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Rönnebjerg L, Axelsson M, Kankaanranta H, Ekerljung L. Health-related quality of life, anxiety, depression, beliefs of medication, and self-efficacy in individuals with severe asthma - a population-based study. J Asthma 2024; 61:148-159. [PMID: 37610189 DOI: 10.1080/02770903.2023.2248512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Individuals with severe asthma often report poor Health-related quality of life (HRQoL) and more research is essential to increase understanding of how they may be helped to improve HRQoL. The main aim of the current paper is to evaluate HRQoL, and possible factors influencing HRQoL, in individuals with severe asthma. The aim is also to explore associations among anxiety, depression, beliefs of medication, self-efficacy, and HRQoL among individuals with severe and other asthma as well as those with no asthma. METHODS Participants with severe asthma (n = 59), other asthma (n = 526), and no asthma (n = 902) were recruited from West Sweden Asthma Study, a population-based study, which includes both questionnaire surveys and clinical examinations. RESULTS Individuals with severe asthma had worse physical HRQoL (measured with SF-8) than those with other and no asthma (median 48.4, 51.9, and 54.3, respectively). They also had worse mental HRQoL (median 46.7) and reported higher anxiety and depression scores (measured using HADS, median 5.0 and 3.5, respectively) compared to no asthma (median 4.0 and 2.0, respectively). HRQoL was particularly affected among women with severe asthma. Individuals with severe asthma believed that their asthma medication was more necessary than those with other asthma, but they reported more concern for the medication. Asthma control and packyears predicted physical HRQoL and anxiety predicted mental HRQoL among individuals with severe asthma. CONCLUSIONS Efforts to improve asthma control and to reduce anxiety may improve HRQoL in individuals with severe asthma. Especially, women with severe asthma seem to need support to improve their HRQoL. Reducing concerns with asthma medication is most likely essential as high concerns may lead to poor adherence, which in turn may negatively affect asthma control and HRQoL.
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Affiliation(s)
- L Rönnebjerg
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - M Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - H Kankaanranta
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - L Ekerljung
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Maspero JF, Khan AH, Philpott C, Hellings PW, Hopkins C, Wagenmann M, Siddiqui S, Msihid J, Nash S, Chuang CC, Kamat S, Rowe PJ, Deniz Y, Jacob-Nara JA. Health-Related Quality of Life Impairment Among Patients with Severe Chronic Rhinosinusitis with Nasal Polyps in the SINUS-24 Trial. J Asthma Allergy 2023; 16:323-332. [PMID: 37016622 PMCID: PMC10066887 DOI: 10.2147/jaa.s372598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammatory disease with a high symptom burden. Data are lacking on the comparative health status of patients with CRSwNP. This analysis compared baseline physical and mental health-related quality of life (HRQoL) and overall health status of patients with severe CRSwNP enrolled in a Phase 3 clinical trial with general population norms and with other chronic diseases. Methods In this post hoc cross-sectional analysis of baseline data from the SINUS-24 study (NCT02912468), HRQoL was measured using the 36-item Short Form (SF-36) questionnaire and general health status was measured using the EuroQol-5 Dimension visual analog scale (EQ-VAS). Analyses included the intention-to-treat (ITT) population and subgroups defined by prior sinonasal surgery, systemic corticosteroid use, and coexisting asthma or non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD). Scores were compared with published values for population norms (50 for SF-36 physical component summary (PCS) and mental component summary (MCS), 70.4-83.3 for EQ-VAS) and for rheumatoid arthritis, type 2 diabetes, and asthma. Results In the ITT population (n=276), mean SF-36 physical component summary (PCS), SF-36 mental component summary (MCS), and EQ-VAS scores were below general population norms (46.4, 48.6, and 66.0, respectively). Mean SF-36 PCS and EQ-VAS scores were below population norms across all subgroups; mean SF-36 MCS scores were below the population norm in all subgroups except no prior surgery. SF-36 PCS and MCS scores from SINUS-24 were generally similar to other chronic diseases, except SF-36 PCS which was lower in rheumatoid arthritis. EQ-VAS scores in SINUS-24 were lower than in other chronic diseases. HRQoL scores weakly correlated with objective measures of disease severity. Conclusion In patients with severe CRSwNP, including those with coexisting asthma/NSAID-ERD, HRQoL was worse than population norms and as burdensome as diseases such as type 2 diabetes, asthma, and rheumatoid arthritis.
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Affiliation(s)
- Jorge F Maspero
- Allergy & Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
- Correspondence: Jorge F Maspero, Allergy & Respiratory Research Unit, Fundación CIDEA, Paraguay 2035, 2SS, Buenos Aires, Argentina, Tel +54 9 11 4183-7294, Email
| | - Asif H Khan
- Global Medical Affairs, Sanofi, Chilly-Mazarin, France
| | - Carl Philpott
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter W Hellings
- Department of Otorhinolaryngology – Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Claire Hopkins
- Department of Otorhinolaryngology, King’s College London, London, UK
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Düsseldorf University Hospital (UKD), Düsseldorf, Germany
| | - Shahid Siddiqui
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | - Jérôme Msihid
- Health Economics and Value Assessment, Sanofi, Chilly-Mazarin, France
| | - Scott Nash
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | - Siddhesh Kamat
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | - Paul J Rowe
- Global Medical Affairs, Sanofi, Bridgewater, NJ, USA
| | - Yamo Deniz
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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Rinaldo RF, Imeri G, Mondoni M, Parazzini EM, Vigo B, Masseroni A, Centanni S, Di Marco F. Does the severity of asthma affect exercise capacity and daily physical activity? J Asthma 2023:1-10. [PMID: 36650704 DOI: 10.1080/02770903.2023.2169932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Exercise capacity, daily physical activity, and psychological profile are crucial aspects in the management of asthmatic patients. Whether these features are expressed in a different way in mild-moderate (MMA) and severe asthma (SA) is unknown. METHODS In this observational cross-sectional study, patients matching the American Thoracic Society/European Respiratory Society (ATS/ERS) definition for SA underwent incremental cardiopulmonary exercise testing (CPET), full lung function testing, and an evaluation of daily step count and physical activity. Questionnaires on quality of life, general fatigue, and presence of anxiety and depression traits (Hospital Anxiety and Depression Scale - HADS) were administered. Patients were compared with a cohort of age- and gender-matched MMA patients. RESULTS We enrolled 16 SA, 17 MMA patients, and 16 healthy subjects. Compared to MMA, SA subjects showed a median (interquartile range) reduced peak oxygen consumption during CPET (20.4 (17.2-23.3) vs. 25.6 (18.5-30.3) ml/min/kg; p = 0.019), a reduced resting lung function (FEV1% of predicted 77 (67-84) vs. 96 (84-100); p < 0.001) and a pronounced anxiety trait at HADS (9.5 (3-11.7) vs. 4.0 (2.0-7.5); p = 0.023). In addition, SA patients showed a significantly higher reduction in inspiratory capacity from rest to peak (310 (160-520) vs. 110 (-65-325) ml; p = 0.031). We found no significant differences in mean daily step count or quality of life. CONCLUSIONS Compared to MMA, SA patients present a reduced exercise capacity and a more pronounced anxiety trait, but not worse daily physical activity or quality of life. These aspects should be considered in the clinical management and research development of SA.
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Affiliation(s)
- Rocco Francesco Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianluca Imeri
- Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Department of Health Sciences, University of Milan, Bergamo, Italy
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Elena Maria Parazzini
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Beatrice Vigo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alessandra Masseroni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Fabiano Di Marco
- Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Department of Health Sciences, University of Milan, Bergamo, Italy
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Boudier A, Markevych I, Jacquemin B, Abramson MJ, Accordini S, Forsberg B, Fuertes E, Garcia-Aymerich J, Heinrich J, Johannessen A, Leynaert B, Pin I, Siroux V. Long-term air pollution exposure, greenspace and health-related quality of life in the ECRHS study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 849:157693. [PMID: 35907524 DOI: 10.1016/j.scitotenv.2022.157693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/11/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Associations of long-term exposure to air pollution and greenspace with health-related quality of life (HRQOL) are poorly studied and few studies have accounted for asthma-rhinitis status. OBJECTIVE To assess the associations of air pollution and greenspace with HRQOL and whether asthma and/or rhinitis modify these associations. METHODS The study was based on the participants in the second (2000-2002, n = 6542) and third (2011-2013, n = 3686) waves of the European Community Respiratory Health Survey (ECRHS) including 19 centres. The mean follow-up time was 11.3 years. HRQOL was assessed by the SF-36 Physical and Mental Component Summary scores (PCS and MCS). NO2, PM2.5 and PM10 annual concentrations were estimated at the residential address from existing land-use regression models. Greenspace around the residential address was estimated by the (i) mean of the Normalized Difference Vegetation Index (NDVI) and by the (ii) presence of green spaces within a 300 m buffer. Associations of each exposure variable with PCS and MCS were assessed by mixed linear regression models, accounting for the multicentre design and repeated data, and adjusting for potential confounders. Analyses were stratified by asthma-rhinitis status. RESULTS The mean (SD) age of the ECRHS-II and III participants was 43 (7.1) and 54 (7.2) years, respectively, and 48 % were men. Higher NO2, PM2.5 and PM10 concentrations were associated with lower MCS (regression coefficients [95%CI] for one unit increase in the inter-quartile range of exposures were -0.69 [-1.23; -0.15], -1.79 [-2.88; -0.70], -1.80 [-2.98; -0.62] respectively). Higher NDVI and presence of forests were associated with higher MCS. No consistent associations were observed for PCS. Similar association patterns were observed regardless of asthma-rhinitis status. CONCLUSION European adults who resided at places with higher air pollution and lower greenspace were more likely to have lower mental component of HRQOL. Asthma or rhinitis status did not modify these associations.
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Affiliation(s)
- Anne Boudier
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France; Pediatrics, CHU Grenoble-Alpes, Grenoble, France
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Bénédicte Jacquemin
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-35000 Rennes, France
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Judith Garcia-Aymerich
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Germany
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Isabelle Pin
- Pediatrics, CHU Grenoble-Alpes, Grenoble, France
| | - Valérie Siroux
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France.
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Heldin J, Malinovschi A, Johannessen A, Alving K, Holm M, Franklin KA, Forsberg B, Schlünssen V, Jögi R, Gislason T, Benediktsdottir B, Svanes C, Janson C. Clinical Remission of Asthma and Allergic Rhinitis - in a Longitudinal Population Study. J Asthma Allergy 2022; 15:1569-1578. [PMID: 36387839 PMCID: PMC9643071 DOI: 10.2147/jaa.s378584] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/14/2022] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Although asthma and allergic rhinitis are chronic diseases, some patients experience periods of remission. Information on prognostic factors associated with the remission of asthma and allergic rhinitis is valuable in resource prioritization. This study investigated factors associated with the clinical remission of asthma and allergic rhinitis. METHODS In the Respiratory Health In Northern Europe (RHINE) study, data was collected with questionnaires in stage one (RHINE I, 1989-1992) and two follow-ups (RHINE II, 1999-2001 and RHINE III, 2010-2012) from Sweden, Norway, Denmark, Iceland and Estonia. Clinical remission was defined as having reported asthma or allergic rhinitis in RHINE I or RHINE II but not in RHINE III. RESULTS Of 13,052 participants, 975 (7.5%) reported asthma in RHINE I or RHINE II, and 3379 (25.9%) allergic rhinitis. Clinical remission of asthma and allergic rhinitis was found in 46.4% and 31.8%, respectively. Living in Estonia (OR (95% CI) 2.44 (1.22-4.85)) and living in an apartment (1.45 (1.06-1.98)) were related to remission of asthma, while subjects reporting allergic rhinitis (0.68 (0.51-0.90)), asthma onset ≤ 12 years of age (0.49 (0.35-0.68)), receiving treatment with antibiotics for respiratory illness (0.64 (0.47-0.87)) were less likely to have asthma remission. Factors related to a higher likelihood of remission of allergic rhinitis were no asthma at baseline, age ≥ 58 years in RHINE III, allergic rhinitis onset after 12 years of age, living in rural areas as a child, having only a primary school education and not being pregnant. CONCLUSION Clinical remission was found in almost one-half of those with asthma and one-third of persons with allergic rhinitis. Coexisting allergic symptoms were associated with less clinical asthma remission. Age, asthma symptoms and environmental factors in childhood, such as living in a rural area, were found to influence the clinical remission of allergic rhinitis.
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Affiliation(s)
- Johanna Heldin
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kjell Alving
- Department of Women’s and Children’s Health, Paediatric Research, Uppsala University, Uppsala, Sweden
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Karl A Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Vivi Schlünssen
- Department of Public Health, Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Rain Jögi
- Tartu University Hospital, Lung Clinic, Tartu, Estonia
| | - Thorarinn Gislason
- The Medical Faculty, University of Iceland, Reykjavik, Iceland
- Department of Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland
| | - Bryndis Benediktsdottir
- The Medical Faculty, University of Iceland, Reykjavik, Iceland
- Department of Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland
| | - Cecilie Svanes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Kharaba Z, Feghali E, El Husseini F, Sacre H, Abou Selwan C, Saadeh S, Hallit S, Jirjees F, AlObaidi H, Salameh P, Malaeb D. An Assessment of Quality of Life in Patients With Asthma Through Physical, Emotional, Social, and Occupational Aspects. A Cross-Sectional Study. Front Public Health 2022; 10:883784. [PMID: 36117601 PMCID: PMC9477115 DOI: 10.3389/fpubh.2022.883784] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/07/2022] [Indexed: 01/21/2023] Open
Abstract
Background Asthma is a prevalent hyperactive airway disease with physical and emotional impact. Severe asthma is associated with considerable health-related quality of life (HRQoL). The aim of this study is to assess the quality of life through physical, emotional, social and occupational aspects and evaluate the factors affecting HRQoL in patients with asthma. Methods This is a cross-sectional multicenter study conducted on adult asthmatic patients enrolled from community pharmacies across different Lebanese geographic areas. Results Having wheezing sometimes and most of the time (Beta = -0.144 and -0.552), experiencing anxiety sometimes and most of the time (Beta = -0.205 and -0.573), encountering sleep problems sometimes and most of the time (Beta = -0.270 and -0.553), having previous chest discomfort sometimes and most of the time (Beta = -0.421 and -0.713), and having depression most of the times (Beta = -0.415) were associated with higher lower quality of life scores. On the other side, holding a secondary level of education was associated with a higher quality of life score (Beta = 0.192). Conclusion This study highlights that asthma affects adults' quality of life through social, emotional, physical, and occupational impacts. Improved follow-up and patient education may be essential in the future to stop disease progression and achieve ideal therapeutic outcomes.
