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Lougheed MD, Thomas NJ, Wasilewski NV, Morra AH, Minard JP. Use of SNOMED CT® and LOINC® to standardize terminology for primary care asthma electronic health records. J Asthma 2017; 55:629-639. [PMID: 28800265 DOI: 10.1080/02770903.2017.1362424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The burden of asthma ranks among the highest for chronic diseases. Interoperable electronic health records (EHRs) can improve the management of chronic diseases such as asthma by facilitating sharing of data between health care settings along the continuum of care. Terminology such as SNOMED CT® (Systematized Nomenclature of Medicine-Clinical Terms) and LOINC® (Logistical Observation Identifier Names and Codes) are prerequisites for interoperability of EHRs. We sought to determine the extent to which data elements in a validated asthma care map (ACM) are congruent with these terminologies. METHODS A certified asthma educator entered all 169 elements in the ACM into the SNOMED CT® browser. Matched elements were assigned a concept name, an identification number, and classified into a hierarchy. LOINC® terminology was reviewed for asthma-related pulmonary function tests (PFTs). RESULTS Forty-two percent of the ACM elements were complete matches to existing SNOMED CT® concepts, 24% partial matches, and 34% unmatched. Specific asthma control parameters were either complete (n = 3) or partial (n = 4) matches, but overall "asthma control" was unmatched. There were 92% complete or partial matches for PFT elements to SNOMED CT® and 83% to LOINC®. Conclusions: The majority of ACM elements are congruent with standardized terminology, enabling EHR interoperability. Future requests for new concepts in SNOMED CT® and LOINC® should be pursued for asthma control parameters paramount to evidence-based practice.
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Affiliation(s)
- M Diane Lougheed
- a Department of Medicine , Queen's University , Kingston , Ontario , Canada.,b Asthma Research Unit, Clinical Research Centre, Kingston General Hospital , Ontario , Canada.,c Department of Public Health Sciences , Queen's University , Kingston , Ontario , Canada
| | - Nicola J Thomas
- d Health Sciences Faculty, St. Lawrence College , Kingston , Ontario , Canada
| | - Nastasia V Wasilewski
- a Department of Medicine , Queen's University , Kingston , Ontario , Canada.,b Asthma Research Unit, Clinical Research Centre, Kingston General Hospital , Ontario , Canada
| | - Alison H Morra
- b Asthma Research Unit, Clinical Research Centre, Kingston General Hospital , Ontario , Canada
| | - Janice P Minard
- a Department of Medicine , Queen's University , Kingston , Ontario , Canada.,b Asthma Research Unit, Clinical Research Centre, Kingston General Hospital , Ontario , Canada
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Boulet LP, Robitaille C, Deschesnes F, Villeneuve H, Boulay MÈ. Comparative Clinical, Physiological, and Inflammatory Characteristics of Elderly Subjects With or Without Asthma and Young Subjects With Asthma. Chest 2017; 152:1203-1213. [PMID: 28941741 DOI: 10.1016/j.chest.2017.09.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Asthma seems to present in the elderly as a specific phenotype that remains to be further described. In this prospective observational study, we aimed to assess the multidimensional aspects of asthma in the elderly. METHODS In young (18 to 35 years old) subjects with mild to moderate asthma and elderly subjects (aged ≥60 years) either with or without mild to moderate asthma, we compared asthma control, health care and medication use, lung function, markers of airway and systemic inflammation, and adherence to therapy. RESULTS Fifty subjects were recruited in each group. Elderly people with asthma showed more marked airway obstruction compared with young people with asthma and elderly people without asthma. They also had poorer asthma control, mainly associated with a lower FEV1, compared with young people with asthma, although airway responsiveness, health care use, prescribed doses of inhaled corticosteroids, and adherence to treatment were similar in both groups. Elderly subjects had an increase in some markers of systemic inflammation and bronchial epithelial dysfunction compared with young people with asthma. Blood eosinophils were higher in both asthma groups, particularly in elderly people with asthma. Sputum neutrophils were increased in both groups of elderly subjects and sputum eosinophils were increased in elderly people with asthma compared with the other two groups. CONCLUSIONS Asthma in the elderly presents as a specific phenotype associated with increased airway obstruction and mixed airway inflammation in addition to signs of systemic inflammation.
