Asthma Control Parameters Research Articles

Clinical characteristics of complete responders versus non-complete responders to omalizumab, benralizumab and mepolizumab in patients with severe asthma: a long-term retrospective analysis

Background Some patients with severe asthma may benefit from treatment with biologics, but evidence has been mostly collected from randomized controlled trials (RCTs), in which patients’ characteristics are different from those encountered in asthma patients in the real-world setting. The aim of this study was to describe the clinical features of complete responders versus non-complete responders to long-term treatment with biologics in patients with severe asthma attended in routine daily practice. Methods Data of a cohort of 90 patients with severe asthma who were treated with biologics (omalizumab, benralizumab, and mepolizumab) for at least 12 months and were followed up to March 2022. Data recorded included clinical characteristics and effectiveness of treatment (exacerbation, Asthma Control Test [ACT] score, lung function, use of maintenance oral corticosteroids [mOCS]), FeNO, and blood eosinophils at baseline, at 12 months, and at the end of follow-up. Complete response is considered if, in addition to not presenting exacerbations or the use of mOCS, the ACT score was >20 and, the FEV1 >80% predicted. Results An improvement in all asthma control parameters was observed after 12 months of treatment and a mean follow-up of 55 months. After 12 months of treatment 27.2% of patients met the criteria of complete response and this percentage even increased to 35.3% at the end of follow-up. Long-term complete response was associated to better lung function with mepolizumab and omalizumab treatment and to less previous exacerbations in the benralizumab group. The main cause of not achieving a complete response was the persistence of an airflow obstructive pattern. Conclusions This study shows that omalizumab, benralizumab, and mepolizumab improved the clinical outcomes of patients with severe asthma in a clinic environment with similar effect sizes to RCTs in the long term follow-up. Airflow obstruction, however, was a predictor of a non-complete response to biologics.

Predictors of change in asthma-related quality of life: a longitudinal real-life study in adult asthmatics

PurposeAsthma negatively impacts health-related quality of life (HRQL). The objective is to investigate the longitudinal relationship between HRQL in asthma and disease control, demographic and clinical objective parameters in an adult population in real-life settings.MethodsWe conducted a longitudinal study on adult asthmatics recruited from Liege University Hospital Asthma Clinic (Belgium) between 2011 and 2019. We selected those who had two visits and completed two patient-reported outcome measures (PROMs), the asthma control test (ACT) and the mini asthma quality of life questionnaire (AQLQ) (n = 290). AQLQ was the dependent variable. Demographic, functional and inflammatory characteristics, asthma control, and exacerbations were the independent variables. We applied generalized linear mixed models to identify the factors associated with change in AQLQ and its dimensions.ResultsMedian (IQR) time interval between the two visits was 7 (5–19) months. Overall, median (IQR) global AQLQ increased from 4.1 (3–5.1) to 4.6 (3.4–5.9) (p < 0.0001). All AQLQ dimensions significantly improved, apart the environmental one. AQLQ improved in patients who had both step-up and step-down pharmacological treatment as well as in patients reporting no change between the two visits. The fitted models indicated that change in ACT was the main predictor of change in AQLQ (p < 0.0001). A rise in 3 units in ACT predicted an improvement of 0.5 AQLQ (AUC-ROC = 0.85; p < 0.0001). Change in BMI inversely impacted global AQLQ (p < 0.01) and its activity dimension (p < 0.0001).ConclusionAsthma control and BMI are key predictors of asthma quality of life acting in an opposite direction. AQLQ may improve without step-up in the pharmacological treatment.

Long COVID outcomes in an asthmatic cohort and its implications for asthma control

Long COVID outcomes in an asthmatic cohort and its implications for asthma control

Obstructive sleep apnea: The key for a better asthma control?

