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Tho NV, Quan VTT, Dung DV, Phu NH, Dinh-Xuan AT, Lan LTT. GINA Implementation Improves Asthma Symptoms Control and Lung Function: A Five-Year Real-World Follow-Up Study. J Pers Med 2023; 13:jpm13050809. [PMID: 37240979 DOI: 10.3390/jpm13050809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Symptoms control remains challenging for most patients with asthma. This study was conducted to evaluate the level of asthma symptoms control and lung function over 5 years of GINA (Global INitiative for Asthma) implementation. We included all patients with asthma who had been managed following GINA recommendations at the Asthma and COPD Outpatient Care Unit (ACOCU) of the University Medical Center in Ho Chi Minh City, Vietnam from October 2006 to October 2016. Of 1388 patients with asthma managed following GINA recommendations, the proportion of patients with well-controlled asthma significantly improved from 2.6% at baseline to 66.8% at month 3, 64.8% at year 1, 59.6% at year 2, 58.6% at year 3, 57.7% at year 4, and 59.5% at year 5 (p < 0.0001 for all comparisons). The proportion of patients with persistent airflow limitation significantly decreased from 26.7% at baseline to 12.6% at year 1 (p < 0.0001), 14.4% at year 2 (p < 0.0001), 15.9% at year 3 (p = 0.0006), 12.7% at year 4 (p = 0.0047), and 12.2% at year 5 (p = 0.0011). In patients with asthma managed according to GINA recommendations, asthma symptoms control and lung function improved after 3 months and the improvement was sustained over 5 years.
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Affiliation(s)
- Nguyen Van Tho
- Department of Tuberculosis and Lung Diseases, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Pulmonary Functional Exploration, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vu Tran Thien Quan
- Department of Pulmonary Functional Exploration, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Pathophysiology-Immunology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Do Van Dung
- Department of Biostatistics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Phu
- Department of Pulmonology, Dong Nai General Hospital, Bien Hoa City, Vietnam
| | - Anh Tuan Dinh-Xuan
- AP-HP, Hôpital Cochin, Service de Physiologie-Explorations Fonctionnelles, Paris, France
| | - Le Thi Tuyet Lan
- Department of Pulmonary Functional Exploration, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Alzaabi A, Idrees M, Behbehani N, Salah F. Patients' and physicians' attitudes and perception about asthma in the Gulf: A subset analysis from the Asthma Insights and Management Survey in the Gulf and Russia. Allergy Asthma Proc 2021; 42:e77-e85. [PMID: 33980343 DOI: 10.2500/aap.2021.42.210027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Asthma is a prevalent disorder in the Gulf region. However, available data concerning asthma control and patients' perception with regard to their disease are still insufficient. Objective: To investigate patients' perception and behavior with regard to the asthma-related burden, the level of asthma control, and asthma management in three Gulf countries. Methods: This study presented a subset analysis of the Asthma Insights and Management survey about the asthma burden and management in the Gulf region and Russia. In this subset analysis, we retrieved the data of the patients from Saudi Arabia, United Arab Emirates, and Kuwait. Results: The current survey's population was composed of 452 patients. One hundred fifty-four patients (34.1%) rated themselves as having poorly controlled asthma, whereas 60.3% of the patients perceived their asthma as completely or well controlled. However, only two patients (0.4%) had controlled asthma according to the global asthma guidelines criteria for asthma control. Most of the patients (67.7%) reported that their asthma got worse when outdoors. Almost 70% of the patients on daily control plus a quick relief regimen reported that their asthma got worse when they were outdoors. Over the past 12 months, 95 patients (21%) reported asthma exacerbation. More than half of the included patients experienced an asthma attack that stopped their activities, whereas 54.2% of the patients were forced to leave work or school due to an asthma attack, and 53.1% had to cancel an appointment or had to go to bed due to the severity of the attack. With concern to asthma management, only 30.5% of the patients were given a lung function test for the assessment of their asthma. A written action plan for asthma treatment was developed by the physician or the practice nurse for only 21.7% of the patients. Conclusion: In the Gulf region, asthma exerts a substantial burden on patients who are affected. Such a burden significantly impacted patients' quality of life.
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Affiliation(s)
- Ashraf Alzaabi
- From the Respiratory Division, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Majdy Idrees
- Pulmonary Division, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Naser Behbehani
- Department of Medicine, Kuwait University, Kuwait City, Kuwait; and
| | - Fatima Salah
- Global Medical and Scientific Affairs, Merck & Co., Inc., Kenilworth, New Jersey
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Chan KP, Ko FWS, Ling KC, Cheung PS, Chan LV, Chan YH, Lo YT, Ng CK, Lui MMS, Yee KSW, Tseng CZS, Tse PY, Wong MLM, Choo KL, Lam WK, Wong CM, Ho SS, Lun CT, Lai CKW. A territory-wide study on the factors associated with recurrent asthma exacerbations requiring hospitalization in Hong Kong. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:569-581. [PMID: 33657275 PMCID: PMC8127557 DOI: 10.1002/iid3.419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Abstract
Background The real‐world relationships between the demographic and clinical characteristics of asthma patients, their prehospitalization management and the frequency of hospitalization due to asthma exacerbation is poorly established. Objective To determine the risk factors of recurrent asthma exacerbations requiring hospitalizations and evaluate the standard of baseline asthma care. Methods A territory‐wide, multicentre retrospective study in Hong Kong was performed. Medical records of patients aged ≥18 years admitted to 11 acute general hospitals from January 1 to December 31, 2016 for asthma exacerbations were reviewed. Results There were 2280 patients with 3154 admissions (36.7% male, median age 66.0 [interquartile range: 48.0–81.0] years, 519 had ≥2 admissions). Among them, 1830 (80.3%) had at least one asthma‐associated comorbidity, 1060 (46.5%) and 885 (38.9%) of patients had Accident and Emergency Department (AED) attendance and hospitalization in the preceding year, respectively. Patients with advancing age (incidence rate ratio [IRR]: 1.003 for every year increment), a history of AED visits or hospitalization (IRR: 1.018 and 1.070 for every additional episode, respectively) for asthma exacerbation in the preceding year, the presence of neuropsychiatric (IRR: 1.142) and gastrointestinal (IRR: 1.154) comorbidities were risk factors for an increasing number of admissions for asthma exacerbation. For patients with ≥2 admissions, 17.1% were not prescribed inhaled corticosteroid and only 44.6% had spirometry checked before the index admission. Asthma phenotyping was often incomplete, as assessment of atopy (total serum immunoglobulin E level and senitization to aeroallergens) was only performed in 30 (5.8%) patients with ≥2 admissions. Conclusions and Clinical Relevance Improving asthma care, especially in elderly patients with a prior history of urgent healthcare utilization and comorbidities, may help reduce healthcare burden. Suboptimal management before the index admission was common in patients hospitalized for asthma exacerbations. Early identification of patients at risk and enhancement of baseline asthma management may help to prevent recurrent asthma exacerbation and subsequent hospitalization.
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Affiliation(s)
- Ka Pang Chan
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Fanny Wai San Ko
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Kwun Cheung Ling
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Pik Shan Cheung
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong, China
| | - Lee Veronica Chan
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong, China
| | - Yu Hong Chan
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Yi Tat Lo
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Chun Kong Ng
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - Macy Mei-Sze Lui
- Department of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | | | | | - Pak Yiu Tse
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - Mo Lin Maureen Wong
- Department of Medicine & Geriatrics, Caritas Medical Centre, Hong Kong, China
| | - Kah Lin Choo
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Wai Kei Lam
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Chun Man Wong
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Sheng Sheng Ho
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Chung Tat Lun
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
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Zhao M, Juanjuan L, Weijia F, Jing X, Qiuhua H, Hua Z, Fuhe L, Hao P. Expression Levels of MicroRNA-125b in Serum Exosomes of Patients with Asthma of Different Severity and its Diagnostic Significance. Curr Drug Metab 2020; 20:781-784. [PMID: 31631818 DOI: 10.2174/1389200220666191021100001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/25/2019] [Accepted: 09/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study aimed to investigate the expression levels of microRNA (miRNA)-125b in serum exosomes and its diagnostic efficacy for asthma severity. METHODS The study included 80 patients with untreated asthma and 80 healthy volunteers. The patients were divided into 4 groups according to disease severity: 20 with the intermittent state, 20 with the mildly persistent state, 20 with the moderately persistent state, and 20 with the severely persistent state. The expression levels of miRNA-125b in serum exosomes of each group were detected using a quantitative polymerase chain reaction and compared. The Spearman correlation analysis was used to study the correlation between the expression levels of miRNA-125b in serum exosomes and asthma severity. The diagnostic efficacy of the expression levels of miRNA-125b in exosomes for asthma severity was evaluated using the Receiver Operating Characteristic (ROC) curve. RESULTS The expression levels of miRNA-125b in serum exosomes of patients with intermittent, mildly persistent, moderately persistent, and severely persistent asthma were all higher than those in the healthy control group, with statistically significant differences. The expression levels of miRNA-125b were also statistically significantly different among patients in each group. The Spearman correlation analysis showed a positive correlation of the relative expression of miRNA-125b in serum exosomes with asthma severity. The area under the ROC curve of the diagnostic efficacy of miRNA-125b in serum exosomes for patients with intermittent, mildly, moderately, and severely persistent asthma was 0.7770, 0.8573, 0.9111, and 0.9995, respectively. CONCLUSION The expression levels of miRNA-125b in serum exosomes had a high diagnostic efficacy and might serve as a noninvasive diagnostic marker for asthma severity.
