Chicago Asthma Consortium Research

Asthma and depression in older American adults: An analysis of Medicare recipients

Rachelle Paul-Brutus — Mon, 02 Mar 2026 18:58:03 GMT

Abstract

Background

Individuals with asthma are disproportionately affected by depression relative to those without asthma. However, this relationship in those ≥65 years of age with asthma remains unclear. This study aims to determine the association between asthma and depression in individuals aged ≥65 receiving Medicare support.

Methods

A pooled cross-sectional analysis of Medicare Current Beneficiary Survey data examined the association between asthma and depression from 2018 to 2020. Depression was defined as a score of ≥10 from the Patient Health Questionnaire-9. Disease-related variables were recorded if the subject met Medicare claims criteria for the calendar year regardless of sufficient fee-for-service coverage. Adjusted regression models were developed to determine the association between prevalent asthma, comorbidities, gender, area deprivation index, and depression.

Results

Among 31,064 individuals available for analysis, the weighted prevalence of depression in subjects with asthma was 38.6%. The adjusted regression model indicated that asthma was not independently associated with depression in this population (odds ratio (OR) = 1.18, 95% confidence interval (CI) [0.96–1.45]). Subjects with asthma and anxiety (OR = 1.11, 95% CI [1.06–1.16]), cardiovascular disease (OR = 1.24, 95% confidence interval (CI) [1.15–1.32]), or diabetes (OR = 1.30, 95% CI [1.24–1.36]) were more likely to report concomitant depression. Women ≥65 years of age with asthma had greater odds of reporting depression compared to men with asthma (OR = 1.09, 95% CI [1.06–1.12]).

Conclusions

Based on our findings, in older adults in the United States, asthma is not independently associated with greater odds of depression when compared to those without asthma.

https://journals.sagepub.com/doi/full/10.1177/30682576251389900

Prediction Pathway for Severe Asthma Exacerbations

Rachelle Paul-Brutus — Wed, 14 Jan 2026 16:25:53 GMT

Abstract

Background

Accurate risk prediction of exacerbations is pivotal in severe asthma management. Multiple risk factors are at play, but the pathway of risk prediction remains unclear.

Research Question

How do the interplays of clinically relevant predictors lead to severe exacerbations in patients with severe asthma?

Study Design and Methods

Patients with severe asthma (n = 6,814, aged ≥ 18 years), biologic naive, were identified from the Severe Asthma Registry (2017-2021). Relevant predictors covered demographics, lung function, inflammation biomarkers, health care use, medications, exacerbation history, and comorbidities. A Bayesian network, representing the prediction process of severe exacerbations, was obtained by combining expert knowledge and machine learning algorithms. Internal validation was performed. The proposed influence diagram integrated decision and utility nodes into the prediction pathway.

Results

The Bayesian network analysis revealed that blood eosinophil count, fractional exhaled nitric oxide level, and FEV1 directly influenced the transition between prior and future severe exacerbations. The presence of chronic rhinosinusitis indirectly affected such transition by directly influencing blood eosinophil count, fractional exhaled nitric oxide, and % predicted FEV1. Macrolide use independently affected history of exacerbations to influence future severe asthma exacerbations. Model discrimination was moderate in 10-fold cross-validation and leave-1-country-out cross-validation, and model calibration was high in train-test data.

Interpretation

This study identified an essential prediction pathway of severe exacerbation, which involves the influence of chronic rhinosinusitis on the immediate predictors of risk transition from current to future severe asthma exacerbations. Macrolide use was another essential prediction pathway identified. The findings support shared clinical decision-making in severe asthma treatment.

https://journal.chestnet.org/article/S0012-3692(25)00647-6/fulltext

Intermittent Asthma and Risk of Severe Exacerbation in Children

Rachelle Paul-Brutus — Wed, 14 Jan 2026 16:23:31 GMT

BACKGROUND: Because of risk of severe asthma exacerbations, current Global Initiative for Asthma recommendations advise against use of short-acting beta-agonists (SABAs) alone as the first step in treating mild asthma. It is unclear if everyone with mild asthma carries equal risk for severe asthma exacerbations. RESEARCH QUESTION: Is there a subgroup of patients with mild asthma with very low risk of severe asthma exacerbations? STUDY DESIGN AND METHODS: This study cohort used administrative claims data for patients ages 2 to 18 years with intermittent asthma enrolled in Ohio Medicaid Managed Care Plans for 3 consecutive years. A low-risk group was identified for the first 2 years; in the third year, risk of severe asthma exacerbations was compared among the low-risk group and the rest of the cohort. RESULTS: A total of 13,208 patients met inclusion criteria. In the third year, among 3,935 low-risk patients, rates of asthma hospitalization, emergency department visits, and urgent care visits for those with 0 to 2 SABA canisters dispensed per year were 3 (0.08%), 37 (0.97%), and 21 (0.55%), respectively, with a relative risk of hospitalization of 0.17 (95% CI, 0.06-0.52) and a relative risk of severe asthma exacerbation of 0.18 (95% CI, 0.13-0.27) compared with high-risk patients. In the low-risk cohort, the number of patients needed to treat to prevent 1 hospitalization was 5,535. The cost to prevent 1 hospitalization using a single inhaler of inhaled corticosteroids per year was $779,716. INTERPRETATION: Our results show that among patients with mild asthma, there is a subgroup of low-risk patients with lower risk of hospitalization and severe asthma exacerbation in which current Global Initiative for Asthma recommendations for first-step treatment may neither be needed nor cost-effective.

https://journal.chestnet.org/article/S0012-3692(25)05124-4/fulltext

The Dose-Response of Inhaled Corticosteroids in Combination Inhaled Corticosteroid/Long Acting Beta2-Agonist Maintenance Therapy for Asthma

Rachelle Paul-Brutus — Wed, 14 Jan 2026 16:21:46 GMT

Background

High doses of a maintenance inhaled corticosteroids (ICSs) in asthma may achieve only modest additional clinical benefit beyond low-to-medium doses and are associated with an increased risk of adverse systemic effects. The ICS dose-response relationship when administered as maintenance combination ICS/long-acting beta2-agonist (LABA) therapy is uncertain.

