Short-acting Beta-agonists Research Articles

Extracellular vesicle-derived microbiome obtained from exhaled breath condensate in patients with asthma

Extracellular vesicle-derived microbiome obtained from exhaled breath condensate in patients with asthma

Reflection on education and clinical care of asthma for lung longevity (RECALL)

Objective Pediatric and adult asthma account for increased healthcare utilization. Preventative measures such as ongoing adherence of preventative medications from childhood to adulthood are essential for positive outcomes. To identify potential challenges for optimal pediatric asthma care, we surveyed adult patients to reflect on their asthma management practices, and education and treatment barriers when they were a child. Methods A descriptive cross sectional survey of specific and open-ended questions in an urban academic medical center. Adult asthmatics (18–30 years old) who participated in a previous pediatric asthma study or received care from the adult emergency department (ED) were enrolled. Results Forty-one adult asthmatic patients (mean (S.D.) age 22.5 (3.5) years and 65.9% females) participated in the survey. Reported childhood asthma related experiences include never attended an asthma education session in almost two-thirds surveyed; their mother or grandmother as the primary person responsible for administering their medications (95.1%); inhaled short-acting beta-agonist (SABA) use information was not helpful (46.3%); wanted to learn more about allergic triggers (78%); and the need for additional asthma educational sessions (48.7%). Conclusion All healthcare providers are encouraged to provide continuous asthma education to their pediatric patients and their family members or guardian.

Prevalence of asthma symptoms and associated factors in adolescents and adults in southern Brazil: A Global Asthma Network Phase I study

BackgroundThe Global Asthma Network (GAN) aims to find out the current status of the prevalence and severity of asthma, rhinitis, and eczema using global surveillance to achieve worldwide recognition and improve the management of asthma, especially in low- and middle-income countries. The aim of this study was to verify the associated factors for asthma in adolescents and their respective parents/caregivers. MethodsAdolescents (13–14 years old; n = 1058) and their respective parents/caregivers (mean age = 42.1 years, n = 896) living in the town of Uruguaiana, Southern Brazil fulfilled the standardized questionnaire. ResultsAlthough the prevalence of wheezing in the past 12 months was higher among adults than adolescents (18.4% vs. 15.8%, respectively), adolescents showed more severe wheezing and worse control over the disease revealed by higher consumption of short-acting beta-2 agonists; going to the emergency room; hospitalization in the last year and dry night cough. Smoking and paracetamol use were associated with risk for developing asthma symptoms and consuming seafood/fish was protective. For the adults smoking (10 or more cigarettes/day) and exposure to mould in the house were associated with risk for asthma symptoms. ConclusionsAdolescents have a high prevalence of asthma symptoms and few have an action plan. Adults do not have their disease under control and they use more relief than preventive medication. Differences in associated factors could determine the outcomes in asthma control among adolescents and their parents.

An Assessment of Epidemiologic Burden of Hospitalization for Bronchial Asthma in Acute Exacerbation among Adult Patients Admitted in a Tertiary Hospital in the Philippines: A Pilot Study

Objective. This pilot study aimed to determine the epidemiologic burden of hospitalization for bronchial asthma in acute exacerbation.
 Methods. We used a descriptive cross-sectional study to describe the demographic profile, comorbidities and level of control of patients admitted for bronchial asthma in acute exacerbation admitted to the Philippine General Hospital from May 1 to October 31 2019. The study computed for the admission rate and compared the average cost of hospitalization (diagnostics, therapeutics and room) using direct costing to the total reimbursable cost from PhilHealth. Associations between patient characteristics (age, type of admission) and hospitalization cost were also determined.
 Results. We enrolled 45 patients in the study. The admission rate was 8/month. The mean cost of admission was significantly higher than the reimbursable amount from PhilHealth (Php 20,074.63 versus Php 9000) (p = 0.004). Cost of hospitalization was significantly higher in pay patients versus charity (p = 0.001 for diagnostics, p = 0.005 for treatment and p = 0.001 for room cost), in patients with poorly controlled asthma (p = 0.020 for diagnostics and p = 0.014 for room cost) and those with frequent short-acting beta-agonist (SABA) use (p = 0.001).
 Conclusion. Asthma remains an economic burden for the Filipino patient. Persistent SABA use, perceived asthma control of patients and increased expenses associated with an asthma exacerbation admission lead to significant out-of-pocket expenditure.

