Asthma control and its predictors in Ethiopia: Systematic review and meta-analysis

Background Determining the status of asthma control and identifying risk factors for poor asthma control is a key strategy for curbing the negative health impacts and the financial burden of the disease. Therefore, this review was aimed to determine the rate of asthma control and assess the predictors of uncontrolled asthma in Ethiopia. Methods PubMed, Web of Science, and Google Scholar searches were performed using key terms; “asthma, bronchial asthma, control, controlled, uncontrolled and Ethiopia” up to October 16, 2020. University repositories were also searched to retrieve gray literature. The results were presented as a prevalence rate with a 95% confidence interval (CI). Subgroup analysis and meta-regression were performed to identify the sources of heterogeneity in the outcomes. Results From 1,388 patients, based on the Global Initiative for Asthma (GINA) symptom control, the rate of the uncontrolled asthma was 45.0% (95% CI 34.0% - 56.0%) with a considerable heterogeneity between the studies; (I2: 94.55, p< 0.001). About 19.0% (95% CI 10.0% - 29.0%); (I2: 96.04, p< 0.001) of the asthma patients had a well-controlled asthma. Moreover, 36.0% (95% CI 22.0% - 50.0%), (I2: 97.11, p< 0.001) of patients had a partly controlled asthma. Similarly, based on the asthma control test (ACT), the rate of well-controlled asthma was 22.0% (95% CI 3% - 42.0%), with considerable heterogeneity between the studies; (I2: 97.75, p< 0.001). The most frequent predictors of uncontrolled asthma were incorrect inhalation techniques, frequent SABA use, moderate/severe persistent asthma, history of exacerbations, presence of comorbidities, use of oral corticosteroids, and irregular follow-up. Conclusion The rate of uncontrolled asthma in Ethiopia was high. Several factors are associated with uncontrolled asthma. Comprehensive asthma educations at each follow-up visit should be strengthened to minimize the morbidity and the cost of uncontrolled asthma.

Evaluating the Impact of Pharmacist Counselling for Asthmatic Children at Karbala Teaching Hospital for Children: An Interventional Prospective Study (Conference Paper )#

Asthma is one of the most common chronic, non-communicable diseases affecting children worldwide. The estimated prevalence of pediatric asthma in Iraq is 15.8%. Physiologic, inflammatory and structural factors contribute to the development of asthma. Assessment and monitoring of asthma control can be done by a validated children asthma control test (CACT). Management of asthma must address three components which are an appropriate management plan, the most appropriate medication if necessary, and the use of safe and effective medication. The management plan should consider patient counseling and education about the definition of asthma, signs, and symptoms, the pathophysiology of asthma, common triggers for asthma and how can avoid them, what are the rescue medication and the controller one, proper inhaler techniques, and how to monitor asthma control. Patient education accounts for 90% of success and this can be achieved by an active collaboration among health care providers. This is a prospective interventional study that aims at evaluating pharmacist counseling for asthmatic children. The study involved 105 participants whose consent was taken and underwent a face-to-face interview about asthma counseling and inhaler technique for those who use it. Ninety-two eligible participants remained. Their CACT was recorded at the first visit and then followed up weekly for one month either by phone or physical to assess asthma control. In the fourth week, a CACT was recorded and compared to the first one before intervention. There was a significant improvement in CACT after providing the counselling and weekly follow up.

Heterogeneous Response of Airway Eosinophilia to Anti-IL-5 Biologics in Severe Asthma Patients

Many questions concerning responders (R) and nonresponders (NR) in severe eosinophilic asthma (SEA) after blocking the IL-5 (interleukin 5) pathway are still not clear, especially regarding the early parameters of response to biologics in personalized treatment strategies. We evaluated 17 SEA patients treated with anti-IL-5 biologics (16 patients mepolizumab, one patient benralizumab) before the introduction of biologics, and at a week 16 follow-up. Clinical, cellular and immunological parameters in peripheral blood were measured in R and NR. Sputum induction with the measurement of cellular and immunological parameters was performed at 16 weeks only. There were 12 R and 5 NR to biologics. After 16 weeks, there was a significant improvement in percentages of FEV1 (p = 0.001), and asthma control test (ACT) (p = 0.001) in the R group, but not in NR. After 16 weeks, the eosinophils in induced sputum were 27.0% in NR and 4.5% in R (p = 0.05), with no difference in IL-5 concentrations (p = 0.743). Peripheral eosinophilia decreased significantly in NR (p = 0.032) and R (p = 0.002). In patients with SEA on anti-IL-5 therapy, there was a marked difference in airway eosinophilic inflammation between R and NR already at 16 weeks, after anti-IL-5 introduction.

