Improve Asthma Control Research Articles

Factors associated with poor health-related quality of life among patients with asthma: A hospital-based study from Jordan

<b>Purpose</b>: Exploring the factors that are associated with diminished health-related quality of life (HRQOL) in patients with asthma is essential to reach the optimal HRQOL. This study aim to assess HRQOL and its associated factors in patients with asthma in Jordan.<br /> <b>Methods</b>: This cross-sectional study was conducted on patients with asthma attending King Abdullah University Hospital and Jordan University Hospital in Jordan. In addition to socio-demographic variables, the study survey included mini asthma quality of life questionnaire (mini AQLQ) to measure HRQOL and asthma control test (ACT) to assess the degree of asthma control in asthmatic patients. Binary logistic regression was used to build a model of the independent predictors of poor HRQOL in the study participants.<br /> <b>Results</b>: Of the 314 participating patients, 70.1% were females, with a mean age of 51.47±16.37 years. 61.1% of the participants had low HRQOL, with a total mean mini AQLQ score of 4.30±1.30. Results revealed that advanced age (OR=0.961; 95% CI: 0.936-0.986; p<0.05) and lack of daily exercise (OR=0.233; 95% CI: 0.085-0.637; p<0.01) were significant predictors of poor HRQOL in patients with asthma, while better controlled disease, manifested by higher ACT score was associated with better HRQOL in these patients (OR=1.499; 95% CI: 1.344-1.672; p<0.01).<br /> <b>Conclusions</b>: HRQOL represents an area for improvement in patients with asthma. The current study provides insight on the factors associated with poor HRQOL. Future interventions and asthma management programs should focus on improving asthma control and encouraging physical activity, particularly for older patients, with the aim of improving HRQOL among patients with asthma.

Omalizumab for Chinese patients with moderate-to-severe allergic asthma in real-world clinical setting: a prospective, observational study

BackgroundWe aimed to investigate the effectiveness of omalizumab, a monoclonal anti-immunoglobulin E antibody, in Chinese patients with moderate-to-severe allergic asthma in real-world clinical practice.MethodsThis single-centre, prospective, observational study included Chinese...

Online Survey to Investigate Asthma Medication Prescription and Adherence from the Perspective of Patients and Healthcare Practitioners in England.

High short-acting β2-agonist (SABA) use and/or inhaled corticosteroid (ICS) underuse are common and are associated with poor asthma outcomes. This study explored patients' and healthcare practitioners' (HCPs') perspectives to contextualize asthma treatment patterns observed in real-world studies. Data were collected using online surveys from HCPs and people with asthma (≥18 years old with a confirmed asthma diagnosis of any severity) who had consented to research participation through the Clinical Practice Research Datalink. Data were analysed using descriptive statistics. In total, 76 HCPs and 63 patients were invited to take part. Of 48 valid HCP responders, 54.2% (n=26) reported scheduling an annual asthma treatment review with their patients and 83.3% of general practitioners (n=40) had prescribed repeated inhalers at the patient's request. Of 47 valid patient responders, 57.4% (n=27) reported using their reliever (SABA) inhaler daily and 55.3% of patients (n=26) reported being prescribed a preventer inhaler. Of the total patient responders, 31.9% (n=15) reported that they never used their preventer inhaler. Consistent annual adherence with preventer inhalers was reported by 44.7% of all valid responders (n=21), while other patients admitted to using preventers intermittently. SABA and ICS prescription patterns are driven by a combination of HCP and patient factors. Opportunities exist to improve asthma control and behaviours around inhaler use.

A cross sectional observational study on uncontrolled bronchial asthma and inhaler technique among out patients in a tertiary care centre in Western Maharashtra.

