Journal articles on the topic 'Asthma severity score'
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YUNG, M., M. SOUTH, and T. BYRT. "Evaluation of an asthma severity score." Journal of Paediatrics and Child Health 32, no. 3 (June 1996): 261–64. http://dx.doi.org/10.1111/j.1440-1754.1996.tb01567.x.
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Çiftci, Nurdan, Emine Vezir, and Bülent Alioğlu. "Assessment of Clinical Asthma Score and Asthma Severity Score in Preschool Children with Recurrent Wheezing." Asthma Allergy Immunology 19, no. 3 (December 22, 2021): 136–41. http://dx.doi.org/10.21911/aai.607.
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Objective: There is no definitive consensus on asthma exacerbation scoring for preschool children with recurrent wheezing. The Clinical Asthma Score (CAS) and Asthma Severity Score (ASS) are two scoring systems that can be used in this population. The aim of this study was to evaluate the relationship between CAS and ASS, acute treatment, and exacerbation outcomes in preschool children with wheezing. Materials and Methods: The study included 70 patients aged 2-5 years who presented to the pediatric emergency department due to an acute wheezing episode. CAS and ASS were evaluated at exacerbation presentation and after initial salbutamol therapy. Results: Presenting scores were significantly higher among patients who had three or more episodes within the last year (p=0.01 for CAS, p=0.019 for ASS). Presenting scores were significantly higher in patients treated with systemic steroid therapy during the episode compared to those who were not (p=0.006 for CAS; p=0.003 for ASS). CAS and ASS predicted the use of acute steroid therapy with a sensitivity of 73.7% and 52.6%, and predicted hospitalization with a sensitivity of 95% and 82.5%, respectively. Conclusion: Our data suggest that these scoring systems can be used to judge the need for systemic steroid therapy and that high scores are associated with greater likelihood of hospital admission. Keywords: Asthma score, children, hospitalization, wheezing, exacerbation
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Dankner, R., L. Olmer, A. Ziv, and A. G. Bentancur. "A simplified severity score for acute asthma exacerbation." Journal of Asthma 50, no. 8 (July 15, 2013): 871–76. http://dx.doi.org/10.3109/02770903.2013.810243.
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Eisner, Mark D., Ashley Yegin, and Benjamin Trzaskoma. "Severity of Asthma Score Prospectively Predicts Clinical Outcomes." Chest 138, no. 4 (October 2010): 823A. http://dx.doi.org/10.1378/chest.9792.
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Smith, Sharon R., Jack D. Baty, and Dee Hodge. "Validation of the Pulmonary Score: An Asthma Severity Score for Children." Academic Emergency Medicine 9, no. 2 (February 2002): 99–104. http://dx.doi.org/10.1197/aemj.9.2.99.
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Arnold, Donald H., Tebeb Gebretsadik, Thomas J. Abramo, Karel G. Moons, James R. Sheller, and Tina V. Hartert. "The RAD score: a simple acute asthma severity score compares favorably to more complex scores." Annals of Allergy, Asthma & Immunology 107, no. 1 (July 2011): 22–28. http://dx.doi.org/10.1016/j.anai.2011.03.011.
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Prasanna, R., Fayrouz Moidu, and Sekar Pasupathy. "Pediatric respiratory assessment measure score in assessing the severity of acute asthma in children." International Journal of Contemporary Pediatrics 6, no. 3 (April 30, 2019): 1211. http://dx.doi.org/10.18203/2349-3291.ijcp20192014.
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Background: Asthma is a chronic inflammatory disease of the lung airways resulting in episodic airflow obstruction. Management of acute pediatric asthma depends on assessment of asthma severity which is difficult in children due to poor coordination. This study is to evaluate the usefulness of a simple yet effective alternative like Pediatric respiratory assessment measure (PRAM) score in assessing the severity and outcome of an acute exacerbation of wheeze in children and to identify the PRAM score predicting the need for hospitalization.Methods: A prospective cohort study was done on 127 children for a period of 2 months in 2018, admitted with acute exacerbation of wheeze using PRAM scores at admission and following each treatment modalities. Usefulness of score in assessing severity was evaluated.Results: Increasing severity was associated with increasing initial PRAM score. Initial mean PRAM score of 11 in severe persistent forms, 7 in moderate persistent, 6.73 in mild persistent and 5.37 in mild intermittent was found. 59.1% of patients had a positive family history. The most common trigger factor according to our study was viral upper respiratory tract infection (50.4%) followed by exposure to dust (13.4%). Patients who were admitted to the Pediatric Intensive Care Unit (PICU) had the maximum number of interventions.Conclusions: In our study, statistically it was proved that PRAM Score is a tool that can be used across different ages and PRAM Score is a tool that can be used to assess severity of asthma.
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Elnady, Hala G., Lobna S. Sherif, Rania N. Sabry, Dina Abu Zeid, Hanan Atta, Amal I. Hassanain, Walaa A. Fouad, Thanaa Rabah, and Ayman A. Gobarah. "Relation of Asthma Control with Quality of Life among a Sample of Egyptian Asthmatic School Children." Open Access Macedonian Journal of Medical Sciences 7, no. 17 (August 13, 2019): 2780–85. http://dx.doi.org/10.3889/oamjms.2019.649.
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BACKGROUND: Asthma is considered a chronic health illness that not only resulted in physical symptoms but also emotional effects. It is; therefore, so important to assess the quality of life of asthmatic patients besides their level of disease control.
AIM: To determine the correlation of asthma control with the health-related quality of life (HRQOL) of asthmatic children in Egypt.
METHODS: One hundred and twenty-eight asthmatic Egyptian children were enrolled in the study. They were subjected to asthma severity grading, asthma control questionnaire (ACQ) and pediatric asthma quality of life questionnaire (PAQLQ). Studied cases were taken from 6 primary and preparatory schools, Giza governorate.
RESULTS: The mean child control score was significantly higher in not well-controlled asthmatics compared to well-controlled asthmatics (p < 0.005). The not well controlled asthmatic children showed significantly lower activity limitation score, symptoms score, and overall asthmatic score compared to controlled asthmatic children (p < 0.05). The severity of asthma shows significant positive correlation with symptoms score, emotional function score and overall asthmatic score (p < 0.05).
CONCLUSION: The quality of life for the asthmatic children is strongly correlated with the level of asthma control and severity.
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Calciano, Lucia, Angelo Guido Corsico, Pietro Pirina, Giulia Trucco, Deborah Jarvis, Christer Janson, and Simone Accordini. "Assessment of asthma severity in adults with ever asthma: A continuous score." PLOS ONE 12, no. 5 (May 18, 2017): e0177538. http://dx.doi.org/10.1371/journal.pone.0177538.
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Foster, C. N., N. M. Rafaels, Y. J. Tsai, T. Murray, M. Stockton-Porter, E. Horowitz, H. Watson, and K. C. Barnes. "Does FEV1/FVC Correlate with Asthma Severity Score in Monitoring Asthma Control?" Journal of Allergy and Clinical Immunology 123, no. 2 (February 2009): S206. http://dx.doi.org/10.1016/j.jaci.2008.12.785.
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Campbell, Adam P., Katie M. Phillips, Lloyd P. Hoehle, Robert A. Gaudin, David S. Caradonna, Stacey T. Gray, and Ahmad R. Sedaghat. "Association between Asthma and Chronic Rhinosinusitis Severity in the Context of Asthma Control." Otolaryngology–Head and Neck Surgery 158, no. 2 (September 5, 2017): 386–90. http://dx.doi.org/10.1177/0194599817728920.
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Objective Comorbid asthma is associated with decreased quality of life (QOL) in chronic rhinosinusitis (CRS). It is unclear whether this association is independent of the patients’ clinical asthma status. We therefore sought to determine if asthma is associated with lower QOL in CRS, independent of asthma control. Study Design Cross-sectional cohort study of 350 patients with CRS. Setting Tertiary academic rhinology clinic. Subjects and Methods In total, 350 participants with CRS were recruited and 28.3% were asthmatic. CRS-specific QOL was measured using the 22-item Sinonasal Outcome Test (SNOT-22). Asthma control was assessed with the Asthma Control Test (ACT). General health-related QOL was assessed with the EuroQoL 5-dimensional general health-related quality of life survey visual analog scale (EQ-5D VAS). Associations were sought between SNOT-22 and EQ-5D VAS (dependent variables) and asthma (independent variable), while controlling for ACT. ACT score for patients with CRS without asthma was set at 25 (indicating completely controlled, asymptomatic asthma). Results Comorbid asthma was associated with SNOT-22 (β = 11.8; 95% confidence interval [CI], 6.2-17.3; P < .001) and EQ-5D VAS (β = −6.2; 95% CI, −11.2 to −1.3; P = .014). After controlling for ACT, asthma was no longer associated with SNOT-22 ( P = .147) or EQ-5D VAS ( P = .994). Instead, ACT score was associated with SNOT-22 (β = −2.1; 95% CI, −3.2 to −1.1; P < .001) and EQ-5D VAS (β = 2.1; 95% CI, 1.1 to 3.0; P < .001). ACT score completely drove the association between asthma and worse QOL. Conclusion Comorbid asthma is not necessarily reflective of decreased QOL in CRS. The association of comorbid asthma with lower QOL in CRS is related to the clinical status (eg, control) of asthma.
