Global, regional, and national burden of asthma and its attributable risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

Issue 3-The occupational burden of respiratory diseases, an update

INTRODUCTION AND AIMS

Workplace exposures are widely known to cause specific occupational diseases such as silicosis and asbestosis, but they also can contribute substantially to causation of common respiratory diseases. In 2019, the American Thoracic Society (ATS) and the European Respiratory Society (ERS) published a joint statement on the occupational burden of respiratory diseases. Our aim on this narrative review is to summarise the most recent evidence published after the ATS/ERS statement as well as to provide information on traditional occupational lung diseases that can be useful for clinicians and researchers.

RESULTS

Newer publications confirm the findings of the ATS/ERS statement on the role of workplace exposure in contributing to the aetiology of the respiratory diseases considered in this review (asthma, COPD, chronic bronchitis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, infectious pneumonia). Except for COPD, chronic bronchitis and infectious pneumonia, the number of publications in the last 5 years for the other diseases is limited. For traditional occupational lung diseases such as silicosis and asbestosis, there are old as well as novel sources of exposure and their burden continues to be relevant, especially in developing countries.

CONCLUSIONS

Occupational exposure remains an important risk factor for airways and interstitial lung diseases, causing occupational lung diseases and contributing substantially in the aetiology of common respiratory diseases. This information is critical for public health professionals formulating effective preventive strategies but also for clinicians in patient care. Effective action requires shared knowledge among clinicians, researchers, public health professionals, and policy makers.

Parental perceptions and knowledge toward Asthma Action Plans

INTRODUCTION

Personalized Asthma Action Plans (AAPs) are a cornerstone of pediatric asthma management. We aimed to assess parental knowledge and perceptions of the use of AAPs in managing their child's asthma.

METHODS

In 2023 we conducted a cross-sectional survey to assess knowledge and perceptions of AAPs in parents/caregivers of children aged 0-17 years with asthma who had an AAP and attended respiratory clinics at Sydney Children's Hospital, Randwick. The questionnaire included parental perceptions on the utility of AAPs, parental asthma management self-efficacy (PAMSE), and an adapted version of the Asthma Action Plan Knowledge Interview tool (AAPKI). Descriptive statistics and regression analyses were used to assess associations between AAPKI, PAMSE and other outcomes.

RESULTS

Seventy-one parents completed the survey. Mean PAMSE score was 4.2/5 (SD 0.5). Median AAPKI score was 70.2% out of 100% (IQR 20.4%). Most parents (80.0%, n = 56) were satisfied/very satisfied with using AAPs to manage their child's asthma. Most agreed/strongly agreed that AAPs were helpful in knowing when to seek medical attention for their child's asthma (81.7%, n = 58), helped their understanding of asthma severity (81.7%, n = 58), and increased their confidence in asthma management (76.0%, n = 54). Over half of parents (55.7%, n = 39) would prefer AAPs digitally and majority (78.6%, n = 55) would like color-coded AAPs.

CONCLUSION

High levels of AAP knowledge and self-efficacy scores were demonstrated. Most parents expressed understanding of the benefits of AAPs. Our findings suggest parents of children with asthma prefer AAPs in color and in digital version which may help guide standardization of AAPs across Australia.

Food for thought: optimal diet in patients with asthma and chronic obstructive pulmonary disease

PURPOSE OF REVIEW

Nutritional intake plays a major role in the management of lung health. This review provides the latest perspective on how dietary choices can modulate lung function in patients with chronic obstructive pulmonary disease (COPD) and asthma.

RECENT FINDINGS

The pathophysiology of COPD and asthma is driven by oxidative stress and inflammation of the airways, which is exacerbated by modifiable risk factors such as cigarette smoking and diet. Various foods can influence patient symptoms; highly processed foods increase the production of reactive oxygen species that augment airway inflammation, whereas foods rich in antioxidants, fiber and protein combat oxidative stress and muscle wastage. Patients with COPD or asthma are at increased risk of developing metabolic comorbidities, including cachexia and obesity that complicate disease phenotypes, leading to greater symptom severity. While clinical findings suggest a role for antioxidant and macronutrient support of lung function, comprehensive translational and clinical studies are necessary to better understand the mechanisms underlying nutrient interaction and lung structure-function.

SUMMARY

Understanding the nutritional requirements that protect lung health and support weight management in COPD and asthma is imperative to providing personalized dietary recommendations and reducing patient morbidity.

Burden of Respiratory Syncytial Virus Disease in Adults with Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review

PURPOSE OF REVIEW

Accumulating data indicate that asthma and chronic obstructive pulmonary disease (COPD) increase the risk of severe respiratory syncytial virus (RSV) infection. This systematic literature review assessed the burden of RSV disease among adults ≥ 18 years with asthma or COPD.

RECENT FINDINGS

Data on the prevalence of asthma or COPD among RSV-infected adults, RSV-related hospitalizations, complications, and mortality were collected from studies published between January 1, 2000 and November 28, 2023 in PubMed, Embase, and grey literature. All extracted data were analyzed descriptively. Pooled estimates of asthma or COPD prevalence among RSV-infected adults were calculated from generalized linear mixed effects model meta-analyses. Forty studies were included. The prevalence of asthma and COPD among RSV-infected adults was high, especially in inpatient settings with pooled estimates (95% confidence interval) of 19.3% (15.0-24.6) for asthma and 30.8% (26.1-36.0) for COPD. Adults with asthma or COPD were more likely to be hospitalized following RSV infection than those without these conditions. The incidence rate ratios of hospitalization were 2.0-3.6 (crude) and 6.7-8.2 (adjusted) for asthma and 3.2-13.4 (crude) and 9.6-9.7 (adjusted) for COPD. The most frequently reported RSV-related complications were exacerbation of asthma (up to 64.9%) and COPD (up to ≥ 83.0%). In-hospital case fatality rates were 2.6-4.3% (asthma) and 2.8-17.8% (COPD). These comprehensive data showing a high RSV disease burden in adults with asthma or COPD can be used to inform policy decisions around RSV vaccines and improve preventive care in this high-risk population.

Public interest in online searching of asthma information: insights from a Google trends analysis

BACKGROUND

Google Trends (GT) is a free tool that provides insights into the public's interest and information-seeking behavior on specific topics. In this study, we utilized GT data on patients' search history to better understand their questions and information needs regarding asthma.

METHODS

We extracted the relative GT search volume (RSV) for keywords associated with asthma to explore information-seeking behaviors and assess internet search patterns regarding asthma disease from 2004 to 2024 in both English and Persian languages. In addition, a correlation analysis was conducted to assess terms correlated with asthma searches. Then, the AutoRegressive predictive models were developed to estimate future patterns of asthma-related searches and the information needs of individuals with asthma.

RESULTS

The analysis revealed that the mean total RSV for asthma-related keywords over the 20-year period was 41.79 ± 6.07. The researchers found that while asthma-related search volume has shown a consistent upward trend in Persian-speaking countries over the last decade, English-speaking countries have experienced less variability in such searches except for a spike during the COVID-19 pandemic. The correlation analysis of related subjects showed that "air pollution", "infection", and "insomnia" have a positive correlation with asthma. Developing AutoRegressive predictive models on retrieved Google Trends data revealed a seasonal pattern in global asthma-related search interest. In contrast, the models forecasted a growing increase in information-seeking behaviors regarding asthma among Persian-speaking patients over the coming decades.

CONCLUSIONS

There are significant differences in how people search for and access asthma information based on their language and regional context. In English-speaking countries, searches tend to focus on broader asthma-related topics like pollution and infections, likely due to the availability of comprehensive asthma resources. In contrast, Persian speakers prioritize understanding specific aspects of asthma-like symptoms, medications, and complementary treatments. To address these divergent information needs, health organizations should tailor content to these divergent needs.

Assessing the diagnostic accuracy of machine learning algorithms for identification of asthma in United States adults based on NHANES dataset

Asthma diagnosis poses challenges due to underreporting of symptoms, misdiagnoses, and limitations in existing diagnostic tests. Machine learning (ML) offers a promising avenue for addressing these challenges by leveraging demographic and clinical data. In this study, we aim to compare different ML diagnostic models and obtain the most valuable features for asthma diagnosis using data from the National Health and Nutrition Examination Survey (NHANES) dataset. A total of 8,888 participants with available asthma diagnosis data from the 2017-2018 NHANES survey were included. After careful selection of variables related to asthma, various ML algorithms including Support Vector Machine (SVM), Random Forest (RF), AdaBoost (ADA), XGBoost (XGB), K-Nearest Neighbors (KNN), Naive Bayes (NB), and Multi-Layer Perceptron (MLP) were evaluated. SVM and ADA emerged as top performers with the highest area under the curve (AUC) scores of 0.72 and 0.71, respectively. RF exhibited high accuracy but low precision. Feature interpretation using SHapley Additive exPlanations (SHAP) values identified significant predictors such as close relative asthma history, dietary fat intake, and chronic bronchitis. Feature reduction experiments showed promising results without significant loss in predictive performance. Our findings demonstrate the potential diagnosis ability of ML algorithms, particularly SVM and ADA, in asthma diagnosis by incorporating diverse clinical and demographic factors. In addition, close relative asthma history, dietary fat intake, and chronic bronchitis could be suggested as the valuable asthma diagnosis features. These outcomes can bring promising results in early diagnosis of asthma.

