National Asthma Education Program Research Articles

Medicaid Coverage of Guidelines-Based Asthma Care Across 50 States, the District of Columbia, and Puerto Rico, 2021-2022.

Asthma affects more than 25 million Americans, including 4.2 million children. The burden of asthma disproportionately affects people enrolled in Medicaid, among other disparate groups. Improved availability and accessibility of guidelines-based treatments and services may ensure positive health outcomes for people with asthma. In this article, we provide an update to the American Lung Association's Asthma Guidelines-Based Care Coverage Project (the Project) to determine the extent of asthma care coverage and associated barriers in Medicaid programs for all 50 states, the District of Columbia, and Puerto Rico, and examine improvements in coverage since 2017. Findings from the Project, representing coverage from 2016-2017, were first published in Preventing Chronic Disease in 2018. The Project was updated in 2021 to reflect the National Asthma Education and Prevention Program guidelines 2020 Expert Panel Report-3 updates, which were finalized in December 2020. It now tracks coverage for 8 areas of guidelines-based care and 7 barriers to care in Medicaid programs by reviewing publicly available plan documents and engaging with Medicaid programs to review and confirm findings. Results from the Project, which reflect coverage in 2021-2022, show an increase in comprehensive coverage in Medicaid programs over the last 5 years. However, coverage remains inconsistent across programs, and barriers to accessing asthma care still exist. Although substantial improvement has been made to coverage, certain gaps and barriers to care must be addressed for patients to fully benefit from guidelines-based care to manage their asthma and improve health outcomes.

Beginning to Address an Implementation Gap in Asthma: Clinicians' Views of Prescribing Reliever Budesonide-Formoterol Inhalers and SMART in the United States.

The Global Initiative for Asthma and National Asthma Education and Prevention Program recently made paradigm-shifting recommendations regarding inhaler management in asthma. The Global Initiative for Asthma now recommends that combination inhaled corticosteroid (ICS)-formoterol inhalers replace short-acting β-agonists as the preferred reliever therapy at all steps of asthma management. Although the most recent guidelines of the National Asthma Education and Prevention Program did not review reliever ICS-formoterol usage in mild asthma, they similarly recommended single maintenance and reliever therapy (SMART) at steps 3 and 4 of asthma management. Despite these recommendations, many clinicians-particularly in the United States-are not prescribing new inhaler paradigms. Clinician-level reasons for this implementation gap remain largely unexplored. To gain an in-depth understanding of the facilitators and barriers to prescribing reliever ICS-formoterol inhalers and SMART in the United States. Community and academic primary care providers, pulmonologists, and allergists who reported regularly caring for adults with asthma were interviewed. Interviews were recorded, transcribed, qualitatively coded, and analyzed using the Consolidated Framework for Implementation Research. Interviews were continued until theme saturation. Among 20 interviewed clinicians, only 6 clinicians described regularly prescribing ICS-formoterol inhalers as a reliever inhaler (either alone or within SMART). Significant barriers to new inhaler approaches included concerns surrounding a lack of Food and Drug Administration labeling for ICS-formoterol as a reliever therapy, a lack of awareness regarding a patient's formulary-preferred ICS-long-acting β-agonist choices, the high cost of combination inhalers, and time constraints. Facilitators to using new inhaler approaches included clinicians' beliefs that the latest inhaler recommendations are simpler and more congruent with real-world patients' behavior, and that a potential change in management strategy would offer a valuable opportunity for shared decision making. Although new guidelines exist in asthma, many clinicians described significant barriers to using them including medicolegal issues, pharmaceutical formulary confusion, and high drug costs. Nonetheless, most clinicians believed that the latest inhaler approaches would be more intuitive for their patients and would offer an opportunity for patient-centered collaboration and care. Stakeholders may find these results useful in future attempts to increase the real-world adoption of recent asthma recommendations.

