Uncontrolled Asthma Group Research Articles

The critical level of vitamin D in childhood asthma

Objectives: Studies have suggested a significant link between vitamin D status and asthma. We sought to determine the cutoff level of25 hydroxy (25-OH) vitamin D that is significantly linked to asthma status in children.Methods: Our cross-sectional study comprised 90 asthmatic children, aged 2-18 years. They were evaluated clinically and classified according to asthma severity and control. Asthma control test (ACT) was performed in those aged above 4 years.Pulmonary functions were performed in cooperative children (n=59). Serum 25-OH vitamin D levels were measured by ELISA in all patients.Results: The study comprised 52 boys (57.7%) and 38 girls (42.3%) with mean age 7.03±4.36 years. Thirty-six patients (40%) had mild asthma, 37 (41%) moderate asthma and 17 (19%) had severe asthma. Forty-two patients (46.6%) had controlled asthma; 14 (15.6%) partially controlled and 34 (37.8%) had uncontrolled asthma. ACT score ranged: 11-26, with mean score: 18.9 ± 4.3 SD. Serum 25-OHvitamin D levels ranged between 2-48 ng/ml (mean± SD: 12.2 ± 9 ng/ml); levels were comparable among different grades of asthma severity (f= 1.975, p=0.145), while the uncontrolled asthma group showed the lowest levels (f=8.511, p <0.001). 25-OH vitamin D levels correlated positively with ACT score (r= 0.369, p= <0.001) but not with inhaled steroids doses or any of the pulmonary function parameters. A level of 7.5 ng/ml was associated with partial/completeuncontrol of asthma with 81 % sensitivity and 53 % specificity.Conclusion: 25-OH vitamin D levels below 7.5 ng/ml are associated with poor asthma status in children.Keywords: Asthma, allergy, children, severity, inhaled steroids, 25 hydroxy vitamin D.

Evaluation of Asthma Symptoms to Assess Asthma Control Status in a Primary Care Setting: An Exploratory Analysis of Pooled Data from Three Trials

Background: Primary care physicians in Japan see many patients in a given day; consequently, they find it challenging to devote sufficient time for detailed clinical consultation and evaluation of asthma control status. The aim of this study was to investigate asthma symptoms that reveal the presence of inadequately controlled asthma. Methods: A pooled analysis of baseline data from 100 patients with asthma treated with inhaled corticosteroid(s) (ICS) alone or ICS/long-acting beta-agonist who participated in three previous clinical trials was performed. Asthma control status and asthmatic symptoms were determined using a five-item Asthma Control Questionnaire, and whether asthmatic symptoms reflect clinical markers was investigated. Results: Nocturnal awakening owing to asthmatic symptoms was observed only in the uncontrolled asthma group. Patient-reported wheezing was not observed in the group with well-controlled asthma, but was observed in all patients in the uncontrolled asthma group. Virtually all patients, irrespective of asthma control status, reported symptoms in the morning, limitation of normal daily activities, and shortness of breath. Conclusions: The presence of nocturnal awakening due to asthma and wheezing likely reflected uncontrolled asthma. These results will lead to re-recognition that clinical interview, querying nocturnal awakening from asthma and wheezing is a simple and useful approach to assess asthma control status in a primary care setting.

Association between asthma and falls: A nationwide population-based study

ABSTRACTObjectives: We evaluated the relationship between asthma and falls in Koreans using data from a large population-based cross-sectional survey. Methods: Data were obtained from 228,642 participants, of whom 6,372 had asthma, who participated in the 2013 Korean Community Health Survey. We explored the risk of falls after adjusting for sociodemographic factors and comorbidities. Logistic regression was used to identify risk factors for falls in asthmatics. Patients with asthma who had been diagnosed by a physician were included after excluding those who did not respond to the self-reported questionnaire. Results: In all, 1,733/6,372 (27.1%) asthma patients and 258/788 (32.7%) patients with uncontrolled asthma (who had visited the emergency room because of asthma exacerbation in the prior 12 months) reported histories of falls. In asthmatics, the crude odds ratio (OR) for falls was 1.57 (95% confidence interval [CI]: 1.48–1.67); the OR for falls in the group with uncontrolled asthma was 2.13 (95% CI: 1.83–2.47). The multivariate OR for falls in the asthma group (compared to the non-asthma group) was 1.27 (95% CI, 1.18–1.35) and the OR for falls in the uncontrolled asthma group (again compared to the non-asthma group) was 1.55 (95% CI, 1.32–1.82). Subgroup analysis of the adjusted ORs for falls in asthmatics by age group revealed a significant difference between the presence of asthma and uncontrolled asthma, and falls, in each age group, similar to the relationship evident in the total adult population. Conclusion: Asthma is associated with falls, even after adjusting for sociodemographic and comorbid variables.

