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Arif MI, Ru L, Wang Y. Risk factors associated with uncontrolled asthma in children - a systematic review and meta-analysis. J Asthma 2024; 61:387-395. [PMID: 37999990 DOI: 10.1080/02770903.2023.2288317] [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: 10/05/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE We aim to assess the risk factors of uncontrolled asthma in children and adolescents. METHODS A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to July 17, 2023. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effects model was used when heterogeneity was seen to pool the studies, and the result was reported in the odds ratio and the corresponding 95% confidence interval. We also used a narrative approach where it was not feasible to quantitatively assess the outcome. RESULTS Ten observational studies were used to conduct this systematic review and meta-analysis. A quantitative analysis of five factors was done. Pooled analysis showed a statistically significant risk of uncontrolled asthma in association with past hypersensitivity reactions (standardized mean difference [SMD] = 1.51 (1.16, 1.98); p = .002; I2 = 84%) and incomplete controller adherence (SMD = 3.15 (1.83, 5.41); p < .0001; I2 = 94%). While non-significant relation was seen in parental asthma (SMD = 1.23 (0.98, 1.55); p = .07; I2 = 15%), oral corticosteroid use (SMD = 0.99 (0.72, 1.36); p = .96; I2 = 81%) and education of caregivers (SMD = 0.99 (0.72, 1.36); p = .96; I2 = 81%). Some other factors were also discussed qualitatively. CONCLUSION Our study shows that some significant risk factors might cause uncontrolled asthma in children and adolescents like past hypersensitivity reactions and incomplete controller adherence.
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Affiliation(s)
- Muhammad Imran Arif
- Department of Pediatrics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Liang Ru
- Department of Pediatrics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yanan Wang
- Department of Pediatrics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Shamji MH, Boyle RJ. Management of childhood asthma and tools to evaluate asthma pathophysiology. Clin Exp Allergy 2023; 53:1138-1140. [PMID: 37963729 DOI: 10.1111/cea.14417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Mohamed H Shamji
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, UK
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Ardura-Garcia C, Mallet MC, Berger DO, Hoyler K, Jochmann A, Kuhn A, Moeller A, Regamey N, Singer F, Pedersen ESL, Kuehni CE. Predictors of asthma control differ from predictors of asthma attacks in children: The Swiss Paediatric Airway Cohort. Clin Exp Allergy 2023; 53:1177-1186. [PMID: 37658735 DOI: 10.1111/cea.14390] [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: 11/09/2022] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND It is unclear if predictors of asthma attacks are the same as those of asthma symptom control in children. OBJECTIVE We evaluated predictors for these two outcomes in a clinical cohort study. METHODS The Swiss Paediatric Airway Cohort (SPAC) is a multicentre prospective clinical cohort of children referred to paediatric pulmonologists. This analysis included 516 children (5-16 years old) diagnosed with asthma. At baseline, we collected sociodemographic information, symptoms, personal and family history and environmental exposures from a parental baseline questionnaire, and treatment and test results from hospital records. Outcomes were assessed 1 year later by parental questionnaire: asthma control in the last 4 weeks as defined by GINA guidelines, and asthma attacks defined as any unscheduled visit for asthma in the past year. We used logistic regression to identify and compare predictors for suboptimal asthma control and asthma attacks. RESULTS At follow-up, 114/516 children (22%), reported suboptimal asthma control, and 114 (22%) an incident asthma attack. Only 37 (7%) reported both. Suboptimal asthma control was associated with poor symptom control at baseline (e.g. ≥1 night wheeze/week OR: 3.2; 95% CI: 1.7-6), wheeze triggered by allergens (2.2; 1.4-3.3), colds (2.3; 1.4-3.6) and exercise (3.2; 2-5), a more intense treatment at baseline (2.4; 1.3-4.4 for Step 3 vs. 1), history of preschool (2.6; 1.5-4.4) and persistent wheeze (2; 1.4-3.2), and exposure to tobacco smoke (1.7; 1-2.6). Incident asthma attacks were associated with previous episodes of severe wheeze (2; 1.2-3.3) and asthma attacks (2.8; 1.6-5 for emergency care visits), younger age (0.8; 0.8-0.9 per 1 year) and non-Swiss origin (0.3; 0.2-0.5 for Swiss origin). Lung function, exhaled nitric oxide (FeNO) and allergic sensitization at baseline were not associated with control or attacks. CONCLUSION Children at risk of long-term suboptimal asthma control differ from those at risk of attacks. Prediction tools and preventive efforts should differentiate these two asthma outcomes.
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Affiliation(s)
| | - Maria Christina Mallet
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Daria Olena Berger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Karin Hoyler
- Kinderpneumologie Horgen, Private Practice for Pediatric Pneumology, Horgen, Switzerland
| | - Anja Jochmann
- Department of Paediatric Pulmonology, University Children's Hospital Basel, Basel, Switzerland
| | - Alena Kuhn
- Department of Paediatrics, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Moeller
- Department of Respiratory Medicine, University Children's Hospital Zurich and Children's Research Centre, University of Zurich, Zurich, Switzerland
| | - Nicolas Regamey
- Division of Paediatric Pulmonology, Children's Hospital, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Florian Singer
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Claudia Elisabeth Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Zhang S, White J, Hunter AG, Hinds D, Fowler A, Gardiner F, Slade D, Murali S, Meeraus W. Suboptimally controlled asthma in patients treated with inhaled ICS/LABA: prevalence, risk factors, and outcomes. NPJ Prim Care Respir Med 2023; 33:19. [PMID: 37156824 PMCID: PMC10167343 DOI: 10.1038/s41533-023-00336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/02/2023] [Indexed: 05/10/2023] Open
Abstract
This observational claims-linked survey study assessed the prevalence of and risk factors for suboptimal asthma control and healthcare utilization in adults with asthma receiving fixed-dose combination (FDC) inhaled corticosteroid/long-acting β2-agonist (ICS/LABA). Commercially insured adults from the Optum Research Database were invited to complete the Asthma Control Test (ACT) and Asthma Control Questionnaire-6 (ACQ-6). Among participants (N = 428), 36.4% (ACT-assessed) and 55.6% (ACQ-6-assessed) had inadequately controlled asthma. Asthma-related quality of life was worse and asthma-related healthcare resource utilization was higher in poorly controlled asthma. Factors associated with ACT-defined suboptimal asthma control in multivariate analysis included: frequent short-acting β2-agonist (SABA) use, asthma-related outpatient visits, lower treatment adherence, and lower education levels. During follow-up, factors associated with asthma exacerbations and/or high SABA use included: inadequately controlled asthma (ACT-assessed), body mass index ≥30 kg/m2, and high-dose ICS/LABA. Approximately 35-55% of adults with asthma were inadequately controlled despite FDC ICS/LABA; poor control was associated with worse disease outcomes.
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Chu F, Kappel N, Akel M, Press VG, Alexander JT, Volerman A. Validity of the Childhood Asthma Control Test in diverse populations: A systematic review. Pediatr Pulmonol 2023; 58:1322-1336. [PMID: 36718492 PMCID: PMC10121871 DOI: 10.1002/ppul.26342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE We examined the validity of the Childhood Asthma Control Test (C-ACT) and identified recommended thresholds for uncontrolled asthma in children from varying backgrounds. METHODS A systematic literature review was performed utilizing PubMed, Ovid Medline, SCOPUS, CINAHL, and conference proceedings. Studies were included if they enrolled children, had a primary outcome of asthma control, examined test validity or psychometrics, and utilized the C-ACT. Along with study design and demographic data, we extracted all outcomes and comparisons used to validate the C-ACT. We evaluated risk of bias using the COSMIN Risk of Bias tool. Our protocol was registered with PROSPERO (CRD42020211119). RESULTS Of 4924 records screened, 28 studies were included. Studies were conducted internationally and published between 2007 and 2018. Average number of enrolled participants was 193 (SD = 155, range = 22-671). Ten studies calculated Cronbach's α (mean [SD] = 0.78(0.05), range = 0.677-0.83). Thirteen studies recommended cut-offs for uncontrolled asthma (≤18-≤24). Nine studies found significant agreement or correlation between C-ACT and Global Initiative for Asthma guidelines/physician assessment of asthma control (correlation coefficients range = 0.219-0.65). Correlation coefficients between C-ACT and spirometry were <0.6 in five of six studies that included spirometry. Kappa values for C-ACT and various spirometry measurements ranged 0.00-0.34. CONCLUSIONS The C-ACT showed good internal consistency and mixed levels of agreement and correlation with various clinical asthma measures. Recommended cut-offs for asthma control varied and had no consistent relationship with nationality, race, ethnicity, or language. Few studies examined cross-cultural validity and multiple populations remain under-studied.
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Affiliation(s)
- Francesca Chu
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Nicole Kappel
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Mary Akel
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Valerie G Press
- University of Chicago, Department of Medicine, Section of General Internal Medicine
- University of Chicago, Department of Pediatrics, Section of Academic Pediatrics
| | - Jason T Alexander
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Anna Volerman
- University of Chicago, Department of Medicine, Section of General Internal Medicine
- University of Chicago, Department of Pediatrics, Section of Academic Pediatrics
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D'Agostino EM, Zhang S, Day SE, Konty KJ, Armstrong S, Skinner A, Neshteruk CD. The longitudinal association between asthma severity and physical fitness among new York City public school youth. Prev Med 2023; 170:107486. [PMID: 36931475 DOI: 10.1016/j.ypmed.2023.107486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/20/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
Severe persistent childhood asthma is associated with low physical activity and may be associated with poor physical fitness. Research on the asthma severity-fitness association longitudinally and across sociodemographic subgroups is needed to inform fitness interventions targeting youth with asthma. We evaluated the relationship between asthma severity (categorized as severe, mild, or no asthma) and subsequent fitness in New York City (NYC) public school youth enrolled in grades 4-12 using the NYC Fitnessgram dataset (2010-2018). Longitudinal mixed models with random intercepts were fit to test the association between asthma severity and one-year lagged fitness z-scores by clustering repeated annual observations at the student level. Models were adjusted for sex, race/ethnicity, grade level, poverty status, time, and stratified by sociodemographic factors. The analytic sample included 663,137 students (51% male; 31% non-Hispanic Black, 40% Hispanic; 55% in grades 4-8, 70% high poverty; 87%, 11% and 1% with no, mild, and severe asthma, respectively). Students with severe asthma and mild asthma demonstrated -0.19 (95% CI, -0.20 to -0.17) and - 0.10 (95% CI, -0.11 to -0.10), respectively, lower fitness z-scores in the subsequent year relative to students without asthma. After stratifying by demographics, the magnitude of the asthma severity-fitness relationship was highest for non-Hispanic white vs. all other racial/ethnic subgroups, and was similar across sex, grade level, and household poverty status. Overall, we observed an inverse longitudinal relationship between asthma severity and subsequent fitness among urban youth, particularly non-Hispanic Whites. Future research should examine how neighborhood-level factors impact the asthma severity-fitness relationship across racial/ethnic subgroups.
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Affiliation(s)
- Emily M D'Agostino
- Department of Orthopaedic Surgery, Duke University Medical School, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America.
| | - Sue Zhang
- Trinity College of Arts and Sciences, Duke University, Durham, NC, United States of America
| | - Sophia E Day
- New York City Department of Health and Mental Hygiene, Office of School Health, NY, New York, United States of America
| | - Kevin J Konty
- New York City Department of Health and Mental Hygiene, Office of School Health, NY, New York, United States of America
| | - Sarah Armstrong
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America; Department of Pediatrics, Duke University Medical School, Durham, NC, United States of America; Duke Global Health Institute, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
| | - Asheley Skinner
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
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Walid Al-Qerem, Jarab A, Abu Heshmeh SR, Ling J. Variables associated with asthma control among adult patients. J Asthma 2022; 60:1290-1298. [PMID: 36336819 DOI: 10.1080/02770903.2022.2144351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective: Asthma is one of the most prevalent chronic diseases with a substantial impact on the health status of affected patients. Further research is necessary to identify factors contributing to poor asthma control. The current study aimed to investigate the factors associated with poor asthma control among adult asthmatic patients.Methods: In this case-control study, the Asthma Control Test (ACT) was translated into Arabic and distributed to adults with asthma attending two hospitals in Jordan to evaluate the degree of asthma control. The following variables were collected for each patient: sociodemographic information, comorbidities, appropriate use of inhaler technique, spirometric measurements, and medications use. Binary regression was used to evaluate factors associated with asthma control.Results: A total of 314 participants with a mean age of 51.47 years (±16.37) completed the study. ACT score had a mean of 16.68 (±4.86). The majority of asthmatic patients had insufficiently controlled asthma (64.6%). Binary regression results showed that previous respiratory infection history (p = 0.014, OR = 0.473 (95%CI 0.261-0.857)), higher exposure to irritants (p = 0.010, OR = 0.747 (95%CI 0.598-0.933)) decreased the odds of being in the controlled asthma group. Patients receiving inhaled corticosteroids (ICS) had higher odds of being in the controlled asthma group (p = 0.039, OR = 2.372 (95%CI 1.043-5.392)).Conclusions: The majority of asthma patients had insufficiently managed disease. The main factors that contributed to poor asthma control were respiratory infection history, increased exposure to asthma symptoms triggers, and ICS nonuse.
