Advances and recent developments in asthma in 2020

Affiliations.

  • 1 Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
  • 2 Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
  • 3 Department of Medical Immunology, Institute of Health Sciences, Bursa Uludag University, Bursa, Turkey.
  • 4 Faculty of Medicine, Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey.
  • 5 Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
  • 6 Swiss Institute for Bioinformatics (SIB), Davos, Switzerland.
  • 7 Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
  • 8 Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
  • 9 Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystok, Poland.
  • 10 Faculty of Medicine, Transylvania University, Brasov, Romania.
  • PMID: 32997808
  • DOI: 10.1111/all.14607

In this review, we discuss recent publications on asthma and review the studies that have reported on the different aspects of the prevalence, risk factors and prevention, mechanisms, diagnosis, and treatment of asthma. Many risk and protective factors and molecular mechanisms are involved in the development of asthma. Emerging concepts and challenges in implementing the exposome paradigm and its application in allergic diseases and asthma are reviewed, including genetic and epigenetic factors, microbial dysbiosis, and environmental exposure, particularly to indoor and outdoor substances. The most relevant experimental studies further advancing the understanding of molecular and immune mechanisms with potential new targets for the development of therapeutics are discussed. A reliable diagnosis of asthma, disease endotyping, and monitoring its severity are of great importance in the management of asthma. Correct evaluation and management of asthma comorbidity/multimorbidity, including interaction with asthma phenotypes and its value for the precision medicine approach and validation of predictive biomarkers, are further detailed. Novel approaches and strategies in asthma treatment linked to mechanisms and endotypes of asthma, particularly biologicals, are critically appraised. Finally, due to the recent pandemics and its impact on patient management, we discuss the challenges, relationships, and molecular mechanisms between asthma, allergies, SARS-CoV-2, and COVID-19.

Keywords: COVID-19; asthma biomarkers; asthma phenotypes; biological therapeutics; comorbidities.

© 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

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Page 1 of 2

Psychological distress and associated factors among asthmatic patients in Southern, Ethiopia, 2021

There is an increased prevalence of psychological distress in adults with asthma. Psychological distress describes unpleasant feelings or emotions that impact the level of functioning. It is a significant exac...

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Retrospective assessment of a collaborative digital asthma program for Medicaid-enrolled children in southwest Detroit: reductions in short-acting beta-agonist (SABA) medication use

Real-world evidence for digitally-supported asthma programs among Medicaid-enrolled children remains limited. Using data from a collaborative quality improvement program, we evaluated the impact of a digital i...

Nonadherence to antiasthmatic medications and its predictors among asthmatic patients in public hospitals of Bahir Dar City, North West Ethiopia: using ASK-12 tool

Globally, adequate asthma control is not yet achieved. The main cause of uncontrollability is nonadherence to prescribed medications.

The hen and the egg question in atopic dermatitis: allergy or eczema comes first

Atopic dermatitis (AD) as a chronic inflammatory systemic condition is far more than skin deep. Co-morbidities such as asthma and allergic rhinitis as well as the psychological impact influence seriously the q...

Medication regimen complexity and its impact on medication adherence and asthma control among patients with asthma in Ethiopian referral hospitals

Various studies have found that medication adherence is generally low among patients with asthma, and that the complexity of the regimen may be a potential factor. However, there is no information on the compl...

Monoclonal antibodies targeting small airways: a new perspective for biological therapies in severe asthma

Small airway dysfunction (SAD) in asthma is characterized by the inflammation and narrowing of airways with less of 2 mm in diameter between generations 8 and 23 of the bronchial tree. It is now widely accepte...

Level of asthma control and its determinants among adults living with asthma attending selected public hospitals in northwestern, Ethiopia: using an ordinal logistic regression model

Asthma is a major public health challenge and is characterized by recurrent attacks of breathlessness and wheezing that vary in severity and frequency from person to person. Asthma control is an important meas...

Static lung volumes and diffusion capacity in adults 30 years after being diagnosed with asthma

Long-term follow-up studies of adults with well-characterized asthma are sparse. We aimed to explore static lung volumes and diffusion capacity after 30 + years with asthma.

Over-prescription of short-acting β 2 -agonists and asthma management in the Gulf region: a multicountry observational study

The overuse of short-acting β 2 -agonists (SABA) is associated with poor asthma control. However, data on SABA use in the Gulf region are limited. Herein, we describe SABA prescription practices and clinical outcom...

A serological biomarker of type I collagen degradation is related to a more severe, high neutrophilic, obese asthma subtype

Asthma is a heterogeneous disease; therefore, biomarkers that can assist in the identification of subtypes and direct therapy are highly desirable. Asthma is a chronic inflammatory disease that leads to change...

Adherence to inhalers and associated factors among adult asthma patients: an outpatient-based study in a tertiary hospital of Rajshahi, Bangladesh

Adherence to inhaler medication is an important contributor to optimum asthma control along with adequate pharmacotherapy. The objective of the present study was to assess self-reported adherence levels and to...

The link between atopic dermatitis and asthma- immunological imbalance and beyond

Atopic diseases are multifactorial chronic disturbances which may evolve one into another and have overlapping pathogenetic mechanisms. Atopic dermatitis is in most cases the first step towards the development...

The effects of nebulized ketamine and intravenous magnesium sulfate on corticosteroid resistant asthma exacerbation; a randomized clinical trial

Asthma exacerbation is defined as an acute attack of shortness of breath with more than 25% decrease in morning peak flow compared to the baseline on 2 consecutive days, which requires immediate standard thera...

Determinants of asthma in Ethiopia: age and sex matched case control study with special reference to household fuel exposure and housing characteristics

Asthma is a chronic inflammatory disorder characterized by airway obstruction and hyper-responsiveness. Studies suggest that household fuel exposure and housing characteristics are associated with air way rela...

Feasibility and acceptability of monitoring personal air pollution exposure with sensors for asthma self-management

Exposure to fine particulate matter (PM 2.5 ) increases the risk of asthma exacerbations, and thus, monitoring personal exposure to PM 2.5 may aid in disease self-management. Low-cost, portable air pollution sensors...

Biological therapy for severe asthma

Around 5–10% of the total asthmatic population suffer from severe or uncontrolled asthma, which is associated with increased mortality and hospitalization, increased health care burden and worse quality of lif...

Treatment outcome clustering patterns correspond to discrete asthma phenotypes in children

Despite widely and regularly used therapy asthma in children is not fully controlled. Recognizing the complexity of asthma phenotypes and endotypes imposed the concept of precision medicine in asthma treatment...

Positive change in asthma control using therapeutic patient education in severe uncontrolled asthma: a one-year prospective study

Severe asthma is difficult to control. Therapeutic patient education enables patients to better understand their disease and cope with treatment, but the effect of therapeutic patient education in severe uncon...

Asthma and COVID-19: a dangerous liaison?

The coronavirus disease 2019 (COVID-19) pandemic, caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), provoked the most striking international public health crisis of our time. COVI...

Knowledge, attitude, and practice towards COVID-19 among chronic disease patients at Aksum Hospital, Northern Ethiopia, 2020: a cross-sectional study

The Coronavirus disease 2019 outbreak is the first reported case in Wuhan, China in December 2019 and suddenly became a major global health concern. Currently, there is no vaccine and treatment have been repor...

Self-reported vs. objectively assessed adherence to inhaled corticosteroids in asthma

Adherence to inhaled corticosteroids (ICS) in asthma is vital for disease control. However, obtaining reliable and clinically useful measures of adherence remains a major challenge. We investigated the associa...

Association between prevalence of obstructive lung disease and obesity: results from The Vermont Diabetes Information System

The association of obesity with the development of obstructive lung disease, namely asthma and/or chronic obstructive pulmonary disease, has been found to be significant in general population studies, and weig...

Changes in quantifiable breathing pattern components predict asthma control: an observational cross-sectional study

Breathing pattern disorders are frequently reported in uncontrolled asthma. At present, this is primarily assessed by questionnaires, which are subjective. Objective measures of breathing pattern components ma...

The role of leukotriene modifying agent treatment in neuropsychiatric events of elderly asthma patients: a nested case control study

In March 2020, the US Food and Drug Administration decided that the dangers related to neuropsychiatric events (NPEs) of montelukast, one of the leukotriene modifying agents (LTMAs), should be communicated thr...

Asthma and stroke: a narrative review

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation, bronchial reversible obstruction and hyperresponsiveness to direct or indirect stimuli. It is a severe disease causing a...

