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Oh SH, Rhee CK, Bae EJ, Ku H. Cost-effectiveness analysis of dupilumab among patients with uncontrolled severe asthma using LIBERTY ASTHMA QUEST Korean data. HEALTH ECONOMICS REVIEW 2024; 14:67. [PMID: 39186143 PMCID: PMC11346198 DOI: 10.1186/s13561-024-00532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 07/03/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND A sub-analysis of the Korean population in the LIBERTY ASTHMA QUEST trial (NCT02414854) revealed that dupilumab effectively treated severe uncontrolled asthma. This study aimed to assess the cost-effectiveness of add-on therapy with dupilumab to background therapy in patients ≥ 12 years of age with uncontrolled severe asthma compared to that of background therapy in South Korea. METHODS The cost-effectiveness analysis was conducted using a Markov model over a lifetime from the Korean healthcare system perspective. Clinical efficacy and utility weights were obtained from post-hoc analyses of the Korean population in the QUEST trial. Data on the costs and treatment setting of exacerbation in a real-world setting were retrospectively collected using the administrative medical database from a single tertiary hospital. RESULTS The base-case results indicated that add-on dupilumab therapy increases costs ($112,924 for add-on dupilumab versus $29,545 for background therapy alone). However, add-on dupilumab increased quality-adjusted life years (QALYs, 8.03 versus 3.93, respectively), with fewer events of severe exacerbations per patient compared to using the background therapy alone (17.920 versus 19.911, respectively). The incremental cost-effectiveness ratio was $20,325 per QALY. Various sensitivity analyses supported the robustness of the base-case results. Probabilistic sensitivity analysis showed that the probability of add-on dupilumab being cost-effective was 87% at a threshold willingness-to-pay of $26,718 (KRW 35 million) per QALY gained. CONCLUSIONS Dupilumab is cost-effective for adolescents and adults with uncontrolled severe asthma in South Korea. Our study provides evidence to support clinicians and policymakers in making informed decisions for severe asthma management.
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Affiliation(s)
- Sung-Hee Oh
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Hyemin Ku
- NDnex, Saebitgongwon-ro 67, Gwangmyeong-si, Gyeonggi-do, 14348, Republic of Korea.
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Khalid M, Almasri T, Goble S, Johnson D, Gilbertson D, Linzer M, Strykowski R. Seasonal variations and social disparities in asthma hospitalizations and outcomes. J Asthma 2024:1-9. [PMID: 39046135 DOI: 10.1080/02770903.2024.2383630] [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: 05/05/2024] [Revised: 06/09/2024] [Accepted: 07/19/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Exposure to asthma exacerbating triggers may be dependent on the season and an individual's social factors and subsequent means to avoid triggers. We assessed for seasonal variations and differential outcomes based on race and income in admissions for asthma in a United States nationwide assessment. METHODS This retrospective study assessed adult hospitalizations for asthma 2016-2019 using the National Inpatient Sample. Hospitalizations were categorized by season: winter (December-February), spring (March-May), summer (June-August), fall (September-November). Multivariable linear and logistic regression were used to assess associations between season, race, income quartile (determined by the median income within a patient's ZIP code), and outcomes. RESULTS The study included 423,140 admissions with a mean age of 51 years, and 73% of the cohort being female and 56% non-white. Admissions peaked during winter (124, 145) and were lowest in summer (80,525). Intubation rates were increased in summer compared to winter (2.73 vs 1.93%, aOR = 1.19, 95% CI: 1.04-1.37) as were rates of noninvasive positive pressure ventilation (NIPPV) (7.92 vs 7.06%, aOR = 1.08, 95% CI: 1.00-1.17). Compared to white patients, intubation (2.53 vs 1.87%, absolute difference 0.66%, aOR = 1.14, 95% CI: 1.02-1.29) and NIPPV (9.95 vs 5.45%, absolute difference 4.5%, aOR = 1.69, 95% CI: 1.57-1.82) were increased in Black patients. No significant associations between income and clinical outcomes were found. CONCLUSIONS Asthma admission peak during winter, while summer admissions and non-white race are associated with higher rates of NIPPV and intubation. Public health initiatives and strategically timed outpatient visits could combat seasonal variation and social disparities in asthma outcomes.
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Affiliation(s)
- Mohammed Khalid
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Talal Almasri
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Spencer Goble
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | | | - David Gilbertson
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
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Rida J, Bouchriti Y, Ait Haddou M, Achbani A, Sine H, Serhane H. Meteorological factors and climate change impact on asthma: a systematic review of epidemiological evidence. J Asthma 2024:1-10. [PMID: 38953539 DOI: 10.1080/02770903.2024.2375272] [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: 06/01/2024] [Accepted: 06/28/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE This systematic review aimed to investigate the epidemiological data about meteorological factors and climate change (CC) impact on asthma. DATA SOURCES A search was performed using three databases (Web of Science, Science Direct, and MEDLINE) for all relevant studies published from January 1, 2018, to December 31, 2022. STUDY SELECTIONS This systematic review complied with the PRISMA document's requirements, including studies related to meteorological factors and CC impact on asthma. The search included studies published in English or French language, and was based on title, abstract, and complete text. Documents not meeting inclusion requirements were excluded. RESULTS We identified 18 studies published in the last five years that were eligible for inclusion in this review. We found that these studies concerned European, Asian, American, and Oceanic cities. Extreme variations in temperature, humidity, wind speed, exceptional incidents like hurricanes, cold and heat waves, and seasonal shifts were strongly correlated with the worsening of asthmatic symptoms, particularly in childhood. In addition, excessive concentrations of air pollutants and aeroallergens were linked to pediatric asthma emergency hospital admissions. CONCLUSIONS A significant association between the consequences of CC and asthma in adults particularly in children has been demonstrated. Future research should quantify the impact of global change in climate regarding the aeroallergens' distribution in terms of geography and time. It is also necessary to research the impact of air pollution on asthmatic health, like sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and particles having an aerodynamic diameter lower than 2.5 µm (PM2.5).
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Affiliation(s)
- Jamila Rida
- Research Laboratory of Innovation in Health Sciences, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
- High Institute of Nursing Professions and Health Techniques, Health Sciences and Environment Laboratory, Health Sciences, Epidemiology and Human Pathologies Research Team, Agadir, Morocco
| | - Youssef Bouchriti
- High Institute of Nursing Professions and Health Techniques, Health Sciences and Environment Laboratory, Health Sciences, Epidemiology and Human Pathologies Research Team, Agadir, Morocco
- Geosciences, Environment and Geomatic Laboratory, Faculty of Sciences, Ibn Zohr University, Agadir, Morocco
| | - Mohamed Ait Haddou
- Geosciences, Environment and Geomatic Laboratory, Faculty of Sciences, Ibn Zohr University, Agadir, Morocco
- Department of Geography, Faculty of Humanities and Social Sciences, Ibn Tofail University, Kenitra, Morocco
| | - Abderrahmane Achbani
- Laboratory of Cell Biology and Molecular Genetics, Faculty of Sciences, Ibn Zohr University, Agadir, Morocco
- High Institute of Nursing Professions and Health Techniques, Marrakesh, Morocco
| | - Hasnaa Sine
- Laboratory of Cell Biology and Molecular Genetics, Faculty of Sciences, Ibn Zohr University, Agadir, Morocco
- High Institute of Nursing Professions and Health Techniques, Marrakesh, Morocco
| | - Hind Serhane
- Research Laboratory of Innovation in Health Sciences, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
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Seret J, Bruyneel A, Larcin L, Gooset F, Azzi D, Martins D, Van Den Bulcke J, Leclercq P, Pirson M. Predictors and components of inpatient asthma hospital cost: A retrospective cohort study. Analysis from a sample of 14 Belgian hospitals. J Public Health Res 2024; 13:22799036241243270. [PMID: 38711424 PMCID: PMC11072054 DOI: 10.1177/22799036241243270] [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: 08/11/2023] [Accepted: 03/14/2024] [Indexed: 05/08/2024] Open
Abstract
Background Addressing the challenges of asthma has involved various approaches, including the examination of costs associated with hospitalization. However, there is a limited number of studies that have investigated the actual expenses incurred by hospital settings in caring for asthma patients. This study aims to describe the costs, predictors, and breakdown of expenditures in different categories. Design and methods A retrospective cohort study was conducted, involving 314 hospital stays of patients over 12 years old who were admitted for asthma and classified under APR-DRG 141 (asthma). Univariate and multiple linear regression analyses were performed. Results The median cost, regardless of DRG severity, amounted to 2.314€ (1.550€-3.847€). Significant variations were observed when the sample was stratified based on the severity of DRG, revealing a cost gradient that increases with severity. The length of stay followed a similar trend. Six predictors were identified: age, admission to intensive care, asthma severity, severity level of the DRG, winter admission, and length of stay. The cost breakdown showed that 44% constituted direct costs, 25% were indirect costs, 26% were attributed to medical procedures performed outside the patient unit, and 5% were related to medication administration. Conclusions This study initiates a discussion on the role of reducing hospital costs in strategies aiming at controlling asthma-related costs. We argue that cost reduction cannot be achieved solely at the hospital level but must be approached from a public health perspective. This includes promoting high-quality outpatient care and addressing factors leading to poor adherence to the care plan.
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Affiliation(s)
- Jehan Seret
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Lionel Larcin
- Research Centre for Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabienne Gooset
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Djohra Azzi
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Dimitri Martins
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Van Den Bulcke
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Pol Leclercq
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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Huang J, Zhou X, Dong B, Tan H, Li Q, Zhang J, Su H, Sun X. Obesity-related asthma and its relationship with microbiota. Front Cell Infect Microbiol 2024; 13:1303899. [PMID: 38292857 PMCID: PMC10825962 DOI: 10.3389/fcimb.2023.1303899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Obesity and asthma are global public health problems. Obesity-related asthma is a special phenotype of asthma with a complex pathogenesis. Its occurrence and development are related to mechanical compression, inflammatory response, metabolic regulation, gene regulation, and vitamin D deficiency. Different treatment strategies used in the process of weight loss have a beneficial impact on asthma. Alterations in gut and airway microbial community structure and their metabolites may also contribute to obesity-related asthma. The role of the Th17/Treg balance in the gut microbiota regulating the immune responses and host metabolism is important. Therapeutic measures associated with the gut microbiota variety may contribute to improving chronic inflammation associated with obesity by regulating the Th17/Treg balance. An early reduction in microbial diversity can predict the development of asthma and lead to allergy through an imbalance of Th2/Th1 responses. Short-chain fatty acids (SCFAs) regulate the differentiation and activation of regulatory T cells, thereby regulating immune homeostasis in the lung to suppress allergic inflammation and weight gain. Therefore, clarifying the microbial mechanism of obesity-related asthma has important guiding significance for clinical treatment. In this review, we used the following terms: "asthma and obesity" and "obesity-related asthma", combining "phenotype", "airway inflammation" and "lung function", and reviewed the characteristics and pathogenesis of obesity-related asthma, the relationship between the gut and airway microbiota and obesity-related asthma, and the current treatment measures for the disease.
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Affiliation(s)
- Jinli Huang
- Department of Pediatrics, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Xuehua Zhou
- Department of Pediatrics, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Bo Dong
- Department of Pediatrics, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Hong Tan
- Department of Pediatrics, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Qiuhong Li
- Department of Pediatrics, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Juan Zhang
- Department of Pediatrics, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Hui Su
- Department of Geriatrics, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Xin Sun
- Department of Pediatrics, Xijing Hospital, the Fourth Military Medical University, Xi’an, China
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Debnath C, Agarwal S, Atkinson C, Chong LK. Impact of race on in-hospital outcomes of patients hospitalized for asthma exacerbation. Ann Allergy Asthma Immunol 2023; 131:380-382. [PMID: 37263379 DOI: 10.1016/j.anai.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Charu Debnath
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Siddharth Agarwal
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Laura K Chong
- Oklahoma Allergy and Asthma Clinic, Oklahoma City, Oklahoma.