A pilot study to improve provider adherence to NAEPP guidelines

The prevalence and morbidity of Asthma in the United States has increased since the 1991 National Asthma Education and Prevention Program (NAEPP) and updated Expert Panel Report −3 (EPR-3) guidelines in 2007 were published. To improve provider adherence to the NAEPP EPR-3 guidelines Children's Hospital of Orange County (CHOC) in California integrated the HealtheIntentSM Pediatric Asthma Registry (PAR) into the electronic medical record (EMR) in 2015. MethodsA serial cross-sectional design was used to compare provider management of CHOC MediCal asthma patients before 2014 (N = 6606) and after 2018 (N = 6945) integration of the Registry with NAEPP guidelines into the EMR. Four provider adherence measures (Asthma Control Test [ACT], Asthma Action Plan [AAP], inhaled corticosteroids [ICS] and spacers) were evaluated using General Linear Mixed Models and Chi square. FindingsIn 2018, patients were more likely to receive an ACT, (OR = 14.95, 95% CI 12.67, 17.65, p < .001), AAP (OR = 12.70, 95% CI 11.10, 14.54, p < .001), ICS (OR = 1.85, 95% CI 8.52, 14.54, p < .001) and spacer (OR = 1.45, 95% CI 1.31, 1.6, p < .001) compared to those in 2014. DiscussionThe pilot study showed integration of the Pediatric Asthma Registry into the EMR, as a computer decision support tool that was an effective intervention to increase provider adherence to NAEPP guidelines. Ongoing monitoring and education are needed to promote and sustain provider behavioral change. Additional research to include multi-sites and decreased time between evaluation years is recommended. Application to practiceCan be used for excellent health policy decision making as a direct impact on patient care and outcomes, by improving provider adherence to the NAEPP guidelines.

American College of Allergy, Asthma and Immunology members' preferred steps 1 to 3 asthma maintenance and reliever therapy and incomplete insurance coverage indicated as main practice hurdle

BackgroundNew asthma guidelines (GINA, 2022; NAEPP EPR-4, 2020) include considerable changes in treatment recommendations, specifically regarding anti-inflammatory rescue and Single MAintenance and Reliever Therapy (SMART). ObjectiveTo explore American College of Allergy, Asthma and Immunology members’ preferred treatment and perceived hurdles. MethodsA survey (SurveyMonkey) regarding steps 1 to 3 asthma therapy was e-mailed to American College of Allergy, Asthma and Immunology members. ResultsThe allergists completed 147 surveys (46% with >20 years of experience; 98% from United States; 29% academic, 75% [also] private practice). In addition, 69% follow the National Asthma Education and Prevention Program and 81% the Global Initiative for Asthma recommendations. Of 147 allergists, 117 (80%) indicated correctly what SMART strategy is; 21%/36%/50%/39% would use SMART in step 3 treatment of a below 5-year-old/5- to 11-year-old/12- to 65-year-old/above 65-year-old patient, respectively. In this group, 11% to 14% incorrectly chose inhaled corticosteroid (ICS) plus salmeterol and 9% ICS plus vilanterol for SMART. In a 4-year-old needing step 1 therapy (N = 129), 55% of the respondents would add anti-inflammatory therapy; for step 2 treatment, most would prescribe ICS 100 to 200 µg budesonide equivalent daily; in step 3, 49% would prescribe ICS plus long-acting beta-agonist (LABA). In a 7-year-old needing step 1 treatment (N = 134), 40% would prescribe only short-acting beta-agonist; in step 3, 45% would institute SMART strategy, but only 8 of 135 (6%) chose very-low dose ICS plus formoterol (as recommended in Global Initiative for Asthma); most (39%) use low-dose ICS plus formoterol. As for rescue therapy, 59% is now instituting some form of anti-inflammatory rescue. Finally, in a 25-year-old patient (N = 144): in step 1, 39% would prescribe exclusively short-acting beta-agonist; in step 2, 4% only anti-inflammatory rescue and the rest prescribes ICS maintenance; one-third begins SMART strategy at step 2 and 50% in step 3.Major hurdles for prescribing one's preferred strategy included incomplete insurance coverage, insurance not approving more than one canister of ICS-formoterol per month, and cost. ConclusionAsthma therapy varies among physicians, with respondents suggesting underutilization of the recommended anti-inflammatory rescue and SMART therapy. A major hurdle is lack of insurance coverage of medication in line with the guidelines.

