Multiple manifestations of uncontrolled asthma increase the risk of severe COVID-19.

OBJECTIVE: Asthma control is of importance when assessing the risk of severe outcomes of COVID-19. The aim of this study was to explore associations of clinical characteristics and the effect of multiple manifestations of uncontrolled asthma with severe COVID-19. METHODS: In 2014-2020, adult patients with uncontrolled asthma, defined as Asthma Control Test (ACT) ≤19 were identified in the Swedish National Airway Register (SNAR) (n = 24533). The SNAR database, including clinical data, was linked with national registers to identify patients with severe COVID-19 (n = 221). The effect of multiple manifestations of uncontrolled asthma was based on: 1) ACT ≤15, 2) frequent exacerbations and 3) previous asthma inpatient/secondary care and evaluated stepwise. Poisson regression analyses were conducted with severe COVID-19 as the dependent variable. RESULTS: In this cohort with uncontrolled asthma, obesity was the strongest independent risk factor for severe COVID-19 in both sexes, but even greater in men. Multiple manifestations of uncontrolled asthma were more common among those with severe COVID-19 vs. without: one, 45.7 vs. 42.3%, two, 18.1 vs. 9.1% and three, 5.0 vs. 2.1%. The risk ratio (RR) of severe COVID-19 increased with an increasing number of manifestations of uncontrolled asthma: one, RR 1.49 (95% CI 1.09-2.02), two, RR 2.42 (95% CI 1.64-3.57) and three, RR 2.96 (95% CI 1.57-5.60), when adjusted for sex, age, and BMI. CONCLUSIONS: It is important to consider the effect of multiple manifestations of uncontrolled asthma and obesity when assessing patients with COVID-19, as this increases the risk of severe outcomes substantially.

Onasm@: Helping severe asthma patients to prepare the telematic visit with their specialist

Background: In March 2020, the state of alarm was declared in Spain due to the health crisis caused by SARS-COV-2. The rapid spread of the virus generated uncertainty and concern about the impact it could have on patients with severe asthma (SA) and boosted for the first time the use of teleconsultation for the management of these patients. For this reason, it was necessary to facilitate the transition to a hybrid model that combines face-to-face and digital consultations. Objective(s): Development of the first document designed for SA patients, aimed to support the preparation of the telematic follow-up consultations with their specialist. Method(s): Nine experts in SA from different specialties: 4 allergists, 3 pulmonologists and 2 asthma unit nurses contributed to the conceptualization and development of the document. In a first phase of conceptualization, the profile of patients to which the material is addressed was defined and the minimum content needed to be useful to both patients and healthcare professionals (HCPs) was established. A first draft was prepared and refined after evaluation by adult patients and parents of pediatric patients through cognitive interviews. Result(s): Onasm@ is the first document intended for SA patients to prepare the telematic follow-up consultation with their specialist. It consists of three blocks: A first one with general considerations to be applied on the telematic consultation, a second one to collect all the information that might be requested by the healthcare professional (HCP) during the off-site visit (asthma medications, dosage, adherence, asthma crisis events, emergency visits and oral corticosteroid use) and the third block with tips for achieving and maintaining asthma control. The asthma control test (ACTTM) for adults and the children's version (cACTTM) is also incorporated. Conclusion(s): The transition to a hybrid healthcare model due to the pandemic situation makes it essential to support SA patients to face the telematic follow-up consultation with their specialist. Onasm@ is the first document designed to help patients to appreciate the information needed to face this type of visit, with the aim to promote a fluid communication with their HCP and more efficient visits. This type of document could be applied to the management of other conditions and as such have broader impact on the future of healthcare, which is currently immersed in far-reaching change and transformation.

A descriptive evaluation of COVID-19 disease in adult asthma patients at La Paz University Hospital

