Small Airway Dysfunction in Asthma Is Associated with Perceived Respiratory Symptoms, Non-Type 2 Airway Inflammation, and Poor Responses to Therapy

Respiration ◽  
2021 ◽  
pp. 1-13
Author(s):  
Ying Liu ◽  
Li Zhang ◽  
Hong Lin Li ◽  
Bin Miao Liang ◽  
Ji Wang ◽  
...  
Keyword(s):  
Asthma Control ◽  
Small Airway ◽  
Chest Tightness ◽  
Asthma Control Test ◽  
Sputum Induction ◽  
Asthma Control Questionnaire ◽  
Asthma Patients ◽  
Ifn Γ ◽  
Treatment Responsiveness

<b><i>Background:</i></b> Emerging evidence has indicated that small airway dysfunction (SAD) contributes to the clinical expression of asthma. <b><i>Objectives:</i></b> The aim of the study was to explore the relationships of SAD assessed by forced expiratory flow between 25 and 75% (FEF<sub>25–75</sub>%), with clinical and inflammatory profile and treatment responsiveness in asthma. <b><i>Method:</i></b> In study I, dyspnea intensity (Borg scale), chest tightness, wheezing and cough (visual analog scales, VASs), and pre- and post-methacholine challenge testing (MCT) were analyzed in asthma patients with SAD and non-SAD. In study II, asthma subjects with SAD and non-SAD underwent sputum induction, and inflammatory mediators in sputum were detected. Asthma patients with SAD and non-SAD receiving fixed treatments were prospectively followed up for 4 weeks in study III. Spirometry, Asthma Control Questionnaire (ACQ), and Asthma Control Test (ACT) were carried out to define treatment responsiveness. <b><i>Results:</i></b> SAD subjects had more elevated ΔVAS for dyspnea (<i>p</i> = 0.027) and chest tightness (<i>p</i> = 0.032) after MCT. Asthma patients with SAD had significantly elevated interferon (IFN)-γ in sputum (<i>p</i> &#x3c; 0.05), and Spearman partial correlation found FEF<sub>25–75</sub>% significantly related to IFN-γ and interleukin-8 (both having <i>p</i> &#x3c; 0.05). Furthermore, multivariable regression analysis indicated SAD was significantly associated with worse treatment responses (decrease in ACQ ≥0.5 and increase in ACT ≥3) (<i>p</i> = 0.022 and <i>p</i> = 0.032). <b><i>Conclusions:</i></b> This study indicates that SAD in asthma predisposes patients to greater dyspnea intensity and chest tightness during bronchoconstriction. SAD patients with asthma are characterized by non-type 2 inflammation that may account for poor responsiveness to therapy.

scholarly journals Assessment of disease control in patients with asthma

Medicina ◽  
2009 ◽  
Vol 45 (12) ◽  
pp. 943 ◽  
Author(s):  
Guoda Pilkauskaitė ◽  
Kęstutis Malakauskas ◽  
Raimundas Sakalauskas
Keyword(s):  
Lung Function ◽  
Asthma Control ◽  
Control Level ◽  
Asthma Management ◽  
Control Test ◽  
Uncontrolled Asthma ◽  
Asthma Control Test ◽  
Inhaled Steroids ◽  
Asthma Patients ◽  
Β2 Agonists

International guidelines indicate that the main criterion of asthma management is asthma control level. The aim of this study was to assess asthma control and its relation with age, gender, and lung function. Material and methods. A total of 106 family physicians and 13 pulmonologists and allergists took part in this study. Each doctor had selected 10–15 asthma patients and had sent invitations to them by post. On the visit day, the patients themselves filled in the Asthma Control Test. The doctors interviewed the patients and filled in a special questionnaire. Pulmonologists and allergists also assessed lung function by performing spirometry. According to the results of the Asthma Control Test, the disease control level was indicated as “totally controlled” (25 points), “well controlled” (24–20 points), and “uncontrolled” (19 points or less). Results. A total of 876 asthma patients were examined. Uncontrolled asthma was diagnosed to 56.2% of the patients, 36.5% of patients had well controlled and 7.3% totally controlled asthma. There was no significant difference in asthma control level comparing men and women. A correlation between asthma control level and age was found revealing poorer asthma control in older patients. Ninety-five percent of patients were treated with inhaled steroids; most of them had used inhaled steroids in combination with long-acting β2 agonists. It was found that lung function correlated with clinical symptoms of asthma, the demand of shortacting β2 agonists, and asthma control level. Conclusion. The study showed that uncontrolled asthma was diagnosed to more than half of the patients, despite most of them used inhaled steroids. Asthma control was worsening with the age of patients with asthma and it correlated with lung function. We suggest that periodical assessment of asthma control should help to optimize asthma management.

