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Dhar R, Talwar D, Christopher DJ, Dumra H, Koul PA, Chhajed PN, Chowdhury SR, Arjun P, Guleria R. Expert opinion on diagnosis and management of Severe Asthma in low and middle income countries (LMIC) with focus on India. J Asthma 2024:1-13. [PMID: 38767570 DOI: 10.1080/02770903.2024.2349614] [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: 01/28/2024] [Accepted: 04/25/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE In this document, 9 Indian experts have evaluated the factors specific to LMICs when it came to Severe Asthma (SA) diagnosis, evaluation, biologic selection, non-biologic treatment options, and follow-up. DATA SOURCES A search was performed using 50 keywords, focusing on the Indian/LMICs perspective, in PubMed, Cochrane Library, and Google Scholar. The key areas of the search were focused on diagnosis, phenoendotyping, non-biological therapies, selecting a biologic, assessment of treatment response, and management of exacerbation. STUDY SELECTIONS The initial search revealed 1826 articles, from these case reports, observational studies, cohort studies, non-English language papers, etc., were excluded and we short-listed 20 articles for each area. Five relevant articles were selected by the experts for review. RESULTS In LMICs, SA patients may be referred to the specialist for evaluation a little late for Phenoendotyping of SA. While biologic therapy is now a standard of care, pulmonologists in LMICs may not have access to all the investigations to phenoendotype SA patients like fractional exhaled nitric oxide (FeNO), skin prick test (SPT), etc., but phenotyping of SA patients can also be done with simple blood investigations, eosinophil count and serum immunoglobulin E (IgE). Choosing a biologic in the overlapping phenotype of SA and ACO patients is also a challenge in the LMICs. CONCLUSIONS Given the limitations of LMIC, it is important to select the right patient and explain the potential benefits of biological therapy. Non-biologic add-on therapies can be attempted in a resource-limited setting where biological therapy is not available/feasible for patients.
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Affiliation(s)
- Raja Dhar
- Department of Pulmonology, CK BIRLA Hospitals, Kolkata, India
| | | | | | - Harjit Dumra
- Sparsh Chest Disease Centre, Navrangpura, Ahmedabad, India
| | - Parvaiz A Koul
- Department of Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Prashant N Chhajed
- Department of Lung Care and Sleep Center, Institute of Pulmonology, Medical Research and Development, Fortis Hiranandani Hospital, Vashi, Mumbai, India
- Department of Respiratory Medicine, Dr. Balabhai Nanavati Hospital and Lilavati Hospital, Mumbai, Maharashtra, India
| | | | - Padmanabhan Arjun
- Department of Respiratory Medicine, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Swarnakar R, Dhar R. Call to action: Addressing asthma diagnosis and treatment gaps in India. Lung India 2024; 41:209-216. [PMID: 38687232 DOI: 10.4103/lungindia.lungindia_518_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/31/2023] [Indexed: 05/02/2024] Open
Abstract
In comparison to the worldwide burden of asthma, although India contributes to 13% of the total asthma prevalence, it has a threefold higher mortality rate and more than twofold higher DALYs, indicating a substantial gap in asthma diagnosis and treatment. Asthma causes significant suffering, affecting people's quality of life and draining the country's resources; therefore, we must devise ways and means to fill these gaps. The most successful and cost-efficient strategy to battle asthma is to form strong partnerships between patients, the general public, the government, the pharmaceutical industry and non-governmental organisations. This necessitates a comprehensive approach that involves raising awareness, developing universally applicable recommendations, increasing access to high-quality asthma care, and other measures. The purpose of this article was to review the existing scenario of asthma management in India and the factors that contribute to it and devise unique and all-encompassing strategies to fill these gaps.
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Affiliation(s)
- Rajesh Swarnakar
- Department of Pulmonology, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India
| | - Raja Dhar
- Department of Pulmonary, Sleep and Critical Care Medicine, Calcutta Medical Research Institute and Hospital, Kolkata, West Bengal, India
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Athanazio RA, Bernal Villada L, Avdeev SN, Wang HC, Ramírez-Venegas A, Sivori M, Dreyse J, Pacheco M, Man SK, Noriega-Aguirre L, Farouk H. Rate of severe exacerbations, healthcare resource utilisation and clinical outcomes in patients with COPD in low-income and middle-income countries: results from the EXACOS International Study. BMJ Open Respir Res 2024; 11:e002101. [PMID: 38637115 PMCID: PMC11029392 DOI: 10.1136/bmjresp-2023-002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/16/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION The EXAcerbations of Chronic obstructive lung disease (COPD) and their OutcomeS (EXACOS) International Study aimed to quantify the rate of severe exacerbations and examine healthcare resource utilisation (HCRU) and clinical outcomes in patients with COPD from low-income and middle-income countries. METHODS EXACOS International was an observational, cross-sectional study with retrospective data collection from medical records for a period of up to 5 years. Data were collected from 12 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Hong Kong, Mexico, Panama, Russia and Taiwan. The study population comprised patients ≥40 years of age with COPD. Outcomes/variables included the prevalence of severe exacerbations, the annual rate of severe exacerbations and time between severe exacerbations; change in lung function over time (measured by the forced expiratory volume in 1 s (FEV1)); peripheral blood eosinophil counts (BECs) and the prevalence of comorbidities; treatment patterns; and HCRU. RESULTS In total, 1702 patients were included in the study. The study population had a mean age of 69.7 years, with 69.4% males, and a mean body mass index of 26.4 kg/m2. The mean annual prevalence of severe exacerbations was 20.1%, and 48.4% of patients experienced ≥1 severe exacerbation during the 5-year study period. As the number of severe exacerbations increased, the interval between successive exacerbations decreased. A statistically significant decrease in mean (SD) FEV1 from baseline to post-baseline was observed in patients with ≥1 severe exacerbation (1.23 (0.51) to 1.13 (0.52) L; p=0.0000). Mean BEC was 0.198 x109 cells/L, with 64.7% of patients having a BEC ≥0.1 x109 cells/L and 21.3% having a BEC ≥0.3 x109 cells/L. The most common comorbidity was hypertension (58.3%). An increasing number of severe exacerbations per year was associated with greater HCRU. DISCUSSION The findings presented here indicate that effective treatment strategies to prevent severe exacerbations in patients with COPD remain a significant unmet need in low-income and middle-income countries.
