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Lo D, Lawson C, Gillies C, Shabnam S, Gaillard EA, Pinnock H, Quint JK. Association between socioeconomic deprivation, ethnicity and health outcomes in preschool children with recurrent wheeze in England: a retrospective cohort study. Thorax 2024:thorax-2023-221210. [PMID: 38955499 DOI: 10.1136/thorax-2023-221210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Preschool-aged children have among the highest burden of acute wheeze. We investigated differences in healthcare use, treatment and outcomes for recurrent wheeze/asthma in preschoolers from different ethno-socioeconomic backgrounds. METHODS Retrospective cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics in England. We reported number of acute presentations and hospitalisations stratified by index of multiple deprivation (IMD) and ethnicity; and factors associated with treatment non-escalation, and hospitalisation rates using multivariable logistic and Poisson regression models. RESULTS 194 291 preschool children were included. In children not trialled on asthma preventer medications, children from the most deprived IMD quintile (adjusted OR 1.67; 95% CI 1.53 to 1.83) and South Asian (1.77; 1.64 to 1.91) children were more likely to have high reliever usage and where specialist referral had not occurred, the odds of referral being indicated was higher in the most deprived quintile (1.39; 1.28 to 1.52) and South Asian (1.86; 1.72 to 2.01) children compared with the least deprived quintile and white children, respectively.Hospitalisation rates for wheeze/asthma were significantly higher in children from the most deprived quintile (adjusted IRR 1.20; 95% CI 1.13 to 1.27) compared with the least, and in South Asian (1.57; 1.44 to 1.70) and black (1.32; 1.22 to 1.42) compared with white children. CONCLUSIONS We identified inequalities in wheeze/asthma treatment and morbidity in preschool children from more deprived, and non-white backgrounds. A multifaceted approach to tackle health inequality at both the national and local levels, which includes a more integrated and standardised approach to treatment, is needed to improve health outcomes in children with preschool wheeze/asthma.
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Affiliation(s)
- David Lo
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Claire Lawson
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Clare Gillies
- Department of Health Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Sharmin Shabnam
- Department of Health Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Erol A Gaillard
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Akinyemi O, Weldeslase T, Odusanya E, Fasokun M, Agboola B, Andine T, Ayeni E, Michael M, Hughes K. The relationship between neighborhood economic deprivation and asthma-associated emergency department visits in Maryland. FRONTIERS IN ALLERGY 2024; 5:1381184. [PMID: 38903705 PMCID: PMC11188351 DOI: 10.3389/falgy.2024.1381184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
Background Asthma represents a substantial public health challenge in the United States, affecting over 25 million adults. This study investigates the impact of neighborhood economic deprivation on asthma-associated Emergency Department (ED) visits in Maryland, using the Distressed Communities Index (DCI) for analysis. Methods A retrospective analysis of Maryland's Emergency Department Databases from January 2018 to December 2020 was conducted, focusing on asthma-associated ED visits. Results The study involved 185,317 ED visits, majority of which were females (56.3%) and non-Hispanic whites (65.2%). A significant association was found between increased neighborhood socioeconomic deprivation and asthma-related ED visits. The poorest neighborhoods showed the highest rates of such visits. Compared to prosperous areas, neighborhoods classified from Comfortable to Distressed had progressively higher odds for asthma-related ED visits (Comfortable: OR = 1.14, Distressed OR = 1.65). Other significant asthma predictors included obesity, female gender, tobacco smoking, and older age. Conclusion There is a substantive association between higher asthma-related ED visits and high neighborhood economic deprivation, underscoring the impact of socioeconomic factors on health outcomes. Public health implications Addressing healthcare disparities and improving access to care in economically distressed neighborhoods is crucial. Targeted interventions, such as community health clinics and asthma education programs, can help mitigate the impact of neighborhood disadvantage.
