Asthma Management Guidelines Research Articles

Factors influencing the initiation of biologic therapy in children with severe asthma: Results of the pediatric asthma noninvasive diagnostic approaches (PANDA) study.

Despite the availability of biologics for severe pediatric asthma, real-life studies reporting on drivers behind initiating biologics and their alignment with the Global Initiative for Asthma (GINA) recommendations are lacking. We performed analysis within the pediatric asthma noninvasive diagnostic approaches study, a prospective cohort of 6- to 17-year-old children with severe asthma. Information was collected on demographic factors, symptom control, treatment, comorbidities, and diagnostic tests from medical records and questionnaires. We divided patients into "starters" or "nonstarters" based on the clinical decision to initiate biologics and performed multivariate logistic regression analysis to identify drivers behind initiating therapy. Additionally, we assessed patient suitability for biologics according to key factors in the GINA recommendations: Type 2 inflammation, frequency of exacerbations, and optimization of treatment adherence. In total, 72 children (mean age 11.5 ± 3.0 years, 65.3% male) were included (13 starters). Initiation of biologics was associated with a higher GINA treatment step (adjusted odds ratio's [aOR] = 5.0, 95%CI 1.33-18.76), steroid toxicity (aOR = 21.1, 95%CI 3.73-119.91), frequency of exacerbations (aOR = 1.6, 95%CI 1.10-2.39), improved therapy adherence (aOR = 1.7, 95%CI 1.10-2.46), Caucasian ethnicity (aOR = 0.20, 95%CI 0.05-0.80), ≥1 allergic sensitization (aOR = 0.06, 95%CI 0.004-0.97), and allergic rhinitis (aOR = 0.13, 95%CI 0.03-0.65). Furthermore, steroid toxicity was identified as an important factor for deviation from the current recommendations on biologic prescription. We identified multiple drivers and inhibitors for initiating biologics, and showed the clinical need for biologics in severe pediatric asthmatics suffering from steroid toxicity. These findings may help refine asthma management guidelines.

Level of Compliance with Spanish Guideline Recommendations in the Management of Asthma.

To describe the clinical management of asthmatic patients and the level of compliance with the Guía Española para el Manejo del Asma (GEMA, Spanish Guidelines for Asthma Management) in the influential al area of Virgen de la Victoria University Hospital, Málaga (Spain). Descriptive, cross-sectional study in asthma patients from the Virgen de la Victoria University Hospital influential area, Málaga (Spain). Asthma Control Test (ACT) results, demographic and clinical characteristics, and GEMA indicators of quality asthma care were obtained from each participating patient. Two hundred and eighty-eight patients (64.2% woman, mean age 48.6 years) were included in the study. The evaluation of the level of compliance with the GEMA quality indicators showed that in 20.8% of the patients the diagnosis of asthma was confirmed by spirometry and bronchodilator test, and 52.5% of the patients with suspicion of allergic asthma performed a sensitization test. Among the smoker patients, 76.3% were recommended to stop smoking; 14.2% of the patients received a paper-based educational plan. Regarding asthma treatment, 92.3% of patients with persistent asthma received inhaled glucocorticoids (IGC). IGC and LABA were the most common treatments for asthma, used in combination (ICG + LABA) in 139 (48.3%) patients; 32.6% discontinued SABA treatment during the study period. Asthma was well controlled in 54.9% of the patients (ACT score ≥20), and 13.9% of the patients registered exacerbations during the previous year with a mean (SD) of 1.38 (0.74) events. Most of the GEMA quality indicators of asthma care are not followed in real-world clinical practice. Specialists select the best option among the available treatments but there is an unmet need for training plans in other relevant aspects, such as diagnosis and/or disease monitoring.

A Review of the Latest Guidelines for Diagnosing and Managing Asthma in Children in the United States and Canada.

