Journal of Asthma (J Asthma)

Publications in this journal

• Article: Rising trends in the prevalence of asthma and allergic diseases among school children in the north-west coastal part of Croatia.

  Srđan Banac, Vojko Rožmanić, Koraljka Manestar, Zrinka Korotaj-Rožmanić, Kristina Lah-Tomulić, Ivana Vidović, Marta Serer, Nastasja Svraka, Tamara Petrić
  [show abstract] [hide abstract]
  ABSTRACT: Abstract Objective. To estimate time trends in prevalence of symptoms and reported diagnosis related to asthma, allergic rhinitis/conjunctivitis and eczema among school children in the north-west coastal part of Croatia. Methods. Results of two identical cross-sectional surveys conducted on the same area 8 years apart (school years 2001/02 vs. 2009/10) in complete adherence to the protocol of the International Study of Asthma and Allergies in Childhood were compared. Surveyed population comprised two age groups: 6-7 (n=1634 vs. n=1052) and 13-14 (n=2194 vs.1181) year olds. Results. Significant (p<0.001) increases in prevalence (%) of symptoms related to asthma (8.4 vs. 14.0), allergic rhinitis (17.5 vs. 25.6), allergic rhinoconjunctivitis (6.7 vs. 15.3) and eczema (3.4 vs. 5.9) were observed in the 13-14 year olds. In the 6-7 year olds there were observed significant (p< 0.001) increases in prevalence of symptoms of eczema (5.4 vs. 8.7) and allergic rhinitis (16.9 vs. 22.1) whereas prevalence of symptoms related to asthma (9.7 vs. 9.4; p=0.398) and allergic rhinoconjunctivitis (5.6 vs. 6.8; p=0.102) showed to be stable. Significant increases in prevalence of reported diagnosis were observed for asthma (5.2 vs. 6.9; p=0.02) and hay fever (10.5 vs. 14.6; p<0.001) in the older, and for eczema (10.6 vs. 14.1; p<0.001) in the younger age group. Conclusion. Prevalence of asthma and allergic diseases among the school children living on the surveyed area showed a rising trend.
  Journal of Asthma 05/2013;
• Article: An evaluation of asthma medication utilization for risk evaluation and mitigation strategies (REMS) in the United States: 2005-2011.

  Rachael L Disantostefano, Anne Yeakey, Ibrahim Raphiou, David Stempel
  [show abstract] [hide abstract]
  ABSTRACT: Abstract Purpose. The purpose of this study was to assess drug utilization patterns of fluticasone propionate (FP)/salmeterol (SAL) combination (FSC) and SAL over the 7-year period of 2005-2011 in patients with asthma as part of the Risk Evaluation and Mitigation Strategies (REMS). Methods. A descriptive, retrospective observational study utilizing national pharmacy data and employer-based claims data to characterize drug utilization patterns. Results. For patients with asthma, the total number of FSC and SAL dispensings and users of FSC and SAL has declined between 2005 and 2011. During this period, FSC and SAL dispensing for asthma decreased 24% and 76%, respectively, with a more pronounced decline between 2010 and 2011 relative to other years. The total number of patients with asthma who were dispensed FSC has decreased 10% among adults and 40% in children and adolescents. While SAL-containing medications decreased, dispensings of FP monotherapy increased 39% during the same 7-year period. The number of patients dispensed FP for asthma has increased 47% in children 4-11 years of age, 72% in adolescents 12-17 years of age, and 6% in adults. SAL use without a controller was infrequent and decreasing, reported by 1.7% and 0.5% of patients with asthma in 2005 and 2011, respectively. Conclusions. In patients with asthma, use of FSC and SAL decreased between 2005 and 2011, while the use of FP increased. Use of SAL monotherapy was infrequent and declined during the study period. The data suggest that the substantial communication activities have encouraged appropriate long acting beta-agonist (LABA) prescribing.
  Journal of Asthma 05/2013;
• Article: The association of asthma with BMI and menarche in the 1958 British Birth Cohort.