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Affiliation(s)
- Walid Al-Qerem
- Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan
| | - Anan Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
- Collage of Pharmacy, Al Ain University, Abu Dhabi, UAE
| | - Shrouq R Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Chester Road, Sunderland, SR1 3SD, United Kingdom
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Gater A, Nelsen L, Coon CD, Eremenco S, O'Quinn S, Khan AH, Eckert L, Staunton H, Bonner N, Hall R, Krishnan JA, Stoloff S, Schatz M, Haughney J, Coons SJ. Asthma Daytime Symptom Diary (ADSD) and Asthma Nighttime Symptom Diary (ANSD): Measurement Properties of Novel Patient-Reported Symptom Measures. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1249-1259. [PMID: 34896298 DOI: 10.1016/j.jaip.2021.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/27/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Asthma Daytime Symptom Diary (ADSD) and the Asthma Nighttime Symptom Diary (ANSD) were developed to meet the need for standardized patient-reported measures of asthma symptoms to assess treatment trial outcomes in adults and adolescents. OBJECTIVE To determine scoring and evaluate the measurement properties of the ADSD/ANSD. METHODS Adolescents (12-17 years) and adults (18+ years) with asthma completed draft 8-item electronic versions of the ADSD/ANSD for 10 days alongside the Adult Asthma Symptom Daily Scales (AASDS) and a Patient Global Impression of Severity (PGIS). Using classical and modern psychometric methods, initial analyses evaluated the performance of ADSD/ANSD items to inform scoring. Subsequent analyses evaluated the reliability and validity of ADSD/ANSD scores. RESULTS A demographically and clinically diverse sample (n = 130 adolescents; n = 89 adults) was recruited. Item performance was generally strong. However, items assessing chest pressure and mucus/phlegm demonstrated redundancy and poorer performance and were removed. Principal-components analysis, confirmatory factor analysis, and item response theory supported combining items to form 6-item total ADSD/ANSD scores. Internal consistency (α = 0.94-0.95) and test-retest reliability (intraclass correlation coefficient = 0.86-0.95) were strong. Strong correlations (r = 0.72-0.80) were observed between ADSD scores and AASDS items assessing asthma symptom frequency, bother, and impact on activities. Significant differences (P < .001) in mean ADSD/ANSD scores were observed between groups categorized by asthma severity (PGIS), asthma control, inhaler use, nebulizer use, activity limitations, and nighttime awakenings. CONCLUSIONS The ADSD/ANSD items and scores demonstrated strong reliability and validity. Implementation of the measures in interventional studies will enable the evaluation of responsiveness and meaningful within-patient change.
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Affiliation(s)
- Adam Gater
- Adelphi Values Ltd, Bollington, Cheshire, United Kingdom.
| | | | | | - Sonya Eremenco
- Patient-Reported Outcome Consortium, Critical Path Institute, Tucson, Ariz
| | | | | | | | - Hannah Staunton
- Roche Products Limited, Welwyn Garden City, Hertfordshire, United Kingdom
| | - Nicola Bonner
- Adelphi Values Ltd, Bollington, Cheshire, United Kingdom
| | - Rebecca Hall
- Adelphi Values Ltd, Bollington, Cheshire, United Kingdom
| | | | | | - Michael Schatz
- Kaiser Permanente Medical Center/Kaiser Foundation Hospital, San Diego, Calif
| | - John Haughney
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Stephen Joel Coons
- Patient-Reported Outcome Consortium, Critical Path Institute, Tucson, Ariz
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Silva-Lavigne N, Valderrama A, Pelaez S, Bransi M, Balli F, Gervais Y, Gaudy T, Tse SM. Acceptability of Serious Games in Pediatric Asthma Education and Self-management: Pilot Study. JMIR Pediatr Parent 2022; 5:e33389. [PMID: 35389354 PMCID: PMC9030910 DOI: 10.2196/33389] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Asthma is the most common chronic pediatric disease. Despite existing tools to manage asthma, 40%-55% of children with asthma experience uncontrolled asthma. Serious games (SGs) represent a novel approach in promoting asthma education and self-management for children. OBJECTIVE In this qualitative pilot study with an embedded quantitative design, we aim to use focus groups and questionnaires to describe the perceived role of SGs in different aspects of asthma self-management by children and their parents. These aspects include asthma perception and knowledge, the impact of asthma and barriers to asthma self-management, and the support system for asthma self-management. METHODS A total of 5 children with asthma and their parents were invited to participate in an organized gaming session. Children and their parents completed a pregaming questionnaire on their medical history and asthma knowledge. Then, they were invited to test 4 original SG prototypes, after which the children answered a postgaming questionnaire on their asthma knowledge and perception of the SGs. Children and their parents subsequently participated in parallel focus groups, which were video-recorded or audio-recorded, transcribed verbatim, and analyzed by reaching consensus among members of the research team. RESULTS The mean age of the children was 10.3 (SD 1.5) years, with 20% (1/5) of the children being male. Qualitative data from the transcripts were coded into three separate domains: asthma self-management perception and knowledge, impact of asthma and barriers to asthma self-management, and support system for asthma self-management. We specifically explored the perceived roles of SGs within each domain. A key takeaway message was identified for each of these three domains: heterogeneity of asthma knowledge and the ability of SGs to encourage knowledge transfer through games, consequences and limitations of asthma and the ability of SGs to allow for identification and management of real-life situations through games, and insufficient support system and the ability of SGs to encourage playing with others for support and shared knowledge. CONCLUSIONS Our pilot study explored the role of SGs in the self-management of asthma, as perceived by children and their parents. Our findings support the acceptability of SGs in asthma education and self-management in pediatrics and the necessity for future development in this field.
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Affiliation(s)
| | - Alena Valderrama
- Health Promotion Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada.,Breathing Games Association, Geneva, Switzerland
| | - Sandra Pelaez
- Research Centre, Sainte-Justine University Hospital Center, Montreal, QC, Canada.,School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Myriam Bransi
- Faculty of Medicine, Laval University, Quebec, QC, Canada.,Department of Pediatrics, Centre mère-enfant Soleil of Quebec City University Hospital Center, Quebec, QC, Canada
| | - Fabio Balli
- Breathing Games Association, Geneva, Switzerland.,Concordia University, Montreal, QC, Canada
| | | | - Thomas Gaudy
- Breathing Games Association, Geneva, Switzerland
| | - Sze Man Tse
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, QC, Canada
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10
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Mulugeta T, Ayele T, Zeleke G, Tesfay G. Asthma control and its predictors in Ethiopia: Systematic review and meta-analysis. PLoS One 2022; 17:e0262566. [PMID: 35025962 PMCID: PMC8758033 DOI: 10.1371/journal.pone.0262566] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Determining the status of asthma control and identifying risk factors for poor asthma control is a key strategy for curbing the negative health impacts and the financial burden of the disease. Therefore, this review was aimed to determine the rate of asthma control and assess the predictors of uncontrolled asthma in Ethiopia. METHODS PubMed, Web of Science, and Google Scholar searches were performed using key terms; "asthma, bronchial asthma, control, controlled, uncontrolled and Ethiopia" up to October 16, 2020. University repositories were also searched to retrieve gray literature. The results were presented as a prevalence rate with a 95% confidence interval (CI). Subgroup analysis and meta-regression were performed to identify the sources of heterogeneity in the outcomes. RESULTS From 1,388 patients, based on the Global Initiative for Asthma (GINA) symptom control, the rate of the uncontrolled asthma was 45.0% (95% CI 34.0% - 56.0%) with a considerable heterogeneity between the studies; (I2: 94.55, p< 0.001). About 19.0% (95% CI 10.0% - 29.0%); (I2: 96.04, p< 0.001) of the asthma patients had a well-controlled asthma. Moreover, 36.0% (95% CI 22.0% - 50.0%), (I2: 97.11, p< 0.001) of patients had a partly controlled asthma. Similarly, based on the asthma control test (ACT), the rate of well-controlled asthma was 22.0% (95% CI 3% - 42.0%), with considerable heterogeneity between the studies; (I2: 97.75, p< 0.001). The most frequent predictors of uncontrolled asthma were incorrect inhalation techniques, frequent SABA use, moderate/severe persistent asthma, history of exacerbations, presence of comorbidities, use of oral corticosteroids, and irregular follow-up. CONCLUSION The rate of uncontrolled asthma in Ethiopia was high. Several factors are associated with uncontrolled asthma. Comprehensive asthma educations at each follow-up visit should be strengthened to minimize the morbidity and the cost of uncontrolled asthma.
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Affiliation(s)
- Temesgen Mulugeta
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
- * E-mail:
| | - Teshale Ayele
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getandale Zeleke
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Gebremichael Tesfay
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
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Papi A, Kostikas K, Nikolaev I, Kottakis I. Indacaterol acetate/glycopyrronium bromide/mometasone furoate: a combination therapy for asthma. CURRENT RESPIRATORY MEDICINE REVIEWS 2022. [DOI: 10.2174/1573398x18666220217151845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract:
Despite the wide range of available therapies, asthma remains uncontrolled in 40–65% of patients for a number of different reasons. Treatment with an inhaled corticosteroid (ICS) is recommended in the Global Initiative for Asthma 2021 report for patients across all asthma severities, with treatment options combining an ICS with a long-acting β2-agonist (LABA) or a LABA and a long-acting muscarinic antagonist (LAMA), depending on disease severity. Based on this, the availability of single inhaler fixed-dose ICS/LABA/LAMA combination is a major need in asthma management. Indacaterol acetate/glycopyrronium bromide/mometasone furoate has been developed as a once-daily inhaled asthma treatment that combines an ICS (mometasone furoate), a LABA (indacaterol acetate) and a LAMA (glycopyrronium bromide) in a formulation delivered using the dry powder inhaler Breezhaler®, for patients with uncontrolled asthma on medium- or high-dose ICS/LABA. This article provides an overview of the different and complementary mechanisms of action, and the clinical effectiveness of the monocomponents of the indacaterol/glycopyrronium/mometasone furoate fixed combination, and highlights the benefits of using the three agents in combination in patients with moderate and severe asthma.
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Affiliation(s)
- Alberto Papi
- Respiratory Medicine, University of Ferrara, Italy
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Pelaia C, Crimi C, Crimi N, Ricciardi L, Scichilone N, Valenti G, Bonavita O, Andaloro S, Morini P, Rizzi A, Pelaia G. Indacaterol/glycopyrronium/mometasone fixed dose combination for uncontrolled asthma. Expert Rev Respir Med 2021; 16:183-195. [PMID: 34845963 DOI: 10.1080/17476348.2021.2011222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Asthma symptoms can be relieved through a maintenance treatment combining long-acting β2-agonist and inhaled corticosteroids (LABA/ICS). However, for patients with inadequately controlled asthma, the LABA/ICS combination might not be sufficient, and clinical guidelines recommend the administration of inhaled long-acting muscarinic antagonists (LAMA) as an add-on therapy to better control asthma and improve lung function. For nearly two decades, the only LAMA to be approved on the market has been tiotropium. AREAS COVERED We reviewed recent clinical studies evaluating the safety and efficacy of LABA/LAMA/ICS fixed dose combinations by searching the PubMed database. Molecular mechanisms and clinical data support the use of a once-daily, single-inhaler fixed dose combination of the LABA/LAMA/ICS indacaterol/glycopyrronium/mometasone (IND/GLY/MF), the first therapy combining three agents in a fixed dose approved in Europe for the treatment of uncontrolled asthma. EXPERT OPINION IND/GLY/MF was superior to both IND/MF and salmeterol/fluticasone, a well-established LABA/ICS combination improving the lung function in uncontrolled asthma. Moreover, IND/GLY/MF, delivered through the Breezhaler inhaler in a single inhalation, is the first inhaled therapy prescribed alongside a digital companion, a sensor and the Propeller app, allowing for improved treatment adherence, reduced rescue inhaler usage and hospitalizations, increased patient satisfaction and asthma control.