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Affiliation(s)
- Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada.
| | - Catherine Robitaille
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
| | - Francine Deschesnes
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
| | - Hélène Villeneuve
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
| | - Marie-Ève Boulay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
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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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Boulay ME, Boulet LP. The Rhinitis Control Scoring System: Development and validation. Am J Rhinol Allergy 2016; 30:54-9. [PMID: 26867531 DOI: 10.2500/ajra.2016.30.4260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Allergic rhinitis is a common health problem that requires regular monitoring of symptoms to provide adequate treatment. There is a need to develop rhinitis control assessment tools that are meaningful and easy to interpret by both the patient and the practitioner. OBJECTIVE To develop a simple, easy-to-interpret instrument, the Rhinitis Control Scoring System (RCSS), for the assessment of rhinitis control, as a companion tool to the Asthma Control Scoring System previously validated. METHODS After a literature review and based on the Allergic Rhinitis and its Impact on Asthma guidelines, allergic rhinitis control parameters were identified. The draft items were subjected to cognitive debriefing regarding instructions, wordings, and response options. The second version of the draft was then pretested and modified according to the results. The final draft of the RCSS, based on the intensity and frequency of symptoms, was then pilot tested with 50 subjects who had allergic rhinitis for validation of some psychometric properties. Each subject completed the RCSS in addition to other rhinitis instruments. They also had nasal peak inspiratory flow measurements. RESULTS The RCSS showed good internal consistency (Cronbach α = 0.84). There was strong criterion validity between the RCSS scores and the other instruments. The discriminant validity demonstrated as mean RCSS scores differed significantly across groups of patients with different Total Nasal Symptom Score severity (F = 58.8, p < 0.0001). CONCLUSIONS This pilot study showed that the RCSS is a simple tool to assess and quantify rhinitis control by using a percentage score. This questionnaire allows the quantification of rhinitis control and, therefore, may help guide therapeutic interventions. Combined with the Asthma Control Scoring System, it can provide a global assessment of rhinitis and asthma control. Clinical Trial number NCT00967967.
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Affiliation(s)
- Marie-Eve Boulay
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada
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Contemporaneous International Asthma Guidelines Present Differing Recommendations: An Analysis. Can Respir J 2016; 2016:3085065. [PMID: 27445525 PMCID: PMC4935927 DOI: 10.1155/2016/3085065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/22/2015] [Indexed: 12/12/2022] Open
Abstract
Background. Several international groups develop asthma guidelines. Conflicting recommendations across guidelines have been described in several disease areas and may contribute to practice variability. Accordingly, we compared the latest Canadian Thoracic Society (CTS) asthma guideline with contemporaneous international asthma guidelines to evaluate conflicting recommendations and their causes. Methods. We identified the latest CTS asthma guideline update (2012) and the following societies which also updated their guidelines in 2012: the British Thoracic Society and Scottish Intercollegiate Guidelines Network and the Global Initiative for Asthma. We compared these three guidelines on (1) key methodological factors and (2) adult pharmacotherapy recommendations. Results. Methods used and documentation provided for literature search strategy and dates, evidence synthesis, outcomes considered, evidence appraisal, and recommendation formulation varied between guidelines. Criteria used to define suboptimal asthma control varied widely between guidelines. Inhaled corticosteroid dosing recommendations diverged, as did recommendations surrounding use of budesonide/formoterol as a reliever and controller and recommendations in the subsequent step. Conclusions. There are important differences between recommendations provided in contemporaneous asthma guidelines. Causes include differences in methods used for interpreting evidence and formulating recommendations. Adopting a common set of valid and explicit methods across international societies could harmonize recommendations and facilitate guideline implementation.
