Global Initiative For Asthma Guidelines Research Articles

Montelukast Improves Symptoms and Lung Function in Asthmatic Women Compared With Men.

Purpose: Gender differences exist in the prevalence of asthma and allergic diseases, partially due to the effects of sex hormones on the development of allergic manifestations. Women, compared with men, are more prone to suffer allergic asthma, experience difficulties in controlling asthma symptoms, and show adverse responses to drugs. However, there are knowledge gaps on the effectiveness of anti-leukotrienes drugs on lung function, symptoms, and pulmonary and systemic inflammation in adult asthmatic women compared with men. We conducted a prospective cohort study to characterize the effectiveness of an anti-leukotrienes drug, montelukast (MS), in asthmatic adult women and men. Methods: Twenty-one asthmatic subjects (11 women and 10 men), who were on low-dose inhaled corticosteroids (ICS), were treated with MS. The optimal control of the symptoms was achieved in both groups according to the Global Initiative for Asthma guidelines. At enrollment, and after 13 weeks from the beginning of MS, pulmonary function tests and asthma control tests were performed, and the fraction of exhaled nitric oxide and blood eosinophils levels were measured. Results: From baseline until the end of the study, women treated with MS + ICS had better control of the asthmatic symptoms, defined as higher asthma control test (ACT) score (17.00 ± 1.07 to 23.36 ± 0.45; p < 0.0015), improved pulmonary function [with higher forced expiratory volume in 1 s (from 77.25 ± 6.79 to 103.88 ± 6.24; p < 0.0077)], and forced vital capacity (from 91.95 ± 6.81 to 113.17 ± 4.79; p < 0.0183) compared with men. Interestingly, MS + ICS-treated women had significantly lower levels of blood eosinophils (from 5.27 ± 0.30 to 3.30 ± 0.31; p < 0.0449) and exhaled nitric oxide (from 44.70 ± 7.30 to 25.20 ± 3.90; p < 0.0294) compared with men. Conclusion: The treatment with MS, added to ICS, in women leads to better control of symptoms, better management of lung function, and decreased inflammation levels compared with ICS + MS treatment in men.

Asthma, asthma control and risk of acute myocardial infarction: HUNT study

Asthma, a chronic inflammatory airway disease, shares several common pathophysiological mechanisms with acute myocardial infarction (AMI). Our aim was to assess the prospective associations between asthma, levels of asthma control and risk of AMI. We followed 57,104 adults without previous history of AMI at baseline from Nord-Trøndelag health study (HUNT) in Norway. Self-reported asthma was categorised as active asthma (i.e., using asthma medication) and non-active asthma (i.e., not using asthma medication). Levels of asthma control were defined as controlled, partly controlled, and uncontrolled based on the Global Initiative for Asthma guidelines. AMI was ascertained by linking HUNT data with hospital records. A total of 2868 AMI events (5.0%) occurred during a mean (SD) follow-up of 17.2 (5.4) years. Adults with active asthma had an estimated 29% higher risk of developing AMI [adjusted hazard ratio (HR) 1.29, 95% CI 1.08-1.54] compared with adults without asthma. There was a significant dose-response association between asthma control and AMI risk, with highest risk in adults with uncontrolled asthma (adjusted HR 1.73, 95% CI 1.13-2.66) compared to adults with controlled asthma (p for trend < 0.05). The associations were not explained by smoking status, physical activity and C-reactive protein levels. Our study suggests that active asthma and poor asthma control are associated with moderately increased risk of AMI. Further studies are needed to evaluate causal relationship and the underlying mechanisms and to clarify the role of asthma medications in the risk of AMI.

Prevalence and impact of risk factors for poor asthma outcomes in a large, specialist-managed patient cohort: a real-life study.

