Guidelines for the management of asthma in adults: Evidence and recommendations.

The multidisciplinary experts in Thailand developed an asthma management recommendation that was relevant to low-middle income countries (LMICS). Populations level consideration about asthma management is emphasized. The healthcare systems, access to and availability of treatments as well as the asthma populations vary from country to country in LMICS. The feasibility in clinical practice for implementation is also a major issue. For these reasons, the practice guidelines that are relevant to local contexts are essential to improve better asthma control. Furthermore, integrative and collaboration between asthma experts and the public health sector to implement and discriminate such guidelines will help to achieve these challenging goals. The topics covered include the current asthma situation in Thailand and the Asia-Pacific region, the definition of asthma, asthma diagnosis, assessment of asthma patients, asthma treatment - both pharmacological and non-pharmacological, management of asthma exacerbation, management of asthma comorbidities, treatment of asthma in special conditions, severe and uncontrolled asthma, Thai alternative medicine and asthma, and asthma and coronavirus disease-19 (COVID-19).

Positive airway pressure therapy adherence for obstructive sleep apnea during the COVID-19 pandemic.

PURPOSE: Positive airway pressure (PAP) adherence is a significant issue among patients with obstructive sleep apnea (OSA). However, the data are limited regarding PAP adherence during the current COVID-19 pandemic. METHODS: A cross-sectional study was conducted between February and October 2020 at the Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Patients with ongoing PAP-treated OSA were recruited. Data on PAP adherence before and during the COVID-19 pandemic were collected. Furthermore, pre-test and post-test questionnaires on knowledge on COVID-19, OSA, and PAP before and after tele-education were also evaluated. RESULTS: Of a total 156 patients, the majority had severe OSA (72%). By self-report, there was no significant difference in PAP usage in hours per day before compared to during the pandemic (p = 0.45), though in a subgroup with highest educational attainment (degree higher than bachelor's), PAP usage did increase during the pandemic (mean difference 0.23 ± 0.10; 95% CI 0.02-0.40, p = 0.03). However, objective PAP usage data demonstrated a trend towards increased usage comparing before and during the pandemic (4.64 ± 1.49 vs 5.12 ± 1.41; mean difference 0.48 ± 1.33; 95% CI 0.13-10.90, p = 0.12). Basic knowledge was significantly improved after tele-education (p < 0.001). CONCLUSION: By objective data, there was a trend towards increased PAP usage during the COVID-19 pandemic for the entire group. In a subgroup of patients with highest educational attainment, PAP adherence increased by self-report. Tele-education appeared to improve knowledge on COVID-19, OSA, and PAP usage.

Multimodality treatment in immunocompromised patients with severe COVID-19: the role of IL-6 inhibitor, intravenous immunoglobulin, and haemoperfusion.

Cytokine release syndrome (CRS) is known to be associated with severe coronavirus disease 2019 (COVID-19). Multiple anti-inflammatory therapies such as tocilizumab, corticosteroids, intravenous immunoglobulin (IVIG), and haemoadsorption or haemoperfusion have been used to combat this life-threatening condition. However, immunocompromised hosts are often omitted from research studies, and knowledge on the clinical efficacy of these therapies in immunocompromised patients is therefore limited. We report two cases of immunocompromised patients with severe COVID-19-related CRS requiring mechanical ventilation who were treated with multimodality treatment consisting of tocilizumab, IVIG, and haemoperfusion. Within 48 h, both patients showed clinical improvement with PaO2:FiO2 ratio and haemodynamic stability. Both survived to discharge. There were no adverse events following these therapies. In conclusion, combined therapeutic modalities, possibly tailored to individual inflammatory profiles, are promising treatment for severe COVID-19 infection in the immunocompromised host. Timely administration of adjunctive therapies that alleviate overwhelming inflammation may provide the best outcome.