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Nicola S, Lo Sardo L, Borrelli R, Quinternetto A, Rashidy N, Brussino L. Beyond the appearances: exploring complexities in anaphylaxis differential diagnosis. Curr Opin Allergy Clin Immunol 2024; 24:313-321. [PMID: 39079157 DOI: 10.1097/aci.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
PURPOSE OF REVIEW Anaphylaxis is a severe, and potentially life-threatening hypersensitivity reaction whose diagnosis is based on clinical signs and symptoms and their prompt recognition. The presence of mimics and unusual presentations necessitate a careful evaluation and expertise in the field, due to potential diagnostic errors and hence a delay in the treatment.The aim of this review is to analyze and make an overview of the potential differential diagnosis of anaphylaxis, focusing on the clinical challenges of recognizing these conditions effectively among similar others. RECENT FINDINGS The presence of mimics and unusual presentations of anaphylaxis necessitate a careful evaluation, emphasizing the importance of a comprehensive diagnostic approach.Tryptase is well known marker of mast cells activation, and a useful tool assisting the diagnosis of anaphylaxis, helping to differentiate it from atypical mimickers. SUMMARY The differential diagnosis of anaphylaxis comprises a very wide setting, and a systematic approach assessing different categories of cardiovascular, skin, respiratory airway, neuropsychiatric, and hematologic systems, can facilitate recognition of the correct diagnosis of this complex and life-threatening condition.
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Affiliation(s)
- Stefania Nicola
- Immunology and Allergy Unit, Mauriziano Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
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2
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Chiner E, Machetti C, Boira I, Esteban V, Castelló Faus C, Torba Kordyukova A. Analysis of Patients Admitted for Asthma Exacerbation in a Tertiary Hospital in Spain. Cureus 2024; 16:e63042. [PMID: 39050304 PMCID: PMC11268450 DOI: 10.7759/cureus.63042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES To analyze the characteristics of adult patients admitted for asthma exacerbation and determine optimization, treatment adherence, and follow-up in clinics. METHODS Patients ≥ 18 years old admitted from May 2021 to June 2023 with a primary diagnosis of asthma exacerbation were included. Patients with a secondary diagnosis of asthma exacerbation and those without a confirmed diagnosis were excluded. RESULTS A total of 186 patients were analyzed, 63% were female, with a mean age of 49 ± 34 years, mean body mass index (BMI) of 26.4 ± 5 kg/m2, mean immunoglobulin E level of 132 ± 235 IU/mL (range: 25-2041), mean eosinophils count of 180 ± 443, and length of stay of 8.6 ± 5 days. Comparing patients with one admission to those with multiple admissions, differences were observed in age (39 ± 15 vs. 58 ± 20, p < 0.0001), BMI (25.2 ± 3 vs. 27.4 ± 4, p < 0.0003), comorbidity (15% vs. 60%, p < 0.0001), and length of stay (4.5 ± 2 vs. 11 ± 3, p < 0.0001). Of the patients, 15% had undiagnosed asthma, 28% had known asthma without maintenance therapy, 23% were managed by primary care, and 34% were followed by pneumology. The mean Test of Adherence to Inhalers (TAI) score was 42.5 ± 8 points, with 70% showing erratic non-adherence, 46% showing deliberate non-adherence, and 21% showing unconscious non-adherence. CONCLUSIONS The young population represents a significant percentage of admissions for asthma exacerbation due to poor follow-up in pulmonology clinics, inadequate treatment optimization, and low adherence. This study adds that it is necessary to improve the approach to asthma in primary care to optimize treatment, reduce under-diagnosis, and avoid hospital admissions.