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Affiliation(s)
- Zelal Kharaba
- Department of Clinical Sciences, College of Pharmacy, Al-Ain University of Science and Technology, Abu Dhabi, United Arab Emirates,Al Ain University Health and Biomedical Research Center (HBRC), Al Ain University, Abu Dhabi, United Arab Emirates
| | - Emilie Feghali
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Farah El Husseini
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Carla Abou Selwan
- INSPECT-LB: Institut National de Santé Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Sylvia Saadeh
- Life Sciences and Health Department, Paris-Est University, Paris, France,Health and Sciences Department, American University of Health and Sciences, Beirut, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon,Psychology Department, College of Humanities, Effat University, Jeddah, Saudi Arabia,Research Department, Psychiatric Hospital of the Cross, Jal El Dib, Lebanon
| | - Feras Jirjees
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Hala AlObaidi
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon,School of Medicine, Lebanese American University, Byblos, Lebanon,Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus,Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon,College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates,*Correspondence: Diana Malaeb
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Abstract
INTRODUCTION The numerous links between allergic rhinitis and asthma have been extensively explored in the last two decades, gaining great concern within the scientific community. These two conditions frequently coexist in the same patient and share numerous pathogenetic and pathophysiological mechanisms. AREAS COVERED We reviewed major pathophysiological, epidemiological, and clinical links between allergic rhinitis and asthma. We also provided a comprehensive discussion of allergic rhinitis treatment according to current guidelines, with a particular focus on the relevance of allergic rhinitis therapies in patients with comorbid asthma. EXPERT OPINION We believe that there are several unmet needs for our patients, however, there are promising advances forecasted for the future. Although allergic rhinitis is a recognized risk factor for asthma, a proper asthma detection and prevention plan in allergic rhinitis patients is not available. Allergen immunotherapy (AIT) represents a promising preventive strategy and may deserve an earlier positioning in allergic rhinitis management. A multidisciplinary approach should characterize the journey of patients with respiratory allergies, with an adequate referral to specialized Allergy/Asthma centers. Molecular Allergy Diagnosis may provide support for optimal AIT use. Finally, a possible evolution of biological treatment can be envisaged, mainly if biosimilars decrease such therapies' costs.
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Håkansson KEJ, Renzi-Lomholt M, Backer V, Ulrik CS. High Use of Antidepressant Medication in Both Mild-to-Modelate and Possible Severe Asthma - A Nationwide Cohort Study. J Asthma Allergy 2022; 15:13-23. [PMID: 35027831 PMCID: PMC8749230 DOI: 10.2147/jaa.s340522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE In asthma, increased severity has been linked to depression assessed as assessed by patient-reported outcomes. However, little is known about predictors of antidepressant use in asthma compared to the background population. METHODS The study consists of 60,534 asthma patients aged 18-45 and a 1:1 age- and sex-matched control group. Using national registries and prescription data, the prevalence of and risk factors for antidepressant use were investigated by logistic regression adjusted for age, sex, workforce and civil status, income- and education-level and comorbidity. Results presented as odds ratio (OR) with 95% confidence intervals (CI). RESULTS A total of 16% and 22%, respectively, among patients with mild-to-moderate and possible severe asthma redeemed antidepressant drugs, compared to 10% of controls. Antidepressant use was more prevalent amongst patients with high rescue medication use (>600 annual doses) and those with a history of moderate or severe exacerbation(s). Both mild-to-moderate and possible severe asthma were independent risk factors for antidepressant use (OR 1.40 (95% CI 1.35, 1.46) and OR 1.55 (95% CI 1.41, 1.70), respectively). Female sex, age, being divorced or never married, having only primary education or currently being under education, as well as being on welfare/transfer income increased odds of antidepressant use. Completing higher education and having high income were associated with lower odds. CONCLUSION In asthma, antidepressant use is significantly higher than in the background population. Even after adjusting for known risk factors, asthma remains a predictor of antidepressant use, signalling a psychologic burden related to living with asthma.
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Affiliation(s)
| | - Martino Renzi-Lomholt
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Vibeke Backer
- Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of ENT, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Tsolakis N, Jacinto T, Janson C, Borres M, Malinovschi A, Alving K. Relationship between longitudinal changes in type-2 inflammation, immunoglobulin E sensitization, and clinical outcomes in young asthmatics. Clin Transl Allergy 2021; 11:e12066. [PMID: 34582101 PMCID: PMC9083004 DOI: 10.1002/clt2.12066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/25/2021] [Accepted: 09/16/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Asthma is a heterogeneous condition where biomarkers may be of considerable advantage in diagnosis and therapy monitoring. However, the changes in asthma biomarkers and immunoglobulin E (IgE) over the course of life has not been extensively investigated. OBJECTIVE To study longitudinal changes in type-2 inflammatory biomarkers, IgE, and clinical outcomes, and the association between these changes, in young asthmatics. METHODS Asthmatics (age 10-35 years, n = 253) were examined at baseline and at a follow-up visit, 43 [23-65] (median [range]) months later. Subjects were analyzed using the multi-allergen tests Phadiatop and fx5 (ImmunoCAP) and grouped based on the baseline allergen-specific IgE antibody (sIgE) concentration: <0.10, 0.10-0.34, and ≥0.35 kUA /L. The relationship between changes (Δ values) in type-2 biomarkers (individualized fraction of exhaled nitric oxide [FeNO%], blood eosinophil [B-Eos] count, total IgE [tIgE] and sIgE, lung function [% predicted forced expiratory volume in 1 second (FEV1 ) and FEV1 /forced vital capacity (FVC)], and Asthma Control Test [ACT]) score were determined. RESULTS At follow up, FEV1 and FEV1 /FVC had decreased (93.6% vs. 95.8%, and 93.4% vs. 94.7% of predicted, respectively [p < 0.001 both]), whereas ACT score had increased (21.6 vs. 20.6, p = 0.001). A significant decline in lung function was seen in subjects with sIgE ≥ 0.10 kUA/L, but not in those with undetectable sIgE (<0.10 kUA /L). Furthermore, tIgE and sIgE declined over time (p < 0.001 all) whereas FeNO% and B-Eos count were not significantly changed. In univariate analysis, significant negative correlations between ∆B-Eos count and ∆FeNO%, on one hand, and changes in lung function, on the other hand, were seen, and multivariate analysis showed an independent relationship between ΔFeNO%, and ΔFEV1 (p < 0.05) and ΔFEV1 /FVC% (p < 0.01). Sex-specific analysis showed that the independent association between ΔFeNO%, and ΔFEV1 remained only in females (p = 0.005), and there was a significant interaction with sex (p = 0.02). CONCLUSION In young asthmatics, IgE levels declined over 43 months, whereas FeNO and B-Eos remained unchanged. In spite of improved asthma control, an accelerated lung function decline was seen in patients with detectable sIgE at baseline, and the decline correlated with changes in type-2 biomarkers. Particularly, the increase in individualized FeNO associated independently with decline in FEV1 in females.
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Affiliation(s)
- Nikolaos Tsolakis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | - Magnus Borres
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,ImmunoDiagnostics, Thermo Fisher Scientific, Uppsala, Sweden
| | | | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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10
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Batmaz SB, Birinci G, Akpınar Aslan E. Quality of Life of Children with Allergic Disease: The effect of Depression and Anxiety of Children and Their Mothers. J Asthma 2021; 59:1776-1786. [PMID: 34503366 DOI: 10.1080/02770903.2021.1978480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: In comparison with the general population, several studies have reported higher anxiety and depression rates not only in children with allergic diseases but also in their parents. We aimed to evaluate the mental health of children and their mothers affecting quality of life (QoL) in children with allergic diseases, and to compare anxiety and depression in these patients and their parents with the general population.Methods: One hundred and sixty-eight patients aged 8-18 years diagnosed with an allergic disease who visited our outpatient clinic and a control group of 61 children who did not have any chronic or allergic diseases were included in the study. Patients completed the Pediatric QoL Inventory, Trait Anxiety Inventory for Children, and Children's Depression Inventory, while mothers completed the General Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9). Independent samples' t-test was used to compare children's QoL, trait anxiety, and depression scores and mothers' GAD-7 and PHQ-9 scores between the controlled/mild and uncontrolled/moderate-severe groups. The effects of age, gender, disease severity, maternal depression/anxiety, and children's depression/anxiety on QoL were analyzed with multivariate regression analyses.Results: QoL was lower in children with allergic diseases than healthy children, and although the mean QoL score was lower in the group with high disease severity, QoL in children with allergic diseases was not associated with disease severity but inversely related to anxiety/depression and maternal depression.Conclusions: As per the results, QoL is impaired in children with allergic diseases. Both anxiety/depression in the child and maternal depression may adversely affect QoL in these patients.
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Affiliation(s)
- Sehra Birgül Batmaz
- Department of Pediatric Allergy and Clinical Immunology, Tokat State Hospital, Tokat, Turkey
| | | | - Esma Akpınar Aslan
- Department of Psychiatry, School of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
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11
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Song HJ, Blake KV, Wilson DL, Winterstein AG, Park H. Health-Related Quality of Life and Health Utilities of Mild, Moderate, and Severe Asthma: Evidence from the Medical Expenditure Panel Survey. J Asthma Allergy 2021; 14:929-941. [PMID: 34349523 PMCID: PMC8326771 DOI: 10.2147/jaa.s316278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/18/2021] [Indexed: 01/31/2023] Open
Abstract
Background Little information is known about the health-related quality of life (HRQOL) and the patient's preference values by the severity of asthma. We evaluated the HRQOL and health utility impairment associated with asthma severity using the SF-12 and SF-6D. Methods We conducted a cross-sectional analysis of 2010-2016 Medical Expenditure Panel Survey database of asthma patients aged ≥18 years and categorized them into mild, moderate, and severe asthma. Study outcomes included the SF-12 physical component summary (PCS) and mental component summary (MCS) for measuring HRQOL and SF-6D for health utility. Survey regression models were used to estimate HRQOL and utilities for mild, moderate, and severe asthma. Results Of 10,222 patients with asthma, 75.4%, 23.9%, and 0.8% had mild, moderate and severe asthma. We observed that the greater the severity, the lower the SF-6D scores: 0.731 in mild, 0.723 in moderate, and 0.659 in severe asthma (P < 0.001). Patients with severe asthma had a significantly lower PCS compared to those with mild asthma (-5.3; P < 0.001) but there was no significant difference in MCS (-1.9; P = 0.309) controlling for socioeconomic and clinical variables. Asthma severity, women, older age, and having a lower level education and public insurance were significantly associated with lower PCS (P < 0.01). Conclusion Asthma patients had worse physical HRQOL than mental health, especially patients with severe asthma. These data suggest that the management of physical health of female, older aged, and low education patients with asthma should be focused on improving HRQOL.
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Affiliation(s)
- Hyun Jin Song
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA
| | - Kathryn V Blake
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health, Jacksonville, FL, USA
| | - Debbie L Wilson
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA
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12
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Dor-Wojnarowska A, Radlińska A, Rabski M, Fal A, Liebhart J, Zaleska A, Babchyshyn M, Samoliński B. Investigation of Repeatability of Peak Nasal Inspiratory Flow Rate Measurements Under Baseline Conditions and After Administration of 0.05% Oxymetazoline. Am J Rhinol Allergy 2021; 36:41-46. [PMID: 33957801 DOI: 10.1177/19458924211015584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Peak nasal inspiratory flow (PNIF) measurement is an inexpensive and user-friendly method to assess nasal patency. However, the repeatability of PNIF measurements, as well as the threshold value of a change in PNIF, which can be considered significant remain unclear. This study aims to investigate the repeatability of PNIF measurements and the change in PNIF after the administration of 0.05% oxymetazoline. METHODS Repeated measurements of PNIF (Clement Clarke In-Check nasal inspiratory flow meter; Clement Clarke International, Ltd, Harlow, Essex, UK) were obtained in 333 healthy volunteers (174 women). Based on age, participants were categorized into three groups (6-7 years, 13-14 years, and 20-45 years). We obtained five measurements in each participant. PNIF was remeasured in 294 subjects 30 min after administration of 0.05% oxymetazoline. The variability in PNIF measurements was assessed using the coefficient of variation (CV = standard deviation × 100%/mean). RESULTS The first four PNIF measurements significantly differed from each other. The difference in PNIF measurements ceased to be statistically significant only between the fourth and fifth measurements (p = 0.19). PNIF repeatability was acceptable; the median CV was 15.5% (0-66), which did not significantly differ between age groups. The administration of 0.05% oxymetazoline led to a statistically significant increase in the PNIF value by 14.3% (-45, 157%) (p = 0.000000). CONCLUSIONS 1. No statistically significant difference was observed in PNIF values only between the fourth and fifth measurements; therefore, at least three measurements are essential to draw meaningful conclusions. 2. PNIF measurements were satisfactorily characterized by a relatively low CV (15%). 3. The administration of 0.05% oxymetazoline led to an increase in PNIF by approximately 14% over the baseline value.