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Affiliation(s)
- Oluwasegun Akinyemi
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, United States
| | - Terhas Weldeslase
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, United States
| | - Eunice Odusanya
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, United States
| | - Mojisola Fasokun
- Department of Epidemiology, University of Alabama, Birmingham, AL, United States
| | - Bukola Agboola
- Maryland Institute for Applied Environmental Health, University of Maryland, College Park, MD, United States
| | - Tsion Andine
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, United States
| | - Esther Ayeni
- Department of Geography and Meteorology, Ball State University, Muncie, IN, United States
| | - Miriam Michael
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC, United States
| | - Kakra Hughes
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
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Punyadasa D, Simms-Williams N, Adderley NJ, Thayakaran R, Mansur AH, Nirantharakumar K, Nagakumar P, Haroon S. Post-hospitalisation asthma management in primary care: a retrospective cohort study. Br J Gen Pract 2024; 74:e355-e363. [PMID: 38438269 PMCID: PMC10947362 DOI: 10.3399/bjgp.2023.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/29/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Clinical guidelines recommend that patients admitted to hospital for asthma attacks are reviewed in primary care following hospital discharge. AIM To evaluate asthma management in primary care following a hospital admission for asthma and its associations with patient characteristics. DESIGN AND SETTING A retrospective cohort study using English primary care data from the Clinical Practice Research Datalink Aurum database and linked Hospital Episode Statistics Admitted Patient Care data. METHOD Patients with asthma aged ≥5 years who had at least one asthma-related hospital admission from 1 January 2017 to 31 December 2019 were included. The primary outcome was a composite of any of the following delivered in primary care within 28 days from hospital discharge: asthma review, asthma management plan, asthma medication prescriptions, demonstration of inhaler technique, or smoking cessation counselling. The association between patient characteristics and delivery of clinical care was assessed using logistic regression. RESULTS The study included 17 457 patients. A total of 10 515 (60.2%) patients received the primary outcome within 28 days of hospital discharge. There were 2311 (13.2%) who received an asthma review, 1459 (8.4%) an asthma management plan, 9996 (57.3%) an asthma medication, 1500 (8.6%) a demonstration of inhaler technique, and 52 (1.2% of smokers) had smoking cessation counselling. Patients from Black ethnic minority groups received less of this care (27%-54% lower odds, depending on age). However, short-acting bronchodilator prescriptions in the previous year were associated with an increased likelihood of the primary outcome. CONCLUSION A significant proportion of patients do not receive timely follow-up in primary care following asthma-related admissions to hospital, particularly among Black ethnic minority groups.
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Affiliation(s)
- Dhanusha Punyadasa
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | | | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Rasiah Thayakaran
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Adel H Mansur
- University Hospitals Birmingham; Institute of Inflammation and Ageing, University of Birmingham, Birmingham
| | | | - Prasad Nagakumar
- Birmingham Women's and Children's Hospital, Birmingham; Institute of Inflammation and Ageing, University of Birmingham, Birmingham
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham
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Scutari M, Kerob D, Salah S. Inferring skin-brain-skin connections from infodemiology data using dynamic Bayesian networks. Sci Rep 2024; 14:10266. [PMID: 38704447 PMCID: PMC11069591 DOI: 10.1038/s41598-024-60937-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
The relationship between skin diseases and mental illnesses has been extensively studied using cross-sectional epidemiological data. Typically, such data can only measure association (rather than causation) and include only a subset of the diseases we may be interested in. In this paper, we complement the evidence from such analyses by learning an overarching causal network model over twelve health conditions from the Google Search Trends Symptoms public data set. We learned the causal network model using a dynamic Bayesian network, which can represent both cyclic and acyclic causal relationships, is easy to interpret and accounts for the spatio-temporal trends in the data in a probabilistically rigorous way. The causal network confirms a large number of cyclic relationships between the selected health conditions and the interplay between skin and mental diseases. For acne, we observe a cyclic relationship with anxiety and attention deficit hyperactivity disorder (ADHD) and an indirect relationship with depression through sleep disorders. For dermatitis, we observe directed links to anxiety, depression and sleep disorders and a cyclic relationship with ADHD. We also observe a link between dermatitis and ADHD and a cyclic relationship between acne and ADHD. Furthermore, the network includes several direct connections between sleep disorders and other health conditions, highlighting the impact of the former on the overall health and well-being of the patient. The average R 2 for a condition given the values of all conditions in the previous week is 0.67: in particular, 0.42 for acne, 0.85 for asthma, 0.58 for ADHD, 0.87 for burn, 0.76 for erectile dysfunction, 0.88 for scars, 0.57 for alcohol disorders, 0.57 for anxiety, 0.53 for depression, 0.74 for dermatitis, 0.60 for sleep disorders and 0.66 for obesity. Mapping disease interplay, indirect relationships, and the key role of mediators, such as sleep disorders, will allow healthcare professionals to address disease management holistically and more effectively. Even if we consider all skin and mental diseases jointly, each disease subnetwork is unique, allowing for more targeted interventions.
