Uncontrolled Persistent Asthma Research Articles

Asthma Is Associated With Increased Sickness Absence Among Young Adults

BackgroundThere is limited knowledge about how asthma affects sickness absence in young adulthood. ObjectiveTo examine how asthma and different asthma phenotypes affect sickness absence among young adults and potential modifying factors. A secondary aim was to estimate productivity losses related to sickness absence for asthma. MethodsThe study included 2,391 participants from the Swedish population-based cohort BAMSE. Information on asthma, asthma phenotypes, and lifestyle factors were collected from questionnaires and clinical examinations at ∼24 years of age (2016–2019). Information on sickness absence >14 days was obtained from a national register for the years 2020–2021. Associations between asthma, asthma phenotypes, and sickness absence were analyzed with logistic regression models adjusted for sex, birth year, education, and overweight status. ResultsAt age 24 years, n=272 (11.4%) fulfilled the definition of asthma. Sickness absence was more common among those with asthma than those without (15.1% vs 8.7%, p=0.001, adjusted odds ratio 1.73, 95% confidence interval 1.19–2.51). Analyses of asthma phenotypes showed that the association tended to be stronger for persistent asthma, uncontrolled asthma, and asthma in combination with rhinitis; no consistent differences were observed across phenotypes related to allergic sensitization or inflammation. The association tended to be stronger among those with overweight than those with normal weight. Asthma, especially uncontrolled asthma was associated with higher productivity losses from sickness absence. ConclusionAsthma may be associated with higher sickness absence and productivity losses. Achieving better asthma control and reducing allergic symptoms may reduce sickness absence among individuals with asthma.

Effect of Azithromycin on Asthma Remission in Adults With Persistent Uncontrolled Asthma: A Secondary Analysis of a Randomized, Double-Anonymized, Placebo-Controlled Trial

BackgroundAsthma remission is a potential treatment goal. Research questionDoes adding azithromycin to standard therapy in patients with persistent uncontrolled asthma induce remission compared to placebo? Study Design and MethodsThis secondary analysis used data from the AMAZES clinical trial – a double-blind placebo-controlled trial that evaluated the safety and efficacy of azithromycin on asthma exacerbations. The primary remission definition (referred to as clinical remission) was zero exacerbations and zero oral corticosteroids (OCS) during the previous six months evaluated at 12 months and Asthma Control Questionnaire (ACQ-5) ≤1 at 12 months. Secondary remission definitions included clinical remission plus lung function criteria (post-bronchodilator FEV1≥80% or post-bronchodilator FEV1≤5% decline from baseline) and complete remission (sputum eosinophils<3% plus the above criteria). Sensitivity analyses explored the robustness of primary and secondary remission definitions. The predictors of clinical remission were identified. Results335 participants (41.5% male; median [Q1, Q3] age 61.01 [51.03, 68.73] years) who completed the 12-month treatment period were included in the analysis. Twelve months treatment with azithromycin induced asthma remission in a subgroup of patients, and a significantly higher proportion in the azithromycin arm achieved both clinical remission (50.6% vs 38.9%; p=0.032) and clinical remission plus lung function criteria (50.8% vs 37.1%; p=0.029) compared with placebo. In addition, a higher proportion of the azithromycin group achieved complete remission (23% vs 13.7%; p=0.058). Sensitivity analyses supported these findings. Baseline factors such as better asthma-related quality of life and absence of OCS burst in the previous year predicted the odds of achieving clinical remission. Azithromycin induced remission in both eosinophilic and noneosinophilic asthma. InterpretationAdults with persistent symptomatic asthma achieved a higher remission rate when treated with azithromycin. Remission on treatment may be an achievable treatment target in moderate/severe asthma, and future studies should consider remission as an outcome measure.

Predictors of adherence to controller medication in urban African American emerging adults with uncontrolled persistent asthma

Background African American emerging adults tend to have low adherence to asthma controller medication, as well as a disproportionate burden of asthma morbidity and mortality. This study explored constructs from the Information-Motivation-Behavioral Skills model as predictors of controller medication adherence in urban African Americans ages 18–29 (N=152) with uncontrolled asthma using multiple measures of self-reported adherence. Methods Structural equation modeling (SEM) was employed to test the hypothesized mediation model that specified the relationship among psychological distress, substance use, asthma knowledge, motivation, self-efficacy, and adherence. Results Results suggested that motivation is an important predictor of adherence to medication; moreover, higher self-efficacy was associated with higher motivation. Results also highlighted psychological distress as an important intervention target to improve medication adherence in emerging adults. Conclusions The model tested in this study may offer a feasible framework for beginning to understand adherence to controller medication in this population.