IntroductionObstructive sleep apnea (OSA) is an important risk factor for poor asthma control. The objective of this study is to analyze the symptomatic control in asthmatic patients with OSA after using continuous positive airway pressure (CPAP). MethodsPatients were collected in a monographic asthma consult and a polygraphy was performed due to clinical suspicion or poor disease control. Asthma associated pathologies, as well as clinical and patient-perceived asthma control parameters were evaluated before and after the initiation of CPAP. ResultsA hundred patients were included, 59% were women and 41% men. From them, 54% had severe OSA, 33% moderate OSA and 13% mild OSA, and 10% could not tolerate CPAP. Eighty four percent had a moderate or severe degree of asthma with fractional exhaled nitric oxide (FENO) 32 ± 24.6 ppm and an asthma control test (ACT) before CPAP of 19 ± 4. Asthma control before CPAP was good in 41% of patients, partial in 29%, and bad in 30%. After three or more months of CPAP, clinical asthma control was good in 70% (p < 0.001), perceived control by ACT after CPAP was 21 ± 4 (p < 0.001). When asked for their opinion, 51.5% referred clinical improvement after CPAP, no change in 46.5%. ConclusionsThe use of CPAP in asthmatic patients with OSA improves both clinical and perceived asthma control in a statistically significant way. Most patients had good adaptation to CPAP (90%) and 51.5% had clinical improvement.

Evaluating Community Pharmacist Provided Short Education Program to Improve Clinical Status of Selected Asthmatic Patients

Background: Incorrect inhaler usage is very common issue that leads to poorly managed asthma. Clinical pharmacist enhanced patient education is critical in reducing such errors. Education on inhaler technique is one area where pharmacists may significantly impact on asthma therapy and improvement in clinical features. Aim: This study aim to evaluate the efficacy of a pharmacist-delivered education program for improving patients' inhaler technique and clinical outcomes. Patients and Methods: This prospective cohort trial included 51 individuals with asthma, divided up between an intervention group of 26 participants who were subjected to pharmacist intervention as well as a control group of 25 participants. MDI and turbuhaler users were gathered to participate in the study from five community pharmacies in different areas of the Thi-Qar province (Nasirriya, Suq Al-Shoyookh, and Al Eslaah cities). Basic asthma control and spirometry parameters were evaluated using standardized questionnaire of asthma control test and spirometer respectively. Patients in intervention group were taught how to properly use their inhalers using a combination including demonstrations and re-demonstrations counselling with aid of advices leaflet. After one month for both groups, clinical outcomes (asthma control and spirometry) were reassessed and comparisons were made. Results: A total of 51 patients were involved, with 35 using a turbuhaler and 16 using an MDI. At first session of assessment for all participants, a low asthma control and low median value of FEV1/FVC ratio were recording. After intervention, the median values for asthma control test and all pulmonary parameters was increased significantly (for ACT of 18.5 to 21, p=0.000, for PEF of 2.2 to 2.8, p=0.001, for FEV1 of 1.6 to 1.9, p=0.001, for FEV1/FVC ratio of 63 to 71.5, p=0.002). Conclusion: Community pharmacist based education program applied to patients with asthma to increase awareness of patients about proper inhaler technique have positive impact in improvement of asthma control level and pulmonary functions parameters. This short education program highly applicable and should be consider as one of daily community pharmacist duties. Keywords: Community pharmacist, asthma control test, asthmatic patients, spirometer, inhaler technique, Thi-Qar.

Evaluation of IGF-1, TNF-α, and TGF-β Gene Expression after Oral Vitamin D Supplementation in School-Aged Children with Chronic Bronchial Asthma

BACKGROUND: Airway remodeling in children with bronchial asthma is due to the effect of inflammatory mediators and growth factors on the bronchial epithelium. Vitamin D (VitD) has immunomodulatory effect in many inflammatory diseases as bronchial asthma. The ant-inflammatory and anti-fibrotic role of VitD could prevent or improve air way remodeling in asthmatic patients. AIM: The study investigated the effect of VitD supplementation on the expression of transforming growth factor-beta (TGF-β), tumor necrosis factor-alpha (TNF-α), and insulin growth factor 1(IGF-1) and to correlate them with asthma severity and level of control. METHODS: The serum level of VitD and the mRNA expression of IGF-1, TGF-β, and TNF-α were estimated in 50 patients and 20 healthy controls control subjects using quantitative PCR in real-time. Asthmatic patients with VitD deficiency received VitD supplementation for 2 months followed by remeasurement of serum VitD and the genes expression TGF-β, TNF-α, and IGF-1. RESULT: Pre-intake of VitD and serum level of VitD were lower in all patients than control subjects (p = 0.005). VitD level was directly correlated with IGF-1 mRNA expression, which was indirectly correlated with TGF-β, r = 0.5 and −0.57; p = 0.0001 and 0.002, respectively. After VitD supplementation, the expression of the TGF-β mRNA gene was the only gene that decreased significantly (p = 0.04) together with improved asthma control and spirometric parameters. CONCLUSIONS: VitD supplementation down regulated the gene expression of TGF-β and improved asthma control level, but it did not significantly affect the gene expression of TNF-α and IGF-1.