Choppy waters: The importance of accounting for shifting drug utilization during the COVID-19 pandemic in future observational drug-related studies.

The 2019 novel Coronavirus (COVID-19) pandemic caused a large shift in the delivery of healthcare globally, including prescription drugs. Media reports of drug stockpiling, anecdotal reports of an uptick in commonly used medications and off-label use of medications to treat COVID-19, have led to rapidly changing drug utilization trends.1 We have observed shifting drug utilization trends in a number of our ongoing projects globally. These shifting drug utilization trends should be of consideration for anyone conducting future observational drug-related studies - we write this Reflective Piece, Hot Topic as a word of caution to our colleagues.

Assessing Asthma Control By Frequency Of High Systemic Corticosteroid And/or SABA Prescriptions In US Administrative Claims Data

Guideline-defined assessment of asthma control incorporates elements of symptom burden (impairment) and exacerbation risk. Commonly used questionnaires assess control primarily in terms of impairment but provide little information about varying risk levels. However, use of systemic corticosteroids (SCS) and frequent need for short-acting beta-agonists (SABA) may be indicative of high symptom burden, disease relapse, severity, and exacerbation risk. Using data from a retrospective analysis of IBM/Watson MarketScan® claims database, we explored the extent of uncontrolled asthma, defined according to numbers of SCS and/or SABA prescriptions filled within one year. Of the 579,955 patients included, 54.3% were classed as GINA 1, 24.8% as GINA 2/3, and 20.9% as GINA 4/5. The proportions of GINA 1 patients with prescription fills within one year for ≥2 SCS, ≥3 SABA, or either (≥2 SCS or ≥3 SABA) were 13.5%, 18.8%, and 28.6%, respectively. For GINA 2/3 patients, these proportions were: 19.8%, 31.7%, and 43.4%; and for GINA 4/5 patients: 31.7%, 44.6%, and 59.1%, respectively. Using a stricter definition for impaired asthma control: For GINA 1 patients, 5.1% had ≥3 SCS, 10.3% had ≥4 SABA, and 14.5% had either (≥3 SCS or ≥4 SABA) prescription fills within one year. For GINA 2/3 patients, these proportions were: 9.0%, 18.8%, and 25.1%; and for GINA 4/5 patients: 17.6%, 29.5%, and 39.7%, respectively. These data suggest high prevalence of impaired asthma control and exacerbation risk across all disease gradations, and indicate substantial need for relief medication among cohorts traditionally described as “moderate” or “mild”.

Impact of a Digital Asthma Intervention on Short-acting Beta-agonist (SABA) Medication Use Among Medicaid-enrolled Children in Southwest Detroit

Digital asthma interventions have been associated with improved outcomes, but evidence among Medicaid-enrolled participants remains limited. We aimed to evaluate the impact of a digital asthma intervention, combined with a collaborative asthma education program, on SABA use among children in Detroit.

Quality Improvement: Enhancing Asthma Control Test Documentation via Smarter EMR Integration

Appropriate assessment of asthma control includes evaluation of five parameters: 1. daytime symptoms, 2. nighttime awakenings, 3. interference with normal activity, 4. short-acting beta2-agonist (SABA) use and 5. number of asthma exacerbations requiring oral steroids in the last year. To improve documentation of asthma control, an electronic asthma control test (ACT) survey for seamless integration into the EMR was developed.

ICS/formoterol in the management of asthma in the clinical practice of pulmonologists: an international survey on GINA strategy

BackgroundThe treatment with short-acting beta-2 agonists (SABA) alone is no longer recommended due to safety issues. Instead, the current Global Initiative for Asthma (GINA) Report recommends the use of the combination of inhaled corticosteroids (ICS) with the rapid/long-acting beta-2 agonist formoterol, although the use in steps 1 and 2 is still off-label in the EU and in many countries. It is important to understand clinicians’ knowledge and opinions on the issue with the ultimate goal to encourage the implementation of the new approach in clinical practice.MethodsWe performed an international survey, directed to pulmonologists interested in the management of patients with asthma.ResultsMost participants reported that SABA alone should not be used in GINA Step 1 asthma treatment. As-needed low-dose ICS/formoterol combination to patients in step 1, and as-needed low-dose ICS/formoterol as reliever therapy in any step were found to be of current use prescribed in their real-life settings. SABA alone was still prescribed to a proportion of patients, although the pulmonologists’ opinion was that it should no longer be used.ConclusionsMost specialists are up to date and understand the relevance of the changes in GINA reports from 2019. Nevertheless, dissemination and implementation of GINA novel management strategy is still needed.