Research Question

What is the ICS dose-response of maintenance ICS/LABA therapy?

Study Design and Methods

A systematic review was conducted using MEDLINE, Embase, the Cochrane Register of Controlled Trials, and ClinicalTrials.gov databases to identify randomized controlled trials that allocated participants to > 1 ICS dose category, per Global Initiative for Asthma categorization, administered in combination with ICS/LABA inhalers. Meta-analysis compared outcomes of high-dose (HD) and medium-dose (MD), HD and low-dose (LD), and MD and LD ICS/LABA. The primary outcome was the proportion of participants with ≥ 1 severe asthma exacerbation; secondary outcomes were patient-reported outcome measures of asthma control, spirometry, and serious adverse events. Certainty of evidence was assessed by using the Grading of Recommendations, Assessment, Development and Evaluations domains.

Results

Twelve randomized controlled trials (6,373 participants) were identified: 7 comparing HD vs MD ICS/LABA, 1 HD vs LD ICS/LABA, and 4 MD vs LD ICS/LABA. HD vs MD ICS/LABA reduced the odds of a severe asthma exacerbation (Peto’s OR, 0.81; 95% CI, 0.67-0.98) with high certainty. There were no other clinically important differences in efficacy or safety outcomes of HD vs MD ICS/LABA. There was no difference in all outcomes comparing HD with LD or MD with LD ICS/LABA.

Interpretation

Our results showed that maintenance HD ICS/LABA reduced the odds of a severe exacerbation by about 20% compared with MD ICS/LABA. The absolute reduction in severe exacerbation risk with HD ICS/LABA is determined by patients’ exacerbation risk, and this effect size may be clinically relevant for patients if this risk is high. Comparisons of other doses of ICS/LABA were limited by the number of identified studies, although no large difference in effect sizes were observed.

https://journal.chestnet.org/article/S0012-3692(25)05145-1/abstract

Tiny Particles, Big Problems: PM2.5 Exposure on Pediatric Asthma Admissions in Illinois From 2006 to 2021

Rachelle Paul-Brutus — Tue, 23 Dec 2025 17:04:36 GMT

BACKGROUND

Air pollution, particularly fine particulate matter (PM_2.5), has been consistently linked to respiratory morbidity, including asthma exacerbations. However, few studies have examined these relationships using statewide zip code–level panels with within-zip identification at a granular zip code level over time.

OBJECTIVE

To assess the association between short-term PM_2.5 exposure and the odds of any pediatric asthma admission from 2006 to 2021 across zip codes, with the goal of identifying patterns of environmental risk for asthma exacerbations.

METHODS

We analyzed zip code–level (zip-day) data from 2006 to 2021, combining hospitalization records for asthma admissions with environmental measures of conventional short-term PM_2.5 exposures, moving averages MA(0–1) and MA(0–3). Zip fixed-effects logistic regression was used to estimate the association between PM_2.5 exposure and the odds of asthma admission, adjusting for day of week, season, flexible calendar time within year, and meteorology (temperature and vapor pressure).

RESULTS

Higher short-term PM_2.5 was associated with higher odds of asthma admission at the zip-day level. Specifically, each +10 μg/m³ increase corresponded to approximately 4% to 5% higher odds (odds ratio ≈ 1.045; 95% CI 1.006–1.085). This relationship was observed under standard moving-average windows after adjustment for meteorological and temporal factors.

CONCLUSIONS

Acute increases in PM_2.5 are associated with a statistically detectable increase in asthma admission odds at the zip code level. Targeted strategies at the zip code level that respond to short-term air quality fluctuations may help reduce asthma-related health burdens.

POLICY IMPLICATIONS

These findings highlight the urgent need for public health interventions and environmental regulations that address short-term increases in air pollution, not just annual averages. Local and state-level policies aimed at monitoring, forecasting, and rapidly mitigating PM_2.5 surges could play a critical role in preventing asthma exacerbations, particularly in urban and vulnerable communities.

https://publications.aap.org/pediatricsopenscience/article/1/4/1/205275/Tiny-Particles-Big-Problems-PM2-5-Exposure-on?autologincheck=redirected

Budesonide/Formoterol Maintenance Plus Reliever Therapy* A New Strategy in Pediatric Asthma

Rachelle Paul-Brutus — Fri, 10 Oct 2025 20:20:29 GMT

Objectives: A fixed combination of long-acting 2-agonists (LABA) plus inhaled corticosteroids

(ICS) has never been proven to reduce asthma exacerbations vs ICS alone in children. This

12-month, double-blind, randomized study in 341 children (age range, 4 to 11 years) with asthma

uncontrolled on ICS investigated whether a novel regimen using budesonide/formoterol for

maintenance and reliever therapy (Symbicort maintenance and relief therapy [SMART]) [Symbicort;

AstraZeneca R&D; Lund, Sweden] could reduce exacerbations.

Methods: Patients received SMART (budesonide/formoterol 80/4.5 g qd maintenance plus

additional inhalations for symptom relief), budesonide/formoterol 80/4.5 g qd for maintenance

(fixed combination), or higher-dose budesonide 320 g qd (fixed-dose budesonide). Blinded

as-needed medication (terbutaline 0.4 g) was provided in both fixed-dose groups.

