Mean Asthma Control Test Score Research Articles

The effectiveness of subcutaneous immunotherapy in allergic diseases of children and adults

ObjectivesImmunotherapy is the gradual administration of increasing doses of allergens to reduce or eliminate the patient's adverse clinical response following exposure to these allergens. The goal of the current study was to evaluate the effectiveness of subcutaneous immunotherapy in patients with allergic diseases referred to the Bushehr Asthma and Allergy Clinic, Iran. Materials and methodsPatients with respiratory allergic diseases, who had positive skin prick test, randomly enrolled in this observational study and underwent immunotherapy for one year. To evaluate the efficacy of immunotherapy, two questionnaires were completed for all the patients before and one year after the start of immunotherapy, including the Total Nasal Symptom Score (TNSS) and Asthma Control Test (ACT). ResultsA total of 878 patients with asthma or allergic rhinitis disorder [53.6% (n=471) male and 46.4% (n=407) female] with a median (IQR) age of 28.0 (12.0–35.0) years were randomly enrolled in this observational study. Five hundred forty-nine patients (64.8%) were over 18 years old and 298 patients (33.9%) were under 18 years old, the age of the other patients was not known. The median (IQR) duration of disease was 84.0 (36.0–138.0) months. Rinithis allergy had most frequent than asthma [39.9% (n=350) vs. 22.2% (n=195), respectively] and 218 patients (24.8%) have both of them. After the treatment, 234 patients (54.5%) completely stop and 26.3% patient (n=113) used less than half of the drugs. The mean TNSS (n=259) and ACT (n=186) scores for patients had significant difference before and after immunotherapy [13.64 vs. 5.68, P<0.001; 7.91 vs. 17.43, P<0.001, respectively]. ConclusionThe mean TNSS and ACT score before and after the treatment significantly improved the patients’ symptoms. To conclude, standard immunotherapy can be effective in patients with moderate to severe allergic rhinitis and mild to moderate persistent allergic asthma to reduce clinical symptoms.

Digital Self-Management Platform for Adult Asthma: Randomized Attention-Placebo Controlled Trial.

Asthma is one of the most common chronic conditions worldwide, with a substantial individual and health care burden. Digital apps hold promise as a highly accessible, low-cost method of enhancing self-management in asthma, which is critical to effective asthma control. We conducted a fully remote randomized controlled trial (RCT) to assess the efficacy of juli, a commercially available smartphone self-management platform for asthma. We conducted a pragmatic single-blind, RCT of juli for asthma management. Our study included participants aged 18 years and older who self-identified as having asthma and had an Asthma Control Test (ACT) score of 19 or lower (indicating uncontrolled asthma) at the beginning of the trial. Participants were randomized (1:1 ratio) to receive juli for 8 weeks or a limited attention-placebo control version of the app. The primary outcome measure was the difference in ACT scores after 8 weeks. Secondary outcomes included remission (ACT score greater than 19), minimal clinically important difference (an improvement of 3 or more points on the ACT), worsening of asthma, and health-related quality of life. The primary analysis included participants using the app for 8 weeks (per-protocol analysis), and the secondary analysis used a modified intention-to-treat (ITT) analysis. We randomized 411 participants between May 2021 and April 2023: a total of 152 (37%) participants engaged with the app for 8 weeks and were included in the per-protocol analysis, and 262 (63.7%) participants completed the week-2 outcome assessment and were included in the modified ITT analysis. Total attrition between baseline and week 8 was 259 (63%) individuals. In the per-protocol analysis, the intervention group had a higher mean ACT score (17.93, SD 4.72) than the control group (16.24, SD 5.78) by week 8 (baseline adjusted coefficient 1.91, 95% CI 0.31-3.51; P=.02). Participants using juli had greater odds of achieving or exceeding the minimal clinically important difference at 8 weeks (adjusted odds ratio 2.38, 95% CI 1.20-4.70; P=.01). There were no between group differences in the other secondary outcomes at 8 weeks. The results from the modified ITT analyses were similar. Users of juli had improved asthma symptom control over 8 weeks compared with users of a version of the app with limited functionality. These findings suggest that juli is an effective digital self-management platform that could augment existing care pathways for asthma. The retention of patients in RCTs and real-world use of digital health care apps is a major challenge. International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN87679686; https://www.isrctn.com/ISRCTN87679686.

Benralizumab in Severe Eosinophilic Asthma and Chronic Rhinosinusitis with Nasal Polyps: The Real-World, Multi-Country RANS Observational Study.