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Capelo AV, de Fonseca VM, Peixoto MVM, de Carvalho SR, Guerino LG. Central obesity and other factors associated with uncontrolled asthma in women. Allergy Asthma Clin Immunol 2015; 11:12. [PMID: 25859274 PMCID: PMC4391683 DOI: 10.1186/s13223-015-0076-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/03/2015] [Indexed: 01/11/2023] Open
Abstract
Background Asthma remains an uncontrolled disease. The Comorbidities, particularly obesity, and several other factors have been identified as being individually associated with asthma control, and these factors vary among different countries and between sexes. Studies have suggested that the harmful effects of these factors are greatest among women. The aim of the present study was to identify associated factors with uncontrolled asthma in women at the outpatient clinic of a Federal University Hospital in Rio de Janeiro, Brazil. Methods Cross-sectional study with asthmatic women, older than 18 years old. All subjects were included according to stringent criteria. The study used a structured questionnaire with data about demographic variables, education level, comorbid conditions, and disease history. Anthropometric and spirometric measurements were obtained. Asthma control was assessed by three different tools: the Asthma Control Test (ACT), the Asthma Control Questionnaire (ACQ) and the Global Initiative for Asthma (GINA) criteria. Results A total of 124 women were included, and 57%, 38% and 21% were totally controlled according to ACT, ACQ and GINA criteria, respectively. A total of 31.5% were obese. According to the CI (Conicity Index) and WC (waist circumference) respectively, 84% and 68% were centrally obese. There was no association between asthma control and age, education, duration of the disease or BMI (Body Mass Index) in the three models, but there was a significant association between central obesity and asthma control with the ACQ and GINA assessment tools, controlling for explanatory variables such as GERD (gastroesophageal reflux disease). Pre-bronchodilator percent predicted forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were significantly associated with age and FVC was also associated with central obesity. Conclusions Asthma remains uncontrolled in women despite treatment, and central obesity seems to have a negative influence on the control of the disease. We believe that women should be studied as a separate group and suggest prospective studies with assessment of fat distribution and biomarkers, controlling for possible comorbidities associated with asthma control.
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Affiliation(s)
- Albertina Varandas Capelo
- Gaffrée and Guinle University Hospital of Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vania Matos de Fonseca
- Institute of women, children and adolescents Health Fernandes Figueira - IFF-FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Sonia Regina de Carvalho
- Gaffrée and Guinle University Hospital of Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Larissa Garcia Guerino
- Gaffrée and Guinle University Hospital of Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Rhinovirus-induced VP1-specific Antibodies are Group-specific and Associated With Severity of Respiratory Symptoms. EBioMedicine 2014; 2:64-70. [PMID: 26137535 PMCID: PMC4484518 DOI: 10.1016/j.ebiom.2014.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/14/2014] [Accepted: 11/17/2014] [Indexed: 01/07/2023] Open
Abstract
Background Rhinoviruses (RVs) are a major cause of common colds and induce exacerbations of asthma and chronic inflammatory lung diseases. Methods We expressed and purified recombinant RV coat proteins VP1-4, non-structural proteins as well as N-terminal fragments of VP1 from four RV strains (RV14, 16, 89, C) covering the three known RV groups (RV-A, RV-B and RV-C) and measured specific IgG-subclass-, IgA- and IgM-responses by ELISA in subjects with different severities of asthma or without asthma before and after experimental infection with RV16. Findings Before infection subjects showed IgG1 > IgA > IgM > IgG3 cross-reactivity with N-terminal fragments from the representative VP1 proteins of the three RV groups. Antibody levels were higher in the asthmatic group as compared to the non-asthmatic subjects. Six weeks after infection with RV16, IgG1 antibodies showed a group-specific increase towards the N-terminal VP1 fragment, but not towards other capsid and non-structural proteins, which was highest in subjects with severe upper and lower respiratory symptoms. Interpretation Our results demonstrate that increases of antibodies towards the VP1 N-terminus are group-specific and associated with severity of respiratory symptoms and suggest that it may be possible to develop serological tests for identifying causative RV groups. Increases of rhinovirus-specific antibodies are surrogate markers for severity of rhinovirus-induced respiratory symptoms. Serological tests based on recombinant rhinovirus coat protein fragments identify the culprit rhinovirus strain. Identification of the most relevant RV strains by serology should allow the rational design of RV vaccines.
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Key Words
- Antibody response
- Asthma
- COPD, Chronic obstructive pulmonary disease
- ELISA, Enzyme-linked immunosorbent assay
- HRP, Horseradish peroxidase
- HSA, Human serum albumin
- ICAM-1, Intercellular adhesion molecule 1
- ICS, Inhaled corticosteroids
- LDL-R, Low density lipoprotein receptor
- MALDI–TOF, Matrix-assisted laser desorption/ionization–time-of-flight mass spectrometry
- MBP, Maltose binding protein
- O.D, Optical density
- PEF, Peak expiratory flow
- RV, Rhinovirus
- Recombinant rhinovirus coat protein
- Rhinovirus
- SABA, Short-acting β2 agonists
- Serological test
- TCID50, Tissue culture 50% infective dose
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Sanchez-Solis M. Could a Visual Analogue Scale be useful, in real life, to manage children with asthma? Allergol Immunopathol (Madr) 2013; 41:357-8. [PMID: 24295930 DOI: 10.1016/j.aller.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/06/2013] [Indexed: 11/18/2022]
Affiliation(s)
- M Sanchez-Solis
- Pediatric Respiratory Unit, Virgen de la Arrixaca University Hospital, Pabellón Docente Universitario, El Palmar, Murcia, Spain.