Comparison of dental caries (DMFT and DMFS indices) between asthmatic patients and control group in Iran: a meta-analysis

The association between caries index, which is diagnosed by Decayed, Missing, and Filled Teeth (DMFT), and asthma has been assessed in several studies, which yielded contradictory results. Meta-analysis is the...

ICS/formoterol in the management of asthma in the clinical practice of pulmonologists: an international survey on GINA strategy

The treatment with short-acting beta-2 agonists (SABA) alone is no longer recommended due to safety issues. Instead, the current Global Initiative for Asthma (GINA) Report recommends the use of the combination...

Sustainability of residential environmental interventions and health outcomes in the elderly

Research has documented that housing conditions can negatively impact the health of residents. Asthma has many known indoor environmental triggers including dust, pests, smoke and mold, as evidenced by the 25 ...

Non-adherence to inhaled medications among adult asthmatic patients in Ethiopia: a systematic review and meta-analysis

Medication non-adherence is one of a common problem in asthma management and it is the main factor for uncontrolled asthma. It can result in poor asthma control, which leads to decreased quality of life, incre...

The outcome of COVID-19 among the geriatric age group in African countries: protocol for a systematic review and meta-analysis

According to the World Health Organization (WHO), the outbreak of coronavirus disease in 2019 (COVID-19) has been declared as a pandemic and public health emergency that infected more than 5 million people wor...

Correction to: A comparison of biologicals in the treatment of adults with severe asthma – real-life experiences

An amendment to this paper has been published and can be accessed via the original article.

The original article was published in Asthma Research and Practice 2020 6 :2

Disease control in patients with asthma and respiratory symptoms (wheezing, cough) during sleep

The Global Initiative for Asthma ( GINA)-defined criteria for asthma control include questions about daytime symptoms, limitation of activity, nocturnal symptoms, need for reliever treatment and patients’ satisfac...

The burden, admission, and outcomes of COVID-19 among asthmatic patients in Africa: protocol for a systematic review and meta-analysis

Coronavirus disease 2019 outbreak is the first reported case in Wuhan, China in December 2019 and suddenly became a major global health concern. According to the European Centre for Disease Prevention and Cont...

The healthcare seeking behaviour of adult patients with asthma at Chitungwiza Central Hospital, Zimbabwe

Although asthma is a serious public health concern in Zimbabwe, there is lack of information regarding the decision to seek for healthcare services among patients. This study aimed to determine the health care...

Continuous versus intermittent short-acting β2-agonists nebulization as first-line therapy in hospitalized children with severe asthma exacerbation: a propensity score matching analysis

Short-acting β2-agonist (SABA) nebulization is commonly prescribed for children hospitalized with severe asthma exacerbation. Either intermittent or continuous delivery has been considered safe and efficient. ...

Patient perceived barriers to exercise and their clinical associations in difficult asthma

Exercise is recommended in guidelines for asthma management and has beneficial effects on symptom control, inflammation and lung function in patients with sub-optimally controlled asthma. Despite this, physica...

Asthma management with breath-triggered inhalers: innovation through design

Asthma affects the lives of hundred million people around the World. Despite notable progresses in disease management, asthma control remains largely insufficient worldwide, influencing patients’ wellbeing and...

A nationwide study of asthma correlates among adolescents in Saudi Arabia

Asthma is a chronic airway inflammation disease that is frequently found in children and adolescents with an increasing prevalence. Several studies are linking its presence to many lifestyle and health correla...

A comparison of biologicals in the treatment of adults with severe asthma – real-life experiences

Anti-IgE (omalizumab) and anti-IL5/IL5R (reslizumab, mepolizumab and benralizumab) treatments are available for severe allergic and eosinophilic asthma. In these patients, studies have shown beneficial effects...

The Correction to this article has been published in Asthma Research and Practice 2020 6 :10

Determinants of Acute Asthma Attack among adult asthmatic patients visiting hospitals of Tigray, Ethiopia, 2019: case control study

Acute asthma attack is one of the most common causes of visits to hospital emergency departments in all age groups of the population and accounts for the greater part of healthcare burden from the disease. Des...

Determinants of non-adherence to inhaled steroids in adult asthmatic patients on follow up in referral hospital, Ethiopia: cross-sectional study

Asthma is one of the major non-communicable diseases worldwide. The prevalence of asthma has continuously increased over the last five decades, resulting in 235 million people suffering from it. One of the mai...

Development of a framework for increasing asthma awareness in Chitungwiza, Zimbabwe

Asthma accounts for significant global morbidity and health-care costs. It is still poorly understood among health professionals and the general population. Consequently, there are significant morbidity and mo...

Epidemiology and utilization of primary health care services in Qatar by asthmatic children 5–12 years old: secondary data analysis 2016–2017

Childhood asthma is a growing clinical problem and a burden on the health care system due to repetitive visits to children’s emergency departments and frequent hospital admissions where it is poorly controlled...

Is asthma in the elderly different? Functional and clinical characteristics of asthma in individuals aged 65 years and older

The prevalence of chronic diseases in the elderly (> 65 years), including asthma, is growing, yet information available on asthma in this population is scarce.

Factors associated with exacerbations among adults with asthma according to electronic health record data

Asthma is a chronic inflammatory lung disease that affects 18.7 million U.S. adults. Electronic health records (EHRs) are a unique source of information that can be leveraged to understand factors associated w...

What is safe enough - asthma in pregnancy - a review of current literature and recommendations

Although asthma is one of the most serious diseases causing complications during pregnancy, half of the women discontinue therapy thus diminishing the control of the disease, mostly due to the inadequate educa...

Biomarkers in asthma: state of the art

Asthma is a heterogenous disease characterized by multiple phenotypes driven by different mechanisms. The implementation of precision medicine in the management of asthma requires the identification of phenoty...

Exhaled biomarkers in childhood asthma: old and new approaches

Asthma is a chronic condition usually characterized by underlying inflammation. The study of asthmatic inflammation is of the utmost importance for both diagnostic and monitoring purposes. The gold standard fo...

Assessment of predictors for acute asthma attack in asthmatic patients visiting an Ethiopian hospital: are the potential factors still a threat?

Recurrent exacerbations in patients with moderate or severe asthma are the major causes of morbidity, mortality and medical expenditure. Identifying predictors of frequent asthma attack might offer the fertile...

Effect of adjusting the combination of budesonide/formoterol on the alleviation of asthma symptoms

The combination of budesonide + formoterol (BFC) offers the advantages of dose adjustment in a single inhaler according to asthma symptoms. We analyzed the relationship between asthma symptoms in terms of peak...

Asthma Research and Practice

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Asthma articles from across Nature Portfolio

Asthma is a form of bronchial disorder caused by inflammation of the bronchi. It is characterized by spasmodic contraction of airway smooth muscle, difficulty breathing, wheezing and coughing.

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Asthma prevalence among United States population insights from NHANES data analysis

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Association of factors with childhood asthma and allergic diseases using latent class analysis

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Documentation of comorbidities, lifestyle factors, and asthma management during primary care scheduled asthma contacts

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Bronchial epithelial transcriptomics and experimental validation reveal asthma severity-related neutrophilc signatures and potential treatments

Transcriptomic analysis of the airway epithelia in asthma patients identifies several neutrophilic signatures and targets associated with asthma severity, and highlights the potential therapeutic value of Reperixin in managing deteriorating asthma.

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Genomic attributes of airway commensal bacteria and mucosa

Systematic culture and genome sequencing of thoracic airway commensal bacteria finds many potential influences on lung health and disease. Polyomics of differentiated airway epithelium also suggest pathways that may sustain host-microbial interactions.

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How to make Asthma Right Care ‘easy’ in primary care: learnings from the 2023 Asthma Right Care Summit

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Boosted electrostatic biocatalysis

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Vitamin B-reath easier: vitamin B6 derivatives reduce IL-33 to limit lung inflammation

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5-hydroxymethylcytosine stabilizes transcription by preventing aberrant initiation in gene bodies

5-hydroxymethylcytosine (5hmC) accumulates in transcribed gene regions (called ‘gene bodies’) and near enhancers, but its biological role has remained mysterious. A new study demonstrates that 5hmC serves to counteract inappropriate, spurious intragenic transcription in airway smooth muscle cells and by doing so, this DNA base functions in the prevention of chronic inflammation in the lung and an asthma-like phenotype.

