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Objective: To identify challenges that disadvantaged adults with asthma face in mitigating social and environmental factors associated with poor symptom control. Methods: Using a community-engaged approach, we partnered with a community health center in New Haven, CT to conduct in-person interviews and a written survey of asthmatic adults with poor symptom control. Using the constant comparative method, we analyzed participant interviews to establish emerging themes and identify common barriers to improved outcomes. Through a written survey utilizing clinically validated questions, we assessed information on access to medical care, asthma control, and selected social and environmental risk factors. Results: Twenty-one patients (mean age 47, 62% female, 71% Black, 95% insured by Medicaid) participated. The average Asthma Control Test (ACT) score was 11.6. Seventy-six percent of participants were currently employed and of those, 75% reported work-related symptoms. Among participants currently in housing, 59% reported exposure to domiciliary mice and 47% to mold. We identified three themes that summarize the challenges the study participants face: 1) Lack of knowledge about home and workplace asthma triggers; 2) Lack of awareness of legal rights or resources available to mitigate adverse conditions in the home or work environment; and 3) Fear of retaliation from landlords or employers, including threats of eviction, sexual assault, and job loss. Conclusion: Patients with poorly controlled asthma in a disadvantaged urban northeast community identified common barriers in both the domestic and work environments that impeded attainment of symptom control. These challenges may be best addressed through legal advocacy for those most at risk. [ABSTRACT FROM AUTHOR]

The article discusses the essential factors to be considered before the development of asthma treatment plan which include ensuring proper diagnosis of severe asthma, considering phenotypes and endotypes, and understanding advantages and disadvantages of available therapies. The clinical trial evidence for add-on asthma treatment options including pharmacologic therapies, omalizumab and reslizumab is explored. The associated biomarkers of asthma are also tackled.

The article discusses the need to consider age-related factors in the diagnosis and management of asthma as etiology, presentation, and progression of the disease may vary across age groups. It notes a presumptive diagnosis of asthma that can be made based on patient history, risk factors, and clinical examination. The development of nonpharmacologic and pharmacologic treatments as the cornerstones of long-term treatment that should be a part of each patient's action plan is tackled.

The article discusses the evolution of concepts in the asthma management landscape in the U.S. being considered as a common condition that imposes substantial patient, health care system, and socioeconomic burdens. Topics include the understanding of asthma etiology, the progress in the diagnosis of asthma, and the management of asthma in primary care. The role of primary care providers (PCPs) in teaching patients for effective self-management is also tackled.

Abstract: Background: Treatment non‐adherence is a challenge to achieve asthma control. However, few prospective studies were done for exploring asthma patient adherence in real world. Objectives: To evaluate treatment adherence and causes of non‐adherence in a large asthma Chinese population. To analyze newly‐diagnosed patients' adherence first time. Methods: About 1582 asthma patients' data were collected from 12 study centers in China from February, 2012 to October, 2012. Disease and treatment information of subjects were collected were at first clinic visit, at 4, 12, and 24 weeks after that, follow‐up phone calls were carried out for recording subjects' treatment adherence based on their self‐reports. Subjects who reported non‐adherence were additionally asked to choose the primary non‐adherence cause from a list of nine potential causes. Results: Treatment adherence rate of all subjects markedly decreased from 83.3% at week 4 to 42.0% at week 24 after the first clinic visit. Significantly, at week 24, good treatment adherence rate in newly‐diagnosed patients was lower than those patients with asthma history (22.9% vs. 63.9%, P < .001). Newly‐diagnosed patients were three times more likely to become non‐adherence than those patients with asthma history. Female patients had lower treatment adherence rate than male patients (38.3% vs. 45.6%, P = .006). Subjects in 30‐39 year age group had the worst treatment adherence (27.3%). The most commonly chosen cause for non‐adherence was “relief of symptoms after short‐term controller medication use” (43.8%). Conclusions: Asthma patients' treatment adherence could be improved by improving patient education, doctor/patient partnership, and level of medical service in Chinese population. [ABSTRACT FROM AUTHOR]

