ABSTRACT
Introduction/Aim: Treatable traits based personalised medicine has been shown to improve outcomes in severe asthma clinic. We assessed the feasibility of a randomised controlled trial of protocolised 'focused' and 'extended' treatable trait guided asthma management in patients not under a severe asthma clinic. Method(s): Ten week single-group cohort study. Participants had a doctor's diagnosis of asthma, asthma control questionnaire (ACQ) score >1, and a history of exacerbation in the last year. Patients already under the care of a severe asthma clinic or receiving high-dose inhaled corticosteroids, biological therapy or maintenance oral corticosteroids were excluded. Intervention(s): asthma medication according to application of a 'focused' treatable trait algorithm, targeting type-2 inflammation and airflow obstruction. Feasibility outcomes: recruitment rates, acceptability of intervention, willingness to enrol in a full RCT, need for 'extended' trait assessment after 10 weeks, and estimation of trait prevalence. Result(s): Recruitment ceased after 14 months with 30/50 participants due to difficulties associated with COVID-19. 92% found the intervention acceptable and were willing to be randomised in a future study. 65% remained not well-controlled with an ACQ >1 after 10 weeks and would have required the 'extended' algorithm. Participants had a mean (SD) 4.8(2.3) of 13 traits assessed. Participation in the study was associated with clinically important improvements in ACQ, -1.0 (1.5) units;St George Respiratory Questionnaire, -15.1 (14.7) units;Asthma Quality of Life Questionnaire, +1.0 (1.1) units;and FEV1, +0.4 (0.4) L. Post-bronchodilator airflow obstruction reduced from 60% of participants at study commencement to 35%. 53% of participants were allocated continuous oral corticosteroids at some point during the study. Conclusion(s): Protocolised treatable trait management was acceptable, associated with significant clinical benefit and a full trial appears feasible. Targeting two traits was insufficient to control asthma in the majority of patients over the timeframe of this study, despite significant corticosteroid exposure.
ABSTRACT
AIMS: To review the demographic and clinical characteristics of confirmed COVID-19 cases within the Greater Wellington Region (GWR). METHODS: A retrospective, observational study of all 96 confirmed COVID-19 cases in the GWR. The primary outcome was time taken from onset to complete resolution of symptoms. Secondary outcomes were the epidemiological and clinical characteristics of cases. RESULTS: The mean (SD) time from symptom onset to complete resolution was 19.1 (1.1) days. The mean (SD) age was 43.1 (16.9). 51% were male. The majority were of European ethnicity (84%), resided in the top five decile neighbourhoods (76%) and had travelled to New Zealand (69%). The mean (SD) time from onset of symptoms to obtaining RT-PCR testing results was 5.3 (0.4) days. The most common symptoms at onset were cough (36%), sore throat (22%) and fatigue (21%);the overall most common symptoms were cough (65%), sore throat (43%), headache (43%) and fatigue (42%);many symptoms were late manifestations. The most common co-morbidity reported was asthma (20%), with no reported exacerbations. The rate of secondary infections within households was 0.05 per primary infection. CONCLUSION: The demography of COVID-19 cases reflected the imported nature of cases. The clinical presentation of COVID-19 was highly variable and there were no particular symptoms that could accurately predict infection.