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Tsang KCH, Pinnock H, Wilson AM, Shah SA. Application of Machine Learning Algorithms for Asthma Management with mHealth: A Clinical Review. J Asthma Allergy 2022; 15:855-873. [PMID: 35791395 PMCID: PMC9250768 DOI: 10.2147/jaa.s285742] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/16/2022] [Indexed: 12/21/2022] Open
Abstract
Background Asthma is a variable long-term condition. Currently, there is no cure for asthma and the focus is, therefore, on long-term management. Mobile health (mHealth) is promising for chronic disease management but to be able to realize its potential, it needs to go beyond simply monitoring. mHealth therefore needs to leverage machine learning to provide tailored feedback with personalized algorithms. There is a need to understand the extent of machine learning that has been leveraged in the context of mHealth for asthma management. This review aims to fill this gap. Methods We searched PubMed for peer-reviewed studies that applied machine learning to data derived from mHealth for asthma management in the last five years. We selected studies that included some human data other than routinely collected in primary care and used at least one machine learning algorithm. Results Out of 90 studies, we identified 22 relevant studies that were then further reviewed. Broadly, existing research efforts can be categorized into three types: 1) technology development, 2) attack prediction, 3) patient clustering. Using data from a variety of devices (smartphones, smartwatches, peak flow meters, electronic noses, smart inhalers, and pulse oximeters), most applications used supervised learning algorithms (logistic regression, decision trees, and related algorithms) while a few used unsupervised learning algorithms. The vast majority used traditional machine learning techniques, but a few studies investigated the use of deep learning algorithms. Discussion In the past five years, many studies have successfully applied machine learning to asthma mHealth data. However, most have been developed on small datasets with internal validation at best. Small sample sizes and lack of external validation limit the generalizability of these studies. Future research should collect data that are more representative of the wider asthma population and focus on validating the derived algorithms and technologies in a real-world setting.
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Affiliation(s)
- Kevin C H Tsang
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew M Wilson
- Asthma UK Centre for Applied Research, and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Syed Ahmar Shah
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
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Brasil-Oliveira R, Cruz ÁA, Souza-Machado A, Pinheiro GP, Inácio DDS, Sarmento VA, Lins-Kusterer L. Oral health-related quality of life in individuals with severe asthma. J Bras Pneumol 2020; 47:e20200117. [PMID: 33174972 PMCID: PMC7889316 DOI: 10.36416/1806-3756/e20200117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate oral health-related quality of life (OHRQoL) among individuals with severe asthma, comparing it with that observed among individuals with mild-to-moderate asthma and individuals without asthma. METHODS We conducted a cross-sectional study of 125 individuals: 40 with severe asthma; 35 with mild-to-moderate asthma; and 50 without asthma. We calculated the decayed, missing, and filled teeth (DMFT) index, as well as the Periodontal Screening and Recording index, and determined the stimulated salivary flow rate. We applied three structured questionnaires: the 14-item Oral Health Impact Profile (OHIP-14); the Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2); and the Work Ability Index (WAI). RESULTS Periodontitis and reduced salivary flow were both more common in the severe asthma group than in the mild-to-moderate asthma and no-asthma groups. In addition, the WAI scores were lower in the severe asthma group than in the mild-to-moderate asthma and no-asthma groups, as were the scores for all SF-36v2 domains. The individuals with severe asthma also scored lower for the OHIP-14 domains than did those without asthma. Although the mean DMFT index did not differ significantly among the groups, the mean number of missing teeth was highest in the severe asthma group. Strong correlations between the SF-36v2 Component Summaries and poorer OHRQoL were only observed in the severe asthma group. CONCLUSIONS Severe asthma appears to be associated with poorer oral health, poorer OHRQoL, a lower WAI, and lower scores for SF-36v2 domains.
