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Koç N, Ersoy N, Yardimci H, Külhaş Çelik İ, Civelek E. Evaluation of Healthy Eating Index and Children's Diet Inflammatory Index according to asthma severity group. BMC Pediatr 2024; 24:127. [PMID: 38365643 PMCID: PMC10874057 DOI: 10.1186/s12887-023-04507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/22/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Diet may contribute to better asthma control in children by impacting the immune and inflammatory pathophysiology. Therefore, this study aimed to investigate differences in nutrient intake, Children's Dietary Inflammatory Index (C-DII), and dietary quality according to asthma severity. MATERIALS AND METHODS Asthma severity, dietary inflammatory status, and diet quality were assessed in a sample of 202 children with asthma (55.6% males, aged 5-18 years) attending a pediatric allergy outpatient clinic. Asthma severity was evaluated according to the Global Initiative for Asthma criteria and categorized as mild, moderate, or severe. The Children's Dietary Inflammatory Index (C-DII) and Healthy Eating Index (HEI-2010) were calculated based on information collected by the 24-h dietary recall method. Dietary quality was categorized as poor, moderate, or good diet according to HEI-2010. RESULTS The mean age of the participants was 9.6 ± 3.2 years. Children with severe asthma were younger on average (p < 0.05). Children with mild asthma had significantly higher fiber and iron intake than those with moderate asthma (p < 0.05). C-DII values did not differ significantly according to asthma severity (p > 0.05). Dietary quality was evaluated as moderate in 89.1% of the participants and also showed no difference based on asthma severity. CONCLUSIONS These findings suggest that inflammatory status and diet quality may not affect asthma severity in children, highlighting the influence of various genetic and environmental factors on the association between diet and asthma severity. More comprehensive and longitudinal studies are needed to investigate the mechanisms linking diet and asthma.
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Affiliation(s)
- Nevra Koç
- Department of Nutrition and Dietetics, Gülhane Health Sciences of Faculty, Sağlık Bilimleri University, İstanbul, Turkey.
| | - Nursena Ersoy
- Ankara University, Institute of Health Sciences, Ankara, Turkey
| | - Hülya Yardimci
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara, Turkey
| | - İlknur Külhaş Çelik
- Division of Pediatric Allergy Immunology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Ersoy Civelek
- Division of Pediatric Allergy Immunology, Sağlık Bilimleri University, Ankara City Hospital, Ankara, Turkey
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Cheraghlou S, Ugwu N, Yu B, Cohen JM. Trends in the Cost and Utilization of Omalizumab in the Medicare Population: 2013-2017. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:207-212. [PMID: 35782473 PMCID: PMC9235260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background: Omalizumab has been demonstrated to be effective in treating chronic spontaneous urticaria (CSU) and was FDA approved for this indication in 2014. Previous work has shown that access to injectable biologics varies across US counties. In the present study we evaluate geographic and temporal trends in the utilization of omalizumab in the Medicare population by dermatologists, with its use by allergists and pulmonologists as comparators. Methods: We analyzed year-over-year trends in omalizumab utilization across geographic regions using the Medicare Provider Utilization and Payment Data: Part D files. Results: Utilization of omalizumab by dermatologists increased rapidly after its FDA approval, from 0.08 claims/100,000 enrollees totaling $209/100,000 enrollees in 2014 to 1.45 claims/100,000 enrollees totaling $3115/100,000 enrollees in 2017. Nonetheless, prescribing dermatologists were present in only 2.8% (95% Confidence Interval (CI): 2.0%-3.9%) and 0.2% (95% CI: 0.0%-0.5%) of metropolitan and non-metropolitan counties, respectively, in 2017, demonstrating limited availability, especially in non-metropolitan counties. Similarly, prescribers of any specialty were available in 32.9% (95% CI: 30.2%-35.6%) and 3.8% (95% CI: 3.1%-4.8%) of metropolitan and non-metropolitan counties, respectively, in 2017. Conclusions: Our data suggest that despite increasing omalizumab utilization, there remains a lack of access across many counties, particularly in non-metropolitan regions. Efforts to expand omalizumab prescriber accessibility in these counties may improve outcomes for patients with CSU.