BackgroundRisk factors for poor asthma outcomes may have considerable influence on the control level and medical care of asthmatic patients. Our objective was to conduct a study that provides data on the level of symptom control and the frequency of specific risk factors for poor asthma outcomes on a large patient cohort.MethodsA cross-sectional, non-interventional real-life study was conducted among asthmatic patients treated by respiratory specialists in Hungary. Asthma control and risk factor assessment were done according to Global Initiative for Asthma guideline (Box 2–2). In the data analysis, phase descriptive statistics, graphical outputs, and Fisher’s exact tests were used.ResultsOf 12743 patients enrolled by 187 specialists, asthma was well controlled in 36.0%, partially controlled in 29.29%, and uncontrolled in 34.71% of the cases. The most common comorbidities were rhinitis/sinusitis (66.84%), cardiovascular diseases (43.81%), and gastroesophageal reflux disease (20.11%). The following risk factors had the strongest relationship with uncontrolled disease: incorrect inhaler technique causing side effects (odds ratio, OR 4.86, 3.51–6.8), previous severe exacerbation (OR 4.79, 4.02–5.72), high short-acting beta agonist (SABA) use (OR 4.46, 4.03–4.93), incorrect inhaler technique associated with an exacerbation (OR 3.91, 3.06–5.03), and persistently low forced expiratory volume in 1 s (FEV1, OR 3.14, 2.8–3.52). The most frequent risk factors were smoking (OR 1.47, 1.36–1.59) and obesity (OR 1.34, 1.24–1.45). Furthermore, high loss of control was associated with an initial low FEV1 (OR 2.21, 2.01–2.44), frequent oral corticosteroid (OCS) use (OR 1.83, 1.64–2.05), poor adherence to treatment (OR 2.51, 2.21–2.86), and allergen exposure (OR 1.63, 1.47–1.81).ConclusionsThis study indicated that the presence of risk factors for poor asthma outcomes listed by the Global Initiative for Asthma document significantly influenced actual control level in a real-world large patient cohort, with high SABA use, previous severe exacerbation, incorrect inhaler technique, persistently low FEV1, and poor adherence to treatment having the highest impact.

Comparison between modified Chinese Version of Test for Respiratory and Asthma Control in Kids and Global Initiative for Asthma guideline

Objective To explore the value of modified Chinese Version of Test for Respiratory and Asthma Control in Kids(TRACK) in the management of asthmatic children aged 0-5 years old by comparing with Global Ini-tiative for Asthma(GINA) guideline. Methods A total of 157 children aged 0-5 years old were enrolled at the Pedia-tric Asthma Outpatient Department of the Affiliated Hospital of Qingdao University from March to August 2018.All children were treated with individualized anti-asthma treatment for 3 months.After treatment, asthma experts assessed the level of asthma symptom control based on the GINA guideline, while caregivers of all children completed TRACK questionnaire.The optimal threshold of the TRACK questionnaire for asthma control was determined by analyzing receiver operating characteristic curve(ROC curve), and consistency of the 2 evaluation methods was compared. Results All enrolled children were divided into 3 groups based on GINA guideline: 59 children for the well controlled group, 52 children for the partly controlled group and 46 children for the uncontrolled group.There was a significant difference statistically in TRACK scores among the well controlled group [90(85, 95) scores], the partly controlled group [80(70, 85) scores] and the uncontrolled group [60(55, 65) scores] after treatment (H=101.740, P<0.001). Area under the ROC curve was 0.909 for diagnosing asthma control by the modified Chinese version of TRACK, with 80 scores for optimal threshold, 87.3% for sensitivity and 73.5% for specificity.The Kappa value of the consistency test between the TRACK questionnaire and the GINA guideline was 0.553, and consistency rate of these 2 evaluation methods was 77.1%. Conclusions The modified Chinese version of TRACK can be used as an effective assessment tool to monitor and manage asthmatic children aged 0-5 years. Key words: Modified Chinese Version of Test for Respiratory and Asthma Control in Kids; Global Initiative for Asthma; Asthma management

Exposure to Ascaris lumbricoides infection and risk of childhood asthma in north of Iran.