The Use of Lactobacillus reuteri as an Adjunct in the Treatment of Children with Newly Diagnosed Asthma in a Tertiary Hospital in the Philippines

Rationale: Probiotics are live microorganisms that exert beneficial effects on the host, including a reduction of allergic disease symptoms. Lactobacillus reuteri in particular was shown to attenuate the allergic airway, and when used as an adjunct in the treatment of asthma in children, resulted in decreased fractional exhaled nitric oxide and interleukin levels when compared to placebo. However, insufficient information is available regarding the significance of L. reuteri as an adjunct in the treatment of allergic disorders, particularly in allergic airway disease. Objectives: The objective of the study was to determine the efficacy of L. reuteri as an adjunct for the control of newly diagnosed asthma in children. Methodology and Population: In this analytical, experimental, prospective, randomized controlled trial, 44 asthmatic patients aged 6–18 years were recruited from the University of Santo Tomas Hospital outpatient department, for a study period of three months. Baseline clinical assessment included skin prick test to aeroallergens, spirometry, and Childhood Asthma Control Test. Asthma severity and level of control was based on the National Asthma Education and Prevention Program’s Expert Panel 3 (EPR-3) and the Global Initiative for Asthma Guidelines 2018, respectively. Patients were randomized and half of them received L. reuteri 26.5 mg/chewable tab (at least 100 million colony forming units) once daily for 30 days, while the other half did not. Spirometry and C-ACT test were conducted at the start of intervention as baseline, after one month, two months, and three months post intervention. The results of patients from the experimental group were compared to results of patients in the control group. Results: The FEV1 of patients in the L. reuteri group was significantly higher than those in the control group (p = 0.045). The median FVC of the two groups significantly differed from each other through time (p = 0.007), with the L. reuteri group having significantly higher FVC than the control group. There were statistically significant improvements in ACT scores between patients in the L. reuteri and control groups, particularly at two months and three months of treatment. Among polysensitized patients, there were significant improvements in the FEV1, FEF25–75, and FVC between the L. reuteri and control group. Conclusion: The use of L. reuteri as an adjunct was associated with significant lung function improvement and asthma symptom control amongst newly diagnosed asthmatic children. Key Words: Lactobacillus reuteri, Probiotics, Asthma, Children

Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee

The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.

The Impact of Cultural Factors, The Level of Health Education Received by the Caregivers, and Stigma on Asthma Treatment among Children in Southern Jordan

For asthma treatment in children, caregivers need good knowledge and attitudes regarding the disease and its treatment. This study aimed to determine the impact of cultural factors, the level of health education provided to patients and their families, as well as the impact of stigmatization on the treatment awareness of children with asthma in southern Jordan. A validated questionnaire was used to collect data from a sample of ninety-seven caregivers selected from three hospitals in southern Jordan. Open ended questions were answered after demonstrating the inhaler technique in and evaluated according to the instructions of the National Asthma Education and Prevention Program (NAEPP, 2013). The result revealed moderate knowledge of asthma with a mean score of (22.36/32), as well as moderate knowledge of asthma treatment (24.26/40). A high mean was found for the impact of cultural and environmental factors (22.93/28), whereas low impact was found for stigma with a mean value of (4.73/12). Therefore, to improve future asthma management, additional efforts are required to educate caregivers and improve their asthma awareness and rectify any falsehoods regarding asthma medications by health care providers.

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.

Factors Associated With Persistence of Severe Asthma From Late Adolescence to Early Adulthood

