Long-term Management Of Asthma Research Articles

Evaluation of asthma control after reinforcement of proper inhaler techniques in a tertiary care center in northern India.

Asthma is an obstructive lung disease with high prevalence. Symptom control in asthma remains poor despite significant advancements in treatment guidelines and inhalational devices. This is often attributed to inadequate patient adherence to the inhaler technique and insufficient education on its long-term use. Through this study, we aimed to assess the impact of reinforcement of proper inhaler technique on asthma symptom control and quality of life. A prospective cohort of 400 asthma patients using dry powder inhalers and metered dose inhalers was recruited in the outpatient clinic of our hospital. At the time of recruitment, the correctness of inhaler technique usage was assessed, and the pre-test Inhaler Technique Score (ITS) was recorded for each patient. Then, a ten-step inhalation technique was taught through demonstration, and the post-test ITS score was recorded again. This was done for each patient at monthly intervals for 3 months. Along with it, two tailored questionnaires, the Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire (AQLQ), were administered at each visit to assess disease control and quality of life. Significant enhancements in inhalation technique were noted from the first to the third visit using the ten-step inhalation usage scores, which improved from 6.91 to 9.87 (out of 10) (p<0.001), paralleled by ACT score increases from 17.06 to 19.37 (out of 25) (p<0.001) from visits one to two, and from 19.37 to 20.52 (out of 25) (p<0.001) from visits two to three, signifying improvement in symptom control. Quality of life similarly improved from 4.45 to 5.12 to 5.45 (out of 7) (p<0.001) across the three visits as assessed by AQLQ. In conclusion, promoting proper inhaler technique through structured education programs is crucial for optimizing long-term asthma management and enhancing patients' quality of life.

The Miasmatic Approach in the Management of Bronchial Asthma in Homoeopathy

Bronchial asthma is a chronic obstructive disease of airways affecting bronchi, resulting in bronchoconstriction, tightening of chest and airway inflammation. Asthma remains a disease with clearly unsatisfactory therapeutics. With the mounting evidence in support of asthma being an inflammatory illness, anti-inflammatory agents have now become prerequisite for the long-term management of asthma. Along with anti-inflammatory agents, there is a need to search for other effective therapies to treat every aspect of the disease. Although asthma is a global disease, there are important differences in epidemiology, clinical spectrum and management practices in India.

The Anti-Inflammatory Reliever (AIR) Algorithm Study: a protocol for a single-group study of an AIR stepwise approach to the treatment of adult asthma.

The stepwise approach to long-term asthma management, which traditionally incorporates short-acting β2-agonist reliever therapy, has been a core feature of asthma guidelines for over 30 years. There have been no studies, however, directly investigating the use of an entire guideline-recommended track. Recently, inhaled corticosteroid-formoterol has been recommended as the preferred reliever therapy in adult asthma, in accordance with a stepwise "Anti-Inflammatory Reliever" (AIR) treatment track. The aim of this study was to evaluate the AIR stepwise approach recommended by the New Zealand adolescent and adult asthma guidelines, in combination with a novel algorithm for transitioning between treatment steps. This 52-week, open-label, single-group study will recruit 100 adults aged 18 to 75 years with mild, moderate and moderate-severe asthma (ACTRN12620001010987). Participants will be allocated to budesonide-formoterol 200/6 µg, one actuation as needed (Step 1), one actuation twice daily and as needed (Step 2), or two actuations twice daily and one as needed (Step 3). Treatment steps will be adjusted throughout the study, in response to reliever use and asthma attacks, according to a stepwise AIR algorithm. Following a 26-week period of investigator-led transitions, participants will adjust their own treatment step. The primary outcome is participant satisfaction as measured by the Global Satisfaction score of the Treatment Satisfaction Questionnaire for Medication. Secondary outcomes will assess efficacy and safety, and describe patterns of medication use and participant flow through the treatment steps. This is the first trial to assess the AIR treatment track and algorithm. The results will provide knowledge to guide the clinical use of this approach.

