk of childhood asthma and wheezing.

Screening for asthma in preschool children with sickle cell disease

Background Asthma in preschool children is poorly defined, proving to be a challenge for early detection. The Breathmobile Case Identification Survey (BCIS) has been shown to be a feasible screening tool in older SCD children and could be effective in younger children. We attempted to validate the BCIS as an asthma screening tool in preschool children with SCD. Methods This is a prospective, single-center study of 50 children aged 2–5 years with SCD. BCIS was administered to all patients and a pulmonologist blinded to the results evaluated patients for asthma. Demographic, clinical, and laboratory data were obtained to assess risk factors for asthma and acute chest syndrome in this population. Results Asthma prevalence (n = 3/50; 6%) was lower than atopic dermatitis (20%) and allergic rhinitis (32%). Sensitivity (100%), specificity (85%), positive predictive value (30%), and negative predictive value (100%) of the BCIS were high. Clinical demographics, atopic dermatitis, allergic rhinitis, asthma, viral respiratory infection, hematology parameters, sickle hemoglobin subtype, tobacco smoke exposure, and hydroxyurea were not different between patients with or without history of ACS, although eosinophil was significantly lower in the ACS group (p = 0.0093). All those with asthma had ACS, known viral respiratory infection resulting in hospitalization (3 RSV and 1 influenza), and HbSS (homozygous Hemoglobin SS) subtype. Conclusion The BCIS is an effective asthma screening tool in preschool children with SCD. Asthma prevalence in young children with SCD is low. Previously known ACS risk factors were not seen, possibly from the beneficial effects of early life initiation of hydroxyurea.

Validation of the Arabic Version of the European Community Respiratory Health Survey Screening Questionnaire.

The European Community Respiratory Health Survey (ECRHS) questionnaire has been widely used in epidemiological studies to quantify respiratory symptoms and screen for asthma, but there is no formally validated Arabic version. This study developed an Arabic ECRHS screening questionnaire, comprehensively evaluated its reliability and validity, and used it to estimate the population prevalence of respiratory symptoms and asthma in Saudi Arabia. The ECRHS screening questionnaire was adapted to Arabic through translation and back-translation by bilinguals with consultation to a professional committee and lay panel. Reliability and validity were evaluated in a prospective, cross-sectional convenience sample of adults (>18 years) between January and July 2022 in Riyadh, Saudi Arabia. A subgroup completed the questionnaire again three weeks later to assess test-retest reliability. All respiratory symptom-positive participants were invited for spirometry to diagnose asthma according to GINA criteria. Internal consistency was assessed using Cronbach's α coefficient, test-retest reliability with Cohen κ coefficients, and reliability by calculating the sensitivity and specificity for diagnosing asthma. Of 2500 invited individuals, 1881 participated (75.2%). A total of 668 (35.5%) participants reported respiratory symptoms according to the ECRHS questionnaire, and 157/1881 (8.3%) had a current diagnosis of asthma on ECRHS questions. Cronbach's α coefficient for internal consistency was 0.831, "good" internal consistency. The test-retest reliability (n = 303) was "excellent" for all questions (Cohen's κ≥0.75). A total of 543 (81.3%) screening-positive participants underwent spirometry, of whom 278 (52%) were diagnosed with asthma according to GINA guidelines, an overall estimated prevalence of 14.8%. Most questions showed good-to-fair specificity and variable sensitivity for physician-diagnosed asthma. This Arabic version of the ECRHS screening questionnaire is conceptually similar to the English version, comprehensible, and reliable. Many asthma cases remain hidden and undiagnosed. In addition to utility in epidemiological studies, the ECRHS screening questionnaire might be a simple, quick, and useful tool for asthma case finding.

Polypharmacy Interactions Impacting Methacholine Challenge Testing for Asthma Assessment in Older People.