Asthma and Ascaris lumbricoides infection are common health issues affecting 250 and 700 million people worldwide, respectively. The relationship between ascariasis and asthma is a matter of substantial interest and research. We performed a case-control study to evaluate whether the exposure to Ascaris infection is associated with asthma in children. We also assessed potential risk factors for Ascaris infection and asthma in study area. We enrolled 145 asthmatic children and 115 healthy controls. The Global Initiative for Asthma guideline was used to evaluate asthma symptoms and severity in study participants. Ascaris infection was assessed by the presence of anti-Ascaris IgG ≥ 11IU/mL measured by enzyme-linked immunosorbent assay. We have found a significant relationship between exposure to Ascaris and asthma (odds ratio, 2.92; 95% CI 1.04-8.18; P value = 0.034), and this relationship remained significant after adjustment for covariates (adjusted OR, 3.36; 95% CI 1.04-13%; P value = 0.047). Ascaris infection was more frequent in children with mild sustainable asthma (13.2%; 15/113) than in children with moderate sustainable asthma (6.2%, 2/32), although there was a non-significant difference between these groups (OR, 2.3; 95% CI 0.5-10.1; P value = 0.35). Based on results of a multi-regression analysis, contact with soil (OR, 6.7; 95% CI 1.9-23.5), and drinking unsafe water (OR, 4.2; 95% CI 1.2-14.2) were significant risk factors for Ascaris infection in the study area. Results of this study suggest that A. lumbricoides infection might affect susceptibility to asthma in children. These results could be useful in prevention, early diagnosis and management of childhood asthma.

Inhaled Corticosteroid Therapy in Adult Asthma. Time for a New Therapeutic Dose Terminology.

The Global Initiative for Asthma guidelines use the traditional terminology of "low," "medium," and "high" doses of inhaled corticosteroids (ICS) to define daily maintenance doses of 100 to 250 μg, >250 to 500 μg, and >500 μg, respectively, of fluticasone propionate or equivalent for adults with asthma. This concise clinical review proposes that this terminology is not evidence based and that prescribing practice based on this terminology may lead to the use of inappropriately excessive doses of ICS. Specifically, the ICS dose that achieves 80-90% of the maximum obtainable benefit is currently classified as a low dose, with the description of two higher dose levels of medium and high, which are associated with significant risk of systemic adverse effects. Asthma guidelines and clinician prescribing practice need to be modified in accordance with the currently available evidence of the dose-response relationship of ICS in adult asthma. We propose a reclassification of ICS doses based on a "standard daily dose," which is defined as 200-250 μg of fluticasone propionate or equivalent, representing the dose at which approximately 80-90% of the maximum achievable therapeutic benefit of ICS is obtained in adult asthma across the spectrum of severity. It is recommended that ICS treatment be started at these standard doses, which then represent the doses at which maintenance ICS are prescribed at step 2 and within ICS/long-acting β-agonist combination therapy at step 3. The opportunity is available to prescribe higher doses within ICS/long-acting β-agonist maintenance therapy in accordance with the stepwise approach to asthma treatment at step 4.

PRS7 SEVERE AND UNCONTROLLED ASTHMA IN SOUTH KOREA: PROPORTION OF EXACERBATION LEADING TO HOSPITALIZATION OR INTENSIVE CARE UNIT ADMISSION

To estimate proportion of exacerbation leading to hospitalization or intensive care unit (ICU) admission in patients with severe and uncontrolled asthma in Korea. This study was performed using nationally representative data, Health Insurance Review and Assessment Service-National Patient Sample 2016, that included medical and pharmacy claims of approximately 1.4 million patients. To define patients and exacerbation, we used the recommendation of European Respiratory Society/American Thoracic Society and Global Initiative for Asthma guideline. We included patients with severe and uncontrolled asthma defined as subjects satisfying all conditions as follows: (1) ≥1 claim of asthma diagnosis (ICD-10 code J45/J46); (2) ≥1 claim of inhaled corticosteroid [ICS]); (3) ≥1 claim of additional controller or ≥180 days use of add-on low dose oral corticosteroids (OCS); and (4) ≥2 exacerbations or ≥1 exacerbation leading to hospitalization or ICU admission. Additional controller included LABA, leukotriene modifiers, theophylline, and tiotropium. Low dose OCS was defined as ≤7.5 mg/day prednisolone (or equivalent). Exacerbation was defined as outpatient visit, emergency department visit, hospitalization, or ICU admission with asthma diagnosis with corticosteroids bursts (defined as >30 mg/day prednisolone for >3 days or 200 mg hydrocortisone injection). Proportion of exacerbation leading to hospitalization or ICU admission was estimated as dividing the number of exacerbation episode with hospitalization or ICU admission by the number of exacerbation episode in patients with severe and uncontrolled asthma. Among eighty patients (with 138 exacerbation episodes) with severe and uncontrolled asthma, the mean age was 57.65 years, and 53.75% were women. The proportion of exacerbation leading to hospitalization or ICU admission was 53.62%. Of the exacerbations leading to hospitalization or ICU admission, the proportion of exacerbation leading to ICU admission was 13.51%. Among patients with severe and uncontrolled asthma, the occurrence of exacerbation requiring hospitalization or ICU admission was relatively high. Effective management strategy is needed.

