Changes In Asthma Severity Research Articles

Adolescent Views on Asthma Severity and Management During the COVID-19 Pandemic.

Background: Asthma and COVID-19 have overlapping symptoms. During the 2019-2022 pandemic, pediatric asthma control appears to have improved, with some researchers theorizing that that is due to changes in asthma self-management. This study examined adolescents' views regarding how the pandemic impacted their asthma severity and self-management. Differences by urbanicity, sex, and race/ethnicity were explored. Methods: We utilized baseline data from adolescents with poorly controlled asthma (n = 183) who were participating in 1 of 2 school-based clinical trials-1 in rural schools and 1 in urban schools-testing the impact of interventions to improve asthma control. Adolescents reported if they believed their asthma severity remained the same, improved, or worsened during the pandemic, and if it changed, how it changed. They also reported if and how they modified their asthma management since the pandemic. We used multinomial logistic regression and binary logistic regression to assess the relationship between demographic factors and changes in asthma severity during the pandemic, and if adolescents altered their asthma management. Results: Adolescents' mean age was 15.9 years; most lived in rural communities (65.6%) and identified as female (66.7%). About half (56.2%) self-identified as black, 13.1% as Hispanic, and 10.4% as another race/ethnicity. Most (68.4%) reported that their asthma severity remained unchanged; 26.0% reported it worsened. Nearly 30% reported they altered how they managed their asthma, with most (80%) reporting additional efforts. Compared with asthma remaining the same, females had a higher relative risk than males of reporting that their asthma worsened [adjusted relative risk ratio = 3.65, 95% confidence interval (CI) = 1.34-9.90, P < 0.05]. Urban youth had greater odds (adjusted odds ratio = 5.4, 95% CI = 2.0-14.5, P < 0.001) of reporting they changed their asthma self-management compared with rural peers. Conclusion: This study demonstrates that during the 2019-2022 pandemic, adolescents generally believed their asthma severity stayed consistent and many took additional self-management efforts.

Impact of Electronic Medication Monitoring on Pediatric Asthma Severity and Control in a Real-World Multidisciplinary Clinic

Compared to adult asthma, the impact of electronic medication monitoring (EMM) systems on pediatric asthma outcomes has not been well described. This study assessed changes in asthma severity, control, and rescue inhaler use with EMM use in real-world, poorly controlled pediatric asthma patients.

Association of low-dosage systemic corticosteroid use with disease burden in asthma

There is an ongoing debate about the benefit–risk balance of systemic corticosteroids (SCS) in asthma treatment. We investigated the associations between SCS use and disease burden in a database cohort of asthmatics, categorized into SCS and non-SCS prescription at baseline and quartiles (Q) by cumulative SCS dosage. Of the 10,579 patients, the SCS cohort comprised 3103 patients (29.3%). Mean SCS dosages at baseline were 0.08, 0.29, 0.79, and 4.58 mg/day in Q1, Q2, Q3, and Q4, respectively. Similar SCS dosages were used within each quartile throughout the study period. No remarkable changes in asthma severity or control status were observed. All SCS cohorts had a higher risk of intermittent SCS exposure during the observation period. SCS use was associated with osteoporosis, diabetes, anxiety/neurosis, and depression. SCS-dependent treatment does not necessarily lead to the future improvement of asthma control; rather, it may negatively impact systemic health, even at mean dosages <5 mg/day.

Changes in asthma severity in the first year of school and difficulty learning to read

Objective: Asthma is a risk factor for poor early reading in children, for reasons that are unclear. This analysis examines the relationship between changes in asthma severity during the first year of school and being in the lowest quartile of reading achievement after 1 year of school.Methods: We used previously unreported data from our cohort study. Parent interviews and teacher questionnaires enquired about asthma and covariates of achievement at school entry (T1) and 12 months later (T2). Asthma severity scores at T1 and T2 showed that in 27 of 51 children with asthma, symptoms improved over the year, whereas in 24, symptoms persisted or worsened. Word and story reading were assessed at T1 and T2. We compared reading achievement at both timepoints between children with asthma and children who had no reported respiratory symptoms between birth and T2 (controls, N = 74), and between those with persistent versus improved symptoms.Results: More children with asthma than controls were in the lowest quartiles for reading. Further, significantly more children in the persistent group compared to the improved group were in the lowest quartiles for word reading (58 versus 30%, respectively) and story reading (54 versus 26%, respectively). School absences, increased behavior problems, stressful life events or parental mental health were not associated with the differences in either comparison. Logistic regression modeling identified persistent asthma as the most important variable associated with being in the lowest quartile of reading after 1 year in school.Conclusions: Active asthma symptoms during early school may influence early reading achievement.

