Persistent Asthma Research Articles

An assessment of asthma exacerbations in pediatric patients using a long-acting B2-agonist plus inhaled corticosteroid versus an inhaled corticosteroid alone

BackgroundAn asthma exacerbation is an anticipated sudden worsening of the disease severity, which usually does not respond to conservative therapy. The management of asthma depends on the severity of the disease symptoms, which includes an inhaled corticosteroid (ICS) and a bronchodilator. This study aimed to assess the efficacy of combining a long-acting B2-agonist (LABA) with ICS, compared to ICS alone, to reduce the incidence of asthma exacerbations in pediatric patients, diagnosed with severe persistent asthma. MethodsA retrospective analysis of the medical records was conducted for 586 children, admitted to the Emergency Department (ED) at King Abdullah Specialized Children Hospital in Riyadh, Saudi Arabia, for the management of severe persistent asthma symptoms, from January 2016 to September 2019. ResultsThe majority (n = 480, 81.9%) of the patients received fluticasone (Flovent)® as the standard of care ICS treatment for controlling asthma, and a small proportion (n = 106, 18.1%) were treated with a combination of LABA and ICS. A significant increase in the frequency of recurrent asthma exacerbation episodes occurred in the group receiving ICS alone (98.5%), compared to 67.0% in the combination group (p < 0.0001). Moderate to severe exacerbations were significantly higher in the ICS group compared to the combination group (95.6% versus 84.5%, respectively, p = 0.0005). ConclusionsThe current results confirm the substantial efficacy of the LABA/ICS combination therapy in reducing the incidence and severity of asthma exacerbations in pediatric patients, compared to ICS alone.

Development of Sensitization to Multiple Allergen Molecules from Preschool to School Age Is Related to Asthma

Introduction: Allergic sensitization in early life has been identified as a strong risk factor for subsequent asthma in childhood. It is still unclear why only a part of sensitized children develop asthma, and the role of specific allergen molecules in asthma pathogenesis is ambiguous [Pharmacol Ther. 2009 Feb;121(2):174–84]. We assessed the sensitization to multiple allergen molecules longitudinally and explored its relation to persistent asthma at 7 years. Methods: Seventy-two children included during an acute wheezing episode (cases) were followed prospectively from early preschool age (EPA) to age 7, and compared to 43 healthy controls at EPA. Allergen molecules were analyzed at EPA and age 7 using ImmunoCAP Solid-phase Allergen Chip (ISAC). Asthma diagnosis at 7 years was based on symptoms, medication, and spirometry. Results: At EPA, cases compared to controls showed a tendency toward having a higher prevalence of allergic sensitization (23.6% vs. 9.3%, p = 0.055). The prevalence of sensitization increased in cases from EPA to 7 years (23.6% vs. 38.9%; p = 0.048) as well as the median number (range) of immunoglobulin E (IgE)-reactive molecules 3 (3–14) versus 6.5 (1–21); p = 0.024. Sensitization to each additional molecule from EPA to the age of 7 was significantly related to asthma at 7 (OR = 1.25, 95% confidence interval [1.01, 1.54]). Conclusion: Polysensitization, assessed by allergen molecules, had a significant impact on persistent asthma at school age. The extent of sensitization, illustrated by molecular spreading from preschool to school age, was related to asthma diagnosis at 7 years in children with a history of wheezing at early life.

Quantitative comparison of dose-effect and time-course of fluticasone furoate and fluticasone propionate in adult and adolescent patients with persistent asthma: A systematic review and meta-analysis.

