Real-World Prescribing Pattern of Asthma Management in China: A Retrospective, Descriptive Analysis

Background Asthma is a chronic inflammatory disorder of the airway that requires long-term medication management. Objective To describe the real-world prescribing patterns for asthma management in the Chinese population. Methods A retrospective analysis of 8,732 patients from January 2011 to September 2019 in 10 hospitals was conducted. Prescribing patterns of short-acting beta-agonists (SABA), long-acting beta-agonists (LABA), inhaled corticosteroids (ICS), intravenous corticosteroids, antihistamines, leukotriene receptor antagonists (LTRA), theophylline, antibiotics, and Chinese patent medicines were included in the analysis. Chi-square and logistic regression were calculated. P value of <0.05 was considered as statistical significance. Results ICS/LABA were prescribed for 2,940 (33.67%) patients with stable asthma and 141 (31.4%) patients with asthma exacerbations. LTRA was prescribed in 2,006 (22.97%) patients with stable asthma, and 86 (19.15%) patients with asthma exacerbations. Systemic antibiotics (46.1Z%), systemic corticosteroids (57.91%), and theophylline (51.45%) were frequently prescribed during exacerbations. A total of 5,766 patients (64.95%) were managed with traditional Chinese medication (TCM); 3237 patients (36.47%) received western medicine. Patients using ICS/LABA (P=0.019) and SABA (P=0.008) had a significantly lower rate of asthma exacerbations. Conclusions This study provides valuable insight into clinical practices of asthma management in China. Poor adherence to clinical reports was identified. Efforts are required to improve the quality of asthma care.

Association of genetic variants of oxidative stress responsive kinase 1 (OXSR1) with asthma exacerbations in non-smoking asthmatics

Background Asthma exacerbation threatens patient's life. Several genetic studies have been conducted to determine the risk factors for asthma exacerbation, but this information is still lacking. We aimed to determine whether genetic variants of Oxidative Stress Responsive Kinase 1 (OXSR1), a gene with functions of salt transport, immune response, and oxidative stress, are associated with exacerbation of asthma. Methods Clinical data were obtained from 1454 asthmatics and single nucleotide polymorphisms (SNPs) of OXSR1 were genotyped. Genetic associations with annual exacerbation rate were analyzed depending on smoking status. Results Eleven SNPs were selected using Asian data in the International HapMap database. The common allele of rs1384006 C > T of OXSR1 showed a significantly higher annual exacerbation rate than the rare allele in non-smoking asthmatics (CC vs. CT vs. TT: 0.43 ± 0.04 vs. 0.28 ± 0.03 vs. 0.31 ± 0.09, P = 0.004, Pcorr = 0.039). The frequent exacerbators had a significantly higher frequency of the common allele of rs1384006 C > T than did the infrequent exacerbators (74.4% vs. 55.2%, P = 0.004, Pcorr = 0.038). Conclusion The common allele of rs1384006 C > T of OXSR1 was associated with the asthma exacerbation rate and a higher risk of being a frequent exacerbator, indicating that non-smoking asthmatics who carry common alleles may be vulnerable to asthma exacerbations.

Saudi Arabian real-life experience with biologic therapy in severe asthma

Background: Severe asthma (SA) is a common health problem associated with increased morbidity and mortality and high medical costs. Biological therapies have emerged in recent decades as promising treatment options for patients with high type 2 (T2) SA. This retrospective observational study from Saudi Arabia aimed to investigate the effects of additional biologics therapy on reducing oral corticosteroid (OCS) consumption, frequency of asthma exacerbations, improvement in lung function, and asthma control.Methods: This multicenter observational study enrolled a cohort of 97 patients from Mach 2019 to February 2021. Outcomes of anti-IgE, anti-IL5/IL5R, and anti-IL4R therapies in severe type 2 asthma were recorded and analyzed in terms of number of exacerbations (emergency visits or hospitalizations required), asthma symptoms, and use of oral corticosteroids, blood eosinophil count, asthma control according to GINA classification, and FEV1 before and during biologic therapy.Results: Ninety-seven patients were included in the analysis The mean age was 46.7±14.1 years, and 69.1% of them were female. The average duration of biological treatment was 16.4±6.8 months. At the time of data collection, the four biologic therapies reduced the exacerbation rate per year from 82/97 (84.5%) to 14/97 (14.4%) with a percent improvement of 83% from 2.9 per year in the year before biologic treatment to 1.6 per year (p<0.001). OCS was reduced from 75/97 (77.3%) to 10/97 (10.3%) for a percent improvement of 86.7%, and the average OCS dose decreased from 7.12 mg to 6.8 mg. Mean blood eosinophil count also decreased after biologic therapy from 750.5±498.5 to 188.0±122.4 cells/μl, most significant result achieved with benralizumab, and mean FEV1 improved from 59.0±12.9% to 76.0±10.2%, most significant result achieved with omalizumab. ll patients had uncontrolled asthma before biologics therapy, but asthma control improved by 91.8% after treatment.Conclusions: Biologic as add-on therapy for high T2 SA was found to reduce asthma exacerbations, systemic glucocorticoid doses, and SA symptoms.

