scholarly journals Asthma control: actual problems and solutions in real clinical practice

2019 ◽  
Vol 29 (3) ◽  
pp. 346-352
Author(s):  
I. V. Leshchenko
Keyword(s):  
Clinical Practice ◽  
Asthma Control ◽  
Asthma Severity ◽  
Pharmacological Therapy ◽  
Inhalation Technique ◽  
Adherence To Treatment ◽  
Asthma Control Test ◽  
Problems And Solutions ◽  
Long Acting ◽  
Real Clinical Practice

Asthma control is still difficult to achieve. One of main tools for evaluating asthma control is a well-known Asthma Control Test (ACT). Common causes of insufficient asthma control include poor adherence to treatment and non-compliance of the patient with the dosing regimen. Correct inhalation technique significantly contributes to better adherence to treatment. Elliptа is a multi-dose powder inhaler with dose counter and indication of remaining dose number. Actuation of Ellipta inhaler requires only one movement. Inhaled glucocorticosteroids (ICS) and long-acting β2-agonists (LABA) are the key agents in the maintenance pharmacological therapy of asthma. A novel vilanterol/fluticasone furoate (VI/FF) combination is a highly effective combination for maintenance treatment of moderate to severe asthma with 24-hour effect providing once-daily dosing. The Salford study demonstrated advantages of VI/FF combination over ICS monotherapy and other combination of ICS/LABA in real clinical practice in patients with asthma out of dependence of asthma severity or comorbidities.

scholarly journals Effectiveness of inhaled corticosteroids and long-acting β-agonists combinations in real clinical practice: results of a multicenter cross-sectional study in Russian patients with asthma

2021 ◽  
Vol 31 (5) ◽  
pp. 613-626
Author(s):  
Vladimir V. Arkhipov ◽  
Zaurbek R. Aisanov ◽  
Sergey N. Avdeev
Keyword(s):  
Clinical Practice ◽  
Adverse Events ◽  
Asthma Control ◽  
Inhalation Technique ◽  
Adherence To Treatment ◽  
Uncontrolled Asthma ◽  
Cross Sectional ◽  
Long Acting ◽  
Adherence To Therapy ◽  
Real Clinical Practice

Asthma management approaches are improving yearly, but the problem of asthma control is still acute. Combinations of inhaled glucocorticosteroids (ICS) and long-acting β2-agonists (LABA) play a crucial role in asthma therapy, but their effectiveness in real practice can be insufficient, and asthma control level in the population remains low. Optimizing the use of these drugs, changing the usual therapy regimens, and implementing upgraded inhalers can improve adherence to treatment and inhalation technique, which affects the effectiveness of the therapy.The study aimed to describe the key characteristics of the patient population getting asthma treatment in real clinical practice and assess factors influencing asthma control, including adherence to therapy.Methods. A single-stage cross-sectional observational study in 124 primary health care centers in 22 cities of the Russian Federation included 3,214 patients > 18 years old, with a clinical diagnosis of asthma for at least 1 year, who were able to perform a spirometry test and fill out the ACQ-5 and TAI-12 questionnaires.Results. Assessment of asthma control with the ACQ-5 questionnaire showed that most patients had uncontrolled asthma (56%). Controlled and partially controlled asthma was diagnosed in 21 and 19% of patients, respectively. 4% of patients had severe uncontrolled asthma. The TAI questionnaire revealed low adherence to therapy in more than half of the patients (53.6%). The rate of patients with controlled asthma and the average annual frequency of exacerbations were significantly lower in subgroups of patients who received therapy with extrafine ICS/LABA and ICS/formoterol in single inhaler regimen, compared with controller therapy using fixed and free combinations of ICS and LABA.Conclusion. The main causes of insufficient asthma control are low adherence to treatment, inhalation errors, monotherapy with ICS, asthma with small airways dysfunction, and adverse events associated with ICS. Prescribing the combinations of ICS/LABA in the form of extra-fine aerosol and using it in the Maintenance and Reliever Therapy (MART) regimen can significantly increase asthma control, reduce the risk of adverse events, and increase patient adherence to treatment. A potential alternative to improve asthma control is administering ICS-LABA combinations once daily.

