Concurrent Diagnoses Of Asthma Research Articles

GOLD 2021 Strategy Report: Implications for Asthma-COPD Overlap.

In its 2021 strategy report, the Global Initiative for Chronic Obstructive Lung Disease states: “we no longer refer to asthma-COPD overlap (ACO), instead we emphasize that asthma and COPD are different disorders, although they may […] coexist in an individual patient. If a concurrent diagnosis of asthma is suspected, pharmacotherapy should primarily follow asthma guidelines, but pharmacological and non-pharmacological approaches may also be needed for their COPD.” What does this mean for the treating physician? In this review, we explore the implications of this new guidance on treating patients with chronic obstructive pulmonary disease, arguing for a personalized approach to treatment.

Comorbidity profile of patients with concurrent diagnoses of asthma and COPD in Germany

The aim of this study was to estimate the prevalence of concurrent diagnoses of asthma/COPD and examine its full spectrum of comorbid disorders in Germany. We used nationwide outpatient claims data comprising diagnoses of all statutory health insurees (40+ years) in 2017 (N = 40,477,745). The ICD-10 codes J44 (COPD) and J45 (asthma) were used to identify patients. The odds of 1,060 comorbid disorders were examined in a case–control study design. Of all insurees, 4,632,295 (11%) were diagnosed with either asthma or COPD. Of them, 43% had asthma only, 44% COPD only and 13% both diseases. The prevalence of concurrent asthma/COPD was 1.5% with a slightly higher estimate among females than males (1.6% vs. 1.4%) and constant increase by age in both sexes. Comorbid disorders were very common among these patients. 31 disorders were associated with a strong effect size (odds ratio > 10), including other respiratory diseases, but also bacterial (e.g., mycobacteria, including tuberculosis) and fungal infections (e.g., sporotrichosis and aspergillosis). Patients with concurrent asthma/COPD suffer from comorbid disorders involving various body systems, which points to the need of a multidisciplinary care approach. Regular screening for common comorbid disorders may result in better clinical course and prognosis as well as improvement of patients’ quality of life.

Fractional Exhaled Nitric Oxide as an Inflammatory Biomarker in Chronic Obstructive Pulmonary Disease (COPD) with or without Concurrent Diagnosis of Asthma: The Canadian Cohort Obstructive Lung Disease (CanCOLD)

We studied whether fractional exhaled nitric oxide (F ENO) can differentiate chronic obstructive pulmonary disease (COPD) with concurrent diagnosis of asthma from COPD-only as well as its ability to predict disease severity and progression. This study was embedded in the Canadian Cohort Obstructive Lung Disease (CanCOLD). Subjects of ≥40 years old completed F ENO measurements were subdivided into four groups, including COPD (N = 86 [COPD-only (N = 35) and COPD with concurrent diagnosis of asthma (N = 51)], healthy (N = 72), and at risk (N = 151). Three of the most common clinical definitions were used for characterizing COPD with concurrent diagnosis of asthma: 1) atopy and self-reported physician diagnosis of asthma, 2) ≥12% and ≥200 ml post-bronchodilator FEV1; 3) self-reported physician diagnosis of asthma. F ENO values were classified using quartiles and the American Thoracic Society (ATS) guideline 2011. Compared to COPD-only, more COPD with concurrent diagnosis of asthma had a significant F ENO50 level of 33.5 ppb (fourth quartile) than COPD-only (p = 0.045, 0.011, and 0.006, for definition 1, 2, and 3, respectively). Considering the ATS guideline 2011, fewer COPD with concurrent diagnosis of asthma had F ENO50 < 25 than COPD-only, which was statistically significant with definition 1 and 3 (p = 0.038 and 0.026, respectively). F ENO as a biomarker has the potential to be used as a complementary value for differentiating COPD with concurrent diagnosis of asthma from COPD-only. Further studies should be conducted on validated definitions of COPD with concurrent diagnosis of asthma, which may include a reference to the type of airway inflammation in addition to the clinical definition.

Treatment Patterns in Asthma- Chronic Obstructive Pulmonary Disease Overlap Syndrome.

Asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is a complex disease entity with limited guidance surrounding medication therapy. To evaluate a patient population with possible ACOS and their medication regimen based on the Global Initiative for Asthma and Global Initiative for COPD joint statement for ACOS. This was a retrospective study based at a large clinical practice within a school of medicine. The sample included adults 40 to 85 years old who had an active concurrent diagnosis of asthma and COPD. Patients were considered to have likely inconsistent therapy (only preventive, no rescue medication), inconsistent therapy (neither preventive nor rescue medication), and likely consistent therapy (both preventive and rescue medication or rescue medication alone). A total of 513 patients were included the study. The majority of the sample were female (75%) and white (87.1%), with an average age of 61 years. About 7% of patients had likely inconsistent therapy, whereas 7.7% had inconsistent therapy to control their airway disease. Never smokers were more likely than former smokers to have inconsistent therapy (adjusted odds ratio [OR] = 4.54; CI = 1.86-11.04). Adults 65 years and older were more likely than those aged 40 to 49 years to be in the likely inconsistent therapy group (adjusted OR = 4.01; CI = 1.04-15.34). Patients without any comorbid conditions were more likely than those with 2 or more comorbid conditions to be in the likely inconsistent group (adjusted OR = 3.50; CI = 1.39-8.77). As the disease definition and treatment recommendations evolve, future studies should continue to monitor ACOS treatment patterns and outcomes.

The Effects of Azithromycin in Treatment-Resistant Cough: A Randomized, Double-Blind, Placebo-Controlled Trial.

Chronic cough is a common clinical problem worldwide. Although many patients have underlying precipitating conditions such as asthma, gastroesophageal reflux, or rhinitis, many remain symptomatic despite treating these conditions. New approaches are needed for the treatment of this group of patients. We conducted a randomized, double-blind, placebo-controlled trial to determine whether 250 g of azithromycin three times a week for 8 weeks would affect the Leicester Cough Questionnaire (LCQ) score in 44 patients with treatment-resistant cough. Cough severity on a visual analog scale and bronchial exhaled nitric oxide were measured as secondary outcomes. There was a clinically important improvement in LCQ score with azithromycin (mean change, 2.4; 95% CI, 0.5 to 4.2) but not placebo (mean change, 0.7; 95% CI, -0.6 to 1.9), but the between-group difference was not statistically significant (P = .12). There were no significant between-group differences for any of the secondary outcome measures. Looking at subgroups of responders, there was a large and significant improvement in LCQ score in patients with chronic cough and a concurrent diagnosis of asthma who were treated with azithromycin (mean, 6.19; 95% CI, 4.06 to 8.32). Treatment with low-dose azithromycin for 8 weeks did not significantly improve LCQ score compared with placebo. The use of macrolides for treatment-resistant cough cannot be recommended from this study, but they may have a place in the treatment of chronic cough associated with asthma; this is worthy of further investigation. WHO International Clinical Trials Registry; No.: ISRCTN75749391. URL: http://apps.who.int.

Association of rheumatoid arthritis with allergic diseases: A nationwide population-based cohort study.

Low-grade inflammation conditions, e.g., type 2 diabetes, have been shown to be associated with an increased risk of rheumatoid arthritis (RA). However, the association between other chronic inflammatory conditions, e.g., asthma, allergic rhinitis, and atopic dermatitis, is still unclear. To investigate the risk of RA in patients with allergic diseases, including asthma, allergic rhinitis, and atopic dermatitis, by using a nationwide health claims database. The Taiwan National Health Insurance Research Database was used to assemble a cohort of 170,570 patients ages 20 years old and older diagnosed with allergic diseases, including asthma, allergic rhinitis, or atopic dermatitis. A comparison cohort of 170,238 patients was constructed from the same data base, with frequency matching for sex, 10-year age group, and year of insurance enrollment. Cox proportional hazards regression analyses were conducted to assess the association between the allergic diseases and incident RA. Asthma (adjusted hazard ratio [AHR] 1.67, [95% confidence interval {CI}], 1.32-2.62) and allergic rhinitis (AHR 1.62 [95% CI, 1.33-1.98]) were significantly associated with the incident RA. These associations remained significant even after excluding patients who had concurrent diagnoses of asthma and allergic rhinitis. Patients with more than one allergic disease had an increased risk of developing RA (AHR 1.98 [95% CI, 1.50-2.62]). Subgroup analysis further indicated that middle-aged and elderly female patients with more than one allergic disease exhibited a high risk of developing RA. Significant associations between common allergic diseases and incident RA was found in this population-based cohort study. Our findings provided support to the hypothesis that allergic diseases and RA might share a similar underlying etiologic pathway related to chronic inflammatory responses.

