Asthma Control Status Research Articles

Parental Perspectives on the Implementation of House Dust Mite Avoidance Measures for Children with House Dust Mite Sensitization

ABSTRACTObjective: The avoidance of house dust mite (HDM) is crucial in the management of HDM allergies. We aimed to demonstrate the implementation and perspective of the parents whose children had HDM allergy/sensitization to HDM avoidance measures. Materials and Methods: Parents of the patients with HDM sensitization were interviewed via telephone questionnaires.Results: One hundred and three patients with asthma (73.8%), allergic rhinitis (AR) (77.7%) and/or atopic dermatitis (AD) (29.1%) aged four to 18 years were included in the study. Seventy-one patients had multiple allergic diseases (68.9%). Of the parents, 39.8% fully adhered to HDM avoidance measures, and their education status was as follows: 41.5% illiterate/elementary/middle school, 31.7% high school, and 26.8% associate’s degree/university. In addition, 32.2% of the mothers who were partially adherent (n=62) were illiterate or had graduated from elementary/middle school, 33.9% had graduated from high school, and 33.9% had an associate’s degree or had graduated from university. Forty-one (39.8%) mothers were working, and most of them (61%) had graduated from university or had an associate’s degree. Nearly half of the mothers who were partially adherent to HDM measures were working (n=32). In the multivariate analysis, the risk factors for partial adherence to measures was to be a working mother [OR:4.072, 95%CI: 1.350-12.882, p=0.013] and to have the belief that the measures were useless [OR:4.886, 95%CI: 1.499-15.923, p=0.008]. However, no relationship was shown between adherence to the measures and the severity of AR or AD, asthma control status and having multiple allergic diseases.Conclusion: Full adherence to HDM avoidance measures was considerably dependent on the mothers’ working status and belief in the ineffectiveness of the measures whereas there was no relationship to the severity of allergic diseases. This study also revealed how the education status of the mothers affected the adherence to allergen avoidance measures in real life.Keywords: Children, Dermatophagoides pteronyssinus,Dermatophagoides farinae, house dust mites, avoidance measures, parents, pediatrics, questionnaire

Effects of Home-based Incentive Spirometry on FEV1, FVC, 6-MWT, Control Status and Quality of Life of Asthma Patients

Rehabilitation management of Asthma patient, including breathing retraining that could be using incentive spirometry as biofeedback tool for patient when doing breathing exercise. The purpose of the research is to prove effect of home-based incentive spirometry (flow based) on FEV1, FVC, 6-MWT, asthma control status (ACT) and Quality of life (SGRQ) and spirometry test of asthma patient. This experimental study with Randomized Pre-test and Post-test Controlled Group design conducted at Dr Soetomo General Academic Hospital. A total of 16 asthma patients aged 18-40 years were randomly and evenly divided into two groups. An exercise program using Incentive Spirometry (flow based) was given to the intervention group, whereas the control group doing diaphragmatic breathing exercises. Both workouts were performed at home for four weeks with frequency five times per day, each session has ten repetitions. Results indicates that exercise with home-based incentive spirometry (flow based) showed improvements in FVC parameters (p-value 0.009) large effect size (1.25), 6 MWT distance (p-value 0.005) large effect size (1.40); and activity score SGRQ (p-value 0.041) large effect size (0.8). Giving 4 weeks of home-based exercise with Incentive Spirometry-(flow-based) improves FVC, 6-MWT distance, and activity score of quality of life (SGRQ) in asthmatic patient.

Clusters of Severe Eosinophilic Asthma in a Korean Asthma Cohort

Background: Targeted therapies have broadened the available treatment options for patients with severe eosinophilic asthma (SEA). However, differences in the magnitude of treatment responses among patients indicate the presence of various underlying pathophysiological processes and patient subgroups. Objectives: We aimed to describe the characteristics of SEA and identify its patient subgroups. Methods: Clinical data from the Cohort for Reality and Evolution of Adult Asthma in Korea were analyzed. Cluster analysis was performed among those with SEA using 5 variables, namely, prebronchodilator forced expiratory volume in 1 s, body mass index, age at symptom onset, smoking amount, and blood eosinophil counts. Results: Patients with SEA showed prevalent sensitization to aeroallergens, decreased lung function, and poor asthma control status. Cluster analysis revealed 3 distinctive subgroups among patients with SEA. Cluster 1 (n = 177) consisted of patients reporting the lowest blood eosinophils (median, 346.8 cells/μL) and modest severe asthma with preserved lung function during the 12-month treatment period. Cluster 2 (n = 42) predominantly included smoking males with severe persistent airway obstruction and moderate eosinophilia (median, 451.8 cells/μL). Lastly, cluster 3 (n = 95) included patients with the most severe asthma, the highest eosinophil levels (median, 817.5 cells/μL), and good treatment response in terms of improved lung function and control status. Conclusions: Three subgroups were identified in SEA through the cluster analysis. The distinctive features of each cluster may help physicians predict patients who will respond to biologics with greater magnitude of clinical improvement. Further research regarding the underlying pathophysiology and clinical importance of each subgroup is warranted.