  Louisa Gnatiuc, Bernet Kato, Melanie C Matheson, Roger B Newson, Deborah L Jarvis
  [show abstract] [hide abstract]
  ABSTRACT: Abstract Background: Obesity and early menarche have been associated with asthma. In this report we assess the association of asthma with BMI and with changes in BMI from childhood to early adulthood. In addition we determine if, in girls, any observed association of asthma with menarche can be explained by BMI. Methods: In a large national birth cohort, the associations of asthma at age 7, 11, 16 and 33 with BMI, and of, asthma at age 33 with changes in BMI from age 7 to age 33 was assessed using logistic and mixed effects models as appropriate. Associations of asthma with age of menarche in girls was similarly assessed with and without adjustment for BMI. Results: Information on asthma, BMI, onset of menarche and confounders at all assessments was available for 1,968 girls and 2,223 boys. Obesity was relatively uncommon (<2%) in childhood. Overweight (BMI 25+) girls had more asthma. Girls with early menarche were more likely to be overweight. At age 11 years asthma was associated with early menarche (OR=1.70, 95%CI 1.17-2.47, after adjustment for BMI OR =1.60, 95%CI 1.10-2.34). Across all ages, asthma was significantly associated with BMI (OR=1.50, 95%CI 1.18-1.90) but not with early menarche (OR=1.24, 95%CI 0.95-1.63).Conclusion: Asthma is more common in overweight girls. Early menarche is more common in overweight girls but this does not explain its association with asthma at age 11. Early menarche is not a risk factor for asthma at age 33 in this cohort.
  Journal of Asthma 05/2013;
• Article: Bronchial Thermoplasty Failure in Severe Persistent Asthma: A Case Report.

  Diana C Doeing, Aliya N Husain, Edward T Naureckas, Steven R White, Douglas K Hogarth
  [show abstract] [hide abstract]
  ABSTRACT: Abstract Introduction: Bronchial thermoplasty (BT) is an emerging therapy for patients with severe persistent asthma who remain poorly controlled despite standard maximal medical therapy. Thermoplasty elicits asthma control over time by applying thermal radiofrequency energy to airways to ablate underlying smooth muscle. While this therapy is suggested to eliminate such smooth muscle permanently, no human studies have examined the possibility of treatment failure. Case Report: We present a 62-year-old female with severe, refractory asthma symptoms who underwent BT without apparent complications. However, severe symptoms including multiple clinical exacerbations persisted despite BT treatment. Repeat endobronchial biopsy done six months after BT treatment demonstrated persistent smooth muscle hyperplasia in multiple airways that previously had been treated. The patient continued to have uncontrolled, refractory asthma despite multiple therapies. Conclusion: This case is the first to describe a failure of BT to reduce or eliminate airway smooth muscle in a patient with severe persistent asthma. It suggests the potential for treatment failure in the management of these patients after BT and highlights the need for further study of potential BT-refractory patients.
  Journal of Asthma 05/2013;
• Article: Is Daily Headache Related to Asthma? Results from a population-based survey.

  Young Seok Lee, Gi Dong Lee, Jae Seung Lee, Chin Kook Rhee, Tae Sun Shim, Woo Sung Kim, Sang-Do Lee, Yeon-Mok Oh
  [show abstract] [hide abstract]
  ABSTRACT: Abstract Background: Despite the high worldwide prevalence of asthma and headache, little is known about the association between these conditions. The objective of our study was to evaluate the association between asthma and daily headache in a representative sample of the general population of South Korea. Methods: We retrospectively analyzed 7,984 individuals included in the Second Korean National Health and Nutrition Examination Survey (KNHANES II), a prospectively administered survey performed in 2001 by a government organization within the Ministry of Health and Welfare. After adjustment of risk factors for daily headache, multivariate logistic regression analysis was performed to evaluate the association between asthma and daily headache. Results: Of 7,984 individuals, 69 (0.9%) had daily headache and 429 (5.4%) had asthma symptoms. Daily headache was significantly more prevalent in subjects with asthma symptoms (14/429, 3.3%) than in those without (55/7555, 0.7%; P<0.001). Of the 4,833 nonsmokers, 46 (1.0%) had daily headache and 287 (5.9%) had asthma symptoms, with daily headache being significantly more prevalent in subjects with asthma symptoms (11/231, 4.8%) than in those without (35/4602, 0.8%; P<0.001). Multivariate logistic regression showed that the odds ratios for daily headache were 2.3 (95% CI: 1.21-4.33, P=0.01) in all individuals with asthma symptoms and 3.4 (95% CI: 1.65-7.12, P=0.001) in nonsmokers with asthma symptoms. Conclusion: Individuals with asthma symptoms are at higher risk of daily headache than those without the symptoms, suggesting a link between these conditions.
  Journal of Asthma 05/2013;
• Article: Insight into Older Peoples' health care experiences with managing COPD, Asthma and Asthma-COPD Overlap.