Globally, asthma remains the most widespread chronic respiratory condition in children, with a larger proportion of children being affected by the condition. Regardless of the higher prevalence rates, the outcomes of pediatric asthma have remained inadequate, even as there are numerous preventable deaths (approximately 300 children in the United States and 250 children in Canada, annually). The characteristic symptoms of pediatric asthma include wheezing, cough, and shortness of breath that are characteristically triggered by several potential stimuli. However, several diagnostic challenges exist and have resulted in either overdiagnosis or underdiagnosis, making pediatric asthma diagnosis and management problematic. Effective management of asthma in children entails a holistic approach that encompasses non-pharmacological and pharmacological management, alongside self-management and educational aspects. Working with pediatric asthma patients and their families/caregivers is vital to promoting and realizing better asthma diagnosis and management outcomes. Educational guidelines regarding the best ways for effective treatment, avoidance of triggers, modifiable risk factors, and the actions that should be taken during chronic asthma attacks through individualized action plans are vital. Thus, the objective of this systematic review is to provide an overview of the latest guidelines on pediatric asthma diagnosis and management. In this regard, this review presents several similarities in existing pediatric asthma diagnosis and management guidelines in the United States and Canada. For instance, most guidelines and studies reviewed have proposed the use of objective tests for confirmation of asthma diagnosis, particularly in symptomatic individuals. The peak flow variability measurement, bronchodilator reversibility testing, and spirometry have also been proposed by the guidelines and studies, even as the recommendations regarding the timing and hierarchy of the objective test substantially vary between the guidelines and studies. We hope that the present review will be helpful to physicians and healthcare service providers working within pediatric health contexts.

Cost-effectiveness analysis of budesonide/formoterol SMART therapy versus salmeterol/fluticasone plus as-needed SABA among patients ≥12 years with moderate asthma from the Chinese societal perspective

Objectives To evaluate the cost-effectiveness of budesonide/formoterol reliever and maintenance therapy compared with salmeterol/fluticasone plus salbutamol as reliever therapy for asthma patients ≥12 years from the societal perspective in China. Methods A Markov model was developed with three health states (non-exacerbation, exacerbation, and death) with a lifetime horizon. The exacerbation rates were obtained from a prospective cohort study conducted in Chinese asthma patients. Healthcare resources utilization data were estimated based on current clinical asthma management guidelines. Asthma-related mortality, cost input and utility values were derived from public database and literature. Model robustness was assessed with one-way sensitivity and probabilistic sensitivity analyses. Results Compared with salmeterol/fluticasone plus salbutamol, budesonide/formoterol reliever and maintenance therapy led to fewer exacerbation events (13.6 vs. 15.9) and 0.0077 quality-adjusted life years (QALY) gain at an additional cost of ¥196.38 over lifetime. The base case incremental cost-effectiveness ratio (ICER) was ¥25,409.98 per QALY gained. The variables that had most impact on the model output included drug costs and medication adherence. At a willingness-to-pay threshold of ¥257,094/QALY (3 times of gross domestic product per capita in China in 2022), the probability of budesonide/formoterol maintenance and reliever therapy being cost-effective versus salmeterol/fluticasone plus as-needed salbutamol was 83.00%. Conclusion From the societal perspective, budesonide/formoterol reliever and maintenance therapy is likely to be a cost-effective option compared with salmeterol/fluticasone plus as-needed salbutamol for Chinese asthma patients ≥12 years.

Obesity and Asthma: Implementing a Treatable Trait Care Model.

Recognition of obesity as a treatable trait of asthma, impacting its development, clinical presentation and management, is gaining widespread acceptance. Obesity is a significant risk factor and disease modifier for asthma, complicating treatment. Epidemiological evidence highlights that obese asthma correlates with poorer disease control, increased severity and persistence, compromised lung function and reduced quality of life. Various mechanisms contribute to the physiological and clinical complexities observed in individuals with obesity and asthma. These encompass different immune responses, including Type IVb, where T helper 2 cells are pivotal and driven by cytokines like interleukins 4, 5, 9 and 13, and Type IVc, characterised by T helper 17 cells and Type 3 innate lymphoid cells producing interleukin 17, which recruits neutrophils. Additionally, Type V involves immune response dysregulation with significant activation of T helper 1, 2 and 17 responses. Finally, Type VI is recognised as metabolic-induced immune dysregulation associated with obesity. Body mass index (BMI) stands out as a biomarker of a treatable trait in asthma, readily identifiable and targetable, with significant implications for disease management. There exists a notable gap in treatment options for individuals with obese asthma, where asthma management guidelines lack specificity. For example, there is currently no evidence supporting the use of incretin mimetics to improve asthma outcomes in asthmatic individuals without Type 2 diabetes mellitus (T2DM). In this review, we advocate for integrating BMI into asthma care models by establishing clear target BMI goals, promoting sustainable weight loss via healthy dietary choices and physical activity and implementing regular reassessment and referral as necessary.

