- Email: [email protected]
Highlights Page
ORIGINAL ARTICLE HIGHLIGHTS FROM THIS ISSUE
Mapping the Asthma Care Process: Implications for Research and Practice Dima et al
868
What is already known about this topic? Asthma management is a complex process influenced by multiple interacting factors. There is limited integration of research on these influences, making it difficult to use research evidence in clinical practice. What does this article add to our knowledge? We propose a fully-integrated logic model of asthma care that emphasizes the role of patient behaviors (medication adherence, self-monitoring, trigger management, and management of severe asthma exacerbations) and health care professional behaviors (medical care and self-management support activities) in improving health outcomes. How does this study impact current management guidelines? The model can be used as an integrative framework for research and clinical practice in asthma, and optimized or adapted for different clinical contexts and respiratory conditions. Level of Asthma Controller Therapy Before Admission to the Hospital Belhassen et al
877
What is already known about this topic? Choice of controller therapy and adherence to treatment affect the risk of future asthma severe exacerbations leading to hospitalization. What does this article add to our knowledge? Before an asthma-related hospitalization, more than 60% of patients received little controller therapy and 4% were exposed to unbalanced use of long-acting beta agonists relative to inhaled corticosteroids. How does this study impact current management guidelines? A significant part of asthma-related hospitalizations could be prevented with improved management. Comparative Analysis of Persistence to Treatment among Patients with Asthma or COPD Receiving AirFluSal Forspiro or Seretide Diskus Salmeterol/Fluticasone Propionate Combination Therapy Bender et al 884 What is already known about this topic? Although effective treatments for both asthma and chronic obstructive pulmonary disease are available, low adherence and persistence result in poor patient outcomes including symptoms, reduced quality of life, exacerbations, hospitalizations, and increased mortality. What does this article add to our knowledge? Persistence to treatment for first-time users of salmeterol/fluticasone propionate combination therapy is suboptimal. Inhaler devices, which differ in the technique required for correct drug inhalation, may influence persistence behavior. How does this study impact current management guidelines? These new data provide a basis for further research to better understand persistence behavior and to develop strategies to address poor persistence. Long-Term Inhaled Corticosteroid Adherence in Asthma Patients with Short-Term Adherence Laforest et al
890
What is already known about this topic? Although adherence to inhaled corticosteroids (ICS) is known to be poor in asthma, it is unclear to which extent patients regularly using ICS during consecutive months remain adherent to therapy in the longer-term. What does this article add to our knowledge? Identifying asthma patients’ regular use of ICS during several months does not predict long-term adherence, which suggests quickly waning use in asthma. In our population, markers of asthma severity or lower control, younger age (children and teenagers), and factors contributing to the continuity of care improved drug coverage. How does this study impact current management guidelines? To allow valid assessment, adherence to asthma therapy should be studied for prolonged periods, because episodes of regular use do not last.
