Asthma Symptom Scores Research Articles

Efficacy and safety of house dust mite subcutaneous immunotherapy in polysensitized children with allergic asthma

IntroductionThe aim of this study was to compare the efficacy and safety of 3 years of HDM subcutaneous immunotherapy (HDM-SCIT) in allergic asthma (AA) children with mono- and polysensitized. MethodsThis was a retrospective observational study, 51 AA children (aged 4–14 years) who had completed 3 years of standardized HDM-SCIT were enrolled in. Based on skin prick tests (SPT) and allergen-specific IgE antibody (sIgE) test results, children were classified into two groups: the monosensitized group (n = 31) and the polysensitized group (n = 20). Total asthma symptoms score (TASS), total medication score (TMS), visual analog scale (VAS) scores, fractional exhaled nitric oxide (FeNO), lung function parameters, and adverse reactions were evaluated before treatment and at 6 months, 1, 2, 3 years of HDM-SCIT. ResultsIn terms of effectiveness, compared to baseline, TASS, TMS, VAS, FeNO and lung function parameters were significantly improved in both groups after 3 years of HDM-SCIT (all P < 0.05). The comparison between the two groups showed that efficacy indicators were no statistically significant difference at follow-up time points (all P > 0.05) except PEF%pred at 6 months (P = 0.048). In terms of security, the number of adverse reactions in both groups also no statistical difference between the two groups (all P > 0.05). ConclusionThis study confirmed that no significant difference was observed in the clinical efficacy and safety of HDM-SCIT between mono-and polysensitized children with allergic asthma.

Combined analysis of five non-interventional studies of the effectiveness, tolerability, and safety of the extrafine fixed dose beclomethasone/formoterol combination in the treatment of asthma in Austria

ObjectiveThe real-world effectiveness and tolerability of an extrafine fixed dose beclomethasone/formoterol (BDP/FF) treatment of patients with partially or non-controlled asthma was evaluated in five non-interventional studies (NISs) from Austria. MethodsAsthma patients enrolled in these five NISs were treated with beclomethasone/formoterol (Foster® or Foster® Nexthaler®) as maintenance and reliever over 12 weeks. Asthma control, lung function and symptom scores were assessed at baseline, after 4–8 weeks and at the end of the investigations in week 12. In addition, tolerability and handling of the devices were evaluated by questionnaires. ResultsThe combined analysis included 891 patients (53% female, aged 49.3 years) demonstrating significant improvements in asthma control, lung function parameters (PEF, FEV1 and FVC) and symptom scores (reduction of breathlessness, wheezing, chest tightness and cough). These changes were already detectable after 4–8 weeks. The treatment was effective irrespective of smoking status, exercise, or previous medication. Tolerability of the therapy with extrafine BDP/FF was rated as “very good” or “good” in 98% of the patients. 95% of the patients intended to continue the treatment, and nearly all (99%) rated the handling of the device as “very good” or “good”. No serious adverse reactions were reported. ConclusionsThis combined analysis of five non-interventional studies confirms the effectiveness and tolerability of the extrafine fixed-dose BDP/FF combination (Foster® and Foster® Nexthaler®) in a heterogenous patient population suffering from partially or non-controlled asthma. Therapy was associated with a high patient satisfaction and the absence of serious adverse reactions.

Health-related quality of life as associated with asthma control, psychological status and insomnia.

Asthma is associated not only with lower health-related quality of life (HRQL) but also with psychological health and insomnia. The aim of this study was to investigate associations between HRQL, asthma symptoms, psychological status and insomnia in adults from three Nordic countries. This study comprised 2,270 subjects aged 29-55 from Sweden, Iceland and Norway. HRQL was measured with the 36-Item Short Form Health Survey (SF-36). The physical (PCS) and mental health (MCS) component scores were calculated with higher values, indicating better health status. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Insomnia was assessed with the Basic Nordic Sleep Questionnaire. An asthma score consisting of a sum of the positive answers to five respiratory symptoms was used in the analysis. Spirometry and allergy tests were also performed. High HADS and sleep disturbance scores were both related to a low PCS and MCS, respectively, after adjusting for confounders. High age and high body mass index (BMI) were associated with low scores on the PCS, whilst the opposite was found for the MCS. A higher asthma score was related to a low PCS. An interaction between the HADS and the asthma symptom score was observed for the PCS (P = 0.0002), where associations between psychological status and the PCS were more pronounced for individuals with more symptoms than for individuals without symptoms. In this study, we found that HRQL of life was independently related to the HADS, insomnia and asthma symptoms. Further prospective studies to identify the most efficient target for intervention in order to improve asthma control are needed.