Budesonide Attains Its Wide Clinical Profile by Alternative Kinetics.

The introduction of inhaled corticosteroids (ICSs) changed over a few decades the treatment focus of mild-to-moderate asthma from bronchodilation to reduction in inflammation. This was achieved by inhaling a suitable corticosteroid (CS), giving a high, protracted airway concentration at a low total dose, thereby better combining efficacy and tolerance than oral therapy. Successful trials with the potent, lipophilic "skin" CS beclomethasone dipropionate (BDP) paved the way, suggesting that ICSs require a very low water solubility, prolonging their intraluminal dissolution within airways. The subsequent ICS development, with resulting clinical landmarks, is exemplified here with budesonide (BUD), showing that a similar efficacy/safety relationship is achievable by partly alternative mechanisms. BUD is much less lipophilic, giving it a 100-fold higher water solubility than BDP and later developed ICSs, leading to its more rapid intraluminal dissolution and faster airway and systemic uptake rates. In airway tissue, a BUD fraction is reversibly esterified to intracellular fatty acids, a lipophilic conjugate, which prolongs airway efficacy. Another mechanism is that the rapidly absorbed bulk fraction, via short plasma peaks, adds anti-inflammatory activity at the blood and bone marrow levels. Importantly, these plasma peaks are too short to provoke systemic adverse actions. Controlled clinical trials with BUD changed the use of ICS from a last resort to first-line treatment. Starting ICS treatment immediately after diagnosis ("early intervention") became a landmark for BUD. An established dose response made BUD suitable for the treatment of patients with all degrees of asthma severity. With the development of the budesonide/formoterol combination inhaler (BUD/FORM), BUD contributed to the widely used BUD/FORM maintenance and reliever therapy (MART). Recent studies demonstrated the value of BUD/FORM as a generally recommended as-needed therapy for asthma ("anti-inflammatory reliever", AIR). These abovementioned qualities have all influenced international asthma management and treatment guidelines.

Systemic Inflammation in Asthma: What Are the Risks and Impacts Outside the Airway?

Airway inflammation in asthma has been well recognized for several decades, with general agreement on its role in asthma pathogenesis, symptoms, propensity toward exacerbation, and decline in lung function. This has led to universal recommendation in asthma management guidelines to incorporate the use of inhaled corticosteroid as an anti-inflammatory therapy for all patients with persistent asthma symptoms. However, there has been limited attention paid to the presence and potential impact of systemic inflammation in asthma. Accumulating evidence from epidemiological observations and cohort studies points to a host of downstream organ dysfunction in asthma especially among patients with longstanding or more severe disease, frequent exacerbations, and underlying risk factors for organ dysfunction. Most studies to date have focused on cognitive impairment, depression/anxiety, metabolic syndrome, and cardiovascular abnormalities. In this review, we summarize some of the evidence demonstrating these abnormalities, highlight the proposed mechanisms and potential benefits of treatment in limiting these extrapulmonary abnormalities in patients with asthma. The goal of this commentary is to raise awareness of the importance of recognizing potential extra-pulmonary conditions associated with systemic inflammation of asthma. This area of treatment of patients with asthma is a large unmet need.

Role of Community Pharmacist in Asthma Management: Knowledge, Attitudes and Practice.

To investigate knowledge, attitude, and practice of asthma management counseling and the perceived barriers by community pharmacists. This cross-sectional study was conducted on 416 community pharmacists using an online-based questionnaire. The questionnaire included five parts that assessed socio-demographics and medical references used to seek drug-related information, pharmacists' knowledge (7 items), attitudes (5 items), practice (22 items) and the barriers for the provision of asthma management counseling (10 items). Binary logistic regression was conducted to find the variables that were significantly and independently associated with knowledge, attitude and asthma management counseling practice. Increased years of experience was associated with decreased knowledge (OR = 0.918, 95% Cl (0.869:0.970), P = 0.002) and less positive attitude toward asthma management (OR = 0.876, 95% Cl. (0.821:0.935), P < 0.001), while working in independent community pharmacy (OR = 2.097, 95% Cl. (1.273:3.454), P = 0.004) and increased awareness of asthma management guidelines (OR = 1.60, 95% CI. (1.044:2.453), P = 0.031) increased the odds of being in the high knowledge group. In contrast, increasing the daily number of pharmacy visitors OR = 1.009, 95% Cl. (1.001:1.016), P = 0.024) and having a pharmacy degree (OR = 2.330, 95% Cl. (1.256:4.326), P = 0.007) increased the odds of having a positive attitude. Male pharmacists (OR = 0.553, 95% Cl. (0.350:0.873), P = 0.011) and having bachelor in pharmacy (OR = 0.354, 95% Cl. (0.179:0.700), P = 0.003) decreased the odds of being in the high practice group. On the other hand, increased awareness of asthma management guidelines tripled the odds of being in the high practice group (OR = 3.067, 95% Cl. (1.964:4.787), P < 0.001). The current study findings offer valuable insights into the gaps in knowledge, attitude, and practice of asthma management counseling among community pharmacists, as well as the barriers and factors that impede the provision of these services. These insights serve as a guide for developing future strategies aimed at enhancing the role of pharmacists in asthma care.