Zinc Supplementation in Children with Asthma Exacerbation.

Zinc deficiency has demonstrated an association with the risk of asthma. This study aimed to evaluate the efficacy of zinc supplementation in reducing the severity of childhood asthma exacerbation. A number of 42 children with asthma exacerbation admitted to the hospital were randomized to receive either zinc bis-glycinate (30 mg elemental zinc/day) or a placebo in adjuvant to the standard treatment. The pediatric respiratory assessment measure (PRAM) was used to measure the asthma severity. The primary outcome was a change in asthma severity from the baseline to the end of study. The study found that PRAM score in the zinc group showed a more rapid decrease compared to the control group at the 24-hour (2.2±1.3 vs. 1.2±1.3; P = 0.015) and 48-hour (3.4±2.0 vs. 2.2±1.8; P = 0.042) intervals. At admission, overall mean serum zinc level was 63.8 mg/dL and 57.1% of children had zinc deficiency with no difference in prevalence between groups. PRAM scores did not differ between children with low and normal zinc status. In conclusion, zinc supplementation as the adjuvant therapy to the standard treatment during asthma exacerbation resulted in rapid lessening of severity.

Reduced severity and improved control of self-reported asthma in Finland during 2001-2010.

BackgroundAsthma and allergies are common and cause substantial burden in symptoms and suffering, hospitalizations and medication costs. However, despite the high prevalence, asthma burden has already decreased in Finland in 2000s.ObjectiveWe carried out an asthma barometer survey in all Finnish pharmacies to study changes in asthma severity and control, and use of health care services from 2001 to 2010.MethodsAsthma severity, comorbid allergic conditions, and use of medication and health care services were assessed in subjects who purchased asthma or allergy medication from the pharmacies all across the country during one week in 2001 and again in 2010. In 2001, 3,062 patients (mean age, 49 years), and in 2010, 1,114 patients (mean age, 51 years) participated.ResultsIn 2001 90% and in 2010 73% of the respondents reported physician-diagnosed asthma and were entitled to special reimbursement for their drug costs, i.e., they needed regular maintenance treatment. In 2001, 10% of the asthmatics regarded their disease as severe, compared with 4% in 2010, while the figures for mild asthma were 45% and 62%, respectively (p < 0.001). The proportion of patients needing emergency care during the last year decreased from 34% (2001) to 14% (2010) (p < 0.001) and the need for hospitalizations from 18% to 6% (p < 0.001). Smoking reduced from 24% to 18% among asthmatics ( p = 0.002). In 2010, risk factors for severe asthma were older age, comorbid atopic eczema, and food allergy.ConclusionDuring ten years, self-reported asthma severity has reduced and disease control improved in Finland.

Predictors for the development of progressive severity in new-onset adult asthma

A proportion of patients with adult-onset asthma have severe disease. Risk factors for an increase in asthma severity are poorly known. We sought to identify predictors for the development of severe asthma in adults. A cohort of 200 adults with new-onset asthma was prospectively followed for 2 years. At baseline, patients underwent a comprehensive assessment of clinical, functional, and inflammatory parameters. After 2 years, change in asthma severity was assessed by using the Global Initiative for Asthma score (range, 1-4), which is based on asthma control (Asthma Control Questionnaire), lung function (FEV1), and inhaled corticosteroid requirement. ANOVA and multiple regression equations were used in the analysis. One hundred twenty-eight patients completed 2 years of follow-up. Seventeen (13.3%) patients had an increase in asthma severity, whereas 53 (41.4%) patients had a decrease. A lower postbronchodilator FEV1/forced vital capacity ratio and a higher number of cigarette pack years smoked at baseline were significantly associated with an increase in asthma severity at follow-up. Multiple regression equations showed that only the number of cigarette pack years smoked was independently associated with an increase in asthma severity, with an odds ratio of 1.4 (95% CI, 1.02-1.91) for every 10 pack years smoked. A history of cigarette smoking in patients with new-onset adult asthma predicts an increase in asthma severity during the first 2 years of the disease in a dose-dependent manner.

