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Melhorn J, Lavoie G. Uncontrolled mild-to-moderate asthma may not be mild or moderate, or even asthma: The benefits of early phenotyping. Respirology 2024. [PMID: 38991666 DOI: 10.1111/resp.14795] [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: 06/19/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
See related article
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Affiliation(s)
- James Melhorn
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Gabriel Lavoie
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Zhang G, Li X, Zheng X. Associations of serum carotenoids with asthma and mortality in the US adults. Heliyon 2024; 10:e24992. [PMID: 38318021 PMCID: PMC10840010 DOI: 10.1016/j.heliyon.2024.e24992] [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: 10/25/2023] [Revised: 12/17/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
Objective This study was to investigate the association between serum carotenoid levels and the prevalence of asthma, as well as the relationship between serum carotenoid levels and the risk of mortality among individuals with asthma. Methods Data on five serum carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin, and lycopene) were obtained from the National Health and Nutrition Examination Survey (NHANES) 2001-2006. Mortality data was extracted from the pertinent mortality records within the NHANES database, up to December 31, 2019. Logistic regression analysis was employed to investigate the association between serum carotenoid concentrations and asthma prevalence. Cox proportional hazards models were used to investigate the connection between serum carotenoids and mortality rates in asthma individuals. Results Among the study population, 1569 (12.63 %) individuals were diagnosed with asthma, while 25.01 % of asthma patients died within a median follow-up duration of 15.5 (13.8-17.3) years. After controlling for all other variables, greater serum levels of certain carotenoids, such asα-carotene, β-carotene, β-cryptoxanthin, and lutein/zeaxanthin, were found to be substantially linked with a decreased prevalence of asthma. Furthermore, persons with asthma who had greater levels of serum carotenoids in the fourth quartile had a significantly lower risk of all-cause death compared to those in the first quartile. Specifically, the presence of α-carotene, β-cryptoxanthin, and lutein/zeaxanthin was associated with reductions in all-cause mortality by 45 % (HR = 0.55 [0.36-0.84], Ptrend = 0.002), 38 % (HR = 0.62 [0.42-0.92], Ptrend = 0.004), and 45 % (HR = 0.55 [0.41-0.73], Ptrend<0.001), respectively. The above relationships are mostly linear and remain robust in sensitivity analyses. Conclusions Our findings indicate that higher serum carotenoids are related with a reduced likelihood of mortality in asthmatic individuals.
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Affiliation(s)
- Guidong Zhang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical College, 515041, PR China
| | - Xiaocong Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical College, 515041, PR China
| | - Xiaohe Zheng
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical College, 515041, PR China
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Budiarto A, Tsang KCH, Wilson AM, Sheikh A, Shah SA. Machine Learning-Based Asthma Attack Prediction Models From Routinely Collected Electronic Health Records: Systematic Scoping Review. JMIR AI 2023; 2:e46717. [PMID: 38875586 PMCID: PMC11041490 DOI: 10.2196/46717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND An early warning tool to predict attacks could enhance asthma management and reduce the likelihood of serious consequences. Electronic health records (EHRs) providing access to historical data about patients with asthma coupled with machine learning (ML) provide an opportunity to develop such a tool. Several studies have developed ML-based tools to predict asthma attacks. OBJECTIVE This study aims to critically evaluate ML-based models derived using EHRs for the prediction of asthma attacks. METHODS We systematically searched PubMed and Scopus (the search period was between January 1, 2012, and January 31, 2023) for papers meeting the following inclusion criteria: (1) used EHR data as the main data source, (2) used asthma attack as the outcome, and (3) compared ML-based prediction models' performance. We excluded non-English papers and nonresearch papers, such as commentary and systematic review papers. In addition, we also excluded papers that did not provide any details about the respective ML approach and its result, including protocol papers. The selected studies were then summarized across multiple dimensions including data preprocessing methods, ML algorithms, model validation, model explainability, and model implementation. RESULTS Overall, 17 papers were included at the end of the selection process. There was considerable heterogeneity in how asthma attacks were defined. Of the 17 studies, 8 (47%) studies used routinely collected data both from primary care and secondary care practices together. Extreme imbalanced data was a notable issue in most studies (13/17, 76%), but only 38% (5/13) of them explicitly dealt with it in their data preprocessing pipeline. The gradient boosting-based method was the best ML method in 59% (10/17) of the studies. Of the 17 studies, 14 (82%) studies used a model explanation method to identify the most important predictors. None of the studies followed the standard reporting guidelines, and none were prospectively validated. CONCLUSIONS Our review indicates that this research field is still underdeveloped, given the limited body of evidence, heterogeneity of methods, lack of external validation, and suboptimally reported models. We highlighted several technical challenges (class imbalance, external validation, model explanation, and adherence to reporting guidelines to aid reproducibility) that need to be addressed to make progress toward clinical adoption.
