Terms Of Asthma Control Research Articles

Biologic Therapies in Pediatric Asthma.

Undeniably, childhood asthma is a multifactorial and heterogeneous chronic condition widespread in children. Its management, especially of the severe form refractory to standard therapy remains challenging. Over the past decades, the development of biologic agents and their subsequent approval has provided an advanced and very promising treatment alternative, eventually directing toward a successful precision medicine approach. The application of currently approved add-on treatments for severe asthma in children, namely omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab have been shown to be effective in terms of asthma control and exacerbation rate. However, to date, information is still lacking regarding its long-term use. As a result, data are frequently extrapolated from adult studies. Thus, the selection of the appropriate biologic agent, the potential predictors of good asthma response, and the long-term outcome in the pediatric population are still to be further investigated. The aim of the present study was to provide an overview of the current status of the latest evidence about all licensed monoclonal antibodies (mAbs) that have emerged and been applied to the field of asthma management. The innovative future targets are also briefly discussed.

Investigating the Outcomes of an Asthma Educational Program and Useful Influence in Public Policy.

The study was conducted to evaluate the effectiveness of an asthma educational program for asthma control, asthma self-management, asthma knowledge, and patient activation. The study analyzes different demographic variables with the purpose of investigating which asthma patients performed better than others. Based on these demographic characteristics, the study provides several recommendations for various stakeholders. The study is based on a positivist approach since its purpose is to investigate the consequences of an asthma educational program with a view to generalizing the results to a larger population. The study targets public and private hospitals which have applied the asthma educational program in collaboration with the Saudi Initiative for Asthma (SINA). Multiple questionnaires were deployed 263 valid responses were received from patients of public and private hospitals using online and offline data collection method. Several parametric and non-parametric tests were carried out in terms of data analysis. The results reveal that patients in the intervention group obtained high scores and were therefore more knowledgeable and able to control their asthma compared to the control group. Overall, patients in the intervention group performed better in terms of asthma control, asthma self-management and knowledge and awareness. There was a high level of patient activation in this group. In the context of demographic features, it was found that patients who are married and are undergraduate degree holders in employment scored high compared to patients who were young, single, post-graduate degree holders that were mainly self-employed. The results of this study can guide policy makers, SINA authorities, and hospitals as to which demographic category of asthma patients require immediate attention. The significance of asthma educational programmes has increased especially through social media platforms as the number of adult patients continues to increase day by day.

Effet de l’omalizumab dans l’aspergillose broncho-pulmonaire allergique : à propos de 10 patients asthmatiques

BackgroundThe treatment of allergic bronchopulmonary aspergillosis (ABPA) consists of oral corticosteroids but adverse effects commonly occur. Case reports have reported the efficacy of omalizumab (a monoclonal IgE antibody), particularly due to its steroid-sparing effect. AimTo evaluate the effects of omalizumab in patients with ABPA at the Pneumology Department of Strasbourg University Hospital. Patients and methodsThis was a single-centre retrospective study. Data were collected at 6 and 12 months after the start of treatment. The efficacy of omalizumab was assessed in terms of asthma control according to GINA 2018, annualized rate of severe exacerbations, medications used and pulmonary function. ResultsTen patients were included. At baseline, the median annualized rate of exacerbations was 5.5 [0–13]. After 6 months of treatment, the median annualized rate of exacerbations was 2 [0–14], with systemic corticosteroids being stopped in 5/8 (62.5%) of patients and asthma control being attained in 5/10 (50%). However, between the 6th and 12th months, 60% of patients stopped omalizumab due to lack of asthma control. Among the 40% of patients continuing treatment with omalizumab beyond 12 months, asthma control was achieved in 100% of cases, the annualized rate of exacerbations was zero, and none of the patients was on systemic corticosteroids at 6 and 12 months. ConclusionOmalizumab resulted in a steroid-sparing effect in ABPA, with a reduction in severe exacerbations and oral corticosteroid use.

Asthma control, lung function, nutritional status, and health-related quality of life: differences between adult males and females with asthma.

