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The Global Burden of Asthma
Abstract
There has been a sharp increase in the global prevalence, morbidity, mortality, and economic burden associated with asthma over the last 40 years, particularly in children. Approximately 300 million people worldwide currently have asthma, and its prevalence increases by 50% every decade. In North America, 10% of the population have asthma. Asthma is underdiagnosed and undertreated, although the use of inhaled corticosteroids has made a positive impact on outcomes. The increasing number of hospital admissions for asthma, which are most pronounced in young children, reflect an increase in severe asthma, poor disease management, and poverty. Worldwide, approximately 180,000 deaths annually are attributable to asthma, although overall mortality rates have fallen since the 1980s. Most asthma deaths occur in those > or = 45 years old and are largely preventable, frequently being related to inadequate long-term medical care or delays in obtaining medical help during the last attack. The financial burden on patients with asthma in different Western countries ranges from 1,300 per patient per year, disproportionately affecting those with the most severe disease. There are a number of significant barriers to reducing the burden of asthma, particularly in developing countries, where many patients have limited access to care and essential medications. The Global Initiative for Asthma has outlined a six-point patient management plan to address the effective handling of the increased number of patients in primary care. The plan focuses on patient education, written treatment plans, and ongoing communication and review with patients and their providers.
... Asthma is a common chronic disease of the respiratory tract characterized by wheezing, coughing, and airflow obstruction [1]. The detection rate of asthma in children has reached 10%, making it a global public health problem [2]. ...
... We systematically searched the PubMed, Embase, and Cochrane Library databases to identify potential studies published from their inception to March 31, 2023 Two reviewers independently performed the literature search and screening, and conflicts between the reviewers were resolved by an additional reviewer after full-text evaluations. Studies were included if they met the following criteria: [1] Population: age of individuals less than 18.0 years; [2] Definition: clear definition of asthma; [3] Outcome: prevalence of asthma or a specific risk factor for asthma was reported in at least three studies; and [4] Study design: cross-sectional studies. The details of exclusion criteria are listed as follows: [1] studies that included individuals aged 18 years or older; [2] studies that did not provide a clear and consistent definition of asthma; [3] studies that did not report the prevalence of asthma or specific risk factors for asthma fewer than three studies; and [4] studies that were not cross-sectional in design. ...
... Studies were included if they met the following criteria: [1] Population: age of individuals less than 18.0 years; [2] Definition: clear definition of asthma; [3] Outcome: prevalence of asthma or a specific risk factor for asthma was reported in at least three studies; and [4] Study design: cross-sectional studies. The details of exclusion criteria are listed as follows: [1] studies that included individuals aged 18 years or older; [2] studies that did not provide a clear and consistent definition of asthma; [3] studies that did not report the prevalence of asthma or specific risk factors for asthma fewer than three studies; and [4] studies that were not cross-sectional in design. ...
Background
This study aimed to systematically review and perform a meta-analysis on epidemiological studies in order to estimate the global and regional prevalence and to identify risk factors associated with childhood asthma.
Methods
A comprehensive search of the PubMed, Embase, and Cochrane Library electronic databases was conducted for relevant literature published from their inception to March 31, 2023. The primary endpoint was the prevalence of childhood asthma. Secondary endpoint focused on the identification of risk factors associated with childhood asthma.
Results
A total of 1,547,404 children participated in the 164 studies selected for the meta-analysis. The overall prevalence of childhood asthma was 10.2% (95% CI: 9.5-11.0%), while the prevalence of childhood asthma in Asia, Europe, Latin America, North America, Oceania, Africa, or Eurasia were 10% (95%CI: 7-13%), 9% (95%CI: 7-12%), 14% (95%CI: 9-20%), 13% (95%CI: 12-14%), 23% (95%CI: 19-28%), 11% (95%CI: 7-19%), and 8% (95%CI: 2-27%), respectively. Moreover, the identified risk factors for childhood asthma included older age, male sex, obesity, parental smoking, high education of the mother, premature birth, cesarean section, no breastfeeding, family history of asthma, rhinitis, eczema, pets, high density of road traffic, meat, margarine, fast food, paracetamol use, and antibiotic use.
Conclusion
Childhood asthma is common, and the prevalence of asthma is highest in Oceania, with a lower prevalence in Eurasia. Moreover, the risk factors for childhood asthma were comprehensively identified, and health education should be provided to prevent modifiable factors.
... Asthma has become a global problem, one of the most common chronic diseases worldwide. The global prevalence, morbidity and mortality of asthma have increased sharply over the last 40 years (Braman, 2006;Serebrisky and Wiznia, 2019). It is estimated that approximately 300 million people worldwide currently have asthma, and will increase to 400 million by 2025 (Gulliver et al., 2007;Masoli et al., 2004). ...
... Asthma has a prevalence ranging from 1% to 18% (Al-Numani et al., 2015). The prevalence increases by 50% every decade, and approximately 180,000 deaths annually are attributable to asthma (Braman, 2006). It will cause more unemployment, fewer school days, poor quality of life, frequent emergency department visits, and hospitalizations of the patients (Al-Moamary et al., 2012).The economic burden of asthma in many countries is relatively high which may spend 1%-2% of their healthcare budget and it must be considered as the priority disorder in government health strategies (Serebrisky and Wiznia, 2019). ...
... The pathogenesis of asthma is very complex, and it is a multiple phenotypes syndrome (Expert Panel Working Group of the National Heart L et al., 2020) which is influenced by various inducers and provokers (Hvizdos and Jarvis, 2000). There are numerous cells and cellular elements (Braman, 2006) (such as eosinophils, mast cells, T lymphocytes, neutrophils, smooth muscle cells, airway epithelial cells, etc.) and cell components involved in the inflammation which induce Asthma (Crim et al., 2001). The main inducers and provokers are allergy. ...
Background
Fluticasone propionate is a synthetic trifluoro-substituted glucocorticoid, a highly selective glucocorticoid receptor agonist. Fluticasone propionate nebuliser suspensions is an inhaled corticosteroid with the low systemic bioavailability which provides a low risk (benefit outcome without the adverse effects that accompany systemically administered corticosteroids), referred as a first-line preventive agent for patients with persistent asthma. China has become one of the countries with the highest asthma mortality rate in the world in the past years. It urgently needs good generic drugs to help ease patients’ burden and improve their quality of life.
Objective
The primary objective of this study was to evaluate the bioequivalence of fluticasone propionate nebuliser suspensions between test formulation (generic product) and reference formulation (original product, Flixotide Nebules®) with the pharmacokinetic parameters as the endpoint indicators and the secondary objective was to evaluate the safety of two inhalated fluticasone propionate nebuliser suspensions under the condition of fasting in healthy Chinese subjects.
Methods
The bioequivalence study was conducted with a single-center, randomized, open-label, single-dose, two sequences, two-period crossover design. 24 healthy subjects were randomly assigned into T-R and R-T sequence groups with 12 patients in each group. The subjects were administered 1 mg (2 mL:0.5 mg,plastic ampoules) of generic fluticasone propionate nebuliser suspension as a test formulation or Flixotide Nebules® as reference formulation and cross administration after sufficient washout period (5 days) for the second period study. The blood sample was collected at predetermined time points up to 48 h and the plasma concentration of fluticasone propionate was determined by HPLC-MS/MS in healthy subjects after inhalation of test or reference formulation. The non-compartment model method (NCA module) of the WinNonlin® software (version 8.3) was used to calculate the pharmacokinetic parameters (Cmax, AUC0-t, AUC0-∞) between the test formulation and the reference formulation were within the predefined range of 80.00% and 125.00%, bioequivalence of both formulations was demonstrated.
Results
The 90% confidence intervals of the T/R ratio of the geometric mean of Cmax, AUC0-t, and AUC0-∞ for both formulations were 90.24%–112.68%, 96.99%–112.27% and 96.41%–111.59% respectively, which were all within the bioequivalent range of 80%–125%. No severe, suspicious or unexpected serious adverse reactions were reported.
Conclusion
The test and reference formulations of fluticasone propionate nebuliser suspension were pharmacokinetic bioequivalent and were well tolerated and safe in all subjects.
... Asthma is a common chronic respiratory disease that poses a significant public health challenge worldwide (1,2). It is estimated that up to 300 million individuals are affected by asthma (3). ...
... In this cross-sectional study, we analyzed data from a total of 8,327 adults between the ages of 20 and 80 who participated in the NHANES study from 2005-2008, covering two survey cycles. Exclusion criteria established by the study design included the following (participants with partial missing data were entirely excluded): [1] age < 20 years; [2] missing data for evaluate the Pittsburgh Sleep Quality Index(PSQI), sleep disorders, and sleep duration; [3] missing data for Patient Health Questionnaire-9 (PHQ-9); and [4] respondents with incomplete main covariates. The selection process is detailed in Figure 1. ...
... Data were retrieved from the NHANES database utilizing the keywords "bronchodilator/antiasthma medication," encompassing selective phosphodiesterase-4 inhibitors, mast cell stabilizers, leukotriene modifiers, and inhaled corticosteroids. Asthma was evaluated based on the following criteria (20): [1] self-reported diagnosis of asthma by a healthcare professional, [2] use of anti-asthmatic medications, and [3] use of bronchodilator/anti-asthma medication under the age of 40 who are non-smokers and do not have chronic bronchitis or emphysema. ...
Background
Asthma, depression, and sleep problems are three significant public health issues that are closely interrelated. This study aims to explore the relationship between depression, sleep status and asthma, as well as the potential interaction among these conditions and their effects on asthma.
Method
This cross-sectional study utilized data from the 2005-2008 National Health and Nutritional Examination Survey, including information on asthma, depression, sleep status and confounding factors. Multivariate logistic regression analyses were conducted to investigate the relationship between depression, sleep status, and asthma. Subgroup analyses were conducted to test the p-interaction between depression and each stratified variable. Additionally, both multiplicative and additive approaches were employed to assess the interaction between depression and sleep status on asthma, as well as to quantify their combined effects.
Results
A total of 8,327 participants (mean age 46.53 years) were included in this study. Compared to the individuals without depression, those with depression have an increased risk of asthma [Odds ratio (OR) = 1.57, 95% Confidence interval (CI) = 1.22-2.03], and an increase in the severity of depressive symptoms is associated with a higher risk of developing asthma. Additionally, poor sleep quality, sleep disorders, and insufficient sleep was associated with an increased risk of asthma. Effect modification was observed between depression and PIR status, smoking status, and sleep disorders in relation to asthma (p-interaction <0.05). Moreover, we found a positive interaction between severe depression and excessive sleep (OR = 29.07, 95% CI = 3.24-260.38). Furthermore, we observed the quantitative additive interaction indicators between moderately severe depression and insufficient sleep [Relative excess risk due to interaction (RERI) = 1.63, 95%CI = 0.18-3.83; Attributable proportion (AP) = 0.51, 95%CI = 0.15-0.87; Synergy index (SI) = 3.92, 95%CI = 1.65-23.50] influencing asthma risk.