2021 Canadian Thoracic Society Guideline – A focused update on the management of very mild and mild asthma

Background This asthma guideline update focuses on the management of individuals with asthma at the mild end of the spectrum. It applies to children 1 year of age and over and adults. This update was initiated to address new clinical trials in this patient group as well as changes in the recommendations from the Global Initiative for Asthma (GINA) asthma strategy group. This guideline applies the current evidence to the Canadian context. Methods A representative multidisciplinary panel of experts undertook a formal clinical practice guideline development process. A total of 9 key clinical questions were defined according to the Patient/problem, Intervention, Comparison, Outcome (PICO) approach. The panel performed an evidence-based, systematic literature review, assessed and graded the relevant evidence to synthesize 11 key recommendations. These recommendations were reviewed in the context of the existing Canadian Asthma Guidelines and changes from previous guidelines are highlighted. Results The updated evidence demonstrated that daily inhaled corticosteroids (ICS) + PRN short-acting beta-agonist (SABA) decrease exacerbations and improve asthma control compared to PRN SABA in individuals with very mild and mild asthma. There is new evidence in children ≥12 years of age and adults that PRN budesonide/formoterol (bud/form) decreases exacerbations in comparison to PRN SABA, with different levels of evidence in those with very mild versus mild asthma. Individuals with very mild asthma at higher risk of exacerbation should be given the option of switching from PRN SABA to daily ICS + PRN SABA (all ages) or PRN bud/form (≥12 years of age). In individuals with mild asthma, daily ICS + PRN SABA are still recommended as first line controller therapy. However, in individuals ≥12 years of age with poor adherence to daily medication despite substantial asthma education and support, PRN bud/form is an alternative. Intermittent use of very high dose ICS for acute loss of asthma control is not suggested in preschoolers given potential for harm. Discussion This guideline provides a detailed review of the evidence and provides recommendations for the treatment of very mild and mild asthma within the Canadian context for preschoolers, children and adults. The Canadian Thoracic Society 2021 Asthma Guideline update will amalgamate these recommendations with previous guidelines to provide a document that address diagnosis and management of asthma.

Direct healthcare cost comparison of Fluticasone propionate/Salmeterol vs Budesonide/Formoterol Maintenance And Reliever Therapy for moderate/severe asthma: Results from Thailand.

Inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) for moderate/severe asthma i.e. regular Fluticasone propionate/Salmeterol (FP/Salm) with as-needed short acting beta-2 agonist (SABA) or ICS/Formoterol Maintenance And Reliever Therapy (MART) are the recommended options. To compare healthcare cost between regular FP/Salm with as-needed SABA vs MART in Thailand. Direct healthcare cost data from 3 published randomized trials in asthma patients aged ≥12 years comparing regular twice-daily FP/Salm with as-needed SABA vs Budesonide/Formoterol (BUD/Form) MART in moderate/severe asthma were considered: AHEAD (NCT00242775/17 countries/2309 patients), COMPASS (AstraZeneca study SD-0390735/16 countries/3335 patients), and COSMOS (AstraZeneca study SD-039-0691/16 countries/2143 patients). Total direct treatment cost comparison/patient/year was calculated as a combination from 1) medication costs plus 2) healthcare utilization costs i.e. cost for health care visit, emergency room visit, and hospitalization. Unit costs referred from National drug information and Health Intervention and Technology Assessment (HITAP), Ministry of Public Health. Annual medication costs of FP/Salm + SABA were lower than MART in all studies with average cost as 182.01 vs 347.21 USD. Average annual healthcare utilization costs were 17.51 vs 13.01 USD in FP/Salm + SABA and MART, respectively. In overall, total direct treatment costs/patient/year with FP/Salm was 199.53 vs 360.22 USD of MART. Percent saving of total direct treatment costs by FP/Salm + SABA was 45% lower than with MART. In moderate/severe asthma patients, total direct treatment costs with regular twice-daily FP/Salm with as-needed SABA were lower than with BUD/Form MART primarily due to lower medication costs. Healthcare cost should be considered for asthma care in Thailand.

Short-Acting Beta2-Agonist Use in Asthma in Korea: A 10-Year Population-Based Study.

