Anti-muscarinic drugs as preventive treatment of exercise-induced bronchoconstriction (EIB) in children and adults

Association between Asthma and Lower Levels of Physical Activity: Results of a Population-Based Case-Control Study in Spain

(1) Background: Our aim was to determine changes in the prevalence of physical activity (PA) in adults with asthma between 2014 and 2020 in Spain, investigate sex differences and the effect of other variables on adherence to PA, and compare the prevalence of PA between individuals with and without asthma. (2) Methods: This study was a cross-sectional, population-based, matched, case-control study using European Health Interview Surveys for Spain (EHISS) for 2014 and 2020. (3) Results: We identified 1262 and 1103 patients with asthma in the 2014 and 2020 EHISS, respectively. The prevalence of PA remained stable (57.2% vs. 55.7%, respectively), while the percentage of persons who reported walking continuously for at least 2 days a week increased from 73.9% to 82.2% (p < 0.001). Male sex, younger age, better self-rated health, and lower body mass index (BMI) were significantly associated with greater PA. From 2014 to 2020, the number of walking days ≥2 increased by 64% (OR1.64 95%CI 1.34-2.00). Asthma was associated with less PA (OR0.87 95%CI 0.47-0.72) and a lower number of walking days ≥2 (OR0.84 95%0.72-0.97). (4) Conclusions: Walking frequency improved over time among people with asthma. Differences in PA were detected by age, sex, self-rated health status, and BMI. Asthma was associated with less LTPA and a lower number of walking days ≥2.

Prospective Real-World Analysis of Asthma Patients With Preserved and Reduced Physical Activity

BACKGROUND

Asthma is a highly heterogeneous airway disease, and the clinical characteristics of patients with asthma with preserved and reduced physical activity are poorly understood.

OBJECTIVE

We aimed to investigate the risk factors and clinical phenotypes associated with reduced physical activity in a wide range of patients with asthma.

METHODS

We conducted a prospective observational study of 138 patients with asthma, including patients with asthma without chronic obstructive pulmonary disease (COPD) (n = 104) and asthma-COPD overlap (n = 34), and 42 healthy controls. Physical activity levels were measured for 2 weeks using a triaxial accelerometer at baseline and 1 year later.

RESULTS

Higher eosinophils and body mass index (BMI) were associated with reduced physical activity in patients with asthma without COPD. Cluster analysis of asthma without COPD revealed 4 asthma phenotypes. We identified a cluster with preserved physical activity (n = 43) that was characterized by good symptom control and lung function and included a high proportion of biologics users (34.9%). Multivariate regression analysis revealed that patients with late-onset eosinophilic (n = 21), high-BMI noneosinophilic (n = 14), and symptom-predominant asthma phenotypes (n = 26) had lower levels of physical activity than controls. Patients with asthma-COPD overlap also had significantly lower physical activity levels than controls. Similar trends in physical activity levels were observed in each asthma group at 1-year follow-up.

CONCLUSION

This study showed the clinical features of patients with asthma with preserved and reduced physical activity. Reduced physical activity was observed in various asthma phenotypes and in asthma-COPD overlap.

Diagnosis and management of allergy and respiratory disorders in sport: An EAACI task force position paper

Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well-being across the lifespan. This EAACI Task Force was therefore established, to develop an up-to-date, research-informed position paper, detailing the optimal approach to the diagnosis and management of common exercise-related allergic and respiratory conditions. The recommendations are informed by a multidisciplinary panel of experts including allergists, pulmonologists, physiologists and sports physicians. The report is structured as a concise, practically focussed document, incorporating diagnostic and treatment algorithms, to provide a source of reference to aid clinical decision-making. Throughout, we signpost relevant learning resources to consolidate knowledge and understanding and conclude by highlighting future research priorities and unmet needs.