Conclusion
Our study revealed distinct associations between depression, the severity of depressive symptoms, poor sleep quality, sleep disorders, and insufficient sleep with asthma. Additionally, there was an interaction between moderately severe depression and insufficient sleep on asthma. Psychological and sleep assessment are essential in asthma management. Clinicians should consider the potential risk of depression and sleep problems in asthma patients and intervene. Further longitudinal research is needed to better understand the pathophysiological mechanisms behind the interactions between asthma, depression, and sleep problems.
... Asthma affects millions of individuals worldwide, wielding a notable impact on disadvantaged communities (45,46). Sudden asthma attacks and subsequent emergency department visits occur disproportionately in vulnerable groups, particularly individuals with limited income, members of racial or ethnic minorities, and those with restricted access to healthcare services (10,47). ...
... This suggests a noteworthy correlation between county vulnerability and higher rates of asthma-related EMS visits. Prehospital management of acute exacerbation of asthma symptoms, namely asthma attack, is a crucial component of EMS (45). So far EMS data are underutilized in the literature. ...
Introduction
This ecologic study explores the relationship between the Social Vulnerability Index (SVI) and probable asthma-related emergency medical service (EMS) rates before and during the COVID-19 pandemic at the county level in Illinois.
Methods
The number of asthma-related EMS visits was obtained in all 102 counties for adults aged 18 years or more, and for 82 of these counties for children aged less than 18 from 2018 to 2021. They were converted into rates and examined in relation to SVI rankings. Pearson’s correlation coefficients and negative binomial regression were used to examine associations, adjusting for the level of rurality.
Results
The rate of asthma-related EMS visits increased in adults from 23.1 to 28.9 per 1,000 between 2018 and 2021 but decreased in children from 5.9 to 5 per 1,000. Every 1% increase in the overall SVI was associated with a nearly two-fold increase in the rate of EMS visits in adults (pre-COVID-19: IRR = 1.94, p < 0.01; during-COVID: IRR = 1.90, p < 0.01) and an even greater increase in children (pre-COVID-19: IRR = 2.61, p < 0.01; during-COVID: IRR = 2.92, p < 0.01) Consistent associations were found for the SVI themes of socioeconomic status, housing type, and transportation across age groups and time periods.
Discussion
During the pandemic, all four themes of SVI were associated with the asthma EMS rate in children. This study has shown that the same factors that lead to community vulnerability in a disaster align with a greater need for on-site asthma emergency treatment.
... It is often underdiagnosed and under-treated, particularly in lowand middle-income countries (1). It is increasing in prevalence, affecting an estimated 300 million people worldwide in 2021 and leading to 455, 000 deaths (2). It affects 1-18% of the population in different countries of the world. ...
... It affects 1-18% of the population in different countries of the world. In North America, asthma is present in 10% of the population (2). In a recent review, the prevalence of physician-diagnosed asthma, clinical asthma, and wheezing in Nigeria was 2.5%, 6.4%, and 9.0% respectively (3). ...
Background: Bronchial asthma is a global health issue affecting the socioeconomic , financial, psycho-social, and emotional well-being of individual patients. It is a major non-communicable disease that affects children, adolescents, and adults. Bronchial asthma has been linked with a high burden of physical limitation and functional disability. Aim/objective: This study was conducted to determine the prevalence of disability and its predictors in adolescents and adult patients treated for bronchial asthma. Method: This is a facility-based cross-sectional study involving 106 randomly selected patients, and randomly selected asthmatic patients attending the General OutPatient Department and Respiratory Clinics were recruited for this study. A structured questionnaire was used to collect the socio-demographic characteristics and the level of disability, which was assessed with WHODAS 2.0 short-form having a five-point ordinal scale, ranging from 1 to 5. Data was analyzed with SPSS version 16. Frequency, mean, and standard deviation were used to summarize the data. Associations between variables were assessed by using the chi-squared (χ2) test and Student's t-test. Associations between the independent effects of variables were assessed by using Poisson regression analysis. The level of statistical significance was set at a p-value of 0.05. Results: This study included 32 (30.2%) males and 74 (69.8%) female participants with a mean age of 35.82±0.56 years. More than half of both male (n=19, 59.3%) and female (n=49, 66.2%) participants reported no disability, while only 1 male and 5 females reported severe disability. The differences were not statistically significant (p>0.05). The mean disability in this study was 2.1, suggesting low disability based on the International Classification of Functioning, Disability, and Health severity range. However, age (CI=0.998-1.003), BMI (CI=0,994-1.013), and duration of disability (CI=1.001-1.002) were the significant predictors of disability. Conclusion: This study showed that individuals with asthma have a low burden of disability. Age, BMI, and duration of disability were the most important predictors of disability burden. The finding of a low asthma prevalence of disability in asthma emphasizes the need to incorporate disability assessment into asthma management. [Ethiop. J. Health Dev. 2024; 38(2): 00-00]
... Asthma represents a chronic inflammatory syndrome of the airways that affects millions of people in the world with considerable morbidity and healthcare costs [1,2]. As characterized by reversible airflow obstruction of transient nature, accompanied by airway hyperreactivity as well as persistent inflammation, asthma continues to be a public health danger. ...
... Bronchial asthma (BA) is a common chronic respiratory condition affecting millions worldwide, with systemic corticosteroids being a cornerstone of treatment for acute exacerbations [1]. ...
... Asthma is a chronic respiratory disease that is associated with airway inflammation and affects millions of people worldwide [1][2][3][4][5]. Wheeze is a symptom of asthma, and a common condition characterized by a continuous high-pitched sound that emanates from the chest during exhalation [6,7]. ...
Background: The rise of asthma prevalence in recent decades has been attributed to changes in dietary patterns, especially in developing countries. Studies have also suggested that dietary patterns play an important role in both asthma development and management. This study aimed to investigate the association between consumption of various foods and environmental factors with asthma and wheeze among adolescents. Methods: A self-administered standardized International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to collect data on demographics, respiratory health, exposure to air pollution, and diet on n = 2855 adolescents residing in Vhembe District, South Africa. Results: The prevalence of asthma and wheeze were 18.91% and 37.69%, respectively. Consuming various foods such as fast foods (OR = 1.41; 95% CI: 1.06–1.88), bread (OR = 0.60; 95% CI: 0.45–1.81), pasta (OR = 1.39; 95% CI: 1.06–1.84), seafood (OR = 1.79; 95% CI: 0.65–1.24), and nuts (OR = 0.85; 95% CI: 0.65–1.12) were significantly associated with asthma in the crude logistic regression analysis. Further analysis in the multiple regression model indicated a strong association of asthma with consumption of nuts (OR = 1.55; 95% CI: 1.11–2.17), seafood (OR = 1.60; 95% CI: 1.03–2.49), and cereal (OR = 0.67; 95% CI: 0.45–0.99). In relation to wheeze, consumption of meat (red) (OR = 0.77; 95% CI: 0.60–0.99) was a protective factor in the crude analysis. The multiple logistic regression model showed that, seafood (OR = 0.76; 95% CI: 0.59–0.96), fruit (OR = 0.55; 95% CI: 0.32–0.94), nuts (OR = 1.88; 95% CI: 1.50–2.66), and olive oil (OR = 1.48; 95% CI: 1.09–2.00) were significantly associated with wheeze. Conclusion: Diet plays a major role in respiratory health, especially in asthma and wheeze. Dietary changes may play a role in reducing the burden of asthma and other respiratory symptoms in adolescents.
... Inadequate inhalation technique decreases drug delivery and effectiveness, which in turn contributes to uncontrolled asthma.In this study, home or work triggers were significantly associated with hospital and ICU admission rates. This finding is consistent with previous studies, which have shown that frequent exposure to multiple triggers exacerbates asthma[26][27][28].Asthma guidelines recommend that patients with asthma identify triggers and reduce exposure to these triggers to improve control and reduce their need for medication[29,30]. Our study found that smoking was significantly associated with hospitalization. ...
Objective: To identify factors associated with poor bronchial asthma control in patients attending Atbara Teaching Hospital, Sudan, in 2020. Methods: This was an analytical, descriptive, cross-sectional hospital-based study conducted at the Atbara Teaching Hospital in River Nile State, Sudan, between February and June 2020. All patients diagnosed with bronchial asthma who were attending any hospital department were included. Results: In total, 292 patients were enrolled, 51.4% were aged 18–45 years and 51.4% were female. The most frequent complaints were an audible wheeze and shortness of breath (approximately 93%), and 49% had been diagnosed with asthma >10 years previously. Of the patients, 42% were admitted 1 to 3 times and 47.3% were admitted to the intensive care unit (ICU). Hospital admission was associated with improper inhaler use (P = 0.003), the presence of triggers at home or work (P = 0.003), and passive smoking (P = 0.016). ICU admission was associated with female sex (P = 0.039) and the presence of triggers at home or work (P = 0.026). Conclusion: Asthma is a major problem in Atbara City. Improper inhaler use, the presence of triggers at home or work, and passive smoking were significantly associated with hospital admission. Female sex and the presence of triggers at home or work were significantly associated with ICU admission.
... The animal model features many similarities to human asthma. Asthma is a chronic inflammatory disease of the respiratory system affecting more than 300 million people worldwide [8]. The pathogenesis of asthma is complex, with diverse clinical phenotypes, but eosinophilic or neutrophilic lung inflammation and the release of Th2-type inflammatory cytokines in an allergic response to environmental antigens are similar between this model and human disease [9,10]. ...
Laboratory mice are instrumental for preclinical research but there are serious concerns that the use of a clean standardized environment for specific-pathogen-free (SPF) mice results in poor bench-to-bedside translation due to their immature immune system. The aim of the present study was to test the importance of the gut microbiota in wild vs. SPF mice for evaluating host immune responses in a house-dust-mite-induced allergic airway inflammation model without the influence of pathogens. The wild mouse microbiome reduced histopathological changes and TNF-α in the lungs and serum when transplanted to microbiota-depleted mice compared to mice transplanted with the microbiome from SPF mice. Moreover, the colonic gene expression of Gata3 was significantly lower in the wild microbiome-associated mice, whereas Muc1 was more highly expressed in both the ileum and colon. Intestinal microbiome and metabolomic analyses revealed distinct profiles associated with the wild-derived microbiome. The wild-mouse microbiome thus partly reduced sensitivity to house-dust-mite-induced allergic airway inflammation compared to the SPF mouse microbiome, and preclinical studies using this model should consider using both ‘dirty’ rewilded and SPF mice for testing new therapeutic compounds due to the significant effects of their respective microbiomes and derived metabolites on host immune responses.