Real-world evidence of benralizumab effectiveness on nasal polyps (NP) and asthma outcomes in patients with severe eosinophilic asthma (SEA) and comorbid chronic rhinosinusitis with NP are limited. The objective of this study was to assess NP and asthma outcomes in benralizumab-treated patients with SEA and comorbid NP in a real-world setting. RANS was a retrospective, multi-country observational study (ClinicalTrials.gov: NCT05180357) using medical chart reviews of adults with SEA and comorbid NP. Total NP Score (NPS), SinoNasal Outcome Test-22 (SNOT-22) total score, annualized exacerbation rate (AER), and 6-item Asthma Control Questionnaire (ACQ-6) and Asthma Control Test (ACT) scores during the 12 months pre-index (baseline) and post-index (follow-up) were measured. Clinically meaningful improvement from baseline following treatment, in terms of total NPS (≥1-point reduction), SNOT-22 total (≥8.9-point reduction), ACQ-6 (≥0.5-point reduction) or ACT (≥3-point increase) scores, were reported. A total of 233 patients were included. Baseline mean (standard deviation [SD]) NPS and SNOT-22 total scores were 3.8 (2.4) and 47.5 (22.6), respectively. The mean change (95% confidence interval [CI]) from baseline was -1.2 (-1.7, -0.6) for NPS, and -19.8 (-23.6, -15.9) for SNOT-22. The AER (95% CI) was 1.2 (0.96, 1.41) at baseline and 0.2 (0.13, 0.28) at follow-up. Mean (SD) ACQ-6 and ACT scores were 1.6 (1.3) and 15.0 (5.2) at baseline and 0.8 (1.0) and 22.0 (3.9) at follow-up, respectively. The proportion of patients who achieved clinically meaningful improvements in NPS, SNOT-22 total, ACQ-6, and ACT scores was 49.1%, 67.6%, 56.6%, and 81.1%, respectively. In this real-world study, improvements in NP and asthma outcomes in patients with SEA and comorbid NP were observed during the 12 months following benralizumab initiation.

The Association of Food Insecurity With Asthma Control in Adults During COVID-19.

Food insecurity has been associated with poorer asthma control in children, but research lacks in adults. To assess the frequency of food insecurity and its association with asthma control in adults during the coronavirus disease 2019 pandemic. An online cross-sectional survey study was conducted in US adults with asthma. Survey questions included how worried or concerned participants were about food security since the pandemic. Asthma control was assessed using the Asthma Control Test, with uncontrolled asthma defined as Asthma Control Test score less than or equal to 19. Self-report of food insecurity since the pandemic was assessed. Food insecurity variables were dichotomized into high insecurity (≥3) or low insecurity (<3). Descriptive statistics and bivariate analyses were performed. Of the total participants (N= 866), 82.79% were female; mean age of participants was 44 ± 15.05 years, their mean Asthma Control Test score was 19.25 ± 4.54, and 18.48% had high food insecurity. Participants with high food insecurity were more likely to have uncontrolled asthma (74.38%) compared with those with lower food insecurity (34.99%; P < .01). The relationship between asthma control and food insecurity remained significant after adjusting for age, education, sex, race, anxiety, and living stability concerns due to the pandemic. Food insecurity exists in adults with asthma and is associated with uncontrolled asthma. Providers should consider screening their patients for food insecurity when treating individuals with uncontrolled asthma.

Effectiveness and Treatment Compliance of Salmeterol-Fluticasone Easyhaler® Among Patients with Asthma, COPD, or Asthma-COPD Overlap Syndrome: Real-World Study Findings.

For inhalation therapies to be effective, it is crucial that patients manage inhaler use correctly in their everyday life and achieve treatment compliance. We investigated the effectiveness of the salmeterol-fluticasone propionate Easyhaler® (SF EH) device-metered dry powder inhaler in a real-world setting in Hungary among adult patients with asthma, chronic obstructive pulmonary disease (COPD), or asthma-COPD overlap syndrome (ACO). A prospective, open-label, multicenter, noninterventional, investigator-sponsored study was conducted in outpatient pneumonology centers. Eligible patients were aged ≥ 18years with either a new diagnosis of asthma, COPD, or ACO, or whose disease was not controlled with preexisting medication. Data were collected at baseline and 12 + 4weeks, including the asthma control test (ACT), COPD assessment test (CAT), spirometry parameters [including forced expiratory volume for 1s (FEV1)], and physician- and patient-reported outcomes. Five hundred sixteen patients were recruited from 103 centers: 376 with asthma; 104 with COPD; and 36 with ACO. At week 12, there were significant improvements from baseline in both mean ACT score in patients with asthma (14.4 ± 4.2 versus 21.4 ± 2.8; P < 0.001) and mean CAT score in patients with COPD (24.0 ± 6.1 versus 16.0 ± 5.8; P < 0.001). Significant improvement was observed when the switch from the most frequently used previous inhalers was analyzed separately. Mean FEV1 improved from 76.0% ± 17.2 to 84.7% ± 16.1 (P < 0.001) and from 53.8% ± 15.0 to 59.9% ± 15.0 (P < 0.001) in patients with asthma or COPD, respectively. The study demonstrated improved physician-rated overall treatment compliance and patient preference for the SF EH over 3months use compared with previous inhaler treatment, with patients effectively adopting the SF EH into everyday life. Treatment with SF EH significantly improved patients' lung function parameters and disease control.