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Affiliation(s)
- Corrado Pelaia
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Claudia Crimi
- Respiratory Disease Unit, University Hospital of Catania, Catania, Italy
| | - Nunzio Crimi
- Respiratory Disease Unit, University Hospital of Catania, Catania, Italy
| | - Luisa Ricciardi
- Allergy and Clinical Immunology Unit, A.O.U. Policlinico "G. Martino", Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Nicola Scichilone
- Medicine of the Respiratory System, Hospital 'P. Giaccone', University of Palermo, Palermo, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Pta Biondo, ASP Palermo, Italy
| | | | | | - Paolo Morini
- Medical Department, Novartis Farma Origgio, Varese, Italy
| | - Andrea Rizzi
- Medical Department, Novartis Farma Origgio, Varese, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
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Intimate Partner Violence and Adult Asthma Morbidity: A Population-Based Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4300-4309.e7. [PMID: 34364825 DOI: 10.1016/j.jaip.2021.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/01/2021] [Accepted: 06/16/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The etiologies for difficult-to-control asthma are complex and incompletely understood. Intimate partner violence (IPV) is a pervasive problem and may play a role in difficult-to-control asthma. IPV is associated with increased prevalence of asthma. There are no prior studies evaluating IPV's association with adult asthma exacerbations. OBJECTIVE This study hypothesized that IPV exposure would be associated with increased asthma exacerbations, higher symptom burden, and poorer asthma control among adults. METHODS Analyses are based on 2634 adults who participated in the 2005 Behavioral Risk Factor Surveillance System survey, reported active asthma, and completed the asthma and IPV questions. We used multivariate logistic regression to examine the association of IPV with asthma morbidity outcomes while controlling for the following potential confounders: sex, race, education, health care coverage, smoking status, age, and body mass index. RESULTS The prevalence of IPV was 32.4%. IPV was associated with increased odds of an asthma exacerbation (adjusted odds ratio [AOR] = 1.75, 95% confidence interval [CI] = 1.26-2.43), higher symptom burden (AOR = 2.33, 95% CI = 1.53-3.55), and lack of asthma control (AOR = 2.23, 95% CI = 1.22-4.09) when using composite measures for these outcomes. When using single-item measures for outcomes, IPV was also associated with increased asthma-related emergency department or urgent care visits (AOR = 2.35, 95% CI = 1.56-3.54), other urgent provider visits (AOR = 1.84, 95% CI = 1.28-2.64), perceived asthma attacks (AOR = 1.53, 95% CI = 1.12-2.09), limitations (AOR = 2.07, 95% CI = 1.49-2.89), daytime symptoms (AOR = 1.92, 95% CI = 1.35-2.72), and nocturnal awakenings (AOR = 1.88, 95% CI = 1.32-2.69). CONCLUSIONS IPV is prevalent in adult asthmatics and consistently and significantly associated with worsened adult asthma morbidity, even after adjusting for key confounders. Further research is needed to more fully understand the mechanisms underlying these relationships.
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Racine G, Forget A, Moullec G, Jiao T, Blais L, Lemiere C. Predictors of Asthma Control and Exacerbations: A Real-World Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2802-2811.e2. [PMID: 33962067 DOI: 10.1016/j.jaip.2021.04.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Achieving optimal asthma control and minimizing the risk of exacerbation are the main goals of asthma treatment. OBJECTIVE This study aimed to assess the predictors of poor asthma control and asthma exacerbations within a population of moderate to severe asthmatic patients treated in a tertiary-care center. METHODS We conducted a cohort study assessing 738 patients enrolled in the Quebec registry in respiratory health (RESP) with a diagnosis of asthma confirmed by a respirologist and treated in a tertiary care center from April 2010 to March 2016. Sociodemographic and clinical data, including Asthma Control Questionnaire score, were collected at enrollment in the registry (ie, cohort entry) and patients were followed for a 2-year period thereafter. The information regarding exacerbations that occurred during follow-up was collected in administrative databases (Régie d l'assurance médicale du Québec [RAMQ], Maintenance et exploitation des données pour l'étude de la clientèle hospitalière [MED-ECHO], and medication data registry [reMed]). RESULTS We assessed 738 subjects (64% women). Psychological distress (odds ratio [OR] 1.91; 95% confidence interval [95% CI] 1.21-3.02), smoking (OR 3.72; 95% CI 1.72-8.05]), and poor lung function, forced expiratory volume in 1 second less than 50% (OR 4.1; 95% CI 1.48-11.34]) appeared as significant factors associated with uncontrolled asthma. Occurrence of previous asthma exacerbations (hazard ratio [HR] 6.25; 95% CI 4.01-9.75]), poor asthma control (HR 1.60; 95% CI 1.07-2.38]), forced expiratory volume in 1 second between 50% and 80% (HR 2.25; 95% CI 1.58-3.34]), and older age (HR 2.26; 95% CI 1.37-3.74]) were associated with asthma exacerbations. Adherence to asthma treatment was very low in patients with (44.4% ± 34.4%) and without asthma exacerbations (37.5% ± 33.0%). CONCLUSIONS Psychological distress and current smoking are modifiable factors that need to be addressed in tailored behavioral interventions to improve asthma control. Asthma exacerbations are mostly associated with the intrinsic severity of the disease.
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Affiliation(s)
- Geneviève Racine
- CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada
| | - Amélie Forget
- CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada
| | - Grégory Moullec
- CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada
| | - Tianze Jiao
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lucie Blais
- CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada
| | - Catherine Lemiere
- CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada.
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15
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Roman-Rodriguez M, Molina-Paris J, Fernandez-Sanchez A. Compliance with the clinical guidelines for managing asthma by primary care physicians: An ambispective observational study. Rev Clin Esp 2021; 221:207-216. [PMID: 32151431 DOI: 10.1016/j.rce.2019.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/23/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. MATERIAL AND METHODS We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. RESULTS Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3-30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4-33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13-0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12-0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40-2.06). CONCLUSIONS Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines.
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Affiliation(s)
- M Roman-Rodriguez
- Centro de Salud Son Pisa, Instituto de Investigación Sanitaria de Baleares, Palma de Mallorca, Baleares, España.
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16
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Ilmarinen P, Stridsman C, Bashir M, Tuomisto LE, Vähätalo I, Goksör E, Kankaanranta H, Backman H, Langhammer A, Piirilä P, Rönmark E, Lundbäck B, Nwaru BI, Wennergren G. Level of education and asthma control in adult-onset asthma. J Asthma 2021; 59:840-849. [PMID: 33497270 DOI: 10.1080/02770903.2021.1871742] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Education in itself and as a proxy for socioeconomic status, may influence asthma control, but remains poorly studied in adult-onset asthma. Our aim was to study the association between the level of education and asthma control in adult-onset asthma. METHODS Subjects with current asthma with onset >15 years were examined within the Obstructive Lung Disease in Northern Sweden study (OLIN, n = 593), Seinäjoki Adult Asthma Study (SAAS, n = 200), and West Sweden Asthma Study (WSAS, n = 301) in 2009-2014 in a cross-sectional setting. Educational level was classified as primary, secondary and tertiary. Uncontrolled asthma was defined as Asthma Control Test (ACT) score ≤19. Altogether, 896 subjects with complete data on ACT and education were included (OLIN n = 511, SAAS n = 200 and WSAS n = 185). RESULTS In each cohort and in pooled data of all cohorts, median ACT score was lower among those with primary education than in those with secondary and tertiary education. Uncontrolled asthma was most common among those with primary education, especially among daily ICS users (42.6% primary, 28.6% secondary and 24.2% tertiary; p = 0.001). In adjusted analysis, primary education was associated with uncontrolled asthma in daily ICS users (OR 1.92, 95% CI 1.15-3.20). When stratified by atopy, the association between primary education and uncontrolled asthma was seen in non-atopic (OR 3.42, 95% CI 1.30-8.96) but not in atopic subjects. CONCLUSIONS In high-income Nordic countries, lower educational level was a risk factor for uncontrolled asthma in subjects with adult-onset asthma. Educational level should be considered in the management of adult-onset asthma.
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Affiliation(s)
- Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | - Muwada Bashir
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Iida Vähätalo
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Emma Goksör
- Department of Paediatrics, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden
| | - Arnulf Langhammer
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Bright I Nwaru
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Göran Wennergren
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden
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17
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Sheriff F, Agarwal A, Thipse M, Radhakrishnan D. Hot spots for pediatric asthma emergency department visits in Ottawa, Canada. J Asthma 2021; 59:880-889. [PMID: 33567912 DOI: 10.1080/02770903.2021.1887891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Pediatric asthma emergency department (ED) visits and repeat visits place a substantial burden on healthcare. National and provincial level studies demonstrate geographic variation in asthma ED visits and links to marginalization, but preclude translation into practical targeting of healthcare delivery. It is important to understand the relationship between pediatric asthma ED visits and marginalization at a more granular level. To map the city-level geographic variation in pediatric asthma ED visit and re-visit rates at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada and the relationship with marginalization. METHODS We performed a single center retrospective cohort study of children ages 1-17 with one or more ED visits for asthma at the CHEO in Ottawa. Using postal codes, we linked patients to census tracts. Per census tract, we mapped pediatric asthma ED visit and re-visit rates within one year and identified overlap with the Ontario Marginalization Index. RESULTS Of 1,620 children with an index ED visit, 18.5% had a repeat ED visit. We identified 10 hot spot census tracts each for pediatric asthma ED visit and re-visit rates. We identified an overlap between urban hot spots and areas with high ethnic concentration or low dependency. CONCLUSION At a granular, city-wide level, pediatric asthma ED visit and re-visit rates are heterogeneous. Urban hot spots, in contrast to rural, have more overlap with marginalization, especially ethnic concentration. These methods can be used in other jurisdictions to inform practical community strategies for geographically-targeted prevention of pediatric asthma-related ED visits in vulnerable areas.Abbreviations:ED:Emergency department;CHEO:Children's Hospital of Eastern Ontario;PRAM:Pediatric Respiratory Assessment Measure;ON-Marg:Ontario Marginalization Index;SES:Socioeconomic status;US:United States. Supplemental data for this article can be accessed at publisher's website.
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Affiliation(s)
- Falana Sheriff
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Amisha Agarwal
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Madhura Thipse
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Dhenuka Radhakrishnan
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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18
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Cox ED, Palta M, Lasarev M, Binder AT, Connolly JR, Flynn KE. Influences of health and environmental deprivation on family relationships among children with chronic disease. Qual Life Res 2021; 30:1337-1346. [PMID: 33496901 DOI: 10.1007/s11136-020-02737-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Families play a key role in managing chronic illness. Among chronically ill children, we describe the Patient-Reported Outcomes Measurement Information System (PROMIS) Family Relationships measure over time and its associations with sociodemographics, environmental deprivation, and health. METHODS Parents of children aged 8-18 years with asthma (n = 171), type 1 diabetes (n = 199), or sickle cell disease (n = 135), recruited in pediatric clinics and emergency departments (ED), completed demographic surveys. Every six months for up to three years, children completed PROMIS Family Relationships, Anxiety, and Depressive Symptoms short forms (T-scores; mean 50, SD = 10), and a 5-level health status item. Linear mixed models were fit to estimate associations. RESULTS Older baseline age was associated with weaker family relationships. For example, for each 3-year higher baseline age, relationships were 3 points weaker for males (- 3.0; 95%CI - 5.7 to - .0.2) and females (- 3.1; 95%CI - 6.0 to - 0.3) with asthma recruited in the ED. For each 1-unit higher mean overall health, relationships were 4.6 points (95%CI 3.2-6.1) stronger for children with diabetes and about 2 points stronger for children with asthma (2.3; 0.7-3.9) and sickle cell disease (2.1; 0.3-3.9). Family relationships were 0.3-0.5 points weaker for each 1-unit increment in mean anxiety or depressive symptoms across all three diseases. Relationships were not significantly associated with environmental deprivation and generally stable over time. CONCLUSIONS Family relationships were weaker among older children and generally stable over time, yet fluctuated with physical and mental health. Monitoring PROMIS Family Relationships scores may facilitate referrals for chronically ill children who need support.