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Natural mouse microbes transiently block innate responses to allergens

Cohousing pet-store mice with laboratory mice leads to the natural transfer of microbes and subsequent inflammation in laboratory mice. Lung group 2 innate lymphoid cells — rapid responders to airway allergens — are transiently inhibited by inflammatory signals, but their activity recovers once the active infection subsides.

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Asthma Research

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Over the years, and as part of our broader commitment to research on lung diseases, the NHLBI has led and supported asthma research to discover better prevention and treatment options. Research supported by the NHLBI has also helped us understand what leads to and affects asthma, and it has provided doctors with information about what treatments work best for people who have asthma. 

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NHLBI research that really made a difference

For nearly 20 years, the NHLBI  Severe Asthma Research Program (SARP)  has transformed our knowledge of severe asthma. Research supported through the program has identified  secondhand smoke, pneumonia, and obesity as key risk factors for asthma . Studies have also found genetic variations linked with severe asthma and biomarkers for asthma severity. Researchers can  request access to the data on dbGaP .

Research funded by the NHLBI

Our  Division of Lung Diseases  and its  Airway Biology and Disease Branch  oversee much of the research on asthma we fund. The Asthma Program supports research related to asthma, including the role of inflammation in the development of asthma, genetics and asthma, and clinical management of asthma in adults and children.

Find  funding opportunities  and  program contacts  for asthma research.

Current research on asthma treatment

  • How ventilators may lead to asthma: The NHLBI-funded Post-Vent study will use data collected from the Prematurity-Related Ventilatory Control (Pre-Vent): Role in Respiratory Outcomes NHLBI Collaborative Program to study long-term health outcomes of premature birth and intermittent low oxygen levels shortly after babies are born prematurely. These babies often develop asthma. This study will try to predict which premature babies are most likely to develop asthma. 
  • Why medicines work: An NHLBI-funded study is assessing how an antibiotic called azithromycin (AZ) reduces severe wheezing in preschool children seen in the emergency room. While prior studies have shown that AZ benefits these children, it is unclear if the beneficial effects are because of the antibacterial activity of AZ or because of the anti-inflammatory activity of AZ. To help answer this question, this study will compare whether children with bacteria growing in their throats get more benefit from AZ treatment than children who do not have bacteria growing in their throats at the time they go to the emergency room with severe wheezing.
  • Personalized medicine: The  Precision Interventions for Severe and/or Exacerbation Prone Asthma Network (PrecISE) is conducting clinical trials to identify personalized medicine approaches that treat severe asthma more effectively. It has established 30 locations nationwide that will test new and approved treatments based on each patient’s specific biology and biomarkers.

Find more NHLBI-funded studies on asthma treatment at NIH RePORTER. 

An illustration of lungs

Learn about one PrecISE study that is looking at treatments that may help support people with severe asthma or asthma that hasn’t responded to traditional treatments: Personalizing treatment for severe asthma .

Current research on asthma biology

The different bacteria in a person’s body can affect the immune system. We support studies to figure out whether different bacteria play a role in developing certain types of asthma.

  • Airway cells and asthma: NHLBI-funded research will look at how genes are regulated in airway epithelial cells to better understand how they affect the development of asthma. Epithelial cells line the lung’s airways. As researchers learn more about how changes in the cells lead to asthma, they hope to develop treatments to reprogram the epithelium and prevent or cure asthma and other lung diseases.
  • Bacteria in the airways: An AsthmaNet  study found  different bacteria in the airways of people with asthma compared to those without asthma. Some of the observed differences could help predict the response to inhaled steroids. Researchers can  request the data  through our Biologic Specimen and Data Repository Information Coordinating Center.
  • Targeted treatments for severe asthma: NHLBI-supported researchers are developing new and personalized approaches to treating severe asthma . The study builds on earlier research which led the researchers’ discovery of three mechanisms that are relevant to severe asthma.

Find more NHLBI-funded studies on asthma biology at NIH RePORTER.

Researchers have identified a key role for the circadian system — the biological clock that controls your sleep/wake cycle: Study of biological clock may explain why asthma worsens at night .

Current research on asthma disparities

African Americans are more likely to develop asthma and three times more likely to die from asthma-related causes than white Americans. Research on this topic is part our broader commitment to addressing  health disparities and inequities . 

  • Genetic factors: The  Consortium on Asthma among African-Ancestry Populations in the Americas (CAAPA)  aims to discover genes that confer asthma risk among individuals of African ancestry and to study genetic diversity in populations of African descent. Read  some of the results here  or  request access to the data on dbGaP .
  • Comprehensive care for at-risk children: We also fund the  Asthma Empowerment Collaborations to Reduce Childhood Asthma Disparities . We support clinical trials to evaluate programs that provide comprehensive care for children at high risk of poor asthma outcomes, such as low-income minority children. 
  • Race, sex, and socioeconomic factors: The NHLBI recently launched the DECIPHeR program to study differences in heart and lung diseases among groups defined by race and ethnicity, sex and/or gender, and socioeconomic status. The first projects began in September 2020, with one project focused on asthma in children in Colorado.  Working with communities across the state, from rural to urban areas in Colorado, researchers will work with school-based asthma navigators and nurses to test a team approach to asthma control in school children in low-income areas.

Find more NHLBI-funded studies on  asthma and health disparities .

African American boy with inhaler outside

An NHLBI-funded study found that African-American boys, but not girls, with higher levels of BPA (Bisphenol A) tended to have more asthma symptoms: Study links exposure to higher levels of BPA plasticizer to more asthma symptoms in black boys .

Asthma research labs at the NHLBI

The  Laboratory of Asthma and Lung Inflammation , located within the  Pulmonary Branch , is focused on developing new treatment approaches for people with severe asthma. Headed by Stewart J. Levine, M.D., the lab’s researchers found a new biological pathway that leads to asthma. They continue to study this pathway, as well as an important molecule in it called apolipoprotein E (ApoE).

“By studying the pathways of the disease, we identified a new biological mechanism that leads to asthma,” explained Stewart J. Levine, M.D. Read the research feature: Disease pathways lead to possible new treatment for severe asthma .

Learn about research opportunities in the lab:

  • Post-doctoral Fellowship on Apolipoprotein Pathways in Asthma  
  • Graduate Medical Education (GME): NHLBI/UMD Pulmonary-Critical Care Fellowship  

Related asthma programs and guidelines

  • The NAEPP’s  Expert Panel Report 4 (EPR-4) Working Group  was established in 2018 to update the 2007  Guidelines for the Diagnosis and Management of Asthma (EPR-3) in focused topic areas. The working group members reviewed the latest research to update the guidelines on treatments and management of asthma, including the role of immunotherapy, the effectiveness of indoor allergen reduction, and the use of fractional exhaled nitric oxide (FeNO). Read  Asthma Management Guidelines: Focused Updates 2020 .
  • Learn More Breathe Better®  is a national health education program for asthma, COPD, and other lung and respiratory diseases. The program raises awareness about asthma and other lung conditions and supports the promotion, implementation, and adoption of evidence-based care.  Learn More Breathe Better® Asthma offers a  series of asthma handouts  to patients and caregivers, including tips for talking to your doctor. 
  • Since 1989, the  National Asthma Education and Prevention Program (NAEPP)  has worked with medical associations, voluntary health organizations, and community programs to educate patients, healthcare professionals, and the public about asthma.
  • The Lung Tissue Research Consortium (LTRC)  provides human lung tissues to qualified investigators for use in their research. The program enrolls patients who are planning to have lung surgery, collects blood and other clinical data from these donors, and stores donated tissue that otherwise would be discarded after the lung surgery. The LTRC provides tissue samples and data at no cost to approved investigators.

Explore more NHLBI research on asthma

The sections above provide you with the highlights of NHLBI-supported research on asthma. You can explore the full list of NHLBI-funded studies on the NIH RePORTER .

To find more studies:

  • Type your search words into the  Quick Search  box and press enter. 
  • Check  Active Projects  if you want current research.
  • Select the  Agencies  arrow, then the  NIH  arrow, then check  NHLBI .

If you want to sort the projects by budget size — from the biggest to the smallest — click on the  FY Total Cost by IC  column heading.

