Short-acting Beta-agonists Research Articles

Farm Exposures and Allergic Disease Among Children Living in a Rural Setting

ABSTRACT Objectives The purpose of this study was to examine the association between farm exposures and asthma and allergic disease in children while also highlighting the experiences of non-farm rural children. Methods This was a cross-sectional analysis of data collected from across the province of Saskatchewan, Canada in 2014. Surveys were completed by parents of 2275 rural dwelling children (farm and non-farm) aged 0 to 17 years within 46 rural schools. Questionnaires were distributed through schools for parents to complete. Results Asthma prevalence was 7.6%, of which 29.5% of cases were allergic. After adjustment for potential confounders, home location (farm vs non-farm) and other farm exposures were not associated with asthma and asthma phenotypes. Those who completed farm safety education were more likely to have asthma (11.7% vs. 6.7%; p = .001) compared to children without asthma. In sub-analyses among 6–12-year-old children, boys were more likely to have asthma (non-allergic) and use short-acting beta-agonists compared to girls. Doing farm work in the summer was associated with an increased risk of asthma [adjusted OR (aOR) = 1.71 (1.02–2.88); p = .041]. Doing routine chores with large animals was associated with an increased risk of asthma [aOR = 1.83 (1.07–3.15); p = .027] and allergic asthma [aOR = 2.37 (95%CI = 1.04–5.40); p = .04]. Conclusion The present study showed that the prevalence of asthma and asthma phenotypes were similar between farm and non-farm rural children. There did not appear to be differential involvement in farming activities between those with and without asthma although those with asthma had more training suggesting possible attempts to mitigate harm from farm exposures.

Efficacy of two-year anti-IgE therapy in patients with severe allergic bronchial asthma in Sverdlovsk region

Introduction. The study of omalizumab efficacy in patients with severe bronchial asthma (SA) in randomized clinical trials is limited to 52 weeks. In real clinical practice, patients can receive the drug for much longer.Aim. Evaluate the one-year and two-year efficacy of omalizumab in patients with SA in Sverdlovsk region.Material and methods. The study included patients (n = 54) with allergic and mixed SA from the registry of Sverdlovsk region. Omalizumab efficacy was assessed over 12 and 24 months of therapy by dynamics of asthma exacerbations frequency, the use of health care resources, the need for short-acting beta-agonists (SABA) and systemic glucocorticosteroids (SGCS), the level of asthma control according to ACT, and the quality of life according to AQLQ, FEV1 levels and peripheral blood eosinophils.Results. During 12 months of omalizumab therapy, the reduction in asthma exacerbation rate was 63.7% (from 2.01 ± 1.51 per patient per year to 0.73 ± 1.03) (p < 0.001), which was accompanied by a decrease in emergency calls and hospitalizations rates by 92.4 and 84.1%, respectively (p < 0.001). Improved asthma control (by ACT) from 9 (Q1-Q3: 7–13) to 20 points (Q1-Q3: 16–23); the proportion of patients with uncontrolled SA decreased from 97.4 to 48.7% (p < 0.001). The need for SABA decreased to 92.9% (p < 0.001). The proportion of patients on SGCS decreased from 60.5% to 15.8% (p < 0.001). The quality of life (AQLQ) significantly improved, FEV1 increased (p < 0.001), the number of eosinophils in peripheral blood decreased (p = 0.015). By the end of the second year of therapy, the trend of improvement in indicators of efficacy continued.Conclusions. During 1 year of therapy with omalizumab, patients with allergic SA experienced a significant decrease in the number of exacerbations and use of health care resources, improved quality of life and asthma control, reduced need for SABA and SGCS, and improved respiratory function. In patients treated with omalizumab for 2 years, there was a further improvement or stabilization of efficacy indicators.

Inhaled Short-Acting Beta Agonist Treatment-Associated Supraventricular Tachycardia in Children: Still a Matter of Concern in Pediatric Emergency Departments?