Fractional Exhaled Nitric Oxide Values in Indigenous Australians 3 to 16 Years of Age

Fractional exhaled nitric oxide (Feno) levels can identify eosinophilic asthma phenotypes. We aimed to determine Feno values of healthy Aboriginal and/or Torres Strait Islander (Indigenous) Australians, differences between these Indigenous ethnic groups, and appropriateness of published cutoff values. We measured Feno levels in 1,036 Indigenous Australians (3-16 years of age). Participants were classified into healthy (ie, no asthma or atopy history) or asthmatic and/or atopic groups. Median Feno values and distribution did not differ between Indigenous ethnicities. For healthy participants< 12 years of age (n= 390), 7.2%of our cohort fell into the inflammatory zone of the American Thoracic Society (ATS), National Institute for Health and Care Excellence (NICE), and British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) guidelines (cutoff 35 parts per billion [ppb]), but only 3.8%fell into this category when using the Global Initiative for Asthma (GINA) guidelines (50 ppb). Similarly, when using the NICE and BTS/SIGN guidelines (40 ppb) for participants 12 to 16 years of age (n= 213), more healthy participants fell into the inflammatory zone compared with the ATS and GINA guidelines (50 ppb) (9.9%vs4.7%, respectively). Feno values for healthy Indigenous Australians children (3-16 years of age) are likely higher than published white-based values. The GINA recommended cutoff value (>50 ppb) appears the most appropriate for identifying healthy Indigenous children but requires confirmation from a larger study.

Prise en charge thérapeutique des asthmatiques adultes et application des recommandations du GINA dans les pays du Maghreb et à Madagascar

IntroductionDuring asthma, the knowledge and adherence to guidelines is an essential step in improving patient management. However, several studies have shown that there is a considerable gap between these recommendations and current practice. AimTo determine the level of knowledge and adequacy of the Global Initiative for Asthma (GINA) guidelines in patients followed for asthma in the Maghreb countries and Madagascar. MethodsA multicentric cross-sectional study conducted from 1st September to 30rd November 2018 in the Maghreb countries (Tunisia, Algeria and Morocco) and Madagascar. Patients over 15 years old diagnosed with asthma for at least 12 months were included. Data of included patients and participating physicians were collected. ResultsDuring the inclusion period, 26 physicians participated in the study and 485 patients (211 men, 274 women, mean age : 42.08±16.4 years) were included. According to the participating physicians, the asthma treatment was not considered consistent with GINA guidelines in 1 patient out of 4, mainly due to unavailability of treatments. The latter scenario was particularly frequent among Tunisian patients and those followed in the public hospital sector (p<10−3). In addition, only 49.4% of physicians had ranked their patients at the correct therapeutic level according to the GINA guidelines. This finding was more frequently observed among non-pneumologist doctors practicing in the private sector (p<10−3). ConclusionOur results underscore the need for greater efforts in the Maghreb countries and Madagascar to improve treatment availability and to provide continuing medical education and training in order to improve adherence to guidelines and quality of care for asthmatic patients.

INCIDENCE OF PRENATAL AND POSTNATAL RISK FACTORS FOR CHILDHOOD ASTMA

Asthma is one of the most frequent chronic diseases of childhood. Its etiology is not fully understood and risk factors for its development are numerous. The aim of this study was to determine the incidence of prenatal and postnatal risk factors in children suffering from asthma. The study was conducted on a sample of 100 patients with a diagnosis of asthma according to Global Initiative for Asthma guidelines. The data was collected using a questionnaire. We have considered prenatal (smoking during pregnancy, hormone and antibiotic therapy, the use of acetaminophen and dietary supplements, maternal blood sugar level, the term of delivery and the method of childbirth) and postnatal risk factors (oxygen and antibiotic therapy during the first year of life, immunization status during the first 6 months of life and presence of the older sibling in the family). In our study group, the most common prenatal risk factors related to asthma were: smoking during pregnancy, hormone therapy, the use of the dietary supplements and delivery via Caesarean section, while the most frequently found postnatal risk factors were: antibiotic therapy during the first year of life and the presence of older child in the family.