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Asthma is a chronic respiratory condition characterized by airway inflammation and narrowed airways leading to bouts of coughing, wheezing, and shortness of breath. Essays on asthma could explore its causes, prevalence, management strategies including medication and lifestyle adjustments, and its impact on quality of life. Additionally, discussions around the healthcare systems’ role in managing chronic diseases like asthma could also be explored. A vast selection of complimentary essay illustrations pertaining to Asthma you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

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This paper is in the following e-collection/theme issue:

Published on 29.4.2024 in Vol 26 (2024)

This is a member publication of University College London (Jisc)

Digital Self-Management Platform for Adult Asthma: Randomized Attention-Placebo Controlled Trial

Authors of this article:

Author Orcid Image

Original Paper

  • Aaron Kandola 1, 2 , BSc, MSc, PhD   ; 
  • Kyra Edwards 3 , BSc, MSc   ; 
  • Joris Straatman 2 , BA, MSc   ; 
  • Bettina Dührkoop 2 , DipKFM   ; 
  • Bettina Hein 2 , MA, MSc, Ref.iur   ; 
  • Joseph Hayes 2, 3, 4 , MBChB, MSc, MRCPsych, PhD  

1 Medical Research Council Unit of Lifelong Health and Aging, University College London, London, United Kingdom

2 juli Health, Hull, MA, United States

3 Division of Psychiatry, University College London, London, United Kingdom

4 Camden and Islington NHS Foundation Trust, London, United Kingdom

Corresponding Author:

Joseph Hayes, MBChB, MSc, MRCPsych, PhD

Division of Psychiatry

University College London

Maple House

149 Tottenham Court Road

London, W1T 7BN

United Kingdom

Phone: 44 2089288300

Email: [email protected]

Background: Asthma is one of the most common chronic conditions worldwide, with a substantial individual and health care burden. Digital apps hold promise as a highly accessible, low-cost method of enhancing self-management in asthma, which is critical to effective asthma control.

Objective: We conducted a fully remote randomized controlled trial (RCT) to assess the efficacy of juli, a commercially available smartphone self-management platform for asthma.

Methods: We conducted a pragmatic single-blind, RCT of juli for asthma management. Our study included participants aged 18 years and older who self-identified as having asthma and had an Asthma Control Test (ACT) score of 19 or lower (indicating uncontrolled asthma) at the beginning of the trial. Participants were randomized (1:1 ratio) to receive juli for 8 weeks or a limited attention-placebo control version of the app. The primary outcome measure was the difference in ACT scores after 8 weeks. Secondary outcomes included remission (ACT score greater than 19), minimal clinically important difference (an improvement of 3 or more points on the ACT), worsening of asthma, and health-related quality of life. The primary analysis included participants using the app for 8 weeks (per-protocol analysis), and the secondary analysis used a modified intention-to-treat (ITT) analysis.

Results: We randomized 411 participants between May 2021 and April 2023: a total of 152 (37%) participants engaged with the app for 8 weeks and were included in the per-protocol analysis, and 262 (63.7%) participants completed the week-2 outcome assessment and were included in the modified ITT analysis. Total attrition between baseline and week 8 was 259 (63%) individuals. In the per-protocol analysis, the intervention group had a higher mean ACT score (17.93, SD 4.72) than the control group (16.24, SD 5.78) by week 8 (baseline adjusted coefficient 1.91, 95% CI 0.31-3.51; P =.02). Participants using juli had greater odds of achieving or exceeding the minimal clinically important difference at 8 weeks (adjusted odds ratio 2.38, 95% CI 1.20-4.70; P =.01). There were no between group differences in the other secondary outcomes at 8 weeks. The results from the modified ITT analyses were similar.

Conclusions: Users of juli had improved asthma symptom control over 8 weeks compared with users of a version of the app with limited functionality. These findings suggest that juli is an effective digital self-management platform that could augment existing care pathways for asthma. The retention of patients in RCTs and real-world use of digital health care apps is a major challenge.

Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN87679686; https://www.isrctn.com/ISRCTN87679686

Introduction

Asthma is one of the most common chronic conditions worldwide, with an increasing prevalence that currently affects 1 in 10 people at some time [ 1 - 3 ]. The inflammatory disease causes mild-to-severe respiratory symptoms, including shortness of breath, chest tightness, wheezing, and cough. It significantly burdens patients and health care services, including the need for long-term treatment, emergency care, and hospitalizations that will cost the US economy an estimated US $300 billion over the next 20 years in direct health care expenditure [ 4 ]. Effective asthma control is necessary to reduce these costs and improve the quality of life for people with the condition.

Asthma management is based on achieving symptom control and reducing the frequency and severity of exacerbations [ 5 ]. This involves the use of inhaled anti-inflammatory medications and the avoidance of asthma triggers. Symptom control is associated with improved quality of life, reduced health care costs, and better work performance [ 6 ]. However, a significant proportion of individuals with asthma have suboptimal control because of poor adherence to medication, insufficient recognition of triggers, comorbidities (such as rhinitis or obesity), health behaviors (such as smoking), and inadequate information about treatment [ 7 ]. Mobile apps may address some of these treatment challenges by enabling people with asthma to more easily and consistently self-manage their condition compared to existing treatment plans. For example, digital apps can offer timely reminders to improve medication adherence or real-time feedback to identify and adapt to possible triggers and health behaviors [ 8 , 9 ].

A 2017 systematic review and meta-analysis of randomized controlled trials (RCTs) of mobile, web-based, and messaging service apps to support asthma self-management [ 9 ] concluded that these interventions could improve asthma control, but that effectiveness and important features of the apps varied. The majority of these apps included combinations of medication prompts, patient education, digital diaries, action plans, and professional support facilitation [ 9 ]. A similar 2018 review of RCTs and observational studies concluded that, in adults with asthma, mobile apps were more effective than other types of digital interventions, such as web-based interventions [ 10 ]. Studies of app-based interventions published since these reviews have generally been feasibility trials or small underpowered RCTs [ 11 - 14 ]. A 2022 Cochrane review examined the effect of digital apps on asthma medication adherence, concluding they were likely to be useful in poorly adherent populations, but again highlighting heterogeneity among mobile or web-based interventions [ 8 ]. Despite the mixed evidence for effectiveness, several apps are publicly available. These apps frequently incorporate behavior change techniques and gamification. Reviews of these apps have highlighted that they vary considerably in quality, use a range of behavior change techniques, struggle with adequate engagement and retention, and lack clinical validation of efficacy [ 15 - 17 ]. The Global Strategy for Asthma Management and Prevention (Global Initiative for Asthma [GINA]) highlights that, despite the use of digital technologies rapidly increasing in patients with asthma, “high-quality studies are needed to evaluate their utility and effectiveness” [ 3 ].

We aimed to address the fundamental issue that commercially available apps require sufficient evaluation of their effectiveness, by conducting an RCT of juli. This is a digital health app that aims to support people with asthma by combining numerous approaches that have been shown as effective in research-grade apps for asthma, including symptom tracking; medication reminders; trigger identification (including geolocated weather, pollen, and air pollution data); data visualization of respiratory symptoms, mood, exercise, activity, sleep, and heart rate variability; and behavioral activation recommendations about how to improve these parameters [ 18 , 19 ]. Our RCT was fully remote, increasing time efficiency, cost-effectiveness, and reach. We hypothesized that participants randomized to juli would have a greater reduction in asthma symptoms at 8 weeks than those randomized to the attention-placebo control.

Study Design and Participants

We conducted a fully remote pragmatic single-blind, placebo-control RCT to test the efficacy of juli in adults with asthma. The trial was open to individuals from anywhere in the world, provided they were aged 18 to 65 years, English-speaking, had access to a smartphone, and self-identified as having asthma. We also only included people with asthma symptoms that were uncontrolled according to a score of 19 or lower on the Asthma Control Test (ACT) at baseline. An ACT score of 19 is consistent with GINA-defined uncontrolled asthma [ 20 ].

Recruitment

Recruitment ran from May 2021 until April 2023. We recruited via self-help groups for asthma, online adverts, and social media posts. For the duration of the RCT, we modified the onboarding so that recruitment was automated with study information provided to participants within the app. The support for potential participants interested in the RCT was provided by this study’s team via email.

Ethical Considerations

The University College London Ethics Committee gave full ethical approval (19413/001). All participants supplied written informed consent within the app, with additional information on a dedicated web page. Data required for the RCT were stored separately in an anonymized format. The juli app is Health Insurance Portability and Accountability Act, Service Organization Control Type 2, and General Data Protection Regulation compliant. Participants in both arms of the RCT were entered into a prize draw at 2, 4, 6, and 8 weeks with the possibility of winning US $20 at each time point. The trial was entered on the International Standard Randomised Controlled Trial Number (ISRCTN) registry (ISRCTN87679686). At the same time, we were running an RCT of the juli app for depression. This RCT had a similar design and analysis [ 21 ].

