Asthma Severity Levels Research Articles

Analysis of Health-related Quality of Life Determinants in Adult Ashmatic Patients in a District Hospital in East Jakarta

Background: Uncontrolled asthma leads to patients' poor outcomes and decreases health-related quality of life/HRQoL. Little research has been done to analyze the determinants of HRQoL in asthmatics patients. Objective: To determine asthma control and patients' compliance levels, and evaluate the appropriateness of medicine use and determinants of HRQoL. Methods: During this prospective study, adult asthmatic patients who currently experienced asthma attack were evaluated in asthma clinic of a district hospital in Jakarta and administered study questionnaires. Demographic variables and data related to asthma control, patients' compliance level and the appropriate use of medications were summarized using descriptive statistics. The determinants of HRQoL were determined using bivariate and multivariate regression analysis. All data were analyzed using SPSS version 22.0. Results: There were 11 males and 43 females aged approximately 45 years old. More than 50% of the patients had uncontrolled asthma and low level compliance to their medications. Nearly all medicines used were inappropriate according to National Asthma Treatment Guideline. Bivariate correlation test revealed four factors which significantly determined the total score of HRQoL, namely asthma duration (P=0.033), asthma control level (p=0.007), asthma severity level (p=0.001) and the presence of smoke exposure in neighbourhood (p=0.032). Further, multivariate analysis showed only the presence of smoke exposure significantly affecting patients' quality of life. Conclusion: This study uncovered the majority of patients had uncontrolled asthma status and low level of compliance to their medications. In addition, this study highlighted the exposure of smoke exposure as the solely determinant of HRQoL amongst asthmatic patients.

Personalized Prediction of Asthma Severity and Asthma Attack for a Personalized Treatment Regimen.

Control of asthma is critical for disease management and quality of life. Asthma treatment depends on the patient demographic information (e.g., age), and disease severity, which is determined by: (1) how symptoms affect a patient's daily life, (2) measured lung function, and (3) estimated risk of having an asthma attack. In this paper, we will present the Tensorflow Text Classification (TC) method to classify a patient's asthma severity level. We will also propose a Qlearning method to train an agent through trials and errors to improve the prediction accuracy and create a personalized treatment regimen for asthma patients.

Documentation of quality measures for patients discharged from the hospital with an acute asthma exacerbation

Background: Acute asthma exacerbations are one of the most common diagnoses admitted to pediatric hospitals nationwide. Despite the frequency of admissions for acute asthma exacerbations, opportunities exist for improvement in asthma quality measures. Objective: The specific aims of this QI project were by December 2015 to increase to greater than 90% for patients admitted with asthma on the following measures: 1) Documentation of the chronic level of asthma severity 2) If tobacco smoke exposure screen is positive, smoking cessation counseling provided 3) Documentation of …

Clinical effect of corticosteroids in asthma-affected horses: A quantitative synthesis.

There are limited findings from low-powered studies based on few number of subjects with equine asthma. Furthermore, no studies have been performed to assess a meaningful clinically detectable impact of corticosteroids in equine asthma. To assess and compare the clinical effect of inhaled and systemic corticosteroids in equine asthma and identify a quantitative clinical score suitable to assess the Minimal Important Difference (MID), expressed as the Minimally Clinically Detectable Difference (MCDD). Pair-wise and network meta-analysis. Literature searches for studies on corticosteroid therapy in equine asthma were performed. The risk of publication bias was assessed by Funnel plots and Egger's test. The effect on changes in clinical scores vs. control was analysed via random-effects models and Bayesian networks. Corticosteroids significantly improved the clinical condition (Standardised Mean Difference: -1.52, 95% CrI -2.07 to -0.98; P<0.001 vs. control). No difference was detected between inhaled and systemic corticosteroids with regard to the changes in clinical scores (Relative Effect: 0.08, 95% CrI -1.45 to 1.32; P = 0.8). An Improved clinically Detectable Equine Asthma Scoring System (IDEASS) indicated that corticosteroids improved the clinical condition of asthmatic horses by 30% compared with controls (IDEASS value: -2.36, 95% CI -3.39 to -1.33; P<0.001). A one-point change in IDEASS represented the MCDD in equine asthma. Moderate quality of evidence for systemic corticosteroids. Inhaled corticosteroids are effective in improving the clinical condition of horses with equine asthma and prevent exacerbations. Systemic corticosteroids should be used only in selected cases with symptomatic airway hyperresponsiveness during exacerbation. IDEASS requires further validation but may represent a suitable approach to rank the level of asthma severity and assess the clinical effect of pharmacotherapy in horses with equine asthma.

