Course of respiratory allergy by treatment strategy based on German routine data

Patient characteristics associated with allergen immunotherapy initiation and adherence

Background and AimPreterm birth is associated with increased risk of asthmatic symptoms in childhood, but it seems uncertain whether this association persists into adulthood. We have investigated the association between...

To determine whether diagnosis and treatment of paradoxical vocal fold movement disorder (PVFMD) leads to decreased asthma medication use. Secondary objectives include determining initial rate of asthma medication use, characterizing symptom improvement, and correlating with pulmonary function testing (PFT). Prospective observational study. Patients newly diagnosed with PVFMD at a single institution were recruited to participate. Medication questionnaires were completed at the initial visit, at the first return visit for therapy, and at 6 months. PFTs were reviewed when available. Sixty-six patients were recruited; the study was closed early because findings reached significance. Fifty-six patients (85%) were taking asthma medication at presentation. Forty-four patients presented with PFTs, and two-thirds were normal. Forty-two patients completed follow-up questionnaires; 79% decreased asthma medication use (P < .001), and 82% reported symptom improvement. Seventy-seven percent of patients participated in therapy and 23% did not, with equal rates of decrease in asthma medication use between these groups. Outcomes did not vary based on PFT pattern (i.e., obstructive vs. nonobstructive, P = .75). Diagnosis and treatment of PVFMD lead to a decline in asthma medication use. This decrease occurred alongside symptom improvement and irrespective of PFT findings. Use of asthma medication in this patient population is high, at 85%. 4. Laryngoscope, 127:1531-1537, 2017.

Objective. The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma—in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children. Methods. A literature search using electronic search engines (i.e., Medline, International Pharmaceutical s (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms “asthma,” “children,” and “medicines” (and derivatives of these keywords) was conducted. Results. The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child’s self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, “off-label” prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications. Conclusion. These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.

Five-fold increase in use of inhaled corticosteroids over 18 years in the general adult population in West Sweden

To investigate the impact of adenotonsillectomy on asthma in the pediatric population. Retrospective chart review. All children who underwent adenotonsillectomy at our institution from 2002-2007 were identified from a medical records database. Of the 560 charts reviewed, 93 of the patients had the diagnosis of asthma from a pediatric pulmonologist. Outcome measures of asthma control were analyzed one year preoperatively and one year postoperatively and included: hospital visits, systemic steroid use, asthma medication use, and asthma control test scores. There was a statistically significant improvement in postoperative asthma severity in all measures including mean hospital visits, systemic steroid administration, asthma medication use, and childhood asthma control test scores (p<0.01). This study suggests that adenotonsillectomy, which provides improvement in the upper airway of children, may in turn lead to improvement of the lower airways of children, especially those with bronchial asthma.

Towards prevention

Lipoprotein levels in elderly patients with asthma

Introductionasthma tends to be more severe with worse symptoms in Africa due to late diagnosis and delayed initiation of treatment. To identify patient and treatment-related factors which influence the appropriate use of asthma medications.Methodsthe study was institution based cross-sectional design. Patients were invited to provide information regarding the use of their asthma medications and factors potentially associated with appropriate use of these medications. A stepwise multivariate logistic regression analysis was used to evaluate the most important factor at a 0.05 level of significance.Resultsrespondents with better knowledge of their asthma medications were more likely to use them appropriately (OR 5.82 [CI 95% 2.25-15.04]) as were those with positive attitudes and beliefs towards asthma and asthma medications (OR 3.88 [CI 95% 1.44-10.44]).Conclusionpatients need to understand the importance of adhering to the prescribed regimen for their asthma medications even in the absence of overt symptoms in order to optimize clinical outcome.

Asthma is a chronic respiratory condition exacerbated by exposure to particulate air pollution. Smoke from landscape fires has been associated with increased mortality, asthma-related admissions to emergency and other hospital departments, and uptake in primary care services. With climate change and more frequent landscape fires, healthcare systems must prepare for disaster, including surges in asthma medication demand. Past reviews have not resolved the direction and magnitude of the association between PM2.5 exposure during landscape fires and asthma medication use. The aim of this review was to investigate the relationship between exposure to landscape fire smoke and the use of asthma medications. We conducted a systematic review of PubMed, Scopus, and Web of Science, identifying peer-reviewed articles that examined asthma medication usage following environmental exposure to landscape fire smoke. After a full-text review, we identified twelve articles, three from Canada, three from the USA and six from Australia, with five being retrospective cohort studies. Despite differences in study design, outcome and exposure assessment, the included studies reported a consistent increase in asthma medication use after exposure to wildfires. There is consistent evidence that exposure to wildfire smoke is associated with an increase in the use of reliever medications, particularly salbutamol. Increases in other asthma management medications were also consistently identified. Increases in demand for asthma medications after exposure to wildfire smoke highlight the urgent need to address the growing frequency and intensity of wildfires driven by climate change.

For more than 70 years, the coexistence of asthma and paranasal rhinosinusitis has been noted in the medical literature. Causal relationships have been proposed but not proved. To date, limited evidence exists suggesting that asthma improves after surgical correction of rhinosinusitis. To determine whether asthma control improved after first-time functional endoscopic sinus surgery (FESS). A retrospective medical record analysis was performed on 13 patients with chronic bronchial asthma who underwent FESS for medically refractory chronic rhinosinusitis. Patients received comprehensive asthma care before and after FESS (mean, 19.3 and 33.1 months, respectively). Outcomes analyzed included pre- and post-FESS individual and group mean asthma symptom scores, medication use scores, pulmonary function test results, and emergency department visits or hospital admissions for asthma. Patient medical records were obtained from a private allergy-immunology practice affiliated with a medical school. The surgical procedure was performed at a tertiary care teaching hospital by a single ear, nose, and throat surgeon (R.L.). Following FESS, there was no statistically significant change in group mean asthma symptom scores, asthma medication use scores, pulmonary function test results, and the number of emergency department visits or hospital admissions. Only a few patients demonstrated statistically significant improvement after FESS in asthma symptom scores (1 patient), medication use scores (1 patient), or pulmonary function test results (2 patients). The data do not support the hypothesis that first-time FESS for medically refractory chronic rhinosinusitis in adult patients with chronic asthma leads to reduced postoperative asthma symptoms or asthma medication use or improved pulmonary function. Based on this limited study, a reexamination of the benefits of sinus surgery to coexisting asthma is in order.