10A
J ALLERGY CLIN IMMUNOL PRACT VOLUME 4, NUMBER 5
11A
Irregular and Ineffective: A Quantitative Observational Study of the Time and Technique of Inhaler Use Sulaiman et al 900 What is already known about this topic? Previous observational studies suggest that up to 60% of patients make errors in inhaler handling and many miss doses. What does this article add to our knowledge? Of 60 doses expected to be taken in a month per person, on average 49 doses (82%) were attempted; when errors were accounted for, the average number of actual doses taken was 34 doses (57%). How does this study impact current management guidelines? These data highlight that ineffective and irregular inhaler use is common and only 20% of patients use their inhaler correctly and on time. Mismatching Among Guidelines, Providers, and Parents on Controller Medication Use in Children With Asthma Wu et al 910 What is already known about this topic? Underuse of controller medicines among children with persistent asthma remains widespread despite clear national guidelines and quality measures. What does this article add to our knowledge? Providers do not recommend that inhaled steroids be used according to national guidelines. Mismatches between parent reports and providers intentions regarding how the child was supposed to use inhaled steroids occurred in half of the children. How does this study impact current management guidelines? Efforts to increase the use of controller medicines for asthma should focus on ways to align provider decision making with national guidelines and ways to reduce mismatches between parent and provider intentions regarding controller medication use. Asthma Status and Risk of Incident Myocardial Infarction: A Population-Based Case-Control Study Bang et al 917 What is already known about this topic? Asthma has been reported to be associated with risks of a broad range of cardiovascular diseases (CVD), but the nature of the association between asthma and risks of CVD has been poorly understood. What does this article add to our knowledge? Active asthma is an unrecognized risk factor for incident myocardial infarction. The impact of asthma may go beyond airway-related morbidity and pose systemic inflammatory risks. How does this study impact current management guidelines? Clinicians caring for patients with active asthma should have a higher index of suspicion of myocardial infarction if their patient presents with suggestive symptoms. Further studies are needed to assess the role of asthma control status and medications in the risk of myocardial infarction. The High Impact of Penicillin Allergy Registration in Hospitalized Patients van Dijk et al
926
What is already known about this topic? Suspected penicillin allergy is often not verified or excluded by diagnostic testing. What does this article add to our knowledge? Prevalence of penicillin allergy registration in a general population of patients hospitalized in a Dutch University Medical Center is 5.6%, has high impact on antibiotic prescribing, and is associated with a higher risk of readmission within 12 weeks. How does this study impact current management guidelines? Verification of the penicillin allergy in hospitalized patients might restrict the use of reserve antibiotics and improve patient outcome. A Randomized Controlled Trial of the Effect of Broccoli Sprouts on Antioxidant Gene Expression and Airway Inflammation in Asthmatics Sudini et al 932 What is already known about this topic? Broccoli sprouts are a rich source of a potent antioxidant, sulforaphane, and a robust antioxidant response is thought to protect the airways from inflammation. What does this article add to our knowledge? In this double-blind, placebo-controlled trial of broccoli sprouts in adults with asthma, short-term ingestion of 100 g of broccoli sprouts increased blood sulforaphane levels, but did not reduce airway inflammation or induce protective biologic effects. How does this study impact current management guidelines? Although broccoli sprouts are commercially available and purported by some to have beneficial health effects, eating large amounts for 3 consecutive days had no effects on the airway despite increasing blood sulforaphane levels.
12A
J ALLERGY CLIN IMMUNOL PRACT SEPTEMBER/OCTOBER 2016
Hypereosinophilia in Children and Adults: A Retrospective Comparison Williams et al
941
What is already known about this topic? Aside from a handful of case reports and a small case series, little is known about the clinical presentation, ultimate diagnosis, treatment, and prognosis of hypereosinophilia and hypereosinophilic syndrome in children. What does this article add to our knowledge? This article characterizes and compares the clinical presentation, treatment, and prognosis of hypereosinophilia and hypereosinophilic syndrome in children and adults. How does this study impact current management guidelines? In view of the remarkable similarities between hypereosinophilic syndrome in children and adults, recommended diagnostic and treatment algorithms for adults with eosinophilia are likely to be applicable to the pediatric population. Tolerability and Effectiveness of 17-a-Alkylated Androgen Therapy for Hereditary Angioedema: A Reexamination Zuraw et al 948 What is already known about this topic? 17-a-Alkylated androgens have been widely used for prophylactic treatment of hereditary angioedema (HAE) to reduce attack frequency and severity. Relatively little is known about the variability in clinical responses or degree of side effects they cause. What does this article add to our knowledge? In the largest cohort ever reported, we show that androgen effectiveness is extremely variable and that many subjects continue to swell even on high doses. Reported side effects are extremely frequent, severe, and dose related. How does this study impact current management guidelines? Androgens should not be used for most patients with HAE. When tried, androgens should be given at the lowest possible dose. If ineffective, patients should be switched to an alternative rather than increasing the androgen dose. Food Allergy Sensitization and Presentation in Siblings of Food Allergic Children Gupta et al
956