The 2014 Asia Pacific - Asthma Insight and Management (AP-AIM) study showed that none of the Indian asthmatics had controlled asthma when evaluated objectively. Our study aims to detect through objective measurements, uncontrolled asthma in OPD patients, the adequacy of their inhaler technique, and their awareness regarding the importance of inhaler technique. The asthma Control Test (ACT) score was used to screen for uncontrolled asthma. A validated objective questionnaire and scoring were used to objectively assess the correctness and awareness of the inhalation technique. The study was carried out over 2 month period and 80 patients meeting the inclusion criteria were enrolled. Out of 80 patients; 47 (58.75%) had well-controlled asthma and 33 (41.25%) had uncontrolled asthma. 64 (80%) patients had good, and 16 (20%) had poor inhalation techniques. Among the 64 patients with good inhalation technique 43 (67.18%) had well-controlled asthma and 21 (32.82%) had uncontrolled asthma. Among the 16 patients with poor inhalation technique 4 (25%) had well-controlled asthma and 12 (75%) had uncontrolled asthma. There was a statistically significant association between asthma control and inhaler technique (P value 0.002). In the study population 56 (70%) patients were aware of the inhalation technique and 24 (30%) were unaware of the inhalation technique. Out of the 56 patients who were aware of the inhalation technique 53 (94.64%) had good inhaler technique and 3 (5.36%) had poor inhalation technique. Among the 24 patients who were unaware of the inhaler technique 11 (45.83%) had good inhaler technique and 13 (54.17%) had poor inhaler technique. There was a statistically significant association between awareness of inhaler technique and good inhaler technique (P value 0.001). There is a statistically significant association between asthma control and inhaler technique and between inhaler technique and inhaler awareness. Improving the awareness regarding inhaler technique among bronchial asthma patients is the way forward to improve asthma control in our country.

Health-related quality of life, anxiety, depression, beliefs of medication, and self-efficacy in individuals with severe asthma – a population-based study

Objective Individuals with severe asthma often report poor Health-related quality of life (HRQoL) and more research is essential to increase understanding of how they may be helped to improve HRQoL. The main aim of the current paper is to evaluate HRQoL, and possible factors influencing HRQoL, in individuals with severe asthma. The aim is also to explore associations among anxiety, depression, beliefs of medication, self-efficacy, and HRQoL among individuals with severe and other asthma as well as those with no asthma. Methods Participants with severe asthma (n = 59), other asthma (n = 526), and no asthma (n = 902) were recruited from West Sweden Asthma Study, a population-based study, which includes both questionnaire surveys and clinical examinations. Results Individuals with severe asthma had worse physical HRQoL (measured with SF-8) than those with other and no asthma (median 48.4, 51.9, and 54.3, respectively). They also had worse mental HRQoL (median 46.7) and reported higher anxiety and depression scores (measured using HADS, median 5.0 and 3.5, respectively) compared to no asthma (median 4.0 and 2.0, respectively). HRQoL was particularly affected among women with severe asthma. Individuals with severe asthma believed that their asthma medication was more necessary than those with other asthma, but they reported more concern for the medication. Asthma control and packyears predicted physical HRQoL and anxiety predicted mental HRQoL among individuals with severe asthma. Conclusions Efforts to improve asthma control and to reduce anxiety may improve HRQoL in individuals with severe asthma. Especially, women with severe asthma seem to need support to improve their HRQoL. Reducing concerns with asthma medication is most likely essential as high concerns may lead to poor adherence, which in turn may negatively affect asthma control and HRQoL.

Impact of exacerbation history on long-term efficacy of dupilumab in patients with asthma.

The phase 3 QUEST (NCT02414854) and TRAVERSE (NCT02134028) studies demonstrated the efficacy of dupilumab 200/300 mg versus placebo every 2 weeks for 52 weeks (QUEST) and dupilumab 300 mg up to an additional 96 weeks (TRAVERSE) in patients ≥12 years of age with uncontrolled, moderate-to-severe asthma. Overall, safety was consistent with the known dupilumab safety profile. This post hoc analysis assessed long-term dupilumab efficacy for up to 3 years by exacerbation history. Unadjusted annualised severe exacerbation rates (AER) and change from parent study baseline (PSBL) in pre-bronchodilator forced expiratory volume in 1 s (FEV1) and 5-item Asthma Control Questionnaire (ACQ-5) score were assessed in patients with PSBL eosinophils ≥150 cells·µL-1 or fractional exhaled nitric oxide ≥20 ppb and 1 (n=624), 2 (n=344), or ≥3 (n=311) exacerbations in the year before enrolment in QUEST. In all three groups, dupilumab treatment progressively reduced AER range to 0.17-0.30 during TRAVERSE (Weeks 48-96), increased pre-bronchodilator FEV1 range by 0.28-0.49 L by Week 96 and improved asthma control (reduced ACQ-5 score range by 1.51-2.03 by Week 48). For patients who first received dupilumab upon TRAVERSE enrolment, AER decreased, and lung function and asthma control improved rapidly, as was observed upon initiation of dupilumab in QUEST. Dupilumab was efficacious regardless of exacerbation history. For patients with uncontrolled, moderate-to-severe asthma with elevation of at least one type 2 biomarker, dupilumab treatment provides sustained, long-term reduction of exacerbation rates and improvements in lung function and asthma control irrespective of exacerbation history.