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Affiliation(s)
- Rebeca Brasil-Oliveira
- . Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador (BA) Brasil
| | - Álvaro Augusto Cruz
- . Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador (BA) Brasil
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia, Salvador (BA) Brasil
| | - Adelmir Souza-Machado
- . Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador (BA) Brasil
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia, Salvador (BA) Brasil
| | - Gabriela Pimentel Pinheiro
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia, Salvador (BA) Brasil
| | - Debora Dos Santos Inácio
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia, Salvador (BA) Brasil
| | | | - Liliane Lins-Kusterer
- . Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador (BA) Brasil
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Kui SL, How CH, Koh J. PILL Series. The 'problematic' asthma patient. Singapore Med J 2016; 56:368-71; quiz 372. [PMID: 26243972 DOI: 10.11622/smedj.2015106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Asthma is a reversible chronic inflammatory disorder of the airways that can be effectively controlled without causing any lifestyle limitation or burden on the quality of life of the majority of asthma patients. However, persistently uncontrolled asthma can be frustrating for both the patient and the managing physician. Patients who fail to respond to high-intensity asthma treatment fall into the category of 'problematic' asthma, which is further subdivided into 'difficult' asthma and 'severe refractory' asthma. Establishing the correct diagnosis of asthma and addressing comorbidities, compliance, inhaler technique and environmental triggers are essential when dealing with 'problematic' asthma patients. A systemic approach is also crucial in managing such patients. This is pertinent for general practitioners, as the majority of asthma patients are diagnosed and managed at the primary care level.
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Affiliation(s)
- Swee Leng Kui
- SingHealth Residency (Internal Medicine), Changi General Hospital, Singapore
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore
| | - Jansen Koh
- SingHealth Residency (Internal Medicine), Changi General Hospital, Singapore ; Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
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Son J, Brennan PF, Zhou S. Rescue inhaler usage prediction in smart asthma management systems using joint mixed effects logistic regression model. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/0740817x.2015.1078014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Several years ago, omalizumab became commercially available for the treatment of severe asthma. It remains the only monoclonal antibody to be marketed for this purpose. Since then, many studies have been published endorsing its efficacy and effectiveness. Concomitantly, evidence of an overlap between atopic and non-atopic severe asthma has emerged. However, there also appears to be some disagreement regarding the value of omalizumab in the management of non-atopic disease, as some studies have failed to show any benefit in these patients. The recent literature has also sought to identify appropriate prognostic biomarkers for the use of omalizumab, other than immunoglobulin (IgE) levels. This article briefly summarizes the evolution of asthma treatment, the pathophysiology of the condition, and the method of action of omalizumab. The author describes the controlled and uncontrolled studies (also named "real-life studies") published in adult and pediatric populations in different countries and expresses his view on the current place of the drug in the management of severe allergic asthma. He offers a personal perspective on the recent evidence for the use of omalizumab in non-atopic patients, highlighting the implications for current clinical practice and the gaps in our knowledge. The author justifies his belief that omalizumab is not only an IgE-blocking drug and should be considered as a disease-modifying therapy because of its multiple effects on different biologic pathways. Finally, some areas for future research are indicated.
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Affiliation(s)
- Christian Domingo
- Pulmonary Service, Hospital de Sabadell (Corporació Sanitària i Universitària Parc Taulí), Parc Taulí 1, 08208, Sabadell (Barcelona), Spain,
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Gomes-Filho IS, Soledade-Marques KR, Seixas da Cruz S, de Santana Passos-Soares J, Trindade SC, Souza-Machado A, Fischer Rubira-Bullen IR, de Moraes Marcílio Cerqueira E, Barreto ML, Costa de Santana T, Freitas Coelho JM. Does periodontal infection have an effect on severe asthma in adults? J Periodontol 2013; 85:e179-87. [PMID: 24224961 DOI: 10.1902/jop.2013.130509] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The effect of periodontal infection on systemic diseases and conditions has been the subject of numerous studies worldwide. It is considered that periodontitis may influence the hyperinflammatory response in patients with severe asthma as a result of immuno-inflammatory changes. This study aims to evaluate the influence of periodontitis on severe asthma in adults. METHODS A case-control study was carried out, comprising 220 adult individuals: 113 diagnosed with asthma (case group) and 107 without asthma diagnosis (control group). The diagnosis of periodontitis was established after a full clinical examination using probing depth, clinical attachment level, and bleeding on probing. The diagnosis of severe asthma was based on the criteria recommended by the Global Initiative of Asthma (2012). Descriptive analyses of the variables were performed, followed by bivariate analyses, using the χ(2) test. Association measurements (odds ratio [OR]), with and without adjustment for potential confounders, were obtained. A significance level of 5% was used. RESULTS The ORunadjusted for the main association was 4.38 (95% confidence interval [CI] = 2.47 to 7.75). In the logistic regression model, after adjusting for age, education level, osteoporosis, smoking habit, and body mass index, the ORadjusted was 4.82 (95% CI = 2.66 to 8.76), which was statistically significant. Individuals with periodontal infection showed, approximately, five times more likelihood to have bronchial inflammation than those without such periodontal tissue infection. CONCLUSION The findings demonstrate the influence of periodontitis on severe asthma, given that the frequency of periodontitis is higher in individuals with severe asthma than in those without a diagnosis of bronchial inflammation.