  Vanessa Marie McDonald, Isabel Higgins, Peter G Gibson
  [show abstract] [hide abstract]
  ABSTRACT: Objective: The aim of this study was to explore older peoples' experiences of asthma or COPD with reference to their journey in the health care system. Methods: We recruited older patients with a confirmed diagnosis of asthma or COPD and invited them to participate in a qualitative interview. Interviews were conducted with 21 participants. A line by line analysis of the interviews was performed and they were coded for common themes. Results: From the data 6 main themes emerged, these were; 'limits to being', 'being with or without a diagnosis', 'not being heard or recognised', 'expectation, fears and hopes', 'to medicate or not: the underuse, abuse and misuse' and 'needing to understand more'. The findings of these interviews provide an important understanding of the behaviours and health care needs of older people with asthma and COPD. Older patients' adherence patterns, desire for person centredness and involvement in shared decisions as well as desire for increased objective assessment are described. Conclusions: These findings provide an important understanding of the behaviours and health care needs of older people with asthma and COPD, an area that has not been well defined. The knowledge gained about older patients' desire for person centredness and involvement in shared decisions, as well as desire for increased objective assessment is essential in improving care.
  Journal of Asthma 05/2013;
• Article: Levels of TNF, TNF autoantibodies, and soluble TNF receptors in patients with bronchial asthma.

  Golikova Elena Alexeevna, Lopatnikova Julia Anatolievna, Kovalevskaya-Kucheryavenko Taniana Vladimirovna, Nepomnyashih Vera Makarovna, Sennikov Sergey Vitalievich
  [show abstract] [hide abstract]
  ABSTRACT: Abstract Objectives: The aim of the study was to evaluate the potential contribution made by tumor necrosis factor (TNF) autoantibodies to the pathogenesis of bronchial asthma (BA). Methods: We used affinity chromatography methods and a magnetic separation procedure to purify human autoantibodies specific to TNF. The autoantibodies were used as a calibration material to determine the absolute content of autoantibodies to TNF using enzyme-linked immunosorbent assay (ELISA). TNF content and levels of soluble receptors to TNF were determined using the ELISA commercial test kits. Results: We demonstrated significant increases in the levels of TNF and soluble TNF receptors in the sera of patients with uncontrolled and controlled BA, as compared with healthy donors. Levels of autoantibodies of the IgG2 and IgG4 subclasses were significantly higher in sera from patients with uncontrolled BA than in healthy donors. Levels of IgG2 autoantibodies were significantly higher in sera from patients with uncontrolled BA than in patients with controlled BA. Conclusions: BA is associated with changes in the levels of not only TNF and soluble receptors for TNF, but also autoantibodies to TNF. Given the magnitude of the changes in the levels of different subclasses of autoantibodies to TNF, we propose that these autoantibodies might contribute to the pathogenesis of BA.
  Journal of Asthma 05/2013;
• Article: Step-down of budesonide/formoterol in early stages of asthma treatment leads to insufficient anti-inflammatory effect.

  Yasushi Obase, Masaki Ikeda, Koji Kurose, Masaaki Abe, Hiroki Shimizu, Yoshihiro Ohue, Keiji Mouri, Shigeki Katoh, Yoshihiro Kobashi, Mikio Oka
  [show abstract] [hide abstract]
  ABSTRACT: Abstract Objective: Administration of the combination of an inhaled corticosteroid (ICS) and a long-acting beta agonist (LABA) is the main treatment strategy for bronchial asthma. The ICS/LABA dosage can be reduced (stepped down) when the patient's symptoms and lung function are well-controlled. In this study, we obtained fractional exhaled nitric oxide (FeNO) measurements to clarify whether the anti-inflammatory effect of budesonide/formoterol is shortened by step-down. Methods: Fifty-four patients who visited the Kawasaki Medical School Hospital with newly diagnosed asthma from November 2008 to July 2010 received budesonide/formoterol for 8 weeks or more. In 29 patients, the forced expiratory volume in 1 second% predicted increased to 80% or more, and the Asthma Control Questionnaire (ACQ) score decreased to 0.5 or less within 12 weeks. These 29 patients were randomly divided into 2 groups: the dosage-continued group (n = 14) and the step-down group (n = 15). Then, the impact of budesonide/formoterol step-down on ACQ score, pulmonary function, and FeNO level was compared between the groups. Results: In the step-down group, the dosage was stepped down from 538 mcg/day to 331 mcg/day. In both groups, pulmonary function indicators and symptoms did not change. However, the mean FeNO level decreased significantly in the dosage-continued group (from 50.9 ppb to 45.0 ppb), and increased significantly in the step-down group (from 51.0 ppb to 65.7 ppb). Conclusions: Clinicians should be more careful when stepping down budesonide/formoterol based solely on patients' symptoms and/or pulmonary function.
  Journal of Asthma 05/2013;
• Article: Asthma Control, Cost, and Race: Results from a National Survey.