Randomization and Masking

We assigned participants in a 1:1 ratio to either an attention-placebo control or the full version of juli. We automated and conducted randomization within the app, using random block sizes ranging from 4 to 8. To ensure data integrity, the treatment allocation was concealed from both the research team and independent statisticians until the analysis was finalized.

Intervention

The juli app was developed by gamification experts in collaboration with patients, a psychiatrist, and a pulmonologist. A patient with asthma and a psychiatrist with expertise in mental health and physical health interface are the chief technical officer and chief medical officer of juli, respectively. We held development and user testing interviews with 10 patients with asthma (5 female individuals, aged 18-65 years). The app underwent multiple iterations following feedback from these patient panel interviews and discussions with a pulmonologist. Our trial used a full version of the juli app for the intervention group and a limited version in the attention-placebo control group. Participants with the complete juli app received automatic prompts to open the app each day at a user-inputted time. The app asked participants about how their asthma was affecting them on a 5-face emoji scale, their emergency inhaler use that day, how often they had a shortness of breath episode, and whether they woke in the night due to shortness of breath. Individuals could also track various factors they regarded as relevant to their asthma symptoms, such as tobacco smoke exposure [ 19 ]. The app connects to smart peak flow meters (such as Smart Peak Flow [Smart Respiratory Products Ltd] or MIR Smart One [Smart One]) through Google Fit or Apple HealthKit, or participants could enter this information manually.

The app presented participants with regular, geolocated weather, pollen, and air pollution data relevant to their asthma [ 22 ]. All participants could also access passively gathered smartphone data on relevant health-related factors, including, activity, menstrual cycle, and sleep. Participants could check this information daily and see associations with their asthma [ 23 - 25 ]. If they had them, participants with wearables that they chose to connect to the app would see additional data on workouts and heart rate variability, as well as improved data on activity and sleep. However, the lack of access to a wearable was not an exclusion criterion.

The app also uses behavioral activation techniques to provide personalized recommendations about these factors to encourage healthy behaviors. The app includes customizable medication reminders to improve medication adherence [ 26 ]. The juli app also encouraged participants to use the positive affect journaling function [ 27 ]. The design of the juli app guides participants toward all elements of the app but allows them to flexibly choose where they want to engage.

Attention-Placebo Control

Participants in the control arm had a limited version of the app. The app prompted participants to open it each day and rate how they were feeling on the 5 emoji scale, but they did not have access to any further functionality or intervention. There was no change to usual care in either arm.

Assessment Tools

Participants in both arms completed baseline assessments and follow-up assessments at 2, 4, 6, and 8 weeks remotely from within the app. Assessments included the ACT for asthma symptoms and the 12-Item Short Form Health Survey (SF-12) for health-related quality of life. The ACT is a widely used, self-completed asthma symptom scale that is responsive to change with scores ranging from 5 to 25 [ 28 ]. A cutoff score of 19 or lower identifies patients with uncontrolled asthma. The SF-12 is a self-reported measure assessing the impact of health on an individual’s everyday life. Scores ranging from 0 to 100 with higher scores indicate a better quality of life [ 29 ].

The total ACT score at 8 weeks was our primary outcome. Secondary outcomes were continuous ACT score at 2, 4, 6, and 8 weeks in a repeated measures analysis using mixed-effect models; remission, defined as a score of >19 at 8 weeks; remission at 2, 4, 6, and 8 weeks in a repeated measures analysis; SF-12 physical and mental component scores at 8 weeks; and SF-12 physical and mental component scores at 4 and 8 weeks in a repeated measures analysis.

We added achieving a minimal clinically important difference (MCID) at 8 weeks (a 3-point increase on the ACT) [ 30 ] and a worsening of asthma symptoms (ie, a decrease in ACT scores from baseline) as post hoc outcomes.

Sample Size Estimation

The best MCID estimate for the ACT is between 2.2 and 3.0 (SD 3.1 to 4.7) [ 30 ]. A 2-sided 5% significance level at 80% power requires a total sample size of 146 for an MCID of 3. We aimed to recruit 90 participants per arm, allowing for 23% attrition [ 31 ].

Statistical Analyses

We preprinted the analysis plan on UCL Discovery [ 32 ] and preregistered the RCT on the ISRCTN registry with a description of the primary and secondary outcomes before the trial started. In reporting and analyzing our data we followed the CONSORT (Consolidated Standards of Reporting Trials) guidelines [ 33 ].

Our primary outcome was the difference in total ACT score at 8 weeks between the control and intervention groups in a per-protocol analysis. We estimated this difference with a linear regression model adjusted for baseline ACT and any imbalanced baseline covariates. We tested how robust the result was to model specification by also using a Poisson model and adjusting for any variables not balanced at baseline. We used logistic regression to calculate the odds ratio (OR) of remission at 8 weeks (ACT>19), achieving MCID (≥3 point ACT improvement), and worsening of asthma, adjusting for baseline ACT. We completed the repeat measures analyses using linear or logistic mixed-effect models adjusting for ACT at baseline.

We repeated the analysis of all outcomes in a modified intention-to-treat (ITT) analysis. This analysis included all randomized participants with a complete baseline and week 2 ACT score, dropping participants who were randomized but never used the app (see Figure 1 ). We imputed the missing ACT scores first using multiple imputation models and then using the last observation carried forward [ 34 ]. The multiple imputation models included predictive mean matching with 5 nearest neighbors and 50 iterations. This method means that only plausible values are imputed and is more robust to model misspecification than fully parametric imputation [ 35 ].

An independent statistician with no conflicts of interest with the company providing juli completed the analyses. All analyses we conducted using Stata (version 17; StataCorp) and R (version 4.3.1 for Windows; R Foundation for Statistical Computing).

write a research paper on asthma

Participants

Of 1199 participants who completed the baseline ACT, 411 (34.3%) participants met eligibility criteria. The 411 participants were randomized: 204 (49.6%) to the intervention arm and 207 (50.4%) to the active control arm. Of the 411 participants randomized, 325 (79.1%) were from the United States. Attrition was similar in both arms: 71 (34.8%) out of 204 participants in the intervention arm and 78 (37.7%) out of 207 participants in the active control arm left this study before the week-2 ACT. The remaining 262 participants contributed to our modified ITT analysis ( Figure 1 ). Further attrition occurred between week 2 and week 8: a total of 66 (49.6%) out of 133 remaining participants left the intervention group, and 44 (34.1%) out of 129 remaining participants left the active control group. The remaining 152 participants contributed to our per-protocol analysis ( Figure 1 ). Participants included in the modified ITT and per-protocol analyses were similar in terms of baseline characteristics (see Table 1 and Multimedia Appendix 1 ).

a ACT: Asthma Control Test (possible range 5-25).

b SF-12 physical health subscale: Short-Form Health Survey-12 physical health subscale (possible range 0-100).

c SF-12 mental health subscale: Short-Form Health Survey-12 mental health subscale (possible range 0-100).

Per-Protocol Analysis

Of the 152 participants in the per-protocol analysis, they were mostly female individuals (n=122, 80.3%) who had been diagnosed by a physician more than 5 years ago (n=115, 75.7%) and had ongoing contact with a doctor about their asthma (n=134, 88.2%; Table 1 ). Participants had a mean baseline ACT score of 12.84 (SD 4.00).

Intervention group participants had a mean ACT score of 17.93 (SD 4.72) compared with 16.24 (SD 5.78) in the control group after 8 weeks (see Figure 2 ). After adjusting for baseline ACT score, the intervention group showed a greater improvement in symptom scores at 8 weeks than those in the control group (adjusted coefficient 1.91, 95% CI 0.31-3.51; P =.02; Table 2 ). After adjusting for imbalanced baseline characteristics, the improvement was 2.01 (95% CI 0.48-3.53; P =.01) points on the ACT. Using Poisson regression rather than linear regression did not alter our results.

The chance of being in remission by week 8 did not differ between the intervention and control groups after accounting for baseline asthma. However, participants in the intervention group were more likely to experience an MCID (adjusted OR 2.38, 95% CI 1.20-4.70; P =.01) than those in the control group. This effect was consistent across the 2-, 4-, 6-, and 8-week assessments ( Table 2 ). The odds of worsening symptoms were similar in both arms (adjusted OR 0.55, 95% CI 0.23-1.32, P =.18). There were no between-group differences in SF-12 mental or physical component scores.

write a research paper on asthma

a ACT: Asthma Control Test.

b coefficient.

c Odds ratio.

d SF-12: 12-Item Short Form Health Survey.

e MCID: minimal clinically important difference.

f ITT: intention-to-treat.