Real-life Effectiveness of Omalizumab in Patients with Severe Allergic Asthma: RELIEF Study.

Patients with severe allergic asthma (SAA) are at risk of severe exacerbations. Omalizumab is recommended as an add-on treatment for patients with uncontrolled SAA, despite high-dose inhaled corticosteroids and long acting β2-agonist combination therapy (standard therapy).RELIEF was a prospective, open label, multicenter study conducted to assess the real-life effectiveness of omalizumab co-administered with standard therapy in patients with SAA for 24 months. A total of 347 patients aged ≥ 6 years with SAA were enrolled, 285 of whom (8 pediatrics and 277 adolescents and adults) completed this 24-month study. Compared with the 12 months prior to baseline, the mean number of exacerbations was reduced in the overall population at any time interval during the study. Proportion of patients with no exacerbations increased to 77.7% at 24 months from 32.6% at 12 months prior to baseline. A reduction in healthcare resource utilization was also observed. The mean number of specialist visits reduced from baseline (5.8 visits) to 2.4 visits at Month 24. The mean asthma control test score was >19 at every time-point during the study. The rate of Global Evaluation of Treatment Effectiveness (GETE) for asthma response significantly increased at Months 18 and 24 (P <0.05) compared to baseline. Pulmonary function remained relatively stable for the overall study population. There were no new or unexpected safety findings in the study. RELIEF study showed that add-on therapy with omalizumab is effective in reducing exacerbations, healthcare utilization, and improving GETE score in patients with SAA uncontrolled by standard therapy.

SELF-ADMINISTRATION OF BIOLOGIC THERAPY IN SEVERE ASTHMA AND CHRONIC RHINOSINUSITIS WITH NASAL POLYPS: COMPLIANCE AND QUALITY OF LIFE IMPROVEMENT

TYPE: Late Breaking Abstract TOPIC: Practice Management and Administration PURPOSE: PURPOSE: to analyze compliance and clinical response in a group of patients with severe asthma (SA) and chronic rhinosinusitis with nasal polyps (CRwNP) performing self-administration of biologic therapy at home. METHODS: METHODS: we enrolled patients with severe asthma (step 5 of GINA Guidelines) and CRwNP receiving biologic therapy in the ambulatory care of the Pneumology department (ASL 5, La Spezia. They switch to self-administration at home. At the first injection in the clinic, patients were educated to self-administration. They could communicate to a dedicated nurse any adverse event or question. Asthma Control Test (ACT), Severe Asthma Questionnaire (SAQ), and Sino-Nasal Outcome Test (SNOT-22) were performed at baseline and after three months. RESULTS: RESULTS: 10 patients treated with biologics (4 with mepolizumab, 3 dupilumab, 2 omalizumab, 1 benralizumab) had self-administration at home. All patients performed it during the scheduled date. At baseline the mean ACT score was 8.8, SAQ 177.9, SNOT-22 was 34. At three months ACT score was 23.7, SAQ 340.3, SNOT-22 was 6. CONCLUSIONS: CONCLUSIONS: self-administration of biologics at home is safe, patients had good compliance and an improvement of symptoms. CLINICAL IMPLICATIONS: CLINICAL IMPLICATIONS: self-administration at home is well tolerated, with an improvement of SA and CRwNP symptoms. Our study suggests the importance of dedicated pathways in the management of chronic diseases at home to shift the burden of care to the outpatient setting. DISCLOSURE: No significant relationships. KEYWORD: SEVERE ASTHMA, SELF ADMINISTRATION, QUALITY OF LIFE

The comparative effect of Leukotriene receptor antagonist add on therapy and step up inhaled Corticosteroid in partially controlled asthma: An open-labeled randomized controlled trial.