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Affiliation(s)
- Eusebi Chiner
- Pulmonology, Hospital Universitario San Juan de Alicante, Alicante, ESP
| | - Clara Machetti
- Pulmonology, Hospital Universitario San Juan de Alicante, Alicante, ESP
| | - Ignacio Boira
- Pulmonology, Hospital Universitario San Juan de Alicante, Alicante, ESP
| | - Violeta Esteban
- Pulmonology, Hospital Universitario San Juan de Alicante, Alicante, ESP
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The Importance of Endoscopy with Biopsy: Real-World Evidence of Gastrointestinal Involvement in Primary Immunodeficiency in Two Main Northern Italian Centres. Biomedicines 2023; 11:biomedicines11010170. [PMID: 36672678 PMCID: PMC9855427 DOI: 10.3390/biomedicines11010170] [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: 12/02/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Inborn errors of immunity (IEI) represent a heterogeneous group of diseases in which the true prevalence of GI involvement is not well-known. This study evaluates the prevalence of lower GI manifestations in patients with common variable immunodeficiency (CVID), analysing the histologic findings in colonic samples and assessing any correlations with biochemical abnormalities. MATERIALS AND METHODS A retrospective study was performed by collecting the data of IEI adult patients followed up at two main Northern Italian centres. Demographic and clinical data, and blood tests were collected. A colonoscopy with multiple biopsies in standard sites, in addition to a biopsy for any macroscopic lesion, was performed. The gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS) and the short Inflammatory Bowel Disease Questionnaire (sIBDQ) were used to assess GI symptoms. RESULTS 141 patients were included: 121 (86.5%) with CVID, 17 (12.1%) with IgG subclass deficiency, and 2 (1.4%) with X-linked agammaglobulinemia. Of the patients, 72 (51%) complained of GI symptoms. No differences were seen between patients receiving or not IgRT. GI infections were found in 9 patients (6.4%). No significant correlations were found between gut infections and symptoms or leukocyte infiltrates. Colonoscopy alterations were present in 79 patients (56%), and the most common were colon polyps (42%). Microscopical abnormalities were seen in 60 histologic samples (42.5%) and the most frequent was nodular lymphoid hyperplasia (40%). A leukocyte infiltrate was present in 67 samples (47.5%), and the most common was a lymphocyte infiltrate (33%). No correlation was found between GI symptoms and macroscopic alterations, whereas a positive correlation between symptoms and microscopic alterations was detected. CONCLUSIONS GI symptoms and microscopic alterations in colon samples are closely related; hence, it is important to carry out serial colonic biopsies in every CVID patient, even in the absence of macroscopic lesions.
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Schnyder D, Lüthi-Corridori G, Leuppi-Taegtmeyer AB, Boesing M, Geigy N, Leuppi JD. Audit of Asthma Exacerbation Management in a Swiss General Hospital. Respiration 2023; 102:12-24. [PMID: 36380628 PMCID: PMC9843545 DOI: 10.1159/000527268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adequate management is crucial to reduce symptoms, hospitalization, and relapses in patients with asthma. Hospitals often struggle to meet treatment guidelines, and no recent data for Switzerland are available. OBJECTIVES The aim of the study was to audit the asthma exacerbation management in the Cantonal Hospital of Baselland in order to evaluate the level of compliance with guidelines in a narrative discussion. METHOD The study design is a retrospective observational cohort study. We evaluated all adult patients presenting to the hospital with a physician-diagnosed asthma exacerbation in 2018 and 2019. The asthma management patients received was compared to the Swiss guidelines and the international GINA guidelines. RESULTS 160 patients were included (mean age: 50 years old, 57.5% female). SpO2 and heart rate were assessed at presentation in nearly all patients. Peak expiratory flow (PEF) was measured in only 14%. Adequate management of asthma exacerbation with inhaled bronchodilator medication in a combination of short-acting beta-agonists and short-acting anticholinergics was administered to 96% of the patients. Patients with severe symptoms received systemic glucocorticosteroids within 6 h in 55%. At discharge, a reliever medication was prescribed for 64% of the patients and 55% received a new or increased controller therapy with inhaled glucocorticosteroid (ICS). 49% of the patients had no follow-up organized. CONCLUSION To increase the guideline conformity and quality of asthma exacerbation management, the severity should be better assessed, especially by routinely performing PEF measurements. Treatment needs to be intensified; in particular, the ICS dose should be increased significantly and systemic glucocorticosteroids should be given with a lower threshold.