The association between urinary concentrations of organophosphate metabolites and asthma-related outcomes at 12-month follow-up among children from informal settlements in Western Cape, South Africa

BACKGROUND AND AIM: There is limited evidence on the relationship between pesticide exposure and child respiratory outcomes in non-agricultural settings. This study investigated the association between organophosphate pesticide (OP) exposure and child asthma-related outcomes among children from four informal settlements. METHODS: This study was a longitudinal study of 590 schoolchildren, with a 12-month follow-up period. A standardised questionnaire adopted from the International Study of Asthma and Allergies in Childhood (ISAAC) was administered to caregivers on child’s respiratory symptoms and household characteristics. Spirometry and fractional-exhaled nitric oxide (FeNO), including a phadiatop test (atopy status) and urinary concentrations of dialkyl phosphate (DAP) metabolites diethylphosphate (DEP), dimethylthiophosphate (DMTP)] were measured at baseline and follow-up. Dimethylphosphate (DMP) was measured only at baseline. RESULTS: The mean age of schoolchildren were 9.9 &amp;#xb1; 0.91 years and median sum DAP was 32.9 ng/ml (18.4 – 52.9 ng/ml) at baseline. Incidence proportions of new asthma outcome cases at 12-months were 2.2 % doctor diagnosed asthma, 17.8 % asthma-symptom score &amp;#x2265; 2, 14.5 % forced expiratory volume 1&amp;#x3c; lower limit of normal, and 5.9 % airway inflammation across all areas. In the linear mixed and fixed effect model, no consistent patterns of increased risk of new asthma-associated outcomes at the 12-month was found. However, there was a significant increase in airway inflammation (β:2.99 (95% CI: 0.48 - 5.50) in the 3rd DEP quintile (1.9 – 3.0 ng/mL) compared to the reference quintile (1.10 ng/ml). CONCLUSION: DAP concentrations were higher than those of children in other settings. However, the study did not find consistent associations between urinary concentrations of DAP metabolites and asthma related outcomes over a 12-month follow-up period among schoolchildren. Future studies with a longer follow-up period and repeated OP pesticide biomonitoring are recommended. KEYWORDS: Pesticides, organophosphates, asthma, children, informal settlements, dialkyl phosphates, South Africa

Exposome Profiles and Asthma among French Adults.

Rationale: Although previous studies in environmental epidemiology focused on single or a few exposures, a holistic approach combining multiple preventable risk factors is needed to tackle the etiology of multifactorial diseases such as asthma. Objectives: To investigate the association between combined socioeconomic, external environment, early-life environment, and lifestyle-anthropometric factors and asthma phenotypes. Methods: A total of 20,833 adults from the French NutriNet-Santé cohort were included (mean age, 56.2 yr; SD, 13.2; 72% women). The validated asthma symptom score (continuous) and asthma control (never asthma, controlled asthma, and uncontrolled asthma) were considered. The exposome (n = 87 factors) covered four domains: socioeconomic, external environment, early-life environment, and lifestyle-anthropometric. Cluster-based analyses were performed within each exposome domain, and the identified profiles were studied in association to asthma outcomes in negative binomial (asthma symptom score) or multinomial logistic (asthma control) regression models. Measurements and Main Results: In total, 5,546 (27%) individuals had an asthma symptom score ⩾1, and 1,206 (6%) and 194 (1%) had controlled and uncontrolled asthma, respectively. Three early-life exposure profiles ("high passive smoking-own dogs," "poor birth parameters-daycare attendance-city center," or "⩾2 siblings-breastfed" compared with "farm-pet owner-molds-low passive smoking") and one lifestyle-anthropometric profile ("unhealthy diet-high smoking-overweight" compared with "healthy diet-nonsmoker-thin") were associated with more asthma symptoms and uncontrolled asthma. Conclusions: This large-scale exposome-based study revealed early-life and lifestyle exposure profiles that were at risk for asthma in adults. Our findings support the importance of multiinterventional programs for the primary and secondary prevention of asthma, including control of specific early-life risk factors and promotion of a healthy lifestyle in adulthood.

Integrating the evidence in allergen immunotherapy: Why real-world data should be important for the practicing clinician?

