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Salsman ML, Nordberg HO, Wittchen HU, Klotsche J, Mühlig S, Riedel O, Ritz T. Extrapulmonary symptoms of patients with asthma treated in specialist pulmonary care. J Psychosom Res 2021; 148:110538. [PMID: 34174713 DOI: 10.1016/j.jpsychores.2021.110538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Patients seeking treatment for their asthma are most likely motivated by a change in their experience of symptoms, but primary complaints are not always related to the pulmonary system. This study aimed to determine the frequency of such extrapulmonary symptoms in asthma outpatients and their association with psychopathology and asthma outcomes. METHODS This cross-sectional study utilized data collected as part of a nationwide, clinical-epidemiological study. The final sample of 572 asthma patients represented all levels of asthma control and severity. Information on demographics and respiratory function was obtained from physicians' documentation. Symptoms were explored using a standardized checklist. RESULTS Primary symptoms reported by asthma patients were not necessarily airway-related. Patients reported feeling at least occasionally "tired" (72.1%) and "exhausted" (66.8%) more than any other asthma symptom. Hyperventilation and mood symptoms were experienced by 34.4-42.6% of patients. Anxiety or depression diagnoses indicated higher scores in all symptom domains. Controlling for asthma-related factors and psychopathology, fatigue had a small but significant effect on both asthma-related quality of life (AQLQ) (rsp2 = 0.02, P < .001) and asthma control (rsp2 = 0.01, P = .003). Mood symptoms also showed a small but significant effect on AQLQ (rsp2 = 0.02, P < .001). CONCLUSION Findings suggest that extrapulmonary symptoms are endorsed more frequently than previously reported. Symptoms nonspecific to asthma can play a substantial role in clinical presentation and exclusive focus on airway symptoms may miss important information related to patients' well-being. Surveillance of extrapulmonary symptoms alongside pulmonary function is warranted for an integrated medicine approach to asthma management.
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Affiliation(s)
- Margot L Salsman
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Hannah O Nordberg
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU) Muenchen, Germany
| | - Jens Klotsche
- Deutsches Rheumaforschungszentrum, Ein Leibniz-Zentrum, Berlin, Germany
| | - Stephan Mühlig
- Chemnitz University of Technology, Department of Psychology, Chemnitz, Germany
| | - Oliver Riedel
- Department of Clinical Epidemiology, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
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2
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Terl M, Pohunek P, Kuhn M, Bystron J. Four seasons of Czech asthma study: asthma characteristics and management reality in the Czech Republic. J Asthma 2019; 57:898-910. [PMID: 31144543 DOI: 10.1080/02770903.2019.1619082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To describe the characteristics and management of asthma in clinical practice in the Czech Republic in the context of international guidelines and clinical realities.Methods: Data were collected over four seasons from summer 2016 to spring 2017 and are mostly presented using descriptive statistics.Results: We obtained valid data for 4557 adult patients with asthma, including detailed phenotyping (71% eosinophilic allergic, 10% eosinophilic non-allergic, 19% non-eosinophilic non-allergic asthma) from 58 allergologists and 56 pulmonologists. The average time to diagnosis was 3 years. In more than half of the subjects, bronchodilator testing (BDT) results were available at primary diagnosis. More than 10% of physicians did not test for mold allergy. Occupational asthma was diagnosed in 0.7% of subjects. According to the attending physician, 68% of patients had well-controlled and 10% had uncontrolled asthma. Ninety-four percent of patients were on preventive treatment, with 91% using an inhaled corticosteroids (ICS) at an average dose of 705 µg/day budesonide equivalent. Approximately 75% of patients were on an ICS/LABA, with 91% using fixed combinations. Among patients using ICS/formoterol, a maintenance and reliever therapy regime was prescribed in 67%.Conclusions: The quality of asthma management in the Czech Republic is comparable to that of other developed countries and better in some respects (frequent BDT, phenotyping, and use of preventive treatment). Nevertheless, there is unnecessary delay in diagnosis and lack of research on possible environmental causes (workplace, molds). Pharmacotherapy shows good adherence to guidelines. Although 10% of patients show poor control, there is concurrently a trend for overtreatment.