Background: COVID-19 is an infectious entity caused by the SARS-CoV-2 virus. There have been reported risk factors like chronic airway entities such as chronic obstructive pulmonary disease. Since asthma is a respiratory disease, it could be found as a risk factor to develop severe COVID-19 disease. However, most of the evidence reveals that asthma isn't associated with higher severity or worse prognosis. Madrid has been one of the most affected regions in the world during the pandemic. La Paz University Hospital has developed one of the largest cohorts in Europe. We used this data and described several characteristics around COVID-19 disease in asthma patients. Method(s): We collected data by individual review of the patients' electronic clinical records (DXC-HCIS, Healthcare Information System). Then we describe the general characteristics of the patients, their asthma, and COVID-19 evolution. The analyzed data includes general demographics, asthma classification (T2 or no T2), basal treatment, and pre-COVID-19 asthma control (by ACT and exacerbations). We studied acute COVID-19 disease symptoms and treatment, the presence of pneumonia, thromboembolism, the need for hospitalization, admission to the intensive care unit (ICU), and mortality. Result(s): The total number of patients studied was 173, the majority were women (67%) with an average age of 55 and type 2 asthma (67%) which was controlled before COVID-19 disease (ACT median was 25, the median of exacerbations was 0). The majority used the combination of long-acting beta 2 agonists and inhaled corticosteroids (ICS+LABA) for asthma treatment (67%). Only 2 patients were treated with omalizumab, which was discontinued during COVID-19 disease. The most frequent symptoms were cough and dyspnea (80% and 75% respectively). 4% of patients presented thromboembolism. 60% had pneumonia. 60% required hospitalization, 11% of whom died due to COVID-19 complications. The most common treatment was hydroxychloroquine and azithromycin (75% and 45% respectively), followed by oral corticosteroids (15%), lopinavir/ritonavir (8%), tocilizumab (5%), and remdesivir (2%). Conclusion(s): This cohort represents asthmatic patients in La Paz University Hospital. We observed that the proportion of hospitalizations, ICU admissions, and mortality due to COVID-19 was similar as described in previous studies and therefore no different from non-asthmatic patients. The characteristics presented in this study help us better understand the complications of asthmatic patients thanks to one of the largest COVID-19 cohorts in Europe.

Quality of life and the psychological status of the adolescents with asthma and their parents during the COVID-19 pandemic

Background: People's concerns about both health and emerging social life significantly affected not only their physical but also mental health during the COVID-19 pandemic. Patients those with chronic diseases such as asthma are more vulnerable about the outcomes of the pandemic. We aim to evaluate the anxiety and quality of life(QoL) of adolescents and their parents who were followed up with the diagnosis of asthma during the pandemic comparing with age-matched control group. Method(s): This study was conducted after the first lockdown of the coronavirus pandemic, namely new normalization period. Demographic features were noted, all adolescents completed the State-Trait Anxiety Inventories for Children(STAI-C) state and trait scales, and Pediatric QoL inventories(PedsQL). Parents also fulfilled PedsQL parent version, STAI state and trait scales. Asthma control test(ACT) was completed by only asthma group. Result(s): Totally 121 adolescents(61 asthma group[59% female];60 control group[73.8% female]) were included into the study. The mean age of the patients was 15.4(+1.69) and their parents was 41.52(+6.04) years. The comparative demographic and general characteristics of the patients are shown in Table 1. There were no significant difference in terms of PedsQL both child's and parent's perspective, STAI-C and STAI scores between study groups. In the asthma group 65.6% of the patients used asthma medications regularly and 73.8% of them continued asthma follow-up during the pandemic. The asthma group was divided into three subgroups according to asthma symptom control in Global Initiative for Asthma report (well-controlled, partly controlled, uncontrolled). The QoL was associated with asthma severity;PedsQL PH, PSH and TH scores were also significantly different according to the asthma control status, p value is < 0.001, 0.023 and 0.008, respectively. The uncontrolled asthma group had the lowest PedQL scores and also reached the highest STAI-C trait scores. Girls with asthma had significantly lower PedQL and ACT scores than boys. Conclusion(s): Although the quality of life and anxiety scores of children with asthma do not differ from control group, good asthma control in adolescents with asthma may improve QoL. Optimizing asthma treatment adherence and being aware of the difficulties that adolescents may experience during the pandemic is important. Clinicians should routinely enquire about mental health as well as physical health of patients with chronic diseases. (Table Presented).