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Affiliation(s)
- Shayan Cheraghlou
- The Ronald O. Perelman Department of Dermatology, New
York University Grossman School of Medicine, New York, NY, USA
| | - Nelson Ugwu
- Department of Dermatology, Yale School of Medicine, New
Haven, CT, USA
| | - Beverly Yu
- Department of Dermatology, Yale School of Medicine, New
Haven, CT, USA
| | - Jeffrey M. Cohen
- Department of Dermatology, Yale School of Medicine, New
Haven, CT, USA,To whom all correspondence should be addressed:
Jeffrey M. Cohen, MD, Department of Dermatology, Yale University School of
Medicine, 15 York Street, New Haven, CT 06510;
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Asthma and COVID-19: Emphasis on Adequate Asthma Control. Can Respir J 2021; 2021:9621572. [PMID: 34457096 PMCID: PMC8397565 DOI: 10.1155/2021/9621572] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/18/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
Asthmatics are at an increased risk of developing exacerbations after being infected by respiratory viruses such as influenza virus, parainfluenza virus, and human and severe acute respiratory syndrome coronaviruses (SARS-CoV). Asthma, especially when poorly controlled, is an independent risk factor for developing pneumonia. A subset of asthmatics can have significant defects in their innate, humoral, and cell-mediated immunity arms, which may explain the increased susceptibility to infections. Adequate asthma control is associated with a significant decrease in episodes of exacerbation. Because of their wide availability and potency to promote adequate asthma control, glucocorticoids, especially inhaled ones, are the cornerstone of asthma management. The current COVID-19 pandemic affects millions of people worldwide and possesses mortality several times that of seasonal influenza; therefore, it is necessary to revisit this subject. The pathogenesis of SARS-CoV-2, the virus that causes COVID-19, can potentiate the development of acute asthmatic exacerbation with the potential to worsen the state of chronic airway inflammation. The relationship is evident from several studies that show asthmatics experiencing a more adverse clinical course of SARS-CoV-2 infection than nonasthmatics. Recent studies show that dexamethasone, a potent glucocorticoid, and other inhaled corticosteroids significantly reduce morbidity and mortality among hospitalized COVID-19 patients. Hence, while we are waiting for more studies with higher level of evidence that further narrate the association between COVID-19 and asthma, we advise clinicians to try to achieve adequate disease control in asthmatics as it may reduce incidences and severity of exacerbations especially from SARS-CoV-2 infection.
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Peer K, Adams WG, Legler A, Sandel M, Levy JI, Boynton-Jarrett R, Kim C, Leibler JH, Fabian MP. Developing and evaluating a pediatric asthma severity computable phenotype derived from electronic health records. J Allergy Clin Immunol 2021; 147:2162-2170. [PMID: 33338540 PMCID: PMC8328264 DOI: 10.1016/j.jaci.2020.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Extensive data available in electronic health records (EHRs) have the potential to improve asthma care and understanding of factors influencing asthma outcomes. However, this work can be accomplished only when the EHR data allow for accurate measures of severity, which at present are complex and inconsistent. OBJECTIVE Our aims were to create and evaluate a standardized pediatric asthma severity phenotype based in clinical asthma guidelines for use in EHR-based health initiatives and studies and also to examine the presence and absence of these data in relation to patient characteristics. METHODS We developed an asthma severity computable phenotype and compared the concordance of different severity components contributing to the phenotype to trends in the literature. We used multivariable logistic regression to assess the presence of EHR data relevant to asthma severity. RESULTS The asthma severity computable phenotype performs as expected in comparison with national statistics and the literature. Severity classification for a child is maximized when based on the long-term medication regimen component and minimized when based only on the symptom data component. Use of the severity phenotype results in better, clinically grounded classification. Children for whom severity could be ascertained from these EHR data were more likely to be seen for asthma in the outpatient setting and less likely to be older or Hispanic. Black children were less likely to have lung function testing data present. CONCLUSION We developed a pragmatic computable phenotype for pediatric asthma severity that is transportable to other EHRs.
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Affiliation(s)
- Komal Peer
- Department of Environmental Health, Boston University School of Public Health, Boston, Mass.
