Background: Adherence to inhaler medication is an important contributor to optimum asthma control along with adequate pharmacotherapy. The objective of the present study was to assess self-reported adherence levels and to identify the potential factors associated with non-adherence to the inhalers among asthma patients.
Methods: This facility-based cross-sectional study was conducted in the medicine outpatient department of Rajshahi Medical College Hospital from November 2020 to January 2021. A total of 357 clinically confirmed adult asthma patients were interviewed. Inhaler adherence was measured using the 10-item Test of Adherence scale (TAI).. Both descriptive and inferential statistics were used to express the socio-demographic of the patients and predictors of poor adherence to inhaler.
Results: A substantial number of participants were non-adherent (86%) to inhaler medication. Patients non-adherent to inhaler medication are often younger (23.15, 95% CI 3.67-146.08), lived in the rural area (23.28, 95% CI 2.43-222.66), less year of schooling (5.69, 95% CI 1.27-25.44), and belonged to the middle income (aOR 9.74, 95% CI 2.11-44.9) than those adherent with the inhaler. The presence of comorbidities (12.91, 95% CI 1.41-117.61), prolonged duration of inhaler intake (5.69, 95% CI 1.22-26.49), consulting non-qualified practitioners (13.09, 95% CI 3.10-55.26) were the significant contributor of non-adherence.
Conclusion: Despite ongoing motivation and treatment, non-adherence to inhalation anti-asthmatic is high and several factors have been found to contribute. Regular monitoring and a guided patient-centered self-management approach might be helpful to address them in long run.
背景:坚持吸入器用药是实现最佳哮喘控制和适当药物治疗的重要因素。本研究旨在评估哮喘患者自我报告的依从性水平,并确定与不依从吸入器治疗相关的潜在因素:这项以医院为基础的横断面研究于 2020 年 11 月至 2021 年 1 月在拉杰沙希医学院医院内科门诊部进行。共访问了 357 名经临床确诊的成年哮喘患者。采用10项依从性量表(TAI)测量吸入器的依从性。采用描述性和推论性统计方法对患者的社会人口学特征和吸入器依从性差的预测因素进行了表述:结果:大量参与者未坚持吸入器用药(86%)。与坚持使用吸入器的患者相比,不坚持使用吸入器的患者通常更年轻(23.15,95% CI 3.67-146.08),居住在农村地区(23.28,95% CI 2.43-222.66),受教育年限较低(5.69,95% CI 1.27-25.44),属于中等收入阶层(aOR 9.74,95% CI 2.11-44.9)。合并症(12.91,95% CI 1.41-117.61)、吸入时间过长(5.69,95% CI 1.22-26.49)、咨询无资质医生(13.09,95% CI 3.10-55.26)是导致不坚持治疗的重要因素:结论:尽管有持续的激励和治疗,但不坚持吸入抗哮喘药物的现象仍很严重,这其中有几个因素。从长远来看,定期监测和以患者为中心的自我管理方法可能有助于解决这些问题。
{"title":"Adherence to inhalers and associated factors among adult asthma patients: an outpatient-based study in a tertiary hospital of Rajshahi, Bangladesh.","authors":"Md Abdur Rafi, Chowdhury Ibtida Tahmin, Symom Tashrik, Atia Sharmin Bonna, Ferdousy Jannat, Sabrina Jahan Mily, Abhigan Babu Shrestha, Senjuti Seemanta, Afsana Rashid, Mosarrat Mahjabeen, Nurunnahar Nura, Tasnim Shahriar, Ashrafur Rahaman Mahadi, Kawser Ahmed, Mohammad Jahid Hasan, Md Azizul Haque, Md Golam Hossain","doi":"10.1186/s40733-022-00083-7","DOIUrl":"10.1186/s40733-022-00083-7","url":null,"abstract":"<p><strong>Background: </strong>Adherence to inhaler medication is an important contributor to optimum asthma control along with adequate pharmacotherapy. The objective of the present study was to assess self-reported adherence levels and to identify the potential factors associated with non-adherence to the inhalers among asthma patients.</p><p><strong>Methods: </strong>This facility-based cross-sectional study was conducted in the medicine outpatient department of Rajshahi Medical College Hospital from November 2020 to January 2021. A total of 357 clinically confirmed adult asthma patients were interviewed. Inhaler adherence was measured using the 10-item Test of Adherence scale (TAI).. Both descriptive and inferential statistics were used to express the socio-demographic of the patients and predictors of poor adherence to inhaler.</p><p><strong>Results: </strong>A substantial number of participants were non-adherent (86%) to inhaler medication. Patients non-adherent to inhaler medication are often younger (23.15, 95% CI 3.67-146.08), lived in the rural area (23.28, 95% CI 2.43-222.66), less year of schooling (5.69, 95% CI 1.27-25.44), and belonged to the middle income (aOR 9.74, 95% CI 2.11-44.9) than those adherent with the inhaler. The presence of comorbidities (12.91, 95% CI 1.41-117.61), prolonged duration of inhaler intake (5.69, 95% CI 1.22-26.49), consulting non-qualified practitioners (13.09, 95% CI 3.10-55.26) were the significant contributor of non-adherence.</p><p><strong>Conclusion: </strong>Despite ongoing motivation and treatment, non-adherence to inhalation anti-asthmatic is high and several factors have been found to contribute. Regular monitoring and a guided patient-centered self-management approach might be helpful to address them in long run.</p>","PeriodicalId":8572,"journal":{"name":"Asthma research and practice","volume":" ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8827279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39766385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-15DOI: 10.1186/s40733-021-00082-0
