scholarly journals The Genomics and Metagenomics of Asthma Severity (GEMAS) Study: Rationale and Design

2020 ◽  
Vol 10 (3) ◽  
pp. 123
Author(s):  
Javier Perez-Garcia ◽  
José M. Hernández-Pérez ◽  
Ruperto González-Pérez ◽  
Olaia Sardón ◽  
Elena Martin-Gonzalez ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Basque Country ◽  
Severe Disease ◽  
Predictive Biomarkers ◽  
Asthma Severity ◽  
Pulmonary Medicine ◽  
Clinical Variables ◽  
Phenotype Definition ◽  
Asthma Exacerbations ◽  
Asthma Patients

Asthma exacerbations are a major contributor to the global disease burden, but no significant predictive biomarkers are known. The Genomics and Metagenomics of Asthma Severity (GEMAS) study aims to assess the role of genomics and the microbiome in severe asthma exacerbations. Here, we present the design of GEMAS and the characteristics of patients recruited from March 2018 to March 2020. Different biological samples and demographic and clinical variables were collected from asthma patients recruited by allergy and pulmonary medicine units in several hospitals from Spain. Cases and controls were defined by the presence/absence of severe asthma exacerbations in the past year (oral corticosteroid use, emergency room visits, and/or asthma-related hospitalizations). A total of 137 cases and 120 controls were recruited. After stratifying by recruitment location (i.e., Canary Islands and Basque Country), cases and controls did not differ for most demographic and clinical variables (p > 0.05). However, cases showed a higher proportion of characteristics inherent to asthma exacerbations (impaired lung function, severe disease, uncontrolled asthma, gastroesophageal reflux, and use of asthma medications) compared to controls (p < 0.05). Similar results were found after stratification by recruitment unit. Thereby, asthma patients enrolled in GEMAS are balanced for potential confounders and have clinical characteristics that support the phenotype definition. GEMAS will improve the knowledge of potential biomarkers of asthma exacerbations.

scholarly journals Patient and Physician Perspectives on Asthma and Its Therapy in Romania: Results of a Multicenter Survey

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1089
Author(s):  
Dragos Bumbacea ◽  
Carmen Panaitescu ◽  
Roxana Silvia Bumbacea
Keyword(s):  
Maintenance Therapy ◽  
Asthma Control ◽  
Severe Asthma ◽  
Asthma Management ◽  
Asthma Severity ◽  
Treatment Goals ◽  
Cross Sectional ◽  
Multicenter Survey ◽  
Patient Reported ◽  
Asthma Patients

Background and Objectives: Patient’s behaviours, attitudes and beliefs related to asthma and its treatment were shown to influence the adherence to therapy and the level of asthma control. This survey aimed to assess the level of asthma control and patient-reported behaviours, attitudes and expectations related to their disease in Romanian patients. Materials and Methods: This cross-sectional quantitative survey was performed in February-March 2019 and enrolled 70 specialist physicians experienced in asthma management and 433 asthma patients under their care. Results: Of the 433 patients enrolled, 19.4% had mild asthma, 60.5% moderate asthma and 20.1% severe asthma. For the previous 12 months, asthma symptoms, exacerbations and emergency room visits were common in the sample analysed, with significantly higher figures in severe asthma patients (p < 0.001). The most important treatment goal for asthma patients was participation in all activities of daily living, while for physicians this was preventing asthma exacerbations. The valuation of the treatment goals was different between patients with severe asthma and those with mild and moderate forms. Based on the patients’ responses, 3 attitude clusters were identified: empowered savvy (36.5% of the patients), pessimistic non-compliers (43.2%), and anxious strugglers (20.3%). “Empowered savvy” had the lowest frequency of severe asthma, the highest adherence to maintenance therapy and the highest level of confidence in the effectiveness of asthma medication. The opposite of this attitude cluster is the “anxious strugglers”, containing more patients with severe asthma, a higher score for worries about asthma therapy and better self-reported knowledge of their treatment, contrasting with a proportion of 25% taking maintenance therapy only when having breathing difficulties. Conclusion: Asthma control in Romania remains poor, with frequent exacerbations and hospitalizations. The differences in treatment goals found between patients and physicians and between different asthma severity groups suggest the need for more patient-centred approaches.

