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1.
Lung India ; 39(SUPPL 1):S117-S118, 2022.
Article in English | EMBASE | ID: covidwho-1857152

ABSTRACT

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.

2.
Respirology ; 26(SUPPL 3):45, 2021.
Article in English | EMBASE | ID: covidwho-1583444

ABSTRACT

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.

3.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):455, 2021.
Article in English | EMBASE | ID: covidwho-1570397

ABSTRACT

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.

4.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):468-469, 2021.
Article in English | EMBASE | ID: covidwho-1570395

ABSTRACT

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.

5.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):425, 2021.
Article in English | EMBASE | ID: covidwho-1570394

ABSTRACT

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.

6.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):487-488, 2021.
Article in English | EMBASE | ID: covidwho-1570381

ABSTRACT

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.

7.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):113, 2021.
Article in English | EMBASE | ID: covidwho-1570349

ABSTRACT

Background: The treatment with controller medication, regular monitoring of symptoms and lung function is required for achieving and maintenance of asthma control in children. The telemedicine technologies using have benefits for distance monitoring, especially during the COVID-19 pandemic. The aim of the study was to analyze the efficacy of our developed mobile technology called MedQuizBot, to evaluate the patient adherence and satisfaction with it. Method: The 6 month prospective observation study of 68 children with asthma (4 to 17 ages) was conducted. All patients were offered to use MedQuizBot via Telegram messenger. Patients had to enter their peak expiratory flow (PEF) values daily and complete asthma control tests (ACT) monthly from March to September 2020 year. MedQuizBot sent notifications to enter data. All patients were able to send e-messages to the doctor via Telegram. Results: 41 patients agreed to use MedQuizBot for the asthma symptoms monitoring. Poor adherence to data entry was mostly detected: ACT was completed 1.5 times, CACT-1.8 times in average. Uncontrolled asthma was observed 7 times more often in children >12 y.o. (27%), than in children under 12 y.o (4%). PEF values were entered by 21 patients (51%). Patients <12 y.o., who completed the test with the parents, entered data 7 times more often, than adolescents. 70% of patients had good asthma control. The data were entered 2.5 times more often during the lockdown in Moscow, caused by COVID-19 pandemic and high tree pollen season in spring compared to summer 2020 (609 and 263 interactions, respectively). 5 patients (12%) sent questions to the doctor about their symptoms (cough, shortness of breath, nasal congestion or sneezing) and received the answers with recommendations. Most patients (92%) noted the satisfaction with MedQuizBot using, its effectiveness in achieving asthma control and would agree to use it again. Conclusion: Among various telemedicine technologies, the use of messengers for monitoring asthma patients seems to be the most effective. MedQuizBot was effective in achieving asthma control and is especially needed for monitoring the patients with insufficient disease control, during pollen allergens exposure, acute respiratory diseases, pandemic, poor access to health care.

8.
J Asthma ; 58(9): 1270-1272, 2021 09.
Article in English | MEDLINE | ID: covidwho-592353

ABSTRACT

INTRODUCTION: Only little is known about COVID-19 in patients with asthma. There is no data on COVID-19 in patients with severe asthma or patients with asthma who are treated with monoclonal antibodies. CASE STUDY: Here, we present the case of a severe eosinophilic asthmatic in whom benralizumab treatment, an anti-IL-5R monoclonal antibody, was initiated 2 years ago. Prior to benralizumab treatment, every viral infection had resulted in a prolonged course of oral corticosteroids (OCS). Since initiation of benralizumab, the patient has had good asthma control. Mid-March 2020, the patient developed high fever. RESULTS: A SARS-CoV-2-PCR (nasopharyngeal swab) was positive. The patient's symptoms subsided after few days. No OCS was needed. The asthma control questionnaire 6-item scale worsened moderately in the week of the infection and returned to normal levels thereafter. The asthma control test, measuring longer term asthma control, showed no decline. CONCLUSION: The course of COVID-19 was very mild in this particular patient with severe eosinophilic asthma. So far, there is no evidence that would suggest a more severe course of COVID-19 in patients with asthma. It is worth noting, that prior to the initiation of benralizumab this patient had multiple exacerbations per year triggered by viral infections (4/year), which all required OCS. Whilst only anecdotal, this case study provides the first evidence to support the current recommendation of continuing monoclonal antibodies in patients with severe asthma during the COVID-19 pandemic.


Subject(s)
Anti-Asthmatic Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Asthma/complications , Asthma/drug therapy , COVID-19/complications , Adult , Humans , Male , Pandemics , SARS-CoV-2 , Severity of Illness Index
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