EFFECT OF YOGA BREATHING EXERCISE ON THE PULMONARY FUNCTION PARAMETER (PEAK EXPIRATORY FLOW RATE) AND SYMPTOM CONTROL OF CHILDREN WITH MODERATE PERSISTENT BRONCHIAL ASTHMA ATTENDING TERTIARY CARE CENTRE-A QUASI EXPERIMENTAL STUDY

Objectives: The study was undertaken with the objective of assessing the effect of breathing exercise ( Alternate Nostril Breathing Exercise with deep breathing and controlled relaxation, pranayama a form of yoga breathing technique) on the pulmonary function parameter as well as symptom control of children with moderate persistent bronchial asthma. Background: Childhood asthma is a chronic health condition that affects more than 1 million school-aged children and their families. Nonpharmacological therapy includes yoga breathing techniques such as Alternative Nostril Breathing techniques significantly reduces the stress and improves better asthma control in children with bronchial asthma. Design &amp;Methods: Quasi-Experimental, two group pretest- post-test design were adopted. Sixty children with moderate persistent bronchial asthma attending asthma clinic of tertiary care hospital were selected for the study. Simple random sampling with a comparison group was used for selection of the sample. TREND checklist for quasi-experimental design used as guidelines for the current study. Results: Breathing exercise significantly changed the Peak Expiratory Flow Rate as evidenced by the significant change in the mean percentage of PEFR value from the predicted value in the experimental group. Comparison of mean percentage PEFR value from age wise predicted value in the experimental group showed that 69.5%/ 82.4% , t= 8.275, p= o.ooo (p&lt; 0.05) and in the control group was 66.0%/ 66.2% , t= 1.326 , p = 0.195 ( p&gt; 0.05). There was statistically significant change in asthma control parameters in the experimental group. Breathing exercise significantly improved the level of symptom control in the experimental group. No such significant improvement in Symptomcontrol was noted in the control group.(McNamer 0.000/ 0.063), (p&lt; 0.05). Conclusion: Based on the above findings, the present study concluded that breathing exercise has an effect on improving the pulmonary functions and symptom control of children with bronchial asthma.Relevance to clinical practice:The practice of yogabreathing exercises improves asthma symptoms and helps children to achieve better control over asthma along with pharmacological management.

Impact of immunotherapy with autologous activated T-lymphocytes on clinical parameters and quality of life in patients with allergic bronchial asthma

Aim. To assess the impact of autologous activated T-lymphocyte immunotherapy on clinical parameters and quality of life in patients with allergic bronchial asthma (BA) in comparison with patients with allergic BA who received standard therapy.Materials and methods. A non-randomized, pilot study included 19 patients with allergic BA of moderate severity (7 men and 12 women aged 23–61 years, average age – 38.5 ± 4.3 years) who received the T-cell vaccine (n = 12) and standard therapy with inhaled glucocorticoids, short- and long-acting β2-adrenergic agonists (n = 7). After signing an informed consent, the patients were subcutaneously injected with autologous activated T-lymphocytes with a frequency of 4 injections 1 time / week, and then 6 injections 1 time / month. The research methods included asthma control measurement according to the ACQ-5 questionnaire and quality of life assessment according to the AQLQ(S) questionnaire. Clinical data were collected during lung function tests and by measuring the total immunoglobulin E (IgE) level.Results. In the course of the study, the immunotherapy was well tolerated, no systemic adverse reactions were noted. The treatment approach in the patients who received the T-cell vaccine resulted in significant improvement of asthma control parameters (according to the ACQ-5 questionnaire) and parameters of the patients’ quality of life (according to the AQLQ(S) questionnaire) within all 4 categories. Besides, their lung function improved by the end of treatment, and the total IgE level decreased. No significant changes in these parameters were observed during the follow-up in patients who received standard therapy. The study was conducted before immunotherapy, after 2 months (after 5 injections), and after 7 months (after 10 injections).Conclusion. Evaluation of the impact of immunotherapy with autologous activated T-lymphocytes on the clinical parameters and quality of life in patients with BA indicates effectiveness of treatment in patients with allergic BA.