Asthma Control and Its Predictive Factors in Adult Asthma Patients.

BackgroundAsthma is a highly prevalent condition that remains difficult to control, as its associated factors remain poorly understood. Thus, the primary aim of the present investigation was to determine the prevalence of uncontrolled asthma in hospital units in south Jordan and to evaluate the risk factors that may contribute to uncontrolled asthma.MethodsThis was a cross-sectional study involving 93 patients aged 40.5 ± 13.6 years that met the criteria of the Global Initiative for Asthma (GINA). Relevant patient data were collected via a questionnaire and through a review of medical records. The questionnaire comprised of sections pertaining to sociodemographic and clinical characteristics, as well as pharmacological asthma treatment, asthma severity and asthma control. Asthma severity was determined in line with the GINA guidelines, whereby the patients were classified into four groups (intermittent, mild persistent, moderate persistent or severe persistent). Moreover, based on the findings yielded by the asthma control questionnaire (ACQ), patients were divided into three levels, whereby those diagnosed with partly controlled and uncontrolled asthma were combined into one group, denoted as “poorly controlled asthma”, with “uncontrolled asthma” and “controlled asthma” as the remaining two groups. Atopy was defined as one or more positive reactions (A/H ratio > 1) on a skin prick test.ResultsAsthma control was achieved in 45.2% of the sample. Moreover, older age, severe asthma according to the GINA guidelines, longer duration of asthma, atopy, being on treatment for asthma and history of allergic rhinitis were identified as the main risk factors contributing to poorly controlled asthma. Multivariate analyses, however, revealed that only atopy to two or more allergens and having severe asthmatic attacks were statistically significantly associated with poorly controlled asthma, for which the odds ratio Mantel-Haenszel (ORMH) of 17.2 and 2.2 was obtained, respectively.ConclusionOur findings indicate that severe asthma and atopy to two or more allergens are the main risk factors for uncontrolled asthma. However, further studies with larger sample sizes are needed to confirm these results.

Use of inhaler devices in the asthma clinic of Alexandria University Children’s Hospital

Background Asthma is the most common chronic noncommunicable disease among children. High rates of incorrect inhaler use among children with asthma have been reported and are associated with worse outcomes. Aim This study was designed to state the types of inhaler devices and to evaluate inhalation techniques and their relation to control of asthma Patients and methods The study was conducted on 130 asthmatic children on inhaled corticosteroids at the age between 1 and 14 years attending the asthma clinic of Alexandria University Children’s Hospital, Egypt. The cases were subjected to detailed history. A preprepared questionnaire about the type of inhaler device and their correct use by the caregivers or older children was conducted. Correlation between inhaler techniques and asthma control according to Global Initiative for Asthma guidelines was done. Results The number of patients who used meter dose inhaler (MDI)-spacer, turbuhaler, and aerolizer was 115, 8, and 7, respectively. The percentage of children having wrong inhalational techniques was 21.74, 25, and 14.28% for MDI-spacer, turbuhaler, and aerolizer, respectively.Wrong technique has a significant relation with asthma control in the three devices (P Conclusion Poor inhalational technique is associated with poor asthma control and regular assessment of inhalational technique in asthmatic children is recommended.

Preference of diagnostic tools, medications, and devices for asthma management: A survey of doctors in Algeria.

Aim:This study aimed to evaluate the doctors' perspectives in using tools for diagnosis, prescribing medications, and devices for the treatment of asthma in Algeria.Methods:Data were collected from randomly selected physicians, pediatricians, allergists, and pulmonologists through a questionnaire-based survey in 12 cities and 60 rural locations across Algeria.Results:Of the 213 doctors who responded to the survey, >90% doctors attended an average of 20 asthma patients daily. Peak flow meter was used by 69% doctors for diagnosis and by 93% for monitoring of asthma. Spirometer was used by 76% doctors for diagnosis of asthma. Budesonide (86%), fluticasone (46%), and beclomethasone (40%) were the most prescribed inhaled corticosteroid (ICS) by doctors. Formoterol/budesonide was the most preferred ICS/long-acting β2-agonist (LABA) (72%), followed by salmeterol/fluticasone (57%) for asthma treatment. Salbutamol was preferred by 93% doctors as reliever medication. ICS was the preferred controller in mild asthma (76%), and ICS/LABA combination in moderate (74%) and severe asthma (80%). Most doctors (94%) preferred pressurized metered-dose inhalers (pMDIs) with (46%) or without spacer (48%) for their asthma patients. About 83% doctors believed that pMDI with spacer would show a better outcome in asthma, over pMDI alone. Continuous exposure to allergens/smoking (73%) and incorrect inhaler technique (66%) were the most common reasons for uncontrolled asthma.Conclusion:The use of diagnostic tools in asthma was found to be adequate among the doctors in Algeria. Most of the doctors managed asthma in accordance with the global initiative for asthma guidelines. Spacers were found to be less prescribed in regular treatment, despite having good awareness about its better outcomes.

