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Gebresillasie TG, Worku A, Ahmed AA, Kabeta ND. Determinants of asthma among adults in Tigray, Northern Ethiopia: a facility-based case-control study. PeerJ 2024; 12:e16530. [PMID: 38192600 PMCID: PMC10773448 DOI: 10.7717/peerj.16530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/06/2023] [Indexed: 01/10/2024] Open
Abstract
Background Asthma is a public health concern affecting millions of productive age groups. Several studies were conducted on the determinants of asthma in children. However, little is known about the determinants of asthma among adults in Ethiopia. Understanding the determinants of asthma among adults can help reduce its burden. This study was aimed at identifying determinant factors for developing asthma among adults in Tigray hospitals. Methods A facility-based, unmatched case-control study design was conducted from January 1 to April 26, 2019. A total of 698 participants (228 cases and 470 controls) completed their guided interviews using structured and pretested questionnaires by trained data collectors. A modified standard questionnaire from the European Community Respiratory Health Survey II (ECRHS II) was used to collect the data. The case definition was patients having asthma, and the control definition was patients without asthma. Data were entered and cleaned using Epi Data Manager Version 3.1 software and imported to statistical packages for social sciences Version 25 software for analysis. To identify asthma determinants, bivariate and multivariable logistic regression models were fitted. Results The response rate for both cases and controls was 95.9%. The odds of developing asthma was nearly twice higher among those who resided in urban (AOR = 1.68; 95% CI [1.13-2.50]), more than twice higher among those who have income less than 1000 ETB (AOR = 2.3; 95% CI [1.17-4.56]), twice higher among those who had history of skin allergy (AOR = 2.09; 95% CI [1.14-3.86]), over four times higher among those with family history of asthma (AOR = 4.26; 95% CI [2.63-6.91]), three times higher among those having house dust or smoke exposure (AOR = 3.01; 95% CI [1.96-4.64]), over five times higher among those lifetime firewood users (AOR = 5.39; 95% CI [3.34-8.72]), door opening while cooking (AOR = 0.35; 95% CI [0.26-0.55]), nearly two times higher among those having house dampness (AOR = 1.98; 95% CI [1.069-3.68]), over seven times higher among pet owners (AOR = 7.46; 95% CI [4.04-13] and almost twice higher among those who were physically inactive (AOR = 1.75; 95% CI [1.11-2.85]). Conclusion Asthma has been associated with urbanization, low income, a history of allergic diseases, indoor smoke or dust, firewood use, pet ownership, and a sedentary lifestyle. The community should be informed about the known risks and implement preventive steps like opening a door while cooking to lower the risk of asthma.
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Affiliation(s)
- Tirhas G. Gebresillasie
- Department of Public Health, College of Health Sciences, Aksum University, Axum, Tigray, Ethiopa
- School of Public Health, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Ali Ahmed
- School of Public Health, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa Kabeta
- School of Public Health, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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da Silva ES, de Santana MBR, Silveira EF, Torres RT, Silva RC, Fernandes AMS, Belitardo EMMDA, Garcés LFS, Santiago LF, Urrego JR, Vilas-Bôas DS, de Freitas LAR, Zakzuk J, Pacheco LGC, Cruz ÁA, Ferreira F, Cooper P, Caraballo L, Pinheiro CDS, Alcantara-Neves NM. The hybrid protein BTH2 suppresses allergic airway inflammation in a murine model of HDM-specific immunotherapy. Clin Exp Allergy 2023; 53:821-832. [PMID: 36779555 DOI: 10.1111/cea.14293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/22/2023] [Accepted: 01/28/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Allergen-specific immunotherapy (AIT) is the only disease-modifying treatment approach to change disease-causing allergens. Hypoallergenic derivatives show promise as potential therapeutics, amongst which BTH2 was designed to induce tolerance against Blomia tropicalis allergy. Our aim was to investigate the hypoallergenicity and immunoregulatory activity of BTH2 in vitro and its therapeutic potential in a mouse model of AIT. METHODS Recombinant Blo t 5 and Blo t 21 allergens and their hybrid derivatives (BTH1 and BTH2) were expressed and purified. IgE binding capacity was tested by ELISA using sera from Brazilian, Colombian, and Ecuadorian subjects. Secretion of cytokines in supernatants from human cell cultures was measured following stimulation with the four recombinants and controls. The capacity of BTH2 to ameliorate allergic airway inflammation induced by B. tropicalis extract was evaluated in a murine model of AIT. RESULTS rBlo t 5 and rBlo t 21 were identified as major allergens in Latin American patients, and BTH2 had the lowest IgE binding. In vitro stimulation of human cells induced greater levels of IL-10 and IFN-γ and reduced the secretion of Th2 cytokines. BTH2 ameliorated allergic airway inflammation in B. tropicalis-challenged A/J mice, as evidenced by the histopathological and humoral biomarkers: decreased Th2 cytokines and cellular infiltration (especially eosinophils), lower activity of eosinophil peroxidase, an increase in IgG blocking antibodies and strong reduction of mucus production by goblet cells. CONCLUSIONS Our study shows that BTH2 represents a promising candidate for the treatment of B. tropicalis allergy with hypoallergenic, immune regulatory and therapeutic properties. Further pre-clinical studies are required in murine models of chronic asthma to further address the efficacy and safety of BTH2 as a vaccine against B. tropicalis-induced allergy.
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Affiliation(s)
- Eduardo Santos da Silva
- Laboratory of Allergology and Acarology (LAA), Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
- Post-Graduate Program in Biotechnology of the Northeast Biotechnology Network (RENORBIO), Maceió, Brazil
| | - Marina Borges Rabelo de Santana
- Laboratory of Allergology and Acarology (LAA), Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
- Post-Graduate Program in Immunology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Elisânia Fontes Silveira
- Laboratory of Allergology and Acarology (LAA), Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Rogério Tanan Torres
- Laboratory of Allergology and Acarology (LAA), Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Raphael Chagas Silva
- Laboratory of Allergology and Acarology (LAA), Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
- Post-Graduate Program in Immunology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | | | - Emília Maria Medeiros de Andrade Belitardo
- Laboratory of Allergology and Acarology (LAA), Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
- Post-Graduate Program in Immunology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FioCruz), Salvador, Brazil
| | - Luis Fabián Salazar Garcés
- Laboratory of Allergology and Acarology (LAA), Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
- Post-Graduate Program in Immunology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
- Faculty of Health Sciences, Technical University of Ambato, Ambato, Ecuador
| | - Leonardo Freire Santiago
- Laboratory of Allergology and Acarology (LAA), Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | | | - Deise Souza Vilas-Bôas
- Post-Graduate Program in Immunology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
- Laboratory of Histotechnology, Department of Biomorphology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Luiz Antônio Rodrigues de Freitas
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FioCruz), Salvador, Brazil
- Department of Pathology of the School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Josefina Zakzuk
- Institute of Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Luis Gustavo Carvalho Pacheco
- Laboratory of Allergology and Acarology (LAA), Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | | | - Fatima Ferreira
- Department of Biosciences, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Philip Cooper
- Institute of Infection and Immunity, St George's University of London, London, UK
- School of Medicine, International University of Ecuador, Quito, Ecuador
| | - Luis Caraballo
- Institute of Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Carina da Silva Pinheiro
- Laboratory of Allergology and Acarology (LAA), Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
- Post-Graduate Program in Immunology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Neuza Maria Alcantara-Neves
- Laboratory of Allergology and Acarology (LAA), Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
- Post-Graduate Program in Biotechnology of the Northeast Biotechnology Network (RENORBIO), Maceió, Brazil
- Post-Graduate Program in Immunology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
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Cooper PJ, Figueiredo CA, Rodriguez A, Dos Santos LM, Ribeiro-Silva RC, Carneiro VL, Costa G, Magalhães T, Dos Santos de Jesus T, Rios R, da Silva HBF, Costa R, Chico ME, Vaca M, Alcantara-Neves N, Rodrigues LC, Cruz AA, Barreto ML. Understanding and controlling asthma in Latin America: A review of recent research informed by the SCAALA programme. Clin Transl Allergy 2023; 13:e12232. [PMID: 36973960 PMCID: PMC10041090 DOI: 10.1002/clt2.12232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 03/29/2023] Open
Abstract
Asthma is an important health concern in Latin America (LA) where it is associated with variable prevalence and disease burden between countries. High prevalence and morbidity have been observed in some regions, particularly marginalized urban populations. Research over the past 10 years from LA has shown that childhood disease is primarily non-atopic. The attenuation of atopy may be explained by enhanced immune regulation induced by intense exposures to environmental factors such as childhood infections and poor environmental conditions of the urban poor. Non-atopic symptoms are associated with environmental and lifestyle factors including poor living conditions, respiratory infections, psychosocial stress, obesity, and a diet of highly processed foods. Ancestry (particularly African) and genetic factors increase asthma risk, and some of these factors may be specific to LA settings. Asthma in LA tends to be poorly controlled and depends on access to health care and medications. There is a need to improve management and access to medication through primary health care. Future research should consider the heterogeneity of asthma to identify relevant endotypes and underlying causes. The outcome of such research will need to focus on implementable strategies relevant to populations living in resource-poor settings where the disease burden is greatest.
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Affiliation(s)
- Philip J Cooper
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Camila A Figueiredo
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | | | | | - Gustavo Costa
- Center for Data Knowledge and Integration for Health (CIDACS), Fundação Oswaldo Cruz, Bahia, Salvador, Brazil
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
| | - Thiago Magalhães
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Raimon Rios
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Ryan Costa
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Martha E Chico
- Fundacion Ecuatoriana para la Investigacion en Salud (FEPIS), Esmeraldas, Ecuador
| | - Maritza Vaca
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Fundacion Ecuatoriana para la Investigacion en Salud (FEPIS), Esmeraldas, Ecuador
| | | | - Laura C Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Alvaro A Cruz
- Universidade Federal da Bahia and Fundação ProAR, Salvador, Brazil
| | - Mauricio L Barreto
- Center for Data Knowledge and Integration for Health (CIDACS), Fundação Oswaldo Cruz, Bahia, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Johnson RK, Manke J, Campbell M, Armstrong M, Boorgula MP, Pinheiro G, Santana CVN, Mathias RA, Barnes KC, Cruz A, Reisdorph N, Figueiredo CA. Lipid mediators are detectable in the nasal epithelium and differ by asthma status in female subjects. J Allergy Clin Immunol 2022; 150:965-971.e8. [PMID: 35304161 PMCID: PMC9475490 DOI: 10.1016/j.jaci.2022.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/13/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Lipid mediators, bioactive products of polyunsaturated fatty acid metabolism, contribute to inflammation initiation and resolution in allergic diseases; however, their presence in lung-related biosamples has not been fully described. OBJECTIVE We aimed to quantify lipid mediators in the nasal airway epithelium and characterize preliminary associations with asthma. METHODS Using liquid chromatography-mass spectrometry, we conducted a pilot study to quantify 56 lipid mediators from nasal epithelial samples collected from 11 female participants of an outpatient asthma clinic and community controls (aged 30-55 years). We examined the presence of each compound using descriptive statistics to test whether lipid mediators could distinguish subjects with asthma (n = 8) from control subjects (n = 3) using linear regression and partial least squares discriminant analysis. RESULTS Fifteen lipid mediators were detectable in all samples, including resolvin (Rv) D5 (RvD5), with the highest median concentrations (in pg/μg protein) of 13-HODE (126.481), 15-HETE (32.869), and 13-OxoODE (13.251). From linear regression adjusted for age, prostaglandin E2 (PGE2) had a trend (P < .1) for higher concentrations in patients with severe asthma compared to controls (mean difference, 0.95; 95% confidence interval, -0.04 to 1.95). Asthma patients had higher scores on principal component 3 compared to controls (mean difference, 2.42; 95% confidence interval, 0.89 to 3.96), which represented lower levels of proresolving 15-HEPE, 19,20-DiHDPA, RvD5, 14-HDHA, 17-HDHA, and 13-HOTrE. Most of these compounds were best at discriminating asthma cases from controls in partial least squares discriminant analysis. CONCLUSION Lipid mediators are detectable in the nasal epithelium, and their levels distinguish asthma cases from controls.
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Affiliation(s)
- Randi K Johnson
- Division of Biomedical Informatics and Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo.
| | - Jonathan Manke
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Monica Campbell
- Division of Biomedical Informatics and Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Michael Armstrong
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Meher Preethi Boorgula
- Division of Biomedical Informatics and Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Gabriela Pinheiro
- Federal University of Bahia and Fundação Program for Control of Asthma in Bahia (ProAR), Salvador, Brazil
| | - Cinthia Vila Nova Santana
- Federal University of Bahia and Fundação Program for Control of Asthma in Bahia (ProAR), Salvador, Brazil
| | - Rasika A Mathias
- Department of Medicine, Division of Allergy & Clinical Immunology, Johns Hopkins University, Baltimore, Md
| | - Kathleen C Barnes
- Division of Biomedical Informatics and Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Alvaro Cruz
- Federal University of Bahia and Fundação Program for Control of Asthma in Bahia (ProAR), Salvador, Brazil
| | - Nichole Reisdorph
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Camila A Figueiredo
- Federal University of Bahia and Fundação Program for Control of Asthma in Bahia (ProAR), Salvador, Brazil; Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
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Morillo D, Mena-Bucheli S, Ochoa A, Chico ME, Rodas C, Maldonado A, Arteaga K, Alchundia J, Solorzano K, Rodriguez A, Figueiredo C, Ardura-Garcia C, Bachmann M, Perkin MR, Chis Ster I, Cruz A, Romero NC, Cooper P. Prospective study of factors associated with asthma attack recurrence (ATTACK) in children from three Ecuadorian cities during COVID-19: a study protocol. BMJ Open 2022; 12:e056295. [PMID: 35710244 PMCID: PMC9207574 DOI: 10.1136/bmjopen-2021-056295] [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] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Asthma is a growing health problem in children in marginalised urban settings in low-income and middle-income countries. Asthma attacks are an important cause of emergency care attendance and long-term morbidity. We designed a prospective study, the Asthma Attacks study, to identify factors associated with recurrence of asthma attacks (or exacerbations) among children and adolescents attending emergency care in three Ecuadorian cities. METHODS AND ANALYSIS Prospective cohort study designed to identify risk factors associated with recurrence of asthma attacks in 450 children and adolescents aged 5-17 years attending emergency care in public hospitals in three Ecuadorian cities (Quito, Cuenca and Portoviejo). The primary outcome will be rate of asthma attack recurrence during up to 12 months of follow-up. Data are being collected at baseline and during follow-up by questionnaire: sociodemographic data, asthma history and management (baseline only); recurrence of asthma symptoms and attacks (monthly); economic costs of asthma to family; Asthma Control Test; Pediatric Asthma Quality of life Questionnaire; and Newcastle Asthma Knowledge Questionnaire (baseline only). In addition, the following are being measured at baseline and during follow-up: lung function and reversibility by spirometry before and after salbutamol; fractional exhaled nitric oxide (FeNO); and presence of IgG antibodies to SARS-CoV-2 in blood. Recruitment started in 2019 but because of severe disruption to emergency services caused by the COVID-19 pandemic, eligibility criteria were modified to include asthmatic children with uncontrolled symptoms and registered with collaborating hospitals. Data will be analysed using logistic regression and survival analyses. ETHICS AND DISSEMINATION Ethical approval was obtained from the Hospital General Docente de Calderon (CEISH-HGDC 2019-001) and Ecuadorian Ministry of Public Health (MSP-CGDES-2021-0041-O N° 096-2021). The study results will be disseminated through presentations at conferences and to key stakeholder groups including policy-makers, postgraduate theses, peer-review publications and a study website. Participants gave informed consent to participate in the study before taking part.