Asthma is a chronic inflammatory disorder of the airway and is characterized by airway remodeling, hyperresponsiveness, and shortness of breath. Modified Kushen Gancao Formula (mKG), derived from traditional Chinese herbal medicines (TCM), has been demonstrated to have good therapeutic effects on experimental allergic asthma. However, its anti-asthma mechanism remains currently unknown. In the present work, metabolomics studies of biochemical changes in the lung tissue and plasma of ovalbumin (OVA)-induced allergic asthma mice with mKG treatment were performed using ultra high-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS). Partial least squares-discriminate analysis (PLS-DA) indicated that the metabolic perturbation induced by OVA was reduced after mKG treatment. A total of twenty-four metabolites involved in seven metabolic pathways were identified as potential biomarkers in the development of allergic asthma. Among them, myristic acid (L3 or P2), sphinganine (L6 or P4), and lysoPC(15:0) (L12 or P16) were detected both in lung tissue and plasma. Additionally, L-acetylcarnitine (L1), thromboxane B2 (L2), 10-HDoHE (L10), and 5-HETE (L11) were first reported to be potential biomarkers associated with allergic asthma. The treatment of mKG mediated all of those potential biomarkers except lysoPC(15:0) (P16). The anti-asthma mechanism of mKG can be achieved through the comprehensive regulation of multiple perturbed biomarkers and metabolic pathways. [ABSTRACT FROM AUTHOR]

Background We assessed whether lung sound analysis (LSA) is a valid measure of airway obstruction and inflammation in patients with bronchial asthma during treatment with inhaled corticosteroids (ICSs). Methods 63 good adherence patients with bronchial asthma and 18 poor adherence patients were examined by LSA, spirometry, fractional exhaled nitric oxide (FeNO), and induced sputum. The expiration-to-inspiration lung sound power ratio at low frequencies between 100 and 200 Hz (E/I LF) obtained by LSA was compared between healthy volunteers and bronchial asthma patients. Next, post-ICS treatment changes were compared in bronchial asthma patients between the good adherence patients and the poor adherence patients. Results E/I LF was significantly higher in bronchial asthma patients (0.62 ± 0.21) than in healthy volunteers (0.44 ± 0.12, p < 0.001). The good adherence patients demonstrated a significant reduction in E/I LF from pre-treatment to post-treatment (0.55 ± 0.21 to 0.46 ± 0.16, p = 0.002), whereas the poor adherence patients did not show a significant change. The decrease of E/I LF correlated with the improvement of FEV 1 /FVC ratio during the ICS treatment ( r = −0.26, p = 0.04). The subjects with higher pre-treatment E/I LF values had significantly lower FEV 1 /FVC and V 50,%pred ( p < 0.001), and significantly higher FeNO and sputum eosinophil percentages ( p = 0.008 and p < 0.001, respectively). Conclusions The E/I LF measurement obtained by LSA is useful as an indicator of changes in airway obstruction and inflammation and can be used for monitoring the therapeutic course of bronchial asthma patients. [ABSTRACT FROM AUTHOR]

The article focuses on the management of acute asthma among children in primary care. Topics discussed include an overview of asthma in children, the diagnosis of the disease, its causes and symptoms, the assessment of the affected children, the consideration of its features, and the approaches for its treatment.

Paediatric asthma hospitalisation trends in Finland and Sweden over the past 10 years are unclear. We investigated the incidence of paediatric asthma hospitalisations in both countries from 2005 to 2014, using Finland's National Hospital Discharge Register and Sweden's National Patient Register which cover all hospitalisations in the respective countries. During the study period, the incidence of paediatric asthma hospitalisations decreased by 51% in Finland, but remained stable in Sweden. In both countries, asthma hospitalisations decreased over time among children aged 0-4 years, with unclear trends for older ages. The reasons for these intercountry differences are unclear, thus warranting future research. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to compare the effects of inhaled beclomethasone with oral montelukast in long term management of moderate persistent asthma in children. Design: Quasi experimental study. Period: 6 months, from July 20,2007 to January 20, 2008. Settings: Out patient paediatric department at Fauji Foundation hospital, Rawalpindi. Material and Methods: 80 children between 5-12yrs of age presenting with moderate persistent asthma, divided in two groups of 40 each. Group A treated with beclomethasone inhaler while Group B was started on oral montelukast. Drugs effect was recorded on a 2 wkly proforma for 8 weeks. Results: There were 54(67.5%) male and 26(33%) female. Most common triggering factor seen in 54(67.5%) patients was recent history of respiratory tract infection, exposure to carpet dust in 43(53.75%), cigarette smoke in 42(52.5%),recent psychological stress in 28(35%) , pollen allergy in 26 (32.5%) , pets exposure in 8 (10%) and to mite was noticed in 5(6.25%) children. Marked improvement was observed in day time cough in group A with 10(25%) patients being free of cough with inhaler, while 20(50%) showed mild intermittent symptoms. 1(2.5%) showed mild persistent symptoms. In Group B 3(7.5%) patients were symptom free, 23(57.5%)with mild intermittent and 4(10%) with mild persistant symptoms while 6(15%) continued to have moderate persistent symptoms. P value was 0.01. Regarding day time breathlessness, P value was significant of 0.258. Similarly marked improvement was observed in night symptoms of breathlessness, cough and sleeplessness in both groups. P value was less than 0.05 in majority of the variables showing statistically significant improvement with inhaled beclomethasone than with oral montelukast. Conclusions: Inhaled beclomethasone is superior to oral montelukast in controlling chronic symptoms of childhood asthma. [ABSTRACT FROM AUTHOR]

