Juniper Asthma Control Questionnaire Research Articles

The correlation between self-related adherence, asthma-related quality of life and control of asthma in adult patients.

Medication non-adherence mostly occurs in patients with a wide range of disease severity, including asthma. The aim of the study was to assess the self reported adherence to asthma therapy and investigate the relationship between adherence, asthma control and asthma-related quality of life. The study was a cross-sectional study in which participants were recruited from an outpatient department, in one hospital in Surabaya. Patients (aged≥18 years) with asthma who had used any regular asthma medications were included. Standardised questionnaires, including Juniper's Asthma Control Questionnaire (ACQ), Adherence to Refills and Medications Scales (ARMS) and Juniper's Asthma Quality of Life Questionnaire (AQLQ) were used. A total of 82 adults with asthma were recruited in the study. Male participants' mean age was 49.13±14.10 years (n = 23). Approximately 59 participants (72.0%) were females, 30 participants (36.5%) were using Budesonide inhaler, and 73 participants (89.0%) never smoked. The mean of ACQ, AQLQ, and ARMS scores were 1.62±1.19, 4.96±1.24, and 16.98±4.12, respectively. Of 82 patients studied 53 (64.6 %) had "uncontrolled asthma" and more than 85% participants both showed "non adherence" to asthma therapy and nearly 46% of them indicated that their quality of life was affected by asthma. There was a significant association between ACQ and AQLQ (p<0.05), whereas no statistically significant association was found between ACQ and ARMS. The majority of patients reported non-adherence to asthma medications. Poor controlled asthma has been associated with lower asthma-related quality of life.

Higher Omega-3 Index Is Associated with Better Asthma Control and Lower Medication Dose: A Cross-Sectional Study

Asthma is a chronic inflammatory airway disease, associated with systemic inflammation. Omega-3 polyunsaturated fatty acids (n-3 PUFA) have established anti-inflammatory effects, thus having potential as an adjunct therapy in asthma. This study aimed to compare erythrocyte n-3 PUFA in adults with (n = 255) and without (n = 137) asthma and determine the relationship between erythrocyte n-3 PUFA and clinical asthma outcomes. Subjects had blood collected, lung function measured and Juniper Asthma Control Questionnaire (ACQ) score calculated. Fatty acids were measured in erythrocyte membranes by gas chromatography, and the omega-3 index (O3I) was calculated (% eicosapentaenoic acid + % docosahexaenoic acid). O3I was similar in subjects with and without asthma (p = 0.089). A higher O3I was observed in subjects with controlled or partially controlled asthma (ACQ < 1.5) compared to subjects with uncontrolled asthma (ACQ ≥ 1.5) (6.0% (5.4–7.2) versus 5.6% (4.6–6.4) p = 0.033). Subjects with a high O3I (≥8%) had a lower maintenance dose of inhaled corticosteroids (ICS) compared to those with a low O3I (<8%) (1000 μg (400–1000) versus 1000 μg (500–2000) p = 0.019). This study demonstrates that a higher O3I is associated with better asthma control and with lower ICS dose, suggesting that a higher erythrocyte n-3 PUFA level may have a role in asthma management.

Management of Sub-Acute Exacerbation of Bronchial Asthma with Blatta orientalis: A Case Report

AbstractAsthma is a chronic respiratory disease. It is an inflammatory condition of the lower airways that affects around 275–300 million people globally and 25 to 30 million people in India. It can attack all age groups and is characterised by recurrent attacks of breathlessness, wheezing and coughing, which may vary from person to person in severity and frequency. It is caused by inflammation of air passages, hypersensitivity to allergens, pulmonary oedema and congestion of lungs. This case report is an evidence of successful treatment of sub-acute exacerbations of bronchial asthma by using homoeopathic medicine based on acute totality of the case. The case of a 32-year-old woman with bronchial asthma is reported here who was treated with Blatta orientalis 30C. All investigations and pulmonary function tests (spirometry) indicated the diagnosis to be bronchial asthma with moderate obstruction of small airways. After case taking, Blatta orientalis 30C was prescribed, following which, after 6 months of treatment, patient felt better in all aspects with reduction in the number of asthma attacks and marked improvement in Elizabeth Juniper's Asthma Control Questionnaire Score and other investigations.