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Matsunaga, Natasha Yumi, Maria Angela Gonçalves de Oliveira Ribeiro, Ivete Alonso Bredda Saad, André Moreno Morcillo, José Dirceu Ribeiro, and Adyléia Aparecida Dalbo Contrera Toro. "Evaluation of quality of life according to asthma control and asthma severity in children and adolescents." Jornal Brasileiro de Pneumologia 41, no. 6 (December 2015): 502–8. http://dx.doi.org/10.1590/s1806-37562015000000186.
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ABSTRACT OBJECTIVE: To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents. METHODS: We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global Initiative for Asthma, respectively. The patients also completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validated for use in Brazil, in order to evaluate their quality of life. RESULTS: The mean age of the patients was 11.22 ± 2.91 years, with a median of 11.20 (7.00-17.60) years. We selected 100 patients, of whom 27, 33, and 40 were classified as having controlled asthma (CA), partially controlled asthma (PCA), and uncontrolled asthma (UA), respectively. As for asthma severity, 34, 19, and 47 were classified as having mild asthma (MiA), moderate asthma (MoA), and severe asthma (SA), respectively. The CA and the PCA groups, when compared with the NCA group, showed higher values for the overall PAQLQ score and all PAQLQ domains (activity limitation, symptoms, and emotional function; p < 0.001 for all). The MiA group showed higher scores for all of the PAQLQ components than did the MoA and SA groups. CONCLUSIONS: Quality of life appears to be directly related to asthma control and asthma severity in children and adolescents, being better when asthma is well controlled and asthma severity is lower.
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Boeschoten, Shelley, Matthijs de Hoog, Martin Kneyber, Peter Merkus, Annemie Boehmer, and Corinne Buysse. "Current practices in children with severe acute asthma across European PICUs: an ESPNIC survey." European Journal of Pediatrics 179, no. 3 (December 3, 2019): 455–61. http://dx.doi.org/10.1007/s00431-019-03502-9.
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AbstractMost pediatric asthma guidelines offer evidence-based or best practice approaches to the management of asthma exacerbations but struggle with evidence-based approaches for severe acute asthma (SAA). We aimed to investigate current practices in children with SAA admitted to European pediatric intensive care units (PICUs), in particular, adjunct therapies, use of an asthma severity score, and availability of a SAA guideline. We designed a cross-sectional electronic survey across European PICUs. Thirty-seven PICUs from 11 European countries responded. In 8 PICUs (22%), a guideline for SAA management was unavailable. Inhaled beta-agonists and anticholinergics, combined with systemic steroids and IV MgSO4 was central in SAA treatment. Seven PICUs (30%) used a loading dose of a short-acting beta-agonist. Eighteen PICUs (49%) used an asthma severity score, with 8 different scores applied. Seventeen PICUs (46%) observed an increasing trend in SAA admissions.Conclusion: Variations in the treatment of children with SAA mainly existed in the use of adjunct therapies and asthma severity scores. Importantly, in 22% of the PICUs, a SAA guideline was unavailable. Standardizing SAA guidelines across PICUs in Europe may improve quality of care. However, the limited number of PICUs represented and the data compilation method are constraining our findings.What is Known:• Recent reports demonstrate increasing numbers of children with SAA requiring PICU admission in several countries across the world.• Most pediatric guidelines offer evidence-based approaches to the management of asthma exacerbations, but struggle with evidence-based approaches for SAA beyond these initial steps.What is New:• A large arsenal of adjunct therapies and 8 different asthma scores were used.• In a large number of PICUs, a written guideline for SAA management is lacking.
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Gorelick, Marc H., Molly W. Stevens, Theresa R. Schultz, and Philip V. Scribano. "Performance of a Novel Clinical Score, the Pediatric Asthma Severity Score (PASS), in the Evaluation of Acute Asthma." Academic Emergency Medicine 11, no. 1 (January 2004): 10–18. http://dx.doi.org/10.1111/j.1553-2712.2004.tb01365.x.
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Gorelick, Marc H., Molly W. Stevens, Theresa R. Schultz, and Philip V. Scribano. "Performance of a Novel Clinical Score, the Pediatric Asthma Severity Score (PASS), in the Evaluation of Acute Asthma." Academic Emergency Medicine 11, no. 1 (January 2004): 10–18. http://dx.doi.org/10.1197/j.aem.2003.07.015.
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Maue, Danielle K., Nadia Krupp, and Courtney M. Rowan. "Pediatric asthma severity score is associated with critical care interventions." World Journal of Clinical Pediatrics 6, no. 1 (2017): 34. http://dx.doi.org/10.5409/wjcp.v6.i1.34.
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McBride, Sarah C., Kendall McCarty, Jackson Wong, Marc Baskin, Denise Currier, and Vincent W. Chiang. "A pediatric hospital‐wide asthma severity score: Reliability and effectiveness." Pediatric Pulmonology 57, no. 5 (March 28, 2022): 1223–28. http://dx.doi.org/10.1002/ppul.25861.
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Gitomer, Sarah A., Cynthia R. Fountain, Todd T. Kingdom, Anne E. Getz, Stefan H. Sillau, Rohit K. Katial, and Vijay R. Ramakrishnan. "Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis." Otolaryngology–Head and Neck Surgery 155, no. 1 (March 15, 2016): 173–78. http://dx.doi.org/10.1177/0194599816637856.
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Objective (1) Describe clinical and histopathologic findings in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). (2) Determine if tissue and serum eosinophilia predicts disease severity in CRSwNP. Study Design Case series with chart review. Setting Academic hospital specializing in respiratory and allergic disease. Subjects Patients with CRSwNP treated from 2008 to 2010. Methods Clinical data were collected; sinus computed tomography (CT) scans were scored according to the Lund-Mackay system; and surgical specimens were evaluated for degree of tissue eosinophilia. Statistical analysis was performed to compare eosinophilia with indicators of disease severity. Results Seventy CRSwNP patients were included, with a mean Lund-Mackay score of 16.7; 62.1% of patients had severe asthma, and 62.9% were aspirin sensitive. Elevated tissue eosinophil level did not correlate with medication usage, olfactory symptoms, or Lund-Mackay scores, nor did it correlate with presence of asthma or aspirin-sensitivity (P = .09). Patients with mild asthma had significantly more tissue eosinophils versus patients with severe asthma, possibly because of the high amount of chronic corticosteroid use in severe asthmatics. There was no correlation between tissue and serum eosinophil counts (P = .97), but there was a significant positive correlation between CT score and peripheral eosinophil level (P < .05). Conclusions Higher serum eosinophil levels may indicate more extensive mucosal disease as measured on CT scan. Neither serum nor tissue eosinophilia predicted disease severity in our retrospective analysis of CRSwNP patients, and serum eosinophil level did not serve as a marker of tissue eosinophilia.
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Dhillon, R. K., M. Bellolio, and J. L. Anderson. "411: Correlation of Pediatric Asthma Severity Score and End Tidal CO2 Values With Asthma Severity in the Pediatric Population." Annals of Emergency Medicine 54, no. 3 (September 2009): S130. http://dx.doi.org/10.1016/j.annemergmed.2009.06.451.
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Moschovis, Peter P., Mengdi Lu, Douglas Hayden, Lael M. Yonker, Jesiel Lombay, Elsie Taveras, Alexy Arauz Boudreau, et al. "Effect modification by age of the association between obstructive lung diseases, smoking, and COVID-19 severity." BMJ Open Respiratory Research 8, no. 1 (November 2021): e001038. http://dx.doi.org/10.1136/bmjresp-2021-001038.
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IntroductionObstructive lung diseases (asthma and chronic obstructive pulmonary disease (COPD)) and smoking are associated with greater risk of respiratory infections and hospitalisations, but conflicting data exist regarding their association with severity of COVID-19, and few studies have evaluated whether these associations differ by age.ObjectivesTo examine the associations between asthma, COPD and smoking on the severity of COVID-19 among a cohort of hospitalised patients, and to test for effect modification by age.MethodsWe performed a retrospective analysis of electronic health record data of patients admitted to Massachusetts General Hospital, assigning the maximal WHO Clinical Progression Scale score for each patient during the first 28 days following hospital admission. Using ordered logistic regression, we measured the association between maximal severity score and asthma, COPD and smoking and their interaction with age.Measurements and main resultsAmong 1391 patients hospitalised with COVID-19, we found an increased risk of severe disease among patients with COPD and prior smoking, independent of age. We also found evidence of effect modification by age with asthma and current smoking; in particular, asthma was associated with decreased COVID-19 severity among older adults, and current smoking was associated with decreased severity among younger patients.ConclusionsThis cohort study identifies age as a modifying factor for the association between asthma and smoking on severity of COVID-19. Our findings highlight the complexities of determining risk factors for COVID-19 severity, and suggest that the effect of risk factors may vary across the age spectrum.
