Overview of severe asthma, with emphasis on pediatric patients: a review for practitioners

2021 ◽  
pp. jim-2020-001752
Author(s):  
Arabelle Abellard ◽  
Andrea A Pappalardo
Keyword(s):  
Risk Factors ◽  
Health Disparities ◽  
Severe Asthma ◽  
Pediatric Population ◽  
Asthma Management ◽  
Persistent Asthma ◽  
Individual Characteristics ◽  
Severe Persistent Asthma ◽  
The Usa ◽  
Life Threatening

Asthma is the most common life-threatening chronic disease in children. Although guidelines exist for the diagnosis and treatment of asthma, treatment of severe, pediatric asthma remains difficult. Limited studies in the pediatric population on new asthma therapies, complex issues with adolescence and adherence, health disparities, and unequal access to guideline-based care complicate the care of children with severe, persistent asthma. The purpose of this review is to provide an overview of asthma, including asthma subtypes, comorbidities, and risk factors, to discuss diagnostic considerations and pitfalls and existing treatments, and then present existing and emerging therapeutic approaches to asthma management. An improved understanding of asthma heterogeneity, clinical characteristics, inflammatory patterns, and pathobiology can help further guide the management of severe asthma in children. More studies are needed in the pediatric population to understand emerging therapeutics application in children. Effective multimodal strategies tailored to individual characteristics and a commitment to address risk factors, modifiers, and health disparities may help reduce the burden of asthma in the USA.

scholarly journals Assessment of Asthma Control and Severity among Children According to Global Initiative for Asthma Guidelines in Sulaimani City-Iraq

2016 ◽  
Vol 12 (3) ◽  
pp. 160
Author(s):  
Adnan M. H. Hamawandi ◽  
Kosar M Ali ◽  
Ali Z. Naji
Keyword(s):  
Asthma Control ◽  
Objective Assessment ◽  
Asthma Management ◽  
Persistent Asthma ◽  
Cross Sectional ◽  
Asthmatic Children ◽  
Global Initiative For Asthma ◽  
Severe Persistent Asthma ◽  
Global Initiative ◽  
Gina Guidelines

Background: Asthma is a common and potentially serious chronic disease that imposes a substantial burden on patients, their families and the community. Objective: Assessment of the level of asthma control and severity in asthmatic children in Sulaimani city according to the global initiative for asthma (GINA) guidelines. Methods: A cross-sectional study of 82 patients who are known cases of asthma, aged 5 – 15 years , from 1st of March 2014 to 1st of August 2014. Results: Out of 82 patients in our study, 20.8%were classified as having intermittent asthma all of them have well controlled asthma, 42.7% of those classified as having mild persistent asthma 65.7% of them have well controlled asthma, 26.8% of those classified as having moderate persistent asthma 54.5% of them have partly controlled asthma, and 9.8%of those classified as having severe persistent asthma the majority of them 87.5% have uncontrolled asthma and none of them reached to the controlled asthma level according to GINA guidelines. Regarding the peak expiratory flow (PFT) we notice that 58.8% of asthmatic children who were classified as having intermittent severity, their PEF measurements ranged between 160- 250 l/min while those with severe persistent asthma 75% of them have readings between 50-150 l/min. Conclusion: Current levels of asthma control in the Sulaimani city fall far short of the goals specified in the GINA guidelines for asthma management. Also there is a strong correlation between PEF measurements and the level of asthma severity,

scholarly journals Still Fighting for Breath: a patient survey of the challenges and impact of severe asthma

2018 ◽  
Vol 4 (4) ◽  
pp. 00076-2018 ◽  
Author(s):  
Paraskevi Katsaounou ◽  
Mikaela Odemyr ◽  
Otto Spranger ◽  
Michael E. Hyland ◽  
Claus Kroegel ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Online Survey ◽  
Persistent Asthma ◽  
Patient Survey ◽  
Management Support ◽  
Daily Lives ◽  
Global Initiative For Asthma ◽  
Severe Persistent Asthma ◽  
Global Initiative ◽  
The Impact

We conducted a large global survey, Still Fighting for Breath, in patients with severe persistent asthma, 10 years after the Fighting for Breath survey to assess the impact of disease on patients' lives and to determine if control and management have changed in recent years.Data were collected from 1333 adults (aged >18 years) and caregivers of children (aged 6–17 years) with severe persistent asthma from nine countries through an online survey conducted in 2016 by GfK.A decade after the first survey, our results showed that the impact of severe asthma has not changed significantly and a high proportion of patients with severe asthma remain inadequately controlled. A large discrepancy was observed between the proportion of patients who perceived their asthma to be well controlled (42%) and the proportion of patients who reported to be well controlled as per the Global Initiative for Asthma (GINA) assessment (6%). Although most patients perceived their asthma to be controlled, many experienced frequent symptoms that affected their daily lives.Thus, there is a need for improved management (support and strategies) of patients with severe persistent asthma and improved coordination of efforts that would enable these patients to achieve better disease control.