Oral corticosteroid elimination via a personalised reduction algorithm in adults with severe, eosinophilic asthma treated with benralizumab (PONENTE): a multicentre, open-label, single-arm study

No consensus exists on how to reduce oral corticosteroids after the initiation of biologics in severe asthma. The PONENTE trial evaluated the effectiveness and safety of a rapid, individualised steroid-reduction algorithm, including adrenal insufficiency monitoring, after benralizumab initiation. This multicentre, open-label, single-arm study was done at 138 clinical asthma treatment centres across 17 countries. We enrolled adult patients (age ≥18 years) with severe, eosinophilic asthma (blood eosinophil count ≥150 cells per μL at enrolment or ≥300 cells per μL in the previous year) requiring maintenance oral corticosteroids for at least 3 months preceding enrolment. Patients received benralizumab 30 mg (subcutaneous injection) every 4 weeks for three doses, then every 8 weeks thereafter. The oral corticosteroid reduction phase began at week 4 with daily oral corticosteroid dosages reduced by 1-5 mg every 1-4 weeks depending on the starting dosage, asthma control, and adrenal function status. Adrenal function was assessed with an early morning serum cortisol measurement, followed by adrenocorticotropic hormone stimulation when required, once patients achieved a daily oral corticosteroid dosage of 5 mg/day for 4 weeks. Repeat cortisol measurements were taken for patients with evidence of adrenal insufficiency at first testing. Asthma control was assessed with the Asthma Control Questionnaire-6 (ACQ-6) weekly throughout the induction and oral corticosteroid reduction phases. The primary endpoints were the percentage of patients eliminating daily oral corticosteroids, sustained for at least 4 weeks, and the percentage achieving elimination or a daily prednisone or prednisolone dosage of 5 mg or less, for at least 4 weeks, if the reason for no further reduction was adrenal insufficiency. Safety and efficacy analyses included all patients who received at least one dose of benralizumab and were descriptive. We present results after the oral corticosteroid reduction phase; a maintenance phase is ongoing. The trial is registered with ClinicalTrials.gov, NCT03557307. Between April 1, 2018, and Sept 5, 2020, of 705 patients assessed for eligibility, 598 were recruited and all received at least one dose of benralizumab. Overall, 376 (62·88%, 95% CI 58·86-66·76) of 598 patients eliminated oral corticosteroids and 490 (81·94%, 78·62-84·94) of 598 eliminated use or achieved a dosage of 5 mg or less if the reason for stopping the reduction was adrenal insufficiency. Subgroup analysis showed that dosage reductions were achieved irrespective of baseline eosinophil count, baseline oral corticosteroid dosage, or oral corticosteroid treatment duration. Adrenal insufficiency was detected in 321 (60%) of 533 patients at first assessment and in 205 (38%) of 533 patients 2-3 months later. The safety profile was consistent with previous experience. Most patients (448 [75%] of 598) had no asthma exacerbations during the oral corticosteroid reduction phase with an annualised exacerbation rate of 0·63. Of 598 patients, 38 (6%) experienced a total of 46 exacerbations resulting in emergency department or urgent care visits or hospitalisations. Despite a high prevalence of adrenal insufficiency, most patients with eosinophilic asthma treated with benralizumab achieved elimination of oral corticosteroids or maximal possible reduction using a personalised dosage-reduction algorithm. AstraZeneca.

Persistent Eosinophilic Inflammation in Adult Asthmatics with High Serum and Urine Levels of Leukotriene E4.

