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马 兰, 陈 玲, 王 琴, 许 阳, 陈 星. [Control status and follow-up of acute attacks in children with bronchial asthma with normal pulmonary ventilation function]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:476-480. [PMID: 38802907 PMCID: PMC11135059 DOI: 10.7499/j.issn.1008-8830.2311149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/02/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To investigate the control status of bronchial asthma (referred to as "asthma") in school-age children with normal pulmonary ventilation function and the occurrence of acute attacks within 1 year of follow-up. METHODS A retrospective analysis was conducted on clinical data of 327 children aged 6-14 years with bronchial asthma and normal pulmonary ventilation function from April to September 2021. Based on the measured value of one second rate (FEV1/FVC), the children were divided into the ≥80% group (267 cases) and the <80% group (60 cases). The pulmonary ventilation function, asthma control level, and occurrence of acute attacks within 1 year were compared between the two groups. RESULTS The baseline pulmonary ventilation function in the <80% group was lower than that in the ≥80% group, and the proportion of small airway dysfunction was higher than that in the ≥80% group (P<0.05). After standardized treatment for 1 year, the small airway function indices in the <80% group improved but remained lower than those in the ≥80% group (P<0.05). The rate of incomplete asthma control at baseline was 34.6% (113/327), and the asthma control level in the <80% group was lower than that in the ≥80% group (P<0.05). After standardized treatment for 1 year, the asthma control level in the <80% group remained lower than that in the ≥80% group, and the proportion of acute asthma attacks was higher than that in the ≥80% group (P<0.05). CONCLUSIONS Approximately one-third of school-age children with asthma still have incomplete asthma control when their pulmonary ventilation function is normal. Among them, children with measured FEV1/FVC<80% have an increased risk of acute asthma attacks and require close follow-up and strengthened asthma management.
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Suarthana E, Le Moual N, Henneberger PK, Kigloo HN, Vandenplas O. Reply to "Both quality of life and exacerbation are important outcomes of work-related asthma". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:804-805. [PMID: 38458711 DOI: 10.1016/j.jaip.2023.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 03/10/2024]
Affiliation(s)
- Eva Suarthana
- Research Institute of the McGill University Health Center, Montréal, QC, Canada.
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WVa
| | - Hormoz Nassiri Kigloo
- Research Institute of the McGill University Health Center, Montréal, QC, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City, QC, Canada
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
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Gerstein E, Bierbrier J, Whitmore GA, Vandemheen KL, Bergeron C, Boulet LP, Cote A, Field SK, Penz E, McIvor RA, Lemière C, Gupta S, Hernandez P, Mayers I, Bhutani M, Lougheed MD, Licskai CJ, Azher T, Ezer N, Ainslie M, Alvarez GG, Mulpuru S, Aaron SD. Impact of Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma on Symptoms, Quality of Life, Healthcare Use, and Work Productivity. Am J Respir Crit Care Med 2023; 208:1271-1282. [PMID: 37792953 DOI: 10.1164/rccm.202307-1264oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/04/2023] [Indexed: 10/06/2023] Open
Abstract
Rationale: A significant proportion of individuals with chronic obstructive pulmonary disease (COPD) and asthma remain undiagnosed. Objectives: The objective of this study was to evaluate symptoms, quality of life, healthcare use, and work productivity in subjects with undiagnosed COPD or asthma compared with those previously diagnosed, as well as healthy control subjects. Methods: This multicenter population-based case-finding study randomly recruited adults with respiratory symptoms who had no previous history of diagnosed lung disease from 17 Canadian centers using random digit dialing. Participants who exceeded symptom thresholds on the Asthma Screening Questionnaire or the COPD Diagnostic Questionnaire underwent pre- and post-bronchodilator spirometry to determine if they met diagnostic criteria for COPD or asthma. Two control groups, a healthy group without respiratory symptoms and a symptomatic group with previously diagnosed COPD or asthma, were similarly recruited. Measurements and Main Results: A total of 26,905 symptomatic individuals were interviewed, and 4,272 subjects were eligible. Of these, 2,857 completed pre- and post-bronchodilator spirometry, and 595 (21%) met diagnostic criteria for COPD or asthma. Individuals with undiagnosed COPD or asthma reported greater impact of symptoms on health status and daily activities, worse disease-specific and general quality of life, greater healthcare use, and poorer work productivity than healthy control subjects. Individuals with undiagnosed asthma had symptoms, quality of life, and healthcare use burden similar to those of individuals with previously diagnosed asthma, whereas subjects with undiagnosed COPD were less disabled than those with previously diagnosed COPD. Conclusions: Undiagnosed COPD or asthma imposes important, unmeasured burdens on the healthcare system and is associated with poor health status and negative effects on work productivity.