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Affiliation(s)
- Marco Scutari
- Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), Lugano, Switzerland.
| | - Delphine Kerob
- La Roche-Posay Dermatological Laboratories, Levallois-Perret, France
- Department of Dermatology, AP-HP Saint-Louis Hospital, Paris, France
| | - Samir Salah
- La Roche-Posay Dermatological Laboratories, Levallois-Perret, France
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van Boven JFM, Lavorini F, Agh T, Sadatsafavi M, Patino O, Muresan B. Cost-Effectiveness and Impact on Health Care Utilization of Interventions to Improve Medication Adherence and Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1228-1243. [PMID: 38182099 DOI: 10.1016/j.jaip.2023.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/08/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Poor adherence to asthma and chronic obstructive pulmonary disease maintenance therapies impairs health outcomes. Proven and cost-effective programs to promote adherence and persistence are not yet in regular widespread use. Implementation costs are a potential barrier to uptake of such programs. OBJECTIVE We undertook a systematic literature review and narrative synthesis of studies investigating the cost-effectiveness of treatment adherence-promoting programs or that determined their impact on health care budget directly or via health care resource use (HCRU). METHODS We identified relevant publications using Medline and PreMEDLINE (PubMed), Embase (Embase.com, Elsevier), and EconLit for publications between January 2000 and July 2021. We also searched clinical trial databases and selected conference proceedings. RESULTS Of 1,910 potentially relevant articles, 26 met prespecified inclusion criteria and underwent data extraction. Eleven reported a direct assessment of adherence, 15 included economic evaluations, and 17 described HCRU. None included an analysis of biologic medication use. When they were studied, interventions were often found to be highly cost-effective, with dominant incremental cost-effectiveness ratios in some cases. Reductions in direct costs and HCRU (health care visits, hospital admissions, and/or the use of medications, including add-on/reliever treatment and antibiotics) were frequently reported. Reported use of maintenance treatments improved in some studies. Counseling and/or digitally informed programs were used in all cases in which favorable outcomes were observed. CONCLUSIONS Adherence-promoting interventions are mostly cost-effective and often result in reduced HCRU and associated costs. Multidisciplinary care involving one-to-one advice and digitally enhanced communications appear to offer the greatest benefit.
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Affiliation(s)
- Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD, University Medical Centre Groningen, Groningen, University of Groningen, Groningen, The Netherlands.
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tamas Agh
- Syreon Research Institute, Budapest, Hungary; Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pecs, Pecs, Hungary
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oliver Patino
- Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands
| | - Bogdan Muresan
- Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands
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Azzi V, Malaeb D, Khatib SE, Sakr F, Dabbous M, Hallit S, Soufia M. Association of behaviors and asthma control in a sample of Lebanese adolescents with asthma. Allergol Immunopathol (Madr) 2024; 52:51-59. [PMID: 38459891 DOI: 10.15586/aei.v52i2.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/08/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND The relationship between behavioral problems and asthma is bidirectional; while the presence of a chronic disease such as asthma might predispose the person to stress, anxiety, and other behavioral issues, behavioral problems might in turn cause uncontrolled asthma through nonadherence to asthma management strategies. In Lebanon, behavioral problems and uncontrolled asthma could be of significant concern for adolescents. Consequently, we found it necessary to evaluate association between behavioral problems and uncontrolled asthma in a sample of Lebanese adolescents. METHODS Data for this cross-sectional study were collected using the snowball sampling technique in July 2023. The questionnaire was developed with Google Forms and distributed to participants via social media platforms and messaging applications. The Asthma Control Test (ACT) was used to check for uncontrolled asthma, and the Youth Self-Report (YSR) scale was used to assess behavioral problems. It yields nine subscales (anxious-depressed, withdrawn-depressed, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior, aggressive behavior, and other problems) and a total score. RESULTS When taking each behavior score as an independent variable, older age was associated with lower ACT scores (more controlled asthma); F(15, 186) = 3.66, P = 0.014, and 95% Confidence Interval (CI) [-0.85, -0.10]. Living in a rural area, compared to urban was associated with higher ACT scores, P = 0.018, and 95% Confidence Interval (CI) [0.28, 2.94]. The intake of the COVID-19 vaccine, P = 0.003 and 95% CI [0.73, 3.55]; waterpipe smoking, P = 0.017 and 95% CI [0.38, 3.85]; and having more somatic complaints, P = 0.005 and 95% CI [0.04, 0.25], also were significantly associated with higher ACT scores (more uncontrolled asthma). When taking the total behavior score as an independent variable, higher YSR scores were associated with higher ACT scores (more uncontrolled asthma), F(10, 191) = 4.30, P = 0.038, and 95% CI [0.003, 0.10]. CONCLUSION Our findings support the inclusion of mental health treatments for better asthma control and point to a link between behavioral issues and uncontrolled asthma. In a developing nation without a clear established strategy for asthma prevention, the findings of this study could help develop potentially beneficial public health treatments.