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Affiliation(s)
- Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H6/558 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-4108, USA.
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, USA.,Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, USA
| | - Michael Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, USA
| | - Alex T Binder
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H6/558 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-4108, USA
| | - Jenny R Connolly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H6/558 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-4108, USA
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
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Saifuddin A, Nasir UZ, Rengganis I, Shatri H. Risk factors for asthma exacerbation among Hajj pilgrims: a case study from DKI Jakarta, Indonesia. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.204170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Hajj pilgrims are prone to asthma exacerbation because of the high transmission rate of respiratory infections, severe environmental factors, and high-intensity activities during the Hajj. Well-controlled asthma status and preventive efforts prior to the Hajj could reduce such exacerbations. This research aimed to determine the risk factors of asthma exacerbation during the Hajj to help establish preventive measures.
METHODS Participants were evaluated at community health centers (puskesmas) through history taking, physical examination, and spirometry. The risk factors examined included a history of exacerbation one year before the Hajj, obesity, comorbidities (e.g., diabetes mellitus, hypertension, coronary heart disease), lung function, smoking, fitness level, and influenza vaccination. Asthma exacerbation while in Saudi Arabia was determined through direct observations by authors and physicians assigned to Hajj pilgrim groups and analysis of data obtained from questionnaires distributed to the pilgrims before their departure. Odds ratios (OR) were calculated using logistic regression.
RESULTS Among 68 pilgrims with asthma, exacerbation occurred in 27 (40%) pilgrims. Risk of asthma exacerbation was significantly increased in the pilgrims with a history of exacerbation one year before the Hajj (OR = 4.27; 95% confidence interval [CI] = 1.156–15.829; p = 0.029) and obesity grade II (OR = 4.02; 95% CI = 1.151–14.097; p = 0.029). Other factors, including smoking, comorbidities, lung function, fitness level, obesity grade I, and influenza vaccination, were not significantly related to exacerbation.
CONCLUSIONS Obesity grade II and history of asthma exacerbation one year before the Hajj are strong factors for asthma exacerbation during Hajj pilgrims.
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20
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Jiang D, Wang L, Ding M, Bai C, Zhu X, Chen O. Association between Body Mass Index Status and Childhood Asthma Control. Child Obes 2020; 16:274-280. [PMID: 32484760 DOI: 10.1089/chi.2020.0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The association between body mass index (BMI) status and childhood asthma control is not well understood. The aim of this study was to explore the association between BMI status and childhood asthma control. Methods: Two hundred forty-two children, aged 6-11 years, with asthma were included. The outcome variables were asthma control levels assessed by the Chinese version of the childhood asthma control test (C-ACT), asthma-related hospitalizations or emergency department (ED) visits in the past 12 months, and forced expiratory volume in 1 second (FEV1) as a percentage of the predicted value. The associations between BMI status (underweight, overweight, or obese, relative to normal weight) and the three outcome variables were estimated by ordinal logistic regression, binary logistic regression, and multiple linear regression analyses. Results: No significant association was found between BMI status and asthma control levels assessed by C-ACT, and between BMI status and asthma-related hospitalizations or ED visits in the past 12 months, after adjustment for age, sex, father's education level, mother's education level, per capita family monthly income, medical insurance, passive smoking, allergic rhinitis, course of disease, and medication compliance. A significant association between underweight and FEV1 as a percentage of the predicted value was found after adjustment for the above covariates. However, no significant association between overweight or obese and FEV1 as a percentage of the predicted value was found. Conclusions: This study shows that BMI status may not be associated with childhood asthma control. Given the inconsistency in current evidence, more studies are needed in the future to investigate this association.
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Affiliation(s)
- Di Jiang
- School of Nursing, Shandong University, Jinan, China
| | - Liwen Wang
- School of Nursing, Shandong University, Jinan, China
| | - Mingjie Ding
- Department of Respiratory Diseases, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Chenxiao Bai
- School of Nursing, Shandong University, Jinan, China
| | - Xiaobo Zhu
- Department of Pediatrics, The Second Hospital of Shandong University, Jinan, China
| | - Ou Chen
- School of Nursing, Shandong University, Jinan, China
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21
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Roman-Rodriguez M, Molina-Paris J, Fernandez Sanchez A. Compliance with the clinical guidelines for managing asthma by primary care physicians: An ambispective observational study. Rev Clin Esp 2020; 221:207-216. [PMID: 33998499 DOI: 10.1016/j.rceng.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/02/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. MATERIAL AND METHODS We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. RESULTS Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3-30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4-33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13-0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12-0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40-2.06). CONCLUSIONS Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with a better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines.
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Affiliation(s)
- M Roman-Rodriguez
- Centro de Salud Son Pisa, Instituto de Investigación Sanitaria de Baleares, Palma de Mallorca, Baleares, Spain.
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22
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Lindgren H, Hasselgren M, Montgomery S, Lisspers K, Ställberg B, Janson C, Sundh J. Factors associated with well-controlled asthma-A cross-sectional study. Allergy 2020; 75:208-211. [PMID: 31298735 PMCID: PMC7003902 DOI: 10.1111/all.13976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Helena Lindgren
- Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Mikael Hasselgren
- School of Medical Sciences, Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics Örebro University Örebro Sweden
- Clinical Epidemiology Division, Department of Medicine Karolinska Institutet Stockholm Sweden
- Department of Epidemiology and Public Health University College London UK
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine Uppsala University Uppsala Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine Uppsala University Uppsala Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy & Sleep Research Uppsala University Uppsala Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health Örebro University Örebro Sweden
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FitzGerald JM, Sadatsafavi M. Triple therapy in a single inhaler: a new option for uncontrolled asthma. Lancet 2019; 394:1690-1692. [PMID: 31582315 DOI: 10.1016/s0140-6736(19)32216-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Affiliation(s)
- J Mark FitzGerald
- The Lung Centre, Respiratory Division, University of British Columbia, Vancouver, BC V5Z1M9, Canada.
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V5Z1M9, Canada
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Yaghoubi M, Adibi A, Safari A, FitzGerald JM. The Projected Economic and Health Burden of Uncontrolled Asthma in the United States. Am J Respir Crit Care Med 2019; 200:1102-1112. [PMID: 31166782 PMCID: PMC6888652 DOI: 10.1164/rccm.201901-0016oc] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/05/2019] [Indexed: 01/02/2023] Open
Abstract
Rationale: Despite effective treatments, a large proportion of patients with asthma do not achieve sustained asthma control. The "preventable" burden associated with lack of proper control is likely taking a high toll at the personal and population level.Objectives: We predicted the future excess health and economic burden associated with uncontrolled asthma among American adolescents and adults for the next 20 years.Methods: We built a probabilistic model that linked state-specific estimates of population growth, aging, asthma prevalence, and asthma control levels. We conducted several meta-analyses to estimate the adjusted differences in healthcare resource use, quality-adjusted life years (QALYs), and productivity loss across control levels. We projected, nationally and at the state level, total direct and indirect (due to productivity loss) costs (in 2018 dollars) and QALYs lost because of uncontrolled asthma from 2019 to 2038.Measurements and Main Results: Total 20-year direct costs associated with uncontrolled asthma are estimated to be $300.6 billion (95% confidence interval [CI], $190.1 billion-411.1 billion). When indirect costs are added, total economic burden will be $963.5 billion (95% CI, $664.1 billion-1,262.9 billion). American adolescents and adults will lose an estimated 15.46 million (95% CI, 12.77 million-18.14 million) QALYs over this period because of uncontrolled asthma. Across states, the average 20-year per capita costs due to uncontrolled asthma ranged from $2,209 (Arkansas) to $6,132 (Connecticut).Conclusions: The burden of uncontrolled asthma is substantial and will continue to grow. Given that a substantial fraction of this burden is preventable, better adherence to evidence-informed asthma management strategies by care providers and patients has the potential to substantially reduce costs and improve quality of life.
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Affiliation(s)
- Mohsen Yaghoubi
- Faculty of Pharmaceutical Sciences, Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation and
| | - Amin Adibi
- Faculty of Pharmaceutical Sciences, Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation and
| | - Abdollah Safari
- Faculty of Pharmaceutical Sciences, Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation and
| | - J. Mark FitzGerald
- Department of Medicine, Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - for the Canadian Respiratory Research Network
- Faculty of Pharmaceutical Sciences, Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation and
- Department of Medicine, Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada
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Kavati A, Zhdanava M, Ortiz B, Lecocq J, Schiffman B, Pilon D, Ho H, Lefebvre P, Stone B. Retrospective Study on the Association of Biomarkers With Real-world Outcomes of Omalizumab-treated Patients With Allergic Asthma. Clin Ther 2019; 41:1956-1971. [PMID: 31563391 DOI: 10.1016/j.clinthera.2019.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/26/2019] [Accepted: 07/27/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Biomarkers, including blood eosinophils (EoS) and fractional exhaled nitric oxide (FeNO), may affect omalizumab outcomes in allergic asthma, but evidence in the literature remains mixed. This study assessed omalizumab outcomes in real-world patients with allergic asthma stratified by pretreatment biomarker levels. METHODS Patients with allergic asthma aged ≥12 years initiated on omalizumab with ≥12 months of data after index were identified in the Allergy Partners electronic medical records (2007-2018). Patients with ≥1 diagnosis of chronic obstructive pulmonary disease in combination with ≥10 pack-years of smoking, cystic fibrosis, Alpha-1 antitrypsin deficiency, bronchiectasis, interstitial lung disease, and sarcoidosis in the 12 months before or after index were excluded. Patients were stratified by pretreatment EoS (≥/<300 cells/μL) and FeNO (≥/<25 parts per billion). Outcomes, including Asthma Control Test (ACT) scores, forced expiratory volume in 1 second (FEV1), and FEV1 as a percentage of predicted value (FEV1% predicted), were compared using generalized estimating equations at 6 and 12 months after versus before index date in stratified patients with outcome measures available at both time periods. FINDINGS A total of 77 and 86 patients were stratified into the high and low EoS strata, respectively, and 56 patients into each of the intermediate-high and low FeNO strata. Compared with 6 months before index, mean difference (MD) in ACT scores at 6 months after index reached the minimally important difference of ≥3 points in high (MD = 3.75; 95% CI, 2.05-5.45) and low (MD = 4.56; 95% CI, 2.86-6.26) EoS, as well in the intermediate-high (MD = 3.75; 95% CI, 1.95-5.55) and low (MD = 3.55; 95% CI, 1.53-5.57) FeNO strata. Statistically significant improvements in mean FEV1 were observed in the high EoS (MD = 0.22 L/s; 95% CI, 0.08-0.35 L/s) and intermediate-high FeNO (MD = 0.13 L/s; 95% CI, 0.03-0.24 L/s) strata but not in the lower strata. In terms of mean FEV1% predicted, a statistically significant improvement was observed in high EoS stratum (MD = 4.95%; 95% CI, 0.60%-9.30%). Results that compared 12 months after versus before index date were similar. IMPLICATIONS Omalizumab was associated with statistically significant improvements in ACT scores largely reaching or exceeding minimally important difference across biomarker levels and with a statistically significant improvement in lung function more evident in high biomarker strata. Although response varied by biomarkers for some outcomes, all strata indicated improvements on ≥1 measure. Real-world patients with allergic asthma could benefit from omalizumab regardless of pretreatment biomarker levels, suggesting that pretreatment biomarker levels might not inform response.
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Affiliation(s)
| | | | - Benjamin Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Jason Lecocq
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Harriet Ho
- Analysis Group, Montreal, Quebec, Canada
| | | | - Brian Stone
- Allergy Partners of San Diego, San Diego, CA, USA
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26
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Smith CJ, Spaeder MC, Sorkness RL, Teague WG. Disparate diagnostic accuracy of lung function tests as predictors of poor asthma control in children. J Asthma 2019; 57:327-334. [PMID: 30663912 DOI: 10.1080/02770903.2019.1566471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Rationale: In practice, asthma control is assessed according to symptom burden and office spirometry. However, spirometry poorly tests peripheral lung function, which may be abnormal in asthma. Impluse oscillometry (IOS) and multiple-breath washout (MBW) are novel methods which measure reactance (X5) and ventilation heterogeneity (VH) in the peripheral lung, but how well these tests reflect asthma control is poorly understood. Objective: To compare the diagnostic accuracy of tests of large airways caliber (FEV1, FEV1/FVC, R20), peripheral zone properties (X5, VH), and airways inflammation (FeNO) as predictors of poor control in asthmatic children (44 poorly controlled/10 controlled). Methods: 54 children enriched in severe asthma completed a symptom-based control scale (ACT/cACT) and lung function tests after overnight bronchodilator withhold. The accuracy of each variable to predict poor control was ranked by area under the receiver operating characteristic (ROC) curve, sensitivity and specificity. Results: Among measures of large airways caliber, the FEV1% had the highest ROC curve area, with low sensitivity but perfect specificity. Among measures of peripheral lung function, X5 and VH in the conducting zone had fair curve areas with higher sensitivity but lower specificity compared to the FEV1%. VH in the acinar zone and FeNO both had poor accuracy. Conclusion: Tests of large airway and peripheral zone lung function performed disparately as predictors of poor control in a sample of children enriched in severe asthma. Further studies in a larger sample with more diverse phenotypic features are necessary to validate this preliminary conclusion.