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Affiliation(s)
- Milan Terl
- Department of Pulmonary Medicine, Faculty of Medicine in Pilsen, University Hospital, Charles University, Prague, Czech Republic
| | - Petr Pohunek
- Department of Paediatrics, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Matyas Kuhn
- Data Analysis Department, Institute of Biostatistics and Analysis, Brno, Czech Republic
| | - Jaromir Bystron
- Department of Allergology and Clinical Immunology, University Hospital Olomouc, Olomouc, Czech Republic
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3
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Richter AK, Klimek L, Merk HF, Mülleneisen N, Renz H, Wehrmann W, Werfel T, Hamelmann E, Siebert U, Sroczynski G, Wasem J, Biermann-Stallwitz J. Impact of increasing treatment rates on cost-effectiveness of subcutaneous immunotherapy (SCIT) in respiratory allergy: a decision analytic modelling approach. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:1229-1242. [PMID: 29574666 DOI: 10.1007/s10198-018-0970-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Specific immunotherapy is the only causal treatment in respiratory allergy. Due to high treatment cost and possible severe side effects subcutaneous immunotherapy (SCIT) is not indicated in all patients. Nevertheless, reported treatment rates seem to be low. This study aims to analyze the effects of increasing treatment rates of SCIT in respiratory allergy in terms of costs and quality-adjusted life years (QALYs). METHODS A state-transition Markov model simulates the course of disease of patients with allergic rhinitis, allergic asthma and both diseases over 10 years including a symptom-free state and death. Treatment comprises symptomatic pharmacotherapy alone or combined with SCIT. The model compares two strategies of increased and status quo treatment rates. Transition probabilities are based on routine data. Costs are calculated from the societal perspective applying German unit costs to literature-derived resource consumption. QALYs are determined by translating the mean change in non-preference-based quality of life scores to a change in utility. Key parameters are subjected to deterministic sensitivity analyses. RESULTS Increasing treatment rates is a cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of 3484€/QALY compared to the status quo. The most influential parameters are SCIT discontinuation rates, treatment effects on the transition probabilities and cost of SCIT. Across all parameter variations, the best case leads to dominance of increased treatment rates while the worst case ICER is 34,315€/QALY. Excluding indirect cost leads to a twofold increase in the ICER. CONCLUSIONS Measures to increase SCIT initiation rates should be implemented and also address improving adherence.
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Affiliation(s)
- Ann-Kathrin Richter
- Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany.
| | - Ludger Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - Hans F Merk
- Clinic for Dermatology and Allergology, University Clinic RWTH, Aachen, Germany
| | | | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University, Marburg, Germany
| | - Wolfgang Wehrmann
- Dermatological Clinic Prof. Wehrmann, Dr. Rödder-Wehrmann and colleagues, Münster, Germany
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Dept of Dermatology and Allergy, Hannover Medical School, Hanover, Germany
| | - Eckard Hamelmann
- Children's Center Bethel, Protestant Hospital Bielefeld and Allergy Center Ruhr-University, Bochum, Germany
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MGH-ITA, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Jürgen Wasem
- Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - Janine Biermann-Stallwitz
- Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
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4
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Björstad Å, Cardell LO, Hahn-Pedersen J, Svärd M. A Cost-Minimisation Analysis Comparing Sublingual Immunotherapy to Subcutaneous Immunotherapy for the Treatment of House Dust Mite Allergy in a Swedish Setting. Clin Drug Investig 2017; 37:541-549. [PMID: 28326466 DOI: 10.1007/s40261-017-0516-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES In Sweden, approximately 6% of children and 10% of adults suffer from house dust mite (HDM) allergy with symptoms of allergic rhinitis and allergic asthma. Treatment is aimed at reducing HDM exposure and to control the symptoms of allergic rhinitis and allergic asthma by symptom-relieving pharmacotherapy. This pharmacotherapy is often effective, but some patients remain inadequately controlled. For these patients, allergy immunotherapy (AIT, subcutaneous or sublingual) with repeated administration of HDM allergen should be considered. The objective of this study was to compare the costs for sublingual AIT (SLIT; SQ® SLIT-tablet) to the costs for subcutaneous AIT (SCIT; SQ® SCIT) for the treatment of HDM allergy in a cost-minimisation analysis (CMA). METHODS The CMA included resources (and costs) for treatment, healthcare visits, travelling and lost productivity. Resource use based on Swedish clinical treatment practice and costs were obtained from medical price lists. Analyses were conducted from the societal, as well as healthcare perspective, by use of a time horizon of 3 years. RESULTS The results show that SQ® SLIT-tablet is a cost-saving treatment as compared to SQ® SCIT for the treatment of HDM allergy (€6800 over 3 years). The results are mainly driven by the cost of healthcare visits and the frequency of SCIT administrations. CONCLUSION In conclusion, cost-savings of €6800 over 3 years are expected from treating HDM allergy with SQ® SLIT-tablet as compared to SQ® SCIT, including costs for treatment, healthcare visits, travelling and lost productivity. The reduced number of healthcare visits compensates for higher medication costs.