ABSTRACTObjective:To evaluate health-related quality of life in asthma patients treated at a referral center in southern Brazil, identifying differences between male and female patients, as well as to evaluate differences between the males and females in terms of asthma control, lung function, and nutritional status. Methods:This was a cross-sectional study involving patients ≥ 18 years of age treated at an asthma outpatient clinic. We evaluated clinical parameters, lung function, nutritional status, and quality of life. Results:A total of 198 patients completed the study. The mean age was 56.2 ± 14.8 years, and 81.8% were female. The proportion of patients with uncontrolled asthma was higher among females than among males (63.0% vs. 44.4%; p = 0.041). The body mass index (BMI) and percentage of body fat were higher in females than in males (30.2 ± 5.8 kg/m2 vs. 26.9 ± 4.5 kg/m2 and 37.4 ± 6.4% vs. 26.5 ± 7.4%; p = 0.002 and p < 0.001, respectively). Quality of life was lower in females than in males in the following domains: symptoms (3.8 ± 1.5 vs. 4.6 ± 1.7; p = 0.006); activity limitation (3.6 ± 1.3 vs. 4.4 ± 1.5; p = 0.001); emotional function (3.6 ± 1.9 vs. 4.5 ± 1.7; p = 0.014); and environmental stimuli (3.2 ± 1.6 vs. 4.3 ± 1.9; p = 0.001). Conclusions:Male asthma patients appear to fare better than do female asthma patients in terms of health-related quality of life, asthma control, BMI, percentage of body fat, and comorbidities.

A virtual asthma clinic for children: fewer routine outpatient visits, same asthma control.

eHealth is an appealing medium to improve healthcare and its value (in addition to standard care) has been assessed in previous studies. We aimed to assess whether an eHealth intervention could improve asthma control while reducing 50% of routine outpatient visits.In a multicentre, randomised controlled trial with a 16-month follow-up, asthmatic children (6-16 years) treated in eight Dutch hospitals were randomised to usual care (4-monthly outpatient visits) and online care using a virtual asthma clinic (VAC) (8-monthly outpatient visits with monthly web-based monitoring). Outcome measures were the number of symptom-free days in the last 4 weeks of the study, asthma control, forced expiratory volume in 1 s, exhaled nitric oxide fraction, asthma exacerbations, unscheduled outpatient visits, hospital admissions, daily dose of inhaled corticosteroids and courses of systemic corticosteroids.We included 210 children. After follow-up, symptom-free days differed statistically between the usual care and VAC groups (difference of 1.23 days, 95% CI 0.42-2.04; p=0.003) in favour of the VAC. In terms of asthma control, the Childhood Asthma Control Test improved more in the VAC group (difference of 1.17 points, 95% CI 0.09-2.25; p=0.03). No differences were found for other outcome measures.Routine outpatient visits can partly be replaced by monitoring asthmatic children via eHealth.

1-year prospective real life monitoring of asthma control and quality of life in Italy

ObjectivesThe study aimed at prospectively evaluating the evolution of asthma control in Italy, to evaluate the reasons for lack of asthma control, perceived quality of life (QoL) and association with level of asthma control, the impact of pharmacological treatment, the number of exacerbations and the healthcare resource consumption.MethodsPRISMA (PRospectIve Study on asthMA control) was an observational study performed in asthmatic patients including a cross-sectional phase and a 12-month prospective phase. Asthma control was assessed with the Asthma Control Test™ (ACT) and QoL was evaluated with EuroQoL-5D questionnaire filled in and collected during 5 clinic visits together with all the other data.ResultsThe prospective phase included 1017 patients with uncontrolled (55.7%) or partly controlled asthma (44.3%). Out of the 739 patients evaluable after 12 months, 22.2% achieved full asthma control (ACT score = 25) and 58.7% reached a good control (ACT score: 20–24). The improvement in asthma control was associated with improved QoL and reduced hospital visits. The main reasons for lack of asthma control were comorbidities, continued exposure to irritants/triggers and poor adherence to therapy. The frequency of exacerbations was lower in patients with controlled asthma.A fixed combination therapy with an inhaled corticosteroid and a long-acting β2 agonist was reported by 77.0% of patients. A better asthma control and improved QoL were achieved with extrafine beclomethasone/formoterol compared to either budesonide/formoterol or fluticasone/salmeterol.ConclusionsAn improvement in asthma control and QoL can be achieved during a 1-year monitoring in a real life setting. Extrafine beclomethasone/formoterol was associated with significant benefit in terms of asthma control and QoL compared to large-particles combinations.ClinicalTrials.gov number NCT01110460.