Asthma care during pregnancy in South Asia

Bronchial asthma is among the commonest chronic inflammatory respiratory diseases affecting women of reproductive age group. Adequate attention has not been given to the diagnosis and the management of asthma in countries of South Asia. Management of asthma in pregnant women is more or less same as that of in non-pregnant women and stepwise approach is recommended. To confirm the diagnosis of asthma during pregnancy, spirometry can be used. Patients suffering from very severe asthma or difficult-to control asthma are more prone to develop exacerbations during pregnancy needs hospitalization for care. Well-controlled asthma during pregnancy prevents complications of pregnancy and results in better pregnancy outcomes. It better to follow the guidelines for management of asthma during pregnancy. The pregnant women must be educated regarding the care of asthma during pregnancy, delivery, in postpartum period and thereafter.

Ocena Jakości Wytycznych Praktyki Klinicznej Dotyczących Postępowania w Astmie za Pomocą Narzędzia AGREE II

Przedmiot badań Wytyczne praktyki klinicznej stanowią wsparcie w optymalizacji opieki zdrowotnej poprzez promowanie zaleceń opartych na dowodach naukowych. Odpowiednia metodyka i rygorystyczna strategia podczas formułowania zaleceń zawartych w wytycznych klinicznych ma istotny wpływ na ich jakość, wiarygodność i możliwość skutecznego wdrożenia zaleceń w praktyce. Cel badań Celem przeprowadzonego badania była ocena jakości wytycznych praktyki klinicznej dotyczących postępowania w astmie przy użyciu narzędzia AGREE II. W ramach analizy porównano jakość polskich wytycznych klinicznych z wytycznymi opracowanymi w innych krajach oraz przez organizacje międzynarodowe. Ocenie poddano 9 dokumentów wytycznych: Postępowanie w zaostrzeniach astmy u dorosłych – wytyczne dla lekarzy rodzinnych (twórca: Naczelna Izba Lekarska, Polska), Global Strategy for Asthma Management and Prevention (twórca: The Global Initiative for Asthma (GINA)), Asthma and Respiratory Foundation NZ Adolescent and Adult Asthma Guidelines 2020: a quick reference guide (twórca: Asthma and Respiratory Foundation Nowa Zelandia), Australian Asthma Handbook V2.0 (twórca: National Asthma Council Australia), National Clinical Guideline: The Diagnosis and Management of Asthma in Adults V2.1 (twórca: Ministry of Public Health Katar), SIGN 158 British guideline on the management of asthma (twórca: Scottish Intercollegiate Guidelines Network (SIGN) British Thoracic Society), , Management of Asthma in Adults (twórca: Malaysian Health Technology Assessment Section (MaHTAS)), Asthma: diagnosis, monitoring and chronic asthma management (twórca: National Institute for Health and Care Excellence (NICE)) oraz The Spanish Guideline on the Management of Asthma (twórca: Guía Española para el Manejo del Asma (GEMA)). Wyniki Najwyżej punktowanymi obszarami były: przejrzystość i sposób prezentacji zaleceń (wszystkie wytyczne oceniono na 100% lub blisko 100%), zakres wytycznych i cel oraz niezależność redakcyjna. Domeny, które zostały najniżej ocenione dotyczyły obszarów związanych z zaangażowaniem zainteresowanych podmiotów oraz stosowalnością (odpowiednio 79,3% oraz 69.2%). Największe różnice zaobserwowano w obszarze niezależności redakcyjnej - od 100% (maksymalna możliwa do uzyskania liczba punktów) do 16,7%. Najwyższą ocenę ogólną uzyskały wytyczne opracowane przez National Institute for Health and Care Excellence oraz Scottish Intercollegiate Guidelines Network. Wytyczne polskie otrzymały maksymalną liczbę punktów w obszarach związanych z zakresem i celem, przejrzystością i sposobem prezentacji oraz niezależnością redakcyjną. Wnioski Odpowiednio przeprowadzony proces opracowania wytycznych, w tym zaangażowanie ekspertów oraz przestrzeganie standardów metodycznych pozwala na uzyskanie wytycznych praktyki klinicznej charakteryzujących się wysoką jakością. Wysokiej jakości wytyczne praktyki klinicznej, mogą być z powodzeniem wykorzystywane jako narzędzia wspomagające podejmowanie decyzji klinicznych w danym obszarze, przy czym twórcy wytycznych powinni zwrócić szczególną uwagę na możliwości zastosowania wytycznych w praktyce oraz zaangażowanie wszystkich interesariuszy. W celu usprawnienia procesu tworzenia wytycznych oraz dostępu pacjentów do najnowszych terapii istotne jest również uwzględnienie synergii pomiędzy rekomendacjami zawartymi w wytycznych klinicznych oraz raportach oceny technologii medycznych.

