Predictors of asthma relapse in patients who attended an emergency department

Pola-Bibian, B; Domínguez‐Ortega, Javier; Vilà-Nadal, Gemma; Entrala, A; González-Cavero, Lourdes; Paredes, Pilar; Cancelliere, Nataly; Díaz-Almirón, Mariana; Quirce, Santiago

doi:10.2500/aap.2018.39.4130

Cited by 8 publications

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“…By contrast, according to a large UK and US study, the ER admission rate and costs in the GINA step 5 group approximately doubled the rate and costs in the GINA step 1 population 17 . This observation is not reported by other studies which highlighted the poor asthma control due to low treatment adherence, and the inadequate knowledge about self-management of an asthma attack as major determinants of asthma-related emergency department admissions in the adult population, in accordance with our results 15, 16. Moreover, Steppuhn et al described a higher prevalence of exacerbations requiring emergency room in asthmatic patients with comorbidities including allergic rhinitis, gastroesophageal reflux disease, and acetylsalicylic acid exacerbated respiratory disease (AERD), the latter being particularly relevant 18 .…”

Section: Discussionsupporting

confidence: 91%

“…Despite a number of treatment options, asthma control, even in diagnosed and treated patients, still represents an unmet need 1, 8, 14. The first determinant of lack of control is non-adherence to the treatment 15, 16. The high proportion of white-green codes suggests that ER admissions are related to poorly controlled and not to truly severe asthma, as highlighted by a general practitioner large database analysis reporting an increased risk of asthma related hospital admissions in mild to moderate uncontrolled asthma 8 .…”

Section: Discussionmentioning

confidence: 99%

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Trends and determinants of Emergency Room admissions for asthma: A retrospective evaluation in Northeast Italy

Caminati

Vianello

Ricci

et al. 2019

World Allergy Organization Journal

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Background Asthma still represents a cause of death and hospital admissions worldwide. Our study aimed at analyzing the trend of Emergency Room (ER) asthma admissions in Northeast Italy in order to investigate the relevance of specific patient-related determinants and environmental triggers (pollens, mold spores, and pollutants). Methods Retrospective data from admissions for asthma exacerbations registered between the years 2013 and 2015 in two main ERs in Northeast Italy were collected. Data about patients' age, sex and nationality were recorded. Classification of disease severity followed the current Italian ER triage scoring system (white: no need for emergency treatment; green: need for fast treatment; yellow: severe condition; red: life-threatening condition). Data on pollen/mold spore counts and pollutants were analyzed. Results Overall, 1745 ER admissions for asthma were registered, with a persistent and significant increase year by year. A slight prevalence of females and patients over 50 years old was observed. Immigrants accounted for 32%, 36% and 26% of admissions respectively in 2013, 2014 and 2015. The prevalence of immigrants' admissions was significantly higher when comparing the relative ratio of immigrant populations/Italian nationals (p < 0.05). The admissions were coded as follows: white, 6.30%; green, 35.36%; yellow, 39.37%; red, 18.97%. People aged ≥50 years were more frequently admitted with a red code, but the trend was not statistically significant (p = 0,0815). By contrast, amongst immigrants there was a higher prevalence of white and green codes observed in comparison with Italian nationals. Grass pollen peak and PM 10 high levels represented environmental determinants of ER admissions increase. Conclusions The increasing rate of asthma-related ER admissions highlights the need for implementing asthma control strategies. Investigating the traits of patients referring to ER for asthma exacerbations, as well as environmental-related determinants, may help in identifying at-risk individuals and in orienting preventive strategies accordingly. Immigrants represent the most vulnerable sub-population, and their potential difficulties in accessing treatments and health services should be specifically addressed. Overall, implementing patient education in order to improve treatment adherence, as well as providing an asthma action plan to every asthmatic patient, continue to be the most urgent needs.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Trends and determinants of Emergency Room admissions for asthma: A retrospective evaluation in Northeast Italy

Caminati

Vianello

Ricci

et al. 2019

World Allergy Organization Journal

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“…Together, our findings suggest a possible self-perpetuating vicious cycle underlying recurrent exacerbations, leading to an impaired anti-viral response, which in turn leads to viral-induced exacerbations, causing more airway inflammation (Figure 7). This might provide part of the explanation for the increased risk of recurrent exacerbations and exacerbation relapses observed in patients with eosinophilic airway inflammation (50). They may further suggest that in order to stabilize asthma patients with recurrent exacerbations, treatment approaches that reduce oxidative stress may be relevant.…”