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Affiliation(s)
- Rodrigo Abensur Athanazio
- Pulmonology Division, Heart Institute-InCor-Clinical Hospital, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | | | - Sergey N Avdeev
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Alejandra Ramírez-Venegas
- Tobacco Smoking and COPD Research Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Martín Sivori
- Pneumology Unit, Dr J M Ramos Mejía Pulmonology University Center, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Jorge Dreyse
- Department of Internal Medicine and Critical Care Center, Clínica Las Condes and School of Medicine Universidad Finis Terrae, Santiago, Chile
| | - Manuel Pacheco
- Internal Medicine Research Group, Universidad Tecnológica de Pereira, Pereira, Colombia
- Fundación Universitaria Visión de las Américas y Respiremos Unidad de Neumología, Pereira, Colombia
| | - Sin Kit Man
- Department of Medicine and Geriatrics, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong Special Administrative Region (HKSAR), Tuen Mun, People's Republic of China
| | - Lorena Noriega-Aguirre
- Center for Diagnosis and Treatment of Respiratory Diseases (CEDITER), Panama City, Panama
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Lai K, Sun D, Dai R, Samoro R, Park HS, Åstrand A, Cohen D, Jison M, Shih VH, Werkström V, Yao Y, Zhang Y, Zheng W, Zhong N, Albert A, Jianping B, Bi C, Lijun C, Mei C, Min C, Ping C, Zhimin C, Chih-Feng C, Sook CY, Xiuhua F, Xiwen G, Wei G, Wei H, Zhihai H, Wei HX, Kewu H, Mao H, Grace Dawn IM, Inbeom J, Luning J, Mingyan J, Shanping J, Meiling J, Jian K, Woo KJ, Sang-Ha K, Jiulong K, Ping-Hung K, Jie L, Manxiang L, Minjing L, Ruoran L, Wen L, Xianhua L, Yanming L, Yong LS, Chuanhe L, Chuntao L, Jing L, Xiaoxia L, Huiyu L, Zhuang L, Shengxi M, Liangping M, Hoon MK, Lin M, Choon-Sik P, Sim PH, Hye-Kyung P, Jung-Won P, Diahn-Warng P, Ronnie S, Guochao S, Debin S, Dejun S, Chun-Hua W, Guangfa W, Limin W, Xuefen W, Yan W, Liping W, Haihong W, Yi X, Zuke X, Canmao X, Jin-Fu X, Xingxiang X, Xiyuan X, Jianping Y, Hongzhong Y, Joo YH, Wencheng Y, Jin Z, Longju Z, Min Z, Wei Z, Jianping Z, Ziwen Z, Xiaoli Z, Yingqun Z. Benralizumab efficacy and safety in severe asthma: A randomized trial in Asia. Respir Med 2024:107611. [PMID: 38570145 DOI: 10.1016/j.rmed.2024.107611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Benralizumab is indicated as add-on therapy in patients with uncontrolled, severe eosinophilic asthma; it has not yet been evaluated in a large Asian population with asthma in a clinical trial. OBJECTIVE To evaluate the efficacy and safety of benralizumab in patients with severe asthma in Asia. METHODS MIRACLE (NCT03186209) was a randomized, Phase 3 study in China, South Korea, and the Philippines. Patients aged 12-75 years with severe asthma receiving medium-to-high-dose inhaled corticosteroid/long-acting β2-agonists, stratified (2:1) by baseline blood eosinophil count (bEOS) (≥300/μL; <300/μL), were randomized (1:1) to benralizumab 30 mg or placebo. Endpoints included annual asthma exacerbation rate (AAER; primary endpoint), change from baseline at Week 48 in pre-bronchodilator (BD) forced expiratory volume in 1 second (pre-BD FEV1) and total asthma symptom score (TASS). Safety was evaluated ≤ Week 56. RESULTS Of 695 patients randomized, 473 had baseline bEOS ≥300/μL (benralizumab n = 236; placebo n = 237). In this population, benralizumab significantly reduced AAER by 74% (rate ratio 0.26 [95% CI 0.19, 0.36], p < 0.0001) and significantly improved pre-BD FEV1 (least squares difference [LSD] 0.25 L [95% CI 0.17, 0.34], p < 0.0001) and TASS (LSD -0.25 [-0.45, -0.05], p = 0.0126) versus placebo. In patients with baseline bEOS <300/μL, there were numerical improvements in AAER, pre-BD FEV1, and TASS with benralizumab versus placebo. The frequency of adverse events was similar for benralizumab (76%) and placebo (80%) in the overall population. CONCLUSIONS MIRACLE data reinforces the efficacy and safety of benralizumab for severe eosinophilic asthma in an Asian population, consistent with the global Phase 3 results.
