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Bateman ED, Price DB, Wang HC, Khattab A, Schonffeldt P, Catanzariti A, van der Valk RJP, Beekman MJHI. Short-acting β 2-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study. Eur Respir J 2021; 59:13993003.01402-2021. [PMID: 34561293 PMCID: PMC9068976 DOI: 10.1183/13993003.01402-2021] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022]
Abstract
Background To gain a global perspective on short-acting β2-agonist (SABA) prescriptions and associated asthma-related clinical outcomes in patients with asthma, we assessed primary health data across 24 countries in five continents. Methods SABINA III was a cross-sectional study that employed electronic case report forms at a study visit (in primary or specialist care) to record prescribed medication(s), over-the-counter (OTC) SABA purchases and clinical outcomes in asthma patients (≥12 years old) during the past 12 months. In patients with ≥1 SABA prescriptions, associations of SABA with asthma symptom control and severe exacerbations were analysed using multivariable regression models. Results Of 8351 patients recruited (n=6872, specialists; n=1440, primary care), 76.5% had moderate-to-severe asthma and 45.4% experienced ≥1 severe exacerbations in the past 12 months. 38% of patients were prescribed ≥3 SABA canisters; 18.0% purchased OTC SABA, of whom 76.8% also received SABA prescriptions. Prescriptions of 3–5, 6–9, 10–12 and ≥13 SABA canisters (versus 1–2) were associated with increasingly lower odds of controlled or partly controlled asthma (adjusted OR 0.64 (95% CI 0.53–0.78), 0.49 (95% CI 0.39–0.61), 0.42 (95% CI 0.34–0.51) and 0.33 (95% CI 0.25–0.45), respectively; n=4597) and higher severe exacerbation rates (adjusted incidence rate ratio 1.40 (95% CI 1.24–1.58), 1.52 (95% CI 1.33–1.74), 1.78 (95% CI 1.57–2.02) and 1.92 (95% CI 1.61–2.29), respectively; n=4612). Conclusions This study indicates an association between high SABA prescriptions and poor clinical outcomes across a broad range of countries, healthcare settings and asthma severities, providing support for initiatives to improve asthma morbidity by reducing SABA overreliance. Findings from SABINA III, which included 8351 patients from 24 countries, indicate that across treatment steps and clinical care settings, high SABA prescriptions were associated with higher rates of severe exacerbations and poorer asthma controlhttps://bit.ly/2VHBISg
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Affiliation(s)
- Eric D Bateman
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore.,Division of Applied Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Adel Khattab
- Chest Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Patricia Schonffeldt
- Especialista Medicina Interna y Enfermedades Respiratorias, Instituto Nacional del Tórax ITMS Telemedicina de Chile, Santiago, Chile
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152
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Buendía JA, Patiño DG, Feliciano-Alfonso JE. Cost-utility of azithromycin in patients with severe asthma. J Asthma 2021; 59:2008-2015. [PMID: 34516322 DOI: 10.1080/02770903.2021.1980586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND An important proportion of asthma patients remain uncontrolled despite the use of inhaled corticosteroids and long-acting beta-agonists. Some add-on therapies, like azithromycin, have been recommended for this subgroup of patients. The purpose of this study was to assess the cost-effectiveness of azithromycin as an add-on therapy to ICS + LABA for patients with severe asthma. METHODS A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with severe asthma in Colombia. The total costs and QALYS of two interventions, including standard therapy (ICS + LABA), and add-on therapy with azithromycin, were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. RESULTS The model suggests a potential gain of 0.037 QALYs per patient per year on azithromycin, with a difference of US $718 in favor of azithromycin, showing dominance with respect to SOC. A position of dominance negates the need to calculate an incremental cost-effectiveness ratio. In the deterministic sensitivity analyses, our base-case results were robust to variations in all assumptions and parameters. CONCLUSION Add-on therapy with azithromycin was found to be cost-effective when added to usual care in patients who remain uncontrolled despite treatment with medium or high-dose ICS/LABA.