Martina Yaneva, Razvigor Darlenski
Atopic diseases are multifactorial chronic disturbances which may evolve one into another and have overlapping pathogenetic mechanisms. Atopic dermatitis is in most cases the first step towards the development of the atopic march and represents a major socio-economic burden in the industrialized countries. The treatment of atopic diseases is often long-lasting and in some cases with lower effectiveness than expected.In order to prevent the development of the atopic march, the links between the atopic diseases have to be understood. The aim of this review is to present some major points outlining the link between atopic dermatitis and asthma, through a research in the medical literature from recent years.Stratifying patient populations according to the clinical phenotype of their disease and according to specific measurable values (biomarkers) can help to establish the main etiopathogenetic mechanisms of the disease in these populations. This will add predictive value for the evolution of the disease, and will allow the use and research of more targeted therapy in order to stop this evolution and comorbidities.
{"title":"The link between atopic dermatitis and asthma- immunological imbalance and beyond.","authors":"Martina Yaneva, Razvigor Darlenski","doi":"10.1186/s40733-021-00082-0","DOIUrl":"https://doi.org/10.1186/s40733-021-00082-0","url":null,"abstract":"<p><p>Atopic diseases are multifactorial chronic disturbances which may evolve one into another and have overlapping pathogenetic mechanisms. Atopic dermatitis is in most cases the first step towards the development of the atopic march and represents a major socio-economic burden in the industrialized countries. The treatment of atopic diseases is often long-lasting and in some cases with lower effectiveness than expected.In order to prevent the development of the atopic march, the links between the atopic diseases have to be understood. The aim of this review is to present some major points outlining the link between atopic dermatitis and asthma, through a research in the medical literature from recent years.Stratifying patient populations according to the clinical phenotype of their disease and according to specific measurable values (biomarkers) can help to establish the main etiopathogenetic mechanisms of the disease in these populations. This will add predictive value for the evolution of the disease, and will allow the use and research of more targeted therapy in order to stop this evolution and comorbidities.</p>","PeriodicalId":8572,"journal":{"name":"Asthma research and practice","volume":"7 1","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8672460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39841079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-30DOI: 10.1186/s40733-021-00081-1
Kimia Farshadfar, Maryam Sohooli, Ramin Shekouhi, Ali Taherinya, Mostafa Qorbani, Mehdi Rezaei-Kojani
Background and aims: Asthma exacerbation is defined as an acute attack of shortness of breath with more than 25% decrease in morning peak flow compared to the baseline on 2 consecutive days, which requires immediate standard therapy. The majority of asthmatic patients are considered to be steroid-sensitive; however, corticosteroid-resistant asthma is a subset of asthma with poor response to corticosteroids and is responsible for frequent hospital admissions. In this study we aimed to compare the effects of two enhancing strategies, the nebulized ketamine and IV magnesium sulfate, in treatment of severe steroid resistant asthma.
Materials and methods: This double-blind randomized clinical trial was conducted on patients who presented to a referral clinic in Alborz, Iran. Using random allocation, patients were divided into two groups. The first group was treated with nebulized ketamine and the second group was treated with intravenous magnesium sulfate. Peak expiratory flow rates were assessed before the intervention, 30 and 60 min after the intervention and compared with the aid of SPSS software.
Results: The Peak expiratory flow rates before the intervention, 30 min and 60 min after the intervention was statistically significantly different in both ketamine and magnesium sulfate groups. Peak expiratory flow rates change between 0 and 60 min were 29.4 and 15.2% in the ketamine and magnesium sulfate group respectively. Although the ketamine group showed much higher increase in mean PEFR compared to the MgSO4 groups, there was no statistically significant difference across both groups.
Conclusion: Our study concluded that combined with standard therapy, both ketamine and IV magnesium sulfate are effective agents in the improvement of PEFR in patients with acute severe asthma that failed to respond to traditional therapies. However, there were no statistically significant difference between the two groups.