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Affiliation(s)
- Meizhen Zhao
- Shenzhen Key Laboratory of E.N.T, Institute of E.N.T, Shenzhen 518172, China
| | - Li Juanjuan
- Shenzhen Key Laboratory of E.N.T, Institute of E.N.T, Shenzhen 518172, China
| | - Fan Weijia
- Shenzhen Key Laboratory of E.N.T, Institute of E.N.T, Shenzhen 518172, China
| | - Xie Jing
- Shenzhen Key Laboratory of E.N.T, Institute of E.N.T, Shenzhen 518172, China
| | - Huang Qiuhua
- Shenzhen Key Laboratory of E.N.T, Institute of E.N.T, Shenzhen 518172, China
| | - Zhang Hua
- Shenzhen Key Laboratory of E.N.T, Institute of E.N.T, Shenzhen 518172, China
| | - Liao Fuhe
- Shenzhen Key Laboratory of E.N.T, Institute of E.N.T, Shenzhen 518172, China
| | - Peng Hao
- Shenzhen Key Laboratory of E.N.T, Institute of E.N.T, Shenzhen 518172, China
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5
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Hon KL, Bao YM, Chan KC, Chau KW, Chen RS, Cheok KTG, Chiu WK, Deng L, He CH, Ieong KM, Kung JSC, Lam P, Lam SYD, Lee QU, Lee SL, Leung TF, Leung TNH, Shi L, Siu KK, Tan WP, Wang MH, Wong TW, Wu BJ, Yip AYF, Zheng YJ, Ng DK. Determinants for asthma control, quality of life and use of complementary and alternative medicine in asthmatic pediatric patients in four cities. World J Pediatr 2018; 14:482-491. [PMID: 30047047 DOI: 10.1007/s12519-018-0167-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Asthma is a significant chronic health problem worldwide. Management aims at disease control by reducing functional impairment and exacerbations and improving quality of life (QoL). We report a multi-center study to survey asthma control and QoL in four cities in the Pearl River Delta. METHODS The conjoint survey involved ten Hong Kong pediatric hospitals/units, two Shenzhen hospitals, two Macau hospitals, and two Guangzhou hospitals on asthma control (using Asthma Control Test) and QoL (Pediatric Allergic Disease Quality of Life Questionnaire, PADQLQ). Acceptability of a treatment is graded as very good/good/fair/poor. RESULTS Good asthma control was only reported in 80% subjects in Hong Kong, but higher in sister cities (85-94%, P < 0.001). Allergic rhinitis, "incense burning", and "smoker in family" were prevalent among the four cities. Logistic regression showed better control of asthma was associated with better PADQLQ (B = - 0.029, P < 0.001), better acceptability of bronchodilator (B = - 1.488, P = 0.025), negatively with "smoker in family" (B = - 0.83, P = 0.015) and various PADQLQ domains. Conversely, worse PADQLQ was associated with allergic rhinitis severity (B = 4.77, P < 0.001), poor control of asthma (B = 7.56, P < 0.001), increased frequency of traditional Chinese medicine use (B = 1.7, P < 0.05), increased frequency of bronchodilator usage (B = 1.05, P < 0.05), "smoker in family" (B = 4.05, P < 0.05), and incense burning at home (B = 3.9, P < 0.05). CONCLUSIONS There are some clinical and cultural differences among the four southern Chinese cities within the Guangdong province. This study identifies potentially modifiable environmental and treatment factors associated with poor asthma control and QoL for health-care interventions. Having a smoker in the family is independently associated with poor asthma control and QoL.
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Affiliation(s)
- Kam Lun Hon
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China.
| | - Yan Min Bao
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen, 518026, China
| | - Kate C Chan
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Kin Wai Chau
- Hong Kong Society of Pediatric Respirology and Allergy, Hong Kong SAR, China.,Pediatric Respiratory and Sleep Disorders Center, Room 1315D, Argyle Centre Phase 1, 688 Nathan Road, Mongkok, Kowloon, Hong Kong SAR, China
| | - Rong-Shan Chen
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | | | - Wa Keung Chiu
- Department of Pediatrics and Adolescent Medicine, United Christian Hospital, 130, Hip Wo Street, Kwun Tong, Hong Kong SAR, China
| | - Li Deng
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Chun-Hui He
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Kin Mui Ieong
- Department of Pediatrics, Central Hospital Conde S. Januario, Macau, China
| | - Jeng Sum C Kung
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Ping Lam
- Department of Pediatrics and Adolescent Medicine, Caritas Medical Center, 111, Wing Hong Street, Sham Shui Po, Hong Kong SAR, China
| | - Shu Yan David Lam
- Department of Pediatrics and Adolescent Medicine, Tuen Mun Hospital, 23 Tsing Chung Koon Road,Tuen Mun, New Territories, Hong Kong SAR, China
| | - Qun Ui Lee
- Department of Pediatrics and Adolescent Medicine, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong SAR, China
| | - So Lun Lee
- Department of Pediatrics and Adolescent Medicine, Queen Mary Hospital, 102, Pokfulam Road, Hong Kong SAR, China.,Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ting Fan Leung
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Theresa N H Leung
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chaiwan, Hong Kong SAR, China.,Department of Pediatrics, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian, Shenzhen, China
| | - Lei Shi
- Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chaiwan, Hong Kong SAR, China
| | - Ka Ka Siu
- Department of Pediatrics, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian, Shenzhen, China
| | - Wei-Ping Tan
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
| | - Maggie Haitian Wang
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.,JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tak Wai Wong
- Department of Pediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, 11, Chuen On Road, Tai Po, Hong Kong SAR, China
| | - Bao-Jing Wu
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Ada Y F Yip
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
| | - Yue-Jie Zheng
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen, 518026, China
| | - Daniel K Ng
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
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6
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Ip KI, Hon KL, Tsang KYC, Leung TNH. Steroid phobia, Chinese medicine and asthma control. CLINICAL RESPIRATORY JOURNAL 2017; 12:1559-1564. [PMID: 28876537 DOI: 10.1111/crj.12705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/14/2017] [Accepted: 09/01/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inhaled corticosteroids (ICS) are the mainstay of treatment for asthma. Corticosteroid (CS) phobia and fears are prevalent, and these may influence therapeutic efficacy and asthma control. AIM The aim of this study was to evaluate if CS fear is associated with asthma control in children. METHODS Patients aged >4 years with asthma at a pediatric outpatient clinic were surveyed, and the Asthma Control Test (ACT) was used for the assessment of asthma control. RESULTS Ninety-eight patients and their parents were interviewed. Thirty-four (35%) parents reported moderate or significant CS fear. They were more likely than those with no or little fear to have poorer asthma control (mean ACT scores 21.3 ± 4.0 vs 23.1 ± 3.3, P = 0.02), discuss their fears with their doctors (P < 0.001), request CS sparing medications (P = 0.044) and resort to Chinese medicine (CM) usage (P < 0.001). Backward binomial logistic regression showed parents with moderate/significant fears were more likely to discuss their fears with their doctors (OR: 5.21; 95% CI: 1.86-14.59; P = 0.002) and have used CM (OR: 4.28; 95% CI: 1.61-11.41; P = 0.004). CS fear was not translated to reduced self-reported compliance in the prescribed ICS. About 40% of the respondents had ever used Chinese Medicine (CM) with 82% of the users reported having used Chinese herbal medicine and 49% had used cold moxibustion. CONCLUSIONS CS fear and CM usage are prevalent. Parents with CS fear were more likely to have children with poorer asthma control and have used Chinese medicine. Physicians caring for children with asthma should be aware of parents with CS fear, prepared to address the fear or concerns and offer evidence-based alternative treatment.