Biomarkers related to respiratory symptoms and lung function in adults with asthma

Background: There is a need for easily measurable biomarkers that are able to identify different levels of asthma severity. Aim: To assess the association between peripheral blood cell counts, fractional nitric oxide in exhaled air (FeNO), urinary biomarkers of oxidative stress (8-hydroxy-2′-deoxyguanosine and 8-isoprostane), and asthma severity in adult patients from the general population. Methods: In the Gene Environment Interactions in Respiratory Diseases study, 287 subjects with asthma (aged 20–64) were identified from the general population in Verona (Italy) (2008–2010). Self-reported asthma attacks, asthma-like symptoms and the use of hospital services in the past year were synthesized in a score of respiratory symptoms (SRS). The association of biomarkers with SRS and lung function measures (pre-bronchodilator FEV1% predicted and FEV1/FVC) was assessed using quasi-Poisson and Gaussian regression models, respectively. Results: Eosinophils (ratio of expected scores: RES[95%CI] = 1.19[1.09,1.30]), basophils (RES[95%CI] = 1.24[1.10,1.40]), lymphocytes (RES[95%CI] = 1.27[1.12,1.45]) and FeNO (RES[95%CI] = 1.18[1.02,1.37]) were positively associated with SRS. However, only eosinophils (RES[95%CI] = 1.15[1.02,1.30]) and lymphocytes (RES[95%CI] = 1.25[1.06,1.47]) showed an independent association. Furthermore, eosinophils (change in the expected outcome for 1-SD increase: CEO[95%CI] = −1.18[−2.09, −0.27]%), basophils (CEO[95%CI] = −1.24[−2.16, −0.33]%) and lymphocytes (CEO[95%CI] = −1.07[−1.99, −0.14]%) were individually, but not independently, associated with FEV1/FVC. Finally, neutrophils were negatively associated with FEV1% predicted (CEO[95%CI] = −2.22[−4.00, −0.44]%). Conclusions: We identified a pattern of association between a set of biomarkers and asthma endotypes in adult patients from the general population, which could improve understanding of the heterogeneity and severity of the disease and could be useful in defining targeted therapeutic approaches.

Review of Infrared Carbon-Dioxide Sensors and Capnogram Features for Developing Asthma-Monitoring Device

Introduction: Asthma is one of the most common heterogeneous respiratory chronic diseases and fourteenth most imperative illness in the world in terms of duration and extent of disability. The existing method for early identification of asthma is based on health care provider’s physical assessment and spirometer or peak flow meter which is manual and unreliable if patients are non-cooperative. Therefore, capnography, which measured the respired carbon dioxide concentration, has been proposed as a patient independent method for the assessment of asthma. Aim: This study aims to critically review, investigate, and compare the specifications of different infrared CO2 sensors and capnogram features to develop an asthma-monitoring device. Materials and Methods: A rigorous and extensive search was carried out on Google scholar, the Web of Science, PubMed, and Scopus and several index terms (CO2 sensor, infrared sensor, CO2 measurement, asthma detection, capnograph, and capnogram) were employed to identify appropriate CO2 sensors, technology, and capnogram features to develop asthma monitoring device. Results: The review revealed that the COMET CO2 sensor is the most suitable and reliable for developing a capnograph device owing to its weight (7 g), output range (0-99 mmHg), warm-up time (2-15 s), and response time (0.028 s). Furthermore, slope and time-frequency components measured from alveolar phase and complete breath cycle respectively are found the most significant features to screen asthma severity level. Further, the effects of pressure and temperature on CO2 values were tested using Proteus software. Finding reveals that the CO2 values changed drastically from 17,835.19 parts per million (ppm) to 86,321.29 ppm as the pressure changed from 16.53 kPa to 81.53 kPa at a constant temperature (25°C). With a change in temperature from 25 to 27°C, the CO2 values were found to change from 16,812.19 ppm to 17,249.13 ppm at a constant pressure (16.53 kPa). Based on the review, a CO2 measurement device using COMET equivalent CO2 sensor was developed. Conclusion: The developed device is capable of the assessment of cardiorespiratory condition instead of asthma severity level due to lack of significant capnogram features, which still remains to be integrated into the device.