To determine risk factors in childhood that predict severe persistent asthma in late adolescence and early adulthood.Patients aged 5 to 12 years with mild to moderate asthma and a positive methacholine challenge enrolled in the Childhood Asthma Management Program (CAMP) trial.The CAMP participants above who had data available from late adolescence to early adulthood were included. The first study visit at age 18 years was used to determine asthma activity in late adolescence, whereas the first study at age 22 years was used to determine asthma activity in early adulthood. The American Thoracic Society definition of severe asthma was used for patients on high dose inhaled corticosteroids and the National Asthma Education and Prevention Program Expert Panel Report (NAEPP EPR) 3 definition of severe asthma was used for those not receiving high dose inhaled corticosteroids. Additional criteria for intermittent and persistent asthma were included. The following factors were analyzed: secondhand smoke exposure, maternal smoking during pregnancy, body mass index percentile, hay fever, eczema, food allergy, parental asthma being sensitized and exposed to any perennial aeroallergen, bronchial hyperreactivity, prebronchodilator FEV1/FVC ratio, post bronchodilator FEV1/FVC ratio, bronchial hyperresponsiveness to methacholine challenge, log10 of serum total IgE and log10 of serum absolute eosinophil count. Characteristics were compared from baseline to late adolescence and from baseline to early adulthood.Six hundred eighty-two CAMP participants were included. Of these participants, severe asthma was present in 81 (12%) participants in late adolescence and 131 (19%) participants in early adulthood. Half of the patients with severe asthma in late adolescence continued to have severe asthma into early adulthood. About 18% of patients improved severity, 61% did not change, and 21% of patients worsened in severity from late adolescence to early adulthood. The postbronchodilator percent predicted FEV1 and pre and post bronchodilator FEV1/FVC ratio significantly decreased from childhood to late adolescence and from late adolescence to early adulthood (P < .0001), whereas prebronchodilator FEV1 values increased from childhood to late adolescence (P < .0001) and stabilized in early adulthood (P = .040). Bronchodilator reversibility and bronchial hyperresponsiveness each decreased from childhood to late adolescence (P < .0001), whereas bronchial hyperresponsiveness also significantly decreased from childhood to early adulthood (P = .0003). Patients with persistent and severe asthma had higher serum IgE in late adolescence and were more likely to have a positive aeroallergen skin test, along with sensitization and exposure to perennial allergens in childhood. Significant factors in early childhood that were associated with persistence of severe asthma from late adolescence to early adulthood included a younger age, male sex, no reported hay fever, a low prebronchodilator FEV1/FVC ratio, a low postbronchodilator FEV1/FVC ratio, and a physician diagnosis of moderate asthma during the screening period. Notably, for every 5% decrease in post bronchodilator FEV1/FVC ratio in childhood, the odds of severe asthma persistence increased by 2.36-fold (P < .0001) as well as maternal smoking during pregnancy increased odds of severe asthma persistence by 3.17-fold (P = .020). There was a strong association between a reduced-growth lung function trajectory and severe asthma persistence.Lower FEV1/FVC ratio in childhood and maternal smoking during pregnancy were the strongest predictors for severe asthma between late adolescence and early adulthood.Understanding early factors for persistence of asthma into adulthood can help develop targeted primary prevention measures such as reduction of smoking during pregnancy as well as early intervention measures with therapies to preserve lung function in childhood.URL: www.pediatrics.org/cgi/doi/10.1542/peds.10.1164/rccm.202010-3763OC

Asthma management: How the guidelines compare

This quick guide details the similarities and differences between recommendations from the National Asthma Education and Prevention Program and the Global Initiative for Asthma.

Suboptimal Control of Asthma Among Diverse Patients: A US Mixed Methods Focus Group Study.

PurposeThe US National Asthma Education and Prevention Program updates and Global Initiative for Asthma report encourage considering the patient perspective to improve asthma control. The objective of the present study was to collect data about the perceptions, experiences, and concerns of adult patients and caregivers of children with asthma regarding rescue, maintenance, and oral corticosteroid treatments.Patients and MethodsIn-person focus groups were conducted in three cities across the US. Participants also completed patient-reported outcome measures assessing asthma control and experiences.ResultsFocus groups were conducted in demographically and clinically diverse adults with asthma (five groups, n=34), caregivers of children with asthma (five groups, n=35), and adults with a dual diagnosis of asthma and chronic obstructive pulmonary disease (one group, n=5). Only 28% of patients were well-controlled by Asthma Control Test/Asthma Control Test-Caregiver Report and 18% by Asthma Impairment and Risk Questionnaire. Forty-four percent of participants reported not following their prescribed medical plan. Four key themes emerged from the focus groups: (1) asthma symptom control and monitoring are often inadequate; (2) treatments are often used incorrectly; (3) communication between health care professionals and patients or caregivers is often ineffective; and (4) concerns related to treatment and desires to improve treatment.ConclusionControl of asthma symptoms is suboptimal in the vast majority of patients and both patients and caregivers do not feel sufficiently informed about asthma. Health care providers should be encouraged to engage patients and caregivers in shared decision making for managing asthma and selecting treatments that integrate patient values, preferences, and lifestyles.

