Management Of Chronic Asthma Research Articles

Cross-domain microbiomes: the interaction of gut, lung and environmental microbiota in asthma pathogenesis.

Recent experimental and epidemiological studies underscore the vital interaction between the intestinal microbiota and the lungs, an interplay known as the "gut-lung axis". The significance of this axis has been further illuminated following the identification of intestinal microbial metabolites, such as short-chain fatty acids (SCFA), as key mediators in setting the tone of the immune system. Through the gut-lung axis, the gut microbiota and its metabolites, or allergens, are directly or indirectly involved in the immunomodulation of pulmonary diseases, thereby increasing susceptibility to allergic airway diseases such as asthma. Asthma is a complex outcome of the interplay between environmental factors and genetic predispositions. The concept of the gut-lung axis may offer new targets for the prevention and treatment of asthma. This review outlines the relationships between asthma and the respiratory microbiome, gut microbiome, and environmental microbiome. It also discusses the current advancements and applications of microbiomics, offering novel perspectives and strategies for the clinical management of chronic respiratory diseases like asthma.

Knowledge on prevention and management of Chronic Obstructive Pulmonary Disease and Asthma among medical officers: a multi-centerpre and post-test study

Background: Despite Chronic Obstructive Pulmonary Disease (COPD) and Asthma being one of the leading causes of morbidity and mortality in India, knowledge about these diseases among healthcare professionals seems inadequate. Aims: This study aimed to assess the knowledge gained by medical and paramedical staff in the prevention and management of COPD and asthma following a two-day training program. Settings and methods: This quasi-experimental (before-after) study was carried out among medical and paramedical staff of public health systems of the government of India in three training centers in Maharashtra. Aquestionnaire was given in the form of a pre-test before a two-day training program. The training was comprised of prevention and management of COPD and asthma. After completion of training, a post-test was given, and scores were calculated. Statistical analysis: A two-tailed paired sample t-test was used to assess knowledge gain. P<0.05 was considered statistically significant. Results: A total of 77 participants completed both pre-test and post-test before and after the training programme. Twenty-Five (32.5%) were female and 52 (67.5%) were male. The mean age of participants was 42.7± 7.9 years. The majority (92.2%) of the participants were medical professionals. Only nine participants (11.7%) had ever attended a training program on COPD or asthma. The mean pre-test score was 14.68±3.88, while the mean post-test score was 25.60±6.52. There was a statistically significant improvement in knowledge scores at all three training centers, among both genders and across all qualifications (p<0.001). Conclusion: Adequate training of medical and para-medical staff in public health systems across the country can result in effective and timely diagnosis, treatment, and referral for patients with COPD and Asthma. This will ensure a reduction in the social and economic burden of disease.

The influence of novel coronavirus pneumonia on chronic disease management of asthma-a narrative review.

The coronavirus disease 2019 (COVID-19) pandemic has taken a huge global toll on all fronts, creating new challenges for the diagnosis and treatment of respiratory diseases. For chronic management of asthma, on the one hand, the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may affect the asthma disease itself; on the other hand, in order to control the spread of the pandemic, forced isolation, mask-wearing and various disinfection measures also have an impact on the condition and medication of asthma patients. This article reviews the changes in chronic asthma management under the COVID-19 pandemic to provide reference for chronic disease management of asthma after the pandemic and for various public health emergencies in the future. Online searching of literature was performed. The National Center for Biotechnology Information (NCBI), PubMed, Google Scholar, and EMBASE were searched. COVID-19 has had a huge impact on the world, and has also brought new challenges to the diagnosis and treatment of asthma and chronic disease management. On the one hand, the existence of the 2019 novel coronavirus directly affects the asthma disease itself, on the other hand, due to the particularity of the asthma disease itself, different levels of isolation and controls can cause patients with different degrees of medical difficulties; in addition, the application of various disinfectants in the environment also increases the risk of acute attacks of asthma patients, as well as mask-wearing, vaccination, anxiety about the disease, panic, etc., all of which have posed various degrees of impact on the condition and psychology of asthma patients. The pandemic of COVID-19 has brought many difficulties to the chronic disease management of asthma, and has had a certain impact on the disease control of asthma patients. In the era with overflowing information, internet hospital is the current trend, and there is a long way to go for effectively penetrating medical resources virtually via the internet into chronic disease management of asthma.