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Affiliation(s)
- Vanessa Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Sami El Khatib
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
- Center for Applied Mathematics and Bioinformatics (CAMB), Gulf University for Science and Technology (GUST), Hawally, Kuwait
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan;
| | - Michel Soufia
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
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Andersén H, Bhatta L, Bashir M, Nwaru B, Langhammer A, Krokstad S, Piirilä P, Hisinger-Mölkänen H, Backman H, Kankaanranta H, Hedman L. Is there still a social gradient in respiratory symptoms? A population-based Nordic EpiLung-study. Respir Med 2024; 223:107561. [PMID: 38340905 DOI: 10.1016/j.rmed.2024.107561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Respiratory symptoms are a common public health issue that can partly be attributed to preventable risk factors, such as tobacco smoking and occupational exposure, which are more common in individuals with lower socioeconomic status. OBJECTIVE Our aim was to evaluate the social gradient in respiratory symptoms in Nordic countries. METHODS This study included participants aged 30-65 years from five cross-sectional population-based questionnaire surveys in 2016 in Finland and Sweden (N = 25,423) and in 2017-2019 in Norway (N = 27,107). Occupational skill levels 1 and 2 (occupations requiring compulsory education) were combined and compared to skill levels 3 and 4 (occupations requiring upper secondary and tertiary education). Meta-analysis was conducted to obtain pooled age- and sex adjusted odds ratios (aORs) of associations between occupational skill and the respiratory symptoms including recurrent wheeze, dyspnoea, and productive cough. RESULTS In the meta-analysis, recurrent wheeze, dyspnoea, and productive cough showed a social gradient. The participants with occupational skill 1 and 2 had higher risk for recurrent wheeze (aOR 1.78, 95% CI 1.34-2.22) and dyspnoea (aOR 1.59, 95% CI 1.29-1.90) compared to occupational skill 3 and 4 in Sweden and Finland. Similarly increased risk was observed for combined assessment of dyspnoea and wheeze (aOR 1.05, 95% CI 1.03-1.07) in Norway. In a meta-analysis including all three countries, the aOR for productive cough was 1.31 95% CI 1.07-1.56. CONCLUSIONS Occupations with lower, compared to higher, skill levels were associated with an increased risk of recurrent wheeze, dyspnoea, and productive cough.
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Affiliation(s)
- Heidi Andersén
- Vaasa Central Hospital, Oncology Unit, Cancer Center, Vaasa, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Laxmi Bhatta
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Muwada Bashir
- Krefting Research Center, Department of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bright Nwaru
- Krefting Research Center, Department of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Arnulf Langhammer
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway; HUNT Research Center, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Steinar Krokstad
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway; HUNT Research Center, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Päivi Piirilä
- Unit of Clinical Physiology, Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Finland; University of Helsinki, Helsinki, Finland
| | | | - Helena Backman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Krefting Research Center, Department of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Guilleminault L, Mounié M, Sommet A, Camus C, Didier A, Reber LL, Conte C, Costa N. The economic burden of asthma prior to death: a nationwide descriptive study. Front Public Health 2024; 12:1191788. [PMID: 38439749 PMCID: PMC10909909 DOI: 10.3389/fpubh.2024.1191788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 01/30/2024] [Indexed: 03/06/2024] Open
Abstract
Background In addition to the clinical burden, asthma is responsible for a high economic burden. However, little is known about the economic burden of asthma prior to death. Objective We performed an economic analysis to describe the costs during 12 and 24 months prior to asthma death between 2013 and 2017 in France. Methods An observational cohort study was established using the French national health insurance database. Direct medical and non-medical costs, as well as costs related to absence from the workplace, were included in the analysis. Results In total, 3,829 patients were included in the final analysis. Over 24 and 12 months prior to death, total medical costs per patient were €27,542 [26,545-28,641] and €16,815 [16,164-17,545], respectively. Total medical costs clearly increased over 24 months prior to death. Over 12 months prior to death, costs increased significantly according to age categories, with mean total costs of €8,592, €15,038, and €17,845, respectively, for the categories <18 years old, 18-75 years old, and 75+ years old (p < 0.0001). Over 12 months prior to death, costs were statistically higher in patients with a dispensation of six or more SABA canisters compared to those with a dispensation of five or less canisters (p < 0.0001). In multivariate analysis, comorbidities, hospital as location of death, and dispensation of 12 or more canisters of SABA per year are independent factors of the highest costs. Conclusion To conclude, the economic burden of asthma death is high and increases with time, age, and SABA dispensation.