What is already known about this topic? Peanut allergy in 1 sibling may be a potential risk factor for peanut allergy in the younger sibling, but little data are available about sibling-to-sibling risk of other allergies. What does this article add to our knowledge? The risk of clinically irrelevant food sensitization is several-fold more likely than sensitization with clinical reactivity, showing low frequency of sibling-associated risk of food allergy compared with falsely positive test results. How does this study impact current management guidelines? Food allergy screening of 1 sibling based on food allergy in another may be unwarranted, given a low prevalence of clinical reactivity and a high likelihood of detecting clinically irrelevant sensitization in siblings of food allergic children. Safety and Usage of C1-Inhibitor in Hereditary Angioedema: Berinert Registry Data Riedl et al
963
What is already known about this topic? The safety of plasma-derived C1-inhibitor (C1-INH; Berinert) has been well documented in studies in patients with hereditary angioedema (HAE) treated with recommended doses. Rare cases of thromboembolic events have been reported with C1-INH use, generally off-label and at supratherapeutic doses. What does this article add to our knowledge? This large, international, registry of patients using C1-INH is the most extensive of its kind, providing real-world data regarding general safety and intentional surveillance for issues of particular interest, including thromboembolism and possible viral transmission. How does this study impact current management guidelines? Recent HAE guidelines consistently recommend self-administration of C1-INH. The Berinert registry data provide real-world evidence for widespread implementation of this practice and support the feasibility and safety of C1-INH administration outside of a health care setting.
J ALLERGY CLIN IMMUNOL PRACT VOLUME 4, NUMBER 5
Developing, Implementing, and Evaluating a School-Centered Asthma Program: Step-Up Asthma Program Liptzin et al
13A
972
What is already known about this topic? Asthma is a problem in school-aged children and contributes to poor school performance. What does this article add to our knowledge? Developing a successful school-centered asthma program involves collaboration between school nurses, school administration, and local providers. This report describes a school-centered asthma program that reduced asthma morbidity and is being disseminated to additional school districts, demonstrating sustainability. How does this study impact current management guidelines? The Step-Up Asthma Program applies National Asthma Education and Prevention Program-National Heart, Lung, and Blood Institute guidelines for evidence-based programs for children with asthma.
Mapping the Asthma Care Process: Implications for Research and Practice Dima et al
868
What is already known about this topic? Asthma management is a complex process influenced by multiple interacting factors. There is limited integration of research on these influences, making it difficult to use research evidence in clinical practice. What does this article add to our knowledge? We propose a fully-integrated logic model of asthma care that emphasizes the role of patient behaviors (medication adherence, self-monitoring, trigger management, and management of severe asthma exacerbations) and health care professional behaviors (medical care and self-management support activities) in improving health outcomes. How does this study impact current management guidelines? The model can be used as an integrative framework for research and clinical practice in asthma, and optimized or adapted for different clinical contexts and respiratory conditions. Level of Asthma Controller Therapy Before Admission to the Hospital Belhassen et al
877
What is already known about this topic? Choice of controller therapy and adherence to treatment affect the risk of future asthma severe exacerbations leading to hospitalization. What does this article add to our knowledge? Before an asthma-related hospitalization, more than 60% of patients received little controller therapy and 4% were exposed to unbalanced use of long-acting beta agonists relative to inhaled corticosteroids. How does this study impact current management guidelines? A significant part of asthma-related hospitalizations could be prevented with improved management. Comparative Analysis of Persistence to Treatment among Patients with Asthma or COPD Receiving AirFluSal Forspiro or Seretide Diskus Salmeterol/Fluticasone Propionate Combination Therapy Bender et al 884 What is already known about this topic? Although effective treatments for both asthma and chronic obstructive pulmonary disease are available, low adherence and persistence result in poor patient outcomes including symptoms, reduced quality of life, exacerbations, hospitalizations, and increased mortality. What does this article add to our knowledge? Persistence to treatment for first-time users of salmeterol/fluticasone propionate combination therapy is suboptimal. Inhaler devices, which differ in the technique required for correct drug inhalation, may influence persistence behavior. How does this study impact current management guidelines? These new data provide a basis for further research to better understand persistence behavior and to develop strategies to address poor persistence. Long-Term Inhaled Corticosteroid Adherence in Asthma Patients with Short-Term Adherence Laforest et al
890
What is already known about this topic? Although adherence to inhaled corticosteroids (ICS) is known to be poor in asthma, it is unclear to which extent patients regularly using ICS during consecutive months remain adherent to therapy in the longer-term. What does this article add to our knowledge? Identifying asthma patients’ regular use of ICS during several months does not predict long-term adherence, which suggests quickly waning use in asthma. In our population, markers of asthma severity or lower control, younger age (children and teenagers), and factors contributing to the continuity of care improved drug coverage. How does this study impact current management guidelines? To allow valid assessment, adherence to asthma therapy should be studied for prolonged periods, because episodes of regular use do not last.