Variability in total serum IgE over 1\xa0year in severe asthmatics

BackgroundImmunoglobulin E (IgE) is the treatment target of omalizumab, a monoclonal antibody indicated in the treatment of severe allergic asthma. Long-term variability of serum total IgE (sIgEtot) in asthmatics remains poorly documented.MethodsIn this prospective study, sIgEtot levels were measured over 1 year at 7 time points in 41 severe asthmatics treated with high-dose of inhaled corticosteroids and long-acting β2 agonists. 33 patients were atopic based on at least one positive RAST to common aeroallergens. Patients were divided into three groups according to their baseline sIgEtot level: low (< 76 IU/mL; n = 10), intermediate (76–700 IU/mL; n = 20) or high (> 700 IU/mL; n = 11). Patients also completed the six-item Juniper Asthma Control Questionnaire (ACQ6). The sIgEtot variability and factors predictive for this variability were studied, as well as ACQ6 outcomes.ResultsThe variation in sIgEtot level was mostly the consequence of between patient-variability, which represented 96%, 71% and 96% of the total variability in the low, intermediate and high sIgEtot subgroups, respectively. The residual within-patient variability was therefore limited. In 10/41 patients, sIgEtot levels increased or decreased, for at least one visit, beyond the predefined range of the subgroups to which they were assigned (< 76 IU/mL; 76–700 IU/mL; > 700 IU/mL). There was a significant but weak correlation between sIgEtot and ACQ6 score over all time points (r = 0.15, p = 0.02), but sIgEtot failed to associate with severe exacerbation. sIgEtot decreased by 3% with any additional year of age for the whole group (p = 0.01) and increased by 5% per one unit of allergen exposure score in atopic patients (p = 0.002).ConclusionIn severe asthmatics, limited within-patient variability of sIgEtot levels was observed over 1 year as opposed to marked between-subject variability. sIgEtot decreases with age. Variation in sIgEtot weakly associates with asthma control but not with exacerbation.

Impact of a history of maternal depression and anxiety on asthma control during pregnancy

ABSTRACTObjective: To determine the impact of self-reported maternal depression/anxiety on asthma control during pregnancy. Method: Pregnant women with a doctor diagnosis of asthma (n = 189) were prospectively recruited at their antenatal booking visit, and the presence of maternal depression and anxiety was identified using self-report and routine questionnaire assessments. Data on exacerbations and asthma control were collected during gestation. Asthma control was assessed using the Juniper Asthma Control Questionnaire (ACQ) and women were classified as having recurrent uncontrolled asthma if their ACQ score was >1.5 during two or more consecutive study visits. Exacerbations were defined as events that led to increased treatment requirements, and doctor or hospital visits. Results: There were 85 women with self-reported depression/anxiety and 104 women without self-reported depression/anxiety. The presence of depression/anxiety was associated with an increased likelihood (adjusted hazard ratio (HR) 1.67: 95% confidence interval (CI) 1.03–2.72) and incidence (adjusted incidence rate ratio (IRR) 1.71: 95% CI 1.13–2.58) of uncontrolled asthma during pregnancy, as well as an increased risk of recurrent uncontrolled asthma during 2 or more study visits (adjusted relative risk (RR) 1.98: 95% CI 1.00–3.91). No impact of depression/anxiety was observed with respect to the likelihood (adjusted HR 0.70: 95% CI 0.35–1.41) or incidence of exacerbations during pregnancy (adjusted IRR 0.66: 95% CI 0.35–1.26). Conclusions: This study provides evidence that the presence of maternal depression/anxiety is associated with an increased likelihood and incidence of uncontrolled asthma during pregnancy. Given the high prevalence of co-morbid depression/anxiety among asthmatics, further research investigating such associations is urgently required.