Results: SMART prolonged the time to first exacerbation vs fixed-dose budesonide (p0.02) and

fixed-dose combination (p<0.001). Rates of exacerbation requiring medical intervention were reduced

by 70 to 79% with SMART vs fixed-dose budesonide and fixed-dose combination (0.08/patient vs

0.28/patient and 0.40/patient, respectively; both p<0.001). Mild exacerbation days and awakenings were

significantly lower with SMART; yearly growth improved by 1.0 cm vs fixed-dose budesonide (p<0.01).

Conclusion: The SMART regimen using budesonide/formoterol for both maintenance and as-needed

symptom relief reduces the exacerbation rate compared with both fixed-dose combination and higher

fixed-dose ICS alone in children with asthma. (CHEST 2006; 130:1733–1743)

Key words: asthma; budesonide/formoterol; inhaled corticosteroids; long-acting 2-agonist; pediatric; Symbicort

Abbreviations: ACTHadrenocorticotrophic hormone; AEadverse events; ANOVAanalysis of variance;EDemergency

department; ICSinhaled corticosteroids; LABAlong-acting 2-agonists; PEFpeak expiratory flow; SMARTSymbicort

maintenance and relief therapy

Bisgaard et. al. (Chest, 2008) Budesonide-Formoterol Maintenance Plus Reliever Therapy, a New Strategy in Pediatric Asthma (1).pdf

Budesonide–formoterol versus salbutamol as reliever therapy in children with mild asthma (CARE): a 52-week, open-label, multicentre, superiority, randomised controlled trial

Rachelle Paul-Brutus — Thu, 02 Oct 2025 20:35:15 GMT

Background

Combination inhaled corticosteroid–formoterol reliever monotherapy reduces the rate of asthma attacks compared to short-acting β2-agonist (SABA) reliever monotherapy in adults. Its comparative efficacy in children has not been established.

Methods

CARE was a 52-week, open-label, parallel-group, multicenter, superiority, randomized controlled trial in children aged 5–15 years with asthma using SABA reliever monotherapy at 15 clinical trials sites in New Zealand. Participants were randomly assigned (1:1) to either budesonide 50 μg–formoterol 3 μg, two actuations as needed, or salbutamol 100 μg, two actuations as needed. The primary outcome was asthma attacks as rate per participant per year. This trial was registered with the Australian New Zealand Clinical Trials Registry, ACTRN12620001091998.

Findings

From Jan 28, 2021, to June 23, 2023, we assessed 382 participants for eligibility. We randomly assigned 360 (94%) participants to treatment (179 [50%] to the budesonide–formoterol group and 181 [50%] to the salbutamol group). The annualized rate of asthma attacks was lower in the budesonide–formoterol group than in the salbutamol group—cluster-adjusted rates 0·23 versus 0·41 per participant per year (relative rate 0·55 [95% CI 0·35–0·86]; p=0·012). The number of participants with at least one adverse event was 162 (91%) in the budesonide–formoterol group and 167 (92%) in the salbutamol group (odds ratio 0·79 [95% CI 0·35–1·79]).

Interpretation

In children aged 5–15 years with mild asthma, budesonide–formoterol reliever monotherapy is superior to salbutamol for preventing asthma attacks, with a similar safety profile.

Funding

Health Research Council of New Zealand, Cure Kids New Zealand, and the Barbara Basham Medical Charitable Trust (managed by Perpetual Guardian).

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00861-X/fulltext

Effects of residential ventilation and filtration interventions on adult asthma outcomes

Rachelle Paul-Brutus — Tue, 23 Sep 2025 19:58:02 GMT

Abstract

This study evaluates how long-term use (i.e., at least one year) of three types of residential ventilation interventions, some of which are coupled with improved central filtration, affects asthma outcomes in adults by reducing exposure to indoor air pollutants. We conducted a quasi-randomized, parallel-group intervention trial involving 51 adults with physician-diagnosed asthma across 40 homes. Each home received one of three interventions: continuous energy recovery ventilators (ERVs), intermittent central-fan-integrated supply (CFIS) systems, or continuous bathroom exhaust fan(s). Homes with ERV or CFIS systems also received central air filtration upgrades to MERV 10 filters, replaced quarterly. Indoor and outdoor air pollutants were measured quarterly. Asthma Control Test (ACT) scores were collected monthly and health-related quality of life and stress were assessed at baseline and endline. Overall, the interventions led to a 6.3 % increase in ACT scores (p < 0.001) over a > 12-month duration, while the increase was 5.4 % when comparing ACT scores within the initial 12-month window following interventions (p < 0.001). The ERV group experienced the greatest improvement, with an 8.4 % increase in ACT scores (p < 0.001) and an increase in the proportion of participants with well-controlled asthma from 50 % to 86 % (p = 0.030). Additionally, the association between reduced indoor pollutant concentrations and asthma outcomes showed that a one standard deviation decrease in indoor NO₂ (IQR: 9.3 ppb) was associated with a 7.1 % increase in ACT scores (p = 0.034). Subgroup analysis indicates that asthma improvements were greater among participants aged ≥45, Black/African American individuals, and those with incomes below $75,000, compared to their respective comparison groups, driven in part by having lower baseline ACT scores.

Residential Ventilation and Infrastructure.pdf

Associations between in-home environmental exposures and lung function in a safety net population of children with asthma using electronic health records and geospatial data

Rachelle Paul-Brutus — Tue, 23 Sep 2025 19:56:15 GMT

Abstract

Purpose

The effects of in-home environmental exposures (IHEEs) on asthma are challenging to examine in populations because information on asthma triggers is usually absent. We leveraged data from electronic health records (EHRs) to investigate the associations of residential cockroach and rodent exposures with lung function among children with asthma.