Anxiety, depression and global distress among African American young adults with uncontrolled asthma

Background Anxiety and depression are mental health disorders that are often comorbid with asthma. Urban African American young adults with asthma often experience increased risk of anxiety and depression. Objective To explore relationships between symptoms of psychological distress and asthma-related anxiety with asthma outcomes among urban African American young adults with poorly controlled persistent asthma. Methods A secondary analysis of baseline data from a larger study of 141 African American young adults with uncontrolled persistent asthma was examined. Participants completed the Brief Symptom Inventory (BSI-18), Youth Asthma-related Anxiety Scale, Asthma Control Test (ACT), a daily diary to assess asthma symptoms; and number of asthma attacks. Spirometry assessed airway obstruction. Generalized linear models tested associations. Results In multivariable models testing, higher somatization scores were significantly associated with lower ACT scores (adjusted β = −0.49; 95% CI = −0.69, −0.28; p < 0.01), and higher symptoms (adjusted β = 0.39; 95% CI = 0.14, 0.65; p < 0.01). After adding asthma-related anxiety to the model, the somatization subscale and asthma-related anxiety were significantly associated with ACT scores (adjusted β = −0.36; 95% CI = −0.57, −0.15; p < 0.01), (adjusted β = −0.32; 95% CI = −0.50, −0.14; p < 0.01), respectively. Asthma-related anxiety was also significantly associated with asthma attacks (adjusted β = 0.24; 95% CI = 0.05, 0.43; p < 0.05). Conclusion This study suggests, asthma-related anxiety may differ from general anxiety and be related to poorly controlled asthma among African American young adults.

Тяжелая бронхиальная астма у детей – возможен ли контроль заболевания?

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

Method for lung inflation determining in asthma patients with osmotic airway hyperresponsiveness

Aim. To develop a method for determining the lung inflation by the indexes of forced expiratory flow­volume spirometry.Materials and methods. In 43 patients with mild persistent uncontrolled asthma in combination with osmotic airway hyperresponsiveness, the lung function indexes were assessed by spirometry using a bronchodilation test and bodyplethysmography.Results. From the entire set of parameters, using regression analysis, two equations were con­structed, with the inclusion of the main spirometric indicators (FEV1 in % of the due value, AFEVt and AFEF75 after the bronchodilation test, in %). The equations obtained make it possible to calculate lung inflation indices in asthma patients with osmotic airway hyperresponsiveness to select patients for referral for bodyplethysmography and multispiral computed tomography of the lungs in order to diagnose the severity of hyperinflation.Conclusion. The developed regression models provide an opportunity for a preliminary assessment of the presence and degree of lung hyperinflation in asthma patients with osmotic airway hyperresponsiveness, to determine personal approaches to basic anti-inflammatory therapy and, if necessary, to correct it in a timely manner.

EE565 Cost-Utility Analysis of Dupilumab in Adults and Adolescents With Uncontrolled Persistent Severe Asthma in Portugal

EE565 Cost-Utility Analysis of Dupilumab in Adults and Adolescents With Uncontrolled Persistent Severe Asthma in Portugal