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Affiliation(s)
- Kefang Lai
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dejun Sun
- Inner Mongolia People's Hospital, Hohhot, China
| | - Ranran Dai
- Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ronnie Samoro
- Healthlink Medical-Surgical-Dental Clinics and Diagnostic Center, Iloilo City, Philippines
| | - Hae-Sim Park
- Ajou University School of Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Annika Åstrand
- Late-stage Respiratory & Immunology, AstraZeneca, Gothenburg, Sweden
| | - David Cohen
- Late-stage Respiratory & Immunology, AstraZeneca, Gaithersburg, MD, USA
| | - Maria Jison
- Late-stage Respiratory & Immunology, AstraZeneca, Gaithersburg, MD, USA
| | - Vivian H Shih
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | | | - Yuhui Yao
- Respiratory & Immunology, R&D China, AstraZeneca, Shanghai, China
| | - Yajuan Zhang
- Respiratory & Immunology, R&D China, AstraZeneca, Shanghai, China
| | | | - Nanshan Zhong
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Albay Albert
- Manila Doctors Hospital, Metro Manila, Philippines
| | - Bo Jianping
- Second Hospital of Shanxi Medical University, Shanxi, China
| | - Chen Bi
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chen Lijun
- Yinchuan First People's Hospital, Yinchuan, China
| | - Chen Mei
- Chengdu Fifth People's Hospital, Sichuan, China
| | - Chen Min
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Chen Ping
- The General Hospital of Shenyang Military, Shenyang, China
| | - Chen Zhimin
- The Children's Hospital of Zhejiang University College of Medicine, Zhejiang, China
| | | | | | - Fu Xiuhua
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Gao Xiwen
- Central Hospital of Minhang District, Shanghai, China
| | - Gu Wei
- Nanjing First Hospital, Nanjing, China
| | - Han Wei
- Qingdao Municipal Hospital, Qingdao, China
| | | | - Hu Xi Wei
- The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Huang Kewu
- Beijing Chaoyang Hospital, Beijing, China
| | - Huang Mao
- Jiangsu Province Hospital, Jiangsu, China
| | | | - Jeong Inbeom
- Konyang University Hospital, Daejeon, Republic of Korea
| | - Jiang Luning
- Affiliated Hospital of Jining Medical College, Jining, China
| | | | - Jiang Shanping
- Sun Yat-Sen Memorial Hospital Sun Yat-Sen University, Guangzhou, China
| | - Jin Meiling
- Zhongshan Hospital of Fudan University, Shangha, China
| | - Kang Jian
- The First Affiliated Hospital of China Medical University, Chongqing, China
| | - Kim Jin Woo
- The Catholic University of Korea, Seoul, Republic of Korea
| | - Kim Sang-Ha
- Yonsei University Wonju Severance Christian Hospital, Gangwon-do, Republic of Korea
| | - Kuang Jiulong
- The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | | | - Li Jie
- First Affiliated Hospital of Ganzhou Medical University, Guangzhou, China
| | - Li Manxiang
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Minjing
- The First People's Hospital of Foshan, Foshan, China
| | - Li Ruoran
- Xuzhou Central Hospital, Jiangsu, China
| | - Li Wen
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Li Xianhua
- The First People's Hospital of Neijiang, Neijiang, China
| | | | | | - Liu Chuanhe
- Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Liu Chuntao
- West China Hospital, Sichuan University, Sichuan, China
| | - Liu Jing
- The Fifth Affiliated Hospital Sun YAT-SEN University, China
| | | | - Lu Huiyu
- Taizhou People's Hospital, Taizhou, China
| | - Luo Zhuang
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ma Shengxi
- Xinxiang Central Hospital, Xinxiang, China
| | - Mao Liangping
- Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Min Kyung Hoon
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Mu Lin
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Park Choon-Sik
- Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Park Hae Sim
- Ajou University Hospital, Suwon-si, Republic of Korea
| | - Park Hye-Kyung
- Pusan National University Hospital, Busan, Republic of Korea
| | | | | | - Samoro Ronnie
- Healthlink Medical-Surgical-Dental Clinics and Diagnostic Center, Iloilo City, Philippines
| | - Shi Guochao
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sun Debin
- Lishui Central Hospital, Lishui, China
| | - Sun Dejun
- Inner Mongolia People's Hospital, Hohhot, China
| | - Wang Chun-Hua
- Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wang Guangfa
- Peking University First Hospital, Beijing, China
| | - Wang Limin
- Hangzhou First People's Hospital, Hangzhou, China
| | - Wang Xuefen
- The First Affiliated Hospital Zhejiang University, Zhejiang, China
| | - Wang Yan
- The Second Affiliated Hospital of Army Medical University, PLA, China
| | - Wei Liping
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Xiao Yi
- Yanan Hospital, Kunming City, Yunnan, China
| | - Xiao Zuke
- Jiangxi Provincial People's Hospital, Jiangxi, China
| | - Xie Canmao
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xu Jin-Fu
- Shanghai Pulmonary Hospital, Shanghai, China
| | - Xu Xingxiang
- Northern Jiangsu People's Hospital, Jiangsu, China
| | - Xu Xiyuan
- The First Affiliated Hospital of Baotou Medical College, Inner Mongolia, China
| | - Yan Jianping
- Zhejiang Provincial People's Hospital, Zhejiang, China
| | | | - Yoon Ho Joo
- Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yu Wencheng
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhang Jin
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhang Longju
- The First People's Hospital of Zunyi, Zunyi, China
| | - Zhang Min
- The People's Hospital of Ganzhou, Ganzhou, China
| | - Zhang Wei
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhao Jianping
- Tongji Hospital of Huazhong Science and Technology University, Wuhan, China
| | - Zhao Ziwen
- Guangzhou First People's Hospital, Guangzhou, China
| | - Zhu Xiaoli
- Zhongda Hospital Southeast University, Nanjing, China
| | - Zhu Yingqun
- The Third Hospital of Changsha, Changsha, China
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Yoo KH, Kim SH, Kim SH, Moon JY, Park HW, Chang YS, Beekman MJ. Short-acting β2-agonist prescriptions in patients with asthma: findings from the South Korean cohort of SABINA III. Korean J Intern Med 2024; 39:123-136. [PMID: 38057957 PMCID: PMC10790050 DOI: 10.3904/kjim.2023.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/31/2023] [Accepted: 08/11/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND/AIMS Despite short-acting β2-agonist (SABA) overuse being associated with poor asthma outcomes, data on SABA use in South Korea is scarce. Herein, we describe prescription patterns of SABA and other asthma medications in patients from the South Korean cohort of the SABA use IN Asthma (SABINA) III study. METHODS This study included patients with asthma aged ≥ 12 years, who had ≥ 3 consultations with the same healthcare provider, and medical records containing data for ≥ 12 months prior to the study visit. Patients were classified by investigator-defined asthma severity (per 2017 Global Initiative for Asthma recommendations) and practice type (primary or specialist care). Data on disease characteristics, asthma treatments, and clinical outcomes in the 12 months before the study visit were collected using electronic case report forms. RESULTS Data from 476 patients (mean age, 55.4 years; female, 63.0%) were analyzed. Most patients were treated by specialists (83.7%) and had moderate-to-severe asthma (91.0%). Overall, 7.6% of patients were prescribed ≥ 3 SABA canisters (defined as over-prescription). In patients prescribed SABA in addition to maintenance therapy, 47.4% were over-prescribed SABA. Most patients (95.4%) were prescribed a fixed-dose combination of an inhaled corticosteroid and a long-acting β2-agonist as maintenance therapy. Although asthma was well-controlled/partly-controlled in 91.6% of patients, 29.6% experienced ≥ 1 severe asthma exacerbation. CONCLUSION SABA over-prescription was reported in nearly 50% of patients prescribed SABA in addition to maintenance therapy, underscoring the need to align clinical practices with the latest evidence-based recommendations and educate physicians and patients on appropriate SABA use.