Exploring Caregiver Interest in and Preferences for Interventions for Children With Risk of Asthma Exacerbation: Web-Based Survey.

Maintaining control of asthma symptoms is the cornerstone of asthma treatment guidelines in the United States. However, suboptimal asthma control and asthma exacerbations among young people are common and are associated with many negative outcomes. Interventions to improve asthma control are needed. For such interventions to be successful, it is necessary to understand the types of interventions that are appealing to caregivers of children with different levels of risk of exacerbation. This study aimed to evaluate whether caregivers of children with high (vs low) risk of asthma exacerbation show different levels of interest in and preferences for potential intervention programs and delivery methods. We contracted with Ipsos to administer a web-based survey to caregivers of children with asthma who were residing in the United States. Caregivers (N=394) reported their interest (1=not at all; 3=a lot) in 9 possible intervention programs and 8 possible intervention delivery methods. Caregivers also indicated their preferences by selecting the 3 intervention programs and 3 delivery methods that "most" interested them. Finally, caregivers completed 2 open-ended questions asking what other resources might be useful for managing their children's asthma. We classified children as having a high risk of exacerbation if they had an exacerbation in the past 3 months (n=116) and a low risk of exacerbation if otherwise (n=278). Caregivers reported higher levels of interest in all intervention programs and delivery methods if they cared for a child with a high risk rather than a low risk of exacerbation. However, regardless of the child's risk status, caregivers expressed the highest levels of interest in programs to increase their child's self-management skills, to help pay for asthma care, and to work with the school to manage asthma. Caregivers expressed the highest levels of interest in delivery methods that maintained personal control over accessing information (websites, videos, printed materials, and smartphone apps). Caregivers' preferences were consistent with their interests; programs and delivery methods that were rated as high in interest were also selected as one of the 3 that "most" interested them. Although most caregivers did not provide additional suggestions for the open-ended questions, a few caregivers suggested intervention programs and delivery methods that we had not included (eg, education about avoiding triggers and medication reminders). Similar interests and preferences among caregivers of children with high and low risk of exacerbation suggest a broad need for support in managing childhood asthma. Providers could help caregivers by directing them toward resources that make asthma care more affordable and by helping their children with asthma self-management. Interventions that accommodate caregivers' concerns about having personal control over access to asthma information are likely to be more successful than interventions that do not.

Effect of monitoring adherence to regular inhaled corticosteroid (ICS) alone or in combination with a long-acting β2-agonist (LABA) using electronic methods on asthma outcomes: a narrative systematic review

ObjectivesTo evaluate through a systematic review the effectiveness of electronic methods in monitoring adherence to regular inhaled corticosteroids (ICS) alone or in combination with long-acting β2-agonists (LABAs) and their effect...

Retrospective Analysis of Biologic Agent Utilization in Severe Asthma: Impact on Exacerbation Rates, Forced Expiratory Volume in the First Second (FEV1), Eosinophils, and IgE Levels.

Introduction Severe uncontrolled asthma is challenging to manage and impacts lung function and symptoms. Biologic agents targeting inflammatory pathways have transformed asthma management. This retrospective chart review aimed to assess biologic therapy in severe uncontrolled asthma patients and evaluate outcomes. Methods The study analyzed medical records of 30 patients receiving biologic therapy for severe asthma at a tertiary care center in Peshawar, Pakistan, from December 2022 to Jun 2023. Ethical approval was obtained, and patient demographics, biologic agent usage, and clinical parameters were collected. Clinical outcomes were evaluated after six months, including forced expiratory volume in the first second (FEV1), eosinophil count, IgE levels, and exacerbation rates. Results After six months, biologic treatment significantly improved FEV1 (48.7% to 62.4%), reduced eosinophils (540 cells/μL to 290 cells/μL) and IgE levels (410 IU/mL to 280 IU/mL), and decreased exacerbations (4.6 to 1.9). Subgroup analysis based on age and sex showed consistent lung function improvements. Conclusion Biologic agents effectively targeted inflammatory pathways, improving asthma control in severe uncontrolled asthma patients. This study provides valuable insights into biologic therapy for severe asthma, offering new possibilities for patient outcomes. Larger studies are needed to validate findings and optimize personalized treatment strategies.