... Asthma prevalence, morbidity, death, and economic burden have all increased globally since the 1970s, especially in children [1,6] . Anti-inflammatory, immunomodulatory, antihistaminic, smooth-muscle relaxant, and allergic action are desirable qualities in medicinal plants used to treat asthma [1,7] . Ayurveda states that an anti-asthmatic medication must possess qualities like anti-kapha and anti-vata [1,8] . ...
As per traditional uses by the Oran community of Sundargarh, Odisha, India, Boswellia serrata fruits are selected and subjected to phytochemical screening followed by antibacterial activities against Streptococcus pyogenes (MTCC 442). Results revealed that fruits have diverse secondary metabolites, and evaluation of MIC showed its antibacterial activities, which might be able to reduce the problems related to asthma. The study recommends doing more experimental work for formulating drugs against asthma.
... approximately 300 million people are affected by asthma, with about 20 million individuals, roughly 8% of adults, suffering from it in the United States alone, reflecting a significant public health concern. The global prevalence, incidence, mortality, and economic burden associated with asthma are all experiencing a sharp increase, necessitating urgent attention and comprehensive strategies to mitigate its impact 1,2 . ...
Asthma is a chronic inflammatory disease that affects millions of people worldwide. Obesity, particularly visceral adipose tissue (VAT), is known to secrete adipokines and pro-inflammatory factors, which are closely associated with various metabolic and cardiovascular diseases. Research indicates that these metabolic disturbances can exacerbate inflammatory conditions, contributing to both cardiovascular and respiratory diseases, including asthma. Despite these associations, studies on the specific relationship between VAT and asthma remain limited and warrant further investigation. Utilizing the NHANES database from 2011 to 2018, we included a total of 11,137 participants. Multivariable regression analysis was performed, stratifying subjects based on VAT levels and adjusting for various confounders. Subgroup interaction analysis and nonlinear analysis were conducted to explore potential effect modifiers and nonlinear associations. In this study, 11,137 participants were included, with 49.74% being female. Among the 509 asthma patients, 69.35% were female. The number of asthma patients among Non-Hispanic Whites was 212, representing 41.65% of the total, the highest proportion among the studied groups. The VAT for asthma patients was 529 g, significantly higher than the 455 g in the non-asthma group (P < 0.001). Multivariable regression analysis showed that for every 200 g increase in VAT, the risk of asthma increased by 10.4% (P = 0.032), 20.8% (P < 0.001), and 20.3% (P = 0.004) across three models (unadjusted, adjusted for demographic factors, and fully adjusted). Subgroup analysis indicated a stronger association between VAT and asthma risk in females and individuals over 40 years old. Nonlinear analysis uncovers a J-shaped relationship between VAT and asthma, with the lowest risk observed at 464.57 g (P < 0.001). The study findings suggest that increased VAT is associated with elevated asthma risk, particularly among females and older individuals. These results underscore the importance of considering VAT in asthma risk assessment and highlight potential targeted interventions to reduce asthma risk associated with excess visceral adiposity.
... It is the most common chronic disease among children [1]. Asthma is estimated to affect 300 million individuals globally, with increasing prevalence in developing countries associated with increasing cost of treatment and rising burden for patients and the community [2]. Asthma causes a loss in productivity, seriously affects children, and disrupts families, which, in turn, contributes to an unacceptable burden on the healthcare system and results in higher mortality, especially among children [3]. ...
Introduction
Asthma, a significant non-communicable disease impacting all age groups, leads to productivity loss, particularly affecting children and causing disruption within families. This study aims to evaluate the knowledge and attitudes of asthmatic patients and caregivers through questionnaires, focusing on available treatment options.
Aims and objectives
The study aimed to assess the knowledge and attitudes of asthmatic patients and caregivers at a tertiary care hospital in Chennai, Tamil Nadu, India. Objectives included evaluating asthma knowledge using a questionnaire and assessing attitudes towards the disease and available treatment options.
Materials and methods
This cross-sectional study, conducted at the Department of Respiratory Medicine, Sree Balaji Medical College & Hospital, Chennai, focused on bronchial asthma patients and their caregivers in the Outpatient Department (OPD) from May 2021 to November 2022. The study included 150 participants selected randomly based on sample size calculations. Data, collected through a proforma, included demographic variables. Participants' knowledge and attitudes toward asthma were assessed using the Asthma Knowledge and Asthma Attitude questionnaires. Exclusion criteria comprised patients with a history of tuberculosis, chronic obstructive pulmonary disease, interstitial lung disease, recent hemoptysis, or evidence of infective exacerbation.
Results and discussion
Among 150 participants, 44% were females and 56% were males. Asthma knowledge was present in 62.1% of females and 79.8% of males, while 37.9% of females and 20.2% of males lacked understanding. High prevalence rates of breathlessness (89.4% females, 90.5% males), wheezing (92.4% females, 81% males), and cough (77.3% females, 75% males) were noted. The knowledge questionnaire revealed a mean score of 4 out of 8, indicating a moderate understanding with significant gaps. Many lacked knowledge about affected sites, harbored misconceptions about pet contact, and dust exposure, and were uninformed about triggers, symptoms, and treatment. Lack of awareness regarding weather-related exacerbations, smoking effects, and medication purposes was evident. Reluctance towards long-term inhaler use underscored the necessity for comprehensive asthma education among patients and caregivers. Attitude questionnaire scores varied: 17 scored 16, 37 scored 18, 24 scored 19, 35 scored 21, 20 scored 24, and 17 scored 26, averaging 20.6, reflecting generally positive attitudes. The attitude questionnaire, with six questions, highlighted attitudes toward asthma. However, stigma around asthma affecting normal lives (77.3%), fear of lifelong medication use (84%), and embarrassment over public inhaler use (74%) highlighted areas for attitude improvement to enhance therapy compliance and patient outcomes.
Conclusion
Our study highlights concerns among asthma patients and caregivers, particularly those with limited education, regarding treatment side effects. Issues include apprehensions about inhaler therapy's addictive potential, insufficient awareness of asthma triggers, improper inhaler techniques, reluctance towards long-term inhaler use, and embarrassment over public use of inhalers contributing to the study's complexities.
... El asma afecta a más de 300 millones de personas y su prevalencia ha aumentado continuamente (60). Evidencia creciente indica que el PM induce radicales libres, que aumentan el estrés oxidativo y provoca inflamación pulmonar, contribuyendo con el desarrollo del asma (61,62). Varios estudios han reportado que la exposición gestacional al PM2.5 se asocia con mayor incidencia de asma (58,63). ...
Particulate matter (PM) is a group of solid and liquid elements produced by different anthropogenic and natural activities, which are emitted directly into the air. It has different physicochemical and thermodynamic properties and according to its aerodynamic diameter, it can be classified as PM10 (<10 μm), PM2.5 (<2.5 μm) and PM0.1 (<0.1 μm). It can be inhaled and reach other organs from the lungs, causing respiratory, cardiovascular and neurological diseases, among others. Considering that the foetus is susceptible to air pollutants such as PM through gestational exposure, and that early life disturbances are crucial for development, PM can cause various disorders or complications including premature birth, low birth weight and neuropsychological damage, among others. This review summarizes the epidemiological evidence that demonstrates the relationship between maternal exposure to PM and adverse outcomes in foetal development, birth, and childhood, as well as some molecular mechanisms that could explain these associations.
... The prevalence of allergic diseases like asthma, hay fever, and eczema has increased dramatically over the past decades, affecting 300 million people worldwide (Braman, 2006). Allergic asthma is characterized by chronic eosinophilic inflammation of the airways, causing bronchial hyperreactivity, airway wall remodeling, and mucus overproduction with plugging (Hammad and Lambrecht, 2021;Schuijs et al., 2013). ...
Asthma is characterized by lung eosinophilia, remodeling, and mucus plugging, controlled by adaptive Th2 effector cells secreting IL-4, IL-5, and IL-13. Inhaled house dust mite (HDM) causes the release of barrier epithelial cytokines that activate various innate immune cells like DCs and basophils that can promote Th2 adaptive immunity directly or indirectly. Here, we show that basophils play a crucial role in the development of type 2 immunity and eosinophilic inflammation, mucus production, and bronchial hyperreactivity in response to HDM inhalation in C57Bl/6 mice. Interestingly, conditional depletion of basophils during sensitization did not reduce Th2 priming or asthma inception, whereas depletion during allergen challenge did. During the challenge of sensitized mice, basophil-intrinsic IL-33/ST2 signaling, and not FcεRI engagement, promoted basophil IL-4 production and subsequent Th2 cell recruitment to the lungs via vascular integrin expression. Basophil-intrinsic loss of the ubiquitin modifying molecule Tnfaip3, involved in dampening IL-33 signaling, enhanced key asthma features. Thus, IL-33–activated basophils are gatekeepers that boost allergic airway inflammation by controlling Th2 tissue entry.
... The finan-cial cost of treating patients with severe asthma exceeds the cost of treating tuberculosis and HIV/AIDS. Health insurers in developed countries may spend approximately 1.00-2.00% of their budget on asthma management [17]. However, the cost of biological treatment per patient is around 650-1200 € per month in Slovakia [18]. ...
Introduction
Asthma is defined as a chronic inflammatory disease that significantly affects the bronchial tubes, making breathing more difficult during strenuous activities. Severe asthma is a complex and heterogeneous respiratory disease, with persistent symptoms, frequent asthma attacks and numerous comorbidities. It affects between 3.00 and 10.00% of people worldwide and has a major impact not only on their personal lives but also on the lives of their families.
Aim
To investigate to what extent severe asthma interferes with the patient’s daily and cultural-social life.
Material and methods
We conducted a qualitative study where we selected patients diagnosed with severe asthma based on spirometric parameters. Subsequently, their basic anthropometric parameters (body height and body weight) were measured. On the basis of personal interviews with the patients and the answers obtained by us, we processed the raw data into their actual form.
Results
In our research, we found a significant impact of severe asthma on patients’ quality of life, not only in terms of limitations in various activities (physical exertion, sports or work routine), but also in psychological aspects.
Conclusions
The health status of patients is directly proportional to their lifestyle. There are many variables that affect the movement of the diaphragm and airflow through the airways, especially in patients with severe asthma.
