Improvement In Asthma Severity Research Articles

Severe asthma in adult, inner-city predominantly African–American and latinx population: demographic, clinical and phenotypic characteristics

Introduction The burden of asthma morbidity with co-existing atopy among the racial/ethnic minorities in the socio-economically disadvantaged NYC borough of the Bronx is unusually high. The multidisciplinary Montefiore Asthma Center (MAC) provides guideline-based treatment to this high-risk population through the joint efforts of Allergists/Immunologists, Pulmonologists, and on-site health educators. Methods The objective of this prospective, observational study was to define the demographic and clinical characteristics of severe asthma, evaluate improvement in asthma severity and lung function through the course of treatment at the MAC, and describe the asthma phenotypes of the patients managed at the MAC. Adults with severe asthma receiving treatment at the MAC were followed from their first to their last visit at the MAC. Patient demographics, along with asthma severity and co-existing allergies, were assessed. Possible phenotypes were defined (based on presence or absence of atopy, age at asthma onset, and blood eosinophil counts). Results 227 patients were included in the final analysis, of which 55.5% were Hispanic and 33.9% identified as non-Hispanic Black. Ninety-one percent (91%) of our cohort was found to be atopic and allergic rhinoconjunctivitis (ARC) was the most commonly identified co-existing allergic condition (86.3%). Mean Asthma Control Test (ACT) scores improved from 11.1 (± 4.9) at the initial visit to 14.8 (± 6.1) at the last visit. The spirometric values did not improve despite treatment at MAC. Conclusion A multidisciplinary severe asthma center is an ideal setting to phenotype patients and offer personalized guideline-based management and education to adults with severe asthma.

The role of airway hyperresponsiveness measured by methacholine challenge test in defining asthma severity in asthma-obesity syndrome.

Asthma is a complex disease defined by chronic inflammation of the airways. In research and clinical practice measures used for diagnosis, an assessment of control and severity of asthma are varied and there exists no gold standard. To date, several studies have explored the link between obesity and asthma although the exact mechanism is not yet fully understood. A study undertaken by our research group in 2015, on the effects of weight loss on asthma severity in obese asthmatics, demonstrated that an improvement in airway hyperresponsiveness could be achieved after significant weight reduction with a weight loss program. The objective of this article is to review the current literature for the primary and secondary outcomes studied to estimate the effects of weight loss on asthma severity in adults with obesity and asthma. A review of the most recent research conducted since 2014 demonstrates that effects of weight loss on asthma severity in adults with obesity and asthma has not been the focus of majority of the studies. Apart from our study published in 2015, very few studies used airway hyperresponsiveness as the primary or secondary outcome measure. The literature reveals that significant weight loss does, however, lead to improvement in asthma severity and control in adults with obesity and asthma. The current literature suggests that improvement in lung function requires moderate to significant (5-10%) weight loss in adults with obesity and asthma. However, with a few exceptions, the majority of these studies were small and used variable and questionable asthma severity outcome measures. There is an urgent need for standardization of diagnosis of asthma, study inclusion criteria, and outcome measures to assess asthma severity in research setting. Long-term effects of weight loss interventions on asthma severity and control, in adults with obesity and asthma, also remain unanswered.

The improvement in asthma severity and pulmonary functions after laser acupuncture application in asthmatic children

The improvement in asthma severity and pulmonary functions after laser acupuncture application in asthmatic children

Efficacy of high-dose sublingual immunotherapy in children allergic to house dust mites in real-life clinical practice