{"title":"The effects of nebulized ketamine and intravenous magnesium sulfate on corticosteroid resistant asthma exacerbation; a randomized clinical trial.","authors":"Kimia Farshadfar, Maryam Sohooli, Ramin Shekouhi, Ali Taherinya, Mostafa Qorbani, Mehdi Rezaei-Kojani","doi":"10.1186/s40733-021-00081-1","DOIUrl":"10.1186/s40733-021-00081-1","url":null,"abstract":"<p><strong>Background and aims: </strong>Asthma exacerbation is defined as an acute attack of shortness of breath with more than 25% decrease in morning peak flow compared to the baseline on 2 consecutive days, which requires immediate standard therapy. The majority of asthmatic patients are considered to be steroid-sensitive; however, corticosteroid-resistant asthma is a subset of asthma with poor response to corticosteroids and is responsible for frequent hospital admissions. In this study we aimed to compare the effects of two enhancing strategies, the nebulized ketamine and IV magnesium sulfate, in treatment of severe steroid resistant asthma.</p><p><strong>Materials and methods: </strong>This double-blind randomized clinical trial was conducted on patients who presented to a referral clinic in Alborz, Iran. Using random allocation, patients were divided into two groups. The first group was treated with nebulized ketamine and the second group was treated with intravenous magnesium sulfate. Peak expiratory flow rates were assessed before the intervention, 30 and 60 min after the intervention and compared with the aid of SPSS software.</p><p><strong>Results: </strong>The Peak expiratory flow rates before the intervention, 30 min and 60 min after the intervention was statistically significantly different in both ketamine and magnesium sulfate groups. Peak expiratory flow rates change between 0 and 60 min were 29.4 and 15.2% in the ketamine and magnesium sulfate group respectively. Although the ketamine group showed much higher increase in mean PEFR compared to the MgSO<sub>4</sub> groups, there was no statistically significant difference across both groups.</p><p><strong>Conclusion: </strong>Our study concluded that combined with standard therapy, both ketamine and IV magnesium sulfate are effective agents in the improvement of PEFR in patients with acute severe asthma that failed to respond to traditional therapies. However, there were no statistically significant difference between the two groups.</p>","PeriodicalId":8572,"journal":{"name":"Asthma research and practice","volume":"7 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8630847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39679835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Asthma is a chronic inflammatory disorder characterized by airway obstruction and hyper-responsiveness. Studies suggest that household fuel exposure and housing characteristics are associated with air way related allergy. But there remains to be a considerable uncertainty about whether that reflects an association with asthma. This study endeavored to bridge the gap by identifying factors associated with asthma, with special reference to household fuel exposure and housing characteristics in selected public hospitals in Addis Ababa, Ethiopia.
Methods: We conducted a hospital-based matched case-control study. A total of 483 study participants were selected from two Ethiopian referral hospitals using a sequential sampling technique, with 161 cases and 322 controls. Standard questionnaire from the European Community Respiratory Health Survey II (ECRHS II) and the American Thoracic Society Division of Lung Disease (ATS-DLD-78) were used to collect household related data. Conditional logistic regression model was applied to identify the determinants of asthma. Both crude and adjusted odds ratios with 95% confidence interval (CI) were used to identify predictors of asthma.
Results: The response rate for both cases and controls was 99.17%. The odds of developing asthma was about four times higher among those who used agricultural residues for cooking (AOR: 3.81, 95% CI: 1.05, 13.79)., about five times higher among those who used wood for cooking (AOR: 4.95, 95% CI: 2.1, 11.69), nearly five times higher among those who had family history of asthma (AOR: 4.72, 95% CI: 1.54, 14.45), just over six times higher among those who smoke tobacco (AOR: 6.16, 95% CI: 1.31, 29.09) and over ten times higher among those who do not practice door opening, while cooking (AOR: 10.25, 95% CI: 3.97, 26.49).
Conclusion: Family history of asthma, tobacco smoking, use of solid fuels including, woods and agricultural residues were associated with development of asthma. To reduce the risk of asthma, people should practice door opening, while cooking, and must avoid using wood and agricultural residues for cooking and should also refrain from tobacco smoking.