Comparison of exacerbation phenotypes among patients with severe asthma

2020 ◽  
Vol 41 (4) ◽  
pp. e67-e79
Author(s):  
Karina Ruth Soenjoyo ◽  
Nivedita Nadkarni ◽  
Mariko Siyue Koh
Keyword(s):  
Severe Asthma ◽  
Immunoglobulin E ◽  
Laboratory Data ◽  
Therapeutic Strategies ◽  
Demographic Differences ◽  
Asthma Exacerbations ◽  
Singapore General Hospital ◽  
Asthma Patients ◽  
Hospital Stays

Background: Exacerbation phenotypes among patients with severe asthma have been largely characterized during stable periods. Little is known about severe asthma patients during exacerbation periods. Objective: To compare persistently frequent exacerbators (PFE), non‐persistently frequent exacerbators (NPFE), and infrequent exacerbators (IFE) among patients with severe asthma during stable and exacerbation periods. Methods: Patients with severe asthma who were admitted for asthma exacerbations from 2011 to 2017 and on follow up at Singapore General Hospital were recruited and categorized as PFEs (two or more exacerbations per year over 2 consecutive years), NPFEs (two or more exacerbations in 1 year only), or IFEs (fewer than two exacerbations per year over 2 consecutive years). Demographic, clinical, and laboratory data were collected at baseline and during exacerbation periods. Results: The participants were categorized as the following: 20 PFEs, 36 NPFEs, and 57 IFEs, with no significant demographic differences. The participants as PFEs (versus NPFEs and IFEs) were characterized by having a higher prevalence of psychiatric disorders (25% versus 8% versus 5%; p = 0.046), more comorbidities (7 versus 4 versus 2; p < 0.001), and a higher steroid burden per year (1150 versus 456 versus 350 mg; p < 0.001). The participants who were PFEs (versus IFEs) had a higher total immunoglobulin E (IgE) level (625 versus 232 IU/mL; p = 0.046) and longer duration of admission stay (3 versus 2 days; p = 0.009). All three groups had higher blood neutrophil counts during exacerbation periods than during stable periods (p = 0.008 versus p < 0.001 versus p = 0.004). Conclusion: The participants categorized as PFEs were characterized by comorbidities, higher steroid burden, IgE levels, and longer hospital stays. Exacerbations in the participants with severe asthma, regardless of exacerbation phenotype, were characterized by neutrophilia. These findings provided insights into potential therapeutic strategies to reduce exacerbations in patients with severe asthma.

scholarly journals Fungal sensitization of patients with asthma in St. Petersburg

2015 ◽  
Vol 12 (5) ◽  
pp. 3-8
Author(s):  
Y I Kozlova ◽  
E V Frolova ◽  
A V Sobolev ◽  
O V Aak ◽  
A E Uchevatkina ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Asthma Severity ◽  
Th2 Cells ◽  
Course Of Disease ◽  
Fungal Allergens ◽  
Asthma Patients ◽  
Serum Total Ige ◽  
Fungal Sensitization

Background. Fungal sensitization is associated with severe uncontrolled asthma. Connections of specific, micromycetes and fungal allergens with disease development and immunopathogenesis of asthma with fungal sensitization are not well understood. Methods. The study included 120 patients with different grades of asthma severity. Results. Fungal sensitization was detected in 48 patients with asthma (40%). Severe course of asthma with fungal sensitization was identified in 7 patients (14,6%). The main fungal allergens in patients with severe asthma were Alternaria spp. and Aspergillus spp., in patients with mild and moderate course of disease - Aspergillus spp. and Penicillium spp. Increasing of serum total IgE and enhancing the ability of blood cells to produce IL2 and IFN-y in patients with bronchial asthma with fungal sensitization were revealed. The obtained results indicated the important role of Th1 along with Th2 cells in the development of immunopathological process in asthma patients withfungal sensitization. Conclusion. Further research is necessary for determination of clinical and immunological criteria of severe asthma with fungal sensitization and study of the effectiveness of antimycotic therapy.

scholarly journals Newly Diagnosed Asthma in China: Initial Severity and Changes Over 1-year Management