  Laura S Gold, Kai Yeung, Nancy Smith, Felicia C Allen-Ramey, Robert A Nathan, Sean D Sullivan
  [show abstract] [hide abstract]
  ABSTRACT: Abstract Objective: Although interventions have been shown to alleviate symptoms in most patients suffering from asthma, only one-third of asthma patients have disease that is well-controlled. The purpose of this study is to investigate whether partly- and uncontrolled asthma are associated with increased costs for asthma-related healthcare utilization compared to well-controlled asthma and to determine whether these associations differed across racial groups. Methods: We classified respondents from the Asthma Insights and Management survey into those with well-, partly- and uncontrolled asthma and compared utilization of healthcare services and costs among these groups, as well as between whites and non-whites. Results: Respondents categorized as having asthma that was not well-controlled reported lower income levels, higher rates of unemployment, and more trouble paying for healthcare; similar results were found in analyses stratified by race. Patients whose asthma was partly- or uncontrolled had greater use of asthma-related medications and medical services compared to patients whose asthma was well-controlled. Total unadjusted and adjusted costs were greater in patients whose asthma was classified as partly- and uncontrolled. Similar results were found in analyses stratified on race. Across all levels of asthma control, non-whites had higher rates of utilization of emergency rooms and urgent care facilities and had greater rates of hospitalizations compared to whites. Conclusions: Our findings indicate that patients with asthma that is not well-controlled utilized more healthcare resources and had greater medical costs, despite lacking of health insurance which may suggest less access to care.
  Journal of Asthma 05/2013;
• Article: ANALYSIS OF AUTONOMIC MODULATION DURING MAXIMAL AND SUBMAXIMAL WORK RATE AND FUNCTIONAL CAPACITY IN ASTHMATIC CHILDREN

  Evelim Leal de Freitas Dantas Gomes, Luciana Maria Malosa Sampaio, Ivan peres Costa, Fernanda Dultra Dias, Graziela Alves da Silva, Viviane da Silva Ferneda, Dirceu Costa
  [show abstract] [hide abstract]
  ABSTRACT: Background: Children who have asthma experience changes in the functional capacity and in autonomic control; the literature suggests that this imbalance is responsible for bronchial hyperresponsiveness, primarily during the physical effort. Objective: The objective was to evaluate the behaviour of variables of autonomic and functional capacity in asthmatic children during maximal and submaximal work rate.Methods: This was a cross-sectional study of 24 children, specifically, 18 in the asthma group(AG) and 6 in the control group(CG), that assessed the heart rate variability HRV and the functional capacity by the shuttle walk test (SWT) and the three-minute step test (ST3). Pulmonary function was also evaluated through spirometry and the expired nitric oxide fraction (FeNO).Results: The FEV1 and FeNO values were different between the groups because they are asthma diagnostic variables (p0.01); the distance walked in SWT was lower in AG (333.13±97.25m x 442.66±127.21m, p0.04).The perceived exertion was higher in the AG. As for the HRV variables, rMSSD and HF did not decrease significantly during the SWT (maximal work rate) in the AG (p0.01 and 0.04). There was a negative correlation of FENO with FEV1/FVC (r -0.70 p0.004) and positive with pNN50 (r0.50 p0.03). Conclusion:Healthy and asthmatic children respond differently to stress from the autonomic point of view with no withdrawal of parasympathetic cardiac modulation on asthmatic children during maximal work rate; children who have asthma present changes in the functional capacity and their lung function varies with inflammation of the airways.
  Journal of Asthma 05/2013;
• Article: Endobronchial Biopsy: A Guide for Asthma Therapy Selection in the Era of Bronchial Thermoplasty.