Methods

We merged clinical pulmonary function test data from EHRs for children with asthma from a large safety net hospital in the Northeast United States with publicly available geospatial data matched to patient addresses. Predicted presence of key IHEE asthma triggers, cockroaches and rodents, were included as main exposures and housing parcel features and census tract characteristics were included as potential confounders in a sensitivity analysis. We fit latent Bayesian hierarchical models of percent predicted forced expiratory volume in one second (FEV1%).

Results

The study population of 1070 children had a mean age of 10.2 years and 75 % identified as Black, many living in historically segregated neighborhoods. In models adjusted for individual characteristics, we observed 2.26 (95 % credible interval, 95 %CrI: − 3.72, − 0.79) and 2.58 (95 %CrI: − 4.54, − 0.66) percentage points (pp) lower FEV1% from a one-unit increase in the log-odds of the probability of cockroach and rodent presence, respectively. The association with lung function increased in magnitude for cockroach exposure but attenuated for rodent exposure in sensitivity analyses.

Conclusions

IHEEs were associated with worse lung function among children with asthma in a safety net population. The observed associations underscore how injustices in housing and neighborhood characteristics contribute to asthma morbidity.

Home Visits, Reduction of Triggers in the Home.pdf

Home visits for pediatric asthma - A strategy for comprehensive asthma management through prevention and reduction of environmental asthma triggers in the home

Rachelle Paul-Brutus — Tue, 23 Sep 2025 19:53:34 GMT

Families often struggle to manage their child's asthma. Clinicians caring for children with asthma struggle too as they are tasked with balancing the limited time available in clinic and the need to provide comprehensive care. As a direct consequence, critical gaps in asthma care remain with respect to asthma education and the identification and reduction of environmental asthma triggers in the home. A home visit model that augments clinic-based care is a viable way to fill gaps in understanding, address incomplete adherence patterns, improve disease control by shifting the focus of asthma management to reduction of environmental asthma triggers, and bring cost savings to the health care system.Home Visits, Reduction of Triggers in the Home.pdf

The effect of home environment modification nursing intervention on symptom control, quality of life, and number of triggers in children with allergic rhinitis: A randomized controlled trial

Rachelle Paul-Brutus — Tue, 23 Sep 2025 19:47:12 GMT

Abstract

Purpose Home Modification and Asthma Triggers.pdf

The study was conducted to investigate the effects of a nursing intervention aimed at home environment modification on symptom control, quality of life, and the number of triggers in children with allergic rhinitis.

Design and methods

This one-to-one, parallel-arm, randomized controlled trial was conducted with a pre-test/post-test design. The study used stratified sampling method. A total of 52 participants were randomly assigned to the intervention group (n = 26) and the control group (n = 26). The intervention group received education on home environment modification and the child was provided with anti-allergic bedding set. The control group continued with routine practices. Statistical significance was set at p < 0.05.

Results

After the nursing intervention for home environment modification, a significant difference was found between the groups in terms of the number of home environment triggers (p < 0.05). According to the mean scores of the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire, no significant difference was found between the groups (p > 0.05). There was no significant difference between the groups in terms of the mean scores for nasal discharge, nasal congestion, sneezing, nasal itching, and eye itching (p > 0.05) after the nursing intervention for home environment modification.

Conclusion

The findings indicate that the nursing intervention for home environment modification is an effective method in reducing the number of triggers in the home environment. However, no significant impact was observed on symptom control and quality of life.

Asthma Burden in a Citywide, Diverse Sample of Elementary Schoolchildren in Chicago

Rachelle Paul-Brutus — Tue, 23 Sep 2025 19:42:50 GMT

Abstract

Objective

The purposes of this study are to describe and develop preliminary models of the burden of diagnosed asthma and symptoms of possible undiagnosed asthma in a large, citywide, ethnically and socioeconomically diverse sample of Chicago elementary schoolchildren. We hypothesized that considering possible asthma would give a more complete picture of race/ethnic disparities in pediatric asthma.

Methods

We studied 35583 students aged 6 to 12 years attending Chicago Public and Archdiocese elementary schools for the Chicago Initiative to Raise Asthma Health Equity (CHIRAH) study. The full enrollments of 105 schools were surveyed for asthma and possible undiagnosed asthma by the Brief Pediatric Asthma Screen Plus (BPAS+) respiratory symptoms. The child had to be 6 to 12 years old, the valid age range for the BPAS+. Questionnaires included the BPAS+, basic demographic information, and household asthma information; they were sent home with each schoolchild for completion by the parent and returned to school for collection and scoring.

Results

Overall, 13.9% of students had diagnosed asthma. For children aged 6 to 12 years, rates of diagnosed asthma varied from 13.1% to 14.5%, whereas the rates of possible undiagnosed asthma varied from 14.8% to 10.9%. The rate of diagnosed asthma was 21.2% for African Americans, 9.7% for whites, 11.8% for Hispanics, with similar rates of possible undiagnosed asthma. By multinomial logistic regression, African Americans were more than twice as likely and Hispanics were 1.57 times more likely than whites to have diagnosed asthma at all school district income levels and controlling for other household members with asthma, type of school, age of the child, gender, and language preference. The odds of African Americans being diagnosed with asthma rather than having possible asthma were 76% higher and for Hispanics were 46% higher compared with whites, at all school district income levels and controlling for other household members with asthma, type of school, age of the child, gender, and language preference.