Real-World Effectiveness of Statin Therapy in Adult Asthma

Blood lipids affect airway inflammation in asthma. Although several studies have suggested anti-inflammatory effects of statins on asthmatic airways, further studies are needed to clarify the long-term effectiveness of statins on asthma control and whether they are an effective treatment option. To evaluate the long-term effectiveness of statins in the chronic management of adult asthma in real-world practice. Electronic medical record data spanning 28 years, collected from the Ajou University Medical Center in Korea, were used to conduct a retrospective study. Clinical outcomes were compared between patients with asthma who had maintained statin use (the statin group) and those not taking statins, whose blood lipid tests were always normal (the non-statin group). We performed propensity score matching and calculated hazard ratios with 95% CIs using the Cox proportional hazards model. Severe asthma exacerbation was the primary outcome; asthma exacerbation, asthma-related hospitalization, and new-onset type 2 diabetes mellitus and hypertension were secondary outcomes. After 1:1 propensity score matching, the statin and non-statin groups each included 545 adult patients with asthma. The risk of severe asthma exacerbations and asthma exacerbations was significantly lower in the statin group than in the non-statin group (hazard ratios [95% CI]= 0.57 [0.35-0.90] and 0.71 [0.52-0.96], respectively). There were no significant differences in the risk of asthma-related hospitalization or new-onset type 2 diabetes mellitus or hypertension between groups (0.76 [0.53-1.09], 2.33 [0.94-6.59], and 1.71 [0.95-3.17], respectively). Statin use is associated with a lower risk of asthma exacerbation, with better clinical outcomes in adult asthma.

A Preliminary Investigation of Mobile Respiratory Function Testing in Western Australian Communities

Although underutilized, spirometry is essential in the diagnosis and management of chronic obstructive pulmonary disease (COPD) and asthma. This study aimed to investigate a mobile (i.e., transportable) lung function testing (LFT) services in two metropolitan and two rural clinics in Western Australia. Individuals attending a mobile LFT clinic in 2021 were invited to complete questionnaires at baseline and after 6–8 weeks. Questionnaires were completed by 59/74 (79.7%) respondents (mean age 62.5 ± 14.2 years); most were female (35/59; 59.3%). A history of asthma was reported in 50.9% (30/59) and COPD in 18.6% (11/59) of respondents [13.6% (8/59) reported both]. At baseline, most (22/30; 73.3%) had asthma control test scores ≤19 (mean 16.6; range 8.0–25.0); at follow-up, 16/31 (51.6%) had scores ≤19 (mean score 18.0; range 6.0–25.0). Of the 11 diagnosed with COPD at baseline, the mean Clinical COPD Questionnaire and COPD assessment test scores were greater at follow-up (1.9 vs. 2.3; and: 10.3 vs. 14.7 respectively), reflecting worsening disease. Most participants (57/59; 96.6%) were satisfied with the LFT experience. The role of mobile LFT services to optimize the diagnosis and management of chronic lung disease and to minimize patient burden requires further investigation to improve short term patient outcomes.

Application of passive monitoring of nighttime respiratory symptoms in chronic asthma management

Application of passive monitoring of nighttime respiratory symptoms in chronic asthma management

Comparison of National and Global Asthma Management Guiding Documents.

