Long‐term predictors of loss of asthma control in school‐aged well‐controlled children with mild to moderate asthma: A 5‐year follow‐up

ObjectiveTo determine the short-term and long-term effects of a high intensity pulmonary rehabilitation programme on asthma control, body composition, lung function and exercise capacity in obese asthma patients.MethodsPatients with obesity (body mass index (BMI)≥30 kg·m−2) and suboptimal controlled asthma (Asthma Control Questionnaire (ACQ)≥0.75) were randomly assigned to a 3-month pulmonary rehabilitation programme (PR only), pulmonary rehabilitation programme with the use of an internet based self-management support programme (PR+SMS) or usual care. The pulmonary rehabilitation programme included high-intensity interval training, nutritional intervention and psychological group sessions. Patients in the usual care group were advised to lose weight and to exercise. The primary outcome was the difference of change of ACQ between PR only and PR+SMS after 3 months. Total follow-up was 12 months.Results34 patients were included in the study (14 PR only, nine PR+SMS, 11 control). Compared with patients in usual care, patients in the PR only group had a significant reduction in BMI and significant improvements in asthma control, exercise capacity and aerobic capacity after 3 months. These improvements persisted during 12 months of follow-up. No difference in ACQ between PR+SMS and PR only groups was observed. However, users of the SMS programme had a significantly lower BMI after 12 months compared with subjects in the PR only group.ConclusionA high-intensity pulmonary rehabilitation programme provides sustained improvements in asthma control, body composition and exercise capacity in obese asthmatics that are not optimally controlled and, therefore, should be considered in the treatment of these patients.

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Long-term effects of asthma medication on asthma symptoms: an application of the targeted maximum likelihood estimation

BMC Medical Research Methodology ◽

10.1186/s12874-020-01175-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Carolin Veit ◽

Ronald Herrera ◽

Gudrun Weinmayr ◽

Jon Genuneit ◽

Doris Windstetter ◽

...

Keyword(s):

Maximum Likelihood ◽

Maximum Likelihood Estimation ◽

Asthma Control ◽

Likelihood Estimation ◽

Asthma Symptoms ◽

Targeted Maximum Likelihood Estimation ◽

Targeted Maximum Likelihood ◽

Control Medication

Abstract Background Long-term effectiveness of asthma control medication has been shown in clinical trials but results from observational studies with children and adolescents are lacking. Marginal structural models estimated using targeted maximum likelihood methods are a novel statistiscal approach for such studies as it allows to account for time-varying confounders and time-varying treatment. Therefore, we aimed to calculate the long-term risk of reporting asthma symptoms in relation to control medication use in a real-life setting from childhood to adulthood applying targeted maximum likelihood estimation. Methods In the prospective cohort study SOLAR (Study on Occupational Allergy Risks) we followed a German subsample of 121 asthmatic children (9–11 years old) of the ISAAC II cohort (International Study of Asthma and Allergies in Childhood) until the age of 19 to 24. We obtained self-reported questionnaire data on asthma control medication use at baseline (1995–1996) and first follow-up (2002–2003) as well as self-reported asthma symptoms at baseline, first and second follow-up (2007–2009). Three hypothetical treatment scenarios were defined: early sustained intervention, early unsustained intervention and no treatment at all. We performed longitudinal targeted maximum likelihood estimation combined with Super Learner algorithm to estimate the relative risk (RR) to report asthma symptoms at SOLAR I and SOLAR II in relation to the different hypothetical scenarios. Results A hypothetical intervention of early sustained treatment was associated with a statistically significant risk increment of asthma symptoms at second follow-up when compared to no treatment at all (RR: 1.51, 95% CI: 1.19–1.83) or early unsustained intervention (RR:1.38, 95% CI: 1.11–1.65). Conclusions While we could confirm the tagerted maximum likelihood estimation to be a usable and robust statistical tool, we did not observe a beneficial effect of asthma control medication on asthma symptoms. Because of potential due to the small sample size, lack of data on disease severity and reverse causation our results should, however, be interpreted with caution.