Short-acting β2-agonist (SABA) use is known to be lower in Korean patients with asthma than in those from other countries, while the rate of asthma exacerbations in Korea is higher than in other countries. Thus, an epidemiologic study on SABA use and the relationship between SABA overuse and treatment outcomes in asthma is needed in Korea. We performed a cross-sectional study using the National Health Insurance Service-National Sample Cohort 2002–2012 database. We evaluated the trend of annual SABA use and overuse (prescription of 3 or more SABA canisters/year) and the impact of SABA overuse on mortality. During the study period, the proportion of asthmatic patients who used SABA was approximately 8%–11%, with no significant change in trend. The mean annual SABA use in asthmatic patients was 0.15–0.22 canisters/patient/year and 1.93–2.05 canisters/patient/year in those who used SABA in 12 months. SABA overuse was observed in about 2%–4% of asthmatic patients during the study period. SABA overuse generally tended to increase as the age of patients increased, with triple peaks in the late 20s (3.3%), late 40s (3.1%), and late 70s (3.6%). SABA overuse was associated with mortality (adjusted odds ratio, 1.72; 95% confidence interval, 1.61–1.84). The rate of SABA use was very low in Korean asthmatic patients between 2002–2012. SABA overuse was found in 2%–4% of patients in Korea. SABA overuse was associated with an increased risk of mortality.

Современные подходы к оптимизации терапии бронхиальной астмы у детей

Bronchial asthma (BA) is a significant challenge to pediatric practice and clinical medicine in general. BA in children reduces both their quality of life and that of their family members, may cause disability, and sometimes dramatic outcomes. The basic therapy for BA aims to control persistent allergic inflammation in the bronchi and reduce the symptoms of bronchial obstruction; short-acting beta2-agonists decrease the risk of exacerbation and improve the quality of life. Current guidelines recommend a combination of inhaled corticosteroids and long-acting beta2-agonists to improve disease control with minimum doses of inhaled corticosteroids. In this article, we analyze clinical efficacy of the budesonide/formoterol combination in children with BA of different severity. Key words: bronchial asthma, children, inhaled corticosteroids, long-acting beta2-agonists, budesonide, formoterol

Uncontrolled asthma in Ethiopia: a systematic review and meta-analysis.

Despite significant improvement in the diagnosis and management of this disorder, asthma in the majority of Ethiopians remains poorly controlled. Although the prevalence of uncontrolled asthma is a public health problem in Ethiopia, its reported prevalence varies from study to study. Hence, this review aims to determine the true prevalence of uncontrolled asthma among asthmatic patients in Ethiopia. Different database searching engines were used including PubMed, Scopus, Google Scholar, Africa journal online, World Health Organization (WHO) afro library, and Cochrane review. They were systematically searched for published studies on uncontrolled asthma in Ethiopia from 2014 to 2019. Primary search terms were "asthma", "uncontrolled asthma", "uncontrolled wheezing", and "Ethiopia". The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. Publication bias was examined by the funnel plot. The random-effect model was fitted to estimate the pooled prevalence of uncontrolled asthma among asthmatic patients. All statistical analysis was done using R version 3.5.3 and the RStudio version 1.2.5033 software for Windows. The overall pooled prevalence of uncontrolled asthma was found to be 71.67% [95% CI (0.6772; 0.7562)]. Potential associated factors were: unscheduled visits, frequency of short-acting beta2-agonist (SABA) use, type of treatment and perceived rate of asthma control, low monthly income, age group, presence of comorbidity, moderate persistent asthma, severe persistent asthma and use of SABA alone as anti-asthmatic medication, use of biomass fuel for cooking, longer duration of asthma (> 30 years), incorrect inhalation technique, and asthma exacerbation in the last 12 months. Self-perceived poor asthma control was associated with any activity limitation due to asthma, inconsistent inhaled corticosteroid use, and lack of health education on metered-dose inhaler technique [AOR =4.96; 95% CI (1.08-22.89)]. Nearly two-thirds of patients were determined to have uncontrolled asthma. Thus, this evidence suggests that attention should be given to asthma patients and health care providers.

