Childhood asthma is a heterogeneous disease wherein systemic inflammation, particularly involving nontype 2 cytokines such as interleukin-6 (IL-6), is not universally present and its clinical significance remains unclear. This cross-sectional observational study aimed to elucidate the association between circulating IL-6 levels and the phenotypic characteristics of pediatric asthma, and to explore the potential value of IL-6 as a predictive biomarker for asthma phenotypic risk stratification. Plasma IL-6 levels were quantified in 105 newly diagnosed pediatric asthma patients (≤15 years old) and 104 age-matched healthy controls to establish a normal reference range. Asthma patients were stratified into two subgroups based on a predefined threshold: "IL-6-normal" (<3.1 pg/mL) and "IL-6-high" (≥3.1 pg/mL, the 95th percentile of IL-6 levels in the healthy control group). Clinical, inflammatory, and lung function characteristics were compared between the two subgroups. Spearman's rank correlation analysis was conducted to explore the associations between cytokine levels and lung function/airway inflammation indices. Multivariate logistic regression analysis was performed to identify variables associated with asthma phenotypic characteristics, and subsequent feature selection was carried out using Least Absolute Shrinkage and Selection Operator (LASSO) regression with fivefold cross-validation. A priori sample size estimation and sex-stratified analyses were conducted, and all methods followed STROBE reporting guidelines. Compared with healthy controls, pediatric asthma patients had significantly elevated serum IgE levels, peripheral blood eosinophil counts, and plasma concentrations of IL-4, IL-6, and IL-12 (all p < 0.05). Among the asthma cohort, the "IL-6-high" subgroup (n = 20, 19.0%) had significantly higher body mass index (BMI) and plasma IL-12 levels relative to the "IL-6-normal" subgroup (n = 85). Sex-stratified analyses demonstrated consistent patterns of elevated IL-6-related airway inflammation and reduced lung function across male and female children, without significant subgroup divergence. Correlation analysis showed that plasma IL-4 levels were significantly negatively correlated with percent predicted forced expiratory volume in 1 s (FEV1; r = -0.245, p = 0.025), and plasma IL-6 levels were significantly positively correlated with fractional exhaled nitric oxide (FeNO) levels (r = 0.214, p = 0.021). Multivariate logistic regression analysis identified asthma onset after 4 years of age, oral corticosteroid use, blood eosinophil count, FeNO level, and percent predicted FEV1 as variables independently associated with asthma phenotypic characteristics. Notably, LASSO regression selected circulating IL-6 as the most prominent predictive biomarker for asthma phenotypic characteristics among all evaluated clinical, inflammatory, and lung function variables. A predictive nomogram incorporating key variables showed excellent discriminative performance in the training cohort (C-index = 0.85, 95%CI: 0.79-0.91) and was validated in an independent cohort (C-index = 0.82, 95%CI: 0.75-0.89). Elevated circulating IL-6 is a prominent feature associated with a distinct phenotypic subgroup of pediatric asthma, and is correlated with impaired lung function and increased airway inflammation in asthmatic children. These findings support the potential of IL-6 as a significant predictive biomarker for phenotypic risk stratification in pediatric asthma, and suggest its potential utility in phenotypic subtyping of asthmatic patients and as a promising therapeutic target for the IL-6-high pediatric asthma subgroup. All conclusions are interpreted cautiously, given the study's methodological limitations, and further large-cohort prospective validation is required. What is already known on this topicChildhood asthma is a heterogeneous condition, and systemic inflammation is only present in a subset of patients. While type 2 inflammatory biomarkers such as IL-4 are often elevated in asthma, the role of nontype 2 cytokines such as IL-6 remains less clearly defined in pediatric asthma.What this study addsThis study reveals that elevated IL-6 is a key feature associated with a distinct subgroup of children with asthma and is significantly correlated with impaired lung function and airway inflammation. Furthermore, IL-6 was identified as a prominent potential predictive biomarker among all evaluated inflammatory and clinical variables via LASSO regression, with a validated predictive model showing good discriminative ability. This provides a basis for its potential application in pediatric asthma phenotypic subtyping and risk stratification.How this study might affect research, practice or policyThese findings suggest that IL-6 could serve as a potential predictive biomarker for asthma phenotypic sub-phenotyping and a promising therapeutic target for the IL-6-high pediatric asthma subgroup. The results may guide more personalized phenotypic stratification and treatment strategies for this specific subgroup and inform future research into anti-cytokine therapies for severe or corticosteroid-resistant non-type 2 asthma in children.