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Affiliation(s)
- Ka Ian Ip
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, People's Republic of China
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kathy Yin Ching Tsang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Theresa Ngan Ho Leung
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, People's Republic of China.,Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong SAR, People's Republic of China
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7
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David-Wang A, Price D, Cho SH, Ho JCM, Liam CK, Neira G, Teh PL. Development and Validation of an Attitudinal-Profiling Tool for Patients With Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:43-51. [PMID: 27826961 PMCID: PMC5102835 DOI: 10.4168/aair.2017.9.1.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 05/13/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022]
Abstract
Purpose To develop a profiling tool which accurately assigns a patient to the appropriate attitudinal cluster for the management of asthma. Methods Attitudinal data from an online survey of 2,467 patients with asthma from 8 Asian countries/region, aged 18-50 years, having had ≥2 prescriptions in the previous 2 years and access to social media was used in a discriminant function analysis to identify a minimal set of questions for the Profiling Tool. A split-sample procedure based on 100 sets of randomly selected estimation and validation sub-samples from the original sample was used to cross-validate the Tool and assess the robustness of its predictive accuracy. Results Our Profiling Tool contained 10 attitudinal questions for the patient and 1 GINA-based level of asthma control question for the physician. It achieved a predictive accuracy of 76.2%. The estimation and validation sub-sample accuracies of 76.7% and 75.3%, respectively, were consistent with the tool's predictive accuracy at 95% confidence level; and their 1.4 percentage-points difference set upper-bound estimate for the degree of over-fitting. Conclusions The Profiling Tool is highly predictive (>75%) of the attitudinal clusters that best describe patients with asthma in the Asian population. By identifying the attitudinal profile of the patient, the physician can make the appropriate asthma management decisions in practice. The challenge is to integrate its use into the consultation workflow and apply to areas where Internet resources are not available or patients who are not comfortable with the use of such technology.
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Affiliation(s)
- Aileen David-Wang
- Section of Pulmonary Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.
| | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.,Observational & Pragmatic Research Institute Pte Ltd, Singapore
| | - Sang Heon Cho
- College of Medicine, Seoul National University, Seoul, Korea
| | - James Chung Man Ho
- Department of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chong Kin Liam
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Glenn Neira
- Medical Affairs Department, Mundipharma Pte Ltd, Singapore
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Yan BD, Meng SS, Ren J, Lv Z, Zhang QH, Yu JY, Gao R, Shi CM, Wu CF, Liu CL, Zhang J, Ma ZS, Liu J. Asthma control and severe exacerbations in patients with moderate or severe asthma in Jilin Province, China: a multicenter cross-sectional survey. BMC Pulm Med 2016; 16:130. [PMID: 27577233 PMCID: PMC5006269 DOI: 10.1186/s12890-016-0292-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background No systemic evaluation of asthma control in Jilin Province has been reported. Asthma control might provide the basis for asthma management in this region. A multicenter hospital-based cross-sectional study was performed to investigate the asthma control and related factors for severe asthma exacerbations in patients with moderate or severe asthma in Jilin Province, China. Methods The study enrolled 1546 patients in five grade one general hospitals from January to December 2013. Asthma medication, patient self-management, asthma control test (ACT) scores and frequency of severe asthma exacerbations during the follow-up (12 months) were collected via a follow-up questionnaire. Results In the study, 889 patients provided a complete follow-up questionnaire. Severe asthma exacerbations occurred in 54.89 % of patients. ACT score ≤15, asthma medication ≤ 3 months, severe asthma, income level lower than average Per Capita Disposable Income (PCDI) and a lower educational level were risk factors of a severe exacerbation. Conclusions Poor adherence to asthma medication, poor asthma symptom control, lower income, a low educational level might be possible reasons for the high incidence of severe asthma exacerbations and poor asthma control in Jilin Province of China.
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Affiliation(s)
- Bing-di Yan
- The Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Shan-Shan Meng
- The Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, China.,Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jin Ren
- The Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Zheng Lv
- The Tumor Centre, The First Hospital of Jilin University, Changchun, China
| | - Qing-Hua Zhang
- The Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Jin-Yan Yu
- The Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Rong Gao
- The Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Chang-Min Shi
- The Department of Respiratory Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chun-Feng Wu
- The Department of Respiratory Medicine, The People's Hospital of Jilin Province, Changchun, China
| | - Chun-Lin Liu
- The Department of Respiratory Medicine, The 208th Hospital of the Chinese People's Liberation Army, Changchun, China
| | - Jie Zhang
- The Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Zhong-Sen Ma
- The Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Jing Liu
- The Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, China.
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9
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Ma Q, Luo G, Zhou X, Huang Y, Liu E, Hong X, Mao L, Wu Y, Chen X, Liao X, Qin G, Wang D, Li L, Zhang S, Wang C. Self-reported reasons for treatment non-adherence in Chinese asthma patients: A 24-week prospective telephone follow-up study. CLINICAL RESPIRATORY JOURNAL 2016; 12:262-268. [PMID: 27402020 DOI: 10.1111/crj.12525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/25/2016] [Accepted: 07/10/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treatment non-adherence is a challenge to achieve asthma control. However, few prospective studies were done for exploring asthma patient adherence in real world. OBJECTIVES To evaluate treatment adherence and causes of non-adherence in a large asthma Chinese population. To analyze newly-diagnosed patients' adherence first time. METHODS About 1582 asthma patients' data were collected from 12 study centers in China from February, 2012 to October, 2012. Disease and treatment information of subjects were collected were at first clinic visit, at 4, 12, and 24 weeks after that, follow-up phone calls were carried out for recording subjects' treatment adherence based on their self-reports. Subjects who reported non-adherence were additionally asked to choose the primary non-adherence cause from a list of nine potential causes. RESULTS Treatment adherence rate of all subjects markedly decreased from 83.3% at week 4 to 42.0% at week 24 after the first clinic visit. Significantly, at week 24, good treatment adherence rate in newly-diagnosed patients was lower than those patients with asthma history (22.9% vs. 63.9%, P < .001). Newly-diagnosed patients were three times more likely to become non-adherence than those patients with asthma history. Female patients had lower treatment adherence rate than male patients (38.3% vs. 45.6%, P = .006). Subjects in 30-39 year age group had the worst treatment adherence (27.3%). The most commonly chosen cause for non-adherence was "relief of symptoms after short-term controller medication use" (43.8%). CONCLUSIONS Asthma patients' treatment adherence could be improved by improving patient education, doctor/patient partnership, and level of medical service in Chinese population.