{"title":"Determinants of asthma in Ethiopia: age and sex matched case control study with special reference to household fuel exposure and housing characteristics.","authors":"Yonas Abebe, Ahmed Ali, Abera Kumie, Tewodros Haile, Mulugeta Tamire, Adamu Addissie","doi":"10.1186/s40733-021-00080-2","DOIUrl":"https://doi.org/10.1186/s40733-021-00080-2","url":null,"abstract":"<p><strong>Background: </strong>Asthma is a chronic inflammatory disorder characterized by airway obstruction and hyper-responsiveness. Studies suggest that household fuel exposure and housing characteristics are associated with air way related allergy. But there remains to be a considerable uncertainty about whether that reflects an association with asthma. This study endeavored to bridge the gap by identifying factors associated with asthma, with special reference to household fuel exposure and housing characteristics in selected public hospitals in Addis Ababa, Ethiopia.</p><p><strong>Methods: </strong>We conducted a hospital-based matched case-control study. A total of 483 study participants were selected from two Ethiopian referral hospitals using a sequential sampling technique, with 161 cases and 322 controls. Standard questionnaire from the European Community Respiratory Health Survey II (ECRHS II) and the American Thoracic Society Division of Lung Disease (ATS-DLD-78) were used to collect household related data. Conditional logistic regression model was applied to identify the determinants of asthma. Both crude and adjusted odds ratios with 95% confidence interval (CI) were used to identify predictors of asthma.</p><p><strong>Results: </strong>The response rate for both cases and controls was 99.17%. The odds of developing asthma was about four times higher among those who used agricultural residues for cooking (AOR: 3.81, 95% CI: 1.05, 13.79)., about five times higher among those who used wood for cooking (AOR: 4.95, 95% CI: 2.1, 11.69), nearly five times higher among those who had family history of asthma (AOR: 4.72, 95% CI: 1.54, 14.45), just over six times higher among those who smoke tobacco (AOR: 6.16, 95% CI: 1.31, 29.09) and over ten times higher among those who do not practice door opening, while cooking (AOR: 10.25, 95% CI: 3.97, 26.49).</p><p><strong>Conclusion: </strong>Family history of asthma, tobacco smoking, use of solid fuels including, woods and agricultural residues were associated with development of asthma. To reduce the risk of asthma, people should practice door opening, while cooking, and must avoid using wood and agricultural residues for cooking and should also refrain from tobacco smoking.</p>","PeriodicalId":8572,"journal":{"name":"Asthma research and practice","volume":"7 1","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2021-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39771588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-05DOI: 10.1186/s40733-021-00079-9
Sherrie Xie, Jessica R Meeker, Luzmercy Perez, Whitney Eriksen, Anna Localio, Hami Park, Alicia Jen, Madison Goldstein, Akua F Temeng, Sarai M Morales, Colin Christie, Rebecca E Greenblatt, Frances K Barg, Andrea J Apter, Blanca E Himes
Background: Exposure to fine particulate matter (PM2.5) increases the risk of asthma exacerbations, and thus, monitoring personal exposure to PM2.5 may aid in disease self-management. Low-cost, portable air pollution sensors offer a convenient way to measure personal pollution exposure directly and may improve personalized monitoring compared with traditional methods that rely on stationary monitoring stations. We aimed to understand whether adults with asthma would be willing to use personal sensors to monitor their exposure to air pollution and to assess the feasibility of using sensors to measure real-time PM2.5 exposure.
Methods: We conducted semi-structured interviews with 15 adults with asthma to understand their willingness to use a personal pollution sensor and their privacy preferences with regard to sensor data. Student research assistants used HabitatMap AirBeam devices to take PM2.5 measurements at 1-s intervals while walking in Philadelphia neighborhoods in May-August 2018. AirBeam PM2.5 measurements were compared to concurrent measurements taken by three nearby regulatory monitors.
Results: All interview participants stated that they would use a personal air pollution sensor, though the consensus was that devices should be small (watch- or palm-sized) and light. Patients were generally unconcerned about privacy or sharing their GPS location, with only two stating they would not share their GPS location under any circumstances. PM2.5 measurements were taken using AirBeam sensors on 34 walks that extended through five Philadelphia neighborhoods. The range of sensor PM2.5 measurements was 0.6-97.6 μg/mL (mean 6.8 μg/mL), compared to 0-22.6 μg/mL (mean 9.0 μg/mL) measured by nearby regulatory monitors. Compared to stationary measurements, which were only available as 1-h integrated averages at discrete monitoring sites, sensor measurements permitted characterization of fine-scale fluctuations in PM2.5 levels over time and space.
Conclusions: Patients were generally interested in using sensors to monitor their personal exposure to PM2.5 and willing to share personal sensor data with health care providers and researchers. Compared to traditional methods of personal exposure assessment, sensors captured personalized air quality information at higher spatiotemporal resolution. Improvements to currently available sensors, including more reliable Bluetooth connectivity, increased portability, and longer battery life would facilitate their use in a general patient population.