scholarly journals Barriers and determinants of asthma control in children and adolescents in Africa: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e053100
Author(s):  
Reratilwe Ephenia Mphahlele ◽  
Omolemo Kitchin ◽  
R Masekela
Keyword(s):  
Systematic Review ◽  
Children And Adolescents ◽  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Control Test ◽  
Asthma Diagnosis ◽  
Asthma Control Test ◽  
Eligibility Criteria ◽  
Asthma Control Questionnaire ◽  
African Children

ObjectiveTo identify reasons for poor asthma control in African children and adolescents.DesignSystematic reviewData sourcesPubMed, Scopus, CINHAL, PsycINFO, MEDLINE and Web of Science databases were systematically searched up to 31 May 2020. Hand searching was done on Sabinet, African Journal online and Google Scholar.Eligibility criteriaStudies identifying barriers to asthma control, where asthma control was assessed by the validated Asthma Control Test/Child Asthma Control Test and/or Asthma Control Questionnaire were included.Data extraction and synthesisTwo reviewers independently selected studies for inclusion with disagreements resolved by a research team discussion, including a third reviewer. Data were extracted using the Cochrane Effective Practice and Organization of Care data collection form. The quality of the included studies was assessed using the modified Newcastle-Ottawa quality assessment scale. Identified barriers were reported in a thematic narrative synthesis.Primary outcomesPoorly controlled asthma and associated factors.ResultsFrom 914 records, three studies conducted between 2014 and 2019 in Nigeria, Uganda and South Africa met the inclusion criteria. A total of 883 children aged 4–19 years were analysed. Older age, concurrent allergy and city-dwelling significantly impacted asthma control. Few children with asthma symptoms in the community had ever used inhaled corticosteroids (6.7%) and identified reasons included lack of asthma diagnosis (38.8%) and no prescribed treatment (47.6%).ConclusionAsthma control in African children is impacted by age, allergy, urbanisation and lack of access to asthma diagnosis and treatment. More studies focusing on identifying barriers to asthma control in Africa are needed.PROSPERORegistration no: CRD42020196755)

scholarly journals The impact of using a mobile application to improve asthma patients’ adherence to medication in Jordan

2021 ◽  
Vol 27 (3) ◽  
pp. 146045822110429
Author(s):  
Mohammad K Al-Nawayseh ◽  
Montaha AL-Iede ◽  
Eman Elayeh ◽  
Rima Hijazeen ◽  
Khaled Al Oweidat ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Asthma Control ◽  
Mobile Application ◽  
Intervention Group ◽  
P Value ◽  
Asthma Control Test ◽  
Adherence To Medication ◽  
Asthma Patients ◽  
Act Score ◽  
The Impact

The main aim of this study is to assess the effectiveness of using a developed asthma mobile application to enhance medication adherence in Jordan. Asthma patients visiting outpatient respiratory clinics and using inhalers were recruited. Patients were assigned into two groups: intervention and control. The intervention group was instructed to download and use the application. Asthma control was assessed using Asthma Control Test (ACT) at baseline and at follow-up of 3 months for both groups. A total of 171 patients (control, n = 83, and intervention, n = 88) participated in the study. After 3 months of usage, patients in the intervention group achieved a significant improvement in ACT score compared to control ( p-value <0.05), and reported a significant satisfaction of the application use. Therefore, the asthma mobile application is found as an effective tool to enhance medication adherence in asthma patients.

scholarly journals EVALUATION OF INDUCED SPUTUM CYTOLOGY IN ASTHMATIC CHILDREN

2021 ◽  
Author(s):  
Debora Carla Chong-Silva ◽  
Adriana Nascimento ◽  
Roberta Cunha ◽  
Elessandra Bitencourt ◽  
Leticia Botelho ◽  
...  
Keyword(s):  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Pulmonary Function Tests ◽  
Sputum Cytology ◽  
Asthma Control Test ◽  
Sputum Induction ◽  
Hypertonic Saline Solution ◽  
Cross Sectional ◽  
Asthmatic Children ◽  
Children With Asthma