Data obtained from controlled clinical trials are the gold standard for evaluation of allergen immunotherapy (AIT) efficacy and safety. Less prone to biases (with a strong internal validity), they allow their use and external validation in the real world. The quantity and diversity of real-world data has increased exponentially, and access to large cohorts and electronic medical records have made this information increasingly accessible and useful for research and regulatory purposes. New retrospective database studies have confirmed the sustained benefits of grass, birch pollen, and house dust mite AIT for both allergic rhinitis and asthma symptom and medication scores, the prevention of asthma (when used in nonasthmatic rhinitics), and the real rate of adverse systemic reactions. They also have addressed clinical practice issues not elsewhere analyzed, including the management of polysensitized patients with respiratory allergies and adherence to AIT. Real-world evidence has its own biases and limits that need to be taken into account. In this article we present a concise summary of the literature about the role of real-world evidence in AIT.

Morning Versus Evening Dosing of Sublingual Immunotherapy in Allergic Asthma: A Prospective Study.

BackgroundSublingual immunotherapy (SLIT) has been proved to be an effective and safe treatment for allergic asthma (AS) in children. Nonetheless, several issues regarding SLIT remain to be resolved, including the information about optimal administration timing.MethodsA total of 163 AS children aged 4-13 years were enrolled and randomized into the morning dosing (MD) group and the evening dosing (ED) group. Participants received SLIT with Dermatophagoides farinae drops between 7:00 a. m. and 9:00 a.m. (for the MD group) or between 8:00 p. m. and 10:00 p.m. (for the ED group). The total asthma symptom score (TASS), total asthma medicine score (TAMS), Asthma Control Questionnaire (ACQ), forced expiratory volume in one second (FEV1), FEV1/forced volume vital capacity (FVC), fractional exhaled nitric oxide (FeNO) and adverse events (AEs) were assessed at baseline, 0.5 and 1 year during the 1-year SLIT.ResultsAfter 1 year, 62 patients in the MD group and 63 patients in the ED group completed the entire study. The clinical efficacy, pulmonary function and FeNO in both groups improved significantly at 0.5 and 1 year (p < 0.001). Compared to the MD group, the ED group showed significant lower ACQ score at 0.5 year (p < 0.001) and lower FeNO at 1 year (p < 0.05). No significant difference between two groups was observed in AE rate (p > 0.05). All AEs occurred in the first month, with no systemic AEs reported.Conclusion1-year house dust mite (HDM) SLIT is effective and well-tolerated in AS children regardless of administration time. SLIT dosing in the evening might enhance the asthma control level and reduce FeNO level compared with SLIT dosing in the morning.

Long-term exposure to ambient air pollution and asthma symptom score in the CONSTANCES cohort

BackgroundThe asthma symptom score allows to consider asthma as a continuum and to investigate its risk factors. One previous study has investigated the association between asthma score and air pollution...

Healthy diet associated with better asthma outcomes in elderly women of the French Asthma-E3N study

PurposeThe impact of a healthy diet on asthma prevention and management, particularly among elderly women, remains poorly understood. We investigated whether a healthy diet would be associated with fewer asthma symptoms, and, among women with asthma, with reduced uncontrolled asthma and metabolic-related multimorbidity.MethodsWe included 12,991 elderly women (mean age = 63 years) from the Asthma-E3N study, a nested case–control study within the French E3N cohort. Negative binomial regressions were used to analyse associations between a healthy diet [evaluated by the Alternate Healthy Eating Index-2010 (AHEI-2010)] and a validated asthma symptom score, and logistic regressions to analyse associations between the AHEI-2010 with the asthma control test and multimorbidity profiles previously identified by clustering methods on medications used.ResultsAfter adjustment for potential confounders, a linear inverse association was found between the AHEI-2010 score and the asthma symptom score [mean score ratio (95% CI) = 0.82 (0.75–0.90) for the highest versus lowest quintile; p for trend < 0.0001]. In addition, women in the highest versus lowest AHEI-2010 tertile were at a lower risk to belong to the “Predominantly metabolic multimorbidity-related medications profile” compared to the “Few multimorbidity-related medications" profile [OR 0.80 (0.63–1.00) for tertile 3; p for trend = 0.05; n = 3474].ConclusionOur results show that a healthy dietary intake could play an important role in the prevention and management of asthma over the life course.

Blood inflammatory phenotypes were associated with distinct clinical expressions of asthma in adults from a large population-based cohort.