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Jochmann, Anja, Luca Artusio, Hoda Sharifian, Angela Jamalzadeh, Louise J. Fleming, Andrew Bush, Urs Frey, and Edgar Delgado-Eckert. "Fluctuation-based clustering reveals phenotypes of patients with different asthma severity." ERJ Open Research 6, no. 2 (April 2020): 00007–2019. http://dx.doi.org/10.1183/23120541.00007-2019.
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Serial peak expiratory flow (PEF) measurements can identify phenotypes in severe adult asthma, enabling more targeted treatment. The feasibility of this approach in children has not been investigated.Overall, 105 children (67% male, median age 12.4 years) with a range of asthma severities were recruited and followed up over a median of 92 days. PEF was measured twice daily. Fluctuation-based clustering (FBC) was used to identify clusters based on PEF fluctuations. The patients’ clinical characteristics were compared between clusters.Three PEF clusters were identified in 44 children with sufficient measurements. Cluster 1 (27% of patients: n=12) had impaired spirometry (mean forced expiratory volume in 1 s (FEV1) 71% predicted), significantly higher exhaled nitric oxide (≥35 ppb) and uncontrolled asthma (asthma control test (ACT) score <20 of 25).Cluster 2 (45%: n=20) had normal spirometry, the highest proportion of difficult asthma and significantly more patients on a high dose of inhaled corticosteroids (≥800 µg budesonide).Cluster 3 (27%: n=12) had mean FEV1 92% predicted, the highest proportion of patients with no bronchodilator reversibility, a low ICS dose (≤400 µg budesonide), and controlled asthma (ACT scores ≥20 of 25).Three clinically relevant paediatric asthma clusters were identified using FBC analysis on PEF measurements, which could improve telemonitoring diagnostics. The method remains robust even when 80% of measurements were removed. Further research will determine clinical applicability.
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Eisner, Mark D., Ashley Yegin, and Benjamin Trzaskoma. "Severity of Asthma Score Predicts Clinical Outcomes in Patients With Moderate to Severe Persistent Asthma." Chest 141, no. 1 (January 2012): 58–65. http://dx.doi.org/10.1378/chest.11-0020.
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Morjaria, Jaymin B., Alan S. Rigby, and Alyn H. Morice. "Symptoms and exacerbations in asthma: an apparent paradox?" Therapeutic Advances in Chronic Disease 10 (January 2019): 204062231988438. http://dx.doi.org/10.1177/2040622319884387.
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Background: There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are commonly thought to be associated. The aim of this study was to analyse asthma symptoms of cough, wheeze, chest tightness and breathlessness in an uncontrolled asthma cohort. We also examined the effect of maintenance and reliever therapy (MART) on these symptoms and its effect on exacerbation rate. Methods: Adults with uncontrolled asthma electronically recorded their asthma symptom severity scores twice-daily over a period of 48 weeks following randomisation to beclometasone/formoterol twice daily plus pro re nata (prn) salbutamol or MART. Subjects with symptom scores of ⩾2 (ranging from 0 to 3 for each symptom) were considered more symptomatic, whereas those below a score of 2 were considered less severe. The influence treatment on exacerbation frequency and symptom profiles were then correlated. Results: Of the 1701 subjects in the analyses, 1403 were symptomatic with ⩾100 symptom episodes for one symptom. The remaining 298 subjects were classified as pauci-symptomatic. There was poor association between the frequency and symptom severity score for each symptom. Surprisingly, wheeze was the least reported symptom. Females were more likely to be polysymptomatic. MART compared with prn salbutamol markedly attenuated severe asthma exacerbations. This effect was most notable in subjects with fewer symptoms. Conclusions: In uncontrolled asthma, there is a poor correlation between reported symptoms and exacerbation frequency. This post hoc analysis suggests that MART should not be reserved for symptomatic subjects but achieves the greatest benefit in pauci-symptomatic patients with asthma. Trial registration: ClinicalTrials.gov identifier: NCT00861926
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Krishnan, Elango, Venmugil Ponnusamy, and Sathiya Priya Sekar. "Trial of vitamin D supplementation to prevent asthma exacerbation in children." International Journal of Research in Medical Sciences 5, no. 6 (May 27, 2017): 2734. http://dx.doi.org/10.18203/2320-6012.ijrms20172479.
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Background: To assess the level of vitamin D in children with bronchial asthma and to study the effects of vitamin D supplementation in asthmatic children who had vitamin D deficiency in terms of asthma control test score and Number of exacerbations.Methods: This interventional study was conducted in Department of Paediatrics, KAPV Government medical college, Trichy, Tamil Nadu, India from September 2016 to February 2017. 96 asthmatic children of age group 5-12 years who attended outpatient department and admitted in ward for asthma exacerbation were selected. After assessing their Vitamin D level, Vitamin D supplementation given along with standard treatment for asthma. Outcomes measured were ACTS (Asthma control test score), number of emergency room visits, number of hospital admissions and reliever medication use.Results: Out of 96 children, 83 (86.4%) children had vitamin D deficiency. There was significant correlation between vitamin D level and absolute eosinophil count (p-value-0.037), asthma severity (p-value<0.001) and asthma control (p-value<0.001). Significant reduction in emergency room visits, (p-value<0.001) reliever medication use (p-value<0.001) and improvement in asthma control test score (p-value-0.008) occurs after vitamin D supplementation.Conclusions: There is a significant correlation between vitamin D level, asthma severity and its control. Asthma exacerbation in terms of emergency room visits and reliever medication use were further reduced by vitamin D supplementation.
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Teoh, Laurel, Ian M. Mackay, Peter P. Van Asperen, Jason P. Acworth, Mark Hurwitz, John W. Upham, Weng Hou Siew, et al. "Presence of atopy increases the risk of asthma relapse." Archives of Disease in Childhood 103, no. 4 (October 11, 2017): 346–51. http://dx.doi.org/10.1136/archdischild-2017-312982.
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ObjectivesTo describe the point prevalence of respiratory viruses/atypical bacteria using PCR and evaluate the impact of respiratory viruses/atypical bacteria and atopy on acute severity and clinical recovery in children with hospitalised and non-hospitalised asthma exacerbations.DesignThis was a prospective study performed during 2009–2011.SettingThe study was performed in the emergency departments of two hospitals.Patients244 children aged 2–16 years presenting with acute asthma to the emergency departments were recruited. A nasopharyngeal aspirate and allergen skin prick test were performed.Main outcome measuresThe outcomes were divided into (1) acute severity outcomes (Australian National Asthma Council assessment, hospitalisation, Functional Severity Scale, Acute Asthma Score, asthma quality of life questionnaires for parents (PACQLQ) on presentation, asthma diary scores (ADS) on presentation and length of hospitalisation) and (2) recovery outcomes (PACQLQ for 21 days, ADS for 14 days and representation for asthma for 21 days).ResultsPCR for viruses/atypical bacteria was positive in 81.7% of children (75.1% human rhinovirus, codetection in 14.2%). Mycoplasma pneumoniae and Chlamydophila pneumoniae were rarely detected. The presence of micro-organisms had little impact on acute asthma or recovery outcomes. Children with atopy were significantly more likely to relapse and represent for medical care by day 14 (OR 1.11, 95% CI 1.00 to 1.23).ConclusionsThe presence of any viruses is associated with asthma exacerbations but does not appear to influence asthma recovery. In contrast, atopy is associated with asthma relapse. M. pneumoniae and C. pneumoniae are rare triggers of acute asthma in young children.
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Phull, G., D. Prue, C. Martinez, K. Scheffey, and D. Pillai. "MP9: SINO-NASAL 5 QUESTIONNAIRE PREDICTS POOR ASTHMA CONTROL IN CHILDREN WITH PERSISTENT ASTHMA." Journal of Investigative Medicine 64, no. 3 (February 25, 2016): 808.1–808. http://dx.doi.org/10.1136/jim-2016-000080.21.