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Qahtani SYA. Efficacy and safety of intravenous leukotriene receptor antagonists in acute asthma. Am J Med Sci 2023; 366:22-26. [PMID: 37080430 DOI: 10.1016/j.amjms.2023.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/07/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023]
Abstract
The incidence of bronchial asthma has increased substantially since recent decades in both children and adults. Moreover, the number of patients presenting with asthma exacerbation to the emergency department has also increased in several countries. Leukotrienes are inflammatory mediators that play an important role in bronchial asthma exacerbation. Leukotriene receptor antagonists reduce asthma exacerbation in chronic asthma; moreover, the current guidelines for asthma management recommend the use of oral leukotriene receptor antagonists for asthma control and reduce further exacerbation. However, data on the use of intravenous leukotriene receptor antagonists during acute asthma exacerbation are scarce. Nevertheless, currently available data revealed a trend of significant improvement of acute asthma and rapid reversal of airflow obstruction when administered during an acute asthma attack. This review aims to summarize currently available data on the use of intravenous leukotriene receptor antagonists in adult patients with acute asthma exacerbation.
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Affiliation(s)
- Shaya Yaanallah Al Qahtani
- Department of Internal Medicine and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
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8
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Ibrahim AO, Aremu SK, Afolabi BA, Ajani GO, Kolawole FT, Oguntoye O. Acute severe asthma and its predictors of mortality in rural Southwestern Nigeria: a-five year retrospective observational study. Chron Respir Dis 2023; 20:14799731221151183. [PMID: 36652901 PMCID: PMC9869197 DOI: 10.1177/14799731221151183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES There is an observed paucity of data regarding the predictors of asthma mortality in Nigeria. This study aimed to ascertain the clinical presentations and predictors of acute severe asthma mortality in rural Southwestern Nigeria. METHODS A retrospective observational study using a data form and a standardized questionnaire was used to review the 124 patients admitted at Emergency Department between January 2015 and December 2019. The data were analyzed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Binary logistic regression analysis was used to determine the predictors of asthma mortality and a p-value <.05 was considered statistically significant. RESULTS A total of 124 patients were studied. The acute severe asthma mortality was 4.8% and its predictors were older age (Crude odds Ratio (COR), 14.857; 95% CI: 2.489-88.696, p < .001), Tobacco smoking (COR, 6.741; 95% CI: 1.170-38.826, p = .016), more than three co-morbidities (COR, 2.750; 95% CI: 1.147-26.454, p = 0.012), diabetes mellitus (COR, 13.750; 95% CI: 2.380-79.433, p < .001), Human Immunodeficiency virus (COR, 117.000; 95% CI: 9.257-1479.756, p < .001), ≥2 days before presentation (COR, 7.440; 95% CI: 1.288-42.980, p = .039), and Short-acting-B2-agonists overuse (COR, 7.041; 95% CI: 1.005-62.165, p = .044). CONCLUSION The mortality rate was 4.8% and its predictors were older age patients, tobacco smoking, multiple co-morbidities, diabetes mellitus, HIV, SP02 <90%, delay presentation, and Short-acting-B2-agonists over use, The study showed that there is high prevalence of asthma mortality in rural Southwestern Nigeria. The findings may be used to plan for asthma preventions and control programs in rural settings, and may also provide an impetus for prospective research on these outcomes.
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Affiliation(s)
| | - Shuaib Kayode Aremu
- Department of Otorhinolaryngology, Afe Babalola University, Ado-Ekiti, Nigeria
| | | | - Gbadebo Oladimeji Ajani
- Department of Medicine, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
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Khosa JK, Louie S, Lobo Moreno P, Abramov D, Rogstad DK, Alismail A, Matus MJ, Tan LD. Asthma Care in the Elderly: Practical Guidance and Challenges for Clinical Management - A Framework of 5 "Ps". J Asthma Allergy 2023; 16:33-43. [PMID: 36636705 PMCID: PMC9829983 DOI: 10.2147/jaa.s293081] [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: 11/20/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
Abstract
Uncontrolled asthma in the elderly is a public health issue recognized in developed countries such as the United States and among the European Union, both from patient safety and economic perspectives. Variations in the cutoff, which defines elderly age, contribute to epidemiological study difficulties. Nonetheless, the relevance of elderly asthma from a socioeconomic perspective is inarguable. The projected growth of the enlarging geriatric population in the United States portends an impending national health burden that may or may not be preventable with pharmacologic and non-pharmacologic treatments. Asthma in the elderly might be a consequence of uncontrolled disease that is carried throughout a lifetime. Or elderly asthmatics could suffer from uncontrolled asthma, which overlaps with other ailments common with advancing ages that merit consideration, eg, COPD, heart disease, OSA, diabetes mellitus, and other comorbidities. Because of the heterogeneity of asthma phenotypes and other conditions that could mimic the symptoms of elderly asthma, further cohort studies are needed to elucidate the elderly asthmatic pathophysiology and management. More studies to characterize elderly asthma can help address these patients' unmet need for evidence-based guidelines. We introduce the 5 "Ps" (phenotypes, partnership, pharmacology, practice in acute exacerbations, and problems or barriers for the elderly asthmatics) that establish a framework approach for clinical practice.
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Affiliation(s)
- Jaskiran K Khosa
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Samuel Louie
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Pamela Lobo Moreno
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Dmitry Abramov
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Daniel K Rogstad
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Abdullah Alismail
- Department of Cardiopulmonary Sciences, Loma Linda University Health, Loma Linda, CA, USA
| | - Michael J Matus
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Laren D Tan
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
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Gilden RC, Harris RL, Friedmann EJ, Han M, Hackney AJ, Olorunyemi E, Spanier AJ. Systematic Review: Association of Pesticide Exposure and Child Wheeze and Asthma. Curr Pediatr Rev 2023; 19:169-178. [PMID: 35538815 DOI: 10.2174/1573396318666220510124457] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/14/2022] [Accepted: 03/18/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The prevalence of wheeze and asthma has risen over recent decades for all age groups, especially children. These disorders can lead to decreased quality of life, missed school, urgent care and emergency department visits, hospitalizations, and increased health care costs. Environmental exposures, including pesticide exposure, are likely a contributing factor to this increased prevalence. OBJECTIVE To evaluate the association of pesticide exposure with childhood wheeze and asthma. METHODS We conducted a systematic review evaluating studies of pesticide exposure (measured objectively) and child respiratory outcomes. We searched PubMed, Embase (Elsevier), CINAHL (EBSCO), Scopus (Elsevier), Cochrane Database of Systematic Reviews (Wiley), and ClinicalTrials. gov from 1988 - 2021. Main search keywords included "pesticides", "insecticides", "herbicides", "respiratory", "asthma" and "wheeze". RESULTS Out of 5767 studies, 25 met the inclusion criteria; eight evaluated prenatal pesticide exposure (n=8407), twelve evaluated postnatal exposures (n= 50,488), and five evaluated pre-and postnatal exposures (n=20,919). Main pesticides investigated were dichlorodiphenyldichloroethylene (DDE) (14 studies) followed by organophosphates (7 studies). Primary methods of outcome assessment were questionnaire-based (84%), followed by spirometry (16%), registry data, and blood measures. Studies varied in the strength of evidence relating to study design and measures. Most studies (84%) reported a positive association of exposure with adverse child respiratory health. CONCLUSION The studies suggest an association of pesticide exposure and childhood wheeze and asthma. The varying results and methods reinforce the need for more research and standardized approaches to these studies to confirm the suggested association of pesticide exposure and childhood wheeze and asthma.
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Affiliation(s)
- Robyn C Gilden
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD 21201, USA
| | - Ryan L Harris
- J. Murrey Atkins Library, University of North Carolina, Charlotte, NC 28202, USA
| | - Erika J Friedmann
- Office of Research, University of Maryland, School of Nursing, Baltimore, MD 21201, USA
| | - Myeunghee Han
- Office of Research, University of Maryland, School of Nursing, Baltimore, MD 21201, USA
| | - Alisha J Hackney
- Office of Research, University of Maryland, School of Nursing, Baltimore, MD 21201, USA
| | - Emmanuel Olorunyemi
- Office of Research, University of Maryland, School of Nursing, Baltimore, MD 21201, USA
| | - Adam J Spanier
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Temporal trends of hospitalizations, comorbidity burden and in-hospital outcomes in patients admitted with asthma in the United States: Population-based study. PLoS One 2022; 17:e0276731. [PMID: 36516114 PMCID: PMC9750011 DOI: 10.1371/journal.pone.0276731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Asthma is a prevalent chronic respiratory condition and remains a common cause for hospitalization. However, contemporary data on asthma hospitalization rates, comorbidity burden, and in-hospital outcomes are lacking. METHODS Survey-weighted analysis of hospitalization records with a primary diagnosis of asthma using data from the US National (Nationwide) Inpatient Sample between 2004 and 2017. Outcomes were number of hospitalizations per 100,000 population and in-hospital outcomes including receipt of ventilation, length of stay, and hospital costs. Patient and admission characteristics and comorbidity burden were examined over time. Multivariable logistic and linear regression models were fitted for over-time risks of the outcomes. RESULTS Among 3,098,863 asthma admissions between 2004 and 2017, mean (±SD) age was 29 (±25), 57% females, 36% White, 40% had Medicaid as primary payer. During 2004-2017, asthma hospitalizations declined from 89 to 56 per 100,000 population; length of stay remained overall stable; median (interquartile range IQR) inflation-adjusted hospital costs doubled from $8,446 (9,227) in 2004 to $17,756 (19,434) in 2017. Common comorbidities in patients admitted with asthma were hypertension and diabetes in adults, but gastroesophageal reflux disease, obstructive sleep apnoea, anemia, and obesity in children. Over time, the prevalence of mental illness increased by >50%. Severe asthma (IRR, 2.48; 95%CI: 2.27-2.72) and psychoses (IRR, 1.10; 1.05-1.14) were predictors of prolonged hospitalization. Asian/Pacific Islanders were more likely to receive ventilation (OR: 2.35; 1.73-3.20) than White patients. Hospital costs were significantly higher in females and adults with hypertension (coefficient, 1405.2; 283.1-2527.4) or psychoses (coefficient, 1978.4; 674.9-3282.0). CONCLUSIONS US asthma hospitalization rates fluctuated in earlier years but declined over time, which may reflect improvements in community care and declining asthma prevalence. Comorbidity burden, including mental illness, increased over time and is associated with in-hospital outcomes. This highlights the changing landscape of asthma admissions which may inform redesigning services to support pre-hospitalization asthma care and help further reduce admissions, particularly among patients with multimorbidity.
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Para O, Montagnani A, Guidi S, Bertù L, Manfellotto D, Campanini M, Fontanella A, Dentali F. Hospitalization and mortality for acute exacerbation of asthma: an Italian population-based study. Intern Emerg Med 2022; 17:1107-1113. [PMID: 35103927 DOI: 10.1007/s11739-021-02923-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/23/2021] [Indexed: 11/27/2022]
Abstract
Asthma is an ever-increasing disease with a highly variable prevalence among different ethnic groups. Information on hospital admission for acute exacerbation of asthma in adult patients and data regarding short-term prognosis of these patients are limited. We, thus, performed an epidemiological study on hospital admission for asthma acute exacerbation in Italy using hospital discharge database records derived from all Italian hospitals. Patients > 15 years old were identified using clinical Modification (ICD-9-CM) codes. Information on baseline characteristics, vital status at discharge, duration of hospitalization, and up to five secondary discharge diagnoses was collected. Comorbidity was evaluated using the Charlson comorbidity index (CCI). During the observation period (2013-2014), 20,056 patients with asthma acute exacerbation were hospitalized. Median length of hospitalization was 7.9 days (interquartile range 4-10) and mean in-hospital mortality was 0.8%. In-hospital mortality and length of hospitalization varied among different regions (from 0 to 2.9% and from 6.5 to 8.9 days, respectively). Old age, invasive and non-invasive mechanical ventilation, and CCI resulted as significantly associated with higher in-hospital mortality. Our study results, on a large sample of patients, confirm that hospitalization for asthma acute exacerbation is not uncommon among Italian current population. Older age, high CCI, and use of ventilator support were associated with a higher mortality rate. These findings should be analyzed to set up appropriate health care policies on patients with asthma.
