Factors associated with exacerbations among adults with asthma according to electronic health record data
Asthma is a chronic inflammatory lung disease that affects 18.7 million U.S. adults. Electronic health records (EHRs) are a unique source of information that can be leveraged to understand factors associated with asthma in real-life populations. In this study, we identify demographic factors and comorbidities associated with asthma exacerbations among adults according to EHR-derived data and compare these findings to those of epidemiological studies.
We obtained University of Pennsylvania Hospital System EHR-derived data for asthma encounters occurring between 2011 and 2014. Regression analyses were performed to model asthma exacerbation frequency as explained by age, sex, race/ethnicity, health insurance type, smoking status, body mass index (BMI) and various comorbidities. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2012 to compare findings with those from the EHR-derived data.
Based on data from 9068 adult patients with asthma, 33.37% had at least one exacerbation over the four-year study period. In a proportional odds logistic regression predicting number of exacerbations during the study period (levels: 0, 1–2, 3–4, 5+ exacerbations), after controlling for age, race/ethnicity, sex, health insurance type, and smoking status, the highest odds ratios (ORs) of significantly associated factors were: chronic bronchitis (2.70), sinusitis (1.50), emphysema(1.39), fluid and electrolyte disorders (1.35), class 3 obesity (1.32), and diabetes(1.28). An analysis of NHANES data showed associations for class 3 obesity, anemiaand chronic bronchitis with exacerbation frequency in an adjusted model controlling for age, race/ethnicity, sex, financial class and smoking status.
EHR-derived data is helpful to understand exacerbations in real-life asthma patients, facilitating design of detailed studies and interventions tailored for specific populations.
What is safe enough - asthma in pregnancy - a review of current literature and recommendations
Although asthma is one of the most serious diseases causing complications during pregnancy, half of the women discontinue therapy thus diminishing the control of the disease, mostly due to the inadequate education and fear of adverse events. Sadly, this is sometimes encouraged by insufficiently educated physicians. Since the incidence and the prevalence of asthma is increasing, it is important to arouse the importance of proper asthma therapy during pregnancy. Inadequate therapy, as well as interrupting or discontinuing therapy, may result in adverse perinatal outcomes for both mother and child.
The main goal of asthma control during pregnancy is control of symptoms and prevention of exacerbations, same as in every asthmatic, but even more important. Maintaining optimal lung function, as well as regular daily activities, ensures maintenance of optimal fetal oxygenation. The therapy should be adapted depending on the frequency and severity of daily and nocturnal symptoms, demand for reliever therapy, by the limitations in everyday activities and the frequency of emergency asthma-related hospitalizations. Pre-conceptual education and therapy are very important and should be supported by an asthma action plan adjusted for the period of pregnancy. It is very important to note that most of the drugs used before pregnancy can be safely continued during pregnancy. Pharmacological and non-pharmacological therapy should be used in parallel. Pregnant women should be informed about the nature of the disease, therapy used during pregnancy, possible complications, avoidance of triggers, proper administration of therapy and, most important, why should the therapy be continued throughout the pregnancy on individual basis. Although drug treatment should be based on using drugs with less harm risk, if control of severe symptoms is needed to be achieved in order to protect both mother and child, any anti-asthmatic drug would have the beneficial benefit/harm ratio.
There is no solid evidence that asthma treatment during pregnancy causes adverse outcomes for the mother and child but for many, especially new drugs, there is not enough data gathered. On the other hand, harmfulness of uncontrolled asthma during pregnancy is well documented so every effort should be put on preserving good control of asthma during pregnancy.
Biomarkers in asthma: state of the art
Asthma is a heterogenous disease characterized by multiple phenotypes driven by different mechanisms. The implementation of precision medicine in the management of asthma requires the identification of phenotype-specific markers measurable in biological fluids. To become useful, these biomarkers need to be quantifiable by reliable systems, reproducible in the clinical setting, easy to obtain and cost-effective.
Using biomarkers to predict asthma outcomes and therapeutic response to targeted therapies has a great clinical significance, particularly in severe asthma. In the last years, significant research has been realized in the identification of valid biomarkers for asthma. This review focuses on the existent and emerging biomarkers with clinical higher applicability in the management of asthma.
Meet the new Interasma's Executive Board
LOUIS PHILIPPE BOULET
FIRST VICE PRESIDENT:
SECOND VICE PRESIDENT:
CHIEF EXECUTIVE DIRECTOR:
GIORGIO WALTER CANONICA
IGNACIO J. ANSOTEGUI
INTERASMA scientific network (INES) is running a internet based survey on "beliefs and behaviours about biological treatments for severe asthma"
GAA-INTERASMA Scientific Network
Dear colleagues, GAA-INTERASMA scientific network (INES) is running an internet based survey on “beliefs and behaviours about biological treatments for severe asthma” which you can access by clicking on the following link:
The survey is anonymous however if you wish to leave your e-mail address you will be part of the communication activities and you will be invited to be part of the INES Network*
GAA-INTERASMA Secretary General
INES (GAA-INTERASMA Scientific network)
* INESnet (GAA-INTERASMA Scientific nertwork) is a meeting place for members to get to know each other, to know who does what and where. The purpose is to create an international network, to work together and offer opportunities. The values which underlie this project are the sharing of efforts, facilities, opportunities, thoughts and ideas with the aim to develop and spread a critical quantity of scientific products, favoring rapidity in full respect of scientific rigor. The drivers for all INESnet members should be to be part of a recognized scientific network and the achievement of benefits from cooperative working. The expected change is the increase of members’ scientific expertise (CV- career) and the opportunity to grow from the professional point of view. INESnet was born as an editorial project on obstructive lung diseases. The startingworking tool will be a dedicated digital platform for meeting, sharing, discussing, researching and writing papers. This will allow to start a tight collaboration characterized by open-mindedness, fluency, speed, productivity on a broad field of issues in obstructive lung diseases.
The following new article have just been published in Asthma Research and Practice: Exhaled biomarkers in childhood asthma: old and new approaches
Asthma is a chronic condition usually characterized by underlying inflammation. The study of asthmatic inflammation is of the utmost importance for both diagnostic and monitoring purposes. The gold standard for investigating airway inflammation is bronchoscopy, with bronchoalveolar lavage and bronchial biopsy, but the invasiveness of such procedures limits their use in children. For this reason, in the last decades there has been a growing interest for the development of noninvasive methods.
In the present review, we describe the most important non-invasive methods for the study of airway inflammation in children, focusing on the measure of the fractional exhaled nitric oxide (feNO), on the measure of the exhaled breath temperature (EBT) and on the analysis of both exhaled breath condensate (EBC) and exhaled air (Volatile Organic Compounds, VOCs), using targeted and untargeted approaches. We summarize what is currently known on the topic of exhaled biomarkers in childhood asthma, with a special emphasis on emerging approaches, underlining the role of exhaled biomarkers in the diagnosis, management and treatment of asthma, and their potential for the development of personalized treatments.
Among non-invasive methods to study asthma, exhaled breath analysis remains one of the most interesting approaches, feNO and “-omic” sciences seem promising for the purpose of characterizing biomarkers of this disease.