Asthma related medication use and exacerbations in children and adolescents with type 1 diabetes.

ObjectivesParadoxical vocal fold motion (PVFM) is a common condition where the vocal folds inappropriately adduct during inspiration. This results in dyspnea and occasionally significant distress. The condition is thought to be primarily functional, with behavioural therapy considered mainstay in the non-acute setting. However, practice variations and limited access to speech language pathology (SLP) services can pose management challenges. We aimed to examine the efficacy of surgeon performed visual biofeedback as first-line treatment for PVFM.Study designProspective, non-randomized, non-comparative clinical study.MethodsAdult patients referred for possible PVFM and congruent laryngoscopy findings over a two-year period were included. Patients were excluded if they presented in acute distress, had alternate diagnosis to explain symptomology and/or coexisting untreated lower respiratory pathology. Patients underwent immediate surgeon-performed visual biofeedback on the same visit day. The primary outcome of interest was change in Dyspnea Index (DI) scores pre- and post-intervention 3 months follow-up. The secondary outcome measured was change in asthma medication use from baseline to follow-up.ResultsOf 34 patients presenting, 25 met inclusion criteria. Of these, 72% were female with an average age of 36.9 ± 14.1. Approximately 48% of patients had a diagnosis of well-controlled asthma at presentation and co-morbid psychiatric diagnoses were common (52%). Pre- and post-intervention analysis showed significant improvement in DI scores (p < 0.001) and reduction in bronchodilator use (p = 0.003).ConclusionThis is a prospective study that evaluates the role of visual biofeedback in PVFM patients. Our data suggests that visual biofeedback effectively reduces short-term subjective symptoms and asthma medication use.Level of evidence3Graphical abstract

BackgroundAsthma is the most common chronic disease during pregnancy and it may have influence on pregnancy outcome.ObjectivesOur goal was to assess the association between maternal asthma and the perinatal risks as well as possible effects of asthma medication.MethodsThe study was based on a nationwide Finnish register-based cohort between the years 1996 and 2012 in the Drug and Pregnancy Database. The register data comprised 962 405 singleton live and stillbirths, 898 333 (93.3%) pregnancies in mothers with neither confirmed asthma nor use of asthma medication (controls), and 26 674 (2.8%) pregnancies with confirmed maternal asthma. 71% of mothers with asthma used asthma medication. The diagnosis of asthma was based on the mothers’ right for subsidised medication which is carefully evaluated by strict criteria including pulmonary function testing. Odds ratio was used in comparison. Premature birth (PB), low birth weight, small for gestational age (SGA), neonatal death were the main outcome measures.ResultsMaternal asthma was associated with adjusted odds ratios (aORs) for perinatal mortality 1.24 (95% CI 1.05 to 1.46), preterm birth 1.18 (1.11 to 1.25), low birth weight 1.29 (1.21 to 1.37), fetal growth restriction (SGA) 1.32, (1.24 to 1.40), and asphyxia 1.09 (1.02 to 1.17). Asthma treatment reduced the increased risk of preterm birth aOR 0.85 (95% CI 0.76 to 0.96) but mothers with treated asthma had higher risks of fetal growth restriction (SGA) aOR 1.26 (1.10 to 1.45), and asphyxia aOR 1.37 (1.17 to 1.61) than mothers with untreated asthma.ConclusionAsthma is associated with increased risks of perinatal mortality, preterm birth, low birth weight, fetal growth restriction (SGA), and asphyxia. Asthma treatment reduces the risk of preterm delivery, but it does not seem to reduce other complications such as perinatal mortality.

IntroductionTaking care of children with asthma, especially those who cannot take their medications according to treatment regimens, can be burdensome for parents and lead to additional parenting stress. Understanding the care process of parents with asthmatic children and helping parents better manage their children's asthma medication use is critical to health care providers. This study aimed to explore how parental factors, namely parental expectation, parental perceived performance, parental confirmation, parental satisfaction, and parenting stress impact parents' intention to adhere to asthma medications (PIAAM) for their children.MethodsA cross‐sectional online Qualtrics survey was administered to parents of children aged between 2 and 12 who were visiting participating asthma/pediatric clinics. The survey assessed the above‐mentioned factors adapted from the expectation confirmation theory (ECT), along with parents' health literacy, number of asthma medications used by the children, and socio‐demographic characteristics of both parents and children. Spearman's correlation, multiple regression, and path analyses were conducted to determine the relationship between model variables with parents' and children's characteristics.ResultsThe findings from a total of 261 surveys indicated that PIAAM was significantly correlated with all parental factors (P &lt; 0.05). Path analyses indicated an indirect effect of parenting stress on PIAAM. Multiple regression and path analyses both suggested that parental expectation (β = 0.369, P &lt; 0.05) and number of asthma medications (β = 0.659, P &lt; 0.05) were significant predictors for PIAAM after controlling for other covariates.ConclusionsReducing parenting stress can enhance parental expectation of asthma medications, and hence improve PIAAM. Understanding parents' perspectives may enable health care providers to provide better care for children with asthma.