This study aimed to quantitatively compare the efficacy of fluticasone furoate (FF) and fluticasone propionate (FP) in adolescents and adults with asthma. We searched the PubMed and EMBASE databases for placebo-controlled trials that met the inclusion criteria. Pharmacodynamic models were established to describe the time-course of the primary outcome (trough forced expiratory volume in the first second [FEV1 ]). Secondary outcomes (asthma symptoms, quality of life and exacerbations) were also compared via a meta-analysis. A total of 14 articles were included in the analysis, involving 6640 subjects. The efficacy plateau of the two drugs could be reached in 2 weeks. The changes from the baseline in trough FEV1 (95% CI) at week 2 of FF at 200 and 100 μg/day were 0.168 L (0.064-0.199) and 0.127 L (0.048-0.163), respectively. The changes from the baseline in trough FEV1 (95% CI) at week 2 of FP at 1000, 500, 250 and 100 μg/day were 0.133 L (0.049-0.171), 0.127 L (0.043-0.163), 0.117 L (0.039-0.150) and 0.093 L (0.032-0.129), respectively. The efficacy of FP had reached a plateau at the maximum evaluated dose (1000 μg/day), while a plateau effect was not seen at the maximum evaluated dose of FF (200 μg/day). In terms of secondary outcomes, the relative effects of the two drugs relative to the placebo were similar and did not show obvious dose-effect relationships. In this study, the time-course and dose-effect characteristics of FP, FF and placebo were quantitatively evaluated, providing necessary quantitative information for asthma-related guidelines.

Predictors of Asthma Control among Libyan Adolescents with Persistent Asthma

Introduction: Among adolescents, asthma is an important public health burden that is associated with high morbidity and mortality. Poor asthma control is likely in this age group. Our aim was to identify the predictors of well controlled asthma among adolescents with persistent asthma in Northwest of Libya. Methods: A sample of 92 adolescents with persistent asthma were recruited from the respiratory clinic in Sabratha Teaching Hospital, and completed questionnaires measuring demographic and clinical characteristics, asthma knowledge, self-efficacy, and asthma control. Logistic regression analysis was carried out, taking the asthma control as the dependent variable. Results: Twenty-four percent of participants had well controlled asthma. In a bivariate analysis, well controlled asthma was significantly associated with adolescents having mild persistent asthma, not having allergic rhinitis, using preventive inhalers regularly, reporting higher level asthma knowledge, and higher self-efficacy. However, in multiple logistic model, only self-efficacy was an independent predictor of asthma control, with higher self-efficacy associated with well-controlled asthma (Adjusted OR= 1.107, 95% CI: 1.012 – 1.210, p= 0.026). Conclusion: Identifying and targeting modifiable predictors of well controlled asthma could improve asthma control. In adolescents with asthma, enhancing self-confidence of adolescents to undertake health behaviour modification seems to be an important step toward a better asthma control.

Prospective study of disease persistence and lung function trajectories of childhood asthma.

A proportion of asthmatic children outgrow their disease by adulthood, but there are limited data on predictors for asthma persistence. This prospective study characterized the trajectory of spirometric indices and identified predictors for the persistence of childhood asthma. Chinese asthmatic children aged 6-15years from pediatric allergy clinic underwent annual visits for ≥5years and until their adulthood. Pre-bronchodilator spirometry and anti-asthma medications were recorded at baseline and then at least annually. Asthma resolution was defined when patients were free from asthma symptoms and use of anti-asthma drugs for ≥2years. Logistic regression was used to identify predictors for asthma persistence. Generalized estimating equation was used to analyze longitudinal changes in lung function parameters in relation to asthma persistence. 181 asthmatic children aged [mean (SD)] 10.0 (2.7) years were followed for [mean (SD)] 12.5 (2.8) years. One third of them outgrew asthma during follow-up. Female was 3.36 times more likely to have persistent asthma. Inhaled corticosteroid (ICS) treatment ever and frequent asthma exacerbation (AE) predicted asthma persistence with respective odds ratios of 3.19 (95% confidence interval [CI] 1.44-7.09) and 3.05 (95% CI 1.39-6.68). Persistent asthma was inversely associated with baseline forced expiratory volume in 1-second (FEV1 %) with an odds ratio of 0.96 (95% CI 0.93-1.00). Throughout follow-up, patients with persistent asthma had generally lower forced expiratory indices than those with asthma resolution. Children with persistent asthma experienced poorer lung function growth. Female, ICS ever, and frequent AE predicted persistent asthma. Patients with persistent asthma had lower forced expiratory indices and poorer lung function growth into adulthood.

