Mild Asthma Symptoms Research Articles

GINA 2019 - step 1 and 2 treatment in asthma: Updates with reasons behind

Asthma is a heterogeneous lung disease characterized by chronic airway inflammation. It was suggested that patients with mild asthma symptoms could be managed with as-needed short-acting β2-agonists (SABA) in previous years. In 2019, GINA made a radical change and recommended that SABA should not be used as monotherapy in patients with mild asthma, but instead as-needed low-dose inhaled corticosteroid (ICS)-formoterol or "additional low-dose ICS taken whenever SABA is taken" treatments should be commenced to relieve and control symptoms. The approach emerged in the light of the studies that indicate the increased risk of severe exacerbation and asthma-related death due to overuse of SABA. The present article aimed to enlighten the updates in GINA 2019 step 1 and 2 treatment, the grounds for these updates with the supportive studies.

Pediatric asthma exacerbations during the COVID-19 pandemic: Absence of the typical fall seasonal spike in Washington, DC

Pediatric asthma exacerbations during the COVID-19 pandemic: Absence of the typical fall seasonal spike in Washington, DC

Effective Asthma Management: Is It Time to Let the AIR out of SABA?

For years, standard asthma treatment has included short acting beta agonists (SABA), including as monotherapy in patients with mild asthma symptoms. In the Global Initiative for Asthma 2019 strategy for the management of asthma, the authors recommended a significant departure from the traditional treatments. Short acting beta agonists (SABAs) are no longer recommended as the preferred reliever for patients when they are symptomatic and should not be used at all as monotherapy because of significant safety concerns and poor outcomes. Instead, the more appropriate course is the use of a combined inhaled corticosteroid–fast acting beta agonist as a reliever. This paper discusses the issues associated with the use of SABA, the reasons that patients over-use SABA, difficulties that can be expected in overcoming SABA over-reliance in patients, and our evolving understanding of the use of “anti-inflammatory relievers” in our patients with asthma.

Clustering asthma symptoms and cleaning and disinfecting activities and evaluating their associations among healthcare workers.

Asthma is a heterogeneous disease with varying severity and subtypes. Recent reviews of epidemiologic studies have identified cleaning and disinfecting activities (CDAs) as important risk factors for asthma-related outcomes among healthcare workers. However, the complexity of CDAs in healthcare settings has rarely been examined. This study utilized a complex survey dataset and data reduction approaches to identify and group healthcare workers with similar patterns of asthma symptoms, and then explored their associations with groups of participants with similar patterns of CDAs. Self-reported information on asthma symptoms/care, CDAs, demographics, smoking status, allergic status, and other characteristics were collected from 2030 healthcare workers within nine selected occupations in New York City. Hierarchical clustering was conducted to systematically group participants based on similarity of patterns of the 27 asthma symptom/care variables, and 14 product applications during CDAs, separately. Word clouds were used to visualize the complex information on the resulting clusters. The associations of asthma health clusters (HCs) with exposure clusters (ECs) were evaluated using multinomial logistic regression. Five HCs were identified (HC-1 to HC-5), labelled based on predominant features as: "no symptoms", "winter cough/phlegm", "mild asthma symptoms", "undiagnosed/untreated asthma", and "asthma attacks/exacerbations". For CDAs, five ECs were identified (EC-1 to EC-5), labelled as: "no products", "housekeeping/chlorine", "patient care", "general cleaning/laboratory", and "disinfection products". Using HC-1 and EC-1 as the reference groups, EC-2 was associated with HC-4 (odds ratio (OR) = 3.11, 95% confidence interval (95% CI) = 1.46-6.63) and HC-5 (OR = 2.71, 95% CI = 1.25-5.86). EC-3 was associated with HC-5 (OR = 2.34, 95% CI = 1.16-4.72). EC-4 was associated with HC-5 (OR = 2.35, 95% CI = 1.07-5.13). EC-5 was associated with HC-3 (OR = 1.81, 95% CI = 1.09-2.99) and HC-4 (OR = 3.42, 95% CI = 1.24-9.39). Various combinations of product applications like using alcohols, bleach, high-level disinfectants, and enzymes to disinfect instruments and clean surfaces captured by the ECs were identified as risk factors for the different asthma symptoms clusters, indicating that prevention efforts may require targeting multiple products. The associations of HCs with EC can be used to better inform prevention strategies and treatment options to avoid disease progression. This study demonstrated hierarchical clustering and word clouds were useful techniques for analyzing and visualizing a complex dataset with a large number of potentially correlated variables to generate practical information that can inform prevention activities.