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Affiliation(s)
- Ombretta Para
- Internal Medicine 1, Careggi University Hospital, Florence, Italy.
| | - Andrea Montagnani
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Grosseto, Italy
| | - Stefano Guidi
- Internal Medicine 1, Careggi University Hospital, Florence, Italy
| | - Lorenza Bertù
- Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Dario Manfellotto
- Department of Internal Medicine, Fatebenefratelli Hospital, Rome, Italy
| | - Mauro Campanini
- Department of Internal Medicine, AOU Maggiore Della Carità, Novara, Italy
| | - Andrea Fontanella
- Department of Internal Medicine, Ospedale del Buon Consiglio, Naples, Italy
| | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy
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13
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Sex Plays a Multifaceted Role in Asthma Pathogenesis. Biomolecules 2022; 12:biom12050650. [PMID: 35625578 PMCID: PMC9138801 DOI: 10.3390/biom12050650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Sex is considered an important risk factor for asthma onset and exacerbation. The prevalence of asthma is higher in boys than in girls during childhood, which shows a reverse trend after puberty—it becomes higher in adult females than in adult males. In addition, asthma severity, characterized by the rate of hospitalization and relapse after discharge from the emergency department, is higher in female patients. Basic research indicates that female sex hormones enhance type 2 adaptive immune responses, and male sex hormones negatively regulate type 2 innate immune responses. However, whether hormone replacement therapy in postmenopausal women increases the risk of current asthma and asthma onset remains controversial in clinical settings. Recently, sex has also been shown to influence the pathophysiology of asthma in its relationship with genetic or other environmental factors, which modulate asthmatic immune responses in the airway mucosa. In this narrative review, we highlight the role of sex in the continuity of the asthmatic immune response from sensing allergens to Th2 cell activation based on our own data. In addition, we elucidate the interactive role of sex with genetic or environmental factors in asthma exacerbation in women.
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14
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Cai KJ, Su SQ, Wang YG, Zeng YM. Dexamethasone Versus Prednisone or Prednisolone for Acute Pediatric Asthma Exacerbations in the Emergency Department: A Meta-Analysis. Pediatr Emerg Care 2021; 37:e1139-e1144. [PMID: 32149991 DOI: 10.1097/pec.0000000000001926] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study evaluates the efficacy and tolerability of dexamethasone (DEX) as an alternative to prednisone/prednisolone (PRED) for the treatment of pediatric asthma exacerbations in emergency department (ED). METHODS Fixed-effects meta-analyses of selected endpoints were performed by using data taken from relevant studies identified by following a priori eligibility criteria after a comprehensive literature search in several electronic databases. RESULTS Data from 10 studies (3208 pediatric asthma patients [1616 DEX treated and 1592 PRED treated], 4.77 years [95% confidence interval, 3.80-5.56 years], 63% [57.76%-62.68%] males) were used. Risk of vomiting drug was significantly lower in DEX group than in PRED group (risk ratio, 0.29 [0.18-0.48]; P ˂ 0.00001). Emergency department stay between DEX and PRED treated patients was statistically different (0.16 [0.03-0.40] hours; P = 0.02) but may not be clinically meaningful. The number of β-agonist therapies received by DEX- and PRED-treated patients was similar. Treatments with both DEX and PRED were associated with improvement in asthma status assessment scores, and there was no significant difference between the groups. There were also no differences between the groups in hospitalization rate, ED revisit rate, and hospital admission rate after relapse. CONCLUSIONS Dexamethasone is a suitable alternative to PRED for the treatment of pediatric asthma exacerbation in ED.
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Affiliation(s)
| | | | | | - Yi-Ming Zeng
- Respiratory, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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15
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Busby J, Price D, Al-Lehebi R, Bosnic-Anticevich S, van Boven JFM, Emmanuel B, FitzGerald JM, Gaga M, Hansen S, Hew M, Iwanaga T, Larenas Linnemann D, Mahboub B, Mitchell P, Morrone D, Pham J, Porsbjerg C, Roche N, Wang E, Eleangovan N, Heaney LG. Impact of Socioeconomic Status on Adult Patients with Asthma: A Population-Based Cohort Study from UK Primary Care. J Asthma Allergy 2021; 14:1375-1388. [PMID: 34785911 PMCID: PMC8591110 DOI: 10.2147/jaa.s326213] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/11/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Asthma morbidity and health-care utilization are known to exhibit a steep socioeconomic gradient. Further investigation into the modulators of this effect is required to identify potentially modifiable factors. Methods We identified a cohort of patients with asthma from the Optimum Patient Care Research Database (OPCRD). We compared demographics, clinical variables, and health-care utilization by quintile of the UK 2011 Indices of Multiple Deprivation based on the location of the patients’ general practice. Multivariable analyses were conducted using generalized linear models adjusting for year, age, and sex. We conducted subgroup analyses and interaction tests to investigate the impact of deprivation by age, sex, ethnicity, and treatment step. Results Our analysis included 127,040 patients with asthma. Patients from the most deprived socio-economic status (SES) quintile were more likely to report uncontrolled disease (OR: 1.54, 95% CI: 1.16, 2.05) and to have an exacerbation during follow-up (OR: 1.27, 95% CI: 1.13, 1.42) than the least deprived quintile. They had higher blood eosinophils (ratio: 1.03; 95% CI: 1.00, 1.06) and decreased peak flow (ratio: 0.95, 95% CI: 0.94, 0.97) when compared to those in the least deprived quintile. The effect of deprivation on asthma control was greater among those aged over 75 years (OR = 1.81, 95% CI: 1.20, 2.73) compared to those aged less than 35 years (OR: 1.22, 95% CI: 0.85, 1.74; pinteraction=0.019). Similarly, socioeconomic disparities in exacerbations were larger among those from ethnic minority groups (OR: 1.94, 95% CI: 1.40, 2.68) than white patients (OR: 1.24, 95% CI: 1.10, 1.39; pinteraction=0.012). Conclusion We found worse disease control and increased exacerbation rates among patients with asthma from more deprived areas. There was evidence that the magnitude of socioeconomic disparities was elevated among older patients and those from ethnic minority groups. The drivers of these differences require further exploration.
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Affiliation(s)
- John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - David Price
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sinthia Bosnic-Anticevich
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Central Sydney Local Area Health District, Sydney, Australia
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - J Mark FitzGerald
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Mina Gaga
- 7th Respiratory Medicine Department and Asthma Centre, Athens Chest Hospital, Athens, Greece
| | - Susanne Hansen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia.,Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Takashi Iwanaga
- Center for General Medical Education and Clinical Training, Kindai University Hospital, Osakasayama, Japan
| | | | - Bassam Mahboub
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Patrick Mitchell
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniela Morrone
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Jonathan Pham
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia.,Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - Celeste Porsbjerg
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital, APHP.Centre, Paris, France.,University of Paris, Cochin Institute (UMR1016), Paris, France
| | - Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, USA.,Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Neva Eleangovan
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Liam G Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
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16
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Redmond C, Akinoso-Imran AQ, Heaney LG, Sheikh A, Kee F, Busby J. Socioeconomic disparities in asthma health care utilization, exacerbations, and mortality: A systematic review and meta-analysis. J Allergy Clin Immunol 2021; 149:1617-1627. [PMID: 34673047 DOI: 10.1016/j.jaci.2021.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior studies investigating the effect of socioeconomic status (SES) on asthma health care outcomes have been heterogeneous in the populations studied and methodologies used. OBJECTIVE We sought to systematically synthesize evidence investigating the impact of SES on asthma health care utilization, exacerbations, and mortality. METHODS We searched Embase, Medline, and Web of Science for studies reporting differences in primary care attendance, exacerbations, emergency department attendance, hospitalization, ventilation/intubation, readmission, and asthma mortality by SES. Study quality was assessed using the Newcastle Ottawa Scale, and meta-analyses were conducted using random-effects models. We conducted several prespecified subgroup analyses, including by health care system (insurance based vs universal government funded) and time period (before vs after 2010). RESULTS A total of 61 studies, comprising 1,145,704 patients, were included. Lower SES was consistently associated with increased secondary health care utilization including emergency department attendance (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.40-1.84), hospitalization (OR, 1.63; 95% CI, 1.34-1.99), and readmission (OR, 1.31; 95% CI, 1.19-1.44). Substantial associations were also found between SES and ventilation/intubation (OR, 1.76; 95% CI, 1.13-2.73), although there was no association with primary care attendances (OR, 0.79; 95% CI, 0.51-1.24). We found evidence of borderline significance for increased exacerbations (OR, 1.18; 95% CI, 0.98-1.42) and mortality (OR, 1.12; 95% CI, 0.92-1.37) among more deprived groups. There was no convincing evidence that disparities were associated with country-level health care funding models or that disparities have narrowed over time. CONCLUSIONS Patients with a lower SES have substantially increased secondary care health care utilization. We found evidence suggestive of increased exacerbations and mortality risk, although CIs were wide. These disparities have been consistently reported worldwide, including within countries offering universally funded health care systems. Systematic review registration: CRD42020173544.
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Affiliation(s)
- Charlene Redmond
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Abdul Qadr Akinoso-Imran
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom.
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17
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Bourdin A, Charriot J, Boissin C, Ahmed E, Suehs C, De Sevin A, Volpato M, Pahus L, Gras D, Vachier I, Halimi L, Hamerlijnck D, Chanez P. Will the asthma revolution fostered by biologics also benefit adult ICU patients? Allergy 2021; 76:2395-2406. [PMID: 33283296 DOI: 10.1111/all.14688] [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: 09/25/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Asthma exacerbations are inflammatory events that rarely result in full hospitalization following an ER visit. Unfortunately, certain patients require prolonged support, including occasional external lung support through ECMO or ECCOR (with subsequent further exposure to other life-threatening issues), and some die. In parallel, biologics are revolutionizing severe asthma management, mostly in T2 high patients. METHODS We extensively reviewed the current unmet needs surrounding ICU-admitted asthma exacerbations, with a focus on currently available drugs and the underlying biological processes involved. We explored whether currently available T2-targeting drugs can reasonably be seen as potential players not only for relapse prevention but also as candidate drugs for a faster resolution of such episodes. The patient's perspective was also sought. RESULTS About 30% of asthma exacerbations admitted to the ICU do not resolve within five days. Persistent severe airway obstruction despite massive doses of corticosteroids and maximal pharmacologically induced bronchodilation is the main cause of treatment failure. Previous ICU admission is the main risk factor for such episodes and may eventually be considered as a T2 surrogate marker. Fatal asthma cases are hallmarked by poorly steroid-sensitive T2-inflammation associated with severe mucus plugging. New, fast-acting T2-targeting biologics (already used for preventing asthma exacerbations) have the potential to circumvent steroid sensitivity pathways and decrease mucus plugging. This unmet need was confirmed by patients who reported highly negative, traumatizing experiences. CONCLUSIONS There is room for improvement in the management of ICU-admitted severe asthma episodes. Clinical trials assessing how biologics might improve ICU outcomes are direly needed.
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Affiliation(s)
- Arnaud Bourdin
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
- PhyMedExp Univ MontpellierCNRSINSERM, CHU Montpellier Montpellier France
| | - Jérémy Charriot
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
- PhyMedExp Univ MontpellierCNRSINSERM, CHU Montpellier Montpellier France
| | - Clément Boissin
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Engi Ahmed
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Carey Suehs
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
- Department of Medical Information Univ Montpellier, CHU Montpellier Montpellier France
| | - Arthur De Sevin
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Mathilde Volpato
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Laurie Pahus
- Aix Marseille UnivAPHM, Hôpital NORDCIC 9502Clinique des bronches allergies et sommeil, Chemin des Bourrely, 13015 Marseille France
- Aix Marseille UnivCNRSEFS, ADES Marseille France
- Aix Marseille UnivINSERM U1263INRA 1260 (C2VN) Marseille France
| | - Delphine Gras
- Aix Marseille UnivINSERM U1263INRA 1260 (C2VN) Marseille France
| | - Isabelle Vachier
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Laurence Halimi
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | | | - Pascal Chanez
- Aix Marseille UnivAPHM, Hôpital NORDCIC 9502Clinique des bronches allergies et sommeil, Chemin des Bourrely, 13015 Marseille France
- Aix Marseille UnivINSERM U1263INRA 1260 (C2VN) Marseille France
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18
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Jezioro JR, Gutman SA, Lovinsky-Desir S, Rauh V, Perera FP, Miller RL. A Comparison of Activity Participation between Children with and without Asthma. OPEN JOURNAL OF OCCUPATIONAL THERAPY 2021; 9. [PMID: 34316416 DOI: 10.15453/2168-6408.1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Asthma affects approximately 6 million children in the United States and can greatly impact quality of life and occupational engagement. Although occupational therapists are well-equipped to address participation limitations, insufficient evidence exists to support the role of occupational therapists in asthma treatment. Method The purpose of this study was to further understand the occupational limitations experienced by children with asthma. We also explored a dual diagnosis of asthma and obesity. The participants included children with (n = 84) and without (n = 63) asthma living in New York City. The Child Behavior Checklist, Youth Self Report, Brief Respiratory Questionnaire, and accelerometer data were used to examine occupational participation. Results Although accelerometry data demonstrated that children with asthma were equally as active as their non-asthmatic peers, the participants with asthma perceived themselves as participating more in sedentary occupations and were less likely to be members of sports teams. They also had more missed school days and nights of troubled sleep. The children with both asthma and obesity reported the highest level of activity limitations. Conclusion This study illustrates specific limitations experienced by children with asthma and supports the need for occupational therapy intervention. Future studies are needed to design and assess interventions that will support the addition of occupational therapists to multidisciplinary asthma treatment teams.
