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Abstract

Background

During the latter half of the 20th century the prevalence of asthma and many other allergic diseases has increased. Information on asthma prevalence trends after 2010, especially regarding studies separating allergic asthma from non-allergic asthma is lacking.

Objective

The aim was to estimate prevalence trends of current asthma, both allergic and non-allergic, from 1996 to 2016.

Methods

Three cross-sectional samples from the same area of Sweden, 20-69 years, participated in surveys with the same questionnaire in 1996 (n=7104 participants, 85% response rate), 2006 (n=6165, 77%) and 2016 (n=5466, 53%), respectively. Allergic rhino-conjunctivitis was used as a marker for allergic sensitization in order to define allergic asthma.

Results

The prevalence of current asthma increased from 8.4% (95%CI 7.8-9.0) in 1996 to 9.9% (95%CI 9.2-10.6) in 2006 and 10.9% (95%CI 10.1-11.7) in 2016 (p=<0.001). Allergic asthma increased from 5.0% (95%CI 4.5-5.5) in 1996 to 6.0% (95%CI 5.4-6.6) in 2006 and further to 7.3% (95%CI 6.6-8.0) in 2016 (p<0.001), while the prevalence of non-allergic asthma remained stable around 3.4-3.8%. The increase in current asthma was most pronounced among women and among the middle-aged. Physician-diagnosed asthma, asthma medication use, and allergic rhino-conjunctivitis also increased significantly, while the prevalence of symptoms common in asthma such as wheeze and attacks of shortness of breath decreased slightly or was stable. The prevalence of current smoking decreased from 27.4% in 1996 to 12.3% in 2016.

Conclusions & Clinical Relevance

The prevalence of allergic asthma increased from 1996 to 2006 and further to 2016, while the prevalence of non-allergic asthma remained on a stable prevalence level. The prevalence of symptoms common in asthma decreased slightly or was stable despite a substantial decrease in the prevalence of current smoking. Clinicians should be aware that the previously observed increase in prevalence of allergic asthma is still ongoing.


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 Francis Nissen1Jennifer K Quint2Samantha Wilkinson1Hana Mullerova3Liam Smeeth1Ian J Douglas1

Author affiliations 

Abstract

Background Asthma is a common, heterogeneous disease with significant morbidity and mortality worldwide. It can be difficult to define in epidemiological studies using electronic health records as the diagnosis is based on non-specific respiratory symptoms and spirometry, neither of which are routinely registered. Electronic health records can nonetheless be valuable to study the epidemiology, management, healthcare use and control of asthma. For health databases to be useful sources of information, asthma diagnoses should ideally be validated. The primary objectives are to provide an overview of the methods used to validate asthma diagnoses in electronic health records and summarise the results of the validation studies.

Methods EMBASE and MEDLINE will be systematically searched for appropriate search terms. The searches will cover all studies in these databases up to October 2016 with no start date and will yield studies that have validated algorithms or codes for the diagnosis of asthma in electronic health records. At least one test validation measure (sensitivity, specificity, positive predictive value, negative predictive value or other) is necessary for inclusion. In addition, we require the validated algorithms to be compared with an external golden standard, such as a manual review, a questionnaire or an independent second database. We will summarise key data including author, year of publication, country, time period, date, data source, population, case characteristics, clinical events, algorithms, gold standard and validation statistics in a uniform table.

Ethics and dissemination This study is a synthesis of previously published studies and, therefore, no ethical approval is required. The results will be submitted to a peer-reviewed journal for publication. Results from this systematic review can be used to study outcome research on asthma and can be used to identify case definitions for asthma.

PROSPERO registration number CRD42016041798.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Parameswaran Nair, M.D., Ph.D., Sally Wenzel, M.D., Klaus F. Rabe, M.D., Ph.D., Arnaud Bourdin, M.D., Ph.D., Njira L. Lugogo, M.D., Piotr Kuna, M.D., Ph.D., Peter Barker, Ph.D., Stephanie Sproule, M.Math., Sandhia Ponnarambil, M.D., and Mitchell Goldman, M.D., for the ZONDA Trial Investigators*

N Engl J Med 2017; 376:2448-2458 DOI: 10.1056/NEJMoa1703501

BACKGROUND

Many patients with severe asthma rely on oral glucocorticoids to manage their disease. We investigated whether benralizumab, a monoclonal antibody directed against the alpha subunit of the interleukin-5 receptor that significantly reduces the incidence of asthma exacerbations, was also effective as an oral glucocorticoid–sparing therapy in patients relying on oral glucocorticoids to manage severe asthma associated with eosinophilia.