The Impact of Theoretical and Practical Guidance Regarding Metered Dose Inhaler Technique on Asthma Patients

Published on:August 2022Journal of Young Pharmacists, 2022; 14(3):327-332Original Article | doi:10.5530/jyp.2022.14.64 Authors: Sara Shahid1,2,*, Fahad Ahmed3, Gul Shahnaz1, Muhammad Saqlain1, Muhammad Ans4, Anosh Sana1, Abdul Nazer Ali5, Ahmad Kamal Ariffin Abdul Jamil6, Asma Fareed Khan7,8, Saba Naeem9, Shakeel Ahmad9, Aiman Mahmood4,9, Qandeel Rafi9, Asifa Anwar2, Rabeel Khan2, Naeem Mubarak2 1Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, PAKISTAN. 2Department of Pharmacy Practice, Lahore Pharmacy College, Lahore Medical and Dental College, University of Health Sciences, Lahore, PAKISTAN.3Faculty of Pharmacy, University of Sargodha, Sargodha, PAKISTAN.4University College of Pharmacy, University of the Punjab, Lahore, PAKISTAN.5Department of Pharmacy Practice, Geethanjali College of Pharmacy, Hyderabad, Telangana, INDIA.6Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, UniSZA, Besut, Terengganu, MALAYSIA.7Disciplines of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, MALAYSIA. 8Children’s Hospital & University of Child Health Sciences, Lahore, PAKISTAN. 9Department of Pharmaceutics, Lahore Pharmacy College, Lahore Medical and Dental College, University of Health Sciences, Lahore, PAKISTAN. Abstract: Background: Asthma is rapidly increasing globally. Inhalation therapy is the backbone for asthma management due to localized delivery and rapid onset of action. Currently, metered dose inhalers (MDIs) are the most widely prescribed and dispensed inhaler devices worldwide due to the advantage of portability, multiple dose delivery and better efficacy. Objectives: The current study aimed to access the effect of educational intervention on asthma patients’ competency regarding pressurized metered dose inhaler (pMDI) technique. Methods: Asthma patients were recruited from Pakistan Institute of Medical Sciences (PIMS) Islamabad, Pakistan. Inhaler technique steps based upon “National Asthma Education and Preventive Program” (NAEPP) criteria was set as evaluating tool to evaluate competency of asthma patients regarding MDI appropriate technique. Intervention involved educating study subjects (asthma patients) practically through placebo inhaler and theoretically through inhaler technique directed literature brochures. Pre intervention and post intervention inhaler technique competency was accessed and evaluated statistically. Results: Among 207 asthma patients, majority were never instructed by healthcare professional regarding inhaler technique (78.8%). However, most of the patients were observed to have inadequate inhaler technique (76.3%) at baseline. As the result of educational intervention, the competency of patients regarding inhaler technique was significantly enhanced from 11.6% pre-intervention to 34.8% post-intervention (p<0.001), statistically analyzed by McNemar testing. Conclusion: Originally, inhaler technique competency of majority of asthma patients was observed to be inappropriate. However, educational intervention proved to be effective in substantially enhancing the competency of study subjects regarding MDI technique. Keywords: Asthma, Inhalation therapy, Metered-dose inhalers, Educational intervention, National Asthma Education and Preventive Program.

The Impact of an Educational Intervention on the Skill of Community Pharmacists in the Use of a Pressurized Metered-dose Inhaler: A Covert Simulated Patient Approach in Pakistan

Introduction: Metered-dose inhalers are the most widely prescribed and dispensed inhaler devices worldwide for the management of asthma. The present study aimed to access the impact of educational intervention on the competency of community pharmacists of Islamabad, Pakistan regarding the pressurized metered-dose inhaler (MDI) technique. Materials and Methods: The intervention involved educating pharmacists practically through placebo inhalers and theoretically through literature brochures; based upon the “National Asthma Education and Preventive Program” inhaler technique. A total of 100 pharmacists were recruited from the rural and urban sectors of Islamabad. A covert simulated patient approach was used to evaluate the inhaler technique of pharmacists. Type of pharmacy, education status of pharmacists and the influence of already received training on the use of inhaler devices were the factors that demonstrated a significant positive association with the competency of pharmacists. Results: McNemar test was applied for pre and post-intervention intragroup comparisons to further access categorical variables. A p-values &lt;0.05 were considered statistically significant. The competency of pharmacists increased significantly from 24% before intervention to 33% after intervention (p&lt;0.001). Conclusion: Originally, the inhaler technique competency of the majority of pharmacy professionals was observed to be inappropriate. However, the educational intervention proved to be effective in substantially enhancing the skill of community pharmacists regarding the MDI technique.

