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Zhou J, Yi F, Wu F, Xu P, Chen M, Shen H, Lin L, Zhang Y, Li S, Wu C, Yuan Y, Wang G, Ye X, Zhang P, Tang H, Ma Q, Huang L, Qiu Z, Deng H, Qiu C, Shi G, Pan J, Luo W, Chung KF, Zhong N, Lai K. Characteristics of different asthma phenotypes associated with cough: a prospective, multicenter survey in China. Respir Res 2022; 23:243. [PMID: 36096782 PMCID: PMC9469623 DOI: 10.1186/s12931-022-02104-8] [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: 03/20/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Asthma is a heterogeneous disease with variable symptoms, which presents with cough either as the sole or predominant symptom with or without wheezing. We compared the clinical and pathophysiological characteristics of cough predominant asthma (CPA), cough variant asthma (CVA) and classic asthma (CA) in order to determine any differential phenotypic traits. Methods In 20 clinics across China, a total of 2088 patients were finally recruited, including 327 CVA, 1041 CPA and 720 CA patients. We recorded cough and wheezing visual analogue scale, Leicester cough questionnaire (LCQ) and asthma control test scores. Fractional exhaled nitric oxide (FeNO), induced sputum cell counts, and capsaicin cough challenge were also measured and compared. Results CPA patients more frequently presented with cough as the initial symptom, and laryngeal symptoms (p < 0.001), had less symptoms related with rhinitis/sinusitis and gastroesophageal reflux (p < 0.05) than CA patients. Comorbidities including rhinitis and gastroesophageal reflux were similar, while the proportion of COPD and bronchiectasis was higher in CA patients. There were no differences in FeNO levels, sputum eosinophil and neutrophil counts, FEV1 (%pred) decreased from CVA to CPA to CA patients (p < 0.001). Cough sensitivity was higher in CVA and CPA compared to CA (p < 0.001), and was positively correlated with LCQ scores. Conclusions CVA, CPA and CA can be distinguished by the presence of laryngeal symptoms, cough sensitivity and airflow obstruction. Asthma-associated chronic cough was not associated with airway inflammation or comorbidities in our cohort. Trial registration The Chinese Clinical Trial Registration Center, ChiCTR-POC-17011646, 13 June 2017 Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02104-8.
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Affiliation(s)
- Jianmeng Zhou
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China
| | - Fang Yi
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China
| | - Feng Wu
- Department of Pulmonary and Critical Care Medicine, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, China
| | - Pusheng Xu
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Meihua Chen
- Dongguan Third People's Hospital, Dongguan, China
| | - Huahao Shen
- The Second Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Lin
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Yunhui Zhang
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Suyun Li
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Changgui Wu
- Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yadong Yuan
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gang Wang
- West China School of Medicine/West China Hospital of Sichuan University, Chengdu, China
| | - Xianwei Ye
- Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Ping Zhang
- Dongguan People's Hospital, Dongguan, China
| | | | - Qianli Ma
- Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | | | - Zhongmin Qiu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Haiyan Deng
- The Second People's Hospital of Shenzhen, Shenzhen, China
| | - Chen Qiu
- Shenzhen People's Hospital, Shenzhen, China
| | - Guochao Shi
- Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayu Pan
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China
| | - Wei Luo
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, & Royal Brompton and Harefield Foundation NHS Trust, London, UK
| | - Nanshan Zhong
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China
| | - Kefang Lai
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China.