{"title":"Feasibility and acceptability of monitoring personal air pollution exposure with sensors for asthma self-management.","authors":"Sherrie Xie, Jessica R Meeker, Luzmercy Perez, Whitney Eriksen, Anna Localio, Hami Park, Alicia Jen, Madison Goldstein, Akua F Temeng, Sarai M Morales, Colin Christie, Rebecca E Greenblatt, Frances K Barg, Andrea J Apter, Blanca E Himes","doi":"10.1186/s40733-021-00079-9","DOIUrl":"https://doi.org/10.1186/s40733-021-00079-9","url":null,"abstract":"<p><strong>Background: </strong>Exposure to fine particulate matter (PM<sub>2.5</sub>) increases the risk of asthma exacerbations, and thus, monitoring personal exposure to PM<sub>2.5</sub> may aid in disease self-management. Low-cost, portable air pollution sensors offer a convenient way to measure personal pollution exposure directly and may improve personalized monitoring compared with traditional methods that rely on stationary monitoring stations. We aimed to understand whether adults with asthma would be willing to use personal sensors to monitor their exposure to air pollution and to assess the feasibility of using sensors to measure real-time PM<sub>2.5</sub> exposure.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 15 adults with asthma to understand their willingness to use a personal pollution sensor and their privacy preferences with regard to sensor data. Student research assistants used HabitatMap AirBeam devices to take PM<sub>2.5</sub> measurements at 1-s intervals while walking in Philadelphia neighborhoods in May-August 2018. AirBeam PM<sub>2.5</sub> measurements were compared to concurrent measurements taken by three nearby regulatory monitors.</p><p><strong>Results: </strong>All interview participants stated that they would use a personal air pollution sensor, though the consensus was that devices should be small (watch- or palm-sized) and light. Patients were generally unconcerned about privacy or sharing their GPS location, with only two stating they would not share their GPS location under any circumstances. PM<sub>2.5</sub> measurements were taken using AirBeam sensors on 34 walks that extended through five Philadelphia neighborhoods. The range of sensor PM<sub>2.5</sub> measurements was 0.6-97.6 μg/mL (mean 6.8 μg/mL), compared to 0-22.6 μg/mL (mean 9.0 μg/mL) measured by nearby regulatory monitors. Compared to stationary measurements, which were only available as 1-h integrated averages at discrete monitoring sites, sensor measurements permitted characterization of fine-scale fluctuations in PM<sub>2.5</sub> levels over time and space.</p><p><strong>Conclusions: </strong>Patients were generally interested in using sensors to monitor their personal exposure to PM<sub>2.5</sub> and willing to share personal sensor data with health care providers and researchers. Compared to traditional methods of personal exposure assessment, sensors captured personalized air quality information at higher spatiotemporal resolution. Improvements to currently available sensors, including more reliable Bluetooth connectivity, increased portability, and longer battery life would facilitate their use in a general patient population.</p>","PeriodicalId":8572,"journal":{"name":"Asthma research and practice","volume":"7 1","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2021-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39384240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-13DOI: 10.1186/s40733-021-00078-w
Silvano Dragonieri, Giovanna Elisiana Carpagnano
Around 5-10% of the total asthmatic population suffer from severe or uncontrolled asthma, which is associated with increased mortality and hospitalization, increased health care burden and worse quality of life. In the last few years, new drugs have been launched and several asthma phenotypes according to definite biomarkers have been identified. In particular, therapy with biologics has revolutionized the management and the treatment of severe asthma, showing high therapeutic efficacy associated with significant clinical benefits. To date, four types of biologics are licensed for severe asthma, i.e. omalizumab (anti-immunoglobulin E) antibody, mepolizumab and reslizumab (anti-interleukin [IL]-5antibody), benralizumab (anti-IL-5 receptor a antibody) and dupilumab (anti-IL-4 receptor alpha antibody). The aim of this article was to review the biologic therapies currently available for the treatment of severe asthma, in order to help physicians to choose the most suitable biologic agent for their asthmatic patients.
哮喘患者总数中约有 5-10%患有严重或无法控制的哮喘,这与死亡率和住院率增加、医疗负担加重和生活质量下降有关。在过去几年中,新药相继问世,并根据明确的生物标志物确定了几种哮喘表型。尤其是生物制剂的治疗彻底改变了重症哮喘的管理和治疗,显示出与显著临床疗效相关的高疗效。迄今为止,已有四种生物制剂获得了治疗重症哮喘的许可,即奥马珠单抗(抗免疫球蛋白 E 抗体)、美博利珠单抗和雷利珠单抗(抗白细胞介素 [IL]-5 抗体)、苯拉珠单抗(抗 IL-5 受体 a 抗体)和杜匹单抗(抗 IL-4 受体 alpha 抗体)。本文旨在回顾目前可用于治疗重症哮喘的生物疗法,以帮助医生为哮喘患者选择最合适的生物制剂。