  Ilyssa O Gordon, Aliya N Husain, Jeffery Charbeneau, Jerry A Krishnan, D Kyle Hogarth
  [show abstract] [hide abstract]
  ABSTRACT: Objective Bronchial thermoplasty (BT) reduces airway smooth muscle in patients with severe asthma. We developed a novel standardized histologic grading system assessing inflammation and structural remodeling on endobronchial biopsy (EBBx) in severe persistent asthma and evaluated airway structure before and after BT. In addition, we correlated invasive and non-invasive inflammatory markers in severe persistent asthma. Methods Thirty-three patients with severe persistent asthma underwent bronchoscopy, including bronchoalveolar lavage and diagnostic EBBx. The control group (N=41) underwent EBBx for other clinical indications. Biopsies were graded for airway inflammation and epithelial and submucosal structural features. We also evaluated airway histology in three patients before and after BT. Results Compared to the control group, patients with severe persistent asthma more often had intraepithelial eosinophils and lymphocytes (67% vs. 17% and 61% vs. 27%; p<0.001 and p=0.005, respectively) and prominent smooth muscle and goblet cell hyperplasia (88% vs. 29% and 47% vs. 22%, p<0.001 and p=0.004, respectively). Other features including epithelial denudation and basement membrane thickening were not significantly different. Following BT, airway smooth muscle was no longer prominent due to partial replacement by fibrosis. Increased submucosal eosinophilic inflammation and bronchoalveolar lavage eosinophilia correlated with exhaled nitric oxide (eNO, p=0.05 for both). Conclusions We developed a clinically applicable standardized histologic grading system which identified structural but not inflammatory changes before and after bronchial thermoplasty in severe persistent asthmatics. Additionally, we demonstrate that eNO is representative of submucosal eosinophilia in this population. This semi-quantitative assessment will be useful for practicing pathologists assessing EBBx from severe persistent asthma patients for diagnostic and clinical research purposes.
  Journal of Asthma 04/2013;
• Article: Fractional Exhaled Nitric Oxide Has a Good Correlation With Asthma Control and Lung Function in Latino Children With Asthma.

  Mario Soto-Ramos, Jose A Castro-Rodríguez, Luis Carlos Hinojos-Gallardo, Raul Hernández-Saldaña, Martin Cisneros-Castolo, Victor Carrillo-Rodríguez
  [show abstract] [hide abstract]
  ABSTRACT: Background: Although measurement of fractional exhaled nitric oxide (FENO) has been recommended for observational studies and clinical trials of asthma, FENO has not been examined in studies of childhood asthma in Latin America. Objective: To examine the relationship between FENO and indicators of disease control or severity [asthma control test/childhood asthma control test (ACT/C-ACT), lung function, and exercise challenge test (ECT)] in Mexican children with persistent asthma. Methods: Children (6-18 years of age) with persistent asthma were consecutively recruited in a tertiary asthma clinic and divided into two groups, e.g. FENO <20 parts per billion (ppb) and ≥ 20 ppb. Adequate FENO measurements were obtained in 134 (83.2%) of 161 eligible children. Results: Children with FENO<20 ppb had significantly higher scores on the ACT/C-ACT than those with FENO≥20 ppb (median [interquartile range] :23 [20.8-25] vs. 21 [18-24], p=0.002, respectively). Compared to children with FENO ≥20 ppb, those with FENO <20 ppb had a higher baseline predicted forced expiratory volume (FEV1) [94% (92.5%-99.4%) vs. 83% (81%-89.9%), p=0.001] and a lower probability of having a positive ECT (42.7 % vs. 71.2%, p=0.001). In addition, FENO was significantly inversely correlated with the participants' ACT/C-ACT score and predicted FEV1, and directly correlated with positive ECT. Conclusion: Among Mexican children with persistent asthma, low levels of FENO (<20 ppb) are associated with better asthma control, and higher lung function.
  Journal of Asthma 04/2013;
• Article: Asthma Medication Device Skills in High-Risk African American Adolescents.

  Sylvie Naar-King, Phebe Lam, Deborah Ellis, Jean-Marie Bruzzese, Elizabeth Secord
  [show abstract] [hide abstract]
  ABSTRACT: Objective. To describe the asthma medication device skills of high-risk African American adolescents and associations between skills and other components of illness management. Methods. 170 African American adolescents, with at least one hospitalization or two emergency department visits in the last year, demonstrated how they use their asthma quick relief and controller medication devices. Observations were scored using an in-vivo observation asthma skills checklist. To assess other areas of asthma management, adolescents and their primary caregiver were interviewed using the Family Asthma Management System Scales. Results. Only 5% of adolescents correctly demonstrated all controller skills, and none of the adolescents correctly showed all quick relief inhaler skills (5% showed between 90-95% of skills). Several components of asthma management predicting controller medication skills were attendance at an asthma specialty clinic, collaboration with provider, medication adherence, and quick relief medication skills. These variables accounted for a total of 24% of the variance in controller medication skills. Conclusions. Results indicate the need for interventions directly targeting observed asthma management skills and the importance of relationship with providers.
  Journal of Asthma 04/2013;
• Article: Cost Consequence Analysis of Multimodal Interventions with Environmental Components for Pediatric Asthma in the State of Maryland.