Comparison of three alternatives for the management of moderate asthma in children aged 6–11 years: a cost-utility analysis

Background Recent asthma guidelines for children 6–11 years with persistent asthma advocate three alternatives: SMART (budesonide/formoterol 80/4.5 mcg qd plus additional doses as needed), fixed combination of budesonide/formoterol, and fixed-dose budesonide. Concerns have arisen as to which of the proposed alternatives has the best possible cost-effectiveness profile. This study aimed to assess the health and economic consequences of SMART, fixed combination, and fixed-dose budesonide therapy in children 6–11 years old with persistent asthma. Methods A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with persistent asthma. Total costs and QALYs of SMART, fixed combination, and fixed-dose budesonide therapy were calculated over a time horizon of 6 years. Multiple sensitivity analyses were conducted. Results The mean QALY per patient was 0.57 and 0.56 QALYs per patient per year of SMART and fixed combination and 0,52 with fixed-dose budesonide. The total mean of discounted costs per patient per cycle were US$111 for SMART, US$133 for fixed combination, and US$67 for fixed-dose budesonide. The net monetary benefit of SMART was US$12,549, US$12278 for fixed combination, and US$11,380 for fixed-dose budesonide Conclusion Our study showed that SMART was more cost-effective than fixed combination and fixed-dose budesonide. These findings complement and support the GINA 2021 and National Asthma Education and Prevention Program asthma guideline recommendations for use of inhaled corticosteroids–formoterol in children 6–11 years old with persistent asthma.

Asthma guidelines: comparison of the National Heart, Lung, and Blood Institute Expert Panel Report 4 with Global Initiative for Asthma 2021.

Asthma continues to be a prevalent respiratory disease that affects lives within the United States and worldwide. Clinical asthma guidelines based on scientific evidence on testing and therapeutic interventions are needed to control this disease better. To meet this need, the NAEPP (National Asthma Education and Prevention Program) and GINA (Global Initiative for Asthma) were formed to assist with best practice diagnosis and treatments for asthma. This paper reviews the subtle differences and similarities between the most recent recommendations put forth by NAEPP 2020 and GINA 2021, mainly examining the six selected topics, as well as methodology, guidance on emerging topics, and implementation. In December 2020, the National Asthma Education and Prevention Program Coordinating Committee released their focused update on fraction of exhaled nitric oxide, indoor allergen mitigation, inhaled corticosteroids, long-acting muscarinic antagonists, allergen immunotherapy, and bronchial thermoplasty. The Global Initiative for Asthma comprehensive document is published annually as a framework for all nations. Therefore, it is timely to consider the National Asthma Education and Prevention Program Coordinating Committee 2020 in relation to the GINA 2021. The comparison provides a better understanding of evidence-based recommendations for asthma. The NAEPP 2020 and GINA 2021 will equip providers with the knowledge to provide their patients with the best and most updated asthma care.

SMART - is it practical in the United States?

The 2020 focused updates to the asthma management guidelines by the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group advocate for inhaled corticosteroid (ICS)-formoterol combinations as single maintenance and reliever therapy (SMART) for patients with persistent asthma. We review the rationale, the evidence supporting SMART use in asthma, and barriers limiting its wide adoption in the United States. A growing body of evidence supports the use of SMART over the conventional use of controller medicaments with an as-needed short-acting β2 agonist for rescue therapy for the purpose of reducing the risk of asthma exacerbation and maintaining asthma control in adolescents and adults with persistent disease. Lack of US Food and Drug Administration approval, inconsistent insurance coverage, and limited options of ICS-formoterol combination available for use as SMART represent obstacles to wider integration of SMART in clinical practice. SMART represents a paradigm shift in asthma management. By identifying and addressing the current and anticipated barriers to implementing SMART, its adoption by providers is likely to increase in the United States.

