Asthma costs and social impact
In recent decades, both asthma prevalence and incidence have been increasing worldwide, not only due to the genetic background, but mainly because of the effect of a wide number of environmental and lifestyle risk factors.
In many countries noncommunicable diseases, like asthma, are not yet considered a healthcare priority. This review will analyze and discuss disparities in asthma management in several countries and regions, such as access to healthcare human resources and medications, due to limited financial capacity to develop strategies to control and prevent this chronic disease.
This review tries to explore the social and economic burden of asthma impact on society. Although asthma is generally accepted as a costly illness, the total costs to society (direct, indirect and intangible asthma costs) are difficult to estimate, mainly due to different disease definitions and characterizations but also to the use of different methodologies to assess the asthma socio-economic impact in different societies.
The asthma costs are very variables from country to country, however we can estimate that a mean cost per patient per year, including all asthmatics (intermittent, mild, moderate and severe asthma) in Europe is $USD 1,900, which seems lower than USA, estimated mean $USD 3,100.
Preacutionary labelling of cross-reactive foods: The case of rapeseed
Alessandro Fiocchi, Lamia Dahdah, Carla Riccardi, Oscar Mazzina and Vincenzo Fierro
Food allergic individuals are exposed to unnecessary dietary restrictions due to precautionary food allergy labelling (PFAL). Two forms of PFAL exist: type I identifies the possible presence of allergenic contaminaion in foods (‘may content…’), type II indicates as potentially dangerous ingredients or contaminants that do no belong to official list of food allergens. PFAL type II is based on the fear of cross-reactivity with foods belonging to that list. PFAL type II is less known, but may be tempting for the legal offices of food companies, for clinicians in a ‘defensive medicine’ key, and even for legislators. We identify here a case of PFAL type II, allergy to rapeseed (belonging to the family of Brassicaceae). Increasingly used for their nutritional and nutraceutic value in asthma prevention, rapeseed has been indicated by regulatory authorities in Canada and Europe as potential cross-reactor with mustard. In this review, we provide the elements for a risk assessment of cross-reactivity of rapeseed/mustard allergy in the general population both clinically and from the point of view of the molecular allergy. Three findings emerge:
1. Allergic reactions to rapeseed are exceptional
2. The allergens identified in rapeseed and mustard are similar, but not identical
3. Reactions to rapeseed have never been described in mustard-allergic patients.
On the ground of existing evidence, a precautionary labeling for rapeseed as potentially dangerous for patients allergic to mustard is not justified. In the interest of patients with multiple food allergy, PFAL type II must be avoided.
Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (
Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases.
Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change.
The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction.
In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant.
Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician’s considerations of disease features, phenotype, and response to previous therapy.
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Asthma phenotypes: the intriguing selective intervention with Montelukast
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation and a variable course associated with various underlying mechanisms that can differ between individuals. Patients with asthma can therefore exhibit different phenotypes, a term used to define the observable characteristics of an organism resulting from the interaction between its genetic makeup and the environment. The heterogeneity of asthma has received a large amount of attention in the last few years in order to better tailor treatment according to the different clinical and biological phenotypes of the disease. Specific asthma phenotypes may require an approach to treatment sometimes different from that recommended by current guidelines, so a personalized approach to asthma pharmacotherapy is recommended. Growing evidence suggests that leukotrienes play an important role in the pathogenesis of bronchial asthma. The mechanisms of action of leukotriene-receptor antagonists theoretically predict a good response in some asthma “phenotypes”.In this article we have performed an analysis of the recent literature (controlled clinical trials and real-life studies) about a possible selective intervention with Montelukast in specific asthma phenotypes.
The management of asthmatic smokers
Asthma is still a major public health problem in most countries; new strategies to better control this disease are necessary. Such strategies must include predisposing factors. One of these factors is smoking and a significant fraction of asthmatics are smokers. However, clinical trials studying new drugs or newer therapeutic regimens for asthma generally exclude smokers. Therefore, there is a lack of specific information about the treatment of asthma in smokers. The asthmatic smoker is a special phenotype with important therapeutic and prognostic clinical implications. Any form of tobacco use, especially cigarette smoking, plays an important role in this disease. Asthmatic smokers are prone to several negative outcomes. Smoking cessation results in an improvement of symptoms and pulmonary functioning. Counselling and first-line medications for smoking cessation (nicotine replacement therapy, bupropion and varenicline) significantly increase quitting rates. The role of electronic cigarettes in this group of patients has only begun to be studied. The treatment of asthmatics that smoke has characteristics that need must be well understood by clinicians, especially the poor response to corticosteroids. This condition is not universal and physicians should always consider its inclusion in the treatment of these patients. The association of inhaled corticosteroids (ICS) plus a long-acting beta2 adrenegic (LABA) by smoking asthmatics results in more pronounced improvement in several asthma outcomes compared with the use of corticosteroid alone. Inhaled corticosteroids in extra-fine particles associated with LABA may be a new perspective of treatment. Also the use of leukotriene antagonists may become another therapeutic alternative. The purpose of this narrative review is to discuss the challenges faced by clinicians to control asthma in smokers and to present methods of coping with smoking treatment and avoiding relapses.
Asthma Research and Practice celebrates its first anniversary
As open access journal Asthma Research and Practice celebrates its first anniversary, we are pleased to bring you a selection of recently published articles. We hope you find the articles of interest and invite you to submit your next manuscript to the journal.
Cynthia Wilson Baffi, Daniel Efrain Winnica and Fernando Holguin
Nguyen et al.
Watkins et al.
About the Journal
Asthma Research and Practice is the official publication of Interasma and publishes cutting edge basic, clinical and translational research in addition to hot topic reviews and debate articles relevant to asthma and related disorders (such as rhinitis, COPD overlapping syndrome, sinusitis). The journal has a specialized section which focusses on pediatric asthma research.
Asthma Research and Practice aims to serve as an international platform for the dissemination of research of interest to pulmonologists, allergologists, primary care physicians and family doctors, ENTs and other health care providers interested in asthma, its mechanisms and comorbidities.
Reasons to Publish with Us
- The official journal of Interasma
- Dedicated section on pediatric asthma
- Translating research from bench to bedside
Asthma Research and Practice: Potential of molecular based diagnostics and its impact on allergen immunotherapy
The following new article has just been published in Asthma Research and Practice
Melioli G, Savi E, Crivellaro M, Passalacqua G
Asthma Research and Practice 2016, 2 :9 (2 June 2016)
Molecular based in vitro technologies greatly changed the diagnostic approaches in allergy. At present, sensitization profiles can be dissected according to IgE subsets, which are specific for genuine or cross-reacting components and potentially dangerous or virtually harmless components. The identification of IgE in components with specific characteristics has a direct impact on the accuracy of the diagnosis (indeed, it is possible at present to not only identify the allergen derived from a given allergen source but also the family of molecules to which the patient is sensitized), on the prognosis of the patient’s allergy, and on the prevention activities to be implemented. More interestingly, during the last few years, and thanks to the tools of molecular diagnostics, the indications for Allergen Immunotherapy (AIT) have also be modified, and novel strategies for the selection of the allergens to be administered have been better defined. Indeed, protocols indicating how Molecular Based Diagnosis (MBD) can be used to identify the best AIT approach have been recently published. In this review, the rationale for the use of MBD tools is discussed, and the recent strategies for the choice of allergens to be used in AIT are reported.