Asthma control and its predictors in Ethiopia: Systematic review and meta-analysis.

BackgroundDetermining the status of asthma control and identifying risk factors for poor asthma control is a key strategy for curbing the negative health impacts and the financial burden of the disease. Therefore, this review was aimed to determine the rate of asthma control and assess the predictors of uncontrolled asthma in Ethiopia.MethodsPubMed, Web of Science, and Google Scholar searches were performed using key terms; “asthma, bronchial asthma, control, controlled, uncontrolled and Ethiopia” up to October 16, 2020. University repositories were also searched to retrieve gray literature. The results were presented as a prevalence rate with a 95% confidence interval (CI). Subgroup analysis and meta-regression were performed to identify the sources of heterogeneity in the outcomes.ResultsFrom 1,388 patients, based on the Global Initiative for Asthma (GINA) symptom control, the rate of the uncontrolled asthma was 45.0% (95% CI 34.0% - 56.0%) with a considerable heterogeneity between the studies; (I2: 94.55, p< 0.001). About 19.0% (95% CI 10.0% - 29.0%); (I2: 96.04, p< 0.001) of the asthma patients had a well-controlled asthma. Moreover, 36.0% (95% CI 22.0% - 50.0%), (I2: 97.11, p< 0.001) of patients had a partly controlled asthma. Similarly, based on the asthma control test (ACT), the rate of well-controlled asthma was 22.0% (95% CI 3% - 42.0%), with considerable heterogeneity between the studies; (I2: 97.75, p< 0.001). The most frequent predictors of uncontrolled asthma were incorrect inhalation techniques, frequent SABA use, moderate/severe persistent asthma, history of exacerbations, presence of comorbidities, use of oral corticosteroids, and irregular follow-up.ConclusionThe rate of uncontrolled asthma in Ethiopia was high. Several factors are associated with uncontrolled asthma. Comprehensive asthma educations at each follow-up visit should be strengthened to minimize the morbidity and the cost of uncontrolled asthma.

Efficacy and Safety of Pidotimod in Persistent Asthma: A Randomized Triple-Blinded Placebo-Controlled Trial

To study whether addition of pidotimod to inhaled corticosteroid (ICS) therapy enhances control in children with persistent asthma, as compared to ICS therapy alone. Triple-blinded, randomized controlled trial. Allergy and Asthma Clinic, Department of Pediatrics, at a tertiary care hospital between May, 2018 and June, 2019. 79 children (5-12 years) with newly diagnosed persistent asthma as per Global Initiative for Asthma guidelines. Children received 7 mL twice-a-day for 15 day, followed by 7 mL once-a-day for 45 days of either pidotimod (n=39) or placebo (n=40). In addition, both groups received inhaled budesonide via metered dose inhaler and spacer, throughout the study. Children were followed up every 4 weeks for a total of 12 weeks. At each follow-up visit, peak expiratory flow (PEF) and asthma symptom score and medicine adverse effects were recorded. Change in PEF at 12 weeks compared to baseline. Secondary outcomes were PEF at each follow-up visit, asthma symptom score at each visit, change in asthma symptom score at 12 weeks, and adverse event profile. The median (IQR) change in PEF (from baseline to 12 weeks) was 13.0% (0.8%, 28.3%) in pidotimod group (n=35) vs17.7% (4.3%, 35.2%) in placebo group (n=35)(P=0.69). All the secondary outcomes were also comparable between the two groups.There were no significant adverse effects observed. Addition ofpidotimod for 8 weeks to standard ICS therapy did not enhance asthma control compared to placebo.

Currently Available Inhaled Therapies in Asthma and Advances in Drug Delivery and Devices.