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Affiliation(s)
- Dominik Schnyder
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Giorgia Lüthi-Corridori
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne Barbara Leuppi-Taegtmeyer
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland,Faculty of Medicine, University of Basel, Basel, Switzerland,Department of Clinical Pharmacology & Toxicology, University Hospital Basel, Basel, Switzerland
| | - Maria Boesing
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Nicolas Geigy
- Emergency Department, Cantonal Hospital of Baselland, Liestal, Switzerland
| | - Joerg Daniel Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland,Faculty of Medicine, University of Basel, Basel, Switzerland,*Joerg Daniel Leuppi,
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COPD, but Not Asthma, Is Associated with Worse Outcomes in COVID-19: Real-Life Data from Four Main Centers in Northwest Italy. J Pers Med 2022; 12:jpm12071184. [PMID: 35887681 PMCID: PMC9321539 DOI: 10.3390/jpm12071184] [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: 06/08/2022] [Revised: 07/10/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Asthma, along with inhaled steroids, was initially considered a risk factor for worse clinical outcomes in COVID-19. This was related to the higher morbidity observed in asthma patients during previous viral outbreaks. This retrospective study aimed at evaluating the prevalence of asthma among patients admitted due to SARS-CoV-2 infection as well as the impact of inhaled therapies on their outcomes. Furthermore, a comparison between patients with asthma, COPD and the general population was made. Methods: All COVID-19 inpatients were recruited between February and July 2020 from four large hospitals in Northwest Italy. Data concerning medical history, the Charlson Comorbidity Index (CCI) and the hospital stay, including length, drugs and COVID-19 complications (respiratory failure, lung involvement, and the need for respiratory support) were collected, as well as the type of discharge. Results: patients with asthma required high-flow oxygen therapy (33.3 vs. 14.3%, p = 0.001) and invasive mechanical ventilation (17.9 vs. 9.5%, p = 0.048) more frequently when compared to the general population, but no other difference was observed. Moreover, asthma patients were generally younger than patients with COPD (59.2 vs. 76.8 years, p < 0.001), they showed both a lower mortality rate (15.4 vs. 39.4%, p < 0.001) and a lower CCI (3.4 vs. 6.2, p < 0.001). Patients with asthma in regular therapy with ICS at home had significantly shorter hospital stay compared to those with no treatments (25.2 vs. 11.3 days, p = 0.024). Discussion: Our study showed that asthma is not associated with worse outcomes of COVID-19, despite the higher need for respiratory support compared with the general population, while the use of ICS allowed for a shorter hospital stay. In addition, the comparison of asthma with COPD patients confirmed the greater frailty of the latter, according to their multiple comorbidities.
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Tilahun D, Michael M, Gashaye M, Melkamu E, Mekoya T. Retrospective cross-sectional study of asthma severity in adult patients at the Jimma Medical Center, Ethiopia. Sci Rep 2022; 12:11483. [PMID: 35798821 PMCID: PMC9263158 DOI: 10.1038/s41598-022-15807-1] [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: 01/24/2022] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Asthma is one of the most prevalent chronic diseases and is a public health problem worldwide. It is a long-standing condition affecting the respiratory system. Thus this study aimed to assess the severity of asthma in patients at the adult emergency department of Jimma Medical Center (JMC), Southwest Ethiopia. A one year (1 May, 2020, to 1 May, 2021) retrospective cross-sectional study was conducted among 189 patients at the adult emergency department of JMC. Data were collected between 25 July, 2021 to 25 August, 2021 by two Bachelor of Science degree holders in nursing (BSC) nurses after providing proper training. We used structured checklist that was obtained from previous studies to collect the data. Finally, data were entered into EpiData version 3.1 then exported to Stata version 15.0 for further analysis. Multinomial analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between risk factors and severity of asthma. Of 195 patients retrieved from the Health management information system (HMIS) logbook and patient profile, 189 fulfilled the eligibility criteria giving a response rate of 96.9%. The mean age of patients was 47.69 (± 19.02) years old ranging from 20 to 85. More than one third of the patients were age range of 20-39 years. Only more than half of the patients were women. Almost 46% of the patients had moderate asthma. Being male, merchant and government employees had lower odds of asthma than their counterparts whereas being daily laborers and smoking contributed to increased odds of moderate asthma. Patients' age and comorbidities had increased odds of severe asthma in relation to the participants of their reference category. Urban residents had decreased odds of severe asthma compared to their rural counterparts. This study highlights that majority of patients had moderate asthma. Health care providers should pay special attention to accurately diagnosing asthma according to its severity which is essential to the optimal management of asthma. This study calls JMC health care providers to give due attention while providing routine care for their patients in accordance to identified factors.