Evaluation of the PPAR-γ Agonist Pioglitazone in Mild Asthma: A Double-Blind Randomized Controlled Trial.

BackgroundPeroxisome proliferator-activated receptor gamma (PPAR-γ) is a nuclear receptor that modulates inflammation in models of asthma. To determine whether pioglitazone improves measures of asthma control and airway inflammation, we performed a single-center randomized, double-blind, placebo-controlled, parallel-group trial.MethodsSixty-eight participants with mild asthma were randomized to 12 weeks pioglitazone (30 mg for 4 weeks, then 45 mg for 8 weeks) or placebo. The primary outcome was the adjusted mean forced expiratory volume in one second (FEV1) at 12 weeks. The secondary outcomes were mean peak expiratory flow (PEF), scores on the Juniper Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ), fractional exhaled nitric oxide (FeNO), bronchial hyperresponsiveness (PD20), induced sputum counts, and sputum supernatant interferon gamma-inducible protein-10 (IP-10), vascular endothelial growth factor (VEGF), monocyte chemotactic protein-1 (MCP-1), and eosinophil cationic protein (ECP) levels. Study recruitment was closed early after considering the European Medicines Agency’s reports of a potential increased risk of bladder cancer with pioglitazone treatment. Fifty-five cases were included in the full analysis (FA) and 52 in the per-protocol (PP) analysis.ResultsThere was no difference in the adjusted FEV1 at 12 weeks (-0.014 L, 95% confidence interval [CI] -0.15 to 0.12, p = 0.84) or in any of the secondary outcomes in the FA. The PP analysis replicated the FA, with the exception of a lower evening PEF in the pioglitazone group (-21 L/min, 95% CI -39 to -4, p = 0.02).ConclusionsWe found no evidence that treatment with 12 weeks of pioglitazone improved asthma control or airway inflammation in mild asthma.Trial RegistrationClinicalTrials.gov NCT01134835

P49 Can The Asthma Control Questionnaire (acq) And/or The Blood Eosinophil Count Accurately Detect Sputum Eosinophilia?

Induced sputum differential cell counts provide important information about airway inflammation and future risk in asthma, but are not universally available. We set out to ascertain the sensitivity and specificity of the Juniper Asthma Control Questionnaire (ACQ) and/or the peripheral blood eosinophil count to detect a sputum eosinophil count >3%. Methods We performed a retrospective, cross-sectional study of 165 subjects with asthma, aged 18–80, prescribed as-required bronchodilators, long-acting β-agonists, 0–4000 mcg inhaled beclometasone diproprionate equivalent or maintenance oral steroids (0–20 mg prednisolone) from our database. Current smokers were excluded. Spirometry, FeNO at 50 ml flow, sputum induction, Asthma Control Questionnaire (ACQ) and blood eosinophils (BEos) were recorded. Induced sputum eosinophils (SEos) defined eosinophilic (EA, SEos ≥3%) and non-eosinophilic (NEA, SEos 10 transformed and groups were compared with t-tests or Mann-Whitney-U using STATA and GraphPad. Receiver operating characteristic (ROC) curves determined cut-points of ACQ and BEos that identified SEos ≥3%, and these were tested retrospectively in a second population of adults with asthma (n = 48, 40% EA, mean FEV 1 82% predicted). Results The 31% with EA had a lower FEV 1 % predicted and FEV 1 /FVC ratio, a higher FeNO, BEos and ACQ compared to NEA (Table 1). There was a significant correlation between ACQ and sputum eosinophils (Pearson r 0.32, p The optimal cut-points of ACQ and BEos identifying a SEos of 3% were an ACQ >1.57 (sensitivity 55%, specificity 78%) and BEos ≥0.22 × 10 9 /L (sensitivity 84% and specificity 68%) respectively. Individuals with both ACQ of ≥1.57 AND a BEos of ≥0.22 the sensitivity was 45% and specificity of 100% for a SEos of 3%. Testing in the second population the ACQ≥1.57 had a sensitivity 47% and specificity 86% for SEos >3% while BEos ≥0.22 had sensitivity 68% and specificity 45%. The combination of ACQ ≥1.57 AND BEos ≥0.22 had a lower sensitivity of 37% but a high specificity of 93% and could be useful to exclude rather than identify the presence of sputum eosinophilia. Conclusion Combined testing using ACQ and BEos only identifies eosinophilia in 37% and can’t replace induced sputum, but may be useful to exclude sputum eosinophilia and prospective study is warranted.