Impact of asthma in Europe: A comparison of web search data in 21 European countries

BackgroundAsthma is a chronic inflammatory disorder of the airways and one of the most important non-communicable diseases worldwide. Analyzing crowdsourced data can help understand public interest and unmet needs as well as potential factors influencing search behavior. ObjectiveThe study aimed to investigate asthma-related web search data in Europe to identify possible regional and seasonal variations and to assess public interest. MethodsGoogle Ads Keyword Planner was used to measure search volume for search terms related to asthma, allergic asthma, and bronchial asthma in 21 European countries between January 2018 and December 2021. The top 10 keywords of each country were categorized qualitatively. Search volume per 100 000 inhabitants was descriptively assessed in terms of regional and seasonal trends. Spearman correlations between search volume and pollen concentration as well as coronavirus disease (COVID-19) cases were investigated. ResultsThe median search volume per 100 000 inhabitants for asthma and allergic asthma was highest in Northern and Western Europe, while the highest search volume for bronchial asthma was observed in Western and Eastern regions. A seasonal trend was identified for all search terms and in all regions. Correlations were found between search frequency and pollen load and search behavior and COVID-19 cases. Overall, Europeans were most interested in the diseases in general, their treatment options, and symptoms. ConclusionThese results highlighted the need for reliable and region-specific information about the disease and for public campaigns to improve asthma control. The study also emphasizes the importance of using crowdsourced data for a more encompassing overview beyond conventional healthcare data.

A Comparative Analysis of Factors Affecting Uncontrolled Asthma among Paediatric Population in Urumqi vs Islamabad

The prevalence of paediatric asthma, a serious worldwide health issue, varies greatly across different geographical areas. Particularly striking contrasts have been found between Islamabad, Pakistan, and Urumqi, China, prompting a comparison of the underlying causes of uncontrolled asthma. Objective: To determine and evaluate the variables influencing uncontrolled asthma in children in the populations of Urumqi and Islamabad. Methods: A comparative cross-sectional study on children with uncontrolled asthma aged 3 to 18 years old was carried out in Urumqi, China, and Islamabad, Pakistan. Analysis of hospital data were used to evaluate the uncontrolled factors related to patient’s demographics, medical history, factors related to asthma control and living conditions and the environment. Results: In both cities, the study found important causes of uncontrolled asthma. Poor inhaler technique, raised BMI, environmental triggers such pollen allergies, poorly ventilated homes, and treatment non-compliance were also noted in both populations. In addition, the study indicated that uncontrolled asthma was present in 32% of paediatric patients in Urumqi and 56% of those in Islamabad for a variety of reasons. Conclusions: The results underscore the importance of context-specific interventions in managing paediatric asthma. Measures such as improving inhaler techniques, ensuring treatment compliance, healthy BMI and proper ventilation can significantly improve asthma control in paediatric populations of both Urumqi and Islamabad.

Triple inhaled therapy for asthma in Canada

A significant number of patients with asthma have poor control on their current inhaled therapies, typically a combination of inhaled corticosteroids (ICS) and long-acting beta-2 adrenergic bronchodilators (LABA). Adding a long-acting antimuscarinic agent (LAMA) has been shown to improve asthma control and the availability of triple therapy formulations (ICS/LABA/LAMA) in a single inhaler device or single inhaler triple therapy (SITT) mitigates the adherence concerns associated with use of multiple inhaler devices. Here, we provide an overview of the pivotal data concerning the use of triple asthma therapy in patients with poor control on ICS-LABA treatment, and present our expert approach to their application in the routine clinical management of such patients as well the appropriate sequencing of initiating triple therapy and seeking a referral for consideration of more advanced therapies.

