Correction to: Global asthma prevalence in adults: findings from the cross-sectional world health survey

Prevalence and predictors of medication adherence among adolescents and adults with asthma in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

This review aimed to estimate the pooled prevalence and predictors of medication adherence among adolescents and adults with asthma in Ethiopia.

DATA SOURCES

Primary studies were searched from PubMed, Scopus, HINARI, and Google Scholar from January 1, 2010 to December 10, 2023. In addition, we have used citation tracking.

STUDY SELECTIONS

Observational studies (cross sectional, case control, and cohort) conducted among asthmatic patients ≥15 years old in Ethiopia, published in English language were included. After screening, the studies were assessed using Joanna Briggs Institute (JBI) critical appraisal tool and data were extracted using a checklist. Heterogeneity was assessed using forest plot, Q-statistics and I2.

RESULTS

The review was performed among 13 institution-based studies with a total of 2901 participants with asthma. About 1058 participants had comorbid disease and 354 were cigarette smokers. The pooled prevalence of adherence to medications among patients with asthma was 40.50% (95% CI: 28.05, 52.96; p value < 0.001) with high heterogeneity (I2 = 98.25%, p < 0.001). Getting health education about asthma and having comorbid disease were predictors of medication adherence among adolescents and adults with asthma in Ethiopia.

CONCLUSIONS

The pooled prevalence of medication adherence among adolescents and adults with asthma in Ethiopia is low and indicated that three out of five adolescents and adults with asthma were non-adherent to medications. This implies the Ministry of Health should develop different strategies to improve medication adherence including patient education and strengthening the health care system. Multicenter longitudinal studies should be further conducted by using objective methods of adherence measurement and large sample size.

Severe Asthma or Chronic Obstructive Pulmonary Disease with Eosinophilic Inflammation? From Uncertainty to Remission under Anti IL-5R Therapy

Background and Objectives: Severe adult-onset eosinophilic asthma and COPD with eosinophilic inflammation are two entities with a similar clinical course and are sometimes difficult to differentiate in clinical practice, especially in patients with a history of smoking. Anti-IL-5 or -IL-5R biological therapy has been shown to be highly effective in severe eosinophilic asthma but has not demonstrated significant benefit in patients with COPD with the eosinophilic phenotype. Our aim was to illustrate this issue in the form of a case report. Materials and Methods: We present the case of a 67-year-old patient who is a former smoker with late-onset severe uncontrolled asthma (ACT score < 15) who experienced frequent exacerbations requiring treatment with systemic corticosteroids. The patient's lung function gradually worsened to a nadir FEV1 = 18%, despite a high dose of ICS in combination with a LABA and intermittent courses of OCS, with negative allergic skin-tests, but with high blood eosinophils level. Biological treatment with an anti-IL5R monoclonal antibody (benralizumab) was initiated, despite the difficulty in the differential diagnosis between asthma and COPD with eosinophilic inflammation. Results: The patient's evolution was favorable; clinical remission was effectively achieved with significant improvement in lung function (FEV1 > 100%), but with persistence of residual mild fixed airway obstructive dysfunction (FEV1/FVC < 0.7). The therapeutic response has been maintained to date. Conclusions: Benralizumab was shown to be very effective in a patient with late-onset severe eosinophilic asthma presenting features of chronic obstructive disease-habitual exposure to tobacco and inhaled noxious substances, and persistent airflow limitation on spirometry.

Development and characterization of anti-IL-5 monoclonal antibody Fab fragment for blocking IL-5/IL-5Rα binding

Interleukin-5 (IL-5) is a homodimeric cytokine that is a crucial regulator of the proliferation, activation, and maturation of eosinophils. Anti-IL-5 monoclonal antibodies, which block the binding of IL-5 to the IL-5 receptor subunit alpha (IL-5Rα), have been successfully used to treat eosinophilic (EOS) asthma. The currently marketed monoclonal antibody drugs require repeated injections for administration, which seriously affect patient compliance and high systemic exposure for injectable drug delivery. Here we successfully screened and developed the Fab (fragment of antigen binding), which is 1/3rd the molecular weight of IgG, favoring inhalation-mediated delivery to the lungs, making it more effective for asthma treatment. The 20A12-Fab-H12L3 can bind to IL-5 with a binding constant of 1.236E-09 M while significantly inhibiting the IL-5/IL-5Rα complex formation. We found that the light chain amino acids (S46 and F71) significantly affected the antibody expression during humanization. The 20A12-Fab-H12L3 significantly inhibited the proliferation of TF-1 cells and blocked the IL-5 binding to the IL-5Rα-overexpressing human embryonic kidney (HEK)-293 cells in vitro. Therefore, based on the mutant IL-5 binding with Fab, we explained why antibodies blocked IL-5 binding to IL-5Rα. Thus, this study provided a candidate pharmaceutical antibody for inhalation drug delivery.

Clinical inertia in asthma

Despite advances in pharmaceutical treatment in recent years, a relatively high proportion of patients with asthma do not have adequate asthma control, causing chronic disability, poor quality of life, and multiple emergency department visits and hospitalizations. A multifaceted approach is needed to overcome the problems with managing asthma, and clinical inertia (CI) is a crucial concept to assist with this approach. It divides clinical inertia into three main categories, which include healthcare provider-related, patient-related, and healthcare system-related CI. The strategies to overcome these CI are complex, and the M-GAP approach, which combines a multidisciplinary approach, dissemination of guidelines, utilization of applications, and development and promotion of low-cost prescriptions, will help clinicians.