SummaryBackgroundAsthma is an inflammatory heterogeneous disease. Asthma inflammatory phenotypes based on blood eosinophil and neutrophil counts have never been identified and characterized in population-based studies.MethodsAdults with current asthma and available blood eosinophil and neutrophil counts from the French population-based CONSTANCES cohort were included. Current asthma was defined by reports of asthma attacks, symptoms or treatments in the last 12 months. Inflammatory phenotypes were based on low (L) and high (H) blood (B) eosinophil (E) (LBE/HBE: </⩾0·25 × 109/L, respectively) and neutrophil (N) (LBN/HBN: </⩾5 × 109/L, respectively) cut-offs. Associations between inflammatory phenotypes and the clinical expressions of asthma were studied using logistic models adjusted for age, sex, smoking status, body mass index, education level, French deprivation index and treatment. Other cut-offs were applied. Stratified analyses according to age or sex were performed.FindingsAmong 15,019 adults with asthma (56% women, 59%≥40 years), the LBE/LBN (reference), LBE/HBN, HBE/LBN and HBE/HBN phenotypes accounted for 57%, 6%, 33% and 4% respectively. The LBE/HBN phenotype was associated with being awaken by an attack of coughing, chronic bronchitis, and dyspnoea (adjusted(a)OR ranging from 1·21 to 1·42). The HBE/LBN and HBE/HBN phenotypes were associated with asthma attacks (aOR=1·31[1·20-1·42], 1·25[1·02-1·53]) and asthma symptom score (p for trend<0·0001, p for trend=0·001, respectively). The HBE/LBN phenotype was also associated with being awaken with chest tightness (aOR=1·30[1·20-1·40]). Results were unchanged whatever the cut-offs used. No statistically significant heterogeneity was observed according to age or sex.InterpretationDifferences in the clinical expressions of asthma were found between the phenotypes, reproducible whatever the cut-offs used, and similar to those observed in case-control and clinical studies. Such phenotypes are of interest to improve asthma management and study its environmental risk factors.FundingThe CONSTANCES cohort receives grants from ANR (ANR-11-INBS-0002), the Caisse nationale d'assurance maladie-CNAM and the Ministry of research. CONSTANCES also receives funding from MSD, AstraZeneca, Lundbeck and L'Oréal, managed by INSERM-Transfert. T.Tsiavia is supported by a PhD grant from the Fondation pour le Recherche Médicale (ECO202006011654).

Impact of body mass index on omalizumab response in adults with moderate-to-severe allergic asthma

BackgroundEffectiveness of asthma treatment, including biologics, may be different in patients with higher body mass index (BMI). ObjectiveTo evaluate response to omalizumab (dosed by serum immunoglobulin E level and weight) by BMI category. MethodsPooled data from 2 randomized, double-blind, placebo-controlled studies of adults with moderate-to-severe allergic asthma were analyzed by BMI category (<25 kg/m2 [normal or underweight], n = 397; 25 to <30 kg/m2 [overweight], n = 330; ≥ 30 kg/m2 [obese], n = 268). Placebo-adjusted exacerbation rate reductions were evaluated by Poisson regression modeling. Changes from baseline in forced expiratory volume in 1 second, beclomethasone dipropionate (BDP) dose, Total Asthma Symptom Score, and Asthma Quality of Life Questionnaire were evaluated by analysis of covariance. ResultsGreater placebo-adjusted exacerbation rate reductions (95% confidence interval) were observed with increasing BMI (normal or underweight, −37.4% [−69.0% to 26.8%]; overweight, −52.7% [−78.4% to 3.7%]; obese, −71.9% [−86.9% to −39.5%]). There were no differences in forced expiratory volume in 1 second improvement between BMI categories at week 16 (normal or underweight, 76.2 [5.3-147.1] mL; overweight, 98.1 [13.9-182.4] mL; obese, 69.1 [−18.9 to 157.2] mL). No differences in BDP dose reduction (µg) were noted between BMI categories (normal or underweight, 23.0 [15.7-30.3]; overweight, 22.5 [13.5-31.5]; obese, 16.6 [5.8-27.3]). Fewer patients in the higher BMI categories eliminated BDP use. There were trends for smaller improvements with higher BMI in Total Asthma Symptom Score (normal/underweight, −0.52 [−0.82 to −0.22]; overweight, −0.50 [−0.80 to −0.20]; obese, −0.39 [−0.77 to 0.00]) and Asthma Quality of Life Questionnaire (normal or underweight, 0.34 [0.16-0.52]; overweight, 0.34 [0.13-0.55]; obese, 0.15 [−0.08 to 0.39]). ConclusionOmalizumab provides benefit to patients with moderate-to-severe allergic asthma, regardless of BMI. Trial RegistrationStudies 008/009 were conducted before clinical trial registration was required, and therefore clinical trial registration numbers are not available.