| | - William G Adams
- Boston Medical Center, Boston, Mass; Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | | | - Megan Sandel
- Boston Medical Center, Boston, Mass; Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, Mass
| | - Renée Boynton-Jarrett
- Boston Medical Center, Boston, Mass; Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | - Chanmin Kim
- Department of Statistics, SungKyunKwan University, Seoul, Korea
| | - Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, Mass
| | - M Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, Mass
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Wang X, Fang H, Shen K, Liu T, Xie J, Liu Y, Wu P, Chen Y, Zhong J, Wu E, Zhou W, Wu B. Cost-effectiveness analysis of double low-dose budesonide and low-dose budesonide plus montelukast among pediatric patients with persistent asthma receiving Step 3 treatment in China. J Med Econ 2020; 23:1630-1639. [PMID: 32991222 DOI: 10.1080/13696998.2020.1830410] [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: 01/10/2023]
Abstract
AIMS For children aged 1-5 years with persistent asthma, double low-dose inhaled corticosteroids (ICS) are recommended as the preferred Step 3 treatment and low-dose ICS plus leukotriene receptor antagonists (LTRA) as an alternative. Budesonide inhalation suspension (0.5 mg daily) and montelukast (4.0 mg daily) are commonly used low-dose ICS and LTRA, respectively, among children in China. This study compared the cost-effectiveness of double low-dose budesonide vs. low-dose budesonide plus montelukast from a Chinese healthcare payer's perspective. METHODS A Markov model was constructed with four health states (i.e. no exacerbation, mild exacerbation, moderate-to-severe exacerbation, and death). Transition probabilities were estimated based on exacerbation rates, case-fatality of hospitalized patients due to exacerbation, and natural mortality. Treatment adherence was considered and assumed to impact both drug costs and exacerbation rates. Costs (in 2019 Chinese Yuan [¥]) included drug costs and exacerbation management costs. Cost inputs and utilities for each health state were obtained from a public database and the literature. In-depth interviews were conducted with a health economics expert to validate the model, and a clinical expert to verify inputs and assumptions related to clinical practice. Costs and quality-adjusted life-years (QALYs) were estimated over a year. Deterministic and probabilistic sensitivity analyses were performed. RESULTS Compared with low-dose budesonide plus montelukast, double low-dose budesonide was associated with lower costs (¥1,534 vs. ¥2,327), fewer exacerbation events (0.43 vs. 1.67) and slightly better QALYs (0.98 vs. 0.97). Sensitivity analyses supported the robustness of the results and the generalizability of findings across geographic regions in China. CONCLUSION The cost-effectiveness analysis suggests that double low-dose budesonide is a dominant Step 3 treatment strategy compared with low-dose budesonide plus montelukast for patients aged 1-5 years with persistent asthma in China.
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Affiliation(s)
- Xiaoling Wang
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | | | - Kunling Shen
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | | | - Jipan Xie
- Analysis Group, Inc., Beijing, China
| | | | | | | | - Jia Zhong
- Analysis Group, Inc., Beijing, China
| | - Eric Wu
- Analysis Group, Inc., Beijing, China
| | - Wei Zhou
- Peking University Third Hospital, Beijing, China
| | - Bin Wu
- Renji Hospital, Shanghai, China
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Alem K, Gebeyehu S, Arega Y. Risk Factors and Treatment Types for Asthma Severity Among Adult Patients. J Asthma Allergy 2020; 13:167-177. [PMID: 32440162 PMCID: PMC7217635 DOI: 10.2147/jaa.s246464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/23/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the risk factors and treatment types for asthma severity among adult patients by applying a retrospective study design. MATERIALS AND METHODS The symptoms of asthma and corresponding medication prescription were addressed by descriptive statistics, and an ordinal logistic regression model was applied to identify the risk factors of asthma severity based on the data obtained from chronic follow-up of 422 adult asthma patients from September 11, 2012, to July 8, 2016, at the University of Gondar Teaching Hospital (UOGTH). RESULTS From 422 study units, the more commonly presenting asthma symptoms were coughing and wheezing expressed by 52.13% and 50.9%, respectively. For the treatment type given to the patients, oxygen and prednisolone were highly distributed drugs to the patients in chronic illness, medication and follow-up clinic of the University of Gondar Teaching Hospital (UOGTH) which were expressed by 73.5% and 35.5%, respectively. The proportional odd logit model was used to analyse asthma severity in patients; patients who were female (OR=1.68), a rural resident (OR=1.56), regular physical exercise (OR=2.39), allergen to pet (OR=3.17), had asthma in childhood (OR=2.27), had a family history (OR=1.89), and had depression (OR=2.31) were more likely to increase asthma severity than others, and patients who were in case with regular cooker, dry season was less likely to increase asthma severity. CONCLUSION Generally, the study presented the most common asthma symptoms and treatment types correspondingly. The study also showed that demographic, environmental, genetic, and health-related factors have a significant effect on asthma severity.