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Affiliation(s)
- Anna Dor-Wojnarowska
- Department of Internal Diseases, Pneumonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | - Anna Radlińska
- Department of Internal Diseases, Pneumonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | - Marek Rabski
- Department of Internal Diseases, Pneumonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | - Andrzej Fal
- Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Jerzy Liebhart
- Department of Internal Diseases, Pneumonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | - Anna Zaleska
- Department of Internal Diseases, Pneumonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | - Mariana Babchyshyn
- Department of Internal Diseases, Pneumonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | - Bolesław Samoliński
- Department of the Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
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13
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de Albornoz SC, Chen G. Relationship between health-related quality of life and subjective wellbeing in asthma. J Psychosom Res 2021; 142:110356. [PMID: 33454566 DOI: 10.1016/j.jpsychores.2021.110356] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 12/17/2020] [Accepted: 01/02/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Poor health-related quality of life (HRQoL) is associated with a high risk of acute exacerbations in patients with asthma. The use of health state utility instruments to measure HRQoL is common, but it has been criticised for failing to adequately capture the impact of the condition from the patient perspective. We aimed to assess the ability of subjective wellbeing and health state utility instruments to capture important HRQoL dimensions for asthma patients. METHODS Regression analyses were conducted using data (n = 856 asthma patients) from a large multi-national cross-sectional survey to explore the relationship between subjective wellbeing (ONS4, PWI, SWLS), health state utility (15D, AQoL-8D, EQ-5D-5L, HUI3, SF-6D, SF-6Dv2), and an asthma-specific instrument (AQLQ-S). The latent structure of different instruments was investigated using an exploratory factor analysis. RESULTS All instruments could distinguish the impact of asthma on HRQoL. Among health utility instruments, 15D, SF-6D and AQoL-8D were more sensitive based on the average standardised regression coefficients. AQOL-8D had the strongest correlation with subjective wellbeing. Nevertheless, the exploratory factor analysis showed a complementary relationship between subjective wellbeing and HRQoL instruments. The most important subjective wellbeing domains were standard of living, achieving in life, and personal relationships; although contributions of these domains to overall life satisfaction differed among asthma patients identified by a latent class analysis. CONCLUSION The use of subjective wellbeing alongside AQLQ-S and health state utility instruments provides a comprehensive approach to assess the impact of asthma on the patient's life. Further research is needed to incorporate these measures in health care evaluation.
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Affiliation(s)
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia.
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14
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Risk of Rehospitalization and Death in Patients Hospitalized Due to Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1960-1968.e4. [PMID: 33359587 DOI: 10.1016/j.jaip.2020.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/13/2020] [Accepted: 12/10/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Asthma is a heterogeneous inflammatory airway disease that continues to cause considerable morbidity across the world, with poor asthma control leading to hospitalizations. OBJECTIVE The present study investigated the risk of rehospitalization, mortality, and the management of patients with asthma who had been hospitalized because of an asthma exacerbation. METHODS National Swedish health registries were linked for patients 6 years or older who were admitted to hospital because of asthma (index date) between January 1, 2006, and December 31, 2015. Exacerbations were defined as asthma-related hospitalization, emergency visits, or collection of oral steroids. Patients were followed for rehospitalizations 12 months after the index date, health care resource utilization and treatment for 36 months, and mortality to study end. Regression models for time-to-event analyses were applied to assess risk factors for rehospitalization and mortality. RESULTS A total of 15,691 patients (mean age, 51.5 years; 63% females) were included, of whom 1,892 (12%) were rehospitalized for asthma within 12 months. Rehospitalized patients had a markedly increased risk of subsequent asthma-related mortality (adjusted hazard ratio, 2.80; 95% CI, 1.95-4.01) compared with those not rehospitalized. Two-third of the patients were not followed up by a hospital-based specialist, and 60% did not collect enough inhaled corticosteroid doses to cover daily treatment the year postindex. CONCLUSIONS In this study, more than 1 in 10 patients were rehospitalized because of asthma within 12 months, and rehospitalizations were associated with asthma-related mortality. Few patients were seen by a hospital-based specialist, and few used inhaled corticosteroid continuously. Closer monitoring after hospitalization is needed.
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15
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Ali R, Ahmed N, Salman M, Daudpota S, Masroor M, Nasir M. Assessment of Quality of Life in Bronchial Asthma Patients. Cureus 2020; 12:e10845. [PMID: 33178501 PMCID: PMC7651774 DOI: 10.7759/cureus.10845] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction Asthma, a well-known chronic respiratory disease, is common worldwide. This study aimed to assess the quality of life in bronchial asthma patients and to determine the factors leading to poor quality of life among these patients. Materials and methods A cross-sectional study was conducted at a public sector hospital. The sample size was calculated as 134, with a nonprobability consecutive sampling technique. The Ethical Review Committee approved the study protocol. Demographic and asthma quality of life data were collected via a questionnaire. Data were analyzed IBM SPSS Statistics for Windows, Version 19.0 (Armonk, NY: IBM Corp.). Multivariate logistic regression was performed to observed the effect of these variables on the poor quality of life. A regression coefficient and odds ratio with a confidence interval of 95% and P-value ≤ .05 were taken as significant. Results The average age of patients was 40.6 ± 9.5 years. In this study, 96 of 134 patients (71.4%) with bronchial asthma reported a poor quality of life. In the univariate analysis, advanced age (≥ 40 years), obesity, being female, family history of asthma, pets at home, and moderate severity of asthma significantly contributed to poor quality of life. Multivariate logistic regression was performed, and it was observed that advanced age (≥ 40 years), being female, a pet at home, and moderate severity of asthma were four to 13 times more likely to predict a poor quality of life for patients with bronchial asthma. Conclusions The severity of asthma significantly contributed to poor quality of life. Health facilitators should look into the causes of such risk to increase the perception of health-related quality of life (HRQoL) among asthma patients.
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Affiliation(s)
- Rashid Ali
- Chest Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Naseem Ahmed
- Chest Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Muhammad Salman
- Paediatrics and Child Health, The Aga Khan University, Karachi, PAK
| | - Sofia Daudpota
- Pulmonary Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Madiha Masroor
- Internal Medicine, Critical Care Unit, South City Hospital, Karachi, PAK
| | - Muhammad Nasir
- Critical Care Medicine, Anesthesiology, South City Hospital, Karachi, PAK
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16
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Backman H, Jansson SA, Stridsman C, Eriksson B, Hedman L, Eklund BM, Sandström T, Lindberg A, Lundbäck B, Rönmark E. Severe asthma-A population study perspective. Clin Exp Allergy 2020; 49:819-828. [PMID: 30817038 DOI: 10.1111/cea.13378] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Severe asthma is a considerable challenge for patients, health-care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study. OBJECTIVE To describe characteristics and estimate the prevalence of severe asthma in a large adult population-based asthma cohort followed for 10-28 years. METHODS N = 1006 subjects with asthma participated in a follow-up during 2012-14, when 830 (mean age 59 years, 56% women) still had current asthma. Severe asthma was defined according to three internationally well-known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Programme (SARP), the 2014 ATS/ERS Task force definition and the GINA 2017. All subjects with severe asthma according to any of these criteria were undergoing respiratory specialist care and were also contacted by telephone to verify treatment adherence. RESULTS The prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS Taskforce), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >90% did not have controlled asthma according to the asthma control test. Severe asthma was related to age >50 years, nasal polyposis, impaired lung function, sensitization to aspergillus, and tended to be more common in women. Further, neutrophils in blood significantly discriminated severe asthma from other asthma. CONCLUSIONS AND CLINICAL RELEVANCE Severe asthma differed significantly from other asthma in terms of demographic, clinical and inflammatory characteristics, results suggesting possibilities for improved treatment regimens of severe asthma. The prevalence of severe asthma in this asthma cohort was 4%-6%, corresponding to approximately 0.5% of the general population.
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Affiliation(s)
- Helena Backman
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sven-Arne Jansson
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Berne Eriksson
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Deparment of Internal Medicine, Central County Hospital of Halland, Halmstad, Sweden
| | - Linnea Hedman
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Britt-Marie Eklund
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thomas Sandström
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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17
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Stridsman C, Axelsson M, Warm K, Backman H. Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health - a report from the OLIN adult asthma cohort. J Asthma 2020; 58:586-595. [PMID: 31910044 DOI: 10.1080/02770903.2020.1713150] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To study asthma exacerbations, healthcare utilization and health status among subjects with asthma with different treatment regimens and levels of asthma control.Methods: In 2012-2014, n = 1425 adults from a population-based asthma cohort within the OLIN studies (Obstructive Lung disease in Northern Sweden) were invited to a follow-up including spirometry and a structured interview, n = 1006 participated. Asthma Control Test (ACT) was used to detect uncontrolled asthma, and physical and mental dimensions of health were measured with SF-8. Pharmacological treatment use was classified by Global Initiative for Asthma treatment steps. Out of n = 830 with current asthma, n = 714 answered ACT (57% women, 32-92 years) and were included in the study.Results: Uncontrolled asthma increased per treatment step (no treatment 9.9%, treatment step 1-3 24.1%, and treatment steps 4-5 39.9%, p < 0.001). A higher proportion of subjects with uncontrolled asthma reported exacerbations, healthcare utilization, and worse health status than those with controlled asthma. The proportion of subjects reporting exacerbations, healthcare visits, emergency room visits and regular follow-up visits increased per treatment step. Worse health was associated with uncontrolled asthma, but not with the level of treatment. A higher proportion of women than men reported exacerbations, any healthcare visits, and lower health. Regular follow-up visits to a physician were uncommon (women 21.2% vs. men 14.6%, p = 0.022).Conclusions: Uncontrolled asthma is common in all treatment steps, and is associated with worse health status. However, health status did not differ by treatment steps. Identifying subjects with uncontrolled asthma regardless of treatment regimens should be a priority, thus follow-up visits are important.
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Affiliation(s)
- Caroline Stridsman
- Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.,Section of Medicine, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Malin Axelsson
- Department of Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Katja Warm
- Section of Medicine, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Helena Backman
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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18
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Jansson SA, Backman H, Andersson M, Telg G, Lindberg A, Stridsman C, Lundbäck B, Rönmark E. Severe asthma is related to high societal costs and decreased health related quality of life. Respir Med 2020; 162:105860. [PMID: 32056670 DOI: 10.1016/j.rmed.2019.105860] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of the present study was to estimate the societal costs and the key cost drivers for patients with severe asthma in Sweden. In addition, health-related quality of life (HRQOL) and morbidity of patients with severe asthma is described. METHODS The study population comprised adults with severe asthma recruited from a large asthma cohort within the Obstructive Lung Disease in Northern Sweden (OLIN) studies. During 2017, patients were interviewed quarterly over telephone regarding their resource utilization and productivity losses. RESULTS Estimated mean annual asthma-related costs per patient with severe asthma amounted to €6,500, of which approximately €2400 and €4100 were direct and indirect costs, respectively. The main cost drivers for direct costs were hospitalizations followed by drugs: approximately €1000 and €800, respectively. Patients on treatment with regular oral corticosteroids (OCS) had greater direct costs compared with those without regular OCS treatment. Co-morbid conditions were common and the costs were substantial also for co-morbid conditions, with a total cost of approximately €4200. The OCS group had significantly lower HRQOL compared to the non-OCS group. CONCLUSIONS The societal costs due to severe asthma were substantial. Costs for co-morbid conditions contributed substantially to both direct and indirect costs. The direct costs were significantly higher in the maintenance OCS-group compared to the non-maintenance OCS-group. These results indicate a need for improved management and treatment regimens for patients with severe asthma.
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Affiliation(s)
- Sven-Arne Jansson
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
| | | | | | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
| | - Caroline Stridsman
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
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19
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Ilmarinen P, Juboori H, Tuomisto LE, Niemelä O, Sintonen H, Kankaanranta H. Effect of asthma control on general health-related quality of life in patients diagnosed with adult-onset asthma. Sci Rep 2019; 9:16107. [PMID: 31695074 PMCID: PMC6834611 DOI: 10.1038/s41598-019-52361-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 10/16/2019] [Indexed: 12/17/2022] Open
Abstract
Health-related quality of life (HRQoL) is a well-established aspect of health that can be measured by both disease-specific and general instruments. The effect of uncontrolled asthma on generic HRQoL has not been shown in patients with clinically confirmed adult-onset asthma and with asthma control defined according to the Global Initiative for Asthma, so the aim of this study was to determine this. In the 12-year follow-up cohort of the Seinäjoki Adult Asthma Study (n = 203), patients with uncontrolled and partially controlled asthma had lower generic HRQoL as determined by 15D compared to the controlled group. On 10 out of 15 dimensions of 15D, the mean scores were significantly lower in patients with uncontrolled asthma compared with those with controlled asthma. The affected dimensions were mobility, breathing, sleeping, usual activities, mental function, discomfort and symptoms, depression, distress, vitality and sexual activity. In the Tobit regression analysis, a poorer 15D score was associated with uncontrolled asthma, lower postbronchodilator FEV1, female sex, depression, treated dyspepsia and poorer 15D score at diagnosis. Our results show that uncontrolled asthma affects everyday life in several aspects, including previously unknown components such as sexual activity and vitality.
