Associations between sarcopenia with asthmatic prevalence, lung function and comorbidity

Background Sarcopenia was listed as a treatment trait in behavioral/risk factors of severe asthma, but studies between asthma and sarcopenia were scant. This study plans to determine the associations between sarcopenia with asthmatic prevalence, symptoms, lung function and comorbidity. Methods 15404 individuals from the China Health and Retirement Longitudinal Study(CHARLS) and 10263 individuals from Study on global AGEing and adult health(SAGE) in China were included in this study. Four components of this study were respectively used to assess bidirectional association in the prevalence between sarcopenia with asthma, and estimate the relationships between sarcopenia with asthmatic symptoms, lung function and comorbidity via generalized additive models. The 10-item Center for Epidemiological Studies–Depression Scale≥12 scores was classified as depression in CHARLS. Results In CHARLS and SAGE, the prevalence of sarcopenia in asthmatics was higher than those without asthma. Asthmatics with sarcopenia had a significantly increased prevalence of severe shortness of breath(sarcopenia yes vs no, adjusted OR=3.71, 95%CI: 1.43-9.60) and airway obstruction in SAGE(sarcopenia yes vs no, adjusted OR=6.82, 95%CI: 2.54-18.34) and an obvious reduction of PEF in CHARLS and SAGE(sarcopenia yes vs no, adjusted RR=0.86, 95%CI: 0.82-0.91) compared to asthmatics without sacropenia. The presence of sarcopenia was positively associated with the prevalence of chronic obstructive pulmonary disease(sarcopenia yes vs no, adjusted OR=5.76, 95%CI:2.01-16.5) and depression(sarcopenia yes vs no, adjusted OR=1.87, 95%CI:1.11-3.14) in asthmatics. Conclusions Our findings indicated that sarcopenia partakes in the development of asthma by affecting lung function and comorbidity and maybe considered a treatable trait of asthma management.

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.

Multi-Omics Profiling Approach to Asthma: An Evolving Paradigm

Asthma is a complex multifactorial and heterogeneous respiratory disease. Although genetics is a strong risk factor of asthma, external and internal exposures and their interactions with genetic factors also play important roles in the pathophysiology of asthma. Over the past decades, the application of high-throughput omics approaches has emerged and been applied to the field of asthma research for screening biomarkers such as genes, transcript, proteins, and metabolites in an unbiased fashion. Leveraging large-scale studies representative of diverse population-based omics data and integrating with clinical data has led to better profiling of asthma risk. Yet, to date, no omic-driven endotypes have been translated into clinical practice and management of asthma. In this article, we provide an overview of the current status of omics studies of asthma, namely, genomics, transcriptomics, epigenomics, proteomics, exposomics, and metabolomics. The current development of the multi-omics integrations of asthma is also briefly discussed. Biomarker discovery following multi-omics profiling could be challenging but useful for better disease phenotyping and endotyping that can translate into advances in asthma management and clinical care, ultimately leading to successful precision medicine approaches.

An Overview of the Obese-Asthma Phenotype in Children

Asthma is the most common chronic disease in childhood. Overweight and obesity are included among the comorbidities considered in patients with difficult-to-treat asthma, suggesting a specific phenotype of the disease. Therefore, the constant increase in obesity prevalence in children and adolescents raises concerns about the parallel increase of obesity-associated asthma. The possible correlation between obesity and asthma has been investigated over the last decade by different authors, who suggest a complex multifactorial relationship. Although the particular non-eosinophilic endotype of obesity-related asthma supports the concept that high body weight precedes asthma development, there is ongoing debate about the direct causality of these two entities. A number of mechanisms may be involved in asthma in combination with obesity disease in children, including reduced physical activity, abnormal ventilation, chronic systemic inflammation, hormonal influences, genetics and additional comorbidities, such as gastroesophageal reflux and dysfunctional breathing. The identification of the obesity-related asthma phenotype is crucial to initiate specific therapeutic management. Besides the cornerstones of asthma treatment, lifestyle should be optimized, with interventions aiming to promote physical exercise, healthy diet, and comorbidities. Future studies should clarify the exact association between asthma and obesity and the mechanisms underlying the pathogenesis of these two related conditions with the aim to define personalized therapeutic strategies for asthma management in this population.