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Affiliation(s)
- Laurent Guilleminault
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, CNRS U5282, Toulouse, France
- CRISALIS F-CRIN/INSERM, Toulouse, France
| | - Michael Mounié
- Unité d’Evaluation Médico-Economique, Centre Hospitalier Universitaire, Toulouse, France
- INSERM-UMR 1295 - Center for Epidemiology and Research in POPulation health (CERPOP), Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Agnès Sommet
- Unité “Méthodologie, Data management, Analyses Statistiques”, Centre d’Investigation Clinique 1436, Service de pharmacologie médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | | | - Alain Didier
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, CNRS U5282, Toulouse, France
- CRISALIS F-CRIN/INSERM, Toulouse, France
| | - Laurent Lionel Reber
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, CNRS U5282, Toulouse, France
| | - Cécile Conte
- Unité “Méthodologie, Data management, Analyses Statistiques”, Centre d’Investigation Clinique 1436, Service de pharmacologie médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Nadège Costa
- Unité d’Evaluation Médico-Economique, Centre Hospitalier Universitaire, Toulouse, France
- INSERM-UMR 1295 - Center for Epidemiology and Research in POPulation health (CERPOP), Université de Toulouse, Inserm, UPS, Toulouse, France
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9
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Sykes DL, See YY, Chow ECY, Crooks MG, Cummings H, Robinson M, Watkins K, Thompson J, Overton K, Riches C, Faruqi S. Digitally monitored inhaled therapy: a 'smart' way to manage severe asthma? J Asthma 2024:1-6. [PMID: 38323583 DOI: 10.1080/02770903.2024.2316726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/05/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION One of the fundamental challenges of managing patients with severe asthma is treatment adherence, particularly with inhaled corticosteroids. Adherence is difficult to measure objectively and poor adherence is associated with worse outcomes. In this study, assess the ability of a 'smart' inhaler to record adherence in severe asthma patients and measure the impact of this on asthma control. METHODS Consecutive consenting patients meeting criteria for biologics had their existing high-dose ICS/LABA//LAMA combination inhaler/s switched to mometasone/indacaterol/glycopyrronium (114/46/136). Routine clinical data, including blood eosinophils, FeNO, and ACQ-6 scores were collected at baseline and at 4 wk. Adherence was then checked on the Propeller Health app, and good adherence was defined as >80% of prescribed usage. Participants were then followed-up at 12 months to record the proportion of patients who were initiated on biologics. RESULTS 77 patients (mean [SD] age = 50.4 [15.7] years, 67.5% female [n = 52]) participated. 71 participants were able to use the device and 65% (n = 46) of these attained good asthma control and were not initiated on biologics at 12-month follow-up. Both groups demonstrated a significant reduction in ACQ6 score at follow-up (2.81 vs. 1.92, p < 0.001 and 3.05 vs. 2.60, p < 0.001, respectively), but there was no statistically significant difference in improvement between groups. Patients with optimal adherence also demonstrated a significant reduction in median FeNO at follow-up (47 ppb vs. 40 ppb, p = 0.003). CONCLUSIONS In severe asthma patients, 'smart' inhalers may represent an effective management tool to improve adherence and asthma control, therefore avoiding the need for patients to commence biological therapies.