Conclusions

Our study confirms national disparities in diagnosed asthma by race/ethnicity. Respiratory symptoms consistent with possible undiagnosed asthma increase the total potential burden of asthma overall to more than one-quarter of the school enrollees. Among students with respiratory symptoms, African Americans, Hispanics (controlling for language), and families where another person has asthma are more likely to have diagnosed rather than possible asthma. Improved knowledge about asthma, recognition of symptoms, and access to high-quality care are necessary to ascertain how much of the possible undiagnosed asthma represents additional cases of asthma requiring treatment.

https://www.academicpedsjnl.net/action/showPdf?pii=S1530-1567(07)00052-4

COPD and asthma: Diagnostic accuracy requires spirometry

Rachelle Paul-Brutus — Tue, 29 Apr 2025 23:43:10 GMT

Up to one-third of patients receiving a clinical diagnosis of COPD or asthma have been shown to lack evidence of disease in subsequent lung-function studies.

https://cdn-uat.mdedge.com/files/s3fs-public/JFP06803076.PDF

Be SMART About Asthma Management: Single Maintenance and Reliever Therapy

Rachelle Paul-Brutus — Tue, 29 Apr 2025 23:07:09 GMT

Abstract

Single maintenance and reliever therapy (SMART) is an asthma treatment approach that utilizes combined inhaled corticosteroids and long-acting β-agonists for maintenance and quick relief therapy. Despite the evidence for its benefits in asthma treatment and its adoption into American and international asthma guidelines and recommendations, SMART remains a practice of some debate. This article reviews the available evidence for SMART and offers guidance for its integration into comprehensive asthma management. Overall, short-acting β-agonist-only asthma therapy regimens should be avoided, regardless of condition severity (SOR A Recommendation). Family medicine clinicians should start SMART for patients requiring either GINA Step 3 or 4 therapy, especially if they have signs of poor adherence (SOR B Recommendation). Finally, use budesonide-formoterol over other inhaled corticosteroid/long-acting β-agonist combinations when implementing SMART (SOR B Recommendation).

Keywords: Anti-Asthmatic Agents; Asthma; Evidence-Based Medicine; Pharmacotherapy; Primary Health Care; Single Maintenance and Reliever Therapy (SMART).

https://pubmed.ncbi.nlm.nih.gov/39455262/

Addressing health disparities in food allergy: A Position Statement of the AAAAI Prior Authorization Task Force

Rachelle Paul-Brutus — Thu, 27 Feb 2025 19:50:06 GMT

Self-reported food allergies (FAs) affect approximately 8% of the US pediatric and approximately 10% of the adult population, which reflects potentially disproportionate increases among ethnically and racially minoritized groups. Multiple gaps and unmet needs exist regarding FA disparities. There is reported evidence of disparities in FA outcomes, and the FA burden may also be disproportionate in low-income families. Low family income has been associated with higher emergency care spending and insecure access to allergen-free food. Pharmacoinequity arises in part as a result of structural racism still experienced by historically marginalized populations today. Historically redlined communities continue to experience greater rates of neighborhood-level air pollution and indoor allergen exposure, lack of transportation to medical appointments, poverty, and lower prescription rates of necessary medications. Clinical research needs racially and ethnically diverse participation to ensure generalizability of research findings and equitable access to medical advances, but race reporting in clinical trials has been historically poor. Addressing health disparities in FA is a priority of clinical care, with professional organizations such as the American Academy of Allergy, Asthma & Immunology having a prominent role to play in mitigating the challenges faced by these individuals. In this position statement we recommend some key steps to address this important issue.

https://www.jacionline.org/article/S0091-6749(24)01065-0/fulltext

Asthma Among Medicare Beneficiaries 65 Years of Age and Older

Rachelle Paul-Brutus — Tue, 11 Feb 2025 14:00:06 GMT

Findings from the 2017-2021 Medicare Current Beneficiary Surveys (MCBS)

Recent national data indicates that 8% of adults ages 18 and older in the United States have current asthma (Centers for Disease Control and Prevention, 2023). However, those rates vary based on sex, race, ethnicity, and age. Among U.S. adults, asthma is more prevalent in females (9.7%) compared to males (6.2%). In terms of race and ethnicity, asthma is most prevalent in non-Hispanic American Indian/Alaskan Natives (13.3%), followed by non-Hispanic Blacks (10.7%), and non-Hispanic Whites (8.0%). It is least prevalent among Hispanics (6.7%) and non-Hispanic Asians (4.2%).

When looking more specifically at older adults (ages 65 and older), 7.2% have current asthma nationally, accounting for approximately 20% of individuals with asthma in the United States (Centers for Disease Control and Prevention, 2023). However, asthma prevalence is likely higher among older adults, as it is widely understood to be underdiagnosed in the older population (Gibson et al., 2010). This is attributed to a combination of factors unique to older adults, including changes in lung structure and function (Dunn et al., 2017), challenges administering and interpreting pulmonary functioning tests used for diagnosis (Battaglia et al., 2016), an increase in comorbidities such as chronic obstructive pulmonary disease (COPD) (Tzortzaki et al., 2011), and complications related to polypharmacy (Battaglia et al., 2016). Additionally, asthma tends to be less controlled in older adults when compared to younger age groups, and mortality rates tend to be higher (Tsai et al., 2012; Talreja & Baptist, 2011). For example, asthma mortality rates in 2021 increased throughout the lifespan, with rates as low as 1.4 per million among those 0-4 years old, 2.4 per million among those 5-11, 2.0 per million among those 12-17, 3.8 per million among those 18-24, 6.4 per million among those 25-34, 11.5 per million among those 35-64, and 27.1 per million among those 65 and older (Centers for Disease Control and Prevention, 2023). The underdiagnoses, in conjunction with high mortality rates and a lack of literature on the disease among older adults, indicate a need for further investigation.

https://publish.illinois.edu/geigerevallab/medicare-current-beneficiary-survey-mcbs/

Ensuring Access to Albuterol in Schools: From Policy to Implementation. An Official ATS/AANMA/ALA/NASN Policy Statement