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19
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Ylivuori M, Ruuhela R, Sintonen H, Virkkula P, Roine RP, Hytönen M. Seasonal Variation in Generic and Disease-Specific Health-Related Quality of Life in Rhinologic Patients in Southern Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126428. [PMID: 34198538 PMCID: PMC8296228 DOI: 10.3390/ijerph18126428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/04/2021] [Accepted: 06/12/2021] [Indexed: 11/16/2022]
Abstract
Background: Seasonal variation in exacerbations, hospitalisations, and mortality statistics has been reported for some diseases. To our knowledge, however, no published studies exist on the seasonality of health-related quality of life (HRQoL) amongst rhinologic patients. Aims/Objectives: This study, therefore, aimed to investigate the possible seasonal variation in rhinologic patients’ HRQoL using the rhinologic disease-specific Sino-Nasal Outcome Test-22 (SNOT-22) and the generic 15D HRQoL instrument. Material and Methods: We enrolled unselected adult rhinologic patients requiring specialist care at the Helsinki University Hospital in this cross-sectional, questionnaire-based prospective study during four seasons: February (winter), May (spring), August (summer), and November (autumn). Patients received SNOT-22 and 15D questionnaires via post. The Finnish Meteorological Institute supplied climate data from these months. Results: SNOT-22 and 15D data were available for 301 and 298 patients, respectively. We found no statistically significant differences (p = 0.948) between the mean monthly 15D scores or mean SNOT-22 scales. Furthermore, the mean SNOT-22 subscales did not differ between the monthly study periods. Conclusions and Significance: Our study shows that seasonality did not impact rhinologic patients’ SNOT-22 or 15D HRQoL scores. Thus, these questionnaires can be used for follow-up amongst rhinologic patients regardless of season.
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Affiliation(s)
- Maija Ylivuori
- Department of Otorhinolaryngology—Head & Neck Surgery, Helsinki University Hospital, Kasarmikatu 11–13, 00029 Helsinki, Finland; (P.V.); (M.H.)
- Correspondence:
| | - Reija Ruuhela
- Weather and Climate Change Impact Research, Finnish Meteorological Institute, 00560 Helsinki, Finland;
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland;
| | - Paula Virkkula
- Department of Otorhinolaryngology—Head & Neck Surgery, Helsinki University Hospital, Kasarmikatu 11–13, 00029 Helsinki, Finland; (P.V.); (M.H.)
| | - Risto P. Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, 00100 Helsinki, Finland;
- Department of Health and Social Management, University of Eastern Finland, 70211 Kuopio, Finland
| | - Maija Hytönen
- Department of Otorhinolaryngology—Head & Neck Surgery, Helsinki University Hospital, Kasarmikatu 11–13, 00029 Helsinki, Finland; (P.V.); (M.H.)
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20
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Pérez de Llano L, Dacal-Rivas D, Blanco-Cid N, Martín-Robles I. Distilling Fact from the Vapor of Nuance: Asthma Exacerbations. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:842-843. [PMID: 33551042 DOI: 10.1016/j.jaip.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Luis Pérez de Llano
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Lugo, Spain.
| | - David Dacal-Rivas
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Lugo, Spain
| | - Nagore Blanco-Cid
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Lugo, Spain
| | - Irene Martín-Robles
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Lugo, Spain
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21
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Kichloo A, Solanki D, Singh J, Dahiya DS, Lal D, Haq KF, Aljadah M, Gandhi D, Solanki S, Khan HMA. Gastric Antral Vascular Ectasia: Trends of Hospitalizations, Biodemographic Characteristics, and Outcomes With Watermelon Stomach. Gastroenterology Res 2021; 14:104-111. [PMID: 34007352 PMCID: PMC8110233 DOI: 10.14740/gr1380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/08/2021] [Indexed: 01/10/2023] Open
Abstract
Background Gastric antral vascular ectasia (GAVE) syndrome is a rare but significant cause of acute or chronic gastrointestinal (GI) bleeding, particularly in the elderly. The primary objective of this study was to determine the biodemographic characteristics, adverse outcomes, and the impact of GAVE hospitalizations on the US healthcare system. Methods This retrospective database cross-sectional study used the National Inpatient Sample (NIS) from 2001 to 2011 to identify all adult hospitalizations with a primary discharge diagnosis of GAVE, with and without hemorrhage, using the International Classification of Diseases, Ninth Revision (ICD-9) codes. Individuals less than 17 years of age were excluded from the study. The outcomes included biodemographic characteristics, comorbidity measures, and inpatient mortality and the burden of the disease on the US healthcare system in terms of healthcare cost and utilization. Results We noted an increase in the total hospitalizations for GAVE from 25,423 in 2001 to 44,787 in 2011. Furthermore, GAVE hospitalizations with hemorrhage rose from 19,168 in 2001 to 27,679 in 2011 while GAVE hospitalization without hemorrhage increased from 6,255 in 2001 to 17,108 in 2011. We also noted a female predominance, the proportional trend of which did not show significant difference from 2001 to 2011. For GAVE hospitalizations, the inpatient mortality decreased from 2.20% in 2001 to 1.73% in 2011. However, the cost of hospitalization increased from $11,590 in 2001 to $12,930 in 2011. After adjusting for possible confounders, we observed that the presence of hemorrhage in GAVE hospitalizations was associated with an increased risk of mortality (odds ratio (OR): 1.27; 95% confidence interval (CI): 1.1 - 1.46; P = 0.001). Conclusions For the study period, the total number of GAVE hospitalizations increased with an increase noted in the proportion of GAVE hospitalizations without bleeding, reflecting an improvement in diagnostic and therapeutic techniques. Although inpatient mortality for GAVE slightly decreased, we noted a significant increase in the cost of care likely secondary to increased use of advanced and expensive interventions.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Dhanshree Solanki
- Department of Internal Medicine, Rutgers University, New Brunswick, NJ, USA
| | - Jagmeet Singh
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Darshan Lal
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Khwaja Fahad Haq
- Division of Gastroenterology, Henry Ford Hospital, Detroit, MI, USA
| | - Michael Aljadah
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Darshan Gandhi
- Department of Radiology, Hartford Healthcare, Hartford, CT, USA
| | - Shantanu Solanki
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
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Chan KP, Ko FWS, Ling KC, Cheung PS, Chan LV, Chan YH, Lo YT, Ng CK, Lui MMS, Yee KSW, Tseng CZS, Tse PY, Wong MLM, Choo KL, Lam WK, Wong CM, Ho SS, Lun CT, Lai CKW. A territory-wide study on the factors associated with recurrent asthma exacerbations requiring hospitalization in Hong Kong. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:569-581. [PMID: 33657275 PMCID: PMC8127557 DOI: 10.1002/iid3.419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Abstract
Background The real‐world relationships between the demographic and clinical characteristics of asthma patients, their prehospitalization management and the frequency of hospitalization due to asthma exacerbation is poorly established. Objective To determine the risk factors of recurrent asthma exacerbations requiring hospitalizations and evaluate the standard of baseline asthma care. Methods A territory‐wide, multicentre retrospective study in Hong Kong was performed. Medical records of patients aged ≥18 years admitted to 11 acute general hospitals from January 1 to December 31, 2016 for asthma exacerbations were reviewed. Results There were 2280 patients with 3154 admissions (36.7% male, median age 66.0 [interquartile range: 48.0–81.0] years, 519 had ≥2 admissions). Among them, 1830 (80.3%) had at least one asthma‐associated comorbidity, 1060 (46.5%) and 885 (38.9%) of patients had Accident and Emergency Department (AED) attendance and hospitalization in the preceding year, respectively. Patients with advancing age (incidence rate ratio [IRR]: 1.003 for every year increment), a history of AED visits or hospitalization (IRR: 1.018 and 1.070 for every additional episode, respectively) for asthma exacerbation in the preceding year, the presence of neuropsychiatric (IRR: 1.142) and gastrointestinal (IRR: 1.154) comorbidities were risk factors for an increasing number of admissions for asthma exacerbation. For patients with ≥2 admissions, 17.1% were not prescribed inhaled corticosteroid and only 44.6% had spirometry checked before the index admission. Asthma phenotyping was often incomplete, as assessment of atopy (total serum immunoglobulin E level and senitization to aeroallergens) was only performed in 30 (5.8%) patients with ≥2 admissions. Conclusions and Clinical Relevance Improving asthma care, especially in elderly patients with a prior history of urgent healthcare utilization and comorbidities, may help reduce healthcare burden. Suboptimal management before the index admission was common in patients hospitalized for asthma exacerbations. Early identification of patients at risk and enhancement of baseline asthma management may help to prevent recurrent asthma exacerbation and subsequent hospitalization.
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Affiliation(s)
- Ka Pang Chan
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Fanny Wai San Ko
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Kwun Cheung Ling
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Pik Shan Cheung
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong, China
| | - Lee Veronica Chan
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong, China
| | - Yu Hong Chan
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Yi Tat Lo
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Chun Kong Ng
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - Macy Mei-Sze Lui
- Department of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | | | | | - Pak Yiu Tse
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - Mo Lin Maureen Wong
- Department of Medicine & Geriatrics, Caritas Medical Centre, Hong Kong, China
| | - Kah Lin Choo
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Wai Kei Lam
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Chun Man Wong
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Sheng Sheng Ho
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Chung Tat Lun
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
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23
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Predictors of In-Hospital Death in Patients with Lung Cancer Admitted for Acute Radiation Pneumonitis: A Healthcare Cost and Utilization Project (HCUP) Analysis. Clin Lung Cancer 2021; 22:e716-e722. [PMID: 33658160 DOI: 10.1016/j.cllc.2021.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Radiation pneumonitis (RP) is a dose-limiting and potentially fatal toxicity of thoracic radiotherapy most often seen in patients treated for primary lung cancer. The purpose of this study was to identify predictors of in-hospital death among lung cancer patients admitted for acute RP in the Healthcare Cost and Utilization Project (HCUP) database. MATERIALS AND METHODS The HCUP National Inpatient Sample database was queried from 2012 through 2016 to capture adult lung cancer patients admitted to the hospital with a principal diagnosis of acute RP. Multivariate logistic regression modeling and χ2 tests were used to determine predictors of in-hospital death. RESULTS Of the 882 patients with lung cancer admitted for RP, 67 patients (7.6%) died during the hospitalization and 90 patients (10.2%) required mechanical ventilation. Of those requiring mechanical ventilation, 38 patients (42.2%) died. The average age at hospitalization was 70.4 years (range, 35-90). Of those factors associated with death on univariate analysis, interstitial lung disease (odds ratio [OR] = 6.14; 95% confidence interval [CI], 1.9-19.4; P = .002), pulmonary hypertension (OR = 3.1; 95% CI, 1.6-6.2; P = .001), diabetes mellitus (OR = 2.0; 95% CI, 1.1-3.3; P = .013), and more affluent Zip Code (OR = 1.9; 95% CI, 1.1-3.2; P = .021) remained statistically significant on multivariate logistic regression. CONCLUSION In the largest reported cohort of patients with lung cancer hospitalized with a principal diagnosis of acute RP, the presence of interstitial lung disease, pulmonary hypertension, diabetes mellitus, and more affluent Zip Code were associated with in-hospital death. Comorbid diagnoses may be useful for risk-stratified management of inpatients with RP.