The effect of internalization and other psychologic factors on the remission and severity of wheeze in children.

Asthma prevalence in Latin America is high and continues to increase. There is evidence that the psychologic characteristics of the child are associated with greater asthma morbidity. This study aimed to investigate the independent effect of internalizing/externalizing problems on two asthma/wheeze outcomes: (i) remission and (ii) progression to severity on Latin American children with mild asthma symptoms at baseline. This was a prospective study in a cohort of 371 asthmatic children living in a poor urban area in Salvador, Brazil. The psychologic characteristics of the child were assessed using the Child Behavior Checklist (CBCL), and wheezing was defined using the ISAAC questionnaire at the start and end of follow-up. A multiple logistic regression model with random effects was used to examine the association between the psychologic components and both outcomes. Remission of symptoms of wheeze was observed among 229 (61.73%) children. Remission was 56% lower among children with internalizing problems (OR = 0.54, 95% CI 0.33-0.87, p = 0.01). In addition, we found that 19 (8.76%) of the children acquired severe symptoms during follow-up and there was strong evidence of the effect of internalizing problems in increasing the risk of progression to severe wheeze symptoms (OR = 4.03, 95% CI 1.39-11.70, p = 0.01). Children with internalizing problems but not externalizing had less remission of wheezing, and a higher risk of acquiring severe symptoms. These results highlight the importance of psychologic care for children with asthma, to improve the prognosis of this condition.

Characterisation of systemic reactions to subcutaneous immunotherapy with airborne allergens and classification according to WAO 2010

BackgroundSystemic reactions (SR) to subcutaneous immunotherapy (SCIT) are rare but potentially severe. The use of different definitions and classifications hampered comparability between studies. AimsTo determine the frequency of SR to SCIT with airborne allergens, and to characterise and classify them according to the WAO 2010 recommendations. MethodsCross-sectional, retrospective study. Data on patients, immunotherapy and SR to SCIT were collected from the SCIT record forms. During the study period, 22,332 SCIT injections were administered (3732 patients). ResultsA total of 26 SR (0.1% of administrations) were recorded in 16 (0.6%) patients (median age 22 years, nine males, all with rhinitis and nine with asthma). Twenty-one (81%) SR occurred during the induction phase; eight (31%) in the first hour after administration. According to the WAO 2010 classification, 12 (46%) were grade 1 and 14 (54%) were grade 2. Most grade 2 reactions occurred in asthmatics, presented as mild asthma symptoms and resolved without need for medical observation. Only two individuals without asthma presented grade 2 reactions, both with concurrent cutaneous and low respiratory symptoms; both required medical observation and treatment despite late onset; 82% (n=12) of grade 2 reactions were late. No grade 3–5 reactions were registered and only one patient needed adrenaline treatment. No risk factors for SR to SCIT were identified in this study. ConclusionsSCIT is a safe treatment when administered by trained staff. The WAO 2010 classification might be useful for retrospectively classifying the severity of reactions, although its usefulness in treatment decision needs further research.