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Affiliation(s)
- Desalew Tilahun
- School of Nursing, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Mesay Michael
- Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mihret Gashaye
- School of Nursing, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Eneyew Melkamu
- School of Midwifery, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsiyon Mekoya
- School of Nursing, Institute of Health, Jimma University, Jimma, Ethiopia
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Vaittinada Ayar P, Taillé C, Vaittinada Ayar P, Gay M, Diallo A, Dara AF, Peyrony O, Chassany O, Casalino E. Assessment of Predictor Factors Associated with Multiple Emergency Department Attendance with Asthma Attack: A Qualitative and Multicentric Prospective Observational Study. J Asthma Allergy 2022; 15:303-313. [PMID: 35283637 PMCID: PMC8906850 DOI: 10.2147/jaa.s337072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/10/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Identified factors associated with multiple emergency department (ED) visits (≥) for asthma, which is associated with death. Patients and Methods We first conducted a qualitative study. We invited French-speaking adults (≥18 years old) with a diagnosis of asthma for more than 6 months. The identified concepts were transcribed into items. A Delphi method allowed for selecting items for a self-reported questionnaire. In an observational multicentric cross-sectional quantitative study, the resulting 20-item questionnaire and 12-item General Health Questionnaire, exploring psychological distress, were administered to adults visiting an ED for asthma exacerbation. Multivariable logistic regression was used to assess factors associated with ED visits. Results Data saturation was obtained after 8 patient interviews. Patients who came to the ED seemed unfamiliar with their illness or treatments but were concerned by the disease. The questionnaire was administered to 182 patients. On multivariable logistic regression, multiple and systematic ED visits were associated with asthma exacerbation (adjusted odds ratio (aOR) = 6.89, 95% confidence interval [CI]: 2.25–21.09), asthma perceived as a handicap (aOR=3.19, 95% CI: 1.55–6.57) and reported atopy (OR=2.09, 95% CI: 1.03–4.26). High educational level and lack of maintenance inhaled corticosteroids were protective for multiple ED visits. Conclusion Inadequate medical care is frequent in patients attending the ED for an asthma exacerbation, associated with strong psychological impact. Questioning the reasons for consulting the ED may help quickly identify patients requiring asthma education and improve their referral.
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Affiliation(s)
- Prabakar Vaittinada Ayar
- Emergency Department, Beaujon University Hospital-APHP, Paris, France
- University of Paris, Paris, France
- Correspondence: Prabakar Vaittinada Ayar, Email
| | - Camille Taillé
- University of Paris, Paris, France
- Respiratory Diseases Department, Bichat University Hospital-APHP, Paris, France
| | | | - Matthieu Gay
- Emergency Department, Beaujon University Hospital-APHP, Paris, France
| | - Alhassane Diallo
- University of Paris, Paris, France
- Epidemiology Department, Biostatistics and Clinical Research, Bichat University Hospital-APHP, Paris, France
| | | | - Olivier Peyrony
- University of Paris, Paris, France
- Emergency Department, Saint-Louis University Hospital-APHP, Paris, France
| | - Olivier Chassany
- University of Paris, Paris, France
- UMR 1123, Inserm, Paris, France
- Health Economics Clinical Trial Unit (URC-ECO), Hotel-Dieu Hospital-APHP, Paris, France
| | - Enrique Casalino
- University of Paris, Paris, France
- Emergency Department, Bichat University Hospital-APHP, Paris, France
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Biologics in Severe Eosinophilic Asthma: Three-Year Follow-Up in a SANI Single Center. Biomedicines 2022; 10:biomedicines10020200. [PMID: 35203409 PMCID: PMC8869384 DOI: 10.3390/biomedicines10020200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/13/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction: Biologic drugs have dramatically improved severe eosinophilic asthma (SEA) outcomes. Our aim was to evaluate the long-term efficacy of biological therapy in SEA in a real-life setting and to identify the predictors for switching to another biological drug in patients with poor asthma control. The outcomes for efficacy were decreased annual exacerbations (AE) and improved asthma control test (ACT). Methods: In 90 SEA patients being treated with a biological drug, clinical examination, ACT, blood eosinophils count and spirometry were assessed before (T0) and after 6 (T1), 12 (T2), 24 (T3) and 36 (T4) months from the start of biological therapy. Patients were considered responders (R) or non-responders (NR) to biologics depending on whether or not they had less than two AE and a 20% increase in the ACT after 12 months of treatment. Results: 75% of the patients were R, 25% NR. In R patients, biological therapy add-on was followed by significant improvement in AE and ACT throughout the whole follow-up period. The percentage of patients on oral corticosteroids (OCS) dropped from 40% to 12%. By contrast, the NR patients were shifted to another biological drug after 12 months of therapy, as they still had high AE and nearly unchanged ACT; 40% of them still needed OCS treatment. The predictors of switching to another biological drug were three or more AE, ACT below 17, nasal polyposis and former smoking (p < 0.05). In NR, the shift to another biological drug was followed by a significant decrease in AE and an increase in the ACT. Discussion: This real-life study confirms the long-term efficacy of biologics in most SEA patients and indicates that even in non-responders to a first biological drug, it is worth trying a second one. It is hoped that the availability of additional biologics with different targets will help improve the personalization of SEA therapy.