Medications delivered in the inhaled form remains the cornerstone of medical management of asthma. There have been considerable advances in the development of inhaled medications and devices over the past several decades. Clinicians also have access to regularly updated international guidelines for management of asthma. Despite this, a substantial proportion of children with asthma continue to have persistent poor asthma control and considerable morbidity even in well-resourced settings. The wide selection of medications and devices may complicate clinical decision making. The ideal inhaler would be one that the patient can and will use as advised. One cannot overemphasize the importance of medication adherence and a correct inhaler technique in achieving optimal asthma control. Clinicians who manage children with asthma should have a good understanding of inhaled medications and devices commercially available for the management of asthma and this would help them select the right medication and device for the right patient. This review aims to provide an overview of physiologic basis of inhaler therapy, commonly used inhaled therapies, and the advances in the field of inhaler devices including emerging technologies.

A prospective and observational study on the variation in Hemoglobin A1c levels among asthmatic children using inhaled corticosteroids

Background: The studies in children regarding the effects of inhaled corticosteroids (ICS) on the carbohydrate metabolism are scant in India. This study was undertaken to determine if there is any effect of inhaled steroids on the glycemic control. Aims and Objectives: The aim of the study was to analyze the pattern of glycated hemoglobin (HbA1c) levels in children with persistent asthma, before and after using prophylactic doses of ICS and to evaluate and compare HbA1c levels separately in those taking budesonide and in those taking fluticasone or other steroids. Materials and Methods: It was a prospective and observational study, based on a study proforma. Children of 2–12 years of age, diagnosed with mild-to-moderate persistent asthma, attending the Asthma Clinic at Paediatrics Department of SAT Hospital, Government Medical College, Thiruvananthapuram were included in the study. The diagnosis of asthma and the severity was recorded according to Global Initiative for Asthma guidelines.5 The sample size was calculated to be 40. Type, dose, and frequency of administration of ICS and other coprescribed drugs were recorded on an asthma diary and entered into the study proforma. HbA1c levels were measured in children before they were started on ICS, on the same day of visit using high perfusion liquid chromatography technique and repeated after 6 months. Student’s t-test was used to compare mean values between two groups. Results: Mean age of patients is 5.75. About 62.5% of patients were males. About 72.5% of the patients had a diagnosis of moderate persistent asthma. The mean HbA1c before the treatment with ICS was 5.36 and after the treatment is 5.37 and the difference was not significant. Conclusions: There was no significant change in HbA1c levels with the use of ICS.

Experimental methods to study sleep disruption and immune balance in urban children with asthma.

Study ObjectivesWe describe research methods developed to examine effects of sleep disruption on changes in immune balance, lung function, and cognitive performance in a sample of urban, ethnically diverse children with persistent asthma. Two case examples (8- and 10-year-old males) are presented to highlight methods of the current study and illustrate effects of experimentally disrupted sleep on the immune balance profile (Th1/Th2 cytokines), key sleep variables from polysomnography data, and lung function in our sample.MethodsChildren follow an individualized structured sleep schedule consistent with their habitual sleep need (≥9.5 hours’ time in bed) for six days before a laboratory-based experimental sleep protocol. Children then spend two successive nights in the sleep lab monitored by polysomnography: a baseline night consisting of uninterrupted sleep, and a disruption night, during which they are awoken for 2 minutes between 20-minute intervals of uninterrupted sleep. Evening and morning blood draws bracket baseline and disruption nights for immune biomarker assessment.ResultsA shift towards immune imbalance following the sleep disruption protocol was observed in these illustrative cases.ConclusionsData from these case examples provide evidence that the experimental protocol caused disruptions in sleep as observed on polysomnography and had the hypothesized downstream effects on immune balance associated with clinical asthma control. Documenting the effects of sleep disruption on immune function in children with persistent asthma is a crucial step towards understanding associations between sleep, immune balance, and asthma outcomes and provides important information for developing novel interventions for youth with asthma and suboptimal sleep.Clinical TrialsNot applicable.