... Asthma affects over 300 million individuals; its global prevalence has doubled over the last 3 decades and continues to rise in emerging economies [1,2]. Allergic asthma involves chronic inflammation of the airways, which is characterized by heterogeneous inflammatory lung disease, airway hyperresponsiveness (AHR), and mucus hypersecretion. ...
Exposure to storage mite (SM) and house dust mite (HDM) allergens is a risk factor for sensitization and asthma development; however, the related immune responses and their pathology have not been fully investigated. The HDMs Dermatophagoides farinae and Dermatophagoides pteronyssinus and SM Tyrophagus putrescentiae are potent allergens that induce asthma. Most SM-related studies have focused on the allergic reactions of individuals by measuring their immunoglobulin (Ig)E expression. Considering the limited research on this topic, the present study aims to investigate the differences in the immune responses induced by HDMs and SMs and histologically analyze lung tissues in a mouse asthma model to understand the differential effects of HDM and SM. The results revealed that all mite species induced airway inflammation. Mice challenged with T. putrescentiae had the highest airway resistance and total cell, eosinophil, and neutrophil counts in the bronchoalveolar lavage fluid (BALF). The SM-sensitized groups showed more severe lesions and mucus hypersecretions than the HDM-sensitized groups. Although the degree of HDM and SM exposure was the same, the damage to the respiratory lung tissue was more severe in SM-exposed mice, which resulted in excessive mucin secretion and increased fibrosis. Furthermore, these findings suggest that SM sensitization induces a more significant hypersensitivity response in mucosal immunity than HDM sensitization in asthma models.
... Although patient and family involvement in asthma management is recommended, over the past 40 years there has been a noticeably increased mortality, morbidity, and economic burden of asthma worldwide [11,12].The ultimate goal of both expert and self-management is to keep asthma under control. However, according to the Communicable Disease and Control (CDC) report, half of adults and over 40% of children have uncontrolled asthma, though a wide range of pharmaceutical and other therapies are available [13]. ...
Introduction
Bronchial asthma is a major public health issue that affects patients, families, and communities worldwide. Despite the growing importance of self-management and its clear link to better health outcomes, the uptake and use of self-management among asthmatic patients is not well understood. Thus, the study aimed to determine the level of self-management practice and associated factors among asthmatic patients on follow-up care at public tertiary hospitals found in south-west Ethiopia.
Method
An institutional-based cross-sectional study design was employed from August 1 to September 30, 2022. The study included all asthmatic patients on follow-up care at public tertiary hospitals found in south west Ethiopia, among whom 274 were interviewed. All asthmatic patients who were registered at the chronic follow-up unit of each hospital and fulfilled inclusion criteria were included and interviewed consecutively. The data were collected using a structured interviewer-administered questionnaire adapted from previous studies, entered into EpiData version 4.6, and exported to SPSS version 25 for analysis. Descriptive statistics were used to summarize the participant’s characteristics. Linear regression was used to identify variables associated with asthma self-management practice, and variables with a p-value of 0.05 were considered statistically significant. Finally, tables, graphs, and text were used to present the data.
Result
Out of 274 interviewed asthmatic patients, 45.26% 95% CI (39, 51) had good asthma self-management practices. Advancing in age (ß = -0.009, P = 0.043), being a smoker (ß = -0.346, 95%, P = 0.03, being alcohol drinker (ß = -0.217, P = 0.001), having depression (ß = -0.038, P = 0.005), having anxiety (ß = -0.029, P = 0.02) and having social support (ß = 0.022, P<0.001) were identified as factors affecting asthma self-management practice.
Conclusion
The finding revealed that four of every nine asthmatic patients had good asthma self-management practices. Age, alcohol consumption, smoking, anxiety, depression, and social support were significantly associated with asthma self-management practice. Ongoing self-management support and collaborative target interventions aimed at improving asthma self-management practices and identified factors are very crucial.
... Asthma prevalence and incidence have been rising globally in recent decades, mostly as a result of numerous environmental risk factors, many of which fall under the category of "modern lifestyle," rather than just genetics. Even in developing nations with low illness incidence in the recent past, the globalization of the economy may have played a substantial role in the rise in the prevalence of asthma [3,4]. ...
Citation: Md Aminul Islam Ripon; et al (2024); Living with chronic Asthma: Navigating lifelong care and healthcare costs. iraetc j. nur. health care; 2(4) 61-65. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International license. Worldwide, asthma places a heavy strain on people with the disease as well as healthcare systems. This load can take many different forms, such as decreased living quality, higher healthcare utilization, and significant financial consequences. It is essential to comprehend the complex nature of this burden in order to create solutions that are both successful and preventative for asthma. This article examines the various repercussions of asthma, including how it affects daily activities, productivity, and the availability of healthcare services. In order to lessen the difficulties that people with asthma and healthcare systems encounter, we hope to raise awareness of the complexity of the condition's burden and make it easier to adopt focused interventions. Moreover, asthma has a greater social cost that affects healthcare systems and productivity in society as a whole. It need an all-encompassing strategy that incorporates patient education, medical management, and public health activities to address this load.
... Direct expenses include medical services, medications, and hospitalizations, while indirect costs stem from reduced productivity at work or school. Notably, 40% of asthma patients have moderate to severe disease [1]. ...
Background: Severe asthma often remains uncontrolled despite optimized inhaled treatment. The rise of biologic therapy in severe asthma represented a major advance for the disease management. However, correct phenotyping and monitoring of severe asthma patients is key to the success of targeted biologic therapy. Materials and Methods: We present the case of a 63-year-old female, never a smoker, diagnosed with asthma at the age of 45 and associated persistent mild rhinitis, without other notable comorbidities. She was prescribed medium-dose ICS/LABA, administered inconstantly in the first years after the diagnosis, with poor overall control of the disease. After several exacerbation episodes, treatment compliance improved, but the control of the disease remained poor despite adding an antileukotriene. In January 2019, she presented an exacerbation episode requiring treatment with oral corticosteroids (OCS) and she was afterwards put on high-dose ICS/LABA and continued the antileukotriene. She was referred for a skin allergy test, which revealed mild sensitization to Dermatophagoides pteronyssinus and farinae, with a total IgE level of 48.3 IU/mL. The blood eosinophil level was 270 cells/mm³. The lung function was variable, going from mild impairment to severe fixed obstruction during exacerbations. Despite optimized inhaled treatment, good adherence and inhaler technique, and allergen avoidance strategies, asthma control was not achieved, and she continued to experience severe episodes of exacerbation requiring OCS. Results: In October 2019, she was initiated on biologic therapy with omalizumab, which allowed asthma control to be achieved and maintained for 18 months, with preserved lung function, good symptom control, no exacerbations and slightly elevated blood eosinophil level (340–360 cells/mm³). In April 2021, she started experiencing exacerbation episodes requiring OCS (three episodes within 6 months), with a progressive increase in blood eosinophil level (up to 710 cells/mm³), and progressive deterioration of asthma control and lung function, despite continuation of previous therapy. A specific IgE test against Aspergillus was negative, and total IgE level was 122.4 IU/mL. In December 2021, the patient was switched from omalizumab to benralizumab. Asthma control was again achieved, lung function improved significantly and the patient did not experience any other exacerbation episodes up until today, which allowed for a reduction in ICS dose. Intriguingly, a relapsing eosinophilia was also noted under anti-IL5-R treatment prior to the dose administration, but with preserved asthma control. Conclusions: This case underscores the pivotal role of meticulous phenotyping in severe asthma management on one side, and careful monitoring of patient evolution and possible side effects of treatment on the other side. By showcasing how diverse inflammatory pathways can coexist within a single patient and impact treatment outcomes, it highlights the necessity of tailored biologic therapy for sustained control.
... Approximately 300 million people worldwide are suffering from the symptoms of this disease, and the prevalence is increasing by 50% every decade. Moreover, worldwide 180.000 deaths related to asthma are reported annually (3). Although the prevalence of asthma is steadily rising and new therapies developed, the basic mechanisms of the disease are still largely unknown (4). ...
Background
Allergic Asthma is a disease presenting various endotypes and no current therapies act curative but alleviate disease symptoms. Dietary interventions are gaining increasing importance in regulating immune responses. Furthermore, short chain fatty acids (SFCA), as the main products of dietary fiber’s fermentation by the gut bacteria, ameliorate the pathogenesis and disease burden of different illnesses including asthma. Nevertheless, the connection and crosstalk between the gut and lung is poorly understood.
Objective
In this work, the role of high fiber diet on the development of allergic asthma at baseline and after exacerbation of disease induced by respiratory viruses was investigated.
Methods
Hereby, SCFA in serum of asthmatic and non-asthmatic pre-school children before and after airway disease symptoms were analyzed. Moreover, the effect of high fiber diet in vivo in a murine model of house dust mite extract (HDM) induced allergic asthma and in the end in isolated lung and spleen cells infected ex vivo with Rhinovirus was analyzed.
Results
In this study, a decrease of the SCFA 3-Hydroxybutyric acid in serum of asthmatic children after symptomatic episodes at convalescent visit as compared to asthmatic and control children at baseline visit was observed. In experimental asthma, in mice fed with high fiber diet, a reduced lung GATA3 + Th2 type mediated inflammation, mucus production and collagen deposition and expression of Fc epsilon receptor Ia (FcεRIa) in eosinophils was observed. By contrast, the CD8+ memory effector T cells were induced in the lungs of asthmatic mice fed with high fiber diet. Then, total lung cells from these asthmatic mice fed with either standard food or with fiber rich food were infected with RV ex vivo. Here, RV1b mRNA was found significantly reduced in the lung cells derived from fiber rich food fed mice as compared to those derived from standard food fed asthmatic mice. Looking for the mechanism, an increase in CD8+ T cells in RV infected spleen cells derived from fiber rich fed asthmatic mice, was observed.
Conclusion
Convalescent preschool asthmatic children after a symptomatic episode have less serum ß-Hydroxybutyric acid as compared to control and asthmatic children at baseline visit. Fiber rich diet associated with anti-inflammatory effects as well as anti-allergic effects by decreasing Type 2 and IgE mediated immune responses and inducing CD8+ memory effector T cells in a murine model of allergic asthma. Finally, ex vivo infection with Rhinovirus (RV) of total lung cells from asthmatic mice fed with fiber rich food led to a decreased RV load as compared to mice fed with standard food. Moreover, spleen cells derived from asthmatic mice fed with fiber rich food induced CD8+ T cells after ex vivo infection with RV.
Clinical implications
Dietary interventions with increased content in natural fibers like pectins would ameliorate asthma exacerbations. Moreover, respiratory infection in asthma downregulated SCFA in the gut contributing to asthma exacerbations.