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Affiliation(s)
- Clyde J Smith
- Division of Critical Care Medicine, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Michael C Spaeder
- Division of Critical Care Medicine, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ronald L Sorkness
- School of Pharmacy and Departments of Medicine and Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - W Gerald Teague
- Child Health Research Center, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
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Rege S, Kavati A, Ortiz B, Mosnaim G, Cabana MD, Murphy K, Aparasu RR. Documentation of asthma control and severity in pediatrics: analysis of national office-based visits. J Asthma 2019; 57:205-216. [PMID: 30657001 DOI: 10.1080/02770903.2018.1554069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To evaluate the extent of documentation of asthma control and severity and associated characteristics among pediatric asthma patients in office-based settings. Methods: This cross-sectional study utilized data from the 2012-2015 National Ambulatory Medical Care Survey (NAMCS). Patients aged 6-17 years with a diagnosis of asthma were included. Weighted descriptive analysis examined the extent of documentation and uncontrolled asthma; while logistic regression evaluated associated characteristics. Results: Overall, there were 2.47 million (95% confidence interval, 95% CI: 2.04-2.90) average annual visits with asthma as a primary diagnosis. Asthma control and severity was documented in only 36.1% and 33.8% of the visits, respectively. An established patient (odds ratio, OR = 3.81), Hispanic ethnicity (OR = 2.10), chronic sinusitis (OR = 5.59), and visits in the Northeast (OR = 2.12) and Midwest (OR = 2.25) regions had higher odds of documented asthma control status, whereas undocumented asthma severity (OR = 0.02), and visits in spring (OR = 0.34), had lower odds. Osteopathic doctors (OR = 0.18), visits in the Northeast region (OR = 0.23), chronic sinusitis (OR = 0.08), and undocumented asthma control status (OR = 0.03) had lower odds of documented asthma severity, whereas visits in spring (OR = 3.88) and autumn (OR = 3.32) had higher odds. Moderate/severe persistent asthma (OR = 15.35) had higher odds of uncontrolled asthma (as compared to intermittent asthma), while visits in the summer (OR = 0.14) had lower odds. Conclusion: The findings of this study suggest a critical need to increase the documentation of asthma severity and control to improve quality of asthma care in children.
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Affiliation(s)
- Sanika Rege
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA
| | - Abhishek Kavati
- US Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Benjamin Ortiz
- US Clinical Development and Medical Affairs, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Michael D Cabana
- Department of Pediatrics, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Kevin Murphy
- Boys Town National Research Hospital, Boys Town, NE, USA
| | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA
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Casale TB, Luskin AT, Busse W, Zeiger RS, Trzaskoma B, Yang M, Griffin NM, Chipps BE. Omalizumab Effectiveness by Biomarker Status in Patients with Asthma: Evidence From PROSPERO, A Prospective Real-World Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:156-164.e1. [DOI: 10.1016/j.jaip.2018.04.043] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/05/2018] [Accepted: 04/30/2018] [Indexed: 12/17/2022]
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Nguyen TS, Nguyen TLH, Pham TTV, Cao TBT, Nguyen VK, Hua S, Li SC. Effectiveness of a short training program for community pharmacists to improve knowledge and practice of asthma counselling - A simulated patient study. Respir Med 2018; 144:50-60. [PMID: 30366584 DOI: 10.1016/j.rmed.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/26/2018] [Accepted: 10/06/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Community pharmacists can make significant contributions and be an indispensable member in the asthma therapy chain. The present study aimed to investigate the current knowledge level of Vietnamese community pharmacists in asthma counselling and the impact of a short training program on asthma knowledge and practice. METHOD 300 community pharmacists participated in the study. A knowledge questionnaire about asthma medications and a standardized inhaler checklist were designed to evaluate their knowledge before and after a 4-h training program. Six to eight weeks later, 10 simulated patients were sent to the community pharmacies to evaluate the pharmacists' knowledge and practice. RESULTS The training program significantly improved the asthma knowledge score of pharmacists from 5.3 to 17.2 out of a maximum score of 20 (p < 0.001). After the training, the percentage of pharmacists performing correctly inhaler devices increased significantly (0% vs.∼50%, p < 0.001). In the simulated patient study, pharmacists who attended the training demonstrated better asthma knowledge with higher scores (5.4 vs 1.7 out of a maximum score of 7.0, p < 0.001), as well as much better inhaler technique scores (6.1 vs 4.3, out of a maximum score of 8, p < 0.001). These pharmacists achieved higher scores in all aspects encompassing distinguishing controllers and relievers, counselling correctly about adherence, and common side effects. CONCLUSION Our results revealed significant knowledge deficiency about asthma among Vietnamese community pharmacists. However, a short training program was effective in upskilling the pharmacists to effectively counsel asthmatic patients about the management of their condition and medications.
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Affiliation(s)
- Tu-Son Nguyen
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Viet Nam; School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Australia
| | | | - Thi Thuy Van Pham
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Viet Nam
| | - Thi Bich Thao Cao
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Viet Nam
| | | | - Susan Hua
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Australia.
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30
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Merchant R, Inamdar R, Henderson K, Barrett M, Su JG, Riley J, Van Sickle D, Stempel D. Digital Health Intervention for Asthma: Patient-Reported Value and Usability. JMIR Mhealth Uhealth 2018; 6:e133. [PMID: 29866644 PMCID: PMC6006012 DOI: 10.2196/mhealth.7362] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/16/2017] [Accepted: 03/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Although digital health tools are increasingly recognized as effective in improving clinical outcomes such as asthma control and medication adherence, few studies have assessed patient experiences and perception of value. Objective The aim of this study was to evaluate patient satisfaction, perception of usability and value, and desire to continue after 12 months of using a digital health intervention to support asthma management. Methods Participants were enrolled in a randomized controlled study evaluating the impact of a digital health platform for asthma management. Participants used electronic inhaler sensors to track medication use and accessed their information in a digital health platform. Electronic surveys were administered to intervention arm participants aged 12 years and older after 12 months of use. The survey assessed asthma control, patient satisfaction with the sensor device, and perception of the usability and value of the digital health platform through closed-ended and open-ended questions. Logistic regression models were used to assess the impact of participants’ characteristics on survey completion, satisfaction, and perception of value. Results Of the 207 intervention arm participants aged 12 years and older, 89 submitted survey responses (42.9% response rate). Of these 89 participants, 70 reported being very satisfied (79%, 70/89) or somewhat satisfied (20%, 18/89) with the inhaler sensor device. Moreover, 93% (83/89) expressed satisfaction with the reports, and 90% (80/89) found the information from the reports useful for learning about their asthma. In addition, 72% (64/89) of the participants reported that they were interested in continuing to use the sensor and platform beyond the study. There were no significant differences in satisfaction with the device or the platform across participants’ characteristics, including device type, age, sex, insurance type, asthma control, or syncing history; however, participants with smartphones and longer participation were more likely to take the survey. Conclusions Electronic sensors and a digital health platform were well received by participants who reported satisfaction and perceived value. These results were consistent across multiple participants’ characteristics. These findings can add to a limited literature to keep improving digital health interventions and ensure the meaningful and enduring impact on patient outcomes.
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Affiliation(s)
- Rajan Merchant
- Dignity Health Woodland Clinic Medical Group, Woodland, CA, United States
| | - Rubina Inamdar
- Dignity Health Mercy Medical Group, Sacramento, CA, United States
| | - Kelly Henderson
- Propeller Health, Research and Development, San Francisco, CA, United States
| | - Meredith Barrett
- Propeller Health, Research and Development, San Francisco, CA, United States
| | - Jason G Su
- University of California Berkeley, Berkeley, CA, United States
| | - Jesika Riley
- Propeller Health, Research and Development, San Francisco, CA, United States
| | - David Van Sickle
- Propeller Health, Research and Development, Madison, WI, United States
| | - David Stempel
- Propeller Health, Research and Development, San Francisco, CA, United States
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Peters SP, Busse WW. New and Anticipated Therapies for Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 5:S15-S24. [PMID: 28888244 DOI: 10.1016/j.jaip.2017.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 10/18/2022]
Abstract
Asthma is frequently undertreated, resulting in a relatively high prevalence of patients with uncontrolled disease, characterized by the presence of symptoms and risk of adverse outcomes. Patients with uncontrolled asthma have a higher risk of morbidity and mortality, underscoring the importance of identifying uncontrolled disease and modifying management plans to improve control. Several assessment tools exist to evaluate control with various cutoff points and measures, but these tools do not reliably correlate with physiological measures and should be considered a supplement to physiological tests. When attempting to improve control in patients, nonpharmacological interventions should always be attempted before changing or adding pharmacotherapies. Among patients with severe, uncontrolled asthma, individualized treatment based on asthma phenotype and eosinophil presence should be considered. The efficacy of the anti-IgE antibody omalizumab has been well established for patients with allergic asthma, and novel biologic agents targeting IL-5, IL-13, IL-4, and other allergic pathways have been investigated for patients with allergic or eosinophilic asthma. Fevipiprant (a CRTH2 [chemokine receptor homologous molecule expressed on Th2 cells] antagonist) and imatinib (a tyrosine kinase inhibition) are examples of nonbiologic therapies that may be useful for patients with severe, uncontrolled asthma. Incorporation of new and emerging treatment into therapeutic strategies for patients with severe asthma may improve outcomes for this patient population.
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Affiliation(s)
- Stephen P Peters
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
| | - William W Busse
- UW Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Martin MA, Press VG, Erwin K, Margellos-Anast H, Ignoffo S, McMahon KS, Mosnaim G, Ramsay J, Paik SM. Engaging end-users in intervention research study design. J Asthma 2018; 55:483-491. [PMID: 28699825 PMCID: PMC8350842 DOI: 10.1080/02770903.2017.1342256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) Plan is a 3-arm multicenter pragmatic trial to evaluate asthma interventions in high-risk Chicago children presenting to emergency departments (ED) with asthma. A formative evaluation with end-users to provide input into the trial design and outcome instruments was conducted prior to trial initiation. METHODS A multi-level data gathering framework from the field of design and standard qualitative methods was employed. This included one focus group with asthma Community Health Workers (N = 8), two focus groups with caregivers of children with asthma (N = 9), in-home interviews with caregivers (N = 9), key informant interviews at six EDs and outpatient clinical sites (N = 19), and ED tours and observations (N = 6). Data were presented, discussed, and organized into themes. RESULTS Data indicated that changes to the study design and discharge tool were warranted. A key insight was that ED discharge protocols typically place patient education at a single inopportune time, as families are preparing to leave the ED. At this point in time, families are less receptive to education due to fatigue and a desire to expedite the discharge process. The trial design was modified to reposition the discharge asthma plan to occur at earlier "teachable moments." Delivery of the asthma discharge plan was assigned to study-employed ED coordinators instead of ED providers and staff. Other potential challenges to study recruitment and implementation were raised and addressed. CONCLUSIONS Engagement of end-users in the design phase of implementation research is critical to improve research feasibility and relevance.