PP127 Asthma Patient Value Framework: Lessons From Patient Focus Groups

IntroductionWe sought to examine patients’ perceptions of disease burden and treatment impact, and what patients value over the course of the asthma experience.MethodsPatient focus groups were conducted in three countries, the USA (n = 8 patients), the United Kingdom (n = 7 patients), and Germany (n = 7 patients), to examine aspects of disease burden and patient experience (physical, emotional, clinical, economic, and social). Cause and effect were also explored. Global Initiative for Asthma guidelines were used to screen patients by severity, based on age, sex, time since diagnosis, number of attacks, oral corticosteroid use, and number of therapies needed to control symptoms. Patients classified and ranked aspects of disease burden, including whether it was continuous or episodic in nature, and discussed the interventions used to manage their asthma.ResultsThe overall burden of illness was driven by the combined effect of the disease and treatment burdens. All patients highlighted the negative impact of oral corticosteroids. Patients believed that they were the key actors in their asthma management (not healthcare professionals), and reported the physical and emotional burdens as being the most dominant. Understanding of the terms “attack” or “exacerbation” differed significantly between patients, and did not necessarily match the clinical definitions. Patients considered asthma to be an individualized condition that drives lifestyle changes; disease management drives burden and vice versa. Patients perceived that burden was continuous over time, with specific phases of variable duration—before, during, and after an attack—whereas other stakeholders had a more episodic focus. Patients expected more holistic and personalized approaches for managing their asthma.ConclusionsThe research indicated a misalignment between what patients value and what clinicians, payers, and regulators consider in their assessments and decisions. Greater alignment among the different stakeholders, and more inclusion of patients’ values in decision making, will improve outcomes.

Quality of life of children with bronchial asthma and their caregivers: A hospital-based study

Objectives: This study aims to describe the health-related quality of life (QOL) and their associated factors in children with bronchial asthma as well as their caregivers in Mansoura, Egypt. Methods: This cross-section hospital-based study included 171 dyad of children with physician diagnosed asthma and their caregivers attending the outpatients’ clinics of three hospitals. Data were collected using the Arabic versions of the pediatric asthma quality of life questionnaire (PAQLQ) and the pediatric asthma caregiver’s quality of life questionnaire (PACQLQ). Asthma severity was assessed using Global Initiative for Asthma guidelines. Results: The overall mean scores of the PAQLQ and its activity, emotion, and symptom domains were 4.7, 4.3, 4.9, and 4.7; respectively. The overall mean scores of the total PACQLQ and its activity and emotion domains were 4.2, 5.4, and 4.0; respectively. Children with low socioeconomic status (SES) had a significantly lower total, activity and emotion domains of PAQLQ scores. Low and very low SES of the family, uncontrolled, and severe asthma are associated with low QOL of both asthmatic child and his caregivers. Conclusions: Early control of severe asthma will contribute to a better QOL of affected children and their caregivers.