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Albanna AS, Atiah AK, Alamoudi SM, Khojah OM, Alajmi RS, Dabroom AA. Treatment response among asthmatic patients with and without reversible airflow limitations. J Taibah Univ Med Sci 2021; 16:950-955. [PMID: 34899139 PMCID: PMC8626803 DOI: 10.1016/j.jtumed.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 11/01/2022] Open
Abstract
Objectives Asthma is a chronic airway disorder associated with variable airflow limitations, which are triggered by different stimuli. The reversibility of airflow limitations reflects patients' responses to the therapy with bronchodilators and improvements in airflow. This study aims to determine the treatment outcomes (improvements in forced expiratory volume in the first second (FEV1) and the number of asthma exacerbations) associated with the presence of airflow reversibility. Methods This retrospective cohort study included 154 adults (>18 years) who were diagnosed with asthma and had pulmonary function testing (PFT) at a tertiary care centre in KSA between January 1st, 2014 and May 31st, 2019. Smokers and patients with comorbidities or medications that could affect PFT were excluded from the analysis. Patients were classified as having a reversible airflow limitation when they exhibited a post-bronchodilator FEV1 increase of 12% and 200 mL. Exacerbations were defined as the need to use oral corticosteroids. Chi-square tests were used for comparative analyses. Results From our cohort, 42 patients exhibited reversibility. In contrast, 112 patients did not show any sign of reversibility. Asthmatics with baseline reversible airflow limitations experienced significant worsening of FEV1 during the follow-up period compared with those with no reversibility, showing a mean difference of 19.96 mL (p = 0.0206). There was no significant association between asthma reversibility and exacerbations (p = 0.23). Conclusion In our study, during the follow-up of patients with asthma, we found that the reversibility of airflow was associated with significantly worse FEV1, although this did not have a significant effect on exacerbations. Therefore, we recommend regular spirometry follow-ups, particularly for patients with significant airway reversibility.
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Affiliation(s)
- Amr S Albanna
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Jeddah, KSA
| | - Abdulqader K Atiah
- College of Medicine, Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, KSA
| | - Saeed M Alamoudi
- College of Medicine, Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, KSA
| | - Osama M Khojah
- College of Medicine, Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, KSA
| | - Rakan S Alajmi
- College of Medicine, Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, KSA
| | - Albara A Dabroom
- College of Medicine, Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, KSA
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3
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Amador EM, Cabrera CI, Benninger MS. Persistent Cough as a Predictor of Poor Responsiveness in Asthma Patients. Laryngoscope 2021; 132:1719-1722. [PMID: 34542169 DOI: 10.1002/lary.29865] [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: 03/12/2021] [Revised: 08/22/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study is to establish a correlation between persistent cough (PC) and asthma diagnosis and its severity. We hypothesize that patients with past or current diagnosis of PC may have more severe asthma diagnosis and thus poor responsiveness to treatment. STUDY DESIGN Retrospective chart review. METHODS A retrospective review was performed on 699 charts that had a positive immunoglobulin E (IgE) allergy blood test between 2014 and 2018, and a positive asthma diagnosis. Patient demographics and asthma severity parameters such as number of clinic and emergency department (ED) visits, asthma treatment, and number of medications were recorded, as well as PC diagnosis. Logistic regressions were used to analyze the likelihood of severe asthma diagnosis in patients with PC. RESULTS A total of 55% of patients were treated with oral corticosteroids in the PC group, compared to 41% in those without (P < .001). The mean number of hospitalizations from the ED was higher for patients with PC 0.65 (2.47) versus 0.38 (1.18) P < .05. Patients with asthma and PC, positive to lamb's quarter 2.92 (95% confidence interval [CI] 1.63, 5.22; P < .001), showed a higher likelihood of ED visits. Positivity to cat dander 2.09 (95% CI 1.03, 4.59; P < .05), lamb's quarter 2.96 (95% CI 1.50, 5.79; P < .002), dog dander 3.37 (95% CI 1.54, 8.45; P < .004) showed a higher likelihood of hospitalizations due to asthma. CONCLUSION Patients with PC, especially those with a positive IgE allergy class test to cat dander, dog dander, house dust, Alternaria tenuis, or lamb's quarter can have a more severe asthmatic presentation. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Eulalia M Amador
