Journal of Asthma最新文献

Introduction: Asthma and COPD are among the leading causes of morbidity and mortality, impacting over 260 million people and causing over 3 million deaths globally (Momtaz-Manesh, S. et al., 2023). Pulmonary symptoms can impair tolerance and increase the negative attribution of anxiety sensations. Reciprocally, anxiety associated with dyspnea can induce hyperventilation. This perpetuates a cycle of symptom exacerbation and poor treatment adherence. Managing labored breathing is challenging due to its subjective nature. Dyspnea is a sufferer's endless pursuit to breathe, rendering its experience as truly, "Sisyphean."

Aim: This study explored the role of anxiety sensitivity and distress tolerance in dyspnea among adults with asthma and COPD (N = 107). A single-group cross-sectional research design was used. Data from pulmonologist-diagnosed adults with asthma and COPD were collected across various clinics in Delhi-NCR.

Results: It was found that anxiety sensitivity, distress tolerance and dyspnea were strongly correlated. Also, an increase in anxiety sensitivity was strongly predictive of dyspnea severity. Further, distress tolerance acted as a partial mediator between anxiety sensitivity and dyspnea.

Conclusions: Improving distress tolerance can act as an adjuvant in effective dyspnea management.

Objectives: To determine whether Opto-Electronic Plethysmography (OEP) can distinguish Exercise-Induced Bronchoconstriction (EIB) breathing patterns by comparing individuals with and without EIB, and between broncho-constriction and recovery. Breathing pattern was quantified in terms of regional contribution, breathing timing, and the phase between chest sub-compartments which indicates the synchronization in movement of the different sub-compartments.

Methods: Individuals (n = 47) reporting no respiratory symptoms and no history of any respiratory disease or disorder were assumed to have a healthy breathing pattern. Of 38 participants reporting respiratory symptoms during exercise, and/or a previous diagnosis of asthma or EIB, 10 participants had a positive result to the Eucapnic Voluntary Hyperpnea test, defined as a fall of at least 10% in FEV₁ from baseline at two consecutive time points and were classified into the EIB group. OEP data was obtained from 89 markers and an 11-camera motion capture system operating at 100 Hz as follows: pre- and post-EVH challenge, and post-inhaler in participants who experienced a bronchoconstriction, and 2) for the healthy group during tidal breathing.

Results: RCpRCa-Phase (upper versus lower ribcage), RCaS-Phase (lower ribcage versus shoulders), and RCpS-Phase (upper ribcage versus shoulders) differed between bronchoconstriction and rest in athletes with EIB and rest in healthy participants (p < 0.05), in all cases indicating greater asynchrony post-bronchoconstriction, and later movement of the abdominal ribcage (RCa) post-bronchoconstriction. RCpS-Phase was different (p < 0.05) between all conditions (rest, post-bronchoconstriction, and post-inhaler) in EIB.

Conclusions: OEP can characterize and distinguish EIB-associated breathing patterns compared to rest and individuals without EIB at rest.

Objectives: The COVID-19 pandemic led to unemployment and associated health insurance loss, prompting an unprecedented adoption of emergency policies, including economic relief efforts and health insurance coverage expansion. We sought to understand pandemic-related challenges for people with asthma and how emergency policies served families facing both chronic disease management and health insurance loss.

Study design: Qualitative interview study.

Methods: In 2021, we conducted semi-structured telephone interviews with 21 adults who had asthma and lost employment and employer-sponsored health insurance coverage during the COVID-19 pandemic. We used thematic analysis to assess how health and economic policies affected participants' ability to access care and manage their asthma.

Results: Participants reported reduced access to care, as well as worry about heightened susceptibility to COVID-19 due to their asthma. While insurance loss exacerbated these challenges, participants indicated that economic relief efforts, including direct stimulus payments, helped them afford needed asthma care. Participants were more critical of enhancements to existing coverage policies such as the Affordable Care Act (ACA) Marketplace and Consolidated Omnibus Budget Reconciliation Act (COBRA) due to difficulty understanding, accessing, and affording such coverage.

Conclusions: Our findings underscore that people affected by asthma and health insurance loss benefit from policies that provide flexible and easy-to-use assistance, such as direct payments, for meeting the diverse challenges posed by living with a chronic disease. Although policies that expand health insurance coverage are critical, more attention is needed to help people with chronic conditions access these programs in a timely way.

Background: The purpose of this study is to determine the variations in the prevalence of self-reported asthma among the adult population in the United States of America (USA), analyzing demographic characteristics, physical indicators, living habits, and sarcopenia.

Methods: 10,566 participants from the 2009 to 2018 National Health and Nutrition Examination Survey (NHANES) of the USA who were 20 years of age or older and not pregnant were included in the study.

Results: The prevalence of patients with asthma varies by age, gender, and race. The weighted prevalence is 15.5%, estimated to represent 19.36 million people in the USA (95% CI, 14.5% to 16.6%). The prevalence of self-reported asthma decreases with age, with the highest prevalence among young adults aged 20-25 for both males and females. Females were also more susceptible to asthma compared to males. The increase in asthma prevalence attributed to smoking was most pronounced among African American and Caucasian participants (p < 0.05), while its effect on Mexican American and Asian participants was relatively minor. Notably, the prevalence of asthma was significantly higher in African American and Caucasian participants with sarcopenia compared to those without sarcopenia.