Serum Vitamin D Levels and Vitamin D Supplement in Adult Patients with Asthma Exacerbation.

Introduction. Vitamin D deficiency has been linked to an increased risk of asthma exacerbations. Objective. This study aimed to compare vitamin D status during the period of severe asthma exacerbations and investigate if vitamin D supplementation improves asthma control. Methods. A total of 47 asthmatic patients and 40 healthy subjects participated in this study. Serum 25-hydroxyvitamin D (25(OH)D), asthma control test (ACT) score, and % predicted peak expiratory flow rate were evaluated in the period with and without severe asthma exacerbations. After that, we provided vitamin D2 supplements to the patients with low vitamin D levels for 3 months. Results. At the period of asthma exacerbation, the prevalence of vitamin D deficiency and insufficiency was 38.29% and 34.04%. There was no significant difference in the levels of serum 25(OH)D with and without asthma exacerbations but the levels were significantly higher in the healthy group. Serum 25(OH)D levels significantly correlated with ACT score. Moreover, vitamin D2 supplementation improved asthma control in uncontrolled asthma group. Conclusions. Hypovitaminosis D was common in asthmatic patients but was not the leading cause of asthma exacerbations. Serum 25(OH)D levels correlated with the ability to control asthma. Improving vitamin D status might be a benefit in uncontrolled asthmatic patients.

Validation of the Brazilian version of the childhood asthma control test (c-ACT).

Children's perception of their symptoms has proved reliable and relevant to disease management and should be considered when assessing their asthma control. The aim of the study is to validate the Brazilian Portuguese version of the Childhood Asthma Control Test (c-ACT) in children aged 4-11 years. This is a cross-sectional study in children diagnosed with asthma undergoing treatment in a pediatric pulmonology outpatient clinic in Porto Alegre, Brazil. The translation and linguistic adaptation of the instrument were performed in accordance with international recommendations for questionnaire validation. A total of 105 participants were included, aged 4-11 years. all correlations between the total score and items on the questionnaire were significant and obtained values of r ≥ 0.3, and c-ACT means showed statistically significant differences between the GINA categories (P < 0.01). The controlled asthma group showed significantly higher c-ACT scores than those of uncontrolled asthma group (controlled 22.0 ± 2.9 vs. uncontrolled 16.3 ± 5.3 P < 0.01); and partially controlled asthma group showed significantly higher c-ACT scores than those of uncontrolled asthma group (partially controlled 20.0 ± 4.0 vs. uncontrolled 16.3 ± 5.3 P = 0.03). Correlations between the c-ACT total score and spirometry and nitric oxide were poor (r = 0.020; P = 0.866 and r = 0.035; P = 0.753, respectively). Reliability: the α-C coefficient for the c-ACT total score was 0.677 (95%CI 0.573-0763). Sensitivity to change had an effect size of 0.8 and an intraclass correlation coefficient of 0.598. No floor or ceiling effects were observed. The Brazilian version of the Childhood Asthma Control Test proved to be valid and reliable in children aged 4-11 years.

Urine AQP2 change in patients with asthma controlled to different clinical levels and its relationship with inflammatory factors

Objective To compare the urine aquaporin 2(AQP2)levels between asthmatic patients and healthy participants,explore the AQP2 levels in patients with asthma of different clinical control levels and its relationship with inflammatory factors.Methods Urine AQP2 levels were examined by ELISA in 60 patients with asthma and 21 healthy participants;plasma interleukin(IL)-4,IL-6,tumor necrosis factor(TNF)-αand interferon(IFN)-γlevels were determined by by CBA method.Results The levels of urine AQP2 in clinical uncontrolled asthma group(ACT below 19)and partially controlled asthma group(ACT 20~24)were significantly higher than that in the healthy control group(P0.01),and the level in the uncontrolled group was(174.28±40.81)pg/mL.The plasma IL-4level in uncontrolled group was(1.10±0.25)pg/mL,which was significantly higher than those in the other two groups(P0.01).The plasma IL-6level in uncontrolled asthma group was the highest but showing no significant difference when compared with the other two groups(P=0.058).The TNF-αlevel in asthma patients was significantly higher than that in healthy controls(P0.05).Urine AQP2 was found significantly correlated with plasma IL-4and IL-6levels(P=0.049,P=0.010);plasma IL-4level was significantly correlated with IFN-γlevel(P=0.019);IL-6was significantly correlated with TNF-αlevel(P=0.010);and IL-10 was significantly correlated with IFN-γlevle(P=0.005).Conclusion Urine AQP2 level of asthma patients is increased,and it is significantly correlated with plasma levels of inflammatory factors IL-4and IL-6.The role of AQP2 in the pathogenesis of bronchial asthma is worth further studying.