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Affiliation(s)
- Jefferson Antonio Buendía
- Research group in Pharmacology and Toxicology" INFARTO". Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia
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153
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Dahmash EZ. Physicians' Knowledge and Practices Regarding Asthma in Jordan: A Cross-Sectional Study. Front Public Health 2021; 9:712255. [PMID: 34532307 PMCID: PMC8438149 DOI: 10.3389/fpubh.2021.712255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Asthma is a chronic non-communicable disease that causes significant morbidity and mortality and requires ongoing clinical care. Appropriate knowledge by physicians is vital in the management of asthma. Therefore, this study aims to explore and identify the gaps in physicians' knowledge and practices concerning the management of asthma. Methods: A cross-sectional study using an online survey was conducted in Jordan to understand the gap in knowledge and practices in the management of asthma among physicians. A previously validated questionnaire was employed, the Physicians' Practice Assessment Questionnaire (PPAQ). The knowledge questions based on the Global Initiative for Asthma (GINA) guidelines were used to assess knowledge and practice among the study's participants. Predictors of good practice were identified using logistic regression. Results: A total of 271 physicians participated in this survey. The overall knowledge among physicians scored above 78%. However, gaps were pertinent to identifying the signs of asthma attacks that accounted for 61.9% of the participants, whereas only 67.6% of the physicians knew the drugs used for the management of asthma. The study revealed alarming results when practices were assessed, with the overall percentage of physicians applying the required practices did not exceed 57.1 ± 25.7%. Logistic regression analysis to determine predictors of good practice showed that out of several independent variables, physicians who see 6–10 asthma patients per day are five times more likely to follow the guidelines' recommendations in their practice; senior physicians (>50 years old) and those who see 1–5 asthma patients daily are around two times more likely to follow the guidelines (p 0.001). Conclusions: The findings of this study identified the need to transform knowledge into practice. This could be achieved through professional education and constant reminders to physicians in a simple form, as well as a clinical audit of practice. There is a need for novel knowledge transfer approaches to induce behavioral and practice change toward the management of asthma.
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Affiliation(s)
- Eman Z Dahmash
- Department of Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
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154
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Deckers J, Marsland BJ, von Mutius E. Protection against allergies: Microbes, immunity, and the farming effect. Eur J Immunol 2021; 51:2387-2398. [PMID: 34415577 DOI: 10.1002/eji.202048938] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/08/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
The prevalence of asthma and other allergic diseases has rapidly increased in "Westernized" countries over recent decades. This rapid increase suggests the involvement of environmental factors, behavioral changes or lifestyle, rather than genetic drift. It has become increasingly clear that the microbiome plays a key role in educating the host immune system and, thus, regulation of disease susceptibility. This review will focus on recent advances uncovering immunological and microbial mechanisms that protect against allergies, in particular, within the context of a farming environment. A whole body of epidemiological data disclosed the nature of the protective exposures in a farm. Current evidence points toward an important role of the host microbiome in setting an immunological equilibrium that determines progression toward, or protection against allergic diseases. Conclusive mechanistic insights on how microbial exposures prevent from developing allergic diseases in humans are still lacking but findings from experimental models reveal plausible immunological mechanisms. Gathering further knowledge on these mechanisms and confirming their relevance in humans is of great importance to develop preventive strategies for children at risk of developing allergies.
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Affiliation(s)
- Julie Deckers
- Laboratory of Immunoregulation and Mucosal Immunology, VIB Center for Inflammation Research, Ghent (Zwijnaarde), Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Benjamin J Marsland
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Erika von Mutius
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Lung Research, München, Germany.,Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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155
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Jung J, Park HJ, Jung M. Association between Parental Cotinine-verified Smoking Status and Childhood Asthma: a Population-based Nationally Representative Analysis. J Korean Med Sci 2021; 36:e193. [PMID: 34342184 PMCID: PMC8329391 DOI: 10.3346/jkms.2021.36.e193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Environmental tobacco smoke exposure due to parents is a modifiable risk factor for childhood asthma, but many studies have evaluated parental smoking using self-reported data. Therefore, we aimed to analyze the relationship between parental cotinine-verified smoking status and asthma in their children. METHODS This population-based cross-sectional study used data from the Korean National Health and Nutrition Examination Survey from 2014 to 2017. Participants aged 0 to 18 years with complete self-reported physician-diagnosed childhood asthma and measurement of their parental urinary cotinine levels were included. Parental urinary cotinine-verified smoking status was defined using both urinary cotinine levels and self-report, as active, passive, and non-smoker. Sample weights were applied to all statistical analyses because of a complex, multistage and clustered survey design. Logistic regression model was used to analyze the relationship between childhood asthma and parental smoking. RESULTS A total of 5,264 subjects aged < 19 years were included. The prevalence of asthma was 3.4%. The proportions of paternal and maternal urinary cotinine-verified active smokers during the study period were 50.4% and 16.9%, respectively. When parental urinary cotinine level increased, the proportion of parental low household income was increased (P < 0.001). There was no significant association between the parental urinary cotinine-verified smoking group and childhood asthma group. However, the adjusted odds ratios of childhood asthma in the middle and highest tertile of paternal urinary cotinine levels compared with those in lowest tertile were 1.95 (95% confidence interval [CI], 0.98-3.89) and 2.34 (95% CI, 1.21-4.54), respectively. CONCLUSION There seems to be a dose-related association between paternal urinary cotinine levels and the risk of childhood asthma. Because of the high rate of paternal smoking, further studies are needed to develop a targeted strategy to reduce parental smoking for childhood asthma.