No studies are comparing the impact of the add-on leukotriene-receptor antagonist (LTRA) with a step-up dose of inhaled corticosteroids (ICS) in partly controlled asthma patients with asthma control test (ACT) score ˂ 23. To study the effect of LTRA add-on therapy in comparison to a step-up to medium dose of ICS in partially controlled asthma. An open-labeled randomized controlled trial was conducted in asthma subjects with partly controlled asthma who had been in regular receipt of low dose ICS. All subjects were assessed for asthma using ACT, daytime and nighttime symptoms, rate of relievers used, spirometry, and impulse oscillometry (IOS) at 3 and 6 months. Subjects were randomized to receive daily oral LTRA 10 mg or step-up medium dose of ICS. Between June 2020 and January 2021, 50 participants were enrolled, all patients completing the study. After treatment, mean ACT scores were increased to more than 23 indicating well-controlled asthma in both groups, control being sustained throughout the whole 6-month study period (P ˂ 0.001). Within each group, ACT scores were improved by a minimal clinical important difference (MCID) ≥ 3 points at 6 months, compared to baseline values. There were significant decreases in nighttime and daytime symptoms, and the numbers of rescue relievers used in 4 weeks in both groups compared to baseline (P ˂ 0.001). LTRA add-on therapy in partially controlled asthma patients is comparable with step-up to medium dose of ICS/LABA as regards asthma control.

Effects of switching from a metered dose inhaler to a dry powder inhaler on climate emissions and asthma control: post-hoc analysis

ObjectiveTo compare the effects of switching from a pressurised metered dose inhaler (pMDI)-based to a dry powder inhaler (DPI)-based maintenance therapy versus continued usual care on greenhouse gas emissions (carbon...

Asthma Control during COVID-19 Lockdown in Patients with Severe Asthma under Biological Drug Treatment

Introduction: Coronavirus disease 2019 (COVID-19) has deeply affected the management of patients with severe asthma, treated with add-on biological therapies. Objective: In this study, severe asthmatic patients on treatment with one of three different biologics (omalizumab, mepolizumab, benralizumab) underwent a survey to evaluate the effects of COVID-19 on the management of their clinical condition, with regard to the changes caused by the limited access to health facilities during the pandemic period. Methods: In this prospective observational study, 28 severe asthmatic outpatients referring to the Respiratory Unit of Magna Graecia University Hospital, Catanzaro (Italy), were asked to answer a telephone survey from May to July 2021. This survey included the evaluation of demographic and clinical data, as well as the number of lung function tests performed, exacerbations, biologic doses administered at hospital, or at general practitioner office, or through self-administration. Adherence to biological therapies before and during the pandemic period was also assessed. Moreover, the most recent asthma control test (ACT) score and the last forced expiratory volume in the first second (FEV1) measurement, recorded during the pandemic phase, were compared to the pre-pandemic (baseline) period. Results: When comparing the pre-pandemic data with the pandemic observations, the mean ACT score and the exacerbation rate did not significantly change [ACT, 21.5 ± 2.8 to 23.0 ± 3.9 (p = 0.1); exacerbation rate, 0.3 ± 0.6 and 0.5 ± 1.5 (p = 0.3)]. When considering some variables related to disease management in the same periods, a statistically significant difference was detected with regard to the mean number of outpatient visits (5.2 ± 3.8 vs. 0.9 ± 2.5, p &lt; 0.0001), as well as to the mean number of accesses to health facilities for the administration of biological drugs (from 7.0 ± 3.4 to 2.5 ± 3.9, p &lt; 0.0001). None of the patients reported to have been infected with the SARS-CoV-2 virus and no adverse drug reactions (ADR) occurred during the study. Conclusions: The above results suggest that COVID-19 pandemic did not induce any significant change related to severe asthma control. Indeed, add-on treatment with biological drugs was regularly continued, despite the obvious limited access to health facilities.