Personalized targeted therapy of moderate and severe atopic asthma in Russia

Introduction. Taking into account the prevalence of asthma and especially severe atopic asthma which requires carefully selected and expensive therapy, the appearance of the domestic biosimilar omalizumab among biological therapy drugs makes the choice of treatment for this category more affordable. The article presents the results of an observational open prospective clinical trial of the omalizumab biosimilar in severe athopic asthma patients.The purposeof this study was to evaluate the efficacy and safety of the domestic production biosimilar in the real clinical practice.Materials and methods. The study involved 10 adult patients aged 19 to 55 years with a diagnosis of moderate to severe uncontrolled persistent asthma treated with mediun to high dose ICS and second&amp;more controller (ACQ-5 ≥ 1,5, FEV1 &lt; 80% of the predicted normal value). For 26 weeks all patients received the omalizumab. The evaluation of the efficacy was provided taking into account asthma symptoms improvement the results of ACQ-5, FEV1, PEF, asthma exacerbations and the use of health resources. Results. According to the results of data analysis due to omalizumab all patients demonstrated reducing daily asthma symptoms, nocturnal awakening and night time symptom, shortness of breath and SABA using. An asthma control improvement was observed after 1 month treatment (Δ ACQ-5 1.6 [1.2; 2.4], p = 0.0002 compared to the baseline data) with a continued tendency to further increase during 6 months of the study. A statistically significant increase in FEV1 was noted (initially, FEV1 56.7% [51.25; 61.8] of the predicted; after 1 month, FEV1 67.5% [63.45; 70.6] of the predicted, p = 0.00003; after 6 months, FEV1 80.6% [80.55; 84.05] of the predicted, p &gt;&lt; 0.001). Omalizumab biosimilar used allowed to reduce the background asthma therapy. No asthma exacerbation was registered due to 26 weeks omalizumab treatment. Conclusions. Based on the results of the study, it was shown that the administration of the omalizumab biosimilar to patients with severe atopic asthma improves control over the symptoms, lung function and reduces the amount of asthma exacerbations, and has a good safety&gt;&lt; 80% of the predicted normal value). For 26 weeks all patients received the omalizumab. The evaluation of the efficacy was provided taking into account asthma symptoms improvement the results of ACQ-5, FEV1, PEF, asthma exacerbations and the use of health resources.Results. According to the results of data analysis due to omalizumab all patients demonstrated reducing daily asthma symptoms, nocturnal awakening and night time symptom, shortness of breath and SABA using. An asthma control improvement was observed after 1 month treatment (Δ ACQ-5 1.6 [1.2; 2.4], p = 0.0002 compared to the baseline data) with a continued tendency to further increase during 6 months of the study. A statistically significant increase in FEV1 was noted (initially, FEV1 56.7% [51.25; 61.8] of the predicted; after 1 month, FEV1 67.5% [63.45; 70.6] of the predicted, p = 0.00003; after 6 months, FEV1 80.6% [80.55; 84.05] of the predicted, p &lt; 0.001). Omalizumab biosimilar used allowed to reduce the background asthma therapy. No asthma exacerbation was registered due to 26 weeks omalizumab treatment.Conclusions.Based on the results of the study, it was shown that the administration of the omalizumab biosimilar to patients with severe atopic asthma improves control over the symptoms, lung function and reduces the amount of asthma exacerbations, and has a good safety.

Dupilumab Improves Asthma Control, and Allergic Rhinitis-Related Health-Related Quality of Life in Children With Uncontrolled Persistent Asthma With Comorbid Allergic Rhinitis

Children with asthma frequently have comorbid allergic rhinitis (AR). Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin (IL)-4/13, key and central drivers of type 2 (T2) inflammation in multiple diseases. VOYAGE, a 52-week, randomized, double-blind, placebo-controlled, phase 3 study (NCT02948959), evaluated dupilumab efficacy and safety in children aged 6–11 years with uncontrolled persistent asthma. We assessed the impact of dupilumab on asthma control (interviewer-administered 7-Item Asthma Control Questionnaire [ACQ-7-IA]) and AR-related health-related quality of life (HRQoL) (interviewer-administered Pediatric Rhinoconjunctivitis Quality of Life Questionnaire [PRQLQ-IA]) in children with a T2 inflammatory asthma phenotype (baseline blood eosinophils ≥150 cells/μL or FeNO ≥20 ppb), and co-existing AR.

The "real-world" effectiveness and safety of omalizumab in patients with uncontrolled persistent allergic asthma in Slovakia: a subgroup analysis of the eXpeRience study.

Omalizumab was proven to be effective and safe in patients with moderate-to-severe allergic asthma. However, there is no direct evidence of the benefits of add-on omalizumab in real-life practice in the Slovakian population. This subgroup analysis assessed the real-life effectiveness and safety of omalizumab in Slovakian patients with severe allergic asthma enrolled in the eXpeRience registry. Patients who commenced omalizumab 15 weeks prior to inclusion were assessed for the physicians' global evaluation of treatment effectiveness (GETE), exacerbation rate, asthma symptoms, lung function, oral corticosteroid (OCS) use, rescue medication, hospitalizations, and school/work absenteeism at 16 weeks and 12 and 24 months. Of 204 patients, 159 (77.9%) completed 2-year follow-up. As per GETE, 69.5% of patients treated with omalizumab achieved excellent/good response at 16 (±1) weeks. The proportion of patients with no severe clinically significant asthma exacerbations increased from 17.3% at pre-treatment to 82.4% and 92.0% at months 12 and 24, respectively. Maintenance OCS use was reduced to 17.0% and 15.3% of patients at 12 and 24 months, respectively, compared with 34.7% at baseline (BL). From BL until month 24, asthma control test scores improved from 11.6 to 20.3; rescue medication use/week decreased from 5.5 to 1.6 days; mean total number of days of asthma-related medical healthcare use decreased from 7.7 to 0.3 days and missed workdays decreased from 16.8 to 0.3 days. No new safety signals were observed. Add-on omalizumab was effective and well-tolerated in Slovakian patients, complementing the results observed in the overall population of eXpeRience.