BackgroundCysteinyl leukotrienes (CysLTs) are key mediators for bronchoconstriction, eosinophil recruitment and mucus production in the airways of asthmatic patients. To better understand the role of CysLTs in different asthma phenotypes, we compared the levels of arachidonic acid metabolites in relation to asthma control status and phenotypes in adult asthmatics on regular anti-asthma medications.MethodsA total of 137 adult asthmatics (47 with aspirin-exacerbated respiratory disease [AERD] and 90 asthmatics with aspirin-tolerant asthma [ATA]) and 20 healthy controls were enrolled. Arachidonic acid metabolites in serum and urine were analyzed using LC-MS/MS methods, and clinical data, including asthma control status, exhaled NO (FeNO) and lung function tests, were collected.ResultsUrine LTE4 levels were significantly higher in AERD patients on inhaled corticosteroid-long-acting β2- agonist plus leukotriene receptor antagonist (LTRA) treatment than in ATA patients (P=0.001). No differences were found in the serum or urine levels of 15-HETE, TXB2, or PGF2α. High serum LTE4 levels were associated with lower FEV1% and uncontrolled status in AERD patients (P=0.006 and P=0.002, respectively), but not in ATA patients. Multivariate analysis demonstrated that blood eosinophil counts, FeNO levels and aspirin hypersensitivity were significant factors affecting urine LTE4 levels.ConclusionDespite LTRA treatment in AERD, the LTE4 levels remained high and showed close associations with blood eosinophilia, high FeNO levels and impaired disease control. Our real-world evidence indicates that control of asthma is not fully achieved by blocking the CysLT pathway with LTRA. Thus, introduction of treatment modalities targeting eosinophilia could be a better option for patients with high CysLTs.

Interaction effects of asthma and rhinitis control on work productivity and activity impairment: A cross-sectional study.

Background: Symptomatic asthma and rhinitis negatively impact patients' work productivity and activity. However, little is known about the potential interaction effect of both asthma and rhinitis control on work productivity and activity impairment. Objective: This study aimed to explore whether there are interaction effects of asthma and rhinitis control on work productivity and activity impairment in patients with asthma and with rhinitis. Methods: A total of 206 adult patients were prospectively recruited and were divided into four groups: both poorly controlled (BPC) n = 53), poorly controlled asthma (PCA) with controlled rhinitis (CR) (n = 38), well controlled asthma with uncontrolled rhinitis (n = 43), and both well controlled (BWC) (n = 72) based on the symptom control status of asthma and rhinitis. Work productivity loss and activity impairment, asthma control, and rhinitis control were assessed by using work productivity and activity impairment questionnaire: general health, the asthma control test, and the rhinitis control assessment test, respectively. General linear regression models were used to study the contribution of asthma control, rhinitis control, and the interaction effect on work productivity and activity impairment. Results: Work productivity loss was most frequently reported in patients in the BPC group. Compared with the patients in the BWC group, the patients in the PCA-CR group had significantly higher activity impairment and worse asthma-related quality of life (both p < 0.001). There were significant interaction effects of asthma and rhinitis control, which accounted for the increase in presenteeism, work productivity loss, and activity impairment (all p < 0.001). Although differences in absenteeism were not significant among the groups, there was a significant interaction effect of control levels accounted for absenteeism (p = 0.035). Conclusion: Distinct interaction effects of asthma and rhinitis control reflected a link between upper and lower airways, which indicated that rhinitis control and the interaction effects of asthma and rhinitis control cannot be neglected during asthma management.

Bronchial provocation test measured by using the forced oscillation technique to assess airway responsiveness.

Background: The bronchial provocation test (BPT) performed by using the forced oscillation technique (FOT) is cooperated without forced expiratory effort. However, a comparison of the application value and safety of BPTs measured by using the FOT and the standardized dosimeter method is lacking, which limits its clinical practice. Objective: We aimed to analyze the diagnostic value and safety of the BPT as measured by the FOT in patients with asthma and in healthy subjects. Methods: This was a randomized cross-over clinical study. Airway responsiveness was measured by using the FOT and the aerosol provocation system (APS) dosimeter method in all the participants. The between-test interval was 24 hours. The diagnostic value and safety of the two tests were analyzed. Results: Asthma control status was assessed based on ACT scores, and patients with asthma (including 27 uncontrolled, 34 partially controlled, and 32 controlled) were collected, and 69 healthy subjects were recruited. Receiver operating characteristic curves revealed slightly superior screening capability of cumulative dose of methacholine causing a 20% decrease (PD20)-forced expiratory volume in the first second of expiration when measured by using the APS-dosimeter method (area under the curve [AUC] 0.981 [95% confidence interval {CI}, 0.952-1.000]) over that of cumulative dose of inhaled methacholine at the inflection point when respiratory resistance began to increase continuously (Dmin) by using the FOT (AUC 0.959 [95% CI, 0.924-0.994]). The sensitivity and specificity were 98.9% and 98.6%, respectively, with the APS-dosimeter method, and 100% and 87.0%, respectively, with the FOT. It took an average of 9.0 minutes (range, 6.0-11.0 minutes) when using the FOT and an average of 17.0 minutes (range, 14.0-25.0 minutes) when using APS-dosimeter method (p < 0.01) in all the participants. The measurement time for the FOT was reduced by 47.1% than the APS-dosimeter. The incidence rate of the adverse events with the FOT was slightly higher than that with the APS-dosimeter method (p < 0.05). Both tests were well tolerated. No serious adverse event was found. Conclusion: The FOT, characterized as being simple, safe, and time saving, could be used to assess airway hyperresponsiveness in patients with asthma and worthy of clinical application.