Using medication utilization information to develop an asthma severity classification model

BackgroundClaims data are currently widely used as source data in asthma studies. However, the insufficient information in claims data related to level of asthma severity may negatively impact study findings. The present study develops and validates an asthma severity classification model that uses medication utilization in Taiwan National Health Insurance claims data.MethodsThe National Health Insurance Research Database was used for the years 2006–2012 and included a total of 7221 patients newly diagnosed with asthma in 2007 for model development and in 2008 for model validation. The medication utilization of patients during the first year after the index date was used to classify level of severity, and the acute exacerbation of asthma during the second through fourth years after the index date was used as the outcome variable. Three models were developed, with subjects classified into four, three, and two groups, respectively. The area under the receiver operating characteristic curve (AUC) and the Kaplan-Meier survival curve were used to compare the performances of the classification models.ResultsIn development data, the distribution of subjects and acute exacerbation rate among the stage 1 to stage 4 were: 62.71%, 5.54%, 22.79%, and 8.96%, and 8.17%, 9.55%, 11.97%, and 14.91%, respectively. The results also showed the higher severity groups to be more prone to being prescribed oral corticosteroids for asthma control, while lower severity groups were more likely to be prescribed short-acting medication and inhaled corticosteroid treatment. Furthermore, the results of survival analysis showed two-group classification was recommended and yield moderate performance (AUC = 0.671). In validation data, the distribution of subjects, acute exacerbation rates, and medication uses among stages were similar to those in development data, and the results of survival analysis were also the same.ConclusionsUnderstanding asthma severity is critical to conducting effective, scholarly research on asthma, which currently uses claims data as a primary data source. The model developed in the present study not only overcomes a gap in the current literature but also provides an opportunity to improve the validity and quality of claims-data-based asthma studies.

Polymorphisms in inflammasome genes and risk of asthma in Brazilian children

Considering its role in inflammation and recently described “alternative” roles in epithelial homeostasis and Th1/Th2 balance, we hypothesize that inflammasome genetics could contribute to the development of asthma. Selected functional polymorphisms in inflammasome genes are evaluated in a cohort of asthmatic children and their families.Gain-of-function NLRP1 variants rs11651270, rs12150220 and rs2670660 resulted significantly associated to asthma in trios (TDT) analysis; and rs11651270 and rs2670660 also with asthma severity and total IgE level in asthmatic children. NLRP1 activators in humans are still unknown, however we hypothesized that individuals with gain-of-function SNPs in NLRP1 could be more prone in activating inflammasome in the presence of asthma-related cell stressors (i.e. ER stress or ROS), and this activation contribute to exacerbate inflammatory response and asthma development.Gain-of-function IL1A rs17561 resulted significantly associated with a reduced pulmonary capacity in asthmatic children. IL18 rs5744256 which lead to lower serum level of IL-18 appeared to be associated to a worse response to bronchodilators.Concluding, this work provides evidences about the contribution of inflammasome genetics in the development of paediatric asthma, both considering its inflammatory role in alveolar macrophages (i.e.: NLRP1) or its homeostatic role in lung epithelial cells (i.e.: IL1A, IL18).