Section: Discussionmentioning

confidence: 99%

Oxidative Stress Attenuates TLR3 Responsiveness and Impairs Anti-viral Mechanisms in Bronchial Epithelial Cells From COPD and Asthma Patients

et al. 2019

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COPD and asthma exacerbations are commonly triggered by rhinovirus infection. Potentially promoting exacerbations, impaired anti-viral signaling and attenuated viral clearance have been observed in diseased bronchial epithelium. Oxidative stress is a feature of inflammation in asthma and COPD and is prominent during exacerbations. It is not known whether oxidative stress affects the anti-viral signaling capacity. Bronchial epithelial cells from asthmatic and COPD donors were infected with rhinovirus or treated with the oxidative stressor H2O2 followed by exposure to the synthetic viral replication intermediate poly(I:C). Poly(I:C) was used to ascertain a constant infection-like burden. Gene and protein levels of antioxidants as well as anti-viral responses were measured 3 and 24 h post poly(I:C) exposure. Rhinovirus infection and poly(I:C) stimulation induced protein levels of the antioxidants SOD1 and SOD2. In asthmatic bronchial epithelial cells pre-treatment with H2O2 dose-dependently decreased the antioxidant response to poly(I:C), suggesting exaggerated oxidative stress. Further, poly(I:C)-induced IFNβ gene expression was reduced after pre-treatment with H2O2. This epithelial effect was associated with a reduced expression of the pattern recognition receptors RIG-I, MDA5 and TLR3 both on gene and protein level. Pre-treatment with H2O2 did not alter antioxidant responses in COPD bronchial epithelial cells and, more modestly than in asthma, reduced poly(I:C)-induced IFNβ gene expression. Knockdown of TLR3 but not RIG-I/MDA5 abrogated impairment of poly(I:C)-induced IFNβ gene expression by H2O2. We developed a method by which we could demonstrate that oxidative stress impairs anti-viral signaling in bronchial epithelial cells from asthmatic and COPD patients, most pronounced in asthma. The impairment apparently reflects reduced responsiveness of TLR3. These present findings shed light on molecular mechanisms potentially causing reduced interferon responses to rhinovirus infection at exacerbations in asthma and COPD. Together, our findings suggest a possible self-perpetuating vicious cycle underlying recurrent exacerbations, leading to an impaired anti-viral response, which in turn leads to viral-induced exacerbations, causing more airway inflammation.

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“…In previous studies, asthma relapse was attributed to personal and environmental factors. Some patients did not manage their symptoms well and went to the emergency department frequently [8]. In addition, female adults and previous ICS usage were also found to be significantly associated with relapse occurrence [9].…”

Section: Introductionmentioning

confidence: 99%

Assessing effects of personal behaviors and environmental exposure on asthma episodes: a diary-based approach

Chan

Chu

et al. 2019

BMC Pulm Med

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BackgroundQuantifying the effects of personal health behaviors and environmental exposure on asthma flare-ups is a challenge. Most studies have focused on monitoring the symptoms and drug usage for relieving symptoms. In this study, we emphasize the need to understand how personal and environmental conditions are related to the occurrence of asthma symptoms.MethodsWe designed an online health diary platform to collect personal health behaviors from children, their parents and other adults with any allergic diseases including asthma, allergic rhinitis, atopic dermatitis and allergic conjunctivitis. The participants used mobile devices or computers to record their daily health-related activities such as sleep, exercise, diet, perception of air quality and temperature, and asthma symptoms. The participants also recorded secondhand smoke exposure and the time of activities, which were combined with ambient air quality measurements for calculating personal air pollution exposure. A generalized linear mixed model was used to estimate the effects of the factors.ResultsDuring the study period (January 2017–June 2017, and October 2017–September 2018), 132 participants provided 25,016 diary entries, and 84 participants had experienced asthma symptoms in 1458 diary entries. The results showed some different risk factors for the minors and adults. For minors, high-intensity exercise, contact with persons with influenza-like illness (ILI) and the perception of hot temperature and bad indoor air quality were associated with the occurrence of asthma episodes. The identified risk factors for the adult participants included having dehumidifiers at home, exposure to secondhand smoke, having bad sleep quality, contact with persons with ILI, not eating fruit and seafood, perceiving cold temperature, bad quality of indoor and outdoor air, and exposure to high concentration of ozone.ConclusionsThe revealed personal risk factors and perceptions of air quality and temperature may provide guidance on behavioral change for people susceptible to asthma to help control acute onset and severe exacerbation of asthma flare-ups.

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Predictors of asthma relapse in patients who attended an emergency department

Abstract: In this population, patients who had multiple ED visits in 1 year, those with uncontrolled asthma, wheezing, ≥400 blood eosinophils/μL, or who had been discharged at the first ED visit are at higher risk of relapse.

Cited by 8 publications

References 0 publications

Trends and determinants of Emergency Room admissions for asthma: A retrospective evaluation in Northeast Italy

Trends and determinants of Emergency Room admissions for asthma: A retrospective evaluation in Northeast Italy

Oxidative Stress Attenuates TLR3 Responsiveness and Impairs Anti-viral Mechanisms in Bronchial Epithelial Cells From COPD and Asthma Patients

Assessing effects of personal behaviors and environmental exposure on asthma episodes: a diary-based approach

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