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Affiliation(s)
- Kidanemariam Alem
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Sefinew Gebeyehu
- Department of Statistics, College of Natural and Computational Sciences, Adigrat University, Adigrat, Ethiopia
| | - Yibeltal Arega
- Department of Statistics, College of Natural and Computational Sciences, University of Gondar, Gondar, Ethiopia
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Ma Y, Yu Z, Jiao H, Zhang Y, Ma B, Wang F, Zhou J. Short-term effect of PM 2.5 on pediatric asthma incidence in Shanghai, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:27832-27841. [PMID: 31342347 DOI: 10.1007/s11356-019-05971-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
Recent epidemiological studies pointed out that air pollution has a significant impact on pediatric asthma. Shanghai is one of the biggest cities in China, and the short-term effect of atmospheric particulate matter on the incidence of pediatric asthma has become a hot topic. From January 1, 2009, to December 31, 2010, we used daily measurements of pollutant concentrations, daily weather data, and daily records of pediatric asthma hospital visits from local authorities to evaluate the short-term effect of air pollution on pediatric asthma incidence in Shanghai, China. We used a generalized additive model (GAM) in the analysis, and the controlled confounding factors include long-term trends, day-of-the-week effects, and weather elements. We divided the entire study group into different age-subgroups. In addition, we took a variety of lag models into consideration. The results showed a strong connection between concentrations of fine particulate matter (PM2.5) and pediatric asthma hospital visits from 2009 to 2010 in Shanghai, China. For the entire study group, the greatest relative risk (RR) of PM2.5 on pediatric asthma hospital visits was 1.060 on a lag of 4 days. As for the three different age-subgroups, the greatest RR of PM2.5 on pediatric asthma hospital visits was 1.061 (at a lag of 5 days), 1.071 (at a lag of 4 days), and 1.052 (at a lag of 2 days), for the under-2-year-olds, 3-to-5-year-olds, and the 6-to-18-year-olds, respectively. The overall short-term effect of PM2.5 on pediatric asthma hospital visits was relatively stronger in younger children. Within the year, we detected the strongest seasonal effect of PM2.5 on pediatric asthma hospital visits in Summer. When adding other air pollutants in the analysis model, RR of PM2.5 on pediatric asthma hospital visits would be increased.
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Affiliation(s)
- Yuxia Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China.
| | - Zhiang Yu
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Haoran Jiao
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Yifan Zhang
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Bingji Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Fei Wang
- Tacheng Meteorological Bureau, Tacheng, 834700, China
| | - Ji Zhou
- Key Laboratory of Meteorology and Health in Shanghai, Shanghai, 200030, China.
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The Protective Effects of 2,3,5,4'-Tetrahydroxystilbene-2- O-β-d-Glucoside in the OVA-Induced Asthma Mice Model. Int J Mol Sci 2018; 19:ijms19124013. [PMID: 30545126 PMCID: PMC6321435 DOI: 10.3390/ijms19124013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/29/2018] [Accepted: 12/10/2018] [Indexed: 01/15/2023] Open
Abstract
Asthma is an inflammatory disease caused by an imbalance of Th1 and Th2 cells. In general, asthma is characterized by a stronger Th2 response. Most conventional asthma treatment focuses on improving airway flow or suppression of airway inflammation. To reduce the side effects of currently used asthma medicines, we have conducted studies on natural products that have no side effects. 2,3,5,4′-tetrahydroxystilbene-2-O-β-d-glucoside (TSG), the main compound of Polygonum multiflorum (PM), has various biological activities, including anti-inflammation and anti-oxidation activities. However, the effect of TSG on asthma has not been studied yet. We examined the effects of TSG on Th2 immune responses using an OVA-induced asthma animal model. OVA-sensitized mice were treated with TSG. 24 h after the last intranasal challenge, airway hyperresponsiveness (AHR) was measured or serum and bronchoalveolar lavage fluid (BALF) were harvested. We measured typical Th1 and Th2 cytokines in serum and BALF. As a result, TSG suppressed Th2 responses, as shown by the lower levels of IL-4, IL-5, total IgE, OVA-specific IgE, and OVA-specific IgG1. On the other hand, TSG increased Th1 responses, as shown by the levels of IFN-gamma. Collectively, these results confirm the potential of TSG for asthma treatment through modulation of inflammatory responses. Considering that the cytotoxic effect of PM extract is due to the cis isomer of TSG, if the effect of TSG on asthma treatment is found to be non-toxic in clinical trials, it would be more effective to use it as a purified component than PM extract as an asthma treatment agent.