Fibromyalgia as a cause of uncontrolled asthma: a case–control multicenter study

Background: Fibromyalgia can affect the control of asthma when both diseases are present in a single patient.Objectives: To characterize asthma in patients with concomitant fibromyalgia to assess whether fibromyalgia is an independent factor of asthma severity that influences poor asthma control. We also evaluated how dyspnea is perceived by patients in order to demonstrate that alterations in the perception of airway obstruction may be responsible for poor asthma control.Methods: This was a cross-sectional case–control multicenter study, in which 56 patients in the asthma and fibromyalgia group were matched to 36 asthmatics by sex, approximate age, and asthma severity level. All patients were women. Study variables included the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), the Nijmegen hyperventilation syndrome questionnaire, the Hospital Anxiety and Depression Scale, and perception of dyspnea after acute bronchoconstriction.Results: Although patients in both study groups showed similar asthma severity and use of anti-asthmatic drugs, patients in the asthma and fibromyalgia group showed lower scores on the ACT and MiniAQLQ questionnaires, and higher scores of anxiety and depression as well as hyperventilation compared to asthma patients without fibromyalgia. All these differences were statistically significant.Conclusions: Fibromyalgia in patients with asthma influences poor control of the respiratory disease and is associated with altered perception of dyspnea, hyperventilation syndrome, high prevalence of depression and anxiety, and impaired quality of life.Clinical implications: Fibromyalgia may be considered a risk factor for uncontrolled asthma in patients suffering from asthma and fibromyalgia concomitantly.

Work-related asthma in a sample of subjects with established asthma.

To assess the impact of occupational exposure to irritants or sensitizers on the occurrence, recrudescence and worsening of asthma and to identify unrecognized cases of work related asthma (WRA) including Work-Exacerbated Asthma (WEA) and Occupational Asthma (OA), in a general asthma clinic population sample. The study was a population-based cross sectional survey. 1289 asthmatic subjects (from 15 to 46yrs old) living in a vast district of Tuscany (Italy) were identified from the Medical Reimbursement Register of the National Health System. 893 subjects agreed to take part in the study. Subjects who were currently working or had worked in past were classified in different categories of occupational risk exposure (No, Low or High) according to the italian standard classification for industries and job titles, associated with the judgment of occupational hygiene experts. 41% of subjects worked in industries and in job titles at risk for exposure to airway irritants and/or sensitizers, 48.6% reported an occupational exposure to gases, dust and fumes, more males than females. Prevalence of WEA and OA was higher in subjects who worked at higher risk exposure; these subjects reported a higher prevalence of markers of asthma severity (asthma control, level of treatment, FEV1) than subjects without WRA. Risk of WEA was significantly associated to female gender, older age, and self-reported exposure, while risk of OA was associated to job title with higher exposure risk to occupational asthmogens. Our study shows a high prevalence of WRA (especially WEA) associated with employment in industries and job titles at risk for airways sensitizers and/or irritants; data also support a role for occupational exposure in determining a poor asthma control and a higher level of asthma severity.

Health Care Utilization and Direct Costs in Mild, Moderate, and Severe Adult Asthma: A Descriptive Study Using the 2014 South Korean Health Insurance Database

PurposeAlthough asthma exacerbation comprises a large burden of the total asthma-related costs, few studies have examined the frequency and cost of acute exacerbation according to asthma severity. This study investigated asthma-related health care utilization and costs according to the severity of asthma. MethodsWe conducted a descriptive study using the national health insurance claims database between January 1 and December 31, 2014. We included adult patients with asthma (18 years of age and older) who had ≥2 claims with for an asthma diagnosis and were prescribed ≥1 asthma medications. They were classified into 3 asthma severity levels (level 1 = mild, level 2 = moderate, and level 3 = severe), based on individual medication prescriptions. Acute exacerbation was defined as having a corticosteroid burst, an emergency department visit, or hospitalization. Health care utilization, acute exacerbation, and direct costs associated with asthma were compared according to asthma severity levels. FindingsOf the 36,687 adult asthma patients, level 1 had the largest proportion of patients (81.2%), followed by level 2 (18.2%), and level 3 (0.6%). The average number of asthma-related outpatient visits was 4.5 for level 1, 7.2 for level 2, and 11.9 for level 3 (P < 0.01). The estimated asthma-related direct cost per patient was $174 for level 1, $634 for level 2, and $1635 for level 3 (P < 0.01). The number of patients who experienced acute exacerbation increased as asthma severity increased: level 1, 22.6%; level 2, 26.0%; and level 3, 48.7% (P < 0.01). Direct costs associated with asthma exacerbation dramatically increased and accounted for 15.1% of the total cost in level 1 patients, 19.5% in level 2 patients, and 40.8% in level 3 patients (P < 0.01). ImplicationsThe direct costs of acute exacerbation increased as asthma severity increased. In patients with severe asthma, acute exacerbation and the relative cost ratio in South Korea were higher than those in other countries. Proper management is required to avoid acute exacerbations and to reduce the burden of asthma, particularly in patients with severe asthma.