The aim of this study was to analyze the temporal association of the national incidence of severe asthma exacerbations (SAEs) in children with the implementation and lifting of NPIs. We performed a time-series analysis of a national, hospital-based French surveillance system. An SAE was defined as asthma associated with acute respiratory failure. All children aged ≤18 years hospitalized for an SAE in metropolitan France between January 2013 and June 2023 were included. The main outcome was the monthly incidence of hospitalizations for SAEs per 100,000 children, analyzed by a quasi-Poisson regression model, adjusted for pollution exposure. The incidence of hospitalizations for acute pyelonephritis over the same period was analyzed as a control outcome. NPI implementation in March 2020 was associated with a significant decrease in the monthly incidence of SAEs (immediate change, -29.4%; 95%CI -49.4 to -1.5; p = 0.041), and a significant increase following the lifting of the NPIs in March 2021 (immediate change, 59.1%; 95%CI 12.8 to 124.6; p = 0.008), resulting in a non-significant excess compared to the pre-COVID-19 pandemic period trend (+12.3%; 95%CI -12.6 to 44.5; p = 0.36), independently of pollution exposure. No significant changes were observed for acute pyelonephritis hospitalizations over the study period. NPIs were associated with significant changes in the incidence of pediatric SAEs. This unexpected benefit suggests that public health interventions targeting respiratory viruses may reduce the burden of SAEs in children. The mid- and long-term impact of lifting NPIs on SAEs and on the use of healthcare resources should be carefully monitored.
Asthma is a prevalent chronic inflammatory airway disease globally, and its acute exacerbations significantly increase healthcare burdens. In recent years, abnormal body composition has been recognized as a potential contributor to the onset and progression of asthma. The Visceral Fat-to-Muscle Ratio (VMR) is a composite indicator reflecting sarcopenic obesity. This study primarily aims to evaluate the relationship between VMR and asthma, as well as asthma-related events. This study utilized cross-sectional data from the 2011-2018 NHANES database, including adult participants. Multivariable logistic regression models were employed to assess the association between VMR and asthma risk, as well as acute exacerbations in the past year. Additionally, restricted cubic spline (RCS) functions were applied to examine potential nonlinear relationships between VMR and asthma risk, and subgroup analyses were conducted to verify the robustness of the results. The study analyzed data from 7352 participants. Further classification into stable asthma and asthma exacerbation groups revealed that higher VMR levels were significantly associated with an increased risk of asthma exacerbations (OR = 1.33, 95% CI: 1.12-1.57). Compared to the lowest group, participants in the highest VMR quartile had a 94% higher risk of asthma exacerbations (OR = 1.94; 95% CI: 1.18-3.18, p < 0.01), whereas no significant association was observed during the stable phase of asthma. RCS analysis indicated a linear relationship between VMR and asthma risk, with the association remaining statistically significant. This cross-sectional study is the first to identify a significant association between VMR and the risk of asthma exacerbations, suggesting that abnormal body composition may be an important factor influencing asthma attacks. As a convenient and modifiable body composition indicator, VMR holds potential clinical value in risk identification and non-pharmacological management of asthma populations.