Clinical outcomes in asthmatic patients following COVID 19 infection

Background: COVID-19 disease caused by SARS-CoV-2, has changed life as we know it, causing millions of deaths worldwide. Reported risk factors for mortality include advanced age, obesity, hypertension, diabetes mellitus, and chronic obstructive pulmonary disease. Although asthma is a chronic obstructive disease, most evidence reveals a protective effect between asthma, eosinophilia and COVID-19. La Paz University Hospital, in Madrid, has developed one of the largest cohorts in Europe, with more than 3500 patients with COVID-19. Our aim was to evaluate post-COVID-19 evolution at 6 and 12 months in asthmatic patients. Method(s): We selected the asthmatic patients in this cohort. We obtained information from their clinical history, including sex, age and comorbidities. We classified patients by T2 or non-T2 asthma and collected pre-COVID19 information: treatment, control (measured by asthma control test (ACT) and number of exacerbations), pulmonary lung function, eosinophils in blood and immunoglobulin E levels. Post-COVID-19 data after 6 and 12 months were recorded: symptoms (chest pain, cough, expectoration and dyspnea), ACT, number of exacerbations, the need to intensify the asthma treatment, and the pulmonary lung function. Result(s): Significant association was found between COVID-19 pneumonia in asthmatic patients and the risk of having chest pain after 6 months (p = 0.009). Fewer eosinophilic count was associated with dyspnea 6 months post-covid (p = 0.043). Asthmatic smokers had an increased risk of thromboembolism 12 months after COVID-19 (p = 0.025). Although significant association standards were not met nor demonstrated, thoracic pain was more frequent 6 months post-COVID-19 in non-T2 asthmatic patients (44.4%) than T2 patients (20.3%) (p = 0.064). Eosinophilic asthma (eosinophil counts higher than 250/ mcl), presented lower prevalence of chest pain 12 months post-COVID-19 (p = 0.081). Conclusion(s): This is the first study that demonstrates the association between risk of chest pain and dyspnea after 6 months in asthmatic patients with COVID-19 pneumonia. It was also found that if these patients smoked, there was an increased risk of thromboembolism at 12 months. Further studies, with a higher number of patients are needed to explore deeply the impact of COVID-19 in asthma outcomes.

Evaluation of Asthma Control Status and Anxiety Level During the COVID-19 Pandemic in Children with Asthma.

Objective: We aimed to evaluate asthma control status, drug compliance and anxiety levels of children and their parents who were followed up with the diagnosis of asthma during the COVID-19 pandemic. Material(s) and Method(s): Sixty-seven children aged between 8-12 years diagnosed with asthma and their parents were prospectively recruited to the study. A questionnaire including demographic features such as age, gender, asthma medications and questions about COVID-19 prepared according to a 5-point Likert scale was conducted to the parents. Children completed the State-Trait Anxiety Inventories for Children (STAI-C) scales, and childhood asthma control test(c-ACT). Parents also fulfilled STAI scales. Result(s): The mean age of the patients was 9.5+/-1.2 years, the median follow-up period for asthma (C-ACT) was 36 (21-66) months, and 45 (67.2%) were male. Most of the children were using their asthma medication regularly. Children's STAI-C state and trait anxiety scores showed a statistically significant positive correlation with parents' STAI state and trait anxiety scores. The anxiety levels of parents who thought that they would get the disease and that there would be no effective treatment and vaccine against COVID-19 were found to be higher. Conclusion(s): During the pandemic period, regular asthma follow-up and drug compliance are very important controlling asthma symptoms in children. Considering the effects of the pandemic in children with asthma, psychosocial evaluations during outpatient controls may have positive effects on children's mental health and disease control.Copyright © 2021 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Impact of the COVID-19 pandemic on Swedish asthma and COPD care

Background: Since the start of the pandemic, healthcare resources have been prioritized for covid-19 care. Aim(s): To describe the impact of the COVID-19 pandemic on the care of patients with asthma and COPD in Sweden. Method(s): Within the Swedish National Airway Register (SNAR), healthcare data on patients with asthma and COPD has been registered since 2013 in primary and secondary care. The variables included in SNAR are harmonized with guidelines which gives the opportunity to identify inequalities and sub-optimal care of patients with obstructive lung diseases. Result(s): The cumulative number of unique patients with asthma and COPD in SNAR were in 2019 n=277467, 2020 n=310436 and 2021 n=334639. Since the initiation of SNAR, annual registrations of visits, spirometries and other follow-up test have increased until the start of the covid-19 pandemic. Compared with 2019, total number of registrations decreased with 21% in 2020, and 41% in 2021 (Fig 1), while registrations of new patients decreased with 31% in 2020, and 50% in 2021, similarly in both asthma and COPD. The numbers of spirometries, available data on Asthma Control Test, and COPD Assessment Test decreased with 53%, 40% and 46% respectively, in 2021 compared with in 2019. Conclusion(s): The reduced number of patient registrations, spirometries, and the use of symptom questionnaires shows that diagnosis and the care of patients with asthma and COPD have been highly affected by the pandemic.