- Lerner Research Insititute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Claudia I Cabrera
- Lerner Research Insititute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Michael S Benninger
- Lerner Research Insititute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine, Head and Neck Institute, Cleveland, Ohio, U.S.A
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Kim Y, Lee H, Park Y, Chung SJ, Yeo Y, Park TS, Park DW, Kim SH, Kim TH, Sohn JW, Yoon HJ, Moon JY. Additive Effect of Obesity and Dyslipidemia on Wheezing in Korean Adults: A Nationwide Representative Survey Study. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:808-816. [PMID: 34486264 PMCID: PMC8419641 DOI: 10.4168/aair.2021.13.5.808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 11/20/2022]
Abstract
Besides obesity, there are limited studies regarding the relationship between the individual components of metabolic syndrome and wheezing. It is largely unknown whether the co-existence of other metabolic syndrome components has additive effects on wheezing in the adult population. The association between the individual components of metabolic syndrome and current wheezing was evaluated in adults using data from the Korea National Health and Nutrition Examination Survey from 2008 to 2012. Subjects with metabolic syndrome more frequently had wheezing during the past 12 months (current wheezing) (adjusted odds ratio [aOR] = 1.56; 95% confidence interval [CI] = 1.37–1.77) and wheezing during exercise in the past 12 months (aOR = 1.59; 95% CI = 1.37–1.84). Of the individual metabolic syndrome components, central obesity (aOR = 1.48; 95% CI = 1.31–1.66) and low high-density lipoprotein (HDL) cholesterol (aOR = 1.18; 95% CI = 1.05–1.34) were significantly associated with current wheezing. There were no significant associations between the other components of metabolic syndrome (high triglyceride level, blood pressure, and fasting plasma glucose level) and the presence of current wheezing. In addition, the association was much higher when both central obesity and low HDL cholesterol were present together compared to when either of the conditions was present alone (aOR = 1.67; 95% CI = 1.44–1.94). There is a significant association between metabolic syndrome and current wheezing in Korean adults. Of the components of metabolic syndrome, low HDL cholesterol and central obesity are independently and additively associated with the increased rate of current wheezing.
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Affiliation(s)
- Youlim Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea.,Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yeonkyung Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Sung Jun Chung
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoomi Yeo
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tai Sun Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae-Hyung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jang Won Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Ricciardolo FL, Bertolini F, Carriero V, Sprio AE. Asthma phenotypes and endotypes: a systematic review. Minerva Med 2021; 112:547-563. [PMID: 33969960 DOI: 10.23736/s0026-4806.21.07498-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Asthma is a complex disorder characterized by expiratory airflow limitation, wheeze, shortness of breath, chest tightness and cough, which can vary over time and in intensity. Being highly heterogeneous, asthma was characterized and classified in several asthma phenotypes and endotypes from 1947 until today. The present systematic review aims to summarize and describe evidence that was published in the last ten years in the field of asthma phenotyping and endotyping. EVIDENCE ACQUISITION The systematic review resumed high-quality evidence (clinical trials and randomized control trials) retrieved on MEDLINE and EMBASE databanks and involving adult asthmatic populations. Analyses of literature were conducted according to PRISMA and CASP guidelines. EVIDENCE SYNTHESIS Querying MEDLINE and EMBASE databanks, 5019 and 12261 entries were retrieved, respectively. Applying limitations for year of publication, age of participants, and type of publication, the search results were reduced to 98 and 132 articles, respectively. After data abstraction and resolution of duplications, only 50 articles were further evaluated. The research products were then classified first in macro-areas of interest (phenotypes or endotypes) and then in detailed micro-areas. CONCLUSIONS This systematic review overviews the principal findings available from high-quality literature in the last decade concerning asthma phenotypes and endotypes. Asthma has been described from different points of view, characterizing symptoms, microbiota composition, comorbidities, viral infections, and airway and/or systemic inflammatory status. The comprehension of precise mechanisms underlying asthma pathogenesis is thereby the basis for the development of novel therapeutic strategies, likely essential to the development of precision medicine.