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Affiliation(s)
- Qianli Ma
- Institute of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Guangming Luo
- Department of Respiratory Medicine, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiangdong Zhou
- Department of Respiratory Medicine, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ying Huang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Hong
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Liangping Mao
- Department of Respiratory Medicine, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Yamei Wu
- Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xumei Chen
- Department of Respiratory Medicine, No.324 Hospital of Chinese PLA
| | - Xiuqing Liao
- Department of Respiratory Medicine, Fuling Center Hospital of Chongqing, Chongqing, China
| | - Guangmei Qin
- Department of Respiratory Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Daoxin Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lian Li
- Department of Respiratory Medicine, Jiangjin Central Hospital, Chongqing, China
| | - Shifu Zhang
- Department of Respiratory Medicine, Chonggang Zong Hospital, Chongqing, China
| | - Changzheng Wang
- Institute of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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10
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Price D, David-Wang A, Cho SH, Ho JCM, Jeong JW, Liam CK, Lin J, Muttalif AR, Perng DW, Tan TL, Yunus F, Neira G. Asthma in Asia: Physician perspectives on control, inhaler use and patient communications. J Asthma 2016; 53:761-9. [DOI: 10.3109/02770903.2016.1141951] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
- Research in Real Life, Singapore
| | - Aileen David-Wang
- Section of Pulmonary Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Sang-Heon Cho
- College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - James Chung-Man Ho
- Department of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of the People's Republic of China
| | - Jae-Won Jeong
- College of Medicine, Inje University, Goyang, Republic of Korea
| | - Chong-Kin Liam
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jiangtao Lin
- Respiratory Medicine Department, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | | | - Diahn-Warng Perng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Faisal Yunus
- Persahabatan Hospital, University of Indonesia, Jakarta, Indonesia
| | - Glenn Neira
- Medical Affairs Department, Mundipharma Pte Ltd, Singapore
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11
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Kobayashi H, Naito M, Masuya M, Maruyama M, Urata K, Takahashi Y, Tomaru A, Fujiwara K, Ohnishi M, Takagi T, Kobayashi T, D'Alessandro-Gabazza C, Urawa M, Gabazza EC, Taguchi O, Takei Y. Circulating fibrocytes correlate with the asthma control test score. Allergol Immunopathol (Madr) 2016; 44:191-6. [PMID: 26774356 DOI: 10.1016/j.aller.2015.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 09/05/2015] [Accepted: 09/30/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bronchial asthma is characterised by airway inflammation and remodelling with a decline of lung function. Fibrocytes are bone marrow-derived mesenchymal progenitor cells that play important roles in the pathogenesis of airway remodelling. Several clinical parameters are currently being used in routine clinical practice to assess outcome of therapy in asthma including frequency of rescue with short-acting β2-agonist and the asthma control test. In this study, we hypothesised that asthma control test is associated with circulating levels of fibrocytes in bronchial asthma. METHODS There were 20 patients with asthma and seven healthy controls. The number of CD45(+)Collagen I(+) circulating fibrocytes was assessed in the peripheral blood by flow cytometry. RESULTS The number of circulating fibrocytes was significantly increased in asthma patients with moderate and severe disease compared to controls, and it was inversely correlated with % forced expiratory volume in one second and % forced vital capacity (%FVC). The frequency of inhalation of short-acting β2 agonist and the asthma control test score was significantly and inversely correlated with the number of circulating fibrocytes. CONCLUSION The results of this study showed that the number of circulating fibrocytes is inversely correlated with clinical asthma control parameters, further supporting the relevance of measuring circulating fibrocytes as a marker of clinical control in bronchial asthma.
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Affiliation(s)
- H Kobayashi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - M Naito
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - M Masuya
- Department of Hematopoietic Pathology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - M Maruyama
- Department of Hematopoietic Pathology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - K Urata
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - Y Takahashi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - A Tomaru
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - K Fujiwara
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - M Ohnishi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - T Takagi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - T Kobayashi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - C D'Alessandro-Gabazza
- Department of Immunology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - M Urawa
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan; Department of Immunology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - E C Gabazza
- Department of Immunology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan.
| | - O Taguchi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
| | - Y Takei
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
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12
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Price D, David-Wang A, Cho SH, Ho JCM, Jeong JW, Liam CK, Lin J, Muttalif AR, Perng DW, Tan TL, Yunus F, Neira G. Time for a new language for asthma control: results from REALISE Asia. J Asthma Allergy 2015; 8:93-103. [PMID: 26445555 PMCID: PMC4590568 DOI: 10.2147/jaa.s82633] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Asthma is a global health problem, and asthma prevalence in Asia is increasing. The REcognise Asthma and LInk to Symptoms and Experience Asia study assessed patients’ perception of asthma control and attitudes toward treatment in an accessible, real-life adult Asian population. Patients and methods An online survey of 2,467 patients with asthma from eight Asian countries/regions, aged 18–50 years, showed greater than or equal to two prescriptions in previous 2 years and access to social media. Patients were asked about their asthma symptoms, exacerbations and treatment type, views and perceptions of asthma control, attitudes toward asthma management, and sources of asthma information. Results Patients had a mean age of 34.2 (±7.4) years and were diagnosed with asthma for 12.5 (±9.7) years. Half had the Global Initiative for Asthma-defined uncontrolled asthma. During the previous year, 38% of patients visited the emergency department, 33% were hospitalized, and 73% had greater than or equal to one course of oral corticosteroids. About 90% of patients felt that their asthma was under control, 82% considered their condition as not serious, and 59% were concerned about their condition. In all, 66% of patients viewed asthma control as managing attacks and 24% saw it as an absence of or minimal symptoms. About 14% of patients who correctly identified their controller inhalers had controlled asthma compared to 6% who could not. Conclusion Patients consistently overestimated their level of asthma control contrary to what their symptoms suggest. They perceived control as management of exacerbations, reflective of a crisis-oriented mind-set. Interventions can leverage on patients’ trust in health care providers and desire for self-management via a new language to generate a paradigm shift toward symptom control and preventive care.
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Affiliation(s)
- David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK ; Research in Real Life, Singapore
| | - Aileen David-Wang
- University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Sang-Heon Cho
- College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - James Chung-Man Ho
- Department of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region of the People's Republic of China
| | - Jae-Won Jeong
- College of Medicine, Inje University, Goyang, Republic of Korea
| | - Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jiangtao Lin
- China-Japan Friendship Hospital, Beijing, People's Republic of China
| | | | - Diahn-Warng Perng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan ; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Faisal Yunus
- Persahabatan Hospital, University of Indonesia, Jakarta, Indonesia
| | - Glenn Neira
- Medical Affairs Department, Mundipharma Pte Ltd, Singapore
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13
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Abstract
The United States Food and Drug Administration recently considered a policy to transfer inhaled short-acting bronchodilators to over-the-counter status if conditions of safe use can be established. The American Thoracic Society filed a comment in opposition to the proposal. This article examines the negative consequences that might result from allowing nonprescription access to bronchodilators and other inhaled asthma medications. Such a proposed policy change conflicts directly with current guidelines for asthma management and would undermine efforts to achieve adequate asthma control in patients. In addition, a policy change to convert asthma medications to over-the-counter status could result in increased costs to patients as well as increased health care costs to society overall due to a worsening of asthma control in the population.
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14
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Lu Y, Ho R, Lim TK, Kuan WS, Goh DYT, Mahadevan M, Sim TB, Van Bever HPS, Larbi A, Ng TP. Neuropeptide Y may mediate psychological stress and enhance TH2 inflammatory response in asthma. J Allergy Clin Immunol 2014; 135:1061-1063.e4. [PMID: 25498790 DOI: 10.1016/j.jaci.2014.10.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/22/2014] [Accepted: 10/29/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Yanxia Lu
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tow Keang Lim
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University of Singapore, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University of Singapore, Singapore
| | - Daniel Yam Thiam Goh
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Malcolm Mahadevan
- Emergency Medicine Department, National University of Singapore, Singapore
| | - Tiong Beng Sim
- Emergency Medicine Department, National University of Singapore, Singapore
| | - Hugo P S Van Bever
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Immunos Building at Biopolis, Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Tze Pin Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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15
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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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16
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Lu Y, Ho R, Lim TK, Kuan WS, Goh DYT, Mahadevan M, Sim TB, Ng TP, van Bever HPS. Psychiatric comorbidities in Asian adolescent asthma patients and the contributions of neuroticism and perceived stress. J Adolesc Health 2014; 55:267-75. [PMID: 24630495 DOI: 10.1016/j.jadohealth.2014.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 01/05/2014] [Accepted: 01/08/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Psychiatric comorbidity is reported to be common among adolescents with asthma, but little is known about its underlying psychological factors. OBJECTIVE This study explored the profile of anxiety and depressive comorbidities among adolescents with well-controlled and poorly controlled asthma and the contribution of neuroticism and perceived stress. METHODS The Revised Child Anxiety and Depression Scale, Neuroticism subscale of Big Five Inventory, Perceived Stress Scale, and Asthma Control Test were administered to 198 adolescents (aged 12-19 years) with well-controlled (n = 137) and poorly controlled asthma (n = 61) as well as 171 healthy neighborhood controls. RESULTS Adolescents with poorly controlled asthma, compared with well-controlled asthma patients and healthy controls, had higher scores of depression (p = .006), panic attacks (p = .002), total anxiety (p = .038), and total internalizing symptoms (p = .017), after adjusting for gender, age, ethnicity, smoking status, and family housing type. Adolescents with asthma had higher neuroticism (p = .025), perceived stress (p = .022), and body mass index (p = .006) and lower self-rated health (p < .001) than healthy controls. No significant differences in psychiatric comorbidity scores were observed after accounting for differences in underlying psychological and physical factors. Among asthma patients, increased asthma control was associated with decreased scores of psychiatric comorbidity (p < .01), but the association was not significant after allowing for decreased neuroticism and perceived stress. CONCLUSIONS The diagnosis of asthma and poor asthma control in adolescents is associated with excess psychiatric comorbidity, which is likely due to increased neuroticism and perceived stress.