Predictors of severe COVID-19 among patients with uncontrolled asthma: a register- based study

Background: Uncontrolled asthma is a risk factor for severe COVID-19. However, research on predictors of severe COVID-19 in patients with a history of uncontrolled asthma is still limited. Aim(s): To identify factors associated with severe COVID-19 in patients with uncontrolled asthma. Method(s): Based on the Swedish National Airway Register, a cohort of 24533 adult patients with uncontrolled asthma were identified in primary and secondary care. Most recent clinical data were obtained before the COVID-19 pandemic. Uncontrolled asthma was defined as Asthma Control Test (ACT) score <=19. By linkage to other Swedish registers, n=221 (0.9%) individuals with severe COVID-19 were identified (defined as hospitalization or death due to COVID-19). Result(s): Patients with severe COVID-19 (n=221) were older (mean 63.3 vs 50.4 years, p<0.001), had a higher BMI (mean 32.9 vs 28.6, p<0.001), lower FEV1 % predicted (mean 76.8 vs. 83.1, p<0.001) and lower ACT scores (mean 14.2 vs 15.2, p<0.001) than those without severe COVID-19 (n=24312). A higher proportion of patients with severe COVID-19 had antihistamine treatment, oral corticosteroids medication, and higher doses of inhaled corticosteroids, compared to patients without severe COVID-19. In both groups, about 50% had received patient education on asthma. Conclusion(s): Among patients with uncontrolled asthma, severe COVID-19 was associated with a history of increased need for asthma medication and lower FEV1 % predicted. Despite all patients having uncontrolled asthma, only about half had received patient education on asthma before the pandemic.

Better COVID-19 outcomes in children with good asthma control

Background: The role of pediatric asthma in susceptibility to COVID-19 is poorly defined. The aim of our study was to assess possible risk factors for severe COVID-19 in children with asthma. Method(s): In our observational study, we systematically assessed the occurrence of COVID-19 in children with asthma <18 years in a six-month period prior to their regular outpatient visit in our asthma clinic from December 1, 2020 to March 31, 2021, by using a predefined questionnaire. We compared characteristics of patients presenting with signs of SARS-CoV-2 upper (URTI) or lower respiratory tract infection (LRTI), focusing on factors that could be associated with severity of COVID-19, such as asthma phenotype, treatment with inhaled corticosteroids (ICS), asthma severity and the degree of asthma control assessed by the Asthma Control Test at the outpatient visit. Result(s): Out of 210 screened patients, 27% (57/210) reported exposure to COVID-19. Forty-two children were symptomatic after the exposure. In the symptomatic group, 64% (27/42) reported symptoms of URTI and 36% (15/42) of LRTI. We observed poorer asthma control in patients with LRTI compared to URTI (80% vs 7%, p <0.001). Moreover, patients with LRTI were older (14.6+/-3.2 years vs 12.0+/-4.1 years, p=.042), more frequently girls (60% vs 26%, p=.029), with a non-allergic asthma phenotype (43% vs 13%, p=.020). Regular ICS use and asthma severity were not associated with COVID-19 presentation in these children. However, patients on regular ICS had better asthma control (p=.026). Conclusion(s): The results of our study suggest that good asthma control, treatment adherence optimization and allergic asthma phenotype enable better COVID-19 outcomes in children with asthma.

Evaluation of Asthma Control Status and Anxiety Level During the COVID-19 Pandemic in Children with Asthma

Objective: We aimed to evaluate asthma control status, drug compliance and anxiety levels of children and their parents who were followed up with the diagnosis of asthma during the COVID-19 pandemic. Material and Methods: Sixty-seven children aged between 8-12 years diagnosed with asthma and their parents were prospectively recruited to the study. A questionnaire including demographic features such as age, gender, asthma medications and questions about COVID-19 prepared according to a 5-point Likert scale was conducted to the parents. Children completed the State-Trait Anxiety Inventories for Children (STAI-C) scales, and childhood asthma control test(c-ACT). Parents also fulfilled STAI scales. Results: The mean age of the patients was 9.5±1.2 years, the median follow-up period for asthma (C-ACT) was 36 (21-66) months, and 45 (67.2%) were male. Most of the children were using their asthma medication regularly. Children's STAI-C state and trait anxiety scores showed a statistically significant positive correlation with parents' STAI state and trait anxiety scores. The anxiety levels of parents who thought that they would get the disease and that there would be no effective treatment and vaccine against COVID-19 were found to be higher. Conclusion: During the pandemic period, regular asthma follow-up and drug compliance are very important controlling asthma symptoms in children. Considering the effects of the pandemic in children with asthma, psychosocial evaluations during outpatient controls may have positive effects on children's mental health and disease control.