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Affiliation(s)
- Fabio L Ricciardolo
- Department of Clinical and Biological Sciences, Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy -
| | - Francesca Bertolini
- Department of Clinical and Biological Sciences, Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Vitina Carriero
- Department of Clinical and Biological Sciences, Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Andrea E Sprio
- Department of Clinical and Biological Sciences, Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy.,Department of Research, ASOMI College of Sciences, Marsa, Malta
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Martin MJ, Beasley R, Harrison TW. Towards a personalised treatment approach for asthma attacks. Thorax 2020; 75:1119-1129. [PMID: 32839286 DOI: 10.1136/thoraxjnl-2020-214692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 12/16/2022]
Abstract
Asthma attacks (exacerbations) are common, accounting for over 90 000 UK hospital admissions per annum. They kill nearly 1500 people per year in the UK, have significant associated direct and indirect costs and lead to accelerated and permanent loss of lung function. The recognition of asthma as a heterogeneous condition with multiple phenotypes has revolutionised the approach to the long-term management of the condition, with greater emphasis on personalised treatment and the introduction of the treatable traits concept. In contrast asthma attacks are poorly defined and understood and our treatment approach consists of bronchodilators and systemic corticosteroids. This review aims to explore the current limitations in the description, assessment and management of asthma attacks. We will outline the risk factors for attacks, strategies to modify this risk and describe the recognised characteristics of attacks as a first step towards the development of an approach for phenotyping and personalising the treatment of these critically important events. By doing this, we hope to gradually improve asthma attack treatment and reduce the adverse effects associated with recurrent courses of corticosteroids.
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Affiliation(s)
- Matthew J Martin
- Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Tim W Harrison
- Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, UK
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7
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Morjaria JB, Rigby AS, Morice AH. Symptoms and exacerbations in asthma: an apparent paradox? Ther Adv Chronic Dis 2019; 10:2040622319884387. [PMID: 31695864 PMCID: PMC6820175 DOI: 10.1177/2040622319884387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 09/27/2019] [Indexed: 12/23/2022] Open
Abstract
Background: There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are commonly thought to be associated. The aim of this study was to analyse asthma symptoms of cough, wheeze, chest tightness and breathlessness in an uncontrolled asthma cohort. We also examined the effect of maintenance and reliever therapy (MART) on these symptoms and its effect on exacerbation rate. Methods: Adults with uncontrolled asthma electronically recorded their asthma symptom severity scores twice-daily over a period of 48 weeks following randomisation to beclometasone/formoterol twice daily plus pro re nata (prn) salbutamol or MART. Subjects with symptom scores of ⩾2 (ranging from 0 to 3 for each symptom) were considered more symptomatic, whereas those below a score of 2 were considered less severe. The influence treatment on exacerbation frequency and symptom profiles were then correlated. Results: Of the 1701 subjects in the analyses, 1403 were symptomatic with ⩾100 symptom episodes for one symptom. The remaining 298 subjects were classified as pauci-symptomatic. There was poor association between the frequency and symptom severity score for each symptom. Surprisingly, wheeze was the least reported symptom. Females were more likely to be polysymptomatic. MART compared with prn salbutamol markedly attenuated severe asthma exacerbations. This effect was most notable in subjects with fewer symptoms. Conclusions: In uncontrolled asthma, there is a poor correlation between reported symptoms and exacerbation frequency. This post hoc analysis suggests that MART should not be reserved for symptomatic subjects but achieves the greatest benefit in pauci-symptomatic patients with asthma. Trial registration: ClinicalTrials.gov identifier: NCT00861926
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Affiliation(s)
- Jaymin B. Morjaria
- Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Castle Road, Cottingham, UK
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Hill End road, Harefield, UK
- Imperial College, Harefield Hospital, Hill End Road, Harefield, UK
| | - Alan S. Rigby
- Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Castle Road, Cottingham, UK
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Bourdin A, Bjermer L, Brightling C, Brusselle GG, Chanez P, Chung KF, Custovic A, Diamant Z, Diver S, Djukanovic R, Hamerlijnck D, Horváth I, Johnston SL, Kanniess F, Papadopoulos N, Papi A, Russell RJ, Ryan D, Samitas K, Tonia T, Zervas E, Gaga M. ERS/EAACI statement on severe exacerbations in asthma in adults: facts, priorities and key research questions. Eur Respir J 2019; 54:13993003.00900-2019. [PMID: 31467120 DOI: 10.1183/13993003.00900-2019] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/17/2019] [Indexed: 01/05/2023]
Abstract
Despite the use of effective medications to control asthma, severe exacerbations in asthma are still a major health risk and require urgent action on the part of the patient and physician to prevent serious outcomes such as hospitalisation or death. Moreover, severe exacerbations are associated with substantial healthcare costs and psychological burden, including anxiety and fear for patients and their families. The European Academy of Allergy and Clinical Immunology (EAACI) and the European Respiratory Society (ERS) set up a task force to search for a clear definition of severe exacerbations, and to also define research questions and priorities. The statement includes comments from patients who were members of the task force.