The relationship between allergy and asthma control, quality of life, and emotional status in patients with asthma: a cross-sectional study.

BackgroundPsychiatric comorbidities are prevalent in patients with chronic somatic disorders such as asthma. But, there is no clear evidence regarding the effect of atopic status and the type of sensitized allergen on emotional status. The aim of the present study was to investigate the effects of house dust mites and pollen allergies on emotional status, asthma control and the quality of life in patients with atopic asthma.MethodsThe study included 174 consecutive patients who were diagnosed with asthma accoring to the GINA criteria and who did not receive therapy for their allergy. All patients underwent a skin prick test. The asthma control, quality of life, and emotional status were evaluated using the ACT (asthma control test), AQLQ (asthma-specific quality of life questionnaire), and HAD (hospital anxiety depression questionnaire).ResultsAtopy was detected in 134 (78.7%) patients. Of those patients: 58 (33.3%) had anxiety and 83 (47.7%) had depression. There was no relationship between emotional status, atopic status, and the type of indoor/outdoor allergen. Furthermore, there was no relationship between atopy and asthma severity, asthma control, and the quality of life. The anxiety and depression scores were significantly higher and the quality of life scores lower in the uncontrolled asthma group. The ACT and AQLQ scores were also lower in the anxiety and depression groups.ConclusionsIt was concluded that anxiety and depression are prevalent in patients with uncontrolled asthma, and atopic status did not affect the scores in ACT, AQLQ, and emotional status tests.

Vitamin D receptor ApaI a allele is associated with better childhood asthma control and improvement in ability for daily activities.

Vitamin D levels have been suggested as a marker of disease severity in asthmatic children. Our aim was to investigate possible associations between the vitamin D receptor (VDR) FokI, BsmI, ApaI, and TaqI polymorphisms and asthma susceptibility and control in children. 127 Greek children with asthma and 91 healthy controls were genotyped for VDR FokI, BsmI ApaI, and TaqI polymorphisms using Sequenom MassARRAY iPLEX platform. Asthma control was assessed according to the Global Initiative for Asthma guidelines (GINA) and Childhood Asthma Control Test (C-ACT) and, for the first time, tested for its possible association with VDR SNPs. Asthmatic children were grouped as "controlled (n=49)", "partially controlled (n=38)," and "uncontrolled (n=40)," according to GINA classification. No association was found between VDR polymorphisms and asthma prevalence. Asthmatic children with the VDR ApaI aa genotype had significantly higher C-ACT score compared with asthmatic children carrying the AA/AC VDR ApaI genotypes (p=0.011). The frequency of VDR ApaI aa genotype was significantly higher in controlled asthma group (n=92) than uncontrolled asthma group (n=35), according to C-ACT (24.5% vs 0.0%, p<0.001) and GINA (32.7% vs 7.5%, p=0.001). Also, VDR ApaI aa genotype was negatively associated with limitation in daily activities because of asthma (p=0.004). VDR ApaI aa genotype was positively associated with well-controlled asthma according to GINA and C-ACT questionnaire and negatively associated with decreased limitation in daily activities in asthmatic children, further supporting the importance of Vitamin D pathway in asthma.

Level of asthma control and its relationship with medication use in asthma patients in Brazil

OBJECTIVE: To assess asthma patients in Brazil in terms of the level of asthma control, compliance with maintenance treatment, and the use of rescue medication. METHODS: We used data from a Latin American survey of a total of 400 asthma patients in four Brazilian state capitals, all of whom completed a questionnaire regarding asthma control and treatment. RESULTS: In that sample, the prevalence of asthma was 8.8%. Among the 400 patients studied, asthma was classified, in accordance with the Global Initiative for Asthma criteria, as controlled, partially controlled, and uncontrolled in 37 (9.3%), 226 (56.5%), and 137 (34.3%), respectively. In those three groups, the proportion of patients on maintenance therapy in the past four weeks was 5.4%, 19.9%, and 41.6%, respectively. The use of rescue medication was significantly more common in the uncontrolled asthma group (86.9%; p < 0.001). CONCLUSIONS: Our findings suggest that, in accordance with the established international criteria, asthma is uncontrolled in the vast majority of asthma patients in Brazil. Maintenance medications are still underutilized in Brazil, and patients with partially controlled or uncontrolled asthma are more likely to use rescue medications and oral corticosteroids.