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Affiliation(s)
- Dominic L Sykes
- Respiratory Research Group, Hull York Medical School, Heslington, UK
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Yee Yong See
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Evon C Y Chow
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Michael G Crooks
- Respiratory Research Group, Hull York Medical School, Heslington, UK
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | | | - Mandy Robinson
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Karen Watkins
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Joanne Thompson
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Kylie Overton
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Charlotte Riches
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Shoaib Faruqi
- Respiratory Research Group, Hull York Medical School, Heslington, UK
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
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10
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Moitra S, Adan A, Akgün M, Anderson A, Brickstock A, Eathorne A, Farshchi Tabrizi A, Haldar P, Henderson L, Jindal A, Jindal SK, Kerget B, Khadour F, Melenka L, Moitra S, Moitra T, Mukherjee R, Semprini A, Turner AM, Murgia N, Ferrara G, Lacy P. Less Social Deprivation Is Associated With Better Health-Related Quality of Life in Asthma and Is Mediated by Less Anxiety and Better Sleep Quality. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2115-2124.e7. [PMID: 37087095 DOI: 10.1016/j.jaip.2023.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Previous studies on health-related quality of life (HRQoL) in asthma have mainly focused on clinical and environmental determinants. Little is known about the role of social determinants on HRQoL in asthma. OBJECTIVES We aimed to investigate the association between social deprivation and HRQoL in asthma. METHODS A total of 691 adult asthmatics from Canada, India, New Zealand, and the United Kingdom were administered a digital questionnaire containing demographic information and questions about social and psychological attributes, sleep disturbances, and alcohol abuse. HRQoL was measured using the Short Form of the Chronic Respiratory Questionnaire (SF-CRQ). We analyzed the direct and indirect relationships between social deprivation and HRQoL using structural equation models with social deprivation as a latent variable. We tested for mediation via anxiety, depression, sleep disturbances, and alcohol abuse. RESULTS We found that less social deprivation (latent variable) was directly associated with better SF-CRQ domain scores such as dyspnea (regression coefficient β: 0.33; 95% confidence interval [CI]: 0.07 to 0.58), fatigue (β: 0.39; 95% CI: 0.14 to 0.64), and emotional function (β: 0.37; 95% CI: 0.11 to 0.62), but with the worse mastery score (β: -0.29; 95% CI: -0.55 to -0.03); however, those associations varied across participating countries. We also observed that among all individual social deprivation indicators, education, companionship, emotional support, instrumental support, and social isolation were directly associated with HRQoL, and the relationship between social deprivation and HRQoL was mediated through anxiety and sleep disturbances. CONCLUSIONS Our results demonstrated that less social deprivation was directly, and indirectly through less anxiety and better sleep quality, associated with better HRQoL in asthma.
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Affiliation(s)
- Subhabrata Moitra
- Division of Pulmonary Medicine and Alberta Respiratory Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Ana Adan
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain; Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Metin Akgün
- Department of Chest Diseases, Ataturk University, Erzurum, Turkey; Department of Pulmonary Medicine, Ağrı İbrahim Çeçen University, School of Medicine, Ağrı, Turkey
| | | | - Amanda Brickstock
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Allie Eathorne
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Ali Farshchi Tabrizi
- Division of Pulmonary Medicine and Alberta Respiratory Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Prasun Haldar
- Department of Medical Laboratory Technology, Supreme Institute of Management and Technology, Mankundu, West Bengal, India; Department of Physiology, West Bengal State University, Barasat, West Bengal, India
| | - Linda Henderson
- Synergy Respiratory and Cardiac Care, Sherwood Park, AB, Canada
| | | | | | - Bugra Kerget
- Department of Chest Diseases, Ataturk University, Erzurum, Turkey
| | - Fadi Khadour
- Synergy Respiratory and Cardiac Care, Sherwood Park, AB, Canada
| | - Lyle Melenka
- Synergy Respiratory and Cardiac Care, Sherwood Park, AB, Canada
| | - Saibal Moitra
- Department of Pulmonary Medicine, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Tanusree Moitra
- Department of Psychology, Barrackpore Rashtraguru Surendrananth College, Barrackpore, West Bengal, India
| | - Rahul Mukherjee
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Alex Semprini
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Alice M Turner
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Nicola Murgia
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Ferrara
- Division of Pulmonary Medicine and Alberta Respiratory Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Paige Lacy
- Division of Pulmonary Medicine and Alberta Respiratory Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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11
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Abbott EE, Vargas-Torres C, Kligler SK, Spadafore S, Lin MP. Predictors of outpatient follow-up care after adult emergency department asthma visits and association with 30-day outcomes. J Asthma 2023; 60:938-945. [PMID: 35938828 PMCID: PMC10014489 DOI: 10.1080/02770903.2022.2109166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/20/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
Objective: Guidelines recommend outpatient follow-up after emergency department visits for asthma, but factors related to rates of follow-up among the adult population are understudied. We sought to describe patient and community-level predictors of outpatient follow-up after an index ED visit for asthma and evaluate the association between outpatient follow-up visits and subsequent ED revisits.Methods: We conducted a retrospective observational cohort study of adult patients with emergency departments visits for asthma. The primary predictor was time to outpatient follow-up visit within 30 days of the index ED visit. The primary outcome was all-cause ED revisit within 30 days of the index ED visit. Cox proportional hazards regression was utilized to test the association between time to outpatient follow-up and hazard of ED revisit within 30 days.Results: Time to outpatient follow-up visit within 30 days was not significantly associated with hazard of 30-day ED revisit for asthma (HR 1.05; 95% CI 0.69-1.61). However, male patients (HR 1.45; 95% C 1.11-1.89) and smokers (HR 1.67; 95% CI 1.22-2.29) were significantly more likely to have an ED revisit.Conclusion: Younger, Black patients with Medicaid were less likely to receive follow-up care relative to older patients insured by Medicare. While follow-up visits were not associated with 30-day revisit rates, differences by age, race, and insurance status suggest disproportionate barriers to accessing care. Future research may target these subgroups to improve transitions of care after an ED visit for asthma.