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Affiliation(s)
- Yanxia Lu
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tow Keang Lim
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital System, Singapore
| | - Win Sen Kuan
- Department of Emergency Medicine, National University Health System, Singapore
| | - Daniel Yam Thiam Goh
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Malcolm Mahadevan
- Department of Emergency Medicine, National University Health System, Singapore
| | - Tiong Beng Sim
- Department of Emergency Medicine, National University Health System, Singapore
| | - Tze-Pin Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Hugo P S van Bever
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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17
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Chinese expert consensus on bronchial asthma control. J Thorac Dis 2014; 6:E61-9. [PMID: 24977029 DOI: 10.3978/j.issn.2072-1439.2014.06.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/29/2014] [Indexed: 11/14/2022]
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18
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Thompson PJ, Salvi S, Lin J, Cho YJ, Eng P, Abdul Manap R, Boonsawat W, Hsu JY, Faruqi RA, Moreno-Cantu JJ, Fish JE, Ho JCM. Insights, attitudes and perceptions about asthma and its treatment: findings from a multinational survey of patients from 8 Asia-Pacific countries and Hong Kong. Respirology 2014; 18:957-67. [PMID: 23730953 DOI: 10.1111/resp.12137] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/26/2013] [Accepted: 04/29/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The Asthma Insight and Management (AIM) survey was conducted in North America, Europe, the Asia-Pacific region and Latin America to characterize patients' insights, attitudes and perceptions about their asthma and its treatment. We report findings from the Asia-Pacific survey. METHODS Asthma patients (≥12 years) from Australia, China, Hong Kong, India, Malaysia, Singapore, South Korea, Taiwan and Thailand were surveyed. Patients answered 53 questions exploring general health, diagnosis/history, symptoms, exacerbations, patient burden, disease management, medications/treatments and patient's attitudes. The Global Initiative for Asthma guidelines were used to assess asthma control. The survey was conducted by random digit telephone dialling (Australia, China and Hong Kong) or by random face-to-face interviews (India, Malaysia, Singapore, South Korea, Taiwan and Thailand). RESULTS There were 80 761 households screened. Data from 3630 patients were collected. Wide disparity existed between objective measures of control and patient perception. Reported exacerbations during the previous year ranged from 19% (Hong Kong) to 67% (India). Reported unscheduled urgent/emergency visits to a doctor's office/hospital/clinic in the previous year ranged from 15% (Hong Kong) to 46% (Taiwan). Patients who reported having controlled asthma in the previous month ranged from 27% (South Korea) to 84% (Taiwan). Substantial functional and emotional limitations due to asthma were identified by 13% (South Korea) to 78% (India) of patients. CONCLUSIONS Asthma has a profound impact on patients' well-being despite the availability of effective treatments and evidence-based management guidelines. Substantial differences across the surveyed countries exist, suggesting unmet, country-specific cultural and educational needs. A large proportion of asthma patients overestimate their level of control.
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Affiliation(s)
- Philip J Thompson
- Lung Institute of WA and Centre for Asthma, Allergy and Respiratory Research University of Western Australia, Nedlands, Western Australia, Australia.
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19
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Chiu KC, Boonsawat W, Cho SH, Cho YJ, Hsu JY, Liam CK, Muttalif AR, Nguyen HD, Nguyen VN, Wang C, Kwon N. Patients' beliefs and behaviors related to treatment adherence in patients with asthma requiring maintenance treatment in Asia. J Asthma 2014; 51:652-9. [PMID: 24580369 PMCID: PMC4133971 DOI: 10.3109/02770903.2014.898772] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives To identify patients’ beliefs or behaviors related to treatment adherence and to assess association between asthma control and adherence in Asian patients with asthma. Methods We conducted a cross-sectional observational study of adult patients with asthma from specialist clinics in six Asian countries. Patients who were deemed by their treating physicians to require a maintenance treatment with an inhaler for at least 1 year were recruited. Patients completed a 12-item questionnaire related to health beliefs and behaviors, the 8-item Morisky Medication Adherence Scale (MMAS-8), the Asthma Control Test (ACT™), and the Standardized Asthma Quality of Life Questionnaire (AQLQ-S). Results Of the 1054 patients recruited, 99% were current users of inhaled corticosteroids. The mean ACT score was 20.0 ± 4.5 and 64% had well-controlled asthma. The mean MMAS-8 score was 5.5 ± 2.0 and 53% were adherent. Adherence was significantly associated with patients’ understanding of the disease and inhaler techniques, and with patients’ acceptance of inhaler medicines in terms of benefits, safety, convenience, and cost (p < 0.01 for all). In multivariate analysis, three questions related to patients’ acceptance of inhaler medicines remained significantly associated with poor adherence, after adjusting for potential confounders: “I am not sure inhaler type medicines work well” (p = 0.001), “Taking medicines more than once a day is inconvenient” (p = 0.002), and “Sometimes I skip my inhaler to use it over a longer period” (p < 0.001). Conclusions Our study showed that patients’ acceptance of the benefits, convenience and cost of inhaler medications have a significant impact on treatment adherence in the participating Asian countries.
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Affiliation(s)
- K-C Chiu
- Division of Chest, Department of Internal Medicine, Lotung Poh-Ai Hospital , Luodong , Taiwan
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20
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Clinical significance of asthma clusters by longitudinal analysis in Korean asthma cohort. PLoS One 2013; 8:e83540. [PMID: 24391784 PMCID: PMC3877049 DOI: 10.1371/journal.pone.0083540] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 11/05/2013] [Indexed: 02/01/2023] Open
Abstract
Background We have previously identified four distinct groups of asthma patients in Korean cohorts using cluster analysis: (A) smoking asthma, (B) severe obstructive asthma, (C) early-onset atopic asthma, and (D) late-onset mild asthma. Methods and Results A longitudinal analysis of each cluster in a Korean adult asthma cohort was performed to investigate the clinical significance of asthma clusters over 12 months. Cluster A showed relatively high asthma control test (ACT) scores but relatively low FEV1 scores, despite a high percentage of systemic corticosteroid use. Cluster B had the lowest mean FEV1, ACT, and the quality of life questionnaire for adult Korean asthmatics (QLQAKA) scores throughout the year, even though the percentage of systemic corticosteroid use was the highest among the four clusters. Cluster C was ranked second in terms of FEV1, with the second lowest percentage of systemic corticosteroid use, and showed a marked improvement in subjective symptoms over time. Cluster D consistently showed the highest FEV1, the lowest systemic corticosteroid use, and had high ACT and QLQAKA scores. Conclusion Our asthma clusters had clinical significance with consistency among clusters over 12 months. These distinctive phenotypes may be useful in classifying asthma in real practice.
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21
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Gold LS, Thompson P, Salvi S, Faruqi RA, Sullivan SD. Level of asthma control and health care utilization in Asia-Pacific countries. Respir Med 2013; 108:271-7. [PMID: 24406243 DOI: 10.1016/j.rmed.2013.12.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Data on the impact of asthma in many countries in the Asia-Pacific region is limited. This study investigated whether partly- and uncontrolled asthma were associated with increased medication use/healthcare utilization and productivity loss among a population of asthma patients from nine Asia-Pacific countries. METHODS We used cross-sectional data from 3630 asthma patients ≥12 years from the 2011 Asia-Pacific Asthma Insights and Management (AP-AIM) survey. Using Global Initiative for Asthma (GINA) guidelines, patients were categorized as having well-controlled, partly- controlled, or uncontrolled asthma. Chi-square tests were used to assess the relation of degree of asthma control with utilization of asthma medications, health services, productivity, and mood. RESULTS Overall, 7.6% of the patients surveyed had asthma that was well-controlled, with the highest proportions in Singapore (14%) and the lowest in India (0%) and China (2%). Patients whose asthma was not well-controlled reported greater use of asthma medications, more emergency healthcare visits or hospitalizations for their asthma, and more interference of their mood due to asthma. They also reported significant decreases in productivity due to asthma. CONCLUSIONS Patients who did not have well-controlled asthma had greater utilization rates of asthma medications and healthcare services and were more likely to report missing multiple days of work/school compared to patients whose asthma was well-controlled. These associations suggest that emphasis on improving asthma control could have dramatic effects on patient well-being and utilization of healthcare resources.