Association between Asthma Control and Exposure to Greenness and Other Outdoor and Indoor Environmental Factors: A Longitudinal Study on a Cohort of Asthmatic Children

Achieving and maintaining asthma control (AC) is the main goal of asthma management. Indoor and outdoor environmental factors may play an important role on AC. The aim of this longitudinal study was to evaluate the association between AC and exposure to greenness and other outdoor or indoor environmental factors in a cohort of asthmatic children. This study involved 179 asthmatic children (5–16 years). Parents were interviewed through a modified version of the SIDRIA questionnaire. AC was assessed at each visit. Exposure to greenness was measured using the normalized difference vegetation index (NDVI). A logistic regression model was applied for assessing risk factors for uncontrolled asthma (UA). Low NDVI exposure was a risk factor for UA (OR: 2.662, 95% CI (1.043–6.799)); children exposed to passive smoke during pregnancy had a higher risk of UA than those non-exposed to passive smoke during pregnancy (OR: 3.816, 95% CI (1.114–13.064)); and a unit increase in the crowding index was associated with an increased risk of UA (OR: 3.376, 95% CI (1.294–8.808)). In conclusion, the current study provided a comprehensive assessment of urban-related environmental exposures on asthma control in children, using multiple indicators of greenness and other outdoor or indoor environmental factors.

Impact of COVID-19 on people with asthma: a mixed methods analysis from a UK wide survey

IntroductionThe impact of acute COVID-19 on people with asthma appears complex, being moderated by multiple interacting disease-specific, demographic and environmental factors. Research regarding longer-term effects in this group is limited. We aimed to assess impacts of COVID-19 and predictors of persistent symptoms, in people with asthma.MethodsUsing data from an online UK-wide survey of 4500 people with asthma (median age 50–59 years, 81% female), conducted in October 2020, we undertook a mixed methods analysis of the characteristics and experience of those reporting having had COVID-19.ResultsThe COVID-19 group (n=471, 10.5%) reported increased inhaler use and worse asthma management, compared with those not reporting COVID-19, but did not differ by gender, ethnicity or household income. Among the COVID-19 group, 56.1% reported having long COVID, 20.2% were ‘unsure’. Those with long COVID were more likely than those without long COVID to describe: their breathing as worse or much worse after their initial illness (73.7% vs 34.8%, p<0.001), increased inhaler use (67.8% vs 34.8%, p<0.001) and worse or much worse asthma management (59.6% vs 25.6%, p<0.001). Having long COVID was not associated with age, gender, ethnicity, UK nation or household income.Analysis of free text survey responses identified three key themes: (1) variable COVID-19 severity, duration and recovery; (2) symptom overlap and interaction between COVID-19 and asthma; (3) barriers to accessing healthcare.ConclusionsPersisting symptoms are common in people with asthma following COVID-19. Measures are needed to ensure appropriate healthcare access including clinical evaluation and investigation, to distinguish between COVID-19 symptoms and asthma.

Perceptions Towards Childhood Asthma and Barriers To Its Management Among Patients, Caregivers and Healthcare Providers: A Qualitative Study From Ethiopia

Background The management of asthma, which is one of the major causes of childhood morbidity and mortality has been affected by non-adherence to recommended treatment regimens with severe consequences. The aim of the present study was therefore to explore the perceptions of the children with asthma, their caregivers and their healthcare providers towards asthma and barriers to long term childhood asthma management in an institutional setting in Addis Ababa, Ethiopia. Methods A qualitative descriptive design was followed for the present study that used individual interviews as a data collection method. The study participants were 23 pairs of children with asthma that had treatment follow ups in two tertiary hospitals and their caregivers and eight healthcare providers who cared for these children. The data was analyzed using thematic analysis approach. Results The study findings revealed that the children and their caregivers were facing physical, emotional and social burdens related with asthma and reported low adherence to their recommended treatment regimens. Factors affecting childhood asthma management were found to be limited awareness about asthma and its management and inadequate education received from healthcare professionals. Non-adherence to especially inhaled corticosteroids appears to be influenced by necessity beliefs towards chronic administration of treatment regimens and concerns related with difficulty of administration, fear of side effects and general bad attitude towards it, in addition to their low availability and affordability. Conclusions Varied perceptions about asthma and its management were reported by children with asthma and their caregivers compared to the biomedical recommendation that were related to different factors. This in turn may contribute to the low adherence of the children to their recommended regimens and suboptimal health outcomes. The findings support the need for strong asthma care and education programs that are sensitive to local and individual patients’ and family perceptions and experiences including emotional distress and of the need to institute chronic care approach.