Uncontrolled asthma and household environmental exposures in Puerto Rico

Objective To describe asthma control and household environmental exposures among adults and children with asthma in Puerto Rico. Methods A cross-sectional analysis was conducted using data from the 2014–2016 Behavioral Risk Factor Surveillance System Asthma Call-back Survey on 931 adults and 177 children with current asthma in Puerto Rico. These data were analyzed to assess the prevalence of uncontrolled asthma in Puerto Rico and potential associations with household environmental exposure to cockroaches, smoke, and mold. Asthma control was classified using daytime and nighttime symptoms, activity limitation, and short-acting beta agonist use. Prevalence and prevalence ratios were calculated, adjusting for sample weighting. Results An estimated 53% of adults with asthma and 29% of children with asthma in Puerto Rico have uncontrolled asthma. Among adults with asthma, in the past 30 days, 29% had seen or smelled mold and 50% had seen cockroaches; in the past week, 12% reported having someone smoke in their home. Adults with uncontrolled asthma were 1.4 times more likely to have observed mold in their homes than were those with controlled asthma when adjusting for age, sex, education, and income (prevalence ratio [95% confidence interval]: 1.4 [1.1, 1.8]). Children with uncontrolled asthma were also more likely to have mold observed in their home than were children with controlled asthma (adjusted PR [95% CI]: 3.0 [1.3, 7.1]). Conclusions Uncontrolled asthma is common among adults and children with asthma in Puerto Rico. These results suggest potential differences in household mold exposure by asthma control status.

As-needed anti-inflammatory reliever therapy for asthma management: evidence and practical considerations.

Asthma is a chronic respiratory disease in which airway inflammation is a key feature, even in the milder expressions of the disease. The conventional pharmacological approach to mild asthma has long relied on reliever therapy with as-needed short-acting beta-agonists (SABAs), while anti-inflammatory maintenance with inhaled corticosteroids (ICSs) has been reserved for patients with more persistent asthma. Poor adherence to maintenance treatment is an important issue in asthma management, and can partly explain suboptimal symptom control. Over-reliance on SABA bronchodilators for rapid symptom relief is common in real life and potentially leads to an increased risk of asthma morbidity and mortality. Combined anti-inflammatory and reliever medications in a single inhaler have the potential to overcome these limitations. Recent studies in patients with mild asthma have shown that anti-inflammatory reliever therapy with budesonide-formoterol, given on an as-needed basis, is superior to SABA in ensuring asthma control and non-inferior to budesonide maintenance therapy in preventing exacerbations. To address the implications of these important findings for the management of patients with asthma, Italian specialists convened at a series of meetings held during the second half of 2018 across Italy. This article presents their position on these topics and includes a review of the evidence supporting the use of anti-inflammatory reliever therapy in mild asthma and the implementation of this novel approach in clinical practice.

Assessment of factors affecting control in asthmatic patients

Objective: To assess the level of symptoms control achieved by Asthmatic Patients in Pakistan and the associated factors making an impact on symptom control. Methods: A prospective cross-sectional study was carried out at Darul Sehat Hospital from December 2018 till December 2019. All patients of irrespective of age and gender diagnosed as bronchial asthma were consecutively included. Symptom control was assessed according to Global Initiative for Asthma (GINA) assessment tool. Prevalence of asthma symptom control was determined while association of risk factors with uncontrolled asthma was also evaluated. Results: Of 113 patients the mean age was 36.8 +-16.6 years. There were 76 (67.3%) patients had uncontrolled asthma. A significant association of uncontrolled asthma was observed with incorrect inhaler technique (p value of 0.039) more than 10 years asthma duration (p value <0.001) lack of inhaled corticosteroid (ICS) use (p value 0.004) Gastroesophageal Reflux Disease (GERD) (p value <0.001) more than 1 episode of asthma exacerbation in last 12 months (p value <0.001) and with high use of short acting beta agonists (p value <0.001). Conclusion: A higher prevalence of uncontrolled asthma was observed in our cohort with significant association of uncontrolled asthma with poor inhaler technique lack of ICS use GERD more than 10 years asthma duration and more than 1 asthma exacerbation episode in last 12 months.

Cost-Effectiveness of Tiotropium in Elderly Patients with Severe Asthma Using Real-World Data