Evaluation of Asthma Control Status and Anxiety Level During the COVID-19 Pandemic in Children with Asthma.

Objective: We aimed to evaluate asthma control status, drug compliance and anxiety levels of children and their parents who were followed up with the diagnosis of asthma during the COVID-19 pandemic. Material(s) and Method(s): Sixty-seven children aged between 8-12 years diagnosed with asthma and their parents were prospectively recruited to the study. A questionnaire including demographic features such as age, gender, asthma medications and questions about COVID-19 prepared according to a 5-point Likert scale was conducted to the parents. Children completed the State-Trait Anxiety Inventories for Children (STAI-C) scales, and childhood asthma control test(c-ACT). Parents also fulfilled STAI scales. Result(s): The mean age of the patients was 9.5+/-1.2 years, the median follow-up period for asthma (C-ACT) was 36 (21-66) months, and 45 (67.2%) were male. Most of the children were using their asthma medication regularly. Children's STAI-C state and trait anxiety scores showed a statistically significant positive correlation with parents' STAI state and trait anxiety scores. The anxiety levels of parents who thought that they would get the disease and that there would be no effective treatment and vaccine against COVID-19 were found to be higher. Conclusion(s): During the pandemic period, regular asthma follow-up and drug compliance are very important controlling asthma symptoms in children. Considering the effects of the pandemic in children with asthma, psychosocial evaluations during outpatient controls may have positive effects on children's mental health and disease control. Copyright © 2021 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Impact of Telehealth Visits on Outcomes among Black and Latinx Patients with Moderate-Severe Asthma

Introduction: Black and Latinx patients bear a disproportionate burden of asthma-related morbidity partly due to inadequate healthcare access. Telehealth could improve access, but its impact on asthma outcomes compared to in-person visits in these populations is unknown. Method(s): Black and Latinx adults with moderate-severe asthma were recruited from US clinics, including Puerto Rico for the PREPARE trial. For this ancillary study, 7/19 sites had available EMR data on asthma care appointment setting (telehealth vs. in-person). Participants whose asthma care included telehealth (TH) vs. those with exclusively in-person visits (IP) starting at COVID-19 pandemic onset (3/2020, greater telehealth prevalence) through 4/2021 (last PREPARE exit) were included if 2+ monthly PREPARE surveys were available for the post-index visit period. Asthma control (ACT) and asthma-related quality of life (ASUI) were compared between TH vs. IP. Result(s): Data were available for n=62 TH and n=36 IP participants, with comparable duration of follow-up (6.36 vs. 6.42 months, respectively). TH were more likely Latinx, from the Northeast, employed, only use inhaled corticosteroids as controller therapy, lower BMI, and lower self-reported asthma therapy adherence compared to IP. Before and after adjustment for these baseline differences and for PREPARE treatment assignment and baseline ACT and ASUI scores, TH and IP had comparable follow-up asthma control (ACT 18.43 vs. 18.93, respectively, p=0.519) and asthma-related quality of life (ASUI 0.79 vs. 0.84, respectively, p=0.163). Conclusion(s): Asthma control and asthma-related quality of life were comparable between TH and IP after adjustment. TH may represent a valuable asthma care option for Black and Latinx patients. Copyright © 2022

