Implementation of asthma guideline in Taiwan--the management in medical centers

Childhood asthma clusters reveal neutrophil-predominant phenotype with distinct gene expression

BACKGROUND

Childhood asthma comprises different phenotypes with complex pathophysiology. Different asthma phenotypes evoke various clinical symptoms and vary in their responses to treatments.

METHODS

We applied k-means clustering algorithm of twelve objective laboratory tests among 351 asthmatic children enrolled in the Taiwanese Consortium of Childhood Asthma Study (TCCAS). We constructed gene expression profiles of peripheral blood mononuclear cells (PBMC) from children with different asthma phenotypes.

RESULTS

Five distinct phenotypes of childhood asthma were identified and can be characterized by either eosinophil-predominant or neutrophil-predominant inflammatory characteristics. In the gene expression profile analysis, significant differences were noted for neutrophil-predominant asthma, compared with samples from all the other asthma phenotypes. The vast majority of the differentially expressed genes in neutrophil-predominant asthma was associated with corticosteroid response. From an independent inhaled corticosteroid (ICS) response cohort, we also found neutrophils could be activated in this severe asthma phenotype and neutrophil-predominant asthma may be associated with corticosteroid nonresponsiveness.

CONCLUSION

Phenotype clustering of childhood asthma can be helpful to identify clinically relevant patients and reveal different inflammatory characteristics in asthmatic children. Neutrophil-predominant asthma is the most severe asthma phenotype with poor corticosteroid response. Gene expression profile of different asthma phenotypes not only improve our knowledge of childhood asthma, but also can guide asthma precision medicine.

Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence

BACKGROUND

Non-adherence to asthma treatment is a contributing factor for poorly controlled asthma.

AIM

The aim of this systematic review is to explore patients' perceptions of their inhaled asthma treatment, and how these relate to adherence, using both qualitative and quantitative data.

METHODS

Pre-determined search terms and inclusion criteria were used to search electronic databases (The Cochrane Library, MEDLINE, EMBASE and PsycINFO). Two researchers screened titles and abstracts using the Rayyan web app and data were extracted in relation to psychological components (beliefs about, and attitudes towards, medicines) and adherence.

RESULTS

Of 1638 papers, 36 met the inclusion criteria. Key themes were: Perceived need for treatment - all 12 studies using the BMQ to measure patients' perceived need for treatment found that patients' beliefs about their necessity for treatment were associated with adherence-; Concerns about treatment - immediate and long-term side effects (58%), worries about safety (19%), and potential addiction to asthma medication (31%)-; and Perceived social stigma - 22% of studies reported that embarrassment contributed to poor adherence.

CONCLUSIONS

Acknowledging and addressing patient treatment beliefs and perceptual barriers to adherence is integral to designing adherence interventions for asthma patients. Further research is needed to better our understanding of the relationship between treatment perceptions and adherence.

Salmeterol/Fluticasone Propionate in a Single Inhaler is Superior to Budesonide Alone in Control of Chinese Asthmatic Adults : An Open-Label, Randomised, 6-Week Study

OBJECTIVE AND DESIGN

There is comparatively little information on asthma management in China. A multicentre, randomised, open-label, parallel-group, 6-week treatment study was conducted to evaluate the efficacy and safety of salmeterol/fluticasone propionate combination treatment in Chinese adult asthmatic patients.

SETTING AND PATIENTS

398 patients with a documented history of moderate-to-severe asthma were randomised to treatment.

INTERVENTIONS

Salmeterol 50mug/fluticasone propionate 100mug twice daily for 6 weeks via Accuhaler((R)) (Diskustrade mark) inhaler and budesonide 400mug twice daily for 6 weeks via Turbuhaler((R)) inhaler.

MAIN OUTCOME MEASURES AND RESULTS

Morning peak expiratory flow (PEF) was investigated as the primary efficacy endpoint; evening PEF, use of salbutamol (albuterol) as rescue medication, and day- and night-time asthma symptom scores were secondary efficacy endpoints. Safety was assessed according to adverse events recorded. Over the 6-week treatment period, salmeterol/fluticasone propionate led to a significantly greater increase in morning (p < 0.0001) and evening (p = 0.0066) PEF compared with budesonide. Moreover, the significant benefit of salmeterol/fluticasone propionate was evident from the first week. Similarly, salmeterol/fluticasone propionate led to significantly greater improvements in the use of rescue medication and day- and night-time asthma symptom scores, compared with budesonide. Both treatments were well tolerated, with a similar incidence (23%) of adverse events in both treatment groups and no serious adverse events.

CONCLUSIONS

Salmeterol/fluticasone propionate 50mug /100mug twice daily was significantly more effective than budesonide 400mug twice daily in improving lung function and reducing symptoms and use of rescue medication in Chinese asthmatic patients who were poorly controlled on low-dose inhaled corticosteroids. This confirms the findings of superior efficacy of this combination product over budesonide in other populations.

Developing a scale to measure self-efficacy on asthma teaching for health care providers

BACKGROUND

A number of educational programs have focused on promoting the knowledge of asthma to health care professionals, but not teaching competency. Increasing the cognition of self-efficacy on patient teaching could enhance the competency in teaching for patients with asthma. However, at present we do not have an appropriate tool to measure self-efficacy on asthma teaching for health care providers.

OBJECTIVES

The aim of this study was to evaluate construct validity by Factor analysis and investigating dimensionality by Rasch analysis of a self-efficacy on asthma teaching scale (SEATs) among nurses in Taiwan.

PARTICIPANTS

A total of 281 nurses from 3 medical centers volunteered to participate and complete the SEATs.

METHODS

A 20-item SEATs was developed including self-efficacy of general teaching and self-efficacy of specific asthma-related teaching. Instrument reliability and validity are examined by classical testing theory (item analysis, internal consistency, content validity, and construct validity). To examine whether each item in the SEATs fits the unidimensionality in the Rasch model, the Winsteps program was used to assess item difficulty, scale unidimensionality, item separation, and linearity.

RESULTS

SEATs has good content validity, internal consistency, and construct validity. Rasch analysis revealed that three items were problematic and need to be re-examined in further study.

CONCLUSION

The first version of SEATs has an acceptable psychometric property to evaluate the asthma teaching efficacy of nurses, although three items were INFIT according to Rasch analysis. A different population of nurses should be recruited to further refine this tool. SEATs could be used as an outcome measure for further program evaluation.