scholarly journals Clinical utility of fractional exhaled nitric oxide in severe asthma management

2020 ◽  
Vol 55 (3) ◽  
pp. 1901633 ◽  
Author(s):  
Andrew Menzies-Gow ◽  
Adel H. Mansur ◽  
Christopher E. Brightling
Keyword(s):  
Nitric Oxide ◽  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Healthcare Providers ◽  
Asthma Management ◽  
Cost Effective ◽  
Chronic Inflammatory Disease ◽  
Initial Diagnosis ◽  
Increased Risk ◽  
The Usa

Asthma is a chronic inflammatory disease of the airways, affecting over 350 million people worldwide and placing a significant burden on healthcare providers and wider society. Approximately 5–10% of asthma patients are diagnosed with severe asthma and typically are associated with increased risk of hospitalisation from exacerbations, increased morbidity, mortality and higher asthma-associated healthcare costs. Nitric oxide (NO) is an important regulator of immune responses and is a product of inflammation in the airways that is over-produced in asthma. Fractional exhaled NO (FeNO) is predominantly used as a predictor of response to inhaled corticosteroids (ICSs), to monitor adherence and as a diagnostic tool in ICS-naïve patients. In the UK, the National Institute for Health and Care Excellence (NICE) guidelines recommend the use of FeNO for the initial diagnosis of patients with suspected asthma. In the USA, American Thoracic Society (ATS) guidelines recommend FeNO as part of the initial diagnosis of asthma and for monitoring of airway inflammation. FeNO has also been shown to be a predictive factor for asthma exacerbations, with higher levels being associated with a greater number of exacerbations. In addition, higher levels of FeNO have been shown to be associated with a decline in lung function. FeNO testing is a cost-effective procedure and has been shown to improve patient management when combined with standard assessment methods. Recent evidence suggests that FeNO may also be useful as a surrogate biomarker for the assessment and management of severe asthma and to predict responsiveness to some biological therapies.

Pilot study investigating diagnostic utility of serum MMP-1 and TGF-β1 in asthma in ‘real world’ clinical practice in India

2021 ◽  
pp. jclinpath-2020-206821
Author(s):  
Aswani Prabha ◽  
Komarla Sundararaja Lokesh ◽  
S K Chaya ◽  
B S Jayaraj ◽  
Sowmya Malamardi ◽  
...  
Keyword(s):  
Pilot Study ◽  
Severe Asthma ◽  
Predictive Value ◽  
Transforming Growth Factor ◽  
Persistent Asthma ◽  
Performance Characteristics ◽  
Therapeutic Monitoring ◽  
Moderate Asthma ◽  
Severe Persistent Asthma ◽  
Tgf Β1

AimsAt a tissue level, matrix metalloproteinase-1 (MMP-1) and transforming growth factor-beta 1 (TGF-β1) contribute to allergic airway inflammation, tissue remodelling and disease severity in asthma via different pathways. Their peripheral blood levels and role in diagnosis and therapeutic monitoring has not been adequately explored. We investigated the association between MMP-1 and TGF-β in moderate and severe persistent asthma and evaluated their performance characteristics by constructing receiver operating characteristic curves.MethodsSerum MMP-1 and TGF-β1 were measured using ELISA in 75 adults; moderate persistent asthma (n=25), severe persistent asthma (n=25) and healthy community controls (n=25). Severity of asthma was determined as per Global Initiative for Asthma guidelines. Subjects were followed up for 3 months and treatment responsiveness was assessed by spirometry and symptom response.ResultsSerum MMP-1 and TGF-β1 were significantly elevated in asthmatics compared with controls (p<0.0001 and p<0.01). While serum MMP-1 was elevated in severe asthma compared with moderate asthma (p<0.05), TGF-β1 was lower in severe asthma compared with moderate asthma (p<0.05). The performance characteristics of serum MMP-1 and TGF-β1 were promising in this cohort with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 82%, 100%, 100% and 99% and 62%, 100%, 100% and 97.8%, respectively; sensitivity of MMP-1 being superior.ConclusionThis pilot study showed that serum MMP-1 and TGF-β1 levels are elevated in chronic asthma and may serve as a useful adjunct in differentiating moderate from severe asthma. A large multicentre study in well characterised cohort of asthmatics is warranted to investigate their role in diagnosis and therapeutic monitoring.

