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Westhölter D, Reuter S, Taube C. [Advances in the management of asthma]. Laryngorhinootologie 2024; 103:500-505. [PMID: 38330996 DOI: 10.1055/a-2249-2207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Asthma is a heterogeneous inflammatory airway disease that causes relevant morbidity across individuals of all age cohorts. In recent years, advances in the understanding of asthma pathophysiology have led to the development of treatments tailored to specific pheno- and endotypes of the disease. This has significantly changed asthma management, especially for patients with severe disease. These new treatment options offer individuals with asthma access to personalized and disease-modifying therapies. The present paper is a comprehensive overview of recent clinical studies and of German and international guideline updates on asthma management.
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Affiliation(s)
- Dirk Westhölter
- Klinik für Pneumologie, Universitätsmedizin Essen - Ruhrlandklinik, Essen, Germany
| | - Sebastian Reuter
- Klinik für Pneumologie, Universitätsmedizin Essen - Ruhrlandklinik, Essen, Germany
| | - Christian Taube
- Klinik für Pneumologie, Universitätsmedizin Essen - Ruhrlandklinik, Essen, Germany
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Mukherjee M, Okusi C, Jamie G, Byford R, Ferreira F, Agarwal U, Weatherill D, Fletcher M, Quint JK, Romel Bhuia M, de Lusignan S, Sheikh SA. Modifiable risk factors for asthma exacerbations during the COVID-19 pandemic: a population-based repeated cross-sectional study using the Research and Surveillance Centre primary care database. THE LANCET REGIONAL HEALTH. EUROPE 2024; 42:100938. [PMID: 38846423 PMCID: PMC11153226 DOI: 10.1016/j.lanepe.2024.100938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 06/09/2024]
Abstract
Background There were substantial reductions in asthma exacerbations during the COVID-19 pandemic for reasons that remain poorly understood. We investigated changes in modifiable risk factors which might help explain the reductions in asthma exacerbations. Methods Multilevel generalised linear mixed models were fitted to examine changes in modifiable risk factors for asthma exacerbations during 2020-2022, compared to pre-pandemic year (2019), using observational, routine data from general practices in the Oxford-Royal College of General Practitioners Research and Surveillance Centre. Asthma exacerbations were defined as any of GP recorded: asthma exacerbations, prescriptions of prednisolone, accident and emergency department attendance or hospitalisation for asthma. Modifiable risk factors of interest were ownership of asthma self-management plan, asthma annual review, inhaled-corticosteroid (ICS) prescriptions, influenza vaccinations and respiratory-tract-infections (RTI). Findings Compared with 2019 (n = 550,995), in 2020 (n = 565,956) and 2022 (n = 562,167) (p < 0.05): asthma exacerbations declined from 67.1% to 51.9% and 61.1%, the proportion of people who had: asthma exacerbations reduced from 20.4% to 15.1% and 18.5%, asthma self-management plans increased from 28.6% to 37.7% and 55.9%; ICS prescriptions increased from 69.9% to 72.0% and 71.1%; influenza vaccinations increased from 14.2% to 25.4% and 55.3%; current smoking declined from 15.0% to 14.5% and 14.7%; lower-RTI declined from 10.5% to 5.3% and 8.1%; upper-RTI reduced from 10.7% to 5.8% and 7.6%. There was cluster effect of GP practices on asthma exacerbations (p = 0.001). People with asthma were more likely (p < 0.05) to have exacerbations if they had LRTI (seven times(x)), had URTI and ILI (both twice), were current smokers (1.4x), PPV vaccinated (1.3x), seasonal flu vaccinated (1.01x), took ICS (1.3x), had asthma reviews (1.09x). People with asthma were less likely to have exacerbations if they had self-management plan (7%), and were partially (4%) than fully COVID-19 vaccinated. Interpretation We have identified changes in modifiable risk factors for asthma exacerbation that need to be maintained in the post-pandemic era. Funding Asthma UK Centre for Applied Research and Health Data Research UK.
