Global Initiative For Asthma Guidelines Research Articles

Use of corticosteroids and antibiotics for the treatment of asthma exacerbations at a quaternary care respiratory institute: A descriptive cohort study

Rationale The Global Initiative for Asthma guidelines recommend 50 mg prednisone for 5-7 days for asthma exacerbations and avoiding antibiotics. Management following failed home action plans is not addressed. Objectives The objectives of this study were to describe management of asthma exacerbations at the Montreal Chest Institute - Day Hospital (MCI-DH). Methods We retrospectively reviewed patients presenting to the MCI-DH for asthma exacerbations from January 2019 to June 2020. Data pertaining to demographics, treatments, and adverse events were collected and presented descriptively without statistical comparison. Measurements and Main Results Most patients present to the MCI-DH with an asthma exacerbation following a failed home action plan. A total of 107 patients (130 visits) were included in the analysis. Systemic corticosteroids were initiated in 119/130 (91.5%) visits, with 30 (25.2%) patients receiving the full course as oral therapy, whereas 89 (74.8%) were transitioned to oral therapy from intravenous. A daily dose of 50 mg of prednisone was observed in 34/119 (28.6%) treatment courses. The mean total corticosteroid duration was 12 days (SD 8), with only 18/119 (15.1%) treatment courses prescribed for 5-7 days. Corticosteroids were tapered over a mean of 14 days (SD 15) in 66 (55.5%) patients. Antibiotics were initiated in 18/130 (13.9%) visits, and 5/18 (27.8%) had no documented rationale. No adverse drug events were recorded in the 90 days following treatments. Conclusions The MCI-DH serves a complex population of patients often presenting following a failed action plan. Clinical judgment appears to have led to longer course high dose corticosteroids for many. Salvage therapy following a failed action plan requires further study.

Comparison of Budesonide/formoterol versus Fluticasone furoate/vilanterol as maintenance and reliever therapy for asthma control: a real-world observational study

BackgroundPrevious studies have reported reduced acute exacerbation rates and improved symptom control in asthma patients treated using inhaled corticosteroids plus formoterol maintenance and reliever therapy (MART). Fluticasone furoate (FF) and vilanterol (VIL) also provide rapid bronchodilation and sustained anti-inflammatory effects, however no studies have investigated FF/VIL as MART for asthma control.MethodsFrom October 1, 2021 to September 30, 2023, this retrospective study included asthma patients classified as step 3 or 4 according to the Global Initiative for Asthma guidelines, who were then divided into two groups. One group received BUD/FOR as MART, while the other received FF/VIL as MART. Pulmonary function tests, exacerbation rates, Asthma Control Test (ACT), fractional exhaled nitric oxide (FeNO) levels, and blood eosinophil counts were measured before and after 12 months of treatment.ResultsA total of 161 patients were included, of whom 36 received BUD/FOR twice daily as MART, and 125 received FF/VIL once daily as MART. After 12 months of treatment, the FF/VIL group showed a significant increase in ACT scores by 1.57 (p < 0.001), while the BUD/FOR group had an increase of 0.88 (p = 0.11). In terms of FeNO levels, the BUD/FOR group experienced a decline of -0.2 ppb (p = 0.98), whereas the FF/VIL group had a mild increase of + 0.8 ppb (p = 0.7). Notably, there was a significant difference in the change of FeNO between the two groups (∆ FeNO: -0.2 ppb in BUD/FOR; + 0.8 ppb in FF/VIL, p < 0.001). There were no significant alterations observed in FEV1, blood eosinophil count, or acute exacerbation decline in either group.ConclusionsIn the current study, patients treated with FF/VIL as MART showed improvements in ACT scores, while those treated with BUD/FOR as MART exhibited a reduction in FeNO levels. However, the difference between the two treatment groups did not reach clinical significance. Thus, FF/VIL as MART showed similar effectiveness to BUD/FOR as MART.

GINA-2024: Key Modifications and Strategic Implementations for Targeted Therapeutic Interventions

This article provides a succinct overview of the revisions and augmentations incorporated into the 2024 edition of GINA (Global Initiative for Asthma). A comparative analysis is conducted between the diagnostic and therapeutic algorithms for bronchial asthma (BA) in children outlined in the updated GINA guidelines and those delineated in the Kyrgyz clinical protocol on BA issued in 2023. Leveraging the latest iteration of GINA, a series of organizational, scientific, clinical, and diagnostic initiatives are slated for implementation in Kyrgyz Republic. Notably, on the basis of the department of allergology and clinical immunology of the National center for maternity and childhood care under the Ministry of health of the Kyrgyz Republic, a research laboratory on allergology, including a room for genetically engineered biological therapy, will be created.

Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Structured Search and Evaluation.

Asthma is a chronic respiratory disorder requiring long-term pharmacotherapy and judicious patient self-management. Few studies have systematically evaluated asthma mobile health (mHealth) apps for quality and functionality; however, none have systematically assessed these apps for their content alignment with international best practice guidelines. This review aims to conduct a systematic search and evaluation of current mHealth apps in the Australian marketplace for their functionality, quality, and consistency with best practice guidelines. The most recent Global Initiative for Asthma (GINA) guidelines were reviewed to identify key recommendations that could be feasibly incorporated into an mHealth app. We developed a checklist based on these recommendations and a modified version of a previously developed framework. App stores were reviewed to identify potential mHealth apps based on predefined criteria. Evaluation of suitable apps included the assessment of technical information, an app quality assessment using the validated Mobile App Rating Scale (MARS) framework, and an app functionality assessment using the Intercontinental Medical Statistics Institute for Health Informatics (IMS) Functionality Scoring System. Finally, the mHealth apps were assessed for their content alignment with the GINA guidelines using the checklist we developed. Of the 422 apps initially identified, 53 were suitable for further analysis based on inclusion and exclusion criteria. The mean number of behavioral change techniques for a single app was 3.26 (SD 2.27). The mean MARS score for all the reviewed apps was 3.05 (SD 0.54). Of 53 apps, 27 (51%) achieved a total MARS score of ≥3. On average, the reviewed apps achieved 5.1 (SD 2.79) functionalities on the 11-point IMS functionality scale. The median number of functionalities identified was 5 (IQR 2-7). Overall, 10 (22%) of the 45 apps with reviewer consensus in this domain provided general knowledge regarding asthma. Of 53 apps, skill training in peak flow meters, inhaler devices, recognizing or responding to exacerbations, and nonpharmacological asthma management were identified in 8 (17%), 12 (25%), 11 (28%), and 14 (31%) apps, respectively; 19 (37%) apps could track or record "asthma symptoms," which was the most commonly recorded metric. The most frequently identified prompt was for taking preventive medications, available in 9 (20%) apps. Five (10%) apps provided an area for patients to store or enter their asthma action plan. This study used a unique checklist developed based on the GINA guidelines to evaluate the content alignment of asthma apps. Good-quality asthma apps aligned with international best practice asthma guidelines are lacking. Future app development should target the currently lacking key features identified in this study, including the use of asthma action plans and the deployment of behavioral change techniques to engage and re-engage with users. This study has implications for clinicians navigating the ever-expanding mHealth app market for chronic diseases. PROSPERO CRD42021269894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269894. RR2-10.2196/33103.

Assessment of Asthma Knowledge of Parents of Children with Bronchial Asthma

Introduction: Understanding bronchial asthma plays a crucial role in the management and control of this chronic disease. While good asthma knowledge of the parents helps in better control of the disease in their children, it remains variable among the parents. Materials and Methods: This cross-sectional observational study was conducted in the outpatient asthma clinic of a tertiary center. New Castle Asthma Knowledge Questionnaire (NAKQ) were filled out by the caregivers of children (between 7 and 15 years, diagnosed as per global initiative for asthma guidelines) with bronchial asthma, after obtaining the proper consent. The validated Hindi version of the NAKQ questionnaire had a total of 31 questions regarding knowledge, acute asthma attacks, maintenance management, and misconceptions. Results: Eighty-five parents responded to the NAKQ questionnaire during this 1-year duration. 58 (68.24%) were fathers, and 27 (31.76%) were mothers, filling out the questionnaires. The knowledge score of the respondents enrolled in the study ranged from 10 to 18, the median knowledge score was 14, and the mean knowledge score of respondents was 14.02 ± 1.93. Conclusion: The mean knowledge score of the parents of bronchial asthma patients was found to be low in our setting as compared to other studies where a similar questionnaire was used.