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Purpose of StudyUp to 80% of asthmatic children may experience upper airway symptoms, including rhinitis, often perceived as coming from lower airways. Asthma diagnosis, classification and assessment of control are defined by the National Asthma Education Prevention Program (NAEPP) 2007 guidelines, but may understate the impact of the upper airway. We explored associations between Sino-Nasal 5 (SN-5) quality of life questionnaire, validated in radiographic confirmed sinus disease, and NAEPP asthma impairment in children. We hypothesize that children with NAEPP defined uncontrolled asthma will have abnormal SN-5 scores.Methods UsedWe performed a retrospective chart review of children (1–21 yr) referred to a pediatric pulmonary clinic for persistent asthma. Data collected include age, gender, BMI%, NAEPP asthma severity, SN-5, asthma control (TRACK children <5 y, ACT children ≥5 y) and pulmonary function testing (PFT). The primary analysis was to identify associations between SN-5 scores and levels of NAEPP guideline impairment: daytime symptoms, night time awakenings, activity interference and PFTs. Significant SN-5 scoring was defined as ≥3.5 based on prior studies. PFT was performed in children ≥5 y. Statistical analysis with SPSS 22.Summary of Results76 children were evaluated; 38% female, mean age 6.9 y and mean BMI% 69%. Significant SN-5 score (≥3.5 vs. <3.5) was associated with decreased control of daytime symptoms (OR 0.16 [95% CI:0.06–0.44]), night time awakenings (OR 0.09 [0.03–0.29]), activity interference (OR 0.2 [0.06–0.68]) and asthma control (OR 0.32 [0.12–0.85]). Those with SN-5 ≥3.5 had poor asthma control based on TRACK (p<0.002) and ACT (p<0.001). Age, gender, BMI%, asthma severity and PFTs were not associated with SN-5.ConclusionsIn persistent asthmatic children, NAEPP defined daytime, night time, activity related impairment and poor asthma control were associated with a significant SN-5 score; PFTs and NAEPP asthma severity were not. This suggests that upper airways may play a larger role in lower airway associated symptoms, and that SN-5 may be beneficial in assessing asthma symptoms. Recognizing and treating upper airway symptoms, an understated area in asthma guidelines, might improve overall asthma control. A prospective analysis in a larger cohort is recommended to evaluate these findings.
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Ramanathan, R., and B. Mahalakshmi. "Comparison of efficacy between levosalbutamol and levosalbutamol-ipratropum nebulization in mild to moderate childhood asthma." International Journal of Contemporary Pediatrics 6, no. 5 (August 23, 2019): 1952. http://dx.doi.org/10.18203/2349-3291.ijcp20193597.
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Background: The objective of the study was to compare the efficacy between levosalbutamol and ipratropium combination over levosalbutamol nebulisation in reversing airflow obstruction and improve oxygenation, evaluated using the pulmonary asthma score, SaO2, and PEFR in mild and moderate asthma.Methods: A prospective, randomized, study was performed in RMMCH pediatric emergency department. Children between 6 and 12 years of age who presented with mild to moderate asthma exacerberations were enrolled in the study. They were randomly allocated into two different groups: one nebulised with levosalbutamol alone and another with addition of ipratropium bromide to levosalbutamol. Baseline Peak expiratory flow rate and Final absolute values or change from baseline 60-120 minutes after the inhalation are measured. Patients were evaluated using the pulmonary score.Results: After treatment there is improvement in the mean pulmonary asthma scores and PEFR percentage in A+B group than A group, but it is not statistically significant (p value >0.05). There is statistically significant improvement in pulmonary asthma score and PEFR in each of the groups after nebulisation and pulmonary asthma score has a sensitivity of 66.7% and 65.6% in diagnosing severity of asthma in relation to PEFR.
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Côté, Johanne, André Cartier, Patricia Robichaud, Hélène Boutin, Jean-Luc Malo, Michel Rouleau, and Louis-Philippe Boulet. "Influence of Asthma Education on Asthma Severity, Quality of Life and Environmental Control." Canadian Respiratory Journal 7, no. 5 (2000): 395–400. http://dx.doi.org/10.1155/2000/787980.
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BACKGROUND:Several studies have examined the influence of asthma education, focusing mainly on the use of health services.OBJECTIVES:To assess the influence of an asthma education program (AEP) on airway responsiveness, asthma symptoms, patient quality of life (QOL) and environmental control.DESIGN:A prospective, randomized, controlled study with parallel groups.SETTING:Three tertiary care hospitals in Quebec.POPULATION:One hundred and eighty-eight patients with moderate to severe asthma.INTERVENTION:After optimization of asthma treatment with inhaled corticosteroids, patients were randomly assigned to receive either an education program based on self-management (group E) or usual care (control group C).RESULTS:One year after an AEP, there was a significant decrease in the number of days per month without daytime asthma symptoms in group E only (P=0.03). Asthma daily symptom scores decreased significantly in group E in comparison with group C (P=0.006). QOL scores improved markedly in both groups after treatment optimization during the run-in period (P<0.01). After an AEP, the QOL score increased further in group E patients in comparison with group C patients (P=0.04). The concentration of methacholine that induces a 20% fall in forced expiratory volume in 1 s (PC20) improved significantly in both groups (group E 1.2±1.1 to 2.4±0.2, group C 1.5±1.2 to 2.4±1.3, P<0.01). After one year, 26 of 37 patients from group E sensitized to house dust mites (HDM) adopted the specific measures recommended to reduce their exposure to HDM, while none of the 21 subjects from group C did (P<0.001). Among the patients sensitized to cats or dogs, 15% of patients from group E and 23% of patients in group C no longer had a pet at home at the final visit (P>0.5).CONCLUSIONS:One year after the educational intervention, it was observed that the program had added value over and above that of optimization of medication and regular clinical follow-ups. The education program was highly effective in promoting HDM avoidance measures but minimally effective for removing domestic animals, suggesting that more efficient strategies need to be developed for the latter.
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Mohammadzadeh, Iraj, Sorena Darvish, Durdi Qujeq, Mahmoud Hajiahmadi, and Mostafa Vaghari-Tabari. "Association of serum 25-OH vitamin D3 with serum IgE and the Pediatric Asthma Severity Score in patients with pediatric asthma." Allergy and Asthma Proceedings 41, no. 2 (March 1, 2020): 126–33. http://dx.doi.org/10.2500/aap.2020.41.190025.
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Background: Pediatric asthma is a prevalent disease and has a significant immunologic and inflammatory nature. In recent years, the role of vitamin D3 in immunologic processes has been studied, and many aspects of this role have been clarified in some human diseases. Objective: The aim of this study was to evaluate the relationship among the vitamin D3 status, Pediatric Asthma Severity Score (PASS), and inflammatory indicators of pediatric asthma. Methods: Among all of the pediatric patients with asthma and with asthma exacerbation, 100 patients were randomly enrolled in the study and subdivided into three groups according to serum levels of 25-OH vitamin D3. The control group consisted of 100 sex- and age-matched healthy subjects. Asthma exacerbation severity was evaluated based on the PASS before starting the medical care. The count of the white blood cells, eosinophil count, and serum levels of total immunoglobulin E (IgE) plus 25-OH vitamin D3 were measured in all the subjects. The obtained data were then compared via proper statistical tests. A p value of <0.05 was considered as statistically significant. Results: The median level of serum IgE was increased in patients with vitamin D3 deficiency compared with other groups. There was a significant inverse correlation between serum levels of 25-OH vitamin D3 and IgE in pediatric patients with asthma (r = ‐0.483, p = 0.001). Furthermore, the serum levels of 25-OH vitamin D3 also significantly inversely correlated with the PASS (r = ‐0.285, p = 0.004). Conclusion: Vitamin D3 deficiency is associated with exacerbation severity and serum IgE levels in patients with pediatric asthma; hence, it can have an important role in pediatric asthma pathogenesis, possibly through IgE.
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Leont’eva, N. M., I. V. Demko, E. A. Sobko, and O. P. Ishchenko. "Level of asthma symptom control and adherence to treatment in young patients." Russian Medical Inquiry 4, no. 4 (2020): 180–85. http://dx.doi.org/10.32364/2587-6821-2020-4-4-180-185.
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Background: asthma is a highly variable disease, with changes in the severity over months and years. In addition to achieving asthma control, many patients experience challenges in the long-term maintenance of this condition. Good symptom control is a volatile entity even in mild asthma. The loss of asthma control is accounted for by poor adherence to treatment due the fears of taking hormonal therapy, contact with an allergen, respiratory viral infections, and the inconvenience of using the inhaler resulting in incorrect inhaler technique. Aim: to assess the control over asthma and adherence to treatment in young patients with mild-to-moderate asthma. Patients and Methods: 146 patients with verified mild-to-moderate asthma were examined. All patients were divided into two groups based on disease severity. Results: at the time of examination, the lack of the control over asthma symptoms was reported in 89% of the patients. In mild asthma, mean Asthma Control Test (AST) score was 17 [15; 21] and АCQ-5 (Asthma Control Questionnaire) score was 1.8 [1.4; 2.2]. Meanwhile, in moderate asthma, mean AST score was 15 [12; 21] and АCQ-5 score was 1.8 [1.4; 2.2]. Poor medication adherence measured by the Morisky Green Levine Medication Adherence Scale was revealed in 94% of the patients with mild asthma and 91% of the patients with moderate asthma. Conclusion: poor patient’s knowledge on asthma and little awareness of the long-term importance of regular basic therapy are the critical factors contributing to poor medication adherence. Therefore, novel approaches to patient education as well as optimized and personalized therapeutic strategies are currently important for achieving and maintaining the control over asthma symptoms. KEYWORDS: asthma, asthma control, stable course, young patients, adherence to treatment. FOR CITATION: Leont’eva N.M., Demko I.V., Sobko E.A., Ishchenko O.P. Level of asthma symptom control and adherence to treatment in young patients. Russian Medical Inquiry. 2020;4(4):180–185. DOI: 10.32364/2587-6821-2020-4-4-180-185.