Unraveling the Relationship of Asthma and COVID-19

Viral infections are one of the main causes of asthma exacerbations. During the COVID-19 era, concerns regarding the relationship of SARS-CoV2 with asthma have been raised. The concerns are both for COVID severity and asthma exacerbations. Many studies on COVID-19 epidemiology and comorbidities have assessed whether asthma represents a risk factor for SARS-CoV2 infection and/or more severe course of the disease. This review covers the current evidence on the prevalence of asthma in COVID-19 and its association with susceptibility to and severity of SARS-CoV2 infection. It will examine the possible role of underlying asthma severity in COVID-19 related outcomes as well as the molecular mechanisms involved in the co-existence of these entities. The possible role of asthma inflammatory phenotypes will also be evaluated. Finally, the impact of asthma comorbidities and the implications of asthma medication on COVID-19 will be addressed.

Real-World Prescribing Pattern of Asthma Management in China: A Retrospective, Descriptive Analysis

Background: Asthma is a chronic inflammatory disorder of the airway that requires long-term medication management. Objective: To describe the real-world prescribing patterns for asthma management in the Chinese population. Methods: A retrospective analysis of 8,732 patients from January 2011 to September 2019 in 10 hospitals was conducted. Prescribing patterns of short-acting beta-agonists (SABA), long-acting beta-agonists (LABA), inhaled corticosteroids (ICS), intravenous corticosteroids, antihistamines, leukotriene receptor antagonists (LTRA), theophylline, antibiotics, and Chinese patent medicines were included in the analysis. Chi-square and logistic regression were calculated. A P value of <0.05 was considered as statistical significance.Results: ICS/LABA were prescribed for 2,940 (33.67%) patients with stable asthma and 141 (31.4%) patients with asthma exacerbations. LTRA was prescribed in 2,006 (22.97%) patients with stable asthma, and 86 (19.15%) patients with asthma exacerbations. Systemic antibiotics (46.1Z%), systemic corticosteroids (57.91%), and theophylline (51.45%) were frequently prescribed during exacerbations. A total of 5,766 patients (64.95%) were managed with traditional Chinese medication (TCM); 3237 patients (36.47%) received western medicine. Patients using ICS/LABA (P=0.019) and SABA (P=0.008) had a significantly lower rate of asthma exacerbations.Conclusions: This study provides valuable insight into clinical practices of asthma management in China. Poor adherence to clinical reports was identified. Efforts are required to improve the quality of asthma care.

Exhaled Metabolite Patterns to Identify Recent Asthma Exacerbations

Asthma is a chronic respiratory disease that can lead to exacerbations, defined as acute episodes of worsening respiratory symptoms and lung function. Predicting the occurrence of these exacerbations is an important goal in asthma management. The measurement of exhaled breath by electronic nose (eNose) may allow for the monitoring of clinically unstable asthma and exacerbations. However, data on its ability to perform this is lacking. We aimed to evaluate whether eNose could identify patients that recently had asthma exacerbations. We performed a cross-sectional study, measuring exhaled breath using the SpiroNose in adults with a physician-reported diagnosis of asthma. Patients were randomly divided into a training (n = 252) and validation (n = 109) set. For the analysis of eNose signals, principal component (PC) and linear discriminant analysis (LDA) were performed. LDA, based on PC1-4, reliably discriminated between patients who had a recent exacerbation from those who had not (training receiver operating characteristic (ROC)–area under the curve (AUC) = 0.76,95% CI 0.69–0.82), (validation AUC = 0.76, 95% CI 0.64–0.87). Our study showed that, exhaled breath analysis using eNose could accurately identify asthma patients who recently had an exacerbation, and could indicate that asthma exacerbations have a specific exhaled breath pattern detectable by eNose.