Abnormal Small Airways Function in Children With Mild Asthma

Small airways disease is a hallmark in adults with persistent asthma, but little is known about small airways function in children with mild asthma and normal spirometry. We assessed ventilation heterogeneity, a marker of small airways function, with an easy tidal breath single-breath washout (SBW) technique in school-aged children with mild asthma and normal FEV1 and healthy age-matched control subjects. The primary outcome was the double-tracer gas phase III slope (SDTG), an index of ventilation heterogeneity in acinar airways derived from the tidal double-tracer gas SBW test. The second outcome was the nitrogen phase III slope (SN2), an index of global ventilation heterogeneity derived from the tidal nitrogen SBW test using pure oxygen. Triplicate SBW and spirometry tests were performed in healthy children (n=35) and children with asthma (n=31) at baseline and in children with asthma after bronchodilation. Acinar (SDTG) but not global (SN2) ventilation heterogeneity was significantly increased in asthma despite normal FEV1. Of the 31 children with asthma, abnormal results were found for SDTG (≤-2 z scores) in 11; forced expiratory flow, midexpiratory phase (FEF25%-75%) in three; and FEV1 in zero. After bronchodilation, SDTG, SN2, FEF25%-75%, and FEV1 significantly changed (mean [95% CI] change from baseline, 36% [15%-56%], 38% [18%-58%], 17% [9-25%], and 6% [3%-9%], respectively). Abnormal acinar ventilation heterogeneity in one-third of the children suggests that small airways disease may be present despite rare and mild asthma symptoms and normal spirometry. The easy tidal SBW technique has considerable potential as a clinical and research outcome in children with asthma.

Change of bronchial hyperresponsiveness in asthmatic children

Bronchial hyperresponsiveness (BHR) is a factor in predicting bronchial asthma independently of inflammation markers. The aims were to determine the frequency and important predictive facts of BHR and the effect of prophylaxis by Global Initiative for Asthma (GINA) and National Asthma Education and Prevention Program (NAEPP) on BHR in asthmatic children. BHR in 106 children was evaluated by the bronchoprovocation test with methacholine. The prevalence rate of symptomatic BHR is 18% for crucial point of PC20 = 4.1 +/- 3.03 mg/ml and PD20 = 3.22 +/- 2.59 micromol methacholine. On average asthmatic children express moderate BHR, which persists even two years after administering prophylaxis. After two years bronchial reactivity is significantly smaller, the change of FEV1 is significantly smaller, the velocity of change of slope dose response curve (sDRC) is faster and the provocative concentration of methacholine that causes wheezing is 2-3 times lower. A mild sDRC shows milder bronchoconstriction after two years. The fast change of bronchial reactivity in 41% of asthmatic children is contributed to aero-pollution with sulfur dioxide and/or, possible insufficient and/or inadequate treatment during two years of administering prophylaxis. A simultaneous effect of allergens from home environment and grass and tree pollens and of excessive aero-pollution on children's airways is important in the onset of symptomatic BHR. After two years of treatment by GINA and NAEPP children do not show asthma symptoms or show mild asthma symptoms, however bronchial sensitivity remains unchanged. Optimal duration of anti-inflammatory treatment in asthmatic children who show moderate bronchial hyperresponsiveness should be longer than two years.

Physical activity in young children is reduced with increasing bronchial responsiveness

Physical activity is essential for young children to develop adequately and for quality of life. It can be lower in children with subclinical asthma, and therefore methods to reveal subclinical reduction in physical activity in young children are warranted. We sought to study an association between physical activity in preschool children and objectively assessed intermediary asthma phenotypes. We studied 253 five-year-old children (127 girls) participating in the Copenhagen Prospective Studies on Asthma in Childhood. The main outcome measure was level of physical activity assessed objectively with accelerometers worn on an ankle for 4 weeks. Objective assessment of asthma intermediary phenotypes included prebronchodilator and postbronchodilator specific airway resistance, bronchial responsiveness to cold dry-air hyperventilation, and exhaled nitric oxide levels. Analyses were performed with generalized linear model and principal component analysis. Physical activity was inversely associated with bronchial responsiveness (relative rate, 0.89; 95% CI, 0.83-0.95; P = .007) and significantly increased in the months of spring and summer (P < .001) and in boys (relative rate, 1.16; 95% CI, 1.09-1.25; P < .001). Physical activity was independent of asthma diagnosis, age, body mass index, baseline specific airway resistance, reversibility to beta(2)-agonist, sensitization, and exhaled nitric oxide level. Physical activity in preschool children was reduced with increasing bronchial responsiveness. The reduced physical activity was subclinical and not realized by parents or doctors despite daily diary cards and close clinical follow-up since birth. This observation warrants awareness of even very mild asthma symptoms in clinical practice.