Inhaled selective short-acting β-2 agonists (SABA), such as salbutamol, are the rescue treatment of choice for the relief of symptoms of acute asthma exacerbations: one of the leading causes of pediatric emergency department admission and hospitalization. Cardiovascular events, including supraventricular arrhythmias, are the most frequent side effects reported with inhaled SABA in children with asthma and are the main reason for a continuing debate about their safety, despite their widespread use. Although supraventricular tachycardia (SVT) is the most common potentially serious dysrhythmia in children, the incidence and risk factor of SVT after SABA administration is currently unknown. We here reported three cases and conducted a review of the literature in an attempt to gain insight into this issue.

Characteristics of patients with asthma overprescribed short-acting beta-agonist (SABA) reliever inhalers stratified by blood eosinophil count in North East London: a cross-sectional observational study.

Overprescription of short-acting beta-agonist (SABA) inhalers and blood eosinophil count have strong associations with exacerbation risk in asthma. However, in the authors' recent publication only a minority of patients overprescribed SABA (≥6 inhalers in 12 months) were eosinophilic (≥0.3 x 109 cells/l). To compare the characteristics of eosinophilic and non-eosinophilic patients with asthma overprescribed SABA inhalers, and identify latent classes using clinical variables available in primary care. Cross-sectional analysis of patients with asthma in North East London, England, using primary care electronic health record data. Unadjusted and adjusted multi-variate regression models and latent class analysis. Eosinophilia was significantly less likely in female patients (P = 0.004), those with multiple mental health comorbidities (P<0.001), and those with SABA on repeat prescription (P<0.001). Latent class analysis identified the following three classes of patients overprescribed SABA: class 1, which represents classical uncontrolled asthma (oral steroids required for exacerbations, step 2-3 asthma medications, high probability of being eosinophilic); class 2, which represents mild asthma (low exacerbation frequency, low asthma medication step, low probability of being eosinophilic); and class 3, which represents difficult asthma (high exacerbation frequency despite high-strength preventer inhalers, low probability of being eosinophilic). The mild asthma class was the largest. Many patients being overprescribed SABA were non-eosinophilic with a low exacerbation frequency, suggesting disproportionately high SABA prescription compared with other asthma control markers. Potential reasons for high SABA prescription in these patients included repeat prescription (being dispensed but not taken) and use of SABA for non-asthma breathlessness (for example, breathing pattern disorders with anxiety). Further research is needed into management of SABA overuse in patients without other markers of uncontrolled asthma.

An assessment of the predictive value of low risk criteria for children with intermittent asthma.

Current asthma guidelines recommend short acting beta agonist medication (SABA) be used in combination with an inhaled corticosteroid to reduce risk for severe asthma exacerbations. This may not be appropriate for patients at low risk for severe exacerbations. This study is a cohort study using computerized claims data from Texas Children's Health Plan. Inclusion criteria were members 1 to <18 years with a diagnosis of asthma in a baseline year between 2016 and 2018 and who had ≤2 SABA canisters or equivalent dispensed, no oral corticosteroid or inhaled corticosteroid dispensing, no asthma hospitalizations, and no asthma emergency department visits in the baseline year. Follow up year outcomes of asthma hospitalizations and emergency department visits were determined for the year following the baseline year. Forty-five thousand two hundred and thiry health plan members 1 to <18 years met inclusion criteria. The rate of follow up year asthma hospitalization was 1.1 per thousand for those with no baseline SABA dispensing and 1.5 per thousand for those with >0 and ≤2 SABA canister dispensings (p = 0.3). Follow up year Emergency Department visits rates were 14 per thousand and 17 per thousand, respectively (p = 0.08). In analyses adjusted for age group, the follow up year asthma hospitalization rate was not different comparing the 0 SABA to the >0 and ≤2 SABA canister dispensings group (odds ratio: 0.99, 95% confidence interval: 0.54-1.81). Asthma patients at low risk for severe exacerbations can be identified. This information can be useful to guide treatment decisions.