Obesity and symptoms of depression contribute independently to the poor asthma control of obesity

Obesity is a major risk factor for poorly controlled asthma, but the reasons for poor asthma control in this patient population are unclear. Symptoms of depression have been associated with poor asthma control, and increase with higher body mass index (BMI). The purpose of this study was to assess whether depressive symptoms underlie poor asthma control in obesity. We determined the relationship between BMI, psychological morbidity and asthma control at baseline in a well-characterized patient population participating in a clinical trial conducted by the American Lung Association-Asthma Clinical Research Centers. Obese asthmatic participants had increased symptoms of depression (Center for Epidemiologic Studies Depression Scale score in lean 10.1 ± 8.1, overweight 10.0 ± 8.1, obese 12.4 ± 9.9; p = 0.03), worse asthma control (Juniper Asthma Control Questionnaire score in lean 1.43 ± 0.68, overweight 1.52 ± 0.71, obese 1.76 ± 0.75; p < 0.0001), and worse asthma quality of life (scores in lean 5.21 ± 1.08, overweight 5.08 ± 1.05, obese 4.64 ± 1.09; p < 0.0001). Asthmatics with obesity and those with symptoms of depression both had a higher risk of having poorly controlled asthma (adjusted odds ratio of 1.83 CI 1.23-3.52 for obesity, and 2.08 CI 1.23-3.52 for depression), but there was no interaction between the two. Obesity and symptoms of depression are independently associated with poor asthma control. As depression is increased in obese asthmatics it may be an important co-morbidity contributing to poor asthma control in this population, but factors other than depression also contribute to poor asthma control in obesity.

Sex differences in asthma symptom profiles and control in the American Lung Association Asthma Clinical Research Centers

Important differences between men and women with asthma have been demonstrated, with women describing more symptoms and worse asthma-related quality of life (QOL) despite having similar or better pulmonary function. While current guidelines focus heavily on assessing asthma control, they lack information about whether sex-specific approaches to asthma assessment should be considered. We sought to determine if sex differences in asthma control or symptom profiles exist in the well-characterized population of participants in the American Lung Association Asthma Clinical Research Centers (ALA-ACRC) trials. We reviewed baseline data from four trials published by the ALA-ACRC to evaluate individual item responses to three standardized asthma questionnaires: the Juniper Asthma Control Questionnaire (ACQ), the multi-attribute Asthma Symptom Utility Index (ASUI), and Juniper Mini Asthma Quality of Life Questionnaire (mini-AQLQ). In the poorly-controlled population, women reported similar overall asthma control (mean ACQ 1.9 vs. 1.8; p=0.54), but were more likely to report specific symptoms such as nocturnal awakenings, activity limitations, and shortness of breath on individual item responses. Women reported worse asthma-related QOL on the mini-AQLQ (mean 4.5 vs. 4.9; p<0.001) and more asthma-related symptoms with a lower mean score on the ASUI (0.73 vs. 0.77; p≤0.0001) and were more likely to report feeling bothered by particular symptoms such as coughing, or environmental triggers. In participants with poorly-controlled asthma, women had outwardly similar asthma control, but had unique symptom profiles on detailed item analyses which were evident on evaluation of three standardized asthma questionnaires.