Asthma management guidelines of the Croatian respiratory society Croatian Medical Association and the Croatian thoracic society

Asthma management guidelines of the Croatian respiratory society Croatian Medical Association and the Croatian thoracic society

Guideline Implementation for Improved Asthma Management and Treatment Adherence in Children in Jordan.

Asthma imposes a significant social burden on children, their families, and society at large. As a chronic health condition, effective management could greatly benefit from consistent adherence to guidelines. Despite this, minimal effort has been exerted to examine the impact of asthma management guidelines and adherence to treatment on children with asthma and the mothers caring for them. This study was designed to evaluate the influence of asthma management guidelines on the knowledge and treatment adherence among children with asthma and their mothers. A quasi-experimental design was utilized, and the study was conducted at two large hospitals in Jordan: Princess Rahma Hospital and King Hussein Medical Center. A purposive sample of children aged 6-12 years (n = 100) who were accompanied by their mothers (n = 100) were recruited for this study. Data were collected using a structured questionnaire and an observation checklist before and after the implementation of guidelines. Statistical analyses were performed using SPSS. The results revealed a statistically significant improvement in knowledge related to asthma among children and their mothers (p < 0.001). Additionally, a statistically significant difference was observed in the children's adherence to their treatment regimen before and after the implementation of asthma management guidelines (p < 0.001). Moreover, the improvements in knowledge and practice related to asthma were sustained in the follow-up assessments. In conclusion, the guidelines had a beneficial effect on the children's adherence to their treatment regimen both before and after their implementation. Thus, asthma patients should adhere to conventional guidelines at various health services to manage their condition effectively.

Multidisciplinary approaches to identifying and managing global airways disease: Expert recommendations based on qualitative discussions.

Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently co-exist and share pathologic features. Taking a "global" treatment approach benefits diagnosis and treatment of both, but care is often siloed by specialty: joined-up clinics are uncommon. Our objectives were to explore expert opinion to give practical suggestions to identify adults needing global airways care; enhance cross-specialty working; and widen knowledge to support diagnosis and management, integrate with existing care pathways, and supplement existing guidelines. Sixteen practicing physicians from northern Europe were invited for their national and/or international standing in treating asthma and/or chronic rhinosinusitis. Appreciative Inquiry techniques were used to guide their discussions. Key themes arising were screening and referral, collaboration on management, awareness and education, and research. Provided are screening criteria and suggestions for specialist referrals, and pointers for physicians to optimize their knowledge of global airways disease. Collaborative working is underscored, and practical suggestions are given for multidisciplinary teamworking within global airways clinics. Research gaps are identified. This initiative provides practical suggestions for optimizing the care of adults with CRSwNP and asthma. Discussion of the role of allergy and drug exacerbations on these conditions, and care for patients with other global airways diseases were beyond scope; however, we expect some principles of our discussion will likely benefit patients with related conditions. The suggestions bridge asthma and CRSwNP management guidelines, envisioning interdisciplinary, global airway clinics relevant to various clinical settings. They highlight the value of joint screening for early recognition and referral of patients.