Cost-Effectiveness of Mepolizumab Add-On in the Treatment of Severe Eosinophilic Asthma in Chile

ObjectiveAsthma is one of the 4 leading causes of death worldwide. Severe asthma is associated with poor quality of life, decreased life expectancy, and higher health resources consumption such as the use of oral corticosteroids (OCSs). This study aimed to assess the cost-effectiveness of mepolizumab as an add-on compared with the standard care of the Chilean public health system (combined inhaled corticosteroid therapy and a long-acting beta-agonist, short-acting beta-agonist, and OCS). Materials and MethodsA Markov model was adapted to represent the day-to-day of patients with severe asthma over a lifetime horizon. Deterministic and probabilistic sensitivity analyses were performed to account for the second-order uncertainty of the model. In addition, a risk subgroup analysis was conducted to evaluate the cost-effectiveness of mepolizumab across different risk populations. ResultsMepolizumab produces more benefits than standard of care alone (1 additional quality-adjusted life-year, a decrease of OCS usage, an approximated 11 avoided exacerbations) but it cannot be considered cost-effective in the light of the Chilean threshold (incremental cost-effectiveness ratio: US dollars [USD] 105 967/quality-adjusted life-year vs USD 14 896). Despite this, cost-effectiveness increases in specific subgroups, with an incremental cost-effectiveness ratio of USD 44 819 in patients with eosinophil count ≥ 300 cell/mcL and exacerbation history of at least 4 exacerbations in the past year. ConclusionMepolizumab cannot be considered a cost-effective strategy for the Chilean health system. Nevertheless, price discount in specific subgroups improves its cost-effectiveness profile significantly and may offer opportunities for access to specific subgroups.

Exploring the appropriateness of prescribing practice of inhaled pharmacotherapy among Aboriginal Australians in the Top End Northern Territory of Australia: a retrospective cohort study

BackgroundAboriginal Australians are reported to have a high burden of chronic airway diseases. However, prescribing patterns and related outcomes of airway directed inhaled pharmacotherapy, (short-acting beta agonists (SABA), short-acting muscarinic...

Asthma outcomes in pediatric patients with 30-day follow-up after an asthma hospitalization in a Medicaid-managed care program

Background National asthma guidelines recommend an outpatient follow-up after hospitalization for asthma. Our aim is determine if a follow-up visit within 30 days after an asthma hospitalization impacts risk for re-hospitalization and emergency department visits for asthma within the following year. Methods This was a retrospective cohort study of claims data of Texas Children’s Health Plan (a Medicaid managed care program) members age 1 to <18 years and hospitalized for asthma between January 1, 2012, and December 31, 2018. Primary outcomes were days to re-hospitalization and emergency department visit between 30 days and 365 days following the index hospitalization. Results We identified 1,485 children age 1 to <18 years hospitalized for asthma. Comparing those with a 30 day follow-up to those without, there was no difference in days to re-hospitalization (adjusted hazard ratio 1.23, 95% Confidence Interval (CI) 0.74–2.06) or emergency department visit for asthma (aHR 1.08, 95% CI 0.88–1.33). Inhaled corticosteroid and short acting beta agonist dispensing were greater in the group completing the 30 day follow-up (means of 2.8 and 4.8 respectively for those with follow-up, 1.6 and 3.5 respectively for those without, p < 0.0001). Conclusion Having a follow-up outpatient visit within 30 days of an asthma hospitalization is not associated with a decrease in asthma re-hospitalization or emergency department visit in the 30–365 day period following the index hospitalization. Non-adherence to regular use of inhaled corticosteroid medication was high in both groups. These findings suggest need for improvement in the quality and quantity of post hospital asthma follow-up.

