Prevent Asthma Attacks Research Articles

Parental knowledge and attitudes toward asthma in Jordanian children with asthma, a multi-center cross-sectional study

Objective We explored Jordanian caregivers’ knowledge, attitudes, and practices (KAP) toward asthma in their children. Methods This cross-sectional investigation was conducted on caregivers visiting the pediatrics clinic at the Jordan University Hospital and King Abdullah University Hospital between December 2021 and January 2023. KAP were measured using a literature-validated questionnaire. Differences in KAP scores across participants’ characteristics were examined using the student-t test and ANOVA. Results A total of 108 caregivers were included in the final analysis. Caregivers were aged 30 to 40 years (54.6%) and had at least secondary education (90.7%). The majority of participants displayed appropriate knowledge with respect to asthma’s clinical course. Furthermore, the greater portion of caregivers were knowledgeable about preventing asthma attacks and treating their children during said attacks. Factors affecting knowledge of asthma included age of mothers (p < .05). On the other hand, attitude scores were affected by occupation, type of medication, and family history of asthma (all p < .05). Moreover, employee mothers, children well controlled on both Asthma Control Test and Global Initiative for Asthma scores, and having no pediatric intensive care unit admissions were associated with higher practice treatment scores (all p < .05). Overall practice score was weakly, yet positively correlated with knowledge scores (r = 0.195, p = .043). Similarly, negative attitudes were weakly correlated with higher knowledge scores (r = 0.199, p = .039). Conclusion While the knowledge and practice scores were satisfactory, the clinical status of children with asthma was unsatisfactory. Future studies should examine factors associated with caregiver insecurity and measure their extent of applying asthma prevention guidelines.

LC-MS/MS Analytical Method for Determination of Montelukast in Human Plasma and its Application to a Bioequivalence Study

Background: This study aimed to develop a sensitive, rapid method based on HPLC-MS/MS for the quantification of Montelukast in human plasma utilizing Montelukast-D6 as an internal standard. Montelukast is a leukotriene inhibitor and is used to prevent asthma attacks in adults and children. Method: Separation was achieved using Thermo Hypersil GOLD™ Cyano HPLC columns (50 × 4.6 mm; 5 μm) with a mobile phase consisting of 0.5 mM ammonium chloride: ACN (20:80%; v/v). Results: The method was found to be linear over a concentration range of 10.0 - 600.0 ng/mL with a correlation coefficient (r2) ≥ 0. 0.9989. The stabilities of Montelukast and internal standard were assessed in several conditions with recovery results &gt; 85%. The precision results were less than 4.0%, while the accuracy results were within 93.0 107.0%. The method proved to be selective with no matrix effect. Conclusion: This method was found to be highly reproducible and was utilized successfully for the analysis of plasma samples following the oral administration of Montelukast (10 mg) in 28 healthy male human volunteers.

ВЛИЯНИЕ ГЕНДЕРНО-ВОЗРАСТНЫХ ОСОБЕННОСТЕЙ ДЕТЕЙ С БРОНХИАЛЬНОЙ АСТМОЙ НА КАЧЕСТВО ЖИЗНИ, ПРИ САНАТОРНО- КУРОРТНОМ ЛЕЧЕНИИ

Bronchial asthma (BA) is still one of the leading causes of morbidity and mortality worldwide, in spite of the increasing costs for its treatment. The goals of asthma treatment in children and adolescents are to minimize the burden of symptoms, prevent asthma attacks, reduce the risk of progression of pathophysiological changes and adverse outcomes, and improve the quality of life. The results of assessing the level of health-related quality of life in patients with BA show that the levels of asthma control can affect the overall level of quality of life (QoL) of both children and parents and/or relatives of patients with BA. 65 children with BA, 42 boys and 23 girls, average age 11.3±0.4 years, were under the observation in the children's sanatorium. All children, regardless of gender and age, showed a positive dynamic of quality-of-life parameters after the sanatorium treatment. The percentage deviation of the quality of life (QOL) at the beginning and at the end of the treatment, can serve as a criterion for determining the effectiveness in young patients with BA, allows to establish the effectiveness of the application of a set of medical procedures in a sanatorium, helping in the overall assessment of the effectiveness of treatment.

