Advances in adult asthma diagnosis and treatment and health outcomes, education, delivery, and quality in 2011: What goes around comes around

Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pa 19104, USA.
The Journal of allergy and clinical immunology (Impact Factor: 11.48). 11/2011; 129(1):69-75. DOI: 10.1016/j.jaci.2011.11.005
Source: PubMed


Last year's review of research advances in adults with asthma emphasized the linear trajectory of translation: the initial studies translating bench findings to the first patients (T1) are connected to larger efficacy studies, including clinical trials studying subjects under tightly controlled conditions (T2), and these in turn are connected to research, including comparative effectiveness research, that tests how the efficacy findings of T2 research fare in the real world, diverse populations, and varied practice settings (T3). This year what was observed was a more interwoven relationship (rather than a linear one), in which each translational level informs the others and new approaches to answering old questions have led to new discoveries. Within this framework, the present review summarizes clinical research on asthma in adults that was reported in the Journal of Allergy and Clinical Immunology in 2011, with emphasis on health outcomes, education, delivery, and quality in terms of discoveries related to mechanisms of disease, environmental exposures, and management.

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    ABSTRACT: Last year's "Advances in pediatric asthma: moving forward" concluded the following: "Now is also the time to utilize information recorded in electronic medical records to develop innovative disease management plans that will track asthma over time and enable timely decisions on interventions in order to maintain control that can lead to disease remission and prevention." This year's summary will focus on recent advances in pediatric asthma on modifying disease activity, preventing asthma exacerbations, managing severe asthma, and risk factors for predicting and managing early asthma, as indicated in Journal of Allergy and Clinical Immunology publications in 2012. Recent reports continue to shed light on methods to improve asthma management through steps to assess disease activity, tools to standardize outcome measures in asthma, genetic markers that predict risk for asthma and appropriate treatment, and interventions that alter the early presentation of asthma to prevent progression. We are well on our way to creating a pathway around wellness in asthma care and also to use new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma.
    The Journal of allergy and clinical immunology 11/2012; 131(1). DOI:10.1016/j.jaci.2012.11.009 · 11.48 Impact Factor
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    ABSTRACT: In the Journal of Allergy and Clinical Immunology in 2012, research reports related to asthma in adults clustered around mechanisms of disease, with a special focus on their potential for informing new therapies. There was also consideration of the effect of the environment on health from pollution, climate change, and epigenetic influences, underlining the importance of understanding gene-environment interactions in the pathogenesis of asthma and response to treatment. (J Allergy Clin Immunol 2013;131:47-54.)
    The Journal of allergy and clinical immunology 01/2013; 131(1):47-54. DOI:10.1016/j.jaci.2012.11.020 · 11.48 Impact Factor
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    ABSTRACT: Randomized controlled trials, known as efficacy trials and long considered the gold standard for evidence-based asthma guidelines, are designed to test whether interventions have a benefit for selective patient populations under ideal conditions. The goal of pragmatic trials and observational studies instead is to understand real-life efficacy, known as effectiveness. This review summarizes the strengths and limitations of efficacy and effectiveness trials, results of recent effectiveness trials in asthma and initiatives promoting effectiveness research. Recent pragmatic trials and observational studies have examined outcomes of interventions for diverse real-life patient populations, including smokers and patients with variable adherence, inhaler technique and baseline asthma control. Study results challenge practice guidelines regarding relative effectiveness of leukotriene receptor antagonists and inhaled corticosteroids (ICS); supplement guidelines with regard to effectiveness of interventions in smokers; and begin to address gaps in guidelines regarding choice of ICS and inhaler device. Initiatives are ongoing to refine methods of observational research and to harmonize asthma outcomes for better integration of results from all types of trials. Results of pragmatic trials and observational studies are an important component of the evidence needed to inform guideline recommendations and decision-making by healthcare providers, patients and policymakers.
    Current Opinion in Allergy and Clinical Immunology 02/2013; 13(1):50-7. DOI:10.1097/ACI.0b013e32835ad059 · 3.57 Impact Factor
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