10A
J ALLERGY CLIN IMMUNOL PRACT VOLUME 4, NUMBER 5
11A
Irregular and Ineffective: A Quantitative Observational Study of the Time and Technique of Inhaler Use Sulaiman et al 900 What is already known about this topic? Previous observational studies suggest that up to 60% of patients make errors in inhaler handling and many miss doses. What does this article add to our knowledge? Of 60 doses expected to be taken in a month per person, on average 49 doses (82%) were attempted; when errors were accounted for, the average number of actual doses taken was 34 doses (57%). How does this study impact current management guidelines? These data highlight that ineffective and irregular inhaler use is common and only 20% of patients use their inhaler correctly and on time. Mismatching Among Guidelines, Providers, and Parents on Controller Medication Use in Children With Asthma Wu et al 910 What is already known about this topic? Underuse of controller medicines among children with persistent asthma remains widespread despite clear national guidelines and quality measures. What does this article add to our knowledge? Providers do not recommend that inhaled steroids be used according to national guidelines. Mismatches between parent reports and providers intentions regarding how the child was supposed to use inhaled steroids occurred in half of the children. How does this study impact current management guidelines? Efforts to increase the use of controller medicines for asthma should focus on ways to align provider decision making with national guidelines and ways to reduce mismatches between parent and provider intentions regarding controller medication use. Asthma Status and Risk of Incident Myocardial Infarction: A Population-Based Case-Control Study Bang et al 917 What is already known about this topic? Asthma has been reported to be associated with risks of a broad range of cardiovascular diseases (CVD), but the nature of the association between asthma and risks of CVD has been poorly understood. What does this article add to our knowledge? Active asthma is an unrecognized risk factor for incident myocardial infarction. The impact of asthma may go beyond airway-related morbidity and pose systemic inflammatory risks. How does this study impact current management guidelines? Clinicians caring for patients with active asthma should have a higher index of suspicion of myocardial infarction if their patient presents with suggestive symptoms. Further studies are needed to assess the role of asthma control status and medications in the risk of myocardial infarction. The High Impact of Penicillin Allergy Registration in Hospitalized Patients van Dijk et al
926
What is already known about this topic? Suspected penicillin allergy is often not verified or excluded by diagnostic testing. What does this article add to our knowledge? Prevalence of penicillin allergy registration in a general population of patients hospitalized in a Dutch University Medical Center is 5.6%, has high impact on antibiotic prescribing, and is associated with a higher risk of readmission within 12 weeks. How does this study impact current management guidelines? Verification of the penicillin allergy in hospitalized patients might restrict the use of reserve antibiotics and improve patient outcome. A Randomized Controlled Trial of the Effect of Broccoli Sprouts on Antioxidant Gene Expression and Airway Inflammation in Asthmatics Sudini et al 932 What is already known about this topic? Broccoli sprouts are a rich source of a potent antioxidant, sulforaphane, and a robust antioxidant response is thought to protect the airways from inflammation. What does this article add to our knowledge? In this double-blind, placebo-controlled trial of broccoli sprouts in adults with asthma, short-term ingestion of 100 g of broccoli sprouts increased blood sulforaphane levels, but did not reduce airway inflammation or induce protective biologic effects. How does this study impact current management guidelines? Although broccoli sprouts are commercially available and purported by some to have beneficial health effects, eating large amounts for 3 consecutive days had no effects on the airway despite increasing blood sulforaphane levels.