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24
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Taha M, Mishra T, Shokr M, Sharma A, Taha M, Samavati L. Burden and impact of arrhythmias in asthma-related hospitalizations: Insight from the national inpatient sample. J Arrhythm 2021; 37:113-120. [PMID: 33664893 PMCID: PMC7896478 DOI: 10.1002/joa3.12452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/05/2020] [Accepted: 10/22/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study aimed to analyze the burden and impact of cardiac arrhythmias in adult patients hospitalized with asthma exacerbation using the nationwide inpatient database. METHODS We used the National Inpatient Sample (NIS) database (2010-2014) to identify arrhythmias in asthma-related hospitalization and its impact on inpatient mortality, hospital length of stay (LOS), and hospitalization charges. We also used multivariable analysis to identify predictors of in-hospital arrhythmia and mortality. RESULTS We identified 12,988,129 patients hospitalized with primary diagnosis of asthma; among them, 2,014,459(16%) patients had cardiac arrhythmia. The most frequent arrhythmia identified is atrial fibrillation (AFib) (8.95%). The AFib and non-AFib arrhythmia group had higher mortality (3.40% & 2.22% vs 0.74%), mean length of stay (LOS) (5.9 & 5.4 vs 4.2 days), and hospital charges ($53,172 & $51,105 vs $34,585) as compared to the non-arrhythmia group (P < .005). Predictors of arrhythmia in asthma-related hospitalization were history of PCI or CABG, valvular heart disease, congestive heart failure (CHF), and acute respiratory failure. Predictors of higher mortality in arrhythmia group were acute respiratory failure, sepsis, and acute myocardial infarction. CONCLUSIONS Around 16% of adult patients hospitalized with asthma exacerbation experience arrythmia (mostly AFib 8.95%). The presence of arrhythmias was associated with higher in-hospital mortality, LOS, and hospital charges in hospitalized asthmatics.
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Affiliation(s)
- Muhanad Taha
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Tushar Mishra
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Mohamed Shokr
- Cardiology Department Leon H. Charney Division of Cardiology, Cardiac Electrophysiology NYU Langone Health New York University Grossman School of Medicine New York NY USA
| | - Aditi Sharma
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Mazen Taha
- Faculty of Medicine Cairo University Giza Egypt
| | - Lobelia Samavati
- Department of Pulmonary Critical Care and Sleep Division Wayne State University Detroit MI USA
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25
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Rapeport WG, Ito K, Denning DW. The role of antifungals in the management of patients with severe asthma. Clin Transl Allergy 2020; 10:46. [PMID: 33292524 PMCID: PMC7646070 DOI: 10.1186/s13601-020-00353-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022] Open
Abstract
In patients with asthma, the inhalation of elevated amounts of fungal spores and hyphae may precipitate the onset of asthma or worsen control to the extent of being life-threatening. Sensitisation to fungi, especially Aspergillus fumigatus, is found in 15% to 48% of asthmatics in secondary care and is linked to worse asthma control, hospitalisation, bronchiectasis and fixed airflow obstruction, irrespective of whether allergic bronchopulmonary aspergillosis (ABPA) is diagnosed. ABPA represents a florid response to the presence of Aspergillus spp. but up to 70% of patients with severe asthma exhibit sensitisation to different fungi without meeting the diagnostic criteria for ABPA. The presence of persistent endobronchial colonisation with fungi, especially A. fumigatus, is linked to significantly higher rates of radiological abnormalities, lower post-bronchodilator FEV1 and significantly less reversibility to short acting bronchodilators. The therapeutic benefit for antifungal intervention in severe asthma is based on the assumption that reductions in airway fungal burden may result in improvements in asthma control, lung function and symptoms (especially cough). This contention is supported by several prospective studies which demonstrate the effectiveness of antifungals for the treatment of ABPA. Significantly, these studies confirm lower toxicity of treatment with azoles versus high dose oral corticosteroid dosing regimens for ABPA. Here we review recent evidence for the role of fungi in the progression of severe asthma and provide recommendations for the use of antifungal agents in patients with severe asthma, airways fungal infection (mycosis) and fungal colonisation. Documenting fungal airways colonisation and sensitisation in those with severe asthma opens up alternative therapy options of antifungal therapy, which may be particularly valuable in low resource settings.
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Affiliation(s)
- W Garth Rapeport
- Airways Disease, National Heart and Lung Institute, Imperial College, London, SW3 6LY, UK.
| | - Kazuhiro Ito
- Airways Disease, National Heart and Lung Institute, Imperial College, London, SW3 6LY, UK
- Pulmocide Ltd., 44 Southampton Building, London, WC2A 1AP, UK
| | - David W Denning
- Manchester Fungal Infection Group (MFIG), Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
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26
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Ito K, Kanemitsu Y, Fukumitsu K, Inoue Y, Nishiyama H, Yamamoto S, Kitamura Y, Kurokawa R, Takeda N, Fukuda S, Uemura T, Tajiri T, Takakuwa O, Ohkubo H, Takemura M, Maeno K, Ito Y, Oguri T, Niimi A. The impact of budesonide inhalation suspension for asthma hospitalization: In terms of length of stay, recovery time from symptoms, and hospitalization costs. Allergol Int 2020; 69:571-577. [PMID: 32417100 DOI: 10.1016/j.alit.2020.04.003] [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: 12/12/2019] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Hospitalization is a major cause of medical expenditure for asthma. Budesonide inhalation suspension (BIS) may assist in reducing asthma-related symptoms in severe asthma exacerbation. However, its effectiveness for hospitalized patients remains poorly known. The objective of this study is to determine associations of BIS with asthma hospitalization. METHODS We retrospectively analyzed 98 patients who were admitted to our hospital due to severe asthma exacerbation (24 treated with BIS in combination with procaterol) from April 2014 to January 2019. Length of stay, recovery time from symptoms (wheezes), and hospitalization costs were compared between the 2 groups according to clinical factors including the use of BIS and sings of respiratory infections (i.e. C-reactive protein, the presence of phlegm, and the use of antibiotics). Multivariate logistic regression analysis was performed to determine factors contributing to hospitalization outcomes. RESULTS The use of BIS was associated with shorter length of stay, faster recovery time from symptoms, and more reduced hospitalization costs (6.0 vs 8.5 days, 2.5 vs 5.0 days, and 258,260 vs 343,350 JPY). Signs of respiratory infection were also associated with hospitalization outcomes. On a multivariate regression analysis, the use of BIS was a determinant of shortened length of stay and reduced symptoms and medical costs for asthma hospitalization along with signs of respiratory infection. CONCLUSIONS BIS may contribute to shorten length of hospital stay and to reduce symptoms and medical expenditure irrespective of the presence or absence of respiratory infection.
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27
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Gilden R, Friedmann E, Holmes K, Yolton K, Xu Y, Lanphear B, Chen A, Braun J, Spanier A. Gestational Pesticide Exposure and Child Respiratory Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7165. [PMID: 33007939 PMCID: PMC7579149 DOI: 10.3390/ijerph17197165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Childhood wheeze may be related to pesticide exposure, and diet and genetics (Paroxonase; PON1) may modify the effects of exposure. METHODS We analyzed data from the HOME Study, a prospective pregnancy and birth cohort, to examine the association of gestational urinary organophosphate (OP) and pyrethroid (3PBA) metabolite concentrations with child wheeze, forced expiratory volume in one second (FEV1) at ages 4 and 5 years, and wheeze trajectory patterns through age 8 years. RESULTS Among 367 singletons, the frequency of wheeze ranged from 10.6% to 24.1% at each measurement age. OP and 3PBA metabolite concentrations were not associated with wheeze at 8 years or from birth to 8 years, but there were three significant interactions: (1) maternal daily fruit and vegetable consumption (less than daily consumption and increasing 3PBA was associated with wheeze at age 8 years, OR = 1.40), (2) maternal PON1-108 allele (CT/TT genotypes and high DE was associated with wheeze at age 8 years, OR = 2.13, 2.74) and (3) PON1192 alleles (QR/RR genotypes with higher diethylphosphate (DE) and dialkyl phosphate (DAP) were associated with wheeze at age 8 years, OR = 3.84). Pesticide metabolites were not consistently related to FEV1 or wheeze trajectory. CONCLUSIONS Gestational OP and 3PBA metabolites were associated with child respiratory outcomes in participants with maternal dietary and genetic susceptibility.
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Affiliation(s)
- Robyn Gilden
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD 21201, USA
| | - Erika Friedmann
- Office of Research and Scholarship, University of Maryland School of Nursing, Baltimore, MD 21201, USA; (E.F.); (K.H.)
| | - Katie Holmes
- Office of Research and Scholarship, University of Maryland School of Nursing, Baltimore, MD 21201, USA; (E.F.); (K.H.)
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (K.Y.); (Y.X.)
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (K.Y.); (Y.X.)
| | - Bruce Lanphear
- Department of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada;
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA;
| | - Joseph Braun
- Department of Epidemiology, Brown University, Providence, RI 02912, USA;
| | - Adam Spanier
- Department of Pediatrics, Division of General Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
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28
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Ho ATN, Shmelev A, Charbek E. Trends and seasonal variation of hospitalization and mortality of interstitial lung disease in the United States from 2006 to 2016. Respir Res 2020; 21:152. [PMID: 32546158 PMCID: PMC7298940 DOI: 10.1186/s12931-020-01421-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background In the recent years, the overall trends in hospital admission and mortality of interstitial lung disease (ILD) are unknown. In addition, there was some evidence that interstitial lung disease death rate highest in the winter but this finding was only available in one study. This study will investigate the trend and seasonal variations in hospital admission and mortality rates of ILD from 2006 to 2016. Method From the Nationwide Inpatient Sample database, we collected all cases with the International Classification of Diseases (ICD)-9 or ICD-10 codes of ILD excluding identifiable external causes (drug, organic or inorganic dusts) from 2006 to 2016. Hospitalization rates of each year were calculated based on U.S Census population data. Monthly hospitalization and in-hospital mortality rates were analyzed by seasonal and trend decomposition. Subgroups of idiopathic interstitial fibrosis (IPF), acute respiratory failure (ARF), pneumonia were analyzed. Results From 2006 to 2016, all-cause hospital admission rate of patients with interstitial lung disease (ILD) and IPF-only subgroup declined but their overall mortality remained unchanged (except IPF subgroup and acute respiratory failure subgroup). Acute respiratory failure related admission account for 23% of all causes and pneumonia 17.6%. Mortality of ILD in general and subgroup of ILD with ARF was highest in winter, up to 8.13% ± 0.60 and 26.3% ± 10.2% respectively. The seasonal variations of hospital admission and mortality of ILD in general was not changed when infectious pneumonia cases were ruled out. All cause admission rates were highest in months from January to April. Subgroup analysis also showed seasonal variations with highest hospitalization rates for all subgroups (IPF, ARF, pneumonia) in the months from December to April (winter to early Spring). Conclusion From 2006 to 2016, admission rates of ILD of all causes and IPF subgroup declined but in-hospital mortality of ILD of all causes remained unchanged. Mortality of IPF subgroup and acute respiratory failure subgroup trended down. All-cause hospital admissions and mortality of ILD have a strong seasonal variation. Hospitalization rates for all subgroups (IPF, ARF, pneumonia) were highest in the months from December to April.