Analysis on the management of type 2 inflammatory asthma from the guideline of Global Strategy for Asthma Management and Prevention

Bronchial asthma is a common chronic respiratory disease, which is involved in a variety of cells and cellular components. In 2019, the guidelines for the diagnosis and treatment of asthma issued by the Global Initiative for Asthma (GINA) Committee put forward the concept of type 2 inflammatory asthma for the first time. The updated evolution of GINA guidelines has promoted the development of biological agents and disease treatment, providing effective prevention and treatment for patients with severe asthma and improving disease outcome. This paper expounds the disease mechanism and management suggestions of type 2 inflammatory asthma in GINA guidelines, and analyzes the relevant clinical studies on targeted treatment of type 2 inflammatory asthma in recent years, in order to provide reference for in-depth understanding of level 3 prevention and management of patients with type 2 inflammatory asthma.

Nurse-Led Educational Program on Practice of Asthma Management Using Global Initiative for Asthma Guideline

The pivotal and nodal role of nurses in the healthcare industry is very vital for the proper management of asthma. To effectively intervene, nurses must be skillful in techniques used in asthma management which must be evidenced-based. The study objective is to use educational program to enhance nurses’ asthma management practice. This study adopted Quasi-experimental one group pre-post research design. Two government teaching hospitals in Rivers State were used in this study. A total number of 52 nurses were purposively selected in collaboration with nurse-leaders in each study setting. Checklist developed by the researcher and experts in the field of medical surgical nursing using modified Delphi method was used to collect data based on GINA guidelines pre- and post-educational program. Reliability test for the checklist using Cronbach’s alpha co-efficient yielded .89. Educational program was administered for six days respectively at the two study settings. Data collected were analysed using descriptive and inferential statistics (paired t-test) at level of 0.05 level of significance. Participants with good asthma management practice at pre-educational program were 36.5% while at post-educational was 80.8%. Paired-simple t-test analysis on the difference in asthma management practice before and after nurse led educational program using GINA guideline indicates that tcal = 51.23, df = 51, and ttab = 1.96 Since tcal&gt;ttab at P&lt;0.05, Hence, the null hypotheses was rejected. The study concluded that nurse-led educational program using adopted GINA guidelines enhanced practice of asthma management among nurses.

Association of Asthma With Patients Diagnosed With Metabolic Syndrome: A Cohort Study in a Tertiary Care Hospital.

Introduction Asthma is defined as a chronic inflammatory airway disease. The prevalence of both asthma and obesity has been rising simultaneously, demonstrating a parallel trend. Obesity is a significant factor in metabolic syndrome, and numerous studies have indicated a connection between metabolic syndrome and bronchial asthma. Aims and objectives The aim of this paper is to evaluate the association of asthma with patients diagnosed with metabolic syndrome. The main objectives were to analyze the clinical profile and spirometric indices in patients with metabolic syndrome and to assess asthmatic patients among them with spirometry and clinical parameters at a tertiary care hospital in Chennai. Materials and methods This hospital-based cohort study was conducted on 73 patients attending the outpatient department who had a known case of metabolic syndrome and were evaluated for asthma through history, physical examination, and a pulmonary function test. A history of cough, expectoration, shortness of breath, wheezing, chest tightness, allergy, seasonal variation, and smoking habits was asked, and a thorough physical examination was performed. Bronchial asthma was confirmed with airflow reversibility by spirometry as per the Global Initiative for Asthma Guidelines. Metabolic and spirometry parameters were examined, such as body mass index (BMI), waist circumference, waist-hip ratio, fasting blood sugar (FBS), postprandial blood sugar, hemoglobin A1C (HbA1C), serum insulin, lipid profile, C-reactive protein (CRP), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and FEV1/FVC pre- and post-reversibility (baseline vs. six months). Results and discussion The average BMI of all participants was 29.6511 ±2.64564. The waist-hip ratio was 0.5512 ±0.43855, which decreased during the follow-ups, demonstrating a decline in the risk of obesity in study participants. The level of HbA1C showed a drop from 6.1% to 5.9% at the first follow-up. This exhibited a further reduction at the six-month follow-up in addition to a positive reflection in insulin sensitivity, indicating successful control of diabetes among study participants. It was discovered that this was statistically significant (p<0.001). At the third and sixth months of follow-up, the FEV1/FVC ratio increased by 38% and 37%, respectively, when metabolic syndrome was under control. The results show that controlling diabetes, hypertension, obesity, and triglyceride values improved asthmatic symptoms, and this was determined to be statistically significant (p<0.001). Conclusion The results of the current study demonstrated that the regulation and maintenance of metabolic parameters such as BMI, diabetes, hyperlipidemia, and hypertension aid in improving asthma control.