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Affiliation(s)
- Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
| | - Hind Juboori
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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20
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González-Freire B, Vázquez I, Pértega-Díaz S. The Relationship of Psychological Factors and Asthma Control to Health-Related Quality of Life. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:197-207. [PMID: 31326620 DOI: 10.1016/j.jaip.2019.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Psychological variables (anxiety, depression, and coping strategies) and asthma control (assessed from the patient's perspective or from the physician's perspective) affect health-related quality of life (HRQoL) in asthmatic patients. However, no study has simultaneously evaluated these variables to understand the independent contribution of each one of these factors to HRQoL. OBJECTIVE To determine the impact of anxiety, depression, coping strategies, and asthma control on HRQoL, and to compare the impact of asthma control on HRQoL when it is established by the physician versus when it is considered by the patient. METHODS A total of 373 asthmatics completed the Hospital Anxiety and Depression Scale, Coping Orientations to Problems Experienced Inventory, 36-Item Short-Form Health Survey, and St. George Respiratory Questionnaire. Asthma control was measured by the patient with Asthma Control Test and by the physician with the classification asthma control of Global Initiative for Asthma. Demographic and clinical characteristics were also collected. RESULTS Anxiety, depression, and poor patient-rated asthma control status were associated with worse HRQoL in all dimensions (except Mental Health for asthma control). Physician-rated asthma control was related to worse HRQoL in physical generic and specific dimensions. Among coping strategies, only avoidant coping impacted HRQoL in a few dimensions. CONCLUSIONS Anxiety, depression, and asthma control (especially patient-rated asthma control) were important independent predictors of asthma HRQoL, and all of them should therefore be considered in interventions to improve HRQoL in asthmatic patients.
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Affiliation(s)
| | - Isabel Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Sonia Pértega-Díaz
- Clinical Epidemiology and Statistics Unit, Complejo Hospitalario Universitario, A Coruña, Spain
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21
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Air Pollution/Irritants, Asthma Control, and Health-Related Quality of Life among 9/11-Exposed Individuals with Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111924. [PMID: 31151302 PMCID: PMC6604324 DOI: 10.3390/ijerph16111924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/23/2019] [Accepted: 05/25/2019] [Indexed: 12/27/2022]
Abstract
Asthma control is suboptimal among World Trade Center Health Registry (WTCHR) enrollees. Air pollution/irritants have been reported as the most prevalent trigger among World Trade Center responders. We examined the relationship between air pollution/irritants and asthma control. We also evaluated the association of asthma control with health-related quality of life (HRQoL). We included 6202 enrollees age ≥18 with a history of asthma who completed the WTCHR asthma survey between 2015 and 2016. Based on modified National Asthma Education and Prevention Program criteria, asthma was categorized as controlled, poorly-controlled, or very poorly-controlled. HRQoL indicators include ≥14 unhealthy days, ≥14 activity limitation days, and self-rated general health. We used multinomial logistic regression for asthma control, and unconditional logistic regression for HRQoL, adjusting for covariates. Overall, 27.1% had poorly-controlled and 32.2% had very poorly-controlled asthma. Air pollution/irritants were associated with poorly-controlled (adjusted odds ratio (AOR) = 1.70; 95% CI = 1.45–1.99) and very poorly-controlled asthma (AOR = 2.15; 95% CI = 1.83–2.53). Poor asthma control in turn worsened the HRQoL of asthmatic patients. Very poorly-controlled asthma was significantly associated with ≥14 unhealthy days (AOR = 3.60; 95% CI = 3.02–4.30), ≥14 activity limitation days (AOR = 4.37; 95% CI = 3.48–5.50), and poor/fair general health status (AOR = 4.92; 95% CI = 4.11–5.89). Minimizing World Trade Center (WTC) asthmatic patients’ exposure to air pollution/irritants may improve their disease management and overall well-being.
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22
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López-López D, Painceira-Villar R, García-Paz V, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Rodríguez-Sanz D, Calvo-Lobo C. Impact of the Allergic Asthma on Foot Health-Related Quality of Life and Depression: A Novel Case-Control Research. ACTA ACUST UNITED AC 2019; 55:medicina55050124. [PMID: 31072062 PMCID: PMC6571550 DOI: 10.3390/medicina55050124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 02/07/2023]
Abstract
Background: Asthma may be considered as a non-communicable condition associated with higher bronchial responsiveness that may impair quality of life (QoL). Purpose: The research aim was to compare scores of depression, as well as general and foot health-related QoL, in patients who suffered from asthma with respect to healthy subjects. Methods: A total sample of 152 subjects, median age of 37.00 ± 16.00 years, were recruited from a respiratory and allergy department of a hospital and divided into patients with asthma (n = 76) and healthy subjects (n = 76). The scores of the Spanish foot health status questionnaire (SFHSQ) domains as well as the Spanish Beck’s Depression Inventory (BDI) scores and categories were collected. Results: The only statistically significant difference (p < 0.05) was shown for the difference of the FHSQ footwear domain establishing that patients who suffered from asthma presented a worse QoL related to foot health for footwear (lower FHSQ scores) compared to healthy matched-paired participants (higher FHSQ scores). Regarding the rest of the outcome measurements, there were no statistically significant differences (p > 0.05) for the other FHSQ domains scores as well as the BDI scores and categories. Conclusions: Patients with allergic asthma presented impairment of the QoL related to foot health for footwear, which seemed to be linked to the presence of asthma.
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Affiliation(s)
- Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol 15403, Spain.
| | - Roi Painceira-Villar
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol 15403, Spain.
| | - Vanesa García-Paz
- Departament of Allergology, Complexo Hospitalario Universitario de Ferrol, Ferrol 15405, Spain.
| | | | | | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid 28040, Spain.
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Faculty of Health Sciences, Universidad de León, Ponferrada 24401, Spain.
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23
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Pate CA, Zahran HS, Bailey CM. Impaired health-related quality of life and related risk factors among US adults with asthma. J Asthma 2019; 56:431-439. [PMID: 29667453 PMCID: PMC7202887 DOI: 10.1080/02770903.2018.1466314] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/12/2018] [Accepted: 04/15/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study assessed health-related quality of life (HRQoL) and related risk factors among adults with asthma in the United States. Using the 2015 Behavioral Risk Factor Surveillance System (BRFSS), we examined the association between four domains of impaired HRQoL and selected explanatory factors. METHODS A BRFSS sample of 39,321 adults with asthma was used in this study. We examined the association between fair/poor health, ≥ 14 mentally unhealthy days, ≥ 14 physically unhealthy days, and ≥ 14 days of activity limitation and selected explanatory variables (sex, race/ethnicity, age, annual household income, healthcare coverage, physical activity, smoking status, body mass index (BMI), having a coexisting disease, and being diagnosed with depression) using multivariable logistic regression models. RESULTS Income, physical activity status, smoking status, coexisting diseases, and depression were strongly associated with all HRQoL domains. Blacks had significantly less ≥ 14 physically unhealthy days (23.4%; aPR = 0.82 [95% confidence interval (CI): 0.72, 0.92]) and ≥ 14 days of activity limitation (18.3%; aPR = 0.81 [0.70, 0.94]) and Hispanics had significantly more fair/poor health (38.4%; aPR = 1.31 [1.18, 1.45]) than whites. Underweight and obese had significantly more fair/poor health, and underweight significantly more ≥ 14 physically unhealthy days, compared with normal weight. Adults aged 55 years or older had significantly less ≥ 14 mentally unhealthy days than adults 18-24 years. CONCLUSIONS Multiple factors were associated with impaired HRQoL. Providing strategies to address potential risk factors such as low income, physically inactive, smoker, and obese or underweight should be considered to improve HRQoL among adults with asthma.
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Affiliation(s)
- Cynthia A. Pate
- Infinite Services & Solutions, Inc. Contractor to
Division of Environmental Health Science and Practice, National Center for
Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia,
USA
| | - Hatice S. Zahran
- Division of Environmental Health Science and Practice,
National Center for Environmental Health, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
| | - Cathy M. Bailey
- Division of Environmental Health Science and Practice,
National Center for Environmental Health, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
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24
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Tsolakis N, Nordvall L, Janson C, Rydell N, Malinovschi A, Alving K. Characterization of a subgroup of non-type 2 asthma with cow's milk hypersensitivity in young subjects. Clin Transl Allergy 2019; 9:12. [PMID: 30834110 PMCID: PMC6385459 DOI: 10.1186/s13601-019-0250-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/31/2019] [Indexed: 02/07/2023] Open
Abstract
Background Asthma with atopy is often characterized by type 2 inflammation but less progress has been made in defining non-type 2 asthma. We have previously identified a subgroup of young non-atopic asthmatics with perceived food hypersensitivity and poor asthma control. Objective Our aim was to further characterize this subgroup of non-type 2 asthmatics, including the use of a broad panel of inflammation-related proteins. Methods Sex- and age-matched subjects (10–35 years old) were divided into three groups with regard to history of asthma and atopy: non-atopic asthmatics with perceived cow’s milk hypersensitivity but with IgE antibodies < 0.35 kUA/L (NAA; n = 24), non-atopic controls with IgE < 0.35 kUA/L (NAC; n = 24), and atopic asthmatics with IgE ≥ 0.35 kUA/L (AA; n = 29). Serum or plasma were analysed using the multi-allergen tests Phadiatop and fx5 (ImmunoCAP), a multiplex immunoassay comprising 92 inflammation-related proteins (Proseek Inflammation), and an ELISA for human neutrophil lipocalin (S-HNL). Fraction of exhaled nitric oxide (FeNO), blood eosinophil (B-Eos) count, C-reactive protein (CRP), airway responsiveness to methacholine (PD20), and asthma-related quality of life (mAQLQ) were also measured. Results NAA had lower FeNO (p < 0.001) and B-Eos count (p < 0.001), but scored worse on mAQLQ (p = 0.045) compared with AA. NAA displayed higher levels of matrix metalloproteinase-1 (MMP-1) compared with both NAC (p = 0.011) and AA (p = 0.001), and lower PD20 compared with NAC (p < 0.001). In NAA, S-HNL correlated negatively with PD20 (rho = − 0.048, p < 0.05) and CRP correlated negatively with mAQLQ (rho = − 0.439, p < 0.05). Conclusion In a subgroup of non-atopic young asthmatics with perceived cow’s milk hypersensitivity we observed poor asthma-related quality of life, airway hyperresponsiveness, and clinically relevant non-type 2 inflammation. MMP-1 was elevated in this group, which deserves further studies. Electronic supplementary material The online version of this article (10.1186/s13601-019-0250-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Tsolakis
- 1Department of Women's and Children's Health, Uppsala University Hospital, Uppsala University, 751 85 Uppsala, Sweden
| | - L Nordvall
- 1Department of Women's and Children's Health, Uppsala University Hospital, Uppsala University, 751 85 Uppsala, Sweden
| | - C Janson
- 2Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - N Rydell
- 3Thermo Fisher Scientific, ImmunoDiagnostics, Uppsala, Sweden
| | - A Malinovschi
- 2Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - K Alving
- 1Department of Women's and Children's Health, Uppsala University Hospital, Uppsala University, 751 85 Uppsala, Sweden
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25
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Cappa V, Marcon A, Di Gennaro G, Chamitava L, Cazzoletti L, Bombieri C, Nicolis M, Perbellini L, Sembeni S, de Marco R, Spelta F, Ferrari M, Zanolin ME. Health-related quality of life varies in different respiratory disorders: a multi-case control population based study. BMC Pulm Med 2019; 19:32. [PMID: 30732605 PMCID: PMC6367788 DOI: 10.1186/s12890-019-0796-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Health-related quality of life (HRQL) in respiratory diseases has been generally investigated in clinical settings, focusing on a single disorder. In this study on a general population sample, we assessed the relationship between HRQL and several respiratory diseases studied simultaneously (COPD, current (CA) and past (PA) asthma, allergic (AR) and non-allergic (NAR) rhinitis and chronic bronchitis (CB). METHODS Controls (n = 328) and cases of NAR (n = 95), AR (n = 163), CB (n = 48), CA (n = 224), PA (n = 126) and COPD (n = 28) were recruited in the centre of Verona in the frame of the Italian multi-case control GEIRD (Gene Environment Interactions in Respiratory Diseases) study; HRQL was measured through the SF-36 questionnaire. The relationships between HRQL (in terms of Physical (PCS) and Mental Component Scores (MCS)), respiratory diseases, and covariates were evaluated. RESULTS With respect to controls, the adjusted PCS median score was worse in subjects suffering from current asthma (- 1.7; 95%CI:-2.8;-0.6), CB (- 3.8; 95%CI:-5.7;-1.9), and COPD (- 5.6; 95%CI:-8.1;-3.1). MCS was worse in current asthmatics (- 2.2; 95%CI:-4.1;-0.3), CB (- 5.5; 95%CI:-8.7;-2.2), and COPD cases (- 4.6; 95%CI:-8.8;-0.5) as well. CONCLUSIONS To our knowledge, this is the first study in the general population that analyzed HRQL performing a simultaneous comparison of HRLQ in several respiratory disorders. We found that subjects suffering from COPD, CA, and CB had the poorest HRQL. Clinicians should carefully consider the possible impact of respiratory disorders as CB and not only that of CA and COPD.