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Affiliation(s)
- Kwang-Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul,
Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul,
Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
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Pratiwi H, Benkő R, Kusuma IY. Navigating the asthma network on Twitter: Insights from social network and sentiment analysis. Digit Health 2024; 10:20552076231224075. [PMID: 38269370 PMCID: PMC10807307 DOI: 10.1177/20552076231224075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/26/2024] Open
Abstract
Background Asthma is a condition in which the airways become inflamed and constricted, causing breathing difficulties, wheezing, coughing, and chest tightness. Social networks can have a substantial effect on asthma management and results. However, no studies of social networks addressing asthma have been undertaken. Objective The aim of this research was to identify the significant social network structures, key influencers, top topics, and sentiments of asthma-related Twitter conversations. Methods All the tweets collected for this study included the keyword "asthma" or were mentioned in or in replies to tweets that were performed. For this study, a random sample of Twitter data was collected using NodeXL Pro software between December 1, 2022, and January 29, 2023. The data collected includes the user's display name, Twitter handle, tweet text, and the tweet's publishing date and time. After being imported into the Gephi application, the NodeXL data were then shown using the Fruchterman-Reingold layout method. In our study, SNA (Social Network Analysis) metrics were utilized to identify the most popular subject using hashtags, sentiment-related phrases (positive, negative, or neutral), and top influencer by centrality measures (degree, betweenness). Results The study collected 48,122 tweets containing the keyword "asthma" or mentioned in replies. News reporters and journalists emerged as top influencers based on centrality measures in Twitter conversations about asthma, followed by government and healthcare institutions. Education, trigger factors (e.g., cat exposure, diet), and associated conditions were highly discussed topics on asthma-related social media posts (e.g., sarscov2, copd). Our study's sentiment analysis revealed that there were 8427 phrases associated neutral comments (18%), 12,582 words reflecting positive viewpoints (26%), and 27,111 words reflecting negative opinions (56%). Conclusion This study investigates the relevance of social media influencers, news reporters, health experts, health organizations, and the government in the dissemination and promotion of asthma-related education and awareness during public health information.
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Affiliation(s)
- Hening Pratiwi
- Department of Pharmacy, Faculty of Health Sciences, Jenderal Soedirman University, Purwokerto, Indonesia
| | - Ria Benkő
- Institute of Clinical Pharmacy, University of Szeged, Szeged,
Hungary
- Albert Szent-Györgyi Health Centre, Central Pharmacy, University of Szeged, Szeged, Hungary
- Albert Szent-Györgyi Health Centre, Emergency Department, University of Szeged, Szeged, Hungary
| | - Ikhwan Yuda Kusuma
- Institute of Clinical Pharmacy, University of Szeged, Szeged,
Hungary
- Pharmacy Study Program, Faculty of Health, Universitas Harapan Bangsa, Purwokerto, Indonesia
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Usmani K, Jain SK, Yadav S. Mechanism of action of certain medicinal plants for the treatment of asthma. JOURNAL OF ETHNOPHARMACOLOGY 2023; 317:116828. [PMID: 37369335 DOI: 10.1016/j.jep.2023.116828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/06/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Asthma is often treated and prevented using the pharmacological properties of traditional medicinal plants. These healthcare systems are among the most well-known, conveniently accessible, and economically priced in India and several other Asian countries. Traditional Indian Ayurvedic plants have the potential to be used as phyto-therapeutics, to create novel anti-asthmatic drugs, and as a cost-effective source of pharmaceuticals. Current conventional therapies have drawbacks, including serious side effects and expensive costs that interfere with treatment compliance and affect the patient's quality of life. The primary objective of the article is to comprehensively evaluate the advancement of research on the protective phytochemicals of traditional plants that target immune responses and signaling cascades in inflammatory experimental asthma models. The study would assist in paving the way for the creation of natural phytomedicines that are protective, anti-inflammatory, and immunomodulatory against asthma, which may then be used in individualized asthma therapy. AIM OF THE STUDY The study demonstrates the mechanisms of action of phytochemicals present in traditional medicinal plants, diminish pulmonary disorder in both in vivo and in vitro models of asthma. MATERIALS AND METHODS A comprehensive review of the literature on conventional plant-based asthma therapies was performed from 2006 to 2022. The study uses authoritative scientific sources such as PubMed, PubChem Compound, Wiley Online Library, Science Direct, Springer Link, and Google Scholar to collect information on potential phytochemicals and their mechanisms of action. World Flora Online (http://www.worldfloraonline.org) and Plants of the World Online (https://wcsp.science.kew.org) databases were used for the scientific names of medicinal plants. RESULTS The study outlines the phytochemical mechanisms of some traditional Ayurveda botanicals used to treat asthma. Active phytochemicals including curcumin, withaferin-A, piperine, glabridin, glycyrrhizin, 18β-glycyrrhetinic acid, trans-cinnamaldehyde, α-hederin, thymoquinone, eugenol, [6]-shogoal, and gingerol may treat asthma by controlling inflammation and airway remodeling. The study concluded that certain Ayurvedic plants' phytochemicals have the ability to reduce inflammation and modulate the immune system, that can effectively cure