Extreme long-term management and objective evaluation of asthma ~Protecting the Quality of Life of Asthmatic Children Now and in the Future~

Extreme long-term management and objective evaluation of asthma ~Protecting the Quality of Life of Asthmatic Children Now and in the Future~

Recent Advances in Long-Term Management of Asthma.

Asthma is one of the most common chronic diseases of childhood with significant morbidity. Management of asthma has evolved from inhaled corticosteroids to personalized therapy in recent years. This article summarizes the recent advances in the management of asthma. The severity of asthma is assessed retrospectively by the level of treatment required to control asthma symptoms.Recently, there has been an emphasis on not to use short-acting beta-2 agonist (SABA) alone, even for intermittent or mild asthma. Single maintenance and reliever therapy (MART) is increasingly being recommended. Asthma therapy should be personalized based on phenotype (clinical presentations) and endotypes (distinct mechanistic pathways) of asthma and by a continuous cycle of assessment of asthma control and risk assessment, treatment, and reviewing the response in children on treatment. Various add-on therapy like tiotropium and biological monoclonal antibodies have been approved for use in a subset of children with severe asthma. Before considering biologicals, it is vital to have a proper diagnosis, good compliance and inhaler technique, and treatment of comorbidities.

Research progress on icariin, a traditional Chinese medicine extract, in the treatment of asthma.

Bronchial asthma is a common chronic airway disease, and long-term management of asthma is the focus and challenge of clinical treatment. Glucocorticoids are often used as the first choice for the treatment of asthma. However, the occurrence of hormone dependence, hormone resistance, and local and systemic adverse reactions caused by hormone application also creates problems for the treatment of asthma. Finding new, safe, and effective therapeutic drugs is an important research direction at present. Icariin is an effective ingredient of the traditional Chinese medicine, Epimedium. It has various biological attributes such as anti-inflammatory and antioxidative activities, and immune regulation. It has high safety and a wide range of clinical applications. Icariin has the characteristics of multitargeted intervention in the treatment of asthma. Here, we review the specific mechanisms of icariin in treating asthma, and icariin is considered a novel therapy in controlling asthma; however, the mechanism is still worth further investigation.

Commentary on Japanese Pediatric Guideline for The Treatment and Management of Asthma 2020 Chapter 7 Long-term Management of Childhood Asthma

Commentary on Japanese Pediatric Guideline for The Treatment and Management of Asthma 2020 Chapter 7 Long-term Management of Childhood Asthma

Pulmonary Rehabilitation in Patients with Chronic Obstructive Airway Diseases

Pulmonary rehabilitation of asthma and COPD patients can improve their physical performance and quality of life, maintain participation in social and professional life and actively promote self-help. In addition, the resources for acute medical treatment can be spared. In case of COPD, rehabilitation directly after exacerbation can also improve the poor survival prognosis and reduce the risk of emergency hospital readmission. Therefore, pulmonary rehabilitation is an essential component of evidence-based long-term management of both bronchial asthma and, in particular, COPD. In the German healthcare system, however, pneumological rehabilitation is offered only for a small fraction of patients. Despite a very good evidence of pulmonary rehabilitation, especially in COPD patients, their share in all rehabilitation services is remarkably low. It does not even amount to 3 % of all medical rehabilitation measures approved by the German Pension Insurance.