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Affiliation(s)
- Laura S Gold
- Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA.
| | - Phillip Thompson
- Lung Institute of Western Australia and Centre for Asthma, Allergy, and Respiratory Research, University of Western Australia, Nedlands, Australia
| | | | - Rab A Faruqi
- Global Medical Affairs, Merck & Co., Inc, Whitehouse Station, NJ, USA
| | - Sean D Sullivan
- Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA
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Patel M, Pilcher J, Munro C, Hosking A, Pritchard A, Shaw D, Black P, Weatherall M, Beasley R. Short-acting β-agonist use as a marker of current asthma control. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:370-7. [PMID: 24565542 DOI: 10.1016/j.jaip.2013.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/18/2013] [Accepted: 04/23/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between current asthma symptoms and rescue bronchodilator (reliever) use is uncertain, leading to different recommendations about the preferred reliever metric to use when assessing asthma control. In a 6-month randomized controlled trial of combination budesonide/formoterol as maintenance and reliever therapy versus combination budesonide/formoterol as maintenance treatment with albuterol as reliever, we measured inhaler use by electronic monitoring. OBJECTIVE To determine the agreement between current asthma symptoms and different metrics of albuterol use for patients randomly assigned to maintenance budesonide/formoterol treatment. METHODS Data on albuterol use were extracted for the 7-day period before visit 2 (at week 3) from 150 adult patients with asthma. Current asthma symptoms were measured by Asthma Control Questionnaire-5 (ACQ-5) score at the clinic visit. RESULTS The number of days of albuterol use, the average number of albuterol actuations/day, and the highest number of albuterol actuations/day in the 1-week period were all positively associated with ACQ-5 score (r = 0.41-0.45, P < .001) and had moderate discrimination for well-controlled and not well-controlled asthma (ACQ-5 scores ≤0.75 and ≥1.5, respectively), with receiver operator characteristic area under the curve of 0.80 to 0.82 and 0.70 to 0.77, respectively. Cut points of ≥3 days of albuterol use, average albuterol use of ≥1 actuation/day, and highest albuterol use of ≥4 actuations/day in the 1-week period had 73% sensitivity and 62% specificity, 78% sensitivity and 67% specificity, and 78% sensitivity and 66% specificity, respectively, for predicting an ACQ-5 ≥1.5. CONCLUSION Our findings support the use of the number of days of albuterol use, the average number of albuterol actuations per day, and the highest number of albuterol actuations per day over a 1-week period of observation as comparable markers of current asthma control.
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Affiliation(s)
- Mitesh Patel
- Medical Research Institute of New Zealand, Wellington, New Zealand; Capital and Coast District Health Board, Wellington, New Zealand; Division of Respiratory Medicine, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Janine Pilcher
- Medical Research Institute of New Zealand, Wellington, New Zealand; Capital and Coast District Health Board, Wellington, New Zealand
| | - Claire Munro
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Alison Pritchard
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Dominick Shaw
- Division of Respiratory Medicine, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Peter Black
- University of Auckland, Auckland, New Zealand; Deceased
| | - Mark Weatherall
- Capital and Coast District Health Board, Wellington, New Zealand; University of Otago, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand; Capital and Coast District Health Board, Wellington, New Zealand; University of Otago, Wellington, New Zealand.
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Ohta K, Jean Bousquet P, Akiyama K, Adachi M, Ichinose M, Ebisawa M, Tamura G, Nagai A, Nishima S, Fukuda T, Morikawa A, Okamoto Y, Kohno Y, Saito H, Takenaka H, Grouse L, Bousquet J. Visual analog scale as a predictor of GINA-defined asthma control. The SACRA study in Japan. J Asthma 2013; 50:514-21. [PMID: 23506422 DOI: 10.3109/02770903.2013.786726] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The assessment of asthma control is pivotal to treatment decisions. A questionnaire that assesses the Global Initiative for Asthma (GINA)-defined control requires four questions. A visual analog scale (VAS) to evaluate asthma control can be simply marked, but its correlation with GINA-defined control has been insufficiently evaluated. The purpose of this study is to evaluate whether VAS levels can predict GINA-defined asthma control with particular emphasis on the distinctions between "partly controlled" and "uncontrolled" and between "partly controlled" and "controlled" asthma, METHODS A cross-sectional multicenter study was carried out throughout Japan (SACRA) from March to August 2009 among patients with a diagnosis and treatment of asthma. Asthma control was studied using the GINA questionnaire and a VAS measurement of asthma severity. Pulmonary function testing was not carried out, RESULTS 1910 physicians enrolled 29,518 patients with asthma. 15,051 (51.0%) questionnaires were administered by physicians; patients filled out 14,076 (47.7%) questionnaires themselves. 28,225 (95.6%) of the patients were evaluable. VAS measurement of asthma symptoms was useful in predicting levels of GINA-defined control categories (the area under the receiver operating characteristic curve ranging from 0.704 to 0.837). Patients with "controlled," "partly controlled," and "uncontrolled" asthma were discriminated by VAS levels (1.50, 4.79, and 7.19). Similar results have been obtained with self- and physician-administered questionnaires showing the validity of results. CONCLUSION Measurement of VAS levels is able to discriminate between patients with "controlled," "partly controlled," and "uncontrolled" asthma. The VAS score could be a simple guide in clinical situations requiring daily or regular evaluation of asthma control.
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Affiliation(s)
- Ken Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan.
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Wong GWK, Kwon N, Hong JG, Hsu JY, Gunasekera KD. Pediatric asthma control in Asia: phase 2 of the Asthma Insights and Reality in Asia-Pacific (AIRIAP 2) survey. Allergy 2013; 68:524-30. [PMID: 23414255 DOI: 10.1111/all.12117] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND We conducted Phase 2 of the Asthma Insights and Reality in the Asia-Pacific (AIRIAP 2) survey in 2006 to determine the level of asthma control in this region and the validity of the Asthma Control Test (ACT) and childhood ACT (C-ACT) in relation to asthma control. METHODS Pediatric participants (0 to <16 years; N = 988) with diagnosed asthma and current asthma symptoms or taking anti-asthma medications were recruited from 12 geographic areas in Asia. The survey consisted of the AIRIAP 2 questionnaire (asthma symptoms, use of urgent healthcare services and anti-asthma medication) and the ACT or C-ACT (English or Chinese translations only), both administered in the participant's preferred language. A symptom control index based on the Global Initiative for Asthma criteria (except lung function) was used to classify asthma control status. RESULTS Most participants had inadequately controlled asthma ('uncontrolled' = 53.4%, 528/988; 'partly controlled' = 44.0%, 435/988). Only 2.5% (25/988) had 'controlled' asthma. Demand for urgent healthcare services (51.7%, 511/988) and use of short-acting beta-agonists (55.2%, 545/988) was high. The optimal ACT and C-ACT cutoff score for detecting uncontrolled asthma (compared with controlled or partly controlled asthma) was determined to be ≤19 (receiver operating characteristic analysis) with good agreement between the ACT and C-ACT and the symptom control index. CONCLUSIONS Findings from this survey show that asthma control is suboptimal in many children in the Asia-Pacific region. Practical tools, such as the ACT or C-ACT, may help clinicians assess asthma control and facilitate adjustment of asthma medication.