Recommendations from a Canadian Delphi consensus study on best practice for optimal referral and appropriate management of severe asthma

BackgroundIn Canada, severe asthma affects an estimated 5–10% of people with asthma and is associated with frequent exacerbations, poor symptom control and significant morbidity from the disease itself, as well as the high dose inhaled, and systemic steroids used to treat it. Significant heterogeneity exists in service structure and patient access to severe asthma care, including access to biologic treatments. There appears to be over-reliance on short-acting beta agonists and frequent oral corticosteroid use, two indicators of uncontrolled asthma which can indicate undiagnosed or suboptimally treated severe asthma. The objective of this modified Delphi consensus project was to define standards of care for severe asthma in Canada, in areas where the evidence is lacking through patient and healthcare professional consensus, to complement forthcoming guidelines.MethodsThe steering group of asthma experts identified 43 statements formed from eight key themes. An online 4-point Likert scale questionnaire was sent to healthcare professionals working in asthma across Canada to assess agreement (consensus) with these statements. Consensus was defined as high if ≥ 75% and very high if ≥ 90% of respondents agreed with a statement.ResultsA total of 150 responses were received from HCPs including certified respiratory educators, respirologists, allergists, general practitioners/family physicians, nurses, pharmacists, and respiratory therapists. Consensus amongst respondents was very high in 37 (86%) statements, high in 4 (9%) statements and was not achieved in 2 (5%) statements. Based on the consensus scores, ten key recommendations were proposed. These focus on referrals from primary and secondary care, accessing specialist asthma services, homecare provision for severe asthma patients and outcome measures.ConclusionsImplementation of these recommendations across the severe asthma care pathway in Canada has the potential to improve outcomes for patients through earlier detection of undiagnosed severe asthma, reduction in time to severe asthma diagnosis, and initiation of advanced phenotype specific therapies.

Effects of nebulised beta-2 agonists on clinical observations in asthma exacerbations

Background: Despite concerns over their side effects, short-acting beta-2 agonists are still used in high doses in prehospital care internationally to treat asthma exacerbations. This systematic review set out to identify the physiological effects associated with this treatment and determine their potential impact on the patient's presenting or underlying conditions. Methods: A systematic search of literature published from 2010 to 2020 focusing on asthmatic patients receiving nebulised beta-2 agonists during an acute exacerbation was undertaken and relevant articles reviewed. Findings: Eight out of 897 studies met the inclusion criteria. While the studies were heterogeneous with a range of outcome measures, synthesis showed evidence of bronchodilator action throughout, with reductions in potassium levels and cardiovascular changes reported in several studies. Conclusions: Therapeutic effects demonstrated within the data support the use of nebulised beta-2 agonists in these patients and, while adverse effects are frequently seen in the cardiovascular and endocrine systems, their impact on the patient's overall condition remains unclear.

Relationship between short-acting beta-agonist use and self-assessment responses in patients with asthma

Digital inhalers have the potential to help improve clinical outcomes by providing information about over-reliance on short-acting beta2-agonist (SABA). Digihaler integrated inhalers transmit data wirelessly to a smart phone application (App), which allows for tracking of inhaler usage. The App includes a voluntary, non-respiratory-specific, daily self-assessment (DSA). The 6-month CONNECT2 study (NCT04677959) compared the Digihaler Maintenance and Reliever Digital System (MRDS; fluticasone propionate/salmeterol and albuterol Digihalers) with standard of care (SoC) maintenance and reliever inhalers in participants with asthma.

Short-acting Beta-agonist (SABA) Use By Race and Neighborhood Socioeconomic Status (nSES) Among Participants Enrolled In A Digital Health Program For Asthma

Short-acting Beta-agonist (SABA) Use By Race and Neighborhood Socioeconomic Status (nSES) Among Participants Enrolled In A Digital Health Program For Asthma

“As-Needed” Inhaled Corticosteroids for Patients With Asthma

Prevention of severe asthma exacerbations is a primary management goal for asthma across the severity spectrum. Inhaled corticosteroids (ICSs) decrease the risk of asthma exacerbations, but patient adherence to ICS-containing medications as a daily maintenance therapy is poor, and many patients overuse short-acting beta2-agonist relievers; both are associated with increased risk of severe exacerbations and death. Airway inflammation also varies over time, influenced by exposures such as viral infections and allergen. As-needed ICS strategies, in which patients receive ICSs (or additional ICSs, if already taking controller therapy) whenever they take their reliever inhaler, empower patients to adjust their ICS intake in response to symptom fluctuation. These strategies can improve asthma morbidity outcomes, particularly by reducing severe exacerbations and reducing the risk of adverse effects of oral corticosteroids. In this review, the evidence for combination ICS-formoterol in a single inhaler, ICS and short-acting beta2-agonists in separate inhalers, and combination ICS-albuterol in a single inhaler is presented, along with practical considerations, evidence gaps, and implications for clinical practice for each strategy, presented by level of asthma severity and age group. Improving access to such strategies on a global scale is imperative to improve asthma outcomes and achieve equityacross populations.