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Affiliation(s)
- Diana Morillo
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
| | | | - Angélica Ochoa
- Department of Biosciences, Universidad de Cuenca, Cuenca, Ecuador
| | - Martha E Chico
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Claudia Rodas
- Facultad de Medicina, Universidad de Azuay, Cuenca, Ecuador
| | - Augusto Maldonado
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
- Emergency Department, Hospital General Docente Calderón, Quito, Ecuador
| | - Karen Arteaga
- Emergency Department, Hospital Verdi Cevallos Balda, Portoviejo, Ecuador
| | - Jessica Alchundia
- Pediatric Pneumology, Hospital de Especialidades Portoviejo, Portoviejo, Ecuador
| | - Karla Solorzano
- Pediatric Pneumology, Hospital de Especialidades Portoviejo, Portoviejo, Ecuador
| | | | - Camila Figueiredo
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | - Max Bachmann
- Norwich Medical School, University of East Anglia, University of East Anglia, Norwich, UK
| | | | - Irina Chis Ster
- Institute of Infection and Immunity, St. George's University of London, London, UK
- Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Alvaro Cruz
- Núcleo de Excelência em Asma, Universidade Federal da Bahia, Salvador, Brazil
| | - Natalia Cristina Romero
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
- GRAAL, Grups de Recerca d'America i Africa Llatines, Cerdanyola del Valles, Barcelona, Spain
| | - Philip Cooper
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St. George's University of London, London, UK
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Trikamjee T, Comberiati P, Peter J. Pediatric asthma in developing countries: challenges and future directions. Curr Opin Allergy Clin Immunol 2022; 22:80-85. [PMID: 35197428 DOI: 10.1097/aci.0000000000000806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Asthma continues to be a significant health problem worldwide, and epidemiological studies in the last few decades have consistently shown a marked increase in childhood asthma prevalence. The International Study of Asthma and Allergies in Childhood (ISAAC) showed significant geographic variability in prevalence, and larger associations with morbidity and mortality in low-middle income countries (LMICs). The Global Burden of Disease estimated that 420,000 deaths occurred globally from asthma in 2016, and although asthma prevalence is higher in high-income countries, most asthma-related mortality occurs in LMICs. The general health of a population is measured, in part, by the under-5 childhood death rate, and developing countries still account for more than 80 percentage of child deaths in the world, highlighting the need for efforts to reduce disease burden in these regions. RECENT FINDINGS The burden of asthma is higher in developing countries and underserved populations. Despite this, LMICs still face many barriers to appropriate allergy and asthma care, resulting in significant morbidity, potentially preventable asthma deaths, and economic consequences. A 2017 survey of 112 countries participating in the Global Asthma Network found that only 26 countries (23%) had a national asthma plan for children, with a lower proportion in LMICs. SUMMARY The rising asthma prevalence and high asthma-related death rates in LMICs suggest that global efforts in improving asthma diagnosis and care are not reaching the most vulnerable communities. Lack of appropriate diagnosis, availability of viable treatment options, and access to specialised care still remain a challenge in many parts of the world. Though barriers to achieving better outcomes differ in specific populations, many LMICs share similar barriers relating to accessibility.
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Affiliation(s)
- Thulja Trikamjee
- Allergy Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jonny Peter
- Allergy Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Division of Allergy and Clinical Immunology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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Mortimer K, Reddel HK, Pitrez PM, Bateman ED. Asthma management in low- and middle-income countries: case for change. Eur Respir J 2022; 60:13993003.03179-2021. [PMID: 35210321 PMCID: PMC9474897 DOI: 10.1183/13993003.03179-2021] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Abstract
Asthma is the most common non-communicable disease in children, and among the most common in adults. The great majority of people with asthma live in low- and middle-income countries (LMICs), where they suffer disproportionately high asthma-related morbidity and mortality. Essential inhaled medications, particularly those containing inhaled corticosteroids (ICS), are often unavailable or unaffordable, and this explains much of the global burden of preventable asthma morbidity and mortality.Guidelines developed for LMICs are generally based on the outdated assumption that patients with asthma symptoms <1-3 times/week do not need (or benefit from) ICS. Even when ICS is prescribed, many patients manage their asthma with oral or inhaled short-acting beta2 agonist (SABA) alone, due to issues of availability and affordability. A single ICS-formoterol inhaler-based approach to asthma management for all severities of asthma, from mild to severe, starting at diagnosis, might overcome SABA overuse/over-reliance and reduce the burden of symptoms and severe exacerbations. However, ICS-formoterol inhalers are currently very poorly available or unaffordable in LMICs. There is a pressing need for pragmatic clinical trial evidence of the feasibility and cost-effectiveness of this and other strategies to improve asthma care in these countries.The global health inequality in asthma care that deprives so many children, adolescents and adults of healthy lives and puts them at increased risk of death - despite the availability of highly effective therapeutic approaches - is unacceptable. A World Health Assembly Resolution on universal access to affordable effective asthma care is needed to focus attention and investment on addressing this need.
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Affiliation(s)
- K Mortimer
- Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, United Kingdom (2) Department of Medicine, University of Cambridge, Cambridge, UK
| | - H K Reddel
- The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia
| | - P M Pitrez
- Pediatric Respiratory Division, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - E D Bateman
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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8
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Santos SP, Lisboa AB, Silva FS, Tiwari S, Azevedo V, Cruz ÁA, Silva ES, Pinheiro CS, Alcantara-Neves NM, Pacheco LG. Rationally designed hypoallergenic mutant variants of the house dust mite allergen Der p 21. Biochim Biophys Acta Gen Subj 2022; 1866:130096. [DOI: 10.1016/j.bbagen.2022.130096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/22/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
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9
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Ardura-Garcia C, Blakey JD, Cooper PJ, Romero-Sandoval N. Caregivers' and healthcare professionals' perspective of barriers and facilitators to health service access for asthmatic children: a qualitative study. BMJ Open Respir Res 2021; 8:8/1/e001066. [PMID: 34949576 PMCID: PMC8705230 DOI: 10.1136/bmjresp-2021-001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is a high burden of asthma morbidity and mortality in Latin America. It has been proposed that this relates to limited access to diagnostic tests, asthma medications and specialised doctors. However, little is known of what caregivers of asthmatic children and healthcare professionals (HCPs) perceive as barriers and facilitators to adequate care. We aimed to explore the barriers and facilitators to asthma care access from caregivers' and HCP's perspective in an Ecuadorian low-resource setting. METHODS In 2017, we conducted 5 focus group discussions (FGD) with 20 caregivers of asthmatic children and 12 in-depth interviews with 3 paediatricians, 6 general doctors and 3 respiratory therapists in Esmeraldas city, Ecuador. FGDs and interviews were digitally recorded, transcribed, open-coded in QDA Miner, categorised using an interpretative phenomenological approach and analysed thematically. Barriers and facilitators were classified into availability, accessibility, acceptability and contact of healthcare services, based on Tanahashi model of health service access. RESULTS Limited resources, use of alternative medicines, fear of medication side-effects and lack of specific training for doctors and knowledge in families were common barriers for both caregivers and HCPs. Caregivers and HCPs proposed the implementation of public health asthma-focused programmes that would include close community-based follow-up of people with asthma, educational sessions for their families and public engagement activities. HCPs also suggested implementing training programmes on asthma management for general doctors. CONCLUSION Multiple barriers identified by caregivers and HCPs referred to economic and health service organisational issues, fear of side effects of medication or ineffective self-management. Increasing caregivers and HCPs' asthma knowledge, as well as HCPs' communication skills to establish a patient-centred approach with a shared decision-making process could improve asthma care in this setting.
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Affiliation(s)
| | - John D Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Medical School, Curtin University, Perth, Western Australia, Australia
| | - Philip J Cooper
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Pichincha, Ecuador.,Institute of Infection and Immunity, St George's University of London, London, UK
| | - Natalia Romero-Sandoval
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Pichincha, Ecuador.,Grups de Recerca d'Amèrica i Àfrica Llatines GRAAL Nodo Ecuador, Quito, Ecuador
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10
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de Carvalho-Pinto RM, Cançado JED, Pizzichini MMM, Fiterman J, Rubin AS, Cerci A, Cruz ÁA, Fernandes ALG, Araujo AMS, Blanco DC, Cordeiro G, Caetano LSB, Rabahi MF, de Menezes MB, de Oliveira MA, Lima MA, Pitrez PM. 2021 Brazilian Thoracic Association recommendations for the management of severe asthma. J Bras Pneumol 2021; 47:e20210273. [PMID: 34932721 PMCID: PMC8836628 DOI: 10.36416/1806-3756/e20210273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/05/2021] [Indexed: 12/20/2022] Open
Abstract
Advances in the understanding that severe asthma is a complex and heterogeneous disease and in the knowledge of the pathophysiology of asthma, with the identification of different phenotypes and endotypes, have allowed new approaches for the diagnosis and characterization of the disease and have resulted in relevant changes in pharmacological management. In this context, the definition of severe asthma has been established, being differentiated from difficult-to-control asthma. These recommendations address this topic and review advances in phenotyping, use of biomarkers, and new treatments for severe asthma. Emphasis is given to topics regarding personalized management of the patient and selection of biologicals, as well as the importance of evaluating the response to treatment. These recommendations apply to adults and children with severe asthma and are targeted at physicians involved in asthma treatment. A panel of 17 Brazilian pulmonologists was invited to review recent evidence on the diagnosis and management of severe asthma, adapting it to the Brazilian reality. Each of the experts was responsible for reviewing a topic or question relevant to the topic. In a second phase, four experts discussed and structured the texts produced, and, in the last phase, all experts reviewed and approved the present manuscript and its recommendations.
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Affiliation(s)
- Regina Maria de Carvalho-Pinto
- . Divisão de Pneumologia, Instituto do Coração − InCor − Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | - Jussara Fiterman
- . Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS − Porto Alegre (RS) Brasil
| | - Adalberto Sperb Rubin
- . Universidade Federal de Ciências da Saúde de Porto Alegre − UFCSPA − Porto Alegre (RS) Brasil
- . Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Alcindo Cerci
- . Universidade Estadual de Londrina − UEL − Londrina (PR) Brasil
- . Pontifícia Universidade Católica do Paraná − PUCPR − Londrina (PR) Brasil
| | - Álvaro Augusto Cruz
- . Universidade Federal da Bahia − UFBA − Salvador (BA) Brasil
- . Fundação ProAR, Salvador (BA) Brasil
| | | | - Ana Maria Silva Araujo
- . Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro − IDT/UFRJ − Rio de Janeiro (RJ) Brasil
| | - Daniela Cavalet Blanco
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS − Porto Alegre (RS), Brasil
| | - Gediel Cordeiro
- . Hospital Júlia Kubitschek, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
- . Hospital Madre Teresa, Belo Horizonte (MG) Brasil
| | | | - Marcelo Fouad Rabahi
- . Faculdade de Medicina, Universidade Federal de Goiás − UFG − Goiânia (GO) Brasil
| | - Marcelo Bezerra de Menezes
- . Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
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11
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Ponte EV, Mingotti CFB, Mamoni RL, Marchi E, Martinelli JE, de Menezes MB, Vianna EDSO, Cruz ÁA. Hospital admission rate in children and adolescents with mild persistent asthma. Pediatr Pulmonol 2021; 56:1889-1895. [PMID: 33721424 DOI: 10.1002/ppul.25363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The health and financial burden of mild-persistent asthma has been poorly investigated. OBJECTIVE Our aim was to compare the rate of hospital admissions that have occurred during the preceding year between children and adolescents with current mild-persistent (MP) and moderate-severe (MS) asthma. METHODS We screened children and adolescents with asthma at eight outpatient clinics. The inclusion criteria were asthma diagnosis, age from 6 to 18 years and follow-up with a physician during the preceding 6 months. Subjects answered standardized questionnaires and underwent spirometry. RESULTS We enrolled 220 MP and 102 MS asthmatic subjects. The proportion of subjects with HA during the preceding year was similar between MP and MS asthma groups (7% vs. 7%; p = .89). Symptoms score and the financial values spent by the family in the care of asthma were lower in MP asthma as compared with MS asthma group (asthma control questionnaire score 0.7 [0.3-1.0) vs. 2.0 [1.1-2.5]; p < .01) (asthma expenses in USD 13 [2-43] vs. 28 [10-83]; p < .01). The frequency of subjects using inhaled corticosteroids maintenance therapy was lower in the MP asthma group as compared with the MS asthma group (54% vs. 100%; p < .01). CONCLUSION We conclude that the frequency of hospital admissions that have occurred during the preceding year was similar between subjects with current MP and MS asthma. Symptoms score and the financial values spent by the family in the care of asthma were lower in the MP asthma group.
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Affiliation(s)
- Eduardo Vieira Ponte
- Department of Internal Medicine, Programa de Pós-Graduação, Faculdade de Medicina de Jundiaí, Jundiaí, Brazil
| | | | - Ronei Luciano Mamoni
- Department of Internal Medicine, Programa de Pós-Graduação, Faculdade de Medicina de Jundiaí, Jundiaí, Brazil
| | - Evaldo Marchi
- Department of Internal Medicine, Programa de Pós-Graduação, Faculdade de Medicina de Jundiaí, Jundiaí, Brazil
| | - José Eduardo Martinelli
- Department of Internal Medicine, Programa de Pós-Graduação, Faculdade de Medicina de Jundiaí, Jundiaí, Brazil
| | | | | | - Álvaro Augusto Cruz
- Department of Internal Medicine, ProAR, Federal University of Bahia, Salvador, Brazil
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12
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Zairina E, Nugraheni G, Achmad GNV, Sulistyarini A, Nita Y, Bakhtiar A, Amin M. The correlation between self-related adherence, asthma-related quality of life and control of asthma in adult patients. J Basic Clin Physiol Pharmacol 2021; 32:453-458. [PMID: 34214370 DOI: 10.1515/jbcpp-2020-0434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Medication non-adherence mostly occurs in patients with a wide range of disease severity, including asthma. The aim of the study was to assess the self reported adherence to asthma therapy and investigate the relationship between adherence, asthma control and asthma-related quality of life. METHODS The study was a cross-sectional study in which participants were recruited from an outpatient department, in one hospital in Surabaya. Patients (aged≥18 years) with asthma who had used any regular asthma medications were included. Standardised questionnaires, including Juniper's Asthma Control Questionnaire (ACQ), Adherence to Refills and Medications Scales (ARMS) and Juniper's Asthma Quality of Life Questionnaire (AQLQ) were used. RESULTS A total of 82 adults with asthma were recruited in the study. Male participants' mean age was 49.13 ± 14.10 years (n = 23). Approximately 59 participants (72.0%) were females, 30 participants (36.5%) were using Budesonide inhaler, and 73 participants (89.0%) never smoked. The mean of ACQ, AQLQ, and ARMS scores were 1.62 ± 1.19, 4.96 ± 1.24, and 16.98 ± 4.12, respectively. Of 82 patients studied 53 (64.6 %) had "uncontrolled asthma" and more than 85% participants both showed "non adherence" to asthma therapy and nearly 46% of them indicated that their quality of life was affected by asthma. There was a significant association between ACQ and AQLQ (p<0.05), whereas no statistically significant association was found between ACQ and ARMS. CONCLUSIONS The majority of patients reported non-adherence to asthma medications. Poor controlled asthma has been associated with lower asthma-related quality of life.
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Affiliation(s)
- Elida Zairina
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.,Innovative Pharmacy Practice and Integrated Outcomes Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia.,Center for Patient Safety Research, Universitas Airlangga, Surabaya, Indonesia
| | - Gesnita Nugraheni
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.,Innovative Pharmacy Practice and Integrated Outcomes Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia
| | - Gusti Noorrizka Veronika Achmad
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.,Innovative Pharmacy Practice and Integrated Outcomes Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia
| | - Arie Sulistyarini
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.,Innovative Pharmacy Practice and Integrated Outcomes Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia
| | - Yunita Nita
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.,Innovative Pharmacy Practice and Integrated Outcomes Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia
| | - Arief Bakhtiar
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department of Pulmonology, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Muhammad Amin
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department of Pulmonology, Universitas Airlangga Hospital, Surabaya, Indonesia
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13
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Jansen EM, van de Hei SJ, Dierick BJH, Kerstjens HAM, Kocks JWH, van Boven JFM. Global burden of medication non-adherence in chronic obstructive pulmonary disease (COPD) and asthma: a narrative review of the clinical and economic case for smart inhalers. J Thorac Dis 2021; 13:3846-3864. [PMID: 34277075 PMCID: PMC8264677 DOI: 10.21037/jtd-20-2360] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/18/2021] [Indexed: 12/14/2022]
Abstract
Medication non-adherence to asthma and chronic obstructive pulmonary disease therapy poses a significant burden for patients and societies. Non-adherence encompasses poor initiation, implementation (including poor inhalation technique) and non-persistence. Globally, non-adherence is associated with poor clinical outcomes, reduced quality of life and high healthcare and societal costs. Costs are mainly caused by excess hospitalizations and impaired work productivity. Multiple intervention programs to increase adherence in patients with asthma and chronic obstructive pulmonary disease have been conducted. However, these intervention programs are generally not as effective as intended. Additionally, adherence outcomes are mostly examined with non-objective or non-granular measures (e.g., self-report, dose count, pharmacy records). Recently developed smart inhalers could be the key to objectively diagnose and manage non-adherence effectively in patients with asthma and chronic obstructive pulmonary disease. Smart inhalers register usage of the inhaler, record time and date, send reminders, give feedback about adherence and some are able to assess inhaler technique and predict exacerbations. Still, some limitations need to be overcome before smart inhalers can be incorporated in usual care. For example, their cost-effectiveness and budget impact need to be examined. It is likely that smart inhalers are particularly cost-effective in specific asthma and chronic obstructive pulmonary disease subgroups, including patients with asthma eligible for additional GINA-5 therapy (oral corticosteroids or biologics), patients with severe asthma in GINA-5, patients with asthma with short-acting beta2 agonists overuse, patients with asthma and chronic obstructive pulmonary disease with frequent exacerbations and patients with asthma and chronic obstructive pulmonary disease of working-age. While there is high potential and evidence is accumulating, a final push seems needed to cost-effectively integrate smart inhalers in the daily management of patients with asthma and chronic obstructive pulmonary disease.