2021 ◽  
Author(s):  
Zhizhen Hu ◽  
Jianwei Xuan ◽  
Haijin Zhao ◽  
Hangming Dong ◽  
Changhui Yu ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Asthma Severity ◽  
Initial Diagnosis ◽  
Mild Asthma ◽  
First Year ◽  
Newly Diagnosed ◽  
Medical Database ◽  
Asthma Patients ◽  
First Diagnosis

Abstract Background: The prevalence of adult asthma is increasing in China. However, there are no large sample, epidemiological data describing asthma severity at the time of new diagnosis and changes during follow-up management. Thus, the purpose of this study was to use a large health care database to examine asthma severity at initial diagnosis, and changes in severity over the first year of management.Methods: Data of patients with a first diagnosis of asthma were extracted from the SuValue electronic medical database. Inclusion criteria were: 1) At least 14 years old at the time of first diagnosis; 2) Initial diagnosis from 2001 to March 2019; 3) Followed-up for at least 12 months; 4) Had a follow-up visit every 3 months. Disease severity at diagnosis and at each follow-up visit, medications prescribed, and symptoms were collected and analysed.Results: A total of 7,654 adult patients with newly diagnosed asthma from tertiary hospitals (26.38%) and secondary hospitals (73.62%) who were followed-up for at least 12 months were included. Approximately 54% were females, and the proportion of patients over 60 years old was the highest (38%). Of all patients, 53.91% were not prescribed medications to control asthma, suggesting that these patients were mild asthma. Approximately 16% of patients were prescribed oral corticosteroid and/or inhaled corticosteroid and long-acting β2-agonist combination, suggesting moderate to severe asthma. The proportions of patients with moderate and severe decreased during the first 6 months, and then the proportions remained stable. The proportion of patients with severe asthma remained stable from the 6th month onward. At the end of the year 2.7% of patients had severe asthma. Patients with mild asthma tended to continue to have mild asthma in the following 3 months (> 76.19%). However, of the patients with mild and moderate asthma at 3 months, 92.85% and 75.1%, respectively, had a reduction in severity and had mild asthma at 12 months. On the other hand, 1.26% and 3.15%, respectively, progressed to severe asthma by 12 months.Conclusion: During the first year after an initial diagnosis of asthma patients diagnosed with mild asthma tended to not progress and remained stable with mild asthma over the year. The proportions of patients diagnosed with moderate and severe asthma remained stable over the year. Further study is needed to examine the clinical features of newly diagnosed patients with severe asthma who do not experience a reduction in severity in order to target these patients for more intensive treatment and reduce the disease burden.

The Management of Mild Asthma

2020 ◽  
pp. 2003051
Author(s):  
Paul M. O'Byrne ◽  
Helen K. Reddel ◽  
Richard Beasley
Keyword(s):  
Severe Asthma ◽  
Maintenance Treatment ◽  
Inhaled Corticosteroids ◽  
Symptom Relief ◽  
Rapid Onset ◽  
Mild Asthma ◽  
Asthma Exacerbations ◽  
Reliever Medication ◽  
Asthma Patients ◽  
Long Acting

Inhaled corticosteroids (ICS) have been recommended as a maintenance treatment, either alone or together with long-acting inhaled β2-agonists, for all asthma patients. Short acting β2-agonists (SABA) are rapid onset bronchodilators, which provide symptom relief, but have no anti-inflammatory properties, yet are the most widely used as-needed reliever treatment for asthma, and often the only treatment prescribed. Asthma patients can find adhering to daily preventative medication with ICS difficult and will often revert to using as-needed SABA as their only treatment, increasing their risk of exacerbations. The purpose of this review was to evaluate the efficacy of reliever medications that contain an ICS when compared to SABA as a reliever, or to maintenance ICS and SABA as reliever, in mild asthma patients.Nine studies were identified which have evaluated the use of ICS as a component of an as-needed reliever in patients with mild asthma. Four of the most recent studies compared the combination of ICS/formoterol to SABA as reliever.An ICS containing reliever medication was superior to SABA as reliever alone, and was equivalent to maintenance ICS and SABA as reliever, particularly in reducing risks of severe asthma exacerbations, in studies which compared these reliever options.SABAs should not be used as a reliever without ICS. The concern about patients with mild asthma not being adherent to maintenance ICS, supports a recommendation that ICS/formoterol should be considered as a treatment option instead of maintenance ICS, to avoid the risk of patients reverting to SABA alone.