{"title":"Biological therapy for severe asthma.","authors":"Silvano Dragonieri, Giovanna Elisiana Carpagnano","doi":"10.1186/s40733-021-00078-w","DOIUrl":"10.1186/s40733-021-00078-w","url":null,"abstract":"<p><p>Around 5-10% of the total asthmatic population suffer from severe or uncontrolled asthma, which is associated with increased mortality and hospitalization, increased health care burden and worse quality of life. In the last few years, new drugs have been launched and several asthma phenotypes according to definite biomarkers have been identified. In particular, therapy with biologics has revolutionized the management and the treatment of severe asthma, showing high therapeutic efficacy associated with significant clinical benefits. To date, four types of biologics are licensed for severe asthma, i.e. omalizumab (anti-immunoglobulin E) antibody, mepolizumab and reslizumab (anti-interleukin [IL]-5antibody), benralizumab (anti-IL-5 receptor a antibody) and dupilumab (anti-IL-4 receptor alpha antibody). The aim of this article was to review the biologic therapies currently available for the treatment of severe asthma, in order to help physicians to choose the most suitable biologic agent for their asthmatic patients.</p>","PeriodicalId":8572,"journal":{"name":"Asthma research and practice","volume":"7 1","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2021-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8362167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39310475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-03DOI: 10.1186/s40733-021-00077-x
Ivana Banić, Mario Lovrić, Gerald Cuder, Roman Kern, Matija Rijavec, Peter Korošec, Mirjana Turkalj
Despite widely and regularly used therapy asthma in children is not fully controlled. Recognizing the complexity of asthma phenotypes and endotypes imposed the concept of precision medicine in asthma treatment. By applying machine learning algorithms assessed with respect to their accuracy in predicting treatment outcome, we have successfully identified 4 distinct clusters in a pediatric asthma cohort with specific treatment outcome patterns according to changes in lung function (FEV1 and MEF50), airway inflammation (FENO) and disease control likely affected by discrete phenotypes at initial disease presentation, differing in the type and level of inflammation, age of onset, comorbidities, certain genetic and other physiologic traits. The smallest and the largest of the 4 clusters- 1 (N = 58) and 3 (N = 138) had better treatment outcomes compared to clusters 2 and 4 and were characterized by more prominent atopic markers and a predominant allelic (A allele) effect for rs37973 in the GLCCI1 gene previously associated with positive treatment outcomes in asthmatics. These patients also had a relatively later onset of disease (6 + yrs). Clusters 2 (N = 87) and 4 (N = 64) had poorer treatment success, but varied in the type of inflammation (predominantly neutrophilic for cluster 4 and likely mixed-type for cluster 2), comorbidities (obesity for cluster 2), level of systemic inflammation (highest hsCRP for cluster 2) and platelet count (lowest for cluster 4). The results of this study emphasize the issues in asthma management due to the overgeneralized approach to the disease, not taking into account specific disease phenotypes.
{"title":"Treatment outcome clustering patterns correspond to discrete asthma phenotypes in children.","authors":"Ivana Banić, Mario Lovrić, Gerald Cuder, Roman Kern, Matija Rijavec, Peter Korošec, Mirjana Turkalj","doi":"10.1186/s40733-021-00077-x","DOIUrl":"https://doi.org/10.1186/s40733-021-00077-x","url":null,"abstract":"<p><p>Despite widely and regularly used therapy asthma in children is not fully controlled. Recognizing the complexity of asthma phenotypes and endotypes imposed the concept of precision medicine in asthma treatment. By applying machine learning algorithms assessed with respect to their accuracy in predicting treatment outcome, we have successfully identified 4 distinct clusters in a pediatric asthma cohort with specific treatment outcome patterns according to changes in lung function (FEV<sub>1</sub> and MEF<sub>50</sub>), airway inflammation (FENO) and disease control likely affected by discrete phenotypes at initial disease presentation, differing in the type and level of inflammation, age of onset, comorbidities, certain genetic and other physiologic traits. The smallest and the largest of the 4 clusters- 1 (N = 58) and 3 (N = 138) had better treatment outcomes compared to clusters 2 and 4 and were characterized by more prominent atopic markers and a predominant allelic (A allele) effect for rs37973 in the GLCCI1 gene previously associated with positive treatment outcomes in asthmatics. These patients also had a relatively later onset of disease (6 + yrs). Clusters 2 (N = 87) and 4 (N = 64) had poorer treatment success, but varied in the type of inflammation (predominantly neutrophilic for cluster 4 and likely mixed-type for cluster 2), comorbidities (obesity for cluster 2), level of systemic inflammation (highest hsCRP for cluster 2) and platelet count (lowest for cluster 4). The results of this study emphasize the issues in asthma management due to the overgeneralized approach to the disease, not taking into account specific disease phenotypes.</p>","PeriodicalId":8572,"journal":{"name":"Asthma research and practice","volume":"7 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2021-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40733-021-00077-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39272436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-21DOI: 10.1186/s40733-021-00076-y
Xiaoxian Zhang, Zhengdao Lai, Rihuang Qiu, E Guo, Jing Li, Qingling Zhang, Naijian Li
Background: Severe asthma is difficult to control. Therapeutic patient education enables patients to better understand their disease and cope with treatment, but the effect of therapeutic patient education in severe uncontrolled asthma is unclear. We evaluated whether therapeutic patient education is effective in improving asthma control and decreasing the frequency of exacerbations in severe uncontrolled asthma.