... Clinically, dyspnea, wheeze, cough and chest tightness often occur in patients with asthma [1]. In addition, asthma causes severe economic and family burdens due to the high cost of treatment [4]. Therefore, it is absolutely imperative that effective drugs for asthma and the underlying mechanisms are further explored and clarified. ...
Background
Calycosin, a flavonoid compound extracted from Astragalus membranaceus, has shown anti-asthma benefits in house dust mite-induced asthma. Recent studies have suggested that innate-type cells, including group 2 innate lymphoid cells (ILC2s) and macrophages, serve as incentives for type 2 immunity and targets for drug development in asthma. This work focuses on the effects of calycosin on the dysregulated ILC2s and macrophages in allergic asthma.
Methods
In vivo, the asthmatic mouse model was established with ovalbumin (OVA) sensitization and challenge, and calycosin was intraperitoneally administered at doses of 20 and 40 mg/kg. In vivo, mouse primary ILC2s were stimulated with interleukin (IL)-33 and mouse RAW264.7 macrophages were stimulated with IL-4 and IL-13 to establish the cell models. Cells were treated with calycosin at doses of 5 and 10 µM.
Results
In vivo, we observed significantly reduced numbers of eosinophils, neutrophils, monocyte macrophages and lymphocytes in the bronchoalveolar lavage fluid (BALF) of OVA-exposed mice with 40 mg/kg calycosin. Histopathological assessment showed that calycosin inhibited the airway inflammation and remodeling caused by OVA. Calycosin markedly decreased the up-regulated IL-4, IL-5, IL-13, IL-33, and suppression tumorigenicity 2 (ST2) induced by OVA in BALF and/or lung tissues of asthmatic mice. Calycosin repressed the augment of arginase 1 (ARG1), IL-10, chitinase-like 3 (YM1) and mannose receptor C-type 1 (MRC1) levels in the lung tissues of asthmatic mice. In vivo, calycosin inhibited the IL-33-induced activation as well as the increase of IL-4, IL-5, IL-13 and ST2 in ILC2s. Calycosin also repressed the increase of ARG1, IL-10, YM1 and MRC1 induced by IL-4 and IL-13 in RAW264.7 macrophages. In addition, we found that these changes were more significant in 40 mg/kg calycosin treatment than 20 mg/kg calycosin.
Conclusions
Collectively, this study showed that calycosin might attenuate OVA-induced airway inflammation and remodeling in asthmatic mice via preventing ILC2 activation and macrophage M2 polarization. Our study might contribute to further study of asthmatic therapy.
In developed countries, the gradual ageing of the population became one of the most significant socioeconomic factors of the twentieth century, as older patients are often malnourished and immunocompromised. Improved living conditions and advances in medical science have increased life expectancy extended by several decades. As people age, they experience various physiological and functional changes, often leading to atrophy and decreased efficiency in several organs and systems, including the respiratory system. The development of the airways and lung parenchyma begins during morphogenesis in utero and continues up to the age of 30 years, after which, a number of processes begin to determine the progressive ageing of the lungs and, in particular, a reduction in mucociliary clearance, a decrease in alveolar surface area, with degradation of elastin and collagen, which is associated with dilatation of the air spaces. The elderly population (>65 years of age) is at greater risk of developing tracheobronchial and lower respiratory tract diseases, due both to long-term exposure to ever-worsening air pollution, smoking, and occupational toxins, and to their fragility and comorbidity; they also have reduced exercise capacity, lower lung oxygenation, and a greater susceptibility to recurrent lung infections and chronic obstructive pulmonary disease (COPD) (Rojas et al. 2015; Brandsma et al. 2017; Bowdish 2019). Airway disease in the elderly can be divided into upper and lower airway disease. A predominant feature of lower airway disease is the involvement of the bronchioles; sometimes this may be associated with the involvement of the more proximal airways or even spread distally to the lung parenchyma (Table 1). The most common lower airway diseases in elderly patients are COPD, asthma, and bronchiectasis. Upper airway diseases, on the other hand, are a heterogeneous group of disorders and are often undiagnosed, usually because they are asymptomatic or paucisymptomatic, and therefore generally untreated. The most common upper airway disorders in older patients are tracheobronchomegaly, tracheobronchial diverticula, tracheobronchomalacia, tracheobronchopathia osteochondroplasia, Wegener’s granulomatosis, and amyloidosis (Table 2). In this chapter, we will look at the main causes of airway pathology in the elderly (Maggi et al. 2006).
The main structural components of mucus produced in the lung are mucin 5B (MUC5B) and mucin 5AC (MUC5AC) where a relatively higher expression of MUC5B is typical in health. In the lungs of individuals with asthma, there is a shift from MUC5B to MUC5AC as the predominantly secreted mucin which has been shown to impair mucociliary clearance (MCC) and increase mucus plug formation in the airways. Given its role in asthmatic lung disease, MUC5AC represents a potential therapeutic target where a gene delivery approach could be leveraged to modulate its expression. For these purposes, we explored adeno-associated virus serotype 6 (AAV6), as a lung-tropic viral gene vector to target airway epithelial cells and reduce MUC5AC expression via siRNA delivery. We confirmed that AAV6 was able to transduce epithelial cells in the airways of healthy mice with high transgene expression in mucus-secreting goblet cells. Using multiple particle tracking analysis, we observed that AAV6 was capable of penetrating both normal and MUC5AC-enriched mucus barriers. Successful transduction with AAV6 was also achieved in IL-13 stimulated human airway epithelial (HAE) cells differentiated at air-liquid interface (ALI). AAV6 expressing MUC5AC-targeting siRNA was evaluated as a prophylactic treatment in HAE cell cultures before IL-13 challenge. IL-13 stimulated HAE cultures treated with AAV6-MUC5AC siRNA had significantly reduced MUC5AC mRNA and protein expression compared to untreated controls. Mucociliary transport in IL-13 stimulated HAE cultures was also maintained and comparable to healthy controls following AAV6-MUC5AC siRNA treatment. Together, these findings support that AAV6 may be used as an inhaled gene therapy to suppress MUC5AC overexpression and restore normal airway clearance function in asthma.
Background and purpose: The potential association between asthma and various oral and dental conditions such as caries, tooth wear, periodontal diseases, and alterations in the oral mucosa remains a topic of ongoing debate among dental professionals. This study sought to assess the prevalence of hyposalivation and dry mouth in children aged 3 to 12 years with asthma, who were referred to Bu Ali Sina Hospital in Sari in 2023. Materials and methods: This descriptive-analytical epidemiological study was conducted on pediatric asthma patients at Bu Ali Sina Hospital in Sari. Data on each patient's asthma severity, duration of the condition, and medication usage were collected through questionnaires and interviews with patients' parents. Unstimulated salivary flow was measured using the gravimetric method. Statistical analyses were performed using Spearman's correlation coefficient, Mann-Whitney, Kruskal-Wallis, and Chi-square tests to compare the data, with a significance level set at 0.05. Results: A total of 66 children (32 boys and 34 girls) participated in this study. Hyposalivation was observed in 33.3% of the children (22 out of 66), while 42.4% (28 out of 66) experienced dry mouth. A statistically significant association was found between gender and hyposalivation, with boys being more affected than girls (P<0.05). Furthermore, dry mouth was notably more prevalent among children with hyposalivation (P<0.001). Children with hyposalivation were approximately 16 times more likely to report dry mouth compared to those without hyposalivation (Odds Ratio=16.35, P=0.001). Conclusion: This study highlights the higher prevalence of hyposalivation in boys compared to girls, though no significant association was found between gender and presence of dry mouth. A strong, statistically significant link between hyposalivation and dry mouth was confirmed through multiple logistic regression analysis. These findings suggest that children with hyposalivation are at a markedly increased risk of experiencing dry mouth, underscoring the need for early detection and management in pediatric asthma patients.
Genetic association studies of asthma have long been used to detect candidate genes involved in the disease pathogenesis. Asthma genetics is not a much-explored area in India. Still, several candidate genes for asthma are identified through population-based study and the most common method is the case–control study for searching single nucleotide polymorphisms (SNPs). In this review, we are discussing asthma-related candidate genes and SNPs identified in different Indian population. The core idea of candidate gene studies is to determine the differences of allele frequency between case and control groups. PCR–RFLP is the most popular technique for SNPs analysis. The base for this review is “Pubmed search” for “genetic association of asthma in India”. Literature survey shows that asthma gene association studies are reported only from few cities in India and replicative studies are lacking. In this review, we have portrayed 26 candidate genes and their respective SNPs for the association or non-association with asthma. New Delhi and Lucknow from the northern part and Mysore from the south are the most explored cities. ADAM 33 is the most studied candidate gene followed by IL4, IL13, and CD14. Candidate gene association studies can identify the risk alleles and provide a better picture of the genetic association of asthma. These studies may not have the ability to explore new genes, they still help to identify the risk individuals who can be targeted for therapeutic evaluation. Hence, further replicative studies on the same candidate gene from the unexplored study zones of India are recommended.
The efficacy of β-agonists in asthma is severely limited by β-adrenoceptor desensitization which results in poorly managed symptoms and refractory bronchoconstriction. Thus, there is a need to identify novel therapeutic pathways and to clarify the relationship between novel therapeutics and functional β-adrenoceptor responsiveness. We have previously demonstrated that acute antagonism of the calcium activated chloride channel, transmembrane member 16A (TMEM16A), relaxes airway smooth muscle (ASM). We sought to determine the efficacy and role of TMEM16A antagonism in the context of desensitization β - adrenoceptor responsiveness. For these studies, we exposed murine tracheal rings on wire myography and precision cut lung slices to contractile mediators in the presence or absence of TMEM16A antagonists and β-agonists with or without prior β-adrenoceptor desensitization. Contractile studies were also performed with human tracheal and bronchial ASM. Finally, the ability of TMEM16A antagonism to prevent desensitization of β2-adrenoceptor-induced cyclic AMP synthesis was measured in human ASM cells. From these studies we demonstrate that acute TMEM16A antagonism is effective in relaxing β-agonist desensitized ASM in central and peripheral murine ASM and human ASM. Furthermore, we demonstrate that chronic pretreatment with TMEM16A antagonists prevents functional desensitization of β-agonist responsiveness in mouse and human upper airways and prevents desensitization of β-agonist-mediated cyclic AMP production in human ASM cells. Taken together, the present study demonstrates a favorable therapeutic profile of TMEM16A antagonism for airway smooth muscle relaxation despite functional desensitization of β-agonist responsiveness which may be a novel therapeutic approach in the face of β-adrenoceptor tachyphylaxis.