Pharmacist care in Federally Qualified Health Centers: A narrative review

Federally Qualified Health Centers (FQHCs) are critical to providing care to underserved populations in the United States. Their focus on interprofessional care has also made FQHCs ideal locations to integrate pharmacists into care teams and advance pharmacy practice. However, despite long-standing involvement by pharmacists, there have been limited attempts to synthesize this literature. We conducted a comprehensive search for published literature on the roles of pharmacists in FQHCs and narrowed our search to 54 manuscripts and s for inclusion in this narrative review. We found that pharmacists in FQHCs are providing care that is interprofessional, multifaceted, and evolving rapidly in response to environmental changes. Pharmacists are routinely involved in the traditional management of chronic disease, such as diabetes, hypertension, behavioral health, and respiratory conditions. In addition, pharmacists have forged roles in preventive care, infectious disease, and pain management. Models include appointment-based approaches;however, there was also heterogeneity in approaches consistent with the dynamic nature of the healthcare system in the United States with engagement in population health, transitions of care, and telehealth, as a few examples. Collaborative practice agreements were used to deliver care in some cases, although this was not commonplace, and reimbursement by third party payers was rarely addressed. Relationships with community pharmacies, often driven by the 340B Drug Pricing Program, were also noted. Recommendations for future research in this area include increasing the rigor of future research by standardizing pharmacy interventions and including comparator groups, a greater focus on financial sustainability, and further exploration of how state laws surrounding pharmacist provider status and scope of practice impact pharmacy service development. Copyright © 2022 The Authors. JACCP: Journal of the American College of Clinical Pharmacy published by Wiley Periodicals LLC on behalf of Pharmacotherapy Publications, Inc.

A study of correlation between asthma control test and lung function parameters

Introduction: Asthma control is the extent to which symptoms of asthma observed in patients and reduction in symptoms after treatment. Simple screening tools are available to assess asthma control. Asthma control test is a simple numerical scoring system that can be easily used on a routine basis. Latest GINA guidelines stress that asthma control is the main objective of asthma treatment. In this COVID pandemic situation there is a hesitancy in performing and undergoing pulmonary function tests among physicians and the patients. Hence in this study was planned to correlate the asthma control test values with FEV1 and other parameters like PEFR, AEC and serum magnesium. Methods: This study was conducted at Department of Pulmonary Medicine, SRM Hospital & Research centre, Chennai. It is a retrospective cross-sectional observational study. Patients of Bronchial Asthma in line with GINA Guidelines were included in the study. AIMS and OBJECTIVES: To study the correlation between asthma control test and FEV1, To study the correlation between asthma control test and other parameters like Peak expiratory flow rate, Absolute eosinophil count and Serum magnesium. Results: Asthma control test had positive correlation with FEV1 with a spearman's correlation of 0.2758 and P value of 0.0414 which was statistically significant. The spearman's correlation between Asthma control test and AEC was -0.4583 with a P value of 0.00043, which was significant. The correlation of asthma control test with serum magnesium was 0.3414 with a p value of 0.010. Conclusion: Asthma control test score had a significant positive correlation with FEV1 and serum magnesium levels. It also had significant negative correlation with Absolute eosinophil count (inflammatory marker). Hence Asthma control test can be used as tool for treatment response in the current COVID pandemic situation and also in resource limited settings.

Asthma status during COVID-19 pandemic

Background and Aims: The social restrictions in COVID- 19 pandemic can affect to patient's asthma status. The use of telecommunications by the physician to know the patient's asthma status during pandemic is recommended. This study aims to determine patient's asthma status before the COVID-19 pandemic compared to one year after. Methods: This preliminary study was a retrospective cohort which was conducted in March of 2020 and March of 2021 at Asthma Polyclinic, Persahabatan Hospital, Jakarta. The subjects were asthma patients who visited Asthma Polyclinic in March of 2020 and requires an ACT score. Patients who didn't come to Asthma Polyclinic in March of 2021 will be contacted by the researchers. Results: The ACT score in March of 2020 are 6% patients had fully controlled asthma, 34% of partial controlled asthma and 60% of uncontrolled asthma while in March of 2021, 26% have fully controlled asthma, 26% of partial controlled asthma and 48% of uncontrolled asthma. There was a significant difference between ACT score in March of 2020 and March of 2021 with a p value 0.020. The patient's activities during pandemic was decreasing, 80% patients who didn't work, while 20% were still working. There was a significant difference between patient's severity of asthma and ACT score in March of 2021 with a p value <0,05. Conclusion: There is a significant difference between the ACT score in March of 2020 and March of 2021, also a significant difference between patient's severity of asthma and ACT score in March of 2021.