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Affiliation(s)
- Veronica Cappa
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
| | - Gianfranco Di Gennaro
- Department of Pathology and Diagnostics, University Hospital of Verona, Verona, Italy
| | - Liliya Chamitava
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
| | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
| | - Cristina Bombieri
- Unit of Biology and Genetics, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Morena Nicolis
- Unit of Hygiene and Preventive, Environmental and Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Luigi Perbellini
- Unit of Occupational Medicine, Azienda Ospedaliero Universitaria di Verona, Verona, Italy
| | - Silvia Sembeni
- Unit of Hygiene and Preventive, Environmental and Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Roberto de Marco
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
| | - Francesco Spelta
- Department of Medicine, Unit of Respiratory Medicine, University of Verona, Verona, Italy
| | - Marcello Ferrari
- Department of Medicine, Unit of Respiratory Medicine, University of Verona, Verona, Italy
| | - Maria Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy
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26
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Janson C, Accordini S, Cazzoletti L, Cerveri I, Chanoine S, Corsico A, Ferreira DS, Garcia-Aymerich J, Gislason D, Nielsen R, Johannessen A, Jogi R, Malinovschi A, Martinez-Moratalla Rovira J, Marcon A, Pin I, Quint J, Siroux V, Almar E, Bellisario V, Franklin KA, Gullón JA, Holm M, Heinrich J, Nowak D, Sánchez-Ramos JL, Weyler JJ, Jarvis D. Pharmacological treatment of asthma in a cohort of adults during a 20-year period: results from the European Community Respiratory Health Survey I, II and III. ERJ Open Res 2019; 5:00073-2018. [PMID: 30723731 PMCID: PMC6355980 DOI: 10.1183/23120541.00073-2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/28/2018] [Indexed: 11/17/2022] Open
Abstract
Asthma often remains uncontrolled, despite the fact that the pharmacological treatment has undergone large changes. We studied changes in the treatment of asthma over a 20-year period and identified factors associated with the regular use of inhaled corticosteroid (ICS) treatment. Changes in the use of medication were determined in 4617 randomly selected subjects, while changes in adults with persistent asthma were analysed in 369 participants. The study compares data from three surveys in 24 centres in 11 countries. The use of ICSs increased from 1.7% to 5.9% in the general population and the regular use of ICSs increased from 19% to 34% among persistent asthmatic subjects. The proportion of asthmatic subjects reporting asthma attacks in the last 12 months decreased, while the proportion that had seen a doctor in the last 12 months remained unchanged (42%). Subjects with asthma who had experienced attacks or had seen a doctor were more likely to use ICSs on a regular basis. Although ICS use has increased, only one-third of subjects with persistent asthma take ICSs on a regular basis. Less than half had seen a doctor during the last year. This indicates that underuse of ICSs and lack of regular healthcare contacts remains a problem in the management of asthma. Despite increased ICS use, only 34% of subjects with persistent asthma take ICSs on a regular basis; <50% have seen a doctor in the last year. Underuse of ICSs and lack of regular healthcare contacts remains a problem in asthma.http://ow.ly/GUZ630mZkVN
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Affiliation(s)
- Christer Janson
- Respiratory, Allergy and Sleep Research, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden.,Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Isa Cerveri
- Division of Respiratory Diseases, IRCCS, Policlinico San Matteo Foundation, Dept of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Sebastien Chanoine
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, Inserm, Université Grenoble Alpes, Grenoble, France.,Pôle Pharmacie, CHU Grenoble Alpes, Grenoble, France
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS, Policlinico San Matteo Foundation, Dept of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Diogenes Seraphim Ferreira
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Alergia e Imunologia, Complexo Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil
| | - Judith Garcia-Aymerich
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - David Gislason
- Dept of Respiratory Medicine and Sleep, Landspitali, Reykjavik, Iceland
| | - Rune Nielsen
- Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Ane Johannessen
- Centre for International Health, Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Andrei Malinovschi
- Clinical Physiology, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jesús Martinez-Moratalla Rovira
- Servicio de Neumología, Complejo Hospitalario Universitario, Albacete, Spain.,Facultad de Medicina Albacete, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Isabelle Pin
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, Inserm, Université Grenoble Alpes, Grenoble, France.,Dept of Paediatrics, CHU Grenoble Alpes, Grenoble, France
| | - Jennifer Quint
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Valerie Siroux
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, Inserm, Université Grenoble Alpes, Grenoble, France
| | - Enrique Almar
- Facultad de Medicina Albacete, University of Castilla-La Mancha, Ciudad Real, Spain.,Service of the Health Delegation of Albacete, Albacete, Spain
| | - Valeria Bellisario
- Dept of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Karl A Franklin
- Dept of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - José A Gullón
- Dept of Pneumology, Universitary Hospital San Agustín, Avilés, Spain
| | - Mathias Holm
- Dept of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC) Munich, Member German Center for Lung Research (DZL), Munich, Germany.,Institute of Epidemiology, Helmholtz Zentrum München - German Research Centre for Environmental Health, Neuherberg, Germany.,Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC) Munich, Member German Center for Lung Research (DZL), Munich, Germany.,Comprehensive Pneumology Center (CPC) Munich, Member German Center for Lung Research (DZL), Munich, Germany
| | | | - Joost J Weyler
- StatUA Statistics Center, University of Antwerp, Antwerp, Belgium
| | - Deborah Jarvis
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
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27
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Janson C, Lisspers K, Ställberg B, Johansson G, Thuresson M, Telg G, Larsson K. Prevalence, characteristics and management of frequently exacerbating asthma patients: an observational study in Sweden (PACEHR). Eur Respir J 2018; 52:1701927. [PMID: 29946008 PMCID: PMC6092688 DOI: 10.1183/13993003.01927-2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 06/11/2018] [Indexed: 01/22/2023]
Abstract
The aim of the study was to investigate the prevalence, management and characteristics of asthma patients with frequent exacerbations.Data from asthma patients (aged ≥18 years) identified in primary care medical records were linked to Swedish national health registries. Exacerbations were defined as hospitalisations, emergency visits and/or collection of oral steroids. Frequent exacerbations were defined as two or more exacerbations per year during the 3-year observation period.Of 18 724 asthma patients, 81.49% had no exacerbations and 6.3% had frequent exacerbations in the year prior to the index date. Frequent exacerbations were observed yearly for 1.8% of the patients. Frequent exacerbators were older, more often females, and had increased eosinophil and neutrophil counts, lower lung function, and more comorbidities than patients without exacerbations. There was a slight increase in asthma medication claims and a slight decrease in physician visits compared with baseline, both in the group with and the group without frequent exacerbations.Patients with frequent exacerbations were characterised by greater age, female predominance, high eosinophil and neutrophil counts, and high prevalence of comorbidities. This study indicates that the Swedish healthcare system lacks efficiency to adjust treatment and management for this patient group. With new treatment options targeting severe asthma available, identification of these patients should be in focus to ensure reduction of exacerbations.
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Affiliation(s)
- Christer Janson
- Respiratory, Allergy and Sleep Research, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Lisspers
- Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Gunnar Johansson
- Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | | | | | - Kjell Larsson
- The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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28
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Tsolakis N, Malinovschi A, Nordvall L, Mattsson L, Lidholm J, Pedroletti C, Janson C, Borres MP, Alving K. Sensitization to minor cat allergen components is associated with type-2 biomarkers in young asthmatics. Clin Exp Allergy 2018; 48:1186-1194. [PMID: 29575179 DOI: 10.1111/cea.13135] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/10/2018] [Accepted: 03/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cat allergy is a major trigger of asthma world-wide. Molecular patterns of cat sensitization vary between individuals, but their relationship to inflammation in asthmatics has not been extensively studied. OBJECTIVE To investigate the prevalence and levels of IgE antibodies against different cat allergen components and their relationship to type-2 inflammation and total IgE among young asthmatic subjects sensitized to furry animals. METHODS Patients with asthma (age 10-35 years; n = 266) and IgE sensitization to cat, dog or horse extract (ImmunoCAP), were analysed for IgE to the cat allergen components Fel d 1 (secretoglobin), Fel d 2 (serum albumin), Fel d 4 and Fel d 7 (lipocalins). Independent associations between IgE-antibody concentrations, and fraction of exhaled nitric oxide (FeNO), blood eosinophil (B-Eos) count, and total IgE were analysed by multiple linear regression after adjustment for possible confounders. RESULTS The level of IgE against Fel d 2 was independently related to FeNO (P = .012) and total IgE (P < .001), and IgE against Fel d 4 associated with Β-Eos count (P = .009) and total IgE (P < .001). IgE antibodies against Fel d 1 or cat extract did not independently relate to these inflammatory markers (P = .23-.51). CONCLUSIONS Levels of IgE to lipocalin (Fel d 4) and serum albumin (Fel d 2), but not to secretoglobin (Fel d 1) or cat extract, were independently associated with type-2 biomarkers and total IgE in young asthmatics. CLINICAL RELEVANCE We suggest that measurement of IgE to minor cat allergen components may be useful when investigating asthma morbidity in cat allergic subjects.
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Affiliation(s)
- N Tsolakis
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Malinovschi
- Medical Sciences, Uppsala University, Uppsala, Sweden
| | - L Nordvall
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - L Mattsson
- Thermo Fisher Scientific, Uppsala, Sweden
| | - J Lidholm
- Thermo Fisher Scientific, Uppsala, Sweden
| | - C Pedroletti
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - C Janson
- Medical Sciences, Uppsala University, Uppsala, Sweden
| | - M P Borres
- Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Thermo Fisher Scientific, Uppsala, Sweden
| | - K Alving
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Mungan D, Aydin O, Mahboub B, Albader M, Tarraf H, Doble A, Lahlou A, Tariq L, Aziz F, El Hasnaoui A. Burden of disease associated with asthma among the adult general population of five Middle Eastern countries: Results of the SNAPSHOT program. Respir Med 2018; 139:55-64. [PMID: 29858002 DOI: 10.1016/j.rmed.2018.03.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/11/2018] [Accepted: 03/28/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Asthma affects millions worldwide resulting in a significant disease burden. However, data on asthma burden from the Middle East is limited. This analysis describes the asthma burden in Egypt, Turkey and a Gulf cluster (Kuwait, Saudi Arabia and United Arab Emirates) as part of the SNAPSHOT program. METHODS SNAPSHOT was an observational, cross-sectional program carried out by telephone in a random sample of the adult general population of the five above mentioned countries. Quotas were defined per country demographics. Subjects were considered to have asthma if they fulfilled the screening criteria, based on the global Asthma Insights and Reality studies. Data collected included demographics, physician consultations, and asthma control (measured by the Asthma Control Test; ACT). Quality of life was assessed using the EuroQol Five-Dimension questionnaire (EQ-5D); and limitations to daily activities using the modified Sheehan Disability Scale (SDS). RESULTS 939 subjects answered questions related to asthma burden. Overall, 367 (44.2%) reported uncontrolled asthma (ACT≤19), and reported significantly lower EQ-5D-3L utility values (0.6 ± 0.4) and EQ-VAS scores (60.7 ± 24.2) compared to controlled subjects (0.8 ± 0.3 and 75.3 ± 19.8 respectively) (p < 0.0001). A significantly higher proportion with uncontrolled asthma also reported experiencing impact on activities of daily living compared to subjects with controlled asthma (p < 0.0001). Overall, 355 (37.8%) asthma subjects were followed by a physician. However, most visits were unscheduled (695;78.0%). CONCLUSION Uncontrolled asthma imposes a significant burden in these Middle Eastern countries resulting in increased frequency of healthcare use, lower quality of life, and a higher impact on daily life compared to controlled asthma.
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Affiliation(s)
- Dilsad Mungan
- Department of Chest Diseases, Division of Allergy and Immunology, Ankara University, School of Medicine, Turkey.
| | - Omur Aydin
- Department of Chest Diseases, Division of Allergy and Immunology, Ankara University, School of Medicine, Turkey.
| | - Bassam Mahboub
- College of Medicine, University of Sharjah, Sharjah, UAE and Department of Pulmonary Medicine, Rashid Hospital, Dubai, United Arab Emirates.
| | | | | | | | | | | | - Fayaz Aziz
- GlaxoSmithKline, Dubai, United Arab Emirates.
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Cançado JED, Penha M, Gupta S, Li VW, Julian GS, Moreira EDS. Respira project: Humanistic and economic burden of asthma in Brazil. J Asthma 2018; 56:244-251. [PMID: 29595345 DOI: 10.1080/02770903.2018.1445267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine the association of asthma on health-related quality of life (QoL), productivity, and use of healthcare resources among adults in Brazil. METHODS Data were analyzed from the 2015 Brazil National Health and Wellness Survey, a cross-sectional survey with 12,000 adult respondents. Asthma and control groups were compared with respect to health-related QoL, asthma control, work productivity, and adherence. Generalized linear models were developed to compare asthma-related associations controlling for potential confounding factors. RESULTS Among respondents, 4.1% (n = 494) reported an asthma diagnosis; those without asthma symptoms were used as the control group (n = 11,487). Regarding asthma control, 51.2% of patients had uncontrolled asthma, 36.4% partially controlled asthma, and 12.3% were fully controlled. Short-acting β2 agonists were the most commonly used class of drugs (38.5%). Approximately 32.4% of asthma patients were considered fully adherent to their treatment. In multivariable analyses, asthma patients presented lower health-related QoL and had more frequent visits with medical healthcare providers (6.1 versus 4.2) emergency room visits (1.0 versus 0.5), and more hospitalizations (0.4 versus 0.2), than control respondents six months prior to the study (p < 0.05). Rates of absenteeism and presenteeism varied between 11.5% and 7.4% (p < 0.05) and 30.4% and 20.9% (p < 0.001) between asthma patients and controls, respectively. CONCLUSIONS Asthma had a negative association on health-related QoL, work productivity, and use of healthcare resources. Excessive use of short-acting β2 agonists and poor treatment adherence reflect poor asthma control and suggest the need to implement new strategies for asthma treatment in Brazil.