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Gao F, Wang H, Wang H. Study on the effect of one-stop service combined with clinical nursing path on patients with acute bronchial asthma. Am J Transl Res 2021; 13:3773-3779. [PMID: 34017564 PMCID: PMC8129301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to establish a one-stop service platform, explore and evaluate the implementation effect of one-stop service combined with clinical nursing path on patients with acute bronchial asthma. METHODS Altogether 86 patients with acute bronchial asthma in our hospital were collected by convenient sampling method, and were randomly divided into the observation group and the control group, with 43 cases in each group. The observation group was given one-stop service combined with clinical nursing path. The control group was only provided with routine nursing intervention. The nursing effect was evaluated by comparing the incidence of examination and preparation defects, the improvement time of clinical symptoms and signs, the score of quality of life, the incidence of interruption of nurses' work due to inquiring about examination-related matters, nursing cooperation and satisfaction between the two groups. RESULTS The incidence of examination and preparation defects in the observation group was significantly lower than that in the control group (P<0.001). The durations of wheezing, coughing, expectoration and lung rales in the observation group were shorter than those in the control group (P<0.05). The quality of life score in the observation group was higher than that in the control group (P<0.05). The incidence of interruption of nurses' work in the observation group was significantly lower than that in the control group (P<0.01). The nursing cooperation and satisfaction of the observation group were higher than those of the control group (all P<0.05). CONCLUSION One-stop service combined with clinical nursing path intervention has a positive effect on the treatment of patients with acute bronchial asthma.
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Affiliation(s)
- Fei Gao
- Outpatient Office, Harbin Traditional Chinese Medicine HospitalHarbin, Heilongjiang Province, China
| | - Hong Wang
- Operating Room, The Fifth Hospital of HarbinHarbin, Heilongjiang Province, China
| | - Hongmei Wang
- Department of Nutriology, Harbin Children’s HospitalHarbin, Heilongjiang Province, China
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Bosi A, Tonelli R, Castaniere I, Clini E, BeghÈ B. Acute severe asthma: management and treatment. Minerva Med 2021; 112:605-614. [PMID: 33634676 DOI: 10.23736/s0026-4806.21.07372-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with acute asthma attack usually access the emergency room with severe functional impairment, despite low perception of symptoms. In this scenario, early functional assessment is essential focusing on vital parameters and respiratory function, alongside perceived dyspnea. Impairment of ventilatory mechanics due to progressive dynamic pulmonary hyperinflation should be promptly treated with medical inhalation and/or intravenous therapy, reserving intensive treatment in case of non-response and/or worsening of the clinical conditions. Therapeutic planning at patient's discharge is no less important than treatment management during emergency room access as educating the patient about therapeutic adherence significantly impact long-term outcomes of asthma. With this review we aim at exploring current evidence on acute asthma attack management, focusing of pharmacological and ventilatory strategies of care and highlighting the importance of patient education once clinical stability allows discharge from the emergency department.