Integrating User Preferences for Asthma Tools and Clinical Guidelines Into Primary Care Electronic Medical Records: Mixed Methods Study.

Asthma is a chronic respiratory disease that poses a substantial burden on individuals and the health care system. Despite published national guidelines for the diagnosis and management of asthma, considerable care gaps exist. Suboptimal adherence to asthma diagnosis and management guidelines contributes to poor patient outcomes. The integration of electronic tools (eTools) into electronic medical records (EMRs) represents a knowledge translation opportunity to support best practices. The purpose of this study was to determine how best to integrate evidence-based asthma eTools into primary care EMRs across Ontario and Canada to improve adherence to guidelines as well as measure and monitor performance. In total, 2 focus groups comprising physicians and allied health professionals who were considered experts in primary care, asthma, and EMRs were convened. One focus group also included a patient participant. Focus groups used a semistructured discussion-based format to consider the optimal methods for integrating asthma eTools into EMRs. Discussions were held on the web via Microsoft Teams (Microsoft Corp). The first focus group discussed integrating asthma indicators into EMRs using eTools, and participants completed a questionnaire evaluating the clarity, relevance, and feasibility of collecting asthma performance indicator data at the point of care. The second focus group addressed how to incorporate eTools for asthma into a primary care setting and included a questionnaire evaluating the perceived utility of various eTools. Focus group discussions were recorded and analyzed using thematic qualitative analysis. The responses to focus group questionnaires were assessed using descriptive quantitative analysis. Qualitative analysis of the 2 focus group discussions revealed 7 key themes: designing outcome-oriented tools, gaining stakeholder trust, facilitating open lines of communication, prioritizing the end user, striving for efficiency, ensuring adaptability, and developing within existing workflows. In addition, 24 asthma indicators were rated according to clarity, relevance, feasibility, and overall usefulness. In total, 5 asthma performance indicators were identified as the most relevant. These included smoking cessation support, monitoring using objective measures, the number of emergency department visits and hospitalizations, assessment of asthma control, and presence of an asthma action plan. The eTool questionnaire responses revealed that the Asthma Action Plan Wizard and Electronic Asthma Quality of Life Questionnaire were perceived to be the most useful in primary care. Primary care physicians, allied health professionals, and patients consider that eTools for asthma care present a unique opportunity to improve adherence to best-practice guidelines in primary care and collect performance indicators. The strategies and themes identified in this study can be leveraged to overcome barriers associated with asthma eTool integration into primary care EMRs. The most beneficial indicators and eTools, along with the key themes identified, will guide future asthma eTool implementation.

Prevalence and Clinical Characteristics of Patients with Moderate-to-Severe Asthma in Japan Using a JMDC Claims Database

Introduction: Although the prevalence and burden of asthma are continuously increasing, there is a lack of evidence on the landscape of moderate-to-severe asthma in Japan. Here, we report the prevalence of moderate-to-severe asthma and describe patient’s demographics and clinical characteristics from 2010 to 2019 using the JMDC claims database. Methods: Patients (≥12 years) from the JMDC database with ≥2 asthma diagnoses in 2 different months in each index year were stratified as moderate-to-severe asthma based on the definition of asthma prevention and management guideline (Japanese Guidelines for Asthma, JGL) or Global Initiative for Asthma (GINA). Primary objective: 10-year trend (2010–2019) in the prevalence of moderate-to-severe asthma. Secondary objective: Demographics and clinical characteristics of patients from 2010 to 2019. Results: Of 7,493,027 patients from the JMDC database, 38,089 and 133,557 were included in JGL and GINA cohorts, respectively, by 2019. Both cohorts presented an increasing trend in the prevalence rate of moderate-to-severe asthma from 2010 to 2019, irrespective of age groups. Demographics and clinical characteristics were consistent across the cohorts in each calendar year. Majority of patients were in the age group of 18–60 years in both JGL (86.6%) and GINA (84.2%) cohorts. Allergic rhinitis was the most frequent comorbidity and anaphylaxis the least frequent comorbidity reported in both the cohorts. Conclusions: In Japan, the prevalence rate of patients with moderate-to-severe asthma, as per JGL or GINA in the JMDC database, increased from 2010 to 2019. The demographics and clinical characteristics were similar in both cohorts over the assessment duration.