Clinical Roles of Lung Volumes Detected by Body Plethysmography and Helium Dilution in Asthmatic Patients: A Correlation and Diagnosis Analysis

Roles of lung volumes in asthma remain controversial. We aimed to evaluate the efficacy of lung volumes in differentiating asthma severity levels. Consecutive outpatients with chronic persistent asthma were enrolled, and body plethysmography (BP) and helium dilution (HD) were performed simultaneously to extract RV%pred, TLC%pred, and RV/TLC. Significant negative correlations were found between FEV1%pred and RV%pred (r = −0.557, P < 0.001), TLC%pred (r = −0.387, P < 0.001), and RV/TLC (r = −0.485, P < 0.001) measured by BP, as well as difference in volumes between these two techniques (ΔRV%pred, ΔTLC%pred and ΔRV/TLC). In mild and moderate asthma, AUC of RV%pred detected by BP and ΔTLC%pred was 0.723 (95%CI 0.571–0.874, P = 0.005) and 0.739 (95%CI 0.607–0.872, P = 0.002) with sensitivity and specificity being 79.41% and 88.24%, and 65.22% and 56.52% at cut-off of 145.40% and 14.23%, respectively. In moderate and severe asthma, AUC of RV%pred detected by BP and ΔTLC%pred was 0.782 (95%CI 0.671–0.893, P < 0.001) and 0.788 (95%CI 0.681–0.894, P < 0.002) with sensitivity and specificity being 77.78% and 97.22%, and 73.53% and 52.94% at cut-off of 179.85% and 20.22%, respectively. In conclusion, lung volumes are reliable complement of FEV1 in identifying asthma severity levels.

Classification of Asthma Severity and Medication Using TensorFlow and Multilevel Databases

Escalating cost of treating chronic diseases demand that they be, to the extent possible, self-managed by the patients. In self-management of disease an imperative is to predict, the possible future state of morbidity (at time, T¹), given the present precursor conditions (at time, Tº) and expected precursor condition (at time, T¹).This paper reports the results of a study to evaluate the potential use of using TensorFlow and Inpatient Databases at national level and hospital level for predicting the asthma severity. Methods of Deep Neural Networks (DNN) have been deployed in classification of morbidity conditions, as well as treatment options. The results indicate that training a DNN to predict asthma severity level or the imminence of an asthma attack is possible.

Overexpression of programmed cell death 5 in a mouse model of ovalbumin-induced allergic asthma

BackgroundProgrammed cell death 5 (PDCD5) was first identified as an apoptosis-promoting protein and involved in some autoimmune diseases and inflammatory processes. Our previous study demonstrated greater expression of serum PDCD5 in asthmatic patients than controls. This study aimed to further explore the significance of PDCD5 in mice with induced allergic asthma.MethodsWe divided 16 female mice into 2 groups: control (n = 8) and allergen (ovalbumin, OVA)-challenged mice (n = 8). The modified ovalbumin inhalation method was used to generate the allergic asthma mouse model, and the impact of OVA was assessed by histology of lung tissue and morphometry. The number of cells in bronchoalveolar lavage fluid (BALF) was detected. Pulmonary function was measured by pressure sensors. PDCD5 and active caspase-3 levels were detected.ResultsThe expression of PDCD5 was higher with OVA challenge than for controls (p < 0.05). PDCD5 level was correlated with number of inflammatory cells in BALF and lung function. Moreover, active caspase-3 level was increased in the OVA-challenged mice (p < 0.001) and correlated with PDCD5 level (p = 0.000).ConclusionsThese data demonstrate an association between level of PDCD5 and asthma severity and indicate that PDCD5 may play a role in allergic asthma.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0317-y) contains supplementary material, which is available to authorized users.