Determining the Best Tool Comparable with Global Initiative for Asthma Criteria for Assessing Pediatric Asthma Control.

Background: Guidelines such as Global Initiative for Asthma (GINA) recommend disease control as the mainstay of asthma management. Objective: To investigate which measure of asthma control best correlates with the GINA criteria for determining asthma control in children. Methods: Child asthma-patients at a tertiary hospital were enrolled in the study after evaluation of response to treatment. Asthma control test (ACT)/pediatric asthma control test (PACT), Pediatric Asthma Quality of Life Questionnaire (PAQLQ), fractional exhaled nitric oxide (FeNO), and lung function parameters were evaluated. Patients were examined by asthma specialists and control status was evaluated based on GINA. Results: The median age (interquartile range) of patients was 10.7 (8.4-12.9) years, 57.9% of patients were boys. Of 228 children, 84.2%, 9.6%, and 6.1% displayed "well-controlled", "partially controlled", and "uncontrolled" asthma, respectively, according to GINA. The patients with "partially controlled" and "uncontrolled" asthma were grouped as "not well-controlled." The cutoff levels were 22, 21, and 5.9 for PACT, ACT, and PAQLQ, respectively, for determining "well-controlled" asthma (P < 0.001). With these cutoff values, ACT exhibited higher comparability with GINA than PACT and PAQLQ (κ = 0.473, 0.221, and 0.150, respectively, P < 0.001). PAQLQ had higher agreement with GINA criteria in children ≥12 years old (κ = 0.326, P < 0.001 and κ = 0.151, P = 0.014, respectively). Correctly classified patients with PACT, ACT, and PALQLQ based on GINA with these cutoff levels were 93 (64.1%), 63 (75.9%), and 139 (62.9%), respectively. FeNO and lung function parameters were unsuccessful at revealing control status according to GINA. Conclusion: ACT is better than PACT for comparability with GINA. Better correlation of PAQLQ and ACT and better comparability of PAQLQ and GINA were evident in older children.

Detecting asthma control level using feature-based time series classification

Asthma symptom control is the best method for asthma treatment. Early detection of asthma control status can provide the time required for presenting preventive treatment programs to reduce the future risk of asthma exacerbation and episodes of poor asthma control. Accordingly, the current study aims to outline a novel model for classifying asthma control status using a time series/time sequence-based classification approach. Few researchers have addressed the problem of classifying asthma control level in the context of the time series/time sequences dynamics-based approach. It is a significant defect in chronic disease management such as asthma that requires continuous monitoring of symptoms. As a result, it is needed to examine the effect of the time-series/time-sequences of the stimuli affecting asthma status in classifying the control level of this disease. We have designed a daily asthma self-monitoring form and collected a total of 2870 daily assessments of asthma control on 96 asthmatics patients older than five years for 9 months. Using a 7-day window of time, we created the asthma control dataset with clinical variables, the patient’s medical history, and environmental parameters, to detect asthma control level using a time series/time sequence-based classification model. Our best model yielded a recall of 87%, a specificity of 94%, a precision of 89%, a negative predictive value of 93%, an accuracy of 92%, an F-measure of 88%, and an AUC of 87%. Our study indicated that time series classification models among data mining techniques have great potential in creating a prognostic model for chronic diseases such as asthma. Furthermore, the time-series/time sequences of daily asthma symptoms also play a significant role in classifying asthma control levels.

Factors Associated with Suboptimal Control of Asthma among Adult Asthma Patients: A Cross-sectional Study.