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Caruso M, Crisafulli E, Demma S, Holgate S, Polosa R. Disabling inflammatory pathways with biologics and resulting clinical outcomes in severe asthma. Expert Opin Biol Ther 2013; 13:393-402. [PMID: 23289846 DOI: 10.1517/14712598.2013.743989] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Patients with severe asthma have a significant unmet need with persistent symptoms and/or frequent exacerbations despite high intensity treatment. These severe unrelenting symptoms have a huge impact on heathcare resources due to frequent hospital admissions and requirement for intensive and expensive medications. There is a compelling need for more effective and safer therapies to help severe asthma sufferers to achieve adequate control of their disease. AREAS COVERED Expanding knowledge of innate and adaptive immune responses has led to development of new biologic approaches for severe asthma. Here, the authors will review the existing efficacy and safety data from clinical trials of some of the new biologic therapies that are in development for severe asthma. Their specific role in distinctively targeted subpopulations of severe asthmatics will be also discussed. EXPERT OPINION Defining and phenotyping severe asthma patients will become increasingly important as some patients who were previously classified as having severe asthma may become well-controlled with a targeted phenotype-specific treatment. However, pharmacoeconomic concerns should also be taken into account given the elevated acquisition costs of recombinant human monoclonals and of the diagnostic screening procedures for the identification of potential responders.
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Affiliation(s)
- Massimo Caruso
- University of Catania-AOU Policlinico-V. Emanuele, Department of Clinical and Molecular Bio-Medicine-Institute of Internal Medicine and Clinical Immunology, Catania, 95124, Italy
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Polosa R, Casale T. Monoclonal antibodies for chronic refractory asthma and pipeline developments. Drug Discov Today 2012; 17:591-9. [PMID: 22306350 DOI: 10.1016/j.drudis.2012.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 12/22/2011] [Accepted: 01/18/2012] [Indexed: 01/21/2023]
Abstract
Patients with severe asthma suffer persistent symptoms and/or frequent exacerbations despite high-intensity treatment. Their severe unrelenting symptoms have a huge impact on healthcare resources owing to frequent hospital admissions and requirement for intensive treatments. Consequently, there is an undeniable need for more-effective and safer medications. Expanding knowledge of innate and adaptive immune responses is leading to the development of novel therapies for severe asthma. Herein, we review efficacy and safety data from human clinical trials of monoclonal antibodies that are approved or under investigation for use in asthma. Future drug candidates directed at key targets and the specific role of monoclonal antibodies in distinctively targeted sub-populations of severe asthmatics will be also discussed.
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Affiliation(s)
- Riccardo Polosa
- Institute of Internal Medicine, G. Rodolico, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Italy.