Methods: This was a prospective, observational, and self-controlled study that enrolled 40 subjects with severe uncontrolled asthma. Patients were seen at a clinic four times (on day 1 and after 3, 6, and 12 months). After baseline data collection, the subjects completed a therapeutic patient education program and were also followed-up via telephone after 1, 2, 4, 5, 7, 8, 9, 10, and 11 months to monitor asthma medication adherence and collect asthma-related information.
Results: Within the 1-year study period, a total of 23 exacerbations were recorded in 14 patients, seven of whom required emergency treatment and two of whom were hospitalized. Twelve months after the standardized therapeutic patient education program, pulmonary function and fractional exhaled nitric oxide levels improved significantly in all 40 patients. Moreover, the scores from three standardized asthma questionnaires and indices suggested improved quality of life in these patients with severe uncontrolled asthma. Serum levels of biomarkers reflecting asthma immune responses did not change between baseline and the 1-year follow-up time point.
Conclusions: Therapeutic patient education is effective in improving asthma control and decreasing exacerbations in patients with severe uncontrolled asthma.
{"title":"Positive change in asthma control using therapeutic patient education in severe uncontrolled asthma: a one-year prospective study.","authors":"Xiaoxian Zhang, Zhengdao Lai, Rihuang Qiu, E Guo, Jing Li, Qingling Zhang, Naijian Li","doi":"10.1186/s40733-021-00076-y","DOIUrl":"https://doi.org/10.1186/s40733-021-00076-y","url":null,"abstract":"<p><strong>Background: </strong>Severe asthma is difficult to control. Therapeutic patient education enables patients to better understand their disease and cope with treatment, but the effect of therapeutic patient education in severe uncontrolled asthma is unclear. We evaluated whether therapeutic patient education is effective in improving asthma control and decreasing the frequency of exacerbations in severe uncontrolled asthma.</p><p><strong>Methods: </strong>This was a prospective, observational, and self-controlled study that enrolled 40 subjects with severe uncontrolled asthma. Patients were seen at a clinic four times (on day 1 and after 3, 6, and 12 months). After baseline data collection, the subjects completed a therapeutic patient education program and were also followed-up via telephone after 1, 2, 4, 5, 7, 8, 9, 10, and 11 months to monitor asthma medication adherence and collect asthma-related information.</p><p><strong>Results: </strong>Within the 1-year study period, a total of 23 exacerbations were recorded in 14 patients, seven of whom required emergency treatment and two of whom were hospitalized. Twelve months after the standardized therapeutic patient education program, pulmonary function and fractional exhaled nitric oxide levels improved significantly in all 40 patients. Moreover, the scores from three standardized asthma questionnaires and indices suggested improved quality of life in these patients with severe uncontrolled asthma. Serum levels of biomarkers reflecting asthma immune responses did not change between baseline and the 1-year follow-up time point.</p><p><strong>Conclusions: </strong>Therapeutic patient education is effective in improving asthma control and decreasing exacerbations in patients with severe uncontrolled asthma.</p>","PeriodicalId":8572,"journal":{"name":"Asthma research and practice","volume":"7 1","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2021-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40733-021-00076-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39206267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-15DOI: 10.1186/s40733-021-00075-z
Carlo Lombardi, Federica Gani, Alvise Berti, Pasquale Comberiati, Diego Peroni, Marcello Cottini
The coronavirus disease 2019 (COVID-19) pandemic, caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), provoked the most striking international public health crisis of our time. COVID-19 can cause a range of breathing problems, from mild to critical, with potential evolution to respiratory failure and acute respiratory distress syndrome. Elderly adults and those affected with chronic cardiovascular, metabolic, and respiratory conditions carry a higher risk of severe COVID-19. Given the global burden of asthma, there are well-founded concerns that the relationship between COVID-19 and asthma could represent a "dangerous liaison".Here we aim to review the latest evidence on the links between asthma and COVID-19 and provide reasoned answers to current concerns, such as the risk of developing SARS-CoV-2 infection and/or severe COVID-19 stratified by asthmatic patients, the contribution of type-2 vs. non-type-2 asthma and asthma-COPD overlap to the risk of COVID-19 development. We also address the potential role of both standard anti-inflammatory asthma therapies and new biological agents for severe asthma, such as mepolizumab, reslizumab, and benralizumab, on the susceptibility to SARS-CoV-2 infection and severe COVID-19 outcomes.