The asthma-anxiety connection

BackgroundThe literature reports a significant association between various mental disorders and asthma, in particular depression and/or anxiety, with some more robust data regarding anxiety disorders. However, the nature of this association remains largely unclear. Objectives(1) To test the hypothesis of a specific association of anxiety and depressive disorder (according to the DSM-IV) with asthma and (2) to test the bidirectional hypothesis of causality between asthma and psychiatric disorders. MethodsNinety-six adults were compared with 96 control subjects matched according to main socio-demographic variables (i.e., gender, age, marital status, cohabiting/non-cohabiting, and BMI). Subjects with asthma were divided according to GINA and ACT classifications. All subjects underwent Structured Clinical Interviews for DSM-IV Axis I (SCID-I) diagnosis. ResultsSignificant association between asthma and lifetime anxiety disorders emerged (OR 3.03; p = 0.003); no significant association with other psychiatric diagnosis emerged. Moreover, lifetime and current anxiety were associated with asthma severity levels (p < 0.01 and p = 0.001 based on age). Asthma preceded anxiety in 48% of cases; in 52% of cases, anxiety preceded asthma, without significant group differences. The risk of asthma, particularly of severe, uncontrolled forms (p < 0.01), resulted higher in lifetime anxiety disorder patients (p = 0.003 and p = 0.001 based on age at onset). Current anxiety increased the risk of asthma, and that of an uncontrolled form (p < 0.05). Asthma increased the risk of lifetime anxiety disorders (p = 0.002 and p = 0.018 using ages). Intermittent asthma increased the risk of lifetime and current anxiety disorders (p < 0.01). ConclusionsAnxiety disorders, in particular Lifetime Anxiety Disorders, represent the only psychiatric disorder significantly associated with asthma, with a possible bidirectional, anxiety-asthma relationship, each of which can be caused or result from the other.

Self-perceived Sleep Quality and Quantity in Adults With Asthma: Findings From the CosteAsma Study.

Nocturnal asthma symptoms are associated with poor sleep quality, excessive daytime sleepiness, and poor daytime functioning. The aim of this study was to describe self-perceived sleep quality and quantity in asthmatic adults in a real-world setting according to different determinants of patient health status. A cross-sectional, observational, seasonal, multiwave survey was designed. Allergists nationwide were asked to consecutively survey adult asthmatics aged 18 to 65 years, evenly distributed by seasons and asthma severity (Global Initiative for Asthma criteria). Sleep quality and quantity were assessed using the self-administered Medical Outcomes Study (MOS) Sleep Scale. The Asthma Control Test was applied to ascertain the degree of asthma symptom control. A total of 1098 individuals (58.7% females, 41.2 [13.6] years) were analyzed. Asthma severity was associated with poor sleep quality and quantity; patients with more severe disease scored higher on the MOS Sleep Scale (P<.001) and also reported significantly fewer daily average hours of sleep (0.3-0.5 hours, P<.001). Level of symptom control and asthma severity were both associated with poor sleep quality and quantity, with the following mean MOS sleep problem index scores: 25.3 (fully controlled asthma), 26.4 (controlled), 32.6 (partly controlled), and 44.6 (uncontrolled) (P<.001), and 48.4 (severe asthma), 39.0 (moderate), 32.6 (mild), and 26.5 (intermittent) (P<.001). Sex was significantly associated with the summary MOS sleep problem index. Sleep quality and quantity was significantly associated with poor health status in asthmatic patients. Guidelines should recommend asking about nocturnal asthma symptoms and encourage clinicians to take a global sleep history. Better control of nocturnal asthma symptoms could lead to improved sleep quality and a decrease in daytime sleep-related symptoms.