  Mandeep S Jassal, Gregory B Diette, David W Dowdy
  [show abstract] [hide abstract]
  ABSTRACT: Background: Applied environmental strategies for asthma control are often expensive, but may save longer-term healthcare costs. Whether these savings outweigh additional costs of implementing these strategies is uncertain. Methods: We conducted a systematic review to estimate expenditures and savings of environmental interventions for asthma in the state of Maryland. Direct costs included hospitalizations, emergency room and clinic visits. Indirect expenditures included costs of lost work productivity and travel incurred during usage of health care services. We used decision analysis, assuming a hypothetical cohort of the approximated 49,290 pediatric individuals in Maryland with persistent asthma, to compare costs and benefits of environmental asthma interventions against the standard of care (no intervention) from the societal perspective. Results: Three interventions among nine articles met inclusion criteria for the systematic review: 1) environmental education using medical professionals; 2) education using non-medical personnel; and 3) multi-component strategy involving education with non-medical personnel, allergen impermeable covers and pest management. All interventions were found to be cost-saving relative to the standard of care. Home environmental education using non-medical professionals yielded the highest net savings of $14.1 million (95% SI: $-.283 million, $19.4 million), while the multi-component intervention resulted in the lowest net savings of $8.1 million (95% SI: $-4.9 million, $15.9 million). All strategies were most sensitive to the baseline number of hospitalizations in those not receiving targeted interventions for asthma. Conclusions: Limited environmental reduction strategies for asthma are likely to be cost-saving to the healthcare system in Maryland and should be considered for broader scale-up in other economically similar settings.
  Journal of Asthma 04/2013;
• Article: Interactive Support Interventions for Caregivers of Asthmatic Children.

  Sue-Hsien Chen, Jing-Long Huang, Kuo-Wei Yeh, Yun-Fang Tsai
  [show abstract] [hide abstract]
  ABSTRACT: Objectives. Asthmatic children and their parents constantly need to adjust their lifestyles due to asthma attacks. We evaluated the effectiveness of a self-management interactive support (SMIS) program for caregivers of asthmatic children. Methods. Children with persistent asthma were randomized into two groups, one receiving self-management interactive support and the other usual care (the control group). The SMIS program involved a three-month multifaceted behavioral intervention. Changes in the caregivers' knowledge and attitude regarding self-management, children's lung function, and number of emergency department visits and hospital admissions were examined at 12 months post enrollment. Results. Sixty-five asthmatic children and caregivers (78% follow-up) completed the study. Primary caregivers in the SMIS group had significant improvements in knowledge and attitude regarding asthma compared to those in the control group (p < 0.05). Most importantly, knowledge about asthma medications and exacerbations significantly improved and attitudes towards medication adherence and dealing with asthma care became more positive in the SMIS group. The FEV1 was significantly improved in the SMIS group after 12 months (p < 0.05), and performance on the methacholine challenge test at the end of the study was significantly better in the SMIS group (p < 0.05). Participants in the SMIS group also had a lower rate of emergency room use (p < 0.05). Conclusion. The SMIS program for the self-management of asthma in children by their caregivers improved lung function and reduced the number of visits to emergency departments. Interactive support interventions reinforce learning incentives and encourage self-care and maintenance of therapeutic regimens.
  Journal of Asthma 04/2013;
• Article: EFFECTIVENESS OF OMALIZUMAB IN SEVERE ALLERGIC ASTHMA: A RETROSPECTIVE UK REAL WORLD STUDY.