Validation of asthma management approach according to risk factors

Background Although studies show that most people successfully control their asthma, polls consistently show that this is not the case in real life. The present study aimed to validate assessment of asthma control using a risk stratification approach in comparison with global strategy for asthma management and prevention (GINA) guidelines with particular attention to high-risk group of asthmatic patients. Patients and methods This was a prospective interventional cohort trial that enrolled 30 patients with asthma in the outpatient department of Ain Shams University Hospital between January 2019 and January 2020. There were 10 female patients and 20 male patients, with a mean age of 51.43 ± 14.94 years. They were enrolled and randomly grouped 1: 1 into group A, which followed asthma risk stratification therapy (ARST), and group B, with the standard GINA approach, within 1-year follow-up period. Following visit 1 in a 2-week interval as a washout period, there were five consecutive visits on 3 months apart, and then visit 6 at the end of treatment at a 2-week interval. All patients were subjected to the Asthma Control Test Questionnaire for assessment of asthma control by GINA approach and to objective control assessments in ARST by Morisky Medication Adherence Scale-8 for adherence assessment, pulmonary function test for evaluation of annual decline of forced expiratory volume in the first second, and the annual rate of exacerbations. Results The results obtained from visits 1 to 6 showed nonstatistically significant differences in forced expiratory volume in the first second (75 vs. 81.82 ml, P=0.820) and in adherence scale (Morisky Medication Adherence Scale-8) on visits 2–5 (40 vs. 17, P=0465), or the rate of exacerbation (two exacerbations in each group), with no statistically significant differences (0 vs. 13.3%, P=0.143) in group A and group B, respectively. On the contrary, the assessment of severity tools in ARST was based on the level of sustainability of the asthma stepwise categorization among the duration therapy. Using ARST for the aims of control and severity assessments on the studied group, in comparison with the GINA assessment approach, there were highly significant statistical differences in numbers of controlled patients as well as numbers of patients with mild and moderate asthma for severity assessments (t=13.263, P=0.001 vs. t=22.941, P=0.0001, respectively). It could be concluded that applying the GINA approach on studied group A revealed underestimation of control and probably overestimation of asthma severity, or better called asthma stability. Conclusion ARST is noninferior to the GINA approach in the norms of asthma control when objectivity was measured, whereas the levels of sustainability or stability among the duration therapy for assessment of asthma severity were statistically overestimated when measured by GINA. These measures could help most patients with asthma, and there should be a concerted action for their implementation in epidemiological research.

Всесвітній день боротьби з астмою 2023: доступність лікування астми для всіх

Abstract. In the world, there is an unequity between the prevalence of bronchial asthma (BA) and the level of medical care provided to patients. While significant progress has been made in the treatment of asthma in high-income countries, the greatest burden of morbidity and mortality from asthma is in low- and middle-income countries. This problem became the theme of World Asthma Day 2023. The aim: to study the peculiarities of the organization of the asthma patients treatment in low- and middle-income countries, including Ukraine. Materials and methods. National and international guidelines, as well as scientific articles on asthma management in low- and middle-income countries were analyzed according to the literature data. Results. Underdiagnosis and inappropriate treatment of asthma are global problems in countries with limited resources. Challenges include the lack of asthma management guidelines and strategies at national levels, the lack of competent respiratory care professionals, and the lack or unavailability of necessary medications. Adapted for regions with limited resources, international guidelines for the management of asthma, offering a narrow choice of therapeutic approaches, cannot be implemented in some places due to the unavailability or high cost of inhaled corticosteroids (ICS). Obstacles in the way of providing medical care to patients with BA are cultural and religious features and in some places low literacy of the population. As for Ukraine, despite the status of a lower middle-income country, our health care system has adequate resources for the full treatment of the majority of BA patients. World Asthma Day’s efforts are aimed at drawing attention to the needs of people with asthma around the world, including those in low-income countries. An important aspect of this effort is to ensure that all patients with asthma, wherever they are, are treated and provided with care that meets the basic quality standard as outlined in the GINA Global Initiative for Asthma strategy. Conclusions. There is currently a global disparity in asthma patients’ access to appropriate treatment due to resource constraints, resulting in children, adolescents and adults suffering from severe and avoidable outcomes. International organizations contribute to the solution of this problem with various measures, one of which was Asthma Day 2023. Key words: World Asthma Day, asthma management, low- and middle-income countries.