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Affiliation(s)
| | - Lars-Olaf Cardell
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden
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5
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Gibson PG, Reddel H, McDonald VM, Marks G, Jenkins C, Gillman A, Upham J, Sutherland M, Rimmer J, Thien F, Katsoulotos GP, Cook M, Yang I, Katelaris C, Bowler S, Langton D, Robinson P, Wright C, Yozghatlian V, Burgess S, Sivakumaran P, Jaffe A, Bowden J, Wark PAB, Yan KY, Kritikos V, Peters M, Hew M, Aminazad A, Bint M, Guo M. Effectiveness and response predictors of omalizumab in a severe allergic asthma population with a high prevalence of comorbidities: the Australian Xolair Registry. Intern Med J 2017; 46:1054-62. [PMID: 27350385 DOI: 10.1111/imj.13166] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/02/2016] [Accepted: 06/21/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Severe asthma is a high impact disease. Omalizumab targets the allergic inflammatory pathway; however, effectiveness data in a population with significant comorbidities are limited. AIMS To describe severe allergic asthma, omalizumab treatment outcomes and predictors of response among the Australian Xolair Registry participants. METHODS A web-based post-marketing surveillance registry was established to characterise the use, effectiveness and adverse effects of omalizumab (Xolair) for severe allergic asthma. RESULTS Participants (n = 192) (mean age 51 years, 118 female) with severe allergic asthma from 21 clinics in Australia were assessed, and 180 received omalizumab therapy. They had poor asthma control (Asthma Control Questionnaire, ACQ-5, mean score 3.56) and significant quality of life impairment (Asthma-related Quality of Life Questionnaire score 3.57), and 52% were using daily oral corticosteroid (OCS). Overall, 95% had one or more comorbidities (rhinitis 48%, obesity 45%, cardiovascular disease 23%). The omalizumab responder rate, assessed by an improvement of at least 0.5 in ACQ-5, was high at 83%. OCS use was significantly reduced. The response in participants with comorbid obesity and cardiovascular disease was similar to those without these conditions. Baseline ACQ-5 ≥ 2.0 (P = 0.002) and older age (P = 0.05) predicted the magnitude of change in ACQ-5 in response to omalizumab. Drug-related adverse events included anaphylactoid reactions (n = 4), headache (n = 2) and chest pains (n = 1). CONCLUSION Australian patients with severe allergic asthma report a high disease burden and have extensive comorbidity. Symptomatic response to omalizumab was high despite significant comorbid disease. Omalizumab is an effective targeted therapy for severe allergic asthma with comorbidity in a real-life setting.