Asthma is a common chronic disease that affects both adults and children, and that continues to have a high economic burden. Asthma management guidelines were first developed nearly 30 years ago to standardize care, maintain asthma control, improve quality of life, maintain normal lung function, prevent exacerbations, and prevent asthma mortality. The two most common asthma guidelines used today were developed by the National Asthma Education and Prevention Program (NAEPP) Expert Panel Working Group and the Global Initiative for Asthma Science Committee. Both guiding documents use scientific methodology to standardize their approach for formulating recommendations based on pertinent literature. Before the 2020 National Asthma Education and Prevention Program (Expert Panel Report 4), nothing had been released since the 2007 guidelines, whereas the Global Initiative for Asthma publishes updates annually. Although each of these asthma strategies is similar, there are some noted differences. Over the years, the focus of asthma treatment has shifted from acute to chronic management. Frontline respiratory therapists and other health-care providers should have a good understanding of these 2 guiding references and how they can impact acute and chronic asthma management. The primary focus of this narrative is to look at the similarities and differences of these 2 guiding documents as they pertain to the 6 key questions identified by the Expert Panel of the National Asthma Education and Prevention Program.

Efficacy of vitamin D supplementation on COPD and asthma control: A systematic review and meta-analysis.

The role of vitamin D (VD) in the management of chronic obstructive pulmonary disease (COPD) and asthma remains largely undetermined. In the present meta-analysis, we aimed to comprehensively investigate the efficacy of VD in the treatment of COPD and asthma according to the latest update. The PubMed, Embase, and Cochrane Library databases were searched from their inception to June 2, 2022. Randomized controlled trials (RCTs) comparing the efficacy of VD with placebo against COPD or asthma were included. A total of 11 RCTs consisting of 1183 COPD patients and 19 RCTs consisting of 2025 asthmatic patients were finally included. As for pulmonary function, FEV1/FVC was not changed significantly, while FEV1% was improved in the VD group. In the asthma subgroup, FEV1% was not changed significantly, while FEV1/FVC was improved in the VD group. For the questionnaire and rating scale, the mMRC (modified Medical Research Council) dyspnoea scale score for COPD and ACT (Asthma Control Test) score for asthma were not significantly changed, while the SGRQ (St. George's Respiratory Questionnaire) score for COPD was improved in the VD group. For inflammation indicators, IL-6 and IL-10 were statistically equivalent between the VD and placebo groups, while IgE, IL-5, and IL-10 (baseline VD deficiency subgroup) were improved in the VD group. The exacerbation, length of hospital stays, and mortality were statistically equivalent between the two groups. VD supplementation improved the indicators of asthma and COPD, especially in pulmonary function, SGRQ scores, IL-5, and IgE. The protocol could be found at PROSPERO with the registration number of CRD42020218058.

Framework and suggestions for kindergarten to third grade teachers in managing asthma and other related chronic illnesses

ABSTRACT Early childhood educator preparation program curricula contain limited course work and accompanying field experiences on chronic illness management and supporting young children with these conditions. The current study examines data from 319 kindergarten to third grade teachers from the southeastern United States and their perceptions of statewide resources, school supports, and professional learning surrounding chronic illness and asthma management in schools. Results indicated teachers were not aware of the statewide supports for understanding regulations and accessing policies to assist children with chronic illness and asthma and that teachers were not adequately prepared to support children with chronic illness in their classrooms. Preparation programs did not include specific standards or experiences for supporting and teaching children with chronic illness. Teachers identified in-service opportunities as the educational context where professional learning about chronic illness took place. Twenty percent of teachers did not have strategies in place nor a minimum level of knowledge about medical emergencies or First Aid/CPR. We present a framework for addressing chronic illness with specific suggestions for improved preparation for teachers to enhance the early learning experiences of children in their classrooms.

Independent risk factors of asthma exacerbations: 3-year follow-up in a single-center prospective cohort study.

