Abstract

Background

Involving patients and the public in research prioritisation is important. Cochrane Airways works with authors to produce systematic reviews of evidence related to chronic airways disease. Cochrane Airways has undertaken activities to identify research priorities, including workshops with stakeholders and consultation with experts. We present the findings of an online survey, designed to align our work with the priorities of people affected by asthma.

Methods

We promoted a survey comprising open-ended questions via social media to people affected by asthma. We compiled the free-text responses and conducted an exploratory thematic analysis to identify important barriers and facilitators to asthma control. We triangulated findings with other research prioritisation activities to produce new review questions.

Results

We received 57 survey responses. Eight main themes emerged, most encompassing both facilitators and barriers: attitudes and knowledge; financial costs; environmental factors and triggers; healthcare systems; lifestyle factors; medication; self-care; and support. Barriers were more frequently mentioned than facilitators and many related to healthcare systems.

Conclusions

These findings offer valuable insights into the challenges faced by individuals affected by asthma in the UK, and possibly further afield. We developed a list of priority reviews based on what was said by people in this survey and at a workshop. This demonstrates the real impact that people affected by asthma have on the research agenda of Cochrane Airways. Over the next 2–3 years we will produce reviews that address some of these questions hopefully leading to health benefits.

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Abstract

Vocal cord dysfunction (VCD) is a term that refers to inappropriate adduction of the vocal cords during inhalation and sometimes exhalation. It is a functional disorder that serves as an important mimicker of asthma. Vocal cord dysfunction can be difficult to treat as the condition is often underappreciated and misdiagnosed in clinical practice. Recognition of vocal cord dysfunction in patients with asthma-type symptoms is essential since missing this diagnosis can be a barrier to adequately treating patients with uncontrolled respiratory symptoms. Although symptoms often mimic asthma, the two conditions have certain distinct clinical features and demonstrate specific findings on diagnostic studies, which can serve to differentiate the two conditions. Moreover, management of vocal cord dysfunction should be directed at minimizing known triggers and initiating speech therapy, thereby minimizing use of unnecessary asthma medications. This review article describes key clinical features, important physical exam findings and commonly reported triggers in patients with vocal cord dysfunction. Additionally, this article discusses useful diagnostic studies to identify patients with vocal cord dysfunction and current management options for such patients.

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Allergic rhinitis (AR) is a common comorbidity of asthma that contributes to asthma severity. Although over 80 % of asthmatics have AR, the condition is frequently underdiagnosed in subjects with asthma. AR itself is also a highly prevalent condition, affecting 10-30 % of adults and up to 40 % of children. AR has been associated with both increased risk of asthma development and asthma severity. The exact mechanisms underlying these relationships have yet to be fully elucidated, but evidence supports a role for allergen sensitization. Compared to those with asthma alone, patients with comorbid AR and asthma have greater use of health care resources, including visits to the general practitioner, emergency department and hospitalizations. Pharmacological treatment of AR reduces this health care burden. Immunotherapy for AR improves both asthma and rhinitis symptoms in addition to preventing future allergen sensitizations and asthma development. Appropriate recognition, diagnosis and treatment of AR can significantly reduce asthma morbidity and improve quality of life.

Abstract

Despite the regular treatment with inhaled corticosteroids (ICS) or ICS plus long-acting beta2-agonists, permits to control de majority of asthmatics, a significant proportion of patients does not respond to this treatment.

This review was aimed to explore the role of psychological factors associated to the unsuccessful fulfilment of optimal levels of asthma control, especially in patients suffering from severe asthma. The results of a Medline search were 5510 articles addressed to different psychological key concepts, constructs and variables. This review will highlight how some selected psychological factors may have a burden on asthma management. Evidences are now available about the link between asthma (in terms of severity and control), some psychological aspects (subjective perception, alexithymia, coping style) and mental health (anxiety, depression). Taking into account this most probably bidirectional influence, a screening of mental symptoms and psychological aspects related to asthma, could lead to plan appropriate interventions to better control asthma and to improve the patient’s well-being.

Carlos E. Baena Cagnani Grant: Best Publication in the Asthma Research and Practice

To honor the memory of its Past President Professor Carlos E. Baena Cagnani, the WCA-2016 will award the “Carlos E. Baena Cagnani Grant” to the Global Asthma Association-INTERASMA Member who has published the Best Article in the Asthma Research and Practice Journal

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Criteria

•    The applicant should be a GAA-INTERASMA Member the last four (4) years.
•    The applicant should have already published an article in the “Asthma Research and Practice” Journal

Communication Grant

The WCA-2016 will award a Communication Grant to a GAA-INTERASMA Member who has most promoted the Organization and its goals through the Internet and social media.

Criteria

•    The applicant should be a GAA-INTERASMA Member for the last five (5) years.
•    The applicant needs to have already submitted articles for publication in the GAA-INTERASMA website.