Relaxation Effect of Extract Ethanol Curcuma Longa on Isolated Guine Pig Trachea

Aims: Asthma is a chronic obstructive pulmonary disease which is a world health problem that is not only infected in developed countries but also in developing countries. According to the National Asthma Education and Prevention Program (NAEPP), asthma can be defined as a chronic inflammatory disorder that occurs in the airways, which involves inflammatory cells. curcumin reduces allergic airway inflammation in mice through inhibition of a specific pathway aimed at investigating the anti-inflammatory effect of curcumin in acute allergic asthma and its underlying mechanisms in mice.&#x0D; Study Design: This study is experimental study.&#x0D; Methodology: The experimental animals were divided into 2 groups, each group consisting of 4 animals. Group 1 gave theophline as a positive control group and group 2 was given extracts with concentrations (1 mg / ml, 2 mg / ml, 3 mg / ml, 4 mg / ml, 5 mg / ml, 6 mg / ml, 7 mg / ml and 8 mg / ml). These animals are acclimatized for 1 (one) week with the aim of homogenizing their food and life with the same conditions so that they are considered eligible for research.&#x0D; Results: The ethanol extract of curcuma longa has no different ability from atropine sulfate 1 x 10-6 M in reducing the smooth muscle contraction of isolated guinea pig tracheal induced by acetylcholine, the strength of acetylcholine without incubation contraction compared to acetylcholine with EETH incubation showed statistically different results (p&lt;0.05).&#x0D; Conclusion: The mechanism of the relaxing effect of curcuma longa on isolated mouse smooth muscle is mediated through inhibition of the PDE enzyme.

Artificial Intelligence Assesses Clinicians’ Adherence to Asthma Guidelines Using Electronic Health Records

Clinicians' asthma guideline adherence in asthma care is suboptimal. The effort to improve adherence can be enhanced by assessing and monitoring clinicians' adherence to guidelines reflected in electronic health records (EHRs), which require costly manual chart review because many care elements cannot be identified by structured data. This study was designed to demonstrate the feasibility of an artificial intelligence tool using natural language processing (NLP) leveraging the free text EHRs of pediatric patients to extract key components of the 2007 National Asthma Education and Prevention Program guidelines. This is a retrospective cross-sectional study using a birth cohort with a diagnosis of asthma at Mayo Clinic between 2003 and 2016. We used 1,039 clinical notes with an asthma diagnosis from a random sample of 300 patients. Rule-based NLP algorithms were developed to identify asthma guideline-congruent elements by examining care description in EHR free text. Natural language processing algorithms demonstrated a sensitivity (0.82-1.0), specificity (0.95-1.0), positive predictive value (0.86-1.0), and negative predictive value (0.92-1.0) against manual chart review for asthma guideline-congruent elements. Assessing medication compliance and inhaler technique assessment were the most challenging elements to assess because of the complexity and wide variety of descriptions. Natural language processing technologies may enable the automated assessment of clinicians' documentation in EHRs regarding adherence to asthma guidelines and can be a useful population management and research tool to assess and monitor asthma care quality. Multisite studies with a larger sample size are needed to assess the generalizability of these NLP algorithms.

2020 NAEPP Guidelines Update and GINA 2021—Asthma Care Differences, Overlap, and Challenges

The 2020 National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group (NAEPP [2020 Focused Asthma Update]) guidelines and the Global Initiative for Asthma (GINA) 2021 strategy report are compared in this Rostrum article. The methodologies of each publication are described. Subsequently, 4 different selected pharmacological recommendations are compared in the 2 documents: step 1 for children 0 to 4 years of age with viral-induced wheezing, step 2 in ages 12 years and older with the intermittent use of inhaled corticosteroid, steps 3 and 4 with single-inhaler maintenance and reliever therapy with inhaled corticosteroids-formoterol (SMART), and steps 3, 4, and 5 with add-on long-acting muscarinic antagonist therapy. Nonpharmacological recommendations are also considered and contrasted, including for exhaled nitric oxide, environmental control, immunotherapy, and bronchial thermoplasty. Similarities and differences in these 2 documents are highlighted, and recommendations are made about harmonizing the approaches where possible.

Clinical guideline highlights for the hospitalist: Focused updates to pediatric asthma management.

2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC) Expert Panel Working Group1 RELEASE DATE: Online: December 3, 2020 PRIOR VERSIONS: 1991, 1997, 2002, 2007 DEVELOPER: NAEPPCC Expert Panel Working Group (referred to as "the Expert Panel") of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health FUNDING SOURCE: NHLBI of the National Institutes of Health TARGET POPULATION: Adults and children with asthma and recurrent wheezing.