Severe uncontrolled eosinophilic asthma, which responded to benralizumab after failure to respond to mepolizumab

We present a case of eosinophilic asthma of a 55-year-old woman who was initially diagnosed with bronchial asthma by the author in February 2008. The diagnosis was confirmed using the Global Initiative for Asthma guidelines. 1 Global Initiative for Asthma (GINA), National Heart, Lung and Blood Institute (NHLBI)Global strategy for asthma management and prevention. Bethesda, MD: Global Initiative for Asthma (GINA), National Heart, Lung and Blood Institute (NHLBI). Revised 2006. http://www.ginasthma.com Google Scholar Her forced expiratory volume in 1 second (FEV1) was 63.9% of the predicted value, with an increase of 12.9% in FEV1 after 180 μg salbutamol inhaler. She had no history of smoking. She met the American Thoracic Society criteria for a diagnosis of refractory asthma. 2 American Thoracic SocietyProceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered question. Am J Respir Crit Care Med. 2000; 162: 2341-2351 Crossref PubMed Scopus (903) Google Scholar She had nonallergic asthma, diagnosed with serum total IgE level 94 IU/mL and negative results of serum specific IgE for common inhaled allergens, including mold, and Dermatophagoides farinae and pteronyssinus. She had occasionally been treated with systemic corticosteroids. Her basal regimen included daily use of budesonide/formoterol 160 μg/4.5 μg inhaler 6 puffs/day and montelukast 10 mg daily.

Cross-sectional study of allergen sensitization in pre-school children living in urban environment of the Altai region with asthma and/or rhinitis

Sensitization spectrum in pre-school children with asthma and/or rhinitis remains unclear. Objective. Our aim was to estimate the allergen sensitization in preschool children living in urban environment of the Altai region with asthma and/or rhinitis. Materials and methods. A cross-sectional survey was performed in 182 children aged from 3 to 6 years suffering from asthma and/or rhinitis in 5 cities of Altai region. Asthma was diagnosed according to the Global Initiative for Asthma guidelines, allergic rhinitis was diagnosed according to the ARIA guidelines. ImmunoCAP and skin prick test were used to assess sensitization spectrum. Results. Among the 182 patients 144 (79,1%) had sensitization at least to one allergen. Sensitization to one allergen was detected in 38.5% of children, sensitization to 2 or more allergens - in 40,6%. Sensitization to Dermatophagoides pteronyssinus was detected in 46,7%, to birch pollen - in 37,3%, to cat epithelium - in 27,4% of patients. Sensitization to food allergens was detected only in 10,4%. Conclusion. The study revealed a high frequency of sensitization to 2 or more allergens - in 79,1% of 3-6 years old children with asthma and/or rhinitis . Most often, preschool children with asthma and/or rhinitis are sensitized to 3 inhaled allergens - to Dermatophagoides pteronyssinus (46,7%), to birch pollen (37,3%) and to cat epithelium (27,4%).

Airway reversibility in asthma and phenotypes of Th2-biomarkers, lung function and disease control

BackgroundHigh bronchodilator reversibility in adult asthma is associated with distinct clinical characteristics. In this study, we aim to make a comparison with T-helper 2 (Th2)-related biomarkers, lung function and asthma control between asthmatic patients with high airway reversibility (HR) and low airway reversibility (LR).MethodsPatients with asthma diagnosed by pulmonologist according to Global Initiative for Asthma guidelines were recruited from the outpatient department of our hospital from August 2014 to July 2017. Patients were divided into HR and LR subgroups based on their response to bronchodilators of lung function (HR = Δforced expiratory volume in one second (FEV1) postbronchodilator ≥ 20%). Blood eosinophil count and serum IgE level, which are biomarkers of T-helper (Th)-2 phenotypes, were detected for patients. Asthma Control Test (ACT) was used to assess asthma control after the first-month initial treatment.ResultsA total of 265 patients with asthma were followed 1 month after initial treatment. HR group shows a higher level of Th2-high biomarkers (blood eosinophil count (10^9/L): 0.49 ± 0.28 vs 0.36 ± 0.19, P < 0.01; IgE (ng/ml): 1306 ± 842 vs 413 ± 261, P < 0.01), lower baseline lung function (FEV1%pred: 51.91 ± 19.34% vs 60.42 ± 19.22%, P < 0.01; forced expiratory flow (FEF)25–75: 0.76 ± 0.37 vs 1.00 ± 0.67, P < 0.01; FEF25–75%pred: 21.15 ± 10.09% vs 29.06 ± 16.50%, P < 0.01), and better asthma control (ACT score: 22 ± 4 vs 20 ± 4, P = 0.01) than LR group. HR was associated with a decreased risk of uncontrolled asthma after the first-month initial treatment (adjusted OR: 0.12 [95% confidence intervals: 0.03–0.50]).ConclusionsHR is a physiologic indicator of lower lung function and severe small airway obstruction, and is more related with an increased level of Th2-biomarkers than LR. Moreover, HR may indicate controlled asthma after the first-month initial treatment. This finding may contribute to identification of asthma endotype.