Predictors of a Minimal Clinically Important Difference Following Omalizumab Treatment in Adult Patients With Severe Allergic Asthma

Several factors have been found to be predictors of a good response following omalizumab treatment in patients with severe allergic asthma (SAA). However, it remains unclear whether clinical characteristics can predict a minimal clinically important difference (MCID) following omalizumab treatment in this population. Therefore, the aim of this study was to investigate the features associated with an MCID following omalizumab treatment in adult patients with SAA. Of the 124 participants enrolled in this retrospective, cross-sectional study, 94, 103, 20 and 53 achieved the MCID following treatment with omalizumab and were considered to be responders of exacerbation reduction (no exacerbation during the 1-year follow-up period or ≧50% reduction in exacerbations from baseline), oral corticosteroid (OCS) sparing (no use of OCS to control asthma during the study period or a reduction of the monthly OCS maintenance dose to &lt;50% of baseline), lung function (an increase of ≧230 ml in the forced expiratory volume in 1 s from baseline) and asthma control (an increase of ≧3 points in the asthma control test score from baseline), respectively. Normal weight [&lt;25 vs. ≧30 kg/m2, odds ratio (OR) = 3.86, p = 0.024] was predictive of a responder of reduction in exacerbations following omalizumab treatment while subjects with a blood eosinophil level of &lt;300 cells/μL (&lt;300 vs. ≧300 cells/μL, OR = 5.81, p = 0.001) were more likely to exhibit an MCID in OCS sparing. No factor was found to be a predictor of lung function or asthma control. When choosing treatment for adult patients with SAA, our findings may help to select those who may benefit the most from omalizumab treatment.

The effect of the socioeconomic status on the measurement of asthma control

Background: The Asthma Control Test (ACT) is a commonly used scoring system for evaluation of asthma control in the pediatric and adult populations. Asthma control has been deemed poor in those economically disadvantaged. Objective: To study whether the ACT is affected by socioeconomic status (SES) as evaluated by the percentage of the federal poverty level and the education level. Methods: This was a cross-sectional study (N = 307), in which the patients were surveyed for demographics data and underwent ACT scoring, spirometry (forced expiratory volume in the first second of expiration) and fractional concentration of exhaled nitric oxide testing. Results: There was a positive correlation of improved mean score on the ACT (p < 0.001) with higher education status and higher federal poverty level status. Conclusion: SES plays a factor in the way patients perceived their asthma control, and therefore affected how they scored on the ACT.

Neuropeptide Y and Asthma Clinical Course

Background: The spectrum of clinical manifestations and pathogenetic mechanisms of bronchial asthma (BA) is very wide. Given the complex pathogenesis and syndromic nature of BA, it is not surprising that there is no single universal biomarker. The objective of this study was to evaluate levels of neuropeptide Y (NPY) and its association with levels of leptin, adiponectin, oxidative damage, antioxidant status, spirometry parameters, and asthma control in BA patients. Methods and Results: Overall, 140 patients [35(25%) men and 105(75%) women; mean age of 57.0±9.34 years] with moderate asthma participated in the study. According to body mass index, all patients were divided into three groups. The asthma diagnosis was based on the integral assessment of symptoms, medical history, health status, and spirometry values according to the Global Strategy for Asthma Management and Prevention. (GINA, 2017 REPORT). The Asthma Control Test (АСТ) was used to assess asthma control. NPY was measured in blood serum in EIA. The NPY level was significantly higher in overweight patients and patients with obesity than in patients with normal body weight. The NPY level significantly correlated with leptin (r=0.44; P<0.05), adiponectin (r=-0.24; P<0.05), ImanOx (r=-0.40; P<0.05), PerOx (r=0.58; P<0.05), ACT (r=-0.41; P<0.05), VC (r=-0.31; P<0.05), FEV1 (r=-0.41; P<0.05), FEF25% (r=-0.26; P<0.05), FVC (r=-0.23; P<0.05), Tiffno index (r=-0.36; P<0.05), FEF50% (r=-0.22; P<0.05), and PEF (r=-0.23; P<0.05) Conclusion: The severity of the asthma clinical course is associated with different factors, including oxidative stress, levels of leptin, adiponectin and NPY. NPY seems to be associated with worse asthma control and higher levels of leptin and oxidative damage.