Exploring Barriers to Medication Adherence Among African American Emerging Adults With Uncontrolled Asthma.

African American emerging adults (age 18-29 years) tend to have poor asthma outcomes, possibly due to poor adherence to medication. Few studies have explored barriers to controller adherence in this population. This study utilized electronic daily diaries to assess barriers to adherence and asthma symptoms among 141 African American emerging adults with uncontrolled persistent asthma and poor adherence. Participants reported symptoms M = 3.43 days (of 7 days). They reported unintentional (e.g., forgetting) and intentional (e.g., choosing not to take) barriers to adherence, but forgetting, being too busy, and sleeping through a dose were the most common. Significant correlations were found between symptoms and barriers, as well as asthma control and medication adherence in the expected directions. Asthma symptoms and number of barriers were significant predictors of asthma control. Existing intervention strategies such as text-messaging may prove effective to address these barriers, but measuring and addressing adherence remains complex.

Persistent Uncontrolled Asthma: Long-Term Impact on Physical Activity and Body Composition

RationaleAsthma, obesity and physical activity (PA) are interrelated. However, longitudinal data with objective PA measures and direct assessment of body composition are still lacking.ObjectiveTo study the impact of symptom control on PA and body composition.MethodsIn a longitudinal cohort study of the German Center for Lung Research, we assessed the body composition of 233 asthma patients and 84 healthy controls using bioelectrical impedance analysis. PA (ie average daily steps and time of at least moderate activity, steps/min) was measured by accelerometry for one week. Asthma control was assessed by ACT score, ACQ-5 score and history of severe exacerbations. After two years of follow-up, we studied changes in physical activity and body composition in relation to asthma control.ResultsPatients with uncontrolled asthma had increased fat mass and decreased muscle mass compared to patients with controlled asthma or healthy controls. Both fat mass and muscle mass correlated better with asthma control than the body mass index (BMI). In multivariate regressions adjusted for age and sex, asthma control and physical activity were independent predictors of body composition (R2 = 0.61, p < 0.001). Persistent uncontrolled asthma patients (n=64) had lower physical activity at both baseline (6614 steps/118 min) and follow-up (6195/115). Despite having stable BMI, they also had significant muscle loss (−1.2%, −0.88 kg, p<0.01) and fat accumulation (+1%, +1.1 kg, p<0.01). By contrast, temporarily uncontrolled or controlled asthma patients had higher physical activity at baseline (8670/156) and follow -up (9058/153) with almost unchanged body composition.ConclusionPersistent uncontrolled asthma is associated with sustained physical inactivity and adverse changes in body composition that might be overlooked by relying solely on BMI. Physical activity is an independent predictor of body composition and reliable long-term marker of symptom control.

Understanding the key issues in the treatment of uncontrolled persistent asthma with type 2 inflammation.

Asthma is a complex respiratory disease that varies in severity and response to treatment. Several asthma phenotypes with unique clinical and inflammatory characteristics have been identified. Endotypes, based on distinct molecular profiles, help to further elucidate the heterogeneity within asthma. Type 2 inflammation, involving both the innate (type 2 innate lymphoid cell) and adaptive (T-helper type 2 cells) immune systems, underpins the complex pathophysiology of chronic inflammation in asthma, as well as the presence of comorbid disease (e.g. chronic rhinosinusitis with nasal polyps, allergic rhinitis and atopic dermatitis). Type 2 inflammation is characterised by upregulation of the type 2 cytokines interleukin (IL)-4, IL-5 and IL-13, IgE-mediated release of immune mediators and dysfunction of epithelial or epidermal barriers. Targeting these key proximal type 2 cytokines has shown efficacy in recent studies adopting a personalised approach to treatment using targeted biologics. Elevated levels of biomarkers downstream of type 2 cytokines, including fractional exhaled nitric oxide, serum IgE and blood and sputum eosinophils, have been linked to mechanisms involved in type 2 inflammation. They have the potential to aid diagnosis, and to predict and monitor response to treatment. The objective of this review is to summarise the current understanding of the biology of type 2 inflammation in asthma, examine its influence on type 2 inflammatory comorbidities, and discuss how type 2 inflammatory biomarkers can be harnessed to further personalise treatments in the age of biologic medicines.