Особенности иммунного ответа на инфекцию Helicobacter pylori у детей с бронхиальной астмой

Актуальность. Течение бронхиальной астмы у детей нередко сопровождается заболеваниями желудочно-кишечного тракта (ЖКТ), ассоциированными с Helicobacter pylori (H.pylori)-инфекцией. Наличие H.рylori способствует активации и поддержанию воспалительного процесса с высвобождением цитокинов и медиаторов воспаления и последующими системными эффектами. Цель исследования: изучение особенностей продукции интерферона-γ (IFN-γ) и интерлейкина‑4, -5 и -13 (IL‑4, -5, -13) как маркеров интенсивности аллергического воспаления у детей, больных бронхиальной астмой, инфицированных H.pylori. Материалы и методы. Обследовано 120 детей в возрасте от 6 до 18 лет с бронхиальной астмой. Идентификация H.pylori проводилась дыхательным хелик-тестом (ООО «АМА», Россия). Сывороточные концентрации IFN-γ и IL‑4, -5 и -13 определялись методом иммуноферментного анализа (тест-наборы Diaklone, Франция) до и через 7 дней после окончания лечения патологии ЖКТ. Статистическую обработку проводили с помощью методов вариационной статистики, реализованных в пакете прикладных программ Statistica 6.1. Результаты. У 78 детей с бронхиальной астмой была диагностирована патология ЖКТ, в том числе у 37 человек — ассоциированная с инфекцией H.рylori. Для изучения влияния H.pylori на течение бронхиальной астмы дети были разделены на 3 группы: I группа — 37 детей с бронхиальной астмой и патологией ЖКТ, инфицированных H.pylori, II — 41 Н.pylori-негативный ребенок с бронхиальной астмой и патологией ЖКТ, III — 42 Н.pylori-негативных ребенка с бронхиальной астмой без патологии ЖКТ. Длительность заболевания бронхиальной астмой в I группе составила 7,80 ± 0,17 года, во II — 5,90 ± 0,26 года, в III группе — 3,90 ± 0,48 года (p &lt; 0,05). Наличие Н.рylori-инфекции у детей с бронхиальной астмой сопровождалось более низкими концентрациями IFN-γ по сравнению с детьми II группы (соответственно 8,47 ± 0,14 пг/мл и 9,69 ± 0,32 пг/мл, р &lt; 0,05). Уровень IL‑13 в сыворотке крови был достоверно выше у детей I группы по сравнению с пациентами II группы (8,74 ± 0,22 пг/мл и 7,21 ± 0,35 пг/мл соответственно, р &lt; 0,05). Сывороточные концентрации IL‑4 и -5 были повышены во всех исследуемых группах по сравнению с группой контроля и не зависели от наличия инфекции Н.рylori. После лечения патологии пищеварительного тракта отмечалось улучшение показателей контроля над бронхиальной астмой, которое сопровождалось достоверным снижением концентраций IFN-γ и IL‑13 в I группе детей и IFN-γ и IL‑5 и -13 — во II группе. Вывод. Наличие инфекции H.рylori у детей с гастродуоденальной патологией, протекающей на фоне бронхиальной астмы, сопровождается дисбалансом иммунного ответа, который выражается в снижении выработки IFN-γ, IL‑4 и увеличением IL‑13 по сравнению с Н.рylori-негативными детьми. Лечение патологии ЖКТ сопровождается снижением IFN-γ и исследуемых цитокинов, что клинически способствует улучшению параметров контроля над бронхиальной астмой.