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Keskin, O., S. Balaban, M. Keskin, E. Kucukosmanoglu, B. Gogebakan, M. Y. Ozkars, S. Kul, H. Bayram, and Y. Coskun. "Relationship between exhaled leukotriene and 8-isoprostane levels and asthma severity, asthma control level, and asthma control test score." Allergologia et Immunopathologia 42, no. 3 (May 2014): 191–97. http://dx.doi.org/10.1016/j.aller.2012.09.003.
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Youssef, Doaa Mohammed, Rabab Mohamed Elbehidy, Dina Mahamoud Shokry, and Eman Mohamed Elbehidy. "The influence of leptin on Th1/Th2 balance in obese children with asthma." Jornal Brasileiro de Pneumologia 39, no. 5 (September 2013): 562–68. http://dx.doi.org/10.1590/s1806-37132013000500006.
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OBJECTIVE: In individuals with asthma, obesity induces the production of leptin and is associated with disease severity. Our objective was to evaluate the levels of serum leptin and their effect on Th1/Th2 balance in obese and non-obese children with asthma, as well as to investigate the association between serum leptin levels and clinical outcomes. METHODS: We evaluated 50 atopic children with physician-diagnosed moderate-to-severe persistent asthma and 20 controls. The children with asthma were divided into two groups, by body mass index percentile: obese (n = 25) and non-obese (n = 25). From all subjects, we collected peripheral blood samples in order to determine the levels of leptin, IFN-γ, and IL-4. Asthma severity was assessed by an asthma symptom score, and the results were correlated with the parameters studied. RESULTS: Serum leptin levels were significantly higher in the obese asthma group than in the non-obese asthma group, as well as being significantly higher in the children with asthma than in the controls, whereas IFN-γ levels were significantly higher and IL-4 levels were significantly lower in the obese asthma group than in the non-obese asthma group. In addition, the obese asthma group showed higher asthma symptom scores and significantly lower FEV1 (% of predicted) than did the non-obese asthma group. There was a significant positive correlation between leptin and IFN-γ levels only in the obese asthma group. CONCLUSIONS: Although leptin is involved in the pathogenesis of asthma in obese and non-obese children, its effect is more pronounced in the former. In the presence of high leptin levels, only obese children with asthma exhibited Th1 polarization, with higher IFN-γ levels and greater asthma severity.
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Megalaa, R., G. Phull, D. Prue, K. Scheffey, and D. Pillai. "MP15: PEDIATRIC SLEEP QUESTIONNAIRE DETECTS SLEEP DISORDERED BREATHING IN ASTHMATICS WITH POOR NIGHTTIME CONTROL." Journal of Investigative Medicine 64, no. 3 (February 25, 2016): 811.1–811. http://dx.doi.org/10.1136/jim-2016-000080.27.
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Purpose of StudyUp to 35% of asthmatic children have degrees of sleep disordered breathing (SDB) which may be perceived as uncontrolled asthma. Asthma diagnosis, classification and assessment of control are defined by the National Asthma Education Prevention Program (NAEPP) 2007 guidelines and include nighttime awakenings as one asthma impairment category. Unclear whether this stems from asthma or SDB. The Pediatric Sleep Questionnaire (PSQ) is validated to identify SDB in children; however associations with specific levels of NAEPP guideline's asthma related impairment have not been evaluated. We hypothesize that asthmatic children with impairment only in NAEPP nighttime awakenings, but not other categories, will have a positive PSQ score (>0.33), suggesting screening for SDB.Methods UsedWe performed a retrospective chart review of children (age 1–21 yrs) referred to a pediatric pulmonary clinic. Data collected included age, gender, BMI%, spirometry, PSQ, asthma control (TRACK <5 yrs, ACT ≥5 yrs), and NAEPP asthma severity, control and impairment. Significant PSQ scoring is >0.33 based on previous validation. Spirometry was performed in children ≥5 yrs. Statistical analysis performed with SPSS 22.Summary of Results76 inner-city children were included in this study; 38% female, mean age 6.9 y, and mean BMI% 69%. Significant PSQ scoring (>0.33 vs ≤0.33) was associated with night time awakenings (OR 11.4 [95% CI:3.7–35.2]) and decreased asthma control seen in TRACK (p<0.003) and ACT questionnaires (p<0.001). Overweight/obese status (BMI% ≥85), spirometry, asthma severity, activity interference and daytime symptoms were not associated with a significant PSQ score.ConclusionsIn asthmatic children, impairment in night time awakenings as defined by NAEPP guidelines was associated with a significant PSQ score, and poor asthma control, based on abnormal TRACK and ACT scores, however other NAEPP categories of impairment; daytime symptoms, activity interference, asthma severity and control, were not. This suggests that screening SDB with the PSQ in children with night time awakenings based on NAEPP criteria may detect underlying SDB. This may lead to further investigations, treatment and subsequent improvement in asthma symptoms. A prospective analysis in a larger cohort is recommended to validate these findings.
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Sposato, Bruno. "Predicted Values for Spirometry may Underestimate Long-Standing Asthma Severity." Open Respiratory Medicine Journal 10, no. 1 (November 30, 2016): 70–78. http://dx.doi.org/10.2174/1874306401610010070.
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Background: Asthma may show an accelerated lung function decline. Asthmatics, although having FEV1 and FEV1/VC (and z-scores) higher than the lower limit of normality, may show a significant FEV1 decline when compared to previous measurements. We assessed how many asymptomatic long-standing asthmatics (LSA) with normal lung function showed a significant FEV1 decline when an older FEV1 was taken as reference point. Methods: 46 well-controlled LSA (age: 48.8±12.1; 23 females) with normal FEV1 and FEV1/VC according to GLI2012 references (FEV1: 94.8±10.1%, z-score:-0.38±0.79; FEV1/VC: 79.3±5.2, z-score:-0.15±0.77) were selected. We considered FEV1 decline, calculated by comparing the latest value to one at least five years older or to the highest predicted value measured at 21 years for females and 23 for males. A FEV1 decline >15% or 30 ml/years was regarded as pathological. Results: When comparing the latest FEV1 to an at least 5-year-older one (mean 8.1±1.4 years between 2 measurements), 14 subjects (30.4%) showed a FEV1 decline <5% (mean: -2.2±2.6%), 19 (41.3%) had a FEV1 5-15% change (mean: -9.2±2.5%) and 13 (28.3%) a FEV1 decrease>15% (mean: -18.3±2.4). Subjects with a FEV1 decline>30 ml/year were 28 (60.8%). When using the highest predicted FEV1 as reference point and declines were corrected by subtracting the physiological decrease, 6 (13%) patients showed a FEV1 decline higher than 15%, whereas asthmatics with a FEV1 loss>30 ml/year were 17 (37%). Conclusion: FEV1 decline calculation may show how severe asthma actually is, avoiding a bronchial obstruction underestimation and a possible under-treatment in lots of apparent “well-controlled” LSA with GLI2012-normal-range lung function values.
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Alobid, Isam, Sara Cardelus, Pedro Benitez, Jose Maria Guilemany, Jordi Roca-Ferrer, Cesar Picado, Manuel Bernal-Sprekelsen, and Joaquim Mullol. "Persistent asthma has an accumulative impact on the loss of smell in patients with nasal polyposis." Rhinology journal 49, no. 5 (December 1, 2011): 519–24. http://dx.doi.org/10.4193/rhino10.295.
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Background: Loss of sense of smell is one of the most frequent complaints in patients with nasal polyposis (NP). The aim of this study was to evaluate the impact of asthma and its severity on the sense of smell. Material and methods: Patients with massive NP and healthy controls were included. More than half of patients presented with asthma. Olfactometry by Barcelona Smell Test 24, nasal symptoms score, nasal endoscopy, allergy study, and paranasal sinus CT scan were assessed. Results: NP patients showed a significant impairment in smell detection, identification, and forced choice compared to the control. Asthmatics reported lower scores for detection, identification, and forced choice than non-asthmatic patients. Patients with persistent asthma had an increased impairment of sense of smell on detection, identification, and forced choice than patients with intermittent asthma. No significant differences were found between mild, moderate, and severe persistent asthmatics. Paranasal sinuses opacification was inversely correlated with smell detection, identification and forced choice. Conclusion: These findings suggest that patients with NP have an impaired sense of smell, that asthma -particularly persistent asthma- has a further impact on sense of smell, and that loss of smell may be used as a clinical tool to identify the severity of both NP and asthma.
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Douros, Konstantinos, Dafni Moriki, Olympia Sardeli, Barbara Boutopoulou, Vasiliki Papaevangelou, Angeliki Galani, and Kostas Priftis. "Assessment and management of asthma exacerbations in an emergency department unit." Allergologia et Immunopathologia 51, no. 1 (January 1, 2023): 74–76. http://dx.doi.org/10.15586/aei.v51i1.720.