Cholecystectomy of a patient with Churg-Strauss syndrome: A case report.

Churg-Strauss syndrome is an allergic granulomatous angitis and the organ most commonly involved in this condition is the lung. However, this syndrome also affects the skin, cardiovascular system, kidney, peripheral nervous system and gastrointestinal system. Cardiac involvement is a rare complication but can lead to rapid-onset heart failure as the result of specific cardiomyopathy. Pericardial effusion may also occur. Acalculous cholecystitis is also a rare complication of Churg-Strauss syndrome. Here, we present a case of a patient with Churg-Strauss syndrome and severe heart failure scheduled for cholecystectomy due to acalculous cholecystitis. The patient had mild asthma symptoms, peripheral neuritis in both legs, and severe heart failure. During the preoperative period, steroids, beta2 agonists, diuretics, and antihypertensive drugs were administered. During anesthesia we attempted to prevent compromising the patient's cardiac and pulmonary functions. The surgery was completed successfully, and the patient was discharged without any complications.

The First Case of Anaphylactic Shock due to Sublingual Immunotherapy with Standardized Mites Allergens

IntroductionSublingual immunotherapy (SLIT) is home administration treatment without medical supervision and therefore the safety of this form of immunotherapy is especially important.Case reportA 16-year-old girl, with a history of perennial allergic rhinitis and well-controlled intermittent asthma due to house dust mites began SLIT with standardized extract of HDM (Stallergenes, France). In the 3rd year of SLIT after 3 week break in maintenance dose (10 drops, 100 IR/ml), with unknown reason the girl administered herself 60 drops (100 IR/ml) of allergen extract, equivalent of 26.9 μg of house dust mites allergen. Within 5 minutes generalized pruritus, flushing and generalized urticaria developed, and the girl became dyspneic, began wheezing and shivering followed by double short collapse. Emergency team was called. The doctor found: blood pressure 70/40 mmHg, heart rate 160/min, weak pulse, generalized urticaria, mild asthma symptoms. The girl was sleepy but conscious. Doctor gave methylprednisone i.v., aminophylline i.v., intravenous fluids and oxygen. After several minutes she was admitted to Hospital Emergency Department when she suddenly became unconscious without pulse and blood pressure. She received epinephrine i.m., oxygen, corticosteroids, intravenous fluids and was transferred to Intensive Care Unit, where she recovered during one day.ConclusionsThe case leads to reconfirm the safety of sublingual immunotherapy schedule with large dose of allergen without up-dosing phase and expands the education and monitoring field of SLIT patients. IntroductionSublingual immunotherapy (SLIT) is home administration treatment without medical supervision and therefore the safety of this form of