Delayed Microbial Maturation Durably Exacerbates Th17-driven Asthma in Mice

Microbial maturation disrupted by early-life dysbiosis has been linked with increased asthma risk and severity; however, the immunological mechanisms underpinning this connection are poorly understood. We sought to understand how delaying microbial maturation drives worsened asthma outcomes later in life and its long-term durability. Drinking water was supplemented with antibiotics on Postnatal Days 10-20. To assess the immediate and long-term effects of delaying microbial maturation on experimental asthma, we initiated house dust mite exposure when bacterial diversity was either at a minimum or had recovered. Airway hyperresponsiveness, histology, pulmonary leukocyte recruitment, flow cytometric analysis of cytokine-producing lymphocytes, and assessment of serum IgG1 (Immunoglobulin G1) and IgE (Immunoglobulin E) concentrations were performed. RT-PCR was used to measure IL-13 (Interleukin 13)-induced gene expression in sequentially sorted mesenchymal, epithelial, endothelial, and leukocyte cell populations from the lung. Delayed microbial maturation increased allergen-driven airway hyperresponsiveness and Th17 frequency compared with allergen-exposed control mice, even when allergen exposure began after bacterial diversity recovered. Blockade of IL-17A (Interleukin 17A) reversed the airway hyperresponsiveness phenotype. In addition, allergen exposure in animals that experienced delayed microbial maturation showed signs of synergistic signaling between IL-13 and IL-17A in the pulmonary mesenchymal compartment. Delaying microbial maturation in neonates promotes the development of more severe asthma by increasing Th17 frequency, even if allergen exposure is initiated weeks after microbial diversity is normalized. In addition, IL-17A-aggravated asthma is associated with increased expression of IL-13-induced genes in mesenchymal, but not epithelial cells.

Chronic respiratory diseases and respiratory symptoms after a mining dam rupture: Brumadinho Health Project

OBJECTIVE

To identify factors associated with asthma and chronic obstructive pulmonary disease (COPD) and respiratory symptoms, in Brumadinho, state of Minas Gerais, Brazil, after a dam rupture.

METHODS

This is a cross-sectional study, including a representative sample of adults (aged 18 years and over) in the municipality. Associations were assessed between dependent variables (medical diagnosis of asthma and COPD; symptoms of wheezing, dry cough, and nose irritation) and exploratory variables (sex, age group, smoking habit, having worked at Vale S.A. company before the dam rupture, time and area of residence in relation to the dam rupture). Logistic regression models with odds ratio (OR) calculation and 95% confidence interval were used.

RESULTS

We identified a prevalence of 7.2% of asthma; 3.5% of COPD; 8.8% of wheezing; 23.6% of dry cough; and 31.8% of nose irritation. We observed a greater chance of asthma among women and residents in the affected and mining regions, while a greater chance of COPD was observed in smokers and in those with longer time of residence in the municipality. Among the symptoms, we verified a higher chance of nose irritation among women, while a higher chance of wheezing and dry cough were found among smokers (current and former). Residents of regions affected by the mud reported a greater chance of presenting all the analyzed symptoms. Conversely, level of education was negatively associated with wheezing and dry cough.

CONCLUSION

We found respiratory changes and identified the groups most vulnerable to developing them, which could contribute to directing actions to reduce the population's respiratory problems.

Doenças respiratórias crônicas e sintomas respiratórios após rompimento de barragem de mineração: Projeto Saúde Brumadinho

RESUMO: Objetivo: Identificar fatores associados a asma, doença pulmonar obstrutiva crônica (DPOC) e sintomas respiratórios em Brumadinho (MG), após rompimento de barragem. Métodos: Estudo transversal com amostra representativa de adultos. Verificaram-se associações entre variáveis dependentes (diagnóstico médico de asma e DPOC e os sintomas chiado no peito, tosse seca e irritação nasal) e variáveis exploratórias (sexo, faixa etária, tabagismo, ter trabalhado na Vale S.A. antes do rompimento da barragem, tempo e área de residência em relação ao rompimento da barragem). Modelos de regressão logística com cálculo da odds ratio e intervalo de confiança de 95% foram empregados. Resultados: Identificou-se prevalência de asma de 7,2%, de DPOC de 3,5%, de chiado no peito de 8,8%, de tosse seca de 23,6% e de irritação nasal de 31,8%. Maior chance de asma foi observada no sexo feminino e nos residentes em área diretamente atingida pela lama e área de mineração, enquanto maior chance de DPOC foi vista nos fumantes e naqueles com maior tempo de residência no município. Entre os sintomas, maior chance de irritação nasal foi observada no sexo feminino, e de chiado no peito e tosse seca em fumantes (atuais e no passado). Residentes em área atingida pela lama relataram maior chance de apresentarem todos os sintomas analisados. Já a escolaridade apresentou associação negativa com chiado no peito e tosse seca. Conclusão: O estudo mostrou alterações respiratórias e identificou os grupos com maior vulnerabilidade para desenvolvê-las, podendo contribuir com o direcionamento de ações para a redução de problemas respiratórios da população.