Objective To investigate potential reasons for unusually high incidence of negative Methacholine Challenge Tests (MCT), following standardized MCT medication-hold protocol, in older people with physician-diagnosed asthma. Design An analysis of a longitudinal observational parent study of asthma. Setting Community-dwelling participants were evaluated in an outpatient clinic and at home. Participants Screening inclusion criteria for the parent study included 60 years of age or older, physician diagnosis of asthma, and a positive response to at least one of six asthma screening questions. Participants were enrolled in the study if they also demonstrate either: (1) a postbronchodilator administration response showing an increase of at least 12% and 200 mL in forced expiratory volume or an increase of at least 12% and 200 mL in forced vital capacity, or (2) an MCT result of PC20 ≤ 16 mg/mL (indicating bronchial hyper-responsiveness, MCT positive). Exclusion criteria included diagnosis of cognitive impairment or dementia, residing in a long-term care facility, more than 20 pack/ year smoking history or a history of smoking within the previous five years, inability to perform pulmonary function testing maneuvers, and a Prognostic Index score of greater than 10. Interventions Analysis of participant data for non-medication- and medication-exposure factors for association with negative MCT results. Results Anticholinergic burden and statin use were positively associated with negative MCT. Conclusion Medications not accounted for in medication-hold protocols, and concurrently in use, may impact clinical tests and outcomes.

Analysis of school-based asthma screenings and need for care coordination in underserved urban communities

BackgroundAsthma is one of the most common chronic childhood disease states in the United States and continues to become more prevalent. Data suggest the incidence, morbidity, and mortality of asthma are higher among minority children of lower socioeconomic status living in urban settings. There is a lack of data evaluating the impact of mass school-based asthma screenings and care coordination in underserved communities. ObjectiveThis study aimed to determine whether a school-based asthma screening program is effective in identifying children who are at risk of undiagnosed and uncontrolled asthma and whether there is a need for care coordination. MethodsThis study is a retrospective review describing the outcomes of the 2021 school-based asthma screening program. Asthma screening data from 6 participating school districts (prekindergarten to twelfth grade) in the greater Pittsburgh area were included in this review. An asthma screening questionnaire was distributed school-wide and included questions about demographics, previous asthma diagnosis, repeated episodes of asthma, and frequency of symptoms. Based on caregiver-reported answers, children who screened positive for previously diagnosed asthma, uncontrolled asthma, or undiagnosed asthma received care coordination for follow-up care. ResultsThis study included asthma screening results for 561 participants. Approximately 13% of participants (n = 73) displayed asthma symptoms but did not have a diagnosis of asthma. Of those 73 participants, 9.6% (n = 54) were at risk of uncontrolled asthma. The screening tool also identified 5.6% of participants (n = 32) who had a diagnosis of asthma and were at risk of uncontrolled asthma. ConclusionsThe school-based asthma screening program was effective in identifying children at risk of undiagnosed and uncontrolled asthma. Pharmacists are well positioned to implement asthma screening programs in schools and throughout the community.

Validation of Asthma Life Quality Test for the Screening of Asthma Among Indian Adults

Validation of Asthma Life Quality Test for the Screening of Asthma Among Indian Adults

The Accuracy of a Screening Tool in Epidemiological Studies-An Example of Exhaled Nitric Oxide in Paediatric Asthma.

The cross-sectional study included 447 children (50.8% boys and 49.2% girls) aged 6-9 years. An adapted version of the ISAAC questionnaire was used for the assessment of the respiratory status. FeNO was measured with an electrochemical device (Niox Mino) according to ERS/ATS recommendations. For interpretation, the FeNO cut-off values of 20 parts per billion (ppb), 25 ppb and 35 ppb were applied taking the real-life prevalence of the disease or symptoms into consideration and also for simulated prevalences of 20%, 30%, 40%, 50% for the interpretation of the accuracy of the test. The accuracy was calculated according to the following formula: Accuracy = (Prevalence) (Sensitivity) + (1- Prevalence) (Specificity). The area under the curve was calculated based on logistic regression. For all respiratory outcomes, FeNO accuracy decreased with increasing prevalence, and in general the area under the curve (AUC) was low. The highest FeNO accuracy was found for any asthma diagnosis (with possible coexisting diseases/symptoms), i.e., 78.6%, 92.8% and 88.5% for FeNO cut-offs &gt;19 ppb, &gt;24 ppb and &gt;34 ppb, respectively. The AUC was 0.628. For the same FeNO cut-offs, the accuracy of an asthma diagnosis without any coexisting diseases and symptoms was 81.2%, 87.5%, 92.9%, respectively, with an AUC of 0.757. FeNO accuracy decreases with increasing prevalence of the respiratory disease and symptoms. The best accuracy for the FeNO cut-off in the screening of asthma for epidemiological purposes is 35 ppb. For isolated asthma, the best accuracy for FeNO was 92.9%.