Introduction:Asthma is a major public health problem that negatively impacts patients, families, and the community. Identifying risk factors for poor asthma control may greatly enhance the establishment of more effective treatment of asthma. The level of asthma control and risk factors for poor asthma control is relatively unknown in Ethiopia.Methods:A cross-sectional study was conducted on 150 adult asthma patients at the Outpatient Department (OPD) chest clinic of Jimma Medical Center (JMC), from February 15 –March 20, 2019. The Statistical Package for Social Science (SPSS) 21.0 was used for data analysis. Multivariate logistic regression was conducted to analyze the potential associated factors of suboptimal control of asthma.Results and Discussion:Of 150 adults diagnosed with asthma recruited in this study, 81 [54.0%] of them were females, and the mean age of the patients was 41.1 ± 12.4 years. Inhaled corticosteroid (ICS) plus short-acting beta-agonist (SABA) (64, 42.7%) was the most frequently used anti-asthmatic medication. Over one-fourth (26.0%) (95% CI, 19.2-33.8) of study participants had suboptimal asthma control. On multivariate logistic regression, being an urban dweller (AOR=3.70, p=0.025) and not applying proper inhalation technique (AOR=16.23, p=0.022) were increased the risk of suboptimal asthma control, while non-prescription anti-asthmatic drugs taking habit (AOR=0.25, p=0.010) reduces the odds of having suboptimal asthma control.Conclusion:Suboptimal asthma control is high among adult asthma patients. Being an urban dweller and not applying proper inhalation techniques were increased the likelihood of suboptimal asthma control, while non-prescription anti-asthmatic drugs taking habits had lower odds of suboptimal asthma control. The authors recommend large sample size studies on the comparative status of asthma control using prescription versus non-prescription anti-asthmatic medication.

Asthma Medication Regimens in Pregnancy: Longitudinal Changes in Asthma Status.

This study aimed to assess the impact of common asthma medication regimens on asthma symptoms, exacerbations, lung function, and inflammation during pregnancy. A total of 311 women with asthma were enrolled in a prospective pregnancy cohort. Asthma medication regimen was categorized into short-acting β agonist (SABA) alone, SABA + inhaled corticosteroid (ICS), SABA + ICS + long-acting β agonist (LABA), and no asthma medications (reference). We evaluated asthma control at enrollment (< 15 weeks' gestation) and its change into trimesters 2 and 3, including per cent predicted forced expiratory volume in 1 second (%FEV1) and peak expiratory flow (%PEF), pulse oximetry, fractional exhaled nitric oxide (FeNO), asthma symptoms (asthma attacks/month, night symptoms/week), and severe exacerbations. Linear mixed models adjusted for site, age, race, annual income, gestational age, body mass index, and smoking, and propensity scores accounted for asthma control status at baseline. Women taking SABA + ICS and SABA + ICS + LABA had better first trimester %PEF (83.5% [75.7-91.3] and 84.6% [76.9-92.3], respectively) compared with women taking no asthma medications (72.7% [66.0-79.3]). Women taking SABA + ICS + LABA also experienced improvements in %FEV1 (+11.1%, p < 0.01) in the third trimester and FeNO in the second (-12.3 parts per billion [ppb], p < 0.01) and third (-11.0 ppb, p < 0.01) trimesters as compared with the trajectory of women taking no medications. SABA + ICS use was associated with increased odds of severe exacerbations in the first (odds ratio [OR]: 2.22 [1.10-4.46]) and second (OR: 3.15 [1.11-8.96]) trimesters, and SABA + ICS + LABA use in the second trimester (OR: 7.89 [2.75-21.47]). Women taking SABA alone were similar to those taking no medication. Pregnant women taking SABA + ICS and SABA + ICS + LABA had better lung function in the first trimester. SABA + ICS + LABA was associated with improvements in lung function and inflammation across gestation. However, both the SABA + ICS and SABA + ICS + LABA groups had a higher risk of severe exacerbation during early to mid-pregnancy. · Medication regimens may affect perinatal asthma control.. · Intensive regimens improved lung function/inflammation.. · Women on intensive regimens had more acute asthma events..

Patients' and Clinicians' Visions of a Future Internet-of-Things System to Support Asthma Self-Management: Mixed Methods Study.

BackgroundSupported self-management for asthma reduces acute attacks and improves control. The internet of things could connect patients to health care providers, community services, and their living environments to provide overarching support for self-management.ObjectiveWe aimed to identify patients’ and clinicians’ preferences for a future internet-of-things system and explore their visions of its potential to support holistic self-management.MethodsIn an exploratory sequential mixed methods study, we recruited patients from volunteer databases and charities’ social media. We purposively sampled participants to interview them about their vision of the design and utility of the internet of things as a future strategy for supporting self-management. Respondents who were not invited to participate in the interviews were invited to complete a web-based questionnaire to prioritize the features suggested by the interviewees. Clinicians were recruited from professional networks. Interviews were transcribed and analyzed thematically using PRISMS self-management taxonomy.ResultsWe interviewed 12 patients and 12 clinicians in the United Kingdom, and 140 patients completed the web-based questionnaires. Patients expressed mostly wanting a system to log their asthma control status automatically; provide real-time advice to help them learn about their asthma, identify and avoid triggers, and adjust their treatment. Peak flow (33/140, 23.6%), environmental (pollen, humidity, air temperature) (33/140, 23.6%), and asthma symptoms (25/140, 17.9%) were the specific data types that patient most wanted. Information about asthma and text or email access to clinical advice provided a feeling of safety for patients. Clinicians wanted automated objective data about the patients’ condition that they could access during consultations. The potential reduction in face-to-face consultations was appreciated by clinicians which they perceived could potentially save patients’ travel time and health service resources. Lifestyle logs of fitness regimes or weight control were valued by some patients but were of less interest to clinicians.ConclusionsAn automated internet-of-things system that requires minimal input from the user and provides timely advice in line with an asthma action plan agreed by the patient with their clinician was preferred by most respondents. Links to asthma information and the ability to connect with clinicians by text or email were perceived by patients as features that would provide a sense of safety. Further studies are needed to evaluate the usability and effectiveness of internet-of-things systems in routine clinical practice.