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Affiliation(s)
- Ethan E Abbott
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, NY
| | - Carmen Vargas-Torres
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, NY
| | | | - Sophia Spadafore
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, NY
| | - Michelle P. Lin
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, NY
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York, NY
- Icahn School of Medicine at Mount Sinai, Institute for Health Equity Research, New York, NY
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12
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Tong X, Yin P, Liu W, Chen S, Geldsetzer P, Long Z, Cheng A, Zhou M, Li Y. Spatial, temporal and demographic patterns in asthma mortality in China: A systematic analysis from 2014 to 2020. World Allergy Organ J 2023; 16:100735. [PMID: 36789097 PMCID: PMC9900450 DOI: 10.1016/j.waojou.2022.100735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 01/29/2023] Open
Abstract
Background Asthma is an important contributor to the burden of non-communicable diseases in China. Understanding spatial, temporal, and demographic patterns in asthma mortality is relevant to the design and implementation of targeted interventions. Methods This study collected information on asthma deaths occurring across 605 disease surveillance points (DSPs) as recorded in the population-based national mortality surveillance system (NMSS) of China. Asthma was defined according to the International Classification of Diseases, 10th Revision code J45-J46. Estimates of age-standardized mortality rates and total national asthma deaths were calculated based on yearly population data. Statistical analysis was performed to investigate the influence of various factors on asthma mortality. Results Between 2014 and 2020, a total of 40 116 asthma deaths occurred in DSPs. Standardized asthma mortality per 100 000 people decreased from 1.79 (95% CI: 1.74-1.83) in 2014 to 1.07 (95% CI: 1.03-1.10) in 2020 in China. In 2020, the overall asthma mortality rate was higher for male patients than for female patients, and asthma mortality rates increased substantially with age. Age-standardized asthma mortality per 100,000 people exhibited significant geographic variation, ranging from 0.93 (95% CI: 0.89-0.98) in Eastern China to 1.04 (95% CI: 0.98-1.10) in Central China and 1.37 (95% CI: 1.29-1.45) in Western China in 2020. Asthma mortality in urban areas appeared to be higher than in rural areas. Socioeconomic factors, including gross domestic product per capita and density of hospital beds per 10,000 population, may be related to asthma mortality. Male asthma patients who lived in rural areas and were aged 65 years and above were generally at high risk of asthma-related mortality. Conclusions This study found a spatial and temporal trend for a reduction in asthma deaths over seven years in China; however, there remain important sociodemographic groups that have not secured the same decrease in mortality rates. Trial registration This was a purely observational study and thus registration was not required.
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Affiliation(s)
- Xunliang Tong
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Yin
- National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China
| | - Wei Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China
| | - Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Zheng Long
- National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China
| | - Anqi Cheng
- Department of Tobacco Control and Prevention of Respiratory Diseases China-Japan Friendship Hospital, Beijing, China,WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China,National Center for Respiratory Medicine, Beijing, China,National Clinical Research Center for Respiratory Diseases, Beijing, China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China,Corresponding author. National Center for Chronic and Non-Communicable Disease Control and Prevention, China CDC, Beijing, China
| | - Yanming Li
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China,Corresponding author. Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
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13
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Redmond C, Heaney LG, Chaudhuri R, Jackson DJ, Menzies-Gow A, Pfeffer P, Busby J. Benefits of specialist severe asthma management: demographic and geographic disparities. Eur Respir J 2022; 60:2200660. [PMID: 35777771 PMCID: PMC9753476 DOI: 10.1183/13993003.00660-2022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The benefits of specialist assessment and management have yet to be evaluated within the biologic era of UK severe asthma treatment, and potential disparities have not been considered. METHODS In an uncontrolled before-and-after study, we compared asthma symptoms (Asthma Control Questionnaire-6 (ACQ-6)), exacerbations, unscheduled secondary care use, lung function (forced expiratory volume in 1 s (FEV1)) and oral corticosteroid (OCS) dose after 1 year. We compared outcomes by sex, age (18-34, 35-49, 50-64 and ≥65 years), ethnicity (Caucasian versus non-Caucasian) and hospital site after adjusting for demographics and variation in biologic therapy use. RESULTS 1140 patients were followed-up for 1370 person-years from 12 specialist centres. At annual review, ACQ-6 score was reduced by a median (interquartile range (IQR)) of 0.7 (0.0-1.5), exacerbations by 75% (33-100%) and unscheduled secondary care by 100% (67-100%). FEV1 increased by a median (IQR) of 20 (-200-340) mL, while OCS dose decreased for 67% of patients. Clinically meaningful improvements occurred across almost all patients, including those not receiving biologic therapy. There was little evidence of differences across demographic groups, although those aged ≥65 years demonstrated larger reductions in exacerbations (69% versus 52%; p<0.001) and unscheduled care use (77% versus 50%; p<0.001) compared with patients aged 18-34 years. There were >2-fold differences between the best and worst performing centres across all study outcomes. CONCLUSIONS Specialist assessment and management is associated with substantially improved patient outcomes, which are broadly consistent across demographic groups and are not restricted to those receiving biologic therapy. Significant variation exists between hospitals, which requires further investigation.