immunotherapy is especially important. Sublingual immunotherapy (SLIT) is home administration treatment without medical supervision and therefore the safety of this form of immunotherapy is especially important. Case reportA 16-year-old girl, with a history of perennial allergic rhinitis and well-controlled intermittent asthma due to house dust mites began SLIT with standardized extract of HDM (Stallergenes, France). In the 3rd year of SLIT after 3 week break in maintenance dose (10 drops, 100 IR/ml), with unknown reason the girl administered herself 60 drops (100 IR/ml) of allergen extract, equivalent of 26.9 μg of house dust mites allergen. Within 5 minutes generalized pruritus, flushing and generalized urticaria developed, and the girl became dyspneic, began wheezing and shivering followed by double short collapse. Emergency team was called. The doctor found: blood pressure 70/40 mmHg, heart rate 160/min, weak pulse, generalized urticaria, mild asthma symptoms. The girl was sleepy but conscious. Doctor gave methylprednisone i.v., aminophylline i.v., intravenous fluids and oxygen. After several minutes she was admitted to Hospital Emergency Department when she suddenly became unconscious without pulse and blood pressure. She received epinephrine i.m., oxygen, corticosteroids, intravenous fluids and was transferred to Intensive Care Unit, where she recovered during one day. A 16-year-old girl, with a history of perennial allergic rhinitis and well-controlled intermittent asthma due to house dust mites began SLIT with standardized extract of HDM (Stallergenes, France). In the 3rd year of SLIT after 3 week break in maintenance dose (10 drops, 100 IR/ml), with unknown reason the girl administered herself 60 drops (100 IR/ml) of allergen extract, equivalent of 26.9 μg of house dust mites allergen. Within 5 minutes generalized pruritus, flushing and generalized urticaria developed, and the girl became dyspneic, began wheezing and shivering followed by double short collapse. Emergency team was called. The doctor found: blood pressure 70/40 mmHg, heart rate 160/min, weak pulse, generalized urticaria, mild asthma symptoms. The girl was sleepy but conscious. Doctor gave methylprednisone i.v., aminophylline i.v., intravenous fluids and oxygen. After several minutes she was admitted to Hospital Emergency Department when she suddenly became unconscious without pulse and blood pressure. She received epinephrine i.m., oxygen, corticosteroids, intravenous fluids and was transferred to Intensive Care Unit, where she recovered during one day. ConclusionsThe case leads to reconfirm the safety of sublingual immunotherapy schedule with large dose of allergen without up-dosing phase and expands the education and monitoring field of SLIT patients. The case leads to reconfirm the safety of sublingual immunotherapy schedule with large dose of allergen without up-dosing phase and expands the education and monitoring field of SLIT patients.