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Affiliation(s)
- P G Gibson
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.
| | - H Reddel
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Liverpool Hospital, Sydney, New South Wales, Australia
| | - V M McDonald
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - G Marks
- Department of Respiratory Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - C Jenkins
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - A Gillman
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - J Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - M Sutherland
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia
| | - J Rimmer
- St Vincent's Clinic, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - F Thien
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia
| | - G P Katsoulotos
- St George Specialist Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - M Cook
- Department of Immunology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - I Yang
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - C Katelaris
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - S Bowler
- Department of Respiratory and Sleep Medicine, Mater Adult Hospital, Brisbane, Queensland, Australia
| | - D Langton
- Department of Thoracic Medicine, Frankston Hospital, Melbourne, Victoria, Australia
| | - P Robinson
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - C Wright
- Department of Respiratory Medicine, Nambour Hospital, Nambour, Queensland, Australia
| | - V Yozghatlian
- Department of Respiratory and Sleep Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - S Burgess
- QLD Children's Lung and Sleep Specialists, Brisbane, Queensland, Australia
| | - P Sivakumaran
- Department of Respiratory Medicine, Gold Coast District Hospital, Gold Coast, Queensland, Australia
| | - A Jaffe
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - J Bowden
- Department of Respiratory, Allergy and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - P A B Wark
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - K Y Yan
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - V Kritikos
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - M Hew
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - A Aminazad
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia
| | - M Bint
- Department of Respiratory Medicine, Nambour Hospital, Nambour, Queensland, Australia
| | - M Guo
- Clinical Management, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
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Clark VL, Gibson PG, Genn G, Hiles SA, Pavord ID, McDonald VM. Multidimensional assessment of severe asthma: A systematic review and meta-analysis. Respirology 2017; 22:1262-1275. [PMID: 28776330 DOI: 10.1111/resp.13134] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 01/12/2023]
Abstract
The management of severe asthma is complex. Multidimensional assessment (MDA) of specific traits has been proposed as an effective strategy to manage severe asthma, although it is supported by few prospective studies. We aimed to systematically review the literature published on MDA in severe asthma, to identify the traits included in MDA and to determine the effect of MDA on asthma-related outcomes. We identified 26 studies and classified these based on study type (cohort/cross-sectional studies; experimental/outcome studies; and severe asthma disease registries). Study type determined the comprehensiveness of the assessment. Assessed traits were classified into three domains (airways, co-morbidities and risk factors). The airway domain had the largest number of traits assessed (mean ± SD = 4.2 ± 1.7) compared with co-morbidities (3.6 ± 2.2) and risk factors (3.9 ± 2.1). Bronchodilator reversibility and airflow limitation were assessed in 92% of studies, whereas airway inflammation was only assessed in 50%. Commonly assessed co-morbidities were psychological dysfunction, sinusitis (both 73%) and gastro-oesophageal reflux disease (GORD; 69%). Atopic and smoking statuses were the most commonly assessed risk factors (85% and 86%, respectively). There were six outcome studies, of which five concluded that MDA is effective at improving asthma-related outcomes. Among these studies, significantly more traits were assessed than treated. MDA studies have assessed a variety of different traits and have shown evidence of improved outcomes. This promising model of care requires more research to inform which traits should be assessed, which traits should be treated and what effect MDA has on patient outcomes.
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Affiliation(s)
- Vanessa L Clark
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Grayson Genn
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia
| | - Sarah A Hiles
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia
| | - Ian D Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia
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Asthma Trigger Reports Are Associated with Low Quality of Life, Exacerbations, and Emergency Treatments. Ann Am Thorac Soc 2016; 13:204-11. [PMID: 26599372 DOI: 10.1513/annalsats.201506-390oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Despite the importance of trigger perceptions for asthma diagnosis and management, associations among asthma triggers, affective disorders, and asthma outcome have received little attention. OBJECTIVES Because anxiety and depression are known to influence patients' health reports, we measured and controlled for these affective disorders in analyzing associations among patient perceptions of asthma triggers and asthma treatment outcomes. METHODS Patients from a nationally representative sample of respiratory specialist practices (N = 459) were assessed for clinically significant anxiety and depression and completed questionnaires on asthma triggers, quality of life, and asthma control. Physicians recorded exacerbation and emergency treatment frequencies in the prior year, spirometric lung function, and allergy test results. Hierarchical multiple regressions examined associations among reported trigger factors, anxiety, depression, and asthma outcomes, including quality of life, asthma control, exacerbations, emergencies, and spirometry. MEASUREMENTS AND MAIN RESULTS Patients across asthma severity levels were well represented. Anxiety and depression were associated with more frequent nonallergic, in particular psychological, triggers. Controlling for demographics, asthma severity, anxiety, and depression, nonallergic asthma triggers (including psychological triggers) explained substantial portions of variance in asthma control (total of 19.5%, odds ratios [ORs] = 2.07-1.37 for individual triggers), asthma-related quality of life (total of 27.5%, ORs = 3.21-1.49), and general quality of life (total of 11.3%, ORs = 1.93-1.55). Psychological triggers were consistently associated with exacerbations and emergency treatments (ORs = 1.96-2.04) over and above other triggers and affective disorders. Spirometric lung function was largely unrelated to perceived asthma triggers. CONCLUSIONS Patients' perceptions of asthma triggers are important determinants of asthma outcomes, which can help identify individuals at risk for suboptimal asthma management.