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Asthma Morbidity, Comorbidities, and Modifiable Factors Among Older Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:236-243.e7. [PMID: 28756082 DOI: 10.1016/j.jaip.2017.06.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Asthma morbidity is increased among older adults, especially older adult women. Interventions to improve asthma control in this population are not well described. OBJECTIVE The objective of this study was to identify risk factors (including modifiable factors) associated with asthma-related hospitalizations and emergency department or urgent care center visits (ED/UCV) among older adults. A secondary objective was to investigate sex differences in variables relevant to asthma control. METHODS Data were obtained from 14,076 older adults ≥65 years with active asthma participating in the 2006-2010 Behavioral Risk Factor Surveillance System Asthma Call-back Survey (a random-digit dialed survey) in 40 US states, the District of Columbia, and Puerto Rico, representative of >2.6 million persons. Weighted, adjusted logistic regression was conducted. RESULTS One or more asthma-related hospitalizations in the past year were reported by 5.7% (95% confidence interval [95% CI] = 5.0% to 6.4%) of participants; 10.6% (95% CI = 9.7% to 11.5%) reported ≥1 asthma-related ED/UCV. Compared with older adults without asthma-related hospitalizations, adjusted odds were higher among those with ≥1 asthma-related hospitalization for chronic obstructive pulmonary disease (COPD), coronary artery disease, depression, cockroaches or mold in the home, and cost barriers to asthma-related health care or medication. All these factors, except for cockroaches, were associated with asthma-related ED/UCV. Compared with males, adjusted odds were higher among females for COPD, depression, obesity, and cost barriers to asthma-related health care or medication. CONCLUSIONS Among older adults, asthma-related hospitalizations and ED/UCV were associated with clinical comorbidities, mold in the home, and financial barriers to asthma-related health care. Interventions addressing modifiable factors could reduce asthma morbidity among older adults.
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Stridsman C, Dahlberg E, Zandrén K, Hedman L. Asthma in adolescence affects daily life and school attendance - Two cross-sectional population-based studies 10 years apart. Nurs Open 2017; 4:143-148. [PMID: 28694978 PMCID: PMC5500462 DOI: 10.1002/nop2.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 02/02/2017] [Indexed: 01/02/2023] Open
Abstract
Aim The aim of this study was to study the impact of asthma on daily life, school absenteeism and physical education. In addition, to describe asthma triggers at school. Design Two cross‐sectional population‐based studies ten years apart. Method Within the OLIN‐studies, in 2003 (n = 3,327) and in 2013 (n = 2,345) adolescents (14–15 years) answered an expanded ISAAC questionnaire. Of these, 8% and 11%, respectively with current asthma participated in this study. Results Between the years 2003–2013, the proportion of adolescents reporting that asthma interfered with daily life had increased, in 2013, girls were significantly more affected than boys. The proportion reporting a worsening of asthma at school had decreased, but it was still over a quarter. The proportion of absenteeism from school and from physical education was at the same level both years. Asthma triggers were described to be poor air quality, poorly cleaned environment, allergens, strong fragrance, rebuilding projects, physical education and stress.
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Affiliation(s)
- Caroline Stridsman
- Department of Research The OLIN Unit Norrbotten County Council Luleå Sweden.,Division of Nursing Department of Health Sciences Luleå University of Technology Luleå Sweden
| | - Elisabeth Dahlberg
- Division of Nursing Department of Health Sciences Luleå University of Technology Luleå Sweden
| | - Karin Zandrén
- Division of Nursing Department of Health Sciences Luleå University of Technology Luleå Sweden
| | - Linnéa Hedman
- Division of Nursing Department of Health Sciences Luleå University of Technology Luleå Sweden.,Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine The OLIN Unit Umeå University Umeå Sweden
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11
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Jones CM, DeWalt DA, Huang IC. Impaired Patient-Reported Outcomes Predict Poor School Functioning and Daytime Sleepiness: The PROMIS Pediatric Asthma Study. Acad Pediatr 2017; 17:850-854. [PMID: 28780328 PMCID: PMC5673502 DOI: 10.1016/j.acap.2017.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/25/2017] [Accepted: 07/29/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Poor asthma control in children is related to impaired patient-reported outcomes (PROs; eg, fatigue, depressive symptoms, anxiety), but less well studied is the effect of PROs on children's school performance and sleep outcomes. In this study we investigated whether the consistency status of PROs over time affected school functioning and daytime sleepiness in children with asthma. METHODS Of the 238 children with asthma enrolled in the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Asthma Study, 169 children who provided survey data for all 4 time points were used in the analysis. The child's PROs, school functioning, and daytime sleepiness were measured 4 times within a 15-month period. PRO domains included asthma impact, pain interference, fatigue, depressive symptoms, anxiety, and mobility. Each child was classified as having poor/fair versus good PROs per meaningful cut points. The consistency status of each domain was classified as consistently poor/fair if poor/fair status was present for at least 3 time points; otherwise, the status was classified as consistently good. Seemingly unrelated regression was performed to test if consistently poor/fair PROs predicted impaired school functioning and daytime sleepiness at the fourth time point. RESULTS Consistently poor/fair in all PRO domains was significantly associated with impaired school functioning and excessive daytime sleepiness (Ps < .01) after controlling for the influence of the child's age, sex, and race/ethnicity. CONCLUSIONS Children with asthma with consistently poor/fair PROs are at risk of poor school functioning and daytime sleepiness. Developing child-friendly PRO assessment systems to track PROs can inform potential problems in the school setting.