Mepolizumab improves work productivity, activity limitation, symptoms, and rescue medication use in severe eosinophilic asthma.

Patients with severe eosinophilic asthma experience daily activity limitations and reduced productivity at work. Using anonymized individual patient‐level data from two previously conducted randomized, double‐blind, placebo‐controlled studies (MENSA [GSK ID:115588/NCT01691521]; MUSCA [GSK ID:200862/NCT02281318]), we investigated the effect of mepolizumab on work productivity, activity limitation, symptoms, and rescue medication use. Patient‐reported outcomes including Work Productivity and Activity Impairment–General Health (WPAI‐GH) scores (impairment percentages, 0%–100%), global activity limitation (scale 1–4), and perceived change in activity limitation (Likert scale 1–7) since the start of the study were analyzed. WPAI‐GH scores from MENSA were analyzed post hoc for employed patients using mixed model repeated measures; global activity limitation and perceived change in activity limitation from MUSCA were analyzed by ordinal logistic regression. Mean changes from baseline in daily asthma symptom scores (scale 0–5) and rescue medication use (occasions/day) were also assessed, via a post hoc meta‐analysis of MENSA and MUSCA. At study end, WPAI‐GH scores indicative of overall work impairment, impairment while working, and activity impairment consistently improved with mepolizumab versus placebo. Overall, 76% versus 54% of patients rated their activity as “much better,” “better,” or “slightly better” since the start of the study with mepolizumab versus placebo. Mepolizumab was associated with numerically larger improvements from baseline in asthma symptoms (treatment difference 0.21–0.29 points) and rescue medication use (treatment difference −0.08 to −0.22 occasions/day) versus placebo. Our results indicate that patients with severe eosinophilic asthma may experience improved activity limitation, work productivity, symptoms, and rescue medication use with mepolizumab.

Efficacy and Safety of Pidotimod in Persistent Asthma: A Randomized Triple-Blinded Placebo-Controlled Trial

To study whether addition of pidotimod to inhaled corticosteroid (ICS) therapy enhances control in children with persistent asthma, as compared to ICS therapy alone. Triple-blinded, randomized controlled trial. Allergy and Asthma Clinic, Department of Pediatrics, at a tertiary care hospital between May, 2018 and June, 2019. 79 children (5-12 years) with newly diagnosed persistent asthma as per Global Initiative for Asthma guidelines. Children received 7 mL twice-a-day for 15 day, followed by 7 mL once-a-day for 45 days of either pidotimod (n=39) or placebo (n=40). In addition, both groups received inhaled budesonide via metered dose inhaler and spacer, throughout the study. Children were followed up every 4 weeks for a total of 12 weeks. At each follow-up visit, peak expiratory flow (PEF) and asthma symptom score and medicine adverse effects were recorded. Change in PEF at 12 weeks compared to baseline. Secondary outcomes were PEF at each follow-up visit, asthma symptom score at each visit, change in asthma symptom score at 12 weeks, and adverse event profile. The median (IQR) change in PEF (from baseline to 12 weeks) was 13.0% (0.8%, 28.3%) in pidotimod group (n=35) vs17.7% (4.3%, 35.2%) in placebo group (n=35)(P=0.69). All the secondary outcomes were also comparable between the two groups.There were no significant adverse effects observed. Addition ofpidotimod for 8 weeks to standard ICS therapy did not enhance asthma control compared to placebo.

Clinical Experience with Anti-IgE Monoclonal Antibody (Omalizumab) in Pediatric Severe Allergic Asthma-A Romanian Perspective.