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Affiliation(s)
- G. W. K. Wong
- Department of Paediatrics and School of Public Health; The Chinese University of Hong Kong; Shatin; New Territories; Hong Kong
| | | | - J. G. Hong
- Shanghai First People's Hospital; Shanghai Jiaotong University; Shanghai; China
| | - J.-Y. Hsu
- Taichung Veterans General Hospital; Taichung; Taiwan
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25
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Tho NV, Loan HTH, Thao NTP, Dung NTT, Lan LTT. Implementation of GINA guidelines in Ho Chi Minh City: a model for Viet Nam. Public Health Action 2012; 2:181-5. [PMID: 26392981 PMCID: PMC4463066 DOI: 10.5588/pha.12.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/19/2012] [Indexed: 11/10/2022] Open
Abstract
SETTING The Global Initiative for Asthma (GINA) guidelines have not been implemented effectively in primary care settings in Viet Nam. OBJECTIVES To estimate the proportion of patients with controlled asthma and the direct health care costs of managing asthma according to GINA guidelines at four out-patient clinics in Ho Chi Minh City (HCMC), Viet Nam. METHODS One hundred and six patients with asthma were treated and followed up according to GINA guidelines for 12 months. Clinical and pulmonary function responses and direct health care costs were evaluated every 3 months during the study. RESULTS The proportion of patients with controlled asthma rose from 1.0% at the start of the study to 36.8% by the end of the study (P < 0.0001). The proportion of patients who had at least one hospitalisation per year decreased significantly, from 32.1% to 5.7% (P < 0.0001). The annual per patient median direct health care cost was US$169. Using asthma controllers continuously gave better asthma control than using them intermittently (OR 12.9, 95%CI 4.7-35.7). CONCLUSIONS The implementation of GINA guidelines at out-patient clinics in HCMC, Viet Nam, improved asthma control with modest direct health care costs.
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Affiliation(s)
- N V Tho
- Department of Tuberculosis and Lung Diseases, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam ; Respiratory Care Centre, University Medical Centre at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - H T H Loan
- Health Care Centre of Phu Nhuan District, Ho Chi Minh City, Viet Nam
| | - N T P Thao
- Health Care Centre of Hoc Mon District, Ho Chi Minh City, Viet Nam
| | - N T T Dung
- Regional General Hospital of Thu Duc District, Ho Chi Minh City, Viet Nam
| | - L T T Lan
- Respiratory Care Centre, University Medical Centre at Ho Chi Minh City, Ho Chi Minh City, Viet Nam ; Department of Physiology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
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26
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The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: Systematic review and meta-analysis. J Allergy Clin Immunol 2012; 131:695-703. [PMID: 23058645 DOI: 10.1016/j.jaci.2012.08.023] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 08/20/2012] [Accepted: 08/23/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Currently, the cornerstone of asthma management is the achievement and maintenance of optimal asthma control, but the diagnostic performances of the Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ) have not been evaluated systematically. OBJECTIVE We explored the diagnostic performances of and statistically compared the ACT and ACQ. METHODS Studies that examined the accuracy of the ACT, ACQ, or both in the assessment of asthma control were found by searching PubMed, CENTRAL, Web of Science, Ovid, and Embase. Summary estimates of sensitivity, specificity, and diagnostic odds ratios for the different levels of asthma control were determined by using bivariate random-effects models and hierarchical summary receiver operating characteristic models. RESULTS Twenty-one studies with 11,141 subjects assessed with the ACT and 12,483 assessed with the ACQ were identified. The ACT had good diagnostic accuracy for assessment of controlled and not well-controlled asthma, and the ACQ (ACQ-7 and ACQ-6) had good diagnostic accuracy for assessment of not well-controlled asthma at prespecified cutoff points. The ACT and ACQ had significant differences in the assessment of controlled and not well-controlled asthma after adjusting for potential factors (P = .001 and P = .015). For assessment of uncontrolled asthma, the ACT had poor accuracy, with a hierarchical summary receiver operating characteristic area under the curve of 0.69, and the cutoff point for the ACQ has not been established. CONCLUSION The ACT is preferable to the ACQ in clinical practice, and the ACQ requires further cross-validation. Moreover, neither the ACT nor the ACQ is useful for the assessment of uncontrolled asthma.
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Associations of patient outcomes with level of asthma control. Ann Allergy Asthma Immunol 2012; 109:260-265.e2. [PMID: 23010232 DOI: 10.1016/j.anai.2012.07.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/24/2012] [Accepted: 07/26/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite effective medications, asthma remains a significant burden to the US health care system. OBJECTIVE To determine whether partly and uncontrolled asthma in respondents to the Asthma Insights and Management (AIM) survey was associated with adverse outcomes (such as visits to health care professionals and medication use) compared with well-controlled asthma. METHODS The AIM survey, conducted in 2009, included 2,500 patients with asthma who were 12 years or older. We classified patients into levels of control and compared use of health care services and limitations of activities in patients whose asthma was well controlled vs those with partly and uncontrolled asthma. RESULTS Patients who reported lower income and educational status and lacked health insurance were less likely to have had well-controlled asthma. Respondents with uncontrolled asthma were more likely to report ever use of oral steroids (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.9-3.2) and over-the-counter medicine (OR, 2.7; 95% CI, 2.0-3.7) compared with patients whose asthma was well controlled. Respondents with partly and uncontrolled asthma were also significantly more likely to report ever visiting physicians, specialists, or the emergency department or being hospitalized for asthma compared with those whose asthma was well controlled (ORs ranging from 2.1 to 5.6). Finally, respondents whose asthma was uncontrolled had increased odds (ORs ranging from 14 to 34) of reporting that asthma limited their activities compared with respondents whose asthma was well controlled. CONCLUSION Patients with partly and uncontrolled asthma defined by international guidelines reported use of significantly more health care resources and greater limitations of their daily activities compared with patients whose asthma was well controlled.
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Knight DA, Yang IA, Ko FWS, Lim TK. Year in review 2011: asthma, chronic obstructive pulmonary disease and airway biology. Respirology 2012; 17:563-72. [PMID: 22248232 DOI: 10.1111/j.1440-1843.2012.02126.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Darryl A Knight
- UBC James Hogg Research Centre, Institute for Heart + Lung Health, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada.
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Al Moamary MS, Al-Kordi AG, Al Ghobain MO, Tamim HM. Utilization and responsiveness of the asthma control test (ACT) at the initiation of therapy for patients with asthma: a randomized controlled trial. BMC Pulm Med 2012; 12:14. [PMID: 22449144 PMCID: PMC3359228 DOI: 10.1186/1471-2466-12-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to assess the responsiveness of the asthma control test (ACT) to detect changes at the initiation of therapy and its utilization in the initiation of asthma treatment. Methods This study was designed as a randomized clinical trial conducted in a primary care setting. The subjects were asthma patients who had not received controller therapy for at least two months. The patients were randomized into two groups: The Saudi Initiative for Asthma (SINA) group and the Global Initiative for Asthma (GINA) group. Treatment in the SINA group was initiated at step1 when the ACT scores ≥ 20, step 2 when the score between16-19, and step 3 when the score < 16 began at step 3. The GINA group patients were started on step 2 when they had persistent asthma symptoms or step 3 when they had severely uncontrolled disease. Results Forty-five patients were analyzed in each group. The improvement in ACT score after treatment initiation was significantly higher when the SINA approach was used (2.9 in the SINA group compared to 1.7 in the GINA group (p = 0.04)). The improvement in FEV1 was 5.8% in the SINA group compared to 3.4% in the GINA group (p = 0.46). The number of patients who achieved asthma control at the follow-up visit and required no treatment adjustment was 33 (73.3%) in the SINA group and 27 (60%) in the GINA group (p = 0.0125). Conclusion The ACT was responsive to change at the initiation of asthma treatment and was useful for the initiation of asthma treatment. Trial Registration number ISRCTN31998214
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Affiliation(s)
- Mohamed S Al Moamary
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, PO Box 84252, Riyadh 11671, Saudi Arabia.