Pediatric Asthma Caregiver’s Quality of Life Questionnaire is a useful tool for monitoring asthma in children

PurposeThere is little agreement among researchers whether a caregiver’s QOL can be used to detect changes in asthma severity in children. We assessed correlation between QOL in parents and QOL in children with asthma as well as clinical parameters of asthma. We determined whether changes in caregiver’s QOL scores reflect changes in child’s QOL and their asthma control.MethodsThis was a 9-week period cohort study. One hundred and ten primary caregivers with 110 children were seen in the clinic at enrollment, at week #1, #5 and #9. At each visit, the parents completed the Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ).ResultsOne hundred and one children and 101 caregivers completed the study. We found a significant correlation between asthma diary score in children and QOL in parents (from r = −0.46 to r = −0.53). We also found significant positive correlation between PAQLQ and PACQLQ and significant association between changes in asthma control and PACQLQ score for both domains. We observed significant change in PACQLQ of caregivers whose children obtained asthma control.ConclusionsPACQLQ is a useful tool for monitoring asthma in children. The implementation of the PACQLQ would be helpful in involving parents in therapy of their children with asthma.

Reassessment of Disease Severity in Patients Following Severe Acute Exacerbations of Asthma

Patients with asthma may have severe exacerbations. The impact of severe acute exacerbation on patient outcome has not been studied, however. The purpose of this study was to examine the long-term outcome of severe exacerbation of asthma on baseline disease severity in children. Data were collected retrospectively from all children with asthma older than 5 years who were admitted to the intensive care unit (ICU) with an acute exacerbation and were subsequently followed as outpatients. Patients were divided into 4 severity groups (intermittent, mild persistent, moderate persistent, and severe persistent) based on the severity of asthma prior to ICU admission, at the time of admission, and at 12-month follow-up. Thirty-nine patients were followed for 12 months after ICU admission. Pulmonology consultation was more likely to be obtained in patients with moderate and severe asthma at baseline as compared with those with intermittent or mild asthma ( P = .004). On follow-up, 59% had a change in classification of their asthma severity. Changes in asthma severity were more likely to occur at the time of ICU admission rather than at 12-month follow-up. There was no difference in the gender, race, age, or body mass index at the time of ICU admission between the group who had a change in asthma severity and the group with no change in severity. There was no difference in Modified Pulmonary Index Score, duration of hospitalization, or length of stay in the ICU between the 2 groups. Prior inhaled steroid dose was lower in patients who had a change in severity as compared with those who had not ( P = .018). Children with mild asthma were frequently reclassified to a more severe asthma category after an acute life-threatening episode of asthma. It is likely that this reclassification was due to underestimation of disease severity prior to the ICU admission, but the severe acute event itself may have contributed to increased severity classification.

Effect of Pregnancy on Maternal Asthma Symptoms and Medication Use

To examine whether factors related to the patient or her treatment influence asthma severity during pregnancy. Symptom and medication data were collected by in-person and telephone interviews. Women were recruited before 24 weeks of gestation through private obstetricians and hospital clinics. Eight hundred seventy-two women had physician-diagnosed asthma, 686 were active asthmatics, and 641 with complete data were analyzed. The Global Initiative for Asthma measured severity. Cumulative logistic regression models for repeated measures assessed changes in asthma severity during each month of pregnancy. Two factors had significant and profound effects on the course of asthma: prepregnancy severity and use of medication according to Global Initiative for Asthma guidelines. Although several factors were analyzed (race, age, atopic status, body mass index, parity, fetal sex, and smoking), none were significant risk factors for changes in asthma severity, measured in a clinically important way as a one-step change in Global Initiative for Asthma category. Women with milder asthma received most benefit from appropriate treatment, 62% decreased risk for worsening asthma among those with intermittent asthma (0.38, 95% confidence interval 0.23-0.64) and 52% decreased risk among those with mild persistent asthma (odds ratio 0.48, 95% confidence interval 0.28-0.84). Month or trimester of gestation was not consistently associated with changes in asthma severity. Asthma severity during pregnancy is similar to severity in the year before pregnancy, provided patients continue to use their prescribed medication. If women discontinue medication, even mild asthma is likely to become significantly more severe.

