Diagnosis and Management of Asthma in Adults

McCracken, Jennifer; Veeranki, Sreenivas P.; Ameredes, Bill T.; Calhoun, William J.

doi:10.1001/jama.2017.8372

Cited by 174 publications

(172 citation statements)

References 74 publications

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“…Only a few (1%) used biological treatments but at the time of the study only one biological treatment was available for asthma. Recent recommendations favor biological treatments instead of regular oral corticosteroids in severe asthma [25, 26]. In Finland, results of the public health programs for asthma (1994–2014) and for all allergic conditions (2008–2018) have shown that early treatment with conventional drugs is effective [27].…”

Section: Discussionmentioning

confidence: 99%

Multimorbidity in Asthma, Allergic Conditions and COPD Increase Disease Severity, Drug Use and Costs: The Finnish Pharmacy Survey

Jantunen

Haahtela

Salimäki³

et al. 2019

Int Arch Allergy Immunol

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Background: Asthma, allergic conditions, and COPD overlap, but the effect of them and their combinations on disease severity, need for drugs, use of healthcare, and costs is poorly known. Objective: To study how different allergic diseases co-occur in asthma and allergy patients and evaluate the use of medication well as drug and healthcare costs. Methods: Nationwide Allergy Barometer Survey was carried out in the Finnish pharmacies during 1 week in September 2016. Altogether, 956 patients (5–75 years) who purchased asthma or allergy drugs with prescription participated in 351 pharmacies. Results: Of the participants, 78% reported physician-diagnosed asthma, 57% allergic rhinitis, 24% atopic eczema, 21% food allergy, 20% allergic conjunctivitis, 8% anaphylaxis, and 8% COPD. One-third of the patients had at least three conditions, and multimorbidity was common across all age groups. Disease severity increased with the number of coexisting conditions, and asthma severity also with age. Patients with asthma alone used on average 3.8 drugs with the annual costs of EUR 661. This increased to 4.9 drugs and EUR 847 in asthmatics with multimorbidity. For all participants, costs of drugs and healthcare services together during the preceding year were on average EUR 1,214, of which 56% were drug costs. The costs doubled to EUR 2,714 in 65 subjects (7%) who had both asthma and COPD. Conclusions: In asthma and allergy, multimorbidity and polypharmacy are major concerns. Disease severity, drug use, and costs increased with multimorbid conditions. To reduce the burden, allergy management should be better integrated and more comprehensive.

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Section: Discussionmentioning

confidence: 99%

Multimorbidity in Asthma, Allergic Conditions and COPD Increase Disease Severity, Drug Use and Costs: The Finnish Pharmacy Survey

Jantunen

Haahtela

Salimäki³

et al. 2019

Int Arch Allergy Immunol

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“…There are several asthma phenotypes, among which allergic asthma can be highlighted as the most frequent . The variable degrees of bronchoconstriction, mucus hypersecretion and inflammatory process, triggered by exposure to the allergen, results in the most common symptoms – coughing, wheezing and shortness of breath …”

Section: Introductionmentioning

confidence: 99%

“…1 The variable degrees of bronchoconstriction, mucus hypersecretion and inflammatory process, triggered by exposure to the allergen, results in the most common symptomscoughing, wheezing and shortness of breath. 2 The allergic immune response begins with allergen contact with the epithelium in the lungs, promoting its activation and the release of thymic stromal lymphopoietin (TSLP), interleukin-25 (IL-25) and IL-33. 3 These cytokines trigger activation and migration to the peripheral lymphoid organs of dendritic cells (DCs), where they prime T cells to polarize to T helper type 2 (Th2) [4][5][6] and follicular helper T (Tfh) profiles.…”

