Disease control in patients with asthma and respiratory symptoms (wheezing, cough) during sleep

Abstract Introduction The Global Initiative for Asthma (GINA)-defined criteria for asthma control include questions about daytime symptoms, limitation of activity, nocturnal symptoms, need for reliever treatment and patients’ satisfaction. Patients with nocturnal symptoms like wheezing and cough often suffer from lower sleep quality and impaired daytime performance. The lack of an appropriate method for standardized and objective monitoring of respiratory symptoms leads to difficulties in asthma management. The aim of this study is to present a new method for automated wheeze and cough detection during sleep and to assess the actual level of asthma control by the Asthma Control Test (ACT). Methods Respiratory symptoms like wheezing and cough were recorded with the LEOSound-Monitor for one night in 55 asthmatic patients in their individual domestic setting. Patients were asked to assess their level of asthma subjectively with the ACT. The study consisted of 37 women and 18 men, with a mean age of 41 years, and a mean BMI of 27 kg/m2. Most of the patients had been taking an ICS/LABA combination and would resort to a SABA as their rescue medication. Results 60% of the participants were classed as having controlled, and 40% were classed as having partially- or uncontrolled asthma. During sleep wheezing was found in 8 of the 55 asthma patients (14.5%) and coughing was found in 30 patients (54.5%). The median ACT score in wheezing-patients was 14, while in non-wheezing patients it was 21. Uncontrolled asthma was found in 6 of the 8 wheezing-patients. Coughing versus non-coughing patients did not show a significant difference in the ACT-score (20, 22 respectively). Conclusion Wheezing is a sign of uncontrolled asthma. The ACT-score in wheezing patients is worse compared to patients without wheezing. LEOSound proofed to be a useful tool in providing an objective evaluation of respiratory symptoms, like coughing and wheezing. In clinical practice, this may allow an improvement in asthma therapy.

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Uncontrolled asthma and its risk factors in adult Chinese asthma patients

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753465816663978 ◽

2016 ◽

Vol 10 (6) ◽

pp. 507-517 ◽

Cited By ~ 8

Author(s):

Nanshan Zhong ◽

Jiangtao Lin ◽

Jinping Zheng ◽

Kefang Lai ◽

Canmao Xie ◽

...

Keyword(s):

Asthma Control ◽

Treatment Adherence ◽

Asthma Management ◽

Chinese Patients ◽

Multivariate Logistic Regression Model ◽

Uncontrolled Asthma ◽

Asthma Control Test ◽

Number Of Patients ◽

Asthma Patients ◽

Act Score

Background: Asthma affects a large number of patients in China, but relatively little is known about asthma management among Chinese patients. This study aims to estimate asthma control rate among adult Chinese patients and to identify predictors associated with uncontrolled asthma. Methods: A total of 4125 asthma patients aged ⩾17 years and representing all regions of mainland China except Tibet were surveyed. Asthma control status was assessed using the Asthma Control Test (ACT) and classified as controlled (ACT score ⩾ 20) and uncontrolled (ACT score ⩽ 19). A multivariate logistic regression model was used to identify predictors associated with uncontrolled asthma from the factors including demographics, rhinitis, allergic rhinitis, and treatment adherence. Results: Asthma was controlled in 44.9%, and uncontrolled in 55.1% of the study participants. High rates of uncontrolled asthma were found in patients with treatment nonadherence (77.3%), poor adherence (66.2%), no schooling (64.8%), or obesity (62.9%). The risk of uncontrolled asthma was much higher in the treatment nonadherence group than the complete adherence group [odds ratio (OR) = 4.55 (3.68–5.62), p < 0.001]. Other predictors for uncontrolled asthma included concomitant rhinitis [OR = 1.31 (1.14–1.50), p < 0.001], obesity [OR = 1.31 (1.05–1.64), p = 0.019], asthma duration > 3 years [OR = 1.22 (1.07–1.39), p = 0.004] and age ⩾ 45 years [OR = 1.23 (1.07–1.41), p = 0.004]. Conclusions: About half of the participants in this study had uncontrolled asthma. Treatment nonadherence is one of the significant predictors, which is very strongly associated with uncontrolled asthma. Efforts should be prioritized to promote patients’ treatment adherence to improve asthma control while attention is needed on rhinitis or obesity.