Pattern of vitamin D in patients with chronic obstructive pulmonary diseases and in patients with bronchial asthma

ObjectiveTo determine the prevalence of vitamin D deficiency in patients with COPD and bronchial asthma, and the relation of vitamin D serum levels to pulmonary spirometric measures as well as other important clinical parameters that could affect quality of life in these patients. Subjects and methodsThe study included 80 subjects: 30 patients with COPD and 30 patients with bronchial asthma and 20 healthy volunteers. Patients and control groups were subjected to vitamin D assay by ELISA as well as spirometric assessment. Assessment of patients with COPD was done according to GOLD guidelines 2013: using (mMRCs), CAT score, spirometric assessment of FEV1, and exacerbation assessment. They were also subjected to Combined COPD assessment and BODE index calculation. For all patients with bronchial asthma, GINA classification 2014 of bronchial asthma severity and asthma control assessment were done. ResultsStatistically significant lower values of vitamin D were found in patients with COPD (11.94±7.66ng/ml) compared to patients with bronchial asthma (22.03±8.19ng/ml) with p<0.001, while mean±SD values of 25-hydroxy vitamin D of both groups of patients (COPD and bronchial asthma) were statistically significant lower than control group (35.21±6.04ng/ml) with (p2, p3<0.001) respectively. Seventeen patients that is to say (56.7%) of patients with COPD and 11 patients that is to say (36.7%) patients with bronchial asthma demonstrated a mild to moderate degree of vitamin D deficiency, whereas 13 that is to say (43.3%) patients of COPD and 4 that is to say (13.3%) patients with bronchial asthma showed severe deficiency and all control subjects (n=20) had a normal concentration of 25-hydroxy vitamin D. Statistically significant positive correlation was found between serum level of 25-hydroxy vitamin D and FEV1% of predicted in patients with COPD with (p=0.002), whereas no statistically significant correlation was found between serum level of 25-hydroxy vitamin D and FEV1% of predicted in patients with bronchial asthma with (p=0.120). Statistically significant negative correlations existed between serum level of 25-hydroxy vitamin D and exacerbation risk of patients with COPD and bronchial asthma with (rs=−0.481 and p=0.007), and (rs=−0.496 and p=0.005), respectively. Statistically significant negative correlations were found between serum level of 25-hydroxy vitamin D and exacerbation risk of patients with COPD and bronchial asthma with (rs=−0.481 and p=0.007), and (rs=−0.496 and p=0.005), respectively. Regarding relation between vitamin D level and grading severity of COPD, we found a significant correlation between serum 25-hydroxy vitamin D level and severity of COPD as assessed by GOLD spirometric classification, with decreased serum level of vitamin D as gold severity increased (19.12±4.37, 9.97±7.64, 8.21±5.72ng/ml) in gold I, II, III respectively with p=0.012. Also it was found that CAT score increased and got worse as serum level of vitamin D decreased (16.65±6.98, 8.68±2.27, 9.01±5.67ng/ml) in categories II, III, IV respectively with rs=−0.468 and p=0.034, and according to Combined COPD assessment, vitamin D levels were (19.78±4.66, 17.38±4.59, 6.75±4.77, 7.56±5.83ng/ml) in groups A, B, C and D respectively with rs=−0.448 and p=0.001. A statistically significant negative correlation was found between serum 25-hydroxy vitamin D level and BODE index score of COPD assessment with rs=−0.421, p=0.020. According to the correlation of bronchial asthma severity and control to serum level of 25-hydroxy vitamin D, we found a statistically significant negative correlation between mean±SD of serum level of 25-hydroxy vitamin D and different levels of asthma control with (rs=−0.636, p<0.001) as well as a statistically significant negative correlation between quantification of 25-hydroxy vitamin D and levels of asthma severity with (rs=−0.875, p<0.001). ConclusionVitamin D deficiency was highly prevalent in COPD and bronchial asthma (100% and 50%) respectively. Low levels of vitamin D were associated with low FEV1%, frequent exacerbations in patients with COPD and bronchial asthma, and increased COPD severity as assessed by GOLD guidelines. Important statistically significant negative associations between vitamin D level and both asthma control and asthma severity according to GINA classification were also found. Thus it is advised to include vitamin D levels in the routine assessment of patients with bronchial asthma and COPD, as well as studying the importance and clinical impact of oral supplementation of vitamin D in patients with COPD and bronchial asthma should be an important goal of future research.