ПЕРЕШКОДИ У ДОСЯГНЕННІ КОНТРОЛЮ БРОНХІАЛЬНОЇ АСТМИ В КЛІНІЧНІЙ ПРАКТИЦІ В УМОВАХ ПАНДЕМІЇ COVID-19)

The main goals of bronchial asthma (BA) treatment are to achieve good symptoms control and to minimize future risk of asthma-related mortality, exacerbations, persistent airflow limitation and adverse effects of therapy. Despite the availability of effective treatments for asthma the real life asthma control is lower than expected. The aim of this study was to evaluate the barriers in achieving asthma control in clinical practice during the COVID-19 pandemic according to the literature data. There are both general and COVID-19-related barriers in achieving the goals of asthma treatment. In most patients, the causes for the lack of asthma control are incorrect inhaler technique, poor adherence to treatment, overuse of short-acting bronchodilators, comorbidities, the influence of adverse environmental conditions and psychosocial factors. The COVID-19 pandemic has affected the asthma control through quarantine restrictions and the influence of post-acute COVID-19 disorders. On the one hand, quarantine restrictions had a positive effect on the asthma course: there was a decrease in the seasonal respiratory viral infections and the asthma exacerbations frequency. On the other hand, asthma patients were significantly affected by the pandemic due to a high level of anxiety, stress and limited access to routine medical care. Health disorders in post-COVID-19 period negatively affect the control of BA. After recovery from acute COVID-19 a proportion of asthma patients experienced poorer control and required increased asthma maintenance therapy. Approaches to improving asthma control include adherence to established asthma management guidelines, patient and healthcare professional education, regular asthma monitoring and assessment, review of inhaler technique, provision of a written asthma action plan, use of digital technologies. Key words: bronchial asthma, asthma control, COVID-19.

Comparison of National and Global Asthma Management Guiding Documents.

Asthma is a common chronic disease that affects both adults and children, and that continues to have a high economic burden. Asthma management guidelines were first developed nearly 30 years ago to standardize care, maintain asthma control, improve quality of life, maintain normal lung function, prevent exacerbations, and prevent asthma mortality. The two most common asthma guidelines used today were developed by the National Asthma Education and Prevention Program (NAEPP) Expert Panel Working Group and the Global Initiative for Asthma Science Committee. Both guiding documents use scientific methodology to standardize their approach for formulating recommendations based on pertinent literature. Before the 2020 National Asthma Education and Prevention Program (Expert Panel Report 4), nothing had been released since the 2007 guidelines, whereas the Global Initiative for Asthma publishes updates annually. Although each of these asthma strategies is similar, there are some noted differences. Over the years, the focus of asthma treatment has shifted from acute to chronic management. Frontline respiratory therapists and other health-care providers should have a good understanding of these 2 guiding references and how they can impact acute and chronic asthma management. The primary focus of this narrative is to look at the similarities and differences of these 2 guiding documents as they pertain to the 6 key questions identified by the Expert Panel of the National Asthma Education and Prevention Program.

Parental knowledge and usage of air quality in childhood asthma management.

The current United States asthma management guidelines recommend usage of the Air Quality Index (AQI) for outdoor activity modification when air pollution is high. Little is known about parental knowledge and usage of air quality including the AQI in managing childhood asthma. Forty parents (or legal guardians) of children with persistent asthma completed a questionnaire designed to assess 4 areas related to outdoor air pollution: awareness, perception, behavioral modification, and prior healthcare provider discussion. Descriptive statistics were obtained and Fisher's exact test was used for analysis of behavioral change by selected variables. Almost all parents reported awareness of air quality alerts or AQI, however, only 20% checked the AQI on the AirNow app or website. Most parents reported air pollution as a trigger (65%), yet few parents reported behavioral modification of their child's outdoor activity based on the perception of poor air quality (43%) or based on AQI or alerts (40%). Over half of parents reported a healthcare provider had ever discussed air pollution as a trigger, with few parents (23%) reporting recommendations for behavior change. Perception of air pollution as a trigger, healthcare provider discussion and recommendations, and usage of AirNow were associated with increased reported activity change. Healthcare providers should discuss outdoor air pollution during asthma management in children and should discuss AirNow as a source for AQI information and behavioral recommendations.