Real-life effectiveness of extrafine beclometasone dipropionate/formoterol in adults with persistent asthma according to smoking status

The efficacy and safety of extrafine beclomethasone dipropionate 100 μg/formoterol 6 μg (BDP/F HFA) pressurized metered dose inhaler (pMDI) in patients with moderate-to-severe persistent asthma, has been demonstrated in randomised controlled trials (RCTs). The aim of this prospective observational study was to assess real-life effectiveness in terms of asthma control in smoking (most of the time excluded from RCTs) and non-smoking asthmatics. Adult patients with persistent asthma, in whom treatment with an inhaled corticosteroid/long-acting β(2)-agonist (ICS/LABA) combination is indicated, were included. Pulmonary function (FEV1%pred or PEF absolute value), Asthma Control Questionnaire (ACQ) and asthma control according to GINA criteria were measured at baseline as well as 2-8 months and >8-14 months after treatment initiation with BDP/F HFA. Overall, 619 patients were enrolled by 97 investigators. In the effectiveness cohort (N = 568), at baseline, smoking asthmatics (N = 123) had higher ACQ6 (p < 0.0001) and lower asthma control (p = 0.021) than non-smoking asthmatics. Treatment with BDP/F HFA pMDI was associated with significant (p < 0.0001) improvements in pulmonary function (+7.1% in FEV1% pred), ACQ6 (-1.32) and GINA asthma control (improvement of control in 49.8% of patients). Importantly, the same treatment benefits were observed in former or current smokers compared with non-smoking asthmatics. There was a reduction in the dose of ICS from 489 ± 192 μg BDP extrafine equivalents at baseline to 265 ± 125 μg after one year. The drug was well-tolerated. This prospective cohort study demonstrates the real-life effectiveness and safety of BDP/F HFA in adult asthma patients, including smokers, in normal clinical practice.

Anxiety Sensitivity, Asthma Control, and Quality of Life in Adults with Asthma

Objective. The aim of this study was to examine the role of anxiety sensitivity (AS) in terms of asthma control and asthma-related quality of life in a sample of adults with a physician-verified diagnosis of asthma. Methods. Self-report measures assessing psychological and asthma symptoms were mailed to 368 asthma patients from a community allergy and asthma office who had been seen for a physician follow-up visit between 1 January 2009 and 1 January 2010. Participants in the current study were 127 asthma patients (74% female; Mage = 43.4 years, SD = 12.3) who completed and returned the self-report measures. Results. The results indicated that, after controlling for gender, age, negative affect, and number of comorbid medical problems, the physical concerns factor of AS (AS-Physical Concerns) significantly predicted asthma control and all domains of asthma-related quality of life (symptoms, activity limitations, emotional functioning, and environmental stimuli). Conclusions. These findings replicate and extend previous research and indicate that the fear of physical sensations negatively affects both asthma control and quality of life. These findings also suggest that targeting the AS-Physical Concerns may be a novel way to improve asthma control and quality of life.

The Role of Anxiety Sensitivity in terms of Asthma Control: A Pilot Test among Young Adult Asthmatics

The aim of the present pilot investigation was to examine the role of specific subfactors of anxiety sensitivity (physical, cognitive, and social concerns) in terms of asthma control among a young adult sample (N = 56; M age = 20.0; SD = 3.9; Range = 18-45 years). Results indicated that, after controlling for gender, cigarette smoking status, and negative affectivity, the physical concerns factor of anxiety sensitivity, relative to cognitive and social concern factors, significantly predicted asthma control. These findings support the theory that fear of physical sensations is associated with poorer asthma control and suggest that targeting the physical concerns facet of anxiety sensitivity may be a novel way to improve asthma control.

