ADAM wearable monitors asthma via app

Juan Carlos Ivancevich Saturday, 31 January 2015 04:09

Health Care Originals ADAM asthma wearable


According to the Centers for Disease Control and Prevention, asthma affects over 25 million adults and children in the US alone, and is responsible for 14.2 million physician visits each year as well as 1.8 million emergency care visits. With that huge - and growing - population of asthma sufferers and the associated costs of treating the disease, monitoring and managing asthma is quickly becoming a necessity. Health Care Originals highlighted its ADAM (Asthma Detection And Monitoring) wearable and app at CES 2015, a system designed to detect symptoms of asthma, provide alerts, and more.

ADAM uses a small wearable patch to detect coughs, monitor respiration and heart rate, and listen for wheezing. The device and app are expected to ship in the second quarter of 2015. By that time it's expected that the sensor will also be able to monitor inhaler use, provide alerts of impending asthma attacks, let patients forward those alerts to their primary care physician or specialist, track and trend symptoms, and even provide treatment plans.

ADAM description

Need a reminder to use your inhaler or take other prescribed medication? The ADAM app will provide you with reminders. All data that is generated by the sensor and captured by the app is kept in HIPAA-compliant storage, and the company is looking into integration with HealthKit as well.

ADAM is yet another example of how app-connected devices are beginning to revolutionize health care, hopefully reducing both patient visits and the cost of treatment.

More information: http://healthcareoriginals.com/

The minimal clinically important difference of the control of allergic rhinitis and asthma test (CARAT): cross-cultural validation and relation with pollen counts

Juan Carlos Ivancevich Saturday, 24 January 2015 13:24

NPJ PRIMARY CARE RESPIRATORY MEDICINE | ARTICLE OPEN

npj Primary Care Respiratory Medicine 25, Article number: 14107 (2015) 
doi:10.1038/npjpcrm.2014.107

Abstract

Background: The Control of Allergic Rhinitis and Asthma Test (CARAT) monitors control of asthma and allergic rhinitis.

Aims: To determine the CARAT’s minimal clinically important difference (MCID) and to evaluate the psychometric properties of the Dutch CARAT.

Methods: CARAT was applied in three measurements at 1-month intervals. Patients diagnosed with asthma and/or rhinitis were approached. MCID was evaluated using Global Rating of Change (GRC) and standard error of measurement (s.e.m.). Cronbach’s alpha was used to evaluate internal consistency. Spearman’s correlation coefficients were calculated between CARAT, the Asthma Control Questionnaire (ACQ5) and the Visual Analog Scale (VAS) on airway symptoms to determine construct and longitudinal validity. Test–retest reliability was evaluated with intra-class correlation coefficient (ICC). Changes in pollen counts were compared with delta CARAT and ACQ5 scores.

Results: A total of 92 patients were included. The MCID of the CARAT was 3.50 based on GRC scores; the s.e.m. was 2.83. Cronbach’s alpha was 0.82. Correlation coefficients between CARAT and ACQ5 and VAS questions ranged from 0.64 to 0.76 (P<0.01). Longitudinally, correlation coefficients between delta CARAT scores and delta ACQ5 and VAS scores ranged from 0.41 to 0.67 (P<0.01). Test–retest reliability showed an ICC of 0.81 (P<0.01) and 0.80 (P<0.01). Correlations with pollen counts were higher for CARAT than for ACQ5.

Conclusions: This is the first investigation of the MCID of the CARAT. The CARAT uses a whole-point scale, which suggests that the MCID is 4 points. The CARAT is a valid and reliable tool that is also applicable in the Dutch population.

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YKL-40 is correlated with FEV1 and the asthma control test (ACT) in asthmatic patients: influence of treatment

Juan Carlos Ivancevich Thursday, 15 January 2015 03:14
Open Access
 
Research article

Tianwen LaiMin ChenZaichun DengYingying L¿Dong WuDongming Li and Bin Wu

Abstract (provisional)

Background

YKL-40 is also called chitinase-3-like-1 (CHI3L1) protein and may be a marker for asthma. The aims of the present study were to investigate whether serum YKL-40 levels are stable or decreased in patients with asthma after appropriate treatment and to evaluate the correlation of YKL-40 levels with lung function and asthma control test (ACT) results.

Methods

A total of 103 asthmatic patients (mean age 33.1 +/- 0.9 years) with diagnosed asthma were enrolled in our study. All patients underwent a detailed clinical examination and completed the ACT questionnaire, serum YKL-40 measurement, and spirometry before (visit 1) and 8 weeks after initiation of treatment (visit 2).