asthma. CONCLUSION Plants used in traditional Ayurvedic medicine have been utilized for millennia, advocating phyto-therapy as a treatment for a variety of illnesses. A theoretical foundation for the use of cutting-edge asthma treatments has been built with the growth of experimental research on traditional phytochemicals. In-depth phytochemical research for the treatment of asthma using Indian Traditional Ayurvedic herbs is compiled in the study. The approach for preventative therapeutics and cutting-edge alternatives to battle the molecular pathways in the pathophysiology of asthma are the key themes of the study. The phytochemical mechanism of action of traditional Ayurvedic herbs is explained to get the attention of the pharmaceutical industry so they can make future anti-asthma drugs for personalized asthma care in the community. The study develops strategies for customized phyto-therapeutics, concentrating on low-cost, side-effect-free approaches that employ bioactive phytochemicals from plants as the major source of effective anti-asthmatic therapy.
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Affiliation(s)
- Kainat Usmani
- Department of Zoology, School of Biological Sciences, Dr. Harisingh Gour Vishwavidyalaya (A Central University), Sagar, 470003, MP, India.
| | - Subodh Kumar Jain
- Department of Zoology, School of Biological Sciences, Dr. Harisingh Gour Vishwavidyalaya (A Central University), Sagar, 470003, MP, India.
| | - Shweta Yadav
- Department of Zoology, School of Biological Sciences, Dr. Harisingh Gour Vishwavidyalaya (A Central University), Sagar, 470003, MP, India.
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8
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Yasaratne D, Idrose NS, Dharmage SC. Asthma in developing countries in the Asia-Pacific Region (APR). Respirology 2023; 28:992-1004. [PMID: 37702387 DOI: 10.1111/resp.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
There is growing interest in the epidemiology of asthma in developing countries, especially in the Asia-Pacific Region (APR). A number of reviews have been published in this field, but a comprehensive synthesis of overall data has not been reported. Here, we summarized the burden, risk factors and challenges of asthma management in developing countries with a specific emphasis on the APR by consolidating evidence from both systematic and narrative reviews published up until February 2023. We found that although asthma prevalence in low and low-middle-income countries (LMICs) is known to be generally lower compared to high-income countries, the burden is substantially greater. Studies conducted in APR LMIC have reported a range of risk factors, including pre- and post-natal factors, environmental considerations, lifestyle measures, individual features and genetics. The low and inequitable distribution of quality preventive and curative health care, a lack of advanced diagnostic measures, non-availability and non-affordability of novel therapeutics, cultural beliefs and practices, and diverse disease phenotypes make it challenging to achieve optimal asthma control in the region. Hence, we call for the development of a region-specific blueprint for action to mitigate this challenging situation, to help reduce the burden of asthma in APR LMIC.
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Affiliation(s)
- Duminda Yasaratne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - N Sabrina Idrose
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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9
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Alzaabi A, Bell JP, Montero-Arias F, Price DB, Jackson DJ, Wang HC, Budgen N, Farouk H, Maslova E. Greenhouse Gas Emissions from Respiratory Treatments: Results from the SABA CARBON International Study. Adv Ther 2023; 40:4836-4856. [PMID: 37684493 PMCID: PMC10567885 DOI: 10.1007/s12325-023-02663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Healthcare systems are looking to reduce their carbon impact. Short-acting β2-agonist (SABA) overuse (≥ 3 canisters/year) is common in asthma and linked to poor outcomes; however, its environmental impact remains unknown. As part of the CARBON programme, this study retrospectively quantified the carbon footprint of SABA and controller inhalers across all respiratory indications and SABA overuse in asthma in lower-middle-income countries (LMICs), upper-middle-income countries and high-income countries across Africa, Asia Pacific, Latin America and the Middle East. METHODS Two data sources were utilised to evaluate the carbon contribution of inhalers to respiratory care. To quantify greenhouse gas (GHG) emissions associated with total inhaler use across all respiratory indications, inhaler sales data were obtained from IQVIA MIDAS® (Q4/2018-Q3/2019) and compared by dose to prevent confounding from differences in canister actuation counts. GHG emissions associated with SABA overuse in asthma were evaluated using prescription and self-reported over-the-counter purchase data from the SABA use IN Asthma (SABINA) III study (2019-2020). Inhaler-related GHG emissions were quantified using published data and product life cycle assessments. RESULTS SABA accounted for > 50% of total inhaler use and inhaler-related emissions in most countries analysed. The total SABA-related emissions were estimated at 2.7 million tonnes carbon dioxide equivalents, accounting for 70% of total inhaler-related emissions. Among the countries, regions and economies analysed, per capita SABA use and associated emissions were higher in Australia, the Middle East and high-income countries. Most SABA prescriptions for asthma (> 90%) were given to patients already overusing SABA. CONCLUSIONS Globally, SABA use/overuse is widespread and is the greatest contributor to the carbon footprint of respiratory treatment, regardless of the economic status of countries. Implementing evidence-based treatment recommendations, personalising treatment and reducing healthcare inequities, especially in LMICs, may improve disease control and patient outcomes, thereby reducing SABA overuse and associated carbon emissions beyond SABA use alone.