Labial Adhesions and Outcomes of Office Management

Labial adhesions (LA) are a relatively common complaint seen in the pediatric population. Between 0.6-5% of pre-pubertal females present with this condition, most commonly at 13-23 months of age. The hypoestrogenic state seen in prepubertal patients is believed to play a main role, therefore topical Estrogen is the initial treatment of choice. Topical steroids have been proposed as an alternative, however, studies thus far have shown inconsistent rates of recurrence, time to resolution, and need for surgery for this condition. Our primary aim was to evaluate the clinical outcomes of patients with LA in a single institution. Our secondary aim was to examine the possible association between severity of LA (single vs. multiple treatment) and conditions exacerbated by allergies, including lichen sclerosis (LS), asthma or eczema (ECZ). Upon IRB approval, 50 children with LA were identified from a single Pediatric and Adolescent Gynecology clinic between July 2006 and June 2011. Clinical outcomes and need for surgical intervention (manual separation) were evaluated. Additional medical conditions such as LS, ECZ and asthma were also noted. Analyses were performed in SAS statistical software 9.3 (SAS, Cary, NC). The mean age of LA diagnosis was 19.6 months (range 0 months to 72 months). Nearly half were Caucasian (48%). Most patients were symptomatic at presentation (62%) and after counseling on options 100% chose topical treatment. Estrogen cream was the first treatment choice in all cases; however, most patients required multiple treatments, including topical steroids (74%), while 26% received a single treatment. Compared to those receiving a single treatment, patients in the multiple treatment group were much more likely to be severely agglutinated (31% vs. 65%, p=0.05) and were slightly more likely to need a manual separation after failed topical treatment with progressive agglutination, although differences did not reach statistical significance (p=0.08). The prevalence of asthma, LS and eczema in the entire cohort was 9.8%, 7.8% and 3.9% respectively. There was no association between the presence of LS, ECZ or asthma, and requirement for one versus several treatments for LA. Both asthma (N=4; 14.3%) and LS (N=2; 7.1%) were more common among the severe than the less agglutinated group (N=1; 4.5% and N=0; 0% respectively), although due to low numbers these differences did not reach significance. Finally, no difference in the frequency of eczema was seen in either group. Severe agglutination tends to be associated with a higher likelihood of requiring multiple treatments and manual separation. Patients requiring multiple treatments were no more likely than patients responding to single treatments to have a concurrent diagnosis of asthma, LS or ECZ. Both asthma and LS appeared to increase with severity of agglutination, however, future larger studies are needed to confirm these associations. The study represents original work, and has not been previously presented or published.

Allergic diseases and respiratory symptoms in urban and rural children in Grodno Region (Belarus)

Because of the unknown frequency of asthma and other common allergic diseases in children living in Belarus, we conducted a population-based respiratory health survey. The objective of the study was to estimate the prevalence of allergic diseases and major allergic symptoms in children of the Grodno Region (Western Belarus) and to examine their familial and environmental correlates. The cross-sectional study was conducted in 2010 and included 2606 urban and 2422 rural children aged 6-16 years. Physician-diagnosed respiratory diseases and symptoms were ascertained using the ISAAC questionnaire completed by the parents. Both family and environmental factors were examined for their association with respiratory health outcomes including asthma and spastic bronchitis. Descriptive statistics and multiple logistic regression analysis were used to test associations. The prevalence of asthma, atopic eczema and allergic rhinitis was 1.39%, 10.25%, and 3.84%, respectively. Spastic bronchitis was reported for 6.74% of children. Chronic respiratory symptoms occurring in the past 12 months and suggestive of asthma included chest wheeze (9.71%) attacks of dyspnea at rest (1.77%), symptoms of hay fever (2.45%) attacks of sneezing and nasal congestion without a cold (6.78%), and recurrent itchy rash (13.48%). All diseases except for asthma and spastic bronchitis as well as symptoms of hay fever, congested nose and itchy rash were more frequent in urban than in rural children (p < 0.05). Results of multivariate logistic analysis confirmed associations (p < 0.05) between asthma and parental asthma (OR = 4.82) and dampness in home (OR = 2.12) after adjustment for age, gender and place of residence. Spastic bronchitis in children who did not have a concurrent diagnosis of asthma was related (p < 0.05) to parental asthma (OR = 2.18), dampness in the home (OR = 1.68) and less use of coal-based heating (OR = 0.64). Allergic rhinitis and atopic eczema were associated (p < 0.05) with parental asthma (OR = 5.07 and OR = 1.91, respectively), dampness (OR = 2.33 and OR = 1.51, respectively), lower parental education (OR = 0.74 and OR = 0.68, respectively) and household density (OR = 0.84 and OR = 0.92), respectively. The findings show a low prevalence of allergic diseases and symptoms in children of Western Belarus, following similar East-West gradients described in the literature. All allergic disorders except asthma were less frequent in the rural population. A very low prevalence of childhood asthma and the possibility of underdiagosis of the disease in the surveyed population deserve further investigation.

