Establishing school-centered asthma programs

Juan Carlos Ivancevich Friday, 05 December 2014 13:49
 Asthma is a common chronic childhood disease associated with significant morbidity and high rates of school absenteeism, along with excessive costs for the patient and society. Asthma is a leading cause of school absenteeism, but this absenteeism is not equally distributed among those with asthma. Second to their home, school-aged children spend the largest portion of their wakeful hours at school. Opportunities exist to partner with schools to reach most children with asthma and those at the highest risk for asthma burden and in need of assistance. Asthma management at schools is important for pediatric pulmonologists and allergists, primary care providers, and the whole interdisciplinary team working alongside them to provide quality asthma care. The variability of asthma care services and programs provided in schools should prompt clinicians to understand their own school system and to advocate for appropriate services. Models of asthma care that place schools at the center or core of the model and coordinate evidence-based asthma care are applicable nationwide and might serve as a model for managing other chronic illnesses.


Defining adult asthma endotypes by clinical features and patterns of volatile organic compounds in exhaled air

Juan Carlos Ivancevich Wednesday, 03 December 2014 13:21
Open Access

Norbert Meyer12*Jan W Dallinga3*Sarah Janine Nuss1Edwin JC Moonen3Joep JBN van Berkel3Cezmi Akdis4Frederik Jan van Schooten3 and Günter Menz1

Abstract (provisional)

Background: Several classifications of adult asthma patients using cluster analyses based on clinical and demographic information has resulted in clinical phenotypic clusters that do not address molecular mechanisms. Volatile organic compounds (VOC) in exhaled air are released during inflammation in response to oxidative stress as a result of activated leukocytes. VOC profiles in exhaled air could distinguish between asthma patients and healthy subjects. In this study, we aimed to classify new asthma endotypes by combining inflammatory mechanisms investigated by VOC profiles in exhaled air and clinical information of asthma patients. Methods: Breath samples were analyzed for VOC profiles by gas chromatography mass spectrometry from asthma patients (n=195) and healthy controls (n=40). A total of 945 determined compounds were subjected to discriminant analysis to find those that could discriminate healthy from asthmatic subjects. 2-step cluster analysis based on clinical information and VOCs in exhaled air were used to form asthma endotypes. Results: We identified 16 VOCs, which could distinguish between healthy and asthma subjects with a sensitivity of 100% and a specificity of 91.1%. Cluster analysis based on VOCs in exhaled air and the clinical parameters FEV1, FEV1 change after 3?weeks of hospitalization, allergic sensitization, Junipers symptoms score and asthma medications resulted in the formation of 7 different asthma endotype clusters. We identified asthma clusters with different VOC profiles but similar clinical characteristics and endotypes with similar VOC profiles, but distinct clinical characteristics. Conclusion:This study demonstrates that both, clinical presentation of asthma and inflammatory mechanisms in the airways should be considered for classification of asthma subtypes.

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


Development of a tool to recognize small airways dysfunction in asthma (SADT)

Juan Carlos Ivancevich Wednesday, 26 November 2014 14:30
Open Access

Lieke Schiphof-Godart12Erica van der Wiel23Nick HT ten Hacken23Maarten van den Berge23Dirkje S Postma23 and Thys van der Molen12*

  • *Corresponding author: Thys van der Molen This email address is being protected from spambots. You need JavaScript enabled to view it.

Author Affiliations

Abstract (provisional)

Background: Small airways dysfunction (SAD) contributes to the clinical expression of asthma. The identification of patients who suffer from SAD is important from a clinical perspective, as targeted therapy may improve patients? well-being and treatment efficacy.Aims: We aimed to realize the first step in the development of a simple small airways dysfunction tool (SADT) that may help to identify asthma patients having SAD.Methods: Asthma patients with and without SAD were interviewed. Patients were selected to participate in this study based on FEF50% and R5-R20 values from spirometry and impulse oscillometry respectively.Results: Ten in depth interviews and two focus groups revealed that patients with and without SAD perceived differences in symptoms and signs, habits and health related issues. For example, patients with SAD reported to wheeze easily, were unable to breathe in deeply, mentioned more symptoms related to bronchial hyperresponsiveness, experienced more pronounced exercise-induced symptoms and more frequently had allergic respiratory symptoms after exposure to cats and birds. Based on these differences, 63 items were retained to be further explored for the SADT.Conclusions:The first step of the development of the SADT tool shows that there are relevant differences in signs and respiratory symptoms between asthma patients with and without SAD. The next step is to test and validate all items in order to retain the most relevant items to create a short and simple tool, which should be useful to identify asthma patients with SAD in clinical practice.

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

Asthma in pregnancy: a hit for two

Juan Carlos Ivancevich Thursday, 27 November 2014 15:27
Vanessa E. Murphy1 and  Michael Schatz2
+Author Affiliation
1Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia. 2Dept of Allergy, Kaiser Permanente Medical Center, San Diego, CA, USA. V.E. Murphy, Centre for Asthma and Respiratory Diseases, Level 2, West Wing, Hunter Medical Research Institute, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


Asthma commonly occurs in pregnant females, and recent data have outlined the risks of adverse perinatal outcomes among this population. There is an increased risk of low birth weight and small for gestational age, particularly among females with moderate-to-severe asthma and exacerbations during pregnancy. There is also an increased risk of preterm birth, especially with oral steroid use, a small but statistically significant increased risk of congenital malformations, particularly of cleft lip with or without cleft palate, and an increased risk of neonatal hospitalisation and death. Active management may reduce these risks, possibly through reductions in exacerbations.

Additional reassuring data have been presented for asthma medication use, which support the benefits outweighing the risks of indicated asthma medication use in pregnancy. Viral infections are an important trigger of asthma exacerbations in pregnancy, and recent data provides possible immunological changes that may explain this. Poor medication adherence despite worsening asthma symptoms in pregnancy is a problem which continues to be demonstrated in the literature. Improving asthma control in pregnancy has the potential to improve not only the mother’s health but also that of her child.

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ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 3.0.

The Global Asthma Report 2014

Juan Carlos Ivancevich Saturday, 22 November 2014 03:34

The Global Asthma Report 2014 includes strategic and practical recommendationsand valuable information for governments, health organisations, health professionals, and people with asthma, including:

  • Latest Asthma Research
  • Maps and data on the global prevalence
  • Economic burden of asthma
  • Success stories
  • Key recommendations

Asthma may affect as many as 334 million people today and prevalence is rising. Low- and middle-income countries suffer the most severe cases. We have the tools to counter the devastating personal and economic impact of untreated and poorly managed asthma. We must act now!

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Editor: Juan C. Ivancevich, MD

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