Toward a Predict and Prevent Approach in Obstructive Airway Diseases

Asthma and chronic obstructive pulmonary disease (COPD) are currently diagnosed and treated after demonstration of variable airflow limitation and symptoms. Under this framework, undiagnosed and unchecked airway inflammation is associated with recurrent acute attacks, airway remodeling, airflow limitation, adverse effects of corticosteroids, and impaired quality of life, ultimately leading to the collection of side-effects termed 'people remodeling'. This one-size-fits-all, damage control approach aims to control symptoms and treat exacerbations rather than modify the underlying disease process. The advent of highly effective therapies targeting proximal drivers of airways inflammation calls for a paradigm shift; upstream-acting therapies offer potential to alter the disease course and achieve clinical remission. We propose moving away from downstream firefighting and towards a predict and prevent model, measuring inflammation and providing anti-inflammatory therapy early, without waiting for further clinical deterioration. Much in the same way that high blood pressure and cholesterol are used to predict and prevent heart attacks, in asthma elevated blood eosinophils and/or exhaled nitric oxide (FeNO) can be used to predict and prevent asthma attacks. We advocate also moving research further upstream by identifying patients with subclinical airways inflammation or disease who may be at risk of progressing to airflow limitation and associated morbidities and intervening early to prevent them. In summary, we call for a 'predict and prevent' approach in obstructive airways disease.

Asthma exacerbations: the Achilles heel of asthma care.

Asthma exacerbations significantly impact millions of patients worldwide to pose large disease burdens on affected patients, families, and health-care systems. Although numerous environmental factors cause asthma exacerbations, viral respiratory infections are the principal triggers. Advances in the pathophysiology of asthma have elucidated dysregulated protective immune responses and upregulated inflammation that create susceptibility and risks for exacerbation. Biologics for the treatment of severe asthma reduce rates of exacerbations and identify specific pathways of inflammation that contribute to altered pathophysiology, novel therapeutic targets, and informative biomarkers. Major steps to prevent exacerbations include the identification of molecular pathways whose blockage will prevent asthma attacks safely, predictably, and effectively.

Preventing unscheduled hospitalisations from asthma: a retrospective cohort study using routine primary and secondary care data in the UK (The PUSH-Asthma Study)—protocol paper

IntroductionAsthma is the most common chronic respiratory disease in children and adults. Asthma results in significant disease-related morbidity, healthcare costs and, in some cases, death. Despite efforts through implementation of...

Thunderstorm allergy and asthma: state of the art.

Thunderstorm-triggered asthma (TA) can be defined as the occurrence of acute asthma attacks immediately following a thunderstorm during pollen seasons. Outbreaks have occurred across the world during pollen season with the capacity to rapidly inundate a health care service, resulting in potentially catastrophic outcomes for allergic patients. TA occurs when specific meteorological and aerobiological factors combine to affect predisposed atopic patients with IgE-mediated sentitization to pollen allergens. Thunderstorm outflows can concentrate aeroallergens, most commonly grass pollen but also other pollens such as Parietaria and moulds in TA, at ground level to release respirable allergenic particles after rupture by osmotic shock related to humidity and rainfall. Inhalation of high concentrations of these aeroallergens by sensitized individuals can induce early asthmatic responses which can be followed by a late inflammatory phase. There is evidence that, during pollen season, thunderstorms can induce allergic asthma outbreaks, sometimes also severe asthma crisis and sometimes deaths in patients suffering from pollen allergy. It has been observed that changes in the weather such as rain or humidity may induce hydratation of pollen grains during pollen seasons and sometimes also their fragmentation which generates atmospheric biological aerosols carrying allergens. Asthma attacks are induced for the high concentration at ground level of pollen grains which may release allergenic particles of respirable size after rupture by osmotic shock. In other words, it is a global health problem observed in several cities and areas of the world that can strike without sufficient warning, inducing sometimes severe clinical consequences also with deaths of asthma patients. Due to constant climate change, future TA events are likely to become more common, more disastrous and more unpredictable, as a consequence it is important to have deep knowledge on this topic to prevent asthma attacks. Other environmental factors, such as rapid changes in temperature and agricultural practices, also contribute to causing TA.