Rola zakażeń Chlamydia pneumoniae i Mycoplasma pneumoniae w przebiegu astmy

Respiratory infections are one of the major causes of asthma exacerbations. Among numerous pathogens that may lead to exacerbations, particular attention should be paid to atypical bacteria: Chlamydia pneumoniae and Mycoplasma pneumoniae. Despite significant frequency, infections caused by these species are underestimated due to untypical clinical course and lack of easily accessible diagnostic tests. Although acute infection can be easily linked with deterioration of asthma control, the role of respiratory colonisation by Chlamydia pneumoniae or Mycoplasma pneumoniae has not been precisely defined. It is known that serologic signs of both past infection and chronic current infection (IgA) with Chlamydia pneumoniae or Mycoplasma pneumoniae are found more often in asthmatics compared to healthy controls. Besides respiratory colonisation by Chlamydia pneumoniae or Mycoplasma pneumoniae confirmed by culture or molecular tests is also more common in asthmatics. This is particularly relevant in cases of uncontrolled asthma that followed symptoms of respiratory infection. This may lead to the conclusion that atypical infections can play a role in asthma induction in previously healthy individuals as well as deteriorations in the course of the disease. Studies mentioned above have led to the new therapeutic possibility—eradication of Chlamydia pneumoniae. In some of the studies on eradication with macrolides promising results have been gained in terms of asthma control, but in most of the cases improvement was only temporary.

ABS74: Large variations in asthma control between UK general practices participating in the asthma control, concordance and tolerance (ACCT) Initiative

Despite availability of effective asthma, outcomes remain suboptimal. The issue of whether different practices achieve different results in terms of asthma control is currently unknown although much discussed. To evaluate variation in asthma control using patient reported outcomes and routine practice recorded data. Subjects and method: Practices participating in the ACCT initiative evaluated asthma control using the asthma control questionnaire (ACQ) and other patient reported outcomes for adults prescribed preventative asthma therapy. Routine anonymous data was also extracted from practice computer systems including current asthma treatment and recorded exacerbations. Practices with full data on more than 30 adult patients only were included in this analysis. Proportions with evidence of poor asthma control using practice reported oral steroid usage and high ACQ scores (>1.5) are reported [1]. Data from 36 practices met the study criteria. Median practice proportion of patients receiving at least one course of oral steroids was 14.2% (IQR 7.3% to 19.6%) and median proportion with an ACQ score of >1.5 was 36.5% (IQR 27.0% to 48.1%). The absolute range for oral steroids from 0% to 37.8% of patients and for high ACQ score from 12.3% to 78.3%. This data suggests vast variation exists between practices in terms of achieved asthma control as evidenced by oral steroid usage and high ACQ scores. Conflict of interest and funding The ACCT programme is supported by an unrestricted educational grant by Altana pharma.

Effect of montelukast on lung function in asthma patients with allergic rhinitis: analysis from the COMPACT trial

The Clinical Outcomes with Montelukast as a Partner Agent to Corticosteroid Therapy (COMPACT) trial demonstrated that montelukast added to budesonide (MNT + BD) was as efficacious as double the dose of budesonide (dBD) in improving morning peak expiratory flow (AM PEF) in adult asthmatics. Recent studies have demonstrated that montelukast is also effective in treating daytime and nighttime allergic rhinitis (AR) symptoms in asthmatic patients. This analysis was designed to examine whether asthmatic patients with comorbid AR respond differently than patients without comorbid AR in terms of asthma control (lung function). There were 216 asthmatic patients in the MNT+BD group and 184 patients in the dBD group with AR. Treatment differences in the change from baseline in AM PEF were compared. Least square (LS) mean and 95% confidence interval (CI) were derived from an anova model adjusting for baseline and study site. There was a 9.2% increase in AM PEF from baseline in the MNT+BD group compared with a 6% increase in the dBD group. The LS mean difference [(MNT+BD)-dBD] was 14.2 l/min (P=0.028). Other secondary endpoints were similar between groups. In the subgroup of asthmatic patients with AR, a combined treatment approach that included montelukast and budesonide provided significantly greater efficacy in reducing airflow obstruction compared with doubling the dose of budesonide. These results support recommendations by the Allergic Rhinitis and its Impact on Asthma initiative that suggest a unified approach aimed at treating the airway inflammation common to both diseases is beneficial for the large proportion of asthmatics who also suffer from AR.