PBI1 Liberty Asthma Traverse Dupilumab Shows Sustained Efficacy and Improvements in Asthma Control and Health-Related Quality of Life (HRQOL) in Patients with Moderate-to-Severe Asthma

Achieving asthma control and improving HRQoL are important long-term asthma management goals. Dupilumab, a monoclonal antibody targeting IL-4/IL-13, is approved for management of moderate-to-severe asthma. We report effects of long-term use of dupilumab on asthma control and HRQoL outcomes from the TRAVERSE open-label extension (OLE) study (NCT02134028) in patients who completed a previous dupilumab asthma study. 5-item Asthma Control Questionnaire (ACQ-5) and overall Asthma Quality of Life Questionnaire (AQLQ) scores up to 48 weeks of OLE in patients with moderate-to-severe asthma who had participated in the DRI (24-week) or QUEST (52-week) studies and received add-on dupilumab 300 mg q2w during the OLE were evaluated in the overall ITT population and type 2 asthma population (defined as blood eosinophils ≥150 cells/mL or FeNO ≥25 ppb at parent study baseline [PSBL]). A within-patient change of ≥0.5 in ACQ-5 or AQLQ score was considered clinically meaningful. 2,062 patients from DRI and QUEST were enrolled. ACQ-5 and AQLQ scores improved throughout the OLE. Mean (SD) ACQ-5 scores at PSBL for placebo-dupilumab/dupilumab-dupilumab patients in DRI and QUEST were 2.63(0.77)/2.74(0.80) and 2.73(0.74)/2.76(0.79), respectively; at Week 48 of OLE, mean (SD) change from baseline was −1.33(1.07)/−1.57(1.11) and −1.64(1.08)/−1.69(1.08). Mean (SD) AQLQ scores at PSBL for placebo-dupilumab/dupilumab-dupilumab patients in DRI and QUEST were 4.27(1.12)/3.98(1.10) and 4.25(1.01)/4.29(1.08), respectively; at Week 48 of OLE, mean (SD) change from baseline was 1.07(1.13)/1.40(1.19) and 1.39(1.17)/1.40(1.18). Similar efficacy was observed in DRI/QUEST patients with type 2 asthma. The safety profile during the OLE was similar to that observed in the overall populations of the parent studies. Asthma control and HRQoL in patients with moderate-to-severe asthma continued to improve with dupilumab and were sustained over the long-term treatment duration of the OLE study.

Analytical methods for estimation of Budesonide in bulk and in Pharmaceutical dosage forms: A Review

Budesonide is a potent glucocorticoid with a high local anti-inflammatory effect and low systemic bioavailability. The inhaled form is used in the long-term management of asthma and chronic obstructive pulmonary disease. Several analytical methods including UV, HPLC, LC-MS techniques has been developed for Budesonide alone and in combination with others. Methods indicating HPLC bioanalytical method, stability indicating HPLC method, ion pairing chromatographic method and chemometrics assisted HPLC methods are also described for Budesonide. For qualitative and quantitative estimation of Budesonide these analytical methods can be used. The following study describes reported analytical methods of Budesonide.

Task-shifting to improve asthma education for Malawian children: a qualitative analysis

BackgroundAsthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced asthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.MethodsWe conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.ResultsPrior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.DiscussionAsthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.Trial registration The RCT was registered in the Pan African Clinical Trials Registry: PACTR201807211617031

Achieving equitable management of allergic disorders and primary immunodeficiency in a Black, Asian and Minority Ethnic population

Achieving equitable management of allergic disorders and primary immunodeficiency in a Black, Asian and Minority Ethnic population

Biological Therapies of Severe Asthma and Their Possible Effects on Airway Remodeling.

Asthma is a chronic and heterogenic respiratory tract disorder with a high global prevalence. The underlying chronic inflammatory process and airway remodeling (AR) contribute to the symptomatology of the disease. The most severely ill asthma patients may now be treated using a variety of monoclonal antibodies aiming key inflammatory cytokines involved in asthma pathogenesis. Although clinical data shows much beneficial effects of biological therapies in terms of reduction of exacerbation rates, improvement of lung functions, asthma control and patients' quality of life, little is known on the effects of these monoclonal antibodies on AR—a key clinical trait of long-term asthma management. In this review, the authors summarize the data on the proven effects of monoclonal antibodies in asthma on AR. To date, in terms of reversing AR, the mostly studied was omalizumab. However, some studies also addressed this clinical issue in context of other severe asthma biological therapies (mepolizumab, benralizumab, tralokinumab). Still, data on effects of particular biological therapies on AR in severe asthma are incomplete and require further studies. According to the American Thoracic Society research recommendations, future research shall focus on AR in asthma and improve drugs targeting AR, including the available and future monoclonal antibodies.