Proposal of a New Composite Score (DAMADECO) to Simultaneously Evaluate Asthma and CRSwNP Severity in Comorbid Patients

Background: Asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) are chronic respiratory conditions that frequently coexist. However, an integrated assessment tool for both conditions is currently lacking. This study aimed to develop and preliminarily evaluate a composite score capable of simultaneously assessing asthma and CRSwNP in comorbid patients. Methods: An expert panel comprising three pulmonologists, one allergist/clinical immunologist, and four ear, nose and throat (ENT) specialists developed a tool to capture asthma and CRSwNP severity. The tool (D'Amato-De Corso score, or DAMADECO score) incorporates eight parameters, four specific to asthma and four specific to CRSwNP, to assign individual scores for each condition. A composite score is then calculated to reflect the overall disease burden (ranging from -8: poor control and +8: optimal control). A retrospective pilot study was conducted to evaluate the tool. Results: The DAMADECO composite score was applied to 21 comorbid patients. The mean partial scores for asthma and CRSwNP were -1.57 and -1.67, respectively, with a mean total composite score of -3.24. A total of 13 out of 21 patients had uncontrolled domains in both diseases, while fewer patients had only uncontrolled domains in asthma (1/21) or CRSwNP (6/21). The DAMADECO score also allows researchers to track disease progression and monitor treatment effectiveness. Conclusions: The preliminary results suggest that the DAMADECO score is a promising tool for simultaneously assessing asthma and CRSwNP, addressing the unmet need for an integrated approach to comorbid respiratory diseases. Further validation studies are needed to validate the tool in larger patient populations.

Global, regional, national burden of asthma from 1990 to 2021, with projections of incidence to 2050: a systematic analysis of the global burden of disease study 2021

Background

Asthma is the second leading cause of mortality among chronic respiratory illnesses. This study provided a comprehensive analysis of the burden of asthma.

Methods

Data on asthma were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. We focused on the effects of age, sex, risk factors, and the socio-demographic index (SDI) on the burden of asthma and calculated the average annual percent change (AAPC) via joinpoint regression. Two-sample Mendelian randomization (MR) was adopted to estimate the causal relationships between risk factors and asthma. The Bayesian age-period-cohort (BAPC) model was used to predict incidence patterns of asthma from 2022 to 2050.

Findings

In 2021, there was an observed prevalence of asthma, with 3,340 cases per 100,000 people. Males who were below 20 years old had a greater prevalence of asthma. The incidence and prevalence correlated positively with the SDI, whereas mortality and disability-adjusted life years (DALYs) correlated negatively. The contribution of high body mass index (BMI) to asthma DALYs increased by 4.3% worldwide between 1990 and 2021. MR studies have confirmed that high BMI and smoking can increase the risk of asthma. The prediction results indicated that the global age-standardised incidence rate will remain high from 2022 to 2050.

Interpretation

The global mortality of patients with asthma is a significant concern. The analysis of the burden of asthma can help formulate public health policies, allocate resources, and prevent asthma.

Funding

This study was supported by the National Natural Science Foundation of China; Program for Young Talents of Basic Research in Universities of Heilongjiang Province; Marshal Initiative Funding; Mathematical Tianyuan Fund of the National Natural Science Foundation of China; XingLian Outstanding Talent Support Program 2024.

Evaluating the timing of triple therapy initiation for the treatment of asthma in Japan: prompt versus delayed

OBJECTIVE

In Japan, the optimal initiation timing and efficacy of single-inhaler triple therapy (SITT) in asthma management remain unexplored. This study investigated SITT initiation timing following an asthma exacerbation, and examined patient demographics and clinical characteristics.

METHODS

Observational, retrospective cohort study in patients with asthma aged ≥15 years who initiated SITT following their earliest observed asthma exacerbation (February-November 2021), using data from Japanese health insurance claims databases (JMDC and Medical Data Vision [MDV]). The study period ended May 2022 for JMDC and September 2022 for MDV. Descriptive analyses were performed independently by database. Variables evaluated included timing of SITT initiation post exacerbation (prompt, delayed and late, ≤30, 31-180 and >180 days post index, respectively), patient demographics, clinical characteristics, and pre-index treatment.

RESULTS

Of patients in the JMDC and MDV databases, most initiated SITT promptly after an asthma exacerbation, 60.8% (n = 951/1565) and 44.4% (n = 241/543), respectively. Delayed initiation occurred in 22.6% (n = 354/1565) and 26.3% (n = 143/543) of patients, and late initiation occurred in 16.6% (n = 260/1565) and 29.3% (n = 159/543), respectively. Most patients were indexed on a moderate asthma-related exacerbation, 97.1% (n = 1519/1565) and 68.7% (n = 373/543), respectively.

CONCLUSION

Most patients with asthma initiated SITT promptly following a moderate exacerbation, with delayed and late initiation more common among patients with complex clinical profiles. The findings underscore the necessity for future research to examine the interaction between patient characteristics, clinical outcomes, and the timing of SITT initiation to optimize treatment strategies, as clinical practice may vary by exacerbation severity.

Association of life's essential 8 and asthma: mediating effect of inflammation and oxidative stress

BACKGROUND

The association of cardiovascular health (CVH) with asthma risk in U.S. adults remains unclear. This study aimed to explore the association of Life's Essential 8 (LE8), a measurement of CVH, with asthma and investigate the potential mediating effect of inflammation and oxidative stress.

METHODS

The data was obtained from the National Health and Nutrition Examination Survey (NHANES) in 2005-2018. LE8 score (range 0 ∼ 100) was measured and categorized as low (<50), moderate (50 ∼ <80), and high (≥80) CVH. Survey-weighted logistic regression and restricted cubic spline model were employed to explore the association between LE8 score and asthma. Mediation analyses were conducted to identify the mediating effects of inflammation and oxidative stress biomarkers.

RESULTS

This study included 10,932 participants aged ≥ 20 years, among whom 890 (8.14%) reported prevalent asthma. After adjusting for all covariates, the odd ratios (OR) for asthma were 0.67 (95% confidence interval (CI): 0.48, 0.94) in the moderate CVH group and 0.52 (95% CI: 0.34, 0.79) in the high CVH group compared with the low CVH group, respectively. The OR for asthma was 0.85 (95% CI: 0.78, 0.93) for every 10 score increase in LE8 score, and linear dose-response relationship was observed (p = 0.0642). Mediation analyses showed that inflammation and oxidative stress mediated 15.97% and 11.50% of the association between LE8 score and asthma, respectively (all p < 0.05).

CONCLUSIONS

LE8 score was negatively associated with asthma, and inflammation and oxidative stress partially mediated this association. It is recommended that maintaining optimal CVH may prevent asthma.

Patterns and trends in burden of asthma and its attributable risk factors from 1990 to 2021 among South Asian countries: a systematic analysis for the Global Burden of Disease Study 2021

OBJECTIVE

Asthma poses a significant health burden in South Asia, with increasing incidence and mortality despite a global decline in age-standardized prevalence rates. This study aims to analyze asthma trends from 1990 to 2021, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs) across South Asia. The study also assesses the impact of risk factors like high body mass index (BMI), smoking, and occupational exposures on asthma outcomes.

METHOD

We extracted asthma data from the Global Burden of Disease database for South Asia (1990-2021). Joinpoint regression analysis was used to assess temporal trends in asthma burden. Total Percentage change (TPC) in age-standardized rates of incidence, mortality, and DALYs were calculated. Data were stratified by gender, and the contribution of risk factors was evaluated.

RESULTS

Asthma-related mortality in South Asia decreased by 37%, from 27.78 per 100,000 (1990) to 17.54 per 100,000 (2021). The Maldives showed the most significant reduction in mortality (78.31%), while Bangladesh recorded a 47.44% reduction in prevalence and a 62.64% decrease in DALYs. High BMI, smoking, and environmental risks contributed significantly to DALYs, with environmental factors playing a major role in countries like Afghanistan (20.73%) and Bhutan (18.58%). Females, particularly those over 20, experienced higher asthma-related DALYs than males.

CONCLUSION

Asthma burden in South Asia has reduced over the past three decades, yet the absolute number of cases continues to rise, driven by population growth and environmental risk factors. Targeted interventions addressing risk factors and healthcare disparities are essential for further reducing asthma burden.

How the early life microbiome shapes immune programming in childhood asthma and allergies

Despite advances in our understanding of their diagnosis and treatment, pediatric allergies impose substantial burdens on affected children, families, and healthcare systems. Further, the prevalence of allergic diseases has dramatically increased over the past half-century, leading to additional concerns and concerted efforts to identify the origins, potential predictors and preventions, and therapies of allergic diseases. Together with the increase in allergic diseases, changes in lifestyle and early-life environmental influences have corresponded with changes in colonization patterns of the infant gut microbiome. The gut microbiome plays a key role in developing the immune system, thus greatly influencing the development of allergic disease. In this review, we specifically highlight the importance of the proper maturation and composition of the gut microbiome as an essential step in healthy child development or disease progression. By exploring the intertwined development of the immune system and microbiome across pediatric allergic diseases, we provide insights into potential novel strategies for their prevention and management.

The interaction between genetic predicted gut microbiome abundance and particulate matter on the risk of incident asthma in adults

Air pollution and gut microbial abundance (GMA) are both closely related with asthma incidence. This study aims to explore significant interact on the risk of incident asthma in adult exist between GMA and PM2.5 exposure based on a prospective cohort of UK Biobank. Polygenic score of GMA was calculated using 19 distinct single nucleotide polymorphisms. PM2.5 exposure was predicted using a validated Land Use Regression model. Incident asthma was identified by linking with medical encounters or first occurrence source. Cox proportional hazards regression models were used to evaluate the associations. Hazard ratios (HRs) and 95 % confidence intervals (CIs) were calculated. During an average follow-up of 11.4 years within 390,054 participants, a total of 11,312 asthma cases occurred with an incidence density of 2.54 per 1000 person years. Participants with the highest PM2.5 and GMA exposure were associated with a 13 % (HR = 1.13, 95 % CI: 1.05, 1.22; Pfor trend < 0.001) higher and 16 % (HR = 0.84, 95 %CI: 0.74, 0.94; Pfor trend < 0.01) lower risk of incident asthma, respectively. A significant negative additive interaction between GMA and PM2.5 exposure with the risk of incident asthma in adult was found (Relative Excess Risk due to Interaction = -0.08, 95 % CI, -0.16, -0.002). Participants with very high GMA and lowest PM2.5 exposure level were associated with a 26 % (HR = 0.74, 95 % CI: 0.57, 0.96) lower risk of incident asthma. A higher level of GMA has the potential to alleviate the detrimental effect of PM2.5 exposure on the risk of asthma in adults. Strategies targeting GMA, such as modifying diet and using probiotics supplement may be helpful for preventing asthma derived from PM2.5 exposure.

