Asthma research and practice最新文献

[This corrects the article DOI: 10.1186/s40733-020-00055-9.].

Introduction: The Global Initiative for Asthma (GINA)-defined criteria for asthma control include questions about daytime symptoms, limitation of activity, nocturnal symptoms, need for reliever treatment and patients' satisfaction. Patients with nocturnal symptoms like wheezing and cough often suffer from lower sleep quality and impaired daytime performance. The lack of an appropriate method for standardized and objective monitoring of respiratory symptoms leads to difficulties in asthma management. The aim of this study is to present a new method for automated wheeze and cough detection during sleep and to assess the actual level of asthma control by the Asthma Control Test (ACT).

Methods: Respiratory symptoms like wheezing and cough were recorded with the LEOSound-Monitor for one night in 55 asthmatic patients in their individual domestic setting. Patients were asked to assess their level of asthma subjectively with the ACT. The study consisted of 37 women and 18 men, with a mean age of 41 years, and a mean BMI of 27 kg/m². Most of the patients had been taking an ICS/LABA combination and would resort to a SABA as their rescue medication.

Results: 60% of the participants were classed as having controlled, and 40% were classed as having partially- or uncontrolled asthma. During sleep wheezing was found in 8 of the 55 asthma patients (14.5%) and coughing was found in 30 patients (54.5%). The median ACT score in wheezing-patients was 14, while in non-wheezing patients it was 21. Uncontrolled asthma was found in 6 of the 8 wheezing-patients. Coughing versus non-coughing patients did not show a significant difference in the ACT-score (20, 22 respectively).

Conclusion: Wheezing is a sign of uncontrolled asthma. The ACT-score in wheezing patients is worse compared to patients without wheezing. LEOSound proofed to be a useful tool in providing an objective evaluation of respiratory symptoms, like coughing and wheezing. In clinical practice, this may allow an improvement in asthma therapy.

Background: Coronavirus disease 2019 outbreak is the first reported case in Wuhan, China in December 2019 and suddenly became a major global health concern. According to the European Centre for Disease Prevention and Control, on August 4, 2020 the reported cases of coronavirus disease 2019 were 18,456,952 cases worldwide, 11,691,229 recovered with 697,719 deaths. Evidence on Burden, admission and outcome of Coronavirus Disease in 2019 among Asthmatic patients has not been published in Africa. This research protocol will, therefore, be driven to conduct systematic review and meta-analysis of the Coronavirus Disease in 2019 burden, admission and outcome among Asthmatic patients in Africa.

Methods: All observational studies among Asthmatic patients in Africa and written without language limitation will be included. A search technique was applied using Databases (PubMed / MEDLINE, EMBASE, HINARI, Cochrane Library, World Health Organization COVID-19 database, Africa Wide Knowledge and Web of Science). Two independent authors carried out data extraction and assess the risk of bias using a predetermined and structured method of data collection. We will use random-effects to estimate the overall pooled burden, admission and outcome of COVID-19 Asthmatic patients in Africa. To assess possible publication bias, funnel plot test and Egger's test methods will be used. This systematic and meta-analysis review protocol will be reported based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis protocol guidelines.

Discussion: The description will be used to show the COVID-19 distribution data by interest variables such as residence, setting, and person-level characteristics. The findings of this review will notify health care professionals about the burden, admission and outcome of COVID - 19 in asthmatic patient, while providing evidence to bring about the requisite improvements in clinical practice for asthmatic patients.

Systematic review registration: This review is registered in the PROSPERO International Prospective Register of Systematic reviews with the registration number of CRD42020202049.

Background: Although asthma is a serious public health concern in Zimbabwe, there is lack of information regarding the decision to seek for healthcare services among patients. This study aimed to determine the health care seeking behaviour of adult patients with asthma attending Chitungwiza Central Hospital in Zimbabwe.