METHODS

In a 28-week randomized, controlled trial, we assessed the effects of benralizumab (at a dose of 30 mg administered subcutaneously either every 4 weeks or every 8 weeks [with the first three doses administered every 4 weeks]) versus placebo on the reduction in the oral glucocorticoid dose while asthma control was maintained in adult patients with severe asthma. The primary end point was the percentage change in the oral glucocorticoid dose from baseline to week 28. Annual asthma exacerbation rates, lung function, symptoms, and safety were assessed.

 RESULTS

Of 369 patients enrolled, 220 underwent randomization and started receiving benralizumab or placebo. The two benralizumab dosing regimens significantly reduced the median final oral glucocorticoid doses from baseline by 75%, as compared with a reduction of 25% in the oral glucocorticoid doses in the placebo group (P<0.001 for both comparisons). The odds of a reduction in the oral glucocorticoid dose were more than 4 times as high with benralizumab as with placebo. Among the secondary outcomes, benralizumab administered every 4 weeks resulted in an annual exacerbation rate that was 55% lower than the rate with placebo (marginal rate, 0.83 vs. 1.83, P=0.003), and benralizumab administered every 8 weeks resulted in an annual exacerbation rate that was 70% lower than the rate with placebo (marginal rate, 0.54 vs. 1.83, P<0.001). At 28 weeks, there was no significant effect of either benralizumab regimen on the forced expiratory volume in 1 second (FEV1), as compared with placebo. The effects on various measures of asthma symptoms were mixed, with some showing significant changes in favor of benralizumab and others not showing significant changes. Frequencies of adverse events were similar between each benralizumab group and the placebo group.

CONCLUSIONS

Benralizumab showed significant, clinically relevant benefits, as compared with placebo, on oral glucocorticoid use and exacerbation rates. These effects occurred without a sustained effect on the FEV1. (Funded by AstraZeneca; ZONDA ClinicalTrials.gov number, NCT02075255.)

 

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Academy of Allergy, Asthma and Immunology (AAAAI) and the World Allergy Organization (WAO). The AAAAI is accredited by the ACCME to provide continuing medical education for physicians.

Designation Statement

The American Academy of Allergy, Asthma and Immunology designates this internet enduring material for a maximum number of 2.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty

Planning Committee:
Lanny J. Rosenwasser, M.D.
University of Missouri - Kansas City, School of Medicine

Author: 
Reynold A. Panettieri, Jr., M.D.
Vice Chancellor for Translational Medicine and Science
Rutgers University

Reviewer: 
F. Myron Zitt, M.D.
State University of New York, Stony Brook

The faculty disclosed no relevant financial relationships.

Activity Reviewers

Samuel Gubernick, MD, FAAAAI
Family Allergy, Asthma and Immunology Associates, Largo, Florida

The activity reviewers disclosed no relevant financial relationships.

Acknowledgement of Commercial Support

WAO thanks Boston Scientific for support through an independent education grant. Boston Scientific had no involvement in the content development or selection of faculty for this program.

Activity Term

November 4, 2016 to November 3, 2019

Online Course Access

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Pavadee Poowuttikul, MD,1 Benjamin Hart, MD, PhD, MPH,2 Ronald Thomas, PhD,1 and Elizabeth Secord, MD1
 

Abstract

Background. Asthma results in significant pediatric hospitalizations in the inner city. Many asthmatic children were admitted to our hospital as a result of lack of medications or medical supplies that had been previously prescribed (“ran out,” “broken,” or “lost”). Objective. To identify the incidence of children admitted for asthma because of lack of prescribed medications/supplies and to assess risk factors for poor adherence between groups. Methods. This was a prospective chart review of 200 asthmatic children admitted to Children’s Hospital of Michigan, Detroit. The data included asthma severity, lack of prescribed medications/medical supplies, and outpatient management. Results. In all, 35.5% or 71/200 of asthmatic children admitted had lack of prescribed medication/supplies (9% lacked both). The most common deficiency was β2-agonist (20.5%; 41/200). Teenagers had the highest lack of medications/medical supplies (55.6%; 5/9) compared with toddlers (17.2%; 16/93) and preschoolers (17.9%; 5/28). Patients with severe persistent asthma had a higher incidence of lacking medicine (31.8%; 7/22) compared with 25% (14/56) with moderate persistent asthma and 23.4% (15/64) of mild asthmatics. We found the lack of asthma medical supplies, including nonfunctioning or lost nebulizers/spacers, in 44.4% (4/9) of teenagers, 17.2% (16/93) of toddlers, and 21.4% (6/28) of preschool-aged children. We found no significant difference in these deficiencies whether patients were managed by asthma specialists or primary care providers. Conclusions. Significant numbers of asthmatic children admitted reported lack of prescribed medications/medical supplies. The most severe asthmatics were most likely to run out of medications. Interventions targeted at these deficiencies may avoid hospitalizations.

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