New validated stability indicating RP-UFLC method for the determination of Budesonide

Budesonide is a glucocorticoid used in the long-term management of asthma and chronic obstructive pulmonary disease (COPD). Also used to prevent difficulty breathing, chest tightness, wheezing and coughing caused by asthma. A new stability indicating RP-UFLC method has been developed and validated for the determination of Budesonide in pure and pharmaceutical dosage forms. Shimadzu Model CBM-20A/20 Alite UFLC system (Shimadzu Co., Kyoto, Japan) equipped with SPD M20A prominence photodiode array detector on Agilent C18 column was used with a mobile phase consisting of formic acid and ACN (25: 75, v/v) and flow rate 1.2 ml/min (UV detection at 247 nm). Budesonide obeys Beer-Lambert's law over a concentration range of 10–100 μg/ml. The linear regression equation was found to be y = 35317x + 3515.8 (r2 = 0.9999). The LOD and LOQ was found to be and 2.913 and 8.7643 μg/ml. Budesonide was subjected to forced degradation and the method was validated as per ICH guidelines.

Real-world evaluation of the clinical safety and efficacy of fluticasone/formoterol FDC via the Revolizer® in patients with persistent asthma in India

The combination of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABAs) is widely used for the management of asthma. This prospective, open-label, non-comparative, observational, 24-week multicentre study is the first real-world study from India to compare the efficacy and safety of fixed-dose combination of fluticasone/formoterol (Maxiflo® 100/6 mcg or 250/6 mcg) capsules via the Revolizer® device in patients with persistent asthma. The primary efficacy analyses included mean change in Asthma Control Test (ACT™) at 4, 8, 16 and 24 weeks. Secondary efficacy analyses included mean change in morning and evening peak expiratory flow rate (PEFR) at the end of 4, 8, 16 and 24 weeks, number of patients having symptom-free days and nights at the end of 4, 8, 16 and 24 weeks, the number and severity of exacerbations over 24 weeks and response to the Usability Preference Satisfaction Confidence questionnaire after 1 week. Overall, 385 (of 401; 96.01%) enrolled patients completed the study. The mean change in ACT™ score was 6.7 ± 3.71 (95% CI: 6.32, 7.06; p < 0.0001) at week 24. The ACT™ score at weeks 4, 8 and 16 showed progressive and statistically significant increase from baseline. A statistically significant improvement in morning and evening PEFR at weeks 4, 8, 16 and 24 was reported. The proportion of patients experiencing symptom-free days and nights continuously increased from baseline to week 24. A good safety profile over the 24-week period was observed. The Revolizer® device was preferred by 94.26% patients over their current device. Fluticasone propionate/formoterol fumarate FDC capsules administered via a single-dose dry powder inhaler ([DPI], (Revolizer®) offers a novel, well-tolerated and effective treatment option for the long-term management of asthma.

THE ROLE OF YOGA THERAPY IN THE MANAGEMENT OF BRONCHIAL ASTHMA (TAMAKA SHWASA)