DASH for asthma: A pilot study of the DASH diet in not-well-controlled adult asthma

This pilot study aims to provide effect size confidence intervals, clinical trial and intervention feasibility data, and procedural materials for a full-scale randomized controlled trial that will determine the efficacy of Dietary Approaches to Stop Hypertension (DASH) as adjunct therapy to standard care for adults with uncontrolled asthma. The DASH diet encompasses foods (e.g., fresh fruit, vegetables, and nuts) and antioxidant nutrients (e.g., vitamins A, C, E, and zinc) with potential benefits for persons with asthma, but it is unknown whether the whole diet is beneficial. Participants (n=90) will be randomized to receive usual care alone or combined with a DASH intervention consisting of 8 group and 3 individual sessions during the first 3months, followed by at least monthly phone consultations for another 3months. Follow-up assessments will occur at 3 and 6months. The primary outcome measure is the 7-item Juniper Asthma Control Questionnaire, a validated composite measure of daytime and nocturnal symptoms, activity limitations, rescue medication use, and percentage predicted forced expiratory volume in 1second. We will explore changes in inflammatory markers important to asthma pathophysiology (e.g., fractional exhaled nitric oxide) and their potential to mediate the intervention effect on disease control. We will also conduct pre-specified subgroup analyses by genotype (e.g., polymorphisms on the glutathione S transferase gene) and phenotype (e.g., atopy, obesity). By evaluating a dietary pattern approach to improving asthma control, this study could advance the evidence base for refining clinical guidelines and public health recommendations regarding the role of dietary modifications in asthma management.

Efficacy of Anti-Interleukin-5 Therapy with Mepolizumab in Patients with Asthma: A Meta-Analysis of Randomized Placebo-Controlled Trials

BackgroundInterleukin (IL)-5 is believed to be a key cytokine in eosinophil inflammatory infiltration in asthma. Previous clinical trials have evaluated the efficacy and safety of mepolizumab, a monoclonal antibody against IL-5, in patients with asthma. However, most of these studies were small, the conclusions were inconsistent, and the precise effects are therefore debatable.MethodsA meta-analysis of randomized placebo-controlled trials was conducted to evaluate the effect of intravenous infusion of mepolizumab on clinical outcomes in patients with asthma. Trials were searched in PubMed, Embase, Web of Science, Cochrane CENTRAL, Scopus, reviews, and reference lists of relevant articles. The outcome variables analyzed included eosinophil counts in blood and sputum, airways outcome measures, exacerbations, asthma control, and quality of life scores.ResultsSeven studies met final inclusion criteria (total n = 1131). From the pooled analyses, mepolizumab significantly reduced eosinophils in blood (MD −0.29×109/L, 95% CI −0.44 to −0.14×109/L, P = 0.0001) and sputum (MD −6.05%, 95% CI −9.34 to −2.77%, P = 0.0003). Mepolizumab was also associated with significantly decreased exacerbation risk than placebo (OR 0.30, 95%CI 0.13 to 0.67, P = 0.004), and with a significant improvement in the scores on the Asthma Quality of Life Questionnaire (AQLQ) (MD 0.26, 95% CI 0.03 to 0.49, P = 0.03) in patients with eosinophilic asthma. There were no statistical differences between the groups with respect to FEV1, PEF, or histamine PC20 (all P>0.05), and a non-significant trend for improvement in scores on the Juniper Asthma Control Questionnaire (JACQ) (MD −0.21, 95% CI −0.43 to 0.01, P = 0.06) in the mepolizumab group was observed.ConclusionsMepolizumab reduces the risk of exacerbations and improves quality of life in patients with eosinophilic asthma, but no significant improvement in lung function outcomes was observed. Further research is required to establish the possible role of anti–IL-5 as a therapy for asthma.

The Effect of Educational and Modifying Intervention on Asthma Control among Adolescents: a Randomized Clinical Trial.

Controlling over allergens and environmental irritants is one of the essential elements of controlling asthma. Asthma control in adolescents is a challenge. The current study was performed with the goal of investigating the effect of an educational and modifying intervention about asthma triggers on asthma control among adolescents. The current study was a randomized clinical trial. 60 adolescents of 12-18 years of age participated in this study. The participants were randomly divided into the two control and experimental groups. The Juniper's Asthma Control Questionnaire was completed by the adolescents before and 5 weeks after the intervention. Training sessions, planning for modification of asthma triggers and telephone follow-up were performed in the experimental group. There was a significant difference between the asthma control score before and after the intervention in the control and experimental groups. The asthma control status improved in the experimental group. In other words, the educational interventions to modify asthma triggers were effective in improving asthma control. Since this intervention method can improve the asthma control in adolescents, it is recommended that adolescents directly participate in such programs about asthma triggers and the education become less parent-centred. Moreover, the necessity of such an intervention in clinics and outpatient clinics is emphasized.

Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial

Obesity and asthma are associated conditions; however, the mechanisms linking the two remain unclear. Few studies have examined the effects of weight loss on inflammation and clinical outcomes in obese-asthma. To compare the effects of weight loss achieved by dietary restriction, exercise or combined dietary restriction and exercise on airway inflammation and clinical outcomes in overweight and obese adults with asthma. Participants (n = 46; 54.3% female, body mass index (mean ± SD) 33.7 ± 3.5 kg/m(2) ) were randomized to complete a 10-week dietary, exercise or combined dietary and exercise intervention. Dual-energy x-ray absorptiometry was performed, the Juniper Asthma Control Questionnaire and Juniper Asthma Quality of Life Questionnaire completed and inflammatory markers, dietary intake and physical activity measured. The trial was registered with the Australian Clinical Trials Registry: ACTRN12611000235909. Retention was 82.6%. Mean ± SD weight loss was 8.5 ± 4.2%, 1.8 ± 2.6% and 8.3 ± 4.9% after the dietary, exercise and combined interventions respectively. Asthma control improved after the dietary (mean ± SD; -0.6 ± 0.5, P ≤ 0.001) and combined interventions (-0.5 ± 0.7, P = 0.040), whereas quality of life improved after the dietary [median (IQR); 0.9 (0.4, 1.3), P = 0.002], exercise [0.49 (0.03, 0.78), P = 0.037] and combined [0.5 (0.1, 1.0), P = 0.007] interventions. A 5-10% weight loss resulted in clinically important improvements to asthma control in 58%, and quality of life in 83%, of subjects. Gynoid adipose tissue reduction was associated with reduced neutrophilic airway inflammation in women [β-coefficient (95% CI); 1.75 (0.02, 3.48), P = 0.047], whereas a reduction in dietary saturated fat was associated with reduced neutrophilic airway inflammation in males (r = 0.775, P = 0.041). The exercise intervention resulted in a significant reduction to sputum eosinophils [median (IQR); -1.3 (-2.0, -1.0)%, P = 0.028]. This study suggests a weight-loss goal of 5-10% be recommended to assist in the clinical management of overweight and obese adults with asthma. The obese-asthma phenotype may involve both innate and allergic inflammatory pathways.

Measurement Characteristics of the Pediatric Asthma Health Outcome Measure

Introduction. The Pediatric Asthma Health Outcome Measure (PAHOM) was designed to measure quality-adjusted life years (QALYs) in children with asthma. Our objective was to compare parent- and child-reported PAHOM scores to each other, to parent-reported scores on the Juniper Asthma Control Questionnaire (ACQ), and to physician-rated asthma control. Methods. A convenience sample of primarily African-American parent–child dyads (N = 261) was recruited from asthma clinics between May 2008 and May 2010. Correlations and differences in scores between the instruments and respondents were compared across variables of interest. The sensitivity and specificity of each, relative to physician-rated asthma control, were estimated. Results. Mean (SD) parent- and child-reported PAHOM scores were significantly different, 0.91 (0.13) and 0.95 (0.08), respectively, (p < .01) and were weakly correlated (0.24). Parent-reported PAHOM and parent-reported ACQ, 5-item version (ACQ5) scores were moderately correlated (−0.69). Both the parent- and child-reported PAHOM scores distinguished between physician-rated well-controlled and not well-controlled asthma (p < .01 and p < .01, respectively). When compared with physician-rated asthma control, the areas under the receiver operating characteristic (ROC) curves for the parent-reported PAHOM and the ACQ5 were similar (p = .11), but both performed better than the child-reported PAHOM (both p < .01). Discussion. The validity of the PAHOM is supported by its moderate correlation with the ACQ and its association with physician-rated asthma control. Although intended to be administered to children, parent-reported scores were better predictors of physician-rated asthma control. Conclusions. A validation study in a more economically and ethnically diverse population is needed. Until then, we recommend the PAHOM to be administered to both parents and children.