Background:
Asthma is one of the most common reasons for hospital admission among children, with significant economic burden and impact on quality of life. Non-invasive positive pressure ventilation (NPPV) is increasingly used in the care of children with acute asthma, although the evidence supporting it is weak, and clinical guidelines do not offer any recommendations on its routine use. However, NPPV might be an effective way to improve outcomes for some children with asthma. A previous review did not demonstrate a clear benefit, but was limited by few studies with small sample sizes. This is an update of the previous review.
Objectives:
To assess the benefits and harms of NPPV as an add-on therapy to usual care (e.g. bronchodilators and corticosteroids) in children (< 18 years) with acute asthma.
Search methods:
We searched the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, and Embase. We also conducted a search of ClinicalTrials.gov and the WHO ICTRP. We searched all databases from their inception to March 2023, with no restrictions on language of publication.
Selection criteria:
We included randomised clinical trials (RCTs) assessing NPPV as add-on therapy to usual care versus usual care for children hospitalised for acute asthma exacerbations.
Data collection and analysis:
We used standard Cochrane methods.
Main results:
We included three RCTs randomising 60 children with acute asthma to NPPV and 60 children to control. All included trials assessed the effects of bilevel positive airway pressure (BiPAP) for acute asthma in a paediatric intensive care unit (PICU) setting. None of the trials used continuous positive airway pressure (CPAP). The controls received standard care. The median age of children ranged from three to six years, and asthma severity ranged from moderate to severe. Our primary outcome measures were all-cause mortality, serious adverse events, and asthma symptom score. Secondary outcomes were non-serious adverse events, health-related quality of life, arterial blood gases and pH, pneumonia, cost, and PICU length of stay. None of the trials reported any deaths or serious adverse events (except one trial that reported intubation rate). Two trials reported asthma symptom score, each demonstrating reductions in asthma symptoms in the BiPAP group. In one trial, the asthma symptom score was (mean difference (MD) -2.50, 95% confidence interval (CI) -4.70 to -0.30, P = 0.03; 19 children) lower in the BiPAP group. In the other trial, a cross-over trial, BiPAP was associated with a lower mean asthma symptom score (MD -3.7; 16 children; very low certainty evidence) before cross-over, but investigators did not report a standard deviation, and it could not be estimated from the first phase of the trial before cross-over. The reduction in both trials was above our predefined minimal important difference. Overall, NPPV with standard care may reduce asthma symptom score compared to standard care alone, but the evidence is very uncertain. The only reported serious adverse event was intubation rate in one trial. The trial had an intubation rate of 40% and showed that BiPAP may result in a large reduction in intubation rate (risk ratio 0.47, 95% CI 0.23 to 0.95; 78 children), but the evidence is very uncertain. Post hoc analysis showed that BiPAP may result in a slight decrease in length of PICU stay (MD -0.87 day, 95% CI -1.52 to -0.22; 100 children), but the evidence is very uncertain. Meta-analysis or Trial Sequential Analysis was not possible because of insufficient reporting and different scoring systems. All three trials had high risk of bias with serious imprecision of results, leading to very low certainty of evidence.
Authors' conclusions:
The currently available evidence for NNPV is uncertain. NPPV may lead to an improvement in asthma symptom score, decreased intubation rate, and slightly shorter PICU stay; however, the evidence is of very low certainty. Larger RCTs with low risk of bias are warranted.
Introdução: A asma é uma enfermidade inflamatória crônica das vias aéreas inferiores mais habitual na infância. Objetivo: Descrever características clínicas dos pacientes admitidos no pronto socorro do Hospital Regional de Taguatinga (HRT) com quadro de exacerbação de asma que fizeram uso de sulfato de magnésio. Métodos: Estudo documental, descritivo e retrospectivo, de caráter transversal. A amostra se baseia nos pacientes com idade entre 3 e 13 anos que foram internados com crise de asma grave, no serviço de Pronto Socorro de Pediatria do Hospital Regional de Taguatinga de janeiro de 2020 a dezembro de 2021. Resultados: Dos 625 pacientes internados por asma, 51 fizeram uso do sulfato de magnésio endovenoso, desses 61% eram do sexo masculino e a maioria possuíam entre 4 e 7 anos. Apesar do diagnóstico prévio de asma, poucos possuíam o acompanhamento de um médico. O tratamento com sulfato de magnésio melhorou os sintomas na maior parte dos casos e não possuiu nenhum efeito adverso relatado Conclusão: Foi possível traçar um perfil dos pacientes e apontar um indicativo de que o sulfato de magnésio realmente resultou em uma melhora do quadro clínico dos pacientes, sem a presença de efeitos adversos.
The increasing use of multiwalled carbon nanotubes(MWCNTs) could increase the risk of allergic lung disease inoccupational or consumer settings. We previously reported thatMWCNTs exacerbated allergic lung disease in mice induced byextract from house dust mites (HDM), a common cause of asthmain humans. Because MWCNTs avidly bind biomolecules to formprotein coronas that can modify immunotoxicity, we hypothesizedthat exacerbation of allergic lung disease in mice caused bycoexposure to MWCNTs and HDM extract was due to theformation of an allergen corona. In a first set of experiments,male and female C57BL/6J mice were coexposed to MWCNTs andHDM extract over 3 weeks compared to MWCNTs or HDM extractalone. In a second set of experiments, mice were exposed to pristineMWCNTs or MWCNTs with an HDM allergen corona (HDM-MWCNTs). HDM-MWCNTs were formed by incubatingMWCNTs with HDM extract, where ∼7% of proteins adsorbed to MWCNTs, including Der p 1 and Der p 2. At necropsy,bronchoalveolar lavage fluid was collected from lungs to assess lactate dehydrogenase, total protein and inflammatory cells,while lung tissue was used for histopathology, qPCR, and Western blotting. Compared to MWCNTs or HDM extract alone,coexposure to MWCNTs and HDM extract or exposure to HDM-MWCNTs increased pathological outcomes associated withallergic lung disease (eosinophilia, fibrosis, mucous cell metaplasia), increased mRNAs associated with fibrosis (Col1A1, Arg1)and enhanced STAT6 phosphorylation in lung tissue. These findings indicated that exacerbation of HDM-induced allergic lung disease by MWCNTs is due to an allergen corona.
Background
The interpretation of lung sounds plays a crucial role in the appropriate diagnosis and management of pediatric asthma. Applying artificial intelligence (AI) to this task has the potential to better standardize assessment and may even improve its predictive potential.
Objective
This study aims to objectively review the literature on AI-assisted lung auscultation for pediatric asthma and provide a balanced assessment of its strengths, weaknesses, opportunities, and threats.
Methods
A scoping review on AI-assisted lung sound analysis in children with asthma was conducted across 4 major scientific databases (PubMed, MEDLINE Ovid, Embase, and Web of Science), supplemented by a gray literature search on Google Scholar, to identify relevant studies published from January 1, 2000, until May 23, 2023. The search strategy incorporated a combination of keywords related to AI, pulmonary auscultation, children, and asthma. The quality of eligible studies was assessed using the ChAMAI (Checklist for the Assessment of Medical Artificial Intelligence).
Results
The search identified 7 relevant studies out of 82 (9%) to be included through an academic literature search, while 11 of 250 (4.4%) studies from the gray literature search were considered but not included in the subsequent review and quality assessment. All had poor to medium ChAMAI scores, mostly due to the absence of external validation. Identified strengths were improved predictive accuracy of AI to allow for prompt and early diagnosis, personalized management strategies, and remote monitoring capabilities. Weaknesses were the heterogeneity between studies and the lack of standardization in data collection and interpretation. Opportunities were the potential of coordinated surveillance, growing data sets, and new ways of collaboratively learning from distributed data. Threats were both generic for the field of medical AI (loss of interpretability) but also specific to the use case, as clinicians might lose the skill of auscultation.
Conclusions
To achieve the opportunities of automated lung auscultation, there is a need to address weaknesses and threats with large-scale coordinated data collection in globally representative populations and leveraging new approaches to collaborative learning.
Non adherence to inhaler therapy and associated factors among Sudanese patients with bronchial asthma
Objective
Ginseng is one of the most commonly used herbal medicines in Asia owing to its anti-inflammatory, cognitive, and immune effects. Many of these properties can be attributed to the ginsenosides, major pharmacological agents of ginseng. Ginsenosides influence the innate and humoral immune responses, and previous studies have described ginsenosides as potential therapeutic agents for respiratory disorders. Asthma affects over 300 million people worldwide and is underdiagnosed and undertreated, despite the availability of diagnostic tools and therapies. This review summarizes current studies on ginseng as an anti-asthmatic agent in murine models.
Methods
PubMed, EMBASE, and Cochrane databases were used to conduct a systematic search of published literature until March 29, 2023. Eight full-text articles that examined the association between ginseng and asthma were reviewed.
Results
The findings of this study demonstrate that Korean red ginseng, Korean white ginseng, and ginsenosides exert an anti-asthmatic effect, primarily through reduction in mucus cell hypersecretion, inflammatory cell infiltration, Th2 cytokines, and inhibition of inflammatory NFB and COX2 pathways.
Conclusion
We suggest that ginseng has a therapeutic potential for the treatment of asthma. As this analysis utilized murine models, the anti-asthmatic effects of ginseng must be further supported by laboratory studies and clinical trials.
Introduction:
Asthma is a common chronic respiratory disease affecting 262 million people globally, causing half a million deaths each year. Poor asthma outcomes are frequently due to non-adherence to medication, poor engagement with asthma services, and a lack of objective diagnostic tests. In recent years, technologies have been developed to improve diagnosis, monitoring, and care.
Areas covered:
Technology has impacted asthma care with the potential to improve patient outcomes, reduce healthcare costs, and provide personalized management. We focus on current evidence on home diagnostics and monitoring, remote asthma reviews, and digital smart inhalers. PubMed, Ovid/Embase, Cochrane Library, Scopus and Google Scholar were searched in November 2023 with no limit by year of publication.
Expert opinion:
Advanced diagnostic technologies have enabled early asthma detection and personalized treatment plans. Mobile applications and digital therapeutics empower patients to manage their condition and improve adherence to treatments. Telemedicine platforms and remote monitoring devices have the potential to streamline asthma care. AI algorithms can analyze patient data and predict exacerbations in proof-of-concept studies. Technology can potentially provide precision medicine to a wider patient group in the future, but further development is essential for implementation into routine care which in itself will be a major challenge.
Background:
Chronic respiratory disease disproportionately affects residents of Appalachia, particularly those residing in Central Appalachia. Asthma is particularly burdensome to Central Appalachian residents regarding cost and disability. Improving our understanding of how to mitigate these burdens requires understanding the factors influencing asthma control among individuals with asthma living in Central Appalachia, specifically rural Kentucky.