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Affiliation(s)
- Ashraf Alzaabi
- Respiratory Medicine Division, Zayed Military Hospital, Abu Dhabi, United Arab Emirates.
| | - John P Bell
- BioPharmaceutical Medical, Medical Affairs Respiratory and Immunology, AstraZeneca, Baar, Switzerland
| | - Felicia Montero-Arias
- Servicio de Neumología, Hospital México, CCSS y Hospital Clínica Bíblica Santa Ana, San José, Costa Rica
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Centre of Academic Primary Care, Division of Applied Science, University of Aberdeen, Aberdeen, UK
| | - David J Jackson
- Guy's Severe Asthma Centre, King's College London, London, UK
| | - Hao-Chien Wang
- Department of Medicine, National Taiwan University Cancer Center, Taipei City, Taiwan
| | - Nigel Budgen
- Global Sustainability, AstraZeneca, Macclesfield, UK
| | - Hisham Farouk
- International Medical, AstraZeneca, Dubai, United Arab Emirates
| | - Ekaterina Maslova
- BioPharmaceutical Medical, Medical Affairs Respiratory and Immunology, AstraZeneca, Cambridge, UK
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10
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Barne M. Gaps in asthma diagnosis and treatment in low- and middle-income countries. FRONTIERS IN ALLERGY 2023; 4:1240259. [PMID: 37937199 PMCID: PMC10627233 DOI: 10.3389/falgy.2023.1240259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/02/2023] [Indexed: 11/09/2023] Open
Abstract
Low- and middle-income countries (LMICs) contribute to a major proportion of asthma morbidity and mortality globally, even though the prevalence is higher in high income countries. Mortality due to asthma is avoidable and patients should be able to live a near normal life. There are factors that influence overall disease prevalence and poor health outcomes due to asthma in LMICs. This article summarizes the gaps in asthma diagnosis and management in LMICs. The gaps are diverse. Each challenge needs to be addressed through policy decisions, upgrade of infrastructure, knowledge and skills for early diagnosis and correct management among health care providers, both clinicians and paramedics. Healthcare accessibility and affordability are genuine challenges, and the public healthcare system needs to be geared up to address these at primary and tertiary levels. Mass education of the population through national level government initiatives is needed to help bridge the sociocultural gaps.
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Affiliation(s)
- Monica Barne
- Department of Training, Pulmocare Research and Education Foundation, Pune, India
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11
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Rabe APJ, Loke WJ, Gurjar K, Brackley A, Lucero-Prisno III DE. Global Burden of Asthma, and Its Impact on Specific Subgroups: Nasal Polyps, Allergic Rhinitis, Severe Asthma, Eosinophilic Asthma. J Asthma Allergy 2023; 16:1097-1113. [PMID: 37822519 PMCID: PMC10563777 DOI: 10.2147/jaa.s418145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023] Open
Abstract
Background The complex nature of asthma has resulted in a poor understanding of its epidemiology, particularly in low-and middle-income countries (LMIC). Clinical subgroups, such as patients with severe asthma, eosinophilic asthma, allergic rhinitis, or nasal polyps, experience additional barriers to care. Methods Prevalence estimates for asthma and key clinical subgroups were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 and from a targeted literature review conducted through PubMed in October of 2021. National estimates were calculated and the roles of potential explanatory factors were explored through qualitative analysis. Results In total, 162 publications from 69 countries were included. Across continents, asthma prevalence values ranged from 3.44% (Asia), 3.67% (Africa), 4.90% (South America), 5.69% (Europe), 8.29% (North America), to 8.33% (Oceania). Globally, of those with asthma, 26.70% had severe asthma, 30.99% had eosinophilic asthma, 48.95% had allergic rhinitis, and 7.0% to 25.40% had nasal polyps. Countries with higher air quality, income status, and healthcare access and quality reported a higher asthma prevalence. Conclusion Asthma prevalence values were low in LMICs, potentially indicating health system deficiencies resulting in low diagnosis and reporting. The prevalence of eosinophilic asthma and severe asthma phenotypes was high in many countries, although the prevalence estimates of all asthma subgroups were quite variable.