Disrupted Expression of Circadian Clock Genes in Patients with Bronchial Asthma.

PurposeCircadian clock is synchronized to the 24-hour day by the daily light–dark cycle and proper function of circadian rhythm is essential for many physiological processes. Disruption of circadian rhythm can affect disease processes and influence disease severity, treatment responses, and even survivorship. In this retrospective case-controlled study, we tried to explore whether expression of circadian clock genes was disturbed in patients with bronchial asthma.Patients and MethodsWe performed real-time quantitative reverse transcriptase-polymerase chain reactions to examine the expression of the nine core circadian clock genes (BMAL1, CK1ε, CLOCK, CRY1, CRY2, PER1, PER2, PER3, and TIM) in total leukocytes of peripheral blood collected at chest clinics from 120 patients with asthma and 60 health individuals.ResultsExpression levels of the nine circadian clock genes were significantly different between patients and healthy individuals, but not associated with the asthma control status. We also noted the difference of PER3 expression in asthmatic patients with and without nocturnal symptoms. In well-controlled asthmatics, expression of BMAL1, CK1ε, CLOCK, CRY1, CRY2, and PER1 was significantly lower in patients with nocturnal symptoms than those without nocturnal symptoms. However, in not well-controlled asthmatics, expression of only BMAL1, CK1ε, PER1, and PER2 was significantly different between patients with and without nocturnal symptoms. Binary logistic regression analysis selected BMAL1, CKIε, PER3, and TIM as independent factors for bronchial asthma and ROC curves showed the combined expression of these four genes enhanced the capability of predicting asthma (AUC=0.924; 95% CI=0.875–0.958; P<0.001).ConclusionOur results showed altered expression of circadian clock genes in patients with bronchial asthma and down-regulated PER3 in patients with nocturnal symptoms. Altered expression of circadian clock genes was also observed in asthmatics with or without nocturnal symptoms in well- or not well-controlled subgroups. Combined expression of BMAL1, CKIε, PER3, and TIM could be a potential predictor for bronchial asthma.

The association between control level and self-reported treatment adherence across different treatment types in Japanese asthma patients.

Poor control of asthma symptoms is associated with a higher asthma disease burden, and asthma medication adherence is a known predictor for a better control status. This study sought to describe the current asthma control status, self-reported treatment adherence, and the association between them, as well as to describe how control level and better adherence impact the health outcomes of asthma patients. This study used cross-sectional data from the 2018 Japan National Health and Wellness Survey (NHWS). Asthma control status and adherence were assessed using the Asthma Control Test (ACT) and Morisky Medication Adherence Scale-8 (MMAS-8), respectively. Asthma treatment and patients' health outcomes, i.e. health-related quality of life (HRQoL) and work productivity, were self-reported. Asthma control and self-reported treatment adherence were analyzed descriptively, and the association was investigated by comparing mean ACT scores across adherence levels. Health outcomes were compared across control and adherence levels by multivariate analyses. A total of 816 patients had a physician diagnosis of asthma, with 67.0% reporting at least well controlled (ALWC). Of 505 asthma patients receiving prescription medication, half reported low adherence to medication use. Among asthma patients reporting high adherence, 35.6% were not well controlled (NWC). After adjusting for covariates, NWC asthma patients had significantly worse health outcomes than ALWC patients. One-third of asthma patients in Japan suffer from poorly controlled asthma. Results of the 2018 NHWS show that poor control status negatively affects patients' HRQoL and work productivity, suggesting an unmet need for better treatments to lessen the burden of asthma.