Objective: The present study was conducted on patients taken from Swasthavrutta department of Gujarat Ayurved University in Jamnagar town, Gujarat. The study was done with an objective of providing a safe and reliable as well as cost-effective natural management of symptoms occurring in patients of bronchial asthma. This is also done to reduce the various harmful effects of modern medicines among the patients and to reduce the use and dependency on inhalers.&#x0D; Methods: Thirty-two patients with bronchial asthma (Tamaka Shwasa) underwent training for 16 weeks in an integrated set of yoga exercises, including prayer, strengthening exercises, Yogasanas (including standing Asana, prone Asana, sitting Asana, and supine Asana), Pranayama (Nadi Shodhana, Ujjayi, Bhramari, and Aumkara Dharana), and Shuddhi Kriya (to be done once in a week) which includes Kunjal, Sutraneti, and Kapalabhati. The patients were told to practice these exercises for 60 min daily.&#x0D; Results: Significant improvement was seen in the patients who undergone yogic interventions. There was significant improvement in the duration of Shwasakashtata, frequency of Shwasakashtata, reduction in taking number of emergency medicine, Pinasa, Kaphashtheevana, cough, Ghurghuraka, orthopnea, Parshvashula, Lalate Sweda, result on peak expiratory flow rate, airway exchange catheters, oxyhemoglobin saturation, and chest expansion.&#x0D; Conclusion: From the study, it can be concluded that yoga practices can be opted as long-term management of bronchial asthma, but its beneficial effects need to be studied in more details on large sample size.

School-aged asthma children with high fractional exhaled nitric oxide levels and lung dysfunction are at high risk of prolonged lung dysfunction.

BackgroundLong-term management of bronchial asthma based on the fractional exhaled nitric oxide (FeNO) value alone is not conclusive yet. Therefore, we combined FeNO testing and spirometry, a commonly used test in routine practice, to evaluate acute exacerbation and respiratory function in children with bronchial asthma.ObjectiveWe combined FeNO testing and spirometry, commonly used in routine practice, to evaluate acute exacerbations and respiratory function in children with bronchial asthma.MethodsSubjects were school aged children 7 years and older with bronchial asthma who underwent FeNO testing in January 2015 to May 2016. We evaluated the changes in the frequency of acute exacerbations and respiratory function in the 30 subsequent months. Subjects were divided into 2 groups: those with initial FeNO levels ≥ 21 parts per billion (ppb) (high FeNO) and < 20 ppb (normal FeNO) groups.ResultsThere were 48 children (33 boys) in the high FeNO group and 68 children (46 boys) in the normal FeNO group. Spirometry was conducted on 83 children (72%) prior to the initial FeNO test, revealing no difference in the ratio of detecting lung dysfunction between the 2 groups. The observation period was 25.8 ± 0.7 and 24.7 ± 0.6 months for the high and normal FeNO groups, respectively. The children in the high FeNO group with lung dysfunction in the initial FeNO test continued to exhibit lung dysfunction at the test at 30 months. In the normal FeNO group, even if lung dysfunction was observed at the initial FeNO, it improved within the 20-month point, and the improvement was maintained thereafter.ConclusionChildren with bronchial asthma with high FeNO levels and lung dysfunction are at a higher risk of prolonged lung dysfunction.

Assessment of predictors for acute asthma attack in asthmatic patients visiting an Ethiopian hospital: are the potential factors still a threat?

BackgroundRecurrent exacerbations in patients with moderate or severe asthma are the major causes of morbidity, mortality and medical expenditure. Identifying predictors of frequent asthma attack might offer the fertile ground of asthma management. However, systematic data on asthma management is scarce in Ethiopia.ObjectiveThe purpose of the present study was to determine predictors of acute asthma attack in patients with asthma attending emergency department of University of Gondar Comprehensive Specialized Hospital (UOGCSH) in Gondar, northwestern Ethiopia.MethodsAn institutional-based cross-sectional self-administered survey was conducted on 108 asthmatic patients who came to the emergency department of UOGCSH following acute asthma attack. Data were collected through interviewer administered questionnaire. Logistic regression was done to see the possible association of potential factors that may lead to asthma exacerbation.ResultAbout half of the respondents (51.9%) were female and one third of patients (38.9%) were within the age range of between 46 and 60 years. The leading potential predictor were frequent exposure to various ongoing allergen (68.5%) followed by revelation to occupational sensitizers (67.6%). Chronic sinusitis (AOR = 3.532, 95% CL = 1.116–11.178), obstructive sleep apnea (AOR = 3.425, 95% CL = 1.255–9.356) and psychological disfunctioning (3.689 (1.327–10.255)) were among the significantly associated factors of acute asthma exacerbation.ConclusionsNow days, the backbone for long-term asthma management is to prevent exacerbations. Chronic sinusitis, obstructed sleep apnea and psychosocial dysfunction were originated to be considerably linked with repeated exacerbations of asthma. Among those significantly associated predictors, obstructed sleep apnea were the most prevalent one.