Tiotropium has the potential to alleviate asthmatic symptoms caused by the aging of lungs. However, few studies have focused on specific treatments for elderly patients with asthma. To estimate the cost-effectiveness of adding tiotropium to inhaled corticosteroids and long-acting beta-agonists in elderly patients with severe asthma using real-world data. Phase I was a retrospective cohort study using the National Health Insurance claims data to measure clinical and economic outcomes. In phase II, a Markov model was constructed to evaluate cost-effectiveness from Korean health care system perspective, based on phase I, including 2 health states, and an asthma exacerbation event. We estimated cost given in 2018 US dollars, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Subgroup analyses for patients with poorly controlled symptoms (frequent short-acting beta-agonist users; frequent exacerbators) were performed. In elderly patients with severe asthma, the incremental cost and effectiveness in the tiotropium group compared with the inhaled corticosteroid and long-acting beta-agonist group were $2281 and 0.038 QALYs, respectively. The incremental cost-effectiveness ratio was $60,074/QALY, indicating that the addition of tiotropium is not a cost-effective alternative. Meanwhile, 2 subgroups with poorly controlled symptoms showed that adding tiotropium is a cost-effective alternative (frequent short-acting beta-agonist users $4078/QALY; frequent exacerbators $8332/QALY). Tiotropium shows a higher cost-effectiveness profile when applied to elderly patients with uncontrolled symptoms. These results using real-world evidence provide information beyond the clinical outcomes reported by randomized controlled trials, providing a complementary ground in establishing the reimbursement criteria of tiotropium for elderly patients with severe asthma.

Updated Australian guidelines for mild asthma: what's changed and why?

SUMMARYThe Australian asthma guidelines have recently been updated and include additional treatment options for adults and adolescents with mild asthmaMild asthma is not necessarily a benign condition and patients are still at risk of severe flare-ups, particularly if they overuse short-acting beta2 agonists such as a salbutamol inhalerFor adults and adolescents with mild asthma, the updated guidelines include as-needed inhaled low-dose budesonide–formoterol as an alternative to daily low-dose inhaled corticosteroid plus as-needed short-acting beta2 agonistThe budesonide–formoterol combination should be taken as needed to provide symptom relief and reduce the risk of severe exacerbations

Effectiveness and safety of a glutaraldehyde-modified, L-tyrosine-adsorbed and monophosphoryl lipid A-Adjuvanted allergen immunotherapy in patients with allergic asthma sensitized to olive pollen: A retrospective, controlled real-world study

BackgroundAllergy to olive pollen is one of the primary causes of allergic asthma in Spain. Even though allergen immunotherapy (AIT) has shown clinical benefits in patients sensitized to different allergens, studies in asthmatic patients sensitized to olive pollen are insufficient. ObjectiveTo assess the effectiveness and safety of an ultra-short course of AIT with an L-tyrosine-adsorbed and monophosphoryl lipid A-adjuvanted olive pollen and olive/grass pollen extract (Pollinex Quattro®) in patients with allergic asthma in the real-world setting. MethodsRetrospective, controlled study including patients with asthma, with and without allergic rhinitis, caused by sensitization to olive pollen from 11 centers in Spain. Patients received out-of-season (October–March) treatment with AIT in addition to their pharmacological treatment (active group) or pharmacological treatment (control group). Effectiveness variables, including unscheduled visits to the healthcare center, emergency room admissions, symptoms of asthma and rhinitis (following GEMA and ARIA classifications, respectively), and use of medication to treat asthma and rhinitis during the subsequent pollen season were compared between treatment groups. ResultsOf 131 study patients, 42 were treated with their usual asthma medication (control group) and 89 were treated with AIT (active group), either Pollinex Quattro® 100% olive pollen (n = 43, 48.3%) or 50% olive pollen/50% grass pollen (n = 46, 51.7%). Patients’ demographic and clinical characteristics were similar between groups. The mean (SD) number of unscheduled visits to a healthcare center and emergency room admissions due to allergy symptoms was 2.19 (1.40) and 0.43 (0.63) in the control group, and 1.09 (1.25) and 0.11 (0.51) in the active group (P = 0.001 and P = 0.006, respectively). Severity and control of asthma symptoms remained unchanged (P = 0.347 and P = 0.179, respectively), rhinitis type improved (P = 0.025), and severity remained unchanged in the active compared to the control group. The use of short-acting beta-agonists and inhaled corticosteroids to treat asthma symptoms decreased in the active vs. the control group (P = 0.001 and P = 0.031, respectively). Twelve (13.5%) and two (2.2%) patients in the active group experienced local adverse reactions (edema, swelling, erythema, hives, pruritus, and heat), and systemic adverse reactions (hypertensive crisis and low-grade fever) to AIT, respectively; none was serious. ConclusionAIT with Pollinex Quattro® specific for olive pollen and olive/grass pollens resulted in reduced visits to the healthcare center and emergency room and the use of asthma medication during the pollen season, indicating that this treatment was safe and effective in treating asthma in patients sensitized to these pollens.