Zinc and vitamin C deficiencies associate with poor pulmonary function in children with persistent asthma.

One of the pathophysiologic mechanisms involved in asthma is the increase in oxidative stress. Zinc (Zn), vitamin C (VC), and vitamin E (VE) have antioxidant functions. However, the status of oxidative stress, Zn, VC, and VE in Thai asthmatic children have not been reported. We aimed to evaluate the status of oxidative stress, Zn, VC, VE, pulmonary function tests, and airway inflammation in Thai asthmatic children with persistent asthma. In this cross-sectional study, the data was collected from asthmatic children aged 7-17 years. The plasma PGF2α concentration as a marker of oxidative stress was measured using an ELISA kit. Plasma Zn concentration was measured through atomic absorption spectrophotometry. Plasma VC and VE concentrations were determined using HPLC. Pulmonary function tests were evaluated as forced expiratory volume in first second (FEV₁) and forced vital capacity (FVC), using a spirometer. The status of airway inflammation was determined by measuring fractional exhaled nitric oxide. There were 76 asthmatic children in this study. Seventy-two participants had high oxidative stress. All participants had Zn deficiency. Nearly 40% of participants had VC deficiency. VC deficiency was associated with severe asthma and airway obstruction. Plasma Zn concentrations were positively correlated with FEV₁ (r = 0.27) and FEV₁/FVC ratio (r = 0.65). Deficiency of Zn and/or VC was related to severe asthma and decreased pulmonary function. Nutrition assessment and management should be considered to alleviate asthma burden.

Генно-инженерная терапия тяжелой астмы у детей: опыт применения

This article presents the results of anti-IgE-therapy in children with severe persistent uncontrolled atopic bronchial asthma. The clinical course of the disease during 3 years of follow-up was analyzed. The effectiveness of IgE-therapy was evaluated by the frequency of hospitalizations, asthma control, and changes in baseline therapy. Treatment with Omalizumab resulted in decreased frequency of acute states, normalized external respiration function, reduced severity of co-morbid pathology in the form of allergic rhinitis and atopic dermatitis.

Спектр сенсибілізації до молекулярних компонентів алергенів собаки у пацієнтів з респіраторною алергопатологією

Abstract. The aim of study: to analyze the dependence of the severity of the course of allergic rhinitis (AR) and/or bronchial asthma (BA) in patients with hypersensitivity to dog allergens from sensitization to individual dog allergenic proteins. Research materials and methods. Blood serum obtained from the venous blood of 102 patients (37 women and 65 men) with a confirmed diagnosis of persistent AR and/or BA and hypersensitivity to dog allergens was used for the study of dog allergenic proteins. Serum was analyzed for the presence of the major dog allergen proteins Can f1 and Can f5 and the minor (cross-linking) protein Can f3 using ImmunoCAP technology (Thermo Fisher Scientific, Uppsala, Sweden). Results. The vast majority of patients with a mild form of persistent AR were monosensitized to one of the main dog allergen proteins Can f1 (50 %) or Can f5 (33 %). Whereas sensitization to 2 proteins occurred in this category of patients much less frequently, as only 12 % of patients were sensitized to Can f1 and Can f5, and 5 % to Can f1 and Can f3 simultaneously. In patients with a moderate and severe form of persistent AR, the sensitization profile was dominated by hypersensitivity to several allergenic components (Can f1 and Can f5), which occurred in 40 % of the examined, and sensitization to 3 components (Can f1, Can f5 and Сan f3) of allergens dogs — in 50 % of patients. Among the examined patients with BA, the most frequent proteins in the form of mono- or co-sensitization were the main dog allergens Can f1 and Can f5. Monosensitization to the minor component of Can f3 was not detected in any patient from both groups of subjects. Conclusions. The vast majority of patients with AR and/or BA and hypersensitivity to dog allergens were sensitized to one or both of the major dog allergens Can f1 and Can f5. As a rule, sensitization to 2 or more allergenic proteins was associated with a more severe course of respiratory allergy pathology. At the same time, special attention should be paid to monosensitization to Can f5 dog urinary kallikrein, which occurred in the examined subjects, because this component is often absent in allergen extracts for skin prick tests and in allergen extracts for allergen-specific immunotherapy (AIT), which can lead to before receiving false-negative test results and ineffective AIT.