Evaluation of a Medicaid Asthma Disease Management Program

This study evaluates 1-year outcomes of an asthma disease management program implemented in an Oregon Medicaid population. A non-randomized pre-post study, a matched case-control study, and a "programmatic effects" analysis were conducted. Compared to matched controls, the treatment cohort had significantly fewer emergency room visits per thousand (7 vs. 28, P < 0.001) and higher office visits per thousand (57 vs. 7, P < 0.0001) but no significant difference in hospital admission rates. The programmatic effects model identified the participants' initial severity levels and the number of various communications they received as the most important variables in explaining the change in asthma severity from baseline to 12 months. These findings are supportive of the DM design, which is to reduce acute services by improving coordination of care between patients and their providers. Additionally, it appears that there is a close association between the number of patient contacts and their subsequent change in health status.

Obesity, allergy and immunology

J ALLERGY CLIN IMMUNOL described an association between obesity and asthma (Fig 2). In a large population of white Australian girls, a higher bodymass indexwas reported to be a risk factor for atopy and wheeze. As a corollary, weight loss, as after bariatric surgery, has consistently been shown to improve asthma severity and control (Fig 3). Changes in airway structure and function have been associated with obesity. For example, it is common to observe an atypical obese airway pattern in morbidly obese persons at bronchoscopy (Fig 4). This pattern is

Impact of school nurse case management on students with asthma.

This project determined asthma prevalence in a large school district, absentee rates, and potential effects of school nurse case management for student asthma over three years. Data were derived from an asthma tracking tool used by nurses in one school district for every student reported as having asthma by their parent. School nurses began collecting data in their schools in 1999-2000 when an asthma-management protocol was first developed. Nurses documented perceived asthma severity for each student, presence of medication and peak flow meters in school, and case management activities provided. This data base was cross matched with percentage of days students were absent for any illness. Prevalence of asthma, based on school nurse records of parent report, was between 5.1% to 6.2% during the three years. Between 13.5% and 15% were moderate or severe. Students with asthma were absent between one-half to one and one-quarter days more often than those without asthma. In year three, 39% of students with asthma had medication at school, and 12% had a peak flow meter. Contacting a parent was the nurse case management activity provided for the largest number of students (27% of students with asthma), followed by asthma education (16.5%), contact with physician (6%), and home visits (1%). Students who received at least one school nurse case management intervention were more likely the next year to have an asthma medication at school, to use a peak flow meter at school, and to have a change in asthma severity. School nurse case management activity had no association with student absences. Availability of medication and peak flow meters at school was low, suggesting standards of care for asthma were not followed. School nurse case management, when performed outside a project or intervention, offers a promising strategy to improve asthma management.

Fluticasone propionate (FP) was superior to montelukast (MON) in producing at least a 2-step improvement in asthma severity in children 6-12 years of age

Rationale Asthma is characterized by symptoms that vary in severity from patient to patient and within a patient over time. As such, the NHLBI guidelines recommend a stepwise approach for the diagnosis and management of asthma in children, with the goal of pharmacotherapy to reduce symptoms and achieve near normal lung function. Patients may be classified according to severity based on their lung function, symptoms, and rescue albuterol use. An analysis was conducted to evaluate the step change in asthma severity from baseline to endpoint following treatment with FP or MON in children 6-12 years of age. Methods This was a randomized, double-blind, double-dummy, parallel group, 12-week study comparing FP (50μg BID; n=172) with MON (5mg QD; n=170) in symptomatic children using PRN albuterol. Asthma severity classification was defined according to the NHLBI guidelines and was based on % predicted FEV 1, daytime and nighttime symptoms, and albuterol use. Results At baseline, most patients (96%) in each treatment group met the classification criteria for moderate persistent asthma. At endpoint, significantly more patients (p=0.001) treated with FP (37.6%) demonstrated at least a 2-step improvement in asthma severity or improvement to mild intermittent asthma compared with patients who received MON 5 mg (21.1%). Conclusion FP is more effective in producing a ≥2-step improvement in asthma severity than MON in children 6-12 years of age with persistent asthma resulting in more children with an improvement to mild intermittent asthma.