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Affiliation(s)
- Arif Budiarto
- Asthma UK Center for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Bioinformatics and Data Science Research Center, Bina Nusantara University, Jakarta, Indonesia
| | - Kevin C H Tsang
- Asthma UK Center for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew M Wilson
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Aziz Sheikh
- Asthma UK Center for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Syed Ahmar Shah
- Asthma UK Center for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Celis-Preciado CA, Leclerc S, Duval M, Cliche DO, Larivée P, Lemaire-Paquette S, Lévesque S, Côté A, Lachapelle P, Couillard S. Phenotyping the Responses to Systemic Corticosteroids in the Management of Asthma Attacks (PRISMA): protocol for an observational and translational pilot study. BMJ Open Respir Res 2023; 10:e001932. [PMID: 37940357 PMCID: PMC10632890 DOI: 10.1136/bmjresp-2023-001932] [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: 07/04/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION Asthma and its associated exacerbation are heterogeneous. Although severe asthma attacks are systematically prescribed corticosteroids and often antibiotics, little is known about the variability of response to these therapies. Blood eosinophils and fractional exhaled nitric oxide (FeNO) are type 2 inflammation biomarkers that have established mechanistic, prognostic and theragnostic values in chronic asthma, but their utility in acute asthma is unclear. We speculate that the clinical and biological response to those treatments varies according to inflammometry and microbiological test results. METHODS AND ANALYSIS An observational longitudinal pilot study with multimodal clinical and translational assessments will be performed on 50 physician-diagnosed ≥12-year-old asthmatics presenting with an asthma attack and 12 healthy controls, including blood eosinophil count (venous and point-of-care (POC) capillary blood), FeNO and testing for airway infection (sputum cultures and POC nasopharyngeal swabs). People with asthma will be assessed on day 0 and after a 7-day corticosteroid course, with home monitoring performed in between. The primary analysis will be the change in the forced expiratory volume in 1 s according to type 2 inflammatory status (blood eosinophils ≥0.15×109/L and/or FeNO ≥25 ppb) after treatment. Key secondary analyses will compare changes in symptom scores and the proportion of patients achieving a minimal clinically important difference. Exploratory analyses will assess the relationship between clinical, lung function, inflammatory and microbiome parameters; satisfaction plus reliability indices of POC tests; and sex-gender variability in treatment response. Ultimately, this pilot study will serve to plan a larger trial comparing the clinical and biological response to systemic corticosteroids according to inflammatory biomarkers, offering valuable guidance for more personalised therapeutic strategies in asthma attacks. ETHICS AND DISSEMINATION The protocol has been approved by the Research Ethics Committee of the CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada (#2023-4687). Results will be communicated in an international meeting and submitted to a peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05870215).
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Affiliation(s)
- Carlos Andrés Celis-Preciado
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Internal Medicine-Pulmonary Unit, Faculty of Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Simon Leclerc
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Martine Duval
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Dominic O Cliche
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Pierre Larivée
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Samuel Lemaire-Paquette
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Simon Lévesque
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Laboratoire de Microbiologie, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
| | - Andréanne Côté
- Department of Medicine, Faculty of Medicine, Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Philippe Lachapelle
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Simon Couillard
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Beydon N, Taillé C, Corvol H, Valcke J, Portal JJ, Plantier L, Mangiapan G, Perisson C, Aubertin G, Hadchouel A, Briend G, Guilleminault L, Neukirch C, Cros P, Appere de Vecchi C, Mahut B, Vicaut E, Delclaux C. Digital Action Plan (Web App) for Managing Asthma Exacerbations: Randomized Controlled Trial. J Med Internet Res 2023; 25:e41490. [PMID: 37255277 PMCID: PMC10365576 DOI: 10.2196/41490] [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: 07/27/2022] [Revised: 11/30/2022] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND A written action plan (WAP) for managing asthma exacerbations is recommended. OBJECTIVE We aimed to compare the effect on unscheduled medical contacts (UMCs) of a digital action plan (DAP) accessed via a smartphone web app combined with a WAP on paper versus that of the same WAP alone. METHODS This randomized, unblinded, multicenter (offline recruitment in private offices and public hospitals), and parallel-group trial included children (aged 6-12 years) or adults (aged 18-60 years) with asthma who had experienced at least 1 severe exacerbation in the previous year. They were randomized to a WAP or DAP+WAP group in a 1:1 ratio. The DAP (fully automated) provided treatment advice according to the severity and previous pharmacotherapy of the exacerbation. The DAP was an algorithm that recorded 3 to 9 clinical descriptors. In the app, the participant first assessed the severity of their current symptoms on a 10-point scale and then entered the symptom descriptors. Before the trial, the wordings and ordering of these descriptors were validated by 50 parents of children with asthma and 50 adults with asthma; the app was not modified during the trial. Participants were interviewed at 3, 6, 9, and 12 months to record exacerbations, UMCs, and WAP and DAP use, including the subjective evaluation (availability and usefulness) of the action plans, by a research nurse. RESULTS Overall, 280 participants were randomized, of whom 33 (11.8%) were excluded because of the absence of follow-up data after randomization, leaving 247 (88.2%) participants (children: n=93, 37.7%; adults: n=154, 62.3%). The WAP group had 49.8% (123/247) of participants (children: n=45, 36.6%; mean age 8.3, SD 2.0 years; adults: n=78, 63.4%; mean age 36.3, SD 12.7 years), and the DAP+WAP group had 50.2% (124/247) of participants (children: n=48, 38.7%; mean age 9.0, SD 1.9 years; adults: n=76, 61.3%; mean age 34.5, SD 11.3 years). Overall, the annual severe exacerbation rate was 0.53 and not different between the 2 groups of participants. The mean number of UMCs per year was 0.31 (SD 0.62) in the WAP group and 0.37 (SD 0.82) in the DAP+WAP group (mean difference 0.06, 95% CI -0.12 to 0.24; P=.82). Use per patient with at least 1 moderate or severe exacerbation was higher for the WAP (33/65, 51% vs 15/63, 24% for the DAP; P=.002). Thus, participants were more likely to use the WAP than the DAP despite the nonsignificant difference between the action plans in the subjective evaluation. Median symptom severity of the self-evaluated exacerbation was 4 out of 10 and not significantly different from the symptom severity assessed by the app. CONCLUSIONS The DAP was used less often than the WAP and did not decrease the number of UMCs compared with the WAP alone. TRIAL REGISTRATION ClinicalTrials.gov NCT02869958; https://clinicaltrials.gov/ct2/show/NCT02869958.
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Affiliation(s)
- Nicole Beydon
- Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires, Institut National de la Santé et de la Recherche Médicale 938, Centre de Recherche Saint Antoine, Hôpital Armand Trousseau, Assistance Publique Hôpitaux de Paris, F-75012, Paris, France
| | - Camille Taillé
- Service de Pneumologie et Centre de Référence Constitutif des Maladies Pulmonaires Rares, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale 1152, Université Paris Cité, F-75018, Paris, France
| | - Harriet Corvol
- Service de Pneumologie Pédiatrique, Hôpital Armand Trousseau, Assistance Publique Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale Centre de Recherche Saint-Antoine, Sorbonne Université, F-75012, Paris, France
| | - Judith Valcke
- Service de Pneumologie, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, F-75015 Paris, Hôpital Privé Armand Brillard, F-94130, Paris, France
| | - Jean-Jacques Portal
- Clinical Research Unit Saint-Louis Lariboisière, Assistance Publique Hôpitaux de Paris, Université de Paris Cité, F-75010, Paris, France
| | - Laurent Plantier
- Département de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre Hospitalier Universitaire de Tours, Institut National de la Santé et de la Recherche Médicale unité 1100, Université de Tours, F-37000, Tours, France
| | - Gilles Mangiapan
- Service de Pneumologie, Centre Hospitalier Interrégional de Créteil, F-94010, Créteil, France
| | - Caroline Perisson
- Service de Pneumologie Pédiatrique, Hôpital Armand Trousseau, Assistance Publique Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale Centre de Recherche Saint-Antoine, Sorbonne Université, F-75012, Paris, France
| | - Guillaume Aubertin
- Centre de pneumologie et d'allergologie de l'enfant, F-92100, Boulogne Billancourt, France
| | - Alice Hadchouel
- Service de Pneumologie Pédiatrique, Centre de Référence pour les Maladies Respiratoires Rares de l'Enfant, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Université de Paris Cité, F-75015, Paris, France
| | - Guillaume Briend
- Service de Pneumologie, Centre hospitalier de Pontoise, F-95303, Cergy Pontoise, France
| | - Laurent Guilleminault
- Département de Pneumologie et Allergologie, Centre Hospitalo-Universitaire Purpan, Centre National de la Recherche Scientifique U5282, Institut National de la Santé et de la Recherche Médicale U1291, Toulouse Institute for Infectious, Inflammatory Disease, Toulouse, France
| | - Catherine Neukirch
- Service de Pneumologie et Centre de Référence Constitutif des Maladies Pulmonaires Rares, Hôpital Bichat, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale 1152, F-75018, Paris, France
| | - Pierrick Cros
- Département de Pédiatrie, Hôpital Universitaire Morvan, F-29200, Brest, France
| | | | | | - Eric Vicaut
- Clinical Research Unit Saint-Louis Lariboisière, Assistance Publique Hôpitaux de Paris, Université de Paris Cité, F-75010, Paris, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique-Centre du Sommeil, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale NeuroDiderot, Université de Paris Cité, F-75019, Paris, France
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Lu J, Ji X, Wang L, Sun F, Huang C, Peng H, Jiang Y, Guo Z, Liu X, Ji Y, Lu D. Interleukin‑27 ameliorates allergic asthma by alleviating the lung Th2 inflammatory environment. Int J Mol Med 2022; 49:86. [PMID: 35514302 PMCID: PMC9106376 DOI: 10.3892/ijmm.2022.5142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/20/2022] [Indexed: 11/22/2022] Open
Abstract
Interleukin (IL)‑27 can inhibit the differentiation of Th2 cells and plays a role in the development of asthma. However, whether the therapeutic administration of IL‑27 in a mouse model of asthma can inhibit allergic responses remains a matter of debate. Additionally, the mechanisms through which IL‑27 ameliorates inflammatory responses in asthma are not yet fully understood. Thus, the aim of the present study was to examine the effects of IL‑27 on asthma using a mouse model and to elucidate the underlying mechanisms. For this purpose, mice received an intranasal administration of IL‑27 and the total and differential cell counts, levels of cytokines and type 1 regulatory T (Tr1) cells in the lungs were detected. The protein and mRNA levels of signal transducer and activator of transcription (STAT)1 and STAT3 were analyzed and airway remodeling was assessed. The results indicated that IL‑27 did not ameliorate airway inflammation, airway hyperresponsiveness, and airway remolding when administrated therapeutically. Preventatively, the administration of IL‑27 decreased the concentrations of Th2 cytokines and increased the number of Tr1 cells. The protein and mRNA levels of STAT1 and STAT3 were increased. Taken together, these findings demonstrate that the prophylactic administration of IL‑27 ameliorates asthma by alleviating the lung Th2 inflammatory environment through the restoration of both the STAT1 and STAT3 pathways. IL‑27 may thus prove to be useful as a novel agent for the prevention of asthma.