What is New in the Management of Childhood Asthma?

Asthma still causes considerable morbidity and mortality globally and minimal improvement has been seen in key outcomes over the last decade despite increasing treatment costs. This review summarizes recent advances in the management of asthma in children and adolescents. It focuses on the need for personalized treatment plans based on heterogenous asthma pathophysiology, the use of the terminology ‘asthma attack’ over exacerbation to instill widespread understanding of severity, and the need for every attack to trigger a structured review and focused strategy. The authors discuss difficulties in diagnosing asthma, accuracy and use of Fractional exhaled nitric oxide both as second line test and as a method to monitor treatment adherence or guide the choice of pharmacotherapy. The authors discuss acute and long-term management of asthma. Asthma treatment goals are to minimize symptom burden, prevent attacks and (where possible) reduce risk and impact of progressive pathophysiology and adverse outcomes. The authors discuss pharmacological management; optimal use of short acting β2 agonists, long acting muscarinic antagonist (tiotropium), use of which is relatively new in pediatrics, allergen specific immunotherapy, biological monoclonal antibody treatment, azalide antibiotic azithromycin, and the use of vitamin D. They also discuss electronic monitoring and adherence devices, direct observation of therapy via mobile device, temperature controlled laminar airflow device, and the importance of considering when symptoms may actually result from dysfunctional breathing rather than asthma.

Effect of long-term asthma management on asthma patients from China-Japan Friendship Hospital

Objective: To investigate the outcome of long-term asthma management of China-Japan Friendship Hospital. Methods: A face-to-face, questionnaire-based survey was carried out in outpatient department in 30 general hospital (including China-Japan Friendship Hospital) from Oct 2015 to May 2016. Data of demographic characteristics, asthma control, asthma management, asthma attacks and self-management, disease perception was collected. Results from China-Japan Friendship Hospital were compared to the national mean level within the same period. Results: Altogether 150 asthmatic outpatients were recruited from China-Japan Friendship Hospital. Asthma control level was significantly higher than the national asthma control level[56.7% (85/150) vs 28.5% (1 099/3 854), P<0.001]. The rate of hospitalizations due to asthma exacerbations was significantly lower than the national hospitalization rate[13.3% (20/150) vs 26.4% (1 017/3 858), P<0.001]. The rate of peak flow meter (PFM) usage was significantly higher than the national PFM usage rate[50.7% (76/150) vs 10.1% (388/3 837), P<0.001]. For reasons of not using PFM, the proportion of doctors never introduced was lower than the national level[43.3% (65/150) vs 65.2% (2 518/3 860), P<0.001]. As to the choice of anti-asthmatics when symptoms deteriorated, the proportion of inhaled corticosteroid (ICS)+ formoterol was significantly higher than the national level[70.0% (105/150) vs 45.8% (1 776/3 875), P<0.001]. The proportion of the patients that had right perception on disease nature was significantly higher than the national level[78.7% (118/150) vs 69.0% (2 660/3 857), P=0.011]. The proportion of the patients that had right perception on medication choice on daily-used first-line medication for chronic asthma was significantly higher than the national level[70.7% (106/150) vs 60.2% (2 321/3 857), P=0.010]. Conclusion: The level of asthma control, disease management and disease perception in China-Japan Friendship Hospital are much higher than national level due to the conduction of long-term asthma management.