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Affiliation(s)
- Charlene Redmond
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Liam G Heaney
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Belfast Health and Social Care NHS Trust, Belfast, UK
| | | | - David J Jackson
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, UK
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | | | | | - John Busby
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
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14
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Global burden of asthma associated with high body mass index from 1990 to 2019. Ann Allergy Asthma Immunol 2022; 129:720-730.e8. [PMID: 36002091 DOI: 10.1016/j.anai.2022.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/29/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND High body mass index (BMI) plays a key role in the progression of asthma and asthma related to high BMI resulted in a high burden of disease globally. OBJECTIVE This study aimed to explore the geographical and temporal trends in the global burden of asthma associated with high BMI from 1990 to 2019. METHODS This is a retrospective analysis with data based on the Global Burden of Disease Study 2019 database. The deaths, disability-adjusted life-years (DALYs), age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were estimated according to sex, age and sociodemographic indexes (SDI) levels. Estimated annual percentage change (EAPC) was used to evaluate the variation trends of ASMR and ASDR from 1990 to 2019. RESULTS In 2019, the number of global asthma deaths and DALYs related to high BMI increased by 69.69% and 63.91% respectively compared with 1990, among which more deaths and DALYs occurred in females. The corresponding ASMR and ASDR showed a slightly decreasing tendency globally. South Asia accounted for the highest number of deaths and DALYs, with India ranked first worldwide in 2019. The number of deaths and DALYs mainly appeared in individuals 60-79 years old and 55-69 years old respectively from 1990 to 2019. The heaviest burden existed in the low-middle SDI region. CONCLUSION The global asthma burden associated with obesity increased in absolute value but the standardized burden decreased slightly. Large variations existed in the high BMI-related asthma burdens among sexes, ages and regions.
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15
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Paoletti G, Pepys J, Casini M, Di Bona D, Heffler E, Goh CYY, Price DB, Canonica GW. Biologics in severe asthma: the role of real-world evidence from registries. Eur Respir Rev 2022; 31:31/164/210278. [PMID: 35675922 DOI: 10.1183/16000617.0278-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/20/2022] [Indexed: 11/05/2022] Open
Abstract
Asthma is one of the most common noncommunicable diseases; in the majority of patients it is well controlled with inhaled bronchodilators and inhaled corticosteroids, but the management of severe asthma has been a significant challenge historically. The introduction of novel biologic drugs in the past few decades has revolutionised the field, presenting physicians with a variety of biologic drugs with different mechanisms for the treatment of severe asthma.It is of crucial importance to evaluate the effectiveness of these drugs by following their "real-life" effectiveness rather than relying solely on their efficacy, established in carefully designed clinical trials, which therefore do not necessarily match the profile of the real-life patient. Understanding the actual effectiveness of the specific drugs in real-life patients is a crucial part of tailoring the right drugs to the right patients. Registries serve as an important tool in obtaining real-life evidence, since they are in effect observational studies, following the entire patient population.
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Affiliation(s)
- Giovanni Paoletti
- IRCCS Humanitas Research Hospital, Milan, Italy.,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Jack Pepys
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Casini
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Dept of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Enrico Heffler
- IRCCS Humanitas Research Hospital, Milan, Italy.,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Celine Y Y Goh
- Optimum Patient Care Global, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David B Price
- Optimum Patient Care Global, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Giorgio Walter Canonica
- IRCCS Humanitas Research Hospital, Milan, Italy .,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
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