Conclusions: The prevalence of asthma is associated to varying degrees with factors such as age, gender, smoking, and the presence of sarcopenia. The elevated prevalence of asthma among young people and females warrants attention. Intensifying efforts toward smoking cessation and the scientific management of sarcopenia could be instrumental in reducing the incidence of asthma.

Background: Immune cells may have a significant role in the pathophysiology of asthma, according to increasing evidence, although it is yet unclear how immune cells cause asthma. Therefore, we aimed to use Mendelian randomization (MR) methods to investigate this causal relationship.

Methods: This study explored the causal effects between immune cells and asthma using a two-sample MR technique. Using publicly available genetic data, the causal connection between asthma risk and 731 immune cell phenotypes was investigated. Sensitivity analysis guaranteed the results' stability. To further evaluate the existence of reverse causality, we employed reverse MR analysis.

Results: According to the inverse-variance weighted (IVW) method, five immune cell phenotypes were found to be statistically significantly associated with asthma risk (p < 0.001). Among them, TCRgd %T cell (OR = 0.968, 95%CI = 0.951 - 0.986), TCRgd %lymphocyte (OR = 0.978, 95%CI = 0.965 - 0.991), HLA DR + NK AC (OR = 0.966, 95% CI = 0.947 - 0.986) and CD3 on CD4 Treg (OR = 0.956, 95%CI= 0.931 - 0.981), four phenotypes that resulted in a decreased risk of asthma. CD25 on transitional (OR = 1.033, 95%CI = 1.014 - 1.052) resulted in an increased risk of asthma. Reverse MR analysis revealed that asthma increases HLA DR + NK AC levels (p < 0.05).

Conclusion: The results of MR analysis showed a causal relationship between immune cell phenotype and asthma risk, which provides a direction for future asthma treatment.

Objective: We aimed to determine the frequency of restless legs syndrome (RLS) in children with allergic diseases.

Methods: The age, gender, height, weight, BMI z-scores, and laboratory values of children diagnosed with asthma, allergic rhinitis, atopic dermatitis, and chronic urticaria, as well as a healthy control group, were examined. RLS was assessed using a questionnaire based on the diagnostic criteria of the International Restless Legs Syndrome Study Group. Neurological examination findings, questionnaire results, and RLS severity scores were evaluated by a pediatric neurology specialist.

Results: The study evaluated data from 270 children diagnosed with allergic diseases and 150 healthy controls. Both groups were statistically similar in terms of age, gender, weight, height, and BMI z-scores (p > 0.05). The frequency of RLS was reported as 13.3% in children with allergic airway disease, 15.5% in those with allergic skin disease, and 6.7% in the control group. The frequency of RLS in children with allergic airway disease and allergic skin disease was significantly higher compared to the control group (p = 0.041 and p = 0.022, respectively). The frequency of mild RLS in children with allergic diseases and the control group was 43.6% (n = 17) and 50% (n = 5), respectively (p = 0.737). The rate of females with RLS was significantly higher than those without RLS (69.2% vs. 30.8%) (p = 0.045). According to logistic regression analysis, individuals with allergic diseases were 2.307 (95.0% CI of OR 1.087 to 4.897) times more likely to develop RLS compared to those without allergic diseases (p = 0.029).

Conclusion: The frequency of RLS is higher in children with allergic diseases. Early diagnosis of RLS may allow for a holistic management of quality-of-life-reducing problems, such as sleep disorders, that may be associated with both conditions.

Objective: This study assessed patients' knowledge of asthma, their level of self-management and satisfaction with care at the Korle-Bu Teaching Hospital Adult Asthma Clinic.

Methods: This study was a quantitative cross-sectional study at the Korle-Bu Teaching Hospital Adult Asthma Clinic in Accra. Sixty-eight (68) clinically diagnosed asthma patients who have been attending clinic regularly for reviews for more than six months, were recruited in this study. An abridged version of the Asthma Knowledge and the modified version of the Asthma Self-Management Questionnaire was used to assess the outcome measures of interest.

Results: This study showed that patients were adequately informed about the various domains of knowledge in asthma, that is; etiology (73.5%), pathophysiology (67.7%), symptoms and assessment of severity (74.3%), medication (92.3%), prevention (98.5%), and natural history (93.0%). Two-thirds of the patients (66.0%) had adequate knowledge regarding asthma, 41.2% of patients had a high level of self-management and, 19.1% had poor self-management. There was no association between level of education (p = 0.619), gender (p = 0.673), age group (p = 0.534), and knowledge regarding asthma.

Conclusion: This study has shown that most asthma patients attending the KBTH Asthma Clinic have adequate basic knowledge about asthma and its treatment, although there are aspects of etiology, pathophysiology, symptoms, and assessment of severity that need reenforcement. Also, most patients had good self-management skills and agreed that self-management was an integral part of improving healthcare outcomes. Targeted interventions should be developed and implemented to improve patient knowledge and self-management to ensure a high quality of life among asthma patients.