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Affiliation(s)
- An Thi Nhat Ho
- Department of Pulmonary and Critical Care Medicine, Saint Louis University Hospital, Saint Louis, MO, USA.
| | - Artem Shmelev
- Department of surgery, Saint Agnes Hospital, Baltimore, MD, USA
| | - Edward Charbek
- Department of Pulmonary and Critical Care Medicine, Saint Louis University Hospital, Saint Louis, MO, USA
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29
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Cushing AM, Bucholz E, Michelson KA. Trends in Regionalization of Emergency Care for Common Pediatric Conditions. Pediatrics 2020; 145:peds.2019-2989. [PMID: 32169895 PMCID: PMC7236317 DOI: 10.1542/peds.2019-2989] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND For children who cannot be discharged from the emergency department, definitive care has become less frequent at most hospitals. It is uncertain whether this is true for common conditions that do not require specialty care. We sought to determine how the likelihood of definitive care has changed for 3 common pediatric conditions: asthma, croup, and gastroenteritis. METHODS We used the Nationwide Emergency Department Sample database to study children <18 years old presenting to emergency departments in the United States from 2008 to 2016 with a primary diagnosis of asthma, croup, or gastroenteritis, excluding critically ill patients. The primary outcome was referral rate: the number of patients transferred among all patients who could not be discharged. Analyses were stratified by quartile of annual pediatric volume. We used logistic regression to determine if changes over time in demographics or comorbidities could account for referral rate changes. RESULTS Referral rates increased for each condition in all volume quartiles. Referral rates were greatest in the lowest pediatric volume quartile. Referral rates in the lowest pediatric volume quartile increased for asthma (13.6% per year; 95% confidence interval [CI] 5.6%-22.2%), croup (14.8% per year; 95% CI 2.6%-28.3%), and gastroenteritis (16.4% per year; 95% CI 3.5%-31.0%). Changes over time in patient age, sex, comorbidities, weekend presentation, payer mix, urban-rural location of presentation, or area income did not account for these findings. CONCLUSIONS Increasing referral rates over time suggest decreasing provision of definitive care and regionalization of inpatient care for 3 common, generally straightforward conditions.
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Affiliation(s)
- Anna M Cushing
- Boston Children's Hospital, Boston, Massachusetts; and .,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Emily Bucholz
- Boston Children's Hospital, Boston, Massachusetts; and
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30
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Grunwell JR, Gillespie S, Morris CR, Fitzpatrick AM. Latent Class Analysis of School-Age Children at Risk for Asthma Exacerbation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2275-2284.e2. [PMID: 32198127 DOI: 10.1016/j.jaip.2020.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/07/2020] [Accepted: 03/01/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Factors responsible for asthma exacerbations in children are complex and may differ from those that drive asthma severity. OBJECTIVE To identify latent classes of children at risk for asthma exacerbation and determine whether latent class assignment is useful in the prediction of future exacerbation. METHODS Latent class analysis was performed on 513 children aged 6 to 17 years at risk for asthma exacerbation, with 31 variables encompassing demographics, medical history, treatment, symptoms, lung function, sensitization, and type 2 inflammation. Primary and secondary outcomes included exacerbation occurrence by 12 months and time to first exacerbation, respectively. RESULTS Four latent classes were identified with differing demographic features, sensitization and type 2 inflammatory markers, prior exacerbation severity and health care utilization, and lung function. Exacerbations occurred in 22.4% of class 1 ("lesser sensitization with normal lung function"), 27.9% of class 2 ("lesser sensitization with prior severe exacerbation and normal lung function"), 45.3% of class 3 ("multiple sensitization with reversible airflow limitation"), and 64.3% of class 4 ("multiple sensitization with partially reversible airflow limitation") (P < .001). Time to exacerbation also followed similar trends and was shortest in the latent classes with multiple sensitization and airflow limitation (P < .001). Outcomes were driven largely by children with exacerbation-prone asthma (defined as ≥3 exacerbations in the prior year), who were present in each class but most strongly represented in classes 3 and 4. CONCLUSIONS Children at risk for asthma exacerbation are a heterogeneous group. Sensitization, prior exacerbation severity, and lung function variables may be particularly useful in identifying children at greatest risk for future exacerbation.
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Affiliation(s)
- Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Center for Clinical and Translational Research, Children's Healthcare of Atlanta, Atlanta, Ga
| | | | - Claudia R Morris
- Department of Pediatrics, Emory University, Atlanta, Ga; Center for Clinical and Translational Research, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Center for Clinical and Translational Research, Children's Healthcare of Atlanta, Atlanta, Ga.
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31
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Shafiq M, Ma X, Taghizadeh N, Kharrazi H, Feller-Kopman DJ, Tremblay A, Yarmus LB. Healthcare Costs and Utilization among Patients Hospitalized for Malignant Pleural Effusion. Respiration 2020; 99:257-263. [PMID: 32155630 DOI: 10.1159/000506210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Malignant pleural effusion (MPE) poses a considerable healthcare burden, but little is known about trends in directly attributable hospital utilization. OBJECTIVE We aimed to study national trends in healthcare utilization and outcomes among hospitalized MPE patients. METHODS We analyzed adult hospitalizations attributable to MPE using the Healthcare Cost and Utilization Project - National Inpatient Sample (HCUP-NIS) databases from 2004, 2009, and 2014. Cases were included if MPE was coded as the principal admission diagnosis or if unspecified pleural effusion was coded as the principal admission diagnosis in the setting of metastatic cancer. Annual hospitalizations were estimated for the entire US hospital population using discharge weights. Length of stay (LOS), hospital charges, and hospital mortality were also estimated. RESULTS We analyzed 92,034 hospital discharges spanning a decade (2004-2014). Yearly hospitalizations steadily decreased from 38,865 to 23,965 during this time frame, the mean LOS decreased from 7.7 to 6.3 days, and the adjusted hospital mortality decreased from 7.9 to 4.5% (p = 0.00 for all trend analyses). The number of pleurodesis procedures also decreased over time (p = 0.00). The mean inflation-adjusted charge per hospitalization rose from USD 41,252 to USD 56,951, but fewer hospitalizations drove the total annual charges down from USD 1.51 billion to USD 1.37 billion (p = 0.00 for both analyses). CONCLUSIONS The burden of hospital-based resource utilization associated with MPE has decreased over time, with a reduction in attributable hospitalizations by one third in the span of 1 decade. Correspondingly, the number of inpatient pleurodesis procedures has decreased during this time frame.
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Affiliation(s)
- Majid Shafiq
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA,
| | - Xiaomeng Ma
- Center for Population Health IT, Department of Health Policy Management, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy Management, Johns Hopkins University, Baltimore, Maryland, USA
| | - David J Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alain Tremblay
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lonny B Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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32
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Engelkes M, de Ridder MA, Svensson E, Berencsi K, Prieto-Alhambra D, Lapi F, Giaquinto C, Picelli G, Boudiaf N, Albers FC, Cockle SM, Bradford ES, Suruki RY, Brusselle GG, Rijnbeek PR, Sturkenboom MC, Verhamme KM. Multinational cohort study of mortality in patients with asthma and severe asthma. Respir Med 2020; 165:105919. [PMID: 32174450 DOI: 10.1016/j.rmed.2020.105919] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma. METHODS Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma. RESULTS The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality. CONCLUSION All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.
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Affiliation(s)
| | | | | | | | - Daniel Prieto-Alhambra
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain; Musculoskeletal Pharmaco and Device Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | | | | | | | - Nada Boudiaf
- Research and Development, GlaxoSmithKline, Middlesex, UK
| | - Frank C Albers
- Global Respiratory Franchise, GlaxoSmithKline, Research Triangle Park, NC, United States
| | - Sarah M Cockle
- Research and Development, GlaxoSmithKline, Brentford, UK
| | - Eric S Bradford
- Research and Development, GlaxoSmithKline, Research Triangle Park, NC, United States
| | | | - Guy Go Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Departments of Epidemiology and Respiratory Medicine, ErasmusMC, Rotterdam, the Netherlands
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Lin J, Xing B, Tang H, Yang L, Yuan Y, Gu Y, Chen P, Liu X, Zhang J, Liu H, Wang C, Zhou W, Sun D, Chen Y, Chen Z, Huang M, Lin Q, Hu C, Yang X, Huo J, Ye X, Zhou X, Jiang P, Zhang W, Huang Y, Dai L, Liu R, Cai S, Xu J, Zhou J. Hospitalization Due to Asthma Exacerbation: A China Asthma Research Network (CARN) Retrospective Study in 29 Provinces Across Mainland China. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:485-495. [PMID: 32141261 PMCID: PMC7061152 DOI: 10.4168/aair.2020.12.3.485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/22/2019] [Accepted: 12/26/2019] [Indexed: 11/20/2022]
Abstract
Purpose Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients. Methods A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed. Results There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%). Conclusions Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
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Affiliation(s)
- Jiangtao Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.
| | - Bin Xing
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Huaping Tang
- Department of Respiration, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Lan Yang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yadong Yuan
- Department of Respiration, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuhai Gu
- Department of Respiration, Qinghai People's Hospital, Xining, China
| | - Ping Chen
- Department of Respiratory Diseases, General Hospital of Shenyang Military Command, Shenyang, China
| | - Xiaoju Liu
- Department of Respiration, The First Affiliated Hospital of Lanzhou University, Lanzhou, China
| | - Jie Zhang
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Huiguo Liu
- Department of Respiration, Tongji Hospital, Wuhan, China
| | - Changzheng Wang
- Department of Respiration, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Wei Zhou
- Department of Respiration, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Dejun Sun
- Department of Pulmonary and Critical Care Medicine, Inner Mongolia People's Hospital, Hohhot, China
| | - Yiqiang Chen
- Department of Respiration, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhuochang Chen
- Department of Respiration, Henan Provincial People's Hospital, Zhengzhou, China
| | - Mao Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qichang Lin
- Department of Respiration, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chengping Hu
- Department of Respiration, Xiangya Hospital, Changsha, China
| | - Xiaohong Yang
- Department of Pulmonary and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jianmin Huo
- Department of Respiration, The First Affiliated Hospital of Harbin Medical University, Harbin China
| | - Xianwei Ye
- Department of Respiration, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xin Zhou
- Department of Respiration, Shanghai Central Hospital, Shanghai, China
| | - Ping Jiang
- Department of Respiration, Tianjin First Central Hospital, Tianjin, China
| | - Wei Zhang
- Department of Respiration, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yijiang Huang
- Department of Respiration, Hainan General Hospital, Haikou, China
| | - Luming Dai
- Department of Respiration, Kunming General Hospital of the People's Liberation Army, Kunming, China
| | - Rongyu Liu
- Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shaoxi Cai
- Department of Respiration, Nanfang Hospital, Guangzhou, China
| | - Jianying Xu
- Department of Respiration, Shanxi Bethune Hospital, Taiyuan, China
| | - Jianying Zhou
- Department of Respiration, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Kolbin AS, Avdeev SN, Zhuravleva MV, Gomon YM, Balykina YE, Matveyev NV, Proskurin MA, Fedosenko SV. [Clinical and economic analysis of Reslizumab use in the treatment of patients with severe allergic eosinophilic asthma]. TERAPEVT ARKH 2019; 91:47-56. [PMID: 32598589 DOI: 10.26442/00403660.2019.12.000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Asthma is a heterogeneous chronic disease of airways. One of its endotypes is eosinophilic asthma, accompanied by both peripheral blood and airway eosinophilia, where severe eosinophilia is usually associated with more severe asthma. Anti - interleukin-5 (IL-5) monoclonal antibodies (MAb) can reduce eosinophil counts in peripheral blood and tissues in asthma patients. The first drug of this class registered in Russia was reslizumab. AIM Comparative clinical and economic analysis of reslizumab use in patients with allergic asthma and eosinophilia. MATERIALS AND METHODS Omalizumab was chosen as a reference drug, because until now it was the only MAb for the treatment of severe asthma in Russia. The study population included patients with allergic asthma with both high levels of IgE and high eosinophil counts in peripheral blood, i.e. individuals eligible for both omalizumab and reslizumab treatment. A decrease in the number of exacerbations requiring prescription of systemic corticosteroids and an increase in QALY index was used as efficacy criteria. An indirect comparative study was used, because no direct comparison has been conducted to date. As a result, reslizumab demonstrated a statistically significant reduction in the frequency of clinically significant asthma exacerbations compared with omalizumab. The utility of the both asthma treatment strategies was compared using Markov models, taking into account the frequency of exacerbations, their severity, as well as decrease in QALYs due to exacerbations. The time horizon was 12 months. RESULTS Reslizumab treatment was 37.2% less expensive compared with omalizumab for the patients who are equally eligible for the both drugs. The calculated cost - effectiveness and cost - utility ratios were in favor of reslizumab. Budget impact analysis showed a significant effect of reslizumab on reducing budget costs. If reslizumab is used in 4250 patients (an estimated number of patients with severe allergic asthma and eosinophilia in Russia), this would reduce the costs for their treatment by up to 4896 million rubles per year. CONCLUSIONS For patients with severe allergic eosinophilic asthma who are equally eligible for the both drugs, reslizumab can be considered a more reasonable medical technology in terms of pharmacoeconomics when compared with omalizumab.