Methods:
This community-based, cross-sectional epidemiologic study used survey data to identify characteristics associated with uncontrolled and controlled asthma. The designation of "uncontrolled asthma" was based on a self-report of ≥ 2 asthma exacerbations in the past year. Individuals with ≤ 1 or no exacerbations were considered to have controlled asthma. Chi-square or Fisher exact tests assessed the association between categorical variables and asthma control categories. Logistic regression was conducted to determine the impact of factors on the likelihood of uncontrolled asthma.
Results:
In a sample of 211 individuals with self-reported asthma, 29% (n = 61, 46 females) had uncontrolled asthma. Predictors of uncontrolled asthma included depression (odds ratio 2.61, 95% CI 1.22-5.61, p = .014) and living in multi-unit housing (odds ratio 4.99, 95% CI 1.47-16.96, p = .010) when controlling for age, sex, financial status, and occupation. Being overweight or obese was not a predictor of uncontrolled asthma. Physical activity and BMI did not predict the likelihood of uncontrolled asthma.
Conclusion:
This study highlights significant challenges rural communities in Appalachian Kentucky face in managing asthma. Factors like depression, housing conditions, and a lack of self-management strategies play pivotal roles in asthma control in this population.
Objective:
Asthma is a major global disease affecting adults and children, which can lead to hospitalization and death due to breathing difficulties. Although targeted monoclonal antibody therapies have revolutionized treatment of severe asthma, some patients still fail to respond. Here we critically evaluate the literature on biologic therapy failure in asthma patients with particular reference to anti-drug antibody production, and subsequent loss of response, as the potential primary cause of drug failure in asthma patients.
Recent findings:
Encouragingly, asthma in most cases responds to treatment, including the use of an increasing number of biologic drugs in moderate to severe disease. This includes monoclonal antibody inhibitors of immunoglobulin E and cytokines, including interleukin 4, 5, or 13 and thymic stromal lymphopoietin. These limit mast cell and eosinophil activity that cause the symptomatic small airways obstruction and exacerbations.
Summary:
Despite humanization of the antibodies, it is evident that benralizumab; dupilumab; mepolizumab; omalizumab; reslizumab and tezepelumab all induce anti-drug antibodies to some extent. These can contribute to adverse events including infusion reactions, serum sickness, anaphylaxis and potentially disease activity due to loss of therapeutic function. Monitoring anti-drug antibodies (ADA) may allow prediction of future treatment-failure in some individuals allowing treatment cessation and switching therefore potentially limiting disease breakthrough.
INTRODUCTION
Asthma is one of the most common chronic noncommunicable diseases. Aeroallergens are often implicated in the pathogenesis of allergic rhinitis (AR) and bronchial asthma (BA). Identification of the most prevalent aeroallergens, to which the patients are sensitized, plays an important role in the diagnosis and treatment of BA. Among various diagnostic tests for detecting sensitizing allergens, the skin prick test (SPT) is a useful method to demonstrate hypersensitivity to a specific antigen.
METHODOLOGY
This was a hospital-based cross-sectional observational study carried out on BA patients attending our institute during the year 2020–2021. BA patients of both sex and age between 18 and 65 years, diagnosed according to the latest GINA guidelines and gave written informed consent were included in the study. After recruitment, the participant’s detailed medical history and sociodemographic data were obtained. Total eosinophil count (TEC), serum immunoglobulin E (S. IgE), X-ray PNS, chest X-ray, and other investigations as required were done. SPT was done using 63 antigens, which included 20 pollens, 8 fungi, 5 insects, 8 dusts, 4 dander, 2 dust mites, 2 feathers, and 14 food allergens.
RESULTS
Six thousand and three hundred SPTs were performed with a total of 63 allergens using the modified SPT technique. Of the 100 patients enrolled, 71% were diagnosed as BA and 29% as BA with AR. Among the study population, 44% were females and 56% were males. The majority was constituted of young adults, aged 21–30 years. More than half of the patients (68%) had their duration of disease between 1 and 5 years. Seventy percent patients reported seasonal variation in symptoms, and spring season was associated with maximum allergic exacerbations followed by winter. Significant positive reaction (≥2+) in SPT was found in 89% of patients, whereas 11% tested negative for all allergens. pollens were the most common aeroallergen group identified, whereas feathers and food allergens were the least common in the present study. Among pollen, Prosopis juliflora was the most common (24%) pollen-causing sensitization closely followed by Holoptelea integrifolia (17%) and Gynandropsis gynandra (18%). Female cockroach (37%) and mosquito (37%) were the most common insects to which the majority of the population were sensitized. Dermatophagoides farinae was accounting for 23% of positive reactions in the study population. Alternaria tenuis was the most common fungus to which 6% of the patients tested positive. House dust (17%) was the most common dust subgroup associated with positive SPT. Among danders, buffalo dander (8%) was observed to be the most common sensitizer followed by dog dander (6%). The pigeon feather was the most common feather identified. A strong positive correlation was observed between S. IgE and the number of allergens that tested positive ( r = 0.489; P < 0.0001) and a strong positive correlation was observed between serum TEC and the number of allergens that tested positive ( r = 0.430; P < 0.0001).
CONCLUSION
Our study identified pollen as the most common sensitizing aeroallergen followed by insects. Such studies, conducted from time to time, shed light on the changing trends of the commonly prevalent allergens in a particular area. The identification of offending allergens for a patient also explores treatment options such as allergen-specific immunotherapy.
Sudden aggravations of chronic inflammatory airway diseases are difficult-to-foresee life-threatening episodes for which advanced prognosis-systems are highly desirable. Here we present an experimental chip-based fluidic system designed for the rapid and sensitive measurement of biomarkers prognostic for potentially imminent asthma or COPD exacerbations. As model biomarkers we chose three cytokines (interleukin-6, interleukin-8, tumor necrosis factor alpha), the bacterial infection marker C-reactive protein and the bacterial pathogen Streptococcus pneumoniae—all relevant factors in exacerbation episodes. Assay protocols established in laboratory environments were adapted to 3D-printed fluidic devices with emphasis on short processing times, low reagent consumption and a low limit of detection in order to enable the fluidic system to be used in point-of-care settings. The final device demonstrator was validated with patient sample material for its capability to detect endogenous as well as exogenous biomarkers in parallel.
Trends in annual hospital admission rates for asthma in the 0 to 14 year age group were examined in New Zealand, England and Wales, the United States, Canada, and Australia. There has been a striking increase in hospital admissions for asthma in children in all these countries since the mid 1960s.
Information was obtained from 336 21-year-olds who had begun wheezing before the age of 7 about their knowledge of asthma and its effect on their current life style. Two-thirds of the subjects were still symptomatic. A control group of 62 subjects was available for comparison. Knowledge about asthma was poor, particularly among those with less troublesome symptoms. Half of those with frequent episodic asthma and one-third with persistent asthma did not regard excess use of bronchodilator aerosols as potentially dangerous. Over three-quarters of those with persistent asthma were not receiving adequate treatment. One-third of third of those with persistent asthma were missing substantial time from work because of respiratory illness, and a similar proportion were restricting sporting activities. The incidence of smoking was disturbingly high in all asthma groups. The higher the number of cigarettes ever smoked and the higher the current tobacco consumption the less satisfactory was the progress of asthma. Both cigarette smoking and severity of asthma contributed to chronic production of sputum. Children and teenagers with asthma should be educated to seek more appropriate medical help and thereby reduce morbidity.
Asthma prevalence is increasing and asthma-related costs are likely to increase, but few studies have analysed the relationship of asthma costs and severity. The impact of severity on costs was quantified in a cohort of 318 asthmatic patients followed up prospectively for 1 yr.
Patients presenting with a broad range of severity of the disease (intermittent, mild persistent, moderate persistent, severe persistent) were recruited by chest physicians throughout France and treated for 1 yr according to customary clinical practice and following international guidelines. Severity, direct and indirect costs, and quality of life (QoL) were assessed. A multivariate analysis was conducted to relate factors contributing to the costs measured.
Mean direct costs for goods and services excluding hospitalization, numbers of consultations, supplementary examinations, and the use and cost of bronchodilators and corticosteroids, indirect costs of days lost from work, and adverse QoL parameters all increased significantly with increasing severity. This also applied to mean age, body weight, asthma duration, depression of forced expiratory volume in one second, and inhaled corticosteroid posology in the 234 patients completing the study. There was a significant relationship (r=0.614, p<0.001) between direct costs (hospitalization and cures were excluded) and three domains of the QoL questionnaire (mobility, pain and energy).
Overall costs of asthma (including individual direct costs, indirect costs, and intangible quality of life costs) are clearly related to severity. This is the first study in asthma to combine rigorous independent classification of grades of severity in statistically valid numbers of patients of grades receiving “real-world” treatment and followed-up prospectively for 1 yr. It allowed severity to be accurately related to direct, indirect and intangible costs of asthma. Quality of life explained a significant part of these costs.
Until now, care provided by asthma nurses has been additional to care provided by paediatricians. A study was undertaken to compare nurse led outpatient management of childhood asthma with follow up by a paediatrician.
Seventy four children referred because of insufficient control of persistent asthma were randomly allocated to 1 year follow up by a paediatrician or asthma nurse. The main outcome measure was the percentage of symptom-free days. Additional outcome measures were airway hyperresponsiveness, lung function, daily dose of inhaled corticosteroids (ICS), number of exacerbations, number of additional visits to the general practitioner, absence from school, functional health status, and disease specific quality of life.
There were no significant differences at the end of the 1 year study period between the two treatment groups in percentage of symptom-free days (mean difference 2.5%; 95% CI -8.8 to 13.8), airway hyperresponsiveness (log10 PD20 0.06; -0.19 to 0.32), functional health status (10.1; -0.3 to 19.8), disease specific quality of life of patients (0.08; -0.9 to 0.7), and disease specific quality of life of caregivers (0.09; -0.2 to 0.3), nor in any other outcome parameters. Most outcome parameters improved considerably over the 1 year study period. These improvements were achieved although the daily dose of ICS was reduced by a mean of 26% compared with the dose received by children at referral. All parents were satisfied with the asthma care received.
After initial assessment in a multidisciplinary clinic, childhood asthma can be successfully managed by an asthma nurse in close cooperation with a paediatrician. During close follow up by paediatrician or asthma nurse, asthma control improved despite a reduction in ICS dose.
Asthma nurse practice improves outcomes and reduces costs in primary health care
Objective. The aim of this study was to elucidate the care of patients with asthma in primary health care from medical, patient self‐management, health, quality of live, and health economic perspectives.