In 2020, the NHLBI released the Focused Asthma Management Updates. However, awareness, knowledge, and implementation of these guidelines have been inadequate. Here, we evaluate the ability of electronic and print versions of a pocket card containing key recommendations from the NHLBI 2020 Asthma Guideline Update to increase implementation among primary care providers (PCPs). In a prospective, randomized trial, 138 PCPs were given an electronic or print version of a pocket card with information on asthma treatment and management. A knowledge-based survey was provided at baseline, and after 1 month of use of the pocket card, the survey was repeated. Implementation questions at the 1-month follow-up included utilization of the pocket cards, settings in which they were used, and perceived usefulness. 77 participants (55.8%) completed both baseline and follow-up surveys. At baseline, the mean percent-correct score for the electronic pocket card group was 46.9% and the print-out pocket card group was 42.2%. After the intervention, the scores for both groups improved to 56.7% and 57.3% respectively (p < 0.001 for both groups compared to baseline). There was no significant difference between groups. 71.4% of the electronic and 83.3% of the printed pocket card groups reported that the pocket cards were at least somewhat effective/useful, but only 50% of each group remembered to use the card during clinical encounters. Both electronic and printed pocket cards can increase medical knowledge around the Focused Asthma Updates and may be considered as part of an implementation strategy.
In 2024, brand-name Flovent (fluticasone propionate), the most widely prescribed inhaled corticosteroid (ICS) in the United States, was discontinued, eliminating a key treatment option for pediatric asthma. There have yet to be reports describing pediatric clinicians' experiences with this abrupt loss of a mainstay therapy for one of the most common chronic diseases in children. The study aimed to examine the experience of pediatric clinicians with the discontinuation of Flovent for asthma management. A web-based survey was disseminated via pediatric and pediatric pulmonary networks, both regionally and nationally, to pediatric primary care and subspecialty physicians and advanced practice practitioners. The survey assessed clinician awareness, preparedness, and the clinical impact of Flovent discontinuation. Among 226 respondents, 71% were aware of the Flovent discontinuation in advance; however, 79% felt unprepared or very unprepared once it went into effect. Clinicians reported significant disruptions in prescribing and clinical workflow, with 56% describing the impact on their practice as severe. Factors most frequently cited as causing moderate or severe burden included prescribing alternate ICS therapy, including insurance authorization requirements (90%), pharmacy shortages (85%), and difficulty finding age-appropriate alternatives (82%). In free-text responses, clinicians described perceived worsening asthma control and increased acute healthcare utilization following the discontinuation, particularly among younger patients. Pediatric clinicians who care for children with asthma reported significant disruptions to patient care following the discontinuation of Flovent. These findings underscore the need for systems-level support of clinicians during major formulary transitions to minimize disruptions, particularly within pediatric asthma.
The efficacy of Monoclonal Antibodies in severe asthma has long been established. In terms of clinical remission, several patients can reach, in the first year of treatment, all four goals: 1) tapering/discontinuation in the use of systemic glucocorticoids, 2) reduction in exacerbations, 3) symptom control, and 4) gain in respiratory function. In this study, we aimed to analyze the time course and magnitude of functional improvement assessed by forced spirometry, including Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), and the FEV1/FVC ratio, over 24 months of therapy. We evaluated data from a cohort of 15 severe asthmatic patients treated with mepolizumab for 24 months, analyzing respiratory function by performing spirometry at baseline and after 1, 2, 3, 6, 12, and 24 months. The main objective was to assess the change in terms of FEV1, FVC, and FEV1/FVC ratio, as well as the temporal pattern of these modifications. The analysis has shown an improvement in FEV1 of 366 ± 271 ml (p = 0.03) after 28 days and of 555 ± 386 ml (p = 0.0084) after 56 days of therapy. This improvement remained stable for the rest of the observation period. For the FVC parameter, the improvement became statistically significant from the third month of therapy (p = 0.034). The increase in FEV1 observed in this cohort of patients shows that functional response is already detectable in the first two months of treatment. These clinical and functional improvements were sustained over two years of biologic therapy, even as pharmacologic treatment-particularly systemic corticosteroids-was progressively reduced.
