Advances in adult asthma diagnosis and treatment and health outcomes, education, delivery, and quality in 2011: what goes around comes around

Thoracic index in adults with asthma: a study of validity and reliability

Background

The Thoracic Index (TI) is a useful tool for evaluating costal mobility as a component of respiritory mechanics in adults with asthma. In a review of the literature, however, few studies were found that reported the psychometrics of this test. The goal of this study is to evaluate the reproducibility and validity of the TI in adults with asthma.

Methods

A cross-sectional study was conducted to evaluate the diagnostic tests. Measurements were done randomly by two independent evaluators. The variables measured included thoracic mobility (TI and photogrammetric analysis), sociodemographic and anthropometric variables, and other variables related to the disease. TI reliability included the determination of the intra- and inter-evaluator agreement and reproducibility using the Bland and Altman limits of agreement method and the Interclass Correlation Coefficient (ICC). The convergent validity was established using Pearson’s correlation coefficient. The level of significance was p < 0.05.

Results

Twenty-six adults with stable asthma participated in this study. The limits of the intra- and inter-evaluator agreement were found to be acceptable and good, respectively, with an average of differences close to zero in both cases. The intra-evaluator reproducibility was between poor and acceptable (TI between 0.57 and 0.93), while the inter-evaluator reproducibility was between acceptable and good (TI between 0.62 and 0.86). The convergent validity between the TI and photogrammetric analysis was between moderate and high (r between 0.55 and 0.73).

Conclusions

The TI is a reliable and valid measurement that can be used to evaluate costal mobility in adults with asthma. In a clinical setting, it can contribute to a nonbiased measurement, and in a research environment, it is useful for documenting the results of interventions, reducing the probability that the results will be affected by any variability in measurement.

Efficacy versus effectiveness trials: informing guidelines for asthma management

PURPOSE OF REVIEW

Randomized controlled trials, known as efficacy trials and long considered the gold standard for evidence-based asthma guidelines, are designed to test whether interventions have a benefit for selective patient populations under ideal conditions. The goal of pragmatic trials and observational studies instead is to understand real-life efficacy, known as effectiveness. This review summarizes the strengths and limitations of efficacy and effectiveness trials, results of recent effectiveness trials in asthma and initiatives promoting effectiveness research.

RECENT FINDINGS

Recent pragmatic trials and observational studies have examined outcomes of interventions for diverse real-life patient populations, including smokers and patients with variable adherence, inhaler technique and baseline asthma control. Study results challenge practice guidelines regarding relative effectiveness of leukotriene receptor antagonists and inhaled corticosteroids (ICS); supplement guidelines with regard to effectiveness of interventions in smokers; and begin to address gaps in guidelines regarding choice of ICS and inhaler device. Initiatives are ongoing to refine methods of observational research and to harmonize asthma outcomes for better integration of results from all types of trials.

SUMMARY

Results of pragmatic trials and observational studies are an important component of the evidence needed to inform guideline recommendations and decision-making by healthcare providers, patients and policymakers.

Higher environmental relative moldiness index values measured in homes of adults with asthma, rhinitis, or both conditions

Higher values of the environmental relative moldiness index (ERMI), a DNA-based method for quantifying indoor molds, have been associated with asthma in children. In this study, settled dust samples were collected from the homes of adults with asthma, rhinitis, or both conditions (n=139 homes) in Northern California. The ERMI values for these samples were compared to those from dust collected in homes from the same geographic region randomly selected as part of the 2006 American Healthy Home Survey (n=44). The median ERMI value in homes of adult with airway disease (6) was significantly greater than median ERMI value (2) in the randomly selected homes (p<0.0001). In this study in Northern California, the homes of adults with asthma had ERMI values consistent with a heavier burden of indoor mold than that measured in other homes from the same region.

Advances in adult asthma diagnosis and treatment in 2012: potential therapeutics and gene-environment interactions

In the Journal of Allergy and Clinical Immunology in 2012, research reports related to asthma in adults clustered around mechanisms of disease, with a special focus on their potential for informing new therapies. There was also consideration of the effect of the environment on health from pollution, climate change, and epigenetic influences, underlining the importance of understanding gene-environment interactions in the pathogenesis of asthma and response to treatment.

Advances in pediatric asthma in 2012: moving toward asthma prevention

Last year's "Advances in pediatric asthma: moving forward" concluded the following: "Now is also the time to utilize information recorded in electronic medical records to develop innovative disease management plans that will track asthma over time and enable timely decisions on interventions in order to maintain control that can lead to disease remission and prevention." This year's summary will focus on recent advances in pediatric asthma on modifying disease activity, preventing asthma exacerbations, managing severe asthma, and risk factors for predicting and managing early asthma, as indicated in Journal of Allergy and Clinical Immunology publications in 2012. Recent reports continue to shed light on methods to improve asthma management through steps to assess disease activity, tools to standardize outcome measures in asthma, genetic markers that predict risk for asthma and appropriate treatment, and interventions that alter the early presentation of asthma to prevent progression. We are well on our way to creating a pathway around wellness in asthma care and also to use new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma.