Association between allergic rhinitis and asthma control in Peruvian school children: a cross-sectional study

[The need for an integrated approach to rhinitis and asthma]

Introduction

Several evidences support the concept of united airway and its pathophysiological, clinical, and therapeutic implications. The existence of rhinitis can generate greater difficulty in asthma control and higher direct and indirect health care costs, which is not sufficiently recognized by the majority of physicians who often treat them as separate entities.

Objective

To examine witness evidence of the relationship between rhinitis and asthma that contributes to the integrated approach to both pathologies.

Methods

A bibliographic search was carried out in the PubMed (Medline), EBSCO, Scielo, and Google Scholar databases using MeSH and DeCS terms related to the clinical and therapeutic relationship between rhinitis and asthma.

Results

Finally, 46 references describing the impact of rhinitis on the quality of life of patients with asthma and its therapeutic correlate were included.

Conclusions

The treatment of both diseases based on this integrated model is imperative. Both, the endo-phenotypic recognition and the consequent therapeutic approach allow to the concomitant control of asthma and rhinitis and a decrease in their morbidity. Complementary therapeutic measures based on the concept "one airway, one disease" support the good clinical practices necessary to achieve the best therapeutic result.

Nonadherence to antiasthmatic medications and its predictors among asthmatic patients in public hospitals of Bahir Dar City, North West Ethiopia: using ASK-12 tool

BACKGROUND

Globally, adequate asthma control is not yet achieved. The main cause of uncontrollability is nonadherence to prescribed medications.

OBJECTIVES

The objective of this study is to assess asthmatic patients' non-adherence to anti-asthmatic medications and the predictors associated with non-adherence.

METHODS

An institution-based cross-sectional study was conducted in three governmental hospitals in Bahir Dar city from September 5 to December 12, 2021. The data was collected using the Adherence Starts with Knowledge-12 tool (ASK-12). Systematic random sampling was applied to select study participants. Bivariable and multivariable logistic regression analyses were used to identify predictors of non-adherence. All statistical tests were analyzed using STATA version 16. P-values less than 0.05 were considered statistically significant.

RESULTS

A total of 422 asthmatic patients were included in the study. Most of the study participants (55.4%) did not adhere to their prescribed anti-asthmatic medicines. The educational status of the study participants (AOR = 0.03, 95% CI = 0.00-0.05), family history of asthma (AOR = 0.13, 95% CI = 0.04-0.21), and disease duration that the patients were living with (AOR = 0.01, 95% CI = 0.00-0.01) were the predictors of non-adherence to anti-asthmatic medications.

CONCLUSIONS

The level of nonadherence to treatment among patients with asthma was high. Religion, educational status of study participants, family history of asthma, and duration of the disease were the predictors of non-adherence of asthmatic patients to their antiasthmatic medications. Therefore, the Ministry of health, health policy makers, clinicians, and other healthcare providers should pay attention to strengthening the adherence level to antiasthmatic medications, and country-based interventions should be developed to reduce the burden of non-adherence to anti-asthmatic medications.

Artemisia gmelinii Extract Alleviates Allergic Airway Inflammation via Balancing TH1/TH2 Homeostasis and Inhibiting Mast Cell Degranulation

A new terminology "combined allergic rhinitis and asthma syndrome (CARAS)" was introduced to describe patients suffering from both allergic rhinitis (AR) and asthma. The pathogenesis of allergic airway inflammation has been well known, with the main contribution of TH1/TH2 imbalance and mast cell degranulation. Artemisia gmelinii has been used as an herbal medicine with its hepaprotective, anti-inflammatory, and antioxidant properties. In this study, the effect of A. gmelinii extracts (AGE) on the ovalbumin (OVA)-induced CARAS mouse model was investigated. AGE administration significantly alleviated the nasal rubbing and sneezing, markedly down-regulated both OVA-specific IgE, IgG₁, and histamine levels, and up-regulated OVA-specific IgG_2a in serum. The altered histology of nasal and lung tissues of CARAS mice was effectively ameliorated by AGE. The AGE treatment group showed markedly increased levels of the TH1 cytokine interleukin (IL)-12 and TH1 transcription factor T-bet. In contrast, the levels of the TH2 cytokines, including IL-4, IL-5, IL-13, and the TH2 transcription factor GATA-3, were notably suppressed by AGE. Moreover, AGE effectively prevented mast cell degranulation in vitro and mast cell infiltration in lung tissues in vivo. Based on these results, we suggest that AGE could be a potential therapeutic agent in OVA-induced CARAS by virtue of its role in balancing the TH1/TH2 homeostasis and inhibiting the mast cell degranulation.

The Prevalence and Impact of Allergic Rhinitis on Asthma Exacerbations in Asthmatic Adult Patients in the Riyadh Region of Saudi Arabia: A Cross-Sectional Study

OBJECTIVES

Allergic rhinitis (AR) and asthma are highly prevalent conditions known to occur concomitantly. However, observational, cross-sectional studies in Saudi Arabia assessing the frequency and severity of rhinitis in asthmatics adults using questionnaires based on guidelines are unavailable. Therefore, this study attempted to investigate this side and evaluate the role of triggers, symptoms, and family history or history of AR on asthma control levels.

METHODS

From April 2nd to September 18th, 2021, this observational cross-sectional study was conducted through an online self-administrated questionnaire that was distributed electronically on social media through the SurveyMonkey website (Momentive Inc., Waterford, NY). The study targeted asthmatic adult patients residing in Riyadh city in Saudi Arabia.

RESULTS

Overall, 187 questionnaires were analyzed. In this study, the frequency of AR in asthmatic patients was 75.5% (95% CI: 74.87-75.4%). Of those, AR was intermittent mild for 15.0%, intermittent moderate to severe for 43.9%, mild persistent for 2.14%, persistent moderate to severe for 14.4%, and 24.6% of patients were without AR. A significant association was observed between asthma control level and the severity of AR (P < 0.001). Moderate to severe persistent AR was more prevalent in patients with uncontrolled asthma (40.6%) than patients with partially controlled (25%) or controlled asthma (2.7%).

CONCLUSIONS

This study suggested that AR was related to more severe asthma and more difficulty in controlling asthma. The frequency significantly increased with the severity of asthma.

Childhood asthma in low and middle-income countries: Where are we now?

Pediatric asthma has been increasing in LMICs (Low Middle-Income Countries), leading to an important burden for both children and national health systems. Implementing measures to achieve control are influenced by the degree of organization health systems have, the availability and affordability of essential asthma medications, and the effective implementation of asthma programs and asthma guidelines. In this review authors give an updated view of the current situation of these components of asthma management in LMICs.

[A Meta analysis of risk factors for asthma in Chinese children]

OBJECTIVE

To investigate the main risk factors for asthma in Chinese children, and to provide a reference for the prevention and treatment of asthma.

METHODS

The databases including CNKI, Wanfang Data, China Biology Medicine disc, VIP Database for Chinese Technical Periodicals, Web of Science, and PubMed were searched for studies on risk factors for asthma in Chinese children published up to September 2017. Stata 12.0 was used for the Meta analysis.

RESULTS

A total of 24 case-control studies were included, with 5 309 cases in the case group and 6 404 cases in the control group. The Meta analysis showed that a family history of asthma (OR=5.246, 95%CI: 3.435-8.011), a family history of allergy (OR=4.627, 95%CI: 2.450-8.738), atopic constitution (OR=4.659, 95%CI: 2.511-8.644), allergic rhinitis (OR=11.510, 95%CI: 6.769-19.574), a history of eczema/dermatitis (OR=4.919, 95%CI: 3.514-6.886), a history of allergies (OR=4.732, 95%CI: 2.802-7.989), a history of food allergies (OR=5.890, 95%CI: 3.412-10.166), a history of drug allergies (OR=4.664, 95%CI: 2.637-8.252), mold contamination at home (OR=2.483, 95%CI: 1.671-3.690), flowers at home (OR=1.748, 95%CI: 1.383-2.209), a history of house decoration (OR=2.823, 95%CI: 2.206-3.935), and cesarean section (OR=1.894, 95%CI: 1.166-3.077) were risk factors for asthma in children, while breastfeeding was a protective factor against asthma (OR=0.508, 95%CI: 0.396-0.653).

CONCLUSIONS

The development of asthma in Chinese children is associated with a variety of factors, among which a family history of asthma, a family history of allergy, atopic constitution, a history of allergies, allergic comorbidities, cesarean section, and bad family environment can increase the risk of asthma in children, while breastfeeding can reduce the risk.

[A Meta analysis of risk factors for asthma in Chinese children]

OBJECTIVE

To investigate the main risk factors for asthma in Chinese children, and to provide a reference for the prevention and treatment of asthma.

METHODS

The databases including CNKI, Wanfang Data, China Biology Medicine disc, VIP Database for Chinese Technical Periodicals, Web of Science, and PubMed were searched for studies on risk factors for asthma in Chinese children published up to September 2017. Stata 12.0 was used for the Meta analysis.

RESULTS

A total of 24 case-control studies were included, with 5 309 cases in the case group and 6 404 cases in the control group. The Meta analysis showed that a family history of asthma (OR=5.246, 95%CI: 3.435-8.011), a family history of allergy (OR=4.627, 95%CI: 2.450-8.738), atopic constitution (OR=4.659, 95%CI: 2.511-8.644), allergic rhinitis (OR=11.510, 95%CI: 6.769-19.574), a history of eczema/dermatitis (OR=4.919, 95%CI: 3.514-6.886), a history of allergies (OR=4.732, 95%CI: 2.802-7.989), a history of food allergies (OR=5.890, 95%CI: 3.412-10.166), a history of drug allergies (OR=4.664, 95%CI: 2.637-8.252), mold contamination at home (OR=2.483, 95%CI: 1.671-3.690), flowers at home (OR=1.748, 95%CI: 1.383-2.209), a history of house decoration (OR=2.823, 95%CI: 2.206-3.935), and cesarean section (OR=1.894, 95%CI: 1.166-3.077) were risk factors for asthma in children, while breastfeeding was a protective factor against asthma (OR=0.508, 95%CI: 0.396-0.653).

CONCLUSIONS

The development of asthma in Chinese children is associated with a variety of factors, among which a family history of asthma, a family history of allergy, atopic constitution, a history of allergies, allergic comorbidities, cesarean section, and bad family environment can increase the risk of asthma in children, while breastfeeding can reduce the risk.

Comorbid disorders associated with asthma in children in Germany - National analysis of pediatric primary care data

BACKGROUND

Using routine healthcare data, the goal of this study was to examine the association between asthma and comorbid disorders in children in Germany.

METHODS

Patients with a diagnosis of asthma documented by a German pediatrician in 2015 were identified. Demographic data included age and gender. Patients younger than 6 and older than 17 and individuals followed for less than a year before index date were excluded. Each patient was matched for age, sex, and physician with an asthma-free control. A total of 34,305 cases and 34,305 controls were available for analysis. There were three different age groups: 6-9 years, 10-13 years, and 14-17 years. Several disorders known to be associated with asthma or found in more than 1% of children and adolescents were also determined on the basis of primary care diagnoses. A multivariate logistic regression model was used to estimate the association between asthma and comorbid disorders.

RESULTS

The mean age was 10.9 years, and 61.6% of the subjects were boys. The most common diseases found in the three age groups were vasomotor and allergic rhinitis, chronic bronchitis, chronic rhinitis, pneumonia, and atopic dermatitis. These five comorbid disorders were associated with asthma to a significant extent.

CONCLUSIONS

Overall, this study, based on primary healthcare data, found a considerably high prevalence of several comorbid diseases in German children with asthma.

Uncontrolled asthma and its risk factors in Chinese children: A cross-sectional observational study

OBJECTIVE

Asthma afflicts many children in China but information about asthma management among Chinese pediatric asthma patients is limited. This study aims to evaluate asthma control among Chinese pediatric patients and identify risk factors associated with uncontrolled asthma.

METHODS

A total of 4223 patients with persistent asthma aged 2-16 years from 42 tertiary hospitals across all regions of mainland China except Tibet were surveyed. Asthma Control Test (ACT), Childhood Asthma Control Test (C-ACT) and Global Initiative for Asthma (GINA) criteria were used to assess asthma control for children aged 12-16 years, 4-11 years and 2-3 years, respectively. Uncontrolled asthma was defined as ACT or C-ACT score ≤19 or GINA-defined uncontrolled asthma. Risk factors associated with uncontrolled asthma were identified using multivariate logistic regression models.

RESULTS

Asthma was uncontrolled in 19.9% of the subjects. High rates of uncontrolled asthma were found in subjects with treatment non-adherence (44.1%), concomitant allergic rhinitis (AR) (23.3%), disease duration ≥ 1.5 years (22.8%), and first-degree relatives with AR (21.5%). The risk of uncontrolled asthma was much higher in the treatment non-adherence group compared to the complete adherence group (OR = 5.79, p < 0.001). Concomitant AR, disease duration ≥ 1.5 years, and first-degree relatives with AR were also confirmed as risk factors associated with uncontrolled asthma.

CONCLUSIONS

About 20% of Chinese pediatric asthma patients had uncontrolled asthma. Treatment adherence and AR were the most significant risk factors. Tailored measures aimed at improving treatment adherence and diagnosis and treatment of AR should be adopted to improve the level of asthma control in Chinese children.

Phenotyping asthma in the elderly: allergic sensitization profile and upper airways comorbidity in patients older than 65 years

BACKGROUND

Data about allergic rhinitis in elderly patients with asthma are lacking.

OBJECTIVE

To investigate the presence of rhinitis and the role of sensitization of airborne allergens in elderly patients with asthma.

METHODS

This was a multicenter cross-sectional study involving subjects at least 65 years old with asthma. Demographic features, comorbidities, and the presence of allergic respiratory disease were retrieved through interview. Skin prick tests for common allergens were performed. Associations of demographic and clinical features were evaluated in relation to asthma control and forced expiratory volume in the first second less than 80% in the total population and in the subgroup with features resembling chronic obstructive pulmonary disease.

RESULTS

Of 368 elderly subjects with asthma, 101 had features resembling chronic obstructive pulmonary disease. Rhinitis was present in 59.0% of subjects (allergic rhinitis in 47.6%), with an age of onset significantly different from that of asthma (49 ± 18 vs 57 ± 18 years). At least 1 sensitization was observed in 52.4% of subjects, more frequently for house dust mite (HDM; 31.8%). The prevalence of poorly and partially controlled asthma was higher in patients sensitized to airborne allergens (odds ratio 1.64, 95% confidence interval 1.03-2.61), in particular to HDM (odds ratio 1.73, 95% confidence interval 1.05-2.85).

CONCLUSION

Approximately 60% of elderly subjects with asthma had rhinitis, mainly allergic and often untreated, whose onset preceded asthma symptoms by a mean of approximately 10 years. Nonallergic asthma was better controlled than allergic asthma. However, HDM sensitization was greater in subjects with asthma with features resembling chronic obstructive pulmonary disease (39% vs 28%). When restricting analysis to this group, the negative role of HDM in overall asthma control (forced expiratory volume in first second and Asthma Control Test) was significant.

Factors associated with asthma control in children: findings from a national Web-based survey

BACKGROUND

Although achieving and maintaining control of asthma is considered to be the goal of asthma treatment, determinants of asthma control are not fully understood. Our aim was to assess factors associated with asthma control among paediatric patients in the general population.

METHODS

In June 2012, a Web-based survey was conducted to identify Japanese children aged 6 to 11 yr who currently have asthma and evaluate control of their disease using the Childhood Asthma Control Test (C-ACT). Associations were evaluated among uncontrolled asthma (C-ACT score <20) between environmental factors, demographics and comorbid allergic diseases.

RESULTS

Among the 3066 children with current asthma, 447 (14.6%) had uncontrolled asthma. Multivariable analysis identified factors such as low birthweight (adjusted OR 1.65, 95% CI 1.25-2.18), obesity (adjusted OR 1.44, 95% CI 1.05-1.99) and pet ownership before birth (adjusted OR 1.68, 95% CI 1.24-2.29) to be associated with uncontrolled disease. Comorbid allergic diseases, especially rhinitis were a significant risk of uncontrolled asthma (adjusted OR for severe rhinitis: 3.88, 95% CI 2.50-6.00). The severity of rhinitis symptoms was inversely correlated with the C-ACT score (p < 0.001).

CONCLUSIONS

A population-based Web survey showed an association between several factors and the control of paediatric asthma. The assessment of these factors may help identify the children at risk with uncontrolled asthma.

Asthma with allergic rhinitis management in China: a nationwide survey of respiratory specialists at tertiary hospitals

BACKGROUND

Many asthmatic patients have coexisting allergic rhinitis (AR). This study aims to investigate the compliance of physicians with respiratory medicine specialty (PRMs) to Global Initiative for Asthma (GINA) and Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines during the management of their asthma-AR patients.

METHODS

This cross-sectional questionnaire study surveyed the diagnostic methods and treatment patterns for asthma-AR comorbidity by PRMs from 98 hospitals across China.

RESULTS

PRMs reported an estimated prevalence of asthma-AR comorbidity of >30% at their clinics. PRMs with greater work experience and a higher professional title estimated treating a significantly higher proportion of patients with AR within the previous month (p = 0.002 and p < 0.001, respectively); they also estimated a higher incidence of patients with AR in the autumn (p < 0.001 and p < 0.001). A higher percentage of PRMs with ≥11 years work experience prescribed nasal steroids for AR as compared to those with 1 to 10 years experience (56.9% vs 44.7%, p = 0.002). A greater proportion of chief physicians used leukotriene modifiers and a lower proportion used antihistamine H1 -receptor blockers for AR as compared to residents (resident vs assistant chief: 27.5% vs 11.6%, p = 0.002; and resident vs chief PRMs: 27.5% vs 9.5%, p = 0.001).

CONCLUSION

PRMs in China demonstrated an up-to-date comprehension of asthma management (>90%); however, knowledge gaps existed in their concepts of AR and asthma-AR comorbidity. Thus, further education is warranted for PRMs regarding the importance of AR in asthma patients, definitive diagnosis (allergy tests), classifications of AR, and treatment guidelines for the asthma-AR comorbidity.