Section: Introductionmentioning

confidence: 99%

Obesity affects peripheral lymphoid organs immune response in murine asthma model

et al. 2019

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Summary Asthma and obesity present rising incidence, and their concomitance is a reason for concern, as obese individuals are usually resistant to conventional asthma treatments and have more exacerbation episodes. Obesity affects several features in the lungs during asthma onset, shifting the T helper type 2 (Th2)/eosinophilic response towards a Th17/neutrophilic profile. Moreover, those individuals can present reduced atopy and delayed cytokine production. However, the impact of obesity on follicular helper T (Tfh) cells and B cells that could potentially result in antibody production disturbances are still unclear. Therefore, we aimed to assess the peripheral response to ovalbumin (OVA) in a concomitant model of obesity and asthma. Pulmonary allergy was induced, in both lean and obese female BALB/c mice, through OVA sensitizations and challenges. Mediastinal lymph nodes (MLNs) and spleen were processed for immunophenotyping. Lung was used for standard allergy analysis. Obese‐allergic mice produced less anti‐OVA IgE and more IgG2a than lean‐allergic mice. Dendritic cells (CD11c+ MHCIIhigh) expressed less CD86 and more PDL1 in obese‐allergic mice compared with lean‐allergic mice, in the MLNs. Meanwhile, B cells (CD19+ CD40+) were more frequent and the amount of PDL1/PD1+ cells was diminished by obesity, with the opposite effects in the spleen. Tfh cells (CD3+ CD4+ CXCR5+ PD1+) expressing FoxP3 were more frequent in obese mice, associated with the predominance of Th (CD3+ CD4+) cells expressing interleukin‐4/GATA3 in the MLNs and interleukin‐17A/RORγT in the spleen. Those modifications to the main components of the germinal centers could be resulting in the increased IgG2a production, which – associated with the Th17/neutrophilic profile – contributes to asthma worsening and represents an important target for future treatment strategies.

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“…The increased exposures that racial minorities experience in substandard housing likely contributes to disparities in sensitization [12]. This has been demonstrated in multiple studies including: (1) The National Health and Nutrition Examination Surveys (NHANES) III study of 10,508 individuals, in which non-Hispanic black individuals were more likely than non-Hispanic white individuals to be atopic (62% versus 51.3%, OR = 1.6 95% confidence interval 1.2-1.8) [13]; (2) The Boston Epidemiology of Home Allergens and Asthma study, in which black women were 2.5 times more likely than white women to be sensitized to more than 3 allergens, including dust mite, dog, cat, cockroach, alternaria and aspergillus species [14]; and (3) A study in Hartford Connecticut in which Puerto Rican children with asthma were more likely than white children to be sensitized to indoor allergens such as cockroaches (OR 3.3 95%CI (1.7-6.4) and dust mites (OR 1.7 CI 1.2-2.4) [15].…”

Section: Health Disparities In Asthmamentioning

confidence: 97%

Asthma in the Disadvantaged: A Phenotype in Need of a Personalized, Multidisciplinary Approach to Therapy

Harris¹,

Welch²,

Soper³

et al. 2018

Asthma Diagnosis and Management - Approach Based on Phenotype and Endotype

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Most patients with asthma can be managed with standardized, traditional therapies; however, 5-10% of patients suffer from disease that is difficult to control. Uncontrolled asthma disproportionally affects low income and racial minority patients. The disadvantaged asthma phenotype is defined by the presence of overlapping social, economic and environmental factors. These factors, such as environmental exposures in substandard housing or suboptimal adherence to controller therapy due to impaired health literacy are challenging to address in the clinic or inpatient setting. Personalized management of the disadvantaged asthma phenotype must target these interconnected factors through a multidisciplinary approach that includes longitudinal collaboration with communitybased organizations, social workers and legal aid.

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Diagnosis and Management of Asthma in Adults

Cited by 174 publications

References 74 publications

Multimorbidity in Asthma, Allergic Conditions and COPD Increase Disease Severity, Drug Use and Costs: The Finnish Pharmacy Survey

Multimorbidity in Asthma, Allergic Conditions and COPD Increase Disease Severity, Drug Use and Costs: The Finnish Pharmacy Survey

Obesity affects peripheral lymphoid organs immune response in murine asthma model

Asthma in the Disadvantaged: A Phenotype in Need of a Personalized, Multidisciplinary Approach to Therapy

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