Because minimizing future risk is the goal of asthma chronic asthma management, it is particularly important to identify risk factors. We conducted this 3-year single-center prospective cohort study to determine the independent risk factors of asthma exacerbations (AEs). We performed this prospective, longitudinal, observational study with a 3-year follow-up on 257 patients aged 18-81 years with at least a 1-year history of asthma. Follow-up visits are conducted through regular annual phone calls, and the primary endpoints were AE. The uncontrolled group was more likely to develop AE than the well-controlled group [odds ratio (OR): 6.34, 95% confidence interval (CI): 1.14-35.21, P<0.05]. Patients with low Asthma Quality of Life Questionnaire (AQLQ) scores were more likely to develop AE than these with high AQLQ scores (OR: 0.59, 95% CI: 0.35-0.99, P<0.05). AQLQ and Asthma Control Questionnaires (ACQ) were both strong independent risk factors within 3 years of enrollment; the cut-off values (COV) of the AQLQ and the ACQ (uncontrolled) that better evaluated the risk with the AE were ≤5.4 and >1, respectively. The AQLQ scores had a sensitivity of 79.07% and a specificity of 59.09% [area under curve (AUC): 0.70, P<0.0001], and the ACQ (uncontrolled) had a sensitivity of 81.4% and a specificity of 52.29% (AUC 0.68, P<0.0001). The findings of this study suggest that patients with uncontrolled asthma and a diminished health-related quality of life had an increased risk of exacerbations in the future. Defining these risk factors associated with AE is important as it will identify these at the highest risk to patients and may guide future interventions.

Optimising asthma care and greener inhaler prescribing

Journal of Prescribing PracticeVol. 4, No. 9 Calculation SkillsOptimising asthma care and greener inhaler prescribingJanice DaviesJanice DaviesE-mail Address: [email protected]Pharmacist Co-Course Leader – Non Medical Prescribing University of Central LancashireSearch for more papers by this authorJanice DaviesPublished Online:12 Sep 2022https://doi.org/10.12968/jprp.2022.4.9.386AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Greener Practice. How to reduce the carbon footprint of inhaler prescribing. 2021. https://s40639.pcdn.co/wp-content/uploads/Reducing-Carbon-Footprint-of-Inhaler-Prescribing-v3.3.2.pdf (accessed 24 August 2022) Google ScholarNational Institute of Health and Care Excellence. Asthma: diagnosis, monitoring and chronic asthma management. 2017. https://www.nice.org.uk/guidance/ng80 (accessed 24 August 2022) Google ScholarPrescqipp. Bulletin 295: Inhaler carbon footprint. https://www.prescqipp.info/our-resources/bulletins/bulletin-295-inhaler-carbon-footprint/ (accessed 24 August 2022) Google Scholar FiguresReferencesRelatedDetails 2 September 2022Volume 4Issue 9ISSN (print): 2631-8385ISSN (online): 2631-8393 Metrics History Published online 12 September 2022 Published in print 2 September 2022 Information© MA Healthcare LimitedPDF download

Stepping Down in Asthma

Beta-2-agonists continue to find a dominant role in all the current guidelines on the management of chronic persistent bronchial asthma. However, the safety of the drugs remains doubtful. Thus, there is a case for review of the "Step up-Step down" approach in the management of chronic persistent bronchial asthma. Based on the currently available experimental and clinical data on bronchial asthma, the authors are of the opinion that chronic persistent bronchial asthma is best managed by a modified "Step I-Step II" approach.

Updated GINA guidance on the management of chronic asthma

The GINA Global Strategy for Asthma Management and Prevention was updated in 2021 in light of new evidence. This article summarises the treatment recommendations and how they might predict the awaited new UK‐wide guidance from NICE, BTS and SIGN.

Pediatric Hospital Medicine Needs More Randomized Controlled Trials.

Pediatric Hospital Medicine Needs More Randomized Controlled Trials.

Caregiver Experiences Managing Persistent Childhood Asthma During the COVID-19 Pandemic.