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Affiliation(s)
- Emily Gerstein
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jared Bierbrier
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Celine Bergeron
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia
| | | | - Andreanne Cote
- Centre de recherche, Hôpital Laval, Université Laval, Quebec, Quebec, Canada
| | - Stephen K Field
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erika Penz
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - R Andrew McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Lemière
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Samir Gupta
- Department of Medicine and Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Irvin Mayers
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - M Diane Lougheed
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Tanweer Azher
- Department of Medicine, Memorial University, St. John's, Newfoundland, Canada; and
| | - Nicole Ezer
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Martha Ainslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Shin S, Whitmore GA, Boulet LP, Boulay MÈ, Côté A, Bergeron C, Lemière C, Lougheed MD, Vandemheen KL, Alvarez GG, Mulpuru S, Aaron SD. Anticipating undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry: a decision tool for bronchial challenge testing. BMC Pulm Med 2023; 23:496. [PMID: 38071285 PMCID: PMC10709915 DOI: 10.1186/s12890-023-02806-9] [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: 08/27/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Some patients with asthma demonstrate normal spirometry and remain undiagnosed without further testing. OBJECTIVE To determine clinical predictors of asthma in symptomatic adults with normal spirometry, and to generate a tool to help clinicians decide who should undergo bronchial challenge testing (BCT). METHODS Using random-digit dialling and population-based case-finding, we recruited adults from the community with respiratory symptoms and no previous history of diagnosed lung disease. Participants with normal pre- and post-bronchodilator spirometry subsequently underwent BCT. Asthma was diagnosed in those with symptoms and a methacholine provocative concentration (PC20) of < 8 mg/ml. Sputum and blood eosinophils, and exhaled nitric oxide were measured. Univariate analyses identified potentially predictive variables, which were then used to construct a multivariable logistic regression model to predict asthma. Model sensitivity, specificity, and area under the receiver operating curve (AUC) were calculated. RESULTS Of 132 symptomatic individuals with normal spirometry, 34 (26%) had asthma. Of those ultimately diagnosed with asthma, 33 (97%) answered 'yes' to a question asking whether they experienced cough, chest tightness or wheezing provoked by exercise or cold air. Other univariate predictors of asthma included female sex, pre-bronchodilator FEV1 percentage predicted, and percent positive change in FEV1 post bronchodilator. A multivariable model containing these predictive variables yielded an AUC of 0.82 (95% CI: 0.72-0.91), a sensitivity of 82%, and a specificity of 66%. The model was used to construct a nomogram to advise clinicians which patients should be prioritized for BCT. CONCLUSIONS Four readily available patient characteristics demonstrated a high sensitivity and AUC for predicting undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry. These characteristics can potentially help clinicians to decide which individuals with normal spirometry should be investigated with bronchial challenge testing. However, further prospective validation of our decision tool is required.
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Affiliation(s)
- Sheojung Shin
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | | | - Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Marie-Ève Boulay
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Andréanne Côté
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Céline Bergeron
- The Lung Center, Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | | | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
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Jiménez-Gómez M, Díaz Campos RM, Catalinas Muñoz E, Díaz Miravalls J, Peña del Cura MB, Melero Moreno C, García García R. Does Airway T2 Inflammation Increase the Severity of Bronchial Hyperresponsiveness? OPEN RESPIRATORY ARCHIVES 2023; 5:100279. [PMID: 38024201 PMCID: PMC10661189 DOI: 10.1016/j.opresp.2023.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
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