Delayed onset localized urticarial reactions to Dupilumab

Dupilumab is an anti-IL-4 receptor monoclonal antibody used to treat persistent uncontrolled asthma. We characterize a previously undescribed injection-site urticarial reaction in patients receiving Dupilumab. Case series of two patients evaluated at Emory University Hospital in 2019-2020 who developed injection-site urticaria after receiving Dupilumab. Patient 1 is a 31-year-old female with history of asthma, allergic rhinitis receiving Dupilumab 200mg biweekly. Her first injection-site urticaria was after 16 doses of treatment and lasted 1-2 weeks. It required topical triamcinolone 0.1% cream to manage symptoms. Her blood eosinophil count was 30/mcL at the time and prior to therapy was 80/mcL. The urticarial reaction spontaneously remitted over 6 weeks despite continued dupilumab. Patient 2 is a 72-year-old male with history of nasal polyps, chronic sinusitis, and asthma receiving Duupilumab 300mg biweekly. He experienced a large pruritic wheal at injection site after 9 doses of treatment. His symptoms started at time of injection and self-resolved in 3-4 days each time. Symptoms were unresponsive to oral antihistamines, requiring topical clobetasol 0.05%. Initial symptoms were more severe and improved over time, however remained persistent. Early onset, dose dependent injection-site reactions have been documented with Dupilumab; however, our patients developed a previously unreported delayed localized urticarial reaction months after receiving therapy uneventfully. Topical steroid treatment alleviated symptoms and allowed for continuation of therapy.

Difficult and Severe Asthma in Children.

Asthma is the most frequent chronic inflammatory disease of the lower airways affecting children, and it can still be considered a challenge for pediatricians. Although most asthmatic patients are symptom-free with standard treatments, a small percentage of them suffer from uncontrolled persistent asthma. In these children, a multidisciplinary systematic assessment, including comorbidities, treatment-related issues, environmental exposures, and psychosocial factors is needed. The identification of modifiable factors is important to differentiate children with difficult asthma from those with true severe therapy-resistant asthma. Early intervention on modifiable factors for children with difficult asthma allows for better control of asthma without the need for invasive investigation and further escalation of treatment. Otherwise, addressing a correct diagnosis of true severe therapy-resistant asthma avoids diagnostic and therapeutic delays, allowing patients to benefit from using new and advanced biological therapies.

Group-randomized trial of tailored brief shared decision-making to improve asthma control in urban black adults.

To assess the intervention effects of BREATHE (BRief intervention to Evaluate Asthma THErapy), a novel brief shared decision-making intervention and evaluate feasibility and acceptability of intervention procedures. Group-randomized longitudinal pilot study. In total, 80 adults with uncontrolled persistent asthma participated in a trial comparing BREATHE (N=40) to a dose-matched attention control intervention (N=40). BREATHE is a one-time shared decision-making intervention delivered by clinicians during routine office visits. Ten clinicians were randomized and trained on BREATHE or the control condition. Participants were followed monthly for 3months post-intervention. Data were collected from December 2017 - May 2019 and included surveys, lung function tests, and interviews. Participants were Black/multiracial (100%) mostly female (83%) adults (mean age 45). BREATHE clinicians delivered BREATHE to all 40 participants with fidelity based on expert review of audiorecordings. While the control group reported improvements in asthma control at 1-month and 3-month follow-up, only BREATHE participants had better asthma control at each timepoint (β=0.77; standard error (SE)[0.17]; p≤0.0001; β=0.71; SE[0.16]; p≤0.0001; β=0.54; SE[0.15]; p=.0004), exceeding the minimally important difference. BREATHE participants also perceived greater shared decision-making occurred during the intervention visit (β=7.39; SE[3.51]; p=.03) and fewer symptoms at follow-up (e.g., fewer nights woken, less shortness of breath and less severity of symptoms) than the controls. Both groups reported improved adherence and fewer erroneous medication beliefs. BREATHE is a promising brief tailored intervention that can be integrated into office visits using clinicians as interventionists. Thus, BREATHE offers a pragmatic approach to improving asthma outcomes and shared decision-making in a health disparity population. The study addressed the important problem of uncontrolled asthma in a high-risk vulnerable population. Compared with the dose-matched attention control condition, participants receiving the novel brief tailored shared decision-making intervention had significant improvements in asthma outcomes and greater perceived engagement in shared decision-making. Brief interventions integrated into office visits and delivered by clinicians may offer a pragmatic approach to narrowing health disparity gaps. Future studies where other team members (e.g., office nurses, social workers) are trained in shared decision-making may address important implementation science challenges as it relates to adoption, maintenance, and dissemination. TRAIL REGISTRATION: clinicaltrials.gov # NCT03300752.