Background: Asthma is the most common chronic disease affecting children, with a negative impact on their quality of life. Asthma is often associated with comorbid allergic diseases, and its severity may be modulated by immunoglobulin E (IgE)-mediated allergen sensitization. Omalizumab is a humanized monoclonal anti-IgE antibody, the first biological therapy approved to treat patients aged ≥6 years with severe allergic asthma. The primary objective of our study was to investigate the efficacy and safety of Omalizumab in Romanian children with severe allergic asthma. Methods: In this observational real-life study, 12 children and adolescents aged 6 to 18 years (mean 12.4 years) with severe allergic asthma received Omalizumab as an add-on treatment. Asthma control, exacerbations, lung function, and adverse events were evaluated at baseline and after the first year of treatment. Results: We observed general improvement in total asthma symptom scores and reduction in the rate of exacerbation of severe asthma. Omalizumab treatment was associated with improvement in the measures of lung function, and no serious adverse reactions were reported. FEV1 improved significantly after one year of treatment with Omalizumab [ΔFEV1 (% pred.) = 18.3], and [similarly, ΔMEF50 (%) = 25.8]. The mean severe exacerbation rate of asthma decreased from 4.1 ± 2.8 to 1.15 ± 0.78 (p < 0.0001) during the year of treatment with Omalizumab. Conclusions: This study showed that Omalizumab can be an effective and safe therapeutic option for Romanian children and adolescents with severe allergic asthma, providing clinically relevant information on asthma control and exacerbation rate in children and adolescents. The results demonstrated the positive effect of Omalizumab in young patients with asthma, starting from the first year of treatment.

A Randomized Trial of Subcutaneous Allergy Immunotherapy in Inner-city Children With Asthma Less Than 4 Years of Age

To evaluate the effect of subcutaneous immunotherapy (SCIT) on asthma in inner-city children <4 years of age.Children between the ages of 18 to 47 months were recruited when seen in the asthma or allergy clinic at Jacobi Medical Center in Bronx, New York, which cares for a mostly low-income, inner-city population. Participants were required to have physician-diagnosed asthma or at least 2 lifetime episodes of wheezing and be at high risk of persistent asthma on the basis of an Asthma Predictive Index. Patients with any other chronic medical condition, history of severe prematurity, or a sustained oxygen requirement at birth were excluded. Although all patients had at least 1 common environmental allergen positive on skin-prick testing, most had multiple and mainly indoor allergen sensitizations. The majority of patients were male and used an asthma controller medication, with an average asthma symptom score indicating mild persistent asthma.Participants were randomly assigned to the SCIT (n = 27) or control group (n = 23). SCIT was administered per published guidelines, with biweekly maintenance injections. Asthma, nasal-ocular, and skin symptom scores and medication use were monitored by a phone call every 2 weeks. In interim power analysis, it was indicated there was an insufficient sample size to reach the planned power of 80%, so the study was terminated early before some participants had completed SCIT for 3 years.On the basis of intention-to-treat analysis, there was no statically significant difference in asthma, nasal-ocular, or skin symptom scores in the SCIT and control groups. Quality of life, as assessed by the parent, showed significant improvement in the SCIT group (β coefficient: 0.32; SE: 0.09; P ≤ .01), particularly related to interference of child’s asthma on family or work plans and nighttime symptoms. Allergen specific serum immunoglobulin G4 levels increased in the SCIT group only (P ≤ .04). New allergen sensitization or loss of sensitization rates at the end of the study were not significantly different between the SCIT and control groups. Systemic reactions occurred in in 22% of children and 1.8% of injections, all of which were mild and resolved with antihistamine administration. Children in the SCIT group missed 28% of injection visits.Apart from improved quality of life, allergen immunotherapy in inner-city children with asthma <4 years of age did not show significant improvement in asthma, allergy, or eczema clinical outcomes.Although perhaps limited by small sample size and a high rate of missed appointments, with the results, the authors support the common practice of waiting until near 5 years of age to start SCIT. Factors unique to an inner-city, younger pediatric population may warrant larger studies to determine the efficacy of early immunotherapy in improving asthma.