Fluticasone propionate administered via metered-dose inhaler with valved holding chamber and attached facemask is effective in improving asthma control by producing at least a 2-step improvement in asthma staging in pre-school age children with asthma

Rationale NHLBI guidelines recommend a stepwise approach for diagnosis and management of asthma in children and adults, with the goal of minimizing symptoms and optimizing lung function. A retrospective analysis was conducted to evaluate the step change in asthma severity from baseline to endpoint following treatment with fluticasone propionate (FP) in pre-school age children. Methods Existing data from 4, multi-center, randomized, double-blind, parallel group trials evaluating FP CFC 88μg (FP 88) versus placebo (propellant alone; PLA), in patients 6-23 (Study 1), 24-47 (Study 2), and 12-47 (Studies 3 and 4) months of age, were pooled for analysis. Treatments were administered via a metered-dose inhaler with valved holding chamber (Aerochamber Plus ™, Optichamber ™, or Babyhaler ™) and attached facemask, twice-daily for 12 weeks, in children with documented symptoms of asthma. Asthma severity classification was defined according to the NHLBI guidelines and was based on daily parental/guardian assessments of the child's daytime and nighttime asthma symptoms and supplemental albuterol use. Results A total of 334 children received PLA and 330 received FP 88. At baseline, most patients (94% PLA and 93% FP 88) met the classification criteria for moderate or severe persistent asthma. At endpoint, more patients treated with FP 88 demonstrated at least a 2-step improvement in or improvement to mild intermittent asthma category compared with patients who received PLA, 45% and 34%, respectively (p=0.007). Conclusion In pre-school age children with moderate to severe persistent asthma, treatment with FP 88μg BID was effective in improving asthma control as demonstrated by a ≥2-step improvement in asthma staging.

Development of a Drug Treatment-Based Severity Measure in Childhood Asthma

Valid measures of severity are crucial in asthma pharmacoepidemiological research. This study reports the development and validation of a severity measure in childhood asthma for application to health care administrative data. A drug treatment-based asthma severity measure was developed following the stepped care approach to treatment, and this was applied to a cohort of 16,862 children who met a case definition for asthma drug prescription use between January 1995 and March 1996. Assessments were made of the measure's reliability, validity, and responsiveness to change over time. The drug treatment-based asthma severity measure classified 42% of children as having mild asthma, 37% as having moderate asthma, 19% as having moderate-severe asthma, and 2% as having severe asthma. Agreement on severity classification between two successive time periods was excellent (kappa = 0.82). Children classified as having severe asthma were significantly more likely than children with mild–moderate asthma to have previous asthma hospitalizations, to visit asthma specialists, to have high physician utilization, and to require hospital critical care. They were more likely to be reclassified as having severe asthma 2 years later. These findings show that a drug treatment-based severity measure in childhood asthma, which can be applied to prescription data, has good reliability and validity, and is responsive to changes in asthma severity over time.

Impact of changes in asthma severity on health-related quality of life in pediatric and adult asthma patients: results from the asthma outcomes monitoring system.