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Affiliation(s)
- Molly A Martin
- University of Illinois at Chicago, Department of Pediatrics, 840 South Wood Street, M/C 856, Chicago, IL, 60612
| | - Valerie G Press
- University of Chicago, Department of Medicine, 5841 S Maryland Ave, Chicago, IL, 60637
| | - Kim Erwin
- Illinois Institute of Technology, Institute of Design, 565 W Adams St, Chicago, IL, 60661
| | - Helen Margellos-Anast
- Sinai Urban Health Institute, Sinai Health System, 1500 S Fairfield Ave, Chicago, IL, 60608
| | - Stacy Ignoffo
- Chicago Asthma Consortium, PO Box 31757, Chicago, IL, 60631
| | | | - Giselle Mosnaim
- NorthShore University Health System, NorthShore Research Institute, 1001 University Pl, Evanston, IL, 60201
| | - Jessica Ramsay
- Sinai Urban Health Institute, Sinai Health System, 1500 S Fairfield Ave, Chicago, IL, 60608
| | - S. Margaret Paik
- University of Chicago, Department of Pediatrics, 5841 S Maryland Ave, Chicago, IL, 60637
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Tarraf H, Al-Jahdali H, Al Qaseer AH, Gjurovic A, Haouichat H, Khassawneh B, Mahboub B, Naghshin R, Montestruc F, Behbehani N. Asthma control in adults in the Middle East and North Africa: Results from the ESMAA study. Respir Med 2018; 138:64-73. [PMID: 29724395 DOI: 10.1016/j.rmed.2018.03.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Low levels of asthma control are reported in many countries worldwide. Improved knowledge of asthma control in the Middle East and Africa and predictive factors is needed to address this major public healthcare burden. OBJECTIVE To assess the level of asthma control in patients attending a routine consultation for asthma in the Middle East and North Africa, and the relationship between level of control and patient and disease characteristics, adherence, and quality of life (QoL). METHODS A large-scale cross-sectional epidemiological study (ESMAA: Assessment of Asthma Control in Adult Asthma Population in the Middle East and North Africa) was performed in adults suffering from asthma for at least 1 year and without an acute asthma episode within 4 weeks. Asthma control was assessed per the 2012 GINA guidelines and the ACT questionnaire. QoL and adherence were assessed with the SF-8 and Morisky questionnaires respectively. Predictive factors of asthma control were analysed with univariate and multivariate logistic regressions analyses. RESULTS Overall 7236 eligible patients were included in 577 sites between June 2014 and December 2015 (median 10 patients/site). Mean age was 45 years (±14), 57% were female, mean BMI was 28.5 kg/m2 (±6.0), and 11% were active smokers. Reliever medication was prescribed in 96% of patients with 65% having fixed-dose combined inhaled corticosteroid plus long-acting beta agonists. Good medication adherence was reported in 24% of patients. Among 7179 patients evaluable for GINA, asthma was controlled in 29.4% (95% CI, 28.4%-30.5%), partly controlled in 29.1% (95% CI, 28.1%-30.2%), and uncontrolled in 41.5% (95% CI, 40.3% to 42.6). The mean global ACT score was 17.8 (±5.0), with 16% of patients considering their asthma as controlled. Poor medication adherence, active smoking, absence of medical insurance, lower level of education, or diagnosis at least 5 years earlier were significantly associated with uncontrolled asthma in multivariate analyses (p < 0.001). CONCLUSIONS Asthma control in the Middle East and North Africa is unsatisfactory with less than one-third of asthma patients having controlled disease, highlighting the need to improve treatment access and medication adherence, along with better follow-up and education among healthcare providers and patients.
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Affiliation(s)
- Hesham Tarraf
- Cairo University, 22 Talaat Harb St, City Centre, Cairo, Egypt.
| | - Hamdan Al-Jahdali
- King Saud University for Health Sciences/McGill University/Sleep Disorders Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | | | - Anamarija Gjurovic
- AstraZeneca, Ibn Sina Building, Dubai Healthcare City, PO Box 505070, Dubai, United Arab Emirates.
| | - Houria Haouichat
- Service de Pneumologie, Hôpital Central de l'Armée, BP 244, Kouba, Algeria.
| | | | - Bassam Mahboub
- University of Sharjah, P. O. Box 27272, Sharjah, United Arab Emirates.
| | - Roozbeh Naghshin
- Rasoul Akram Hospital/Tehran, Hazrat-e Rasool General Hospital, Niyayesh St, Satarkhan St, Tehran, Iran.
| | | | - Naser Behbehani
- Department of Medicine, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait.
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Asthma Control and Asthma Medication Use among Swedish Elite Endurance Athletes. Can Respir J 2018; 2018:4646852. [PMID: 29743961 PMCID: PMC5878909 DOI: 10.1155/2018/4646852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/19/2018] [Indexed: 11/19/2022] Open
Abstract
Background Asthma is common in elite athletes. In this study, we examined the use of asthma medication and asthma control in endurance athletes in Sweden and compared the findings with those in a reference group of patients with asthma. Methods The Asthma Control Test (ACT) and a questionnaire on asthma, respiratory symptoms, and medication use were posted to endurance athletes (n=711) and the reference group of patients with asthma (n=1026). Four hundred and sixty-nine athletes (66%) responded, of whom 141 (20%) reported physician-diagnosed asthma. In the reference group, 397 (39%) responded. Results Seventy-seven percent of the athletes with asthma reported using asthma medication during the previous year; 39% used short/long-acting β2-agonists, 31% used inhaled corticosteroids, and 31% used both daily. According to the ACT scores, 19%, 24%, and 58% of athletes with asthma had uncontrolled, partially controlled, or well-controlled asthma, respectively. After adjustment, there was no difference in ACT scores or daily use of asthma medication between the study groups. Conclusions Many endurance athletes had uncontrolled or partially controlled asthma, and one-third used inhaled corticosteroids and long-acting β2-agonists daily. Their adjusted ACT scores and use of asthma medication were similar to the values in the reference population.
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35
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Ménard S, Jbilou J, Lauzier S. Family caregivers' reported nonadherence to the controller medication of asthma in children in Casablanca (Morocco): Extent and associated factors. J Asthma 2018; 55:1362-1372. [PMID: 29336706 DOI: 10.1080/02770903.2017.1414235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Recent statistics show a relatively high prevalence of asthma among Moroccan children and a weak control over their symptoms. To our knowledge, no research has been carried out to document adherence to the controller treatment in this population. This study aims 1) to assess the extent of children's nonadherence to the controller treatment of asthma in an urban region of Morocco as reported by a family caregiver, and 2) to identify the associated factors. METHODS We conducted a cross-sectional study among caregivers of asthmatic children (2-12 years old) in different health and education facilities of Casablanca-Settat. We administered face-to-face questionnaires incorporating validated instruments (Medication Adherence Rating Scale-Asthma (MARS-A), Beliefs about Medicines Questionnaire (BMQ), Asthma Knowledge Questionnaire). Univariate and multivariate log-binomial regressions evaluating the association between several factors and reported nonadherence were performed (prevalence ratios (PR) and 95% confidence intervals (CI)). RESULTS Through two public hospitals, three private medical clinics, and one private school, 103 caregivers were recruited. Low adherence to the controller treatment of asthma was reported by 48% of the caregivers (MARS-A <45). In the multivariate model, caregivers with the lowest level of knowledge about asthma were almost three times more likely to report low adherence compared to caregivers with the highest level (PR = 2.93; 95% CI: 1.14-7.52). CONCLUSIONS This study highlights the finding that low adherence is widespread in this context and also the importance of targeting caregivers' knowledge of asthma for interventions.
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Affiliation(s)
- Sandra Ménard
- a Department of Social and Preventive Medicine, Faculty of Medicine , Laval University , Quebec , QC , Canada
| | - Jalila Jbilou
- b Research Professor, Centre de formation médicale du Nouveau-Brunswick , Moncton , NB , Canada ; Associate Professor, School of Psychology, Université de Moncton , Monction , NB , Canada
| | - Sophie Lauzier
- c Researcher, Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center , QC , Canada ; Assistant Professor, Faculty of Pharmacy, Laval University , Quebec , QC , Canada
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Abir M, Truchil A, Wiest D, Nelson DB, Goldstick JE, Koegel P, Lozon MM, Choi H, Brenner J. Cluster Analysis of Acute Care Use Yields Insights for Tailored Pediatric Asthma Interventions. Ann Emerg Med 2017; 70:288-299.e2. [PMID: 28757228 DOI: 10.1016/j.annemergmed.2017.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 04/17/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE We undertake this study to understand patterns of pediatric asthma-related acute care use to inform interventions aimed at reducing potentially avoidable hospitalizations. METHODS Hospital claims data from 3 Camden city facilities for 2010 to 2014 were used to perform cluster analysis classifying patients aged 0 to 17 years according to their asthma-related hospital use. Clusters were based on 2 variables: asthma-related ED visits and hospitalizations. Demographics and a number of sociobehavioral and use characteristics were compared across clusters. RESULTS Children who met the criteria (3,170) were included in the analysis. An examination of a scree plot showing the decline in within-cluster heterogeneity as the number of clusters increased confirmed that clusters of pediatric asthma patients according to hospital use exist in the data. Five clusters of patients with distinct asthma-related acute care use patterns were observed. Cluster 1 (62% of patients) showed the lowest rates of acute care use. These patients were least likely to have a mental health-related diagnosis, were less likely to have visited multiple facilities, and had no hospitalizations for asthma. Cluster 2 (19% of patients) had a low number of asthma ED visits and onetime hospitalization. Cluster 3 (11% of patients) had a high number of ED visits and low hospitalization rates, and the highest rates of multiple facility use. Cluster 4 (7% of patients) had moderate ED use for both asthma and other illnesses, and high rates of asthma hospitalizations; nearly one quarter received care at all facilities, and 1 in 10 had a mental health diagnosis. Cluster 5 (1% of patients) had extreme rates of acute care use. CONCLUSION Differences observed between groups across multiple sociobehavioral factors suggest these clusters may represent children who differ along multiple dimensions, in addition to patterns of service use, with implications for tailored interventions.
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Affiliation(s)
- Mahshid Abir
- Department of Emergency Medicine, Acute Care Research Unit, University of Michigan, Ann Arbor, MI; RAND Corporation, Santa Monica, CA.
| | - Aaron Truchil
- Camden Coalition of Healthcare Providers, Camden, NJ
| | - Dawn Wiest
- Camden Coalition of Healthcare Providers, Camden, NJ
| | | | | | | | - Marie M Lozon
- University of Michigan Medical School, Ann Arbor, MI
| | - Hwajung Choi
- University of Michigan Medical School, Ann Arbor, MI
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Care transition interventions for children with asthma in the emergency department. J Allergy Clin Immunol 2017; 138:1518-1525. [PMID: 27931533 DOI: 10.1016/j.jaci.2016.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/20/2016] [Accepted: 10/20/2016] [Indexed: 11/22/2022]
Abstract
The emergency department (ED) is a critical point of identification and treatment for some of the most high-risk children with asthma. This review summarizes the evidence regarding care transition interventions originating in the ED for children with uncontrolled asthma, with a focus on care coordination and self-management education. Although many interventions on care transition for pediatric asthma have been tested, only a few were actually conducted in the ED setting. Most of these targeted both care coordination and self-management education but ultimately did not improve attendance at follow-up appointments with primary care providers, improve asthma control, or reduce health care utilization. Conducting any ED-based intervention in the current environment is challenging because of the many demands on ED providers and staff, poor communication within and outside of the medical sector, and caregiver/patient burden. The evidence to date suggests that ED care transition interventions should consider expanding beyond the ED to bridge the multiple sectors children with asthma navigate, including health care settings, homes, schools, and community spaces. Patient-centered approaches may also be important to ensure adequate intervention design, enrollment, retention, and evaluation of outcomes important to children and their families.
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Hammer SC, Sonneveld LJH, van de Kant KDG, Hendriks HJ, Heynens JW, Droog R, Dompeling E, Jöbsis Q. Introduction of a new paediatric asthma guideline: Effects on asthma control levels. Pediatr Allergy Immunol 2017; 28:266-272. [PMID: 28107572 DOI: 10.1111/pai.12697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND In 2008, a new national paediatric asthma management guideline based on the international Global Initiative for Asthma (GINA) guideline was launched in the Netherlands. We studied whether asthma control and treatment regimens improved after introduction of the guideline by comparing survey data before and after the guideline introduction. METHODS Two comparable groups of children (6-16 years) with asthma were included before (2004) and after (2013) the introduction of the guideline. Children, parents and paediatricians completed questionnaires about asthma symptoms, medication and healthcare use. Spirometry was performed. RESULTS Data of 209 patients were analysed. Level of asthma control did not improve between 2004 and 2013 with a proportion of (partly) controlled asthmatics of 51% in 2004 and 59% in 2013 (p = 0.28). In 2013, paediatricians characterized 76% of children as (partly) controlled, while 59% of children was (partly) controlled according to GINA criteria (p < 0.05). Step-down treatment in controlled patients was more applied by paediatricians in 2013 compared to 2004 (from 8 to 40%, p < 0.05). Step-up treatment in uncontrolled patients did not improve. CONCLUSIONS Asthma control did not improve after the introduction of the new guideline. Compared to 2004, an improvement was observed in step-down treatment in patients with controlled disease.