Objective: Previously the epicenter of the COVID-19 pandemic in New York, the Bronx has one of the highest prevalence rates of pediatric asthma in the United States. Pandemic mitigation efforts altered asthma management practices in at-home and clinical settings. We were interested in identifying family caregiver-reported barriers to asthma management during the COVID-19 pandemic to optimize care for Bronx children with asthma.

Methods: To explore family caregiver perspectives about asthma management and resources needed during the COVID-19 pandemic, we conducted qualitative interviews with caregivers of children with asthma receiving care at 9 clinics in the Bronx. Caregivers were asked via telephone about the COVID-19 pandemic and how it affected the family and child's asthma management. Child demographic characteristics and asthma status were obtained from medical records and survey data. Interview notes were independently coded for common themes. Investigators agreed on emerging themes.

Results: 61 caregivers participated (95% female). Nearly half of caregivers reported improvement in child's asthma due to stay-at-home orders and decreased outdoor trigger exposure. Many experienced challenges accessing medical care during the pandemic.Some children were exposed to indoor triggers like secondhand smoke. Caregivers also reported challenges finding opportunities for physical activity and challenges associated with caregiver and child mental health.

Conclusions: Caregivers experienced improved asthma management because of the pandemic. However, inconsistent access to care demonstrates the need for continuity of medical care and careful planning for any future stay-at-home orders.Clinical trial: This study is registered with ClinicalTrials.gov, identifier # NCT03066596.

Background: Various methods are available to screen for allergic bronchopulmonary aspergillosis (ABPA) in asthma, but their comparative performance remains uncertain.

Objectives: To identify the optimal screening algorithm for ABPA in asthmatic patients and evaluate the crude cost of various diagnostic approaches.

Methods: We performed a post hoc analysis of prospectively collected data from consecutive adult asthmatic patients evaluated for ABPA. The diagnosis was based on the revised International Society for Human and Animal Mycology ABPA Working Group criteria. Initial evaluations included measurements of serum Aspergillus fumigatus-IgE (≥0.35 kUA/L), serum total IgE (≥500 IU/mL), serum A. fumigatus-IgG (≥27 mgA/L), blood eosinophil count (BEC ≥500 cells/μL), and chest CT findings. A decision tree was manually constructed using recursive partitioning to identify the most effective diagnostic pathway.

Results: Among 543 adult asthmatics, 106 were diagnosed with ABPA. Serum A. fumigatus-IgE was positive in 221 (40.7%) patients, while serum total IgE was elevated (≥500 IU/mL) in 300 (55.3%) patients. The serum total IgE-based approach required 196 additional tests during screening, compared to 115 in the A. fumigatus-IgE method. The BEC-based strategy missed 28 cases of ABPA. Although the CT-directed protocol had the fewest false positives, it required 437 additional screening radiographic procedures and missed eight ABPA cases. The A. fumigatus-IgE pathway emerged as the most cost-effective, whereas imaging-based strategies were the most expensive.

Conclusions: Serum A. fumigatus-IgE is the optimal screening test for ABPA in asthma. It minimizes unnecessary testing while maintaining high diagnostic accuracy, making it a preferable approach in clinical practice.

Background: The ultimate goal of asthma management is to have complete control of the condition, yet the number of patients with uncontrolled asthma continues to rise. This study aims to determine the prevalence of uncontrolled asthma, identify predictive parameters, and compare MART and non-MART treatment regimes.

Methods: A prospective questionnaire was administered to 495 patients who signed the consent form. According to the scores obtained from the Asthma control test (ACT), patients were grouped into Group 1 (ACT score ≤ 19): Uncontrolled Asthma and Group 2 (ACT score > 19): Well-Controlled Asthma. Treatment adherence was evaluated by using the Morisky Medication Adherence Scale (MMAS).

Results: The proportion of patients with uncontrolled asthma was found to be 54.9%. Effective predictors of uncontrolled asthma were female gender (OR = 1.7, 95% CI 1.1-2.7, p = 0.023), FEV₁/FVC%<93% (OR = 2.5, 95% CI 1.5-4.1, p < 0.001), a history of visits to the emergency department during the previous year (OR = 2.7, 95% CI 1.7-4.3, p < 0.001), and receiving non-MART treatment (OR = 2.0, 95% CI 1.3-3.1, p = 0.001). MMAS was found to be higher, and medication adherence lower, in uncontrolled asthma patients (p = 0.040). The MART treatment regimen was preferred in 36% of cases. In the MART treatment group, as compared to the non-MART treatment group, uncontrolled asthma (43.8% vs. 61.2%) was observed according to ACT (p < 0.001).

Conclusion: The risk of uncontrolled asthma was found to be higher in female patients, or those who had visited the emergency department, had been hospitalized within the past year, had poor pulmonary function test results or low treatment compliance, and who were on non-MART treatment regimens.