Although multiple studies have shown that a high proportion of young adults with asthma do not achieve asthma control, that adherence to asthma medication is low and that there is inadequate self-management of the disease, the underlying reasons have not been fully explored. To explore young adults' experiences of self-managing their asthma treatment. A qualitative study using individual semi-structured interviews with young adults with current asthma (n = 15), recruited from an ongoing population-based birth cohort. The interviews were recorded, transcribed verbatim, and the transcribed data were analyzed using systematic text condensation. The participants' experiences of managing their asthma treatment resulted in four categories: "unsure of how to treat my asthma," "my everyday life affects the treatment," "difficulties in maintaining contact with healthcare," and "medicate only when needed." The young adults described being unsure of which medication to use when and how to use their inhalers. Due to the business of life, they sometimes forgot to take medication. Furthermore, they described that it was hard to get prescriptions for medication or checkups for their asthma. Many used their asthma medication only when exercising or when symptoms appeared. The young adults described both challenges in and strategies for self-management of their asthma, yet commonly expressed uncertainty regarding appropriate treatment actions. To overcome these barriers, person-centered support and education from healthcare providers are essential to empower young adults for improved asthma self-management.
Childhood asthma is a chronic condition that can be controlled with treatment. However, parents of children with asthma may face stressors such as juggling work and asthma care responsibilities, including the unpredictability of acute episodes. The current study examines associations between child asthma and parental mental health by parental sex and explores whether these differences reflect established differences seen in depression and anxiety symptoms. Weighted pair data from the 2019-2023 National Health Interview Survey permitted separate analysis of mother-child and father-child pairs. Logistic regression models examined associations between current child asthma and episodes/attacks in the past 12 months among children with current asthma with reported feelings of parental anxiety and/or depression, controlling for sociodemographic characteristics. Mothers living with a child with asthma were more likely to report feelings of anxiety and/or depression compared to mothers not living with a child with asthma (AOR = 1.99, 95% CI = 1.64-2.42). In addition, mothers living with a child with asthma who had an episode/attack in the past 12 months were more likely to report feelings of anxiety and/or depression than mothers living with a child with asthma without an episode/attack (AOR = 1.52, 95% CI = 1.06-2.19). Weaker and nonsignificant associations were found between feelings of anxiety and/or depression among fathers by child asthma status (AOR = 1.30, 95% CI = 0.95-1.79) and whether the child had an episode/attack in the past 12 months (AOR = 1.32, 95% CI = 0.69-2.52). The current study highlights a potential increased risk for anxiety and/or depression among mothers raising a child with asthma when compared to fathers.
To evaluate the effectiveness of a new device (SOBIstat-F®) for bronchodilator administration via pMDI compared with the conventional method. Protocols for managing severe asthma exacerbations include bronchodilators (short-acting beta-2 agonists and ipratropium bromide) administered by nebulizer or pressurized metered-dose inhaler(pMDI) with a valved holding chamber, corticosteroids IV, and magnesium sulfate IV. A randomized superiority clinical trial was conducted in children with severe acute asthma at the emergency department. Patients were assigned to one of the following groups: pMDI-SOBx, in which they received bronchodilators in pMDI through the SOBIstat-F® device, or in pMDI with oxygen via cannula or mask (pMDI-OxStand). The primary outcome was the need for hospitalization at the end of 8 h. 84 patients participated in the study, of which 43 were treated with the pMDI-SOBx device and 41 with pMDI-OxStand. There were no baseline differences between the groups. Children treated with pMDI-SOBx had a lower hospitalization rate compared to those with pMDI-OxStand (9.3% vs. 26.8%, respectively, p = 0.036; absolute risk difference: -17.5% [95% CI: -33.6 to -1.4] and OR: 0.26 [95% CI: 0.08-0.91]). Additionally, a significant clinical improvement (pulmonary score) was observed from 90 min (p < 0.001), and an increase in SpO2 was observed from 60 min (p < 0.001) in the pMDI-SOBx group. Side effects were similar. For the first time, bronchodilator administration using the SOBIstat-F® device was more effective than the conventional method in reducing hospitalizations and improving the clinical condition of children with severe asthma exacerbations.