Rachelle Paul-Brutus — Fri, 25 Oct 2024 17:01:45 GMT

For children with asthma, access to quick-relief medications is critical to minimizing morbidity and mortality. An innovative and practical approach to ensure access at school is to maintain a supply of stock albuterol that can be used by any student who experiences respiratory distress. To make this possible, state laws allowing for stock albuterol are needed to improve medication access.

https://web.archive.org/web/20240420124321/https://www.atsjournals.org/doi/10.1164/rccm.202106-1550ST

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort

Rachelle Paul-Brutus — Fri, 25 Oct 2024 16:59:19 GMT

Treatments for long-term control of asthma have improved and include a promising but expensive class of biologic therapies. However, the clinical trials evaluating these and other novel treatments have used a variety of different outcomes to evaluate efficacy. The evolution of asthma care calls for a re-examination of outcomes that are most important to patients and other stakeholders.

https://www.annallergy.org/article/S1081-1206(21)00256-8/abstract

Perspectives on decisions for treatment and care in severe asthma

Rachelle Paul-Brutus — Fri, 25 Oct 2024 16:57:41 GMT

Severe asthma is a subtype of asthma that can be hard to control, resulting in an exceptional impact on an individual's quality of life. The aim of this review article is to explore the misalignment of perceptions of severe asthma among different stakeholders to identify how to reduce burden and improve delivery of care.

https://www.worldallergyorganizationjournal.org/article/S1939-4551(20)30403-8/fulltext

Global Quality Standard for Identification and Management of Severe Asthma

Rachelle Paul-Brutus — Fri, 25 Oct 2024 16:55:46 GMT

Severe asthma is a debilitating, life-threatening disease associated with substantial global morbidity, mortality, and health care resource utilization. Patients may not receive guideline-directed medical care for severe asthma. Moreover, viable precision-based assessment tools and newer preventive therapies that can reduce the frequency of exacerbations and associated functional impact are underused. As a result, high rates of poorly controlled severe asthma persist, and patient health-related quality of life suffers.

https://link.springer.com/article/10.1007/s12325-020-01450-7

CARIBBEAN LATINX ADULTS WITH MODERATE-SEVERE ASTHMA BEAR GREATER ASTHMA MORBIDITY COMPARED TO OTHER LATINX SUBGROUPS

Rachelle Paul-Brutus — Fri, 25 Oct 2024 16:48:31 GMT

Hispanic/Latinx (HL) ethnicity incorporates many subgroups from diverse racial and cultural backgrounds. Studies suggest that Puerto Ricans (PR) have a greater asthma prevalence and asthma-related morbidity relative to White and Mexican counterparts. However, these studies were in children or limited in clinical and phenotypic characterization. Our purpose was to determine whether clinical, phenotypic differences, and disparities in asthma-related morbidity exist across adult HL subgroups. Considering the shared heritage between PR and other Caribbean HL (Cubans and Dominicans, C&D), we hypothesized that Caribbean HL (CHL; PR and C&D) adults would have greater asthma morbidity compared to other HLs (OHL; Mexicans, Spaniards, Central/South Americans).

https://journal.chestnet.org/article/S0012-3692(21)01523-3/fulltext

Impact of Social Determinants on the Burden of Asthma and Eczema: Results from a US Patient Survey

Rachelle Paul-Brutus — Fri, 25 Oct 2024 16:47:22 GMT

Little is known about how patients with asthma and eczema perceive their medical care and burden of disease. A survey was conducted to evaluate the perceptions among the general patient population with asthma and/or eczema regarding disease and treatment burden and barriers to adequate care.

https://link.springer.com/article/10.1007/s12325-021-02021-0

“Black People Like Me”: A virtual conference series to engage underserved patients with asthma in patient centered outcomes research

Rachelle Paul-Brutus — Fri, 25 Oct 2024 16:45:31 GMT

Background

In response to racial inequity in asthma, asthma-related research among diverse patients is vital. However, people from historically marginalized groups are underrepresented in clinical and patient-centered outcomes research (PCOR). The “Black People Like Me” (BPLM) virtual conference series was developed to: (1) engage Black patients with asthma and their caregivers in education and discussions about asthma, and (2) encourage involvement in PCOR. Education about COVID-19 and COVID-19 vaccination was also incorporated.

https://researchinvolvement.biomedcentral.com/articles/10.1186/s40900-023-00428-3

Asthma innovations from the first International Collaborative Asthma Network forum

Rachelle Paul-Brutus — Fri, 25 Oct 2024 16:40:33 GMT

Background

Many patients have uncontrolled asthma despite available treatments. Most of the new asthma therapies have focused on type 2 (T2) inflammation, leaving an unmet need for innovative research into mechanisms of asthma beyond T2 and immunity. An international group of investigators developed the International Collaborative Asthma Network (ICAN) with the goal of sharing innovative research on disease mechanisms, developing new technologies and therapies, organising pilot studies and engaging early-stage career investigators from across the world. This report describes the purpose, development and outcomes of the first ICAN forum.