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Affiliation(s)
- S C Hammer
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - L J H Sonneveld
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - K D G van de Kant
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - H J Hendriks
- Department of Paediatrics, Vie Curi Hospital, Venlo, The Netherlands
| | - J W Heynens
- Department of Paediatrics, Orbis Medical Centre, Sittard, The Netherlands
| | - R Droog
- Department of Paediatrics, Elkerliek Hospital, Helmond, The Netherlands
| | - E Dompeling
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Q Jöbsis
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Kuti BP, Omole KO, Kuti DK. Factors associated with childhood asthma control in a resource-poor center. J Family Med Prim Care 2017; 6:222-230. [PMID: 29302522 PMCID: PMC5749061 DOI: 10.4103/jfmpc.jfmpc_271_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction: Optimal asthma control is a major aim of childhood asthma management. This study aimed to determine factors associated with suboptimal asthma control at the pediatric chest clinic of a resource-poor center. Methods: Over a 12-month study period, children aged 2–14 years with physician-diagnosed asthma attending the pediatric chest clinic of the Wesley Guild Hospital (WGH), Ilesa, Nigeria were consecutively recruited. Asthma control was assessed using childhood asthma control questionnaire. Partly and uncontrolled asthma was recorded as a suboptimal control. Relevant history and examinations findings were compared between children with good and suboptimal asthma control. Binary logistic regression analysis was used to determine the predictors of suboptimal asthma control. Results: A total of 106 children participated in the study with male:female ratio of 1.5:1, and majority (83.0%) had mild intermittent asthma. Suboptimal asthma control was observed in 19 (17.9%) of the children. Household smoke exposure, low socioeconomic class, unknown triggers, concomitant allergic rhinoconjunctivitis, and poor parental asthma knowledge, were significantly associated with suboptimal control (P < 0.05). Low socioeconomic class (odds ratio [OR] =6.231; 95% confidence interval [CI] =1.022–8.496; P = 0.005) and poor parental asthma knowledge (OR = 7.607; 95% CI = 1.011–10.481; P = 0.007) independently predict suboptimal control. Conclusion: Approximately, one in five asthmatic children attending the WGH pediatric chest clinic who participated in the study had suboptimal asthma control during the study. More comprehensive parental/child asthma education and provision of affordable asthma care services may help improve asthma control among the children.
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Affiliation(s)
- Bankole Peter Kuti
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Ilesa, Nigeria.,Department of Paediatrics, Wesley Guild Hospital, Ilesa, Nigeria
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Abstract
Objectives: To explore the determinants of uncontrolled asthma in Saudi Arabia. Methods: A consecutive series of adult asthma patients attending 3 pulmonary primary care clinics in Riyadh, Saudi Arabia for a scheduled appointment were interviewed. A multiple logistic regression analysis was used. Results: The proportion of patients with uncontrolled asthma was 68.1% (177/260). Daily tobacco smoking or monthly household income less than 15,000 Saudi Arabian Riyals were associated with a 4.6 (95% confidence interval [CI]=1.3-16.4) and 3.4 (95% CI=1.8-6.6) times increase in the odds of having uncontrolled asthma. Patients with less than a graduate degree (odds ratio [OR]=3.1; 95% CI=1.0-9.5) or patients who were unemployed, disabled, or too ill to work (OR=3.1; 95% CI=1.4-6.9) had poorer asthma control. Having heartburn during the past 4 weeks decreased the odds of asthma control by 2.5 (95% CI=1.3-4.9), and having chronic sinusitis during the past 4 weeks decreased the odds of asthma control by 2.0 (95% CI=1.0-4.0) times. Being female (OR=2.0; 95% CI=1.0-4.0) or ≥35 years of age (OR=2.0; 95% CI=1.0-3.9) was also associated with having uncontrolled asthma. Conclusion: Our findings suggest that most respondents had uncontrolled asthma. Less modifiable socio-demographic factors (for example, income, education, occupation, gender, and age) significantly increased the odds of having uncontrolled asthma. However, modifiable risk factors such as tobacco smoking and clinical factors such as heartburn and chronic sinusitis could also be targeted for intervention.
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Affiliation(s)
- Abdulaziz A BinSaeed
- Department of Family and Community Medicine (34), College of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. Fax. +966 (11) 4671967. E-mail.
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Randomized Trial of Once-Daily Fluticasone Furoate in Children with Inadequately Controlled Asthma. J Pediatr 2016; 178:246-253.e2. [PMID: 27622699 DOI: 10.1016/j.jpeds.2016.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/28/2016] [Accepted: 08/03/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the dose-response, efficacy, and safety of fluticasone furoate (FF; 25 µg, 50 µg, and 100 µg), administered once daily in the evening during a 12-week treatment period to children with inadequately controlled asthma. STUDY DESIGN This was a Phase IIb, multicenter, stratified, randomized, double-blind, double-dummy, parallel-group, placebo- and active-controlled study in children aged 5-11 years with inadequately controlled asthma. The study comprised a 4-week run-in period, 12-week treatment period, and 1-week follow-up period. Children were randomized to receive either placebo once daily, fluticasone propionate (FP) 100 µg twice daily, FF 25 µg, FF 50 µg, or FF 100 µg each once daily in the evening. Primary endpoint was the mean change from baseline in daily morning peak expiratory flow (PEF) averaged over weeks 1-12. Adverse events (AEs) also were investigated. RESULTS In total, 593 children were included in the intent-to-treat population. The difference vs placebo in change from baseline daily morning PEF averaged over weeks 1-12 was statistically significant for the FF 25, FF 50, FF 100, and FP 100 groups (18.6 L/min, 19.5 L/min, 12.5 L/min, and 14.0 L/min, respectively; P < .001 for all). The incidence of AEs was greater in the FF groups (32%-36%) than in the placebo group (29%); the most frequent AE was cough. CONCLUSION FF and FP resulted in significant improvements in morning PEF compared with placebo, suggesting that they are effective treatments for children with inadequately controlled asthma. All treatments were well tolerated; no new safety concerns were identified. TRIAL REGISTRATION ClinicalTrials.gov:NCT01563029.
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Ahmadizar F, Vijverberg SJ, Arets HG, de Boer A, Lang JE, Kattan M, Palmer CN, Mukhopadhyay S, Turner S, Maitland-van der Zee AH. Childhood obesity in relation to poor asthma control and exacerbation: a meta-analysis. Eur Respir J 2016; 48:1063-1073. [DOI: 10.1183/13993003.00766-2016] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/11/2016] [Indexed: 01/08/2023]
Abstract
To estimate the association between obesity and poor asthma control or risk of exacerbations in asthmatic children and adolescents, and to assess whether these associations are different by sex.A meta-analysis was performed on unpublished data from three North-European paediatric asthma cohorts (BREATHE, PACMAN (Pharmacogenetics of Asthma medication in Children: Medication with Anti-inflammatory effects) and PAGES (Pediatric Asthma Gene Environment Study)) and 11 previously published studies (cross-sectional and longitudinal studies). Outcomes were poor asthma control (based on asthma symptoms) and exacerbations rates (asthma-related visits to the emergency department, asthma-related hospitalisations or use of oral corticosteroids). Overall pooled estimates of the odds ratios were obtained using fixed- or random-effects models.In a meta-analysis of 46 070 asthmatic children and adolescents, obese children (body mass index ≥95th percentile) compared with non-obese peers had a small but significant increased risk of asthma exacerbations (OR 1.17, 95% CI 1.03–1.34; I2: 54.7%). However, there was no statistically significant association between obesity and poor asthma control (n=4973, OR 1.23, 95% CI 0.99–1.53; I2: 0.0%). After stratification for sex, the differences in odds ratios for girls and boys were similar, yet no longer statistically significant.In asthmatic children, obesity is associated with a minor increased risk of asthma exacerbations but not with poor asthma control. Sex does not appear to modify this risk.
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Abstract
Hospitals and health systems are facing increased pressure to improve quality and outcomes while reducing expense. Quality-based reimbursement models are providing the necessary incentives for health care institutions to focus on issues such as avoidable hospital-acquired conditions and 30-day readmission rates. While our health care facilities certainly play a vital role in achieving optimal outcomes, patient engagement remains at the center of these efforts.
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Desalu OO, Onyedum CC, Adeoti AO, Ozoh OB, Fadare JO. Knowledge and use of asthma control measurement tools in the management of asthma: a survey of doctors working in family and internal medicine practice in Nigeria. Afr Health Sci 2016; 16:480-9. [PMID: 27605963 DOI: 10.4314/ahs.v16i2.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the knowledge and use of asthma control measurement (ACM) tools in the management of asthma among doctors working in family and internal medicine practice in Nigeria. METHOD A questionnaire based on the global initiative on asthma (GINA) guideline was self-administered by 194 doctors. It contains 12 test items on knowledge of ACM tools and its application. The knowledge score was obtained by adding the correct answers and classified as good if the score ≥ 9, satisfactory if score was 6-8 and poor if < 6. RESULTS The overall doctors knowledge score of ACM tools was 4.49±2.14 (maximum of 12). Pulmonologists recorded the highest knowledge score of 10.75±1.85. The majority (69.6%) had poor knowledge score of ACM tools. Fifty (25.8%) assessed their patients' level of asthma control and 34(17.5%) at every visit. Thirty-nine (20.1%) used ACM tools in their consultation, 29 (15.0%) of them used GINA defined control while 10 (5.2 %) used asthma control test (ACT). The use of the tools was associated with pulmonologists, having attended CME within six months and graduated within five years prior to the survey. CONCLUSION The results highlight the poor knowledge and use of ACM tools and the need to address the knowledge gap.
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Gater A, Nelsen L, Fleming S, Lundy JJ, Bonner N, Hall R, Marshall C, Staunton H, Krishnan JA, Stoloff S, Schatz M, Haughney J. Assessing Asthma Symptoms in Adolescents and Adults: Qualitative Research Supporting Development of the Asthma Daily Symptom Diary. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:440-450. [PMID: 27325336 DOI: 10.1016/j.jval.2016.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/08/2015] [Accepted: 01/17/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Despite the widespread availability of patient-reported asthma questionnaires, instruments developed in accordance with present regulatory expectations are lacking. To address this gap, the Patient-Reported Outcome (PRO) Consortium's Asthma Working Group has developed a patient-reported asthma daily symptom diary (ADSD) for use in clinical research to assess outcomes and support medical product labeling claims in adults and adolescents with asthma. OBJECTIVES To summarize the qualitative research conducted to inform the initial development of the ADSD and to provide evidence for content validity of the instrument in accordance with the Food and Drug Administration's PRO Guidance. METHODS Research informing the initial development and confirming the content validity of the ADSD is summarized. This comprised a review of published qualitative research, semi-structured concept elicitation interviews (n = 55), and cognitive interviews (n = 65) with a diverse and representative sample of adults and adolescents with a clinician-confirmed diagnosis of asthma in the United States to understand the asthma symptom experience and to assess the relevance and understanding of the newly developed ADSD. RESULTS From the qualitative literature review and concept elicitation interviews, eight core asthma symptoms emerged. These were broadly categorized as breathing symptoms (difficulty breathing, shortness of breath, and wheezing), chest symptoms (chest tightness, chest pain, and pressure/weight on chest), and cough symptoms (cough and the presence of mucus/phlegm). Conceptual saturation was achieved and differences in the experience of participants according to socio-demographic or clinical characteristics were not observed. Subsequent testing of the ADSD confirmed participant relevance and understanding. CONCLUSIONS The ADSD is a new patient-reported asthma symptom diary developed in accordance with the Food and Drug Administration's PRO Guidance. Evidence to date supports the content validity of the instrument. Item performance, reliability, and construct validity will be assessed in future quantitative research.