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Level of asthma symptom control and adherence to treatment in young patients

Russian Medical Inquiry ◽

10.32364/2587-6821-2020-4-4-180-185 ◽

2020 ◽

Vol 4 (4) ◽

pp. 180-185

Author(s):

N.M. Leont’eva ◽

◽

I.V. Demko ◽

E.A. Sobko ◽

O.P. Ishchenko ◽

...

Keyword(s):

Medication Adherence ◽

Asthma Control ◽

Symptom Control ◽

Young Patients ◽

Mild Asthma ◽

Adherence To Treatment ◽

Moderate Asthma ◽

Asthma Symptoms ◽

Poor Medication Adherence

Background: asthma is a highly variable disease, with changes in the severity over months and years. In addition to achieving asthma control, many patients experience challenges in the long-term maintenance of this condition. Good symptom control is a volatile entity even in mild asthma. The loss of asthma control is accounted for by poor adherence to treatment due the fears of taking hormonal therapy, contact with an allergen, respiratory viral infections, and the inconvenience of using the inhaler resulting in incorrect inhaler technique. Aim: to assess the control over asthma and adherence to treatment in young patients with mild-to-moderate asthma. Patients and Methods: 146 patients with verified mild-to-moderate asthma were examined. All patients were divided into two groups based on disease severity. Results: at the time of examination, the lack of the control over asthma symptoms was reported in 89% of the patients. In mild asthma, mean Asthma Control Test (AST) score was 17 [15; 21] and АCQ-5 (Asthma Control Questionnaire) score was 1.8 [1.4; 2.2]. Meanwhile, in moderate asthma, mean AST score was 15 [12; 21] and АCQ-5 score was 1.8 [1.4; 2.2]. Poor medication adherence measured by the Morisky Green Levine Medication Adherence Scale was revealed in 94% of the patients with mild asthma and 91% of the patients with moderate asthma. Conclusion: poor patient’s knowledge on asthma and little awareness of the long-term importance of regular basic therapy are the critical factors contributing to poor medication adherence. Therefore, novel approaches to patient education as well as optimized and personalized therapeutic strategies are currently important for achieving and maintaining the control over asthma symptoms. KEYWORDS: asthma, asthma control, stable course, young patients, adherence to treatment. FOR CITATION: Leont’eva N.M., Demko I.V., Sobko E.A., Ishchenko O.P. Level of asthma symptom control and adherence to treatment in young patients. Russian Medical Inquiry. 2020;4(4):180–185. DOI: 10.32364/2587-6821-2020-4-4-180-185.

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Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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Brief summary of Kleť photographic search programme for minor planets

International Astronomical Union Colloquium ◽

10.1017/s0252921100031419 ◽

1999 ◽

Vol 173 ◽

pp. 189-192

Author(s):

J. Tichá ◽

M. Tichý ◽

Z. Moravec

Keyword(s):

Ccd Camera ◽

Minor Planet ◽

Minor Planets ◽

Main Belt

AbstractA long-term photographic search programme for minor planets was begun at the Kleť Observatory at the end of seventies using a 0.63-m Maksutov telescope, but with insufficient respect for long-arc follow-up astrometry. More than two thousand provisional designations were given to new Kleť discoveries. Since 1993 targeted follow-up astrometry of Kleť candidates has been performed with a 0.57-m reflector equipped with a CCD camera, and reliable orbits for many previous Kleť discoveries have been determined. The photographic programme results in more than 350 numbered minor planets credited to Kleť, one of the world's most prolific discovery sites. Nearly 50 per cent of them were numbered as a consequence of CCD follow-up observations since 1994.This brief summary describes the results of this Kleť photographic minor planet survey between 1977 and 1996. The majority of the Kleť photographic discoveries are main belt asteroids, but two Amor type asteroids and one Trojan have been found.

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