The factors of family management affecting asthma control status in school-age children with asthma in China

Objective To identify the factors of family management affecting asthma control status in school-age children with asthma in China. Method The cross-sectional descriptive study was conducted among 139 children with asthma and their parents. The age range of the children was 7 to 14 years of age (Mage = 9.85; 76.26% boys). Eight dimensions (Children Identity, View of Condition, Management Mindset, Parental Mutuality, Parenting Philosophy, Management Approach, Family Focus, Future Expectation) of the Family Management Scale for Children with Asthma (FMSCA) were used as factors of family management. The Asthma Control Test (ACT) and the Children Asthma Control Test (C-ACT) were used to measure the asthma control status of children. A parental questionnaire was used to collect information regarding demographic data of familial socioeconomic status, general data about the child, and medical services status (Follow-Up Plan, received manual of asthma education, attended a lecture on asthma) received from medical institutions. A multivariate ordinal logistic regression model was performed. Results Factors significantly associated with asthma control were “Follow-Up Plan” (OR, 2.004; 95% CI, 1.009–3.981), “Attended a Lecture on asthma” (OR, 2.586; 95% CI, 1.103–6.066) and two dimensions of the FMSCA, “Children Identity” (OR = 1.133; 95% CI, 1.024–1.254) and “Family Focus” (OR = 1.114; 95% CI, 1.007–1.232). Conclusion This study shows that asthma control status of school-age children in China is related to the parents’ views of their child as having a “normal condition” and the parents’ satisfaction with the balance between asthma related management and other aspects of family life.

Relationship between Poorly Controlled Asthma and Sleep-Related Breathing Disorders in Children with Asthma: A Two-Center Study.

Objective Asthma and sleep-related breathing disorders (SRBD) are common chronic respiratory diseases in children. The relationship between asthma and SRDB is bidirectional. However, only a few studies have analyzed the relationship between asthma control status and risk of SRBD. The aim of this study was to evaluate the relationship between asthma control and SRBD and further assess the relationship between therapy/atopy/lung function of children with asthma and SRBD. Methods A total of 209 children aged 3–16 years were enrolled in this study. Pediatric sleep questionnaire (PSQ) scores were used to identify children at high risk of developing SRBD. Data on asthma control status, therapy, allergy, lung function, and exhaled nitric oxide were collected. Results A significantly higher risk of SRBD was found among children with poorly controlled asthma (34.25% vs. 13.97%, P < 0.01) and allergic rhinitis (AR) (34.29% vs. 13.92%, P < 0.01) than among children with well-controlled asthma and AR. The prevalence of SRBD was also significantly higher in asthmatic children with obesity than that with just obesity (42.11% vs. 20.00%, P < 0.05). Multiple logistic regression analysis showed that poorly controlled asthma (OR, 2.746 (95% CI, 1.215–6.209); P < 0.05) and poorly controlled AR (OR, 3.284 (95% CI, 1.430–7.544); P < 0.01) increased the odds of having SRBD. Conclusion Poorly controlled asthma and AR increase the risk of SRBD. A routine check of the level of asthma control and appropriate use of medication for AR are important because of their influence on SRBD.

Association of serum periostin levels with clinical features in children with asthma.

The aim of this study was to investigate the association of serum periostin levels with clinical features in children with asthma. Children with physician-diagnosed asthma who attended regularly to an outpatient pediatric allergy and asthma center were enrolled in the study along with control subjects. Asthma severity and control status of the patients were evaluated according to the recent GINA guidelines. A total of 158 children (125 with asthma and 33 age- and sex-matched control subjects) with a median age of 10.2years (range 5.9-17.0) were enrolled. Asthma severity was mild in 41 (32.8%), moderate in 63 (50.4%), and severe in 21 (16.8%) children. Children with asthma had significantly higher periostin levels than controls (53.1±13.1 vs 43.0±11.2ng/mL, P<.001). The mean serum periostin levels in children with severe asthma (63.8±10.8) were significantly higher than in children with moderate asthma (53.3±12.7) and mild asthma (47.4±11.1) (P<.001). Results of multivariable logistic regression analysis demonstrated an association between serum periostin levels and asthma severity in children (OR, 1.10; 95% CI, 1.04-1.15, P<.001). When analyzed for the best cut-off value with the highest combined sensitivity and specificity, a cut-off value of 52ng/mL for serum periostin level was obtained with sensitivity, specificity, PPV, and NPV of 100%, 50%, 29%, and 100%, respectively. Although serum periostin levels are higher in children with asthma, its diagnostic role in identifying children with severe asthma is limited.