Increased breath naphthalene in children with asthma and wheeze of the All Age Asthma Cohort (ALLIANCE)

Exhaled breath contains numerous volatile organic compounds (VOCs) known to be related to lung disease like asthma. Its collection is non-invasive, simple to perform and therefore an attractive method for the use even in young children. We analysed breath in children of the multicenter All Age Asthma Cohort (ALLIANCE) to evaluate if ‘breathomics’ have the potential to phenotype patients with asthma and wheeze, and to identify extrinsic risk factors for underlying disease mechanisms. A breath sample was collected from 142 children (asthma: 51, pre-school wheezers: 55, healthy controls: 36) and analysed using gas chromatography–mass spectrometry (GC/MS). Children were diagnosed according to Global Initiative for Asthma guidelines and comprehensively examined each year over up to seven years. Forty children repeated the breath collection after 24 or 48 months. Most breath VOCs differing between groups reflect the exposome of the children. We observed lower levels of lifestyle-related VOCs and higher levels of the environmental pollutants, especially naphthalene, in children with asthma or wheeze. Naphthalene was also higher in symptomatic patients and in wheezers with recent inhaled corticosteroid use. No relationships with lung function or TH2 inflammation were detected. Increased levels of naphthalene in asthmatics and wheezers and the relationship to disease severity could indicate a role of environmental or indoor air pollution for the development or progress of asthma. Breath VOCs might help to elucidate the role of the exposome for the development of asthma. The study was registered at ClinicalTrials.gov (NCT02496468).

Impact of the GINA asthma guidelines 2019 revolution on local asthma guidelines and challenges: special attention to the GCC countries

The Global Initiative for Asthma (GINA) provides the most comprehensive and frequently updated guidelines for the management of asthma. The primary aim of guidelines is to bridge the gap between research and current medical practice by presenting the best available evidence to aid clinical decision-making, thereby improving patient outcomes, quality of care, and cost-effectiveness. Guidelines are particularly useful in situations where scientific evidence is limited, multiple treatment options exist, or there is uncertainty about the best course of action. However, due to variations in healthcare system structures, many countries have developed their own local guidelines for the management of asthma. Adoption of GINA recommendations into local guidelines has been uneven across different countries, with some embracing the changes while others continue to follow older approaches. This review article will explore the impact of the noteworthy changes in GINA guidelines, particularly in the 2019 version, on local guidelines and some of the challenges associated with implementing them.

Assessing prescriber adherence with Global Initiative for Asthma (GINA) guideline-recommended reliever therapy.

In 2019, a landmark change was made to the Global Initiative for Asthma (GINA) guidelines in which an as-needed low-dose inhaled corticosteroid (ICS)-formoterol inhaler was updated to be the preferred reliever therapy for all asthma patients. Use of short-acting beta-agonist monotherapy is no longer recommended. The purpose of this study was to assess provider adherence with the GINA guidelines in regards to reliever therapy. This was a retrospective cohort study of patients presenting with an acute asthma exacerbation from January to May of 2020 and 2021. The primary objective of this study was to quantify provider adherence with the GINA guidelines in terms of reliever therapy. Preferred reliever therapy was defined asuse of an as-needed low-dose ICS-formoterol combination inhaler. Alternative reliever therapy was defined as use of a SABA inhaler with ICS-containing controller therapy. Secondary objectives included the number of patients discharged on any form of corticosteroid and the number of patients who may have been ideal candidates for transition to preferred reliever therapy. A total of 127 patients were included in the analyses. Upon hospital discharge, three patients (2.4%) received preferred reliever therapy and 97 (76.4%) received alternative reliever therapy. Rates of recommended reliever therapy prescription increased from 55 to 79% upon hospital discharge (p < 0.001). Prescription of GINA guideline-recommended reliever therapy was 79% within the patient population evaluated; however, rates significantly improved following hospitalization for asthma exacerbation. Additional studies that assess barriers to guideline adherence may be recommended.