Nasal TSLP and periostin in infants with severe bronchiolitis and risk of asthma at 4 years of age

BackgroundSevere bronchiolitis is often associated with subsequent respiratory morbidity, mainly recurrent wheezing and asthma. However, the underlying immune mechanisms remain unclear. The main goal of this study was to investigate the association of nasal detection of periostin and thymic stromal lymphopoietin (TSLP) during severe bronchiolitis with the development of asthma at 4 years of age.MethodsObservational, longitudinal, post-bronchiolitis, hospital-based, follow-up study. Children hospitalized for bronchiolitis between October/2013 and July/2017, currently aged 4 years, included in a previous study to investigate the nasal airway secretion of TSLP and periostin during bronchiolitis, were included. Parents were contacted by telephone, and were invited to a clinical interview based on a structured questionnaire to obtain information on the respiratory evolution. The ISAAC questionnaire for asthma symptoms for 6–7-year-old children, was also employed.ResultsA total of 248 children were included (median age 4.4 years). The mean age at admission for bronchiolitis was 3.1 (IQR: 1.5–6.5) months. Overall, 21% had ever been diagnosed with asthma and 37% had wheezed in the last 12 months. Measurable nasal TSLP was detected at admission in 27(11%) cases and periostin in 157(63%). The detection of nasal TSLP was associated with the subsequent prescription of maintenance asthma treatment (p = 0.04), montelukast (p = 0.01), and the combination montelukast/inhaled glucocorticosteroids (p = 0.03). Admissions for asthma tended to be more frequent in children with TSLP detection (p = 0.07). In the multivariate analysis, adjusting for potential confounders, the detection of TSLP remained independently associated with chronic asthma treatment prescription (aOR:2.724; CI 1.051–7.063, p:0.04) and with current asthma (aOR:3.41; CI 1.20–9.66, p:0.02).Nasal detection of periostin was associated with lower frequency of ever use of short-acting beta2-agonists (SABA) (p = 0.04), lower prevalence of current asthma (p = 0.02), less prescription of maintenance asthma treatment in the past 12 months (p = 0.02, respectively). In the multivariate analysis, periostin was associated with lower risk of asthma at 4 years, independently of the atopic status (aOR:0.511 CI 95% 0.284–0.918, p:0.025).ConclusionsOur results show a positive correlation between nasal TSLP detection in severe bronchiolitis and the presence of current asthma, prescription of asthma maintenance treatment and respiratory admissions up to the age of 4 years. By contrast, we found a protective association between nasal periostin detection and current asthma at 4 years, ever diagnosis of asthma, maintenance asthma treatment prescription, and respiratory admissions.

Real-world evaluation of asthma reliever therapy among continuous users of asthma maintenance medication in Japan: A retrospective cohort study using a claims database