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Affiliation(s)
- Annamaria Bosi
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy
| | - Ivana Castaniere
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy
| | - Bianca BeghÈ
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy -
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Paoletti G, Keber E, Heffler E, Malipiero G, Baiardini I, Canonica GW, Giua C. Effect of an educational intervention delivered by pharmacists on adherence to treatment, disease control and lung function in patients with asthma. Respir Med 2020; 174:106199. [PMID: 33120195 DOI: 10.1016/j.rmed.2020.106199] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lack of therapeutic adherence is a relevant problem in clinical practice and it can be assessed via validated tools such as the Test of Adherence to Inhalers (TAI). Education on the correct use of inhaler devices has been associated with improvement in adherence. Many studies highlighted the pivotal role of pharmacists in promoting therapeutic adherence in the management of respiratory diseases. OBJECTIVE To evaluate the effectiveness on adherence and clinical parameters of an educational intervention administered by clinical pharmacists (CPs) to patients with asthma on long-term inhalation therapy. METHODS A prospective comparative study involving 34 community pharmacies in Italy (23 intervention, 11 control). Enrolled subjects were evaluated for adherence to inhalation therapy by TAI, asthma control by "Asthma Control Test" (ACT), and lung function at baseline and after 2 months. The educational intervention at baseline was based on TAI results and administered by specifically trained pharmacists. RESULTS A total of 242 consecutive subjects (167 intervention, 75 control) were enrolled. There was a significant improvement in TAI score, ACT and lung function parameters (p-value<0.001) in the intervention group between baseline and the follow-up visit. Patients with baseline ACT≥20 maintained disease control more frequently in the intervention group compared to the control arm (95% vs 79.5%, p = 0.004). Conclusions through administration of TAI-driven educational interventions addressing both technical and psychological issues, trained CPs can help improve adherence to treatment and asthma control.
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Affiliation(s)
- Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Enrico Keber
- Società Italiana Farmacia Clinica (SIFAC), Cagliari, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| | - Giacomo Malipiero
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
| | - Ilaria Baiardini
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Corrado Giua
- Società Italiana Farmacia Clinica (SIFAC), Cagliari, Italy
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12
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Cesarone MR, Belcaro G, Hu S, Dugall M, Hosoi M, Ledda A, Feragalli B, Maione C, Cotellese R. Supplementary prevention and management of asthma with quercetin phytosome: a pilot registry. Minerva Med 2019; 110:524-529. [PMID: 31578841 DOI: 10.23736/s0026-4806.19.06319-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In association with standard management, natural pharmaceutical standard (PS) supplements may play an important role in managing and preventing mild-to-moderate symptoms of asthma, a significant health issue that impacts patients and the healthcare system. Quercetin is a natural flavonoid with important biological properties (anti-inflammatory, antihistamine and anti-oxidative actions). METHODS In this pilot registry, we evaluated the effects of quercetin formulated with the Phytosome® delivery system (Quercefit™, QFit)+standard management (SM) in otherwise healthy subjects with mild-moderate asthmatic attacks and rhinitis. Subjects used either QFit 1 or 2 tabs/day in association with SM or SM only (control group). After 30 days of management, we evaluated the presence of the main signs/symptoms of asthma according to the GINA classification system also considering the need of rescue medication, nasal drops, the use of inhalers, the rhinitis score and oxidative stress. RESULTS QFit+SM showed superior results compared with SM alone in controlling, preventing and reducing daily and night symptoms, in maintaining higher peak expiratory flow (PEF) and in decreasing PEF variability. The supplementary use of QFit improved additional measures of asthma management, decreasing the use of inhalers, nasal drops, rescue medications and improving the rhinitis score. QFit produced a significantly more evident reduction in oxidative stress compared with SM; Qfit showed a very good safety profile. CONCLUSIONS This preliminary supplement, concept registry shows a potential protective and preventive effect of quercetin on attacks frequency and in controlling the most common signs/symptoms of asthma in the milder cases of the disease.
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Affiliation(s)
- Maria R Cesarone
- IRVINE3 Labs, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Gianni Belcaro
- IRVINE3 Labs, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy -
| | - Shu Hu
- IRVINE3 Labs, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Mark Dugall
- IRVINE3 Labs, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Morio Hosoi
- IRVINE3 Labs, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Andrea Ledda
- IRVINE3 Labs, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Beatrice Feragalli
- IRVINE3 Labs, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Claudia Maione
- IRVINE3 Labs, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Roberto Cotellese
- IRVINE3 Labs, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
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