Background The aim of the study was to evaluate the efficacy and safety of high-dose mite sublingual immunotherapy (SLIT) administered in children with allergic rhinitis in real-life clinical practice. Moreover, we analysed the clinical course of asthma severity. Methods Retrospective, observational, monocentre study. Medical records of patients treated between 2001 and 2008 were reviewed. Patients received a standardised Dermatophagoides pteronyssinus+ Dermatophagoides farinae extract (300 IR/ml) manufactured by Stallergenes (Staloral ® 300). Patients were evaluated before SLIT initiation and at 6, 12, 24, 36 and 48 months. Global assessment of SLIT efficacy was measured using a visual analogue scale (VAS) and a rhinitis medication consumption score (RMCS). A global asthma score was used to estimate the clinical course of asthma severity. Results We obtained data from 78 patients, 43.6% male. The mean (±SD) age was 11.0±3.0 years. Most patients (69.2%) suffered from allergic rhinitis plus asthma. Patient evaluation of allergy severity (VAS) revealed a highly significant improvement between baseline and six months (p<0.001, Wilcoxon test): 4.0±1.7 cm vs. 7.3±4.6 cm. This improvement was maintained throughout the four-year follow-up period. The use of medications (RMCS) was significantly reduced in the first six months (4.6±2.5 points at baseline vs. 0.8±1.6 points at six months visit, p<0.001, Wilcoxon test) and remained very low until the end of follow-up. We did not find a temporal improvement in asthma severity. Conclusions This retrospective study indicates that high-dose SLIT in children with rhinitis caused by house dust mites is well-tolerated and could be an effective treatment.

Efficacy and Safety of Fluticasone Propionate Hydrofluoroalkane Inhalation Aerosol in Four- to Eleven-Year-Old Children with Asthma: A Randomized, Double-Blinded, Placebo-Controlled Study

This randomized, double-blinded, placebo-controlled study assessed the efficacy and tolerability of fluticasone propionate hydrofluoroalkane delivered via metered-dose inhaler without spacer. Children ages 4 to 11 years with ≥6 months' history of asthma requiring pharmacotherapy who were outpatients at primary and secondary care centers were eligible. Fluticasone, 88 µg (n = 160) or placebo (n = 81) was administered twice daily for 12 weeks. The primary efficacy end point was mean change in percent predicted morning predose clinic peak expiratory flow (PEF) from baseline to end point. Secondary end points were mean change from baseline to endpoint in percent predicted forced expiratory volume in 1 second (FEVi), morning and evening diary PEF, asthma symptom scores, daily rescue albuterol use, nighttime awakenings, duration of participation in the study, and improvement in asthma severity. Children treated with fluticasone had significantly (p = 0.003) greater improvements from baseline to endpoint in percent predicted morning predose clinic PEF (10.1% versus 3.9%) compared to children who received placebo. Morning and evening diary PEF, FEV1, percent predicted FEV1 albuterol use, and nighttime awakenings were all significantly improved (p = 0.05) relative to placebo. The week 12 improvement in asthma severity was significantly higher in the fluticasone group (30%) than in the placebo group (16%) (p = 0.028). The adverse event profile and 12-hour overnight urinary cortisol excretion for children treated with fluticasone was comparable to that of children who received placebo. Compared to placebo, fluticasone propionate hydrofluoroalkane 88 µg twice daily significantly improved asthma symptoms and was well tolerated. (Pediatr Asthma Allergy Immunol 2006; 19[2]:106–117.)

Zur Effizienz der Nachschulung von Kindern und Jugendlichen mit Asthma bronchiale

Background: Repetitive individual ambulatory education sessions after an individual ambulatory asthma training program are known to increase its effectiveness. We aimed to study how many additional ambulatory asthma training sessions are necessary in order to optimize the training effect. Methods: Within 2 years, a total of 522 patients participated in our ambulatory asthma training program. At the first visit in the asthma clinic, each patient obtained individual asthma training. Additional individual training sessions were offered at each appointment in the asthma clinic. The appointments were at intervals of 3 - 6 months. 1 additional training session was accepted by 185 patients. 155 patients took part in 2 additional training sessions, 108 in 3,56 in 3, 15 in 5 and 3 patients in 6 sessions, respectively. At each appointment, the course of the disease was evaluated by a questionnaire, furthermore, lung function testing was performed. The percentages of patients showing improvement, no improvement, or deterioration in asthma severity were compared by Χ 2 -tests. Results: The highest percentage of patients (72.2%) showing improvement in asthma severity was documented at the fourth appointment, i.e. after 3 additional individual training sessions. Conclusion: In individual ambulatory asthma training programs, at least 3 additional individual training sessions at intervals of 3 - 6 months appear to be necessary for obtaining the maximum effect. In conclusion, structured education programs can be effective even in an outpatient setting, especially if additional training sessions are offered.