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Affiliation(s)
- Evalyne M Jansen
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Susanne J van de Hei
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - Boudewijn J H Dierick
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, The Netherlands
| | - Janwillem W H Kocks
- Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, The Netherlands.,General Practitioners Research Institute (GPRI), Groningen, The Netherlands.,Observational and Pragmatic Research Institute (OPRI), Singapore
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, The Netherlands
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14
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Pitrez PM, Giavina-Bianchi P, Rizzo JÂ, Souza-Machado A, Garcia GF, Pizzichini MMM. An expert review on breaking barriers in severe asthma in Brazil: Time to act. Chron Respir Dis 2021; 18:14799731211028259. [PMID: 34167379 PMCID: PMC8236765 DOI: 10.1177/14799731211028259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022] Open
Abstract
Currently, Brazil lacks a national asthma management program and is burdened with nearly 200,000 hospitalizations due to the disease per year and approximately 5 deaths per day. The purpose of this article was to analyze the current issues surrounding severe asthma in Brazil, as the status of diagnosis and treatment is largely unknown, and to provide feasible recommendations to elicit imminent action. A panel of Brazilian medical experts in the field of severe asthma was provided with a series of relevant questions to address prior to a multi-day conference. Within this conference, each narrative was discussed and edited by the entire group. Through numerous rounds of discussion consensus was achieved. In order to overcome barriers to adequate asthma treatment, this panel recommends specific initiatives that can be implemented in the short-term to decrease the burden of severe asthma in Brazil. With increasing healthcare costs and limited resources globally, there is an opportunity to implement these recommendations in other countries in order to achieve adequate asthma care. Severe asthma is a heterogeneous and complex disease with various phenotypes that requires strict attention for diagnosis and management. Although this disease affects only a small proportion of the population with asthma, it poses a great burden to healthcare systems. Thus, barriers to diagnosis, treatment, and management should be overcome as quickly and efficiently as possible.
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Affiliation(s)
- Paulo Márcio Pitrez
- Pediatric Pulmonology Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Ângelo Rizzo
- Head Pneumology Department, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Adelmir Souza-Machado
- Institute of Health Sciences, Federal University of Bahia Coordinator of Program for Asthma Control in Bahia (ProAR), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Guilherme Freire Garcia
- Clinical Guidelines Coordinator of the Fundação Hospitalar de Minas Gerais (FHEMIG), Belo Horizonte, Brazil
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15
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Duenas-Meza E, Giraldo-Cadavid LF, Karpf E, Afanador F, Angarita OL, Barón O, Medina MS, Pachón A, Gonzalez A, Jurado J, Torres-Duque CA. Cost-utility analysis of an integrated care program for children with asthma in a medium-income country. Pediatr Pulmonol 2020; 55:3110-3118. [PMID: 33460317 DOI: 10.1002/ppul.24996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the cost-utility of an integrated care program (ASMAIRE Infantil Program [PAI]) for children with asthma compared with standard of care. METHODS A decision-analytic model was used to compare an integrated care program compared to the standard of care in children with asthma in Bogota, Colombia. Baseline characteristics of the patients were established according to the distribution of patients in the PAI database. Other inputs were obtained from published meta-analysis, local registries, medical bills, general mortality data, and expert opinion. Costs were presented in 2017 Colombian pesos. Outcomes included quality-adjusted life-years (QALYs). Costs and outcomes were discounted by 5% per year. Incremental cost-utility ratios were presented for PAI compared with standard of care. Univariate and multivariate probabilistic sensitivity analyses were conducted to assess model robustness to parameter uncertainty. RESULTS The model predicted that patients that are part of the PAI would accrue more QALYs than patients on standard of care. The incremental results suggest that the PAI is a cost-effective treatment (incremental cost-utility ratio of Colombian pesos $33 753 817/QALY) compared with standard of care. Sensitivity analyses suggest that results are most sensitive to cost of care (with and without PAI) and costs of severe exacerbation. However, the PAI is cost-effective irrespective of variation in any of the input parameters. CONCLUSION Our model predicted that an integrated intervention for the management of asthma in pediatric patients improves QALYs, reduces number of disease related exacerbations compared to standard therapy and is cost-effective for the long-term control of the disease in Colombia.
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Affiliation(s)
- Elida Duenas-Meza
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Pediatric Department, School of Medicine, University of La Sabana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Luis F Giraldo-Cadavid
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Epidemiology and Biostatistics, School of Medicine, University of La Sabana, Bogotá, Colombia
| | | | | | | | - Oscar Barón
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Maria S Medina
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Angelica Pachón
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia
| | - Angelica Gonzalez
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia
| | - Jenny Jurado
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Pediatric Department, School of Medicine, University of La Sabana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Carlos A Torres-Duque
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,School of Medicine, University of La Sabana, Bogotá, Colombia
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16
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da Silva ES, Aglas L, Pinheiro CS, de Andrade Belitardo EMM, Silveira EF, Huber S, Torres RT, Wallner M, Briza P, Lackner P, Laimer J, Pacheco LGC, Cruz ÁA, Alcântara-Neves NM, Ferreira F. A hybrid of two major Blomia tropicalis allergens as an allergy vaccine candidate. Clin Exp Allergy 2020; 50:835-847. [PMID: 32314444 PMCID: PMC7384089 DOI: 10.1111/cea.13611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 12/21/2022]
Abstract
Introduction Allergen‐specific immunotherapy (AIT) represents a curative approach for treating allergies. In the tropical and subtropical regions of the world, Blomia tropicalis (Blo t 5 and Blo t 21) is the likely dominant source of indoor allergens. Aim To generate a hypoallergenic Blo t 5/Blo t 21 hybrid molecule that can treat allergies caused by B tropicalis. Methods Using in silico design of B tropicalis hybrid proteins, we chose two hybrid proteins for heterologous expression. Wild‐type Blo t 5/Blo t 21 hybrid molecule and a hypoallergenic version, termed BTH1 and BTH2, respectively, were purified by ion exchange and size exclusion chromatography and characterized by physicochemical, as well as in vitro and in vivo immunological, experiments. Results BTH1, BTH2 and the parental allergens were purified to homogeneity and characterized in detail. BTH2 displayed the lowest IgE reactivity that induced basophil degranulation using sera from allergic rhinitis and asthmatic patients. BTH2 essentially presented the same endolysosomal degradation pattern as the shortened rBlo t 5 and showed a higher resistance towards degradation than the full‐length Blo t 5. In vivo immunization of mice with BTH2 led to the production of IgG antibodies that competed with human IgE for allergen binding. Stimulation of splenocytes from BTH2‐immunized mice produced higher levels of IL‐10 and decreased secretion of IL‐4 and IL‐5. In addition, BTH2 stimulated T‐cell proliferation in PBMCs isolated from allergic patients, with secretion of higher levels of IL‐10 and lower levels of IL‐5 and IL‐13, when compared to parental allergens. Conclusions and Clinical Relevance BTH2 is a promising hybrid vaccine candidate for immunotherapy of Blomia allergy. However, further pre‐clinical studies addressing its efficacy and safety are needed.
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Affiliation(s)
- Eduardo Santos da Silva
- Laboratório de Alergia e Acarologia, Departamento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Biotecnologia da Rede Nordeste de Biotecnologia (RENORBIO), Natal, Brazil.,Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Lorenz Aglas
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Carina Silva Pinheiro
- Laboratório de Alergia e Acarologia, Departamento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Emília M M de Andrade Belitardo
- Laboratório de Alergia e Acarologia, Departamento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Imunologia da Universidade Federal da Bahia, Salvador, Brazil
| | - Elisânia Fontes Silveira
- Laboratório de Alergia e Acarologia, Departamento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Sara Huber
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Rogério Tanan Torres
- Laboratório de Alergia e Acarologia, Departamento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Michael Wallner
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Peter Briza
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Peter Lackner
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Josef Laimer
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Luis Gustavo C Pacheco
- Laboratório de Alergia e Acarologia, Departamento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Álvaro A Cruz
- Núcleo de Excelência de Asma da, Universidade Federal da Bahia, Salvador, Brazil
| | - Neuza Maria Alcântara-Neves
- Laboratório de Alergia e Acarologia, Departamento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Biotecnologia da Rede Nordeste de Biotecnologia (RENORBIO), Natal, Brazil.,Programa de Pós-Graduação em Imunologia da Universidade Federal da Bahia, Salvador, Brazil
| | - Fatima Ferreira
- Department of Biosciences, University of Salzburg, Salzburg, Austria
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17
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Bezerra de Menezes M, Ponte EV, Bertagni Mingotti CF, Carvalho Pinto RM, Bagatin E, Bião Lima V, Vianna EO, Cruz ÁA. Provision of inhaled corticosteroids is associated with decrease in hospital admissions in Brazil: A longitudinal nationwide study. Respir Med 2020; 166:105950. [PMID: 32250873 DOI: 10.1016/j.rmed.2020.105950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe trends of hospital admissions due to asthma from 2008 to 2015 and to evaluate their relationship with trends of inhaled corticosteroids (ICS) provision by the government in Brazil. METHODS We used Brazilian Government data to calculate hospital admission rates due to asthma, number of physicians, number of hospital beds, number of subjects that received ICS per 100,000 inhabitants in Brazil and in each of its municipalities for each year of the study. We performed Poisson Multilevel Regression Analyses to evaluate the relationship between the trends of hospital admission rates due to asthma with the trends of the number of subjects that had been receiving ICS during the study period. The analyses were adjusted for the number of physicians and hospital beds. FINDINGS The number of patients who received ICS/100,000 inhabitants increased from 2008 to 2015 (943.9-1988.5). Hospital admissions/100,000 inhabitants decreased in patients aged 5-14 years (148.3-110.9) and in patients aged 15-39 years (59.9-32.3); the reduction was greater in municipalities in which ICS provision increased. The number of physicians/100,000 inhabitants increased and the number of hospital beds/100,000 inhabitants decreased in the study period. The increase in the number of physicians and in the number of subjects that received ICS were associated with reduction in hospital admissions. CONCLUSION We found that provision of ICS by the Brazilian Government was associated with a decrease of hospital admissions for asthma in the municipalities and country levels from 2008 to 2015.
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Affiliation(s)
| | | | | | | | - Ericson Bagatin
- Medical School of Jundiaí. State University of Campinas, Brazil.
| | | | - Elcio Oliveira Vianna
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
| | - Álvaro A Cruz
- ProAR - Faculdade de Medicina da Bahia, Federal University of Bahia, Brazil.
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Ponte EV, Lima A, Almeida PCA, de Jesus JPV, Souza-Machado A, Barreto ML, Cruz ÁA. Rural to urban migration contributes to the high burden of asthma in the urban area. CLINICAL RESPIRATORY JOURNAL 2019; 13:560-566. [PMID: 31301264 DOI: 10.1111/crj.13058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 03/02/2019] [Accepted: 07/05/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It is unknown whether rural-urban migration contributes to worse the burden of asthma in the cities. OBJECTIVES The aim of this study was to evaluate whether subjects with asthma that migrated from rural areas to a large urban center in Brazil have more severe disease than asthmatic subjects that was born and always lived in the urban area. METHODS This is a case-control study. We enrolled two groups of subjects with asthma currently living in a large urban center in Brazil: 486 subjects with moderate-severe asthma and 432 subjects with mild asthma. RESULTS Rural-urban migrants had higher odds of moderate-severe asthma [adjusted OR 1.57, 95% CI (1.18-2.01)] and uncontrolled symptoms of asthma [adjusted OR 1.80, 95% CI (1.16-2.76)] than urban-born subjects. CONCLUSIONS Rural-urban migrants in Brazil have more severe asthma than urban-born subjects. Our results suggest that rural-urban migration is associated with the high burden of asthma in the urban area.
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Affiliation(s)
- Eduardo Vieira Ponte
- Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí, Brazil
| | - Aline Lima
- Núcleo de Excelência em Asma, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | | | | | - Álvaro A Cruz
- Núcleo de Excelência em Asma, Universidade Federal da Bahia, Salvador, Brazil
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Fischer GB, Sarria EE, Camargos P, Mocelin HT, Soto-Quiroz M, Cruz AA, Bousquet J, Zar HJ. Childhood asthma in low and middle-income countries: Where are we now? Paediatr Respir Rev 2019; 31:52-57. [PMID: 30987798 DOI: 10.1016/j.prrv.2018.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/04/2018] [Indexed: 01/08/2023]
Abstract
Pediatric asthma has been increasing in LMICs (Low Middle-Income Countries), leading to an important burden for both children and national health systems. Implementing measures to achieve control are influenced by the degree of organization health systems have, the availability and affordability of essential asthma medications, and the effective implementation of asthma programs and asthma guidelines. In this review authors give an updated view of the current situation of these components of asthma management in LMICs.
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Affiliation(s)
- Gilberto Bueno Fischer
- Department of Paediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Paediatric Pulmonology Section, Hospital da Crianças Santo Antônio (HCSA), Porto Alegre, Brazil.
| | - Edgar E Sarria
- Department of Biology and Pharmacy, School of Medicine, Universidade de Santa Cruz do Sul (UNISC), Brazil; Paediatric Pulmonology Section - HCSA, Brazil
| | - Paulo Camargos
- Department of Paediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Postgraduate Program on Health Sciences, Universidade Federal de São João del-Rei, Divinópolis, Brazil.
| | - Helena Teresinha Mocelin
- Department of Paediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Paediatric Pulmonology Section - HCSA, Porto Alegre, Brazil
| | - Manuel Soto-Quiroz
- Pediatric Pulmology, University of Costa Rica, Hospital CIMA, San Jose, Costa Rica
| | - Alvaro A Cruz
- ProAR - Federal University of Bahia, School of Medicine, Bahia, Brazil
| | - Jean Bousquet
- MACVIA, France; Contre les Maladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.
| | - Heather J Zar
- Dept Pediatrics & Child Health, Red Cross Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, South Africa.
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20
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Emilio CC, Mingotti CFB, Fiorin PR, Lima LA, Muniz RL, Bigotto LH, Marchi E, Ponte EV. Is a low level of education a limiting factor for asthma control in a population with access to pulmonologists and to treatment? ACTA ACUST UNITED AC 2019; 45:e20180052. [PMID: 30758430 PMCID: PMC6534401 DOI: 10.1590/1806-3713/e20180052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether a low level of education is a risk factor for uncontrolled asthma in a population of patients who have access to pulmonologists and to treatment. METHODS This was a cross-sectional study involving outpatients > 10 years of age diagnosed with asthma who were followed by a pulmonologist for at least 3 months in the city of Jundiai, located in the state of São Paulo, Brazil. The patients completed a questionnaire specifically designed for this study, the 6-item Asthma Control Questionnaire (to assess the control of asthma symptoms), and a questionnaire designed to assess treatment adherence. Patients underwent spirometry, and patient inhaler technique was assessed. RESULTS 358 patients were enrolled in the study. Level of education was not considered a risk factor for uncontrolled asthma symptoms (OR = 0.99; 95% CI: 0.94-1.05), spirometry findings consistent with obstructive lung disease (OR = 1.00; 95% CI: 0.99-1.01), uncontrolled asthma (OR = 1.03; 95% CI: 0.95-1.10), or the need for moderate/high doses of inhaled medication (OR = 0.99; 95% CI: 0.94-1.06). The number of years of schooling was similar between the patients in whom treatment adherence was good and those in whom it was poor (p = 0.08), as well as between those who demonstrated proper inhaler technique and those who did not (p = 0.41). CONCLUSIONS Among asthma patients with access to pulmonologists and to treatment, a low level of education does not appear to be a limiting factor for adequate asthma control.