scholarly journals Association of the CFTR Gene With Asthma and Airway Mucus Hypersecretion

2020 ◽  
Author(s):  
Astrid Crespo Lessmann ◽  
Sara Bernal ◽  
Elisabeth del Río ◽  
Ester Rojas ◽  
Carlos Martínez-Rivera ◽  
...  
Keyword(s):  
Asthma Control ◽  
Genetic Variant ◽  
Severe Disease ◽  
Asthma Severity ◽  
Illumina Platform ◽  
Cross Sectional ◽  
Mucus Hypersecretion ◽  
Asthma Patients ◽  
Inflammatory Phenotype ◽  
Airway Mucus

Abstract IntroductionAirway mucus hypersecretion is an undercharacterized phenotype of asthma. Objectives(1) To determine the presence of genetic variants of the CFTR gene in patients with asthma with and without airway mucus hypersecretion. (2) To identify the characteristics of the asthma phenotype with airway mucus hypersecretion.MethodComparative cross-sectional multicentre study including 39 hypersecretors and 61 non-hypersecretors asthma patients. Asthmatic hypersecretion was defined as the presence of cough productive of sputum on most days for at least three months in two successive years. Spirometry, fractional exhaled nitric oxide, induced sputum cell count, blood test and questionnaires were performed. Blood DNA samples were sequenced using a MiSeq sequencer and the Illumina platform was used for the CFTR gene analysis.ResultsGenetic differences were observed in the c.1680-870T>A genetic variant of the CFTR gene, significantly more evident in hypersecretors than in non-hypersecretors: 78.94% vs. 59.32% in the majority allele and 21.05% vs. 40.67% in the minority allele (p=0.036). Asthma hypersecretors were older (57.4 years vs. 49.4 years; p=0.004) and had greater asthma severity (58.9% vs. 23.7%; p=0.005), greater airway obstruction (FEV1/FVC% 64.3 vs. 69.5; p=0.041), poorer asthma control (60% vs. 29%; p=0.021), and lower IgE levels (126.4 IU/mL vs. 407.6 IU/mL; p=0.003).ConclusionPatients with asthma and with mucus hypersecretion may have a different disease mechanism produced by an intronic genetic variant in the CFTR gene (NM_000492.3:c.1680-870T>A). They present a more severe disease, poorer asthma control and a non-allergic inflammatory phenotype.

scholarly journals An algorithmic approach for the treatment of severe uncontrolled asthma

2018 ◽  
Vol 4 (1) ◽  
pp. 00125-2017 ◽  
Author(s):  
Eleftherios Zervas ◽  
Konstantinos Samitas ◽  
Andriana I. Papaioannou ◽  
Petros Bakakos ◽  
Stelios Loukides ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Severe Disease ◽  
Treatment Options ◽  
Management Planning ◽  
Algorithmic Approach ◽  
Small Subgroup ◽  
Asthma Patients ◽  
New Treatment ◽  
Impaired Quality

A small subgroup of patients with asthma suffers from severe disease that is either partially controlled or uncontrolled despite intensive, guideline-based treatment. These patients have significantly impaired quality of life and although they constitute <5% of all asthma patients, they are responsible for more than half of asthma-related healthcare costs. Here, we review a definition for severe asthma and present all therapeutic options currently available for these severe asthma patients. Moreover, we suggest a specific algorithmic treatment approach for the management of severe, difficult-to-treat asthma based on specific phenotype characteristics and biomarkers. The diagnosis and management of severe asthma requires specialised experience, time and effort to comprehend the needs and expectations of each individual patient and incorporate those as well as his/her specific phenotype characteristics into the management planning. Although some new treatment options are currently available for these patients, there is still a need for further research into severe asthma and yet more treatment options.

scholarly journals Risk factors for the development of bronchiectasis in patients with asthma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Donghai Ma ◽  
María-Jesús Cruz ◽  
Iñigo Ojanguren ◽  
Christian Romero-Mesones ◽  
Diego Varona-Porres ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Asthma Control ◽  
Severe Asthma ◽  
Factors Associated ◽  
Asthmatic Patients ◽  
Asthma Exacerbations ◽  
Severe Asthmatic ◽  
Asthma Patients ◽  
High Age

