To determine the association between asthma severity and hospital admission measured by Pediatric Respiratory Assessment Measure (PRAM) score at Indus Hospital and Health Network, Karachi, Pakistan, 2020-2021

Objectives: To determine the association between asthma severity and the likelihood of hospitalization by using Pediatric Respiratory Assessment Measure (PRAM) score for pediatric patients who present to the emergency department (ED) with mild, moderate or severe asthma exacerbations and those who received standard intensive asthma therapy. Methods: This was a retrospective study conducted in children aged between 2 to 14 years. The data was entered and analysed using Statistical Package for the Social Sciences (SPSS) version 21. To be included in the study, the children must have received “intensive asthma therapy” defined as administration of systemic corticosteroids with three albuterol treatments and ipratropium. Results: A total of 437 patients were enrolled in the study out of which 250 were male and 187 were female. The mean age was 6.1 ± 3.4 years with a minimum age of two and a maximum age of 14 years. The 4-hour PRAM score (AUC = 0.88) overall significantly improved the predictive value of admission (p value <0.001) as compared to the PRAM score calculated at triage (AUC = 0.81). Conclusion: The 4-hour PRAM score is the best predictor for the need of hospitalization. It is suggested that these results are applied clinically in the pediatric ED to improve patient flow and to better facilitate intensive therapy of patients at triage to decrease the need for hospitalization. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5783 How to cite this:Kazi U, Gul Rukh S, Zawawi S, Laila S, Fareeduddin M, Saleem SG. To determine the association between asthma severity and hospital admission measured by Pediatric Respiratory Assessment Measure (PRAM) score at Indus Hospital and Health Network, Karachi, Pakistan, 2020-2021. Pak J Med Sci. 2022;38(2):345-350. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5783 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Selection of therapy in smoking patients with bronchial asthma

Despite the evidence and logical fact that smoking and asthma are incompatible, many patients are smoke. The proportion of smokers among asthmatics is comparable to the proportion of smokers in the population. The proportion of smokers among asthmatics is comparable to the proportion of smokers in the population. Currently, the prevalence of tobacco use in the Russian Federation remains high at over 20%. In addition to active smoking, patients may be exposed to the negative effects of tobacco smoke through secondhand smoke. Smokers with asthma are more likely to have signs of poor disease control, and are more likely to seek exacerbation. However, a therapy strategy for them has not been worked out. For many randomized trials, patient smoking is the exclusion criterion, and therefore the effectiveness of a particular anti-asthma therapy in smokers is poorly understood. In addition, it is a known fact that smoking develops resistance to the main anti-asthma therapy, inhalation glucocorticosteroids. The article discusses the mechanism of exposure to tobacco smoke on lung tissue, the development of pathological processes under the influence of components of tobacco smoke and possible solutions to the problem. The mechanism of inflammatory and anti-inflammatory effects of various components of tobacco smoke. Particular attention is paid to the role of cysteinyl leukotrienes in the formation of inflammation in the lower respiratory tract in smoking patients with asthma and the possibility of treating these patients with leukotriene receptor antagonists. A review of studies conducted in patients with bronchial asthma and exposure to tobacco smoke in whom montelukast was used as therapy is presented. Provides information on the safety and side effects of the drug.

The correlation between self-related adherence, asthma-related quality of life and control of asthma in adult patients

Objectives Medication non-adherence mostly occurs in patients with a wide range of disease severity, including asthma. The aim of the study was to assess the self reported adherence to asthma therapy and investigate the relationship between adherence, asthma control and asthma-related quality of life. Methods The study was a cross-sectional study in which participants were recruited from an outpatient department, in one hospital in Surabaya. Patients (aged≥18 years) with asthma who had used any regular asthma medications were included. Standardised questionnaires, including Juniper’s Asthma Control Questionnaire (ACQ), Adherence to Refills and Medications Scales (ARMS) and Juniper’s Asthma Quality of Life Questionnaire (AQLQ) were used. Results A total of 82 adults with asthma were recruited in the study. Male participants’ mean age was 49.13 ± 14.10 years (n = 23). Approximately 59 participants (72.0%) were females, 30 participants (36.5%) were using Budesonide inhaler, and 73 participants (89.0%) never smoked. The mean of ACQ, AQLQ, and ARMS scores were 1.62 ± 1.19, 4.96 ± 1.24, and 16.98 ± 4.12, respectively. Of 82 patients studied 53 (64.6 %) had “uncontrolled asthma” and more than 85% participants both showed “non adherence” to asthma therapy and nearly 46% of them indicated that their quality of life was affected by asthma. There was a significant association between ACQ and AQLQ (p<0.05), whereas no statistically significant association was found between ACQ and ARMS. Conclusions The majority of patients reported non-adherence to asthma medications. Poor controlled asthma has been associated with lower asthma-related quality of life.

Evaluation of Solar-Powered Battery Systems for Individuals Using Electricity-Dependent Medical Devices in Puerto Rico Following Hurricane Maria

Objectives: To determine if solar-powered battery systems could be successfully used for electricity-dependent medical devices by families during a power outage. Methods: We assessed the use of and satisfaction with solar-powered battery systems distributed to 15 families following Hurricane Maria in rural Puerto Rico. Interviews were conducted in July 2018, 3 mo following distribution of the systems. Results: The solar-powered battery systems powered refrigeration for medications and prescribed diets, asthma therapy, inflatable mattresses to prevent bedsores, and continuous positive airway pressure machines for sleep apnea. Despite some system problems, such as inadequate power, defective cables, and blown fuses, families successfully dealt with these issues with some outside help. Almost all families were pleased with the systems and a majority would recommend solar-powered battery systems to a neighbor. Conclusions: Families accepted and successfully used solar-powered battery systems to power medical devices. Solar-powered battery systems should be considered as alternatives to generators for power outages after hurricanes and other disasters. Additional research and analysis are needed to inform policy on increasing access to such systems.

Synthesis and Regulation of Th2 Cell And Il–4 As Target for Asthma Therapy

Salah satu karakteristik dari penyakit asma adalah terjadinya reaksi hipersensitivitas di saluran respirasi manusia. Hal ini disebabkan oleh reaksi peradangan pada otot polos pada bronkus. Pengobatan asma yang paling bayak diketahui adalah bronkodilator dengan prinsip kerjanya menurunkan respons otot polos bronkus terhadap sitokin – sitokin pro-inflamasi. Namun, penggunaan obat bronkodilator ini menyebabkan efek samping yang tidak diharapkan. Di sisi lain, pengobatan asma yang langsung menargetkan penyebab reaksi hipersensitivitas seperti faktor pro-inflamasi IL-4 jarang dibahas. Oleh karena itu, tinjauan literatur ini akan membahas potensi obat baru yang menargetkan regulasi IL-4 dan Th2. Kumpulan data diambil dengan cara mencari beberapa studi dan tinjauan yang sudah dilakukan sebelumnya. Dalam tinjauan literatur ini, ditemukan bahwa terdapat potensi obat asma yang menargetkan langsung ke IL-4, Th2, dan faktor transkripsi.