Asthma is a common chronic respiratory disease affecting people of all ages, but little is known about age-related differences in treatment strategies. The present study aims to explore age-related differences in inhaled corticosteroid (ICS) use and place of asthma management. All Danish adults with a registered secondary care asthma diagnosis or active treatment (>1 redemption of ICS within 365 days) in 2021 were included. Individuals with chronic obstructive pulmonary disease and individuals who migrated or died during the observation period were excluded. Danish national registries provided all treatment data. A total of 184,565 patients with asthma (median age 57 [IQR 43-69], 59% female) were included. Overall, 15.7% of the asthma population was treated with high (>800-1600 budesonide-equivalent ug/day) or supratherapeutic (>1600 budesonide-equivalent ug/day) doses of ICS, and the proportion increased with age before reaching a plateau from age 56 onwards (lowest: 18-45 years, 9.7%; highest: 66-75 years, 18.9%; p < .001). Significantly fewer of the patients in the oldest age group were seen in specialist care (highest: 56-65 years, 18.9%; lowest: >86 years, 11.4%; p < .001), and 77.3% of patients exposed to high or supratherapeutic doses of ICS were managed only in primary care. The prevalence of high- and supratherapeutic ICS exposure was higher among patients ≥56 years, and when exceeding 76 years of age, a smaller proportion were managed in secondary care. With an increased focus on adverse effects of high-dose ICS treatment and earlier initiation of other treatments, our findings will, hopefully, facilitate less age inequity in asthma management.
The objective of this study is to describe and compare the clinical characteristics, treatment approaches, and associated comorbidities of patients with severe asthma across Greece, Southern Europe, and the global population. This comparative approach aims to enhance the understanding of region-specific differences and similarities among patients living with severe asthma. Data from the International Severe Asthma Registry (ISAR) were analyzed across three cohorts: Greek, Southern European, and Global. Variables included demographics, baseline characteristics, age at asthma onset, medication use, lung function, exacerbation history, biomarkers, and comorbidities. A total of 16,063 patients from the global ISAR dataset, 3406 from Southern Europe, and 206 from Greece were included. Greek patients had a lower mean annual exacerbation rate (1.24 ± 1.67) compared with the global cohort (1.84 ± 2.58, p = 0.001) and Southern Europe (1.73 ± 2.56, p = 0.052). Uncontrolled asthma was most prevalent in Greece (60.32%) versus Southern Europe (35.58%, p < 0.001) and the global cohort (57.07%, p = 0.034). Long-term oral corticosteroid use was less frequent in Greece (24.73%) and in global cohort (21.50%, p = 0.287) than in Southern Europe (52.04%, p < 0.001). The prevalence of eosinophilic phenotype was high in all cohorts. However, in Greece, it was lower compared to Southern Europe (73.55% vs. 89.89% p < 0.001) and globally (73.55% vs. 83.34%, p = 0.011). Greek patients also demonstrated lower fractional exhaled nitric oxide (FeNO) levels and lower eosinophil counts than Southern Europe, along with reduced biologic therapy initiation (56.31%) compared to Southern Europe (74.02%, p < 0.001) but higher than global rates (48.40%, p = 0.024). Regional differences in severe asthma underline the importance of tailored treatment approaches, and multidisciplinary management of comorbid conditions.
The Treating Respiratory Emergencies in Children Study (T-RECS) pilot study evaluated the feasibility of a prehospital treatment protocol for life-threatening pediatric asthma, including combined albuterol/ipratropium (DuoNeb) and dexamethasone with a checklist, to inform a future trial. Prospective, before-and-after study across three US EMS agencies (January 2024-February 2025). We enrolled patients aged 2-17 with severe asthma exacerbations who met specific criteria. The intervention phase introduced the new protocol and checklist. The primary outcome was the hospital admission status collection rate. Secondary outcomes included NIH PROMIS asthma impact score collection, hospital-free days, and ICU-free days. Implementation outcomes were assessed using the RE-AIM framework, including reach, paramedic adoption, and protocol implementation. Paramedic surveys assessed protocol and checklist acceptability. The study was registered on clinicaltrials.gov on 8/10/23 (NCT06074185). The study screened 302 patients and enrolled 43. Hospital admission status was collected for 58% of enrolled patients. There was an observed increase in the use of albuterol/ipratropium (50% to 78.1%) and dexamethasone (41.7% to 65.6%) in the post-intervention phase, with an increase in the combined use of both (16.7% to 53.1%). Paramedic surveys (28% response rate) indicated the protocol was generally easy to follow, and the checklist was helpful. Challenges included time constraints and specific eligibility criteria. This pilot trial evaluated the feasibility and acceptability of implementing a prehospital protocol for severe pediatric asthma. While hospital data collection needs to be improved, these findings provide important considerations for a larger trial to evaluate the impact of this intervention on patient outcomes.