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Affiliation(s)
- Jiameng Lu
- School of Microelectronics, Shandong University, Jinan, Shandong 250100, P.R. China
| | - Xiaoqing Ji
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong 250014, P.R. China
| | - Lixia Wang
- Division of Disinfectant and Supply, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Fei Sun
- Graduate School of Shandong First Medical University, Jinan, Shandong 250000, P.R. China
| | - Chuanjun Huang
- Department of Respiratory Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong 250014, P.R. China
| | - Haiying Peng
- Graduate School of Shandong First Medical University, Jinan, Shandong 250000, P.R. China
| | - Yunxiu Jiang
- Graduate School of Shandong First Medical University, Jinan, Shandong 250000, P.R. China
| | - Zihan Guo
- Graduate School of Shandong First Medical University, Jinan, Shandong 250000, P.R. China
| | - Xinyi Liu
- Graduate School of Shandong First Medical University, Jinan, Shandong 250000, P.R. China
| | - Yanbo Ji
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong 250014, P.R. China
| | - Degan Lu
- Department of Respiratory Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong 250014, P.R. China
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Fletcher M, van der Molen T, Lenney W, Boucot I, Aggarwal B, Pizzichini E. Primary Care Management of Asthma Exacerbations or Attacks: Impact of the COVID-19 Pandemic. Adv Ther 2022; 39:1457-1473. [PMID: 35157217 PMCID: PMC8853035 DOI: 10.1007/s12325-022-02056-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/21/2022] [Indexed: 12/26/2022]
Abstract
The COVID-19 pandemic has brought a renewed focus on appropriate management of chronic respiratory conditions with a heightened awareness of respiratory symptoms and the requirement for differential diagnosis between an asthma attack and COVID-19 infection. Despite early concerns in the pandemic, most studies suggest that well-managed asthma is not a risk factor for more severe COVID-related outcomes, and that asthma may even have a protective effect. Advice on the treatment of asthma and asthma attacks has remained unchanged. This article describes some challenges faced in primary care asthma management in adults and in teenagers, particularly their relevance during a pandemic, and provides practical advice on asthma attack recognition, classification, treatment and continuity of care. Acute attacks, characterised by increased symptoms and reduced lung function, are often referred to as exacerbations of asthma by doctors and nurses but are usually described by patients as asthma attacks. They carry a significant and underestimated morbidity and mortality burden. Many patients experiencing an asthma attack are assessed in primary care for treatment and continuing management. This may require remote assessment by telephone and home monitoring devices, where available, during a pandemic. Differentiation between an asthma attack and a COVID-19 infection requires a structured clinical assessment, taking account of previous medical and family history. Early separation into mild, moderate, severe or life-threatening attacks is helpful for continuing good management. Most attacks can be managed in primary care but when severe or unresponsive to initial treatment, the patient should be appropriately managed until transfer to an acute care facility can be arranged. Good quality care is important to prevent further attacks and must include a follow-up appointment in primary care, proactive regular dosing with daily controller therapy and an understanding of a patient's beliefs and perceptions about asthma to maximise future self-management.
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Affiliation(s)
- Monica Fletcher
- The Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Thys van der Molen
- Department of General Practice and GRIAG Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Warren Lenney
- Department of Pharmacy and Bioengineering, University of Keele, Keele, Staffordshire, UK
| | | | - Bhumika Aggarwal
- Respiratory, General Medicines Emerging Markets, GlaxoSmithKline, Singapore, 139234, Singapore
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Lee YQ, Selvakumar A, See KC. Treatable Traits in Chronic Respiratory Disease: A Comprehensive Review. Cells 2021; 10:3263. [PMID: 34831485 PMCID: PMC8624727 DOI: 10.3390/cells10113263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/07/2021] [Accepted: 11/20/2021] [Indexed: 12/05/2022] Open
Abstract
Chronic respiratory diseases are major contributors to the global burden of disease. While understanding of these diseases has improved, treatment guidelines have continued to rely on severity and exacerbation-based approaches. A new personalised approach, termed the "treatable traits" approach, has been suggested to address the limitations of the existing treatment strategies. We aim to systematically review the current evidence regarding treatable traits in chronic respiratory diseases and to identify gaps in the current literature. We searched the PubMed and Embase databases and included studies on treatable traits and chronic respiratory diseases. We then extracted information on prevalence, prognostic implications, treatment options and benefits from these studies. A total of 58 papers was included for review. The traits identified were grouped into five broad themes: physiological, biochemical, psychosocial, microbiological, and comorbidity traits. Studies have shown advantages of the treatable traits paradigm in the clinical setting. However, few randomised controlled trials have been conducted. Findings from our review suggest that multidisciplinary management with therapies targeted at treatable traits has the potential to be efficacious when added to the best practices currently implemented. This paradigm has the potential to improve the holistic care of chronic respiratory diseases.
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Affiliation(s)
- Yong Qin Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; (Y.Q.L.); (K.C.S.)
| | - Asvin Selvakumar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; (Y.Q.L.); (K.C.S.)
| | - Kay Choong See
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; (Y.Q.L.); (K.C.S.)
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore
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Ramakrishnan S, Couillard S. Antibiotics for asthma attacks: masking uncertainty. Eur Respir J 2021; 58:58/1/2100183. [PMID: 34215662 DOI: 10.1183/13993003.00183-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Sanjay Ramakrishnan
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Dept of Medicine, University of Oxford, Oxford, UK .,School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Simon Couillard
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
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