Paediatric and adolescent asthma: A narrative review of telemedicine and emerging technologies for the post-COVID-19 era.

Children and young people with asthma need regular monitoring to maintain good asthma control, prevent asthma attacks and manage comorbidities. The COVID‐19 pandemic has resulted in healthcare professionals making fundamental changes to the way healthcare is delivered and for patients and families adapting to these changes. Comprehensive remotely delivered, technology‐based healthcare, closer to the patients home (reducing hospital footfall and possibly reducing carbon footprint) is likely to be one of the important collateral effects of the pandemic. Telemedicine is anticipated to impact everyone involved in healthcare ‐ providers and patients alike. It is going to bring changes to organization, work areas and work culture in healthcare. Healthcare providers, policymakers and those accessing healthcare services will experience the impact of technology‐based healthcare delivery. Telemedicine can play an exciting role in the management of childhood asthma by delivering high‐quality care closer to the child's home. However, unlike adults, children still need to be accompanied by their carers for virtual care. Policymakers will need to take into account potential additional costs as well as the legal, ethical and cultural implications of large scale use of telemedicine. In this narrative review, we review evidence regarding the role of telemedicine and related emerging technologies in paediatric and adolescent asthma. Although there are gaps in the current knowledge, there is evidence demonstrating the important role of telemedicine in management of childhood and adolescent asthma. However, there is an urgent need for healthcare researchers and policymakers to focus on improving the technologies and address the disparities in accessing novel technology‐based management strategies to improve asthma care.

Circulating MicroRNAs and Treatment Response in Childhood Asthma.

Rationale: Inhaled corticosteroids (ICS) are key treatments for controlling asthma and preventing asthma attacks. However, the responsiveness to ICS varies among individuals. MicroRNAs (miRNAs) have been lauded for their prognostic utility.Objectives: We hypothesized that circulating miRNAs obtained at baseline/prerandomization in the Childhood Asthma Management Program (CAMP) could serve as biomarkers and biologic mediators of ICS clinical response over the 4-year clinical trial period.Methods: We selected baseline serum samples from 462 CAMP subjects subsequently randomized to either ICS (budesonide) or placebo. Samples underwent small RNA sequencing, and read counts were normalized and filtered by depth and coverage. Linear regression was used to associate miRNAs with change in FEV1% (prebronchodilator FEV1 as a percent predicted) over the 4-year treatment period in both main effects and interaction models. We validated the function of the top associated miRNAs by luciferase reporter assays of glucocorticoid-mediated transrepression and predicted response to ICS through logistic regression models.Measurements and Main Results: We identified 7 miRNAs significantly associated with FEV1% change (P ≤ 0.05) and 15 miRNAs with significant interaction (P ≤ 0.05) to ICS versus placebo treatments. We selected three miRNAs for functional validation, of which hsa-miR-155-5p and hsa-miR-532-5p were significantly associated with changes in dexamethasone-induced transrepression of NF-κB. Combined, these two miRNAs were predictive of ICS response over the course of the clinical trial, with an area under the receiver operating characteristic curve of 0.86.Conclusions: We identified two functional circulating miRNAs predictive of asthma ICS treatment response over time.

Evaluation of a Diagnostic Therapeutic Educational Pathway for Asthma Management in Children and Adolescents.