BackgroundThe decrease in mortality rate owing to asthma has slowed in recent years. A large proportion of patients with asthma remain uncontrolled in Japan. This study aimed to determine the prevalence of short-acting beta 2 agonists (SABA) overuse and its associated factors. MethodsThis large-scale retrospective cohort study analyzed continuously treated patients with asthma aged 15–74 years between January 2017 and December 2017 using a Japanese insurance claims database. Characteristics, disease information, and prescribed drugs were extracted from the database, and treatment steps were defined according to drug combinations based on the criteria of the Japanese asthma guidelines. SABA overuse was defined as ≥3 canisters per year. Factors associated with SABA overuse were estimated using multivariable logistic regression. ResultsAmong 7,483 patients with mild-to-moderate asthma, 7,001 (93.6%) and 482 (6.4%) had low and high SABA use, respectively. Inhaled corticosteroids (ICS)/long-acting β-agonists (LABA) were the main asthma control treatments. The proportions of patients who overused SABA were 347 (9.9%) and 1,201 (5.6%) in the ICS and ICS/LABA groups, respectively. The factors associated with SABA overuse were male sex, ICS monotherapy, higher treatment steps, no history of allergic rhinitis, no history of chronic sinusitis, and no asthma management. ConclusionsThere is a relatively low prevalence of SABA overuse among asthmatic patients in Japan. ICS/LABA therapy, treatment steps, allergic rhinitis, chronic sinusitis, and asthma management are associated with a decreased risk of SABA overuse. Further studies are needed to investigate the association between SABA overuse and asthma exacerbation and mortality.

The ICS/Formoterol Reliever Therapy Regimen in Asthma: A Review

The Global Initiative for Asthma recommends that low-dose inhaled corticosteroid (ICS)/formoterol be preferred to short-acting beta2-agonists as reliever therapy in adolescents and adults with asthma, across the range of asthma severity. This recommendation represents the most fundamental change in asthma management for many decades. In this commentary, we review the rationale for combination ICS/formoterol therapy, the evidence on which this recommendation has been made, the limitations in the evidence, the practical issues relevant to the implementation of ICS/formoterol reliever-based regimens in clinical practice, and the emerging evidence for the efficacy and safety of combination ICS/salbutamol reliever therapy regimens.

Impact of COVID-19 pandemic on control of bronchial asthma in children attending the asthma clinic in a tertiary care centre in Kerala

Abstract BACKGROUND: COVID-19 pandemic led to widespread change in the life of people across the globe, including children, with far-reaching consequences. When control of disease is considered among children with asthma, a positive impact is to be expected. This study aimed to assess the impact of the COVID-19 pandemic on disease control among children with asthma. OBJECTIVES: The main objectives are (1) to compare the level of asthma control pre-COVID versus during the COVID pandemic in terms of exacerbations and short-acting beta agonist (SABA) usage and (2) to compare the use of inhaled corticosteroids (ICS) pre-COVID versus during the COVID pandemic. MATERIALS AND METHODS: Hospital-based study was conducted among children aged 5–15 years attending the asthma clinic of Government TD Medical College, Alappuzha, during the period May 2021–January 2022. Asthma control in terms of SABA usage, emergency visits, hospitalizations, and ICS usage was compared pre-COVID (before March 2020) to Complete lockdown (March 2020–May 2020), phased reopening (June 2020–May 2021) and after the lifting of major restrictions (June 2021–January 2022). Statistical analysis was done using IBM SPSS Statistics v.26. RESULTS: In total, 139 children were included in the study. A decrease was observed in the number of children requiring SABA as reliever therapy, with 18%, 25.9%, and 33.1% not requiring SABA during the complete lockdown, during phased reopening, and after the lifting of major restrictions, respectively, when compared to pre-COVID. A statistically significant decrease in hospitalizations and visits to the emergency department due to asthma exacerbations were also observed during various phases of the pandemic. ICS was stopped in 15.1%, 30.2%, and 35.3% of the study subjects during various phases of the pandemic without further exacerbations. CONCLUSION: There was a significant impact on asthma control during the pandemic, which was sustained during various phases of lifting restrictions.

The emerging role of digital health in the management of asthma.

The most common reasons seen for lack of asthma control include misconceptions about disease control, low controller treatment adherence, poor inhaler technique, and the resulting underuse of controllers and overuse of short-acting beta2 agonists (SABAs). Narrowing these care gaps may be achieved through well-designed patient education that considers the patient's motivation, beliefs, and capabilities regarding their asthma and its management and empowers the patient to become an active participant in treatment decisions. Digital health technologies (DHTs) and digital therapeutic (DT) devices provide new opportunities to monitor treatment behaviors, improve communication between healthcare providers and patients, and generate data that inform educational interactions. DHT and DT have been proven effective in enhancing patient self-management in other chronic conditions, particularly diabetes. Accelerated integration of DHT and DT into the management of asthma patients is facilitated by the use of digital inhalers that employ sensor technology ("smart" inhalers). These devices efficiently provide real-time feedback on controller adherence, SABA use, and inhaler technique that have the strong potential to optimize asthma control.