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Chishimba L, Niven RM, Cooley J, Denning DW. Voriconazole and posaconazole improve asthma severity in allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization. J Asthma 2012; 49:423-33. [PMID: 22380765 DOI: 10.3109/02770903.2012.662568] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Rationale and objectives. Severe asthma with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA) are progressive allergic fungal lung diseases whose effective treatment remains to be established. Current treatment with itraconazole is associated with a 40% failure rate and adverse events (AEs). We assessed the effect of voriconazole or posaconazole as second- and third-line therapies. Methods. We conducted a retrospective review of adult asthmatic patients with either ABPA or SAFS receiving voriconazole or posaconazole. Clinical, radiological, and immunological evaluation was used to assess response. Results. There were 25 patients, ABPA (n = 20) or SAFS (n = 5), 10 males, median age = 58 years. All patients had failed itraconazole (n = 14) or developed AEs (n = 11). There were 33 courses of therapy analyzed, 24 with voriconazole and 9 with posaconazole. Clinical response to voriconazole was observed in 17/24 (70%) patients at 3 months, 15/20 (75%) at 6 months, and 12/16 (75%) at 12 months compared with 7/9 (78%) at 3, 6, and 12 months for posaconazole. Eighteen of 24 (75%) patients discontinued oral corticosteroids (OCS), 12 of them within 3 months of therapy. Asthma severity was downgraded from severe to moderate (n = 8) and moderate to mild (n = 1) asthma in 9 of 24 (38%) asthmatic patients. There was a marked reduction in OCS and short-acting beta-2 agonist use, health-care utilization due to asthma, and improvement in overall health status. Furthermore, there was a statistically significant reduction in immunological markers appearing at 9 months (p = .008) for total IgE and at 12 months for radioallergosorbent test IgE for Aspergillus fumigatus (p = .0056). Six of 23 (26%) patients on voriconazole had AEs requiring discontinuation before 6 months compared with none on posaconazole (p = .15). Four relapsed (57%), one at 3 months and three at 12 months after discontinuation. Conclusion. Both voriconazole and posaconazole are potentially effective alternative treatment options for SAFS and ABPA and may improve asthma control and reduce severity, though larger prospective studies are required to support these retrospective study findings.
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Affiliation(s)
- Livingstone Chishimba
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Kim SH, Cho SH. Educational and decision-support tools for asthma-management guideline implementation. Asia Pac Allergy 2012; 2:26-34. [PMID: 22348204 PMCID: PMC3269598 DOI: 10.5415/apallergy.2012.2.1.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 12/20/2011] [Indexed: 11/04/2022] Open
Abstract
Many international and national asthma guidelines are now available in large parts of the world, but they are not yet implemented appropriately. There is a gap between scientific evidence-based medicine and real clinical practice. Implementation of guidelines is highly complex. Special strategies are needed to encourage guideline-based, high-quality care. It is important to understand the contents, the format, and the learning strategies which physicians prefer for the dissemination of guidelines. Physicians prefer more concise and immediately available guidelines that are practical to use. Thus, asthma guidelines should be disseminated as convenient and easily accessible tools. Various education programs and decision-support tools have been designed and applied to the clinical management of asthma to solve these challenging problems. Many of them have been shown to be effective at increasing physicians' knowledge and adherence to asthma guidelines and improving patients' clinical outcomes. These educational and decision-support tools are expected to contribute to a narrowing of the gap between asthma guidelines and practice/implementation of the guidelines.
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Affiliation(s)
- Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
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32
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Jindal SK. Symptoms or severity: what to act upon? Expert Rev Respir Med 2012; 5:601-3. [PMID: 21955229 DOI: 10.1586/ers.11.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Miedinger D, Neukomm E, Chhajed PN, Schnyder A, Naef M, Ackermann M, Leuppi JD. The use of the Asthma Control Test in general practice and its correlation with asthma control according to the GINA guidelines. Curr Med Res Opin 2011; 27:2301-8. [PMID: 21988667 DOI: 10.1185/03007995.2011.630722] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The GINA guidelines have redefined the primary goal of asthma treatment as achieving optimum control. OBJECTIVES To document the level of asthma control in Switzerland, the correlations between the international guidelines by GINA and the ACT's rating of asthma control, current treatment in adolescent and adult Swiss asthma patients and factors associated with asthma control. METHODS General practitioners and specialists (pulmonologists, allergologists and paediatricians) were invited to participate in the cross-sectional survey. Asthma control was assessed in 1093 asthma patients using both the ACT and the GINA classification for asthma control. RESULTS According to the GINA guidelines controlled asthma was found in 290 (27%) patients, when measured with the ACT 124 (11.5%) patients showed sufficient asthma control. Of the test results 65% were in accordance with each other, whereas in 85% of the non-matching results the ACT underestimated control according to GINA classification. An ACT cut-off score of ≤17 best identified uncontrolled asthma according to GINA guidelines. A total of 956 (87.7%) patients received controller medication and 849 (77.9%) patients received reliever medication. The following parameters were consistently identified to be significantly associated with insufficient asthma control in both GINA and ACT measurements: presence of exacerbation, use of reliever medication, switch of therapy and smoking. STUDY LIMITATION For this study only the ACT version for adults was used. CONCLUSION Asthma control remains insufficient in the majority of patients, despite prescription of regular controller medication. This survey confirms the validated ACT to be useful and important in everyday practice as an objective measure for asthma control according to GINA guidelines in order to monitor control and adjust treatment.
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Affiliation(s)
- David Miedinger
- University Hospital Basel, Internal Medicine, Basel, Switzerland.
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Korn S, Both J, Jung M, Hübner M, Taube C, Buhl R. Prospective evaluation of current asthma control using ACQ and ACT compared with GINA criteria. Ann Allergy Asthma Immunol 2011; 107:474-9. [PMID: 22123375 DOI: 10.1016/j.anai.2011.09.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 08/23/2011] [Accepted: 09/02/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND The goal of asthma treatment is to achieve and maintain current best control and reduce future risk of exacerbations and long-term morbidity. OBJECTIVE To prospectively compare current asthma control as defined by ACQ (asthma control questionnaire) and ACT (asthma control test) criteria with the GINA (Global Initiative for Asthma) classification in treated patients in a real-life setting. METHODS In 150 adult patients (48% male, age 46.3 ± 14.4 years., forced expiratory volume in 1 second [FEV(1)], 2.3 ± 0.9 L or 78.5 ± 21.8% pred.), asthma control was evaluated using the GINA classification as the "true" and ACQ-7, ACQ-5, and ACT as "predictor" criteria. The relationship between GINA-defined uncontrolled vs controlled/partly controlled asthma and ACQ and ACT scores was assessed with the ACQ cutpoint of ≥ 1.50 and the ACT cut-point of ≤ 19 for uncontrolled asthma. RESULTS The ACQ-7 and ACT correctly predicted GINA-defined uncontrolled asthma in 71.3% and 80.7% of patients, respectively. Sensitivity was high, with 88% for ACQ-7 and 94% for ACT, specificity was 57% and 70%, positive predictive value was 63% and 72%, and negative predictive value was 86% and 93%. Similar results were obtained using ACQ-5. ACQ-7 and ACT classified significantly more patients as having uncontrolled asthma compared with the GINA criteria (P < .001). CONCLUSIONS ACQ scores ≥ 1.50 and ACT scores ≤ 19 are suitable to indicate uncontrolled asthma. To identify GINA-defined uncontrolled asthma, cutoff points for ACQ-5 should be ≥ 1.9 and for ACT ≤ 16, at least in real-life adult patients with mostly moderate and severe asthma.
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Affiliation(s)
- Stephanie Korn
- Pulmonary Department, Mainz University Hospital, Langenbeckstr. 1, 55131 Mainz, Germany.
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Sims EJ, Price D, Haughney J, Ryan D, Thomas M. Current control and future risk in asthma management. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 3:217-25. [PMID: 21966601 PMCID: PMC3178819 DOI: 10.4168/aair.2011.3.4.217] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 07/15/2011] [Indexed: 01/21/2023]
Abstract
Despite international and national guidelines, poor asthma control remains an issue. Asthma exacerbations are costly to both the individual, and the healthcare provider. Improvements in our understanding of the therapeutic benefit of asthma therapies suggest that, in general, while long-acting bronchodilator therapy improves asthma symptoms, the anti-inflammatory activity of inhaled corticosteroids reduces acute asthma exacerbations. Studies have explored factors which could be predictive of exacerbations. A history of previous exacerbations, poor asthma control, poor inhaler technique, a history of lower respiratory tract infections, poor adherence to medication, the presence of allergic rhinitis, gastro-oesophageal reflux disease, psychological dysfunction, smoking and obesity have all been implicated as having a predictive role in the future risk of asthma exacerbation. Here we review the current literature and discuss this in the context of primary care management of asthma.
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Affiliation(s)
- Erika J Sims
- Research in Real Life Ltd., Warren House, Sankence, Aylsham, Norfolk, UK
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