Chronomodulated drug delivery: Challenges, benefits, and future directions in asthma treatment

This review discusses the challenges in drug delivery and the potential benefits of Chronomodulated drug delivery for antiasthmatic drugs. It explores new drugs, personalized medicine approaches, and future directions in asthma treatment, such as immunotherapy and gene therapy. The analysis also discusses the risks of gene therapy for severe asthma and its potential benefits, such as improved medication effectiveness and reduced side effects. Chronomodulated drug delivery, which involves administering medications at specific times to align with the body's natural rhythms, has shown promising results in improving asthma control and reducing the frequency and severity of attacks. For instance, a study found that administering a Chronomodulated antiasthmatic drug in the morning, when lung function is typically at its lowest, significantly improved drug absorption and bioavailability compared to regular drug delivery. This optimized drug delivery not only enhanced the medication's effectiveness but also reduced the need for frequent dosing and minimized side effects, leading to better overall asthma management.

Real-world outcomes of mepolizumab treatment in severe eosinophilic asthma patients - retrospective cohort study in Slovakia.

Mepolizumab, a fully-humanized recombinant IgG1 kappa monoclonal antibody directed against IL-5, has shown improved asthma control and lung function in randomised controlled trials. The aim of this study was to evaluate real-world clinical experience in patients with severe eosinophilic asthma treated with mepolizumab in Slovakia. A retrospective, non-interventional study based on medical records of all adult asthma patients initiating mepolizumab between November 1, 2017 and January 31, 2019, completing 12 months of treatment. At baseline, general and clinical profile data were recorded 12 months prior to treatment. Primary and secondary endpoints described the results of mepolizumab use at 2, 6, and 12 months after the initiation and compared to baseline. Statistical testing of individual change (in each patient) in selected parameters was performed. The cohort included 17 patients with particularly severe asthma at baseline, with frequent severe exacerbations (SE, median 5 [IQR 4-6]/patient/year), high blood eosinophil counts (median 0.6x109/L), frequent oral corticosteroid (OCS) dependence (82.35%), median dose 15 (IQR 7.5-20) mg/day, impaired lung function, and a spectrum of comorbidities. In a one-year follow-up, the data showed reductions in median SE (0 [IQR 0-1] patient/year, eosinophilia (median 0.175x109/L) and OCS maintenance dose (median 6.25 [IQR 2.5-20] mg/day), all statistically significant after 12 months on mepolizumab. Improved and stabilised lung functions throughout the cohort and a reduced incidence of nasal polyposis were observed. The results provide clinical evidence of mepolizumab efficacy in a real sample of patients with severe asthma when administered in routine care settings in Slovakia.

Impact of a Five Minute Counseling Session of Proper Inhaler Technique on Control of Asthma in Patients Presenting to Tertiary Care Hospital

Objectives: To determine the effectiveness of counseling session of inhaler technique in improving control of symptoms in asthma patients, the factors affecting the improper inhaler technique and association of inhaler use with control of asthma. It has been observed that patients coming to tertiary care hospitals have poor asthma control and patients does not know exactly how to use inhaler in asthma symptoms. Study design: A facility based Observational, Prospective, Cross-sectional study conducted on patient with asthma symptoms and signs. Settings: This study was done in Department of Medicine, Sir Ganga Ram hospital Lahore. Timings: From 24-1-2023 to 23-5-2023. Methods: A facility based Observational, Prospective, Cross-sectional study was conducted on patient with asthma symptoms and signs. This study described the improvement in asthma symptoms by counseling sessions of using inhaler techniques in asthma patients. This study was done in Department of Medicine, Sir Ganga Ram hospital, Lahore. Patients who come to Out patient department of the hospital were selected who had asthma symptoms and signs. Sample size: A total of eighty Patients were selected with asthma symptoms and signs. Patients history were recorded and they were asked to use inhaler and there inhaler use technique were scored. Sample Selection: Inclusion Criteria: Patients age 16 years above, Both male and female patients, new onset asthma symptoms and signs, previously uncontrolled asthma on corticosteroid inhalers and meter dose inhaler devices. Exclusion criteria: Patients with history of chronic bronchitis and Patient with history of emphysema, Patients age less than 16 years. Data Collection procedure: A questionnaire was given to doctors who filled the data and record of patients with asthma symptoms and signs. A proper five minutes counseling of inhaler technique was done in asthma patients who came to Out Patient department of hospital. A questionnaire was filled and used for interpretation of results. We separated patients in two groups. One group of patients did not know how to use inhaler and other group knew how to use inhalers. Improper technique for use of inhaler defined as less than 75 percent of corrected steps done for use of inhaler device. Then we scored patient about the level of effective use of inhaler in asthma patients. We did a five minute counseling session to teach them how to use inhalers properly. We followed these patients in out patients department of tertiary care of hospital and see the improvement in control of asthma symptoms. We observed that patients asthma were controlled, if symptoms and signs improved, reduce nocturnal awakening of patients with cough and shortness of breath, improved quality of life and daily activities. We did the comparison of both group of patients coming to tertiary care hospital and see the impact of five minute counseling of proper inhaler techniques in improving asthma control in these patients. Results: A total of eighty patients were enrolled in the study. Mean age of Patients were 38.12 years and among them 40 percent were male 60 percent were female. 85.12 percent patients asthma symptoms were not controlled, 14.17 percent patients asthma symptoms were controlled. 11 percent patients were diabetics, 26 percent patients had hypertension, 11 percents were smokers, 3.7 percent patients had ischemic heart disease. Among total 80 patients, 48.12 percent patients were using inhalers. 70 percent patients did not know how to use inhaler devices correctly , 30 percent knew how to use inhalers. All patients who were well controlled with asthma were those who knew how to use asthma inhaler correctly. After counseling of proper inhaler techniques, patients were followed and questionnaire were interpreted and inhaler technique was scored, 78 percent patients have better control of asthma symptoms who scored well on use of inhaler technique of asthma devices. Practical Implication: Patients asthma are well controlled, if patients know there technique to use inhaler properly and if patients are well compliant to their inhaler medications for asthma. Conclusion: Patients who were counseled about proper use of inhaler techniques in asthma patients have better asthma symptoms control as compare to patients who did not know how to use asthma inhaler devices. These findings emphasis the need for patient education about asthma inhaler use for good control of asthma symptoms. Keywords: Asthma, Inhaler Technique, Allergens, Control of symptoms.