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Affiliation(s)
- A S Kolbin
- Pavlov First Saint Petersburg State Medical University.,St. Petersburg State University
| | - S N Avdeev
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M V Zhuravleva
- Sechenov First Moscow State Medical University (Sechenov University).,Scientific Center for Expert Evaluation of Medicinal Products
| | - Y M Gomon
- Pavlov First Saint Petersburg State Medical University
| | | | | | - M A Proskurin
- Pavlov First Saint Petersburg State Medical University
| | - S V Fedosenko
- Teva Limited Liability Company.,Siberian State Medical University
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Liang HJ, Wu MJ, Jerng JS, Yang CH. Reinforcement of Tobacco Control and Reduction in Medical Utilization for Asthma in Taiwan: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3950. [PMID: 31627282 PMCID: PMC6844081 DOI: 10.3390/ijerph16203950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/26/2019] [Accepted: 10/15/2019] [Indexed: 11/21/2022]
Abstract
Environmental air quality can affect asthma control and the development of overt asthmatic manifestations. In this population-based study, we investigated the effect of reinforcing a smoking ban in Taiwan through the enactment of the Tobacco Hazards and Prevention Act (THPA) on healthcare utilization rate by asthmatics. Analysis was performed based on data relevant to non-hospitalized asthmatic patients with insurance claims between 2005 and 2013 from the National Health Insurance Research Database of Taiwan, reported data on Asian dust storms, and penalty rates for violations of the tobacco ban. Poisson regression showed that the risk for outpatient visits for asthma was lower after enactment of the THPA (RR = 0.98, 95% CI = 0.98-0.99), with a yearly trend of a reduced risk (RR = 0.99, 95% CI = 0.99-1.00), also lower in geographic regions with medium (RR = 0.79, 95% CI = 0.79-0.80) and high (RR = 0.91, 95% CI = 0.91-0.92) penalty rates. Subgroup analysis showed that asthma visit rates were reduced in both male and female groups after the enactment of the THPA. The risk of an asthma ER visit was increased after the enactment of the amended THPA (RR = 1.07, 95% CI = 1.05-1.09), although the yearly trend was not significant (RR = 1.00, 95% CI = 1.00-1.00). The risk of emergency room visits for asthma was significantly reduced in regions with medium (RR = 0.68, 95% CI = 0.68-0.69) and high (RR = 0.75, 95% CI = 0.74-0.76) penalty rates. Subgroup analysis showed that the visit rates were similar in both male and female groups. The effectiveness of reinforcing the smoking ban warrants further policies aimed at further reducing passive smoking.
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Affiliation(s)
- Huang-Ju Liang
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 108, Taiwan.
- Center for Quality Management, National Taiwan University Hospital, Taipei 100, Taiwan.
| | - Ming-Jiuan Wu
- Department of Business and Management, Ming Chi University of Technology, New Taipei City 243, Taiwan.
| | - Jih-Shuin Jerng
- Center for Quality Management, National Taiwan University Hospital, Taipei 100, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan.
| | - Chiang-Hsing Yang
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 108, Taiwan.
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Gómez Sáenz JT, Gérez Callejas MJ, Hidalgo Requena A, Ginel Mendoza L, González Aguilera J, Quintano Jiménez JA. [Mortality due to asthma in Spain, 1990-2015]. Semergen 2019; 45:449-457. [PMID: 31105029 DOI: 10.1016/j.semerg.2019.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Asthma is a major public health problem affecting more than 300 million people worldwide. The importance of a disease can be measured by its prevalence, burden of care, and its morbidity and mortality. OBJECTIVE To determine the mortality rates for asthma in Spain in the period 1990-2015. MATERIAL AND METHODS The number of deaths attributed to asthma by gender and five-year age groups, together with the population as of July 1 between the years 1990-2015 were obtained from the National Institute of Statistics. Based on these data, the gross mortality rate per 100,000 global inhabitants was calculated, by gender and age groups. RESULTS In 2015, 1,134 people (195 men and 939 women) died in Spain with a diagnosis of asthma as the main cause, with rates of 0.82 / 100,000 inhabitants compared to 2.58, respectively. The asthma mortality rates in Spain have remained stable for the last 25 years, and are slightly higher than those in the surrounding countries. While asthma mortality has declined by over 67% in males, it has increased by 32% in females. The deaths are concentrated in those over 65 years, and particularly over 80 years, where the value of death certificates is more limited. Mortality in the 5-35 years age groups is among the lowest in Europe.
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Nafiu OO, Owusu-Bediako K, Chimbira WT. Unequal Rates of Serious Perioperative Respiratory Adverse Events Between Black and White Children. J Natl Med Assoc 2019; 111:481-489. [PMID: 31003832 DOI: 10.1016/j.jnma.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 09/22/2018] [Accepted: 03/26/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent data among pediatric otolaryngology patients showed unexplained higher rates of serious perioperative respiratory adverse events (PRAE) in black children compared to their white peers. We evaluated whether preoperative respiratory comorbidity (PRC) burden contributes to racial disparity in serious PRAE in children undergoing non-otolaryngologic procedures. METHODS Rates of serious PRAE (laryngospasm and/or bronchospasm) were compared across racial groups in a retrospective cohort of black and white children (N = 18538; black 10%) who underwent various elective, non-otolaryngologic procedures between 2007 and 2014 at a US tertiary Children's hospital. Self-reported race was the primary exposure while age, gender, recent upper respiratory tract infection, use of endotracheal intubation, PRC burden and an interaction term between PRC and race were covariates. RESULTS Serious PRAE occurred in 9.6% of black children and 6.6% of white children. Although there was no significant difference in age between the groups, being black (odds ratio (OR) 1.70; 95% confidence interval (CI) 1.11-2.62) was independently associated with serious PRAE. Similarly, baseline PRC was independently linked (p < 0.001) with serious PRAE. Notably, there was no significant (p = 0.454) interactions between race and PRC and serious PRAE in our subjects. CONCLUSION Race and PRC are important considerations in the risk of serious PRAE and black children are especially at risk compared to their white peers. Children, with PRC (particularly those with SDB and asthma) are also at risk suggesting that due consideration should be given to these factors in the perioperative care of children undergoing elective surgical procedures. Mechanisms underlying these associations deserve further evaluation.
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Affiliation(s)
- Olubukola O Nafiu
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
| | - Kwaku Owusu-Bediako
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Wilson T Chimbira
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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Colborn KL, Helmkamp L, Bender BG, Kwan BM, Schilling LM, Sills MR. Colorado Asthma Toolkit Implementation Improves Some Process Measures of Asthma Care. J Am Board Fam Med 2019; 32:37-49. [PMID: 30610140 PMCID: PMC6943943 DOI: 10.3122/jabfm.2019.01.180155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/30/2018] [Accepted: 10/02/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Colorado Asthma Toolkit Program (CATP) has been shown to improve processes of care with less evidence demonstrating improved outcomes. OBJECTIVE To model the association between pre-and-post-CATP status and asthma-related process and outcome measures among patients ages 5 to 64 years receiving care in safety-net primary care practices. METHODS This is an implementation study involving secondary prepost analysis of existing structured clinical, administrative, and claims data. Nine primary care practices in a federally qualified health center network implemented the CATP. Processes of care and health and utilization outcomes were evaluated prepost implementation in a cohort of patients with asthma using generalized linear mixed models. RESULTS The study cohort included 2678 patients age 5 to 64 years with at least one visit to one of the 9 participating practices during the study period (March 12, 2010 to December 1, 2012). A comparison of 12 months pre- and post-CATP implementation showed improvement in some process measures of asthma care associated with the intervention, including the rate of asthma-severity measurement, although no change in 2 Health care Effectiveness Data and Information Set measures: asthma medication ratio and medication management for people with asthma. We also found no change in asthma outcomes measured across multiple domains: exacerbations, utilization, symptom scores, and pulmonary physiology measures. CONCLUSIONS Implementation of the CATP in a primary care setting led to some improved processes of asthma care, but no changes in measured outcomes. Recommendations for future work include supplemental follow-up training including case review.
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Affiliation(s)
- Kathryn L Colborn
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS).
| | - Laura Helmkamp
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Bruce G Bender
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Bethany M Kwan
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Lisa M Schilling
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Marion R Sills
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
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Lam J, Hay JW, Salcedo J, Kenyon NJ. A cost-effectiveness analysis of reslizumab in the treatment of poorly controlled eosinophilic asthma. J Asthma 2018; 56:872-881. [PMID: 30003833 DOI: 10.1080/02770903.2018.1500584] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Poorly controlled severe eosinophilic asthma is difficult and costly to manage. Reslizumab, an add-on treatment for adults with severe eosinophilic asthma, reduces the number of exacerbations and improves the quality of life (QoL). The objective of this study was to evaluate the cost-effectiveness of reslizumab. Methods: A Markov model was used to compare the cost-effectiveness of add-on reslizumab with the standard-of-care (SOC) from the US societal perspective over a five-year time horizon. Efficacy and safety inputs for the model were based on data from two clinical trials (NCT01287039 and NCT01285323). Other model inputs, including mortality rates, costs, and utility, were estimated from literature, the Centers for Disease Control and Prevention (CDC), the US Department of Veterans Affairs (VA) and the Centers for Medicare and Medicaid Services (CMS). One-way, threshold, and probabilistic sensitivity analyses (PSA) were performed. Adherence, treatment response, and the placebo effect were evaluated in separate scenario analyses. Results: The base case incremental cost-effectiveness ratio (ICER) was $697 403 (2017 USD) per quality-adjusted life-years (QALYs). In the PSA, reslizumab becomes cost-effective in 50% of the iterations at a willingness-to-pay (WTP) threshold of $689 000. The model is most sensitive to the QoL improvement with reslizumab treatment in the one-way and threshold analyses. The response and adherence models had lower ICERs than the base model but still above $500 000. The ICER of the placebo effect model was $29 820. Conclusions: The improvement in QoL and exacerbation rates with reslizumab are associated with high costs, making reslizumab unlikely to be cost-effective at the $200 000 WTP threshold.
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Affiliation(s)
- Jenny Lam
- a Department of Health Economics, Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy , University of Southern California , Los Angeles , CA , USA
| | - Joel W Hay
- a Department of Health Economics, Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy , University of Southern California , Los Angeles , CA , USA
| | - Jonathan Salcedo
- a Department of Health Economics, Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy , University of Southern California , Los Angeles , CA , USA
| | - Nicholas J Kenyon
- b Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California , Davis, Sacramento , CA , USA
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Generating evidence to inform an update of asthma clinical practice guidelines: Perspectives from the National Heart, Lung, and Blood Institute. J Allergy Clin Immunol 2018; 142:744-748. [PMID: 30036600 DOI: 10.1016/j.jaci.2018.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/11/2018] [Accepted: 07/12/2018] [Indexed: 11/23/2022]
Abstract
Asthma is the most prevalent chronic respiratory disease worldwide. Its increasing prevalence and evidence of suboptimal control require renewed efforts in the development and widespread implementation of clinical practice guidelines for prevention, treatment, and control. Given the rapidly changing landscape and evolving best practices for guideline development, the National Heart, Lung, and Blood Institute made a commitment to support rigorous systematic evidence reviews that frontline health care providers and stakeholders could use to create new or update existing guidelines. This article describes the protocols, key questions, methodology, and analytic framework to support the update of the 2007 National Asthma Education and Prevention Program Expert Panel Report 3 (EPR-3) on the diagnosis and management of asthma in adults and children. It also describes the expert panel's practical experience in managing asthmatic patients across the age and severity spectrum. The article explains the process for ensuring that the expert panel's deliberations are conducted in accordance with the Institute of Medicine's standards and recommendations for guideline development. The outcome of this ambitious effort will be an update of the EPR-3 asthma guidelines and publication of the key recommendations in the Journal of Allergy and Clinical Immunology. Importantly, several novel approaches will be explored and incorporated as appropriate to accelerate adoption and sustained implementation of the guidelines.