Risk of long covid in patients with pre-existing chronic respiratory diseases: a systematic review and meta-analysis

BACKGROUND

An estimated 10-30% of people with COVID-19 experience debilitating long-term symptoms or long covid. Underlying health conditions associated with chronic inflammation may increase the risk of long covid.

METHODS

We conducted a systematic review and meta-analysis to examine whether long covid risk was altered by pre-existing asthma or chronic obstructive pulmonary disease (COPD) in adults. We identified studies by searching the PubMed and Embase databases from inception to 13 September 2024. We excluded studies that focused on children or defined long covid only in terms of respiratory symptoms. We used random-effects, restricted maximum likelihood models to analyse data pooled from 51 studies, which included 43 analyses of asthma and 30 analyses of COPD. The risk of bias was assessed using a ROBINS-E table.

RESULTS

We found 41% increased odds of long covid with pre-existing asthma (95% CI 1.29 to 1.54); pre-existing COPD was associated with 32% increased odds (95% CI 1.16 to 1.51). Pre-existing asthma, but not COPD, was associated with increased odds of long covid-associated fatigue. We observed heterogeneity in the results of studies of asthma related to hospitalisation status. Potential confounding and inconsistent measurement of exposure and outcome variables were among the identified limitations.

CONCLUSIONS

Our findings support the hypothesis that pre-existing asthma and COPD increase the risk of long covid, including chronic fatigue outcomes in patients with asthma. Because COVID-19 targets the respiratory tract, these inflammatory conditions of the lower respiratory tract could provide mechanistic clues to a common pathway for the development of long-term sequelae in patients with long covid.

Clinical effectiveness and implementation outcomes of pMDI-to-DPI switch in children between 5 and 12 years of age: a scoping review protocol

INTRODUCTION

Inhalers are critical in asthma treatment, and inappropriate inhaler use leads to poor asthma outcomes. In adults and adolescents, dry powder inhalers (DPIs) are safe and effective alternatives to mainstay pressurised metered dose inhalers and could bridge the asthma care gap while also reducing the environmental burden of asthma care. Despite being licensed for use in ages 5 years old and older, the evidence for clinical effectiveness is less clear for patients between ages 5 and 12 years. This protocol describes a scoping review. The primary aim of the review is to identify and synthesise evidence on the clinical effectiveness of DPI use in children aged 5-12 years old with asthma and other wheezing conditions. The secondary aim of the review is to outline the implementation strategies and outcomes supporting the prescribing or switching to DPIs in children.

METHODS AND ANALYSIS

We will conduct a systematic and comprehensive literature search across four electronic databases (Medline, Embase, Cochrane Library and CINAHL) and grey literature. Screening and data extraction will be done independently by two review authors with discrepancies resolved through consensus. Data will be extracted and charted by two independent reviewers, then presented diagrammatically or tabulated with an accompanying narrative summary.

ETHICS AND DISSEMINATION

Ethical approval was not required for this study as it is a scoping review. The results of this scoping review will be submitted to a peer-reviewed scientific journal for publication.

Association of environmental, demographic and clinical parameters with physical activity in children with asthma

Personal characteristics, unfavorable weather conditions and air pollution have been linked with reduced physical activity in children. However, among children with asthma the effects of these parameters remain unclear. This study objectively quantified the physical activity of children with asthma and evaluated its association with environmental, personal, and clinical parameters. Participants of the prospective LIFE-MEDEA asthma study wore the EMRACE™ smartwatch daily for continuous monitoring of physical activity and acquisition of global positioning system data. Daily physical activity, personal and clinical data were combined with daily temperature, precipitation, and air pollution levels in adjusted mixed effect regression models to examine the relationship between physical activity and the examined parameters. For a follow-up period of 4 months, 186 children with asthma demonstrated a decrease of 796 steps (95% CI: -1080, -512) on days with precipitation compared to non-precipitation days and a decrease of 96 steps (95% CI: -182, -9) for every 10 µg/m3 increase in PM10. The relationship between temperature and daily steps was characterized by an inverted U-shape. There was also evidence that gender and age-adjusted BMI z-score were negatively associated with daily steps. These results can further inform the design of physical activity interventions targeting children with asthma.

The relationship between MUC5AC levels in lung and asthma: a meta-analysis based on animal experiments

INTRODUCTION

Asthma is one of the severe respiratory diseases and affects the health of people globally. Animal studies have found that the mucin 5ac (Muc5ac) levels in the lung are associated with asthma. This paper aimed to systematically evaluate the relationship between Muc5ac levels in lung and asthma by extracting relevant data from animal experiments.

METHODS

Literatures published before September 2022 in PubMed, Web of Science, Embase and Cochrane databases were collected. Literatures screening and data extraction were performed according to the criteria and the risks of bias were assessed for the included literatures according to the SYRCLE tool. Type 2 inflammatory asthma model was applied in this paper. Meta-analysis was performed using Stata 16.0 software.

RESULTS

A total of 40 publications containing 347 control mice and 337 mice with asthma were included in this study. Meta-analysis results showed the levels of Muc5ac in BALF of mice in asthma group were significantly higher than that in control group [SMD = 3.50, 95%CI(1.45, 5.54)], and the heterogeneity test results showed I2 = 93.0%, p < 0.05. The mRNA expression levels of Muc5ac in lung tissue of mice in asthma group showed a higher level than that in control group [SMD = 4.46, 95%CI (3.38, 5.55)], and the heterogeneity test results showed I2 = 84.3%, p < 0.01. The protein expression levels of Muc5ac in lung tissue of mice in asthma group were significantly higher than those in control group [SMD = 5.70, 95%CI (4.09,7.31)], and the heterogeneity test results showed I2 = 89.7%, p < 0.01.

CONCLUSION

The meta-analysis clarified the positive relationship between Muc5ac in lung and asthma.

Predicting Asthma Exacerbations Using Machine Learning Models

INTRODUCTION

Although clinical, functional, and biomarker data predict asthma exacerbations, newer approaches providing high accuracy of prognosis are needed for real-world decision-making in asthma. Machine learning (ML) leverages mathematical and statistical methods to detect patterns for future disease events across large datasets from electronic health records (EHR). This study conducted training and fine-tuning of ML algorithms for the real-world prediction of asthma exacerbations in patients with physician-diagnosed asthma.

METHODS

Adults with ≥ 2 ICD9/10 asthma codes within 1 year and at least 30 days apart were identified from the Optum Panther EHR database between 2016 and 2023. An emergency department (ED), urgent care, or inpatient visit for asthma, while on systemic administration of corticosteroids, was considered an exacerbation. To predict factors associated with exacerbations in a 6-month study period, clinical information from patients was retrieved in the preceding 6-month baseline period. Clinical information included demographics, lab results, diagnoses, medications, immunizations, and allergies. Three models built using Extreme Gradient Boosting (XGBoost), Long Short-Term Memory (LSTM), and Transformers algorithms were trained and tested on independent datasets. Predictions were explained using the SHAP (SHapley Additive exPlanations) library.

RESULTS

Of 1,331,934 patients with asthma, 16,279 (1.2%) experienced ≥ 1 exacerbation. XGBoost was the best predictive algorithm (area under the curve [AUC] = 0.964). Factors associated with exacerbations included a prior history of exacerbation, prednisone usage, high-dose albuterol usage, and elevated troponin I. Reduced probability of exacerbations was associated with receiving inhaled albuterol, vitamins, aspirin, statins, furosemide, and influenza vaccination.

CONCLUSION

This ML-based study on asthma in the real world confirmed previously known features associated with increased exacerbation risk for asthma, while uncovering not entirely understood features associated with reduced risk of asthma exacerbations. These findings are hypothesis-generating and should contribute to ongoing discussion of the strengths and limitations of ML and other supervised learning models in patient risk stratification.

Identification of regional and sex differences in asthma mortality trends in Spanish Autonomous Communities (1980-2022)

OBJECTIVE

Despite global declines in asthma mortality, regional variations and sex disparities persist. This study investigates asthma mortality trends in Spanish Autonomous Communities (ACs) from 1980 to 2022, analyzing data by sex.

METHODS

Data on asthma deaths and population were obtained from the National Institute of Statistics for the study period. Age-standardized mortality rates (ASMRs) were calculated, and joinpoint regression models were applied to identify trends.

RESULTS

Overall, 44,728 asthma deaths occurred, with a steeper decline observed in men (-3.5% per year) compared to women (-0.7% per year). The female-to-male mortality ratio climbed from 0.7 in 1980 to 5.4 in 2016. Both sexes exhibited a significant decrease in ASMRs, with a more substantial decline in males (-6.3%).While all ACs showed a significant decrease in male ASMRs, female trends varied, with significant decreases in 13 ACs and stable trends elsewhere. Joinpoint analysis revealed diverse regional patterns for both sexes, with some ACs experiencing steady declines and others exhibiting periods of slower decline or even stabilization.

CONCLUSION

This study identified concerning regional and sex disparities in Spanish ACs' asthma mortality (1980-2022). While male rates declined significantly across all regions, female rates showed variation, with even increases in some ACs. Targeted interventions addressing these disparities and their underlying causes (healthcare access, management practices, etc.) are crucial.

Biologics as well as inhaled anti-asthmatic therapy achieve clinical remission: Evidence from the Severe Asthma Network in Italy (SANI)

Background

This study aimed to evaluate the impact of severe asthma (SA) treatments after 12 months in achieving clinical remission (CR) within the context of the Severe Asthma Network in Italy (SANI) using the recent SANI definition of CR on treatment.

Methods

CR has been defined by SANI as complete, partial, and no CR. Complete CR is defined by the absence of oral corticosteroids (OCS), no symptoms, no exacerbations, and stable lung function, and partial CR requires the absence of OCS and the fulfillment of 2 out of the other 3 criteria. Patients who do not meet the previous criteria do not reach CR.