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Background: The Pediatric Respiratory Assessment Measure (PRAM) score is a useful tool for the assessment of asthma exacerbations in children. This study aimed to estimate the risk of hospitalization in children, assessed with the PRAM score and having mild–moderate asthma exacerbation, who were treated with salbutamol delivered via a metered-dose inhaler and spacer (MDI/S). Methods: The study population consisted of children aged 3–16 years with mild–moderate asthma exacerbations. All children received 1mg/kg prednisolone p.o. (max 40 mg) and 4–6 puffs of salbutamol via MDI/S. Results: Fifty patients participated in the study. Admission was associated positively with the initial PRAM score (OR: 18.91, CI: 2.42–123.12, P = 0.005) and negatively with the improvement in PRAM score (OR: 0.52, CI: 0.01–0.78, P = 0.032). Conclusion: PRAM is a reliable tool that can be used effectively to estimate the asthma exac-erbation severity.
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Paterson, NA, JK Peat, CM Mellis, W. Xuan, and AJ Woolcock. "Accuracy of asthma treatment in schoolchildren in NSW, Australia." European Respiratory Journal 10, no. 3 (March 1, 1997): 658–64. http://dx.doi.org/10.1183/09031936.97.10030658.
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Insufficient use of anti-inflammatory drugs, such as inhaled corticosteroids and cromoglycate, may contribute to the disease burden associated with asthma. Conversely, aggressive treatment of mild disease may result in avoidable costs and/or adverse drug effects. The aim of this study was to determine the relationship between asthma severity and inhaled corticosteroid/cromoglycate use in a large (n=4,909) random sample of children, aged 8-11 yrs, in NSW, Australia. Asthma and its treatment were assessed by questionnaire responses. Asthma, defined as diagnosis plus current wheeze, was present in 901 children (18% of the sample), of whom 225 (5%) had moderate asthma, defined as asthma plus additional symptoms (sleep disturbance), utilization (hospital, casualty), or disability (reduced activity, school absence). Use of inhaled corticosteroid/cromoglycate was reported by 636 children (13% of the sample). Determinants of use included: asthma diagnosis, current wheeze, and troublesome dry nocturnal cough. There was also a strong relationship between anti-inflammatory treatment and a multicomponent asthma severity score constructed for each child. Inhaled corticosteroids and/or cromoglycate were used by 56% of the children with asthma (24% daily) and by 76% of children with moderate asthma (42% daily). Undertreatment, defined as less than daily inhaled corticosteroids/cromoglycate in moderate asthma, was identified in 130 children (14% of those with asthma or 3% of the sample). Conversely, apparently aggressive treatment, defined as inhaled corticosteroid/cromoglycate use in children with persistent minimal symptoms (asthma severity score of less than 3) was identified in 101 children (2% of the sample). Although there were significant differences between regions in the choice of anti-inflammatory drugs and in the prevalence both of undertreatment and apparently aggressive treatment, there was no clear relationship to regional utilization of emergency and hospital services for asthma. Nevertheless, the frequency of undertreatment suggests an opportunity to reduce asthma morbidity by more consistent application of current therapeutic guidelines.
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Ay, Arzu, Hülya Ucaryılmaz, Ayca Emsen, and Hasibe Artaç. "The Relationship Between Body-Mass Index, Central Obesity and Asthma in Children." Asthma Allergy Immunology 19, no. 1 (April 30, 2021): 24–31. http://dx.doi.org/10.21911/aai.546.
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Objective: We hypothesized that, compared with body mass index (BMI) alone, central obesity would provide added information regarding types of asthma (allergic, nonallergic) and asthma severity. Materials and Methods: A total of 150 children aged between 7-17 years with 50 allergic asthma, 50 nonallergic asthma and 50 controls were included in the study. Height, weight, waist and hip circumferences of the groups were measured. Waist-to-hip ratio and BMI were calculated. Pulmonary function test results were recorded. The relation between anthropometric measurements, asthma, atopy, obesity and each other was analyzed. Results: Obesity according to BMI was higher in the group with allergic asthma than nonallergic asthma and the control group (p: 0.014). A positive correlation was found between asthma and BMI percentile, BMI z score and waist-to-hip ratio (p: 0.002; 0.003; 0.040, respectively). Children with obesity according to waist circumference were more frequent in the groups with allergic and nonallergic asthma compared to the control group (p: 0.048). There was a significant relationship between asthma severity and central obesity (p: 0.048). FEV1 / FVC and FEF25-75 were lower in the asthmatic groups compared to the control group (p: 0.028; 0.012, respectively). Conclusion: This study showed that central obesity was associated with asthma and asthma severity, but not with atopy. More investigation is needed to clarify how central obesity in children affects the control of asthma and the response to asthma medication. Keywords: Childhood asthma, central obesity, waist-to-hip ratio, body mass index
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Kirrane, Michelle, Rob Cunney, Roisin McNamara, and Ike Okafor. "P40 The effect of a pharmacist-led inhaler technique assessment, education and training intervention on asthma control test scores in a paediatric hospital outpatient setting." Archives of Disease in Childhood 103, no. 2 (January 19, 2018): e2.44-e2. http://dx.doi.org/10.1136/archdischild-2017-314585.49.
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BackgroundStudies have consistently demonstrated that the correct and effective use of inhaler therapy reduces the frequency and severity of asthma symptoms and thus improves asthma control. Pharmacists are particularly well positioned to educate and train patients in the correct use of their inhaled therapy.1 They are often the last healthcare professionals to have contact with patients prior to the use of prescribed inhaled medication.2 This places pharmacists in an opportune situation for patient counselling with regard to inhaler technique. An extensive literature search revealed that pharmacist-led inhaler technique assessment and training has not, to my knowledge, been carried out in the paediatric population in a hospital setting.AimTo determine if pharmacist-led inhaler technique assessment, education and training improves asthma control scores in the paediatric population (4–16 years).MethodThis prospective single-centre interventional study was undertaken in patients with a confirmed diagnosis of asthma between the 1 st April and 30th June 2014. Those prescribed inhaled therapy prior to attendance at clinic, were referred to the investigating pharmacist. Patients with concurrent respiratory conditions and those under the age of four were excluded. The pharmacist delivered structured inhaler technique assessment and practical training with regard to correct inhaler technique. Additional educational advice was provided and baseline asthma control scores recorded.ResultsThe results of this study show that inhaler technique assessment, education and training in a single session by a hospital based clinical pharmacist significantly improved ACT scores [Baseline Score=19.33±3.312, Follow-up Score=21.75±2.701, (p=0.04)] and cACT scores [Baseline Score=19.50±4.993, Follow-up Score=21.04±4.647, (p=0.047)].ConclusionThis study shows feasibility and potential for clinical pharmacists in the hospital healthcare setting to provide inhaler technique assessment, education and training for patients with asthma. This study also provides a unique insight into a snapshot of the paediatric population with asthma in Ireland. References 1. Government of Western Australia: DoH (2012). Asthma Model of Care: Respiratory Health Network.Referenceshttp://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/Asthma_Model_of_Care.pdf [Accessed: 15 September 2014.Giraud V, Allaert F, Roche N. Inhaler technique and asthma: Feasibility and acceptability of training by pharmacists. Respiratory Medicine2011;105(12):1815–22.
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Forster, U., S. Strathmann, D. Schafer, A. J. Szczepek, and H. Olze. "Eicosanoid imbalance correlates in vitro with the pattern of clinical symptoms of Samter's triad." Rhinology journal 51, no. 1 (March 1, 2013): 61–69. http://dx.doi.org/10.4193/rhino12.117.
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Background: Hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is often associated with chronic rhinosinusitis (CRS), nasal polyps (CRSwNP) and asthma, together known as Samter's triad. The disease is characterised by eicosanoid imbalance. In our study, we determined clinical and laboratory parameters in respect of three groups of patients: 1) CRSwNP, 2) CRSwNP and asthma (CRSwNP-A), and 3) CRSwNP with asthma and NSAID-triggered hypersensitivity (CRSwNP-AA). Our main goal was to improve the characterisation of the stages of development in Samter's triad, pointing to the homogeneous or heterogeneous course of disease. Methodology: Forty-three patients (10 CRSwNP, 14 CRSwNP-A, 19 CRSwNP-AA) and 10 control subjects were included in the study. Nasal assessment using the CRS visual analogue score, endoscopy- and computer tomography scores, allergy tests, analysis of sinus surgeries, asthma severity and in vitro functional eicosanoid tests (FET) with peripheral blood leucocytes were performed. Results: The scores reflecting CRS symptoms such as nasal congestion, nasal discharge and smell impairment differed between the patients groups reflecting the severity of disease (CRSwNP-AA > CRSwNP-A > CRSwNP). Eicosanoid imbalance correlated with nasal congestion, nasal discharge and loss of smell. Conclusion: The data presented support the hypothesis of the continuous development of NSAID-triggered hypersensitivity, culminating in Samter's triad.