12A
J ALLERGY CLIN IMMUNOL PRACT SEPTEMBER/OCTOBER 2016
Hypereosinophilia in Children and Adults: A Retrospective Comparison Williams et al
941
What is already known about this topic? Aside from a handful of case reports and a small case series, little is known about the clinical presentation, ultimate diagnosis, treatment, and prognosis of hypereosinophilia and hypereosinophilic syndrome in children. What does this article add to our knowledge? This article characterizes and compares the clinical presentation, treatment, and prognosis of hypereosinophilia and hypereosinophilic syndrome in children and adults. How does this study impact current management guidelines? In view of the remarkable similarities between hypereosinophilic syndrome in children and adults, recommended diagnostic and treatment algorithms for adults with eosinophilia are likely to be applicable to the pediatric population. Tolerability and Effectiveness of 17-a-Alkylated Androgen Therapy for Hereditary Angioedema: A Reexamination Zuraw et al 948 What is already known about this topic? 17-a-Alkylated androgens have been widely used for prophylactic treatment of hereditary angioedema (HAE) to reduce attack frequency and severity. Relatively little is known about the variability in clinical responses or degree of side effects they cause. What does this article add to our knowledge? In the largest cohort ever reported, we show that androgen effectiveness is extremely variable and that many subjects continue to swell even on high doses. Reported side effects are extremely frequent, severe, and dose related. How does this study impact current management guidelines? Androgens should not be used for most patients with HAE. When tried, androgens should be given at the lowest possible dose. If ineffective, patients should be switched to an alternative rather than increasing the androgen dose. Food Allergy Sensitization and Presentation in Siblings of Food Allergic Children Gupta et al
956
What is already known about this topic? Peanut allergy in 1 sibling may be a potential risk factor for peanut allergy in the younger sibling, but little data are available about sibling-to-sibling risk of other allergies. What does this article add to our knowledge? The risk of clinically irrelevant food sensitization is several-fold more likely than sensitization with clinical reactivity, showing low frequency of sibling-associated risk of food allergy compared with falsely positive test results. How does this study impact current management guidelines? Food allergy screening of 1 sibling based on food allergy in another may be unwarranted, given a low prevalence of clinical reactivity and a high likelihood of detecting clinically irrelevant sensitization in siblings of food allergic children. Safety and Usage of C1-Inhibitor in Hereditary Angioedema: Berinert Registry Data Riedl et al
963
What is already known about this topic? The safety of plasma-derived C1-inhibitor (C1-INH; Berinert) has been well documented in studies in patients with hereditary angioedema (HAE) treated with recommended doses. Rare cases of thromboembolic events have been reported with C1-INH use, generally off-label and at supratherapeutic doses. What does this article add to our knowledge? This large, international, registry of patients using C1-INH is the most extensive of its kind, providing real-world data regarding general safety and intentional surveillance for issues of particular interest, including thromboembolism and possible viral transmission. How does this study impact current management guidelines? Recent HAE guidelines consistently recommend self-administration of C1-INH. The Berinert registry data provide real-world evidence for widespread implementation of this practice and support the feasibility and safety of C1-INH administration outside of a health care setting.
J ALLERGY CLIN IMMUNOL PRACT VOLUME 4, NUMBER 5
Developing, Implementing, and Evaluating a School-Centered Asthma Program: Step-Up Asthma Program Liptzin et al
13A
972
What is already known about this topic? Asthma is a problem in school-aged children and contributes to poor school performance. What does this article add to our knowledge? Developing a successful school-centered asthma program involves collaboration between school nurses, school administration, and local providers. This report describes a school-centered asthma program that reduced asthma morbidity and is being disseminated to additional school districts, demonstrating sustainability. How does this study impact current management guidelines? The Step-Up Asthma Program applies National Asthma Education and Prevention Program-National Heart, Lung, and Blood Institute guidelines for evidence-based programs for children with asthma.