1-Year Prospective Study of the Relationship of Serial Exhaled Nitric Oxide Level and Asthma Control.

Previous studies found that the fractional nitric oxide concentration in exhaled breath (FeNO) levels in healthy Chinese adults was higher than in White adults. More understanding of serial changes of FeNO levels with asthma control in a real-life clinical setting would be important to explore the utility of this biomarker in routine asthma management. This study assessed the FeNO levels of Chinese asthma subjects with different levels of asthma control and the serial changes with respect to the changes in asthma control over 1 year. A 12-month prospective study (subjects recruited between November 2019 and January 2021) with serial measurement of FeNO levels at baseline, 4, 8 and 12 months. Asthma control was assessed by the Global Initiative for Asthma classification, Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ). Altogether, 136 subjects (mean age 51.51±15.09 years, 46[33.8%] male) had successful baseline FeNO measurements. At baseline, the FeNO levels did not show a statistically significant difference for controlled, partly controlled and uncontrolled asthma according to GINA classification, ACT and ACQ. FeNO levels decreased with improving asthma control and stayed at similar levels with unchanged or worsening asthma control for all subjects. For subjects with baseline blood eosinophil levels ≥300 cells/µL(n=59), FeNO levels decreased with improving asthma control, stayed similar without change for asthma control and increased with worsening asthma control. Receiver operating characteristic (ROC) analysis with the highest area under curve (AUC) for changes in FeNO levels for improving asthma control was between ≤ -10 to -25 ppb at various time points in the 12-month study. Changes in FeNO levels over time were associated with changes in clinical asthma control, particularly in those with higher blood eosinophil count and are likely more useful than a single time point measurement in managing asthma.

ADHERENCE TO ASTHMA CONTROLLER THERAPY AMONG CHILDREN

Asthma is a chronic respiratory condition that affects millions of children worldwide, necessitating diligent adherence to prescribed asthma controller therapy. This research paper explores the impact of adherence to asthma controller therapy on asthma control and health outcomes in pediatric patients. The study examines various factors influencing adherence rates, such as parental involvement, socio-economic status, and healthcare provider-patient communication. The research utilizes a quantitative approach, and data collected through structured surveys and medical records review. The study population includes children aged 5 to 17 years who were receiving asthma controller therapy. The results demonstrated a significant positive correlation between adherence to asthma controller therapy and improved asthma control. Children with high adherence rates experienced better lung function, reduced asthma symptoms, and fewer asthma exacerbations. Effective adherence also led to decreased healthcare utilization, with fewer emergency department visits and hospitalizations for asthma-related issues. Parental involvement emerged as a crucial factor influencing adherence, with actively engaged parents positively impacting adherence rates. Additionally, effective healthcare provider-patient communication and higher socio-economic status were associated with better adherence. Addressing concerns about potential side effects of medications was identified as a barrier to adherence. The implications of this research extend to healthcare professionals and policy makers. Healthcare providers should prioritize adherence in asthma management and involve parents as active partners in their child's treatment. Implementing comprehensive asthma education programs and promoting effective communication can enhance adherence rates. Policy makers should recognize the cost-effectiveness of adherence interventions and work towards reducing financial barriers to asthma controller therapy.