Correlation Between Specific Immunoglobulin E Levels and the Severity of Reactions in Egg Allergic Patients

Benhamou AH, Zamora SA, Eigenmann PA. Pediatr Allergy Immunol. 2008;19(2):173–179 PURPOSE OF THE STUDY. To determine if specific immunoglobulin E (IgE) antibody titers to egg were predictive of the severity of reaction during a standardized food challenge. STUDY POPULATION. The study was a retrospective review of children who underwent oral food challenges to egg over a 2-year period. Median age of patients was 3.9 years (range: 16 months to 11.9 years). Children with high egg-specific IgE titers and those with a severe reaction &amp;lt;2 years earlier were not tested. METHODS. Children with immediate-type reactions were tested by open food challenge, and those with atopic dermatitis or equivocal reactions were tested by double-blind, placebo-controlled food challenge. Graded challenges were performed with pasteurized raw egg, cooked egg, or egg hidden in a chocolate testing preparation. The challenge was terminated when the patient reached a total dose of 45 g of egg or if there was unambiguous clinical reactivity and reaction severity was graded. RESULTS. Of the 51 challenges performed during the study period, 35 (69%) were positive. Thirteen (37%) of the positive challenges were considered severe. An egg radioallergosorbent (RAST) assay result of ≥17.4 kU/L was associated with 95% probability of having a positive challenge; 8.2 kU/L was associated with a 90% probability. For all challenges, egg-specific IgE titers ranged from &amp;lt;0.35 to 14.9 kU/L. The negative challenge group had a median egg-specific IgE titer of 1.17 kU/L (range: 0.35–6.41 kU/L); the mild-to-moderate group median was 2.47 kU/L (range: 0.35–14.9 kU/L); and the severe group median was 3.70 kU/L (range: 1.18–11 kU/L). The differences of median egg-specific IgE levels were statistically significant (P = .006). Children with a positive challenge who received cooked egg were found to have a higher specific IgE level versus those who received raw egg (P = .016), but there was no statistically significant difference between severity of reactions between these groups. The median dose that caused a mild-to-moderate reaction was 6 g (range: 2.5–20 g) and was the same median dose that caused severe reactions (range: 0.5–15 g). CONCLUSIONS. There is a correlation between median egg-specific IgE levels and the severity of reaction during oral food challenge to egg. These levels may be helpful in predicting a potential reaction to egg. REVIEWER COMMENTS. It is often assumed that reaction severity correlates with the food-specific IgE level, but most studies have refuted this notion. Here, a relationship was determined. However, it is difficult to assess the clinical utility of these results, because there was considerable overlap of the ranges of egg-specific IgE levels between groups. These findings may be more relevant to the controlled setting of a diagnostic food challenge rather than to the community setting in which a large or uncontrolled dose of egg might be ingested. In a real-life setting, a severe reaction may occur even with a low egg-specific IgE level, particularly if one considers patient-dependent factors such as concurrent diagnosis of asthma or personal history of a previous severe reaction.

Pneumothorax in cats with a clinical diagnosis of feline asthma: 5 cases (1990–2000)

AbstractObjective: This paper characterizes the clinical findings in 5 cats with feline asthma complicated by concurrent pneumothorax.Design: Retrospective study. Medical records of cats with concurrent diagnoses of asthma and pneumothorax that were presented to the Veterinary Hospital of the University of Pennsylvania from 1990 to 2000 were reviewed.Results: Of 421 cases of feline asthma, 5 cats fulfilled the inclusion criteria (1.2%). All 5 had respiratory distress at presentation. One cat was panting, and the other 4 cats had respiratory rates of 28, 52, 58 and 120 breaths per minute (bpm), respectively (mean RR 65±39 bpm). Historical findings included untreated chronic cough (n=3), previously treated asthma (n=1), and no previous illness (n=1). Thoracocentesis was performed in 4/5 cats, and 3 of those cats required thoracostomy tubes. Four cats required immediate oxygen supplementation, and 1 of those cats required ventilation. All 5 cats had evidence of pneumothorax on initial radiographs. Follow‐up radiographs revealed partial or complete resolution of pneumothorax in 4 cats which were discharged alive with total hospitalization of 2–7 days, but were then lost to follow‐up. One cat was euthanized because it could not be weaned off mechanical ventilation, and necropsy confirmed end‐stage feline asthma and emphysema.Conclusion: Small airway obstruction can predispose asthma patients to increased alveolar pressure, emphysema, and spontaneous pneumothorax, which can lead to dyspnea in affected cats. The short‐term outcome in these cats was good despite the severity of dyspnea at presentation.