Asthma Control and Psychological Health in Pediatric Severe Asthma

To determine the prevalence of anxiety and depression and impact on asthma control in pediatric patients with severe asthma.Children aged ≥4 years who were referred to the Boston Children’s Hospital Severe Asthma Program by a pediatric pulmonologist, allergist, or intensivist after a life-threatening asthma exacerbation.This was a single-center prospective cohort study from March 2017 to December 2019. Asthma severity for each participant was defined on the basis of the National Heart, Lung, and Blood Institute (NHLBI) asthma medication steps. At each clinical encounter, children completed the Patient Health Questionnaire (PHQ-4) and the Asthma Control Test (ACT) or childhood ACT with parental assistance and had spirometry done to assess lung function, including forced expiratory volume in 1 second (FEV1) to forced vital capacity. The association of the longitudinal psychological assessments and pulmonary function measures were determined by using a linear mixed model (adjusted for sex, age, race, and NHLBI asthma medication step).Data were obtained for 93 clinical encounters from 43 patients. The mean age was 11.7 (+/− 4.2) years; 65% were male (n = 28 of 43); 49% were White (n = 22 of 43). The median NHLBI asthma medication step was 5.5 (interquartile range: 4.5–6.0). A total of 58% (n = 25 of 43) had at least 1 symptom of anxiety and depression, and 19% (n = 8 of 43) had a PHQ-4 score >2, indicating at least mild impairment. Bivariate analyses after adjusting for age, sex, race, and medication step revealed a significant difference in mean ACT scores (7 points lower) for girls with a PHQ-4 score >2 versus that of those with a score ≤2 (95% confidence interval [CI]: −10.88 to −3.12; P = .01); this effect was not seen in mean ACT scores for boys with PHQ-4 scores >2 versus that of those with scores ≤2. Compared with girls, boys with PHQ-4 scores >2 had a mean ACT score that was 4.18 points higher (95% CI: 0.63 to 7.73; P = .03). A PHQ-4 score >2 was significantly associated with percent FEV1 predicted but not with FEV1 to forced vital capacity (95% CI: −33.83 to 1.12; P = .06).Pediatric patients with severe asthma often have comorbid mental health impairment, which is associated with poor asthma-related quality of life. Girls with greater anxiety and depression perceived significantly worse asthma control. No difference in perceived asthma control was seen in boys, regardless of anxiety or depression level.Individuals with poorly controlled asthma can have psychological comorbidities including anxiety and depression, whereas, conversely, these factors can exacerbate asthma and negatively impact asthma control and severity. The perception of asthma control may impact self-care, asthma self-management, and inaccurate perception of symptoms, potentially resulting in higher rates of asthma-related health care use. Just as women often are more likely to report symptoms than men, the girls in this study had the higher level of mental health impairment and more negatively perceived asthma control. Although sex differences were observed in the association between psychological impairment and perceived asthma control, there was no association with objective spirometry results. Study limitations include the small sample size and use of PHQ-4, which is not a standard psychological screening tool. However, with these results, the authors highlight the potential impact of psychological symptoms in our clinical management of patients with asthma.

Effect of atorvastatin on serum periostin and blood eosinophils in asthma - a placebo-controlled randomized clinical trial.

ObjectiveTo investigate the effect of atorvastatin on serum periostin level and blood eosinophil count in patients with asthma.MethodsPatients diagnosed with asthma were enrolled and randomised into an intervention or placebo group, to receive 40 mg atorvastatin or similar placebo, daily, for 8 weeks. Spirometry was performed at baseline, and at the end of weeks 4 and 8; patients also provided blood samples and completed an asthma control test (ACT) at baseline and at the end of week 8. Primary study outcomes were blood eosinophil count and serum periostin levels.ResultsEighty patients completed the study (40 per group). Mean ACT scores were similar between the intervention and placebo groups at baseline (17.95 ± 3.75 versus 17.98 ± 3.77, respectively), and improved in the intervention group (19.88 ± 3.28), but remained unchanged in the placebo group (18.6 ± 3.26) during the treatment period. No statistically significant differences in spirometric changes, blood eosinophil count or serum periostin levels were observed between the groups during the treatment period.ConclusionSpirometric parameters and inflammatory markers did not change significantly in response to atorvastatin treatment, and did not differ between the placebo and intervention groups.

Sensor-Based Electronic Monitoring for Asthma: A Randomized Controlled Trial

To assess whether sensor-based monitoring of daily inhaled corticosteroids and short-acting b-agonist medications can improve asthma outcomes in diverse populationsA socioeconomically and racially diverse population of caregiver and children dyads were randomly assigned to control (n = 127) or sensor-based electronic monitoring (n = 125) for asthma.This was a randomized controlled multicenter trial of socioeconomically and racially diverse caregiver and children pairs from 5 Chicago medical clinics. The primary outcomes measured were the Asthma Control Test (ACT) (≥19 score equivalent to controlled asthma) and health care use (emergency department visits, hospitalizations, and oral corticosteroid prescriptions). Caregiver quality of life (QoL) and adherence to inhaled corticosteroids were also evaluated with multitiered models to ascertain changes.The intervention group had a significant increase in adjusted mean ACT scores (19.1 [n = 123; SE = 0.3] to 21.8 [n = 102; SE = 0.4]). The control group also had an increase in adjusted mean ACT scores (19.4 [n = 126; SE = 0.3] to 19.9 [n = 118; SE = 0.4]), the change was less than that of the intervention group at all time points (P < .01 for all comparisons). There was no difference in terms of the reported number of asthma attacks, missed school days, and steroid prescriptions in the ED and/or hospital. However, more children in the intervention group were prescribed steroids for asthma attacks during the 12 month study than controls were (72.5% intervention versus 34.6% control; P < .01). Improved QoL was reported by caregivers of the intervention group; this change was greater that of seen in the control group at 1 month follow-up, but there was no difference at 12 months.The outcomes of the study reveal that sensor-based inhaler monitoring with clinical participant–provider feedback may enhance asthma control and caregiver QoL in racially and socioeconomically diverse populations. However this improvement in outcomes for child and caregiver comes at the price of higher health care use, so further improvement in the sensor and participant–provider feedback system is needed.The authors should be recognized for demonstrating that use of sensor monitoring for asthma medications in children can improve asthma control and caregiver QoL in diverse populations. However, these improvements may come at a price of increasing health care use (steroid prescriptions). The limitations of the study include that data had to be manually entered because the blue chip device did not fit the inhaler and the absence of documentation or quantification of participant–provider phone feedback and adherence in both study groups as well as cost-effectiveness analysis.