Reliability, Validity, and Responsiveness of the Asthma Control Questionnaire among Pediatric Patients

The Juniper Asthma Control Questionnaire (ACQ) represents a concise, patient-centered tool for evaluating asthma control. It has been validated in the adult population but its validity among children is not as well-established. We hypothesize that the ACQ is a reliable, valid, and responsive tool for identifying poorly-controlled asthma among pediatric patients ages 6 to 17.

Disturbed Cytokine Production at the Systemic Level in Difficult-to-Control Atopic Asthma: Evidence for Raised Interleukin-4 and Decreased Interferon-γ Release following Lipopolysaccharide Stimulation

Background: Disturbed cytokine production is thought to govern inflammation in asthma, which, in its turn, may lead to uncontrolled disease. The aim of this study was to assess the relationship between cytokine production from blood leucocytes and the level of asthma control. Methods: We compared the production of interleukin (IL)-4, IL-6, IL-10, interferon (IFN)-γ and tumour necrosis factor-α from peripheral blood leucocytes in non-atopic healthy subjects (n = 22), atopic non-asthmatics (n = 10), well-controlled asthmatics [Juniper asthma control questionnaire (ACQ) score <1.5; n = 20] and patients with uncontrolled asthma despite inhaled or oral corticoids (ACQ score ≧1.5; n = 20). Fifty microlitres of peripheral blood was incubated for 24 h with RPMIc, lipopolysaccharide (LPS; 1 ng/ml) or phytohaemagglutinin (1 µg/ml), and cytokines were measured by immunotrapping (ELISA). Results: Both controlled and uncontrolled asthmatics as well as atopic non-asthmatics spontaneously produced more IL-4 than non-atopic healthy subjects (p < 0.001). IL-4 production induced by LPS was significantly greater (p < 0.05) in both asthma groups compared to atopic non-asthmatics and non-atopic healthy subjects. By contrast, IFN-γ release induced by LPS was lower in uncontrolled asthmatics than in non-atopic healthy subjects (p < 0.05) and controlled asthmatics (p < 0.05). IL-10 release after LPS was greater in uncontrolled asthmatics than in atopic non-asthmatics (p < 0.05). No difference was observed regarding other cytokines. Conclusion: Blood cells from patients with difficult-to-control atopic asthma display highly skewed Th2 cytokine release following LPS stimulation.

Effects of Obstructive Sleep Apnea and Gastroesophageal Reflux Disease on Asthma Control in Obesity

Background. Obesity is a risk factor for asthma. Obese asthmatics often have poor asthma control and respond poorly to therapy. It has been suggested that co-morbidities associated with obesity, such as reflux and obstructive sleep apnea, could be important factors contributing to poor asthma control in obese patients. Objectives. The purpose of this study was to determine if (1) reflux and/or (2) symptoms of sleep apnea contribute to poor asthma control in obesity. Methods. We studied asthmatic subjects participating in a trial of reflux treatment. Participants underwent baseline evaluation of asthma symptoms and lung function. Overall 304 participants underwent esophageal pH probe testing; 246 participants were evaluated for obstructive sleep apnea symptoms. Results. Of 402 participants in this trial, 51% were obese. Role of reflux in asthma control. Those with higher body mass index (BMI) reported a higher prevalence of reflux symptoms, but the prevalence of pH probe acid reflux was similar in all groups. Reflux was not associated with measures of asthma control in obese patients. Role of obstructive sleep apnea in asthma control. Symptoms and self-report of obstructive sleep apnea were more common with increasing BMI and associated with worse asthma control as measured by the Juniper Asthma Control questionnaire and Asthma Symptom Utility Index. Conclusions. Our data suggest that obstructive sleep apnea, but not gastroesophageal reflux disease, may contribute significantly to poor asthma control in obese patients.