Objective: To evaluate the viability of sputum cytology in asthmatic children, recognizing inflammatory patterns and correlating them with clinical, epidemiological and functional variables of the disease. Methods: This was a cross-sectional and observational study of children with asthma who underwent sputum induction through increasing concentrations of nebulized hypertonic saline solution from 3% to 7%. The samples were processed according to the technique developed by Pizzichini et al. and the cytological pattern classified as pauci-granulocytic, neutrophilic, eosinophilic and mixed. Samples with cell viability> 50% were considered adequate. Asthma control was assessed using the asthma control test (ACT). Results: Seventy-nine children performed sputum induction. Thirty-three samples were excluded because they were not viable for analysis, resulting in 46 samples. The children’s average age was 9.4 (± 3) years. There was a predominance of eosinophilic (25/46, 54.3%), followed by mixed (13/46, 28.3%), pauci-granulocytic (7/46, 15.2%) and neutrophilic (1/46, 2.2%) pattern. Sixty-three percent of the children had severe asthma and 84.7% were treated with inhaled corticosteroids. The ACT showed that 25 (56.8%) patients had the disease under control. Forty-five children (97.8%) underwent pulmonary function tests (spirometry) and in 13 cases (28.9%) an obstructive ventilatory defect was found. Conclusions: The eosinophilic profile was predominant in the assessed asthmatic children. Non-eosinophilic phenotypes were found, but less frequently. There was no difference between the clinical variables and the sputum profile in this study group. Sputum induction in children with asthma is feasible and safe and can contribute to a specific and personalized approach to the disease.

scholarly journals Effect of exacerbation history on clinical response to dupilumab in moderate-severe uncontrolled asthma

2021 ◽  
pp. 2004498
Author(s):  
Jonathan Corren ◽  
Constance H. Katelaris ◽  
Mario Castro ◽  
Jorge F. Maspero ◽  
Linda B. Ford ◽  
...  
Keyword(s):  
Asthma Control ◽  
Forced Expiratory Volume ◽  
Severe Exacerbation ◽  
Uncontrolled Asthma ◽  
Phase 3 ◽  
Asthma Control Questionnaire ◽  
Elevated Type ◽  
Post Hoc ◽  
Blood Eosinophils

BackgroundThe phase 3 QUEST study (NCT02414854) in patients with uncontrolled, moderate-to-severe asthma has demonstrated the efficacy and safety of dupilumab 200 and 300 mg every 2 weeks versus placebo. This post hoc analysis assessed the effect of dupilumab on efficacy outcomes and asthma control across a range of historical exacerbation rates in patients with type 2−high asthma.MethodsAnnualised severe exacerbation rates over the 52-week treatment period, pre-bronchodilator forced expiratory volume in 1 s (FEV1) at weeks 12/52, and the 5-item Asthma Control Questionnaire (ACQ-5) score at 24/52 were assessed in patients with ≥1, ≥2, or ≥3 exacerbations in the previous year. Subgroups were stratified by baseline blood eosinophils ≥150 or ≥300 cells·μL−1 or baseline fractional exhaled nitric oxide ≥25 ppb and baseline inhaled corticosteroid dose.ResultsAcross all type 2−high subgroups, dupilumab versus placebo significantly reduced severe exacerbations by 54 to 90%, with greater improvements in patients with more exacerbations prior to study initiation. Similarly, improvements in FEV1 (least squares [LS] difference versus placebo: ≥1 exacerbation, 0.15 to 0.25 L; ≥2 exacerbations, 0.12 to 0.32 L; ≥3 exacerbations, 0.09 to 0.38 L; majority p<0.05) and ACQ-5 score (LS mean difference range: ≥1 exacerbation, −0.30 to −0.57; ≥2 exacerbations, −0.29 to −0.56; ≥3 exacerbations, −0.43 to −0.61; all p<0.05) were observed, irrespective of prior exacerbation history, across all subgroups.ConclusionsDupilumab significantly reduced severe exacerbations and improved FEV1 and asthma control in patients with elevated type 2 biomarkers irrespective of exacerbation history and baseline ICS dose.

scholarly journals Heterogeneous Response of Airway Eosinophilia to Anti-IL-5 Biologics in Severe Asthma Patients

2022 ◽  
Vol 12 (1) ◽  
pp. 70
Author(s):  
Maruša Kopač Šokić ◽  
Matija Rijavec ◽  
Peter Korošec ◽  
Urška Bidovec-Stojkovič ◽  
Izidor Kern ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Eosinophilic Inflammation ◽  
Asthma Control Test ◽  
Sputum Induction ◽  
Immunological Parameters ◽  
Eosinophilic Asthma ◽  
Interleukin 5 ◽  
Severe Eosinophilic Asthma ◽  
Asthma Patients