The "real-world" effectiveness and safety of omalizumab in patients with uncontrolled persistent allergic asthma in Slovakia: a subgroup analysis of the eXpeRience study.

Omalizumab was proven to be effective and safe in patients with moderate-to-severe allergic asthma. However, there is no direct evidence of the benefits of add-on omalizumab in real-life practice in the Slovakian population. This subgroup analysis assessed the real-life effectiveness and safety of omalizumab in Slovakian patients with severe allergic asthma enrolled in the eXpeRience registry. Patients who commenced omalizumab 15 weeks prior to inclusion were assessed for the physicians' global evaluation of treatment effectiveness (GETE), exacerbation rate, asthma symptoms, lung function, oral corticosteroid (OCS) use, rescue medication, hospitalizations, and school/work absenteeism at 16 weeks and 12 and 24 months. Of 204 patients, 159 (77.9%) completed 2-year follow-up. As per GETE, 69.5% of patients treated with omalizumab achieved excellent/good response at 16 (±1) weeks. The proportion of patients with no severe clinically significant asthma exacerbations increased from 17.3% at pre-treatment to 82.4% and 92.0% at months 12 and 24, respectively. Maintenance OCS use was reduced to 17.0% and 15.3% of patients at 12 and 24 months, respectively, compared with 34.7% at baseline (BL). From BL until month 24, asthma control test scores improved from 11.6 to 20.3; rescue medication use/week decreased from 5.5 to 1.6 days; mean total number of days of asthma-related medical healthcare use decreased from 7.7 to 0.3 days and missed workdays decreased from 16.8 to 0.3 days. No new safety signals were observed. Add-on omalizumab was effective and well-tolerated in Slovakian patients, complementing the results observed in the overall population of eXpeRience.