Developing therapeutics for the diseases of protein misfolding

Our current structural and biologic understanding of the misfolding diseases has restricted the development of therapies that target these diseases at a molecular level. The prion diseases are illustrative of this group of misfolding disorders and provide a model system for therapeutic intervention. Strategies to inhibit the replication and accumulation of the prion protein are being developed and have entered animal and clinical studies. Due to the underlying molecular basis of this disease class, many of the therapeutic approaches used to target prion misfolding have parallels in other misfolding diseases.

Effect of salmeterol on patients' adherence to their prescribed refills for inhaled corticosteroids.

Optimal treatment for persistent asthma requires multiple classes of medication, including antiinflammatory agents and bronchodilators. Inhaled corticosteroids are the most effective antiinflammatory agents available and are recommended by recent guidelines as first-line treatment. Salmeterol, a long-acting inhaled bronchodilator, is recommended as adjunctive therapy to inhaled corticosteroids. Non-adherence to prescribed medication is prevalent and has been implicated in asthma exacerbations. Salmeterol's benefits in terms of asthma control are readily perceived by patients whereas the benefits of inhaled corticosteroid therapy may be less apparent. To evaluate whether the addition of salmeterol to a medication regimen affects patient adherence to prescription refills for inhaled corticosteroids. A retrospective medical chart and pharmacy claims record review before and after the addition of salmeterol was used. Medication adherence rates were calculated for 67 patients requiring inhaled corticosteroids for at least 8 months before and after the addition of salmeterol. Adherence with inhaled corticosteroid therapy before (49.7% +/- 29.3%) and after (56.5% +/- 28.6%) the introduction of salmeterol was not significantly different (P = .0785, pre versus post). Adherence with salmeterol was significantly higher (58.7% +/- 28.3%) than inhaled corticosteroids at baseline (P = .0202), but not with concurrent use. Dosing frequency of inhaled corticosteroid administration was not a significant factor in adherence, but increasing age was (r = 0.41788, P = .0048). The addition of salmeterol does not adversely affect the adherence rates to prescription refills for prescribed inhaled corticosteroid therapy. On average, important antiinflammatory treatment should not be supplanted with salmeterol if prescribed in combination.

The complementary role of glucocorticosteroids and long-acting beta-adrenergic agonists.

In summary, beta 2-adrenergic agonists and corticosteroids can interact to produce beneficial effects on airway function. The regular use of short-acting, beta 2-adrenergic agonists as relief therapy is safe and effective; however, some degree of caution may be required with the use of very high doses. Long-acting beta 2-adrenergic agonists provide further benefits in terms of asthma control in patients already established on inhaled corticosteroid therapy. The mechanism by which this interaction occurs remains to be elucidated, but may involve a protective effect of corticosteroids on dysfunctional beta-adrenergic receptor expression and function. In asthma, there may be a degree of uncoupling of the airway receptors, probably caused by cytokines such as IL-1 beta. However, this has not been established yet. Furthermore, beta-adrenergic receptor-mediated effects may be more quickly downregulated with beta-receptor stimulation, leading to a reduction in anti-inflammatory effects. The regular use of corticosteroids leads to an inhibition of cytokine production and prevents beta-adrenergic receptor downregulation, allowing beta 2-adrenergic agonists to be more effective. Further research, which may lead to a greater understanding of these mechanisms, may also lead to the development of more effective treatment regimens.