Methods: A cross-sectional study was conducted among 400 patients with asthma. A questionnaire with four thematic areas (i) patients' demographic characteristics, (ii) types of health seeking behaviours (iii) knowledge of asthma treatment and (iv) attitudes on asthma treatment was used.

Results: We determined the sequence of remedial action that people undertake to rectify perceived ill health commonly referred to as health care seeking behaviours in 400 adult patients with asthma. This behaviour was considered good if the patient sought care at the hospital/clinic and or private practitioners. Poor health seeking behaviour was adjudged if patients sought no treatment, self-treated or resorted to traditional or faith healers for care.The majority 261(65.3%) of the study participants were females mainly between ages 29-39 years who lived in the urban setting. Distance to health facility, perception of supportive roles of healthcare providers, perceived good quality of service and knowledge of asthma complications were key determinants for health seeking behaviour. The results showed that majority 290 (72.5%) reported good health seeking behaviour. The correlates of good health seeking behaviour included financial capacity to pay for medical care [OR: 0.50 (CI: 0.31-0.83); p = 0.008)] and receiving good quality of asthma treatment [OR: 0.59 (CI: 0.37-0.93); p = 0.03)]. The inability to voluntarily seek own asthma treatment [OR: 1.68 (CI: 1.05-2.70); p = 0.03) was a significant risk factor (68% more likely) for poor health seeking behaviour.

Conclusions: We concluded that prior to scaling up asthma treatment programmes in Zimbabwe, there is need to address, individual-level, community-level and health service level barriers to health seeking among asthma patients.

Background: Short-acting β2-agonist (SABA) nebulization is commonly prescribed for children hospitalized with severe asthma exacerbation. Either intermittent or continuous delivery has been considered safe and efficient. The comparative efficacy of these two modalities is inconclusive. We aimed to compare these two modalities as the first-line treatments.

Methods: An efficacy research with a retrospective cohort study design was conducted. Hospital records of children with severe asthma exacerbation admitted to Hat Yai Hospital between 2015 and 2017 were retrospectively collected. Children initially treated with continuous salbutamol 10 mg per hour or intermittent salbutamol 2.5 mg per dose over 1-4 h nebulization were matched one-to-one using the propensity score. Competing risk and risk difference regression was applied to evaluate the proportion of children who succeeded and failed the initial treatment. Restricted mean survival time regression was used to compare the length of stay (LOS) between the two groups.

Results: One-hundred and eighty-nine children were included. Of these children, 112 were matched for analysis (56 with continuous and 56 with intermittent nebulization). Children with continuous nebulization experienced a higher proportion of success in nebulization treatment (adjusted difference: 39.5, 95% CI 22.7, 56.3, p < 0.001), with a faster rate of success (adjusted SHR: 2.70, 95% CI 1.73, 4.22, p < 0.001). There was a tendency that LOS was also shorter (adjusted mean difference - 9.9 h, 95% CI -24.2, 4.4, p = 0.176).

Conclusion: Continuous SABA nebulization was more efficient than intermittent nebulization in the treatment of children with severe asthma exacerbation.

Background: Exercise is recommended in guidelines for asthma management and has beneficial effects on symptom control, inflammation and lung function in patients with sub-optimally controlled asthma. Despite this, physical activity levels in patients with difficult asthma are often impaired. Understanding the barriers to exercise in people with difficult asthma is crucial for increasing their activity, and in implementing successful, disease modifying, and holistic approaches to improve their health.

Methods: 62 Patients within the WATCH Difficult Asthma Cohort (Southampton, UK) completed an Exercise Therapy Burden Questionnaire (ETBQ). The results were analyzed with contemporaneous asthma-related data to determine relationships between perceived exercise barriers and asthma and comorbidity characteristics.