ЕВОЛЮЦІЯ РЕКОМЕНДАЦІЙ GINA. ПРАКТИЧНІ АСПЕКТИ ЛІКУВАННЯ ПАЦІЄНТІВ З АСТМОЮ ЧЕРЕЗ ПРИЗМУ КЛІНІЧНИХ ДОСЛІДЖЕНЬ

EVOLUTION OF GINA GUIDELINES. PRACTICAL ASPECTS OF ASTHMA MANAGEMENT THROUGH THE PRISM OF CLINICAL TRIALS S. V. Zaikov, F. T. Bogomolov, G. L. Gumeniuk Abstract Through the 28 years lifetime of GINA (Global Initiative for Asthma) recommendations, there’s been a shift in the paradigm of asthma management. GINA is a Global Strategy of treatment and prophylaxis of asthma, established by National Heart, Lung and Blood Institute in collaboration with National Institute of Health and World Health Organization in 1993. First published in 1995 GINA report has become a widespread consensus, which made a basis for clinical recommendations on asthma worldwide. One can define three major periods in evolution of GINA. The first period covered 1994–2004 years since GINA originated and first edition published until experts have recognized the advantage of inhaled rout of asthma drugs administration. It was proved that in many patients the main goal was establishing asthma control, while combination of inhaled corticosteroid with long-acting beta agonist (ICS/LABA) was a preferred option in moderate persistent asthma. In this period it was recommended to chose an approach to managent of asthma, based on scientific evidence, rather then expert’s opinion. In this regard, a second period (2005–2014 years) should be considered outstanding, due to the change in perception of major goals of asthma management, considering exclusively data from numerous studies. Such concepts as patient-medical personnel partnership, patient’s education, guided self-control and goals of treatment have been introduced. GINA recommends to use asthma control as a major approach to treatment instead of severity of disease. Personalized treatment should be aimed on exacerbation risk reduction. Steps 3-5 of treatment algorithm were modified to include ISC-formoterol for maintenance therapy and relief of symptoms (MART-therapy). Third period of GINA started after SYGMA 1 and 2 studies results became available. It was demonstrated that on-demand symptom-relief use of anti-inflammatory therapy with ICS/formoterol combination was highly effective in mild asthma patients. Use of this combination as rescue medication decreased the risk of exacerbation in comparison with short-acting beta agonist (SABA) and may be used in any variant of asthma. Since GINA 2019 edition SABA became not the only one available option even for the mildest forms of asthma. Eventually, in 2021 the culmination of GINA evolution occurred: major algorithm of asthma management has been divided in two tracks: preferred (Track 1) therapy with ICS/formoterol and alternative (track 2) therapy with SABA as rescue medication. The authors of this article review in details the periods of GINA evolution, resulted in dividing asthma management into two tracks, which provide personalized treatment strategy considering all patient’s needs and characteristics such as fast relief of symptoms, decreased risk of exacerbation and establishing asthma control. Key words: asthma, GINA, evolution of treatment approaches. Ukr. Pulmonol. J. 2022;30(1):6–14

Parent/Guardian Experiences With the Healthcare System and Community Supports for Pediatric Asthma Management.

Determinants of pediatric asthma management include child, family, healthcare, and community factors. The purpose of this study is to investigate how parents/guardians are impacted by and act on these factors to aid in their child’s asthma self-management. Interviews were conducted in Fall 2020 with 12 female parents/guardians of Black/African American children who participated in a community paramedic pilot study with their child in South Carolina. Children in the initial study had an asthma diagnosis of moderate persistent asthma, had Medicaid insurance, and were determined high-risk for emergency room presentation. Inductive and deductive qualitative analysis identified that child management self-efficacy and independence, parent/guardian health literacy, parent and child negative experiences related to asthma diagnosis and management, asthma management tools, and social support from multiple sources impact child self-management. Findings from this study highlight the importance of clear asthma education and management tool recommendations from healthcare and community providers, particularly for parents/guardians with low health literacy. Health literacy impacted parental responses and likely how families comprehend Medicaid and clinical asthma guidance.

The Melbourne epidemic thunderstorm asthma event 2016: a 5-year longitudinal study.

In 2016, Melbourne was struck by the world's largest and most devastating epidemic thunderstorm asthma (ETSA) episode. While affected individuals displayed worsened short-term asthma control, little is known about their longer-term natural history, nor about interventions that restore control. We assessed the asthma symptomatology and related behaviours of ETSA-affected individuals through a single-centre prospective 5-year longitudinal study. We embedded an open-label observational trial investigating the role of grass pollen sublingual tablet (Oralair) allergen immunotherapy in improving asthma and allergic rhinitis symptoms. Allergic rhinitis symptom severity, frequency of asthma symptoms and inhaled corticosteroid usage were assessed via questionnaire yearly. In 2018, a subgroup of participants was enrolled in an observational study of Oralair treatment compared to control. The active group received Oralair from 2019 to 2021; both groups were followed-up for 5 years. Subgroup analyses were performed for participants with complete datasets, and who completed the trial per-protocol. Year-on-year data across 5 years was available for 30 participants. The rate of persistent asthma symptoms declined from 37% to 7% in 2016 to 2021. Only 10%-27% of participants reported being completely asymptomatic in any given year. The inhaled preventer prescription rate was 67%, with only 35% being adherent. Twenty-seven participants with available data completed the Oralair trial per-protocol. No significant difference was noted between control and active groups for allergic rhinitis symptoms or asthma control, although the Oralair group saw a significant improvement in asthma control comparing 2019 with 2021. This is the longest documented follow-up of ETSA-affected individuals. Five years following sentinel event, there was progressive reduction but some persistence in asthma symptoms. Oralair allergen immunotherapy did not further improve allergic rhinitis or asthma symptoms compared to control, but there were no further ETSA events to test a protective effect during the study period.