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Affiliation(s)
- Adrian Paul J Rabe
- BioPharmaceutical Medical, Respiratory & Immunology, AstraZeneca, Cambridge, UK
- Imperial College, London, UK
| | - Wei Jie Loke
- East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Khushboo Gurjar
- RWA Health Economics, Cytel Health Canada, Toronto, Ontario, Canada
| | | | - Don Eliseo Lucero-Prisno III
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- University of the Philippines Open University, Los Baños City, Philippines
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12
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Su KW, Yan DC, Ou LS, Lin LL, Wu CY, Huang SJ, Yao TC, Yeh KW, Huang JL. Prevalence, associated factors, and impact of adolescent asthma in Taiwan: Global Asthma Network phase I survey. World Allergy Organ J 2023; 16:100794. [PMID: 37497258 PMCID: PMC10365951 DOI: 10.1016/j.waojou.2023.100794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/05/2023] [Accepted: 05/27/2023] [Indexed: 07/28/2023] Open
Abstract
Background The prevalence of asthma in Taiwan was increasing in the past 30 years, causing a great impact on adolescent health. This study aimed to investigate the current prevalence, impact, and associated factors of asthma in Taiwanese adolescents. Material and methods Parents or guardians provided passive consent at home prior to the survey. Adolescents aged 13-14 years completed a questionnaire survey in 2017 in Taipei, Taiwan. The prevalence, impact, and associated factors of asthma were analyzed. We also compared the asthma prevalence with the prevalence in 1995 and 2001. Results We analyzed 3474 validated questionnaires. The prevalence of physician-diagnosed asthma was 12.4%. The prevalence of current wheezing was 9.2% in 2017, which was 5.2% in 1995 and 7.0% in 2001. 3.3% of 13-14-year-old adolescents had severe asthma symptoms. Asthma significantly impacted the lives of adolescents. Of the students with asthma, 10.9% had school absenteeism, 16.5% urgently needed to see a doctor, 9.5% went to the emergency department, and 3.5% were admitted to hospitals within the preceding 12 months. The associated factors for physician-diagnosed asthma in Taiwanese adolescents were male (prevalence ratio [PR], 1.38; 95% confidence interval [CI], 1.05-1.83; p = 0.02), maternal history of asthma (PR, 2.61; 95% CI, 1.69-4.02; p < 0.01), and recent paracetamol use at least once per month (PR, 2.60; 95% CI, 1.24-5.42; p = 0.01). The associated factors for school absenteeism were nocturnal cough (PR, 1.99; 95% CI, 1.16-3.41; p = 0.01), current wheezing (PR, 7.52; 95% CI, 4.39-12.9; p < 0.01), and recent paracetamol use (at least once per month, PR, 3.16; 95% CI, 1.10-9.06; p = 0.03; at least once per year, PR, 2.19; 95% CI, 1.25-3.83; p < 0.01). Conclusions The prevalence of physician-diagnosed asthma was 12.4%. Asthma substantially impacted the lives of adolescents. Reducing nocturnal cough, wheezing frequency, and paracetamol usage might help decrease school absenteeism.
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Affiliation(s)
- Kuan-Wen Su
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Dah-Chin Yan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Liang-Shiou Ou
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Lun Lin
- Department of Pediatrics, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chao-Yi Wu
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Jung Huang
- Department of Pediatrics, Jen-Ai Hospital, Taichung, Taiwan
| | - Tsung-Chieh Yao
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jing-Long Huang
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, New Taipei Municipal TuCheng Hospital, New Taipei, Taiwan
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Dhar R, Rhee CK, Perng DW, Fukunaga K, Ip MSM, Juthong S, Koh MS, Li J, Sharma S, Wiyono WH. The burden of systemic corticosteroid use in asthma management in Asia. Respirology 2023. [PMID: 37301540 DOI: 10.1111/resp.14533] [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: 08/30/2022] [Accepted: 05/03/2023] [Indexed: 06/12/2023]
Abstract
For most patients, asthma can be effectively managed using inhaled medications. However, patients who have severe and/or uncontrolled asthma, or who experience exacerbations, may require systemic corticosteroids (SCSs) to maintain asthma control. Although SCS are highly effective in this regard, even modest exposure to these medications can increase the risk for long-term, adverse health outcomes, such as type 2 diabetes, renal impairment, cardiovascular disease and overall mortality. Clinical and real-world data from studies investigating asthma severity, control and treatment practices around the globe have suggested that SCS are overused in asthma management, adding to the already substantial healthcare burden experienced by patients. Throughout Asia, although data on asthma severity, control and SCS usage are limited and vary widely among countries, available data strongly suggest a pattern of overuse consistent with the broader global trend. Coordinated changes at the patient, provider, institutional and policy levels, such as increasing disease awareness, promoting better adherence to treatment guidelines and increasing availability of safe and effective alternatives to SCS, are likely necessary to reduce the SCS burden for patients with asthma in Asia.
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Affiliation(s)
- Raja Dhar
- Department of Pulmonology, CK Birla Group of Hospitals, Kolkata, West Bengal, India
| | - Chin Kook Rhee
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, South Korea
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Koichi Fukunaga
- Department of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mary Sau-Man Ip
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Siwasak Juthong
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jing Li
- Allergy and Clinical Immunology Department, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shubham Sharma
- Heart and Lung Transplant Unit, Yashoda Hospitals, Secunderabad, India
| | - Wiwien Heru Wiyono
- Department of Pulmonology and Respiratory Medicine Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia
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14
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Dhar R, Talwar D, Salvi S, Muralimohan BV, Panchal S, Patil S, Bhagat S, Khatri N, Barkate H. Use of single-inhaler triple therapy in the management of obstructive airway disease: Indian medical experts' review. ERJ Open Res 2022; 8:00556-2021. [PMID: 35350278 PMCID: PMC8958219 DOI: 10.1183/23120541.00556-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/07/2022] [Indexed: 11/05/2022] Open
Abstract
Obstructive airway disease (OAD), which includes COPD and asthma, is the leading cause of morbidity and mortality in India. Long-acting bronchodilators (long-acting β2 agonists (LABAs) and/or long-acting muscarinic antagonists (LAMAs)) and inhaled corticosteroids (ICS) have a vital role in the management of patients with OAD. While symptom burden and exacerbations are common amongst treated patients, poor adherence to inhaler therapy is a frequent challenge. Better treatment options that optimise symptom control, improve quality of life, reduce exacerbation risk and improve adherence are desired. Triple therapy (ICS/LABA/LAMA) is recommended in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2021 guidelines for symptomatic COPD patients on ICS/LABA or LABA/LAMA, and who are at increased risk for frequent or severe exacerbations. Similarly, add-on LAMA is recommended in uncontrolled asthma patients on medium- to high-dose ICS/LABA by the Global Initiative for Asthma (GINA) 2021 guideline. In the real world, high-risk and overlapping phenotypes exist, which necessitate early initiation of triple therapy. We aim to provide an expert review on the use of single-inhaler triple therapy (SITT) for OAD management in global and Indian settings, knowledge from which can be extrapolated for appropriate treatment of Indian patients. The OAD population in India may benefit from early optimisation to SITT characterised by a high burden of exacerbating OAD, nonsmoker COPD and asthma-COPD overlap.