INCREASING PATIENT CONFIDENCE MANAGING ASTHMA USING ASTHMA ACTION PLANS

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Asthma is a common illness affecting 8% of the US population and costing $81.9 billion per year. Due to its chronic and variable nature, asthmatics need frequent medication adjustments, making management challenging for both physicians and patients. Patients can control their asthma with an asthma action plan (AAP), which has directions for daily assessment, medications, and steps to detect and treat exacerbations. Self-management using AAPs is associated with a reduction in hospital admissions and ED visits by 40% and 20%, respectively. Despite evidence that AAPs are efficacious, the exact reason for their success is not known. We hypothesized that AAPs increase patient confidence managing asthma and that this is a reason for AAPs success. Our study explored whether AAP use increases confidence in self-management and asthma control. METHODS: Patients with a physician diagnosis of asthma were recruited. An eight-question Likert Scale survey developed prior gauged confidence about asthma management. At the initial visit, each patient completed the survey, received a personalized AAP, and was taught to use a peak flow meter. The same survey was given at a follow-up scheduled at the provider’s discretion. Asthma control was assessed pre and post-AAP use with the Asthma Control Test (ACT), a validated measure of asthma control. An ACT score of ≥ 19 indicates good control. All data was collected using REDCap. Results were calculated using the student t-test. RESULTS: We recruited 71 patients, and 17 were excluded for lack of follow-up. Post-AAP use, confidence using a peak flow meter increased by 45%, with 93% (50/54) rating confidence at ≥ 3 (4 being ‘strongly agree I am confident’). Fifteen percent more patients felt confident managing exacerbations, with 95% (51/54) rating confidence at ≥ 3. A 15% increase was seen in knowing asthma triggers, with 89% (48/54) rating confidence at ≥ 3. Confidence understanding medications was not impacted by AAPs, with 94% (51/54) of patients rating confidence at ≥ 3 pre and post-AAP use. Mean pre and post-AAP survey scores were 23.28 and 25.89, respectively. AAP use was associated with significantly higher mean survey scores (25.89±4.16, p =.0001). ACT data was available for 87% (47/54) of patients and 68% (32/47) scored a ≥ 19 on the follow-up ACT. Mean pre and post-AAP scores were 18.49 and 20.11, respectively. AAP use was associated with significantly higher mean ACT scores (20.11±3.35, p =.0043). CONCLUSIONS: This is the first study that shows AAP use increases patient confidence in asthma management. All but one survey question gauged at measuring increased confidence improved post-AAP use. Understanding of asthma medications likely did not see improved confidence due to a lack of discussion about this during AAP education at the initial visit. AAP use resulted in an improved mean ACT score. It is unclear if this is due to AAP use or changes made in medications. Limitations include the variable time interval for follow-up and the lack of ongoing assessment to account for the variable nature of asthma control. CLINICAL IMPLICATIONS: With an increasing reliance on telemedicine during the COVID-19 pandemic, the importance of self-management has been brought to the forefront. AAPs are a simple and effective tool that help physicians hand control over care to their patients. The routine use of AAPs can revolutionize how providers approach asthma management and reduce asthma morbidity. DISCLOSURES: No relevant relationships by Pankhuri Jha, source=Web Response No relevant relationships by Jessica Most, source=Web Response

Impact of guideline adherence and race on asthma control in children.