Results

After 12 months of treatment, 283 patients were selected to evaluate the effectiveness of biologics (225 patients) and inhaled therapy (58 patients) in achieving CR. Among patients treated with biologic agents, 45.8% reached complete CR, 23.1% partial CR, and 31.1% no CR. Differences in CR achievement according to type of biologic agent administered were observed. Interesting results were found when assessing the inhaled therapy (ICS/LABA/LAMA and no biologics) effectiveness: 34.5% patients reached complete CR, 34.5% partial CR, and 31.0% did not reach CR. This finding is noteworthy since it further supports the efficacy of inhaled treatment in certain SA patients and highlights the relevance of using CR as a modern outcome of SA treatments. Chronic rhinosinusitis with nasal polyps (CRSwNP) comorbidity was associated, though not significantly, with CR achievement in patients treated with biologics. Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ) scores significantly impacted CR (p = 0.003 and p = 0.027, respectively), while biomarkers, namely IgE, blood eosinophils, or fractional exhaled nitric oxide (FeNO), were not associated with CR achievement.

Conclusions

This study confirmed the effectiveness of biologics in reaching CR and demonstrated also inhaled therapies able to achieve CR. These innovative findings should encourage post hoc analysis of randomized clinical trials or even retrospective analysis of SA patient cohorts to evaluate CR with different inhaled treatments and further define the populations eligible for each treatment.

Trial registration

ClinicalTrials.gov ID: NCT06625216; Central Ethics Committee: Comitato Etico Area Vasta Nord-Ovest Toscana (study number 1245/2016, protocol number:73714).

Improving Individualized Salbutamol Treatment: A Population Pharmacokinetic Model for Oral Salbutamol in Virtual Patients

BACKGROUND

Salbutamol, a short-acting β2-agonist used in asthma treatment, is available in multiple formulations, including inhalers, nebulizers, oral tablets, and intravenous, intramuscular, and subcutaneous routes. Each formulation exhibits distinct pharmacokinetic (PK) and pharmacodynamic (PD) profiles, influencing therapeutic outcomes and adverse effects. Although asthma management predominantly relies on inhaled salbutamol, understanding how these formulations interact with patient-specific characteristics could improve personalized medicine approaches, potentially uncovering the therapeutic benefits of alternative formulations for an individual patient. Herein, this study aims to analyze how covariates-such as age, weight, gender, body surface area (BSA), cytochrome P450 (CYP) expression, race, and health status-affect the therapeutic regime of orally administered salbutamol using population PK (popPK) modeling. The final model is intended as a tool to support the selection of optimal formulation and dosage regimen based on individual patient profiles.

METHODS

A dataset of 40 virtual patients derived from a physiologically based PK (PBPK) model of oral salbutamol was included in the popPK model.

RESULTS

A two-compartment model with first-order elimination and absorption, with a transit compartment, best described the plasma concentration-time profile following a 4 mg dose. Relationships were identified between gender and mean transit time (Mtt) and clearance (Cl), as well as the effects of weight and BSA on the volume of distribution of the central compartment (V1) and Cl, and a significant impact of health status on Cl.

CONCLUSIONS

Despite current contraindications for oral salbutamol, our findings suggest that certain individuals, particularly children, may benefit from oral treatment over inhalation. We also identified individual characteristics associated with increased salbutamol toxicity risk, indicating the need for dose adjustment or alternative administration. This study further highlights the potential of popPK modeling in personalized therapy through a fully in silico approach.

Natural ingredients in the regulation of abnormal lipid peroxidation: a potential therapy for pulmonary diseases

Pulmonary diseases are a major category of diseases that pose a threat to human health. The most common drugs currently used to treat lung diseases are still chemical drugs, but this may lead to drug resistance and damage to healthy organs in the body. Therefore, developing new drugs is an urgent task. Lipid peroxidation is caused by the disruption of redox homeostasis, accumulation of reactive oxygen species (ROS), depletion of glutathione (GSH), and inactivation of glutathione peroxidase 4 (GPX4). Lipid peroxidation is closely related to the occurrence and progression of respiratory diseases, including acute lung injury, asthma, pulmonary fibrosis, pulmonary hypertension, chronic obstructive pulmonary disease, and lung cancer. Natural ingredients have high safety, high availability, and low cost, and can regulate lipid peroxidation through multiple pathways and targets, making them valuable new drugs. This article aims to summarize the pharmacology and mechanism of natural ingredients targeting lipid peroxidation in the treatment of lung diseases. The reviewed data indicate that natural ingredients are a promising anti-lipid peroxidation drug, mainly alleviating lipid peroxidation through the cystine/glutamate antiporter (System Xc -)/GSH/GPX4 axis, Nrf2 pathway, and ROS pathway. In the future, it will still be necessary to further study the mechanisms of natural products in treating pulmonary diseases through lipid peroxidation and conduct multi-center, large-sample clinical trials to promote the development of new drugs.

Characterization of Serum Cytokine Patterns in Frequent-Exacerbation Asthma: Implications for Phenotyping and Management

(1) Background: Asthma exacerbations represent significant clinical events, however, the underlying inflammatory mechanisms and cytokine profiles in patients with frequent exacerbations remain incompletely understood; (2) Methods: In this prospective, cross-sectional study of 120 stable asthma patients, we compared the serum concentrations of eight key cytokines (IL-4, IL-12, IL-13, IL-17, IFN-α, IFN-γ, TNF-α, and IL-1β) between two groups: 60 patients with frequent exacerbations (≥ 2 events per year) and 60 matched controls with few exacerbations (1 event per year); (3) Results: Patients with frequent exacerbations showed significantly higher serum concentrations of IL-4 and IL-13 (p < 0.05), along with an increased prevalence of allergic history and comorbidities (chronic rhinosinusitis, GERD, OSA; all p < 0.05). The IgE levels correlated positively with IFN-α (rh = 0.26) and TNF-α (rh = 0.29), while the FeNO levels correlated with IL-17 (rh = 0.26) and IL-1β (rh = 0.33) (all p < 0.05); (4) Conclusions: Our findings identify a distinct cytokine signature in frequent exacerbators characterized by elevated IL-4 and IL-13 levels. The correlations between specific cytokines and established biomarkers suggest potential mechanisms underlying exacerbation susceptibility, which may inform targeted therapeutic strategies for this high-risk population.

SnS2 QDs@MXene Ohmic Junction-Based Surface Plasmon Coupling ECL Sensor to Detect Saliva Exosome for the Diagnosis of Childhood Asthma

This study represents a novel surface plasmon coupling electrochemiluminescence (SPC-ECL) method for detecting salivary exosomes and the diagnosis of childhood asthma. First, SnS2 QDs@MXene Ohmic junctions was developed as efficient ECL emitters. The Ohmic junction provided a low resistance to reduce the contact resistance and improve charge injection efficiency, which enhanced the ECL signal by 2.76 times. Furthermore, the self-assembled surface plasmonic Bi@SiO2 array was prepared. When the ECL of SnS2 QDs@MXene resonated with the electronic oscillations in the Bi@SiO2 NPs array, the luminescence intensity was enhanced and regulated into the directionally polarized signal by the SPC-ECL effect. Remarkably, the detection of CD9-exosomes in saliva was achieved successfully based on the above sensing system, which can be used to analysis the acute exacerbation and chronic persistence of childhood asthma.

Red cell distribution width to albumin ratio is associated with asthma risk: a population-based study

Background

The red cell distribution width to albumin ratio (RAR), a newly identified biomarker of inflammation, has been linked to a variety of inflammatory diseases. Asthma, a major burden on global health, is an inflammatory airway disease that is profoundly affected by inflammation. This study primarily sought to examine the influence of RAR on the risk of developing asthma.

Methods

Data from 1999 to 2020 was gathered from the NHANES database. The impact of RAR on asthma risk and their non-linear relationship were clarified by multivariate logit and restricted cubic spline (RCS) analyses. Subgroup and interaction analyses collectively formed the sensitivity analysis for this study.

Results

This study was based on an analysis of 54,161 individuals. RAR has been identified as an independent risk factor for asthma, according to logit analysis. The moderate and high RAR groups had a 16% [95% confidence interval (CI): 1.06-1.27] and 43% (95% CI: 1.30-1.58) higher risk, respectively, compared to the lowest group. Every 0.5 unit increase in RAR almost doubled the risk of asthma [odds ratio (OR): 1.82, 95% CI: 1.55-2.12]. There was no non-linear relationship between RAR and asthma risk, based on RCS analysis. Combining subgroup and interaction analyses results, all subgroups in this study showed consistent trends with the overall population.

Conclusion

Notably, this article, the first to examine the relationship between RAR and asthma risk, unveiled a positive linear correlation between them. With an increase in RAR, whether analyzed as a categorical or continuous variable, asthma risk significantly increases. This finding was beneficial for clinicians to anticipate and assess the onset of asthma through stratified or dynamic management. Given RAR's numerous advantages, its application in clinical settings held considerable promise.

Patient Characteristics, Management, and Outcomes of Adult Asthma in a Singapore Population: Data from the SDG-CARE Asthma Registry

Purpose

Patients with asthma in Singapore often have complex patient journeys, with diagnosis and management across various primary and speciality care settings. Real-world population health data is needed to identify care gaps and inform policies.

Patients and Methods

This retrospective, longitudinal cohort study assessed real-world data from adults (aged ≥18 years) with asthma in the SingHealth Chronic Obstructive Pulmonary Disease and Asthma Data Mart, an integrated database of electronic medical records of patients who attended primary and/or speciality care clinics in the SingHealth Regional Health System 01/01/2015-12/31/2020. Patients were indexed by first asthma diagnosis and categorized into cohorts of index year. Patient characteristics, asthma management and outcomes were described during baseline (1-year pre-index) and follow-up periods (1-year post-index).