Results: Patients were reflective of a difficult asthma cohort, 66% were female, and 63% were atopic. They had a high BMI (median [inter-quartile range]) of 29.3 [25.5-36.2], age of 53.5 [38.75, 65.25], impaired spirometry with FEV1 73% predicted [59.5, 86.6%] and FEV/FVC ratio of 72 [56.5, 78.0] and poor symptom control, as defined by an Asthma Control Questionnaire (ACQ6) result of 2.4 [1.28, 3.2]. A high perceived barriers to exercise score was significantly correlated with increased asthma symptoms (r = 0.452, p < 0.0001), anxiety (r = 0.375, p = 0.005) and depression (r = 0.363, p = 0.008), poor quality of life (r = 0.345, p = 0.015) and number of rescue oral steroid courses in the past 12 months (r = 0.257, p = 0.048). Lung function, blood eosinophil count, FeNO, Njimegen and SNOT22 scores, BMI and hospitalisations in the previous year were not related to exercise perceptions.

Conclusion: In difficult asthma, perceived barriers to exercise are related to symptom burden and psychological morbidity. Therefore, exercise interventions combined with psychological input such as CBT to restructure thought processes around these perceived barriers may be useful in facilitating adoption of exercise.

Background: Asthma affects the lives of hundred million people around the World. Despite notable progresses in disease management, asthma control remains largely insufficient worldwide, influencing patients' wellbeing and quality of life. Poor patient handling of inhaling devices has been identified as a major persistent problem that significantly reduces inhaled drugs' efficacy and is associated with poor adherence to treatment, impairing clinical results such as asthma control and increasing disease-related costs. We herein review key research and development (R&D) innovation in inhaler devices, highlighting major real-world critical errors in the handling and inhalation technique with current devices and considering potential solutions. Furthermore, we discuss current evidence regarding breath-triggered inhalers (BTI).

Main body: The two most common significant problems with inhalers are coordinating actuation and inhalation with pressurized metered-dose inhalers (pMDIs), and the need to inhale forcibly with a dry powder inhaler. BTI R&D plans were designed to overcome these problems. Its newest device k-haler® has several other important features, generating a less forceful aerosol plume than previous pMDIs, with efficient drug delivery and lung deposition, even in patients with low inspiratory flow. The local and systemic bioavailability of fluticasone propionate and formoterol (FP/FORM) administered via k-haler® has been shown to be therapeutically equivalent when administered via the previous FP/FORM pMDI. This device requires very few steps and has been considered easy to use (even at first attempt) and preferred by the patients in a randomized crossover study. In our country, FP/FORM k-haler is available without additional costs compared to FP/FORM pMDI. All devices continue to require education and regular checking of the correct inhalation technique.

Conclusion: BTI R&D can bring advantage over current available inhalers, avoiding the two most common identified critical errors in inhalation technique. K-haler® BTI is currently available, without an increased cost, and approved for adolescents and adults with asthma in whom treatment with inhaled combined therapy with long-acting beta₂-agonists and corticosteroids is indicated. Its attractive and practical design to facilitate its use has been awarded. K-haler® represents added value through innovation to fulfill actual asthma patient needs, thus with potential relevant impact in asthma management and effective control.

Background: Asthma is a chronic airway inflammation disease that is frequently found in children and adolescents with an increasing prevalence. Several studies are linking its presence to many lifestyle and health correlates. The objective of this study was to explore these correlates and find characteristics of self-reported asthmatics among adolescents in Saudi Arabia.

Methods: This is a cross-sectional, school-based study carried out in all 13 regions of Saudi Arabia. Sampling was randomly done from intermediate and secondary school students. Data in our study consisted of demographic characteristics, health conditions and lifestyle patterns and were compared between the two groups: asthmatics versus non-asthmatics. Comparison between the two groups was done by analyzing our data using Statistical Analysis Software SURVEYFREQ procedure (SAS Version 9; SAS Institute, Cary, NC).

Results: Among a sample of 11,348 participants, the prevalence of self-reported asthma was found to be 8.2%. Various characteristics were found significantly different between the 2 groups including the gender, the weight, the family's education, and dietary patterns. Self -reported asthmatic were more likely to be males, overweight or obese, with a lower father's level of education and a higher consumption of milk and power drinks.