Effect of Vitamin D3 Supplementation on Severe Asthma Exacerbations in Children With Asthma and Low Vitamin D Levels: The VDKA Randomized Clinical Trial

To investigate if supplementation with vitamin D3 would improve the time to a severe exacerbation in children at high risk with vitamin D insufficiency and taking low-dose inhaled corticosteroids (ICSs) for persistent asthma.The participants were recruited from 7 children’s hospitals across the United States. Participants, 6 to 16 years of age, had to have physician-diagnosed asthma for at least 1 year, being treated with low-dose ICSs, and have a serum 25-hydroxyvitamin D level less than 30 ng/mL. They also had to have at least 1 severe asthma exacerbation in the last year (defined as systemic steroids for at least 3 days or an emergency department visit or hospitalization requiring systemic corticosteroids). All participants had to show bronchodilator responsiveness or airway responsiveness to methacholine inhalation. The mean age of the participants was 9.8 years (40% girls). A total of 219 subjects passed screening and entered run-in. A total of 192 subjects were randomly assigned to active drug or placebo capsules.This was a randomized, double-blind, parallel, placebo-controlled clinical trial. Participants initially all received placebo capsules and were maintained on inhaled fluticasone propionate, 176 μg per day (6–11 years) or 220 μg per day (12–16 years) during run-in. They continued the ICSs and then were randomly assigned to daily vitamin D3 4000 IU or continuing placebo for 48 weeks. After 24 weeks, participants dose of fluticasone was reduced by 50%, if asthma was well controlled and spirometry was normal. Serum vitamin D levels and parameters of asthma control were measured every 16 weeks. The primary outcome was the time to a severe asthma exacerbation. Secondary outcomes included the time to a viral-induced severe exacerbation, the proportion of participants in whom the dose of ICS was reduced halfway through the trial, and the cumulative fluticasone dose during the trial.A total of 94% of randomly assigned subjects completed the trial. A total of 36 participants (37.5%) in the vitamin D3 group and 33 (34.4%) in the placebo group had ≥1 severe exacerbations. Compared with the placebo, vitamin D3 supplementation did not significantly improve the time to a severe exacerbation. The mean time to exacerbation was 240 days in the vitamin D3 group versus 253 days in the placebo group (mean group difference: −13.1 days; adjusted hazard ratio: 1.13; P = .63). Vitamin D3 supplementation, compared with the placebo, did not significantly improve the time to a viral-induced severe exacerbation, the proportion of participants whose dose of ICSs was reduced, or the cumulative fluticasone dose during the trial. Serious adverse events were similar in both groups (vitamin D3 group: n = 11; placebo group: n = 9).In children 6 to 16 years old with persistent asthma and low vitamin D levels, vitamin D3 supplementation, compared with a placebo, did not significantly improve the time to a severe asthma exacerbation or ICS dosing.As the authors note, in several observational studies, researchers have linked low serum vitamin D levels to severe asthma exacerbations, lower lung function, and reduced response to corticosteroids. Yet meta-analyses and reviews of vitamin D3 supplementation for severe asthma exacerbations have found insufficient evidence to recommend vitamin D3 supplementation in children. In this study, the authors, looking at a high-risk population for asthma exacerbations, add to that negative body of literature.

Assessment of asthma control and lung function in asthmatic children in Sokoto, North Western Nigeria

Objectives: This study aimed at assessing asthma control using Global Initiative for Asthma (GINA) asthma assessment, and determining its relationship with lung function parameters among asthmatic children in Usmanu Danfodiyo University Teaching hospital, Sokoto. Materials and Methods: This was a cross-sectional study among 60 children with asthma diagnosed based on GINA guidelines. It was conducted over a period of 4 months. The GINA asthma control assessment was administered to assess asthma control. Lung function was done using a portable spirometer. Results: Males accounted for 58.3% of the study population with M: F of 1.4:1 and median age of 9.47 years, with majority from urban domicile (91.7%). Well-controlled asthma accounted for 50.0% while 35.0% had partly controlled asthma and 15.0% had poorly controlled asthma. The median FEV1/FVC among the study participants was 0.856 (IQR: 0.170). There was no relationship between asthma control and LF parameters (FEV1: r = 0.044, P = 0.736, FVC: r = 0.010, P = 0.941, FEV1/FVC: r = 0.122, P = 0.352, and PEFR: r = 0.015, P = 0.911). Conclusion: Majority of the study participants had well-controlled asthma and no relationship was found between asthma control and lung function. Thus, serial monitoring of LF in addition to uniformly agreed standardized assessment of asthma control is required to objectively evaluate asthma control in children.