Global Initiative for Asthma (GINA) guideline: achieving optimal asthma control in children aged 6-11 years.

The Global Initiative for Asthma (GINA) 2021 guidelines for asthma have been set forth with some alterations in Step 3, for children from 6-11-year-old age group. The low dose LABA-ICS, very low dose formoterol-ICS, medium dose ICS and ICS-LTRA combination were recommended in the guideline. We organized this study to draw an effective comparison between these three combinations of controller therapies in pediatric population. A retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan which enrolled 114 children aged 6-11 years old, from July 2021 to December 2022. These children were admitted with asthma exacerbations and were discharged on controller medications as per GINA guidelines on step 3 for control of asthma for 3 months. They were then followed for re-admission within 30 days of discharge, number of ER visits with asthma exacerbations for 1 year, number of admissions with asthma including HDU and PICU admissions, length of stay per admission for all admissions in subsequent one year. The pulmonary function test was done at 1 week follow-up in clinic after discharge and at 3 months visit post discharge. A total of 114 pediatric patients from age 6-11-year-old, were enrolled in the study period out of which 36 (31.57%), 33(28.9%) and 34 (29.82%) patients were categorized into ICS-LABA, ICS and ICS-LTRA groups respectively. ER visits were significantly low in ICS-LABA group followed by ICS-LRTA group and then ICS group (1.75±0.96 vs 2.93±1.412 vs 3.11±1.21, p<0.001). Similar statistically significant results were observed on average number of admissions per year (1.52±1.02 vs 1.96±0.84 vs 2.06±1.07, p=0.047) and number of patients needing PICU (13.88% vs 26.47% vs 39.39%, p=0.034) in these groups respectively. ICS- LABA group patients had the best values of FEV1 and FEV1/FVC ratio after pulmonary function tests at 3 months follow-up followed by ICS-LTRA and ICS group. Amongst the three options regimens for children managed at step 3 on GINA 2021 guidelines, ICS-LABA therapy helps attain optimal patient outcomes and lung functions in children with asthma followed by ICS-LTRA and ICS group respectively.

Quality of life and its relation to pediatric asthma severity

BackgroundBronchial asthma is a global health problem that negatively affects the quality of life (QOL) of both children and their caregivers. However, there is a paucity of data regarding the impact of QOL on asthma severity in the pediatric population. Therefore, we aimed to examine the effect of health-related QOL of children with asthma and their caregivers on the level of asthma control and the degree of asthma severity.ResultsAt enrollment, thirty asthmatic children and their caregivers completed the study. The standardized Arabic versions of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ) were fulfilled by the asthmatic patients and their caregivers, respectively. Asthma control and severity were assessed using Global Initiative for Asthma guidelines and asthma severity scores. The relations between QOL and the other study parameters including asthma severity were examined which revealed that poor QOL of both asthmatic children and their caregivers was associated with frequent asthma-related hospital admissions (p = 0.046, 0.011). In addition, significant associations were found between symptoms, activity domains of PAQLQ score, and asthma control test score (p = 0.019,0.039). Furthermore, both QOL questionnaires’ total scores correlated strongly with asthma severity scores (p < 0.05 for all).ConclusionsIn this study, QOL appears to be strongly related to the level of asthma control and asthma severity in children. Therefore, improving QOL is recommended for proper management of patients with severe asthma. Moreover, QOL questionnaires can be used as useful tools for monitoring asthma severity in children.

Adherence to the Global Initiative for Asthma Recommendations: A Narrative Review

Asthma, a chronic inflammatory disorder of the airways, affects millions of individuals worldwide. The Global Initiative for Asthma (GINA) provides evidence-based recommendations for diagnosing and managing asthma. This narrative review aims to explore the significance of adhering to the GINA recommendations for improving asthma outcomes. We delve into the key components of GINA guidelines, their impact on clinical practice, challenges in adherence, and potential strategies to enhance guideline implementation.