The feasibility of a pragmatic randomised controlled trial to compare usual care with usual care plus individualised homeopathy, in children requiring secondary care for asthma

To test the feasibility of a pragmatic trial design with economic evaluation and nested qualitative study, comparing usual care (UC) with UC plus individualised homeopathy, in children requiring secondary care for asthma. This included recruitment and retention, acceptability of outcome measures patients' and health professionals' views and experiences and a power calculation for a definitive trial. In a pragmatic parallel group randomised controlled trial (RCT) design, children on step 2 or above of the British Thoracic Society Asthma Guidelines (BTG) were randomly allocated to UC or UC plus a five visit package of homeopathic care (HC). Outcome measures included the Juniper Asthma Control Questionnaire, Quality of Life Questionnaire and a resource use questionnaire. Qualitative interviews were used to gain families' and health professionals' views and experiences. 226 children were identified from hospital clinics and related patient databases. 67 showed an interest in participating, 39 children were randomised, 18 to HC and 21 to UC. Evidence in favour of adjunctive homeopathic treatment was lacking. Economic evaluation suggests that the cost of additional consultations was not offset by the reduced cost of homeopathic remedies and the lower use of primary care by children in the homeopathic group. Qualitative data gave insights into the differing perspectives of families and health care professionals within the research process. A future study using this design is not feasible, further investigation of a potential role for homeopathy in asthma management might be better conducted in primary care with children with less severe asthma.

The Madison Avenue effect: How drug presentation style influences adherence and outcome in patients with asthma

Little is known about how drug presentation influences medication adherence. To examine the effect of an educational program aimed at increasing expectations of treatment benefit on medication adherence. Data are analyzed from 99 participants who underwent electronic drug monitoring during the Trial of Asthma Patient Education, a randomized, placebo-controlled, multicenter trial. Participants with suboptimally controlled asthma were randomized to placebo or montelukast in conjunction with a presentation mode that was either neutral or designed to increase outcome expectancy. Adherence was monitored electronically over 4 weeks and was defined as ≥ 80% use of prescribed doses. Outcome expectancy, peak expiratory flow, prebronchodilator FEV₁, asthma control (Juniper asthma control questionnaire), and asthma-related quality of life were assessed at baseline and at the 4-week follow-up. Average electronic medication adherence was 69.9%. There was a significant interaction between presentation mode and drug assignment, with participants in the enhanced/montelukast group having a higher change in outcome expectancy (Δ 2.1 points; P < .001) and better medication adherence (odds ratio, 4.0; 95% CI, 1.1-14.3) compared with those in the neutral/placebo group. There was no difference in asthma symptoms, quality of life, or clinical outcomes on the basis of presentation mode. Rather, increased outcome expectancy was associated with modest improvements in asthma symptoms after adjusting for presentation mode, drug assignment, and medication adherence. The use of an enhanced presentation aimed at increasing outcome expectancy may lead to improved medication adherence.

Body Mass and Fat Mass in Refractory Asthma: An Observational 1 Year Follow-Up Study

Background. Asthma and obesity are common; however the impact of obesity upon asthma remains uncertain. Objectives. To assess relationships between obesity and fat mass with airway inflammation, lung function, and disease control in patients with refractory asthma. Methods. 151 refractory asthma patients were characterised for measures of airway inflammation, lung function, Juniper asthma control questionnaire (JACQ), body mass index (BMI), and fat mass index (FMI) derived from dual energy X-ray absorptiometry. Patients were reassessed over 12 months. Results. 74% of patients had an elevated BMI. BMI and FMI correlated (r = 0.9, P < .001). FMI and JACQ correlated in men (r = 0.3, P = .01). After 12 months 23% lost weight. Weight change over 12 months correlated with FEV1 change (r = −0.3, P = .03), but not with change in JACQ or exacerbations. Conclusion. Increased fat mass is common in refractory asthma and is associated with asthma symptom control in men. Loss of weight is associated with improvement in lung function in refractory asthma.