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Affiliation(s)
| | | | - Paula Regina Fiorin
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Leydiane Araujo Lima
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Raisa Lemos Muniz
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Luis Henrique Bigotto
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Evaldo Marchi
- . Departamento de Cirurgia, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Eduardo Vieira Ponte
- . Departamento de Clínica Médica, Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
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21
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Jesus JPVD, Lima-Matos AS, Almeida PCA, Lima VB, Mello LMD, Souza-Machado A, Ponte EV, Cruz ÁA. Obesity and asthma: clinical and laboratory characterization of a common combination. ACTA ACUST UNITED AC 2019; 44:207-212. [PMID: 30043887 PMCID: PMC6188692 DOI: 10.1590/s1806-37562017000000034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 12/22/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the relationship between obesity and asthma. METHODS This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires. RESULTS Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02). CONCLUSIONS Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.
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Affiliation(s)
- Juliana Pires Viana de Jesus
- . Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Núcleo de Excelência em Asma/Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil
| | - Aline Silva Lima-Matos
- . Núcleo de Excelência em Asma/Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil.,. Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | | | - Valmar Bião Lima
- . Núcleo de Excelência em Asma/Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil
| | - Luane Marques de Mello
- . Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | - Adelmir Souza-Machado
- . Núcleo de Excelência em Asma/Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil.,. Instituto de Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - Eduardo Vieira Ponte
- . Instituto de Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Álvaro Augusto Cruz
- . Núcleo de Excelência em Asma/Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil.,. Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
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Bousquet J, Mohammad Y, Bedbrook A, To T, McGihon R, Bárbara C, Melo-Gomes E, Rosado-Pinto J, Simão P, George F, Punturieri A, Kiley JP, Nunes E, Cossa A, Camargos P, Stelmach R, Cruz AA, Rostan MV, Yañez A, González-Díaz SN, Urrutia-Pereira M, Calderon MA, Gómez RM, German Z, Kolek V, Špičák V, Lan LTT, Hurd S, Lenfant C, Yorgancioglu A, Gemicioğlu B, Ekinci B, Ozkan Z, Abou Al-Zahab B, Dmeirieh A, Shifa R, Faroun H, AlJaber A, Halloum R, Fatmeh Y, Alzein A, Aloush J, Dib G, Shaaban R, Arrais M, do Céu Teixeira M, Conceição C, Ferrinho P. Country activities of Global Alliance against Chronic Respiratory Diseases (GARD): focus presentations at the 11th GARD General Meeting, Brussels. J Thorac Dis 2018; 10:7064-7072. [PMID: 30746253 DOI: 10.21037/jtd.2018.12.84] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jean Bousquet
- WHO Collaborating Center for Rhinitis and Asthma, Montpellier, France.,MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.,INSERM, VIMA: Ageing and Chronic Diseases. Epidemiological and Public Health Approaches, U1168, Paris, France.,UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Yvelines, France.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany
| | - Yousser Mohammad
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria.,Department of Internal Medicine, Syrian Private University, Damascus, Syria
| | - Anna Bedbrook
- WHO Collaborating Center for Rhinitis and Asthma, Montpellier, France.,MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Teresa To
- The Hospital for Sick Children, Research Institute, Toronto, Ontario, Canada
| | - Rachel McGihon
- The Hospital for Sick Children, Research Institute, Toronto, Ontario, Canada
| | - Cristina Bárbara
- Instituto de Saúde Ambiental, Faculty of Medicine, University of Lisbon, Portugal
| | | | - José Rosado-Pinto
- Global Alliance against Chronic Respiratory Diseases (GARD) Portugal Coordinator, Serviço de Imunoalergologia, Hospital da Luz, Lisboa, Portugal
| | - Paula Simão
- Directorate-General of Health, Lisbon, Portugal
| | | | - Antonello Punturieri
- Division of Lung Diseases, NHLBI/National Institutes of Health, Bethesda, Maryland, USA
| | - James P Kiley
- Division of Lung Diseases, NHLBI/National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabete Nunes
- Department of Pulmonology, Maputo Central Hospital, Maputo, Mozambique
| | - Anilsa Cossa
- Department of Pulmonology, Maputo Central Hospital, Maputo, Mozambique
| | - Paulo Camargos
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Anahí Yañez
- Investigaciones en Alergia y Enfermedades Respiratorias (INAER), Buenos Aires, Argentina
| | | | | | - Moïses A Calderon
- Imperial College London, London, U.K.Royal Brompton Hospital, London, UK.,Universidad de Costa Rica, San Jose, Costa Rica
| | - René Maximiliano Gómez
- Fundación Ayre, Salta, Argentina.,School of Health Sciences, Catholic University of Salta, Argentina.,Argentinean Association of Allergy & Clinical Immunology (AAAeIC), Salta, Argentina
| | - Zachary German
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island, USA
| | - Vítězslav Kolek
- Department of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Václav Špičák
- Department of Pediatrics, Hospital Na Bulovce, Prague, Czech Republic
| | - Le Thi Tuyet Lan
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Vietnam
| | - Suzanne Hurd
- Global Initiative for Asthma (GINA), the Global Initiative for Chronic Obstructive Lung Disease (GOLD), Vancouver, WA, USA
| | - Claude Lenfant
- Global Initiative on Obstructive Lung Disease (GOLD), Gaithersburg, MD, USA
| | | | - Bilun Gemicioğlu
- Department of Chest Diseases, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Banu Ekinci
- Department of Chronic Diseases and Elderly, Directorate General of Public Health, Ankara, Turkey
| | - Zubeyda Ozkan
- Department of Chronic Diseases and Elderly, Directorate General of Public Health, Ankara, Turkey
| | | | | | | | | | - Aicha AlJaber
- National Professional Officer at WHO office in Syria, Damascus, Syria
| | - Ramsa Halloum
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | - Yassine Fatmeh
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | | | | | - Ghazal Dib
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | - Rafea Shaaban
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | | | | | - Cláudia Conceição
- Instituto de Higiene Medicina Tropical, NOVA University of Lisbon, Lisbon, Portugal
| | - Paulo Ferrinho
- Instituto de Higiene Medicina Tropical, NOVA University of Lisbon, Lisbon, Portugal
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Flórez-Tanus Á, Parra D, Zakzuk J, Caraballo L, Alvis-Guzmán N. Health care costs and resource utilization for different asthma severity stages in Colombia: a claims data analysis. World Allergy Organ J 2018; 11:26. [PMID: 30459927 PMCID: PMC6231276 DOI: 10.1186/s40413-018-0205-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Asthma is one of the most common chronic respiratory conditions worldwide. Asthma-related economic burden has been reported in Latin America, but knowledge about its economic impact to the Colombian health care system and the influence of disease severity is lacking. This study estimated direct medical costs and health care resource utilization (HCRU) in patients with asthma according to severity in Colombia. METHODS This study identified all-age patients who had at least one medical event linked to an asthma diagnosis (CIE-10: J45-J46) between 2004 and 2014. Patients were selected if they had a continuous enrollment and uninterrupted insurance coverage between January 1-2015 and December 31-2015 and were categorized into 4 different severity levels using a modified algorithm based on Leidy criteria. Healthcare utilization and costs were estimated in a 1-year period after the identification period. A Generalized Linear Model (GLM) with gamma distribution and log link was used to analyze costs adjusting for patient demographics. RESULTS A total of 20,410 patients were included: 69.5% had mild intermittent, 18.0% mild persistent, 6.9% moderate persistent and 5.5% severe persistent asthma; with mean costs (SD) of $67 (134), $482 (1506), $1061 (1983), $2235 (3426) respectively (p < 0.001). The mean total direct cost was estimated at $331 (1278) per patient. Medication and hospitalization had the higher proportion in total costs (46% and 31% respectively). General physician visits was the most used service (57.2%) and short-acting β-2 agonists the most used medication (24%). CONCLUSIONS Health services utilization and direct costs of asthma were highly related to disease severity. Nationwide health policies aimed at the effective control of asthma are necessary and would play an important role in reducing the associated economic impact.
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Affiliation(s)
- Álvaro Flórez-Tanus
- Health Economics Research Group, University of Cartagena, Campus Piedra de Bolívar, Cartagena, Colombia
- Center for Research and Innovation in Health, Coosalud, Street 11 – 2 Floor 8, Bocagrande, Cartagena, Colombia
| | - Devian Parra
- Health Economics Research Group, University of Cartagena, Campus Piedra de Bolívar, Cartagena, Colombia
- ALZAK Foundation, Calle 70 #6-99, Cartagena, Colombia
| | - Josefina Zakzuk
- Health Economics Research Group, University of Cartagena, Campus Piedra de Bolívar, Cartagena, Colombia
- Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia
- Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cra 5 #7-77, Cartagena, Colombia
- ALZAK Foundation, Calle 70 #6-99, Cartagena, Colombia
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia
- Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cra 5 #7-77, Cartagena, Colombia
| | - Nelson Alvis-Guzmán
- Health Economics Research Group, University of Cartagena, Campus Piedra de Bolívar, Cartagena, Colombia
- Hospital Management and Health Policy Research Group, Universidad de la Costa, Barranquilla, Colombia
- ALZAK Foundation, Calle 70 #6-99, Cartagena, Colombia
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Lenney W, Bush A, Fitzgerald DA, Fletcher M, Ostrem A, Pedersen S, Szefler SJ, Zar HJ. Improving the global diagnosis and management of asthma in children. Thorax 2018. [PMCID: PMC6035489 DOI: 10.1136/thoraxjnl-2018-211626] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still needs substantial improvement. From infancy to the teenage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. Guidelines are increasingly evidence based, but their impact on improving outcomes has been negligible in many parts of the world, often due to lack of implementation. New thinking is needed to enable substantial improvements in outcomes. The disease varies globally and plans will need to differ for individual countries or places where region-specific barriers prevent optimal care. A wide selection of educational activities is needed, including community-targeted initiatives, to engage with families. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.
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Affiliation(s)
- Warren Lenney
- Department of Child Health, Keele University, Stoke-on-Trent, UK
- Department of Child Health, Royal Stoke University Hospital (RSUH), Stoke-on-Trent, UK
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, London, UK
| | - Andrew Bush
- Paediatrics, Imperial College London, London, UK
- Paediatrics, National Heart and Lung Institute, London, UK
- Paediatrics, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Dominic A Fitzgerald
- Sydney Medical School, Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Monica Fletcher
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, London, UK
- Asthma UK Centre for Applied Research (AUKCAR), University of Edinburgh, Edinburgh, UK
| | | | - Soren Pedersen
- Pediatric Research Unit, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | - Stanley J Szefler
- Pediatric Asthma Research Program, Section of Pediatric Pulmonary Medicine, Breathing Institute, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
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25
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van Boven JFM, Ryan D, Eakin MN, Canonica GW, Barot A, Foster JM. Enhancing Respiratory Medication Adherence: The Role of Health Care Professionals and Cost-Effectiveness Considerations. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 4:835-46. [PMID: 27587317 DOI: 10.1016/j.jaip.2016.03.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 12/13/2022]
Abstract
Adherence to medication comprises a multiphased temporal process involving (1) initiation of prescribed therapy, (2) implementation as prescribed, and (3) subsequent persistence. Medication adherence remains suboptimal in most patients with long-term respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Interventions have been shown to effectively improve treatment initiation, implementation, and persistence when delivered at the health care professional level or the system level, but demonstration of the cost-effectiveness of these interventions is necessary to ensure their widespread use. This review summarizes how health care professionals can intervene to improve medication adherence in patients with asthma and COPD, provides some examples of effective primary care interventions, and illustrates some of the challenges to optimal implementation arising from cost-effectiveness modeling. Improving adherence is shown to be an economically viable treatment option for patients with asthma and COPD, but there are differences in the health economics pertaining to each condition and setting that can affect whether an intervention is considered cost-effective. Targeting adherence interventions at patients with the greatest to gain, and tailoring them to individual patient needs, may help to optimize cost-effectiveness ratios and improve the probability of positive reimbursement decisions, systemwide implementation, and resultant health benefits.
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Affiliation(s)
- Job F M van Boven
- Department of Primary Care, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Unit of Pharmacoepidemiology & Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Dermot Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - Giorgio W Canonica
- Allergy and Respiratory Diseases Clinica, DIMI Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Aji Barot
- Patient Connect Service, Surrey, United Kingdom
| | - Juliet M Foster
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
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Rodriguez-Martinez CE, Sossa-Briceño MP, Castro-Rodriguez JA. A cost-effectiveness threshold analysis of a multidisciplinary structured educational intervention in pediatric asthma. J Asthma 2017; 55:561-570. [PMID: 28759278 DOI: 10.1080/02770903.2017.1348512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Asthma educational interventions have been shown to improve several clinically and economically important outcomes. However, these interventions are costly in themselves and could lead to even higher disease costs. A cost-effectiveness threshold analysis would be helpful in determining the threshold value of the cost of educational interventions, leading to these interventions being cost-effective. The aim of the present study was to perform a cost-effectiveness threshold analysis to determine the level at which the cost of a pediatric asthma educational intervention would be cost-effective and cost-saving. METHODS A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a single uncontrolled before-and-after study performed with Colombian asthmatic children. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs). RESULTS A deterministic threshold sensitivity analysis showed that the asthma educational intervention will be cost-saving to the health system if its cost is under US$513.20. Additionally, the analysis showed that the cost of the intervention would have to be below US$967.40 in order to be cost-effective. CONCLUSIONS This study identified the level at which the cost of a pediatric asthma educational intervention will be cost-effective and cost-saving for the health system in Colombia. Our findings could be a useful aid for decision makers in efficiently allocating limited resources when planning asthma educational interventions for pediatric patients.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- a Department of Pediatrics, School of Medicine , Universidad Nacional de Colombia , Bogota , Colombia.,b Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine , Universidad El Bosque , Bogota , Colombia
| | - Monica P Sossa-Briceño
- c Department of Internal Medicine, School of Medicine , Universidad Nacional de Colombia , Bogota , Colombia
| | - Jose A Castro-Rodriguez
- d Division of Pediatrics, School of Medicine , Pontificia Universidad Catolica de Chile , Santiago , Chile
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Solé D, Aranda CS, Wandalsen GF. Asthma: epidemiology of disease control in Latin America - short review. Asthma Res Pract 2017; 3:4. [PMID: 28507765 PMCID: PMC5427548 DOI: 10.1186/s40733-017-0032-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
Asthma is reported as one of the most common chronic diseases in childhood, impairing the quality of life of patients and their families and incurring high costs to the healthcare system and society. Despite the development of new drugs and the availability of international treatment guidelines, asthma is still poorly controlled, especially in Latin America. Original and review articles on asthma control or epidemiology with high levels of evidence have been selected for analysis among those published in PubMed referenced journals during the last 20 years, using the following keywords: "asthma control" combined with "Latin America", " epidemiology", "prevalence", "burden", "mortality", "treatment and unmet needs", "children", "adolescents", and "infants". There was a high prevalence and severity of asthma during the period analyzed, especially in children and adolescents. Wheezing in infants was a significant reason for seeking medical care in Latin American health centers. Moreover, the frequent use of quick-relief bronchodilators and oral corticosteroids by these patients indicates the lack of a policy for providing better care for asthmatic patients, as well as poor asthma control. Among adults, studies document poor treatment and control of the disease, as revealed by low adherence to routine anti-inflammatory medications and high rates of emergency care visits and hospitalization. In conclusion, although rare, studies on asthma control in Latin America repeatedly show that patients are inadequately controlled and frequently overestimate their degree of asthma control according to the criteria used by international asthma treatment guidelines. Additional education for doctors and patients is essential for adequate control of this illness, and therefore also for reduction of the individual and social burden of asthma.