What lies beyond Asthma Control Test: Suggestions for clinical practice

2016 ◽  
Vol 53 (6) ◽  
pp. 559-562 ◽  
Author(s):  
Marco Caminati ◽  
Cristian Caimmi ◽  
Annarita Dama ◽  
Michele Schiappoli ◽  
Giovanni Passalacqua ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Asthma Control ◽  
Control Test ◽  
Asthma Control Test

scholarly journals First analysis of the Severe Paediatric Asthma Collaborative in Europe registry

2020 ◽  
Vol 6 (4) ◽  
pp. 00566-2020
Author(s):  
Norrice M. Liu ◽  
Karin C.L. Carlsen ◽  
Steve Cunningham ◽  
Grazia Fenu ◽  
Louise J. Fleming ◽  
...  
Keyword(s):  
Asthma Control ◽  
Severe Asthma ◽  
Suboptimal Control ◽  
High Dose ◽  
Asthma Control Test ◽  
European Respiratory Society ◽  
Paediatric Asthma ◽  
Global Initiative For Asthma ◽  
Global Initiative ◽  
Long Acting

New biologics are being continually developed for paediatric asthma, but it is unclear whether there are sufficient numbers of children in Europe with severe asthma and poor control to recruit to trials needed for registration. To address these questions, the European Respiratory Society funded the Severe Paediatric Asthma Collaborative in Europe (SPACE), a severe asthma registry. We report the first analysis of the SPACE registry, which includes data from 10 paediatric respiratory centres across Europe.Data from 80 children with a clinical diagnosis of severe asthma who were receiving both high-dose inhaled corticosteroid and long-acting β2-agonist were entered into the registry between January 2019 and January 2020. Suboptimal control was defined by either asthma control test, or Global Initiative for Asthma criteria, or ≥2 severe exacerbations in the previous 12 months, or a combination.Overall, 62 out of 80 (77%) children had suboptimal asthma control, of whom 29 were not prescribed a biologic. However, in 24 there was an option for starting a licensed biologic. 33 children with suboptimal control were prescribed a biologic (omalizumab (n=24), or mepolizumab (n=7), or dupilumab (n=2)), and for 29 there was an option to switch to a different biologic.We conclude that the SPACE registry provides data that will support the planning of studies of asthma biologics. Not all children on biologics achieve good asthma control, and there is need for new trial designs addressing biologic switching.

scholarly journals 4CPS-020 Use, efficacy and adherence to treatment with PCKS9 inhibitors in real clinical practice

2020 ◽  
Author(s):  
R Claramunt García ◽  
CL Muñoz Cid ◽  
A Sánchez Ruiz ◽  
AM López ◽  
E Pérez Cano ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Adherence To Treatment ◽  
Real Clinical Practice

scholarly journals Does vitamin D deficiency in asthma affect clinical and functional parameters? A Turkish multicenter study

2021 ◽  
Vol 42 (5) ◽  
pp. e152-e158 ◽  
Author(s):  
Nurhan Sarıoglu ◽  
Arzu Didem Yalcın ◽  
Fusun Sahin ◽  
Sadan Soyyigit ◽  
Fatma Merve Tepetam ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Asthma Control ◽  
Asthma Severity ◽  
Control Test ◽  
Asthma Control Test ◽  
Functional Parameters ◽  
Control Subjects ◽  
Vitamin D Levels ◽  
Target Values

Background: In recent years, interest in the effects of vitamin D on human health and the immune system has increased. Objective: This study aimed to investigate the relationship of vitamin D with asthma severity, attacks, and clinical and functional parameters in adult patients with asthma who were living in different geographic regions in Turkey. Methods: A total of 384 patients with stable asthma and 87 control subjects were included. A physical examination and a pulmonary function test were performed, and routine blood analyses and vitamin D levels were evaluated. Asthma Control Test was applied. The number of exacerbations in the previous year, asthma therapy, and medication adherence were recorded. Results: In our study, vitamin D levels were below the target values in both patients with asthma (median [minimum-maximum] 16.0 ng/mL [3.5‐48 ng/ml]) and control subjects (median [minimum-maximum] 20.0 ng/mL [5.8‐58.79 ng/mL]). However, it was lower in the patients with asthma than in the control subjects (p = 0.001). There was a negative relationship between the levels of vitamin D and the severity of asthma (Kendall τ = −0.146; p < 0.001). Furthermore, the patients with severe asthma were received The Global Initiative for Asthma (GINA) step 5 treatment showed significantly lower vitamin D compared with the patients who received GINA step 4 treatment (p = 0.037). Vitamin D levels correlated with forced vital capacity (FVC), forced expiratory volume in the first second of expiration (FEV1), and peak expiratory flow (r, 0.221‐0.236; p ≤ 0.001). In addition, a positive relationship was found between Asthma Control Test and vitamin D (r = 0.229; p = 0.001). However, body mass index (BMI), asthma exacerbation, and hospitalization were inversely related to vitamin D (r, 0.198‐0.233; p = 0.001). Multivariable regression analysis revealed that FVC (p = 0.002), FEV1 (p = 0.033), and BMI (p = 0.037) were independent determinants associated with vitamin D. Conclusion: This study suggested a high prevalence of vitamin D deficiency in adults with asthma living in different geographic areas in Turkey. Vitamin D deficiency is associated with asthma severity, poor control, and lower lung function.

