Session Highlights New Research Findings in Asthma

The Journal of Allergy and Clinical Immunology: In Practice provides practical information for physicians that can be used in daily practice. During a session at the 2018 AAAAI Annual Meeting, Robert S. Zeiger, MD, PhD, FAAAAI, of the University of California San Diego School of Medicine in La Jolla, gave an overview of the latest research published in the journal.

He highlighted the following study outcomes during the presentation:

• A prospective, randomized, controlled trial found that prenatal supplementation of vitamin D may have a beneficial effect on asthma and recurrent wheezing by 3 years of age.
• A retrospective study of 10,860 children (6-17 years) and 24,115 adults (18-79 years)—identified between 2001 and 2010 from the National Health and Nutrition Examination Survey (NHANES)—suggested evidence of a relationship between vitamin D insufficiency and respiratory disease in both pediatric and adult patients.
• A cross-sectional study of 1517 children (6-7 years) demonstrated that early antibiotic exposure in an urban—but not rural—setting was associated with current wheeze and allergic rhinoconjunctivitis in childhood.
• A cross-sectional analysis of 645 children (5-18 years) with uncontrolled asthma found that mouse sensitization and exposure was associated with asthma severity and treatment burden.
• A prospective, randomized, controlled pilot study of 25 children (6-10 years) with asthma found that the installation of classroom air cleaners reduced levels of pollutants.
• A retrospective, matched-cohort control study examined a United Kingdom (UK) database (1999-2012) to identify children with asthma (mean age, 9 years), and found that long-acting beta-adrenoceptor agonist (LABA) treatment as a separate inhaler was associated with poorer asthma controlled compared with a fixed-dose combination (FDC) inhaler.
• A prospective, observational study of 56 children (6-17 years) with severe asthma found that endotypic markers are better predictors of poor response to triamcinolone than phenotypic features.
• A retrospective study of the Pediatric Health Information System claims database of children (6-11 years) found that marked variability in hospital treatments exists for severe pediatric asthma.
• A prospective study of 165 pregnant women with asthma found that overweight/obesity was associated with more asthma exacerbations, and these patients need more active care.
• A prospective, longitudinal, observational study of the Tucson Children’s Respiratory Birth Cohort Study of 327 adolescents found that stress events are associated with onset of asthma and increased exacerbations.
• A retrospective analysis of the NHANES study (2007-2012) of 509 adults (≥56 years) with asthma found that screening for depression in older adults with poor asthma control is important.
• A retrospective study of 307 patients with asthma seen in the pulmonary clinic found that fungal sensitization is a major risk factor for life-threatening asthma, and this adverse event should be monitored closely.
• A prospective, observational study of 262 patients (≥12 years) with severe uncontrolled asthma found that a prior exacerbation is the strongest risk of future severe exacerbations. Elevated high blood eosinophil count increases the risk of exacerbations, while a favorable asthma medication ratio reduces the risk.
• A retrospective, observational study of 2392 patients (18-64 years) with persistent asthma found that the top drivers for asthma costs are medications and frequent exacerbations.
• A retrospective, observational study of 118,981 patients with active asthma found that two or more courses of acute oral corticosteroids are a major predictor or two or more future exacerbations.
• A retrospective study of 1059 patients with confirmed chronic rhinosinusitis with nasal polyps found that aspirin-exacerbated respiratory disease (AERD) is a frequent and major burden that requires more comprehensive therapies.
• A cross-sectional, observational study of 3660 patients (≥16 years) with asthma using FDC inhaled corticosteroid/LABA found that inhaler errors were frequent with both dry powder and metered dose FDC inhalers, and some of these errors were related to poor asthma control and exacerbations.
• An observational study in 83 patients with asthma or chronic obstructive pulmonary disease found that a video learning program improves inhaler technique in the short term, but repeat teaching is needed on a desktop or handheld device to maintain these skills.
• A historical, matched-control study of a U.K. database identified 4504 patients (12-80 years) with asthma from 1994 to 2013 and found that spacers added to pressurized metered dose inhalers do not improve asthma outcomes, which challenges long-standing assumptions.
• A meta-analysis confirmed long-term efficacy of omalizumab, with a 10% increase in forced expiratory volume in one second and 5.6 increase in Asthma Control Test score after 24 months of follow-up.
• A prospective, observational study of seven adults with documented AERD and asthma found that AERD was a frequent and major burden that requires more comprehensive therapies.
• A multicenter, longitudinal, open-label, extension study of patients receiving reslizumab confirmed long-term efficacy and safety of the drug after 24 months of follow-up.

Presentation 1520: JACI: In Practice Year-in-Review Workshop