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Affiliation(s)
- Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Escola Paulista de Medicina, Federal University of São Paulo, Rua dos Otonis, 725 - Vila Clementino, 04025-002 São Paulo, Brazil
| | - Carolina Sanchez Aranda
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Escola Paulista de Medicina, Federal University of São Paulo, Rua dos Otonis, 725 - Vila Clementino, 04025-002 São Paulo, Brazil
| | - Gustavo Falbo Wandalsen
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Escola Paulista de Medicina, Federal University of São Paulo, Rua dos Otonis, 725 - Vila Clementino, 04025-002 São Paulo, Brazil
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Asher I, Haahtela T, Selroos O, Ellwood P, Ellwood E. Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma. Allergol Immunopathol (Madr) 2017; 45:105-114. [PMID: 28161283 DOI: 10.1016/j.aller.2016.10.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/31/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Several countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to individuals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world. METHODS The Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013-2014. One of the questions was: "Has a national asthma strategy been developed in your country for the next five years? For children? For adults?". RESULTS Investigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults; 22 (19.6%) countries had a strategy for both children and adults; 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p<0.001). INTERPRETATION In 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy.
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Abstract
Tremendous efforts have been invested in research to (1) discover risk factors, biomarkers, and clinical characteristics; (2) understand the pathophysiology and treatment response variability in severe asthma; and (3) design new therapies. However, to combat severe asthma, many questions concerning the pathogenesis of severe asthma, including its natural history, genetic and environmental risk factors, and disease mechanisms, must be answered. In this article we highlight some of the major discoveries concerning the pathogenesis of severe asthma and its therapeutic development. We conclude that discoveries on numerous fronts of severe asthma, from disease heterogeneity, features of airway remodeling, cytokine mediators and signaling pathways underlying disease pathogenesis, disease mechanisms, potential biomarkers, to new therapeutic targets, demonstrate that progress has been made in understanding and developing more effective treatments for this difficult-to-treat disease.
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Melo J, Moreno A, Ferriani V, Araujo AC, Vianna E, Borges M, Roxo P, Gonçalves M, Mello L, Parreira R, Silva J, Stefanelli P, Panazolo L, Cetlin A, Queiroz L, Araujo R, Dias M, Aragon D, Domingos N, Arruda LK. University and public health system partnership: A real-life intervention to improve asthma management. J Asthma 2016; 54:411-418. [PMID: 27715349 DOI: 10.1080/02770903.2016.1218012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Asthma is under-diagnosed in many parts of the world. We aimed to assess the outcome of a capacitating program on asthma for non-specialist physicians and other healthcare professionals working in the public system in Ribeirão Preto, Brazil. METHODS A group of 16 asthma specialists developed a one-year capacitating program in 11 healthcare clinics in the Northern District of the city, which included lectures on asthma, training on inhalation device use and spirometry, and development of an asthma management protocol. Researchers visited one health unit 2-4 times monthly, working with doctors on patients' care, discussing cases, and delivering lectures. Asthma education was also directed to the general population, focusing on recognition of signs and symptoms and long-term treatment, including production of educational videos available on YouTube. Outcome measures were the records of doctors' prescriptions of individual asthma medications pre- and post-intervention. RESULTS Prior to the program, 3205 units of inhaled albuterol and 2876 units of inhaled beclomethasone were delivered by the Northern District pharmacy. After the one-year program, there was increase to 4850 units (51.3%) for inhaled albuterol and 3526 units (22.6%) for inhaled beclomethasone. The albuterol increase followed the recommendation given to the non-specialist doctors by the asthma experts, that every patient with asthma should have inhaled albuterol as a rescue medication, by protocol. No increase was observed in other districts where no capacitating program was conducted. CONCLUSION A systematic capacitating program was successful in changing asthma prescription profiles among non-specialist doctors, with increased delivery of inhaled albuterol and beclomethasone.
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Affiliation(s)
- Janaina Melo
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Adriana Moreno
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Virginia Ferriani
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Ana Carla Araujo
- c Department of Medicine , University of Ribeirão Preto UNAERP , Ribeirão Preto , Brazil
| | - Elcio Vianna
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Marcos Borges
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Pérsio Roxo
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Marcos Gonçalves
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Luane Mello
- d Department of Social Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Rosa Parreira
- e Department of Pediatrics , Barão de Mauá University Center , Ribeirão Preto , Brazil
| | - Jorgete Silva
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Patricia Stefanelli
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Larissa Panazolo
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Andrea Cetlin
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Luana Queiroz
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Rosângela Araujo
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Marina Dias
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Davi Aragon
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Nélio Domingos
- f Health Secretariat of Municipal Government of the City of Ribeirão Preto , Ribeirão Preto , Brazil
| | - L Karla Arruda
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
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31
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Bousquet J, Farrell J, Crooks G, Hellings P, Bel EH, Bewick M, Chavannes NH, de Sousa JC, Cruz AA, Haahtela T, Joos G, Khaltaev N, Malva J, Muraro A, Nogues M, Palkonen S, Pedersen S, Robalo-Cordeiro C, Samolinski B, Strandberg T, Valiulis A, Yorgancioglu A, Zuberbier T, Bedbrook A, Aberer W, Adachi M, Agusti A, Akdis CA, Akdis M, Ankri J, Alonso A, Annesi-Maesano I, Ansotegui IJ, Anto JM, Arnavielhe S, Arshad H, Bai C, Baiardini I, Bachert C, Baigenzhin AK, Barbara C, Bateman ED, Beghé B, Kheder AB, Bennoor KS, Benson M, Bergmann KC, Bieber T, Bindslev-Jensen C, Bjermer L, Blain H, Blasi F, Boner AL, Bonini M, Bonini S, Bosnic-Anticevitch S, Boulet LP, Bourret R, Bousquet PJ, Braido F, Briggs AH, Brightling CE, Brozek J, Buhl R, Burney PG, Bush A, Caballero-Fonseca F, Caimmi D, Calderon MA, Calverley PM, Camargos PAM, Canonica GW, Camuzat T, Carlsen KH, Carr W, Carriazo A, Casale T, Cepeda Sarabia AM, Chatzi L, Chen YZ, Chiron R, Chkhartishvili E, Chuchalin AG, Chung KF, Ciprandi G, Cirule I, Cox L, Costa DJ, Custovic A, Dahl R, Dahlen SE, Darsow U, De Carlo G, De Blay F, Dedeu T, Deleanu D, De Manuel Keenoy E, Demoly P, Denburg JA, Devillier P, Didier A, Dinh-Xuan AT, Djukanovic R, Dokic D, Douagui H, Dray G, Dubakiene R, Durham SR, Dykewicz MS, El-Gamal Y, Emuzyte R, Fabbri LM, Fletcher M, Fiocchi A, Fink Wagner A, Fonseca J, Fokkens WJ, Forastiere F, Frith P, Gaga M, Gamkrelidze A, Garces J, Garcia-Aymerich J, Gemicioğlu B, Gereda JE, González Diaz S, Gotua M, Grisle I, Grouse L, Gutter Z, Guzmán MA, Heaney LG, Hellquist-Dahl B, Henderson D, Hendry A, Heinrich J, Heve D, Horak F, Hourihane JOB, Howarth P, Humbert M, Hyland ME, Illario M, Ivancevich JC, Jardim JR, Jares EJ, Jeandel C, Jenkins C, Johnston SL, Jonquet O, Julge K, Jung KS, Just J, Kaidashev I, Kaitov MR, Kalayci O, Kalyoncu AF, Keil T, Keith PK, Klimek L, Koffi N’Goran B, Kolek V, Koppelman GH, Kowalski ML, Kull I, Kuna P, Kvedariene V, Lambrecht B, Lau S, Larenas-Linnemann D, Laune D, Le LTT, Lieberman P, Lipworth B, Li J, Lodrup Carlsen K, Louis R, MacNee W, Magard Y, Magnan A, Mahboub B, Mair A, Majer I, Makela MJ, Manning P, Mara S, Marshall GD, Masjedi MR, Matignon P, Maurer M, Mavale-Manuel S, Melén E, Melo-Gomes E, Meltzer EO, Menzies-Gow A, Merk H, Michel JP, Miculinic N, Mihaltan F, Milenkovic B, Mohammad GMY, Molimard M, Momas I, Montilla-Santana A, Morais-Almeida M, Morgan M, Mösges R, Mullol J, Nafti S, Namazova-Baranova L, Naclerio R, Neou A, Neffen H, Nekam K, Niggemann B, Ninot G, Nyembue TD, O’Hehir RE, Ohta K, Okamoto Y, Okubo K, Ouedraogo S, Paggiaro P, Pali-Schöll I, Panzner P, Papadopoulos N, Papi A, Park HS, Passalacqua G, Pavord I, Pawankar R, Pengelly R, Pfaar O, Picard R, Pigearias B, Pin I, Plavec D, Poethig D, Pohl W, Popov TA, Portejoie F, Potter P, Postma D, Price D, Rabe KF, Raciborski F, Radier Pontal F, Repka-Ramirez S, Reitamo S, Rennard S, Rodenas F, Roberts J, Roca J, Rodriguez Mañas L, Rolland C, Roman Rodriguez M, Romano A, Rosado-Pinto J, Rosario N, Rosenwasser L, Rottem M, Ryan D, Sanchez-Borges M, Scadding GK, Schunemann HJ, Serrano E, Schmid-Grendelmeier P, Schulz H, Sheikh A, Shields M, Siafakas N, Sibille Y, Similowski T, Simons FER, Sisul JC, Skrindo I, Smit HA, Solé D, Sooronbaev T, Spranger O, Stelmach R, Sterk PJ, Sunyer J, Thijs C, To T, Todo-Bom A, Triggiani M, Valenta R, Valero AL, Valia E, Valovirta E, Van Ganse E, van Hage M, Vandenplas O, Vasankari T, Vellas B, Vestbo J, Vezzani G, Vichyanond P, Viegi G, Vogelmeier C, Vontetsianos T, Wagenmann M, Wallaert B, Walker S, Wang DY, Wahn U, Wickman M, Williams DM, Williams S, Wright J, Yawn BP, Yiallouros PK, Yusuf OM, Zaidi A, Zar HJ, Zernotti ME, Zhang L, Zhong N, Zidarn M, Mercier J. Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3: Area 5). Clin Transl Allergy 2016; 6:29. [PMID: 27478588 PMCID: PMC4966705 DOI: 10.1186/s13601-016-0116-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/02/2016] [Indexed: 01/16/2023] Open
Abstract
Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS integrated care pathways (ICPs), (2) the joint initiative between the Reference site MACVIA-LR (Contre les MAladies Chroniques pour un VIeillissement Actif) and ARIA (Allergic Rhinitis and its Impact on Asthma), (3) Commitments for Action to the European Innovation Partnership on Active and Healthy Ageing and the AIRWAYS ICPs network. It is deployed in collaboration with the World Health Organization Global Alliance against Chronic Respiratory Diseases (GARD). The European Innovation Partnership on Active and Healthy Ageing has proposed a 5-step framework for developing an individual scaling up strategy: (1) what to scale up: (1-a) databases of good practices, (1-b) assessment of viability of the scaling up of good practices, (1-c) classification of good practices for local replication and (2) how to scale up: (2-a) facilitating partnerships for scaling up, (2-b) implementation of key success factors and lessons learnt, including emerging technologies for individualised and predictive medicine. This strategy has already been applied to the chronic respiratory disease action plan of the European Innovation Partnership on Active and Healthy Ageing.
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Affiliation(s)
- J. Bousquet
- CHRU, University Hospital, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc Roussilon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
- INSERM, VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, Paris, France
- UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Paris, France
| | - J. Farrell
- Department of Health, Social Services and Public Safety, Belfast, Northern Ireland, UK
| | - G. Crooks
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, Scottish Centre for Telehealth and Telecare, NHS 24, Glasgow, UK
| | - P. Hellings
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
- European Academy of Allergy and Clinical Immunology, Zurich, Switzerland
| | - E. H. Bel
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
- European Respiratory Society, Lausanne, Switzerland
| | | | - N. H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Global Alliance Against Chronic Respiratory Diseases (GARD), Cape Town, South Africa
- International Primary Care Respiratory Group, Westhill, UK
| | - J. Correia de Sousa
- Life and Health Sciences Research Institute, ICVS, School of Health Sciences, University of Minho, Braga, Portugal
| | - A. A. Cruz
- Global Alliance Against Chronic Respiratory Diseases (GARD), Cape Town, South Africa
- ProAR – Nucleo de Excelencia em Asma, Federal University of Bahia, Bahia, Brazil
- GARD Executive Committee, Bahia, Brazil
| | - T. Haahtela
- EIP on AHA Commitment for Action, Lisbon, Portugal
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - G. Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - N. Khaltaev
- Global Alliance Against Chronic Respiratory Diseases (GARD), Cape Town, South Africa
| | - J. Malva
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Ageing@Coimbra Reference Site, Coimbra, Portugal
| | - A. Muraro
- European Academy of Allergy and Clinical Immunology, Zurich, Switzerland
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - M. Nogues
- Caisse Assurance Retraite et Santé Au Travail Languedoc-Roussillon (CARSAT-LR), 34000 Montpellier, France
| | - S. Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations, Brussels, Belgium
| | - S. Pedersen
- University of Southern Denmark, Kolding, Denmark
| | | | - B. Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - T. Strandberg
- Helsinki University, Helsinki University Hospital, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- European Union GeriatricMedicine Society, EUGMS, Oslo, Norway
| | - A. Valiulis
- Center of Quality of Life Research, Vilnius University Clinic of Children’s Diseases, Vilnius University Public Health Institute, Vilnius, Lithuania
- European Association of Pediatrics (EAP/UEMS-SP), Brussels, Belgium
| | - A. Yorgancioglu
- Global Alliance Against Chronic Respiratory Diseases (GARD), Cape Town, South Africa
- EIP on AHA Commitment for Action, Lisbon, Portugal
- Department of Pulmonology, Celal Bayar University, Manisa, Turkey
- Turkish Thoracic Society, Antalya, Turkey
| | - T. Zuberbier
- Allergy-Centre-Charité at the Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Secretary General of the Global Allergy and Asthma European Network (GA²LEN), Berlin, Germany
| | - A. Bedbrook
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc Roussilon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - W. Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - M. Adachi
- Department of Clinical Research Center, International University of Health and Welfare/Sanno Hospital, Tokyo, Japan
| | - A. Agusti
- Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - C. A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - M. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - J. Ankri
- INSERM, VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, Paris, France
- UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Paris, France
| | - A. Alonso
- Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - I. Annesi-Maesano
- EPAR U707 INSERM, Paris, France
- EPAR UMR-S UPMC, Paris VI, Paris, France
| | - I. J. Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | - J. M. Anto
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Department of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain
| | | | - H. Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - C. Bai
- Shanghai Respiratory Research Institute, Vice President of Respiratory Society, Chinese Medical Association, China and Chinese Alliance Against Lung Cancer, Shanghai, China
| | - I. Baiardini
- Allergy and Respiratory Diseases Clinic, DIMI, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - C. Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | | | - C. Barbara
- Faculdade de Medicina de Lisboa, Portuguese National Programme for Respiratory Diseases (PNDR), Lisbon, Portugal
| | - E. D. Bateman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - B. Beghé
- Section of Respiratory Disease, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - A. Ben Kheder
- Service de pneumologie IV, hôpital Abderrahman Mami, Ariana, 2080 Tunis, Tunisia
| | - K. S. Bennoor
- Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - M. Benson
- Centre for Individualized Medicine, Department of Pediatrics, Faculty of Medicine, LInköping University, Linköping, Sweden
| | - K. C. Bergmann
- Allergy-Centre-Charité at the Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Secretary General of the Global Allergy and Asthma European Network (GA²LEN), Berlin, Germany
| | - T. Bieber
- Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - L. Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - H. Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France
- EA 2991, Euromov, University Montpellier, Montpellier, France
| | - F. Blasi
- Department of Pathophysiology and Transplantation, IRCCS Fondazione Ca’Granda Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza 35, Milan, Italy
| | - A. L. Boner
- Pediatric Department, University of Verona Hospital, Verona, Italy
| | - M. Bonini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - S. Bonini
- Second University of Naples and Institute of Translational Medicine, Italian National Research Council, Naples, Italy
| | - S. Bosnic-Anticevitch
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW Australia
| | - L. P. Boulet
- Quebec Heart and Lung Institute, Laval University, Québec City, QC Canada
| | - R. Bourret
- Directeur Général Adjoint, Montpellier University Hospital, Montpellier, France
| | | | - F. Braido
- Allergy and Respiratory Diseases Clinic, DIMI, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - A. H. Briggs
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C. E. Brightling
- Respiratory Biomedical Unit, Institute of Lung Health, University Hospitals of Leicester NHS Trust, Leicestershire, UK
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - J. Brozek
- Department of Clinical Epidemiology and Biostatistics, McMaster University, HSC Room 2C16, 1280 Main Street West Hamilton, Hamilton, Canada
| | - R. Buhl
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - P. G. Burney
- National Heart and Lung Institute, Imperial College, London, London, UK
- Wellcome Centre for Global Health, Imperial College, London, London, UK
- MRC-PHE Centre for Environment and Health, Imperial College, London, London, UK
| | - A. Bush
- Imperial College and Royal Brompton Hospital, London, UK
| | | | - D. Caimmi
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - M. A. Calderon
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital NHS, London, UK
| | - P. M. Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool and University Hospital Aintree, Liverpool, UK
| | - P. A. M. Camargos
- Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - G. W. Canonica
- Allergy and Respiratory Diseases Clinic, DIMI, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - T. Camuzat
- Région Languedoc Roussillon, Montpellier, France
| | - K. H. Carlsen
- Department of Paediatrics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - W. Carr
- Allergy and Asthma Associates of Southern California, Mission Viejo, CA USA
| | - A. Carriazo