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Affiliation(s)
- Jinho Jung
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea
| | - Hyun Joon Park
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea
| | - Minyoung Jung
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea.
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156
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Wu H, Wang D, Shi H, Liu N, Wang C, Tian J, Wang X, Zhang Z. PM 2.5 and water-soluble components induce airway fibrosis through TGF-β1/Smad3 signaling pathway in asthmatic rats. Mol Immunol 2021; 137:1-10. [PMID: 34175710 DOI: 10.1016/j.molimm.2021.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 01/12/2023]
Abstract
Epidemiological studies have suggested that fine particulate matter (PM2.5) and asthma have been independently associated with pulmonary fibrosis but rarely studied together. Furthermore, it is unknown whether airway fibrosis in asthma is more attributable to water-soluble ions of PM2.5. Our current study was to explore the potential mechanism of PM2.5 and water-soluble components on airway fibrosis in ovalbumin (OVA)-sensitized asthmatic rats. Rats were intratracheally instilled with PM2.5 and water-soluble components every 3 days for 4 times or 8 times. Histopathological examination demonstrated that lung inflammatory and airway fibrosis were induced after PM2.5 and water-soluble components exposure. Meanwhile, PM2.5, in particular water-soluble extracts, increased expression of collagen 1 (COL-1), connective tissue growth factor (CTGF), interleukin-6 (IL-6), transforming growth factor-β1 (TGF-β1), Smad family member 3 (Smad3), and p-Smad3, whereas decreased secretion of heme oxygenase-1 (HO-1). However, pretreating asthmatic rats with SB432542, the inhibitor of TGF-β1, and SIS3 HCl, the antagonist of Smad3, both reversed the activation of airway fibrosis induced by water-soluble extracts. Therefore, TGF-β1/Smad3 signaling pathway may be responsible for the pathological process of airway fibrosis in asthmatic rats following PM2.5 and water-soluble components exposure.
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Affiliation(s)
- Hongyan Wu
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, China
| | - Dan Wang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, China
| | - Hao Shi
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, China
| | - Nannan Liu
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, China
| | - Caihong Wang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, China
| | - Jiayu Tian
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, China
| | - Xin Wang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, China
| | - Zhihong Zhang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, China.
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157
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Dut R, Soyer O, Sahiner UM, Esenboga S, Gur Cetinkaya P, Akgul S, Derman O, Sekerel BE, Kanbur N. Psychological burden of asthma in adolescents and their parents. J Asthma 2021; 59:1116-1121. [PMID: 33722151 DOI: 10.1080/02770903.2021.1903916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Asthma, a common chronic disease in adolescents is impacted by factors affecting quality of life. This study aimed to determine the psychosocial factors of adolescents with asthma and their parents. METHODS The study included 122 adolescents with asthma, 82 healthy controls, and their parents who completed the Asthma Control Test (ACT), Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Brief Symptom Inventory (BSI). RESULTS The mean age was 14.2 ± 1.9 years. ACT score was high and depression was low in patients with good treatment compliance. As the age of the first asthma symptoms/diagnosis increased, somatization, anxiety, hostility and general psychopathology scores increased, as did the somatization score of parents. Parental anxiety score was not related with adolescent BSI scores in the controls but in the study group when it was higher, the anxiety, depression, somatization, and general psychopathology scores were higher. PAQLQ showed that anxiety, negative self-esteem, somatization, depression, and general psychopathology were higher in patients concerned about asthma. Depression and somatization scores were higher in the parents of patients who perceived that "Treatment does not contribute to asthma control." Somatization scores were higher among parents of patients who noted: "Asthma will not pass in the long-term" and "I cannot control asthma." CONCLUSION Higher scores of asthma patients who were anxious about the disease and families who were despondent about treatment demonstrate that health care providers should spend more time informing patients and caregivers. Increasing patient treatment compliance during early adolescence will lessen the psychological burden of the disease.