Efficacy of Leukotriene Modifiers for the Treatment of Persistent Asthma in Children

The purpose of this study was to evaluate the use of the leukotriene modifiers (LTMs), zafirlukast and montelukast, in children with asthma managed by an inner city pediatric pulmonary practice. A retrospective chart review was done of children 6 years of age with persistent asthma seen at Connecticut Children's Medical Center and prescribed LTM drugs. Eighty-three children whose asthma control was adequately assessed both before and after addition of a LTM to his/her treatment regimen was included in the study. There were statistically significant improvements in several parameters of asthma control following initiation of LTM use, including provider assessment score (p = 0.0005), number of hospitalizations and unscheduled visits (clinic or emergency department; p &lt; 0.0001), use of oral corticosteroids (p = 0.0015), spirometry severity score (p = 0.0015), and spirometry test results (FEV1, FEV1/FVC, FEF, FEF25-75%; p &lt; 0.005 for all). These results suggest that montelukast and zafirlukast help to improve asthma control in young patients with persistent asthma.

Older asthmatic patients have increased discrepancies between symptoms and objective asthma control parameters

RATIONALE: Discrepancies between clinical, physiological and inflammatory asthma control parameters need to be documented in older patients.OBJECTIVE: To compare the prevalence of discrepancies between asthma control parameters among older and younger patients.METHODS: This retrospective, cross-sectional study compared data from older (≥60 years; n = 92) and younger (18–35 years; n = 266) subjects with asthma. Discrepancies ( > 20% difference) between any two parameters of the asthma control scoring system (ACSS): (1) clinical (respiratory symptoms), (2) physiological (forced expiratory volume in one second percent predicted) and (3) inflammatory (sputum eosinophil percentage) were determined.MEASUREMENTS AND MAIN RESULTS: Fifty-seven percent of older asthmatics had at least one discrepancy, against 40% of younger (P = 0.008). A higher proportion of older patients showed discrepancies between clinical and physiological scores (P = 0.0005) and between clinical and inflammatory scores (P = 0.007), with a better clinical than physiological or inflammatory score in most cases.CONCLUSION: The increased prevalence of discrepancies between asthma control parameters in older asthmatics strengthens the importance of considering all parameters of control in the evaluation and management of asthma in older patients.

Benefits of pulmonary rehabilitation in pediatric asthma.

There are limited studies evaluating the role of pulmonary rehabilitation (PR) in pediatric asthma. A retrospective chart review was performed of all pediatric patients with a diagnosis of asthma enrolled in PR. Demographics, medications, and clinical records were reviewed. In addition, PFTs, 6-min walk test (6MWT), and patient/parent symptom and quality of life surveys before and after PR were evaluated. A total of 38 patients were enrolled in PR; 18 (47%) female and 20 (53%) male. Mean participant age was 11.33 ± 3.37 (range 4-19) years. Twenty-two (58%) were Caucasian and nine (24%) African American. Chart review was limited by incomplete data sets for many participants. Following PR, significant improvement was noted in mean 6MWT distance (1541 vs 1616 feet, P = 0.05) and FEV1 (89.9% of predicted versus 96.4%, P = 0.04). Survey instruments demonstrated improvement in several clinical factors, however, there was no significant change in weight following PR despite scheduled cardiovascular exercise and dietary counseling. Structured PR for pediatric patients with asthma can improve 6MWT distance and FEV1 as well as subjective measures of SOB and QOL, suggesting a role for PR in the chronic management of pediatric asthma. Further prospective investigation is needed to determine if PR has positive effects on other clinical parameters of asthma control and its overall impact on childhood obesity.

Association of self-efficacy of parents/caregivers with childhood asthma control parameters.

Objective To verify the association between the self-efficacy of parents/caregivers and control parameters of childhood asthma. Method Cross-sectional study with parents/caregivers of asthmatic children. Data were collected through a sociodemographic questionnaire and the Self-efficacy and their child's level of asthma control scale: Brazilian version. Results Participation of 216 parents/caregivers in the study. There was a statistically significant association between self-efficacy scores and the following variables: unscheduled physician visit (p=0.001), visit to emergency department (p<0.001), hospital stays in the previous 12 months (p=0.005), physical activity limitation (p=0.003), school days missed (p<0.001), impaired sleep (p<0.001), ability to differentiate crisis medication from control medication (p=0.024), use of spacer (p=0.001), performing oral hygiene after use of inhaled corticosteroids (p=0.003), and knowledge of medication gratuity (p=0.004). Conclusion A significant relationship of the self-efficacy of parents/caregivers of asthmatic children with control parameters and training on the necessary skills to reach this control was demonstrated in the study.