Gambaran Tingkat Kontrol Asma Pada Pasien Asma: Literature Review

Asthma is an inflammation of the respiratory tract characterized by shortness of breath, coughing, and wheezing. A person with asthma will experience a descreace in physical condition, emotional changes, and changes inactivity. Based on previous research, the number of uncontrolled asthma patients in Persahabatan Hospital is still large. Asthma cannot be cured, but it can be observed using the asthma control test (ACT) to keep asthma under control in the long term. The purpose of this literature review was to describe the level of asthma control in asthmatic patients. The data collection technique used a literature review method of six articels sourced from online databeses with electronic searches on Garuda and Pubmed. The searching process used key words : “ tingkatkontrol” and “ pasienasma”. The English articles that were searched used key word : “ level of control” AND “asthma patients”. The research instrument used was the JBI critical appraisal checklist for cross-sectional.The results of a literature review of six articels showed that the describption of the level of asthma control was mostly uncontrolled. From this literature review, the results obtained were 71 (9,8%) controlled, 234 (32,19%) partially controlled, and 422 (58%) uncontrolled.The results of this literature review show that the level of asthma control in asthmatic patients is not controlled.Keywords : level of control, asthma patients AbstrakAsma merupakan gangguan pada saluran pernafasan yang mengalami inflamasi ditandai dengan sesak nafas, batuk dan mengi. Seseorang dengan asma akan mengalami penurunan kondi sifisik, perubahan emosional, dan perubahan aktivitas. Berdasarkan penelitian sebelumnya jumlah pasienasma yang tidak terkontrol di rumah sakit persahabatan masih banyak. Asma tidak dapat disembuhkan, tetapi dapat di observasi menggunakan Asthma Control Test (ACT) untuk mempertahankan asma dalam keadaan terkontrol dalam jangka panjang. Tujuan dari literature review ini adalah untuk mengetahui gambaran tingkat control asma pada pasienasma.Teknik pengumpulan data menggunakan metode literature reviewe nama artikel yang bersumber dari data base online dengan penelusuran elektronik pada Garuda dan Pubmed. Pencarian artikel dengan menggunakan kata kunci : “tingkat kontrol” dan “pasien asma”, sedangkan artikel berbahasa inggris menggunakan kata kunci : “level of control” AND “patients asthma”. Instrumen telaah yang digunakan yaitu dengan menggunakan JBI critical appraisal checklist for cross-sectional. Hasil literature review dari enam artikel didapatkan bahwa gambaran tingkat control asma Sebagian besar tidak terkontrol. Dari literatuyre review ini diperoleh hasil sebanyak 71(9,8%) terkontrol, 234 (32,19%) terkontrol sebagian dan 422 (58%) tidak terkontrol. Hasil penelitian literature review ini menunjukkan bahwa tingkat control asma pada pasien asma adalah tidak terkontrol. Kata kunci: tingkat kontrol, pasien asma

Correlation of Metered Dose Inhaler Use Technique and Asthma Control Level in Asthma Patients at a Hospital in Bandung, West Java, Indonesia.

Background: Asthma is still a major health problem in global population, including Indonesia. Antiasthma drugs available in various dosage forms, including inhaler. However, several problems related to inhalation route were found due to its unique device form and spesific use technique. One of the major problems related to inhalation route is inappropriate use technique of inhaler device, which could lead to treatment failure. Therapy outcome can be measured through Asthma Control Test (ACT). Objectives: This study was aimed to evaluate correlation between metered dose inhaler (MDI) use technique and asthma control level in patients. Material and Methods: A cross-sectional analytic study was conducted in May - June 2021. Thirty patients who met inclusion criteria were enrolled in this study. Patients’ MDI use technique and asthma control level were evaluated using a valid and standardized questionnaire. Statistics analysis was performed to determine the correlation between MDI use technique and asthma control level. Results: This study showed that most of asthmatic patients were women in older age, with mild asthma severity for more than 10 years. The most prevalent medication used was Fenoterol HBr, followed by salbutamol, and salmeterol/fluticasone combination. Inappropriate MDI use was found in 70,0% patients, with major problem found in patients’ breathing technique before and during MDI use. Asthma control test was performed and showed that 90,0% of asthmatic patients involved in this study have an uncontrolled asthma. Statistical analysis using Pearson product-moment correlation test showed a positive correlation between proper use of MDI and asthma control level (r=0.425, p<0.05). Conclusions: Patient who properly use MDI may have a higher score in asthma control test, thus have a better control of asthma. This study emphasized pharmacist role as patient educator in ensuring appropriate inhaler use in order to achieve therapeutic goals.

Switch from Omalizumab to Benralizumab in Allergic Patients with Severe Eosinophilic Asthma: A Real-Life Experience from Southern Italy

Background. The wide availability of monoclonal antibodies for the add-on therapy of severe asthma currently allows for the personalization of biologic treatment by selecting the most appropriate drug for each patient. However, subjects with overlapping allergic and eosinophilic phenotypes can be often eligible to more than one biologic, so that the first pharmacologic choice can be quite challenging for clinicians. Within such a context, the aim of our real-life investigation was to verify whether allergic patients with severe eosinophilic asthma, not adequately controlled by an initial biologic treatment with omalizumab, could experience better therapeutic results from a pharmacologic shift to benralizumab. Patients and methods. Twenty allergic patients with severe eosinophilic asthma, unsuccessfully treated with omalizumab and then switched to benralizumab, were assessed for at least 1 year in order to detect eventual changes in disease exacerbations, symptom control, oral corticosteroid intake, lung function, and blood eosinophils. Results. In comparison to the previous omalizumab therapy, after 1 year of treatment with benralizumab our patients experienced significant improvements in asthma exacerbation rate (p < 0.01), rescue medication need (p < 0.001), asthma control test (ACT) score (p < 0.05), forced expiratory volume in the first second (FEV1) (p < 0.05), and blood eosinophil count (p < 0.0001). Furthermore, with respect to the end of omalizumab treatment, the score of sino-nasal outcome test-22 (SNOT-22) significantly decreased after therapy with benralizumab (p < 0.05). Conclusion. The results of this real-life study suggest that the pharmacologic shift from omalizumab to benralizumab can be a valuable therapeutic approach for allergic patients with severe eosinophilic asthma, not adequately controlled by anti-IgE treatment.