Validation of asthma recording in electronic health records: protocol for a systematic review

Juan Carlos Ivancevich Tuesday, 27 June 2017 14:18
 Francis Nissen1Jennifer K Quint2Samantha Wilkinson1Hana Mullerova3Liam Smeeth1Ian J Douglas1

Author affiliations 


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:

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Bronchial Thermoplasty - An Option for Difficult-to-Treat Severe Asthma WAO Online Learning Module (OLM0015)

Juan Carlos Ivancevich Friday, 23 June 2017 12:47

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.


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

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

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

Poor Adherence With Medication Refill and Medical Supplies Maintenance as Risk Factors for Inpatient Asthma Admission in Children

Juan Carlos Ivancevich Monday, 19 June 2017 22:17
Logo of gph
Pavadee Poowuttikul, MD,1 Benjamin Hart, MD, PhD, MPH,2 Ronald Thomas, PhD,1 and Elizabeth Secord, MD1


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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Oral Glucocorticoid–Sparing Effect of Benralizumab in Severe Asthma

Juan Carlos Ivancevich Thursday, 22 June 2017 12:17

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


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.


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.


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.


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 number, NCT02075255.)


Advanced Role of Neutrophils in Common Respiratory Diseases

Juan Carlos Ivancevich Sunday, 11 June 2017 23:42

Journal of Immunology Research
Volume 2017 (2017), Article ID 6710278, 21 pages

Review Article

1Institute of Frontier Medical Science, Jilin University, Changchun 130021, China
2Department of Pathogen Biology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
3Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China


Respiratory diseases, always being a threat towards the health of people all over the world, are most tightly associated with immune system. Neutrophils serve as an important component of immune defense barrier linking innate and adaptive immunity. They participate in the clearance of exogenous pathogens and endogenous cell debris and play an essential role in the pathogenesis of many respiratory diseases. However, the pathological mechanism of neutrophils remains complex and obscure. The traditional roles of neutrophils in severe asthma, chronic obstructive pulmonary diseases (COPD), pneumonia, lung cancer, pulmonary fibrosis, bronchitis, and bronchiolitis had already been reviewed. With the development of scientific research, the involvement of neutrophils in respiratory diseases is being brought to light with emerging data on neutrophil subsets, trafficking, and cell death mechanism (e.g., NETosis, apoptosis) in diseases. We reviewed all these recent studies here to provide you with the latest advances about the role of neutrophils in respiratory diseases.

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