Effectiveness of a Home- and School-Based Asthma Educational Program for Head Start Children With Asthma: A Randomized Clinical Trial

To evaluate if a multilevel home and preschool asthma educational program is more effective in improving asthma control, compared with a preschool-based program alone. Specifically, because this study was conducted within the Head Start program and targeted at an at risk population, with the study, the researchers examined if their multilevel intervention could address asthma disparities.Eligible participants were caregivers with children aged 2 to 6 years with the confirmed physician-diagnosed of asthma who were also enrolled in one of 14 Head Start programs in Baltimore, Maryland. Participants were recruited from April 1, 2011, to November 31, 2016.Screening forms were provided through Head Start staff, and families who gave permission were contacted by telephone to confirm eligibility and schedule the first home visit. Families were randomly assigned to either the Action for a Better Community (ABC) Plus Head Start education group or the Head Start education alone group by using a 1:1 block randomization scheme. Families were not blinded to their random assignment, but the research assistants who completed assessments were blinded and were different from the intervention staff. The ABC family intervention consisted of 4 30- to 45-minute in-person, at-home asthma management educational sessions and 3 booster calls. Assessment visits were completed by research assistants: in home visits at baseline and 6 months and telephone visits at 3, 9, and 12 months. The primary outcome was the Test for Respiratory and Asthma Control in Kids (TRACK) score to assess the degree of asthma control. Caregiver reports of emergency department visits, hospitalizations, and courses of oral corticosteroids (OCS) in the previous 3 months were collected at each assessment visit. Caregiver health–related quality of life was measured by using the Pediatric Asthma Caregiver’s Quality of Life Questionnaire.A total of 398 families were randomly assigned to either the ABC Plus Head Start educational program (n = 199) or Head Start educational program alone (n = 199). Most participants were Black (379 [95.2%]) and had a family income of less than $40 000 a year (357 [89.7%]). There were no significant group differences on any demographic characteristic. Of those in the intervention group, 144 (72.4%) completed at least 1 home education session, 69 (34.7%) completed all 4 home visits, and 71 (35.8%) completed all the booster telephone calls after the 3-, 6-, and 9-month follow-up surveys. Although there was an overall improvement in TRACK total scores for both groups over time (β = 3.00; 95% confidence interval (CI): 2.47 to 3.54; P < .001), those in the intervention group had clinically significant score differences at 3 months, compared with that of those in the control group (β = 6.26; 95% CI: 1.77 to 10.75; P < .001). There was no significant difference in TRACK scores among groups at months 6, 9, and 12. Participants in the intervention group were significantly less likely to have OCS use at 9 months (β = −0.61; 95% CI: −1.13 to −0.09; P = .02) and hospitalization during the 12-month follow-up period (odds ratio: 0.36; 95% CI: 0.21 to 0.61; P < .001). There was a significant improvement in asthma-related quality of life at 12 months for both groups (β = 0.28; 95% CI: 0.19 to 0.38; P < .001) but no difference between intervention and control groups.The multilevel asthma education intervention decreased several measures including asthma symptom scores at 3 months, OCS use at 9 months, and decreased hospitalizations during the 12-month follow-up period.This educational program revealed modest improvements in asthma control and health care use. It is not entirely clear why TRACK scores only revealed differences at 3 months and OCS use at 9 months; however, the decrease in asthma hospitalization during 12-month follow-up indicates a true significant effect, especially because preschool-aged children have the highest risk for use of health care services. However, it should be noted that health care resources for asthma outcomes was collected via caregiver report and not verified by using medical records, possibly leading to bias. Overall, with this study, the authors highlight how implementation of an asthma educational program by using a community partner was an effective strategy for targeting a population disproportionately affected by health disparities.

Asthma Phenotypes and Host Risk Factors Associated With Various Asthma-Related Outcomes in Health Workers.

Background: Work-related asthma phenotypes in health workers (HWs) exposed to cleaning agents have not been investigated extensively as other occupational exposures. This study aimed to describe asthma phenotypes and to identify important host risk factors associated with various asthma-related outcomes.Methods: A cross-sectional study of 699 HWs was conducted in two large tertiary hospitals. A total of 697 HWs completed questionnaire interviews. Sera collected from 682 HWs were analyzed for atopy (Phadiatop) and IgE to occupational allergens (NRL—Hev b5, Hev b6.02; chlorhexidine and ortho-phthalaldehyde—OPA). Methacholine (MCT), bronchodilator challenge (BDR) and fractional exhaled nitric oxide (FeNO) were performed. An asthma symptom score (ASS) used five asthma-related symptoms reported in the past 12 months. Current asthma was based on use of asthma medication or an asthma attack or being woken up by an attack of shortness of breath in the past 12 months. Nonspecific bronchial hyperresponsiveness (NSBH) was defined as having either a positive MCT or a significant bronchodilator response. Two continuous indices of NSBH [continuous index of responsiveness (CIR) and dose-response slope (DRS)] were calculated.Results: The prevalence of current asthma was 10%, atopic asthma (6%) and non-atopic asthma (4%). Overall, 2% of subjects had work-related asthma. There was a weak positive association between NSBH and FeNO [CIR: Beta coefficient (β) = 0.12; CI: 0.03–0.22 and DRS: β = 0.07; CI: 0.03–0.12]. Combining FeNO ≥ 50 ppb with a BDR [mean ratio (MR) = 5.89; CI: 1.02–34.14] or with NSBH (MR = 4.62; CI: 1.16–18.46) correlated better with ASS than FeNO alone (MR = 2.23; CI: 1.30–3.85). HWs with current asthma were twice as likely to be atopic. FeNO was positively associated with atopy (OR = 3.19; CI: 1.59–6.39) but negatively associated with smoking status (GMR = 0.76; CI: 0.62–0.94). Most HWs sensitized to occupational allergens were atopic.Conclusion: Atopic asthma was more prevalent than non-atopic asthma in HWs. Most asthma-related outcomes were positively associated with allergic predictors suggesting a dominant role for IgE mechanisms for work-related symptoms and asthma associated with sensitization to OPA or chlorhexidine.