The goals of asthma treatment have broadened beyond managing traditional clinical markers of disease severity, and now include a focus on benefits of treatment in terms that are most meaningful to patients. Measurement of both generic and disease-specific health-related quality of life (HQL) is advocated because each provides complementary information about how the condition affects everyday functioning and well-being and whether treatments have their intended effects. The purpose of this study was to determine the impact of changes in asthma severity (defined using NHLBI/NAEPP severity staging) on patient-assessed HQL. Two hundred and thirty-three pediatric asthma patients and 269 adult asthma patients were evaluated in a one-year observational study. Analyses were performed to compare the generic and asthma-specific scores for patients whose asthma severity improved, stayed the same, or worsened over one year. The asthma-specific scales are sensitive to changes in disease severity. Of the generic scales, those tapping areas of physical health are more affected than the mental/emotional scales. This confirms that HQL measures are responsive to changes in asthma severity. They complement traditional clinical markers used to evaluate changes in a patient's disease state and thus give the physician another useful tool in following the clinical progress of the child with asthma.

A new tool for monitoring asthma outcomes: the ITG Asthma Short Form.

Asthma treatment has broadened from managing clinical markers to incorporate factors that are most meaningful to patients, collectively called health-related quality of life (HQL). To develop an asthma-specific HQL tool, meeting demands for brevity, usefulness and measurement precision. The 20-item Sydney Asthma Quality of Life Questionnaire (AQLQ) and six additional items were studied using factor analysis, reliability and validity tests among asthma patients 14 and older. The 15-item Integrated Therapeutics Group Asthma Short Form (ITG-ASF) retains the validity of the AQLQ with improved scaling properties and interpretability. The ITG-ASF yields 6 scores: Symptom-Free Index, Functioning with Asthma, Psychosocial Impact of Asthma, Asthma Energy and Asthma-Confidence in Health and a Total. All items correlated 0.40 or higher with their hypothesized scales and passed discriminant validity tests, with scaling success rates from 75 to 100%. Reliability exceeded the minimum of 0.70 for group comparisons. Ceiling and floor effects were acceptable. Scales were valid in relation to changes in asthma severity and lung function. The best predictor of asthma severity (National Asthma Education and Prevention Program (NAEPP) staging) was the Symptom-Free Index. A Spanish translation is available, Chinese-American is forthcoming. The reading grade level is 4.8. Development of the ITG-ASF was a data-driven process maximizing measurement precision and breadth while minimizing burden. The ITG-ASF is a brief, comprehensive and empirically valid tool that complements traditional markers of the outcomes of asthma care.

Trends in hospital readmission for asthma: has the Australian National Asthma Campaign had an effect?

To describe patterns of hospital readmission for asthma in South Australia from 1989 to 1996, in relation to implementation of the National Asthma Campaign. A comparison of hospital admissions in South Australia of patients aged between one year and 49 years for three conditions: asthma (or respiratory failure with asthma as an underlying condition) and two control conditions--diabetes and epilepsy. Individuals were identified by Medicare number and date of birth. Hospital readmission within 28 days and within one year. Overall, by 1996, there was a statistically significant decline in the risk of readmission for asthma within 28 days of 18% and within one year of 17% compared with 1989 readmission rates. There were no reductions in the risk of readmission for diabetes or epilepsy, suggesting that the decline in risk of readmission for asthma was greater than the underlying effects of general changes in hospital casemix. The decline in risk of readmission may reflect changes in asthma severity or improved management practices. However, hospital readmission rates still remain high, and to further reduce readmissions for asthma there is a need to identify factors related to presentation for asthma at accident and emergency departments.

The Marks Asthma Quality of Life Questionnaire: Further Validation and Examination of Responsiveness to Change

We performed analyses to examine the structure, validity, and responsiveness to change of the Marks Asthma Quality of Life Questionnaire (AQLQ), originally validated in Australia in a self-administered format, among 539 U.S. subjects with asthma. Subjects were interviewed twice by telephone over an 18-month period. Based on factor analyses, the subscale structure of the AQLQ was modified slightly to eliminate item overlap among subscale scores. Cross-sectionally, total AQLQ scores were significantly correlated in expected directions with baseline asthma severity scores ( r = 0.58), SF-36 physical ( r =−0.66) and mental ( r = –0.40) health status scores, and pulmonary function (FEV 1% predicted, r = –0.14). Longitudinally, changes in AQLQ total and subscale scores were significantly (P < 0.01) associated with changes in asthma severity and both physical and mental status. The AQLQ, administered by telephone, appears to be useful for assessing changes in the impact of adult asthma.