scholarly journals New possibilities for asthma therapy in children

2018 ◽  
pp. 192-198 ◽  
Author(s):  
T. N. Surovenko ◽  
Е. F. Glushkova
Keyword(s):  
Lung Function ◽  
Asthma Control ◽  
Russian Federation ◽  
Asthma Severity ◽  
Asthma Therapy ◽  
Improve Lung Function ◽  
The Russian Federation ◽  
Asthma In Children ◽  
Long Acting ◽  
Step Therapy

This article discusses issues of clinical diagnosis and course of bronchial asthma in children. We discuss assessment of asthma severity and, accordingly, the extent of the step-by-step therapy according to updated recommendations (GINA 2018). Particular attention is paid to the possibility of improving the control of asthma with the help of the M-cholinolytic drug of long-acting tiotropium bromide, presented as a special inhalation form of tiotropium Respimat and registered in the Russian Federation for treatment of asthma in children of moderate and severe course from 6 years of age. Application tiotropium Respimat in children with insufficient control of asthma allows to improve lung function and asthma control.

scholarly journals Asthma Control and Asthma Medication Use among Swedish Elite Endurance Athletes

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Hampus Persson ◽  
Anne Lindberg ◽  
Nikolai Stenfors
Keyword(s):  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Reference Group ◽  
Medication Use ◽  
Study Groups ◽  
Asthma Medication ◽  
Endurance Athletes ◽  
Act Scores ◽  
Asthma Control Test ◽  
Long Acting

Background. Asthma is common in elite athletes. In this study, we examined the use of asthma medication and asthma control in endurance athletes in Sweden and compared the findings with those in a reference group of patients with asthma. Methods. The Asthma Control Test (ACT) and a questionnaire on asthma, respiratory symptoms, and medication use were posted to endurance athletes n=711 and the reference group of patients with asthma n=1026. Four hundred and sixty-nine athletes (66%) responded, of whom 141 (20%) reported physician-diagnosed asthma. In the reference group, 397 (39%) responded. Results. Seventy-seven percent of the athletes with asthma reported using asthma medication during the previous year; 39% used short/long-acting β2-agonists, 31% used inhaled corticosteroids, and 31% used both daily. According to the ACT scores, 19%, 24%, and 58% of athletes with asthma had uncontrolled, partially controlled, or well-controlled asthma, respectively. After adjustment, there was no difference in ACT scores or daily use of asthma medication between the study groups. Conclusions. Many endurance athletes had uncontrolled or partially controlled asthma, and one-third used inhaled corticosteroids and long-acting β2-agonists daily. Their adjusted ACT scores and use of asthma medication were similar to the values in the reference population.

scholarly journals Monitoring asthma in childhood: management-related issues

2015 ◽  
Vol 24 (136) ◽  
pp. 194-203 ◽  
Author(s):  
Bart L. Rottier ◽  
Ernst Eber ◽  
Gunilla Hedlin ◽  
Steve Turner ◽  
Edwina Wooler ◽  
...  
Keyword(s):  
Asthma Control ◽  
Task Force ◽  
Fungal Spores ◽  
Clinic Visit ◽  
House Dust Mites ◽  
Inhalation Technique ◽  
Adherence To Treatment ◽  
European Respiratory Society ◽  
Inhalation Techniques

Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood.The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient's illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis should be considered as a cause for poor asthma control. Task force members do not screen for gastro-oesophageal reflux and food allergy. Height and weight are generally measured at least annually to identify individuals who are susceptible to adrenal suppression and to calculate body mass index, even though causality between obesity and asthma has not been established.In cases of poor asthma control, before stepping up treatment the above aspects of monitoring deserve closer attention.

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