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Joobeur S, Mhamed SC, Ben Saad A, Mribah H, Dekhil A, Rouatbi N, El Kamel A. [Allergic asthma in central Tunisia]. Pan Afr Med J 2015; 20:133. [PMID: 26097637 PMCID: PMC4462549 DOI: 10.11604/pamj.2015.20.133.5642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/15/2015] [Indexed: 11/29/2022] Open
Abstract
L'asthme allergique pose un réel problème de santé publique vu sa prévalence et son coût de prise en charge élevés. Etudier le profil clinique, fonctionnel respiratoire, allergologique, thérapeutique et évolutif de l'asthme allergique dans une région du centre tunisien. Etude rétrospective portant sur 1132 dossiers de patients porteurs d'asthme allergique suivis dans le service de pneumologie et d'allergologie à l'hôpital de Monastir (Tunisie). L’âge moyen est de 27 ± 12,5 ans. 61,1% des patients sont âgés entre 16 et 39 ans. Une prédominance féminine est notée (56,7%). L'identification de l'allergène en cause s'est basée essentiellement sur les tests cutanés allergologiques (99,4%). Les principaux pneumallergènes identifiés sont les acariens (91,2%), suivis par les pollens (22,8%) et les phanères des animaux (12%). La classification selon la sévérité a conclu à un asthme intermittent à persistant léger chez 87.1% de nos patients. Le traitement s'est basé essentiellement sur la corticothérapie inhalée (67,6%). L'asthme dans notre étude a été jugé contrôlé dans 68,3% des cas, partiellement contrôlé dans 24,8% et non contrôlé dans 6,9% des cas. L'asthme allergique est une affection répandue qui touche essentiellement le sujet jeune en pleine activité. Une prise en charge adéquate permet de contrôler la maladie et de réduire ses répercussions sur le patient et la collectivité.
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Affiliation(s)
- Samah Joobeur
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Monastir, Tunisie
| | - Saousen Cheikh Mhamed
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Monastir, Tunisie
| | - Ahmed Ben Saad
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Monastir, Tunisie
| | - Hathami Mribah
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Monastir, Tunisie
| | - Asma Dekhil
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Monastir, Tunisie
| | - Naceur Rouatbi
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Monastir, Tunisie
| | - Ali El Kamel
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Monastir, Tunisie
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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: 120] [Impact Index Per Article: 12.0] [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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Goodwin RD, Robinson M, Sly PD, McKeague IW, Susser ES, Zubrick SR, Stanley FJ, Mattes E. Severity and persistence of asthma and mental health: a birth cohort study. Psychol Med 2013; 43:1313-22. [PMID: 23171853 PMCID: PMC3857579 DOI: 10.1017/s0033291712001754] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The goal of the current study was to investigate asthma and mental health among youth in the community, and to consider the role of asthma severity and persistence in this link. Method Data were drawn from the Raine Study, a population-based birth cohort study in Western Australia. Logistic regression models and generalized estimating equations were used to examine the relationship between asthma at age 5 years and the range of internalizing and externalizing mental health problems at ages 5-17 years. Analyses were stratified by asthma severity and persistence, and adjusted for a range of potential confounders. RESULTS More severe and persistent asthma at age 5 was associated with significantly increased odds of affective, anxiety, somatic, oppositional defiant and conduct problems at ages 5-17. Mild asthma and remitted asthma were not associated with heightened vulnerability to mental disorders. CONCLUSIONS Our results suggest that youth with symptomatic asthma are more likely to suffer from a wide range of mental health problems, and that the likelihood of mental health problems appears to increase as a function of asthma severity. Youth with poorly controlled and/or more severe and persistent asthma may be considered a vulnerable group who might benefit from mental health screening in clinical, school and community settings.