Methods. Asthma nurse practice (ANP), an alternative asthma self‐management strategy, was compared with traditional asthma care in primary health care in southern Sweden regarding medical history, lifestyle, self‐management, symptoms caused by asthma, effects on sick leave, state of health, quality of life and health care costs. The first part of the investigation comprised a retrospective study of a randomly selected sample of patient records of asthmatics (n=152). The second part, lasting 3 months, was prospective and included consecutive patients visits (n=347).
Results. The ANP approach showed better results in most of the evaluated outcomes such as asthma quality documentation and self‐management and the number of asthma symptoms was significantly lower. From a health economic perspective the results were encouraging with respect to ANP.
Conclusion. This alternative asthma strategy, ANP, improved asthma care in primary health care and resulted in economic advantages in the health care sector. However the result may only be generalized to other practices working with asthma nurses in the same way.
Background:
As part of the International Study of Asthma and Allergies in Childhood (ISAAC), prevalence surveys were conducted among representative samples of school children from locations in Europe, Asia, Africa, Australia, North and South America.
Subjects:
257,800 children aged 6-7 years from 91 centres in 38 countries, and 463,801 children aged 13-14 years from 155 centres in 56 countries.
Methods:
Written symptom questionnaires were translated from English into the local language for self-completion by the 13-14-year-olds and completion by the parents of the 6-7-year-olds. Rhinitis was described as a problem with sneezing, or a runny, or blocked nose when you (your child) DID NOT have a cold or the flu. Additional questions were asked about rhinitis associated with itchy-watery eyes, interference with activities and a history of hay fever ever.
Results:
The prevalence of rhinitis with itchy-watery eyes ("rhinoconjunctivitis") in the past year varied across centres from 0.8% to 14.9% in the 6-7-year-olds and from 1.4% to 39.7% in the 13-14-year-olds. Within each age group, the global pattern was broadly consistent across each of the symptom categories. In centres of higher prevalence there was great variability in the proportion of rhinoconjunctivitis labelled as hay fever. The lowest prevalences of rhinoconjunctivitis were found in parts of eastern Europe, south and central Asia. High prevalences were reported from centres in several regions.
Conclusion:
These results suggest substantial worldwide variations in the prevalence and labelling of symptoms of allergic rhinoconjunctivitis which require further study. These differences, if real, may offer important clues to environmental influences on allergy.
The outcome of childhood asthma was studied in 101 adults who came from a group of 119 asthmatic children (85%) 6 to 14 yr of age who had originally been investigated between 1966 and 1969. Changes in respiratory symptoms, spirometry, and airway responsiveness to histamine in childhood and adult life were analyzed. It was found that 43 of the 101 adults (43%) had current symptoms; 29 of the 43 (67%) were receiving maintenance therapy. In the first study, 83 of the 101 children (82%) showed a response on inhalation of histamine (PC10-histamine less than or equal to 16 mg/ml). The number of subjects in the second study who still had a PC10-histamine less than or equal to 16 mg/ml fell to 29, suggesting that airway responsiveness decreases from childhood to adulthood. During the second survey (in adults), 25 of the 43 (59%) subjects with current symptoms and four of the 58 (7%) without respiratory symptoms responded to histamine. Adults with current symptoms had a significantly lower %FEV1 in both childhood and adulthood than did adults without current symptoms; %FEV1 was not different in females and males or in smokers and nonsmokers in either the first or the second survey. The outcome of childhood asthma is primarily predicted by the initial degree of bronchial obstruction (p = 0.041) and airway responsiveness to histamine (p = 0.050), and does not appear to be related to sex, smoking habits, or age of onset of respiratory symptoms.
The cost effectiveness of asthma care is the first topic of the National Asthma Education and Prevention Program Task Force Report on the Cost Effectiveness, Quality of Care, and Financing of Asthma Care. This working group characterized the role of health economics in understanding optimal asthma management strategies. The report first reviews methods for economic evaluation of medical technologies, with a particular focus on cost-effectiveness analysis. Next, the report explores the nature and usefulness of several key asthma outcome measures, including clinical and symptom measures, measures of lung function, measures of functional status, and measures of health services utilization and cost. The working group also conducted a review of the literature on cost effectiveness of asthma patient education programs, pharmaceutical therapy, and a variety of alternative and adjunct interventions. The report concludes with recommendations for a standardized approach for economic evaluation study designs (e.g., common asthma outcomes, long-term follow-up, and studies with patients of different ages, socioeconomic statuses, and severity levels) and for an expansion in the number of such standardized asthma studies and cost-effectiveness analyses.
Death from asthma is regarded as preventable in principle, especially under the age of 65 years.
In 1994 a confidential inquiry was set up to investigate deaths attributable to asthma in residents of Wales under the age of 65 years. During the period of the inquiry 92 cases were notified as being ascribed to asthma, or (in 1996) having a mention of asthma on the death certificate. Of these, 80 were investigated further with the help of general practitioners, hospital notes, and relatives. The details were then considered by a small panel of doctors who endeavoured to identify factors that may have contributed to the deaths.
Asthma was considered to be the underlying cause of 52 deaths. Although disease severity was usually a major factor, some aspect of the patient's behaviour or circumstances seemed to have contributed to 31 deaths, while in 15 cases there was probably a deficiency in medical care.
Some preventable asthma deaths still occur, particularly in relation to inadequate treatment. Factors associated with patients' behaviour and circumstances are more difficult to tackle but, if doctors are aware of high risk patients, increased vigilance may prevent some deaths.
Asthma management guidelines provide recommendations for the optimum control of asthma. This survey assessed the current levels of asthma control as reported by patients, which partly reflect the extent to which guideline recommendations are implemented. Current asthma patients were identified by telephone by screening 73,880 households in seven European countries. Designated respondents were interviewed on healthcare utilization, symptom severity, activity limitations and asthma control. Current asthma patients were identified in 3,488 households, and 2,803 patients (80.4%) completed the survey. Forty-six per cent of patients reported daytime symptoms and 30% reported asthma-related sleep disturbances, at least once a week. In the past 12 months, 25% of patients reported an unscheduled urgent care visit, 10% reported one or more emergency room visits and 7% reported overnight hospitalization due to asthma. In the past 4 weeks, more patients had used prescription quick-relief medication (63%) than inhaled corticosteroids (23%). Patient perception of asthma control did not match their symptom severity; approximately 50% of patients reporting severe persistent symptoms also considered their asthma to be completely or well controlled. The current level of asthma control in Europe falls far short of the goals for long-term asthma management. Patients' perception of asthma control is different from their actual asthma control.
During the second half of the 20th century, the increasing prevalence, morbidity, economic burden, and, in some countries, mortality from asthma have generated worldwide concern. The prevalence in the United States and other English-speaking countries is higher than that in most other countries, but worldwide variations cannot be explained by current knowledge of recognized risk or protective factors. According to hospital admission rates, asthma morbidity rates have also risen throughout the world during the past 40 years. These trends are likely due to many different factors, including an increase in the prevalence of severe asthma. Asthma mortality rates gradually declined in the United States during the 1960s and 1970s but have exhibited a substantial, progressive increase during the past 20 years. This trend stands in contrast to those in most other western countries, where asthma mortality rates have generally been decreasing during the 1990s. In both western and developing countries, the considerable economic burden of asthma disproportionately affects individuals with severe disease. This observation illustrates the potential for reducing the costs associated with asthma through management approaches that have been proven to reduce morbidity and mortality.
The asthma insights & reality in Japan survey was aimed to assess the current status of asthma treatment and management in Japan. We used random digit dialing to identify current asthmatics in households throughout Japan. Throughout Japan, 38,132 households were contacted. A detailed survey on asthma management was conducted among 803 of these households, 401 adults and 402 children. More than half had experienced a daytime asthma attack during the previous month. More than one third had experienced an asthma attack at night during that same period. About 70% of the adults and 60% of the children with asthma reported some limitation on activities of daily life. About 50% of adults and 80% of children had never undergone any pulmonary function testing. Only 6% of adults and 7% of children's parents were aware that "airway inflammation" was a major cause of asthma. Moreover, only 12% of adults and 5% of children were using inhaled steroids. There was an especially large gap between subjective perception of asthma control and objective findings in patients with severe asthma. Many Japanese asthmatics tended to underestimate the severity of their condition. Asthma management in Japan falls far short of goals stated in the guideline. These findings emphasize the need for increased awareness of the burden of asthma in Japan.
Few data on asthma management are available for the Asia-Pacific region.
This study examined asthma symptoms, health care use, and management in the Asia-Pacific region.
We performed a cross-sectional survey, followed by administration of a questionnaire in a face-to-face setting in the respondents' homes in their language of choice. Urban centers in 8 areas were surveyed: China, Hong Kong, Korea, Malaysia, The Philippines, Singapore, Taiwan, and Vietnam.
A population sample of 3207 respondents with physician-diagnosed asthma was identified by screening 108,360 households. Daytime asthma symptoms were reported by 51.4% of respondents, and 44.3% reported sleep disturbance caused by asthma in the preceding 4 weeks. At least 2 in every 5 respondents (43.6%) had been hospitalized, attended a hospital emergency department, or made unscheduled emergency visits to other health care facilities for treatment of asthma during the previous 12 months. Overall, 15.3% of respondents reported that they had required admission to the hospital for asthma treatment. Asthma severity correlated with the frequencies of hospitalizations and emergency visits for asthma in the past year. Even in those patients with severe persistent asthma, 34.3% regarded their disease as being well or completely controlled. Current use of an inhaled corticosteroid was reported by only 13.6% of respondents, and 56.3% used quick-relief bronchodilators. Absence from school and work in the past year was reported by 36.5% of children and 26.5% of adults.
As reported for other regions, current levels of asthma control in the Asia-Pacific region fall markedly short of goals specified in international guidelines for asthma management.
Asthma is common in the elderly population and the differences between younger and older asthmatics should be appreciated (Table 2). Asthma is frequently overlooked in the geriatric population. Objective measures of pulmonary function can aid in a prompt diagnosis and lead to effective treatment and improved quality of life. Because smoking is an important risk factor for asthma-like symptoms of wheezing, cough, and sputum production, asthma is frequently confused with COPD. When airflow obstruction is found, attempts to demonstrate reversibility can uncover an asthmatic component to the disease. In patients who have asthma symptoms and no airflow obstruction, methacholine testing is helpful. When a normal methacholine challenge is present, a diagnosis of asthma can be excluded and the physician can pursue other diagnostic considerations such as heart failure, chronic aspiration syndrome, pulmonary embolic disease, and carcinoma of the lung. The onset of wheezing, shortness of breath, and cough in an elderly patient is likely to cause concern. Although the adage "all that wheezes is not asthma" is true at any age, it is especially true in the elderly. Diagnosis based on objective measures is essential.
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