- Regional Ministry of Equality, Health and Social Policies of Andalusia, Seville, Spain
| | - T. Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, FL USA
| | - A. M. Cepeda Sarabia
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia
- Asma e Immunologia, SLaai, Sociedad Latinoamericana de Allergia, Barranquilla, Colombia
| | - L. Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, Heraklion, 71003 Crete Greece
| | - Y. Z. Chen
- National Cooperative Group of Paediatric Research on Asthma, Asthma Clinic and Education Center of the Capital Institute of Pediatrics, Peking and Center for Asthma Research and Education, Beijing, China
| | - R. Chiron
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - E. Chkhartishvili
- Chachava Clinic, David Tvildiani Medical University-AIETI Medical School, Grigol Robakidze University, Tbilisi, Georgia
| | - A. G. Chuchalin
- GARD Executive Committee, Bahia, Brazil
- Pulmonolory Research Institute FMBA, Moscow, Russia
| | - K. F. Chung
- National Heart and Lung Institute, Imperial College, London, London, UK
| | - G. Ciprandi
- Medicine Department, IRCCS-Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
| | - I. Cirule
- Latvian Allergy Association, Riga, Latvia
| | - L. Cox
- Department of Medicine, Nova Southeastern University, Davie, FL USA
| | - D. J. Costa
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc Roussilon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - A. Custovic
- Department of Paediatrics, Imperial College London, London, UK
| | - R. Dahl
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - S. E. Dahlen
- The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - U. Darsow
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
- ZAUM-Center for Allergy and Environment, Helmholtz Center Munich, Technische Universität München, Munich, Germany
| | - G. De Carlo
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations, Brussels, Belgium
| | - F. De Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France
| | - T. Dedeu
- EUREGHA, European Regional and Local Health Association, Brussels, Belgium
- University of Edinburgh, Edinburgh, UK
| | - D. Deleanu
- Allergology and Immunology Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - P. Demoly
- EPAR U707 INSERM, Paris, France
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - J. A. Denburg
- Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON Canada
| | - P. Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220, Hôpital Foch, Suresnes Université Versailles Saint-Quentin, Suresnes, France
| | - A. Didier
- Respiratory Diseases Department, Rangueil-Larrey Hospital, Toulouse, France
| | - A. T. Dinh-Xuan
- Service de physiologie respiratoire, Hôpital Cochin, Université Paris-Descartes, Assistance publique-Hôpitaux de Paris, Paris, France
| | - R. Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Faculty of Medicine, University Southampton, Southampton, UK
| | - D. Dokic
- Medical Faculty Skopje, University Clinic of Pulmology and Allergy, Skopje, Republic Macedonia
| | - H. Douagui
- Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algers, Algeria
| | - G. Dray
- Ecole des Mines, Alès, France
| | - R. Dubakiene
- Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - S. R. Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - M. S. Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - Y. El-Gamal
- Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
| | - R. Emuzyte
- Clinic of Children’s Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - A. Fiocchi
- Division of Allergy, Department of Pediatric Medicine, The Bambino Gesù Children’s Research Hospital Holy See, Rome, Italy
| | - A. Fink Wagner
- Global Allergy and Asthma Platform (GAAPP), Altgasse 8-10, 1130 Vienna, Austria
| | - J. Fonseca
- Center for Health Technology and Services Research - CINTESIS, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Allergy Unit, CUF Porto Instituto & Hospital, Porto, Portugal
| | - W. J. Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - F. Forastiere
- Department of Epidemiology, Regional Health Service Lazio Region, Rome, Italy
| | - P. Frith
- Repatriation General Hospital, Adelaide, SOUTH AUSTRALIA Australia
| | - M. Gaga
- Athens Chest Hospital, Athens, Greece
| | - A. Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - J. Garces
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - J. Garcia-Aymerich
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Department of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain
| | - B. Gemicioğlu
- Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - J. E. Gereda
- Allergy and Immunology Division, Clinica Ricardo Palma, Lima, Peru
| | - S. González Diaz
- Universidad Autónoma de Nuevo León, San Nicolás De La Garza, Mexico
| | - M. Gotua
- Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Immunology, Tbilisi, Georgia
| | - I. Grisle
- Latvian Association of Allergists, Center of Tuberculosis and Lung Diseases, Riga, Latvia
| | - L. Grouse
- Faculty of the Department of Neurology, University of Washington School of Medicine, St. Louis, MO USA
| | - Z. Gutter
- University Hospital Olomouc – National eHealth Centre, Olomouc, Czech Republic
| | - M. A. Guzmán
- Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
| | - L. G. Heaney
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - B. Hellquist-Dahl
- Department of Respiratory Diseases, Odense University Hospital, Odense, Denmark
| | - D. Henderson
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, Scottish Centre for Telehealth and Telecare, NHS 24, Glasgow, UK
| | - A. Hendry
- NHS Scotland, Edinburgh, Scotland, UK
| | - J. Heinrich
- Institute of Epidemiology I, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - D. Heve
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc Roussilon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
- Agence Régionale de Santé, 34067 Montpellier Cedex 2, France
| | - F. Horak
- Vienna Challenge Chamber, Vienna, Austria
| | - J. O’. B. Hourihane
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - P. Howarth
- University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, UK
| | - M. Humbert
- Service de Pneumologie, Hôpital Bicêtre, Inserm UMR_S999, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - M. E. Hyland
- School of Psychology, Plymouth University, Plymouth, UK
| | - M. Illario
- Federico II University Hospital/Campania RS, Naples, Italy
| | - J. C. Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - J. R. Jardim
- Universidade Federal de Sao Paulo, São Paulo, Brazil
| | | | - C. Jeandel
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc Roussilon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France
| | - C. Jenkins
- The George Institute for Global Health, The University of Sydney, Camperdown, Australia
| | - S. L. Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, London, UK
- MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - O. Jonquet
- Medical Commission, Montpellier University Hospital, Montpellier, France
| | - K. Julge
- Children’s Clinic of Tartu University Hospital, Tartu, Estonia
| | - K. S. Jung
- Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Gyeonggi-Do, South Korea
| | - J. Just
- Allergology Department, Centre de l’Asthme et des Allergies, Hôpital d’Enfants Armand-Trousseau (APHP), Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe EPAR, 75013 Paris, France
| | - I. Kaidashev
- Ukrainian Medical Stomatological Academy, Poltava, Ukraine
| | - M. R. Kaitov
- Federal Medicobiological Agency, Laboratory of Molecular Immunology, Institute of Immunology, National Research Center, Moscow, Russian Federation
| | - O. Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - A. F. Kalyoncu
- Immunology and Allergy Division, Department of Chest Diseases, School of Medicine, Hacettepe University, Ankara, Turkey
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - P. K. Keith
- Department of Medicine, McMaster University, Health Sciences Centre 3V47, 1280 Main Street West, Hamilton, Canada
| | - L. Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - B. Koffi N’Goran
- Société de Pneumologie de Langue Française, Espace francophone de Pneumologie, Paris, France
| | - V. Kolek
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, University Hospital Olomouc, Olomouc, Czech Republic
| | - G. H. Koppelman
- GRIACResearch Institute, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, and HARC, Lodz, Poland
| | - I. Kull
- Sachs’ Children’s Hospital, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - P. Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - V. Kvedariene
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology, Vilnius University, Vilnius, Lithuania
| | - B. Lambrecht
- VIB Inflammation Research Center, Ghent University, Ghent, Belgium
| | - S. Lau
- Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - D. Larenas-Linnemann
- Clínica de Alergia, Asma y Pediatría, Hospital Médica Sur, Ciudad De México, Mexico
| | - D. Laune
- Digi Health, Montpellier, France
| | - L. T. T. Le
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - P. Lieberman
- Divisions of Allergy and Immunology, Departments of Internal Medicine and Pediatrics, University of Tennessee College of Medicine, Germantown, TN USA
| | - B. Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK
| | - J. Li
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120 China
| | - K. Lodrup Carlsen
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - R. Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, Belgium
| | - W. MacNee
- Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Y. Magard
- Service de Pneumo-allergologie, Hôpital Saint-Joseph, Paris, France
| | - A. Magnan
- Service de Pneumologie, UMR INSERM, UMR1087and CNR 6291, l’institut du thorax, University of Nantes, Nantes, France
| | - B. Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
| | - A. Mair
- Scottish Government Health Department, eHealth and Pharmaceuticals, Edinburgh, UK
| | - I. Majer
- Department of Respiratory Medicine, University of Bratislava, Bratislava, Slovakia
| | - M. J. Makela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - P. Manning
- Department of Medicine (RCSI), Bon Secours Hospital, Glasnevin, Dublin, Ireland
| | - S. Mara
- Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - G. D. Marshall
- Division of Clinical Immunology and Allergy, Laboratory of Behavioral Immunology Research, The University of Mississippi Medical Center, Jackson, MS USA
| | - M. R. Masjedi
- Respiratory Medicine Research, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - M. Maurer
- Allergie-Centrum-Charité at the Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S. Mavale-Manuel
- Department of Paediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - E. Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E. Melo-Gomes
- PNDR/Portuguese National Programme for Respiratory Diseases, Lisbon, Portugal
| | - E. O. Meltzer
- Allergy and Asthma Medical Group and Research Center, San Diego, CA USA
| | | | - H. Merk
- Hautklinik - Klinik für Dermatologie & Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Germany
| | - J. P. Michel
- European Union GeriatricMedicine Society, EUGMS, Oslo, Norway
| | | | - F. Mihaltan
- National Institute of Pneumology M. Nasta, Bucharest, Romania
| | - B. Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Serbian Association for Asthma and COPD, Belgrade, Serbia
| | - G. M. Y. Mohammad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria
| | - M. Molimard
- Département de Pharmacologie, CHU de Bordeaux, Universite Bordeaux, INSERM U657, Bordeaux Cedex, France
| | - I. Momas
- Department of Public Health and Biostatistics, EA 4064, Paris Descartes University, Paris, France
- Paris Municipal Department of Social Action, Childhood, and Health, Paris, France
| | | | - M. Morais-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisbon, Portugal
| | - M. Morgan
- National Clinical Director for Respiratory Services, NHS England, Leeds, England, UK
| | - R. Mösges
- Institute of Medical Statistics, Informatics and Epidemiology, Medical Faculty, University of Cologne, Cologne, Germany
| | - J. Mullol
- Sachs’ Children’s Hospital, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Unitat de Rinologia i Clínica de l’Olfacte, Servei d’ORL, Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | - S. Nafti
- Mustapha Hospital, Algers, Algeria
| | - L. Namazova-Baranova
- Scientific Centre of Children’s Health Under the Russian Academy of Medical Sciences, Moscow, Russia
| | - R. Naclerio
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medical Center and The Pritzker School of Medicine, The University of Chicago, Chicago, IL USA
| | - A. Neou
- Allergy-Centre-Charité at the Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Secretary General of the Global Allergy and Asthma European Network (GA²LEN), Berlin, Germany
| | - H. Neffen
- Hospital de Niños Orlando Alassia, Santa Fe, Argentina
| | - K. Nekam
- Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary
| | - B. Niggemann
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - G. Ninot
- EA4556 Epsylon, Université Montpellier 1, Montpellier, France
| | - T. D. Nyembue
- ENT Department, University Hospital of Kinshasa, Kinshasa, Congo
| | - R. E. O’Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC Australia
- Department of Immunology, Monash University, Melbourne, VIC Australia
| | - K. Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
| | - Y. Okamoto
- Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - K. Okubo
- Department of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - S. Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - P. Paggiaro
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - I. Pali-Schöll
- Department of Comparative Medicine, Messerli, Research Institute of the University of Veterinary Medicine and Medical University, Vienna, Austria
| | - P. Panzner
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - N. Papadopoulos
- Center for Pediatrics and Child Health, Institute of Human Development, Royal Manchester Children’s Hospital, University of Manchester, Manchester, M13 9WL UK
- Allergy Department, 2nd Pediatric Clinic, Athens General Children’s Hospital “P&A Kyriakou”, University of Athens, Athens, 11527 Greece
| | - A. Papi
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - H. S. Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - G. Passalacqua
- Allergy and Respiratory Diseases Clinic, DIMI, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - I. Pavord
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - R. Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - R. Pengelly
- Department of Health, Social Services and Public Safety, Belfast, Northern Ireland, UK
| | - O. Pfaar
- Center for Rhinology and Allergology, Wiesbaden, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - R. Picard
- Conseil Général de l’Economie. Ministère de l’Economie, de l’Industrie et du Numérique, Paris, France
| | - B. Pigearias
- Société de Pneumologie de Langue Française, Espace francophone de Pneumologie, Paris, France
| | - I. Pin
- Département de pédiatrie, CHU de Grenoble, BP 217, 38043 Grenoble Cedex 9, France
| | - D. Plavec
- Children’s Hospital Srebrnjak, Zagreb, School of Medicine, University J.J. Strossmayer, Osijek, Croatia
| | - D. Poethig
- Im GerontoLab Europe - Europäische Vereinigung für Vitalität und Aktives Altern (eVAA) e.V., Leipzig, Germany
| | - W. Pohl
- Karl Landsteiner Institute for Clinical and Experimental Pneumology, Hietzing Hospital, Wolkersbergenstraße 1, 1130 Vienna, Austria
| | - T. A. Popov
- Clinic of Allergy and Asthma, Medical University Sofia, 1Sv. Georgi Sofiyski St., 1431 Sofia, Bulgaria
| | - F. Portejoie
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc Roussilon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - P. Potter
- Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - D. Postma
- Department of Pulmonary Medicine and Tuberculosis, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D. Price
- Academic Centre of Primary Care, University of Aberdeen, Aberdeen, UK
- Research in Real-Life, Cambridge, UK
| | - K. F. Rabe
- LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
- Department of Medicine, Christian Albrechts University, Airway Research Center North, Member of the German Center for Lung Research (DZL), Kiel, Germany
| | - F. Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - F. Radier Pontal
- Conseil Départemental de l’Ordre des Pharmaciens, Maison des Professions Libérales, 34000 Montpellier, France
| | | | - S. Reitamo
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - S. Rennard
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Omaha, NE USA
| | - F. Rodenas
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - J. Roberts
- Salford, Royal NHS Foundation Trust and NHS England North, London, UK
| | - J. Roca
- Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - L. Rodriguez Mañas
- Hospital Universitario de Getafe-Servicio Madrileño de Salud, Madrid, Spain
| | - C. Rolland
- Association Asthme et Allergie, Paris, France
| | - M. Roman Rodriguez
- Primary Care Respiratory Research Unit, Institutode Investigación Sanitaria de Palma IdisPa, Palma De Mallorca, Spain
| | - A. Romano
- Allergy Unit, Complesso integrato Columbus, Rome, Italy
| | - J. Rosado-Pinto
- Serviço de Imunoalergologia, Hospital da Luz, Lisbon, Portugal
| | - N. Rosario
- Hospital de Clinicas, University of Parana, Curitiba, PR Brazil
| | - L. Rosenwasser
- Department of Allergy, Asthma, and Immunology, Children’s Mercy Hospitals and Clinics and Pediatrics, Medicine University of Misouri-Kansas City School of Medicine, Kansas City, MO USA
| | - M. Rottem
- Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
| | - D. Ryan
- Woodbrook Medical Centre, Loughborough, UK
- Honorary Clinical Research Fellow, Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK
| | - M. Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico-Docente la, Trinidad and Clínica El Avila, 6a transversal Urb, Altamira, piso 8, consultorio 803, Caracas, 1060 Venezuela
| | - G. K. Scadding
- The Royal National TNE Hospital, University College London, London, UK
| | - H. J. Schunemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, HSC Room 2C16, 1280 Main Street West Hamilton, Hamilton, Canada
| | - E. Serrano
- Otolaryngology and Head and Neck Surgery, CHU Rangueil-Larrey, Toulouse, France
| | - P. Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - H. Schulz
- Helmholtz Zentrum München/Institute of Epidemiology I, Neuherberg, Germany
| | - A. Sheikh
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, Medical School, The University of Edinburgh, Edinburgh, UK
| | - M. Shields
- Child Health, Queen’s University Belfast and Royal Belfast Hospital for Sick Children, Belfast, UK
| | - N. Siafakas
- Department of Thoracic Medicine, University Hospital of Heraklion, Crete, Greece
| | - Y. Sibille
- University Hospital of Mont-Godinne, Catholic University of Louvain, Yvoir, Belgium
| | - T. Similowski
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- INSERM, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Department R3S, AP-HP, Groupe, Paris, France
| | - F. E. R. Simons
- Department of Pediatrics and Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - J. C. Sisul
- Sociedad Paraguaya de Alergia Asma e Inmunología, Asunción, Paraguay
| | - I. Skrindo
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - H. A. Smit
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - D. Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - T. Sooronbaev
- Kyrgyzstan National Centre of Cardiology and Internal Medicine, Euro-Asian Respiratory Society, Bishkek, Kyrgyzstan
| | - O. Spranger
- Global Allergy and Asthma Platform (GAAPP), Altgasse 8-10, 1130 Vienna, Austria
| | - R. Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - P. J. Sterk
