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

Juan Carlos Ivancevich Wednesday, 26 November 2014 14:30
 
Research
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.

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!

Learn More

Childhood Asthma-Predictive Phenotype

Juan Carlos Ivancevich Tuesday, 11 November 2014 13:13

Wheezing is a fairly common symptom in early childhood, but only some of these toddlers will experience continued wheezing symptoms in later childhood. The definition of the asthma-predictive phenotype is in children with frequent, recurrent wheezing in early life who have risk factors associated with the continuation of asthma symptoms in later life. Several asthma-predictive phenotypes were developed retrospectively based on large, longitudinal cohort studies; however, it can be difficult to differentiate these phenotypes clinically as the expression of symptoms, and risk factors can change with time. Genetic, environmental, developmental, and host factors and their interactions may contribute to the development, severity, and persistence of the asthma phenotype over time. Key characteristics that distinguish the childhood asthma-predictive phenotype include the following: male sex; a history of wheezing, with lower respiratory tract infections; history of parental asthma; history of atopic dermatitis; eosinophilia; early sensitization to food or aeroallergens; or lower lung function in early life.

The Journal of Allergy and Clinical Immunology: In Practice Volume 2, Issue 6, Pages 664–670, November–December, 2014

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Atopic cough and fungal allergy

Juan Carlos Ivancevich Thursday, 13 November 2014 15:24

Keynote Lecture

Haruhiko Ogawa1, Masaki Fujimura2, Noriyuki Ohkura3, Koichi Makimura4

1Division of Pulmonary Medicine, Ishikawa-ken Saiseikai, Kanazawa Hospital, Kanazawa 920-0353, Japan; 2Respiratory Medicine, National Hospital Organization Nanao Hospital, Nanao 926-8531, Japan; 3Ishikawa Prefectural Central Hospital, Respiratory Medicine, Kanazawa, Japan; 4Laboratory of Space and Environmental Medicine, Graduate School of Medicine and Graduate School of Medical Technology, Teikyo University, Itabashi-ku Tokyo, Japan

Correspondence to: Haruhiko Ogawa, MD, PhD. Division of Pulmonary Medicine, Ishikawa-ken Saiseikai Kanazawa Hospital, Ni-13-6 Akatsuchi-machi, Kanazawa 920-0353, Japan. Email: This email address is being protected from spambots. You need JavaScript enabled to view it. .

Abstract: We have shown that some patients presenting with chronic bronchodilator-resistant non-productive cough have a global atopic tendency and cough hypersensitivity without nonspecific bronchial hyperresponsiveness, abbreviated as atopic cough (AC). The cough can be treated successfully with histamine H1 antagonists and/or glucocorticoids. Eosinophilic tracheobronchitis and cough hypersensitivity are pathological and physiological characteristics of AC. Fungus-associated chronic cough (FACC) is defined as chronic cough associated with basidiomycetous (BM) fungi found in induced sputum, and recognition of FACC has provided the possibility of using antifungal drugs as new treatment strategies. Bjerkandera adusta is a wood decay BM fungus, which has attracted attention because of its potential role in enhancing the severity of cough symptoms in FACC patients by sensitization to this fungus. Before making a diagnosis of “idiopathic cough” in cases of chronic refractory cough, remaining intractable cough-related laryngeal sensations, such as “a sensation of mucus in the throat (SMIT),” which is correlated with fungal colonization, should be evaluated and treated appropriately in each patient. The new findings, i.e., the detection of environmental mushroom spores that should not be present in the human airways in addition to the good clinical response of patients to antifungal drugs, may lead to the development of novel strategies for treatment of chronic cough.

Keywords: Atopic cough (AC); cough variant asthma (CVA); fungus-associated chronic cough (FACC); Bjerkandera adusta; cough-related laryngeal sensations

doi: 10.3978/j.issn.2072-1439.2014.09.25

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Inhaler reminders improve adherence with controller treatment in primary care patients with asthma

Juan Carlos Ivancevich Tuesday, 11 November 2014 12:58

Abstract

BACKGROUND: Poor adherence contributes to uncontrolled asthma. Pragmatic adherence interventions for primary care settings are lacking.

OBJECTIVE: To test the effectiveness of 2 brief general practitioner (GP)-delivered interventions for improving adherence and asthma control.

METHODS: In a 6-month cluster randomized 2 × 2 factorial controlled trial, with GP as unit of cluster, we compared inhaler reminders and feedback (IRF) and/or personalized adherence discussions (PADs) with active usual care alone; all GPs received action plan and inhaler technique training. GPs enrolled patients prescribed combination controller inhalers, with suboptimal Asthma Control Test (ACT) scores (ACT score ≤19). Inhaler monitors recorded fluticasone propionate/salmeterol adherence (covertly for non-IRF groups) and, in IRF groups, provided twice-daily reminders for missed doses, and adherence feedback. PAD GPs received communication training regarding adherence. Outcomes collected every 2 months included ACT scores (primary outcome) and severe exacerbations. Intention-to-treat mixed-model analysis incorporated cluster effect and repeated measures.

RESULTS: A total of 43 GPs enrolled 143 patients with moderate-severe asthma (mean age, 40.3 ± 15.2 years; ACT score, 14.6 ± 3.8; fluticasone propionate dose, 718 ± 470 μg). Over 6 months, adherence was significantly higher in the IRF group than in non-IRF groups (73% ± 26% vs 46% ± 28% of prescribed daily doses; P < .0001), but not between PAD and non-PAD groups. Asthma control improved overall (mean change in ACT score, 4.5 ± 4.9; P < .0001), with no significant difference among groups (P = .14). Severe exacerbations were experienced by 11% of the patients in IRF groups and 28% of the patients in non-IRF groups (P = .013; after adjustment for exacerbation history; P = .06).

CONCLUSIONS: Inhaler reminders offer an effective strategy for improving adherence in primary care compared with a behavioral intervention or usual care, although this may not be reflected in differences in day-to-day asthma control.

KEYWORDS: Medication adherence; ambulatory monitoring; antiasthmatic agents; asthma; health communication; intervention studies; treatment effectiveness


J Allergy Clin Immunol. 2014 Jul 18. pii: S0091-6749(14)00802-1. doi: 10.1016/j.jaci.2014.05.041. [Epub ahead of print]

 

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Editor: Juan C. Ivancevich, MD

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