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Hallit S, Raherison C, Waked M, Hallit R, Layoun N, Salameh P. Validation of the mini pediatric asthma quality of life questionnaire and identification of risk factors affecting quality of life among Lebanese children. J Asthma 2018. [PMID: 29513606 DOI: 10.1080/02770903.2018.1441417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Few studies used various scales to assess the QOL in Lebanon in general but none was specific to asthma. Our objective was to assess the asthma-related quality of life, using the mini Pediatric Asthma Quality of Life Questionnaire (PAQLQ), in Lebanese asthmatic children, check its validity compared to the original version, and identify clinical and sociodemographic risk factors that might affect these children's QOL. METHODS This retrospective study included 300 children aged between 7-16 years (51.6% boys and 48.4% girls). To confirm the mini-PAQLQ questionnaire construct validity in the Lebanese population, an exploratory factor analysis was launched for the 13 items of the questionnaire, using the principal component analysis technique. Cronbach's alpha was recorded for reliability analysis. A multivariate analysis linear regression was carried out, taking the QOL score as the dependent variable. RESULTS The correlation coefficients for factors 1 (symptoms and emotions) and 2 (activities) were similar to that of the original scale. High Cronbach's alphas were found for factor 1 (0.914), factor 2 (0.888), and the full scale (0.921). Uncontrolled asthma, the child's respiratory problems before the age of 2 years, and the presence of pets at home significantly decreased the children's asthma-related quality of life (Beta = -1.541; Beta = -6.846, and Beta = -5.364, respectively). CONCLUSION We were able to validate the mini-PAQLQ among the Lebanese population. The identification of risk factors, some of which are amenable to intervention, especially uncontrolled asthma, could lead to an improvement in the asthmatic children's QOL.
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Affiliation(s)
- Souheil Hallit
- a Faculty of Pharmacy , Lebanese University , Beirut , Lebanon.,b Faculty of Pharmacy , Saint-Joseph University , Beirut , Lebanon.,c Faculty of Medicine and Medical Sciences , Holy Spirit University Kaslik , Kaslik , Lebanon.,d Research Department , Psychiatric Hospital of the Cross , Jal Eddib , Lebanon.,e Occupational Health Environment Research Team, BPH Bordeaux Population Health Research Center Inserm , Universite de Bordeaux , Bordeaux , France.,f INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Faculty of Public Health , Lebanese University , Beirut , Lebanon
| | - Chantal Raherison
- e Occupational Health Environment Research Team, BPH Bordeaux Population Health Research Center Inserm , Universite de Bordeaux , Bordeaux , France.,g Department of Pulmonology , University Hospital of Bordeaux , Bordeaux , France
| | - Mirna Waked
- h Faculty of Medicine , Balamand University , Koura , Lebanon
| | - Rabih Hallit
- c Faculty of Medicine and Medical Sciences , Holy Spirit University Kaslik , Kaslik , Lebanon
| | - Nelly Layoun
- a Faculty of Pharmacy , Lebanese University , Beirut , Lebanon.,f INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Faculty of Public Health , Lebanese University , Beirut , Lebanon
| | - Pascale Salameh
- a Faculty of Pharmacy , Lebanese University , Beirut , Lebanon.,f INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Faculty of Public Health , Lebanese University , Beirut , Lebanon.,i Faculty of Medicine , Lebanese University , Beirut , Lebanon
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Colodenco D, Palomares O, Celis C, Kaplan A, Domingo C. Moving toward consensus on diagnosis and management of severe asthma in adults. Curr Med Res Opin 2018; 34:387-399. [PMID: 28906154 DOI: 10.1080/03007995.2017.1380617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Asthma is a considerable health problem with an increasing global prevalence. The burden of severe asthma is expected to notably increase in the following years. Some misleading concepts that sometimes appear in the literature can drive the physician responsible for a patient's management to make incorrect decisions. Furthermore, some of the concepts that appear in the literature and in the guidelines may not be clear to understand, follow or adapt to regional and local realities. This could again drive the physicians responsible for a patient's management to make incorrect clinical judgments. In this article, we review the definition, prevalence and immunopathology of severe asthma, describe the asthma phenotypes, clinical features and comorbidities, the diagnosis of severe asthma and personalized asthma treatment. At the end, we offer a treatment approach based on literature publications, personalized medicine and marketed biologic treatment options.
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Affiliation(s)
- Daniel Colodenco
- a Pulmonology , Hospital De Rehabilitación Respiratoria María Ferrer , Buenos Aires , Argentina
| | - Oscar Palomares
- b Department of Biochemistry and Molecular Biology , School of Chemistry, Complutense University of Madrid , Madrid , Spain
| | - Carlos Celis
- c Pulmonary Unit, Internal Medicine Department , Hospital Universitario San Ignacio , Bogota , Colombia
| | - Alan Kaplan
- d University of Toronto , Thornhill , Ontario , Canada
| | - Christian Domingo
- e Servei de Pneumologia , Corporació Sanitària Parc Taulí , Barcelona , Spain
- f Department of Medicine , Universitat Autònoma de Barcelona (UAB) , Barcelona , Spain
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Tsolakis N, Malinovschi A, Nordvall L, Janson C, Borres MP, Alving K. The absence of serum IgE antibodies indicates non-type 2 disease in young asthmatics. Clin Exp Allergy 2018; 48:722-730. [PMID: 29377450 DOI: 10.1111/cea.13103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/22/2017] [Accepted: 01/13/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Atopic asthma is associated with elevated type-2 biomarkers such as fraction of exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) count. However, increased type 2 markers have also been reported in traditionally defined non-atopic asthma. OBJECTIVE To determine a clinically useful level of IgE sensitization for ruling out type 2 asthma. METHODS Asthmatics (N = 408; age 10-35 years) were analysed using the multi-allergen tests Phadiatop and fx5 (ImmunoCAP). Subjects were grouped based on IgE-antibody concentrations: ≥0.35 kUA /L for at least one test (n = 326) or <0.35 kUA /L for both tests (n = 82). Τhe latter group was subsequently divided into 2 groups: IgE 0.10-0.34 kUA /L (n = 34) and IgE < 0.10 kUA /L (n = 48). The relationships between type 2 biomarkers, and inadequate asthma control (ACT < 20), reduced lung function (FEV1 < 80%), recent asthma attacks and airway hyperresponsiveness (AHR) to methacholine were determined. RESULTS In univariate analyses, at least one type 2 marker related to each asthma outcome in subjects with IgE ≥0.35 kUA /L. In subjects with IgE 0.10-0.34 kUA /L, elevated FeNO related to reduced lung function (P = .008) and B-Eos to AHR (P = .03). No associations were found in subjects with IgE < 0.10 kUA /L. In multivariate analysis, a relationship between FeNO and reduced lung function remained in subjects with IgE < 0.35 kUA /L (P = .03). CONCLUSION AND CLINICAL RELEVANCE Clinically relevant elevation of type 2 biomarkers was seen in young asthmatics with IgE antibodies <0.35 kUA /L, but not those with IgE < 0.10 kUA /L. It seems possible to define non-type 2 asthma through sensitive IgE-antibody measurement.
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Affiliation(s)
- N Tsolakis
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Malinovschi
- Medical Sciences, Uppsala University, Uppsala, Sweden
| | - L Nordvall
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - C Janson
- Medical Sciences, Uppsala University, Uppsala, Sweden
| | - M P Borres
- Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Thermo Fisher Scientific, Uppsala, Sweden
| | - K Alving
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Adaptation of a difficult-to-manage asthma programme for implementation in the Dutch context: a modified e-Delphi. NPJ Prim Care Respir Med 2017; 27:16086. [PMID: 28184039 PMCID: PMC5301160 DOI: 10.1038/npjpcrm.2016.86] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/15/2016] [Accepted: 10/04/2016] [Indexed: 12/11/2022] Open
Abstract
Patients with difficult-to-manage asthma represent a heterogeneous subgroup of asthma patients who require extensive assessment and tailored management. The International Primary Care Respiratory Group approach emphasises the importance of differentiating patients with asthma that is difficult to manage from those with severe disease. Local adaptation of this approach, however, is required to ensure an appropriate strategy for implementation in the Dutch context. We used a modified three-round e-Delphi approach to assess the opinion of all relevant stakeholders (general practitioners, pulmonologists, practice nurses, pulmonary nurses and people with asthma). In the first round, the participants were asked to provide potentially relevant items for a difficult-to-manage asthma programme, which resulted in 67 items. In the second round, we asked participants to rate the relevance of specific items on a seven-point Likert scale, and 46 items were selected as relevant. In the third round, the selected items were categorised and items were ranked within the categories according to relevance. Finally, we created the alphabet acronym for the categories ‘the A–I of difficult-to-manage asthma’ to resonate with an established Dutch ‘A–E acronym for determining asthma control’. This should facilitate implementation of this programme within the existing structure of educational material on asthma and chronic obstructive pulmonary disease (COPD) in primary care, with potential for improving management of difficult-to-manage asthma. Other countries could use a similar approach to create a locally adapted version of such a programme.
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Luyster FS, Strollo PJ, Holguin F, Castro M, Dunican EM, Fahy J, Gaston B, Israel E, Jarjour NN, Mauger DT, Moore WC, Wenzel SE. Association Between Insomnia and Asthma Burden in the Severe Asthma Research Program (SARP) III. Chest 2016; 150:1242-1250. [PMID: 27720882 DOI: 10.1016/j.chest.2016.09.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/11/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Sleep difficulties are commonly reported by patients with asthma; however, the prevalence of insomnia and its association with disease burden and well-being is unknown. We aimed to determine the prevalence of insomnia, defined as combined sleep-specific complaints with associated daytime symptoms, among a large sample of adults with asthma, and to compare well-being, asthma control, and asthma-related health care utilization in individuals with asthma and insomnia and those without insomnia. METHODS Baseline data from adults with physician-confirmed asthma enrolled in the Severe Asthma Research Program III was used for analyses (N = 714). Participants completed the Insomnia Severity Index (ISI), Asthma Control Test, Asthma Quality of Life Questionnaire, and Hospital Anxiety and Depression Scale. RESULTS Insomnia (ISI ≥ 10) was identified in 263 participants (37%). Presence of insomnia was associated with higher levels of depression and anxiety symptoms and poorer quality of life. Those with insomnia had a 2.4-fold increased risk for having not well-controlled asthma and a 1.5-fold increased risk for asthma-related health care utilization in the past year compared with those without insomnia. CONCLUSIONS Insomnia is highly prevalent in asthma and is associated with adverse outcomes. Further studies are needed to gain a better understanding of the interaction between insomnia and asthma control.
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Affiliation(s)
- Faith S Luyster
- School of Nursing, University of Pittsburgh, Pittsburgh, PA.
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Fernando Holguin
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Eleanor M Dunican
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - John Fahy
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Benjamin Gaston
- Division of Pediatric Allergy and Immunology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Elliot Israel
- Pulmonary Division, Brigham and Women's Hospital, Boston, MA
| | - Nizar N Jarjour
- Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine, Madison, WI
| | - David T Mauger
- Department of Public Health Science, The Pennsylvania State University College of Medicine, Hershey, PA
| | - Wendy C Moore
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Sally E Wenzel
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Measurement of utility in asthma: evidence indicating that generic instruments may miss clinically important changes. Qual Life Res 2016; 25:3017-3026. [PMID: 27387417 DOI: 10.1007/s11136-016-1357-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Accurate assessment of preference-based health-related quality of life is important in determining the value of asthma interventions. OBJECTIVE To examine the sensitivity and responsiveness of the EQ-5D and the AQL-5D to differences in asthma control measured by the Asthma Control Questionnaire (ACQ-5). METHODS The Observational Study of Asthma Control and Outcomes was a prospective survey of persistent asthma patients ≥12 years old in Kaiser Colorado. Patients received a survey three times in 1 year, including the ACQ-5, AQL-5D and EQ-5D-3L (including VAS). Censored Least Absolute Deviations (CLAD) and logistic regression were used, controlling for sociodemographics and smoking. RESULTS There were 6666 completed surveys (1799 individuals completed all three survey waves). After controlling for covariates, each one-point increase in ACQ-5 was associated with a decrease of 0.066, 0.058, 0.074 and 6.12 in EQ-5D(US), EQ-5D(UK), AQL-5D and VAS scores. Uncontrolled asthma (ACQ-5 > 1.5) was associated with a decrease of 0.15, 0.17, 0.11 and 10, respectively (vs. ACQ ≤ 1.5). AQL-5D scores were statistically significantly different across categories of ACQ-5 scores of 0.5 (the minimum clinically important difference [MCID]), while EQ-5D scores were not significant across most categories. The AQL-5D appeared more robust to changes in control over time (responsiveness) compared to EQ-5D-3L. CONCLUSION The AQL-5D appears more responsive to changes in asthma control over time and more sensitive to detecting differences corresponding to the ACQ-5 MCID than the EQ-5D-3L. Using the EQ-5D-3L without an asthma-specific measure such as the AQL-5D may miss clinically important changes in asthma control.
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Hartmann B, Leucht V, Loerbroks A. Work stress, asthma control and asthma-specific quality of life: Initial evidence from a cross-sectional study. J Asthma 2016; 54:210-216. [PMID: 27328314 DOI: 10.1080/02770903.2016.1201836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Research has suggested that psychological stress is positively associated with asthma morbidity. One major source of stress in adulthood is one's occupation. However, to date, potential links of work stress with asthma control or asthma-specific quality of life have not been examined. We aimed to address this knowledge gap. METHODS In 2014/2015, we conducted a cross-sectional study among adults with asthma in Germany (n = 362). For the current analyses that sample was restricted to participants in employment and reporting to have never been diagnosed with chronic obstructive pulmonary disease (n = 94). Work stress was operationalized by the 16-item effort-reward-imbalance (ERI) questionnaire, which measures the subcomponents "effort", "reward" and "overcommitment." Participants further completed the Asthma Control Test and the Asthma Quality of Life Questionnaire-Sydney. Multivariable associations were quantified by linear regression and logistic regression. RESULTS Effort, reward and their ratio (i.e. ERI ratio) did not show meaningful associations with asthma morbidity. By contrast, increasing levels of overcommitment were associated with poorer asthma control and worse quality of life in both linear regression (ß = -0.26, p = 0.01 and ß = 0.44, p < 0.01, respectively) and logistic regression (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.14-3.07 and OR = 2.34, 95% CI = 1.32-4.15, respectively). CONCLUSIONS The present study provides initial evidence of a positive relationship of work-related overcommitment with asthma control and asthma-specific quality of life. Longitudinal studies with larger samples are needed to confirm our findings and to disentangle the potential causality of associations.