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Patel SJ, Arnold DH, Topoz I, Sills MR. Literature Review: Prediction Modeling of Emergency Department Disposition Decisions for Children with Acute Asthma Exacerbations. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Baptist AP, Hao W, Karamched KR, Kaur B, Carpenter L, Song PXK. Distinct Asthma Phenotypes Among Older Adults with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:244-249.e2. [PMID: 28757370 PMCID: PMC5897052 DOI: 10.1016/j.jaip.2017.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Older adults have high rates of asthma morbidity and mortality. Asthma is now recognized as a heterogeneous disease, yet the distinct phenotypes among older adults are unknown. OBJECTIVE The objective of this study was to identify asthma phenotypes in a diverse population of elderly patients with asthma. METHODS Using cluster analysis, 180 older adults with persistent asthma were analyzed. Subjects completed detailed questionnaires, skin prick testing, and spirometry with reversibility. Twenty-four core variables were analyzed. RESULTS Four groups were identified. Subjects in cluster 1 (n = 69) typically had asthma diagnosed after the age of 40 and the shortest duration of asthma. Cluster 2 (n = 40) had the mildest asthma defined by spirometry, Asthma Control test (ACT), and Asthma Quality of Life Questionnaire (AQLQ). They also had the lowest body mass index (BMI), lowest depression score, and least number of comorbidities. Cluster 3 (n = 46) had the longest duration of asthma (56 years) and the highest atopic skin test sensitization (74%). Cluster 4 (n = 25) had the most severe asthma, with extremely low FEV1% predicted (37.8%), lowest ACT, and lowest AQLQ scores. They were more likely to be black and had the highest comorbidities. Using BMI, posttreatment FEV1% predicted, and duration of asthma, 95.6% of subjects were able to be correctly classified. CONCLUSIONS In older adults with asthma, distinct phenotypes vary on key features that are more pronounced among the elderly, including comorbidities, fixed airway obstruction, and duration of asthma ≥40 years. Further work is required to determine the clinical and therapeutic implications for different asthma phenotypes in older adults.
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Affiliation(s)
- Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Mich.
| | - Wei Hao
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Keerthi R Karamched
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
| | - Bani Kaur
- Department of Internal Medicine, Wayne State University, Detroit, Mich
| | - Laurie Carpenter
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Peter X K Song
- Department of Internal Medicine, Wayne State University, Detroit, Mich
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Yoshii Y, Shimizu K, Morozumi M, Chiba N, Ubukata K, Uruga H, Hanada S, Wakui H, Minagawa S, Hara H, Numata T, Saito K, Araya J, Nakayama K, Kishi K, Kuwano K. Detection of pathogens by real-time PCR in adult patients with acute exacerbation of bronchial asthma. BMC Pulm Med 2017; 17:150. [PMID: 29166936 PMCID: PMC5700744 DOI: 10.1186/s12890-017-0494-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 11/14/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Respiratory tract infection is a major cause of acute exacerbation of bronchial asthma (AEBA). Although recent findings suggest that common bacteria are causally associated with AEBA, a comprehensive epidemiologic analysis of infectious pathogens including common/atypical bacteria and viruses in AEBA has not been performed. Accordingly, we attempted to detect pathogens during AEBA by using real-time polymerase chain reaction (PCR) in comparison to conventional methods. METHODS We prospectively enroled adult patients with AEBA from August 2012 to March 2014. Infectious pathogens collected in nasopharyngeal swab and sputum samples were examined in each patient by conventional methods and real-time PCR, which can detect 6 bacterial and 11 viral pathogens. The causal association of these pathogens with AEBA severity and their frequency of monthly distribution were also examined. RESULTS Among the 64 enroled patients, infectious pathogens were detected in 49 patients (76.6%) using real-time PCR and in 14 patients (21.9%) using conventional methods (p < 0.001). Real-time PCR detected bacteria in 29 patients (45.3%) and respiratory viruses in 28 patients (43.8%). Haemophilus influenzae was the most frequently detected microorganism (26.6%), followed by rhinovirus (15.6%). Influenza virus was the significant pathogen associated with severe AEBA. Moreover, AEBA occurred most frequently during November to January. CONCLUSIONS Real-time PCR was more useful than conventional methods to detect infectious pathogens in patients with AEBA. Accurate detection of pathogens with real-time PCR may enable the selection of appropriate anti-bacterial/viral agents as a part of the treatment for AEBA.
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Affiliation(s)
- Yutaka Yoshii
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Kenichiro Shimizu
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Miyuki Morozumi
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Naoko Chiba
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Kimiko Ubukata
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Hironori Uruga
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470 Japan
| | - Shigeo Hanada
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470 Japan
| | - Hiroshi Wakui
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Shunsuke Minagawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Hiromichi Hara
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Takanori Numata
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Keisuke Saito
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho, Komae-shi, Tokyo, 201-8601 Japan
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Katsutoshi Nakayama
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Kazuma Kishi
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470 Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
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Radovanovic D, Santus P, Blasi F, Mantero M. The evidence on tiotropium bromide in asthma: from the rationale to the bedside. Multidiscip Respir Med 2017; 12:12. [PMID: 28484598 PMCID: PMC5420159 DOI: 10.1186/s40248-017-0094-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 04/18/2017] [Indexed: 02/06/2023] Open
Abstract
Severe and poorly controlled asthma still accounts for a great portion of the patients affected. Disease control and future risk management have been identified by international guidelines as the main goals in patients with asthma. The need for new treatment approaches has led to reconsider anticholinergic drugs as an option for asthma treatment. Tiotropium is the first anticholinergic drug that has been approved for children and adults with poorly controlled asthma and is currently considered as an option for steps 4 and 5 of the Global Initiative for Asthma. In large randomized clinical trials enrolling patients with moderate to severe asthma, add-on therapy with tiotropium has demonstrated to be efficacious in improving lung function, decreasing risk of exacerbation and slowing the worsening of disease; accordingly, tiotropium demonstrated to be non inferior compared to long acting beta-agonists in the maintenance treatment along with medium to high inhaled corticosteroids. In view of the numerous ancillary effects acting on inflammation, airway remodeling, mucus production and cough reflex, along with the good safety profile and the broad spectrum of efficacy demonstrated in different disease phenotypes, tiotropium can represent a beneficial alternative in the therapeutic management of poorly controlled asthma. The present extensive narrative review presents the pharmacological and pathophysiological basis that guided the rationale for the introduction of tiotropium in asthma treatment algorithm, with a particular focus on its conventional and unconventional effects; finally, data on tiotropium efficacy and safety. from recent randomized clinical trials performed in all age categories will be extensively discussed.
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Affiliation(s)
- Dejan Radovanovic
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Pulmonary Unit, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Pulmonary Unit, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Cardio-thoracic unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Mantero
- Department of Pathophysiology and Transplantation, University of Milan, Cardio-thoracic unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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45
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Valenta R. Mucosal Lining Fluid Biomarkers in Asthma: Basis for Rational Use of New Targeted Therapies? EBioMedicine 2017; 19:12-13. [PMID: 28412250 PMCID: PMC5440598 DOI: 10.1016/j.ebiom.2017.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rudolf Valenta
- Div. of Immunopathology, Dept. of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria.
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46
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D’Amato G, Vitale C, Molino A, Stanziola A, Sanduzzi A, Vatrella A, Mormile M, Lanza M, Calabrese G, Antonicelli L, D’Amato M. Asthma-related deaths. Multidiscip Respir Med 2016; 11:37. [PMID: 27752310 PMCID: PMC5059970 DOI: 10.1186/s40248-016-0073-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/17/2016] [Indexed: 11/10/2022] Open
Abstract
Despite major advances in the treatment of asthma and the development of several asthma guidelines, people still die of asthma currently. According to WHO estimates, approximately 250,000 people die prematurely each year from asthma. Trends of asthma mortality rates vary very widely across countries, age and ethnic groups. Several risk factors have been associated with asthma mortality, including a history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalization or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids (a marker of event severity), not currently using inhaled corticosteroids, a history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma. Preventable factors have been identified in the majority of asthma deaths. Inadequate education of patients on recognising risk and the appropriate action needed when asthma control is poor, deficiencies in the accuracy and timing of asthma diagnosis, inadequate classification of severity and treatment, seem to play a part in the majority of asthma deaths. Improvements in management, epitomized by the use of guided self-management systems of care may be the key goals in reducing asthma mortality worldwide.
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Affiliation(s)
- Gennaro D’Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Speciality “A. Cardarelli” Hospital, Napoli, Italy
| | - Carolina Vitale
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Antonio Molino
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Anna Stanziola
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Alessandro Sanduzzi
- Second Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | | | - Mauro Mormile
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Maurizia Lanza
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Giovanna Calabrese
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Leonardo Antonicelli
- Service of Immunoallergology, University Hospital “Ospedali Riuniti”, Ancona, Italy
| | - Maria D’Amato
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
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47
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Raikundalia M, Svider PF, Hanba C, Folbe AJ, Shkoukani MA, Baredes S, Eloy JA. Facial fracture repair and diabetes mellitus: An examination of postoperative complications. Laryngoscope 2016; 127:809-814. [PMID: 27658923 DOI: 10.1002/lary.26270] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Our objectives included using a nationally representative resource to evaluate charges, demographics, and complication rates among diabetics undergoing surgical repair of facial fractures. METHODS We evaluated the Nationwide Inpatient Sample, a database encompassing nearly 8 million hospitalizations, for patients with a diagnosis of a facial fracture who underwent surgical intervention during their hospitalization. Patients were organized by whether they had a diagnosis of diabetes mellitus (DM). RESULTS Of 45,509 inpatients included, diabetics had greater costs, longer length of stays, and were significantly more likely to have a host of baseline comorbidities. On multivariate logistic regression corrected for age, race, gender, and preexisting cardiac disease, DM patients had significantly greater odds for cardiac complications (3.3; P < 0.001) and hepatic failure (15.0; P = 0.007). There were no significant differences associated with DM in the rates of enophthalmos, epiphora, and diplopia among patients with orbital fractures. Diabetics did have a significantly greater risk of postoperative infection after mandible repair. CONCLUSION In addition to a significant association with greater length of stay and increased hospital charges, DM patients undergoing surgical repair of facial fractures had a significantly greater risk of postoperative complications, including cardiac complications. Diabetics undergoing mandible repair had a greater risk of postoperative infection, even upon controlling for demographic factors, suggesting the need for further study evaluating the role of postoperative antibiotic prophylaxis in this patient population. These findings reveal the potential value of developing and using standardized postoperative care algorithms aimed at minimizing complications in this susceptible population. LEVEL OF EVIDENCE 2c. Laryngoscope, 127:809-814, 2017.
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Affiliation(s)
- Milap Raikundalia
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Curtis Hanba
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Adam J Folbe
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Mahdi A Shkoukani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, U.S.A
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48
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Finkelstein J, Jeong IC. Machine learning approaches to personalize early prediction of asthma exacerbations. Ann N Y Acad Sci 2016; 1387:153-165. [PMID: 27627195 DOI: 10.1111/nyas.13218] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/29/2016] [Accepted: 08/03/2016] [Indexed: 12/15/2022]
Abstract
Patient telemonitoring results in an aggregation of significant amounts of information about patient disease trajectory. However, the potential use of this information for early prediction of exacerbations in adult asthma patients has not been systematically evaluated. The aim of this study was to explore the utility of telemonitoring data for building machine learning algorithms that predict asthma exacerbations before they occur. The study dataset comprised daily self-monitoring reports consisting of 7001 records submitted by adult asthma patients during home telemonitoring. Predictive modeling included preparation of stratified training datasets, predictive feature selection, and evaluation of resulting classifiers. Using a 7-day window, a naive Bayesian classifier, adaptive Bayesian network, and support vector machines were able to predict asthma exacerbation occurring on day 8, with sensitivity of 0.80, 1.00, and 0.84; specificity of 0.77, 1.00, and 0.80; and accuracy of 0.77, 1.00, and 0.80, respectively. Our study demonstrated that machine learning techniques have significant potential in developing personalized decision support for chronic disease telemonitoring systems. Future studies may benefit from a comprehensive predictive framework that combines telemonitoring data with other factors affecting the likelihood of developing acute exacerbation. Approaches implemented for advanced asthma exacerbation prediction may be extended to prediction of exacerbations in patients with other chronic health conditions.
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Affiliation(s)
- Joseph Finkelstein
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - In Cheol Jeong
- Chronic Disease Informatics Program, Johns Hopkins University, Baltimore, Maryland
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