Asthma control in African Americans (AA) is considered more difficult to achieve than in Caucasian Americans (CA). The aim of this study was to compare asthma control over time among AA and CA children whose asthma is managed per NAEPP (EPR-3) guidelines. This was a one-year prospective study of children referred by their primary care physicians for better asthma care in a specialty asthma clinic. All children received asthma care per NAEPP guidelines. Results were compared between CA and AA children at baseline and then at three-month intervals for one year. Of the 345 children, ages 2-17years (mean = 6.2 ± 4), 220 (63.8%) were CA and 125 (36.2%) were AA. There were no significant differences in demographics other than greater pet ownership in CA families. At baseline, AA children had significantly more visits to the Emergency Department for acute asthma symptoms (mean = 2.3 [Formula: see text] compared to CA (1.4±2.3, P = 0.003). There were no other significant differences in acute care utilization, asthma symptoms (mean days/month), or mean asthma control test (ACT) scores at baseline. Within 3-6months, in both groups, mean ACT scores, asthma symptoms and acute care utilization significantly improved (P < 0.05 for all) and change over time in both groups was comparable except for a significantly greater decrease in ED visits in AA children compared to CA children (P = 002). Overall, improvement in asthma control during longitudinal assessment was similar between AA and CA children because of consistent use of NAEPP asthma care guidelines.

Effects of Endoscopic Sinus Surgery for Eosinophilic Chronic Rhinosinusitis on Respiratory Functions and FeNO Production in the Lower Respiratory Tract.

To confirm the relevance of upper and lower airway inflammation in eosinophilic chronic rhinosinusitis (ECRS), the effects of endoscopic sinus surgery (ESS) on lower airway functions and inflammation need to be examined in ECRS patients. Chronic rhinosinusitis patients with nasal polyps (25 non-ECRS, 28 ECRS) were enrolled. The 12 patients in the ECRS group had comorbid asthma, in contrast to none in the non-ECRS group. We divided ECRS patients into 2 groups of ECRS with and without asthma. Clinical markers, including fraction of exhaled nitric oxide (FeNO), respiratory functions, and the Asthma Control Test (ACT) questionnaire, were investigated before and after ESS. The FeNO levels in the ECRS with asthma group decreased after ESS. The mean FeNO levels in this group were 56.3 ppb before ESS and 24.9, 25.1, 25.0, and 15.5 ppb 1, 2, 3, and 4 months, respectively, after ESS. The mean forced expiratory rates in 1 second before and after ESS were 67.6% and 73.0%, respectively. The mean maximal expiratory flow rates at 50% of the vital capacity before and after ESS were 45.8% and 58.0%, respectively. Significant differences were observed in respiratory functions before and after ESS. The mean ACT scores in the ECRS with asthma group before and after ESS were 17.5 and 23.5, respectively. The ACT scores were significantly higher after than before ESS. The present results indicate that ECRS and bronchial asthma are common eosinophilic airway inflammatory diseases, and ESS for eosinophilic sinusitis may improve lower airway function.

Clinical evolution of a severe asthmatics group in the use of immunobiological therapy in a Brazilian Public Hospital.

A small portion of the asthmatic population (3.6%) has severe asthma (SA), presenting high morbimortality rates and demanding more financial resources than other asthmatic populations. The use of immunobiological therapy is an effective tool in controlling symptoms, decreasing the number of exacerbations, and reducing the use of systemic corticosteroids in these patients. In Brazil, epidemiological data regarding this asthmatic population using immunobiologicals and their evolution are scarce. This is an observational, analytical, cross-sectional, and retrospective study. The sample consisted of adult patients with SA in follow-up at the pulmonology service of the Complexo Hospital de Clínicas of the Federal University of Paraná, from January 2011 to August 2019. The analyzed variables were as follows: the number of exacerbations that required hospitalization in the previous year, forced expiratory volume in one second (FEV1), and asthma control test (ACT) scores before and after the start of immunobiological therapy. We studied 20 patients with SA using omalizumab or mepolizumab. We observed an increase in the mean ACT score of 4.8 points, a nonsignificant reduction in the number of exacerbations that required hospitalization, and a slight improvement in the FEV1. Regarding the patients using chronic systemic corticosteroid therapy, 14.2% (n=1) of patients had the medication discontinued and 57% (n=4) of patients had the dose reduced by half. The use of omalizumab and mepolizumab as additional therapy in SA provided a significant improvement in the ACT and allowed the dose reduction of systemic corticosteroids, without significant improvement in FEV1 and in the frequency of severe exacerbations.

The association between control level and self-reported treatment adherence across different treatment types in Japanese asthma patients.