ITT Analysis

The baseline characteristics of participants in the intervention and control groups were similar to the per-protocol analysis. Following multiple imputations of missing outcomes, there was a greater improvement in ACT scores in the intervention group than in the active control group (adjusted coefficient 1.56, 95% CI 0.32-2.79; P =.01; Table 2 ). MCID was more common in the intervention group than the control group (adjusted OR 2.17, 95% CI 1.25-3.78, P =.006). Both arms had similar odds of remission, worsening of symptoms, and SF-12 scores. The results from the last observation carried forward analyses were consistent with the per-protocol and multiply imputed results.

Principal Findings

Our primary analysis showed that juli users had a greater improvement in asthma symptoms at 8 weeks compared to an attention-placebo control. The mean improvement in the intervention group was 5.33 (SD 5.33) compared with 3.20 (SD 5.26) in the control group. This total improvement and the difference between arms are consistent with a clinically important effect of juli on asthma control [ 30 ]. Participants assigned to juli had more than twice the odds of a 3-point (MCID) or greater improvement on the ACT. However, the mean ACT score at 8 weeks in both arms fell below the established cut point for “well-controlled” asthma, and there was no difference between arms in terms of odds of remission. The results from our multilevel models covering outcomes from 2 to 8 weeks and the modified ITT analysis with all individuals who were randomized and used the app for at least 2 weeks were consistent with these primary findings.

Participants entering our trial had a mean baseline ACT score of 12.84 (SD 4.00), indicating they fulfilled the GINA definition of “very poorly controlled” (score of 13) as uncontrolled is scores of 19 or lower [ 20 ], and most reported having asthma for several years with routine physician contact, suggesting difficulties with long-term asthma control. The results of this trial indicate that juli can augment the treatment of uncontrolled asthma as indicated by improved ACT scores over 8 weeks. There is consistent evidence that low ACT scores are associated with rescue medication use, asthma exacerbations, reduced lung function, and reduced asthma-specific quality of life, sleep, work, and productivity [ 6 ]. Increases in ACT scores are associated with decreased health care usage and health care costs [ 6 ].

It is unclear which component of juli resulted in improved ACT scores, but participants likely chose elements that suited them, which is a strength of juli’s design, allowing for a degree of self-personalization. Previous research into asthma app functionality has highlighted symptom tracking, clinical questionnaires, goal setting, performance feedback, medication reminders, and tracking as valuable to patients [ 17 ]. Gamification and contingent rewards are also important features incorporated into juli [ 17 ]. Positive affect journaling is a novel, evidence-based addition to juli’s functionality [ 36 ]. Other commercially available apps for adult asthma self-management use similar behavior change techniques, health education, symptom recording, environmental data, medication reminders, and data presentation. A recent review identified over 500 asthma-related mobile and inhaler-based monitoring apps [ 37 ]. However, only a small number of these had any degree of scientific evaluation; with positive fully powered trials being rare [ 37 ]. An additional problem for patients is the high rate of failure of companies providing these apps, with only a small number with evidence being available currently. These include AsthmaMD (AsthmaMD Inc) [ 14 ], Kiss myAsthma (University of Sydney, the Woolcock Institute of Medical Research, and The University of Melbourne) [ 38 ], ASTHMAXcel (ASTHMAXcel) [ 39 ], and eAMS (EAPOC [Evidence at the Point-of-Care]) [ 40 ], each having positive pilot data.

The juli app is available in Android and iOS formats globally. It is a highly accessible platform for people with asthma, and our trial provides methodologically robust evidence of its efficacy in managing asthma. Additional research is required to understand the most cost-effective support procedures to improve adherence to digital self-management tools and how best to integrate them into clinical practice. The majority of the early attrition in our RCT was in participants who never began to use the app. To reduce this, future RCTs of digital interventions may benefit from a run-in period, in which participants become familiarized with the app before randomization [ 41 ].

Strengths and Limitations

There were several strengths and limitations to this RCT. We successfully and remotely recruited, screened, randomized, treated, and assessed participants worldwide. People could easily participate in the trial as our modified version of the juli app allowed consent, randomization, and assessments to occur within the platform. This facilitated a low-cost global recruitment strategy and a pragmatic trial design with good external validity. However, our focus on reducing participant burden limited the types and richness of the data we were able to collect at baseline. For example, we lack relevant information on income, education, and other social determinants of health. Despite this, we did achieve a postrandomization balance in recorded characteristics at baseline, indicating successful randomization. Most of the participants were female, reflecting established differences in sex-specific rates of asthma [ 42 ], health behaviors, and health care use in adults [ 43 ].

Participants completed the ACT, which is a recommended primary end point in clinical trials for asthma [ 6 ]. We also preregistered our primary and secondary outcome measures along with a full analysis plan, which we adhered to. However, we lacked a broader battery of outcome measures that could have further contextualized our findings and identified possible mechanisms of action.

Attrition was greater than we predicted. The attrition in our trial follows a similar pattern to other digital RCTs, including for asthma apps, where it mostly occurs between randomization and week 2. Dropout rates in previous RCTs have ranged from 20% to 60% [ 10 ]. However, studies recruiting via social media have had low retention at 30 days (<20%) [ 44 ], and a similar, all-remote RCT of mobile health support for asthma had an attrition of 62% at 9 weeks [ 45 ]. To manage attrition, we continued recruiting and randomizing participants until we had a sufficient number of participants completing the week 8 outcome measures to meet our sample size calculation. We examined differences in completers versus noncompleters (see Table 1 and Multimedia Appendix 1 ). There were unlikely to be differences between those who dropped out of this study and those who completed it, based on their baseline characteristics, including asthma severity. Our modified ITT and primary analysis findings were similar, suggesting the intervention would have had a similar effect on those who dropped out. The ITT analysis used 2 imputation methods that make different assumptions [ 34 ], and results were consistent using both methods. Despite this, it is impossible to rule out attrition bias and our results should be seen as reflecting the effect on people motivated and able to use juli.

Conclusions

The juli app has been demonstrated to decrease asthma symptoms within 8 weeks, with an increased chance of achieving MCID, but no difference in terms of odds of remission. As such, juli represents a low-risk and low-cost adjunct to the care regimen of individuals with asthma.

Acknowledgments

AK is supported by the UK Research and Innovation (UKRI) Digital Youth program award (MRC project reference MR/W002450/1), which is part of the Arts and Humanities Research Council/Economic and Social Research Council/Medical Research Council (AHRC/ESRC/MRC) Adolescence, Mental Health and the Developing Mind program. JH is supported by the UK Research and Innovation grant MR/V023373/1, the University College London Hospitals NIHR Biomedical Research Centre, and the NIHR North Thames Applied Research Collaboration. This study was funded by juli Health.

Data Availability

All data produced in this study are available upon reasonable request to the authors.

Authors' Contributions

JH conceived this study. JH, AK, BD, BH, and JS designed this study. AK, BD, and BH collected the data. KE analyzed the data. JH wrote the initial draft. All authors edited and approved the final paper.

Conflicts of Interest

AK, BD, BH, JS, and JH are shareholders in juli Health. AK has received consultancy fees from juli Health and Wellcome Trust. BD, BH, JS, and JH are cofounders of juli Health. JH has received consultancy fees from juli Health and Wellcome Trust. KE has no conflicts of interest. The funders played no part in the analysis of the data.

Baseline characteristics of individuals in the modified intention-to-treat analysis.

CONSORT-eHealth checklist (V 1.6.1).

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Abbreviations

Edited by T de Azevedo Cardoso; submitted 19.07.23; peer-reviewed by Anonymous; comments to author 17.08.23; revised version received 23.08.23; accepted 26.03.24; published 29.04.24.

©Aaron Kandola, Kyra Edwards, Joris Straatman, Bettina Dührkoop, Bettina Hein, Joseph Hayes. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

173 Asthma Essay Topic Ideas & Examples

🏆 best asthma topic ideas & essay examples, 💡 interesting topics to write about asthma, 📑 good research topics about asthma, 📌 simple & easy asthma essay titles, 👍 good essay topics on asthma, ❓ research questions about asthma.