Fluticasone propionate (FP) was superior to montelukast (MON) in producing at least a 2-step improvement in asthma severity in children 6-12 years of age

Rationale Asthma is characterized by symptoms that vary in severity from patient to patient and within a patient over time. As such, the NHLBI guidelines recommend a stepwise approach for the diagnosis and management of asthma in children, with the goal of pharmacotherapy to reduce symptoms and achieve near normal lung function. Patients may be classified according to severity based on their lung function, symptoms, and rescue albuterol use. An analysis was conducted to evaluate the step change in asthma severity from baseline to endpoint following treatment with FP or MON in children 6-12 years of age. Methods This was a randomized, double-blind, double-dummy, parallel group, 12-week study comparing FP (50μg BID; n=172) with MON (5mg QD; n=170) in symptomatic children using PRN albuterol. Asthma severity classification was defined according to the NHLBI guidelines and was based on % predicted FEV 1, daytime and nighttime symptoms, and albuterol use. Results At baseline, most patients (96%) in each treatment group met the classification criteria for moderate persistent asthma. At endpoint, significantly more patients (p=0.001) treated with FP (37.6%) demonstrated at least a 2-step improvement in asthma severity or improvement to mild intermittent asthma compared with patients who received MON 5 mg (21.1%). Conclusion FP is more effective in producing a ≥2-step improvement in asthma severity than MON in children 6-12 years of age with persistent asthma resulting in more children with an improvement to mild intermittent asthma.

Impact of a multidisciplinary day program on disease and healthcare costs in children and adolescents with severe asthma: A two‐year follow‐up study

For patients whose asthma remains in poor control necessitating high utilization of medical services, a referral to a specialized "center of excellence" is often considered. A decade ago, we evaluated our pediatric asthma program of long-term hospitalization (median stay of 75 days) and found significant decreases in subjects' medical utilization following this intervention. In an effort to contain treatment costs, the former program was markedly altered to one of abbreviated stay with emphasis on family management of asthma. The purpose of the present study was to determine the outcome of children treated in the revised program with regard to disease severity, quality of life, and subsequent utilization of medical resources. Children with severe asthma who were admitted to the program and fulfilled study criteria were consecutively enrolled. Data was obtained concerning disease characteristics, treatment, and quality of life at admission, and at 1 and 2 years following discharge. Medical records for the year prior to program admission and for the 2 years following discharge were coded for medical care encounters. Ninety-eight children, aged 9 months to 18 years (mean age, 10.9 years), were enrolled. They participated in the program for a mean of 15.6 ( +/- 8 SD), median of 15.0, and range of 2-51 treatment days. The group showed significant improvement (P < 0.0001) from admission to 1- and 2-year follow-up in median corticosteroid use, asthma functional severity, perceived competence in asthma management, and quality of life for both caregiver and child. Medical record data showed significant improvement (P < 0.0001) at both 1- and 2-year follow-up in median number of corticosteroid bursts, emergency department visits, hospital days, and overall utilization of medical care encounters. A median total medical encounter cost/patient of $16,250 ($6,972-$25,714 interquartile range (IQR)) for the year prior to program participation was reduced to $1,902 ($505-$6,524 IQR) at 1-year and $690 ($185-$3,550 IQR) at 2- year follow-up (P < 0.0001). We conclude that multidisciplinary care in a short-term, outpatient, day treatment program can significantly contribute to improvement in asthma severity, quality of life, and reduction in healthcare costs.

Dietary influences on chronic obstructive lung disease and asthma: a review of the epidemiological evidence.