  Neil Barnes, Andrew Menzies-Gow, Adel H Mansur, David Spencer, Fran Percival, Amr Radwan, Rob Niven
  [show abstract] [hide abstract]
  ABSTRACT: Objective: To evaluate the 'real world' effects of the monoclonal antibody omalizumab when used to treat severe persistent allergic asthma in UK clinical practice. Methods: A 10 centre retrospective observational study compared oral corticosteroid (OCS) use and exacerbation frequency in 12 months pre- vs 12 months post-omalizumab (OMB) initiation in 136 patients aged ≥12 years with severe persistent allergic asthma. All patients received ≥1 dose of OMB. Patients who had received OMB in a clinical trial were excluded. Data were obtained from hospital and if necessary General Practitioners' records on OCS use, lung function, hospital resource use and routinely-used quality of life (QoL) measures at baseline (pre-OMB), 16 weeks and up to 12 months post-OMB initiation. Results: Mean total quantity of OCS prescribed per year decreased by 34% between the 12 months pre- and post OMB initiation. During 12 months post-OMB initiation 87 patients (64%) stopped/reduced OCS use by 20% or more and 66 (49%) stopped OCS completely. Mean percent predicted FEV1 increased from 66.0% at baseline to 75.2% at week 16 of OMB therapy. The number of asthma exacerbations decreased by 53% during 12 months post-initiation. Accident & Emergency visits reduced by 70% and hospitalizations by 61% in the 12 months post-OMB initiation. Conclusion: This retrospective analysis showed a reduction in exacerbations and improved quality of life as per previous studies with OMB. However, the total reduction in annual steroid burden and improved lung function in this severely ill group of patients taking regular or frequent OCS is greater than that seen in previous trials.
  Journal of Asthma 04/2013;
• Article: ANALYSIS OF AUTONOMIC MODULATION DURING MAXIMUM AND SUBMAXIMUM WORK RATE AND FUNCTIONAL CAPACITY IN ASTHMATIC CHILDREN.

  Evelim L F Dantas Gomes, Luciana Maria Malosá Sampaio, Ivan Peres Costa, Fernanda Dultra Dias, Viviane S Ferneda, Graziella A Silva, Dirceu Costa
  [show abstract] [hide abstract]
  ABSTRACT: Background: Children with asthma experience changes in functional capacity and autonomic control. The literature suggests that this imbalance is responsible for bronchial hyperresponsiveness, primarily during physical effort. Objective: The aim of the present study was to evaluate variables of autonomic modulation and functional capacity in asthmatic children after maximum and submaximum work rate. Methods: A cross-sectional study was carried out with 24 children [18 in the asthma group (AG) and 6 in the control group (CG)]. Evaluations involved heart rate variability (HRV) and functional capacity [shuttle walk test (SWT) and three-minute step test]. Pulmonary function was also evaluated through spirometry and the fractional concentration of expired nitric oxide (FeNO). Results: The asthma diagnostic variables FEV1 and FeNO differed significantly between groups (p=0.01). Distance travelled on the SWT was lower in the AG (333.13±97.25 m vs. 442.66±127.21 m; p=0.04). Perceived exertion was greater in the AG. The HRV variables rMSSD and HF did not decrease significantly during the SWT (maximum work rate) in the AG (p=0.01 and 0.04). FeNO was negatively correlated with FEV1/FVC (r=-0.70; p=0.004) and positively correlated with pNN50 (r=0.50; p=0.03) in the AG. Conclusion: From the autonomic standpoint, asthmatic and non-asthmatic children respond differently to stress. No withdrawal of parasympathetic cardiac modulation occurs in asthmatic children after maximum work rate. Children with asthma experience changes in functional capacity and lung function may vary depending on the degree of inflammation of the airways.
  Journal of Asthma 04/2013;
• Article: Methacholine-Induced Airway Hyper-Reactivity Phenotypes.

  Eric J Gartman, Ernest K Dinino, Patrick Koo, Mary B Roberts, F Dennis McCool
  [show abstract] [hide abstract]
  ABSTRACT: Objective The incorporation of airways conductance/resistance is a rare feature in clinical methacholine challenge test (MCT) protocols, and the majority of pulmonary laboratories rely solely on spirometric parameters. The importance and interpretation of a MCT demonstrating a significant decline in sGaw, but not FEV1, remains undefined. This study sought to elucidate clinical and physiologic phenotypes of individuals with a ≥40% sGaw decline but <20% FEV1 change. Methods All subjects completed the Asthma Quality of Life Questionnaire (AQLQ), followed by standard MCT, with measurements of sGaw and an additional independent measurement of resistance and reactance by impulse oscillometry before and after MCT. Results Of 201 subjects, 47(23.4%) were in Group 1 (FEV1 declined by ≥20%), 45(22.4%) were in Group 2 (non-significant FEV1 drop, sGaw declined ≥40%), and 109(54.2%) were in Group 3 (no significant decline in FEV1/sGaw). There was a nearly identical change in all oscillometric parameters and sGaw for Groups 1 and 2 versus Group 3. There were no differences between Groups 1 and 2 in any AQLQ category. Groups 1 and 2 were statistically different from Group 3 in all AQLQ elements, and clinically-significantly different in symptoms, environmental, and overall scores. Conclusions Our prospective study suggests that patients with a significant sGaw decline alone during MCT are a clinically and physiologically important hyper-reactivity phenotype - whose hyper-reactivity independently was confirmed to be nearly identical to those with a FEV1 decline. By failing to assess airways conductance/resistance, asthma may be inappropriately "ruled-out" in ∼20% of patients referred for MCT. Based on this, standardized incorporation of body plethysmography and/or impulse oscillometry to MCT protocols should be considered.
  Journal of Asthma 04/2013;
• Article: Factors associated with asthma prevalence among racial and ethnic groups-United States, 2009-2010 Behavioral Risk Factor Surveillance System.