Assessment of Asthma Control and Severity among Children According to Global Initiative for Asthma Guidelines in Sulaimani City-Iraq

Background: Asthma is a common and potentially serious chronic disease that imposes a substantial burden on patients, their families and the community. Objective: Assessment of the level of asthma control and severity in asthmatic children in Sulaimani city according to the global initiative for asthma (GINA) guidelines. Methods: A cross-sectional study of 82 patients who are known cases of asthma, aged 5 – 15 years , from 1st of March 2014 to 1st of August 2014. Results: Out of 82 patients in our study, 20.8%were classified as having intermittent asthma all of them have well controlled asthma, 42.7% of those classified as having mild persistent asthma 65.7% of them have well controlled asthma, 26.8% of those classified as having moderate persistent asthma 54.5% of them have partly controlled asthma, and 9.8%of those classified as having severe persistent asthma the majority of them 87.5% have uncontrolled asthma and none of them reached to the controlled asthma level according to GINA guidelines. Regarding the peak expiratory flow (PFT) we notice that 58.8% of asthmatic children who were classified as having intermittent severity, their PEF measurements ranged between 160- 250 l/min while those with severe persistent asthma 75% of them have readings between 50-150 l/min. Conclusion: Current levels of asthma control in the Sulaimani city fall far short of the goals specified in the GINA guidelines for asthma management. Also there is a strong correlation between PEF measurements and the level of asthma severity,

Asthma Trigger Reports Are Associated with Low Quality of Life, Exacerbations, and Emergency Treatments.

Despite the importance of trigger perceptions for asthma diagnosis and management, associations among asthma triggers, affective disorders, and asthma outcome have received little attention. Because anxiety and depression are known to influence patients' health reports, we measured and controlled for these affective disorders in analyzing associations among patient perceptions of asthma triggers and asthma treatment outcomes. Patients from a nationally representative sample of respiratory specialist practices (N = 459) were assessed for clinically significant anxiety and depression and completed questionnaires on asthma triggers, quality of life, and asthma control. Physicians recorded exacerbation and emergency treatment frequencies in the prior year, spirometric lung function, and allergy test results. Hierarchical multiple regressions examined associations among reported trigger factors, anxiety, depression, and asthma outcomes, including quality of life, asthma control, exacerbations, emergencies, and spirometry. Patients across asthma severity levels were well represented. Anxiety and depression were associated with more frequent nonallergic, in particular psychological, triggers. Controlling for demographics, asthma severity, anxiety, and depression, nonallergic asthma triggers (including psychological triggers) explained substantial portions of variance in asthma control (total of 19.5%, odds ratios [ORs] = 2.07-1.37 for individual triggers), asthma-related quality of life (total of 27.5%, ORs = 3.21-1.49), and general quality of life (total of 11.3%, ORs = 1.93-1.55). Psychological triggers were consistently associated with exacerbations and emergency treatments (ORs = 1.96-2.04) over and above other triggers and affective disorders. Spirometric lung function was largely unrelated to perceived asthma triggers. Patients' perceptions of asthma triggers are important determinants of asthma outcomes, which can help identify individuals at risk for suboptimal asthma management.

Asthma Control in Primary Care

Method: Forty-seven patients were included in the study. Patients’ asthma control was assessed through asthma clinic from January 2012 to December 2012. Data collected included age, sex, smoking, allergy, level of control, Peak Expiratory Flow Rate (PEFR), asthma control test (ACT), and level of asthma severity at the beginning and end of 2012. This asthma clinic utilized The Global Initiative for Asthma (GINA) guidelines in the management of asthma along with recent treatment of asthma, which include combined inhaled corticosteroid (ICS) and long acting beta agonist (LABA).