Optimization of personalized approaches to the basic treatment of persistent bronchial asthma in children regarding the phenotypic and genotypic characteristics of patients

Objective. To evaluate the effectiveness of inhaled glucocorticosteroids in children with atopic and non-atopic asthma phenotypes depending on the acetylation status.Material and methods. A complex clinico-immunological examination involved 119 children with bronchial asthma. The genetic marker, namely the type of acetylation, has been identified by the method of V. M. Prebsting — V. I. Gavrilova in the modification of Timofeeva. They were divided into four clinical groups: group I — 36 children with atopic bronchial asthma (ABA) and slow acetylation type (patients’ average age — 13,4±0,6 years, the proportion of boys — 69,2±2,2%), group II — 30 patients with fast acetylating status and ABA (average age of patients — 12,±0,5 years, the quota of boys — 70,0±2,0%). The third (III) clinical group included 26 patients with nonatopic variant of the disease and slow acetylation phenotype (patients’ average age — 12,6±0,6 years, the proportion of boys — 59,1±1,6%), and in the forth (ІV) group there were 26 patients with nonatopic bronchial asthma (NBA) with a fast typeof acetylation (average age of patients — 12,5±0,6 years; (P&gt; 0,05); the share of boys - 65,2±2,0% (P&gt; 0,05). The main clinical characteristics of the comparison groups were comparable.Results. The use of IGS in patients with a fast acetylation status and atopic bronchial asthma were found to be more effective than that in patients with slow acetylation type, and such treatment improved clinical and paraclinical parameters of asthma control significantly as evidenced by an increase in the relative risk of a relatively satisfactory level of control by 68.1%, an increase in the absolute risk of bronchial asthma control by 58.0%, with a minimum number of patients who need to be treated by such method in order to achieve at least one positive result is 2.2. At the same time, in patients with a non-atopic bronchial asthma phenotype in the presence of a slow acetylation status, the use of IGS resulted in an increase by 59.7% of relative risk by 47.0% of absolute risk of control of the disease. Conclusions. Basic anti-inflammatory therapy of bronchial asthma using ICS is more effective for treatment of children with atopic asthma as well as for patients with nonatopic asthma phenotype associated with a slow type of acetylation.

Anxiety, Depression, and Asthma Control: Changes After Standardized Treatment

It has been documented that anxiety and depression are prevalent in patients with asthma and are associated with greater frequency of exacerbations, increased use of health care resources, and poor asthma control. To examine the association of asthma diagnosis with symptoms of depression/anxiety and asthma control not only at baseline but also over a 6-month period of specialist supervision. We enrolled 3182 patients with moderate to severe asthma. All were evaluated with spirometry, the Asthma Control Test, and the Hospital Anxiety and Depression Scale at baseline and at 6 months. Treatments were decided by specialists according to published guidelines. At baseline, 24.2% and 12% of the patients were diagnosed with anxiety and depression, respectively, according to the Hospital Anxiety and Depression Scale. After 6 months, anxiety and depression improved, affecting 15.3% and 8.1% of patients, respectively (P < .001); mean FEV1 and asthma control also improved (FEV1 from 81.6% ± 20.9% to 86% ± 20.8%; Asthma Control Test score from 15.8 ± 4.7 to 19.4 ± 4.4; both P< .001). Patients with anxiety and depression used significantly more health care resources and had more exacerbations. A multivariate analysis showed that patients with anxiety, depression, and lower FEV1 (odds ratio, 0.20, 0.34, 0.62, respectively; P < .001) were independently associated with poor asthma control. A multiple linear regression analysis showed that anxiety had a nearly 4-fold greater influence over asthma control than depression (0.326/0.85= 4.075). Under standardized asthma care and after a specific visit with the specialist, patients present significant improvement in these psychological disorders and exhibit better asthma control and functional parameters.