Results

Overall, 21,215 patients were included across 4 cohorts: 2016, N=12,947; 2017, N=3419; 2018, N=2816; 2019, N=2033. Most common baseline asthma medication changed from inhaled corticosteroids (ICS) alone in the 2016 cohort (32.8% [n=4252]) to ICS/long-acting β2-agonist in the 2019 cohort (33.3% [n=677]). Asthma symptom control (mean [SD] Asthma Control Test scores) improved from 2016 to 2019 during baseline (18.38 [4.93] vs 19.87 [4.56]; p<0.001) and follow-up (18.34 [4.23] vs 21.07 [3.51]; p<0.001). Mean (standard deviation [SD]) number of exacerbations per patient during follow-up decreased from 2016 to 2019 (1.91 [3.11] vs 0.89 [2.07]; p<0.001). Mean (SD) number of emergency department visits per patient during follow-up decreased from 0.21 (0.75) in 2016 to 0.17-0.18 (0.60-0.65; p<0.001) between 2017 and 2019.

Conclusion

Health status at first asthma diagnosis improved for each succeeding cohort from 2016 to 2019, along with improvements in patient management and outcomes. This reflects greater awareness of the condition and improved use of medication and referrals in recent years, suggesting policy changes and their implementation, including promotion of disease awareness and adoption of guideline recommendations, may improve asthma outcomes in Singapore.

Integrating hot topics and implementation of treatable traits in asthma

People with asthma experience many different problems related to their illness. The number and type of problems differ between patients. This results in asthma being a complex and heterogeneous disorder which mandates a personalised approach to management. These features pose very significant challenges for the effective implementation of evidence-based management. "Treatable traits" is a model of care that has been specifically designed to address these issues. Traits are identified in the pulmonary, extrapulmonary (comorbidity) and behavioural/risk factor domains. Traits are clinically relevant, recognisable with validated trait identification markers and treatable using evidence-based therapies. The clinician and patient agree on a personalised management plan that addresses the relevant traits, and trials show superiority of this approach with significant improvements in asthma control and quality of life. A number of tools have now been developed to assist the clinician in the implementation of this approach. The success of the treatable traits model of care is now being realised in other disease areas.

Optimizing asthma care in low-to-middle income countries through multisectoral collaboration: recommendation report of the first Philippine Asthma Assembly

INTRODUCTION

Asthma is one of the most common noncommunicable diseases, raising serious concerns about asthma-related deaths globally. Studies have reported safety concerns with short-acting beta-agonists (SABAs) monotherapy. SABA overuse contributes significantly to the healthcare burden in the Philippines. Despite Global Asthma Network's years-long advocacy for equal access to essential medicines at affordable cost, the uptake of international healthcare policies is limited in most low- and middle-income countries, including the Philippines.

AREAS COVERED

We reviewed synthesis of targeted nonsystematic literature searches on prevalence of asthma and asthma-related mortality, SABA overreliance and its adverse events, alternatives to SABA, patient referral, and multidisciplinary team (MDT) approach for asthma management. We describe regional challenges and recommendations for improving asthma care through continued multisectoral collaboration.

EXPERT OPINION

Use of medications like inhaled corticosteroid-formoterol combinations may aid in reducing adverse events including severe exacerbations, hospitalizations, complications from oral corticosteroid use, and long-term treatment costs. Raising patient awareness about preventive measures, proper inhaler techniques, and medication adherence can mitigate burden of uncontrolled asthma. Improving access to asthma medications alongside developing treatment algorithms and referral pathways (including MDT) for primary care physicians will pave the way for optimal asthma care in LMICs, including the Philippines.

Efficient use of mepolizumab in children: An analysis of the economically justifiable price in Colombia

INTRODUCTION

Asthma imposes a crucial economic burden on health systems, especially with the incorporation of new drugs. Recently, mepolizumab has been approved to prevent exacerbations in patients with eosinophilic asthma. This study explores the economically justifiable price of mepolizumab for preventing exacerbations in children with severe asthma.

MATERIALS AND METHODS

A model was developed using the microsimulation to estimate the quality-adjusted costs and life years of two interventions: mepolizumab versus not applying standard treatment without mepolizumab. This analysis was made during a time horizon of 50 years and from a third-payer perspective.

RESULTS

Mepolizumab was cost-effective using a WTP of U$ 19,992 per QALY, but not at a WTP of U$ 4828, U$ 5128 per QALY. The economically justifiable cost for mepolizumab in Colombia is between $33 and $350 per dose, for WTP of U$ 4828, and U$ 5128 respectively. At the current price of Mepolizumab, U$ 780 per dose, only using a WTP higher than U$ 10,300 per QALY mepolizumab will be the best alternative to no mepolizumab.

CONCLUSION

Our study shows that the economically justifiable cost for mepolizumab in Colombia is between $33 and $350 per dose, for WTP of 4828 and 5180 respectively. This result should encourage more studies in the region that optimize decision-making processes when incorporating this drug into the health plans of each country.

Relationship between fraction of exhaled nitric oxide and peripheral eosinophilia in asthma

BACKGROUND

Achieving disease control is the goal of asthma management. Serum or sputum eosinophil counts have been known traditional means of assessing eosinophilic airway inflammation in asthma, which is vital in predicting response to corticosteroid therapy which ultimately promotes control of the disease. Evidence suggests that fraction of exhaled nitric oxide (FeNO) may be a more useful non-invasive surrogate biomarker for the assessment of eosinophilic airway inflammation and could help with the timely adjustment of inhaled corticosteroid therapy in the uncontrolled asthma patient. The relationship between FeNO and other markers of airway inflammation has been variable in literature, with limited data in sub-Saharan Africa where FeNO testing is very sparse. We sought to define the relationship between FeNO levels, serum eosinophil counts, spirometry measures and symptom control among asthma patients.

MATERIALS AND METHODS

The study was conducted at the Asthma Clinic of a large tertiary hospital. This study included 82 patients with physician-diagnosed asthma being regularly managed at the clinic. All participants were taken through the asthma control test (ACT), had FeNO and spirometry measurements taken according to the American Thoracic Society (ATS) guidelines. Blood samples were obtained from all participants for serum eosinophil counts. Correlation coefficient was used to ascertain the relationship between FeNO levels and serum eosinophil counts, ACT scores, and spirometry measurements. Logistic regression was used to examine the association between high FeNO and abnormal FEV1 percentage predicted (<80%) with adjustments for age, sex, and BMI.

RESULTS

A total of 82 patients with asthma were included in the study, with higher prevalence of females (72%). Majority (40.2%) of the patients were found in the 60 and above age category. The median FeNO level and ACT score was 42.00 (26.00-52.50) parts per billion (ppb) and 20.0 (18-23) respectively. The median serum eosinophil counts was 0.25(0.90-0.38) × 109/L. The median FeNO levels were significantly higher in patients with partly and very poorly controlled asthma than in the well-controlled group (p < 0.001). A total of 47(57%) of the patients were classified as having well controlled asthma and 35 (42%) uncontrolled. FeNO correlated with serum eosinophil counts (r = 0.450, p < 0.001), ACT (r = -0.648, p < 0.001), and FEV1 percentage predicted (r = -0.353, p = 0.001). High FeNO (>50 ppb) was associated with an over fivefold increased risk of having an abnormal FEV1 percentage predicted.

CONCLUSION

FeNO levels significantly correlated with the ACT scores, serum eosinophil counts and FEV1% predicted among the asthma patients who were on inhaled corticosteroid therapy. High FeNO was significantly associated with abnormal FEV1 percentage predicted. We suggest that the point of care assessment of FeNO is a reliable marker of eosinophilic inflammation in our cohort of patients and together with 'ACT scores' in our asthma clinics could increase asthma control rates.

Diagnostic value of serum thymus and activation-regulated chemokine (TARC) in fatal asthma

OBJECTIVES

Asthma, a chronic inflammatory airway disease, is characterized by airway hyperresponsiveness and structural changes. Accurate postmortem diagnosis is crucial because of legal and insurance implications, necessitating differentiation from other causes of sudden death. Thymus and activation-regulated chemokine (TARC) is a chemokine that potentially acts as a biomarker of asthma. This study evaluated the diagnostic value of serum TARC combined with immunoglobulin E (IgE) levels as biomarkers in forensic settings.

RESULTS

The subjects were 100 autopsy cases, categorized into fatal asthma (n = 25), acute myocardial infarction (AMI) (n = 37), and traumatic deaths (n = 38). TARC levels were significantly elevated in asthma (525.68 ± 801.87 pg/mL) compared with AMI (180.35 ± 109.37 pg/mL) and trauma (173.26 ± 105.01 pg/mL) cases. Similarly, serum IgE levels were higher in asthma (3363.72 ± 7023.46 KU/L) than in AMI (130.92 ± 260.79 KU/L) and trauma (134.53 ± 195.41 KU/L) cases. ROC curve analysis showed that serum TARC had a sensitivity of 68.0 % and specificity of 73.6 % (AUC 0.763, cut-off value of 225 pg/mL). In comparison, serum IgE had a sensitivity of 80 % and specificity of 86.1 % (AUC 0.881, cut-off value of 307 KU/L). The combined use of TARC and IgE increased the diagnostic specificity to 95.8 %.

CONCLUSIONS

Serum TARC and IgE are valuable biomarkers for diagnosing fatal asthma in forensic settings. While serum TARC levels correlate with Th2-mediated inflammation, the combined measurement of TARC and IgE enhances the diagnostic accuracy, providing significant specificity for confirming asthma diagnosis.

Ambient air pollution exposure and adult asthma incidence: a systematic review and meta-analysis

BACKGROUND

Ambient (outdoor) air pollutant exposures have emerged as a plausible risk factor for incident childhood asthma. However, the effect of ambient air pollutant exposures on risk of incident adult asthma is unclear. We aimed to investigate associations between specific ambient air pollutants and the risk of incident adult asthma.

METHODS

In this systematic review and meta-analysis, we searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from inception to Nov 27, 2023. We included observational studies with the outcome of new-onset asthma during adulthood (onset at ≥18 years), and metric of exposure of ambient air pollutants (particulate matter [PM]2·5, nitrogen dioxide [NO2], ozone [O3], and sulphur dioxide [SO2]). Study data were extracted independently by two reviewers and study quality was assessed using the Newcastle-Ottawa scale. When four or more eligible studies were available for a given pollutant, we applied meta-analysis using inverse variance weighting in a random effects model to estimate pooled relative risk (RR), and used meta-regression to explore sources of heterogeneity. The protocol was registered with PROSPERO, CRD42023420139.