Background: Limited evidence exists for the effectiveness of educational programs that improve pediatric asthma control in real-world settings. We aimed to assess the impact of a diagnostic, therapeutic, and educational pathway (DTEP) for asthma management in children and adolescents attending an asthma referral center.Methods: This is a retrospective population-based cohort study, including two groups of patients with asthma, aged 6–17 years and residing in the Local Health Authority (LHA) of Brescia, Italy: (a) the children who followed a DTEP (intervention group) and (b) all the children residing in the LHA who did not follow DTEP (control group). The incidence rates (IRs) of hospitalization, emergency room visit, use of outpatient services, and drug prescription for dyspnea, wheezing, or respiratory symptoms were computed for time before and after attending DTEP in the intervention group and for “early” and “late” time since asthma diagnosis in the control group.Results: There were 9,191 patients included in the study, 804 of whom followed DTEP. In the before-DTEP/early time, the intervention and control groups showed similar IRs for all the outcomes apart from emergency room visits (IRs of 138.6 and 60.3 per 1,000 person-years, respectively). The IRs decreased from before to after DTEP and from early to late time in both groups. The IR decrease for emergency room visits was significantly higher in the intervention than in the control group (−51.3 and −28.2%, respectively; IRR = 0.61, P = 0.001).Conclusion: The DTEP can increase patients' capability in managing asthma and preventing asthma attacks.

Preventing back-to-school asthma attacks

A seasonal peak in asthma attacks has been consistently demonstrated. Hetal Dhruve discusses some of the reasons for this peak and how practice nurses can help to prevent asthma attacks in children Asthma is one of the most common long term conditions in the UK, affecting approximately 1.1 million children. Asthma prevalence, related mortality and health-care utilisation in the UK are estimated to be among the highest in the world. A seasonal peak in asthma attacks has been consistently demonstrated following the summer school holiday and in line with the start of the autumn term. This article discusses some of the reasons for this peak and how asthma attacks can be prevented by practice nurses.

The Benefits and Challenges of Managing Asthma in Hispanic Families in South Texas: A Mixed-Methods Study.

Understanding the experience of Hispanic parents of children diagnosed with asthma can be useful in the delivery of effective and meaningful asthma education. In order to assess the needs of Hispanic families with asthmatic children in South Texas, investigators utilized a combination of qualitative and quantitative research methods. This study aimed (1) to assess the impact of asthma in the quality of life of Hispanic children and their families and (2) to identify barriers and challenges to asthma management as perceived by parents of children diagnosed with asthma. A mixed-methods study included a quality-of-life survey and focus group discussions. The Children's Health Survey for Asthma (CHSA) was completed by 90 parents of children with asthma. Three focus groups were conducted with 15 low-income, Hispanic parents of asthmatic children to assess their needs and experience in managing the disease. Results from the CHSA showed that asthma significantly affects the quality of life of children with asthma and their families, particularly the emotional dimensions and the child's physical health. Fifty-three percent of the children had visited the emergency room, and 51% had been hospitalized due to asthma. One out of five parents had missed work, and 27% of children had missed school in the past 2 weeks due to the child's asthma. In the focus group discussions, the key themes emerging included lack of asthma knowledge, the burden of disease for asthmatic children and their families, and the importance of asthma education and self-management behaviors for asthma control. One of the main challenges faced by Hispanic families with asthmatic children is the lack of asthma-related knowledge to help understand and control their children's disease. Lack of knowledge and self-management skills lead to significant stress and anxiety among children with asthma and their parents. Results highlight that while asthma has an effect on the quality of life of children and their families, particularly on the emotional health domain, a wide dissemination of asthma management education in different settings might help prevent asthma attacks and improve symptom control among those suffering from this disease along the US-Mexico border.

Potential new ways to prevent and treat asthma attacks.

Researchers have discovered potential new ways to treat and prevent asthma attacks.

A Scalable Data Integration and Analysis Architecture for Sensor Data of Pediatric Asthma.