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Affiliation(s)
- Conor M Jones
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tenn
| | - Darren A DeWalt
- Department of Internal Medicine, University of North Carolina at Chapel Hill
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tenn.
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12
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Zhang Q, Lamichhane R, Diggs LA. Disparities in emergency department visits in American children with asthma: 2006-2010. J Asthma 2016; 54:679-686. [PMID: 27880053 DOI: 10.1080/02770903.2016.1263315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This article was to examine the trends in emergency department (ED) visits for asthma among American children in 2006-2010 across sociodemographic factors, parental smoking status, and children's body weight status. METHODS We analyzed 5,535 children aged 2-17 years with current asthma in the Asthma Call-Back Survey in 2006-2010. Multivariate log binomial regression was used to examine the disparities of ED visits by demographics, socioeconomic status, parental smoking status, children's body weight status, and the level of asthma control. We controlled for average state-level air pollutants. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were reported. RESULTS Minority children with current asthma had higher risks of ED visits compared with white children in 2009 and 2010, e.g., the PR (95% CI) for black children in 2009 was 3.64 (1.79, 7.41). Children who had current asthma and more highly educated parents experienced a higher risk of ED visits in 2007 (PRs [95% CI] = 2.15 [1.02, 4.53] and 2.97 [1.29, 6.83] for children with some college or college-graduated parents), but not significant in other years. Children with uncontrolled asthma were significantly more likely to visit the ED in 2008 (PRs [95% CI] = 2.79 [1.44, 5.41] and 6.96 [3.55, 13.64] for not-well-controlled and very poorly controlled children with asthma). CONCLUSIONS Minority children with current asthma or children with uncontrolled asthma were more likely to visit EDs for asthma treatment. However, the disparities in ED visits across sociodemographics, health status, or asthma control vary in scale and significance across time. More research is needed to explain these differences.
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Affiliation(s)
- Qi Zhang
- a School of Community and Environmental Health, Old Dominion University , Norfolk , VA , USA
| | - Rajan Lamichhane
- b Department of Mathematics , Texas A&M University-Kingsville , Kingsville , TX , USA
| | - Leigh Ann Diggs
- a School of Community and Environmental Health, Old Dominion University , Norfolk , VA , USA
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Hsu J, Qin X, Beavers SF, Mirabelli MC. Asthma-Related School Absenteeism, Morbidity, and Modifiable Factors. Am J Prev Med 2016; 51:23-32. [PMID: 26873793 PMCID: PMC4914465 DOI: 10.1016/j.amepre.2015.12.012] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/30/2015] [Accepted: 12/04/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Asthma is a leading cause of chronic disease-related school absenteeism. Few data exist on how information on absenteeism might be used to identify children for interventions to improve asthma control. This study investigated how asthma-related absenteeism was associated with asthma control, exacerbations, and associated modifiable risk factors using a sample of children from 35 states and the District of Columbia. METHODS The Behavioral Risk Factor Surveillance System Child Asthma Call-back Survey is a random-digit dial survey designed to assess the health and experiences of children aged 0-17 years with asthma. During 2014-2015, multivariate analyses were conducted using 2006-2010 data to compare children with and without asthma-related absenteeism with respect to clinical, environmental, and financial measures. These analyses controlled for sociodemographic and clinical characteristics. RESULTS Compared with children without asthma-related absenteeism, children who missed any school because of asthma were more likely to have not well controlled or very poorly controlled asthma (prevalence ratio=1.50; 95% CI=1.34, 1.69) and visit an emergency department or urgent care center for asthma (prevalence ratio=3.27; 95% CI=2.44, 4.38). Mold in the home and cost as a barrier to asthma-related health care were also significantly associated with asthma-related absenteeism. CONCLUSIONS Missing any school because of asthma is associated with suboptimal asthma control, urgent or emergent asthma-related healthcare utilization, mold in the home, and financial barriers to asthma-related health care. Further understanding of asthma-related absenteeism could establish how to most effectively use absenteeism information as a health status indicator.