Large population-based asthma registries improve disease understanding and management and can be developed through the secondary use of electronic medical records (EMRs). We have created an Epic-EMR registry of children treated for asthma at the Children's Hospital of Eastern Ontario (CHEO). This study's objective was to validate the Epic-EMR asthma registry by comparing it against expert clinical asthma diagnoses. The sample included children aged 0-18 years. We randomly selected 200 children from the Epic-EMR asthma registry, 200 children with non-asthma respiratory conditions, and 200 children with non-asthma, non-respiratory diagnoses. All asthma diagnoses were verified by two blinded pediatric respirologists based on data abstracted from the electronic chart. In total 598 children were included for analysis. The Epic-EMR asthma registry had a positive predictive value of 0.91 (95%CI 0.86-0.94) and negative predictive value of 0.92 (95%CI 0.89-0.94). Correcting for the proportion of CHEO patients in the asthma registry (6.6%), the estimated specificity was 0.99 (95%CI 0.99-0.99) and sensitivity was 0.44 (95%CI 0.36-0.53). When age-stratified, the specificity was 0.99 (95%CI 0.99-0.99) and sensitivity was 0.39 (95%CI 0.29-0.50) for participants aged 0 to <6 years, and 0.99 (95%CI 0.98-0.99) and 0.5 (95%CI 0.37-0.63) for participants aged 6-18 years. The Epic-EMR asthma registry accurately identifies children with asthma. With a very high specificity, positive and negative predictive value, this tool is appropriate to use for clinical care and research.
Bronchial asthma in children is a prevalent chronic condition that adversely affects respiratory health, leading to significant healthcare costs and diminished quality of life. Current management strategies, primarily involving inhaled corticosteroids and bronchodilators, are often hindered by poor adherence and inadequate monitoring. This study aimed to evaluate the effectiveness of an intelligent management system compared to traditional methods in enhancing asthma management in pediatric patients. Utilizing a randomized controlled trial design with a 12-month follow-up, 208 children aged 6-12 years with diagnosed asthma were enrolled, with the experimental group (120 cases) receiving real-time monitoring and reminders through the intelligent system as an addition to traditional follow-ups, while the control group (88 cases) underwent conventional outpatient follow-ups. Key findings indicated that the experimental group exhibited significant improvements in medication adherence (89.2% vs 58.0%, p < 0.001), lung function (FEV1% predicted change +12.3% vs +4.2%, p < 0.001), asthma control levels (C-ACT score 22.5 ± 2.8 vs 18.1 ± 3.2, p < 0.001), and a marked reduction in airway inflammation (FeNO levels decreased by 42.9% vs 17.1%, p < 0.001). Additionally, quality of life scores improved significantly (PAQLQ total score 6.8 ± 0.9 vs 5.1 ± 1.3, p < 0.001). This multifaceted intelligent management system, incorporating real-time monitoring, reminders, and remote clinical support, markedly enhances lung function, reduces airway inflammation, and improves quality of life in children with asthma, highlighting its potential as a transformative approach in asthma management. While the comprehensive approach proved effective, further research is needed to identify the most impactful components to facilitate broader implementation. Future research should explore long-term impacts and the integration of psychological support within these management strategies.