Poor control of asthma symptoms is associated with a higher asthma disease burden, and asthma medication adherence is a known predictor for a better control status. This study sought to describe the current asthma control status, self-reported treatment adherence, and the association between them, as well as to describe how control level and better adherence impact the health outcomes of asthma patients. This study used cross-sectional data from the 2018 Japan National Health and Wellness Survey (NHWS). Asthma control status and adherence were assessed using the Asthma Control Test (ACT) and Morisky Medication Adherence Scale-8 (MMAS-8), respectively. Asthma treatment and patients' health outcomes, i.e. health-related quality of life (HRQoL) and work productivity, were self-reported. Asthma control and self-reported treatment adherence were analyzed descriptively, and the association was investigated by comparing mean ACT scores across adherence levels. Health outcomes were compared across control and adherence levels by multivariate analyses. A total of 816 patients had a physician diagnosis of asthma, with 67.0% reporting at least well controlled (ALWC). Of 505 asthma patients receiving prescription medication, half reported low adherence to medication use. Among asthma patients reporting high adherence, 35.6% were not well controlled (NWC). After adjusting for covariates, NWC asthma patients had significantly worse health outcomes than ALWC patients. One-third of asthma patients in Japan suffer from poorly controlled asthma. Results of the 2018 NHWS show that poor control status negatively affects patients' HRQoL and work productivity, suggesting an unmet need for better treatments to lessen the burden of asthma.

A non-interventional switch study in adult patients with asthma or COPD on clinical effectiveness of salmeterol/fluticasone Easyhaler® in routine clinical practice.

Background:Selection of the most appropriate device for a switch from one inhaler to an equivalent product is known to have a major impact on clinical outcomes in patients with asthma or chronic obstructive pulmonary disease (COPD). Salmeterol/fluticasone propionate (S/F) Easyhaler® has been demonstrated to be therapeutically equivalent with a reference product. However, no data on real-life effectiveness are currently available for patients switching to S/F Easyhaler from another S/F inhaler.Methods:The aim of this prospective, open, multicenter, non-interventional study was to assess clinical effectiveness of propionate S/F Easyhaler in adult asthma and COPD patients switched from another inhaler. The primary endpoints were Asthma Control Test (ACT) and COPD Assessment Test (CAT). Secondary endpoints included assessments of patient satisfaction and preference and physician/nurse perception on S/F Easyhaler use. The study included three visits during a 12-week follow-up.Results:A total of 211 patients (160 with asthma; 51 with COPD) were included in the analyses. In patients with asthma, there was a statistically significant increase in the mean ACT score at week 12 (20.2 ± 3.9) compared with the baseline (18.6 ± 4.1), with a mean increase of 1.6 (±3.5) points (p < 0.0001). In patients with COPD, CAT score persisted from baseline (19.9 ± 8.6) to week 12 (19.6 ± 7.0). Patients were significantly more satisfied with Easyhaler and most patients preferred Easyhaler over their previous inhaler. The physicians/nurses reported that it was ‘very easy’ to teach the use of Easyhaler and the training took less than 5 minutes in most cases.Conclusion:The results from this prospective real-life clinical study indicate better or at least similar treatment control of asthma and COPD after switching to S/F Easyhaler from another S/F inhaler. This study also shows that S/F Easyhaler was favored by the patients and that it is easy to teach, learn and use in a real-life setting. The reviews of this paper are available via the supplemental material section.

Sensor-Based Electronic Monitoring for Asthma: A Randomized Controlled Trial.

Although sensor-based monitoring of daily inhaled corticosteroids (ICSs) and short-acting β-agonist medications may improve asthma outcomes, the effectiveness of these interventions in diverse pediatric populations remains unclear. Caregiver and child dyads were randomly assigned to receive inhaler sensors that allowed for caregiver and clinician electronic monitoring of medications. End points included Asthma Control Test scores (≥19 indicated asthma control) and asthma health care use. Caregiver quality of life (QoL) and child ICS adherence were also assessed. Multilevel models were used to estimate adjusted changes from baseline. Dyads were assigned to the control (n = 127) or intervention (n = 125) arms. At the end line, the mean Asthma Control Test score increased from 19.1 (SE = 0.3) to 21.8 (SE = 0.4) among the intervention and from 19.4 (SE = 0.3) to 19.9 (SE = 0.4) among the control (Δintervention-control = 2.2; SE = 0.6; P < .01). Adjusted rates of emergency department visits and hospitalizations among the intervention were significantly greater (incidence rate ratioemergency department = 2.2; SE = 0.5; P < .01; incidence rate ratiohospital = 3.4; SE = 1.4; P < .01) at endline than the control. Caregiver QoL was greater among the intervention at the endline (Δintervention-control = 0.3; SE = 0.2; P = .1) than the control. Findings suggest that sensor-based inhaler monitoring with clinical feedback may improve asthma control and caregiver QoL within diverse populations. Higher health care use was observed among the intervention participants relative to the control, indicating further refinement is warranted.