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Boulay ME, Boulet LP. Discordance between asthma control clinical, physiological and inflammatory parameters in mild asthma. Respir Med 2013; 107:511-8. [DOI: 10.1016/j.rmed.2012.12.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 11/25/2022]
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Jonsson M, Egmar AC, Kiessling A, Ingemansson M, Hedlin G, Krakau I, Hallner E, Kull I. Adherence to national guidelines for children with asthma at primary health centres in Sweden: potential for improvement. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 21:276-82. [PMID: 22751738 DOI: 10.4104/pcrj.2012.00051] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although asthma is the most common chronic paediatric disease in Western Europe, the extent of adherence to guidelines for primary care management of paediatric asthma remains unclear. AIMS To evaluate adherence to national guidelines for primary care management of children with asthma. METHODS This survey involved 18 primary healthcare centres in Stockholm, Sweden. The medical records of 647 children aged 6 months to 16 years with a diagnosis of asthma, obstructive bronchitis, or cough were selected and scrutinised. 223 children with obstructive bronchitis or cough not fulfilling the evidence-based criteria for asthma were excluded, yielding a total of 424 subjects. Documentation of the most important indicators of quality as stipulated in national guidelines (i.e., tobacco smoke, spirometry, pharmacological treatment, patient education, and demonstration of inhalation technique) was examined. RESULTS Only 22% (n=49) of the children 6 years of age or older had ever undergone a spirometry test, but the frequency was greater when patients had access to an asthma nurse (p=0.003). Although 58% (n=246) of the total study population were treated with inhaled steroids, documented patient education and demonstration of inhalation technique was present in 14% (n=59). Exposure to tobacco smoke was documented in 14% (n=58). CONCLUSIONS This study reveals a substantial gap between the actual care provided for paediatric asthma and the recommendations formulated in national guidelines.
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Affiliation(s)
- Marina Jonsson
- Pediatric Outpatient Clinic, Astrid Lindgrens Children's Hospital, Stockholm, Sweden.
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Loss of asthma control in pediatric patients after discontinuation of long-acting Beta-agonists. Pulm Med 2012; 2012:894063. [PMID: 22966431 PMCID: PMC3432548 DOI: 10.1155/2012/894063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/11/2012] [Indexed: 02/05/2023] Open
Abstract
Recent asthma recommendations advocate the use of long-acting beta-agonists (LABAs) in uncontrolled asthma, but also stress the importance of stepping down this therapy once asthma control has been achieved. The objective of this study was to evaluate downtitration of LABA therapy in pediatric patients who are well-controlled on combination-inhaled corticosteroid (ICS)/LABA therapy. Clinical and physiologic outcomes were studied in children with moderate-to-severe persistent asthma after switching from combination (ICS/LABA) to monotherapy with ICS. Of the 54 patients, 34 (63%) were determined to have stable asthma after the switch, with a mean followup of 10.7 weeks. Twenty (37%) had loss of asthma control leading to addition of leukotriene receptor antagonists, increased ICS, or restarting LABA. There were 2 exacerbations requiring treatment with systemic steroids. In patients with loss of control, there was a statistically significant decline in FEV(1) (-8% versus -1.9%, P = 0.03) and asthma control test (-3.2 versus -0.5, P = 0.03). This did not approach significance for FEF(25-75%), exhaled nitric oxide, lung volumes or airway reactivity. No demographic, asthma control measures, or lung function variables predicted loss of control. Pediatric patients with moderate-to-severe persistent asthma who discontinue LABA therapy have a 37% chance of losing asthma control resulting in augmented maintenance therapies. Recent recommendations of discontinuing LABA therapy as soon as control is achieved should be evaluated in a prospective long-term study.
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