  Hatice S Zahran, Cathy Bailey
  [show abstract] [hide abstract]
  ABSTRACT: Background. Although the causes of asthma are poorly understood, multiple factors (e.g., genetic, environmental, socioeconomic, and lifestyle) have been implicated in the development and exacerbation of the disease. Objectives. To identify potential predictive factors of current asthma and to assess if the predictive ability of some factors differ by race and ethnicity. Methods. We used the Centers for Disease Control and Prevention's 2009-2010 Behavioral Risk Factor Surveillance System data to estimate asthma prevalence and to examine the potential predictive factors for asthma (sex, age, educational attainment, household income, obesity, smoking, physical activity, and health insurance) by race and ethnicity. Results. Of the 869519 adult respondents in the survey, 8.6% reported having asthma. Overall asthma prevalence was significantly higher among adults with household income of <$15000 (13.3%; adjusted prevalence ratio [aPR] of 1.9) than those with income of ≥$75000 (6.8%). The prevalence was also higher among obese adults (11.6%; aPR=1.5) than non-obese (7.3%), current and former smokers (10.5%; aPR=1.2 and 8.5%;1.1) than non-smokers (7.8%), and adults with health insurance (8.6%; aPR=1.3) than adults without it (7.8%). However, the prevalence was lower among adults aged 65+ (7.8; aPR=0.7) than adults aged 18-24 (9.3%) and among adults who reported having leisure time physical activity (7.8%; aPR=0.8) than adults who did not report it (10.7%). When examined among race/ethnic groups, these associations were observed among whites and blacks but not for the other four race/ethnic groups. Conclusions. Predictive factors for asthma vary among racial/ethnic groups. Identifying race/ethnicity specific modifiable environmental and host-related factors (mold, pollens, house dust mites, cockroaches, animal allergens, other pollutants, education, income, obesity, smoking, physical activity, and health insurance status) can be important in developing targeted interventions to reduce the health and economic impact of asthma among disproportionately affected segments of the United States population.
  Journal of Asthma 04/2013;
• Article: Increased asymptomatic airway hyper-responsiveness in obese individuals.

  Monique Badier, Chantal Guillot, Stéphane Delpierre
  [show abstract] [hide abstract]
  ABSTRACT: Objective: Asymptomatic airway hyperresponsiveness (AHR) represents a risk of further accelerated decline in lung function, and of asthma. Due to the fact that rare and contradictory results exist concerning the impact of obesity on BHR, we re-assessed the prevalence of bronchial hyperresponsiveness (BHR) in a large cohort of 60 lean, 84 overweight and 360 class 1-3 obese non-asthmatic individuals, by coupled plethysmography and spirometry. Methods: Baseline specific airway conductance (SGaw) and spirometric values were measured and then a methacholine challenge testing (MCT) was performed and considered as positive when a ≥ 200 % increase in specific airway resistance (SRaw = 1/SGaw) was reached. Results: Compared to lean and overweight subjects, obese subjects of any class presented about a twice more frequent AHR (∼ 50 % in obese vs. 17 and 26 % in lean and overweight subjects, respectively). However, the bronchial sensitivity (methacholine dose doubling SRaw) and the shape of the relationship between SGaw and cumulative methacholine doses were the same in the 5 five groups of individuals. Conclusion: The present data show a more frequent AHR in obese subjects. The association of plethysmography with spirometry, by taking into account the bronchodilator effect of the lung inflation (preceding the expiratory flow measurement) in some individuals, permitted to include some MCT which would have been otherwise excluded.
  Journal of Asthma 04/2013;