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J. Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Department of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain
| | - C. Thijs
- Department of Epidemiology, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - T. To
- Sidkkids hospitala and Institute of Health Policy, Management and Evaluation, Toronto, ON Canada
| | - A. Todo-Bom
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M. Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - R. Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - A. L. Valero
- Pneumology and Allergy Department, Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | - E. Valia
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - E. Valovirta
- Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - E. Van Ganse
- Unité de Pharmacoépidémiologie, CHU-Lyon - UR 5558 CNRS, Université Claude Bernard, Lyon, Villeurbanne, France
| | - M. van Hage
- Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - O. Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire Dinant-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - T. Vasankari
- FILHA, Finnish Lung Association, Helsinki, Finland
| | - B. Vellas
- Gérontopôle, CHU Toulouse, Toulouse, France
| | - J. Vestbo
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- University Hospital of South Manchester, Manchester NHS Foundation Trust, Manchester, UK
| | - G. Vezzani
- Pulmonary Unit, Department of Cardiology, Thoracic and Vascular Medicine, Arcispedale S.Maria Nuova/IRCCS, Research Hospital, Reggio Emilia, Italy
- Regional Agency for Health and Social Care, Reggio Emilia, Italy
| | - P. Vichyanond
- Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, 10700 Thailand
| | - G. Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Via Trieste 41, 56126 Pisa, Italy
- CNR Institute of Biomedicine and Molecular Immunology “A. Monroy”, Via U. La Malfa 153, 90146 Palermo, Italy
| | - C. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
| | | | - M. Wagenmann
- Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - B. Wallaert
- Hôpital Albert Calmette, CHRU, Lille, France
| | - S. Walker
- Asthma UK, Mansell Street, London, UK
| | - D. Y. Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - U. Wahn
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - M. Wickman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - D. M. Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC USA
| | - S. Williams
- International Primary Care Respiratory Group, Westhill, UK
| | - J. Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - B. P. Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN USA
| | - P. K. Yiallouros
- Cyprus International Institute for Environmental and Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
- Department of Pediatrics, Hospital “Archbishop Makarios III”, Nicosia, Cyprus
| | - O. M. Yusuf
- The Allergy and Asthma Institute, Lahore, Pakistan
| | - A. Zaidi
- Social Sciences, University of Southampton, Southampton, UK
| | - H. J. Zar
- Department of Paediatrics and Child Health, Red Cross Children’s Hospital, and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | | | - L. Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - N. Zhong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120 China
| | - M. Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - J. Mercier
- Department of Physiology, CHRU and Vice President for Research, University Montpellier, Montpellier, France
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Selroos O, Kupczyk M, Kuna P, Łacwik P, Bousquet J, Brennan D, Palkonen S, Contreras J, FitzGerald M, Hedlin G, Johnston SL, Louis R, Metcalf L, Walker S, Moreno-Galdó A, Papadopoulos NG, Rosado-Pinto J, Powell P, Haahtela T. National and regional asthma programmes in Europe. Eur Respir Rev 2016; 24:474-83. [PMID: 26324809 DOI: 10.1183/16000617.00008114] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This review presents seven national asthma programmes to support the European Asthma Research and Innovation Partnership in developing strategies to reduce asthma mortality and morbidity across Europe. From published data it appears that in order to influence asthma care, national/regional asthma programmes are more effective than conventional treatment guidelines. An asthma programme should start with the universal commitments of stakeholders at all levels and the programme has to be endorsed by political and governmental bodies. When the national problems have been identified, the goals of the programme have to be clearly defined with measures to evaluate progress. An action plan has to be developed, including defined re-allocation of patients and existing resources, if necessary, between primary care and specialised healthcare units or hospital centres. Patients should be involved in guided self-management education and structured follow-up in relation to disease severity. The three evaluated programmes show that, thanks to rigorous efforts, it is possible to improve patients' quality of life and reduce hospitalisation, asthma mortality, sick leave and disability pensions. The direct and indirect costs, both for the individual patient and for society, can be significantly reduced. The results can form the basis for development of further programme activities in Europe.
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Affiliation(s)
- Olof Selroos
- Selroos Medical Consulting (Semeco AB), Ängelholm, Sweden
| | - Maciej Kupczyk
- Dept of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Piotr Kuna
- Dept of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Piotr Łacwik
- Dept of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Jean Bousquet
- National Institute for Health and Medical Research (INSERM), Paris, France
| | - David Brennan
- European Federation of Asthma and Airways Diseases Patients' Association (EFA), Brussels, Belgium
| | - Susanna Palkonen
- European Federation of Asthma and Airways Diseases Patients' Association (EFA), Brussels, Belgium
| | - Javier Contreras
- National Federation of Respiratory Disease Associations (FENAER), Malaga, Spain
| | | | - Gunilla Hedlin
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, UK
| | - Renaud Louis
- Dept of Pneumology, CHU Sart-Tilman Liège, Liège, Belgium
| | | | | | | | | | | | | | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Almomani BA, Al-Sawalha NA, Samrah SM, Gamble JM, Al Momani MA. Asthma insights from Jordan: cross-sectional observational study. J Asthma 2016; 53:349-55. [PMID: 26666170 DOI: 10.3109/02770903.2015.1121493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The burden of uncontrolled asthma on patients in Jordan is largely unknown. This study assessed different aspects of asthma clinical features: the level of asthma control, its correlation with quality of life, and possible predictors of asthma control. METHODS Face-to-face interviews with asthmatic patients (≥16 years old) in north Jordan from 2013 to 2014 were conducted. Outcomes measures were assessed using the asthma control test (ACT), the mini asthma quality of life questionnaire (mini-AQLQ), and the Generic health-related quality of life (EQ-5D). The relationship between asthma control and quality of life was examined using Spearman's correlation coefficient. Predictors of asthma control were determined using multivariable logistic regression adjusted for confounders. RESULTS A total of 255 patients were recruited (mean age 45.16 years, 74.5% female). Approximately one-third of subjects (30.6%; n = 78) had controlled asthma (ACT ≥ 20). A strong correlation between asthma control and both mini-AQLQ and EQ-5D scores was identified (p < 0.001). Subjects who required to step-up treatment (OR = 0.12, 95% CI: 0.02-0.63, p = 0.01) and with acute asthma exacerbation (OR = 0.32, 95% CI: 0.18-0.58, p < 0.001) were independently associated with poor asthma control. CONCLUSIONS Most of the recruited patients have not achieved optimal asthma control and was associated with low quality of life. The study highlights that even in low-income countries, a simple assessment tool such as the ACT can be utilized to screen and categorize asthma control. This approach would facilitate a better treatment plan and eventually improve asthma control and quality of life in asthma patients.
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Affiliation(s)
- Basima A Almomani
- a Department of Clinical Pharmacy , Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Nour A Al-Sawalha
- a Department of Clinical Pharmacy , Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Shaher M Samrah
- b Faculty of Medicine , Jordan University of Science and Technology , Irbid , Jordan .,c Department of Internal Medicine , King Abdullah University Hospital , Irbid , Jordan
| | - Jacqueline M Gamble
- d Centre for Infection and Immunity, Queen's University of Belfast , Northern Ireland , UK .,e Regional Respiratory Centre, Belfast City Hospital , Northern Ireland , UK , and
| | - Miral A Al Momani
- b Faculty of Medicine , Jordan University of Science and Technology , Irbid , Jordan .,f Department of Pediatrics and Neonatology , King Abdullah University Hospital , Irbid , Jordan
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Stelmach R, Cerci Neto A, Fonseca ACDCF, Ponte EV, Alves G, Araujo-Costa IN, Lasmar LMDLBF, Castro LKKD, Lenz MLM, Silva P, Cukier A, Alves AM, Lima-Matos AS, Cardoso ADRO, Fernandes ALG, São-José BPD, Riedi CA, Schor D, Peixoto DM, Brandenburg DD, Camillo EGDS, Serpa FS, Brandão HV, Lima JAB, Pio JE, Fiterman J, Anderson MDF, Cardoso MDSDL, Rodrigues MT, Pereira MNEU, Antila M, Martins SM, Guimarães VGT, Mello YAM, Andrade WCCD, Salibe-Filho W, Caldeira ZMDR, Cruz-Filho ÁASD, Camargos P. A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts. J Bras Pneumol 2015; 41:3-15. [PMID: 25750669 PMCID: PMC4350820 DOI: 10.1590/s1806-37132015000100002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/17/2014] [Indexed: 11/22/2022] Open
Abstract
Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.
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Affiliation(s)
- Rafael Stelmach
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Department of Pulmonology, Heart Institute, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - HC-FMUSP, University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - Alcindo Cerci Neto
- State University at Londrina, Londrina, Brazil. (Paraná) State University at Londrina; and Coordinator. Programa Respira Londrina (Breathe, Londrina Program), Londrina, Brazil
| | | | - Eduardo Vieira Ponte
- Jundiaí School of Medicine, Jundiaí, Brazil. Jundiaí School of Medicine, Jundiaí, Brazil
| | - Gerardo Alves
- Fortaleza Municipal Department of Health, Fortaleza, Brazil. Programa de Atenção Integral à Criança e Adulto com Asma de Fortaleza - PROAICA, Integrated Asthma Management Program for Chidren and Adults in Fortaleza - Fortaleza Municipal Department of Health, Fortaleza, Brazil
| | - Ildely Niedia Araujo-Costa
- University Hospital, Federal University of Maranhão, São Luís, Brazil. Asthma Patient Care Program, Federal University of Maranhão University Hospital, São Luís, Brazil
| | - Laura Maria de Lima Belizário Facury Lasmar
- Federal University of Minas Gerais, Belo Horizonte, Brazil. Federal University of Minas Gerais; and Pediatric Pulmonologist. Centro Multidisciplinar para Asma de Difícil Controle - CEMAD, Multidisciplinary Center for the Treatment of Difficult-to-Control Asthma - and Programa Criança que Chia (Wheezing Child Program), Belo Horizonte City Hall, Belo Horizonte, Brazil
| | - Luci Keiko Kuromoto de Castro
- Programa Respira Londrina, Londrina, Brazil. Programa Respira Londrina (Breathe, Londrina Program), Londrina, Brazil
| | - Maria Lucia Medeiros Lenz
- Conceição Hospital Group, Porto Alegre, Brazil. Asthma Program, Conceição Hospital Group, Porto Alegre, Brazil
| | - Paulo Silva
- Asthma Patient Management Program, Montenegro, Brazil. Asthma Patient Management Program - RESPIRAÇÃO - Montenegro, Brazil
| | - Alberto Cukier
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Department of Pulmonology. Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Alexssandra Maia Alves
- Fortaleza Municipal Department of Health, Fortaleza, Brazil. Fortaleza Municipal Department of Health, Fortaleza, Brazil
| | - Aline Silva Lima-Matos
- Bahia State Asthma Control Program, Salvador, Brazil. Programa para Controle da Asma na Bahia - ProAR, Bahia State Asthma Control Program - Salvador, Brazil
| | - Amanda da Rocha Oliveira Cardoso
- Goiânia Municipal Department of Health, Goiânia, Brazil. Programa Catavento (Pinwheel Program), Goiânia Municipal Department of Health, Goiânia, Brazil
| | - Ana Luisa Godoy Fernandes
- Federal University of São Paulo, Paulista School of Medicine, Department of Pulmonology, São Paulo, Brazil. Department of Pulmonology, Federal University of São Paulo Paulista School of Medicine, São Paulo, Brazil
| | - Bruno Piassi de São-José
- Federal University of Minas Gerais, Hospital das Clínicas, Belo Horizonte, Brazil. Pulmonology Outpatient Clinic, Federal University of Minas Gerais Hospital das Clínicas, Belo Horizonte, Brazil
| | - Carlos Antônio Riedi
- Federal University of Paraná, Curitiba, Brazil. Federal University of Paraná, Curitiba, Brazil
| | - Deborah Schor
- Federal University of Pernambuco, Hospital das Clínicas, Recife, Brazil. Allergy Outpatient Clinic, Recife Allergology Center; and Volunteer Preceptor. Asthma Outpatient Clinic, Federal University of Pernambuco Hospital das Clínicas, Recife, Brazil
| | - Décio Medeiros Peixoto
- Federal University of Pernambuco, Mother and Child Department, Recife, Brazil. Mother and Child Department, Federal University of Pernambuco, Recife, Brazil
| | - Diego Djones Brandenburg
- Porto Alegre Hospital de Clínicas, Montenegro, Brazil. Porto Alegre Hospital de Clínicas, Porto Alegre, Brazil and Asthma Patient Management Program - RESPIRAÇÃO - Montenegro, Brazil
| | | | - Faradiba Sarquis Serpa
- School of Medical Sciences, Santa Casa de Misericórdia de Vitória, Vitória, Brazil. Asthma Program, Santa Casa de Misericórdia de Vitória School of Medical Sciences, Vitória, Brazil
| | - Heli Vieira Brandão
- Bahia State University at Feira de Santana, Department of Pediatrics, Feira de Santana, Brazil. Department of Pediatrics, Bahia State University at Feira de Santana; and Coordinator. Feira de Santana Asthma and Allergic Rhinitis Control Program, Feira de Santana, Brazil
| | - João Antonio Bonfadini Lima
- Porto Alegre Municipal Department of Health, Porto Alegre, Brazil. Asthma Program, Porto Alegre Municipal Department of Health, Porto Alegre, Brazil
| | - Jorge Eduardo Pio
- Rio de Janeiro Municipal Department of Health, Rio de Janeiro, Brazil. Rio de Janeiro Municipal Department of Health, Rio de Janeiro, Brazil
| | - Jussara Fiterman
- Pontifical Catholic University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil. Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Pontifical Catholic University of Rio Grande do Sul - School of Medicine, Porto Alegre, Brazil
| | - Maria de Fátima Anderson
- Brazilian Association of Asthma Patients, Rio de Janeiro, Brazil. Associação Brasileira de Asmáticos - ABRA, Brazilian Association of Asthma Patients - Rio de Janeiro, Brazil
| | - Maria do Socorro de Lucena Cardoso
- Federal University of Amazonas, Manaus, Brazil. Programa de Assistência e Controle da Asma - PACA, Asthma Care and Control Program - and Associate Professor. Universidade Federal do Amazonas - UFAM, Federal University of Amazonas - Manaus, Brazil
| | - Marcelo Tadday Rodrigues
- Santa Casa Sisters of Mercy, Hospital of Porto Alegre, Porto Alegre, Brazil. Universidade de Santa Cruz do Sul - UNISC, University of Santa Cruz do Sul - Santa Cruz do Sul, Brazil; and Pulmonologist. Pereira Filho Ward, Irmandade da Santa Casa de Misericórdia de Porto Alegre - ISCMPA, Santa Casa Sisters of Mercy Hospital of Porto Alegre - Porto Alegre, Brazil
| | - Marilyn Nilda Esther Urrutia Pereira
- Uruguaiana Municipal Department of Health, Uruguaiana, Brazil. Programa Infantil de Prevenção de Asma - PIPA, Children's Asthma Prevention Program - Uruguaiana Municipal Department of Health, Uruguaiana, Brazil
| | - Marti Antila
- Sorocaba Municipal Asthma Program, Sorocaba, Brazil. Sorocaba Municipal Asthma Program, Sorocaba, Brazil. Physician. Programa Respira Rio, Rio de Janeiro, Brazil. Programa Respira Rio (Breathe, Rio Program), Rio de Janeiro, Brazil
| | - Sonia Maria Martins
- Brazilian Society of Family and Community Medicine, Rio de Janeiro, Brazil. Grupo de Trabalho de Problemas Respiratórios - GRESP, Working Group on Respiratory Problems - Sociedade Brasileira de Medicina de Família e Comunidade - SBMFC, Brazilian Society of Family and Community Medicine - Rio de Janeiro, Brazil
| | - Vanessa Gonzaga Tavares Guimarães
- Brasília Mother and Child Hospital, Brasília, Brazil. Programa de Atendimento ao Paciente Asmático do Distrito Federal - PAPA-DF, Asthma Patient Management Program in the Federal District of Brasília - and Supervisor. Residency Program in Pediatric Allergy and Immunology, Brasília Mother and Child Hospital, Brasília, Brazil
| | - Yara Arruda Marques Mello
- Associação Brasileira de Asmáticos, São Paulo, Brazil. Department of Allergy and Immunology, Edmundo Vasconcelos Hospital Complex; and Director. Associação Brasileira de Asmáticos-São Paulo - ABRA, Brazilian Association of Asthma Patients-SP - São Paulo, Brazil
| | - Wenderson Clay Correia de Andrade
- Itabira Municipal Department of Health, Itabira, Brazil. Projeto Respirai (Breathe Project), Itabira Municipal Department of Health, Itabira, Brazil
| | - William Salibe-Filho
- São Camilo University Center, School of Medicine, São Paulo, Brazil. Department of Pulmonology, ABC School of Medicine, Santo André, Brazil; and Professor. São Camilo University Center School of Medicine, São Paulo, Brazil
| | - Zelina Maria da Rocha Caldeira
- Associação Brasileira de Asmáticos, São Paulo, Brazil. Niterói Municipal Health Foundation, Niterói, Brazil. Pediatrician and Director of Government Policy and International Relations. Associação Brasileira de Asmáticos-São Paulo - ABRA, Brazilian Association of Asthma Patients-SP - São Paulo, Brazil
| | - Álvaro Augusto Souza da Cruz-Filho
- Federal University of Bahia, School of Medicine, Salvador, Brazil. Federal University of Bahia School of Medicine; and Coordinator. Center of Excellence in Asthma, Salvador, Brazil
| | - Paulo Camargos
- Federal University of Minas Gerais, Department of Pediatrics, Belo Horizonte, Brazil. Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Forno E, Gogna M, Cepeda A, Yañez A, Solé D, Cooper P, Avila L, Soto-Quiros M, Castro-Rodriguez JA, Celedón JC. Asthma in Latin America. Thorax 2015; 70:898-905. [PMID: 26103996 DOI: 10.1136/thoraxjnl-2015-207199] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/02/2015] [Indexed: 12/20/2022]
Abstract
Consistent with the diversity of Latin America, there is profound variability in asthma burden among and within countries in this region. Regional variation in asthma prevalence is likely multifactorial and due to genetics, perinatal exposures, diet, obesity, tobacco use, indoor and outdoor pollutants, psychosocial stress and microbial or parasitic infections. Similarly, non-uniform progress in asthma management leads to regional variability in disease morbidity. Future studies of distinct asthma phenotypes should follow-up well-characterised Latin American subgroups and examine risk factors that are unique or common in Latin America (eg, stress and violence, parasitic infections and use of biomass fuels for cooking). Because most Latin American countries share the same barriers to asthma management, concerted and multifaceted public health and research efforts are needed, including approaches to curtail tobacco use, campaigns to improve asthma treatment, broadening access to care and clinical trials of non-pharmacological interventions (eg, replacing biomass fuels with gas or electric stoves).