FINDINGS

Our search identified 1891 references. After excluding 651 (34%) duplicates and ineligible studies, we included 25 studies in the systematic review. After excluding studies with overlapping populations or reporting effect estimates that could not be pooled, we performed meta-analysis for PM2·5 (nine studies), NO2 (nine studies), and O3 (four studies). Pooled random effects RRs for incident adult asthma per 5 μg/m3 increase in PM2·5 were 1·07 (95% CI 1·01 to 1·13) and per 10 μg/m3 in NO2 were 1·11 (1·03 to 1·20). We found no significant association between increasing O3 concentration and incident adult asthma (per 60-μg/m3 increase in O3, pooled RR 1·04 [0·79 to 1·36]). We found substantial heterogeneity across studies (I2=88% for all analyses). In exploratory meta-regression, average exposure level was a significant source of heterogeneity for the pooled NO2 estimate (95% CI -0·0077 to -0·0025 per μg/m3).

INTERPRETATION

Exposure to increased ambient PM2·5 or NO2 might present an additional risk factor for incident adult asthma, although high heterogeneity among included studies warrants caution in interpretation. Evidence was inconsistent for O3 and insufficient for SO2. To increase confidence and population representation in pooled estimates, further primary investigations are necessary, ideally with aligned methodology and reporting.

FUNDING

None.

Association Between Oxidative Potential of Particulate Matter Collected by Personal Samplers and Systemic Inflammation Among Asthmatic and Non-Asthmatic Adults

With the rationale that the oxidative potential of particulate matter (PM-OP) may induce oxidative stress and inflammation, we conducted the ASTHMA-FENOP study in which 44 asthmatic patients and 37 matched controls wore a personal sampler for 24 h, allowing the collection of fine and coarse PM fractions separately, to determine PM-OP by the dithiothreitol (DTT) and ascorbic acid (AA) methods. The levels of Interleukin 6 (IL-6) and the IL-6/IL-10 ratio, as indicators of pro- and anti-inflammatory statuses, were determined by calculating the mean differences (MDs), odds ratios (ORs) and p-trends adjusted for sex, age, study level and body mass index. Positive associations for IL-6 levels in the form of adjusted MDs and ORs were obtained for all PM-OP metrics, reaching statistical significance for both OP-DTT and OP-AA in the fine fraction, with adjusted OR = 5.66; 95%CI (1.46 to 21.92) and 3.32; 95%CI (1.07 to 10.35), respectively, along with statistically significant dose-response patterns when restricting to asthma and adjusted also for clinical variables (adjusted p-trend = 0.029 and 0.01). Similar or stronger associations and dose-response patterns were found for the IL-6/IL-10 ratio. In conclusion, our findings on the effect of PM-OP on systemic inflammation support that asthma is a heterogeneous disease at the molecular level, with PM-OP potentially playing an important role.

Inhaled corticosteroid increased the risk of adrenal insufficiency in patients with chronic airway diseases: a nationwide population-based study

Inhaled corticosteroids (ICS) are commonly used for airway disease, but concerns about adrenal insufficiency (AI) have arisen. This retrospective observational study investigated the link between ICS use and AI risk using data from the National Health Insurance Service-National Sample Cohort, analyzing 66,631 patients with COPD (Korean Standard Classification of Diseases [KCD] codes J42-J44) or asthma (KCD codes J45-J46). ICS use, daily dosage, and AI cases (hospitalization or ≥ 2 outpatient visits with KCD code E27) were identified via diagnostic codes. Cox proportional hazard survival analysis and inverse probability of treatment weighting (IPTW) addressed baseline differences between ICS and non-ICS users. In total 66,631 patients, the mean age was 57.3 years, 42.6% were male, and 42.2% had a Charlson comorbidity index (CCI) of 2 or higher. Among the patients, 15.5% used ICS, with a mean daily dose of 404.2 µg/day. The incidence of AI was higher in ICS users (1.69 per 1000) than in non-users (0.54 per 1000). ICS use independently increased AI risk (HR: 3.06, 95% CI: 1.82-5.14, p < 0.001). Each 100 µg/day increase in ICS was associated with a 3% increase in AI incidence (HR: 1.03, 95% CI: 1.02-1.04, p < 0.001). Quartile analysis indicated a significant AI risk increase across all ICS dosage quartiles compared with non-users. Subgroup analysis showed consistent associations with age, sex, and smoking, with stronger links in systemic steroid users (HR: 3.54, 95% CI: 2.10-5.96, p < 0.001) and those with higher CCI (HR: 2.61, 95% CI: 1.64-4.12, p < 0.001). ICS may use increases AI risk in chronic airway disease patients, particularly among systemic steroid users and those with higher CCI. Close monitoring of high-risk patients is advised, and further research is needed to clarify mechanisms and optimize safe ICS use.

Efficacy of probiotics as adjuvant therapy in bronchial asthma: a systematic review and meta-analysis

BACKGROUND

Asthma is a chronic, heterogeneous disease characterized by airway inflammation. Asthma exacerbations significantly increase the disease burden, necessitating new therapeutic approaches. Emerging evidence suggests probiotics, through the gut-lung axis, may benefit asthma management by modulating immune responses and reducing inflammation.

METHODS

This systematic review and meta-analysis adhered to PRISMA guidelines and was registered with PROSPERO (CRD42023480098). A comprehensive search of PubMed, Scopus, Web of Science, and Embase was conducted up to March 2024. Inclusion criteria encompassed randomized controlled trials (RCTs) evaluating probiotic interventions in asthma patients. Statistical analysis was done using RevMan 5.3, with odds ratios (OR) and 95% confidence intervals (CI) calculated, and heterogeneity assessed using I2 statistics.

RESULTS

Twelve RCTs, comprising 1401 participants, met the inclusion criteria. The probiotic strains investigated included various Lactobacillus and Bifidobacterium species. Meta-analysis revealed significant improvements in asthma control test scores (OR 1.18, 95% CI: 1.18-3.64, p = 0.0001) following probiotic supplementation. Probiotics also improved fractional exhaled nitric oxide (FeNO) in one study, but pooled FeNO and eosinophil data were not statistically significant (p = 0.46 and p = 0.29, respectively). One study observed fewer asthma exacerbations in the probiotic group (24/212) compared to placebo (67/210), with no difference in exacerbation duration.

CONCLUSION

Probiotic supplementation may be beneficial in improving asthma symptom control with no significant impact on lung function indices or eosinophil levels. Probiotics can be a potential adjunctive therapy in asthma management, particularly for asthma symptom control.

Association between advanced lung cancer inflammation index and unstable asthma: a population-based study from the NHANES 2007-2018

Background

Asthma exacerbation is associated with obesity and systemic inflammatory diseases, and advanced lung cancer inflammation index (ALI) is a novel biomarker of nutritional inflammation. The purpose of this study was to investigate the potential relationship between ALI and unstable asthma.

Methods

This cross-sectional study utilized data from the 2007-2018 National Health and Nutrition Examination Survey (NHANES). Asthma was assessed through self-reported questionnaires. Multifactorial logistic regression, subgroup analyses, interaction assessments, smoothed curve fitting, and threshold effect analysis models were conducted to investigate the association between ALI and unstable asthma.

Results

The study included 1,822 subjects with current asthma, and we found a linear positive association between ALI and unstable asthma, with higher levels of ALI significantly associated with an increased risk of asthma exacerbations in fully corrected models. However, the associations were not entirely consistent across subgroups. In subgroup analyses by body mass index (BMI) and race, unstable asthma and ALI were independently significant in the BMI (25-29.9) range and the Non-Hispanic White group. Interaction analysis suggested that BMI moderated the relationship between ALI and unstable asthma. Furthermore, smoothed curve fitting showed an inverted U-shaped relationship between log ALI and unstable asthma in subjects with a BMI <25 and male individuals, with inflection points observed at 1.53 and 2.13, respectively.

Conclusion

We found a linear positive association between ALI and unstable asthma, which remained constant in the fully adjusted model. These findings suggest that higher levels of ALI were significantly associated with an increased risk of asthma exacerbation, particularly in asthmatic populations with BMI in the 25-29.9 range. However, more prospective studies are required to confirm our findings.

Association between triglyceride-glucose index and fractional exhaled nitric oxide in adults with asthma from NHANES 2007-2012

BACKGROUND

Several studies have shown a potential relationship between triglyceride-glucose index (TGI) and asthma. However, limited research has been conducted on the relationship between TGI and fractional exhaled nitric oxide (FeNO).

METHODS

A total of 1,910 asthmatic individuals from the National Health and Nutrition Examination Survey (NHANES) database were included in this study. Linear regression analyses were used to investigate the relationship between TGI and FeNO in patients with asthma. Subsequently, a trend test was applied to verify whether there was a linear relationship between the TGI and FeNO. Finally, a subgroup analysis was performed to confirm the relationship among the different subgroup populations.

RESULTS

Multivariable linear regression analyses showed that TGI was linearly related to FeNO in the asthmatic population. The trend test additionally validated the positive linear relationship between TGI and FeNO. The result of XGBoost revealed the five most influential factors on FeNO in a ranking of contrasted importance: eosinophil (EOS), body mass index (BMI), poverty-to-income ratio (PIR), TGI, and white blood cell count (WBC).

CONCLUSIONS

This investigation revealed a positive linear relationship between TGI and FeNO in patients with asthma. This finding suggests a potential relationship between TGI and airway inflammation in patients with asthma, thereby facilitating the prompt identification of irregularities and providing a basis for clinical decision making. This study provides a novel perspective on asthma management.

Validation of the adult asthma epidemiological score: a secondary analysis of the EPI-ASTHMA population-based study

OBJECTIVE

The A2 score is an eight-question patient-reported outcome measure that has been validated for ruling in (score ≥4) and ruling out (score 0-1) asthma. However, this screening tool has been validated in a cohort similar to the derivation cohort used. This study aims to validate the predictive accuracy of the A2 score in a primary care population against general practitioner (GP) clinical assessment and to determine whether the proposed cut-offs are the most appropriate.