Demographics, Treatment Patterns, and Morbidity in Patients with Exercise-Induced Bronchoconstriction: An Administrative Claims Data Analysis

PURPOSE

Exercise-induced bronchoconstriction (EIB) is generally treated with short-acting β2-agonists (SABA) before exercising, to prevent symptoms. Real-world data on treatments and outcomes for patients with EIB alone (EIBalone), or with asthma (EIBasthma), in the USA are limited. This study compared demographics, treatment patterns, morbidity, and costs of treating EIB between these two groups of patients.

PATIENTS AND METHODS

Administrative claims from US IBM® MarketScan® Research databases were analyzed retrospectively. Patients aged ≥4 years filling a SABA claim between 1/1/2011 and 12/31/2016 were evaluated. Patients were indexed on a random SABA claim and required to have 12 months' continuous eligibility pre- and post-index, ≥1 maintenance medication and/or SABA fill post-index, and were designated EIBalone or EIBasthma according to diagnostic codes (EIB only or EIB plus asthma, respectively). Descriptive statistics were used.

RESULTS

In total, 13,480 patients had EIBalone and 14,862 had EIBasthma. Compared with EIBasthma, the EIBalone group was older (mean[SD] 20.4[13.6] vs 17.8[13.6] years), had more females (60.7% vs 54.7%), and filled fewer SABA claims (1.9[1.4] vs 2.5[2.2]) (all p<0.001). A smaller proportion of patients in the EIBalone than EIBasthma group had maintenance therapy claims (79.9% vs 90.6%, p<0.001). The EIBalone group also had a lower proportion of patients with oral or injectable corticosteroid claims (29.4% vs 32.0%) and asthma and/or EIB-related emergency department (1.0% vs 13.0%) or outpatient visits (65.1% vs 72.3%; all p<0.0001). Annual days' supply of oral corticosteroids was similar between groups (mean[SD] EIBalone: 20.7[30.8] vs EIBasthma: 19.8[28] days).

CONCLUSION

Individuals with EIBalone or EIBasthma demonstrate considerable morbidity. New treatment paradigms may be needed to optimize outcomes for both patient groups.

New Technologies for Promoting Physical Activity in Healthy Children and in Children with Chronic Respiratory Diseases: A Narrative Review

Physical activity (PA) is proven to benefit children and adolescents in several ways. New technologies may provide children with stimulating modalities for organizing their leisure time, accessing fitness programs, and obtaining daily goal reminders and peer support. Due to the current COVID-19 pandemic, following WHO recommendations for PA is difficult for many children, especially for those living in urban areas. Therefore, the use of digital tools to support and maintain PA could be useful in healthy children, as well as in those with chronic respiratory diseases (CRDs). This narrative review aims to summarize the most recent evidence about the role of new technologies in promoting PA in healthy children and in those with CRDs, in supporting PA during the COVID-19 pandemic, and in enhancing psychological wellbeing in this age group. The use of technological devices for promoting PA, such as web/mobile apps and games, has been proven to be effective both in healthy children and in those with CRDs. In conclusion, new technologies are very promising in terms of feasibility, acceptability, and efficacy in promoting PA. Further studies are required to evaluate the long-term health benefits of using these technologies.

Impact of chronic medications in the perioperative period: mechanisms of action and adverse drug effects (Part I)

Background: This review article discusses the pharmacology of the most commonly used chronic medications in patients undergoing elective surgical procedures. The mechanism of action and adverse side effects of cardiovascular medications (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled β-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, and psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing drugs) will be reviewed.Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: "chronic medications in the perioperative period", and "chronic medications and anesthetic implications." In addition, we searched for anesthetic side effects associated with the major drug groups.Results and Conclusions: An understanding of the pharmacology and pharmacokinetics of most used chronic medications is important to avoid untoward outcomes in the perioperative period. These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also effect the morbidity, mortality, and recovery time of surgical patients. Part I of this two-part review article focuses on the mechanisms of action and adverse side effects of the chronic medications most commonly taken by surgical patients in the preoperative period.