AbstractThough asthma and bronchiectasis are two different diseases, their coexistence has been demonstrated in many patients. The aim of the present study is to compare the characteristics of asthmatic patients with and without bronchiectasis and to assess risk factors for the development of this condition. Two hundred and twenty-four moderate-severe asthmatic patients were included. The severity of bronchiectasis was assessed by Reiff and FACED parameters. Logistic regression was used to identify independent factors associated with bronchiectasis. Bronchiectasis was identified in 78 asthma patients. In severe asthma patients, its prevalence was 56.9%. Bronchiectasis was defined as mild in81% of patients using modified Reiff criteria and in 74% using FACED criteria. Asthmatic patients with bronchiectasis had decreasing FEV1, FVC and FEV1/FVC (p = 0.002, 0.005 and 0.014 respectively), presented more frequent asthma exacerbations (p < 0.001) and worse asthma control (ACT 21 vs 16pts, p < 0.001). Factors independently associated with bronchiectasis were older age (42–65 years: OR, 3.99; 95% CI 1.60 to 9.95, P = 0.003; ≥ 65 years: OR, 2.91; 95% CI 1.06 to 8.04, P = 0.039), severe asthma grade (OR, 8.91; 95% CI 3.69 to 21.49; P < 0.001) and frequency of asthma exacerbations (OR, 4.43; 95% CI 1.78 to 11.05; P < 0.001). In patients with severe asthma, age of asthma onset (OR, 1.02; 95% CI 1.01 to 1.04; P = 0.015) and asthma exacerbations (OR, 4.88; 95% CI 1.98 to 12.03; P = 0.001) were independently associated with the development of bronchiectasis. The prevalence of bronchiectasis in severe asthmatic patients is high. Age of asthma onset and exacerbations were independent factors associated with the occurrence of bronchiectasis.

scholarly journals Sensitisation to staphylococcal enterotoxins and asthma severity: a longitudinal study in the EGEA cohort

2019 ◽  
Vol 54 (3) ◽  
pp. 1900198 ◽  
Author(s):  
Ina Sintobin ◽  
Valerie Siroux ◽  
Gabriële Holtappels ◽  
Christophe Pison ◽  
Rachel Nadif ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Asthma Severity ◽  
Mild Asthma ◽  
Lower Airway ◽  
Cross Sectional ◽  
Prick Test ◽  
Asthma Exacerbations ◽  
Increased Risk ◽  
Disease Modifier ◽  
Subsequent Risk

IntroductionEvidence is accumulating that Staphylococcus aureus plays an important role as disease modifier in upper and lower airway diseases. Sensitisation to S. aureus enterotoxins (SEs) was associated with an increased risk of severe asthma in previous cross-sectional studies, but evidence from longitudinal studies is lacking. We aimed to assess associations between SE-sensitisation and the subsequent risk for asthma severity and exacerbations.MethodsThis is a nested case–control study from the 20-year Epidemiological Study of the Genetics and Environment of Asthma (EGEA) cohort, including 225 adults (75 without asthma, 76 with mild asthma and 74 with severe asthma) in EGEA2 (2003–2007). For 173 of these individuals, SE-sensitisation was measured on samples collected 11 years earlier (EGEA1). Cross-sectional associations were conducted for EGEA1 and EGEA2. Longitudinal analyses estimated the association between SE-sensitisation in EGEA1 and the risk of severe asthma and asthma exacerbations assessed in the follow-up. Models were adjusted for sex, age, smoking, parental asthma/allergy and skin-prick test to house dust mite.ResultsSE-sensitisation varied between 39% in controls to 58% and 76% in mild and severe asthma, respectively, in EGEA1. An adjusted cross-sectional association showed that SE-sensitisation was associated with an increased risk of severe, but not for mild asthma. SE-sensitisation in EGEA1 was associated with severe asthma (adjusted OR 2.69, 95% CI 1.18–6.15) and asthma exacerbations (adjusted OR 4.59, 95% CI 1.40–15.07) assessed 10–20 years later.ConclusionFor the first time, this study shows that being sensitised to SEs is associated with an increased subsequent risk of severe asthma and asthma exacerbations.

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