DESIGN

This accuracy study is a secondary analysis of the EPI-ASTHMA population-based study.

SETTING

Primary care centres in Portugal.

PARTICIPANTS

Random adult participants answered the A2 score by phone interview.

OUTCOMES

Those with an A2 score ≥1 (plus 5% with an A2 score of 0) were invited to a diagnostic visit carried out by a GP to confirm or not a diagnosis of asthma. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves.

RESULTS

A total of 1283 participants (median 54 (p25-p75 43-66) years; 60% women) were analysed. The A2 score showed high discriminatory power in identifying asthma, with an area under the ROC curve of 82.9% (95% CI 80.4% to 85.4%). The proposed cut-off ≥4 was the most appropriate to rule in asthma (specificity 83.1%, positive predictive value 62.4%, accuracy 78%). Similarly, the proposed cut-off<2 was the most suitable for excluding asthma (sensitivity 92.7%, negative predictive value 93.7%, accuracy 60.5%).

CONCLUSIONS

The A2 score is a useful tool to identify patients with asthma in a primary care population.

TRIAL REGISTRATION NUMBER

NCT0516961.

Over-the-counter short-acting β2-agonist purchase and asthma-related health outcomes: a post hoc analysis of the SABINA III study

This post-hoc analysis of the SABINA III study evaluated the association of short-acting β2-agonist (SABA) prescriptions and self-reported over-the-counter (OTC) SABA purchase in the previous 12 months with asthma-related outcomes using multivariable regression models in 4556 patients (mean age, 48.9 years). Of the 2810 patients prescribed ≥3 SABA canisters, 776 (27.6%) also purchased ≥1 SABA OTC. This subset of 776 patients reported the highest disease burden; 73.2% had ≥1 severe exacerbation and 55.7% had uncontrolled asthma. Asthma-related outcomes worsened with any SABA OTC purchase, regardless of SABA prescriptions; disease burden was the highest in patients with ≥3 SABA prescriptions and ≥1 SABA OTC purchase vs 1-2 SABA prescriptions only (86% lower odds of having at least partly controlled asthma and 124% increased incidence of severe asthma (both P < 0.001). These findings emphasize the need to implement policy changes to restrict SABA purchase without prescriptions and ensure access to affordable asthma care.

Obesity and Asthma: Implementing a Treatable Trait Care Model

Recognition of obesity as a treatable trait of asthma, impacting its development, clinical presentation and management, is gaining widespread acceptance. Obesity is a significant risk factor and disease modifier for asthma, complicating treatment. Epidemiological evidence highlights that obese asthma correlates with poorer disease control, increased severity and persistence, compromised lung function and reduced quality of life. Various mechanisms contribute to the physiological and clinical complexities observed in individuals with obesity and asthma. These encompass different immune responses, including Type IVb, where T helper 2 cells are pivotal and driven by cytokines like interleukins 4, 5, 9 and 13, and Type IVc, characterised by T helper 17 cells and Type 3 innate lymphoid cells producing interleukin 17, which recruits neutrophils. Additionally, Type V involves immune response dysregulation with significant activation of T helper 1, 2 and 17 responses. Finally, Type VI is recognised as metabolic-induced immune dysregulation associated with obesity. Body mass index (BMI) stands out as a biomarker of a treatable trait in asthma, readily identifiable and targetable, with significant implications for disease management. There exists a notable gap in treatment options for individuals with obese asthma, where asthma management guidelines lack specificity. For example, there is currently no evidence supporting the use of incretin mimetics to improve asthma outcomes in asthmatic individuals without Type 2 diabetes mellitus (T2DM). In this review, we advocate for integrating BMI into asthma care models by establishing clear target BMI goals, promoting sustainable weight loss via healthy dietary choices and physical activity and implementing regular reassessment and referral as necessary.

Flavonoid intakes, chronic obstructive pulmonary disease, adult asthma, and lung function: a cohort study in the UK Biobank

BACKGROUND

Given their antioxidative stress, anti-allergic, anti-inflammatory, and immune-modulating effects, flavonoids are hypothesized to play a role in preventing chronic obstructive pulmonary disease (COPD) and asthma.

OBJECTIVES

This cohort study aimed to examine associations between flavonoid intake and COPD, asthma, and lung function.

METHODS

Among 119,466 participants of the UK Biobank, median [interquartile range] age of 60 [53, 65] y, we estimated intakes of flavonoids, flavonoid-rich foods, and a flavodiet score from 24-h diet assessments. Prospective associations with both incident COPD and asthma and cross-sectional associations with measures of lung function [%predicted forced expiratory volume in 1s (FEV1); and FEV1/forced vital capacity (FVC)] were examined using multivariable-adjusted Cox proportional hazards and linear regression models, respectively. We investigated mediation by inflammation--represented by the INFLA score--and stratified analyses by smoking status.

RESULTS

Compared with low intakes, moderate intakes of total flavonoids, flavonols, theaflavins + thearubigins, and flavanones, and moderate-to-high intakes of flavanol monomers, proanthocyanidins, anthocyanins, flavones, and the flavodiet score were associated with up to an 18% lower risk of incident COPD {e.g., [hazard ratio (95% confidence interval) for total flavonoids: 0.83 (0.75, 0.92)]} but not incident asthma. Furthermore, compared with low intakes, higher intakes of all flavonoid subclasses (except theaflavins + thearubigins), and the flavodiet score were associated with better percent predicted FEV1 baseline. Associations were most apparent in ever (current or former) smokers. Flavonoid intakes were inversely associated with the INFLA score, which appeared to mediate 11%-14% of the association between intakes of proanthocyanidins and flavones and incident COPD.

CONCLUSIONS

Moderate-to-high flavonoid intakes were associated with a lower risk of COPD and better lung function, particularly among ever smokers. Promoting intakes of healthy flavonoid-rich foods, namely, tea, apples, and berries, may improve respiratory health and lower COPD risk, particularly in individuals with a smoking history.

Key Challenges to Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Southeast Asia, the Middle East, and North Africa: An Expert Perspective

INTRODUCTION

Respiratory syncytial virus (RSV) is a common, highly contagious pathogen and a leading cause of serious illness among infants and older adults. While existing scientific evidence has predominantly focused on the epidemiology and disease burden of RSV in infants, data in older adults remain limited in some countries, including those in Southeast Asia (SEA) and the Middle East and North Africa (MENA) region. Here, we outline the key challenges for understanding the burden of RSV in older adults in SEA and the MENA region and we propose opportunities for improving understanding and eventually reducing the impact of RSV.

MAIN FINDINGS AND CONCLUSIONS

A key challenge identified by the expert group, particularly in older adults, is a lack of awareness (among healthcare professionals, policy makers, and the public) of RSV burden and the associated risks for severe outcomes. This is often confounded by the complexities of underdiagnosis, surveillance limitations, and comorbidities. To address these issues, we suggest medical education initiatives for physicians in SEA and the MENA region to better understand the need to protect older adults from RSV, and encourage more widespread routine testing to better understand the burden of RSV. We also recommend surveillance studies in these regions to provide comprehensive and accurate epidemiological data on RSV in older adults. Finally, in the absence of current surveillance data in these regions, we propose extrapolating existing global data and local pediatric data to inform the likely burden of RSV in older adults. A graphical abstract is available with this article.

Weight-adjusted waist index is an independent predictor of all-cause and cause-specific mortality in patients with asthma

BACKGROUND

There is a close relationship between obesity and the occurrence of asthma.The weight-adjusted waist index (WWI) is a relatively novel anthropometric parameter that reflects obesity.

OBJECTIVE

We aimed to explore the association between WWI and mortality in the asthma population.

METHODS

We included adult with asthma from NHANES 1999-2018. WWI = Waist circumference (cm)/square root of body weight (kg). Current asthma was determined by the participant's responses in standardized questionnaires. All-cause, cardiovascular disease (CVD), cancer, and respiratory disease mortality information was obtained by prospectively matching these data to the National Death Index. Multivariate-adjusted Cox proportional hazards regression analyses, Kaplan Meier survival analyses, restricted cubic spline (RCS) analyses, stratified analyses, and sensitivity analyses were used to clarify these associations.

RESULTS

A total of 101,316 participants were included in the study, and 3223 were diagnosed with asthma.WWI was independently and positively associated with all-cause and all factor-specific mortality in asthma. In fully adjusted models, each unit increase in WWI was associated with 43 % (hazard ratio [HR] and 95 % confidence interval [CI] = 1.43 [1.25,1.64], p < 0.0001), 58 % (1.58 [1.25, 1.99], p < 0.001), 50 % (1.50 [1.19, 1.90], p < 0.001), and 79 % (1.79 [1.34, 2.39], p < 0.0001) increased all-cause, CVD, cancer, and respiratory disease mortality, respectively. RCS analyses showed largely linear associations between WWI and all mortality risks. Stratified analyses indicated that these associations were influenced by multiple factors, and that age was consistently the effect modifier across all associations.

CONCLUSIONS

WWI is an independent predictor of all-cause, CVD, cancer, and respiratory-related mortality in the adult asthma population. These findings highlight that WWI may have novel prognostic value as a simple and easily accessible obesity parameter in asthma patients.

Self-reported questionnaires to assess indoor home environmental exposures in asthma patients: a scoping review

BACKGROUND

The indoor home environment plays a crucial role in determining the outcome of respiratory diseases, including asthma. Researchers, clinicians, and patients would benefit from self-reported questionnaires to assess indoor home environmental exposures that may impact on respiratory health.

OBJECTIVE

To review self-reported instruments for assessing indoor home environmental exposures in asthma patients and to characterise their content, development, and psychometric properties.

DESIGN

A scoping review was conducted with content assessment.