Conclusion: Asthma disease remains prevalent among adolescents in Saudi Arabia and requires higher awareness and better guidance for its prevention and treatment. Further efforts should focus on health promotion and lifestyle wellness to support preventive efforts of this chronic disease condition.

Background: Anti-IgE (omalizumab) and anti-IL5/IL5R (reslizumab, mepolizumab and benralizumab) treatments are available for severe allergic and eosinophilic asthma. In these patients, studies have shown beneficial effects in oral corticosteroid use and exacerbations. The aim of this retrospective single-center study was to evaluate the effect of biological therapy on severe asthma and to compare different therapies.

Methods: We collected and analysed results of anti-IL5/IL5R and anti-IgE therapies for asthma from January 2009 until October 2019 in specialized care. We compared number of exacerbations, asthma symptoms and use of per oral corticosteroids and antimicrobics because of asthma before and during biological therapy, and in a separate analysis need for per oral corticosteroids, antimicrobics or surgery due to upper respiratory tract diseases in asthmatics receiving biologicals. The analyses were done using the Chi square test, T-test or Mann-Whitney U -test, the Kruskall-Wallis test or the Wilcoxon test.

Results: Of 64 patients, 40 used continuous per oral corticosteroid therapy prior to biological therapy. The mean daily dose of per oral corticosteroid was reduced in those with anti-IL5/IL5R therapy (- 3.0 mg, p = 0.02). The number of annual per oral corticosteroid courses decreased in both the anti-IL5/IL5R (- 2.8 courses, p < 0.05) and anti-IgE groups (- 1.3 courses, p < 0.05). The number of annual antibiotic courses (- 0.7 courses, p = 0.04) and total number of exacerbation events (- 4.4 events/year, p < 0.05) were reduced in the anti-IL5/IL5R group. In the 55 asthma patients analysed for upper respiratory tract findings, the results suggested a reduction in need for chronic rhinosinusitis surgery during biological therapy.

Conclusions: Results with biological therapies in this real-life clinical setting are comparable to those reported in clinical trials. Biological therapy reduces exacerbations and per oral corticosteroid use.

Trial registration: NCT04158050, retrospectively registered 6.11.2019.

Introduction: Acute asthma attack is one of the most common causes of visits to hospital emergency departments in all age groups of the population and accounts for the greater part of healthcare burden from the disease. Despite, Acute asthma attack is an important public health problem that affects not only the patients, but also to the family, health professionals, health care institutions and development of the nation, little is known about the risk factors of acute asthma attack.Therefore, this study is aimed to investigate the determinants of acute asthma attack among.

Objective: The aim of this study was to assess the determinant factors of acute asthma attack among adult asthmatic patients visiting general hospitals of central zone, Tigray, Ethiopia, 2019.

Method: Hospital based unmatched case control study design was conducted in general hospitals of central zone of Tigray, Ethiopia 2019. Data were collected using pretested interviewer administered questionnaire. A total of 289 study subjects (96 cases &193 controls) were selected by systematic random sampling. Data were entered to Epi data version 3.1 then exported to SPSS version 23 for analysis. Bivariate logistic regression was employed to examine the statistical association between dependent and independent variables. Variables with p value < 0.25 in binary logistic regression were entered to multivariable logistic regression model and variables with p value < 0.05 was taken as significant determinants of the outcome variable.

Result: A total of 96 adult asthmatic patients who have acute asthma attack (cases) and 193 adult asthmatic patients without attack (controls)) with 100% response rate were participated in this study. Upper Respiratory tract Infection [AOR = 6.835,95% CI = 3.285,14.222], Season [AOR =2.204,95% CI = 1.011,4.805] kitchen smoke [AOR = 2.307,95%CI1.010,5.272]& sleep apnea [AOR = 9.254, 5%CI =3.563,25.460] were significantly associated with acute asthma exacerbation.