The Effectiveness of a Family-Based Asthma Self-Management Program in Enhancing the Asthma Health Outcomes in School-Age Children

ABSTRACT This quasi-experimental study aimed to evaluate a family-based asthma self-management program, based on the individual and family self-management theory and the McMaster model of family functioning. Children aged 7 to 12 with uncontrolled asthma and their families were recruited from an outpatient pulmonary department of a university hospital in Thailand. Thirty-seven child-parent pairs were randomly assigned to three sessions for a period of two months of the family-based asthma self-management program, while 37 child-parent pairs were assigned to the control group. Data were collected at baseline and after implementation at two months by using the Childhood Asthma Control Questionnaire and the Pediatric Asthma Quality of Life Questionnaire, and the measurement of pulmonary function was performed using peak flow meters. Multivariate analysis of covariance (MANCOVA) was employed to analyze the mean difference between the experimental and control groups. The results indicated significant increased asthma control status, pulmonary function, and quality of life in the children from baseline to after implementation in the experimental group that participated in the family-based asthma self-management program. Significant improvement in these three asthma health outcomes was also seen in the experimental group when compared to the control group. It was seen that the family-based asthma self-management program is useful for promoting the self-management of school-age children, enabling the control of symptoms, and enhancing health outcomes regarding asthma.

Association Between Asthma Control Status and Lung Function with Vitamin D Level in Children with Bronchial Asthma

Bronchial asthma is one of the most common chronic diseases in childhood. Pooled vitD levels were positively correlated with pooled ACT scores, Treg counts, FEV1% values and VDBP levels. Vitamin D supplementation reduced the rate of asthma exacerbation, especially in patients with vitamin D insufficiency. The 25-OH vitamin D levels were lower in pediatric asthma patients with worse spirometry results. Lower vitamin D levels in children with STRA were associated with increased ASM mass and worse asthma control and lung function. Materials and methods: The study was performed in children aged 6 -15 years old, including patients with asthma (n=50), who referred to Sachkhere medical center for a visit. The status of asthma control in the basic group was classified as controlled (n=31) and uncontrolled (n=19). The children underwent serum vitamin D and IgE level, spirometry and skin prick tests for the study. Results: Using the multivariate logistic regression analysis, the presence of asthma was associated with the reduced level of vitamin D (OR=1.35, 95% CI (1,14-1.58) P=0.011; X²=6.78; F-0.022) in children with uncontrolled bronchial asthma. 48% of the patients in the group- controlled asthma (n=15) had vitamin D deficit, and in 52% of the cases (n=16) was confirmed with vitamin D insufficient. In the group –uncontrolled asthma - 5% of the patients (n=1) had Vitamin D insufficiency in blood serum. In 95% (n=18) of the patients vitamin D level was significantly low < 20 ng/ml. According the results, decreased pulmonary function (p-0.039; x2-3.12) is strongly associated with low level of vitamin D; but neither serum IgE level (p-0.54; x2-10.9), nor skin prick test result on dust mite (p-0.50, x2-5.12) was correlations with serum vitamin D low level. Conclusion: The presence of vitamin D deficiency effectively predict increased risk of uncontrolled bronchial asthma in children. Serum vitamin D level is related to lung function too. Therefore, by normalize vitamin D level in blood serum maybe improve lung function and control status in children with bronchial asthma.

Obstructive sleep apnea is a determinant of asthma control independent of smoking, reflux, and rhinitis.

Background: Asthma control is defined as to what extent manifestations of asthma can be observed in a patient or have been reduced or removed by treatment. Regular use of asthma treatments, correct inhaler technique, adequate information provided about the patient's diseases and medicines, and patient-clinician collaboration aid asthma control. Asthma shares risk factors and links in the pathogenesis with obstructive sleep apnea (OSA), and OSA may aggravate asthma symptoms. Objective: To assess the risk of OSA for asthma control. Methods: The study was carried out in subjects with asthma who were followed up at specific time points and who used asthma medication regularly and with an appropriate inhaler technique. An asthma control test and a questionnaire were used to determine the asthma control levels and OSA risk of the subjects. Results: With regard to the questionnaire scoring, 77 of 137 subjects with asthma had a low OSA risk and 60 had a high OSA risk. The proportion of the subjects with a high OSA risk (p < 0.001) and were smokers (p = 0.020) were significantly higher in the subjects with uncontrolled asthma than in those with controlled asthma. Logistic regression analysis showed that the variables that affect asthma control status were the risk of OSA and obesity. The subjects with a low OSA risk were more likely to have controlled asthma than those with a high OSA risk (odds ratio 7.896 [95% confidence interval, 2.902-21.487]; p < 0.001). Conclusion: In the subjects with asthma and who adhered to therapy and used inhalers with the correct technique, a high risk of OSA was associated with poor control of their asthma. This association was independent of other factors, including rhinitis, gastroesophageal reflux, and smoking.