Impulse oscillometry (IOS) is recognized as a sensitive technique for detecting small airway dysfunction (SAD), and previous studies have demonstrated its association with poor asthma control. However, its utility in predicting future asthma control remains uncertain. This study aimed to assess the predictive value of IOS for future asthma control during high pollution periods. Patients with well-controlled asthma were enrolled. Baseline data collection including spirometry, IOS measurements, and asthma control test (ACT) scores was performed between January and February 2024. ACT scores were reassessed during a subsequent high air pollution period (March-April 2024). The diagnostic accuracy of IOS in forecasting future loss of asthma control was evaluated. Seventy-nine subjects with a mean age of 60.4 ± 14.0 years, 53 females (67.1%) were included. The mean particulate matter with an aerodynamic diameter less than or equal to 2.5 micrometers (PM2.5) differed significantly between the nonpollution and pollution periods (21.1 ± 7.8 μg/m³ vs 78.2 ± 31.8 μg/m³, respectively; p < 0.001). Twenty-three participants experienced a loss of asthma control during the pollution period. The area under the receiver operating characteristic curve (AUC) for the %predicted difference between R5 and R20 (R5-R20) in predicting loss of asthma control was 0.39 (95%CI: 0.25, 0.53). Further analysis focusing on %predicted R5-R20 indicated no predictive value for asthma control during periods of high pollution (adjusted RR: 1.00; 95%CI: 0.99, 1.01; p = 0.553). IOS do not predict loss of asthma control during air pollution period in patients with previously stable asthma.
The Resources for Schools Encountering Unexpected Asthma Emergencies-Illinois (RESCUE-IL) program-which provides stock inhalers, materials, and training-expanded to all Illinois public schools in its second year. A survey evaluated fidelity to emergency protocols and implementation experiences over the 2024-2025 school year as part of a larger program evaluation. The 69-item survey was available to school staff (e.g. nurses, administrators, others) registered in the RESCUE-IL portal over February-March 2025. Questions were either respondent-specific (33 questions) or school-specific for up to three schools (12 questions per school). A total of 327 respondents representing 483 schools completed the survey (response rate = 20.6%). Nearly all (96.3%) reported satisfaction with RESCUE-IL over the second implementation year. While 93.9% felt the emergency protocol was effective, fewer were comfortable with the protocol-directed four puffs for mild-moderate distress (61.2%) or with eight puffs for severe distress (49.2%). Most (96.0%) preferred to start with two puffs and give more if necessary. Additionally, 76.2% of respondents preferred to follow a student's Asthma Action Plan (AAP) when available over the provided emergency protocol, contrary to RESCUE rules. Furthermore, 40.9% of schools who had used a stock inhaler and 23.7% of schools who had not (p = 0.05) expressed concerns about student overreliance on stock inhalers. Respondents were satisfied with the program overall but had low comfort with dosages over two puffs outlined in the RESCUE-IL protocol, likely due to discrepancies with student AAPs, requiring further individual and group training. Increasing uptake of current AAP recommendations is a priority.
People with asthma who overuse SABAs were enrolled into the study through community pharmacist invitation. Semi-structured interviews were completed by telephone or via Zoom. The recordings were transcribed and thematically analyzed using inductive and deductive approaches. Between September 2021 and May 2022, 21 people were interviewed. Data analyses yielded six themes. Three themes related to risk perception including risks related to asthma, medicines, and other factors such as environmental triggers. Three themes related to how people responded to their perceived risk. These included actions taken by some to reduce risk while others chose not to act to reduce risk, despite knowing how to, suggesting a lack of self-efficacy. This is the first study of its kind in a group of Australians who have asthma, a common, as yet incurable, often lifelong chronic health condition. Our interviews yielded rich and sometimes surprising insights into the complexity and number of factors contributing to how people perceive and respond to risks associated with their asthma and with the medicines that they take to manage it. Safer use of reliever medications - a matter of better risk communication by health professionals. The Asia-Pacific Society of Respirology Annual Conference; Singapore, November 2023.Short-acting beta2-agonist overuse is risky, but how do users with asthma perceive and respond to risk? Thoracic Society of Australia and New Zealand Annual Conference, Gold Coast, Australia, March 2024.