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Gvozdenovic, Branislav, Vladimir Zugic, Mirjana Lapcevic, Mira Vukovic, Svetlana Milosevic, Slavica Plavsic, and Smiljana Orlovic. "Relationship between respiratory symptoms and satisfaction with inhaled asthma medication." Srpski arhiv za celokupno lekarstvo 134, no. 11-12 (2006): 498–502. http://dx.doi.org/10.2298/sarh0612498g.
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Introduction: Asthma is the chronic inflammatory disease of the airways, and the inhalation treatment is the most convenient way to deliver the medication directly to the airways. Objective: The aim of our study was to evaluate the relationship between respiratory symptom scores in asthmatic outpatients and their satisfaction with inhaled asthma medication. Method: In 124 patients, (39 males; mean age 45?18 years; mean forced expiratory volume in one second (FEV1) 71.8?23.4% predicted), respiratory symptoms were determined by 4-item questionnaire for most frequent asthma symptoms - cough, wheezing, dyspnea and chest tightness (all of them graded from 1 - without symptoms, 2 - mild, 3 - moderate, and 4 - severe symptoms), with overall score (from 4 to 16), as well as by scale for assessment of sinonasal symptoms ? the 20-item sinonasal outcome test (SNOT-20) (in 65 out of 124 patients). SNOT-20 scores ranged from 0 to 5, where higher score indicated more manifested symptom. Patients? satisfaction was measured by standardized "Satisfaction with Inhaled Asthma Treatment Questionnaire" (SATQ), which scores were calculated for the overall satisfaction as well as for individual domains (effectiveness of treatment, easy application, medication burden, and side-effects and related worries). The bigger the score the better the satisfaction, and vice versa. Results: The highest degree of correlation with overall satisfaction scores was found (using the Pearson?s coefficient of linear correlation) for the scores of wheezing (r=-0.271; p=0.002). SNOT-20 scores best correlated with side-effects and worries domain scores. Conclusion: The severity of respiratory symptoms in the asthmatics is strongly correlated with satisfaction with inhaled medication. Improving the asthmatic symptoms Results in enhancement of their satisfaction with inhaled medication and compliance.
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Judge, Pavan, Raymond Tabeshi, Ren Jie Yao, Garth Meckler, and Quynh Doan. "Use of a standardized asthma severity score to determine emergency department disposition for paediatric asthma: A cohort study." Paediatrics & Child Health 24, no. 4 (October 5, 2018): 227–33. http://dx.doi.org/10.1093/pch/pxy125.
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Belachew, Eyayaw Ashete, Ashenafi Kibret Sendekie, Emneteab Mesfin Ayele, and Adeladlew Kassie Netere. "Prevalence and determinants of insomnia among patients living with asthma in Northwest Ethiopian University specialised hospitals: Multicentre cross-sectional study." BMJ Open 12, no. 11 (November 2022): e066215. http://dx.doi.org/10.1136/bmjopen-2022-066215.
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ObjectiveThe study was aimed to determine the prevalence and contributing factors of insomnia among patients with bronchial asthma.DesignA multicentre cross-sectional survey was used.SettingThis study was carried out from January to March 2022 in three university comprehensive specialised hospitals in Northwest Ethiopia.Participants422 patients with bronchial asthma were approached of which 93.8% completed the survey.OutcomesThe degree of asthma control and the severity of insomnia were evaluated using the Asthma Control Test and Insomnia Severity Index (ISI), respectively. The characteristics of the participants were presented, arranged and summarised using descriptive statistical analysis, and correlations between predictors and outcome variables were examined using logistic regression. The cut-off point was a p value of 0.05.ResultsParticipants’ ages ranged from 33.6 to 65.2 years on average. Just under three-fourths (71.4%) of the participants had at least one episode of insomnia as per the ISI measurement (score ≥10). The odds of insomnia episodes were about 5.4 and 1.93 times higher in patients with uncontrolled asthma and partially controlled asthma status, with adjusted OR (AOR)=5.4 (95% CI 4.4 to 6.79, p<0.001) and AOR=1.93 (95% CI 1.21 to 4.11, p<0.001), respectively.ConclusionInsomnia episodes were substantially higher in bronchial patients with asthma. Insomnia is accompanied by asthma severity, and uncontrolled asthma and partially controlled asthma status are the two most determining factors for experiencing sleep disturbance. Furthermore, a prospective follow-up study must determine the real association found between insomnia and asthma control.
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Yousoof, Dar Mohd, Jamal Mohammad, Mir Shahnawaz, Shah Naveed Nazir, Dar Khursheed, and Syed Suriya. "Polysomnographic Evaluation of OSA in Patients of Bronchial Asthma." International Journal of Innovative Research in Medical Science 5, no. 12 (December 12, 2020): 595–98. http://dx.doi.org/10.23958/ijirms/vol05-i12/1007.
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Introduction: Bronchial asthma a common non-communicable disease affecting more than 300 million people world-wide. Compared to general population quality of sleep is poor in asthma patients due to various factors like poor control of asthma, co-morbidities like allergic rhinitis and oesophageal reflex disease but little is known about the potential role of obstructive sleep apnoea. Aims and objectives: This study was conducted is to evaluate the association between Asthma and risk of developing Obstructive Sleep Apnoea. Materials and methods: This was a prospective design study conducted on 137 patients of diagnosed bronchial asthma attending out-patient department of a referral chest from north India after ethical clearance. These patients underwent Berlin score assessment first and later level-1 polysomnography to evaluate for OSA. Results: prevalence of PSG documented OSA observed was 53.3% which is significantly higher than the general population and there was significant association with increasing age as 54.7% of patients were in middle aged population (40-60 years) and obesity with 67.1% patients having OSA with BMI >30 compared to 37.5% prevalence only with BMI <30, as well as with severity of asthma. Besides OSA was seen in 91.9% of Berlin high risk group patients, while it was found in only 21.3 % of Berlin low-risk group. Conclusion: prevalence of OSA in asthma patients is significantly higher as compared to general population and there is significant positive co-relation between severity of asthma, BMI, increasing age and higher Berlin score with the overall prevalence of OSA.
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Van Vyve, T., P. Chanez, JY Lacoste, J. Bousquet, FB Michel, and P. Godard. "Assessment of airway inflammation in asthmatic patients by visual endoscopic scoring systems." European Respiratory Journal 6, no. 8 (September 1, 1993): 1116–21. http://dx.doi.org/10.1183/09031936.93.06081116.
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Inflammation is a hallmark of bronchial asthma. Inflammatory cells both in bronchoalveolar lavage (BAL) and bronchial biopsies of asthmatic patients have been studied and correlated with functional or clinical parameters. We have recently attempted to assess airway inflammation by a visual endoscopic scoring system. The purpose of this study was to compare our own endoscopic scoring system with the bronchitis index previously described by Thompson and coworkers, and to determine whether these scores were correlated with clinical or functional parameters. Sixty asthmatics of variable severity (forced expiratory volume in one second (FEV1) 33-117% of predicted values) and 30 healthy volunteers were studied. The clinical severity of asthma was assessed by the clinical score as described by Aas in all of the patients, and in the last 15 patients by a daily symptom score. Beta 2-agonist consumption was recorded daily during a period of 7 days before the endoscopic procedure. During this period, circadian variation and day-to-day variation of peak expiratory flow rate (PEFR) were determined. During bronchoscopy, airway inflammation was assessed by two independent observers, prior to BAL, by visual inspection of each lobe and the lingula, and the results were quantitated using the bronchitis index and our endoscopic scoring system. Both endoscopic scores were significantly higher in asthmatics than in controls. A significant correlation was observed between the two endoscopic scores both in asthmatics and in controls. In asthmatics, a weak but significant correlation was found between both endoscopic scores and the daily symptom score, as well as the beta 2-agonist consumption.(ABSTRACT TRUNCATED AT 250 WORDS)
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Lucas, Jennifer A., Miguel Marino, Katie Fankhauser, Andrew Bazemore, Sophia Giebultowicz, Stuart Cowburn, Jorge Kaufmann, David Ezekiel-Herrera, and John Heintzman. "Role of social deprivation on asthma care quality among a cohort of children in US community health centres." BMJ Open 11, no. 6 (June 2021): e045131. http://dx.doi.org/10.1136/bmjopen-2020-045131.