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Affiliation(s)
- Raziye Dut
- Department of Pediatrics, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ozge Soyer
- Division of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Umit Murat Sahiner
- Division of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Saliha Esenboga
- Division of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pinar Gur Cetinkaya
- Division of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sinem Akgul
- Division of Adolescent Medicine, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Orhan Derman
- Division of Adolescent Medicine, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bulent Enis Sekerel
- Division of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nuray Kanbur
- Division of Adolescent Medicine, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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158
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Zhou P, Xi L, He H, Zhang B, Li Y. A comparison of efficacy and safety of complementary and alternative therapies for children with asthma: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2021; 100:e24946. [PMID: 33725965 PMCID: PMC7982223 DOI: 10.1097/md.0000000000024946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Bronchial Asthma is a chronic, hyperreactive inflammation of the airway that involves a variety of inflammatory cells. Due to the persistence of airway hyperresponsiveness, lung function is progressively damaged, making asthma more stubborn and difficult to heal. In recent years, the prevalence of childhood asthma is still on an increasing trend. Repeated asthma attacks not only affect children's life and learning, but also bring greater economic and mental burden to children's families, and even threaten children's lives. Traditional treatment methods such as oral western medicine, atomization therapy has obvious limitations, and the complementary and alternative therapy is an effective method to treat asthma in children. This study will evaluate the efficacy and safety of various complementary and alternative therapies for children with asthma by means of mesh meta-analysis. In order to provide the basis for clinical rational use. METHODS Use the computer to search the self-built database until January 2021, the China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journals Database, China Biomedical Literature Database, PubMed, Cochrance Library, EMBASE, Web of Science, Clinical Trials and other electronic databases to collect RCT studies on complementary and alternative therapies for for children with asthma. We will screen the relevant literature included in the systematic review/meta analysis. At the same time, Revman 5.3 software will be used for meta-analysis, and grade will be used to grade the quality of evidence in the network meta-analysis. RESULTS This study will compare the efficacy and safety of different complementary and alternative therapies to treat childhood asthma, and evaluate and rank different interventions. CONCLUSION The combined use of complementary and alternative therapies for childhood asthma on the basis of conventional basic treatment can improve clinical efficacy, reduce the occurrence of adverse reactions, improve the quality of life of children, and provide strong support for the rational use of clinicians. INPLASY REGISTRATION NUMBER INPLASY202120005.
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Affiliation(s)
- Peng Zhou
- The First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Leiming Xi
- The First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Hongan He
- The First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Baoqing Zhang
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine
| | - Yanning Li
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine
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159
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O'Byrne PM, Pavord ID. A golden age of asthma research. Eur Respir J 2020; 56:56/6/2003820. [PMID: 33361451 DOI: 10.1183/13993003.03820-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Paul M O'Byrne
- Firestone Institute for Respiratory Health and the Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ian D Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
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160
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Global Asthma Network Phase I Surveillance: Geographical Coverage and Response Rates. J Clin Med 2020; 9:jcm9113688. [PMID: 33212975 PMCID: PMC7698565 DOI: 10.3390/jcm9113688] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/08/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022] Open
Abstract
Background—The Global Asthma Network (GAN) Phase I is surveying school pupils in high-income and low- or middle-income countries using the International Study of Asthma and Allergies in Childhood (ISAAC) methodology. Methods—Cross-sectional surveys of participants in two age groups in randomly selected schools within each centre (2015–2020). The compulsory age group is 13–14 years (adolescents), optionally including parents or guardians. Six to seven years (children) and their parents are also optional. Adolescents completed questionnaires at school, and took home adult questionnaires for parent/guardian completion. Children took home questionnaires for parent/guardian completion about the child and also adult questionnaires. Questions related to symptoms and risk factors for asthma and allergy, asthma management, school/work absence and hospitalisation. Results—53 centres in 20 countries completed quality checks by 31 May 2020. These included 21 centres that previously participated in ISAAC. There were 132,748 adolescents (average response rate 88.8%), 91,802 children (average response rate 79.1%), and 177,622 adults, with >97% answering risk factor questions and >98% answering questions on asthma management, school/work absence and hospitalisation. Conclusion—The high response rates achieved in ISAAC have generally been maintained in GAN. GAN Phase I surveys, partially overlapping with ISAAC centres, will allow within-centre analyses of time-trends in prevalence.
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