CLINICAL EFFECTS OF ASTHMA AND BRONCHIECTASIS COEXISTENCE

SESSION TITLE: Allergy and Airway SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Both asthma and bronchiectasis are important community health problems. In many patients, asthma and bronchiectasis coexist, and bronchiectasis has been shown to worsen asthma control with pulmonary complications. The aim of this study is to evaluate the clinical effects of asthma and bronchiectasis coexistence. METHODS: In this study, patients admitted to the Pulmonology Department of Akdeniz University Medical Faculty between January 1, 2014 and January 1, 2017 were evaluated. The patients were divided into three groups, asthmatics, bronchiectasis and asthma+bronchiectasis. The diagnosis of asthma was made according to the Global Initiative For Asthma (GINA) guidelines. The diagnosis of bronchiectasis was confirmed by high resolution computerized tomography. Sociodemographic data, comorbidities, physical examination findings, respiratory function test results were recorded in the data on the whole of the cases. Patients with asthma-COPD overlap syndrome, patients with cystic fibrosis were excluded from the study. RESULTS: One hundred-twenty seven patients with mean age of 44.8 years were included in the study. Fifty-six of them were male and 71 were female. 53 (41.7%) of these patients were asthmatics, 53 (41.7%) were bronchiectasis, and 21 (16.5%) were asthmatics+bronchiectasis. When all three groups were compared FEV1 (%), FVC (%), FEV1/FVC (%) and FEV1 (L) values were significantly lower in patients with asthma + bronchiectasis group (p=0.000). According to the GINA guidelines, asthma control levels were significantly worse in patients with asthma and bronchiectasis. When all three groups compared there was no statistically significant difference between the numbers of hospitalization (p=0.21) and exacerbations (p= 0.056). The most frequent symptom was dyspnea in asthma+bronchiectasis group, whereas the most frequent symptom was sputum in bronchiectasis group. CONCLUSIONS: In our study, asthmatic patients with bronchiectasis showed lower respiratory function test results and worse asthma control levels than other groups, but hospitalization and exacerbations rates were similar in all groups. CLINICAL IMPLICATIONS: Asthmatic patients with bronchiectasis showed lower respiratory function test results and worse asthma control levels. This group of patients should be evaluated more carefully. DISCLOSURES: No relevant relationships by Zehra Boztepe, source=Web Response No relevant relationships by Aykut Cilli, source=Web Response No relevant relationships by fatih uzer, source=Web Response

F eNO-based asthma management results in faster improvement of airway hyperresponsiveness.

Asthma is characterised by inflammation and respiratory symptoms. Current asthma treatment is based on severity of asthma symptoms only. Exhaled nitric oxide fraction (FeNO) is not recommended by the Global Initiative for Asthma guidelines. The aim was to compare the usefulness of a FeNO guided versus symptom-based treatment in achieving improved asthma control assessed by airway hyperresponsiveness (AHR).80 asthmatic patients were included in a double-blinded, parallel, randomised controlled trial with follow-up visits after 8, 24 and 36 weeks. Treatment was tailored using either a FeNO or Asthma Control Questionnaire (ACQ) based algorithm. Inclusion criteria were asthma symptoms and a provocative dose causing a 15% fall in forced expiratory volume in 1 s <635 mg mannitol. At each visit AHR, FeNO, ACQ and blood tests were performed.No differences between the two groups were found at inclusion. AHR from 8 to 24 weeks was improved in the FeNO group compared to the ACQ group (response dose ratio (RDR) geometric mean (95% CI): 0.02 (0.01–0.04) versus 0.05 (0.03–0.07), respectively, p=0.015). AHR to mannitol at 36 weeks showed no differences between the two groups (mean difference RDR (95% CI): −0.02 (−0.05–0.02), p=0.3). Total doses of inhaled steroid and number of exacerbations were similar (p>0.05).When using FeNO as a treatment management tool, lowering of airway responsiveness occurred earlier than using ACQ. However, airway responsiveness and asthma control after 9 months were similar.