Тяжелая бронхиальная астма у детей – возможен ли контроль заболевания?

The management of severe asthma in children is challenging due to the risks associated with an uncontrolled disease progression, which significantly increases the likelihood of acute exacerbations, hospitalizations, and even adverse outcomes. In this case, targeted immunobiological agents, particularly omalizumab, may be used to improve disease control. Objective. This open-label prospective clinical study aimed to evaluate the efficacy and safety of omalizumab in children with uncontrolled persistent asthma in clinical practice. Patients and methods. The study included 82 children aged 6 to 18 years (mean age: 12.2 ± 1.4 years) with moderate to severe asthma uncontrolled with medium- or high-dose inhaled corticosteroids (ICS) in combination with long-acting beta-2-agonists (LABAs). Omalizumab was prescribed considering the level of IgE and body weight, and the frequency of administration was once a month. Follow-up duration was 12 months. Asthma control (frequency of exacerbations, need for systemic CS during exacerbations, volume of standard therapy) and adverse events were assessed at baseline and 12 months after the initiation of therapy with omalizumab. Results. After 12 months of omalizumab therapy, we revealed a significant reduction in the frequency of exacerbations by 67% (p &lt; 0.005), including the number of exacerbations requiring systemic CS administration (by 75% from baseline, p &lt; 0.001). There was also a reduction in the volume of standard therapy in 48% of patients and in the use of short-acting beta-2-agonists (SABAs), which was reflected in improved asthma control (the percentage of patients with controlled asthma increased from 0 to 42.6 and 65.8 after 3 and 6 months of therapy, respectively). Conclusion. Omalizumab significantly improves the course of severe asthma in patients with allergic phenotype. Key words: children, bronchial asthma, targeted immunobiologic therapy

An Investigation into the Factors Associated with Incorrect Use of a Pressurized Metered-Dose Inhaler in Japanese Patients.

Rationale: Inhalation of the correct dose of a short-acting beta 2 agonist (SABA) from a pressurized metered-dose inhaler (pMDI) is essential for the relief of symptoms in patients with asthma and/or chronic obstructive pulmonary disease. The aim of this study was to evaluate the prevalence and factors associated with the incorrect use of a pMDI. Methods: This study retrospectively assessed the electronic medical records of 161 patients with various respiratory diseases. The patients had never used a pMDI and underwent training by pharmacists educated in the use of a pMDI followed by bronchodilator reversibility testing at our hospital. The patients' characteristics and various lung capacity parameters were evaluated for association with the incorrect use of a pMDI. Results: Thirty-nine of the 161 (24.2%) patients, including 46% of 28 patients older than 80 years, used the pMDI incorrectly, mainly because of incoordination between activation of the device and inhalation (n = 11), inadequate strength to manipulate the device (n = 9), too short duration of inhalation (n = 6), and difficulty in breath holding (n = 3). Advanced age; lower height; and decreased lung volumes, including vital capacity (VC), inspiratory capacity, inspiratory reserve volume (IRV), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow rate, were associated with the incorrect use of a pMDI. Neither the body weight, tidal volume, expiratory reserve volume, %FVC predicted, %FEV1 predicted, nor FEV1% was associated with the incorrect use of a pMDI. Multivariate binomial logistic regression analysis identified decreased IRV as the only independent predictor associated with the incorrect use of a pMDI. Conclusions: Physicians should be aware that elderly patients or patients with decreased IRV might be unable to obtain the correct SABA dose from a pMDI. A large-scale prospective study is required to confirm these findings from our retrospective study with a small group of patients.