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  • Health, Culture, and Identity as Asthma Treatment Factors She is the guardian of Lanesha and, despite raising another grandson and caring for her elderly mother, she is responsible for the health of the girl.
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  • Occupational Asthma: Michelle’s Case The first test is not prohibitively expensive, and the patient should be able to afford it if she can pay for the medications.
  • Asthma Patient’s Examination and Care Plan HPI: Being discharged from the facility ten weeks ago, the patient reports having shortness of breath, severe wheezing, and coughing. To control symptoms, the patient takes HTCZ and Enalapril.
  • Obstructive Pulmonary Disease-Asthma Overlap The purpose of the research was to expand the current knowledge of the overlap syndrome in order to determine its prevalence and risk factors.
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  • Asthma and Stepwise Management The stepwise approach to asthma treatment and management is a six-step approach, according to which the number and the dose of medications and frequency of management are increased as necessary when symptoms persist and then […]
  • Asthma, Its Diagnostics, Treatment and Prevention Hippocrates was the one who labeled the disease as asthma, a Greek word that was used to denote the idea of “wind or to blow”, perhaps an attempt to describe the wheezing sound produced by […]
  • Asthma: Evidence-Based Pharmacological Treatment For instance, in children under 6, the development of the disease is typically preceded by the asthma-like symptoms that manifest themselves roughly at the age of three.
  • The Evaluation of Evidence Linking Asthma With Occupation Overall, the results of this study supported the initial argument of the authors in regard to the need for frequent updates and modifications of JEMs in order for them to reflect the most relevant and […]
  • Pregnant Woman’s Asthma Case The case mentions the decreased effectiveness of the fluticasone MDI that she uses which can also be a clue to her condition. Her patterns of MDI use in the last two months and the bronchospasm […]
  • Asthma: Causes and Mechanisms The enlargement of the dense oesinophilic line near the bronchus/airways causes the individual to wheeze and gasp for air. The drugs are mainly used in the rapid opening of the bronchus to enable airflow into […]
  • Healthcare: Childhood Asthma and the Risk Factors in Australia From the findings presented above, it is evident that childhood asthma remains a considerable burden in Australia due to socioeconomic, geographic, and health-related issues such as deprived neighbourhoods, decreasing sun exposure and increasing latitude, and […]
  • Intubation and Mechanical Ventilation of the Asthmatic Patient in Respiratory The title of the article gives a clear idea of the research question to be investigated. The authors have detailed the processes of intubation and mechanical ventilation in patients with acute asthma.
  • Asthma Environmental Causes This essay discusses the measures that can be taken to mitigate environmental causes of asthma. In the US, the government has developed a comprehensive strategy to mitigate environmental causes of asthmatic conditions in children.
  • Asthma’s Diagnosis and Treatment The complete occlusion of the airway can lead to growth of a distal at the atelectasis in the lung parenchyma. The level of AHR is connected to the signs of asthma and the urgency of […]
  • The Effects Of Asthma On Pregnant African Americans
  • Urban Children and Asthma Care Barriers
  • Asthma: Asthma and Nocturnal Asthma
  • The Health Problem of Asthma in the United States of America
  • Asthma: Chronic Inflamatory Obstructive Lung Disease
  • Asthma and Food-Allergy Reactions
  • Asthma And Exercise Asthmatic Asthmatics Breathing
  • Automobile Emissions, Co And Asthma
  • Asthma Control and Treatment in Racial and Ethnic Minorities
  • Asthma Is The Most Common Chronic Disease Of The Airways
  • Inflammatory Mediators Of Asthma And Histamines Biology
  • The Impact of Asthma on the Respiratory System, Its Causes, and Treatment
  • How Asthma Affects The Airway And Lungs
  • Diet and Nutrition for Asthma in a Child
  • Urban Asthma And The Neighborhood Environment
  • Asthma And Its Pathophysiological Structure
  • The Effects of Medication on the Increased Performance of Asthma Patients
  • What Parents Need To Know About Asthma
  • Employment Behaviors of Mothers Who have a Child with Asthma
  • The Genetic and Environmental Components of Asthma
  • The Influence of Asthma on the Lives of Students
  • Children’s Elevated Risk of Asthma in Unmarried Families: Underlying Structural and Behavioral Mechanisms
  • The Effects Of Environmental Tobacco Smoke Among Children With Asthma
  • The Effects Of Air Pollution On Children ‘s Asthma Emergency
  • Is Improper Use Of The Inhaler Related To Poor Asthma Control
  • Asthma Symptoms, Diagnosis, Management & Treatment
  • Limitations From Suffering Chronic Asthma
  • Causes And Effect Of Allergies And Asthma
  • Describe The Main Limitations Suffered By Those With Chronic Asthma
  • The Symptoms, Causes and Diagnosis of Asthma
  • Negligent: Asthma and Nursing Interventions
  • The Signs, Causes and What Triggers Asthma
  • The Routine Care for Patients with Coronary Heart Disease, Asthma, Stroke, Irritable Bowel Syndrome, Urinary Tract Infections, Diabetes, and Cervical Cancer
  • The Role Of Nurse Management Asthma And School Health Program
  • The Scope of Asthma in the General Population and on the Health Care System
  • The Most Effective Treatment for an Asthma Exacerbation
  • Pathophysiology Of Chronic Asthma And Acute Asthma
  • The Use Of Vitamin D Asthmatic Children Effectiveness Of Vitamin Supplements In Childhood Asthma
  • The Ways in Which the Symptoms of Asthma Can Be Reduced
  • Measures to Minimize Environmental Causes of Asthma
  • Inner City Adult Asthma Patients and Risk Factors
  • Raising Awareness to Prevent the Rise of Asthma
  • Planning and Intervention in the Disease Process of Childhood Asthma
  • The Anatomy And Physiology Of Respiratory System And The Diagnosis Of Asthma
  • The Causes and Effects of Asthma Sufferers
  • The Application of Corticosteroids in the Management of Bronchial Asthma
  • Salbutamol: History of Development in Asthma Drug Compounds
  • Sensitization To Plant Food Allergens In Patients With Asthma
  • The Diagnosis and Treatment of Otitis Media and Asthma
  • The Discrepancy between Asthma Cases in Minority and White Communities
  • The Chronic Illness in Children Known as Asthma
  • Does Childhood Asthma Improve With Age?
  • What Are the First Warning Signs of Asthma?
  • Which Child Is at Greatest Risk for Asthma?
  • What Is the Genetic Predisposition of Asthma?
  • Can Occupational Therapy Help With Asthma?
  • How to Ventilate Obstructive and Asthmatic Patients?
  • What Is a Risk Factor Associated With Childhood Asthma?
  • What Type of Approach Is Used in Asthma Management?
  • What Is the Difference Between Asthma and Acute Asthma?
  • What Are the Pharmacological Treatment of Asthma?
  • How Is Asthma Diagnosed?
  • Can Asthma During Pregnancy Affect Baby?
  • What Are the Three Mechanisms Involved in Asthma?
  • How Does Genetics and Environment Affect Asthma?
  • How Long Does It Take To Recover From Asthma Exacerbation?
  • What Factors Influence the Development of Asthma?
  • What Is the Physiological Cause of Asthma?
  • What Are the Statistics on Asthma in Australia?
  • What Is the Most Serious Type of Asthma?
  • What Ethnic Group Is Especially Likely to Have Childhood Asthma?
  • What Is a Nursing Care Plan of an Asthmatic Patient?
  • Does Asthma Cause Smooth Muscle Hypertrophy?
  • Should People With Asthma Use a Humidifier?
  • What Is Mechanical Ventilation Asthma?
  • What Is the Most Common Allergen to Trigger Asthma?
  • What Is the Main Physiological Cause of Asthma?
  • What Percent of Asthma Is Caused by Smoking?
  • How Long Does the Average Person With Asthma Live?
  • Which Drug Is Safe for Asthma in Pregnancy?
  • How Many People With Asthma Still Smoke?
  • Chicago (A-D)
  • Chicago (N-B)

IvyPanda. (2024, March 2). 173 Asthma Essay Topic Ideas & Examples. https://ivypanda.com/essays/topic/asthma-essay-topics/

"173 Asthma Essay Topic Ideas & Examples." IvyPanda , 2 Mar. 2024, ivypanda.com/essays/topic/asthma-essay-topics/.

