Guidelines for the management of asthma in adults: Evidence and recommendations

The multidisciplinary experts in Thailand developed an asthma management recommendation that was relevant to low-middle income countries (LMICS). Populations level consideration about asthma management is emphasized. The healthcare systems, access to and availability of treatments as well as the asthma populations vary from country to country in LMICS. The feasibility in clinical practice for implementation is also a major issue. For these reasons, the practice guidelines that are relevant to local contexts are essential to improve better asthma control. Furthermore, integrative and collaboration between asthma experts and the public health sector to implement and discriminate such guidelines will help to achieve these challenging goals. The topics covered include the current asthma situation in Thailand and the Asia-Pacific region, the definition of asthma, asthma diagnosis, assessment of asthma patients, asthma treatment - both pharmacological and non-pharmacological, management of asthma exacerbation, management of asthma comorbidities, treatment of asthma in special conditions, severe and uncontrolled asthma, Thai alternative medicine and asthma, and asthma and coronavirus disease-19 (COVID-19).

The Cost of Asthma Treatment in Phramongkutlao Hospital: Population-Based Study in Adults

BACKGROUND

Asthma is a chronic respiratory disease that affects patients' quality of life and work performance. The cost of asthma treatment is a global economic burden. The costs include the direct medical costs and the indirect costs, such as the loss of productivity, which is difficult to quantify.

OBJECTIVE

Analyze the cost of asthma treatment in Thailand.

MATERIAL AND METHOD

Seventy-four asthmatic patients who had exacerbation were enrolled in the present study. Self-answer questionnaires were completed by the subjects including characteristics, socioeconomic factors, and level of asthma control by asthma control test (ACT) score. We evaluated the cost of asthma treatment calculated from direct medical, direct non-medical, and indirect medical costs.

RESULTS

The average total cost per month was 2,752 Thai baht (US$ 86). The direct medical, direct non-medical, and indirect medical costs were 52.39%, 20.73%, and 26.88%, respectively. The direct medical costs accounted for quick-relief medications 11.91% and control medications 36.85% of the total medical cost. Loss of productivity, loss of work caused by asthma exacerbation, was the majority cost of non-medical costs. The average cost of treatment in uncontrolled was higher than partly controlled asthmatic patients but without significant difference. Healthcare payment system and age range affected the total costs of asthma treatment.

CONCLUSION

The direct non-medical costs and indirect medical costs tend to play an important role of asthma treatment. The data suggested that cost savings could be achieved by improving asthma control.

Vitamin D supplements improve urticaria symptoms and quality of life in chronic spontaneous urticaria patients: A prospective case-control study

Vitamin D plays an important role in the immune system; decreased serum vitamin D concentrations have been linked to dysregulated immune function. Low vitamin D status is probably associated with chronic spontaneous urticaria (CSU). We evaluated the prevalence of low vitamin D status, and the clinical response and quality of life following vitamin D supplementation, in a prospective case-control study with 60 CSU patients and 40 healthy individuals. Serum 25-hydroxy vitamin D (25(OH)D) concentrations were measured at baseline and after 6 weeks. For patients with 25(OH)D concentrations < 30 ng/ml, treatment included 20,000 IU/day of ergocalciferol (vitamin D2) and non-sedative antihistamine drugs for 6 weeks. Urticaria symptom severity and quality of life were assessed based on the Urticaria Activity Score over 7 days (UAS7) and the Dermatology Life Quality Index (DLQI). Of the 100 participants, 73% were female; the mean age was 39 ± 16 years. Vitamin D deficiency (measured as 25(OH)D < 20 ng/ml) was significantly higher in the CSU group than the control group. The median 25(OH)D concentration for the CSU group, 15 (7 - 52) ng/ml was significantly lower than for control group, 30 (25 - 46) ng/ml. Overall, 83% (50/60) of CSU patients (25(OH)D < 30 ng/ml) were treated with ergocalciferol (vitamin D2) supplementation; after 6 weeks, these patients showed significant improvements in UAS7 and DLQI scores compared with the non-vitamin D supplement group. This study revealed a significant association of lower serum 25(OH)D concentrations with CSU. Vitamin D supplements might improve symptoms and quality of life in CSU patients.