METHODS

A literature search was conducted in Embase and PubMed using the key words housing quality, questionnaire and asthma and their index terms, covering articles published in English between January 2000 to July 2023. Articles in which questionnaires or single item questions were used to assess indoor home environmental exposures in asthma patients in middle- and high-income countries were included. We excluded articles in which the questionnaire required an interviewer or onsite observations and those conducted in low-income countries.

RESULTS

We screened 1584 articles to identify 44 studies containing self-reported questionnaires measuring indoor home environmental exposures. 36 studies (82%) were cross sectional, 35 (80%) had a sample size of greater than 1000 participants, and 29 (66%) were conducted in children. Most studies (86%, n = 38) had binary (yes/no) or multiple-choice responses. 25 studies (57%) included a recall period of 12 months. 32 studies (73%) had a response rate of greater than 50%. Dampness, biological exposures (e.g. mould), and second-hand tobacco smoke were the most assessed indoor home environmental exposures. Childhood asthma (54%, n = 24) and asthma symptoms (36%, n = 16) were the most examined asthma related outcomes. The exposure most associated with adverse asthma outcomes was exposure to damp (79%, n = 35). 13 studies (29%) had developed a self-reported instrument by adapting questions from previous studies and almost all instruments (n = 42 studies, 95%) had not been validated.

CONCLUSIONS

The scoping review did not identify a comprehensive, validated self-reported questionnaire for assessing indoor home environmental exposures in patients with asthma. There is need to develop and validate a robust but pragmatic self-reported instrument, incorporating the findings from this review.

Induction of chronic asthma up regulated the transcription of senile factors in male rats

BACKGROUND

The main characteristic of asthma is chronic inflammation. We examined cellular senescence by histology and molecular assay in the lungs of a rat model of asthma. This model comprises sensitization by several intraperitoneal injections of ovalbumin with aluminium hydroxide, followed by aerosol challenges every other day.

RESULTS

Data showed that asthma induction caused histological changes including, hyperemia, interstitial pneumonia, fibrinogen clots, and accumulation of inflammatory cells in the pleura. There is an elevation of IL-1β and NF-kB proteins in the asthmatic group (P < 0.001) compared to the control group. The expression of ß-galactosidase increased (P < 0.01), while the expression of Klotho and Sox2 genes was decreased in the lung tissue of the asthmatic group (P < 0.01).

CONCLUSION

Taken together, these findings suggest that asthmatic conditions accelerated the cellular senescence in the lung tissue.

Particulate Matter-Induced Emerging Health Effects Associated with Oxidative Stress and Inflammation

Environmental pollution continues to increase with industrial development and has become a threat to human health. Atmospheric particulate matter (PM) was designated as a Group 1 carcinogen by the International Agency for Research on Cancer in 2013 and is an emerging global environmental risk factor that is a major cause of death related to cardiovascular and respiratory diseases. PM is a complex composed of highly reactive organic matter, chemicals, and metal components, which mainly cause excessive production of reactive oxygen species (ROS) that can lead to DNA and cell damage, endoplasmic reticulum stress, inflammatory responses, atherosclerosis, and airway remodeling, contributing to an increased susceptibility to and the exacerbation of various diseases and infections. PM has various effects on human health depending on the particle size, physical and chemical characteristics, source, and exposure period. PM smaller than 5 μm can penetrate and accumulate in the alveoli and circulatory system, causing harmful effects on the respiratory system, cardiovascular system, skin, and brain. In this review, we describe the relationship and mechanism of ROS-mediated cell damage, oxidative stress, and inflammatory responses caused by PM and the health effects on major organs, as well as comprehensively discuss the harmfulness of PM.

Genotype-driven asthma prescribing of inhaled corticosteroids and long-acting β2-agonist: A cost-effectiveness analysis

INTRODUCTION

Predicting response to inhaled corticosteroids (ICSs) + long-acting β2-agonist (LABA) by previously detecting the presence of Arg16Gly ADRB2 genotype is a strategy that could reduce and optimize the management of asthmatic patients. There is a need for economic evaluations to facilitate the implementation of such tests. This research aims to evaluate the cost-effectiveness of Arg16Gly ADRB2 screening in children with asthma in Colombia.

METHODS

From the perspective of a third-party payer, we conducted a cost-effectiveness analysis to determine the cost and quality-adjusted life-years (QALYs) of genotype-driven asthma prescribing based on the Arg16Gly ADRB2 genotype versus current treatment based on no genetic testing. Using four state-transition models, we estimate cost and QALYs employing micro-simulation modeling with a time horizon of 10 years and a cycle length of 1 week. Cost-effectiveness was assessed at a willingness-to-pay (WTP) value of US$5180.

RESULTS

The mean incremental cost of strategy genetic testing versus no genetic testing is US$ -6809. The mean incremental benefit of strategy genetic testing is 16 QALYs. The incremental net monetary benefit of strategic genetic testing versus no genetic testing is US$ 88,893. Genetic testing is the strategy with the highest expected net benefit. The outcomes derived from our primary analysis remained robust when subjected to variations in all underlying assumptions and parameter values.

CONCLUSION

Genetic testing of Arg16Gly ADRB2 is a cost-effective strategy to address asthma management in asthmatic children requiring ICS+LABA. This result should encourage the generation of more evidence and the incorporation of such evidence into clinical practice guidelines for pediatric asthma.

Integrating asthma care guidelines into primary care electronic medical records: a review focused on Canadian knowledge translation tools

INTRODUCTION

Asthma is one of the most common chronic respiratory diseases globally. Despite national and international asthma care guidelines, gaps persist in primary care. Knowledge translation (KT) electronic tools (eTools) exist aiming to address these gaps, but their impact on practice patterns and patient outcomes is variable. We aimed to conduct a nonsystematic review of the literature for key asthma care gaps and identify limitations and future directions of KT eTools optimised for use in electronic medical records (EMRs).

METHODS

The database OVID Medline was searched (1999-2024) using keywords such as asthma, KT, primary healthcare and EMRs. Primary research articles, systematic reviews and published international/national guidelines were included. Findings were interpreted within the knowledge-to-action framework.

RESULTS

Key asthma care gaps in primary care include under-recognition of suboptimal control, underutilisation of pulmonary function tests, barriers to care delivery, provider attitudes/beliefs, limited access to asthma education and referral to asthma specialists. Various KT eTools have been validated, many with optimisation for use in EMRs. KT eTools within EMRs have been a recent focus, including asthma management systems, decision support algorithms, data standards initiatives and asthma case definition validation for EMRs.

CONCLUSIONS

The knowledge-to-action cycle is a valuable framework for developing and implementing novel KT tools. Future research should integrate end-users into the process of KT tool development to improve the perceived utility of these tools. Additionally, the priorities of primary care physicians should be considered in future KT tool research to improve end-user uptake and overall asthma management practices.

Associations of asthma and psychiatric comorbidities on suicide mortality among community adolescents: A 20-year cohort study

BACKGROUND

The role of psychiatric comorbidity as a confounder between asthma and subsequent suicide mortality in adolescents remained unclarified.

METHODS

This study used a 20-year community-based cohort in Taiwan. Adolescents aged 11 to 16 from 123 schools were classified into three subgroups: current asthma (symptoms present in the past year), previous asthma (history of asthma but no symptoms in the past year), and no asthma. The mortality and medical care utilizations until the end of follow-up in 2015 were obtained. Cox proportional hazard and competing risk models were performed. Different adjustment models that included covariates of demographic status, allergy, cigarette smoking, psychiatric diagnoses, alcohol or substance misuse, and attention deficit and hyperactivity disorders were compared.

RESULTS

During the follow-up, 285 out of 153,526 participants died from suicide. The crude hazard ratio for suicide was 1.95 (95 % CI=1.46∼2.60) in the current asthma subgroup and 2.01 (1.36∼2.97) in the previous asthma subgroup. The adjusted hazard ratios (aHR) attenuated to 1.67 (1.25∼2.24) and 1.72 (1.16∼2.54) respectively after further adjustment for all mental disorders, ADHD, substance, and alcohol use disorders.

CONCLUSIONS

Our adjustment analyses stratified by different models highlight evidence of asthma as an independent risk factor that predicts suicide among adolescents. Depression and mental disorders were potential confounders and identifications of asthma and psychiatric disorders might help decrease suicide risk.

Understanding Breathlessness Burden and Psychophysiological Correlates in Asthma

BACKGROUND

Breathlessness is a disabling symptom, with complexity that is often under-recognized and undertreated in asthma.

OBJECTIVE

To highlight the burden of breathlessness in people with severe compared with mild-to-moderate asthma and identify psychophysiological correlates of breathlessness.

METHODS

This was a cross-sectional study of people with mild-to-severe asthma, who attended 2 in-person visits to complete a multidimensional assessment. The proportion of people with mild-to-moderate versus severe asthma who reported physically limiting breathlessness (modified Medical Research Council [mMRC] dyspnea score ≥2) was compared. Psychophysiological factors associated with breathlessness in people with asthma were identified via a directed acyclic graph and explored with multivariate logistic regression to predict breathlessness.

RESULTS

A total of 144 participants were included, of whom, 74 (51%) had mild-to-moderate asthma and 70 (49%) severe asthma. Participants were predominantly female (n = 103, 72%) with a median (quartile 1, quartile 3) age of 63.4 (50.5, 69.5) years and body mass index (BMI) of 31.3 (26.2, 36.0) kg/m2. The proportion of people reporting mMRC ≥2 was significantly higher in those with severe- (n = 37, 53%) than those with mild-to-moderate (n = 21, 31%) asthma (P = .013). Dyspnoea-12 Total (8.00 [4.75, 17.00] vs 5.00 [2.00, 11.00], P = .037) score was also significantly higher in the severe asthma group. Significant predictors of physically limiting breathlessness were BMI, asthma control, exercise capacity, and hyperventilation symptoms. Airflow limitation and type 2 inflammation were poor breathlessness predictors.

CONCLUSIONS

Over half of people with severe asthma experience physically limiting breathlessness despite treatment. Targeting psychophysiological factors, or traits, associated with breathlessness may help relieve this distressing symptom, which is of high priority to people with asthma.