Abstract

The acute airway narrowing that occurs as a result of exercise is defined exercise-induced bronchoconstriction (EIB). Most recent guidelines recommend distinguishing EIB with underlying clinical asthma (EIB _A ) from the occurrence of bronchial obstruction in subjects without other symptoms and signs of asthma (EIBw _A ). EIB has been in fact reported in up to 90 % of asthmatic patients, reflecting the level of disease control, but it may develop even in subjects without clinical asthma, particularly in children, athletes, patients with atopy or rhinitis and following respiratory infections. Both EIB _A and EIBw _A have peculiar pathogenic mechanisms, diagnostic criteria and responses to treatment and prevention. The use of biomarkers, proteomic approaches and innovative technological procedures will hopefully contribute to better define peculiar phenotypes and to clarify the role of EIB as risk factor for the development of asthma, as well as an occupational disease.

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Abstract

Despite the regular treatment with inhaled corticosteroids (ICS) or ICS plus long-acting beta2-agonists, permits to control de majority of asthmatics, a significant proportion of patients does not respond to this treatment.

This review was aimed to explore the role of psychological factors associated to the unsuccessful fulfilment of optimal levels of asthma control, especially in patients suffering from severe asthma. The results of a Medline search were 5510 articles addressed to different psychological key concepts, constructs and variables. This review will highlight how some selected psychological factors may have a burden on asthma management. Evidences are now available about the link between asthma (in terms of severity and control), some psychological aspects (subjective perception, alexithymia, coping style) and mental health (anxiety, depression). Taking into account this most probably bidirectional influence, a screening of mental symptoms and psychological aspects related to asthma, could lead to plan appropriate interventions to better control asthma and to improve the patient’s well-being.

Dear colleagues and friends 

It is my privilege and honor to invite you to participate in the 23rd World Congress of Asthma - WCA-2016 in Madrid, Spain, organized by the Asthma Global Association-INTERASMA, from March 12 through March 15, 2016. This congress is supported by the Spanish societies: SEPAR (Sociedad Española de Neumología y Cirugía Torácica), SEAIC (Sociedad Española de Alergología e Inmunología Clínica), SEICAP (Sociedad Española de Alergia, Inmunología Clínica, Asma y Alergia Pediátrica) and Spanish Pediatric Association (AEP) whose members are welcome.

WCA brings together specialists, physicians, and healthcare professionals from all over the world to share valuable scientific knowledge on asthma, ranging from diagnostic and therapeutic tools and techniques to leading-edge research. WCA has been very popular resulting in highly successful well attended congresses with outstanding state-of-the-art scientific programs.

The 23rd World Congress of Asthma - WCA-2016 will not be an exception; we plan to produce a great scientific program once again. The INTERASMA is celebrating its 60th anniversary of uninterrupted education in the field of asthma, making it the most important international asthma and related diseases organization in the world, as well as a reference organization for primary care physicians, healthcare providers and medical students.  

Madrid, the majestic capital of Spain, is one of the most beautiful cities in Europe and it is famous for its rich heritage and culture, hosting important museums with masterpieces of art through centuries of exciting history. Today, Madrid is an economic, financial, administrative and cultural destination, offering great hospitality, infrastructure, great culinary tradition, and a very attractive night life. We look forward to welcoming you in Madrid, Spain, in 2016.

Sincerely, 

Professor Giorgio Walter Canonica President of INTERASMA

http://www.wca-2016.com/ 

Review

Abstract

The use and role of allergen immunotherapy (AIT) in asthma is still a matter of debate, and no definite recommendation about this is made in guidelines, both for the subcutaneous and sublingual routes. This is essentially due to the fact that most controlled randomised trials were not specifically designed for asthma, and that objective measures of pulmonary function were only occasionally considered. Nonetheless, in many trials, favourable results in asthma (symptoms, medication usage, bronchial reactivity) were consistently reported. There are also several meta analyses in favour of AIT, although their validity is limited by a relevant methodological heterogeneity. In addition to the crude clinical effect, a disease modifying action of AIT (prevention of asthma onset and long-lasting effects) have been reported. The safety is an important aspect to consider in asthma. Fatalities were rare: in Europe no fatality was reported in the last three decades, as in the United States in the last 4 years. Based on previous surveys, and common sense, uncontrolled asthma is still recognized as the most important risk factor for severe adverse events. On the contrary, there is no evidence that AIT can worsen or induce asthma. According to the available evidence, AIT can be safely used as add-on treatment when asthma is associated with rhinitis (a frequent condition), provided that asthma is adequately controlled by pharmacotherapy. AIT cannot be recommended or suggested as single therapy. When asthma is the unique manifestation of respiratory allergy, its use should be evaluated case by case.

Keywords: 

Allergen immunotherapy; Sublingual immunotherapy; Subcutaneous immunotherapy; Efficacy; Safety; Allergic asthma; Allergic rhinitis; Adverse events 

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