Overview of severe asthma disease control during the second wave of COVID-19 pandemic in Albania

Background: Under the restriction of direct access to specialized health care, COVID-19 pandemic, has created an “iceberg” regarding disease control data in severe Bronchial Asthma (BA). We aimed to evaluate indicators of asthma control, in severe persistent BA, consequences of pandemic and in-person visits limitations among this patient population. Method: A cross-sectional study, obtained data from 86 patients with yearly pre-pandemic hospitalizations, at the only tertiary hospital center for severe persistent BA in Albania. Descriptive data analysis was performed through anamnestic and clinical records. Standardized and validated questionnaires for inhalers adherence and asthma control, have been performed though phone interview during January 2021. Patients under treatment with biologic drugs (anti-IgE) and allergen specific immunotherapy have been excluded. Results: 64% were classified as high TH2 phenotype, predominating late-onset eosinophilic asthma (30.2%), and in low TH2 phenotype, with predominance of obesity associated asthma (18.6 %). 66,3 % were females with mean age of 49.3 ± 13.9. Overall Asthma Control Test (ACT= 19.5 ± 3.8), 43% controlled (20-25 points), with no statistically significant differences, between sex and phenotypes. Among early onset allergic asthma phenotype (25,6%), lower ACT score (18.5 ± 1.5) resulted in outdoor + indoor allergen polysensitization, compared to monosensitization (p < 0.05). Seasonal influenza vaccination rate was 16.2%, ACT score between vaccinated and unvaccinated groups, with significant difference (p = 0.03). Prevalence of confirmed COVID-19 was 15.1%, only 1,2% severe. ATC score, between confirmed or suspected post COVID-19 severe ABs and COVID-19 negative, was not statistically significant. Coexistence of sporadic and intentional nonadherence affected ACT score (p = 0.01), between controlled (ACT, 20-25) and uncontrolled group (ACT<20 points). Conclusion: Asthma control in severe persistent BA population was <50%, affected by sensitization profile, seasonal flu vaccination and type of non-adherence to inhalers. Differences of disease control in ACT score, were not statistically related with phenotype, sex or post COVID-19 infection condition. Particularly, Severe Persistent Bronchial Asthma needs a periodic specialist care to reach disease control and to lower the burden of indirect pandemic effects on disease progression.

Terrific improvement of refractory atopic dermatitis with benralizumab (anti-IL5 receptor) therapy

In 2012 a 25-year-old man presented to our outpatient clinic for severe atopic dermatitis (AD) and severe allergic eosinophilic asthma in polisensitivity (house dust mite, cat, gramineous plants, birch, milk protein and, in particular, Alternaria). His clinical history was also characterized by gastro-esophageal reflux disease and chronic rhinitis without polyposis, with septal deviation and turbinate hypertrophy, worthy of surgical intervention. History taking revealed egg and cow milk protein allergy and severe asthma since the first months of life, with frequent hospital admissions due to exacerbations. AD was severe and diffuse, involving especially face, neck, back and superior limbs, often complicated by impetigo. The esthetic, social and psychological impact led him to quit his job as a barman. At presentation, the Eczema Area and Severity Index (EASI) score was 72/72. Laboratory tests showed eosinophilic count ranging between 1.060 and 2.140/mm3, and high serum levels of total Immunoglobulin E (5.939 kUI/L). Tryptase levels were normal and autoantibody analysis was negative. Parasite stool examination was negative. Nasal swab tested positive for Staphylococcus aureus, which was treated with Sulfamethoxazole-Trimethoprim. Asthma Control Test was 15/25, pulmonary function tests (PFTs) showed mild obstruction (FEV1 4.43 L, 103%, FEV1/FVC 69%), with positive bronchodilator testing (FEV1 5.12 L, + 670 mL, + 16%). Firstly, he was treated with topical steroids and sometimes with oral corticosteroids, with poor response. Then, in July 2019, he initiated therapy with cyclosporine 3-5 mg/kg. Soon, the drug had to be discontinued due to adverse effects (gastrointestinal symptoms and infections). In November 2019, at the age of 32 years, he started therapy with monoclonal antibody anti-IL-5 receptor alpha (benralizumab 30 mg 1 subcutaneous vial every 4 weeks for the first three administrations and then every 8 weeks), with a terrific clinical improvement of AD since the first administrations and with benefit on asthma control (ACT after the first administration increased up to 25/25;PFTs could not be performed, due to SARS-CoV-2 pandemic). This therapy has always been well tolerated. The eosinophilic count decreased to 0/mm3 after the first administration. At the moment, after one year of therapy, AD is almost fully disappeared (EASI SCORE 4/72), despite being in free diet, and the quality of life of the patient has definitely improved.