Many questions concerning responders (R) and nonresponders (NR) in severe eosinophilic asthma (SEA) after blocking the IL-5 (interleukin 5) pathway are still not clear, especially regarding the early parameters of response to biologics in personalized treatment strategies. We evaluated 17 SEA patients treated with anti-IL-5 biologics (16 patients mepolizumab, one patient benralizumab) before the introduction of biologics, and at a week 16 follow-up. Clinical, cellular and immunological parameters in peripheral blood were measured in R and NR. Sputum induction with the measurement of cellular and immunological parameters was performed at 16 weeks only. There were 12 R and 5 NR to biologics. After 16 weeks, there was a significant improvement in percentages of FEV1 (p = 0.001), and asthma control test (ACT) (p = 0.001) in the R group, but not in NR. After 16 weeks, the eosinophils in induced sputum were 27.0% in NR and 4.5% in R (p = 0.05), with no difference in IL-5 concentrations (p = 0.743). Peripheral eosinophilia decreased significantly in NR (p = 0.032) and R (p = 0.002). In patients with SEA on anti-IL-5 therapy, there was a marked difference in airway eosinophilic inflammation between R and NR already at 16 weeks, after anti-IL-5 introduction.

Gambaran Tingkat Kontrol Asma Pada Pasien Asma: Literature Review

2021 ◽  
Vol 1 ◽  
pp. 1016-1022
Author(s):  
Kurnia Fitri ◽  
Dian Kartikasari
Keyword(s):  
Literature Review ◽  
Asthma Control ◽  
Critical Appraisal ◽  
Control Test ◽  
Asthma Control Test ◽  
Cross Sectional ◽  
Asthmatic Patients ◽  
Asthma Patients ◽  
Data Collection Technique ◽  
English Articles

AbstractAsthma is an inflammation of the respiratory tract characterized by shortness of breath, coughing, and wheezing. A person with asthma will experience a descreace in physical condition, emotional changes, and changes inactivity. Based on previous research, the number of uncontrolled asthma patients in Persahabatan Hospital is still large. Asthma cannot be cured, but it can be observed using the asthma control test (ACT) to keep asthma under control in the long term. The purpose of this literature review was to describe the level of asthma control in asthmatic patients. The data collection technique used a literature review method of six articels sourced from online databeses with electronic searches on Garuda and Pubmed. The searching process used key words : “ tingkatkontrol” and “ pasienasma”. The English articles that were searched used key word : “ level of control” AND “asthma patients”. The research instrument used was the JBI critical appraisal checklist for cross-sectional.The results of a literature review of six articels showed that the describption of the level of asthma control was mostly uncontrolled. From this literature review, the results obtained were 71 (9,8%) controlled, 234 (32,19%) partially controlled, and 422 (58%) uncontrolled.The results of this literature review show that the level of asthma control in asthmatic patients is not controlled.Keywords : level of control, asthma patients AbstrakAsma merupakan gangguan pada saluran pernafasan yang mengalami inflamasi ditandai dengan sesak nafas, batuk dan mengi. Seseorang dengan asma akan mengalami penurunan kondi sifisik, perubahan emosional, dan perubahan aktivitas. Berdasarkan penelitian sebelumnya jumlah pasienasma yang tidak terkontrol di rumah sakit persahabatan masih banyak. Asma tidak dapat disembuhkan, tetapi dapat di observasi menggunakan Asthma Control Test (ACT) untuk mempertahankan asma dalam keadaan terkontrol dalam jangka panjang. Tujuan dari literature review ini adalah untuk mengetahui gambaran tingkat control asma pada pasienasma.Teknik pengumpulan data menggunakan metode literature reviewe nama artikel yang bersumber dari data base online dengan penelusuran elektronik pada Garuda dan Pubmed. Pencarian artikel dengan menggunakan kata kunci : “tingkat kontrol” dan “pasien asma”, sedangkan artikel berbahasa inggris menggunakan kata kunci : “level of control” AND “patients asthma”. Instrumen telaah yang digunakan yaitu dengan menggunakan JBI critical appraisal checklist for cross-sectional. Hasil literature review dari enam artikel didapatkan bahwa gambaran tingkat control asma Sebagian besar tidak terkontrol. Dari literatuyre review ini diperoleh hasil sebanyak 71(9,8%) terkontrol, 234 (32,19%) terkontrol sebagian dan 422 (58%) tidak terkontrol. Hasil penelitian literature review ini menunjukkan bahwa tingkat control asma pada pasien asma adalah tidak terkontrol. Kata kunci: tingkat kontrol, pasien asma

Association of Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ) with asthma exacerbation

2018 ◽  
Author(s):  
Manabu Uematsu ◽  
Junpei Saito ◽  
Suguru Sato ◽  
Atsuro Fukuhara ◽  
Yasuhito Suzuki ◽  
...  
Keyword(s):  
Asthma Control ◽  
Asthma Exacerbation ◽  
Control Test ◽  
Asthma Control Test ◽  
Asthma Control Questionnaire
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