Asthma is a public health problem; in Mexico asthma is included among the ten causes of hospital and medical care. Exacerbations of asthma (asthma attacks or acute asthma) are episodes of progressive increase in shortness of breath, coughing, wheezing, tightness in the chest, or a combination of these symptoms. It has been identified airway infections, as the major etiology of exacerbations. Microbiological study of the sputum of the 90 patients included in this study was performed. The results showed that pathogenic microorganisms associated to asthma exacerbations were isolated in almost 50% of the samples analyzed, the pathogens isolated were bacterias followed by virus. In contrast to previous studies, in this study bacterias were isolated in higher proportion than virus. However, we are not able to conclude that bacterias or virus infections are responsible of the exacerbations, because it was not possible to found a strong association between the severity of the crisis and the presence of some pathogens. [ABSTRACT FROM AUTHOR]

Adherence in asthma is an important cause for concern. Although nearly 50% of asthma patients are considered poorly adherent to therapeutic advices, adherence is still difficult to assess, understand and improve despite major medical consequences. In this review, we revisited the literature of the last 10 years related to adherence in severe asthma. The concepts have changed and 'compliance' is usually replaced by 'adherence'. Assessment of adherence is addressing ethical issues, but provides important insight into difficult-to-treat asthma. Different tools have been used but none is routinely recommended. Health-related outcomes (poor control, exacerbations, hospitalizations, lung function decline), which are clearly associated with severe asthma, are often worsened by non-adherence with consequences also on patient related outcomes (quality of life). The potential behaviour associated with non-adherence and all other related factors including easy-to-recognize psychological traits can help for patient's future management. Therapeutic educational interventions have been recognized with a scientifically proven efficiency even though evolution and improvements are needed. A multidisciplinary approach is required in severe asthma. Therapeutic adherence for a given patient is always a prerequisite to any other aspects when addressing severe asthma phenotypes. Severe asthma should be considered only in those who still experienced poor asthma outcomes despite optimal adherence. At a glance, poor adherence and severe asthma should be considered antinomic. Better understanding of the causes and customised management are potential future directions. [ABSTRACT FROM AUTHOR]

Asthma is a T lymphocyte-controlled disease of the airway wall caused by inflammation, overproduction of mucus and airway wall remodeling leading to bronchial hyperreactivity and airway obstruction. The airway epithelium is considered an essential controller of inflammatory, immune and regenerative responses to allergens, viruses and environmental pollutants that contribute to asthma pathogenesis. Epithelial cells express pattern recognition receptors that detect environmental stimuli and secrete endogenous danger signals, thereby activating dendritic cells and bridging innate and adaptive immunity. Improved understanding of the epithelium's function in maintaining the integrity of the airways and its dysfunction in asthma has provided important mechanistic insight into how asthma is initiated and perpetuated and could provide a framework by which to select new therapeutic strategies that prevent exacerbations and alter the natural course of the disease. [ABSTRACT FROM AUTHOR]

The article presents the key points related to the management of acute asthma among children in primary care. Topics discussed include the number of children under asthma treatment in Great Britain, its features that parents need to consider, and the requirement for asthma patients to have a personalised asthma action plan.

Several charts are presented depicting classification of asthma severity, its initial treatment, a stepwise approach for asthma management, and assessment of asthma control along with adjusting therapy in children.

The article discusses the report "Examining Causes of the Inner City Asthma Epidemic" by Stanley J. Szefler showing the high asthma prevalence in populations living in poor areas in large cities. Topics discussed include asthma risk factors in large cities, contribution of medical health system in solving asthma problem in those places, and impact of social inequities on the asthma treatment process.