COVID-19 has adversely affected child wellness, but it is unclear whether the pandemic led to changes in home management of chronic diseases like asthma. We surveyed 93 caregivers of children with persistent asthma from 2 ongoing asthma trials to measure changes in home asthma management, stressors, access to health care, and caregivers' worry about COVID-19 affecting their child's health. We conducted descriptive analyses, and assessed whether caregiver worry about COVID-19 was associated with asthma management, stressors, health care access, or recent symptoms. Most (80%) caregivers worried that COVID-19 would affect their child's health, and >50% restricted their child's physical activity to avoid asthma symptoms. We observed a dose-dependent relationship between increasing worry about COVID-19 and activity restrictions, financial hardship, difficulty obtaining asthma medications, and nocturnal asthma symptoms. These findings raise concern that children with persistent asthma may be at particular risk for weight gain and obesity-associated asthma morbidity due to the pandemic.

Monitoring of Nighttime Respiratory Patterns to Alert for Changes in Chronic Asthma Management

The frequency and severity of nighttime asthma symptoms may alert providers for the need to alter or reinforce the need for chronic asthma therapy. We hypothesized that the availability of this objective information could be used to achieve better asthma control and reduce adverse events.

Utility of Patient-Generated Health Data and Artificial Intelligence in the Prediction of Asthma Exacerbations

With the advent of the EMR, patient-generated health data (PGHD) has become more accessible, allowing for a patient-centered approach to the management of chronic asthma. Combined with artificial intelligence and remote monitoring, this data has the potential to predict asthma exacerbations and prognosis in individualized patient populations.

Guidelines for the management of asthma in adults and adolescents: Position statement of the South African Thoracic Society - 2021 update.

Asthma prevalence is increasing worldwide, and surveys indicate that most patients in developed and developing countries, including South Africa, do not receive optimal care and are therefore not well controlled. Standard management guidelines adapted to in-country realities are important to support optimal care. The South African Thoracic Society (SATS) first published a guideline for the management of chronic persistent asthma in 1992, which has subsequently been revised several times. The main aim of the present document was to revise and update SATS' statement on the suggested management of chronic asthma, based on the need to promote optimal care and control of asthma, together with the incorporation of new concepts and drug developments. This revised document reinforces optimal care and incorporates the following primary objectives to achieve the recent advances in asthma care: continued emphasis on the use of inhaled corticosteroids (ICS) as the foundation of asthma treatmentto reduce the reliance on short-acting beta-2 agonist (SABA) monotherapy for asthma symptomsto incorporate the evidence and strategy for the use of the combination of an ICS and formoterol for acute symptom relief (instead of a SABA)to incorporate the evidence and strategy for the use of as-needed ICS-long-acting beta agonists (LABA) for patients with infrequent symptoms or 'mild' asthmato incorporate the evidence and strategy for the use of a long-acting muscarinic antagonist (LAMA) in combination with ICS-LABA; andto incorporate the evidence and strategy for the use of and management with a biologic therapy in severe asthma.

Forthcoming UK asthma guidelines: an opportunity to improve asthma outcomes

The UK has a strong tradition of providing excellent, evidence-based asthma guidelines,1 and a totally inglorious one of having some of the worst asthma outcomes in the world.2 Addressing these poor outcomes must top the agenda for those taking forward the forthcoming UK National Institute for Health and Care Excellence (NICE), British Thoracic Society (BTS), and Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the diagnosis, monitoring, and management of chronic asthma.3 The challenge for the group developing these guidelines is to think radically, and produce a document that drives real change in outcomes, including mandating sanctions for non-compliance with new clinical practice recommendations.

Chronic obstructive pulmonary disease and asthma management in older patients.

How can I optimize chronic obstructive pulmonary disease (COPD) and asthma management in my older patients? The prevalence of COPD increases with age (20% to 30% in patients > 70), and asthma in the elderly is also common (> 10% of patients older than 60).[1][1] Accurate diagnosis is crucial but