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Affiliation(s)
- Joy Hsu
- Epidemic Intelligence Service, Office of Public Health Scientific Services, CDC, Atlanta, Georgia;.
| | - Xiaoting Qin
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC, Atlanta, Georgia
| | - Suzanne F Beavers
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC, Atlanta, Georgia
| | - Maria C Mirabelli
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC, Atlanta, Georgia
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Howell CR, Thompson LA, Gross HE, Reeve BB, DeWalt DA, Huang IC. Responsiveness to Change in PROMIS(®) Measures among Children with Asthma: A Report from the PROMIS(®) Pediatric Asthma Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:192-201. [PMID: 27021753 PMCID: PMC4814775 DOI: 10.1016/j.jval.2015.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/28/2015] [Accepted: 12/12/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare the responsiveness to change of the Patient-Reported Outcomes Measurement Information System (PROMIS(®)) asthma impact, pain interference, fatigue, depressive symptoms, mobility, and peer relationship scales to a legacy scale, the Paediatric Asthma Quality of Life Questionnaire (PAQLQ). METHODS Two hundred and twenty-nine child-parent dyads from public insurance programs were enrolled. PROMIS pediatric short forms (SFs) and the PAQLQ were used to measure health-related quality of life across four time points (T1-T4) over 2 years. The Asthma Control and Communication Instrument was used to measure the change in asthma control, and the Global Rating of Change (GRC) Index for breathing problems and overall health was used to measure the change in health status. Responsiveness was tested by comparing the changes in health-related quality of life with the changes in asthma control and health status over time using t tests, generalized estimating equations, and relative validity approaches. Magnitudes of the responsiveness between the Pediatric PROMIS and PAQLQ were assessed through statistical significance, Cohen's d effect size (ES), and standardized response mean (SRM). RESULTS The PROMIS asthma impact scale and all PAQLQ scales exhibited significant responsiveness (p's<0.05) and small to medium ES/SRM when anchored to asthma control, GRC breathing problems, and overall health. Relative validity, especially related to change in asthma control status and GRC breathing problems, was equivalent. PROMIS pain interference, fatigue, and mobility SFs also indicated adequate responsiveness. CONCLUSIONS The PROMIS asthma impact SF indicated similar responsiveness to the PAQLQ scales. Due to its brevity and responsiveness, the PROMIS asthma impact SF is useful for clinical practice or research.
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Affiliation(s)
- Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lindsay A Thompson
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Heather E Gross
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bryce B Reeve
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Darren A DeWalt
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Vasbinder EC, Belitser SV, Souverein PC, van Dijk L, Vulto AG, van den Bemt PMLA. Non-adherence to inhaled corticosteroids and the risk of asthma exacerbations in children. Patient Prefer Adherence 2016; 10:531-8. [PMID: 27110103 PMCID: PMC4835125 DOI: 10.2147/ppa.s92824] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Non-adherence to inhaled corticosteroids (ICSs) is a major risk factor for poor asthma control in children. However, little is known about the effect of adherence to ICS on the incidence of asthma exacerbations. The objective of this study was to examine the effect of poor adherence to ICS on the risk of exacerbations in children with asthma. METHODS In this nested case-control study using data from the Dutch PHARMO Record Linkage System, children aged 5-12 years who had an asthma exacerbation needing oral corticosteroids or hospital admission were matched to patients without exacerbations. Refill adherence was calculated as medication possession ratio from ICS-dispensing records. Data were analyzed using a multivariable multiplicative intensity regression model. RESULTS A total of 646 children were included, of whom 36 had one or more asthma exacerbations. The medication possession ratio was 67.9% (standard deviation [SD] 30.2%) in children with an exacerbation versus 54.2% (SD 35.6%) in the control group. In children using long-acting beta-agonist, good adherence to ICS was associated with a higher risk of asthma exacerbations: relative risk 4.34 (95% confidence interval: 1.20-15.64). CONCLUSION In children with persistent asthma needing long-acting beta-agonist, good adherence to ICS was associated with an increased risk of asthma exacerbations. Possible explanations include better motivation for adherence to ICS in children with more severe asthma, and reduced susceptibility to the consequences of non-adherence to ICS due to overprescription of ICS to children who are in clinical remission. Further study into the background of the complex interaction between asthma and medication adherence is needed.