House dust mite sublingual immunotherapy in patients with receiving subcutaneous immunotherapy maintenance phase: A randomized controlled trial

Background: Allergen-specific immunotherapy (AIT) is the only treatment that cures allergic diseases. Subcutaneous immunotherapy (SCIT) is a conventional treatment which introduced more than 100 years ago. Novel oral formulation sublingual immunotherapy (SLIT) has shown equal efficacy to SCIT, while it is safe without life-threatening allergic reaction. Amid a pandemic of COVID-19, patients are advised to avoid hospital visits. SLIT might be the right choice because patients can take the tablets at home and no need to go to the hospital for weekly injections like SCIT. However, no recent report on the efficacy of changing the route of immunotherapy from SCIT to SLIT. The study aims to assess the efficacy of switching SCIT to SLIT in patients with house dust mite (HDM) allergy. Method: A randomized controlled study was undertaken in 40 patients with allergic rhinitis with/without asthma and receiving maintenance phase of HDM SCIT (TCTR20200606002). HDM SLIT tablet was given daily for 12 weeks and compared to patients with continue SCIT. The principle outcome measure was symptom-medication score (SMS) and asthma control test (ACT) score. immunologic changes in fresh whole blood to monitor T cell subsets, including regulatory T cells (tregs), dysfunctional tregs, and T helper 2 cells were investigated by the flow cytometry method and Der p2-specific IgE, Der p2-specific IgG4 and Der p2-specific IgE/IgG4 were investigated by ELISA method at baseline and 12 weeks after switching treatment. Results: Of 40 patients, 19 patients in the SLIT group and 20 patients in the control group achieved the study. There were no significant differences in SMS and ACT scores between the SLIT group and SCIT group during 12 weeks of treatment. Significantly reduced SMS after 8 weeks compared to baseline (17.6 ± 2.9 to 14 ± 2.4, p = 0.028) was demonstrated in the patients with SLIT. T cell subsets' frequency, specific IgE, IgG4 and IgE/IgG4 ratio did not change significantly in both groups at the end of the study. No severe adverse drug reactions were reported.

Changes in asthma control after administration of COVID-19 mRNA vaccines

Background: Rapid development of vaccines to prevent coronavirus disease 2019 (COVID-19) has become a global imperative. Two mRNA vaccines have been recently approved by European Medicines Agency: BNT162b2 and mRNA-1273 COVID-19 vaccine. They have demonstrated safety in 1-3 phase clinical trials but data in asthmatics vaccinated in real-life is scarce. We sought to assess the change in asthma control before and 4 weeks after the administration of mRNA vaccine against COVID-19 in adults diagnosed with mild to severe asthma. Method: We performed an observational descriptive study of asthmatic healthcare workers who were vaccinated in our Allergy Department. Asthma severity were measured following Spanish Guideline on the Management of Asthma (GEMA) criteria. Asthma control was evaluated prior to vaccination and 4 weeks after vaccination using Asthma Control Test (ACT) questionnaire. The mRNA vaccines were administered under medical supervision and 30 minutes observation. Results: We recorded a total of 52 asthmatic healthcare workers who receive COVID-19 vaccination in our Allergy Department. The mean age was 52.3 years (range 21-66) and 46 (88.5%) were female. Ten (19.2%) and 42 (80.8%) subjects received BNT162b2 and mRNA-1273 COVID-19 vaccine, respectively. Twenty patients (38.5%) had intermittent asthma, 8 (15.4%) mild, 18 (34.6%) moderate, and 6 (11.5%) severe asthma. One patient was receiving oral corticosteroids and one biologic treatment. Coexisting allergic diseases were common: 26 (50%) had allergic rhinitis, 5 (9.6%) atopic dermatitis, 18 (34.6%) food allergy, 19 (36.5%) drug allergy. Other comorbidities were cardiovascular disease (23.1%), obesity (21.2%), autoimmunity (19.2%) and nasal polyposis (5.8%). The ACT before vaccination was 24.2 (range 21-25, SD 1.4). We detected 2 (3.8%) patients with ACT<20 who were vaccinated once ACT was ≥20. Four weeks after the first and second dose of mRNA vaccine, ACT was 23.4 (range 10-25, SD 2.6) and 23.8 (range 12-25, SD 2.5), respectively. We found no statistical significant differences in ACT changes among intermittent, mild, moderate, and severe asthma. Conclusion: In our experience, asthma exacerbation after mRNA vaccination is infrequent and not related to asthma severity. Asthmatic population can safely receive mRNA vaccines against COVID-19.