An evaluation of outpatient pediatric asthma prescribing patterns in the United States

Pediatric asthma is often under-diagnosed and under-treated, resulting in a lack of concentration, difficulty sleeping, and tiredness. The Global Initiative for Asthma (GINA) guidelines recommended that children should be prescribed maintenance inhalers along with rescue inhalers. Concurrent use of rescue and maintenance inhalers were considered appropriate use for this study. The aim of the study was to determine the prevalence of inappropriate prescribing patterns against various patient and prescriber demographic factors. A total of 2,264 patients meeting the inclusion criteria for ICD 10 codes, J45.20 - J45.52 and age less than 18 were extracted from the 2018 National Ambulatory Medical Care Survey (NAMCS), which captures ambulatory services offered in physicians’ offices directly engaged in patient care. This data is collected by the National Center of Health Statistics (NCHS), a division of the CDC. The data were analyzed using descriptive analysis, two-tailed t-tests, and ANOVA with an alpha significance level at 0.05. The majority of the pediatric patient population was in the age range of 17-18 years old. Overall, more patients were prescribed inappropriately (68.3%) as compared to appropriate prescribing (31.7%). Inappropriate prescribing was seen more for patients with Medicaid (24.8%) and self-payment (38.2%) as compared to other types of payment (p= 0.052). General practice/ family physicians (35.1%) and nurse practitioners (20.9%) prescribed more inappropriately as compared to other prescribers. (p= 0.001). Patients from the Southern region of the U.S. were prescribed more inappropriately compared to the other regions in the U.S. (p= 0.205). This study concluded that a significant number of pediatric asthma patients across all demographics were not appropriately prescribed inhalers, thus not adhering to GINA guidelines. Appropriate prescribing and adhering to guidelines would prevent morbidity, mortality and improve the patient's quality of life, thereby saving healthcare costs.

Economic impact of a more extensive use of FENO testing on the Italian population with asthma

BackgroundAsthma is a common chronic inflammatory airway affecting over 260 million people worldwide, and characterized, in the large majority of cases, by the so-called “type 2 inflammation”. Fractional exhaled nitric oxide (FENO) testing is noninvasive point-of-care tool to assess type 2 inflammation and therefore improve asthma management. It has been suggested to determine eligibility for a specific biologic therapy and predict likelihood to respond. The aim of this study was to estimate the overall economic impact of an extensive use of FENO testing on the Italian population with asthma, including extra costs of testing and savings generated by more appropriate prescriptions, increased adherence and lower frequency of exacerbations.MethodsA cost of illness analysis was firstly performed to estimate the yearly economic burden from the National Healthcare Service (NHS) perspective in Italy of the management of asthmatic patients with standard of care (SOC) according to the application of GINA (Global Initiative for Asthma) guidelines; then, we evaluated the changes in the economic burden in patient management by introducing FENO testing into clinical practice. The cost items considered were: visits/exams, exacerbations, drugs, management of adverse events caused by short-term oral corticosteroids use. Efficacy of FeNO test and SOC is based on literature evidence. Costs refer to published data or Diagnosis Related Group/outpatient tariffs.ResultsConsidering one asthma visit every 6 months, the total yearly cost for the management of patients with asthma in Italy is 1,599,217,876€ (409.07€ per patient), while for FENO testing strategy this figure is 1,395,029,747€ (356.84€ per patient). An increased utilization rate of FENO testing from 50 to 100% of patients may lead to savings for the NHS from about 102 to 204 million € compared to SOC.ConclusionsOur study showed that FeNO testing strategy may improve the management of asthmatic patients leading to significant savings for the NHS.

Association of serum periostin levels with asthma control status and severity in children

Objectives Periostin is a promising indicator in the pathogenesis of T-helper type-2 allergic reactions. This study aimed to identify the relationship between serum periostin levels and asthma control in children. Procedure In this study, 90 children were recruited and grouped as follows: 30 children in a control group (group I), and another group comprising 60 children with physician-diagnosed asthma (group II). The control status and severity of asthma in patients were assessed in accordance with the recent Global Initiative for Asthma guidelines. Serum periostin concentrations were examined in all enrolled patients using an enzyme-linked immunosorbent assay kit. Results The median (interquartile range) periostin levels of asthmatic children were substantially higher than those of healthy children [23 (13.1, 48) vs. 15 (10.5, 24); P = 0.015]. Based on a simple logistic regression analysis, serum periostin concentrations strongly correlated with asthma (odds ratio = 1.037; confidence interval = 1.008–1.066; P = 0.012). In a receiver operator characteristic curve analysis, the area under the curve for serum periostin was 0.984, with 100% sensitivity and 95.35% specificity in detecting uncontrolled asthma. Conclusion Serum periostin levels were shown to be a helpful biomarker for assessing childhood asthma control in children.