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Clienti S, Morjaria JB, Basile E, Polosa R. Monoclonal antibodies for the treatment of severe asthma. Curr Allergy Asthma Rep 2011; 11:253-60. [PMID: 21360131 DOI: 10.1007/s11882-011-0184-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Patients with severe asthma have a significant unmet need with persistent symptoms and/or frequent exacerbations despite treatment with high-dose steroid and other currently available therapies. These patients are also at risk of developing steroid-related side effects, and their severe, unrelenting symptoms have a huge impact on health care resources due to frequent hospital admissions and requirement for intensive medication use. Consequently, a compelling need exists for more effective and safer pharmacotherapies to help them achieve adequate disease control. Recent novel therapies for severe asthma are now emerging, some of the most promising of which are monoclonal antibodies. Monoclonal antibodies represent a form of immunotherapy used in a wide variety of therapeutic roles. The spectrum of disease states in which monoclonal antibodies have been approved for therapeutic use now includes respiratory and allergic diseases. At present, only one drug is licensed for allergic asthmatics with severe disease, omalizumab. We review some of the currently available biologics that are approved or under investigation for use in severe asthma. Some have shown to be useful in specifically targeted subpopulations of patients with severe asthma, whereas other have proven to be unsafe and/or unsuccessful. Despite these developments, more effort should be devoted to identifying new molecular targets, testing innovative approaches, and establishing the best use of what is available. Regarding this latter point, identifying individual characteristics that predict successful responses to these treatments is highly desirable.
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Affiliation(s)
- Salvatore Clienti
- Institute of Internal Medicine, S. Marta Hospital, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy
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Abstract
Asthma usually presents with symptoms of wheeze, dyspnoea and cough. However, clinicians should be aware of atypical presentation of this disorder when cough is the main or only symptom in conditions such as cough-variant asthma, nonasthmatic eosinophilic bronchitis and atopic cough. Early diagnosis and treatment of these conditions with inhaled corticosteroids improves symptoms in the majority of patients. Up to 10% of patients with asthma remain poorly controlled in spite of optimal standard therapy. These patients have been encompassed under the term 'treatment-refractory asthma' (TRA), have the greatest morbidity and are responsible for more than 50% of healthcare costs. In this review we discuss investigations, management and pathophysiology of the various phenotypes of atypical presentations of asthma as well as novel biological agents licensed and those that have been reported in clinical trials in terms of their efficacy and safety in TRA.
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Affiliation(s)
- Jaymin B. Morjaria
- Division of Respiratory Medicine, Hull and East Yorkshire NHS Trust, University of Hull, Hull York Medical School, Castle Hill Hospital, Castle Road, Cottingham HU16 5JQ, UK
| | - Jack A. Kastelik
- Division of Respiratory Medicine, Hull and East Yorkshire NHS Trust, University of Hull, Hull York Medical School, Castle Hill Hospital, Castle Road, Cottingham HU16 5JQ, UK
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Stratified medicine in selecting biologics for the treatment of severe asthma. Curr Opin Allergy Clin Immunol 2011; 11:58-63. [PMID: 21150434 DOI: 10.1097/aci.0b013e3283423245] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Despite optimal treatment, asthma symptoms in about 5-10% of patients remain poorly controlled. Apart from having an impact on their asthma-related quality of life and adverse effects of the medications used (especially corticosteroids), their severe symptoms also impact healthcare resources due to frequent admission and requirement for intensive medications use. The last decade has seen an improved understanding in the pathophysiology of the complex cellular and molecular networks involved in the inflammatory and immunological phenotype of severe asthma. This knowledge may help providing strategies by which these phenotypes operate and pave the way for drug development and individualized treatment. RECENT FINDINGS Here we review the current evidence of biological agents in patients with severe asthma recently assessed for safety and efficacy. Some of these agents have shown to be useful in specifically targeted subpopulations of patients with severe asthma, whereas others have proven to be unsafe and/or unsuccessful. In addition, we discuss recent data on clinical and pharmacokinetic-pharmacodynamic aspects of omalizumab, the only licensed anti-IgE therapy for severe atopic asthma. SUMMARY More basic science work is required to improve the current understanding of severe asthma pathophysiology and proof-of-concept clinical studies are required to explore relevant biomolecular targets in this small subset of patients. At present, only one drug is licensed for allergic asthmatic patients with severe disease, omalizumab. Novel therapies in the form of oligonucleotide therapies and other biological agents are also being investigated in the difficult-to-treat asthmatic patient group.
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