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Assessment of disease control in patients with asthma

Medicina ◽

10.3390/medicina45120121 ◽

2009 ◽

Vol 45 (12) ◽

pp. 943 ◽

Cited By ~ 1

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.

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Hubungan Kadar Periostin Serum dan Nilai Asthma Control Test pada Pasien Asma di RSUD Dr. Soetomo Surabaya

Jurnal Respirasi ◽

10.20473/jr.v4-i.2.2018.33-37 ◽

2018 ◽

Vol 4 (2) ◽

pp. 33

Author(s):

Ni Made Dwita Yaniswari ◽

Muhammad Amin

Keyword(s):

Asthma Control ◽

Matrix Protein ◽

Extracellular Matrix Protein ◽

Enzyme Linked Immunosorbent Assay ◽

Control Test ◽

Uncontrolled Asthma ◽

Asthma Control Test ◽

Asthmatic Patients ◽

Act Score ◽

Serum Periostin

Background: Asthma is a heterogenous disease composed of various phenotype. Chronic airway inflammation are fundamental features of asthma. The main treatment of asthma is corticosteroid. The administration of inhaled corticosteroids will reduce the inflammatory process in asthma. Even with adequate inhaled corticosteroid treatment, there are still patients who develop symptoms with lower asthma control test score. Periostin is an extracellular matrix protein as the best single systemic biomarker for assessing tissue eosinophilia, airway remodeling in uncontrolled asthma. The objective of this study was to examine whether serum periostin is correlated with ACT in asthmatic patients. Methods: This research was an observational analytical with cross sectional design conducted in outpatient clinic Dr. Soetomo General Hospital Surabaya for 3 months. In total, we found 40 asthmatic patients who were qualified to the inclusion and exclusion criteria as the research samples. The questionnaire was filled in to assess the Asthma Control Test and venous blood tests to measure serum periostin levels using Sandwich Enzyme-Linked Immunosorbent Assay (ELISA) method. Results: The mean periostin level profile of the sample was 94.82 ± 19.21 ng/ml and the median was 94.7 ng/ml. The average ACT score was 16.55 ± 2.93 with 85% were uncontrolled asthma. The results of the independent t-test showed serum periostin levels and the level of asthma control based on ACT score in asthmatics patients had a significant correlation (p = 0.024). Conclusion: There is a significant correlation between serum periostin levels and ACT score in asthmatic patients.

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Combination of Fractional Exhaled Nitric Oxide (FeNO) Level and Asthma Control Test (ACT) in Detecting GINA-Defined Asthma Control in Treated Asthmatic Patients in Vietnam

Canadian Respiratory Journal ◽

10.1155/2020/5735128 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Vinh Nguyen Nhu ◽

Pham Le An ◽

Niels H. Chavannes

Keyword(s):

Asthma Control ◽

Roc Curve ◽

Medical Center ◽

Asthma Management ◽

Cross Sectional Study ◽

Uncontrolled Asthma ◽

Roc Curve Analysis ◽

Asthma Control Test ◽

Cross Sectional ◽

Asthmatic Patients

Background. FeNO has been used as a marker for Th2-mediated airway inflammation in asthma. There is evidence which recommends the use of this biomarker in asthma management. Little is known about whether the FeNO test alone or in combination with the ACT score can reflect asthma control in Vietnamese patients. Materials and Methods. A cross-sectional study was conducted in asthmatic patients (≥18 years old) recruited at the University Medical Center, Ho Chi Minh City, Vietnam from March 2016 to March 2017. Asthma control levels were assessed following the GINA 2017 guidelines, and FeNO was measured by a Niox Mino device. FeNO cut-offs predicting asthma control status were determined using the ROC curve analysis. The combination of FeNO and ACT was investigated in detecting well-controlled and uncontrolled asthma. The results of the study are as follows: 278 patients with 68% females, mean age of 44 years, and mean asthma duration of 10 years were analyzed. All patients were treated following step 2 to 4 of GINA guidelines. Mean (SD) FeNO was 30.6 (24) ppb. Patients with uncontrolled (16%), partly controlled (29%), and well-controlled asthma (55%) had a median (IQR) FeNO of 50.0 (74), 25.0 (23), and 21.0 (22.3) ppb, respectively, and the mean of FeNO in the uncontrolled group was significantly higher than that in other groups (p<0.001). The area under the ROC curve (AUC) for FeNO detecting uncontrolled asthma was 0.730 with an optimal cut-off point of FeNO > 50 ppb, and this AUC increased to 0.89 when combining FeNO and ACT. The AUC for FeNO detecting well-controlled asthma was 0.601 with an optimal cut-off point of FeNO <25 ppb and this AUC increased to 0.78 if combining FeNO and ACT. Conclusions. FeNO can predict asthma control status with an estimated cut-off point of <25 ppb for well-controlled and >50 ppb for uncontrolled asthma. The combination of FeNO and ACT provides better information regarding asthma control than FeNO alone, and this combination is useful to predict asthma control statuses in asthmatic patients in Viet Nam.