Building Capacity of the Public Health Education Workforce Through Partnerships

2003 ◽  
Vol 1 (1) ◽  
pp. 49-59
Author(s):  
Mark Tomita
Keyword(s):  
Public Health ◽  
Health Disparities ◽  
Health Education ◽  
Public Health Education ◽  
Professional Associations ◽  
State University ◽  
Cd Rom ◽  
The Public ◽  
Prevention Services ◽  
The Usa

The Global Health Disparities CD-ROM Project reaffirmed the value of professional associations partnering with academic institutions to build capacity of the USA public health education workforce to meet the challenges of primary prevention services. The Society for Public Health Education (SOPHE) partnered with the California State University, Chico to produce a CD-ROM that would advocate for global populations that are affected by health disparities while providing primary resources for public health educators to use in programming and professional development. The CD-ROM development process is discussed

Building Capacity of the Public Health Education Workforce Through Partnerships: The Global Health Disparities CD-ROM Project

2003 ◽  
Vol 1 (1) ◽  
pp. 49-59
Author(s):  
Mark Tomita
Keyword(s):  
Public Health ◽  
Health Disparities ◽  
Health Education ◽  
Global Health ◽  
Public Health Education ◽  
Professional Associations ◽  
State University ◽  
Cd Rom ◽  
Prevention Services ◽  
The Usa

The Global Health Disparities CD-ROM Project reaffirmed the value of professional associations partnering with academic institutions to build capacity of the USA public health education workforce to meet the challenges of primary prevention services. The Society for Public Health Education (SOPHE) partnered with the California State University, Chico to produce a CD-ROM that would advocate for global populations that are affected by health disparities while providing primary resources for public health educators to use in programming and professional development. The CD-ROM development process is discussed.

Applying personalized medicine to adult severe asthma

2021 ◽  
Vol 42 (1) ◽  
pp. e8-e16 ◽  
Author(s):  
Angelica Tiotiu
Keyword(s):  
Personalized Medicine ◽  
Severe Asthma ◽  
Negative Impact ◽  
Target Therapy ◽  
Asthma Management ◽  
Future Research ◽  
Biologic Therapies ◽  
Eosinophilic Asthma ◽  
Definition Of ◽  
Structured Approach

Background: Severe asthma is a heterogeneous disease that consists of various phenotypes driven by different pathways. Associated with significant morbidity, an important negative impact on the quality of life of patients, and increased health care costs, severe asthma represents a challenge for the clinician. With the introduction of various antibodies that target type 2 inflammation (T2) pathways, severe asthma therapy is gradually moving to a personalized medicine approach. Objective: The purpose of this review was to emphasize the important role of personalized medicine in adult severe asthma management. Methods: An extensive research was conducted in medical literature data bases by applying terms such as “severe asthma” associated with “structured approach,” “comorbidities,” “biomarkers,” “phenotypes/endotypes,” and “biologic therapies.” Results: The management of severe asthma starts with a structured approach to confirm the diagnosis, assess the adherence to medications and identify confounding factors and comorbidities. The definition of phenotypes or endotypes (phenotypes defined by mechanisms and identified through biomarkers) is an important step toward the use of personalized medicine in asthma. Severe allergic and nonallergic eosinophilic asthma are two defined T2 phenotypes for which there are efficacious targeted biologic therapies currently available. Non-T2 phenotype remains to be characterized, and less efficient target therapy exists. Conclusion: Despite important progress in applying personalized medicine to severe asthma, especially in T2 inflammatory phenotypes, future research is needed to find valid biomarkers predictive for the response to available biologic therapies to develop more effective therapies in non-T2 phenotype.

Association of Vitamin D Levels and Other Risk Factors with Asthma Exacerbations in Children

2020 ◽  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Serum Vitamin ◽  
Persistent Asthma ◽  
Food Allergies ◽  
P Value ◽  
Serum Vitamin D ◽  
Asthma Exacerbations ◽  
Vitamin D Levels ◽  
Animal Dander

Background: The risk factors for asthma exacerbations are well understood. However, the effect of vitamin D levels on number of asthma exacerbations per year is not clearly studied. The objective of the study was to find out the association of serum vitamin D levels and asthma risk factors on asthma exacerbations. Methods: In this study, ninety-nine subjects from 5 to 15 years of age were recruited at an episode of acute exacerbation. It was a cross sectional study and carried out from 2012 to 2015. Pulmonary function test was done by spirometry. Asthma exacerbation was labeled when forced expiratory volume/ forced vital capacity (FEV1/FVC) ratio was less than 80% (American Thoracic Society). Global Initiative for Asthma (GINA) guidelines were used to classify asthma into mild, moderate and severe persistent asthma. Serum vitamin D levels were measured by chemiluminescence method. Pearson Chi-square test was applied and p value (p<0.05) was considered as statistically significant. Results: Children who had exposure to animal dander had significantly lower asthma exacerbations per year (p-value <0.046). There was no significant association between vitamin D levels and number of exacerbations per years (p-value <0.099). Asthma was prevalent in girls of low socioeconomic status (SES) compared to males. However, there was no significant association between smoke, exercise, home environment, food allergies, weather, pollen and dust with asthma exacerbations. Conclusion: Low levels of vitamin D were not associated with increased number of asthma exacerbations per year. However, children exposed to animal dander had lesser number of exacerbations per year (p-value <0.046). Keywords: Asthma; Vitamin D; Children; Exacerbations, Risk factors.

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