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Affiliation(s)
- Mome Mukherjee
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
- HDR UK Better Care, The University of Edinburgh, Edinburgh, UK
- HDR UK BREATHE Data Hub, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Cecilia Okusi
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Rd, Oxford, OX2 6ED, UK
| | - Gavin Jamie
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Rd, Oxford, OX2 6ED, UK
| | - Rachel Byford
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Rd, Oxford, OX2 6ED, UK
| | - Filipa Ferreira
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Rd, Oxford, OX2 6ED, UK
| | - Utkarsh Agarwal
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Rd, Oxford, OX2 6ED, UK
| | - David Weatherill
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Monica Fletcher
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
- HDR UK BREATHE Data Hub, The University of Edinburgh, Edinburgh, UK
| | - Jennifer K. Quint
- HDR UK BREATHE Data Hub, The University of Edinburgh, Edinburgh, UK
- School of Public Health & National Heart and Lung Institute, Imperial College London, London, UK
| | - Mohammad Romel Bhuia
- Department of Statistics, Shahjalal University of Science and Technology (SUST), Sylhet, 3114, Bangladesh
| | - Simon de Lusignan
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Rd, Oxford, OX2 6ED, UK
- Royal College of General Practitioners (RCGP), 30 Euston Square, London, NW1 2FB, UK
| | - Sir Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
- HDR UK Better Care, The University of Edinburgh, Edinburgh, UK
- HDR UK BREATHE Data Hub, The University of Edinburgh, Edinburgh, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Rd, Oxford, OX2 6ED, UK
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Chiner E, Machetti C, Boira I, Esteban V, Castelló Faus C, Torba Kordyukova A. Analysis of Patients Admitted for Asthma Exacerbation in a Tertiary Hospital in Spain. Cureus 2024; 16:e63042. [PMID: 39050304 PMCID: PMC11268450 DOI: 10.7759/cureus.63042] [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] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES To analyze the characteristics of adult patients admitted for asthma exacerbation and determine optimization, treatment adherence, and follow-up in clinics. METHODS Patients ≥ 18 years old admitted from May 2021 to June 2023 with a primary diagnosis of asthma exacerbation were included. Patients with a secondary diagnosis of asthma exacerbation and those without a confirmed diagnosis were excluded. RESULTS A total of 186 patients were analyzed, 63% were female, with a mean age of 49 ± 34 years, mean body mass index (BMI) of 26.4 ± 5 kg/m2, mean immunoglobulin E level of 132 ± 235 IU/mL (range: 25-2041), mean eosinophils count of 180 ± 443, and length of stay of 8.6 ± 5 days. Comparing patients with one admission to those with multiple admissions, differences were observed in age (39 ± 15 vs. 58 ± 20, p < 0.0001), BMI (25.2 ± 3 vs. 27.4 ± 4, p < 0.0003), comorbidity (15% vs. 60%, p < 0.0001), and length of stay (4.5 ± 2 vs. 11 ± 3, p < 0.0001). Of the patients, 15% had undiagnosed asthma, 28% had known asthma without maintenance therapy, 23% were managed by primary care, and 34% were followed by pneumology. The mean Test of Adherence to Inhalers (TAI) score was 42.5 ± 8 points, with 70% showing erratic non-adherence, 46% showing deliberate non-adherence, and 21% showing unconscious non-adherence. CONCLUSIONS The young population represents a significant percentage of admissions for asthma exacerbation due to poor follow-up in pulmonology clinics, inadequate treatment optimization, and low adherence. This study adds that it is necessary to improve the approach to asthma in primary care to optimize treatment, reduce under-diagnosis, and avoid hospital admissions.
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Affiliation(s)
- Eusebi Chiner
- Pulmonology, Hospital Universitario San Juan de Alicante, Alicante, ESP
| | - Clara Machetti
- Pulmonology, Hospital Universitario San Juan de Alicante, Alicante, ESP
| | - Ignacio Boira
- Pulmonology, Hospital Universitario San Juan de Alicante, Alicante, ESP
| | - Violeta Esteban
- Pulmonology, Hospital Universitario San Juan de Alicante, Alicante, ESP
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Westhölter D, Reuter S, Taube C. [Advances in the management of asthma]. Dtsch Med Wochenschr 2023; 148:1123-1128. [PMID: 37611578 DOI: 10.1055/a-1990-2341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Asthma is a heterogeneous inflammatory airway disease that causes relevant morbidity across individuals of all age cohorts. In recent years, advances in the understanding of asthma pathophysiology have led to the development of treatments tailored to specific pheno- and endotypes of the disease. This has significantly changed asthma management, especially for patients with severe disease. These new treatment options offer individuals with asthma access to personalized and disease-modifying therapies. The present paper is a comprehensive overview of recent clinical studies and of German and international guideline updates on asthma management.
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Affiliation(s)
- Dirk Westhölter
- Klinik für Pneumologie, Universitätsmedizin Essen - Ruhrlandklinik, Essen, Germany
| | - Sebastian Reuter
- Klinik für Pneumologie, Universitätsmedizin Essen - Ruhrlandklinik, Essen, Germany
| | - Christian Taube
- Klinik für Pneumologie, Universitätsmedizin Essen - Ruhrlandklinik, Essen, Germany
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Koenigsberg R, Grayson MH. Did the coronavirus disease 2019 pandemic change asthma prevalence? Ann Allergy Asthma Immunol 2023; 131:141-142. [PMID: 37536872 DOI: 10.1016/j.anai.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Rebecca Koenigsberg
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
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Terry PD, Heidel RE, Dhand R. The association of preexisting severe asthma with COVID-19 outcomes. Curr Opin Pulm Med 2023; 29:215-222. [PMID: 36928032 PMCID: PMC10090339 DOI: 10.1097/mcp.0000000000000954] [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] [Indexed: 03/18/2023]
Abstract
PURPOSE OF REVIEW Three years after the emergence of coronavirus disease 2019 (COVID-19), many studies have examined the association between asthma and COVID-related morbidity and mortality, with most showing that asthma does not increase risk. However, the U.S. Centers for Disease Control (CDC) currently suggests that patients with severe asthma may, nonetheless, be particularly vulnerable to COVID-19-related morbidity. RECENT FINDINGS With respect to poor COVID-19 outcomes, our search yielded nine studies that quantified associations with severe asthma, seven that considered use of monoclonal antibodies (mAB), and 14 that considered inhaled corticosteroids (ICS) use. mAb and ICS use have been used as measures of severe asthma in several studies. Severe asthma was significantly associated with poor COVID-19 outcomes. The results for mAb and ICS were mixed. SUMMARY An increased risk of poor COVID-19 outcomes in patients with severe asthma is possible. However, these studies remain sparse and suffer from several methodological limitations that hinder their interpretation. Additional evidence is needed to provide clear, cogent guidance for health agencies seeking to inform patients with asthma about potential risks due to COVID-19.
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Affiliation(s)
| | - R. Eric Heidel
- Department of Surgery, Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee, USA
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