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

Health Informatics Journal ◽

10.1177/14604582211042926 ◽

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.

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Asthma Management Responsibility, Control, and Quality of Life Among Emerging Adolescents

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsz069 ◽

2019 ◽

Vol 45 (1) ◽

pp. 40-49

Author(s):

Mallory Netz ◽

David A Fedele ◽

Rachel Sweenie ◽

Dawn Baker ◽

Michael Light ◽

...

Keyword(s):

Quality Of Life ◽

Asthma Control ◽

Healthcare Providers ◽

Asthma Management ◽

Life Questionnaire ◽

Act Scores ◽

Asthma Control Test ◽

Significant Difference ◽

Related Quality

Abstract Objective To examine how asthma control is related to the association between the division of responsibility for asthma management and asthma-related quality of life among early adolescents. Methods Forty-nine youth aged 10–15 years (Mage = 12.25, 57.1% female) with a physician-verified asthma diagnosis completed the Standardized Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and Asthma Control Test (ACT). Youth and their caregivers also completed the Asthma Responsibility Questionnaire (ARQ). Higher ACT scores indicate better asthma control. Results There was a significant difference in ARQ scores between youth and caregivers (p < .001, d = .94). Youth reported sharing equal responsibility for asthma management with caregivers, while caregivers reported having more responsibility relative to youth. Greater youth-reported ARQ (p = .004) and greater ACT scores (p < .001) were associated with higher PAQLQ scores. ACT scores moderated the effect of youth-reported ARQ on PAQLQ scores (p = .043). For youth with lower ACT scores, higher youth-reported responsibility was associated with higher PAQLQ scores; while for youth with higher ACT scores, PAQLQ scores were high regardless of perceived responsibility. The interaction between caregiver ARQ scores and ACT scores was not significant. Conclusion This study suggests youth and caregivers report discrepant ARQ for asthma management tasks. Responsibility and level of asthma control are important factors for PAQLQ, with results indicating that fostering responsibility is an important factor, even among youth with poorly controlled asthma. Findings suggest that healthcare providers should assess family responsibility and help caregivers support adolescents in developing asthma management skills.

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Gambaran Tingkat Kontrol Asma Pada Pasien Asma: Literature Review

Prosiding Seminar Nasional Kesehatan ◽

10.48144/prosiding.v1i.783 ◽

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

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Role of a Community Pharmacy Service in Care of Bronchial Asthma Patients in Lithuania

Canadian Respiratory Journal ◽

10.1155/2018/6060581 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Arturas Nastaravičius ◽

Kristina Ramanauskienė

Keyword(s):

Asthma Control ◽

Bronchial Asthma ◽

Pharmacy Service ◽

Control Test ◽

Asthma Control Test ◽

Chronic Respiratory Diseases ◽

Asthmatic Patients ◽

Positive Effects ◽

Community Pharmacy Service ◽

Asthma Patients

Bronchial asthma is one of the most common chronic respiratory diseases, and its care is often complex. In this research, we tested the proposal that participation of pharmacists in the management of bronchial asthma can improve patient outcomes. A two-stage study was constructed consisting of a training element and a service element, using the Asthma Control Test and a structured questionnaire about the patients’ disease condition (based on the results of a qualitative study). The study was conducted in 21 pharmacies in Lithuania and involved 338 asthmatic patients (age 18–88 years). It was found that before the pharmacy service was provided, the average number of mistakes patients made in administration of asthma medications was 2.03; this number decreased to 1.12 after the service was provided (p<0.05). Disease control paralleled the improvement in number of mistakes: 26.1% of patients who previously exerted no control over the disease symptoms began to exert sufficient control over their asthma symptoms (Asthma Control Test >20) after the service was provided (p<0.05). The reduced number of mistakes probably can be attributed to the positive effects of the provided services. By reducing the number of patient mistakes, pharmacists may improve the outcomes of asthmatic patients.