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ObjectiveSocial deprivation is associated with worse asthma outcomes. The Social Deprivation Index is a composite measure of social determinants of health used to identify neighbourhood-level disadvantage in healthcare. Our objective was to determine if higher neighbourhood-level social deprivation is associated with documented asthma care quality measures among children treated at community health centres (CHCs).Methods (setting, participants, outcome measures)We used data from CHCs in 15 states in the Accelerating Data Value Across a National Community Health Center Network (ADVANCE). The sample included 34 266 children with asthma from 2008 to 2017, aged 3–17 living in neighbourhoods with differing levels of social deprivation measured using quartiles of the Social Deprivation Index score. We conducted logistic regression to examine the odds of problem list documentation of asthma and asthma severity, and negative binomial regression for rates of albuterol, inhaled steroid and oral steroid prescription adjusted for patient-level covariates.ResultsChildren from the most deprived neighbourhoods had increased rates of albuterol (rate ratio (RR)=1.22, 95% CI 1.13 to 1.32) compared with those in the least deprived neighbourhoods, while the point estimate for inhaled steroids was higher, but fell just short of significance at the alpha=0.05 level (RR=1.16, 95% CI 0.99 to 1.34). We did not observe community-level differences in problem list documentation of asthma or asthma severity.ConclusionsHigher neighbourhood-level social deprivation was associated with more albuterol and inhaled steroid prescriptions among children with asthma, while problem list documentation of asthma and asthma severity varied little across neighbourhoods with differing deprivation scores. While the homogeneity of the CHC safety net setting studied may mitigate variation in diagnosis and documentation of asthma, enhanced clinician awareness of differences in community risk could help target paediatric patients at risk of lower quality asthma care.
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Tehreem Afzal, Naveed Butt, and Shahzad Munir. "Effect of Addition of Nebulized Magnesium Sulphate to Standard Therapy in Children with Severe Asthma." Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 17, no. 4 (February 4, 2022): 295–99. http://dx.doi.org/10.48036/apims.v17i4.419.
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Objective: To compare the outcome of addition of nebulized magnesium sulphate to the standard treatment in children with acute severe asthma. Methodology: The trial was undertaken at the emergency of Paediatrics Department, Federal Government Polyclinic (Post Graduate Medical Institute), Islamabad from 1st April to 30th September 2019.Children between 1 to 12 years of age with acute severe asthma were initially nebulized with salbutamol thrice and ipratropium once.All the patients were also given intravenous steroid.Those not responding to this treatment and still classified as acute severe asthma were randomly divided into two groups each having 38 patients.Each patient in Group A received 2.5 ml (150 mg) of isotonic magnesium sulphate via nebulizer, thrice20 minutes apart, while group B received 2.5 ml of isotonic saline via nebulizer, thrice20 minutes apart.Each nebulization also contained salbutamol. Yung Asthma Severity Score (ASS) was determined at the start of treatment, at30 minutes and at 60 minutes of treatment. Results: After 60 minutes, the mean Asthma Severity Score of children in group A was 6.95 ± 1.29 and 7.63 ± 1.03 in group B (p < 0.05). In group A, 18 (47.4%) children were discharged and 20 (52.6%) were admitted in the hospital. In group B, 7 (18.4%) children were discharged while 31 (81.6%) were admitted in the hospital (p < 0.05). Conclusion: It is concluded that nebulized magnesium sulphate along with salbutamol can give a better outcome than salbutamol alone in children with acute severe asthma.
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Bonapelli, Vijaysagar Reddy, Sujay D. J., Prakruthi J., and Sathiqali A. S. "Acute exacerbations of asthma occurring frequently time to check your techniques." International Journal of Advances in Medicine 6, no. 6 (November 25, 2019): 1755. http://dx.doi.org/10.18203/2349-3933.ijam20195167.
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Background: Asthmatics form a predominant section of patients in OPD. If poorly controlled the frequency of attacks requiring an emergency department visit adds to the burden. It was noticed that the patients who were on inhalational therapy had poor control despite the absence of other factors which could lead to exacerbations. Hence author evaluated the inhalational techniques.Methods: A prospective study undertaken in the department of medicine in tertiary care hospital in Dakshina Kannada District, Karnataka enlisting 25 patients admitted with acute exacerbation of bronchial asthma. The patients were assessed for their symptoms, signs and recurrent attacks along with their cough severity index and inhaler scores and the observations were tabulated.Results: Of the twenty-five, 15 were on inhalation therapy with various modes of deliveries. There were 15 males and 10 females from ages 20 to 50years. The number of attacks of asthma was higher in those not on inhalation therapies than those using inhalation therapies. Also, the level/severity of cough, measured as Cough Severity Index, was assessed among the two groups. Those on inhalation therapy had a lower grade of cough than those not on therapy . Mean AEC was 94 among those on inhalation therapy and 209 among those not on therapy. Inhalational score was calculated for each patient. There is a strong negative correlation of -0.709 between inhalation score and recurrent attacks, which is statistically significant (p=0.003). Lower inhalation scores were associated with recurrent attacks.Conclusions: Recurrent exacerbations in an asthmatic patient on inhalation therapy are due to improper inhalational technique. It was suggested that it is wise to spend time with the patients in authors OPD set up and teach them the correct techniques of using inhalational therapy hence reducing frequency of attacks and cost of health care in such patients.
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Ducharme, Francine M., G. Michael Davis, Francisco Noya, Harold Rich, and Pierre Ernst. "The Asthma Quiz for Kidz: A Validated Tool to Appreciate the Level of Asthma Control in Children." Canadian Respiratory Journal 11, no. 8 (2004): 541–46. http://dx.doi.org/10.1155/2004/783740.
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BACKGROUND:There is an urgent need to bridge the large gap between optimal and observed asthma control among Canadian children.OBJECTIVES:To adapt the criteria of asthma control proposed in the 1999 Asthma Consensus Statement for children and validate the proposed cut-offs in children with asthma.METHODS:Six clinical criteria of asthma control were phrased as questions and response options, and pretested for clarity. A cross-sectional study was conducted in children one to 17 years of age presenting to the hospital's asthma clinics. Children nine years of age or older and their parents were asked to complete The Asthma Quiz for Kidz separately, and then together, before the medical visit. Parents of younger children completed the questionnaire with their child. Physicians were not informed of the results of the quiz.RESULTS:The mean age of the 343 participants was 8.0±4.4 (SD) years with a mean baseline forced expiratory volume in 1 s of 96±15% of predicted values. Asthma severity was rated as mild (67%), moderate (29%) or severe (4%). Overall, 57% of subjects endorsed at least two of the six criteria of poor control. The median (interquartile range) Asthma Quiz score was significantly higher when the physician's assessment of asthma control was poor than when the physician's assessment of asthma control was good (3 [1, 5] versus 1 [0, 2], P<0.001), but it did not correlate with the spirometry. A score of at least 2 out of 6 had 73% sensitivity and 59% specificity for identifying poor control.INTERPRETATION:The Asthma Quiz score provides complementary information to, but does not replace, lung function testing. A score of 2 or more out of 6 suggests poor asthma control and should prompt patients to consult their physician for reassessment.
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Li, Peng-Fei, Chi-Hsiang Chung, Jhih-Syuan Liu, Chieh-Hua Lu, Sheng-Chiang Su, Feng-Chih Kuo, Li-Ju Ho, et al. "Association of dipeptidyl peptidase-4 inhibitor use and the risk of asthma development among type 2 diabetes patients." Therapeutic Advances in Respiratory Disease 16 (January 2022): 175346662211353. http://dx.doi.org/10.1177/17534666221135320.
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Background: Numerous studies have shown that dipeptidyl peptidase-4 inhibitors (DPP-4i) may regulate immunological pathways implicated in asthma. The association between DPP-4i use and risk of asthma development is limited, however. Aim: We aimed to evaluate if DPP-4i treatment in individuals with type 2 diabetes mellitus (T2DM) is associated with a lower risk and severity of asthma. Methods: We performed a population-based retrospective cohort study using the Longitudinal National Health Insurance Research database between 2008 and 2015. After one-to-four propensity score matching from 1,914,201 patients with defined criteria, we enrolled 3001 patients who were on DPP-4i (DPP-4i group) for a diagnosis of T2DM but without a diagnosis of asthma for further analysis. Cox proportional hazards regression analysis was performed to estimate and compare the risk of developing and severity of asthma, including no acute exacerbations event (No-AE), acute exacerbations (AEs), status asthmaticus (Status), and required endotracheal intubation (ET-tube intubated), between the two groups. Results: The participants had a mean age of 66.05 ± 17.23 years and the mean follow-up time was 4.96 ± 4.39 years. The risk of asthma development was significantly lower in the DPP-4i group than in the non-DPP-4i group [adjusted hazard ratio (HR) = 0.65; 95% confidence interval (CI) = 0.29–0.83; p < 0.001], with a class effect. This trend was observed for severity of asthma as No-AE (HR = 0.55; 95% CI = 0.24–0.70; p < 0.001), AE (HR = 0.57; 95% CI = 0.26–0.73; p < 0.001), and Status (HR = 0.78; 95% CI = 0.35–0.99; p = 0.047), but not in ET-tube intubated cases (HR = 0.96; 95% CI = 0.43–1.22; p = 0.258). Conclusion: The use of DPP-4i decreased the risk and severity of asthma with a class effect among No-AE, AE, status of asthma events, but not in ET-tube intubated events. Our report suggests that DPP-4i may play a role in attenuating the impact of asthma on incidence in the future and on more severe forms of disease exacerbation in T2DM patients.