According to the Centers for Disease Control, in the United States there are 6.8 million children living with asthma. Despite the importance of the disease, the available prognostic tools are not sufficient for biomedical researchers to thoroughly investigate the potential risks of the disease at scale. To overcome these challenges we present a big data integration and analysis infrastructure developed by our Data and Software Coordination and Integration Center (DSCIC) of the NIBIB-funded Pediatric Research using Integrated Sensor Monitoring Systems (PRISMS) program. Our goal is to help biomedical researchers to efficiently predict and prevent asthma attacks. The PRISMS-DSCIC is responsible for collecting, integrating, storing, and analyzing real-time environmental, physiological and behavioral data obtained from heterogeneous sensor and traditional data sources. Our architecture is based on the Apache Kafka, Spark and Hadoop frameworks and PostgreSQL DBMS. A main contribution of this work is extending the Spark framework with a mediation layer, based on logical schema mappings and query rewriting, to facilitate data analysis over a consistent harmonized schema. The system provides both batch and stream analytic capabilities over the massive data generated by wearable and fixed sensors.

Long-term control medication use and asthma control status among children and adults with asthma

ABSTRACTBackground: Uncontrolled asthma decreases quality of life and increases health care use. Most people with asthma need daily use of long-term control (LTC) medications for asthma symptoms and to prevent asthma attacks. Ongoing assessment of a person's level of asthma control and medication use is important in determining the effectiveness of current treatment to decrease the frequency and intensity of symptoms and functional limitations. Objective: To assess the use of LTC medication among children and adults with current asthma and identify contributing factors for LTC medication use. Methods: We used the 2006–2010 Behavioral Risk Factor Surveillance System (BRFSS) child and adult Asthma Call-back Survey (ACBS) data to assess the level of asthma control and LTC medication use. Asthma control was classified as well controlled and uncontrolled using guideline-based measures. We used multivariable logistic regression models to identify contributing factors for LTC medication use and having uncontrolled asthma. Results: Among persons with current asthma, 46.0% of children and 41.5% of adults were taking LTC medications and 38.4% of children and 50.0% of adults had uncontrolled asthma. Among children who had uncontrolled asthma (38.4%), 24.1% were taking LTC medications and 14.3% were not taking LTC medications. Among adults who had uncontrolled asthma (50.0%), 26.7% were taking LTC medications and 23.3% were not taking LTC medications. Conclusions: Using BRFSS ACBS data to assess the level of asthma control and LTC medication use can identify subpopulations of persons with asthma who receive suboptimal treatment, for which better asthma-related medical treatment and management are needed.

Personalised approaches for preventing asthma attacks

Asthma is still potentially lethal, despite deaths from the condition being largely avoidable. Viv Marsh explores how management could be improved by personalised care It is poorly understood but asthma can be fatal. However most asthma deaths are avoidable. Avoidable factors relating to patients, health professionals and healthcare systems have been demonstrated. Recognition, identification and modification of avoidable factors could result in lives being saved. This article will explore the risk factors for asthma death and discuss therapeutic approaches to help patients of all ages achieve asthma control and avoid asthma attacks.

Knowledge of asthma in school teachers in nine Spanish cities.

To analyze the knowledge of asthma and its management in Spanish school teachers using the Newcastle Asthma Questionnaire (NAKQ). Descriptive, observational prevalence study, using a self-report questionnaire on knowledge about childhood asthma and its management by teachers in pre-school, primary, and secondary schools in nine Spanish cities. Age, sex, academic training, teaching experience, courses in which they taught, and personal and family history of asthma, were collected from each teacher. For knowledge determination, the validated Spanish version of the NAKQ was used. A total of 208 centers participated, including 7,494 teachers. The questionnaire was completed by 4,679 teachers (62.4%). The mean score of correct responses was 16.0 ± 4.8 points out of 31 (median = 17, range: 0-30). Only 6.8% of teachers were capable of pointing out the three main symptoms of the disease; 1.5% knew the triggering factors of an asthma attack; 8.6% knew two medicines useful during an asthma attack; 32.7% knew that inhaled medications had less side effects than pills, and only 3.8% knew of ways to prevent asthma attacks during exercise. In the multivariate analysis, variables significantly associated with a higher questionnaire score were a "lower age" (Beta coefficient = -0.09), "male gender" (Beta = 0.77), "being asthmatic" (Beta = 2.10), or "having close relatives with asthma" (Beta = 1.36) and "teaching in a private school" (Beta = 0.66) or in "compulsory secondary education" (Beta = 0.59). Teachers have a low level of knowledge about asthma, with an important limitation in some aspects of the disease. They should be trained to recognize the main symptoms of the disease, on how to act in the event of symptoms, and the early identification of situations in which the pupils require health care assistance. Pediatr Pulmonol. 2016;51:678-687. © 2015 Wiley Periodicals, Inc.