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The prevalence of sleep disturbance among asthmatic patients in a tertiary care center

Scientific Reports ◽

10.1038/s41598-020-79697-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tammam M. Alanazi ◽

Hazim S. Alghamdi ◽

Meshal S. Alberreet ◽

Abdulaziz M. Alkewaibeen ◽

Abdulrahman M. Alkhalefah ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Quality ◽

Sleep Disturbance ◽

Asthma Control ◽

Poor Sleep ◽

Uncontrolled Asthma ◽

Poor Sleep Quality ◽

Asthmatic Patients ◽

Obstructive Sleep ◽

Asthma Patients

AbstractSleep disturbances are commonly reported by patients with asthma. However, the prevalence of sleep disturbance and its association with the level of asthma control is unknown. The primary objective was to determine the prevalence of sleep disturbance among Saudi adult asthmatic patients attending pulmonary clinics at King Abdulaziz Medical City (KAMC). The study also aimed to compare sleep quality between controlled and uncontrolled asthma patients. The study was carried out in the outpatient pulmonary clinics at KAMC and utilized a cross-sectional survey. The survey included five different questionnaires: asthma control test and questionnaires related to the quality of sleep (Pittsburgh sleep quality index [PSQI], Epworth sleepiness scale [ESS], Berlin questionnaire [a measure of obstructive sleep apnea risk], and insomnia severity index [ISI]). Among the 200 asthma patients, 66% suffered from poor sleep quality (PSQI > 5), 43% were at high risk for obstructive sleep apnea, 25% had excessive daytime sleepiness (ESS > 10), and 46.5% had significant clinical insomnia (ISI ≥ 10). Poor sleep quality was less common in patients with well-controlled asthma (37%) compared to those with partially controlled asthma (78%) and uncontrolled asthma (82%) (p < 0.001). Poor sleep quality was common among patients with asthma, particularly those with suboptimal levels of asthma control. Further studies are needed to better understand the interaction between these two conditions.

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Rates of asthma exacerbations and mortality and associated factors in Uganda: a 2-year prospective cohort study

Thorax ◽

10.1136/thoraxjnl-2017-211157 ◽

2018 ◽

Vol 73 (10) ◽

pp. 983-985 ◽

Cited By ~ 5

Author(s):

Bruce J Kirenga ◽

Corina de Jong ◽

Levicatus Mugenyi ◽

Winceslaus Katagira ◽

Abdallah Muhofa ◽

...

Keyword(s):

Asthma Control ◽

Associated Factors ◽

Median Number ◽

First Year ◽

Asthma Control Test ◽

Asthma Exacerbations ◽

All Cause Mortality ◽

Asthma Patients ◽

Act Score

Data on asthma treatment outcomes in Africa are limited. 449 patients with asthma (age 5–93 years) in Uganda were followed up for 2 years to determine rates of exacerbations and mortality and associated factors. During follow-up the median number of exacerbations per patient was 1 (IQR 0–5) and 17 patients died (3.7%, 27.3 deaths per 1000 person years). Considering only the first year of follow-up, 59.6% of the patients experienced at least one exacerbation, 32.4% experienced three or more exacerbations. A multivariable model showed that the likelihood of experiencing at least one exacerbation in the first year of follow-up was lower with better baseline asthma control (higher asthma control test (ACT) score), with OR 0.87 (95% CI: 0.82 to 0.93, P=0.000), and was higher with more exacerbations in the year prior to enrolment (OR for log number of exacerbations 1.28, 95% CI: 1.04 to 1.57, P=0.018). Better asthma control (OR 0.93, 95% CI: 0.88 to 0.99, P=0.021) and number of baseline exacerbations (OR 1.35,95% CI: 1.11 to 1.66, P=0.005) were also the only factors that were independently associated with experiencing three or more exacerbations during the first year of follow-up. The only factor found to be associated with all-cause mortality was FEV1, with higher recent FEV1 associated with lower all-cause mortality (OR 0.30, 95% CI: 0.14 to 0.65; P=0.002). Rates of asthma exacerbations and mortality are high in Uganda and are associated with poor asthma control. Health systems should be strengthened to care for asthma patients.

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