https://publications.ersnet.org/content/erjor/9/3/00090-2023

A pragmatic guide to choosing biologic therapies in severe asthma

Rachelle Paul-Brutus — Wed, 16 Oct 2024 18:34:10 GMT

There are now several monoclonal antibody (mAb) therapies (“biologics”) available to treat severe asthma. Omalizumab is an anti-IgE mAb and is licensed in severe allergic asthma. Current evidence suggests it may decrease exacerbations by augmenting deficient antiviral immune responses in asthma. Like all other biologics, clinical efficacy is greatest in those with elevated T2 biomarkers. Three biologics target the interleukin (IL)-5–eosinophil pathway, including mepolizumab and reslizumab that target IL-5 itself, and benralizumab that targets the IL-5 receptor (IL-5R-α). These drugs all reduce the exacerbation rate in those with raised blood eosinophil counts. Mepolizumab and benralizumab have also demonstrated steroid-sparing efficacy. Reslizumab is the only biologic that is given intravenously rather than by the subcutaneous route. Dupilumab targets the IL-4 receptor and like mepolizumab and benralizumab is effective at reducing exacerbation rate as well as oral corticosteroid requirements. It is also effective for the treatment of nasal polyposis and atopic dermatitis. Tezepelumab is an anti-TSLP (thymic stromal lymphopoietin) mAb that has recently completed phase 3 trials demonstrating significant reductions in exacerbation rate even at lower T2 biomarker thresholds. Many patients with severe asthma qualify for more than one biologic. To date, there are no head-to-head trials to aid physicians in this choice. However, post-hoc analyses have identified certain clinical characteristics that are associated with superior responses to some therapies. The presence of allergic and/or eosinophilic comorbidities, such as atopic dermatitis, nasal polyposis or eosinophilic granulomatosis with polyangiitis, that may additionally benefit by the choice of biologic should also be taken into consideration, as should patient preferences which may include dosing frequency. To date, all biologics have been shown to have excellent safety profiles.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8919802/

A Review on Asthma and Allergy: Current Understanding on Molecular Perspectives

Rachelle Paul-Brutus — Wed, 16 Oct 2024 18:30:01 GMT

Asthma, a complex disease characterized by persistent airway inflammation, remains an urgent global health concern. We explored the critical role of allergic biomarkers and dysregulated immune system in asthma through an extensive literature review in databases such as Web of Science, PubMed, EMBASE, Scopus, and Google Scholar. This review summarizes the growing data on the pivotal role of allergic biomarkers and dysregulated immune system in the development and evolution of asthma. Recent studies have uncovered several biomarkers that elucidate intrinsic allergic mechanisms in individuals with asthma. This article highlights these biomarkers’ potential in predicting asthma onset, assessing its intensity, guiding therapeutic interventions, and tracking disease progression. We also explore the innovative therapeutic prospects arising from the convergence of allergy and dysregulated immune system in asthma and emphasize the potential for precision medicine approaches. Understanding allergic biomarkers intertwined with a dysregulated immune system heralds a new era in asthma treatment and points to improved and individualized treatment modalities.

https://www.mdpi.com/2077-0383/13/19/5775

Anti–IL-5 treatments in patients with severe asthma by blood eosinophil thresholds: Indirect treatment comparison

Rachelle Paul-Brutus — Wed, 16 Oct 2024 18:27:18 GMT

Background: Three anti–IL-5 pathway–directed therapies are approved for use in patients with severe eosinophilic asthma (SEA); however, no head-to-head comparison data are available.

Objective: We sought to compare the efficacy of licensed doses of mepolizumab, benralizumab, and reslizumab in patients with SEA, according to baseline blood eosinophil counts.

Methods: This indirect treatment comparison (ITC) used data from a Cochrane review and independent searches. Eligible studies were randomized controlled trials in patients aged 12 years or greater with SEA. End points included annualized rate of clinically significant exacerbations and change from baseline in Asthma Control Questionnaire score and FEV1. An ITC was performed in patients with Asthma Control

https://www.jacionline.org/article/S0091-6749(18)31278-8/fulltext

Asthma and obesity: endotoxin another insult to add to injury?

Rachelle Paul-Brutus — Wed, 16 Oct 2024 18:25:08 GMT

Low-grade inflammation is often an underlying cause of several chronic diseases such as asthma, obesity, cardiovascular disease, and type 2 diabetes mellitus (T2DM). Defining the mediators of such chronic low-grade inflammation often appears dependent on which disease is being investigated. However, downstream systemic inflammatory cytokine responses in these diseases often overlap, noting there is no doubt more than one factor at play to heighten the inflammatory response. Furthermore, it is increasingly believed that diet and an altered gut microbiota may play an important role in the pathology of such diverse diseases. More specifically, the inflammatory mediator endotoxin, which is a complex lipopolysaccharide (LPS) derived from the outer membrane cell wall of Gram-negative bacteria and is abundant within the gut microbiota, and may play a direct role alongside inhaled allergens in eliciting an inflammatory response in asthma. Endotoxin has immunogenic effects and is sufficiently microscopic to traverse the gut mucosa and enter the systemic circulation to act as a mediator of chronic low-grade inflammation in disease. Whilst the role of endotoxin has been considered in conditions of obesity, cardiovascular disease and T2DM, endotoxin as an inflammatory trigger in asthma is less well understood. This review has sought to examine the current evidence for the role of endotoxin in asthma, and whether the gut microbiota could be a dietary target to improve disease management. This may expand our understanding of endotoxin as a mediator of further low-grade inflammatory diseases, and how endotoxin may represent yet another insult to add to injury.

https://pubmed.ncbi.nlm.nih.gov/34918742/

Biologics in severe asthma: A pragmatic approach for choosing the right treatment for the right patient

Rachelle Paul-Brutus — Wed, 16 Oct 2024 18:20:32 GMT

The development of monoclonal antibody therapies targeting specific components of the pathways relevant to asthma pathophysiology has revolutionized treatment of severe asthma both in adults and children and helped to further unravel the heterogeneity of this disease. However, the availability of multiple agents, often with overlapping eligibility criteria, creates a need for pragmatic guidance for specialists undertaking care of patients with severe asthma. In this review, we provide an overview of the data supporting the clinical efficacy of biologics in distinct asthma phenotypes/endotypes. We also focus on the role of biomarkers and treatable traits, including comorbidities, in the choice of asthma biologics, highlight which treatments have been demonstrated to be steroid sparing in corticosteroid dependent asthma, and provide practical guidance that can drive shared decision making on treatment choice with patients. In addition, we summarize what is known to date regarding long-term safety of these drugs, and lastly, discuss future directions in biologics research.

https://www.resmedjournal.com/article/S0954-6111(23)00302-5/fulltext

Cost-Effectiveness and Impact on Health Care Utilization of Interventions to Improve Medication Adherence and Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review

Rachelle Paul-Brutus — Wed, 16 Oct 2024 18:16:45 GMT

What is already known about this topic? Poor adherence to asthma and chronic obstructive pulmonary disease medications is commonplace despite the known risks for adverse health outcomes and associated consumption of costly health care resources.