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Affiliation(s)
- Raja Dhar
- Dept of Pulmonology, The Calcutta Medical Research Institute, Kolkata, India
| | - Deepak Talwar
- Metro Respiratory Center, Pulmonology and Sleep Medicine, Metro Hospitals and Heart Institute, Noida, India
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - B V Muralimohan
- Dept of Internal Medicine and Pulmonology, Narayana Hrudayalaya - Mazumdar Shaw Medical Center, Bengaluru, India
| | - Sagar Panchal
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Saiprasad Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Sagar Bhagat
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Nishtha Khatri
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
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15
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Qin J, Lv M, Jiang Z, Meng X, Wang Y, Cui J, Wang J, Wang Q. Tuo-Min-Ding-Chuan Decoction Alleviate Ovalbumin-Induced Allergic Asthma by Inhibiting Mast Cell Degranulation and Down-Regulating the Differential Expression Proteins. Front Pharmacol 2021; 12:725953. [PMID: 34630102 PMCID: PMC8493414 DOI: 10.3389/fphar.2021.725953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022] Open
Abstract
Allergic asthma is a stubborn chronic inflammatory disease, and is considered a co-result of various immune cells, especially mast cells, eosinophils and T lymphocytes. At present, the treatment methods of allergic asthma are limited and the side effects are obvious. Traditional Chinese medicine has been used to treat diseases for thousands of years in China. One such example is the treatment of allergic asthma, which take the characteristics of less adverse reactions and obvious curative effect. Tuo-Min-Ding-Chuan Decoction (TMDCD) is a traditional Chinese medicine compound for the treatment of allergic asthma optimized from Ma-Xing-Gan-Shi Decoction (MXGSD), which was put forward in Treatise on Febrile Diseases by Zhang Zhongjing in the Eastern Han Dynasty. The compound shows a significant clinical effect, but the mechanism of its influence on the immune system is still unclear. The purpose of this study was to observe whether TMDCD could alleviate the symptoms of ovalbumin (OVA) challenged allergic asthma mice, and to explore its immune regulatory mechanism, especially on mast cell (MC) degranulation. The results showed TMDCD could not only reduce the airway hyperresponsiveness (AHR), inflammatory cell infiltration and mucus secretion in the lung tissue of OVA challenged mice, but also decrease the levels of total IgE, OVA-specific IgE, histamine and LTC4 in serum. We found that TMDCD can downregulate the expression of Fractalkine, Tryptase ε, IL-25, CCL19, MCP-1, OX40L, Axl, CCL22, CD30, G-CSF, E-selectin, OPN, CCL5, P-selectin, Gas6, TSLP in OVA challenged mice serum by using mouse cytokines antibody array. It has been reported in some literatures that these differentially expressed proteins are related to the occurrence of allergic asthma, such as tryptase ε, MCP-1, CCL5, etc. can be released by MC. And the results of in vitro experiments showed that TMDCD inhibited the degranulation of RBL-2H3 cells stimulated by DNP-IgE/BSA. Taken together, we made the conclusion that TMDCD could reduce the infiltration of inflammatory cells in lung tissue and alleviate airway remodeling in mice with allergic asthma, showed the effects of anti-inflammatory and antiasthmatic. TMDCD could also reduce the levels of IgE, histamine, LTC4, Tryptase ε, and other MC related proteins in the serum of allergic asthma mice, and the in vitro experiments showed that TMDCD could inhibit IgE mediated degranulation and histamine release of RBL-2H3 cells, proved its anti allergic effect.
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Affiliation(s)
- Jingbo Qin
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine (BUCM), Beijing, China
| | - Mingsheng Lv
- Respiratory Department, BUCM Third Affiliated Hospital, Beijing, China
| | - Zeqiang Jiang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine (BUCM), Beijing, China
| | - Xianghe Meng
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine (BUCM), Beijing, China
| | - Yi Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine (BUCM), Beijing, China
| | - Jiarui Cui
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine (BUCM), Beijing, China
| | - Ji Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine (BUCM), Beijing, China.,National Institute of TCM Constitution and Preventive Medicine, BUCM, Beijing, China
| | - Qi Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine (BUCM), Beijing, China.,National Institute of TCM Constitution and Preventive Medicine, BUCM, Beijing, China
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16
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Wang G, McDonald VM. Contemporary Concise Review 2020: Asthma. Respirology 2021; 26:804-811. [PMID: 34164877 DOI: 10.1111/resp.14099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 02/05/2023]
Abstract
Bushfires and coronavirus 2019 (COVID-19) were dominate features of 2020. Patients with asthma were significantly affected by the 2019/2020 bushfire season with an increased burden compared to the general population. Patients with controlled asthma do not appear to be at higher risk of severe COVID-19 infection or death than the general population. Personalized medicine is proposed as the next era for asthma management, with treatable traits as a strategy to implement personalized medicine into practice. Patient engagement in personalized medicine strategies is important and needs to be further explored. Oral corticosteroid (OCS) use in asthma is common and contributes a major burden. OCS stewardship is recommended. Biologic therapies reduce exacerbations of severe asthma and biomarkers can be used to predict treatment responders. Epithelia at mucosal and cutaneous surfaces are components in asthma pathogenesis, through airway immunity and inflammation. Dysregulation of resident microbial communities in the lung, gut and skin microbiome is relevant to asthma pathogenesis, but there are still many unknowns in this field.
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Affiliation(s)
- Gang Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Centre for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Centre for Disease-Related Molecular Network, Sichuan University, Chengdu, China
| | - Vanessa M McDonald
- Priority Research Centre of Healthy Lungs, School of Nursing and Midwifery, The University of Newcastle, New Lambton Heights, New South Wales, Australia
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