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Affiliation(s)
- R D Goodwin
- Department of Psychology, Queens College, City University of New York, Flushing, NY 10032, USA.
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Wittchen HU, Mühlig S, Klotsche J, Buhl R, Kardos P, Ritz T, Riedel O. Omalizumab versus 'usual care': results from a naturalistic longitudinal study in routine care. Int Arch Allergy Immunol 2012; 159:83-93. [PMID: 22573022 DOI: 10.1159/000335382] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 11/23/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is unclear how far the superior efficacy of omalizumab, established in randomized controlled clinical trials of patients with severe allergic asthma (SAA), translates into routine practice and when compared to matched controls. METHODS New-onset omalizumab-treated (OT) patients with SAA (n = 53) were compared to a matched control group of usual-care (UC) patients (n = 53). Treatment and procedures were naturalistic. Subsequent to a baseline assessment, patients were followed up over at least 6 months with at least two follow-up assessments. Primary clinical outcomes were the number of asthma attacks, persistence of asthma symptoms and degree of control [asthma control test (ACT), Global Initiative for Asthma]. Secondary outcome criteria were quality of life (Euro-Qol 5D) and number of medications. For each outcome we compared within-group effects from baseline to 6-month follow-up as well as between-group effects. RESULTS OT patients showed significant improvements in number [effect size (ES) = 0.03] and frequency (ES = 0.04) of asthma attacks as well as asthma control (ES = 0.09), whereas controls revealed no significant improvements in these measures. Further improvements in the OT group were found for 'perceived control always' (ACT, p = 0.006), no impairment (ACT, p = 0.02), reduction of sickness days (p = 0.002) and number of medications needed (p = 0.001). CONCLUSIONS Substantial beneficial effects of omalizumab, similar to those observed in controlled trials and after marketing studies, were confirmed, particularly with regard to the reduction of asthma attacks, persistence of symptoms, asthma control and reduction of concomitant asthma medications. This study provides a tougher test and generalizable evidence for the effectiveness of omalizumab in routine care.
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Affiliation(s)
- H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
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Rottem M. Omalizumab reduces corticosteroid use in patients with severe allergic asthma: real-life experience in Israel. J Asthma 2011; 49:78-82. [PMID: 22149205 DOI: 10.3109/02770903.2011.637598] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Approved by the FDA in 2003, omalizumab is the first recombinant humanized monoclonal anti-immunoglobulin E antibody developed for the treatment of allergic asthma. Due to the heterogeneity of asthma symptoms, investigation of the efficacy of omalizumab in patients outside controlled trials is particularly important. The purpose of the current study was to evaluate the efficacy of omalizumab as an add-on treatment for allergic asthma in a real-life setting in Israel. METHODS This was a retrospective study based on patient records and computerized database for drug dispensing, emergency room visits, and hospital admissions. RESULTS The sample comprised 33 individuals (18 men, 15 women; mean age 50.0 ± 12.2, range 25-79) who were treated with omalizumab for severe allergic asthma for a duration of at least 16 weeks. After the initiation of omalizumab therapy, the number of patients who used oral or injected corticosteroids decreased (p < .003, .03, respectively), as did the median dosage of oral corticosteroids (p < .02). Visits to the emergency room decreased from an incidence of 0.526 visits per person-year to an incidence of 0.246 per person-year (p < .05). No adverse reactions to omalizumab were observed. CONCLUSION Omalizumab as an add-on therapy reduced the use of corticosteroids and improved the control of asthma, as evidenced by reduced asthma-related emergency room visits. This study supports both controlled and uncontrolled studies that have demonstrated the efficacy and safety of omalizumab, and particularly those that demonstrated effectiveness among severe asthma patients. "Real-life" studies are important to identify patients who will most benefit from omalizumab therapy.
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Affiliation(s)
- Menachem Rottem
- Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel.
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