Pediatric asthma control in <scp>A</scp>sia: <scp>P</scp>hase 2 of the <scp>A</scp>sthma <scp>I</scp>nsights and <scp>R</scp>eality in <scp>A</scp>sia‐<scp>P</scp>acific (<scp>AIRIAP</scp> 2) survey

Wong, Gary; Kwon, Namhee; Hong, Jian‐Guo; Hsu, Jeng Yuan; Gunasekera, Kirthi

doi:10.1111/all.12117

Cited by 53 publications

(54 citation statements)

References 29 publications

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“…In the AIRIAP report, 884/3,207 (27.6%) subjects were children presenting with mild-intermittent severity in 60.1%, mild-persistent severity in 19.1%, moderate-persistent severity in 12.8%, and severe-persistent severity in 8.0% when asthma severity based on the symptom severity index was assessed.6 In another report on the same study, in addition, 401 (12.5%) subjects were Korean and they presented with mild-intermittent severity in 48%, mild-persistent severity in 19%, moderate-persistent severity in 19%, and severe-persistent severity in 14% 22. In the second phase of the AIRIAP report performed in 2006, 400/4,805 (8.3%) subjects were Koreans and their asthma severity were presented as mild-intermittent in 67%, mild-persistent in 22%, moderate-persistent in 9%, and severe-persistent in 2% 23. However, these data were not directly comparable to the results of the present study as our results were derived from subjects who visited allergy clinics by patients themselves.…”

Section: Discussioncontrasting

confidence: 88%

“…On the other hand, severe asthma comprised <3% which is lower than that previously reported in Western countries 52425. The severity distribution towards a milder one is consistent with AIRIAP report that Korean subjects had milder diseases than others in the Asia-pacific region 23. This milder severity does not seem to be associated with the study periods or the participating centers.…”

Section: Discussionsupporting

confidence: 87%

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Asthma Severity and the Controller Prescription in Children at 12 Tertiary Hospitals

Suh

Yang

Kim

et al. 2017

Allergy Asthma Immunol Res

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PurposeGuidelines need to be tailored to where they are applied. We aimed to describe the distinctive asthma severity profile and the pattern of controller prescription in Korean children.MethodsTwelve pediatric allergists from tertiary medical centers reviewed medical records of all asthmatic children who visited their clinics between September 1 and November 30 of 2013. Controller prescriptions were re-classified into 4 categories, then the prevalence of each asthma severity category and the controller prescription patterns according to asthma severity assessed by a Western (Global Initiative for Asthma, GINA) and an Asia-Pacific (Japanese Pediatric GuideLine, JPGL) guideline were evaluated.ResultsA total of 840 cases were reviewed. Both GINA and JPGL revealed that 328 (39.0%) and 249 (29.6%) subjects had intermittent asthma whereas 24 (2.9%) and 21 (2.5%) subjects had severe persistent asthma, respectively. Although higher category controllers tended to be prescribed to those who had more severe asthma, there was much overlap in categories of prescribed controllers between groups with regard to asthma severities. Leukotriene receptor antagonists (LTRA) was the most frequently prescribed as a single controller (40%) or as an add-on medication (19%) in the group of asthmatic children <6 years.ConclusionsKorean children have distinctive patterns of asthma severity and management strategies with a lower prevalence of severe asthma and a preference toward LTRA rather than low dose inhaled corticosteroids (ICS) alone or add-on long-acting beta-agonist (LABA) in the group of <6 year-old asthmatics that has not been predicted in Western countries. Thus, strategies tailored to regional situations need to be developed and recommended.

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

Asthma Severity and the Controller Prescription in Children at 12 Tertiary Hospitals

Suh

Yang

Kim

et al. 2017

Allergy Asthma Immunol Res

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“…We also found significant association between the frequency distribution of C‐ACT total score and the level of GINA asthma control. Asthma was uncontrolled in 61% of our children as found by others .…”

Section: Discussionsupporting

confidence: 83%

Development of a nomogram to estimate the quality of life in asthmatic children using the Childhood Asthma Control Test