Asthma is the most common chronic respiratory condition of childhood worldwide. In 2021, about 25% of Californians had at some point been diagnosed with asthma. Between 2008 and 2010, the age-adjusted rate of pediatric asthma deaths was 1.9 in California but 5 in San Bernardino. In this study, we compare rates of pediatric asthma hospitalizations across California counties and examine factors correlating to reduced asthma attacks. We analyzed two datasets. The first dataset was from the California Health and Human Services Open Data Portal (CA ODP), "Rates of Preventable Hospitalizations (Age < 18) for Selected Medical Conditions by County." Selected counties included Los Angeles, San Bernardino, Kern, Fresno, Alameda, and Santa Clara. The second dataset was from the California Health Interview Survey, Public Use Files (CHIS PUFs), for Teens and Children for years 2018-2022. Risk-adjusted rates showed a noticeable difference between pediatric asthma hospitalizations across California, with the highest rates being seen in Fresno County at 160.0 per 100,000. Reduced asthma attacks in the past year were significantly associated with having a written asthma action plan (p = 0.004) and receiving one from a healthcare provider (p < 0.001). Participants with a usual source of care other than the emergency room (ER) had fewer asthma attacks compared to those without (p = 0.028). Pediatric asthma morbidity remains high throughout different California regions, with increased rates being seen in Fresno. Various factors including consistent healthcare provider access and written asthma action plans play a role in asthma prognosis.
This study aimed to evaluate the association between omalizumab use during pregnancy and the risk of adverse fetal outcomes among pregnant women with asthma. This population-based retrospective cohort study was conducted using data from the 2010-2022 National Health Insurance Research Database and the Birth Certification Application in Taiwan. The study population was pregnant women with asthma. An active-comparator design was employed. Pregnant women who received at least one dose of omalizumab during pregnancy were assigned as the exposure group, while those having at least one prescription for inhaled corticosteroid (ICS) during pregnancy were assigned as the control group. The study outcome was adverse fetal outcomes. Propensity score matching was used to adjust for measurable confounders. Conditional logistic regression models were used to estimate the risk of adverse fetal outcomes. A total of 4,416 pregnant women with asthma were included, with 16 (0.1%) receiving omalizumab and 4,410 (99.9%) using ICS during pregnancy. The risk of adverse fetal outcomes, including pre-term birth (OR, 1.74; 95% CI, 0.46-6.63), low birth weight (OR, 1.04; 95% CI, 0.22-4.87), small for gestational age (OR, 1.11; 95% CI, 0.14-8.98), did not differ between omalizumab and ICS users. Omalizumab was not associated with an increased risk of adverse fetal outcomes among pregnant women with asthma. Further investigation with a larger sample of omalizumab users is warranted.
To analyze the relationship between anxiety and asthma. We carried an English scientific literature search using electronic search engines (PubMed). We included articles published in peer-review journals from 2020 to December 2024. In order to perform the search for the most suitable and representative articles, keywords were selected (-asthma‖, and -anxiety‖). The evidence level was assessed according to the criteria of the Oxford Center For Evidence-Based Medicine. Across multiple studies, the prevalence of anxiety among patients with asthma ranged from 13.7% to 54.3%, consistently higher than in the general population. Anxiety was associated with poorer asthma control (lower ACQ/ACT scores), reduced quality of life (AQLQ) and, in some cases, impaired lung function and higher inflammatory markers (hs-CRP, NLR). Depression emerged as the strongest risk factor for anxiety (OR 26.00), while well-controlled asthma (ACT ≥ 20) and allergic asthma were associated with approximately 70% lower risk. Being female and asthma onset occurring between ages 40 and 59 were also linked to higher anxiety prevalence. Screening tools such as the mini-AQLQ, HADS, EQ-5D and PHQ-4 demonstrated potential utility in identifying anxiety in asthmatic populations. In specific subgroups, asthma-related anxiety was associated with increased symptom reporting and exacerbations, even without a deterioration in objective measurements for airway obstruction. Anxiety is a common comorbidity among patients with asthma and it is associated with poorer disease control and a reduced quality of life.