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Affiliation(s)
- Erwin C Vasbinder
- Erasmus University Medical Center, Department of Hospital Pharmacy, Rotterdam, the Netherlands
| | - Svetlana V Belitser
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
| | | | - Arnold G Vulto
- Erasmus University Medical Center, Department of Hospital Pharmacy, Rotterdam, the Netherlands
| | - Patricia MLA van den Bemt
- Erasmus University Medical Center, Department of Hospital Pharmacy, Rotterdam, the Netherlands
- Correspondence: Patricia MLA van den Bemt, Erasmus University Medical Center, Department of Hospital Pharmacy, Nc-212, PO Box 2040, 3000 CA Rotterdam, the Netherlands, Tel +31 10 703 3202, Fax +31 10 703 2400, Email
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Mirabelli MC, Beavers SF, Shepler SH, Chatterjee AB. Age at asthma onset and asthma self-management education among adults in the United States. J Asthma 2015; 52:974-80. [PMID: 26291134 DOI: 10.3109/02770903.2015.1020389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma self-management education improves asthma-related outcomes. We conducted this analysis to evaluate variation in the percentages of adults with active asthma reporting components of asthma self-management education by age at asthma onset. METHODS Data from 2011 to 2012 Asthma Call-back Surveys were used to estimate percentages of adults with active asthma reporting six components of asthma self-management education. Components of asthma self-management education include having been taught to what to do during an asthma attack and receiving an asthma action plan. Differences in the percentages of adults reporting each component and the average number of components reported across categories of age at asthma onset were estimated using linear regression, adjusted for age, education, race/ethnicity, sex, smoking status, and years since asthma onset. RESULTS Overall, an estimated 76.4% of adults with active asthma were taught what to do during an asthma attack and 28.7% reported receiving an asthma action plan. Percentages reporting each asthma self-management education component declined with increasing age at asthma onset. Compared with the referent group of adults whose asthma onset occurred at 5-14 years of age, the percentage of adults reporting being taught what to do during an asthma attack was 10% lower among those whose asthma onset occurred at 65-93 years of age (95% CI: -18.0, -2.5) and the average number of components reported decreased monotonically across categories of age at asthma onset of 35 years and older. CONCLUSIONS Among adults with active asthma, reports of asthma self-management education decline with increasing age at asthma onset.
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Affiliation(s)
- Maria C Mirabelli
- a Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Suzanne F Beavers
- a Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Samantha H Shepler
- b Department of Biostatistics , Rollins School of Public Health, Emory University , Atlanta , GA , USA , and
| | - Arjun B Chatterjee
- c Section on Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Department of Internal Medicine, Wake Forest School of Medicine , Winston-Salem, NC , USA
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Einarson TR, Bereza BG, Nielsen TA, Hemels MEH. Utilities for asthma and COPD according to category of severity: a comprehensive literature review. J Med Econ 2015; 18:550-63. [PMID: 25735652 DOI: 10.3111/13696998.2015.1025793] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are incurable diseases that impact quality-of-life. OBJECTIVE To summarize original research articles that measured or utilized preference-based utilities or disutilities according to disease severity. METHODS Medline and Embase were searched from inception until the end of November 2014. Two reviewers independently searched the literature with differences settled through discussion. Data extracted included utility scores as determined in original research categorized according to disease severity as well as disutilities associated with exacerbations or comorbidities. Data were tabulated and analyzed descriptively. RESULTS In total, 862 articles were identified, 790 were rejected, and 69 analyzed. There were 44 dealing with COPD and 25 with asthma. Average utilities determined by research were 0.828 ± 0.062, 0.765 ± 0.090, 0.711 ± 0.120, and 0.607 ± 0.120 for mild, moderate, severe, and very severe COPD, respectively. Utilities used in economic analyses were 0.866 ± 0.038, 0.770 ± 0.024, 0.739 ± 0.045, and 0.596 ± 0.075, respectively. Disutilities (annual) ranged from 0.002-0.378; major and minor exacerbations had respective disutilities of 0.287 and 0.108. For asthma patients, utilities were for 0.86 ± 0.32, 0.83 ± 0.065, and 0.74 ± 0.029, for mild, moderate, and severe disease, respectively. CONCLUSIONS Utilities have been summarized according to severity category of asthma and COPD. These values should be useful for researchers undertaking economic analyses of these diseases.
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Affiliation(s)
- Thomas R Einarson
- Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, ON , Canada
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