Montalbano

Cilluffo

Gentile

et al. 2016

Pediatric Allergy Immunology

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Background: Pediatric Asthma Quality of Life Questionnaire (PAQLQ) provides detailed information on QoL in asthmatic children, whereas Childhood Asthma Control Test (C-ACT) Questionnaire is the most validated instrument for asthma control. No study assessed the relationship between C-ACT and QoL in children by means of those instruments. The aim of this study was to determine whether a QoL estimation is possible using the C-ACT questionnaire in asthmatic children. Methods: Medical history, spirometry, C-ACT, and PAQLQ were assessed in 144 (60% male) outpatient asthmatic children from September 2011 to November 2014. A generalized linear model (GLM) for the prediction of PAQLQ was obtained through a stepwise procedure starting from a full model with all C-ACT items, and predictive nomograms were created. Results: Fifty-five (38%) well-controlled (WC) asthma, 37 (26%) partially controlled (PC) asthma, and 52 (36%) uncontrolled asthma (UA) patients were enrolled. Persistent asthmatics (PA) were significantly more uncontrolled (p < 0.0001). A significant reduction in FEV 1 , FEV 1 /FVC, and FEF 25-75 (p = 0.005, p < 0.0001, and p < 0.001, respectively) was found in WC vs. UA. Through a stepwise process, a reduced model showed a positive relationship between the PAQLQ and the four items of C-ACT. The regression equations for predicted PAQLQ were ln (PAQLQ) = 1.17 + 0.05*C-ACT2 + 0.03*C-ACT3 + 0.04*C-ACT6 + 0.03*C-ACT7. Thus, a nomogram was constructed. Conclusion:The designed nomogram provides a highly predictive assessment of QoL in individual patients, facilitating a more comprehensive assessment of asthmatic children in usual clinical care.

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“…Such finding is consistent with other studies that also reported underutilisation of inhalers [28–30]. The underuse of inhaled corticosteroids (ICS) is an important concern as over 40% of adults and children with asthma in Malaysia have persistent symptoms [31, 32] which denote poor disease control and hence, the need for inhaled corticosteroids to reduce asthma symptoms, improve lung function [33], decrease airway hyperresponsiveness [34], controlling airway inflammation [35] and reducing asthma mortality [36]. In addition, early initiation and regular daily low dose ICS is highly effective in reducing asthma symptoms and asthma related exacerbations, hospitalisation and death [1].…”

Section: Discussionsupporting

confidence: 88%

Prescription of oral short-acting beta 2-agonist for asthma in non-resource poor settings: A national study in Malaysia

2017

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ObjectiveUse of oral short-acting beta 2-agonist (SABA) persists in non-resource poor countries despite concerns for its lower efficacy and safety. Utilisation and reasons for such use is needed to support the effort to discourage the use of oral SABA in asthma. This study examined the frequency of oral short-acting Beta 2-agonist (SABA) usage in the management of asthma in primary care and determined correlates of its usage.MethodsData used were from the 2014 National Medical Care Survey in Malaysia, a nationally representative survey of primary care encounters (weighted n = 325818). Using methods of analysis of data for complex surveys, we determined the frequency of asthma diagnosis in primary care and the rate of asthma medication prescription, which includes oral SABA. Multivariate logistic regression models were built to assess associations with the prescription of oral SABA.ResultsA weighted estimate of 9241 encounters presented to primary care with asthma in 2014. The mean age of the patients was 39.1 years. The rate of oral SABA, oral steroids, inhaled SABA and inhaled corticosteroids prescriptions were 33, 33, 50 and 23 per 100 asthma encounters, respectively. It was most commonly used in patients with the age ranged between 20 to less than 40 years. Logistic regression models showed that there was a higher odds of oral SABA usage in the presence of respiratory infection, prescription of oral corticosteroids and in the private sector.ConclusionOral SABA use in asthma is found to be common in a non- resource poor setting and its use could be attributed to a preference for oral medicines along undesirable clinical practices within a fragmented health system.

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Pediatric asthma control in Asia: Phase 2 of the Asthma Insights and Reality in Asia‐Pacific (AIRIAP 2) survey

Abstract: Findings from this survey show that asthma control is suboptimal in many children in the Asia-Pacific region. Practical tools, such as the ACT or C-ACT, may help clinicians assess asthma control and facilitate adjustment of asthma medication.

Cited by 53 publications

References 29 publications

Asthma Severity and the Controller Prescription in Children at 12 Tertiary Hospitals

Asthma Severity and the Controller Prescription in Children at 12 Tertiary Hospitals

Development of a nomogram to estimate the quality of life in asthmatic children using the Childhood Asthma Control Test

Prescription of oral short-acting beta 2-agonist for asthma in non-resource poor settings: A national study in Malaysia

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