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Affiliation(s)
- Bettina Hartmann
- a Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
| | - Verena Leucht
- a Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
| | - Adrian Loerbroks
- a Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
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Upton J, Lewis C, Humphreys E, Price D, Walker S. Asthma-specific health-related quality of life of people in Great Britain: A national survey. J Asthma 2016; 53:975-82. [PMID: 27115826 DOI: 10.3109/02770903.2016.1166383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although the ultimate goal of asthma treatment is to improve asthma-specific Health-Related Quality-Of-Life (HRQOL), in the UK population this is insufficiently studied. National asthma-specific HRQOL data is needed to inform strategies to address this condition. AIMS AND OBJECTIVES To benchmark asthma-specific HRQOL in a national survey of adults with asthma, and explore differences in this measure within subsections of the population. METHODS We analysed answers to the Marks Asthma Quality-of-Life Questionnaire (AQLQ-M) from a representative sample of 658 adults with asthma. Respondents answered asthma-specific questions to assess control, previous hospital admissions, asthma attacks and an indicator of severity. Higher scores indicate poorer HRQOL (maximum = 60). The highest quintile formed a subgroup 'Poor HRQOL'. Data were weighted to correct for any biases caused by differential non-response. Chi-square analyses were used to determine differences between good and poor quality of life and regression analyses performed to determine what factors are associated with poor HRQOL. RESULTS The response rate was 49%. AQLQ-M median (IQR) scores were 5 (2-13) for the total sample (poor HRQOL = 21, good HRQOL = 3). Significant differences between good and poor HRQOL were observed in smoking status, SES, employment status and co-morbidities, but no differences were found between age groups. Those with poorly controlled asthma were significantly more likely to have poor HRQOL, ≥1 breathing related hospital admission or ≥1 asthma attack. CONCLUSIONS This article provides benchmarking data on asthma-specific HRQOL. Improved strategies are needed to target interventions towards people experiencing poor HRQOL.
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Affiliation(s)
| | | | | | - David Price
- b University of Aberdeen , Aberdeen , Scotland , United Kingdom
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Wang DY, Ghoshal AG, Bin Abdul Muttalif AR, Lin HC, Thanaviratananich S, Bagga S, Faruqi R, Sajjan S, Brnabic AJM, Dehle FC, Cho SH. Quality of Life and Economic Burden of Respiratory Disease in Asia-Pacific-Asia-Pacific Burden of Respiratory Diseases Study. Value Health Reg Issues 2016; 9:72-77. [PMID: 27881264 DOI: 10.1016/j.vhri.2015.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 10/02/2015] [Accepted: 11/05/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Asia-Pacific Burden of Respiratory Diseases is a cross-sectional, observational study examining the burden of disease in adults with respiratory diseases across six countries. The aim of this study was to describe health care resource use (HCRU), work impairment, cost burden, and health-related quality of life (HRQOL) associated with respiratory disease in the Asia-Pacific. METHODS Consecutive participants aged 18 years or older with a primary diagnosis of asthma, allergic rhinitis, chronic obstructive pulmonary disease, or rhinosinusitis were enrolled. Participants completed a survey detailing respiratory symptoms, HCRU, work productivity and activity impairment, and HRQOL. Locally sourced unit costs for each country were used in the calculation of total costs. RESULTS The study enrolled 5250 patients. Overall, the mean annual cost for patients with a respiratory disease was US $4191 (SGD 8489) per patient. For patients who reported impairment at work, the mean annual cost was US $7315 (SGD 10,244), with productivity loss being the highest cost component for all four diseases (US $6310 [SGD 9100]). On average, patients were impaired for one-third of their time at work and 5% of their work time missed because of respiratory disease, which resulted in a 36% reduction in productivity. Patients with a primary diagnosis of chronic obstructive pulmonary disease had the greatest impact on HRQOL. CONCLUSIONS In the Asia-Pacific, respiratory diseases have a significant impact on HCRU and associated costs, along with work productivity. Timely and effective management of these diseases has the potential to reduce disease burden and health care costs and improve work productivity and HRQOL.
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Affiliation(s)
- De Yun Wang
- Department of Otolaryngology, National University of Singapore, Singapore
| | | | | | - Horng-Chyuan Lin
- Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | | | | | | | | | | | | | - Sang-Heon Cho
- Division of Asthma, Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
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Sundbom F, Malinovschi A, Lindberg E, Alving K, Janson C. Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics. J Asthma 2016; 53:398-403. [PMID: 26666333 DOI: 10.3109/02770903.2015.1126846] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma-related quality of life has previously been shown to be associated with asthma control. The aims of the present study were to further analyze this correlation, identify other variables with impact on asthma-related quality of life and investigate the covariance among these variables. METHODS Information was retrieved from a cohort of 369 patients, aged 12-35, with physician-diagnosed asthma requiring anti-inflammatory treatment for at least 3 months per year. Questionnaire data [including the mini-Asthma Quality of Life Questionnaire (mAQLQ), asthma control test (ACT) and Hospital Anxiety and Depression Scale (HADS)], quality of sleep, lung function data and blood samples were analyzed. Linear regression models with the mAQLQ score as the dependent scalar variable were calculated. RESULTS ACT was the single variable that had the highest explanatory value for the mAQLQ score (51.5%). High explanatory power was also observed for anxiety and depression (17.0%) and insomnia (14.1%). The population was divided into groups depending on the presence of anxiety and depression, uncontrolled asthma and insomnia. The group that reported none of these conditions had the highest mean mAQLQ score (6.3 units), whereas the group reporting all of these conditions had the lowest mAQLQ score (3.8 units). CONCLUSIONS The ACT score was the single most important variable in predicting asthma-related quality of life. Combining the ACT score with the data on insomnia, anxiety and depression showed considerable additive effects of the conditions. Hence, we recommend the routine use of the ACT and careful attention to symptoms of insomnia, anxiety or depression in the clinical evaluation of asthma-related quality of life.
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Affiliation(s)
- Fredrik Sundbom
- a Department of Medical Sciences: Respiratory , Allergy and Sleep Research
| | | | - Eva Lindberg
- a Department of Medical Sciences: Respiratory , Allergy and Sleep Research
| | - Kjell Alving
- c Department of Women's and Children's Health , Uppsala University Hospital , Uppsala , Sweden
| | - Christer Janson
- a Department of Medical Sciences: Respiratory , Allergy and Sleep Research
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Lövström L, Emtner M, Alving K, Nordvall L, Borres MP, Janson C, Malinovschi A. High levels of physical activity are associated with poorer asthma control in young females but not in males. Respirology 2015; 21:79-87. [PMID: 26581686 DOI: 10.1111/resp.12671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 07/02/2015] [Accepted: 07/06/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Earlier studies on the levels of physical activity in asthma patients compared with controls have yielded varying results. We have previously reported that high versus moderate levels of physical activity were associated with higher prevalence of wheezing, especially in females. Here we studied the levels of physical activity in young patients with asthma and healthy subjects and their effect on asthma control. METHODS Four hundred eight physician-diagnosed patients with asthma and 118 controls (10-34 years) answered questions concerning frequency and/or duration of physical activity and undertook the Asthma Control Test (ACT), spirometry, methacholine challenges and exhaled nitric oxide measurements. RESULTS Asthma patients were more frequently physically active (P = 0.01) and for longer durations (P = 0.002) than controls. Highly versus moderately physically active patients with asthma had a higher prevalence of not well-controlled asthma (ACT < 20) when physical activity was assessed by frequency (40.6% vs 24.1%, P = 0.001) or duration (39.0% vs 21.7%, P < 0.001). This was only seen in females who had reduced ACT items (P < 0.05). Frequently versus moderately active females had an odds ratio of 4.81 (2.43, 9.51) to have ACT < 20, while no such effect was found in males (OR 1.18 (0.61, 2.30)) and this interaction was statistically significantly associated with gender (P = 0.003). No differences in fraction of exhaled nitric oxide or methacholine reactivity were found between moderately and highly physically active females with asthma. CONCLUSION Young asthma patients were more active than controls. High levels of physical activity were associated with poor asthma control as judged by the ACT in females, but not in males, and this appears unrelated to airway inflammation or responsiveness.
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Affiliation(s)
- Ludvig Lövström
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Margareta Emtner
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lennart Nordvall
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Magnus P Borres
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
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Meyer A, Günther S, Volmer T, Taube K, Baumann HJ. A 12-month, moderate-intensity exercise training program improves fitness and quality of life in adults with asthma: a controlled trial. BMC Pulm Med 2015; 15:56. [PMID: 25947010 PMCID: PMC4431028 DOI: 10.1186/s12890-015-0053-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 04/22/2015] [Indexed: 12/31/2022] Open
Abstract
Background Physical training has been shown to improve exercise capabilities in patients with asthma. Most studies focused on children and younger adults. Previously, the maximum program duration was six months. It is not known whether the same results may be obtained with lower intensity programs and sustained for time periods longer than 6 months. This controlled study was undertaken to investigate the effects of a moderate intensity outpatient training program of one year duration on physical fitness and quality of life in adults with asthma. Methods 21 adult asthmatics (mean age 56 ± 10 years) were allocated to outpatient training (n = 13) or standard care (n = 8). Exercise consisted of once weekly, 60-minute sessions of moderate intensity. Assessments at baseline and after one year included cardiopulmonary exercise testing and Short Form-36 and Asthma Quality of Life Questionnaires. Results Following one year of exercise, relevant improvements were observed in the training group for maximum work capacity (p = 0.005), peak oxygen uptake (p < 0.005), O2pulse (p < 0.05), maximum ventilation (p < 0.005), and most of the quality of life domains. No changes were observed in the control group. Conclusions A physiotherapist-led, long-term, moderate-intensity exercise program of one year duration can induce clinically relevant improvements in exercise capabilities and health-related quality of life in well-motivated adults with asthma. Trial registration clinicaltrials.gov NCT01097473. Date trial registered: 31.03.2010.
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Affiliation(s)
- Andreas Meyer
- Department of Pneumology, Kliniken Mariahilf GmbH, Mönchengladbach, Germany.
| | - Sabine Günther
- Department of Pneumology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | - Hans J Baumann
- Department of Pneumology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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The impact of asthma, chronic bronchitis and allergic rhinitis on all-cause hospitalizations and limitations in daily activities: a population-based observational study. BMC Pulm Med 2015; 15:10. [PMID: 25880039 PMCID: PMC4342897 DOI: 10.1186/s12890-015-0008-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/29/2015] [Indexed: 01/30/2023] Open
Abstract
Background Chronic respiratory diseases are a significant cause of morbidity and mortality worldwide. We sought to evaluate the impact of asthma, chronic bronchitis and allergic rhinitis on all-cause hospitalizations and limitations in daily activities in adults. Methods In the Gene Environment Interactions in Respiratory Diseases study (2007/2010), a screening questionnaire was mailed to 9,739 subjects aged 20–44 (response rate: 53.0%) and to 3,480 subjects aged 45–64 (response rate: 62.3%), who were randomly selected from the general population in Italy. The questionnaire was used to: identify the responders who had asthma, chronic bronchitis, allergic rhinitis or asthma-like symptoms/dyspnoea/other nasal problems; evaluate the total burden [use of hospital services (at least one ED visit and/or one hospital admission) and number of days with reduced activities (lost working days and days with limited, not work related activities) due to any health problems (apart from accidents and injuries) in the past three months]; evaluate the contribution of breathing problems to the total burden (hospitalizations and number of days with reduced activities specifically due to breathing problems). Results At any age, the all-cause hospitalization risk was about 6% among the subjects without any respiratory conditions, it increased to about 9-12% among the individuals with allergic rhinitis or with asthma-like symptoms/dyspnoea/other nasal problems, and it peaked at about 15-18% among the asthmatics with chronic bronchitis aged 20–44 and 45–64, respectively. The expected number of days with reduced activities due to any health problems increased from 1.5 among the subjects with no respiratory conditions in both the age classes, to 6.3 and 4.6 among the asthmatics with chronic bronchitis aged 20–44 and 45–64, respectively. The contribution of breathing problems to the total burden was the highest among the asthmatics with chronic bronchitis (23-29% of the hospitalization risk and 39-50% of the days with reduced activities, according to age). Conclusions The impact of asthma, chronic bronchitis and allergic rhinitis on all-cause hospitalizations and limitations in daily activities is substantial, and it is markedly different among adults from the general population in Italy. The contribution of breathing problems to the total burden also varies according to the respiratory condition.