Externalizing and internalizing behavioural problems related to asthma in school children

We investigated the relationships of behavioural problems as assessed using the standardized Strengths and Difficulties Questionnaire (SDQ) to asthma in view of improving asthma management. Six thousand eight hundred and eighty children (mean age 10.4 years, male: 49%) were recruited in the French 6 Cities Study. Children with abnormal or borderline emotional symptoms (internalizing problems) or conduct problems (externalizing problems) were more asthmatic than others (P < 0.01). Compared to being normal, abnormal emotional symptoms or conduct problems were found to be related to mild-to-moderate persistent asthma (logistic model adjusted odds ratio = 1.55 (95% CI = 1.26-1.90) and 1.42 (95% CI = 1.17-1.71), respectively) and to early-onset asthma (Cox's model Adjusted Hazard Risk = 1.60 (95% CI = 1.27-2.01) and 1.34 (95% CI = 1.05-1.70). Borderline conduct problems were found to be negatively related to parents' knowledge on how to prevent asthma attacks, compared to normal conduct problems [adjusted OR = 0.51 (95% CI = 0.31-0.85)]. Further data are needed to better understand the involvement of behavioural problems in childhood asthma according to phenotypes.

Can the Pelargonium sidoides root extract EPs® 7630 prevent asthma attacks during viral infections of the upper respiratory tract in children?

IntroductionAsthma is a chronic disease characterized by airway inflammation. Viral infection initiates an immune inflammatory response that may produce asthma attacks. There is no effective preventing therapy for asthma attack during upper respiratory tract viral infections. ObjectiveTo investigate the efficacy of 5 days of Pelargonium sidoides therapy for preventing asthma attack during upper respiratory tract viral infections. MethodsSixty one asthmatic children with upper respiratory tract viral infection were enrolled in the study. The patients were randomized to receive Pelargonium sidoides daily for 5 days (n=30) or not (n=31). Before and after treatment, they all were examined and symptom scores were determined. Following five days treatment, children were evaluated whether or not they had an asthma attack. ResultsTreatment with Pelargonium sidoides was not associated with a statistically significant differences in fever and muscle aches (p>0.05, Chi-square test). There were significant differences in cough frequency and nasal congestion between the groups (p<0.05, Chi-square test). There were statistically significant differences in having asthma attack between the groups (p<0.05, Chi-square). Pelargonium sidoides group had less frequency of asthma attack. DiscussionOur study shows that Pelargonium sidoides may prevent asthma attacks during upper respiratory tract viral infections.

Solid State of Tulobuterol : Characterization, Dissolution, Transformation

The objective of this work was to investigate the existence of new crystal forms of tulobuterol which is used to prevent morning asthma attacks by agonist and the transformation of crystal forms. Three crystal forms of tulobuterol have been isolated by recrystallization and Form 2 was transformed to Form 4 at 52% RH and 95% RH and these four crystal forms are characterized by differential scanning calorimetry (DSC), powder X-ray diffractometry (PXRD) and thermogravimetric analysis (TG). The DSC and PXRD patterns of four crystal forms of tulobuterol were different respectively. The dissolution patterns of these three crystal forms of tulobuterol were studied and they showed significant differences in the dissolution rate. After storage of 2 months at 0% RH (silica gel, ), 52% RH (saturated solution of ) and 95% RH (saturated solution of ), Form 1 and Form 3 were not transformed. But Form 2 was transformed to Form 4 at 52% RH and 95% RH.