Cost-utility of as-needed ICS-formoterol versus to maintenance ICS in mild to moderate persistent asthma

Background Recent asthma guidelines, such as the Global Initiative for Asthma (GINA), recommend in adult patients as-needed inhaled corticosteroids (ICS)-formoterol as an alternative to maintenance ICS in mild to moderate persistent asthma. The introduction of these recommendations concerns whether using as-needed budesonide-formoterol would be more cost-effective than to maintenance ICS. This study aimed to evaluate the cost-effectiveness of as-needed combination low-dose budesonide-formoterol compared to short-acting β2-agonist (SABA) reliever therapy in patients with mild asthma. Methods A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with mild asthma in Colombia. Total costs and QALYs of low-dose budesonide-formoterol compared to short-acting β2-agonist (SABA) were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. Results The model suggests a potential gain of 0.37 QALYs and per patient per year on as-needed ICS-formoterol and a reduction in the discounted cost per person-year, of as-needed ICS-formoterol to maintenance ICS, of US$40. This position of dominance of as-needed ICS-formoterol negates the need to calculate an incremental cost-effectiveness ratio. In the deterministic and probabilistic sensitivity analysis, our base‐case results were robust to variations in all assumptions and parameters. Conclusion Low-dose budesonide-formoterol as a reliever was cost-effective when added to usual care in patients with mild asthma. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

Sinus bradycardia in a toddler with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19

This report documents a case of sinus bradycardia in a hospitalised 27-month-old girl with a history of moderate persistent asthma, recent suspected viral respiratory infection and suspicion for multisystem inflammatory syndrome in children (MIS-C). This patient developed profound sinus bradycardia during her hospitalisation despite an overall well clinical appearance and good outcome. Reports of bradycardia related to COVID-19 infection are few but growing in number. In this article, we discuss what has been observed in the literature about bradycardia in relation to COVID-19 and MIS-C. We also propose sinus bradycardia as a potential sign of MIS-C with recent respiratory symptoms, which would warrant close follow-up of such patients.

Factors associated with discrepancies between poor dyspnea perception and abnormal lung function in 65 asthmatic patients

Background: Dyspnea is a subjective symptom of asthma whose perception is characterized by an interindividual varia- bility. Poor dyspnea perception is usually associated with increased risk of exacerbation and may lead to inappropriate asth- ma management and under-treatment. We sought to identify factors associated with discrepancies between poor dyspnea perception and abnormal lung function in patients with moderate persistent asthma. Methodology: 65 patients, who attended their scheduled follow-up pulmonology consultation at Ibn Sina Hospital (Rabat - Morocco), underwent interrogation including modified Medical Research Council (mMRC) scale for dyspnea, physical examination and spirometry. Two groups, those with mMRC < 2 (poor dyspnea perceivers) and those with mMRC scale ≥ 2 were compared. Results: Poor dyspnea perception was found in 21 patients (32.3%). Associated factors were male sex (p : 0.03), low so- cio-economic income (p : 0.01), an onset of symptoms greater than 10 years (p : 0.01), BMI ≥ 25 Kg/m2 (p : 0.04) and depression (p : 0.04). Conclusion: The results revealed factors significantly associated with poor dyspnea perception despite an obstructive venti- latory disorder. These factors could usefully be considered to successfully manage asthma as well as the regular prescription of an objective test like spirometry. Keywords: Asthma; dyspnea perception; spirometry.

A complexidade em alergologia pediátrica: o doente polissensibilizado

AIMS: In the present study, the authors intend to demonstrate the advantages of molecular diagnosis in immunoallergology through the description of a clinical case.CASE DESCRIPTION: We present the case of a 9-year-old male, followed by pediatric immunoallergology with the diagnoses of moderate persistent asthma, persistent rhinitis, atopic eczema and food allergy with severe manifestations (several episodes of anaphylaxis). molecular profile of allergic sensitization contributed to better knowledge of the patient, therapeutic and even prognostic adequacy.CONCLUSIONS: The molecular allergy diagnostic tests, according to the analysis of the present case, allows the establishment and escalation in terms of severity of a more individualistic sensitization profile, which is especially important in the patient who is polysensitized and with reports of respiratory and food allergies.

Effect of Breathing Exercise With Buteyko Methods Improveing Forced Expiratory Volume In One Second (Fev1) Score With Moderate Persistent Asthma

Objective: to know effect of breathing exercise with buteyko methods improveing forced expiratory volume in one second (FEV1) score with moderate persistet asthma.Methods: The research design used in this study is quasy-experiment. With the independent variable is breathing exercise with buteyko method and the dependent variable is forced expiratory volume in one second (fev1) score. This study used a simple random sampling technique which consisted of 9 treatment groups and 9 control groups with pair t test statistical test and man whitney test.Result: The results of the analysis using the man whitney test in the treatment and control groups obtained pvalue = 0.001 thes it can be concluded that there are differences between treatment and control groups.Conclusion: It is expected that this study provides benefits and knowledge as an alternative therapy in increasing FEV1 valuesin patients with moderate persistent asthma, and can be useful for patients with moderate persistent asthma to be able to practice breathing exercises with buteyko method independently, and it is expected that future researchers can do research on the effect of exercise breathing with buteyko method in individuals with moderate persistent asthma with longer interventions and other variables.