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Kämpe M, Lisspers K, Ställberg B, Sundh J, Montgomery S, Janson C. Determinants of uncontrolled asthma in a Swedish asthma population: cross-sectional observational study. Eur Clin Respir J 2014; 1:24109. [PMID: 26557235 PMCID: PMC4629716 DOI: 10.3402/ecrj.v1.24109] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 08/19/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Asthma control is achieved in a low proportion of patients. The primary aim was to evaluate risk factors for uncontrolled asthma. The secondary aim was to assess quality of life associated with asthma control. METHODS In a cross-sectional study, asthma patients aged 18-75 were randomly selected from primary and secondary health care centers. Postal questionnaires were sent to 1,675 patients and the response rate was 71%. A total of 846 patients from primary and 341 patients from secondary care were evaluated. Data were collected using a questionnaire and review of medical records. The questionnaire included questions about asthma control and a quality-of-life questionnaire, the mini-AQLQ, with four domains (symptoms, activity limitation, emotional function, and environmental stimuli). The mean score for each domain and the overall score were calculated. Asthma control was divided into three levels according to the GINA guidelines and partly and uncontrolled asthma were combined into one group - poorly controlled asthma. RESULTS Asthma control was achieved in 36% of the sample: 38% in primary and 29% in secondary care. In primary and secondary care, 35 and 45% had uncontrolled asthma, respectively. Risk factors for poorly controlled asthma were female sex [OR 1.31 (1.003-1.70)], older age [OR 2.18 (1.28-3.73)], lower educational level [OR 1.63 (1.14-2.33)], and current smoking [OR 1.68 (1.16-2.43)]. Older age and lower educational level remained statistically significantly associated with poorly controlled asthma when the analyses were limited to never-smokers. Depression was an independent risk factor for poorly controlled asthma in men [OR 3.44 (1.12-10.54)]. The mini-AQLQ scores and the mean overall score were significantly lower in uncontrolled asthma. CONCLUSION Risk factors for poorly controlled asthma were female sex, older age, low educational level, and smoking. Uncontrolled asthma was significantly associated with lower quality of life.
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Affiliation(s)
- Mary Kämpe
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University Uppsala, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Örebro University Hospital, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, Örebro University Hospital and Örebro University, Örebro, Sweden ; Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden ; Department of Epidemiology and Public Health, University College London, UK
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University Uppsala, Sweden
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Honkoop PJ, Loijmans RJB, Termeer EH, Snoeck-Stroband JB, van den Hout WB, Bakker MJ, Assendelft WJJ, ter Riet G, Sterk PJ, Schermer TRJ, Sont JK. Symptom- and fraction of exhaled nitric oxide-driven strategies for asthma control: A cluster-randomized trial in primary care. J Allergy Clin Immunol 2014; 135:682-8.e11. [PMID: 25174865 DOI: 10.1016/j.jaci.2014.07.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/04/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Aiming at partly controlled asthma (PCa) instead of controlled asthma (Ca) might decrease asthma medication use. Biomarkers, such as the fraction of exhaled nitric oxide (Feno), allow further tailoring of treatment. OBJECTIVE We sought to assess the cost-effectiveness and clinical effectiveness of pursuing PCa, Ca, or Feno-driven controlled asthma (FCa). METHODS In a nonblind, pragmatic, cluster-randomized trial in primary care, adults (18-50 years of age) with a doctor's diagnosis of asthma who were prescribed inhaled corticosteroids were allocated to one of 3 treatment strategies: (1) aiming at PCa (Asthma Control Questionnaire [ACQ] score <1.50); (2) aiming at Ca (ACQ score <0.75); and (3) aiming at FCa (ACQ score <0.75 and Feno value <25 ppb). During 12 months' follow-up, treatment was adjusted every 3 months by using an online decision support tool. Outcomes were incremental cost per quality-adjusted life year gained, asthma control (ACQ score), quality of life (Asthma Quality of Life Questionnaire score), asthma medication use, and severe exacerbation rate. RESULTS Six hundred eleven participants were allocated to the PCa (n = 219), Ca (n = 203), or FCa (n = 189) strategies. The FCa strategy improved asthma control compared with the PCa strategy (P < .02). There were no differences in quality of life (P ≥ .36). Asthma medication use was significantly lower for the PCa and FCa strategies compared with the Ca strategy (medication costs: PCa, $452; Ca, $551; and FCa, $456; P ≤ .04). The FCa strategy had the highest probability of cost-effectiveness at a willingness to pay of $50,000/quality-adjusted life year (86%; PCa, 2%; Ca, 12%). There were no differences in severe exacerbation rate. CONCLUSION A symptom- plus Feno-driven strategy reduces asthma medication use while sustaining asthma control and quality of life and is the preferred strategy for adult asthmatic patients in primary care.
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Affiliation(s)
- Persijn J Honkoop
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
| | - Rik J B Loijmans
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
| | - Evelien H Termeer
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jiska B Snoeck-Stroband
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilbert B van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Moira J Bakker
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem J J Assendelft
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
| | - Peter J Sterk
- Department of Pulmonology, Academic Medical Center, Amsterdam, The Netherlands
| | - Tjard R J Schermer
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacob K Sont
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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von Bülow A, Kriegbaum M, Backer V, Porsbjerg C. The prevalence of severe asthma and low asthma control among Danish adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:759-67. [PMID: 25439368 DOI: 10.1016/j.jaip.2014.05.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/03/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prevalence of severe asthma is unknown. However, international expert statements estimate that severe asthma represents 5% to 10 % of the entire asthma population. OBJECTIVE Based on register data from a nationwide population, we wanted to investigate the prevalence of severe asthma, the extent of asthma control, and contact with specialist care. METHODS A descriptive cross-sectional register study was performed. By using a nationwide prescription database, we identified current patients with asthma (age, 18-44 years) in 2010. Severity was classified as severe versus mild-moderate asthma according to the level of antiasthma treatment. We investigated prescription drug use, hospitalizations, emergency department visits, and outpatient clinic visits according to severity. RESULTS Among a nationwide population, we identified 61,583 current patients with asthma. Based on the level of antiasthma treatment, 8.1% of identified patients was classified as having severe asthma. Low asthma control (dispensed prescriptions of prednisolone, emergency department visits, hospitalization, or excessive short-acting β₂-agonist use) was more frequent in subjects with severe asthma (36.4% vs 25.2%, P < .0001); 63.8% with severe asthma and low asthma control were not managed by specialist care. Patients with severe asthma with specialist contact more frequently had impaired asthma control compared with subjects not treated by a specialist (44.4% vs 33.1%, P < .0001). CONCLUSION Based on the level of treatment, 8.1% of a nationwide population of current patients with asthma was classified as having severe asthma. Low asthma control was more frequent among subjects with severe asthma, and only a minority had access to specialist care. There is room for optimizing asthma management, particularly among patients with severe disease.
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Affiliation(s)
- Anna von Bülow
- Respiratory Research Unit, Department of Respiratory Medicine L, Bispebjerg Hospital, Copenhagen, Denmark.
| | - Margit Kriegbaum
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Respiratory Research Unit, Department of Respiratory Medicine L, Bispebjerg Hospital, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine L, Bispebjerg Hospital, Copenhagen, Denmark
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Tsai Y, Ko Y, Huang M, Lin M, Wu C, Wang C, Chen Y, Li J, Tseng Y, Wang T. CHI3L1 polymorphisms associate with asthma in a Taiwanese population. BMC MEDICAL GENETICS 2014; 15:86. [PMID: 25056157 PMCID: PMC4113488 DOI: 10.1186/1471-2350-15-86] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/08/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND A genome-wide association study uncovered Chitinase 3 like 1 (CHI3L1) as a candidate gene for asthma susceptibility. CHI3L1, which encodes the YKL-40 protein, is associated with asthma in Western European and American populations and with atopy in a Korean population. However, asthma-associated polymorphisms remain unknown for a Taiwanese population. METHODS We enrolled 628 adult asthmatic patients and 1:1 age-sex matched community-based controls in southern Taiwan and performed a combined effect sizes analysis to test if CHI3L1 polymorphisms were related to genetic risks for asthma in the Asian population. Ten tagSNP polymorphisms for the CHI3L1 gene were selected from the HapMap database and genotyped using a TaqMan allelic discrimination assay. RESULTS Adjusted odds ratios of the CHI3L1 rs1538372 CC genotype (aOR = 1.97, 95% CI: 1.23-3.14) and the rs10399931 GG genotype (aOR = 1.77, 95% CI: 1.13-2.77) were significantly associated with asthma in the Taiwanese populations. Predictive values of forced expiratory volume in the first second of the forced vital capacity (12.37%, P = 0.03) and of forced vital capacity (12.10%, P = 0.036) decreased in conjunction with an increase in YKL-40 levels among CHI3L1 rs1538372 CC carriers; these values were 16.1% (P = 0.004) and 14.5% (P = 0.011), respectively, among CHI3L1 rs10399931 GG carriers. Furthermore, steroid use by asthma patients did not affect serum YKL-40 levels, but both polymorphisms had significant effects on YKL-40 levels in asthma patients who used steroids. CONCLUSIONS Our findings suggest that the CHI3L1 polymorphisms rs1538372 and rs10399931 can be used as genetic markers for predicting asthma risk in the Taiwanese population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tsunai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, No, 100, Shi-Chuan 1st Rd, Kaohsiung 807, Taiwan.
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Sliwka A, Wloch T, Tynor D, Nowobilski R. Do asthmatics benefit from music therapy? A systematic review. Complement Ther Med 2014; 22:756-66. [PMID: 25146081 DOI: 10.1016/j.ctim.2014.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 06/30/2014] [Accepted: 07/06/2014] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of music therapy in asthma. METHODS Searches for experimental and observational studies published between 01.01.92 and 31.12.13 were conducted through electronic databases: Medline/PubMed, Embase, SportDiscus, Cochrane Library, Teacher Reference Centre, Web of Science, Academic Search Complete, PsycINFO, PsycARTICLES, PEDro and Scopus. The selection criteria included any method of music therapy applied to patients with asthma, with respect to asthma symptoms and lung function. Two reviewers screened the records independently. The risk of bias was assessed using the Cochrane Collaboration's tool. Strength of recommendation was graded according to GRADE recommendation. RESULTS The literature search identified 867 citations, from which 8 (three RCTs and five nRCTs) low and high risk of bias studies were included in the review. All RCTs used music listening as a form of complementary treatment. One RCT of the low risk of bias indicated positive effects on lung function in mild asthma. In two others, despite the decrease in asthma symptoms, music was not more effective than the control condition. In two nRCTs a decrease in asthma symptoms was reported as an effect of playing a brass or wind instrument; in two nRCTs the same effect was observed after music assisted vocal breathing exercises and singing. Mood improvement, decrease of depression and anxiety were also observed. CONCLUSION The paucity, heterogeneity, and significant methodological limitations of available studies allow for only a weak recommendation for music therapy in asthma. This study highlights the need for further research of mixed methodology.
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Affiliation(s)
- Agnieszka Sliwka
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Cracow, Poland; Department of Pulmonology, University Hospital, Cracow, Poland.
| | - Tomasz Wloch
- Department of Allergy and Clinical Immunology, University Hospital, Cracow, Poland; Unit of Rehabilitation in Internal Diseases, Department of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University School of Physical Education, Cracow, Poland
| | - Dariusz Tynor
- University School of Physical Education in Krakow, Cracow, Poland
| | - Roman Nowobilski
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Cracow, Poland; Department of Allergy and Clinical Immunology, University Hospital, Cracow, Poland
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Prosperi MC, Marinho S, Simpson A, Custovic A, Buchan IE. Predicting phenotypes of asthma and eczema with machine learning. BMC Med Genomics 2014; 7 Suppl 1:S7. [PMID: 25077568 PMCID: PMC4101570 DOI: 10.1186/1755-8794-7-s1-s7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background There is increasing recognition that asthma and eczema are heterogeneous diseases. We investigated the predictive ability of a spectrum of machine learning methods to disambiguate clinical sub-groups of asthma, wheeze and eczema, using a large heterogeneous set of attributes in an unselected population. The aim was to identify to what extent such heterogeneous information can be combined to reveal specific clinical manifestations. Methods The study population comprised a cross-sectional sample of adults, and included representatives of the general population enriched by subjects with asthma. Linear and non-linear machine learning methods, from logistic regression to random forests, were fit on a large attribute set including demographic, clinical and laboratory features, genetic profiles and environmental exposures. Outcome of interest were asthma, wheeze and eczema encoded by different operational definitions. Model validation was performed via bootstrapping. Results The study population included 554 adults, 42% male, 38% previous or current smokers. Proportion of asthma, wheeze, and eczema diagnoses was 16.7%, 12.3%, and 21.7%, respectively. Models were fit on 223 non-genetic variables plus 215 single nucleotide polymorphisms. In general, non-linear models achieved higher sensitivity and specificity than other methods, especially for asthma and wheeze, less for eczema, with areas under receiver operating characteristic curve of 84%, 76% and 64%, respectively. Our findings confirm that allergen sensitisation and lung function characterise asthma better in combination than separately. The predictive ability of genetic markers alone is limited. For eczema, new predictors such as bio-impedance were discovered. Conclusions More usefully-complex modelling is the key to a better understanding of disease mechanisms and personalised healthcare: further advances are likely with the incorporation of more factors/attributes and longitudinal measures.
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Are operating room nurses at higher risk of severe persistent asthma? The Nurses' Health Study. J Occup Environ Med 2014; 55:973-7. [PMID: 23887704 DOI: 10.1097/jom.0b013e318297325b] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the associations between operating room (OR) nursing, a category of health care workers at high risk of exposure to various inhaled agents, and asthma severity/control among women with asthma. METHODS The level of severity/control in nurses with prevalent doctor-diagnosed asthma in 1998/2000 was compared, using nominal logistic regression, in OR nursing (n = 69) and administrative nursing (n = 546) from the US Nurses' Health Study for whom detailed information on asthma and nursing employment status was available. RESULTS We observed a significant association between OR nursing, compared with administrative nursing, and severe persistent asthma (adjusted odds ratio, 2.48; 95% confidence interval, 1.06 to 5.77). CONCLUSIONS Our findings suggest that nurses working in the OR are at a higher risk of severe persistent asthma. Further studies with detailed estimates of occupational exposures, especially to disinfectant/cleaning agents, are warranted.
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