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IvyPanda . 2024. "173 Asthma Essay Topic Ideas & Examples." March 2, 2024. https://ivypanda.com/essays/topic/asthma-essay-topics/.

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IvyPanda . "173 Asthma Essay Topic Ideas & Examples." March 2, 2024. https://ivypanda.com/essays/topic/asthma-essay-topics/.

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  1. Treatment strategies for asthma: reshaping the concept of asthma management

    Background. Asthma, a major global health problem affecting as many as 235 million people worldwide [], is a common, non-communicable, and variable chronic disease that can result in episodic or persistent respiratory symptoms (e.g. shortness of breath, wheezing, chest tightness, cough) and airflow limitation, the latter being due to bronchoconstriction, airway wall thickening, and increased ...

  2. (PDF) An Overview of Asthma and its treatment

    Asthma is a disorder characterized by chronic airway inflammation, air way hypersensitivity to a variety of. stimuli, and airway obstruction. It is at least partially reversible, either ...

  3. Asthma: diagnosis, monitoring and chronic asthma management

    The committee's full set of research recommendations is detailed in the 2017 full guideline on asthma: diagnosis and monitoring and the 2017 full guideline on chronic asthma management. As part of the 2020 update, the guideline committee made 1 new research recommendation on managing asthma within a self-management programme for children and ...

  4. Advances and recent developments in asthma in 2020

    Abstract. In this review, we discuss recent publications on asthma and review the studies that have reported on the different aspects of the prevalence, risk factors and prevention, mechanisms, diagnosis, and treatment of asthma. Many risk and protective factors and molecular mechanisms are involved in the development of asthma.

  5. Asthma

    Definition. Asthma is defined as a chronic inflammatory disease of the airways. The chronic inflammation is associated with airway hyperresponsiveness (an exaggerated airway-narrowing response to specific triggers such as viruses, allergens and exercise) that leads to recurrent episodes of wheezing, breathlessness, chest tightness and/or coughing that can vary over time and in intensity.

  6. Asthma

    Asthma is one of the most common chronic non-communicable diseases worldwide and is characterised by variable airflow obstruction, causing dyspnoea and wheezing. Highly effective therapies are available; asthma morbidity and mortality have vastly improved in the past 15 years, and most patients can attain good asthma control. However, undertreatment is still common, and improving patient and ...

  7. Asthma in Adults

    The prevalence of asthma in adults in the United States is approximately 7.7%. 1 It is one of the most common chronic, noncommunicable diseases in the country and worldwide. 1,2 Among U.S. adults ...

  8. Full article: An update on asthma diagnosis

    Introduction. Asthma is the most common chronic respiratory disease affecting millions of people of all ages across the globe (Citation 1-6).The average global prevalence ranges between 5-10% (Citation 2).Traditionally, asthma diagnosis was based on the history and the response to a trial of various treatments, but emerging evidence shows that under the umbrella of asthma, several subtypes ...

  9. Advances and recent developments in asthma in 2020

    According to an EAACI position paper in 2019, biomarkers for the clinical and inflammatory phenotype of asthma were summarized as follows (1) type 2 asthma: (a) ... Asthma research produces up to 9000 publications per year and represents one of the most rapidly developing areas. Most of the novel developments of the last year focus in the areas ...

  10. Articles

    Long-term follow-up studies of adults with well-characterized asthma are sparse. We aimed to explore static lung volumes and diffusion capacity after 30 + years with asthma. Conrad Uldall Becker Schultz, Oliver Djurhuus Tupper and Charlotte Suppli Ulrik. Asthma Research and Practice 2022 8 :4.

  11. Update in Adult Asthma 2020

    The past year saw a number of publications focusing on the influence of nutritional factors and obesity on asthma outcomes. The association of dietary fiber intake and asthma was studied among adult participants in the National Health and Nutrition Examination Survey ().In adjusted models, participants in the lowest quartile of fiber intake had increased odds of asthma and current respiratory ...

  12. The Burden of Asthma in the United States

    Asthma imposes a growing burden on society in terms of morbidity, quality of life, and healthcare costs. An increasing body of evidence describes the rising prevalence of asthma within the United States and around the world (1-3).Data from the National Health Interview Study suggest that in the United States alone, the number of cases of asthma reported since 1980 has increased by 75% and ...

  13. (PDF) Asthma: pathophysiology, diagnosis and management

    diagnosis and management. NS613 Kaufman G (2011) Asthma: pathophysiology, diagnosis and management. Nursing Standard. 26, 5, 48-56. Date of acceptance: August 18 2 011. 4 Recognise risk factors ...

  14. Asthma

    Asthma is a form of bronchial disorder caused by inflammation of the bronchi. It is characterized by spasmodic contraction of airway smooth muscle, difficulty breathing, wheezing and coughing ...

  15. Full article: Approaches to the assessment of severe asthma: barriers

    Introduction. Asthma is a significant public health threat, affecting more than 300 million individuals globally. Citation 1 Asthma is classified as a non-communicable disease and leads to reduced quality of life, Citation 2 poor physical functioning Citation 3 and reduced emotional well-being. Citation 4 The impact of this disease can be widespread and extends beyond the person living with ...

  16. Asthma: Pathophysiology and Diagnosis

    Introduction. Although asthma is a common disorder affecting approximately 7.8% of the United States population (Schiller et al. 2006) or 23 million Americans, the pathogenesis of this disease remains to be fully elucidated.Extensive research over the last few decades has yielded a better understanding of asthma.

  17. Asthma Research

    Current research on asthma treatment. How ventilators may lead to asthma: The NHLBI-funded Post-Vent study will use data collected from the Prematurity-Related Ventilatory Control (Pre-Vent): Role in Respiratory Outcomes NHLBI Collaborative Program to study long-term health outcomes of premature birth and intermittent low oxygen levels shortly after babies are born prematurely.

  18. Asthma: Epidemiological Analysis and Care Plan Essay

    Introduction. Asthma is an illness that disproportionately affects many adults and children globally. In 2019, 262 million people had asthma, causing 461 000 deaths (WHO, 2020). Scholars have done asthma-related research to provide information on causes, symptoms, therapies, and asthma mitigation. This study will describe asthma as a chronic ...

  19. Asthma Free Essay Examples And Topic Ideas

    22 essay samples found. Asthma is a chronic respiratory condition characterized by airway inflammation and narrowed airways leading to bouts of coughing, wheezing, and shortness of breath. Essays on asthma could explore its causes, prevalence, management strategies including medication and lifestyle adjustments, and its impact on quality of life.

  20. Journal of Medical Internet Research

    Background: Asthma is one of the most common chronic conditions worldwide, with a substantial individual and health care burden. Digital apps hold promise as a highly accessible, low-cost method of enhancing self-management in asthma, which is critical to effective asthma control. Objective: We conducted a fully remote randomized controlled trial (RCT) to assess the efficacy of juli, a ...

  21. Improving primary care management of asthma: do we know what really

    Introduction. Asthma is a common chronic condition that is estimated to affect 339 million people worldwide 1,2.Despite major advances in asthma treatment and the availability of both global 2 and national guidance, asthma continues to cause a substantial burden in terms of both direct and indirect costs 1.In 2016, estimated worldwide asthma deaths were 420,000 1 and although there have been ...

  22. 173 Asthma Topic Ideas to Write about & Essay Samples

    The Nature and Control of Non-Communicable Disease - Asthma. Asthma is caused due to the inflammation of the airways which in turn induces cough, wheezing, breathlessness and a feeling of tightness in the chest. Application: Asthma. The features of the air passage include the bronchi, alveoli and the bronchioles.

  23. Epidemiology of Asthma in Children and Adults

    We have summarized the evidence on asthma trends, environmental determinants, and long-term impacts while comparing these epidemiological features across childhood asthma and adult asthma. While asthma incidence and prevalence are higher in children, morbidity, and mortality are higher in adults. Childhood asthma is more common in boys while ...

  24. 7 Best Research Paper Writing Services: Popular U.S. Companies Reviewed

    The professional writers at EssayPro offer an excellent research paper writing service, but they can also provide any writing services that you need, e.g., dissertations, editing, proofreading, etc.

  25. Bronchial Asthma: Diagnosis and Long-Term Treatment in Adults

    Bronchial asthma is a chronic inflammatory disease of the airways characterized by bronchial hyperreactivity and a variable degree of airway obstruction. It is diagnosed on the basis of the clinical history, physical examination, and pulmonary function tests, including reversibility testing and measurement of bronchial reactivity.