What does this article add to our knowledge? Implementing programs to improve adherence to inhaled medicines can be cost-effective, reducing medical costs and consumption of health care resources and improving disease control and patient-reported outcomes.

How does this study impact current management guidelines? Implementation of proven adherence promotion programs (eg, using digitally enhanced care and one-to-one counseling) is cost-effective and could help improve asthma and chronic obstructive pulmonary disease control and aid management of health care budgets.

https://www.jaci-inpractice.org/article/S2213-2198(24)00006-0/fulltext

Probiotics in Children with Asthma

Rachelle Paul-Brutus — Wed, 16 Oct 2024 18:13:30 GMT

A type-2 immune response usually sustains wheezing and asthma in children. In addition, dysbiosis of digestive and respiratory tracts is detectable in patients with wheezing and asthma. Probiotics may rebalance immune response, repair dysbiosis, and mitigate airway inflammation. As a result, probiotics may prevent asthma and wheezing relapse. There is evidence that some probiotic strains may improve asthma outcomes in children. In this context, the PROPAM study provided evidence that two specific strains significantly prevented asthma exacerbations and wheezing episodes. Therefore, oral probiotics could be used as add-on asthma therapy in managing children with asthma, but the choice should be based on documented evidence.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9316460/

Targeting cell signaling in allergic asthma

Rachelle Paul-Brutus — Wed, 16 Oct 2024 18:08:36 GMT

Asthma is chronic inflammation of the airways characterized by airway hyper-responsiveness, wheezing, cough, and dyspnea. Asthma affects >350 million people worldwide. The Th2 immune response is a major contributor to the pathophysiology of asthma. Targeted therapy modulating cell signaling pathways can be a powerful strategy to design new drugs to treat asthma. The potential molecular pathways that can be targeted include IL-4-IL-13-JAK-STAT-MAP kinases, adiponectin-iNOS-NF-κB, PGD2-CRTH2, IFNs-RIG, Wnt/β-catenin-FAM13A, FOXC1-miR-PI3K/AKT, JNK-Gal-7, Nrf2-ROS, Foxp3-RORγt, CysLTR, AMP, Fas-FasL, PTHrP/PPARγ, PAI-1, FcɛRI-LAT-SLP-76, Tim-3-Gal-9, TLRs-MyD88, PAR2, and Keap1/Nrf2/ARE. Therapeutic drugs can be designed to target one or more of these pathways to treat asthma

https://www.nature.com/articles/s41392-019-0079-0

The basic immunology of asthma

Rachelle Paul-Brutus — Wed, 16 Oct 2024 18:00:50 GMT

In many asthmatics, chronic airway inflammation is driven by IL-4-, IL-5-, and IL-13-producing Th2 cells or ILC2s. Type 2 cytokines promote hallmark features of the disease such as eosinophilia, mucus hypersecretion, bronchial hyperresponsiveness (BHR), IgE production, and susceptibility to exacerbations. However, only half the asthmatics have this ‘‘type 2-high’’ signature, and ‘‘type 2-low’’ asthma is more associated with obesity, presence of neutrophils, and unresponsiveness to corticosteroids, the mainstay asthma therapy. Here, we review the underlying immunological basis of various asthma endotypes by discussing results obtained from animal studies as well as results generated in clinical studies targeting specific immune pathways.

https://www.cell.com/cell/pdf/S0092-8674(21)00166-5.pdf

Collaborative Integration of Community Health Workers in Hospitals and Health Centers to Reduce Pediatric Asthma Disparities: A Quality Improvement Program Evaluation

Rachelle Paul-Brutus — Tue, 10 Sep 2024 18:02:09 GMT

To address pediatric asthma disparities on the South Side of Chicago, a community health worker (CHW) home visiting intervention was implemented collaboratively by academic institutions and community based health centers. This evaluation assessed the effectiveness of this longitudinal quality improvement CHW intervention in reducing asthma morbidity and healthcare utilization. All patients aged 2–18 who met the high-risk clinical criteria in outpatient settings or those who visited the ED due to asthma were offered the program. A within-subject study design analyzed asthma morbidity and healthcare utilization at baseline and follow-up. Multivariable mixed-effects regression models, adjusted for baseline demographic and asthma characteristics, were used to assess changes over time. Among 123 patients, the average age was 8.8 (4.4) years, and 89.3% were non-Hispanic black. Significant reductions were observed in the average daytime symptoms days (baseline 4.1 days and follow-up 1.6 days), night-time symptoms days (3.0 days and 1.2 days), and days requiring rescue medication (4.1 days and 1.6 days) in the past two weeks (all p<0.001). The average number of emergency department visits decreased from 0.92 one year before to 0.44 one year after program participation, a 52% reduction (p<0.001). No significant difference was found in hospital admissions. These results support the use of a collaborative approach to implement the CHW home visiting program as part of standard care for pediatric asthma patients in urban settings. This approach has the potential to reduce asthma disparities and underscores the valuable role of CHWs within the clinical care team.

SSPAC paper Comm Health 2024.pdf