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Affiliation(s)
- Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mudita Gogna
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alfonso Cepeda
- Fundación Hospital Universitario Metropolitano, Laboratorio de Alergia e Inmunología, Universidad Metropolitana, Barranquilla, Barranquilla, Colombia
| | - Anahi Yañez
- Division of Allergy and Immunology, Servicio de Alergia e Inmunología Clínica, Hospital Aeronáutico Central, Buenos Aires, Argentina
| | - Dirceu Solé
- Escola Paulista de Medicina, São Paulo, Brazil
| | - Philip Cooper
- Laboratorio de Investigaciones FEPIS, Quinindé, Esmeraldas, Ecuador Institute of Infection and Immunity, St George's University of London, London, UK
| | | | | | - Jose A Castro-Rodriguez
- Departments of Pediatrics and Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Peytremann‐Bridevaux I, Arditi C, Gex G, Bridevaux P, Burnand B. Chronic disease management programmes for adults with asthma. Cochrane Database Syst Rev 2015; 2015:CD007988. [PMID: 26014500 PMCID: PMC10640711 DOI: 10.1002/14651858.cd007988.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The burden of asthma on patients and healthcare systems is substantial. Interventions have been developed to overcome difficulties in asthma management. These include chronic disease management programmes, which are more than simple patient education, encompassing a set of coherent interventions that centre on the patients' needs, encouraging the co-ordination and integration of health services provided by a variety of healthcare professionals, and emphasising patient self-management as well as patient education. OBJECTIVES To evaluate the effectiveness of chronic disease management programmes for adults with asthma. SEARCH METHODS Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, MEDLINE (MEDLINE In-Process and Other Non-Indexed Citations), EMBASE, CINAHL, and PsycINFO were searched up to June 2014. We also handsearched selected journals from 2000 to 2012 and scanned reference lists of relevant reviews. SELECTION CRITERIA We included individual or cluster-randomised controlled trials, non-randomised controlled trials, and controlled before-after studies comparing chronic disease management programmes with usual care in adults over 16 years of age with a diagnosis of asthma. The chronic disease management programmes had to satisfy at least the following five criteria: an organisational component targeting patients; an organisational component targeting healthcare professionals or the healthcare system, or both; patient education or self-management support, or both; active involvement of two or more healthcare professionals in patient care; a minimum duration of three months. DATA COLLECTION AND ANALYSIS After an initial screen of the titles, two review authors working independently assessed the studies for eligibility and study quality; they also extracted the data. We contacted authors to obtain missing information and additional data, where necessary. We pooled results using the random-effects model and reported the pooled mean or standardised mean differences (SMDs). MAIN RESULTS A total of 20 studies including 81,746 patients (median 129.5) were included in this review, with a follow-up ranging from 3 to more than 12 months. Patients' mean age was 42.5 years, 60% were female, and their asthma was mostly rated as moderate to severe. Overall the studies were of moderate to low methodological quality, because of limitations in their design and the wide confidence intervals for certain results.Compared with usual care, chronic disease management programmes resulted in improvements in asthma-specific quality of life (SMD 0.22, 95% confidence interval (CI) 0.08 to 0.37), asthma severity scores (SMD 0.18, 95% CI 0.05 to 0.30), and lung function tests (SMD 0.19, 95% CI 0.09 to 0.30). The data for improvement in self-efficacy scores were inconclusive (SMD 0.51, 95% CI -0.08 to 1.11). Results on hospitalisations and emergency department or unscheduled visits could not be combined in a meta-analysis because the data were too heterogeneous; results from the individual studies were inconclusive overall. Only a few studies reported results on asthma exacerbations, days off work or school, use of an action plan, and patient satisfaction. Meta-analyses could not be performed for these outcomes. AUTHORS' CONCLUSIONS There is moderate to low quality evidence that chronic disease management programmes for adults with asthma can improve asthma-specific quality of life, asthma severity, and lung function tests. Overall, these results provide encouraging evidence of the potential effectiveness of these programmes in adults with asthma when compared with usual care. However, the optimal composition of asthma chronic disease management programmes and their added value, compared with education or self-management alone that is usually offered to patients with asthma, need further investigation.
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Affiliation(s)
- Isabelle Peytremann‐Bridevaux
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneSwitzerlandCH‐1010
| | - Chantal Arditi
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneSwitzerlandCH‐1010
| | - Grégoire Gex
- Hôpital du ValaisService de PneumologieSionSwitzerland
| | | | - Bernard Burnand
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneSwitzerlandCH‐1010
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Haahtela T, Selroos O, O'Byrne PM. Revisiting early intervention in adult asthma. ERJ Open Res 2015; 1:00022-2015. [PMID: 27730140 PMCID: PMC5005140 DOI: 10.1183/23120541.00022-2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/31/2015] [Indexed: 11/13/2022] Open
Abstract
The term "early intervention" with inhaled corticosteroids (ICS) in asthma is used in different ways, thereby causing confusion and misinterpretation of data. We propose that the term should be reserved for start of ICS therapy in patients with a diagnosis of asthma but within a short period of time after the first symptoms, not from the date of diagnosis. Prospective clinical studies suggest a time frame of 2 years for the term "early" from the onset of symptoms to starting anti-inflammatory treatment with ICS. The current literature supports early intervention with ICS for all patients with asthma including patients with mild disease, who often have normal or near-normal lung function. This approach reduces symptoms rapidly and allows patients to achieve early asthma control. Later introduction of ICS therapy may not reduce effectiveness in terms of lung function but delays asthma control and exposes patients to unnecessary morbidity. Results of nationwide intervention programmes support the early use of ICS, as it significantly minimises the disease burden. Acute asthma exacerbations are usually preceded by progressing symptoms and lung function decline over a period of 1-2 weeks. Treatment with an increased dose of ICS together with a rapid- and long-acting inhaled β2-agonist during this phase has reduced the risk of severe exacerbations.
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Affiliation(s)
- Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Olof Selroos
- Semeco AB, Ängelholm, Sweden and Helsinki University, Helsinki, Finland
| | - Paul M. O'Byrne
- Firestone Institute for Respiratory Health, St Joseph's Hospital and McMaster University, Hamilton, ON, Canada
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Fernandes AGO, Souza-Machado C, Coelho RCP, Franco PA, Esquivel RM, Souza-Machado A, Cruz AA. Risk factors for death in patients with severe asthma. J Bras Pneumol 2015; 40:364-72. [PMID: 25210958 PMCID: PMC4201166 DOI: 10.1590/s1806-37132014000400003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/02/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To identify risk factors for death among patients with severe asthma. METHODS: This was a nested case-control study. Among the patients with severe asthma
treated between December of 2002 and December of 2010 at the Central Referral
Outpatient Clinic of the Bahia State Asthma Control Program, in the city of
Salvador, Brazil, we selected all those who died, as well as selecting other
patients with severe asthma to be used as controls (at a ratio of 1:4). Data were
collected from the medical charts of the patients, home visit reports, and death
certificates. RESULTS: We selected 58 cases of deaths and 232 control cases. Most of the deaths were
attributed to respiratory causes and occurred within a health care facility.
Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease,
long-standing asthma, and persistent airflow obstruction were common features in
both groups. Multivariate analysis showed that male gender, FEV1
pre-bronchodilator < 60% of predicted, and the lack of control of asthma
symptoms were significantly and independently associated with mortality in this
sample of patients with severe asthma. CONCLUSIONS: In this cohort of outpatients with severe asthma, the deaths occurred
predominantly due to respiratory causes and within a health care facility. Lack of
asthma control and male gender were risk factors for mortality.
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Gazzotti MR, Nascimento OA, Montealegre F, Fish J, Jardim JR. Level of asthma control and its impact on activities of daily living in asthma patients in Brazil. J Bras Pneumol 2014; 39:532-8. [PMID: 24310625 PMCID: PMC4075876 DOI: 10.1590/s1806-37132013000500002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 08/12/2013] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE: To evaluate the impact of asthma on activities of daily living and on health
status in patients with controlled, partially controlled, or uncontrolled asthma
in Brazil. METHODS: We used data related to 400 patients in four Brazilian cities (São Paulo, Rio de
Janeiro, Salvador, and Curitiba), obtained in a survey conducted throughout Latin
America in 2011. All study subjects were > 12 years of age and completed a
standardized questionnaire in face-to-face interviews. The questions addressed
asthma control, hospitalizations, emergency room visits, and school/work
absenteeism, as well as the impact of asthma on the quality of life, sleep, and
leisure. The level of asthma control was determined in accordance with the Global
Initiative for Asthma criteria. RESULTS: Among the 400 respondents, asthma was controlled in 37 (9.3%), partially
controlled in 226 (56.5%), and uncontrolled in 137 (34.2%). The numbers of
patients with uncontrolled or partially controlled asthma who visited the
emergency room, who were hospitalized, and who missed school/work were higher than
were those of patients with controlled asthma (p = 0.001, p = 0.05, and p = 0.01,
respectively). Among those with uncontrolled asthma, the impact of the disease on
activities of daily living, sleep, social activities, and normal physical exertion
was greater than it was among those with controlled or partially controlled asthma
(p < 0.001). CONCLUSIONS: In Brazil, asthma treatment should be monitored more closely in order to increase
treatment adherence and, consequently, the level of asthma control, which can
improve patient quality of life and minimize the negative impact of the disease.
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Antunes FP, Costa MDCN, Paim JS, Vieira-da-Silva LM, Cruz AA, Natividade M, Barreto ML. [Social inequalities in spatial distribution of hospital admissions due to respiratory diseases]. CAD SAUDE PUBLICA 2014; 29:1346-56. [PMID: 23843002 DOI: 10.1590/s0102-311x2013000700009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 01/28/2013] [Indexed: 11/21/2022] Open
Abstract
To verify social inequalities in hospital admissions due to respiratory diseases in Salvador, Bahia State, Brazil, 2001-2007, an ecological study was conducted with information zones as the units of analysis. Information zones were stratified according to living conditions and analyzed by Poisson regression. Spatial distribution of hospitalization rates due to respiratory diseases ranged from 3.3 to 80.5/10,000. Asthma, pneumonia, and chronic obstructive pulmonary disease (COPD) showed heterogeneous spatial patterns, in which strata with the worst living conditions showed higher hospitalizations rates. The hospitalization rate for respiratory diseases was 2.4 times higher in zones with very low living conditions as compared to the wealthiest zone. There was a reduction in inequalities in hospital admissions for pneumonia and an increase for asthma and COPD. The sharp social gradient supports the hypothesis that socioeconomic factors are determinants of hospitalizations for respiratory diseases.
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Antunes FP, Costa MDCN, Paim JS, Vieira-da-Silva LM, Santos CADST, Cruz AA, Barreto ML. Trends in hospitalizations for respiratory diseases in Salvador, Bahia State, Brazil, 1998-2009. CAD SAUDE PUBLICA 2013; 28:869-77. [PMID: 22641510 DOI: 10.1590/s0102-311x2012000500006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 12/01/2011] [Indexed: 11/22/2022] Open
Abstract
Respiratory diseases are the leading cause of hospitalizations in Brazil (excluding hospital admissions related to childbirth, pregnancy, and postpartum). To analyze the trend and seasonality of hospitalizations for respiratory diseases in Salvador, Bahia State, Brazil, 1998-2009, a time trend study was performed using simple linear regression. Hospitalization rates for all respiratory diseases and specifically for asthma, chronic obstructive pulmonary disease (COPD), and pneumonia were calculated by year and age group. Hospitalizations for all respiratory diseases decreased by 45.6% (β = -2.2; p < 0.001); those due to asthma showed the largest decline (annual average 1.2/10,000), pneumonia showed the largest reduction until 2002, subsequently tending to stabilize, and COPD remained unchanged. The under-5-year age group showed the largest decline in hospitalizations for all respiratory diseases. There was no seasonality in hospitalizations for COPD. There was a reduction in the burden of hospitalizations due to respiratory diseases in Salvador, mainly due to the drop in asthma and pneumonia in children < 5 years. However, the city still has hospitalization rates for respiratory diseases that are higher than in other large Brazilian cities.
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