Never-Smoking Senile-Onset Asthmatics Show Atypical and Mild Asthma Symptoms

Never-Smoking Senile-Onset Asthmatics Show Atypical and Mild Asthma Symptoms

EARLY INTERVENTION WITH BUDESONIDE IN MILD PERSISTENT ASTHMA: A RANDOMIZED, DOUBLE-BLIND TRIAL

Pauwels RA, Pedersen S, Busse WW, et al. Lancet . 2003;361:1071–1076 To determine whether treatment with low-dose inhaled budesonide would prevent severe asthma-related events and accelerated lung function decline among patients with recent-onset, mild, persistent asthma. A group of 7241 patients, 5 to 66 years of age, with mild asthma symptoms for 3 months to 2 years, were recruited from 499 sites in 32 countries. Patients were randomly allocated to receive 400 μg of budesonide (200 μg for patients <11 years …

Effect of Budesonide in Mild Persistent Asthma

Source: Pauwels RA, Pedersen S, Busse WW, et al, on behalf of the START Investigators Group. Early intervention with budesonide in mild persistent asthma: a randomised, doubleblind trial. Lancet. 2003;361:1071–1076.Although inhaled glucocorticosteroids are recommended and commonly used for more severe forms of persistent asthma, their long-term effect on recent onset, mild, persistent asthma is uncertain. Investigators from 7 countries performed a randomized, double-blind, placebo-controlled study of 7,241 patients in 32 countries to assess the effects of budesonide in patients who had not had previous regular treatment with corticosteroids and had symptoms of mild asthma for less than 2 years. Mild asthma was defined as wheeze, cough, dyspnea, or chest tightening at least once per week, but not daily. The patients ranged in age from 5–66 years, 3,195 of whom were under 18 years; 1,640 received budesonide and 1,535 received placebo once daily for 3 years in addition to their usual asthma medications. The daily budesonide dose was 400 μg or 200 μg for children under 11 years.Budesonide significantly reduced the risk of a first severe asthma-related event by 44% for all patients. After 3 years, 117 patients in the budesonide group had at least 1 severe asthma-related event compared with 198 patients on placebo. Nine patients in the budesonide group and 24 in the placebo had a life-threatening exacerbation. In addition to study treatment, 45% of patients on placebo received inhaled, oral, or systemic corticosteroids during the study compared with 31% on budesonide, and this medication was prescribed earlier in the placebo group than in the active treatment group (P<.001). Compared with those in placebo, patients taking budesonide had significantly improved pre- and post-bronchodilator FEV1 after 1 and 3 years, though this declined over time. Eleven patients died during the study, 3 budesonide and 8 placebo, although only 1 death (placebo group) was directly related to asthma. Children in the budesonide group aged 5-15 years grew less than those in the placebo group (0.43 cm/year).The increasing prevalence, morbidity, and potential mortality of asthma demands that we vigorously pursue every avenue that may lead to a decrease in morbidity and mortality of this ubiquitous entity. This study supports current recommendations by the National Asthma Education and Prevention Program for the use of low-dose, inhaled corticosteroids in mild persistent asthma.1 Initial concerns over the negative growth patterns produced by inhaled corticosteroids have been ameliorated by studies demonstrating that, despite these initial decrements in growth, children on budesonide achieved normal adult height.2,3

Discriminant analysis in allergic rhinitis and asthma: methacholine dose–response slope allows a good differentiation between mild asthma and rhinitis

Asthma and rhinitis frequently coexist in allergic patients, but nasal symptoms may predominate, leading to asthma underdiagnosis and undertreatment. Discriminant analysis obtains the best differentiation between groups using one or one set of variables. Our aim was to identify the laboratory test [allergen exposure, total and specific serum IgE, lung function, blood eosinophils and, bronchial response and sensitivity to methacholine (Mth) and allergen] or combination of them that allowed the best differentiation between mild asthma and allergic rhinitis. A cross-sectional analysis was performed in 86 Dermatophagoides pteronyssinus allergic rhinitis patients, who were classified according to clinical data as rhinitis plus mild asthma ( n =62) or “pure” rhinitis ( n =24). Bronchial symptoms had been exhaustively evaluated during a 2-years pre-inclusion period. Patients underwent skin tests and bronchial challenge with Mth and allergen. The exposure to D. pteronyssinus allergen (Der p1) was quantified in dust samples. Dose–response curves with Mth [until the FEV 1 fell by 40% or the maximal dose (200mg/ml) was inhaled] were attained. We developed multiple models of discriminant analysis in order to evaluate the capacity of the above variables to differentiate groups. Asthma patients had higher total and specific IgE levels and a greater sensitivity (PD 20 values) and response [dose–response slope (DRS)] to both Mth and allergen. The model entering these variables was the one that correctly classified more patients (79.2%). The discriminative power of the model that only included Mth-DRS values was similar to the above (78.8%). Bronchial response to Mth is quantitatively different in allergic rhinitis patients who display mild asthma symptoms when compared to those that only report rhinitis, suggesting a distinct bronchial intrinsic behavior. The utilization of complete dose–response curves with Mth allows a good separation between mild asthma and “pure” rhinitis patients and might be useful in the diagnosis of mild asthma. Whether the early detection and treatment of these patients prevents the development of symptomatic asthma needs further evaluation.

Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study)

Background: Children with allergic rhinitis are likely to develop asthma. Objective: The purpose of this investigation was to determine whether specific immunotherapy can prevent the development of asthma and reduce bronchial hyperresponsiveness in children with seasonal allergic rhinoconjunctivitis. Methods: From 6 pediatric allergy centers, 205 children aged 6 to 14 years (mean age, 10.7 years) with grass and/or birch pollen allergy but without any other clinically important allergy were randomized either to receive specific immunotherapy for 3 years or to an open control group. All subjects had moderate to severe hay fever symptoms, but at inclusion none reported asthma with need of daily treatment. Symptomatic treatment was limited to loratadine, levocabastine, sodium cromoglycate, and nasal budesonide. Asthma was evaluated clinically and by peak flow. Methacholine bronchial provocation tests were carried out during the season(s) and during the winter. Results: Before the start of immunotherapy, 20% of the children had mild asthma symptoms during the pollen season(s). Among those without asthma, the actively treated children had significantly fewer asthma symptoms after 3 years as evaluated by clinical diagnosis (odds ratio, 2.52; P < .05). Methacholine bronchial provocation test results improved significant in the active group (P < .05). Conclusion: Immunotherapy can reduce the development of asthma in children with seasonal rhinoconjunctivitis. (J Allergy Clin Immunol 2002;109:251-6.)

Compliance During Long-Term Treatment with Fluticasone Propionate in Subjects with Early Signs of Asthma or Chronic Obstructive Pulmonary Disease (COPD): Results of the Detection, Intervention, and Monitoring Program of COPD and Asthma (DIMCA) Study

In a prospective study, we investigated the long-term compliance to fluticasone propionate (FP) by dry powder inhalation (Rotadisk®) in subjects with early signs of asthma and chronic obstructive pulmonary disease (COPD) without an established diagnosis. Subjects were selected from a large screening program on early stages of asthma and COPD (Detection, Intervention, and Monitoring Program of COPD and Asthma [DIMCA] program) in the general practice. Forty-eight adult subjects with “early signs of COPD” (slightly increased forced expiratory volume in 1 sec [FEV1] decline of >0.04L/year) and 29 adult subjects with “early signs of asthma” (signs of bronchial hyperresponsiveness or reversibility) participated in a randomized placebo-controlled trial with FP (Flixotide® 500 jag daily) versus placebo with a duration of 2 years or 1 year, respectively. Compliance was measured by counting Rotadisks returned. By means of a questionnaire, participants were asked about perceived effects and/or side effects of the trial drug. The mean overall individual compliance rates of 72% (range 7%-102%) in the early COPD trial and 71% (range 8%-99%) in the early asthma trial were maintained throughout the study. Perceived effectiveness (12% of the participants) or side effects (30% of the participants) of the trial drug were not related to compliance. The willingness of patients to use the trial drug in daily practice if efficacy would be proved was statistically significantly related to compliance during the trial (p = 0.017). It was concluded that the compliance rates found were relatively high in patients with symptoms of mild asthma or COPD without an established diagnosis. Conviction of the importance of treatment influenced compliance more positively than perceived (side) effects. These results again emphasize the importance of patient education in establishing early treatment with inhaled corticosteroids.

Inhaled budesonide reduced symptoms of mild asthma in primary care

Source Citation O'Byrne P, Cuddy L, Taylor DW, et al. Efficacy and cost benefit of inhaled corticosteroids in patients considered to have mild asthma in primary care practice. Can Respir J. 1996 Ma...

A Clinical Study of Colchicine in Childhood Asthma

A double-blind, randomized, crossover study was done to determine the efficacy of colchicine in 30 atopic children with moderately severe asthma. A constant dose of sustained-release theophylline and salbutamol by inhalation, as needed, was administered to all patients. Compared to placebo, colchicine, 0.5 mg twice daily, significantly reduced morning tightness and nocturnal asthma score. There was, however, no significant difference between colchicine and placebo for cough, daytime asthma, or daily combined symptom scores for each patient. Colchicine did not significantly decrease beta-2 agonist inhaler use when compared with placebo. Similarly, there was no statistically significant difference between placebo and colchicine therapy as far as pulmonary function tests and peak flow reversibility were concerned. Thus, colchicine administered for 4 weeks demonstrated insufficient antiasthma activity. Colchicine-induced clinical improvement that was reported in a previous study may be due to selection of patients with mild asthma symptoms. However, our group, comprised of moderately severe asthmatic patients, did not show a satisfactory clinical response.