{"title":"Asthma and COVID-19: a dangerous liaison?","authors":"Carlo Lombardi, Federica Gani, Alvise Berti, Pasquale Comberiati, Diego Peroni, Marcello Cottini","doi":"10.1186/s40733-021-00075-z","DOIUrl":"10.1186/s40733-021-00075-z","url":null,"abstract":"<p><p>The coronavirus disease 2019 (COVID-19) pandemic, caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), provoked the most striking international public health crisis of our time. COVID-19 can cause a range of breathing problems, from mild to critical, with potential evolution to respiratory failure and acute respiratory distress syndrome. Elderly adults and those affected with chronic cardiovascular, metabolic, and respiratory conditions carry a higher risk of severe COVID-19. Given the global burden of asthma, there are well-founded concerns that the relationship between COVID-19 and asthma could represent a \"dangerous liaison\".Here we aim to review the latest evidence on the links between asthma and COVID-19 and provide reasoned answers to current concerns, such as the risk of developing SARS-CoV-2 infection and/or severe COVID-19 stratified by asthmatic patients, the contribution of type-2 vs. non-type-2 asthma and asthma-COPD overlap to the risk of COVID-19 development. We also address the potential role of both standard anti-inflammatory asthma therapies and new biological agents for severe asthma, such as mepolizumab, reslizumab, and benralizumab, on the susceptibility to SARS-CoV-2 infection and severe COVID-19 outcomes.</p>","PeriodicalId":8572,"journal":{"name":"Asthma research and practice","volume":"7 1","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40733-021-00075-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39184418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The Coronavirus disease 2019 outbreak is the first reported case in Wuhan, China in December 2019 and suddenly became a major global health concern. Currently, there is no vaccine and treatment have been reported. The aim of this study was to assess the knowledge, attitude, and practice of COVID-19 among chronic disease patients.
Methods: A hospital-based cross-sectional study was conducted among 422 chronic disease patients from July 01 to August 30, 2020 at Aksum Hospital, Northern Ethiopia. Both bivariable and multivariable logistic regression analyses with 95% confidence intervals were fitted to identify factors associated with poor knowledge and practice towards COVID-19. The adjusted odds ratio (AOR) was used to determine the prevalence of the association between the dependent and independent variables. A P-value < 0.05 was identified as statistically significant.
Results: A total of 422 participants participated in this study, with a 100% response rate. The prevalence of poor knowledge, poor practice and unfavorable attitude was 35.1, 48.8, and 40.5%, respectively. Age (AOR = 1.5, 95% CI: (1.411, 2.432)), educational status of "can't read and write" (AOR = 1.4, 95% CI: (1.332, 9.612)), and rural residence (AOR = 3.12, 95% CI: (2.568, 11.532)) were significantly associated with poor knowledge. Educational status of "can't read and write" (AOR = 2.7, 95% CI (1.03-7.29)), and rural residence (AOR = 2.7, 95% CI (1.09-6.70)) were significantly associated with poor practice.
Conclusions: The prevalence of poor knowledge and poor practice among chronic disease patients were high. Rural residence and educational status with "can not read and write" were significantly associated with poor knowledge and poor practice. Older age was significantly associated with poor knowledge.
{"title":"Knowledge, attitude, and practice towards COVID-19 among chronic disease patients at Aksum Hospital, Northern Ethiopia, 2020: a cross-sectional study.","authors":"Assefa Iyasu, Berihu Hailu Kidanu, Kidane Zereabruk","doi":"10.1186/s40733-021-00074-0","DOIUrl":"https://doi.org/10.1186/s40733-021-00074-0","url":null,"abstract":"<p><strong>Background: </strong>The Coronavirus disease 2019 outbreak is the first reported case in Wuhan, China in December 2019 and suddenly became a major global health concern. Currently, there is no vaccine and treatment have been reported. The aim of this study was to assess the knowledge, attitude, and practice of COVID-19 among chronic disease patients.</p><p><strong>Methods: </strong>A hospital-based cross-sectional study was conducted among 422 chronic disease patients from July 01 to August 30, 2020 at Aksum Hospital, Northern Ethiopia. Both bivariable and multivariable logistic regression analyses with 95% confidence intervals were fitted to identify factors associated with poor knowledge and practice towards COVID-19. The adjusted odds ratio (AOR) was used to determine the prevalence of the association between the dependent and independent variables. A P-value < 0.05 was identified as statistically significant.</p><p><strong>Results: </strong>A total of 422 participants participated in this study, with a 100% response rate. The prevalence of poor knowledge, poor practice and unfavorable attitude was 35.1, 48.8, and 40.5%, respectively. Age (AOR = 1.5, 95% CI: (1.411, 2.432)), educational status of \"can't read and write\" (AOR = 1.4, 95% CI: (1.332, 9.612)), and rural residence (AOR = 3.12, 95% CI: (2.568, 11.532)) were significantly associated with poor knowledge. Educational status of \"can't read and write\" (AOR = 2.7, 95% CI (1.03-7.29)), and rural residence (AOR = 2.7, 95% CI (1.09-6.70)) were significantly associated with poor practice.</p><p><strong>Conclusions: </strong>The prevalence of poor knowledge and poor practice among chronic disease patients were high. Rural residence and educational status with \"can not read and write\" were significantly associated with poor knowledge and poor practice. Older age was significantly associated with poor knowledge.</p>","PeriodicalId":8572,"journal":{"name":"Asthma research and practice","volume":"7 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2021-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40733-021-00074-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39014158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}