SOCIOECONOMIC STATUS AFFECTS ASTHMA MORBIDITY MEASURES AMONG BLACK AND LATINX PATIENTS

SOCIOECONOMIC STATUS AFFECTS ASTHMA MORBIDITY MEASURES AMONG BLACK AND LATINX PATIENTS

Allergen immunotherapy against house dust mites in patients with local allergic rhinitis and asthma

Local allergic rhinitis (LAR) is a clinical rhinitis phenotype characterized by the presence of nasal symptoms of AR in nonatopic patients with a negative skin prick test and undetectable specific IgE (sIgE) in serum against inhalant allergens but with a positive nasal allergen provocation test. This study evaluated the effectiveness of a 12-month course of sublingual immunotherapy (SLIT) for house dust mite (HDM) allergies in adult patients with confirmed LAR and concomitant asthma. Methods The study was a prospective, double-blind, placebo-controlled trial with patients diagnosed with LAR to HDMs and with concomitant asthma who underwent a 12-month treatment course of SLIT for HDM allergies. Seventeen patients were randomized to SLIT with the use of allergen extracts of D. pteronyssinus and D. farinae (50/50%) in SQ-HDM SLIT tablets and 15 patients were randomized to the placebo group. The total rhinitis score (TRSS), total asthma symptom score (TASS), combined total symptom score (TSS), total medication score (TMS), and FEV1 were analyzed. Results: In the final analysis, 16 patients who received SLIT and 14 who received placebo who completed the study protocol were included. Significant reductions in TRSS, TASS, TSS, and TMS after 12 months of treatment were observed in patients after SLIT (p < 0.05). A significant increase in the mean FEV1 between baseline and after 12 months of therapy was observed in the study, with p = 0.03 in the study group. Conclusion: SLIT can improve nasal and bronchial symptoms and reduce symptomatic treatment in patients with LAR and asthma and with hyperresponsiveness to HDMs.

Occupational Exposures to Organic Solvents and Asthma Symptoms in the CONSTANCES Cohort.

Solvents are used in many workplaces and may be airway irritants but few studies have examined their association with asthma. We studied this question in CONSTANCES (cohort of ‘CONSulTANts des Centres d’Examens de Santé’), a large French cohort. Current asthma and asthma symptom scores were defined by participant-reported respiratory symptoms, asthma medication or attacks, and the sum of 5 symptoms, in the past 12 months, respectively. Lifetime exposures to 5 organic solvents, paints and inks were assessed by questionnaire and a population-based Job-Exposure Matrix (JEM). Cross-sectional associations between exposures and outcomes were evaluated by gender using logistic and negative binomial regressions adjusted for age, smoking habits and body mass index. Analyses included 115,757 adults (54% women, mean age 47 years, 9% current asthma). Self-reported exposure to ≥1 solvent was significantly associated with current asthma in men and women, whereas using the JEM, a significant association was observed only in women. Significant associations between exposures to ≥1 solvent and asthma symptom score were observed for both self-report (mean score ratio, 95%CI, women: 1.36, 1.31–1.42; men: 1.34, 1.30–1.40) and JEM (women: 1.10, 1.07–1.15; men: 1.14, 1.09–1.18). Exposure to specific solvents was significantly associated with higher asthma symptom score. Occupational exposure to solvents should be systematically sought when caring for asthma.