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Affiliation(s)
- Arnaud Bourdin
- Université de Montpellier, CHU Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Leif Bjermer
- Dept of Respiratory Medicine and Allergy, Lung and Allergy research Unit, Lund, Sweden
| | - Christopher Brightling
- Dept of Infection, Immunity and Inflammation, Institute for Lung Health, NIHR BRC Respiratory Medicine, University of Leicester, Leicester, UK
| | - Guy G Brusselle
- Dept of Respiratory Diseases, Ghent University Hospital, Ghent, Belgium
| | | | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College, London, UK
| | - Adnan Custovic
- Dept of Paediatrics, Imperial College London, London, UK
| | - Zuzana Diamant
- Dept of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden.,Respiratory and Allergy Research, QPS Netherlands, The Netherlands
| | - Sarah Diver
- Dept of Respiratory Sciences, College of Life Sciences, Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Ratko Djukanovic
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Ildikó Horváth
- National Koranyi Institute for Pulmonology, and Dept of Public Health, Semmelweis University, Budapest, Hungary
| | | | | | - Nikos Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Dept, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Richard J Russell
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Dermot Ryan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.,Woodbrook Medical Centre, Loughborough, UK
| | | | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital, Athens, Greece
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Nordon C, Grimaldi-Bensouda L, Pribil C, Nachbaur G, Amzal B, Thabut G, Marthan R, Aubier M. Clinical and economic burden of severe asthma: A French cohort study. Respir Med 2018; 144:42-49. [PMID: 30366583 DOI: 10.1016/j.rmed.2018.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the clinical and economic burden of severe asthma in France over 12 months. METHODS Data were retrieved from the observational, prospective "Cohorte Obstruction Bronchique et Asthme" (COBRA) cohort, which has enrolled nearly 1000 asthma patients since 2007 from throughout France. Patients undergoing treatment with GINA step-4 or 5 medications uninterruptedly for 12 months (thus defining "severe asthma") were identified and their clinical data used to describe the clinical burden of asthma (exacerbations, symptoms outside exacerbations, and level of asthma control). Patients' utilization of healthcare resources was described and used to estimate the direct medical costs incurred to treat severe asthma. RESULTS 155 patients were included in the present study. Over the 12-month period of interest, 128 (83%) patients experienced at least one asthma exacerbation, 22 (14%) patients were hospitalized for asthma, 133 (86%) patients experienced continuous symptoms outside exacerbations, and 77 (50%) patients experienced important limitations in daily life activities. The median number of asthma-related drugs used was 4. The mean estimated annual asthma-related cost was 8,222 euros (standard deviation, SD = 11,886), including 7,229 euros (SD = 11,703) for controller medications. CONCLUSION Symptoms outside exacerbation periods are highly prevalent in severe asthma patients, for whom the main driver of medical costs is controller medication.
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Affiliation(s)
| | | | - Celine Pribil
- GlaxoSmithKline, 23 Rue François Jacob, 92500, Rueil-Malmaison, France
| | - Gaelle Nachbaur
- GlaxoSmithKline, 23 Rue François Jacob, 92500, Rueil-Malmaison, France
| | - Billy Amzal
- Analytica LA-SER, Audrey House, 16-20 Ely Place, EC1N 6SN, London, United Kingdom
| | - Gabriel Thabut
- Bichat Hospital, AP-HP, Inserm U1152 & Paris-Diderot Medical School, 46 Rue Henri Huchard, 75877, Paris, France
| | - Roger Marthan
- Inserm U1045, Bordeaux Segalen University, Case Courrier 13, 146 Rue Leo Saignat, 33076, Bordeaux Cedex, France
| | - Michel Aubier
- Bichat Hospital, AP-HP, Inserm U1152 & Paris-Diderot Medical School, 46 Rue Henri Huchard, 75877, Paris, France
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