Non-randomised feasibility study testing a primary care intervention to promote engagement in an online health community for adults with troublesome asthma: protocol

IntroductionIn the UK, approximately 4.3 million adults have asthma, with one-third experiencing poor asthma control, affecting their quality of life, and increasing their healthcare use. Interventions promoting emotional/behavioural self-management can...

Real-World Effectiveness Study of Benralizumab for Severe Eosinophilic Asthma: ZEPHYR 2.

Benralizumab is an mAb therapy for severe eosinophilic asthma. Real-world data on its clinical impact in various patient populations such as patients with varying eosinophil levels, previous biologic use, and extended follow-up in the United States are limited. To determine the effectiveness of benralizumab in different asthmatic patient cohorts and its long-term clinical impact. Patients with asthma treated with benralizumab from November 2017 to June 2019 with 2 or more exacerbations in the 12 months before benralizumab initiation (index) were included in this pre-post cohort study that used medical, laboratory, and pharmacy US insurance claims. Asthma exacerbation rates in the 12 months pre and post index were compared. Nonmutually exclusive patient cohorts were defined by blood eosinophil counts (<150, ≥150, 150-<300, <300, and ≥300 cells/μL), a switch from another biologic, or follow-up for 18 or 24 months post index. There were 429 patients in the eosinophil cohort, 349 in the biologic-experienced cohort, and 419 in the extended follow-up cohort. In all eosinophil cohort subgroups, the asthma exacerbation rate decreased from 3.10-3.55 per patient-year (PPY) pre index to 1.11-1.72 PPY post index (52%-64% decrease; P < .001). Similar decreases were observed in patients switching from omalizumab (3.25 to 1.25 PPY [62%]) or mepolizumab (3.81 to 1.78 PPY [53%]) to benralizumab and those followed up for 18 months (3.38 to 1.18 PPY [65%]) or 24 months (3.38 to 1.08 PPY [68%]) (all P < .001). In the extended follow-up cohort, 39% and 49% had no exacerbations in the 0 to 12 months and the 12 to 24 months post index, respectively. Benralizumab achieved significantly improved asthma control in real-world patients with different blood eosinophil counts, including eosinophil counts ranging from less than 150 to greater than or equal to 300 cells/μL, switching from other biologics, or treated for up to 24months.

Use of ICS and Fast-Acting Bronchodilators in Asthma: Past, Present, and Future.

Primary care practitioners (PCPs) play a key role in asthma management since most patients with asthma are treated in primary care settings. Despite continual advances in asthma care, important practice gaps remain, and the high burden of asthma exacerbations persists, with 43% of children with asthma and 41% of adults with asthma in the United States experiencing an asthma exacerbation in 2020. Uncontrolled asthma, incomplete assessment of exacerbation and asthma control history, reliance on systemic corticosteroids (SCS) or short-acting beta2-agonist (SABA)-only therapy, and lack of patient adherence to anti-inflammatory maintenance therapies are challenges clinicians face today with asthma care. Inhaled corticosteroids (ICS) have been thought to have slow onset of action; however, recent data indicate that ICS onset of action on bronchial tissue is seconds to minutes through nongenomic effects. A large body of evidence supports the use of ICS + fast-acting bronchodilator treatments when used as needed in response to symptoms to improve asthma control and reduce rates of exacerbations. The symptoms that occur leading up to an asthma exacerbation provide a window of opportunity to intervene with ICS + fast-acting bronchodilators, potentially preventing the exacerbation and reducing the need for SCS. Incorporating patient perspectives and preferences when designing asthma regimens will help patients be more engaged in their therapy and may contribute to improved outcomes. In January 2023, a SABA-ICS combination rescue inhaler was approved by the US Food and Drug Administration (FDA) as the first asthma rescue inhaler for as-needed use to reduce the risk of exacerbations.