Status of asthma control in children and the effect of parents' knowledge, attitude, and practice (KAP) in China: a multicenter study

BackgroundAsthma is the most common chronic respiratory disease seriously endangering the health of children. But disease awareness and self-management skills are relatively poor in children; parents play an important role in the control of childhood asthma. ObjectiveTo investigate the status of asthma control and severity of asthma in children and to identify impact factors. MethodsWe studied 1 tertiary hospital in each of the 29 provinces. A total of 2,960 parents with children with asthma who visited those hospitals were selected for the knowledge, attitude, and practice (KAP) questionnaire survey, and separated into the controlled asthma group and uncontrolled asthma group according to children's asthma conditions in the past 12 months. Multivariate analysis was carried out based on the answers to 28 tested factors. ResultsIn the past 12 months, 66.0% of children with asthma had asthma attacks, 26.8% visited an emergency room, and 16.2% were hospitalized. The total cost for asthma was significantly higher in the uncontrolled group than controlled group (χ2 = 23.14, P < .01). Twelve protective factors of asthma control were founded, such as older age of children, long disease course, high KAP scores of parents, compliance with using nasal steroids, and knowledge of “3 or more times recurrent wheezing suggesting asthma.” The risk factors were eczema and family history of asthma. ConclusionChildren's asthma is poorly controlled. The cost of asthma is significantly higher in uncontrolled asthma than in controlled. The age of children, course of asthma, personal history of allergy, family history of asthma, parents' education level, and parents' KAP are factors that affect asthma control.

Asma e doença pulmonar obstrutiva crônica: uma comparação entre variáveis de ansiedade e depressão

To evaluate the presence and severity of symptoms of anxiety and depression in individuals with asthma or chronic obstructive pulmonary disease. In order to evaluate symptoms of anxiety and depression, specific instruments of quantification (the State-Trait Anxiety Inventory and the Beck Depression Inventory, respectively) were administered to patients at an outpatient clinic for the treatment of asthma and chronic obstructive pulmonary disease. The population comprised 189 randomly and prospectively selected patients that were divided into three study groups (each with a different therapeutic objective): 40 patients with controlled asthma, 100 patients with uncontrolled asthma, and 49 patients with chronic obstructive pulmonary disease. Included among the variables studied, as part of the methodology, were symptoms of anxiety and depression. The data obtained were compared taking into consideration demographic and functional aspects, as well as the severity of the symptoms of anxiety and depression. Among the asthma patients, the prevalence of moderate or severe anxiety was significantly higher than that observed among those with chronic obstructive pulmonary disease (p < 0.001). The uncontrolled asthma group presented significantly higher rates of depressive symptoms than did the controlled asthma group (p < 0.05). The frequency of symptoms of anxiety and depression is greater among asthma patients than among patients with chronic obstructive pulmonary disease, which can make clinical control difficult.

Validity of the Spanish version of the Pediatric Quality of Life Questionnaire for evaluating quality of life in asthmatic children

To analyze the clinical utility of the quality of life questionnaire for asthmatic children (PAQLQ) and to validate it for use in clinical practice. 1,012 children between 6 and 14 years of age, with a diagnosis of mild to moderate asthma attending 48 Spanish hospitals were included in the study. The patients' socio-demographic and clinical characteristics were recorded and all patients were administered the PAQLQ and EQ-5D questionnaires on two occasions: at the baseline visit and at 2-3 months from baseline in patients with uncontrolled asthma(group A) and at baseline and 15 days from baseline in patients with controlled asthma (group B). The feasibility, validity, reliability and sensitivity to change of the PAQLQ were assessed. The PAQLQ proved to be feasible for use in children over 7 years of age with mild or moderate asthma. The PAQLQ did not show a statistically significant relationship with socio-demographic variables, nor with the majority of clinical variables, with the exception of asthma severity, number of exacerbations, symptoms and use ofon- demand short-term beta2 agonist drugs. Correlations between PAQLQ and EQ-5D dimensions were strongest between dimensions measuring similar attributes. Cronbach's *coefficients for the PAQLQ ranged from 0.88 for the limitations in activities dimension to 0.96 for the overall score. The intraclass correlation coefficient for PAQLQscores in group B ranged from 0.71 (limitation of activities)to 0.83 (overall score). The effect size between both visits ranged from 0.49 to 0.69. The Spanish version of the PAQLQ proved to be valid for use in children with mild to moderate asthma.