Use of SNOMED CT® and LOINC® to standardize terminology for primary care asthma electronic health records

ABSTRACTObjectives: The burden of asthma ranks among the highest for chronic diseases. Interoperable electronic health records (EHRs) can improve the management of chronic diseases such as asthma by facilitating sharing of data between health care settings along the continuum of care. Terminology such as SNOMED CT® (Systematized Nomenclature of Medicine-Clinical Terms) and LOINC® (Logistical Observation Identifier Names and Codes) are prerequisites for interoperability of EHRs. We sought to determine the extent to which data elements in a validated asthma care map (ACM) are congruent with these terminologies. Methods: A certified asthma educator entered all 169 elements in the ACM into the SNOMED CT® browser. Matched elements were assigned a concept name, an identification number, and classified into a hierarchy. LOINC® terminology was reviewed for asthma-related pulmonary function tests (PFTs). Results: Forty-two percent of the ACM elements were complete matches to existing SNOMED CT® concepts, 24% partial matches, and 34% unmatched. Specific asthma control parameters were either complete (n = 3) or partial (n = 4) matches, but overall “asthma control” was unmatched. There were 92% complete or partial matches for PFT elements to SNOMED CT® and 83% to LOINC®. Conclusions: The majority of ACM elements are congruent with standardized terminology, enabling EHR interoperability. Future requests for new concepts in SNOMED CT® and LOINC® should be pursued for asthma control parameters paramount to evidence-based practice.

Evaluation of asthma control in the pharmacy: an Italian cross-sectional study.

Background. In Western countries a large proportion of asthmatic patients remain uncontrolled, despite the availability of effective drugs. An involvement of pharmacies / pharmacists in asthma management has been suggested in guidelines, since this could provide a relevant support. Objective. The present cross-sectional study aimed at assessing the level of asthma control, by using ACT questionnaire, in the community pharmacies in the County of Verona, North East of Italy. Methods. A call for participation was sent by Verona Pharmacists' Association to all the pharmacies located in the Verona municipality. Patients with a medical prescription and an asthma exemption code were recruited in pharmacies. They were asked to fill the ACT questionnaire and to answer some additional questions on asthma treatment, smoke habits and comorbidities. Results. Thirty-seven community pharmacies recruited 239 patients. According to the ACT score, more than 50% of patients had a controlled asthma but 20% of them were totally uncontrolled and 12% were using oral steroid. Only 2.9% of patients had received an asthma action plan. Asthma was intermittent in 17.6% of patients, mild persistent in 13.8%, moderate persistent in 63.1% and severe in 5.4%. Discordance was observed between the self-perceived asthma control and objective parameters, when available. Of note, in the severe asthma group, most patients had an ACT > 20. Conclusion. This is the first Italian pharmacy-based study on asthma control. A better asthma control was recorded in this study in comparison with other trials, but about 50% of patients were insufficiently controlled. The community pharmacies can play a relevant role in the preliminary assessment of asthma control by using easy and not time consuming tools, such as ACT.

Long-term predictors of anxiety and depression in adult patients with asthma

It is well established that anxiety and depression are associated with asthma, but there is limited evidence about the persistence of anxiety/depression in asthma. The aim of our study was to assess the long-term predictors of anxiety and depression in adult asthmatic patients. A total of 90 adult asthma patients (63women, age 18-50years) with different levels of disease control (28 uncontrolled and 34 partially controlled) were assessed at baseline and at follow-up after 7years for anxiety, depression and asthma control. The same work-up on both occasions included: demographics, living conditions, medical history (e.g. comorbidities, adherence and exacerbations), Hospital Anxiety and Depression Scale (HADS), Asthma Quality of Life Questionnaire (AQLQ), disease control and lung function. Persistence was defined as the HADS scores for anxiety and depression present at baseline and follow-up. The HADS results at follow-up visit showed 36 (40%) asthma patients with anxiety and 13 (14%) with depression, with the persistence of anxiety in 17 (19%) and of depression in 7 (8%) patients. Significant predictors of anxiety at follow-up were HADS and AQLQ results at baseline and several parameters of asthma control at follow-up (area under the curve AUC0.917, 95% confidence interval CI0.829-0.969, p< 0.001) and for depression AQLQ mood disorder domain, asthma control and lung function (AUC0.947, 95% CI0.870-0.986, p< 0.001). Anxiety and depression persist over years in some patients with asthma. The association between mood disorders and asthma suggests potential mutual treatability.