Four seasons of Czech asthma study: asthma characteristics and management reality in the Czech Republic.

Objective: To describe the characteristics and management of asthma in clinical practice in the Czech Republic in the context of international guidelines and clinical realities.Methods: Data were collected over four seasons from summer 2016 to spring 2017 and are mostly presented using descriptive statistics.Results: We obtained valid data for 4557 adult patients with asthma, including detailed phenotyping (71% eosinophilic allergic, 10% eosinophilic non-allergic, 19% non-eosinophilic non-allergic asthma) from 58 allergologists and 56 pulmonologists. The average time to diagnosis was 3 years. In more than half of the subjects, bronchodilator testing (BDT) results were available at primary diagnosis. More than 10% of physicians did not test for mold allergy. Occupational asthma was diagnosed in 0.7% of subjects. According to the attending physician, 68% of patients had well-controlled and 10% had uncontrolled asthma. Ninety-four percent of patients were on preventive treatment, with 91% using an inhaled corticosteroids (ICS) at an average dose of 705 µg/day budesonide equivalent. Approximately 75% of patients were on an ICS/LABA, with 91% using fixed combinations. Among patients using ICS/formoterol, a maintenance and reliever therapy regime was prescribed in 67%.Conclusions: The quality of asthma management in the Czech Republic is comparable to that of other developed countries and better in some respects (frequent BDT, phenotyping, and use of preventive treatment). Nevertheless, there is unnecessary delay in diagnosis and lack of research on possible environmental causes (workplace, molds). Pharmacotherapy shows good adherence to guidelines. Although 10% of patients show poor control, there is concurrently a trend for overtreatment.

The effect of omalizumab treatment on severe allergic asthma and allergic comorbidities: real-life experience from the Czech Anti-IgE Registry.

INTRODUCTION: Omalizumab is indicated for the treatment of severe allergic asthma (SAA) and chronic spontaneous urticaria, although a number of studies have confirmed the effectiveness of this therapy also for other IgE-mediated diseases. AIM: To assess the impact of anti-IgE therapy on SAA and comorbid IgE-mediated allergic diseases in patients treated with omalizumab for SAA enrolled in the CAR (Czech Anti-IgE Registry). MATERIAL AND METHODS: Three hundred and ten patients with SAA treated with omalizumab were enrolled in the CAR. Two hundred and twenty-nine individuals were evaluated after 12 months of omalizumab treatment for asthma control test (ACT), examination of fractional exhaled nitric oxide (FENO), forced expiratory volume in 1 s (FEV1), the use of systemic corticosteroids, side effects of treatment and clinical effect of omalizumab on allergic comorbidities (allergic rhinitis, chronic urticaria, atopic dermatitis and food allergy). RESULTS: After 12 months of treatment with omalizumab, patients experienced a significant improvement of ACT and FEV1, reduction of FENO, use of systemic corticosteroids for asthma exacerbations and dose of maintenance oral corticosteroid therapy. The positive effect of treatment with omalizumab was observed in 82.2% of patients with allergic rhinitis, in 85.7% of patients with chronic urticaria, in 82.1% of patients with atopic dermatitis, and in 67.3% of patients with food allergy. CONCLUSIONS: In the CAR registry, patients with SAA treated with omalizumab showed a significant positive effect of anti-IgE therapy not only on the asthma control, but also on allergic comorbidities.

Effect of Nigella sativa (black seed) on subjective feeling in patients with allergic diseases.

Nigella sativa (black seed) is an important medicinal herb. In many Arabian, Asian and African countries, black seed oil is used as a natural remedy for a wide range of diseases, including various allergies. The plant's mechanism of action is still largely unknown. Due to the lack of study data on its efficacy in allergies, four studies on the clinical efficacy of Nigella sativa in allergic diseases are presented. In these studies, a total of 152 patients with allergic diseases (allergic rhinitis, bronchial asthma, atopic eczema) were treated with Nigella sativa oil, given in capsules at a dose of 40 to 80 mg/kg/day. The patients scored the subjective severity of target symptoms using a predefined scale. The following laboratory parameters were investigated: IgE, eosinophil count, endogenous cortisol in plasma and urine, ACTH, triglycerides, total cholesterol, LDL and HDL cholesterol and lymphocyte subpopulations. The score of subjective feeling decreased over the course of treatment with black seed oil in all four studies. A slight decrease in plasma triglycerides and a discrete increase in HDL cholesterol occurred while the lymphocyte subpopulations, endogenous cortisol levels and ACTH release remained unchanged. Black seed oil therefore proved to be an effective adjuvant for the treatment of allergic diseases.