The epidemiological evidence for a relationship between diet and indicators of asthma and chronic obstructive pulmonary disease (COPD) is evaluated. The review focuses on the intake of Na, n-3 fatty acids, and antioxidant vitamins as well as fruit and vegetables. Experimental studies suggest that a high-Na diet has a small adverse effect on airway reactivity in asthma patients. However, observational studies provide no clear evidence that high Na intake has adverse effects on airway reactivity or asthma symptoms in open populations. n-3 Polyunsaturated fatty acids, which are present in fish oils, are metabolized into less broncho-constricting and inflammatory mediators than n-6 polyunsaturated fatty acids. Studies in the general adult population suggest that a high fish intake has a beneficial effect on lung function, but the relationship with respiratory symptoms and clinically-manifest asthma or COPD is less evident. Also, experimental studies in asthma patients have not demonstrated an improvement in asthma severity after supplementations with fish oil. Several studies showed a beneficial association between fruit and vegetable intake and lung function, but the relationship with respiratory symptoms and the clinically-manifest disease was less convincing. A similar pattern was found for vitamin C in relation to indicators of asthma and COPD, but there are still conflicting results with respect to vitamin E and beta-carotene. In conclusion, the epidemiological evidence for a beneficial effect on indicators of asthma and COPD of eating fish, fruit and vegetables is increasing. However, the effectiveness of dietary supplementation in open-population samples is often not demonstrated. Several unresolved questions are raised, which should be addressed in future studies on the relationship between diet and respiratory disease.

Changes in bronchoalveolar lavage inflammatory cells in asthmatic patients treated with high dose inhaled beclomethasone dipropionate

Using serial bronchoalveolar lavage (BAL), we have studied changes in the airway inflammatory cell populations in 20 asthmatic patients, before and after treatment with inhaled beclomethasone dipropionate (BDP), 2,000 micrograms daily in an uncontrolled study. There was a significant improvement in asthma severity, as measured by symptom score and airways responsiveness, and there were significant reductions in the total BAL eosinophil, epithelial cell and mast cell counts, with a significant increase in the percentage BAL lymphocyte count. No significant correlations were found between the changes in airway inflammatory cell numbers and the reduction in asthma severity. In contrast, the fall in ROS generation by the pulmonary macrophage and granulocyte populations was nonsignificant, but the improvement in airways responsiveness was positively correlated to the reduction in the unstimulated pulmonary macrophage activity. Although these data are uncontrolled, the results are compatible with previous studies in suggesting an effect of steroids on the eosinophil, mast cell and epithelial cell in asthmatic airways. They also highlight the probable importance of the luminal lymphocyte population and pulmonary macrophage activation within the asthmatic airway, the beneficial modulatory effect of inhaled BDP treatment upon them, and the relative steroid-resistance of pulmonary inflammatory cell activity.

A placebo-controlled, blind comparison of nedocromil sodium and beclomethasone dipropionate in bronchial asthma

A multi-centre, randomized, blind comparative group study was carried out in 202 adult patients, who had suffered from asthma for at least 2 years, to assess the effectiveness and tolerability of maintenance treatment with either 4 mg nedocromil sodium 4-times daily, 0.1 mg beclomethasone dipropionate 4-times daily or 2 puffs of placebo 4-times daily, given by inhalation. Lung function (FEV1 and sRaw) measurements were made at the beginning and end of a 2-week baseline period and then after 3 and 6 weeks of treatment: assessment were also made of asthma severity. Patients recorded daily on diary cards details of morning and evening PEFR, usage of inhaled bronchodilators, severity of dyspnoea, cough and morning tightness. The results showed that, compared with placebo, both nedocromil sodium and beclomethasone dipropionate-treated patients showed an improvement in FEV1 and a reduction in sRaw values: PEFR increased slightly in all three groups. There was an improvement in asthma severity, diminished rate of dyspnoea and cough, and reduced usage of inhaled bronchodilators in patients receiving active treatment but not in those on placebo. Overall assessment of treatment efficacy by both investigators and patients showed that opinions were significantly in favour of active treatment over placebo. Treatment was well tolerated and no serious side-effects were reported. It was concluded that at the dosages used nedocromil sodium was comparable with and equivalent to inhaled beclomethasone dipropionate in nearly all of the parameters assessed, and both drugs were superior to placebo in the maintenance treatment of asthma in adult patients.