The Use of Lactobacillus reuteri as an Adjunct in the Treatment of Children with Newly Diagnosed Asthma in a Tertiary Hospital in the Philippines

Rationale: Probiotics are live microorganisms that exert beneficial effects on the host, including a reduction of allergic disease symptoms. Lactobacillus reuteri in particular was shown to attenuate the allergic airway, and when used as an adjunct in the treatment of asthma in children, resulted in decreased fractional exhaled nitric oxide and interleukin levels when compared to placebo. However, insufficient information is available regarding the significance of L. reuteri as an adjunct in the treatment of allergic disorders, particularly in allergic airway disease. Objectives: The objective of the study was to determine the efficacy of L. reuteri as an adjunct for the control of newly diagnosed asthma in children. Methodology and Population: In this analytical, experimental, prospective, randomized controlled trial, 44 asthmatic patients aged 6–18 years were recruited from the University of Santo Tomas Hospital outpatient department, for a study period of three months. Baseline clinical assessment included skin prick test to aeroallergens, spirometry, and Childhood Asthma Control Test. Asthma severity and level of control was based on the National Asthma Education and Prevention Program’s Expert Panel 3 (EPR-3) and the Global Initiative for Asthma Guidelines 2018, respectively. Patients were randomized and half of them received L. reuteri 26.5 mg/chewable tab (at least 100 million colony forming units) once daily for 30 days, while the other half did not. Spirometry and C-ACT test were conducted at the start of intervention as baseline, after one month, two months, and three months post intervention. The results of patients from the experimental group were compared to results of patients in the control group. Results: The FEV1 of patients in the L. reuteri group was significantly higher than those in the control group (p = 0.045). The median FVC of the two groups significantly differed from each other through time (p = 0.007), with the L. reuteri group having significantly higher FVC than the control group. There were statistically significant improvements in ACT scores between patients in the L. reuteri and control groups, particularly at two months and three months of treatment. Among polysensitized patients, there were significant improvements in the FEV1, FEF25–75, and FVC between the L. reuteri and control group. Conclusion: The use of L. reuteri as an adjunct was associated with significant lung function improvement and asthma symptom control amongst newly diagnosed asthmatic children. Key Words: Lactobacillus reuteri, Probiotics, Asthma, Children

Prevalence of Uncontrolled Asthma despite Treatment with Medium- or High-Dose ICS/LABA Using Patient-Reported Outcomes in Japan: The KOCU (KnOwing the Controlled statUs of Asthma in Japan) Study

Introduction: Evidence on the prevalence of uncontrolled asthma upon the standard of care in Japan is scarce and inconsistent. We report the prevalence of uncontrolled asthma using the Japanese Guidelines for Asthma (JGL) 2018 and Global Initiative for Asthma (GINA) 2019 classifications in patients who are currently receiving standard-of-care treatment in a real-life setting. Methods: In this prospective, 12-week, noninterventional study, patients with asthma aged 20–75 years and continuously treated with medium- or high-dose inhaled corticosteroid (ICS)/LABA, with or without other controller(s), were assessed for their asthma control status. The demographics, clinical characteristics, treatment patterns, health care resource utilization, patient-reported outcomes (PROs), and adherence to prescribed treatments were assessed for patients classified as either controlled or uncontrolled. Results: Of 454 patients, 53.7% and 36.3% of the patients reported their asthma as uncontrolled based on the JGL and GINA criteria, respectively. Uncontrolled asthma was even higher (JGL, 75.0%; GINA, 63.5%) within the subpopulation of 52 patients receiving long-acting muscarinic antagonists (LAMAs; i.e., ICS/LABA/LAMA subpopulation). Sensitivity analysis by propensity matching identified significant odds ratios of controlled versus uncontrolled asthma for several demographics and clinical characteristics: male; sensitization to animals, fungi, or birch; comorbidities including food allergy or diabetes; and history of exacerbation were associated with the risk of uncontrolled asthma. No significant changes in PROs were observed. Conclusion: The frequency of uncontrolled asthma in the study population was high, as per JGL and GINA guidelines, despite good adherence to ICS/LABA treatment and other prescribed treatments over 12 weeks.

Increased inhaled corticosteroids for treating acute asthma exacerbations

Increased inhaled corticosteroids for treating acute asthma exacerbations