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Affiliation(s)
- Adam Gater
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK.
| | | | | | | | - Nicola Bonner
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK
| | - Rebecca Hall
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK
| | - Chris Marshall
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK
| | | | - Jerry A Krishnan
- University of Illinois Hospital and Health Sciences System, Medical Center Administration, Chicago, IL, USA
| | | | - Michael Schatz
- Kaiser Permanente Medical Center/Kaiser Foundation Hospital, San Diego, CA, USA
| | - John Haughney
- University of Aberdeen, King's College, Aberdeen, UK
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Oliver AJ, Covar RA, Goldfrad CH, Klein RM, Pedersen SE, Sorkness CA, Tomkins SA, Villarán C, Grigg J. Randomised trial of once-daily vilanterol in children with asthma on inhaled corticosteroid therapy. Respir Res 2016; 17:37. [PMID: 27044326 PMCID: PMC4820901 DOI: 10.1186/s12931-016-0353-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/30/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Inhaled corticosteroids (ICS) are effective maintenance treatments for childhood asthma; however, many children remain uncontrolled. Vilanterol (VI) is an inhaled long-acting beta-2 agonist which, in combination with the ICS fluticasone furoate, is being explored as a once-daily treatment for asthma in children. We evaluated the dose-response, efficacy, and safety of once-daily VI (6.25 μg, 12.5 μg and 25 μg) administered in the evening over 4 weeks, on background fluticasone propionate (FP) in children with asthma inadequately controlled on ICS. METHODS This was a Phase IIb, multicentre, randomised, double-blind, parallel-group, placebo-controlled study in children ages 5-11 years with persistent asthma on ICS and as-needed short-acting beta-agonist. The study comprised a 4-week run-in, 4-week treatment period, and 1-week follow-up. From study start, children replaced their current ICS with open-label FP 100 μg twice daily. Children were randomised to receive placebo, VI 6.25 μg, VI 12.5 μg or VI 25 μg once daily. Primary endpoint was treatment difference between VI 25 and placebo groups in mean change from baseline in evening peak expiratory flow averaged over the 4-week treatment. Secondary endpoints included change from baseline in trough forced expiratory volume in one second (FEV1) at Week 4 and change from baseline in percentage of rescue-free and symptom-free 24-h periods. Safety assessments included incidence of adverse events (AEs) and asthma exacerbations. RESULTS In total, 456 children comprised the intention-to-treat population. The adjusted treatment difference between VI 25 and placebo groups for the primary endpoint was not statistically significant (p = 0.227) so no statistical inference was made for other VI dose comparisons or other endpoints. No difference in change from baseline in trough FEV1 was observed for any VI treatments versus placebo; however, VI 25 resulted in an additional 0.6 rescue-free days and 0.7 symptom-free days per week versus placebo. The incidence of AEs was slightly higher in the VI groups (28-33 %) versus placebo (22 %). Nine children experienced asthma exacerbations during the treatment period. CONCLUSION VI plus FP did not result in significant improvements in lung function versus placebo plus FP, but was well tolerated at all doses assessed. TRIAL REGISTRATION NCT01573767 (ClinicalTrials.gov).
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Affiliation(s)
- Amanda J. Oliver
- />GlaxoSmithKline, Stockley Park West, 1 − 3 Iron Bridge Road, Uxbridge, Middlesex UB11 1BT UK
| | - Ronina A. Covar
- />Department of Pediatrics, National Jewish Health, Denver, CO USA
| | - Caroline H. Goldfrad
- />GlaxoSmithKline, Stockley Park West, 1 − 3 Iron Bridge Road, Uxbridge, Middlesex UB11 1BT UK
| | - Ryan M. Klein
- />Southern California Clinical Trials, Newport Beach, CA USA
| | - Søren E. Pedersen
- />University of Southern Denmark, Pediatric Research Unit, Kolding Hospital, Kolding, Denmark
| | | | - Susan A. Tomkins
- />GlaxoSmithKline, Stockley Park West, 1 − 3 Iron Bridge Road, Uxbridge, Middlesex UB11 1BT UK
| | - César Villarán
- />Clinica Ricardo Palma, Javier Prado Este 1166 San Isidro, Lima, Perú
| | - Jonathan Grigg
- />Blizard Institute, Queen Mary University London, London, UK
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Brand PLP, Mäkelä MJ, Szefler SJ, Frischer T, Price D. Monitoring asthma in childhood: symptoms, exacerbations and quality of life. Eur Respir Rev 2016; 24:187-93. [PMID: 26028631 DOI: 10.1183/16000617.00003614] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Monitoring asthma in children in clinical practice is primarily performed by reviewing disease activity (daytime and night-time symptoms, use of reliever medication, exacerbations requiring frequent use of reliever medication and urgent visits to the healthcare professional) and the impact of the disease on children's daily activities, including sports and play, in a clinical interview. In such an interview, most task force members also discuss adherence to maintenance therapy and the patients' (and parents') views and beliefs on the goals of treatment and the amount of treatment required to achieve those goals. Composite asthma control and quality of life measures, although potentially useful in research, have limited value in clinical practice because they have a short recall window and do not cover the entire spectrum of asthma control. Telemonitoring of children with asthma cannot replace face-to-face follow-up and monitoring because there is no evidence that it is associated with improved health outcomes.
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Affiliation(s)
- Paul L P Brand
- Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Stanley J Szefler
- Children's Hospital Colorado and University of Colorado Denver School of Medicine, Denver, CO, USA
| | - Thomas Frischer
- Dept of Paediatrics and Paediatric Surgery, Wilhelminenspital, Vienna, Austria
| | - David Price
- Dept of Primary Care Respiratory Medicine, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Hugo MNB, Walter PYE, Maïmouna M, Malea NM, Ubald O, Adeline W, Bruno T, Emmanuel N, Emmanuel AZ, Christopher K. Assessment of asthma control using asthma control test in chest clinics in Cameroon: a cross-sectional study. Pan Afr Med J 2016; 23:70. [PMID: 27217894 PMCID: PMC4862776 DOI: 10.11604/pamj.2016.23.70.8434] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/28/2016] [Indexed: 01/26/2023] Open
Abstract
Introduction The goal of asthma treatment is to obtain and maintain a good control of symptoms. Investigating factors associated with inadequately control asthma could help in strategies to improve asthma control. This study aimed to determine the prevalence and factors associated with inadequately controlled asthma in asthma patients under chest specialist care. Methods A cross-sectional study was conducted from November 2012 to May 2013. Physician-diagnosed asthma patients aged 12 years and above were included. A questionnaire was used to collect demographic data, comorbidities, and medical history of asthma. Asthma control was assessed using the Asthma Control Test (ACT), with a score less than 20 for inadequately controlled asthma and a score greater or equal to 20 for controlled asthma. A multivariate analysis was used to identify factors associated with inadequately controlled asthma. Results Overall, 243 patients were included in this study. Asthma was controlled in 141 patients (58%) and inadequately controlled in 102 (42%). The mean duration of asthma was 8 years with an interquartile range of 4 and 18 years. Forty-three participants (17.7%) were not under any controller medication while the mean ACT score was 19.3 ± 4.6. Independent associations were found between inadequately controlled asthma and female gender (OR 1.91; 95% CI 1.06-3.47) and obesity (OR 1.81; 1.01-3.27). Conclusion Asthma remains poorly controlled in a large proportion of asthma patients under specialist care in Cameroon. Educational programs for asthma patients targeting women and based on weight loss for obese patients may help in improving the control of asthma.
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Affiliation(s)
- Mbatchou Ngahane Bertrand Hugo
- Department of Internal Medicine, Douala general Hospital, Douala, Cameroon; Faculty of Medicine and Pharmaceutical sciences, University of Douala, Cameroon
| | | | - Mama Maïmouna
- Faculty of Medicine and Pharmaceutical sciences, University of Douala, Cameroon
| | - Nganda Motto Malea
- Faculty of Medicine and Pharmaceutical sciences, University of Douala, Cameroon
| | - Olinga Ubald
- Faculty of Medicine and Pharmaceutical sciences, University of Douala, Cameroon
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Almomani BA, Al-Sawalha NA, Samrah SM, Gamble JM, Al Momani MA. Asthma insights from Jordan: cross-sectional observational study. J Asthma 2016; 53:349-55. [PMID: 26666170 DOI: 10.3109/02770903.2015.1121493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The burden of uncontrolled asthma on patients in Jordan is largely unknown. This study assessed different aspects of asthma clinical features: the level of asthma control, its correlation with quality of life, and possible predictors of asthma control. METHODS Face-to-face interviews with asthmatic patients (≥16 years old) in north Jordan from 2013 to 2014 were conducted. Outcomes measures were assessed using the asthma control test (ACT), the mini asthma quality of life questionnaire (mini-AQLQ), and the Generic health-related quality of life (EQ-5D). The relationship between asthma control and quality of life was examined using Spearman's correlation coefficient. Predictors of asthma control were determined using multivariable logistic regression adjusted for confounders. RESULTS A total of 255 patients were recruited (mean age 45.16 years, 74.5% female). Approximately one-third of subjects (30.6%; n = 78) had controlled asthma (ACT ≥ 20). A strong correlation between asthma control and both mini-AQLQ and EQ-5D scores was identified (p < 0.001). Subjects who required to step-up treatment (OR = 0.12, 95% CI: 0.02-0.63, p = 0.01) and with acute asthma exacerbation (OR = 0.32, 95% CI: 0.18-0.58, p < 0.001) were independently associated with poor asthma control. CONCLUSIONS Most of the recruited patients have not achieved optimal asthma control and was associated with low quality of life. The study highlights that even in low-income countries, a simple assessment tool such as the ACT can be utilized to screen and categorize asthma control. This approach would facilitate a better treatment plan and eventually improve asthma control and quality of life in asthma patients.
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Affiliation(s)
- Basima A Almomani
- a Department of Clinical Pharmacy , Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Nour A Al-Sawalha
- a Department of Clinical Pharmacy , Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Shaher M Samrah
- b Faculty of Medicine , Jordan University of Science and Technology , Irbid , Jordan .,c Department of Internal Medicine , King Abdullah University Hospital , Irbid , Jordan
| | - Jacqueline M Gamble
- d Centre for Infection and Immunity, Queen's University of Belfast , Northern Ireland , UK .,e Regional Respiratory Centre, Belfast City Hospital , Northern Ireland , UK , and
| | - Miral A Al Momani
- b Faculty of Medicine , Jordan University of Science and Technology , Irbid , Jordan .,f Department of Pediatrics and Neonatology , King Abdullah University Hospital , Irbid , Jordan
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Quezada W, Kwak ES, Reibman J, Rogers L, Mastronarde J, Teague WG, Wei C, Holbrook JT, DiMango E. Predictors of asthma exacerbation among patients with poorly controlled asthma despite inhaled corticosteroid treatment. Ann Allergy Asthma Immunol 2015; 116:112-7. [PMID: 26712474 DOI: 10.1016/j.anai.2015.11.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Asthma exacerbations are associated with decreased quality of life and increased health care usage. Identification of characteristics that predict increased risk of future exacerbations in patients with suboptimal control of asthma could guide treatment decisions. OBJECTIVE To examine patient characteristics associated with risk of asthma exacerbations in patients with uncontrolled persistent asthma. METHODS A retrospective analysis of adults and children with inadequately controlled asthma despite asthma controller therapy and enrolled in 2 randomized trials was conducted. Baseline characteristics of subjects who experienced an asthma exacerbation during the treatment period were compared with those of subjects who did not experience an exacerbation. RESULTS Of 718 subjects (402 adults and 295 children), 108 adults (27%) and 110 children (37%) experienced an asthma exacerbation during the study period. Unscheduled health care visits for asthma or use of oral corticosteroids in the previous year were significantly associated with asthma exacerbation during the study period (P < .01). Adult subjects who experienced an exacerbation had significantly lower forced expiratory volume in 1 second compared with those who did not (2.3 vs 2.5 L, respectively, P = .02). Children who experienced an exacerbation had lower baseline pre- and post-bronchodilator ratios of forced expiratory volume in 1 second to forced vital capacity (77% vs 81%, P < .01; 82% vs 86%, P < .001, respectively). Symptom scores on validated questionnaires were significantly worse in adults but not in children who developed an exacerbation. CONCLUSION Spirometric measurements can help identify adults and children at increased risk for asthma exacerbation. Symptom scores could be helpful in identifying adults who are at high risk for exacerbations but could be less helpful in children.
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Affiliation(s)
- Wilson Quezada
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Eun Soo Kwak
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Joan Reibman
- New York University of Medicine, New York, New York
| | - Linda Rogers
- Mount Sinai School of Medicine, New York, New York
| | | | - William G Teague
- University of Virginia Medical Center, Charlottesville, Virginia
| | | | | | - Emily DiMango
- Department of Medicine, Columbia University Medical Center, New York, New York.
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