Results

At the follow-up, the median serum YKL-40 level was significantly decreased compared to the levels at visit 1 (75.2 [55.8-86.8] ng/ml versus 54.5 [46.4-58.4] ng/ml, p < 0.001). The serum YKL-40 level was negatively correlated with %FEV1 (r = -0.37, p < 0.001) and ACT score (r = -0.26, p = 0.007) at visit 1. The change in serum YKL-40 levels between the visits was significantly correlated with changes in FEV1 (r = -0.28, p = 0.006) and ACT score (r = -0.22, p = 0.037). Patients with elevated YKL-40 levels had significantly greater corticosteroid use than patients with lower levels.

Conclusions

YKL-40 was reduced in the serum of asthmatic patients after appropriate treatment, and the levels correlated with improvements in %FEV1 and ACT. High levels of serum YKL-40 may be refractory to current asthma treatments.

Trial registration: ChiCTR-OCC-13003316

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 

The microbiome in asthma

Juan Carlos Ivancevich Thursday, 22 January 2015 23:09

The application of recently developed sensitive, specific, culture-independent tools for identification of microbes is transforming concepts of microbial ecology, including concepts of the relationships between the vast complex populations of microbes associated with ourselves and with states of health and disease. Although most work initially focused on the community of microbes (microbiome) in the gastrointestinal tract and its relationship to gastrointestinal disease, interest has expanded to include study of the relationships of the airway microbiome to asthma and its phenotypes and to the relationships between the gastrointestinal microbiome, development of immune function, and predisposition to allergic sensitization and asthma. Here we provide our perspective on the findings of studies of differences in the airway microbiome between asthmatic patients and healthy subjects and of studies of relationships between environmental microbiota, gut microbiota, immune function, and asthma development. In addition, we provide our perspective on how these findings suggest the broad outline of a rationale for approaches involving directed manipulation of the gut and airway microbiome for the treatment and prevention of allergic asthma.

Sputum eosinophilia is a determinant of FEV1 decline in occupational asthma: results of an observational study

Juan Carlos Ivancevich Saturday, 10 January 2015 14:59

Talini D1Novelli F2Bacci E2Bartoli M2Cianchetti S2Costa F2Dente FL2Di Franco A2Latorre M2Malagrinò L2Vagaggini B2Celi A2Paggiaro P2.

Abstract

OBJECTIVE:

To evaluate the potential determinants of forced expiratory volume in 1 s (FEV1) decline in workers with occupational asthma (OA) still exposed to the causative agent. We hypothesised that sputum eosinophilia might be a predictor of poor asthma outcome after diagnosis.

SETTING, DESIGN AND PARTICIPANTS:

In a specialistic clinical centre of the University Hospital of Pisa, we studied 39 participants (28 M, 11 F) diagnosed as having OA, routinely followed up between 1990 and 2009. They were a subgroup of 94 participants diagnosed as affected by OA in that period: 9 had been removed from work at the diagnosis, 21 were excluded for having ceased occupational exposure after few months from diagnosis, and 25 were lost at the follow-up or had no acceptable sputum measurements at the diagnosis. Estimates of the decline in FEV1 were obtained by means of simple regression analysis during the period of occupational exposure after diagnosis. Logistic regression was used to analyse the effects of factors (baseline FEV1 and sputum inflammatory cells, duration and type of exposure) that may potentially influence FEV1 decline.

RESULTS:

At follow-up (5.7+3.7 years), most participants were still symptomatic despite inhaled corticosteroids (ICS) treatment and had their occupational exposure reduced. Participants with higher sputum eosinophils (>3%) at baseline had a significantly greater decline of FEV1 (-52.5 vs -18.6 mL/year, p=0.012). Logistic regression showed that persistent exposure and sputum eosinophilia were significantly associated with a greater decline in FEV1 (OR 11.5, 95% CI 1.8 to 71.4, p=0.009 and OR 6.7, 95% CI 1.1 to 41.7, p= 0.042, respectively).

CONCLUSIONS:

Sputum eosinophilia at diagnosis, together with the persistence of occupational exposure during follow-up, may contribute to a greater decline in FEV1 in patients with OA still at work. Further long-term studies are required as to whether intensive ICS treatment may be beneficial for patients with OA and increase ad eosinophilic inflammation.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Editor: Juan C. Ivancevich, MD

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