The anti-inflammatory effects of inhaled steroids and β2-agonist added to inhaled steroids in the treatment of mild asthma

The use of inhaled corticosteroids (ICS) alone may be sufficient for asthma control in mild asthma. We investigated the effect of inhaled steroid and beta-2 agonist combination on airway function and inflammation in mild asthma.We randomized 20 mild persistent asthma patients treated with the 200μg budesonide (10 patients) or budesonide 200μg -formoterol 12μg (10 patients) twice daily for 4 weeks. We investigated the effects of treatment groups on pulmonary function tests by spirometry and eosinophil percentage and eosinophil cationic protein (ECP) levels in serum and induced sputum. We compared values before and after treatment within budesonide and budesonide-formoterol groups and after treatment between groups. We observed that eosinophil percentage and ECP levels in serum and induced sputum decreased significantly after treatment in both treatment groups. Only the decrease in serum eosinophil percentage level was not significant in the budesonide group. On the other that, there was no significant reduction of inflammatory markers between the two treatment groups. The spirometric measurements (FVC, FEV1, FEF25-75) showed a statistically significant increase within the budesonide-formoterol treatment group, but not in the budesonide group. These measurements were not statistically changed between the two treatment groups. In patients with mild asthma, budesonide and formoterol combination therapy did not add to the improvement of airway obstruction and inflammation more than budesonide therapy.

Controversies in the treatment of mild asthma. What novelties and practical implications?

Mild asthma is prevalent in childhood and causes as many as 30%–40% asthma exacerbations requiring emergency visits. The management of "intermittent" and "mild persistent" asthma phenotypes is still a matter of debate, even if the role of inhaled corticosteroids, both continuous and intermittent, is a cornerstone in this field. Recent updates of the guidelines on the strategies to manage these patients are coming, since the role of inflammation in these asthma phenotypes is crucial, as well as the potential side effect and risks of short‐acting beta 2 agonists overuse, prescribed as the only "as‐needed" treatments. In this paper, we overview the new (r)evolution regarding intermittent and mild persistent asthma management.

Parental knowledge, attitude toward asthma, and its correlation with compliance of asthma management in children

BACKGROUND: Asthma is one of the common chronic illnesses in children affecting about 10-15% worldwide. Proper management of asthma depends on the knowledge, attitude, and practices of the parents towards asthma which in turn will enable early intervention and prompt management. OBJECTIVE: To determine the parental knowledge, attitude towards asthma and its correlation with the compliance of asthma management in children. METHODOLOGY: It is a cross-sectional observational study carried out in a tertiary care hospital between January 2020 to December 2020. RESULTS: The study included 112 participants. Mothers were the predominant caregivers (72.3%). Family history of asthma was noticed in 42.8%. 88.4% knew that their child was suffering from asthma, 18% felt that asthma is contagious. Change in the climate (91.1%), dust (60.7%), respiratory infection (49.1%), and smoke (44.6%) were the common triggers. 15% tried an alternate system of medication. Majority (87%) had moderate knowledge, 92 (82%) showed good practices. 56 (50%) exhibited negative attitude. Nearly 60% of the participants preferred inhaler therapy. The causes for non-adherence to inhaler therapy were fear of addiction (46.7%), child refusing inhaler (40%), cost of therapy (40%) and child being symptom free in between episodes (37.8%). CONCLUSIONS: This study revealed a moderate level of knowledge and good practices towards childhood asthma among the parents of asthmatic children. Better knowledge and good practices among the parents strongly correlated with mother being the participant of the study, educational status, positive family history of asthma and persistent asthma symptoms. Better knowledge and positive attitude towards asthma was associated with adherence to inhaler therapy.