Implementation of a Work-Related Asthma Screening Questionnaire in Clinical Settings: Multimethods Study.

BackgroundA work-related asthma (WRA) screening questionnaire is currently being validated for implementation in clinical settings. To minimize barriers to integrating tools into clinical practice, a discussion of strategies for the implementation of the questionnaire has begun.ObjectiveThis study aimed to understand the benefits, feasibility, barriers, and limitations of implementing the Work-related Asthma Screening Questionnaire–Long version (WRASQ[L]) and asthma e-tools in clinical settings and propose dissemination and implementation strategies for the WRASQ(L).MethodsThis study was conducted in Kingston, Ontario, Canada, from September 2019 to August 2021. A workshop and 2 questionnaires were used to understand the benefits of and barriers to implementing the questionnaire in clinical settings. An expert advisory committee was established to develop the implementation and dissemination strategies. Workshops were semistructured and used thematic qualitative analysis to identify themes that provided an understanding of the benefits and limitations of and barriers to using the WRASQ(L), and e-tools in general, in clinical settings. Workshop participants included patients and health care providers, including physicians, nurses, and asthma educators, who were implementation specialists and expert electronic medical record users. A questionnaire focusing on providers’ knowledge and awareness of WRA and another focusing on WRASQ(L) feedback was administered at the workshops. Advisory committee members from relevant stakeholders met 3 times to strategize implementation opportunities.ResultsA total of 6 themes were identified in the workshop: involving and addressing patient needs, novel data collection, knowledge translation, time considerations, functional and practical barriers, and human limitations. Questionnaire responses yielded positive feedback on the utility of the WRASQ(L) in clinical settings. All participants agreed that it is an easy way of collecting information on occupational and exposure history and could prompt a discussion between the health care provider and patient on how the workplace and exposures could affect one’s asthma, increase awareness of WRA in patients and providers, and increase awareness of exposures in the workplace. Implementation and dissemination strategies were generated with input from the advisory committee.ConclusionsStakeholders and workshop participants consider the WRASQ(L) to be a useful tool that satisfies many provider needs in their clinical settings. Once validated, dissemination strategies will include developing educational materials that include the WRASQ(L), linking the questionnaire to stakeholder websites or e-toolkits, translation into other languages, leveraging health care and research networks, conference presentations, and peer-reviewed publications. Implementation strategies will include integration into electronic medical records; designing multifaceted interventions; and targeting nontraditional settings such as workplaces, pharmacies, and research settings. The WRASQ(L) addresses many benefits of and barriers to implementation, as identified in the workshop themes. These themes will guide future implementation and dissemination strategies, noting that human limitations identified in providers and patients will need to be overcome for successful implementation.

Assessment of coexistence of subclinical bronchial asthma in patients with allergic nasal polyposis refractory to medical therapy

Background: Coexistence of bronchial asthma and allergic nasal polyposis make both disorders more difficult to control with more exacerbation and more eosinophilic inflammation. Aim: to assess the coexistence of subclinical bronchial asthma in patients with allergic nasal polyp refractory to medical therapy and to identify those at risk of developing asthma. Subjects and methods: A case-control study was conducted on 60 allergic nasal polyp patients and 60 healthy subjects. All of them were assessed by peripheral eosinophils%, allergic rhinitis score (SFAR), NOSE-score, endoscopic-sinus examination, sinus computed tomography using Lund and Mackey scoring-system, asthma screening questionnaire (ASQ), spirometric-indices, and histopathological examination of endoscopically removed polyps. Results: Patients with allergic nasal polyps had significantly lower spirometric-indices than controls. Subclinical asthma was significantly common in patient group than controls (61.7% vs. 10%), it was of mild and moderate severity (83.8% and 16.2%). Allergic nasal polyp patients with coexistence of asthma had significantly higher peripheral eosinophils %, SFAR-score, NOSE-score, Lund and Mackey CT-score, and ASQ score (10, 39.7, 40.5, 40, and 40.1) than patients without asthma (15.2, 15.7, 15.2 and14.1). Moreover, they had significantly common eosinophilic-predominate pathological subtypes (81.1%).