Health-related internet use among adolescents with uncontrolled persistent asthma

Objectives To describe internet use for health information among adolescents with uncontrolled persistent asthma, and to examine whether health-related internet use is associated with responsibility for home asthma management. Methods We analyzed baseline data from the School-Based Asthma Care for Teens (SB-ACT) Trial, which included adolescents (12–16 years) in an urban school district who had uncontrolled persistent asthma per caregiver report. We asked adolescents whether they had ever used the Internet to look for health or medical information (Y/N). Teens then described family responsibility for 9 asthma management tasks (e.g. full caregiver responsibility, shared responsibility, or full teen responsibility). We examined responsibility sum scores in addition to responsibility for individual management tasks. We used bivariate and multivariate analyses to compare health-related internet use with participant characteristics, teen-reported asthma symptoms, and management responsibility. Results We examined data for 425 adolescents (mean age 13.4 years). Almost half (45%) reported seeking health information on the Internet. In adjusted analyses, health-related internet use was strongly associated with teen responsibility (sum score and tasks relating to carrying and using medications); internet use was also more likely among teens who were older, female, or reported uncontrolled disease. Conclusions Adolescents with persistent asthma who share responsibility for home management or report uncontrolled disease are more likely to seek health information online. Future interventions to support teens who co-manage asthma should work to engage patients in both clinical and digital spaces, and ensure that all patients can access accurate, patient-centered asthma information when needed.

The cost-effectiveness of azithromycin in reducing exacerbations in uncontrolled asthma.

Add-on azithromycin (AZM) results in a significant reduction in exacerbations among adults with persistent uncontrolled asthma. The aim of this study was to assess the cost-effectiveness of add-on AZM in terms of healthcare and societal costs.The AMAZES trial randomly assigned 420 participants to AZM or placebo. Healthcare use and asthma exacerbations were measured during the treatment period. Healthcare use included all prescribed medicine and healthcare contacts. Costs of antimicrobial resistance (AMR) were estimated based on overall consumption and published estimates of costs. The value of an avoided exacerbation was based on published references. Differences in cost between the two groups were related to differences in exacerbations in a series of net monetary benefit estimates. Societal costs included lost productivity, over the counter medicines, steroid induced morbidity and AMR costs.Add-on AZM resulted in a reduction in healthcare costs (mean (95% CI)) including nights in hospital (AUD 433.70 (AUD 48.59-818.81) or EUR 260.22 (EUR 29.15-491.29)), unplanned healthcare visits (AUD 20.25 (AUD 5.23-35.27) or EUR 12.15 (EUR 3.14-21.16)), antibiotic costs (AUD 14.88 (AUD 7.55-22.21) or EUR 8.93 (EUR 4.53-13.33)) and oral corticosteroid costs (AUD 4.73 (AUD 0.82-8.64) or EUR 2.84 (EUR 0.49-5.18)); all p<0.05. Overall healthcare and societal costs were lower (AUD 77.30 (EUR 46.38) and AUD 256.22 (EUR 153.73) respectively) albeit not statistically significant. The net monetary benefit of add-on AZM was estimated to be AUD 2072.30 (95% CI AUD 1348.55-2805.23) or (EUR 1243.38 (EUR 809.13-1683.14) assuming a willingness to pay per exacerbation avoided of AUD 2651 (EUR 1590.60). Irrespective of the sensitivity analysis applied, the net monetary benefit for total, moderate and severe exacerbations remained positive and significant.Add-on AZM therapy in poorly controlled asthma was a cost-effective therapy. Costs associated with AMR did not influence estimated cost-effectiveness.

DUPILUMAB IMPROVES PATIENT-REPORTED BREATHING IN ORAL CORTICOSTEROID-DEPENDENT SEVERE ASTHMA

DUPILUMAB IMPROVES PATIENT-REPORTED BREATHING IN ORAL CORTICOSTEROID-DEPENDENT SEVERE ASTHMA

Azithromycin for severe COVID-19

Azithromycin for severe COVID-19