Association and correlation of patient symptom perception and asthma control - a rapid literature review.

BACKGROUND: Several studies suggest that patients often under-estimate their asthma symptoms and over-estimate their level of asthma control, potentially putting them at risk of undertreatment with inhaled corticosteroids. OBJECTIVE: To determine the association and correlation between patient symptom perception and asthma control. METHODS: A rapid literature review comprising searches in MEDLINE, Embase and Cochrane Library identified English language articles published between 2011-2021 that included a statistical measure of the association or correlation between perceptions of symptoms and asthma control in patients with asthma (adults and/or children). [PROSPERO CRD42021230152]. The Joanna Briggs Institute (JBI) instrument was used for study quality appraisal. RESULTS: Of 22 identified studies, nine presented association data and 13 reported correlation analyses. Eight of nine association studies showed a discordance between patients perceived symptoms and level of asthma control or lung function; among these, patients more frequently overestimated their asthma control than they underestimated their asthma control. Of 10 studies reporting correlation coefficients, all reported a statistically significant correlation between increased symptoms and worse asthma control; however, the strength of the correlation was shown to be only weak or moderate in most studies (coefficients numerically ranged from 0.12 to 0.74). CONCLUSION: Many patients with asthma tend to overestimate their level of asthma control. Although more frequent or worse symptoms were shown to be statistically significantly correlated with worsening asthma control, there was wide variation in correlation strengths, most showing weak or moderate correlations. Research to further understand the reasons for patient symptom misperceptions are warranted.

Type 2 inflammation in asthma and other airway diseases.

Chronic inflammatory airway diseases, including asthma, chronic rhinosinusitis, eosinophilic COPD and allergic rhinitis are a global health concern. Despite the coexistence of these diseases and their common pathophysiology, they are often managed independently, resulting in poor asthma control, continued symptoms and poor quality of life. Understanding disease pathophysiology is important for best treatment practice, reduced disease burden and improved patient outcomes. The pathophysiology of type 2 inflammation is driven by both the innate immune system triggered by pollutants, viral or fungal infections involving type 2 innate lymphoid cells (ILC2) and the adaptive immune system, triggered by contact with an allergen involving type 2 T-helper (Th2) cells. Both ILC2 and Th2 cells produce the type-2 cytokines (interleukin (IL)-4, IL-5 and IL-13), each with several roles in the inflammation cascade. IL-4 and IL-13 cause B-cell class switching and IgE production, release of pro-inflammatory mediators, barrier disruption and tissue remodelling. In addition, IL-13 causes goblet-cell hyperplasia and mucus production. All three interleukins are involved in trafficking eosinophils to tissues, producing clinical symptoms characteristic of chronic inflammatory airway diseases. Asthma is a heterogenous disease; therefore, identification of biomarkers and early targeted treatment is critical for patients inadequately managed by inhaled corticosteroids and long-acting ß-agonists alone. The Global Initiative for Asthma guidelines recommend add-on biological (anti IgE, IL-5/5R, IL-4R) treatments for those not responding to standard of care. Targeted therapies, including omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab and tezepelumab, were developed on current understanding of the pathophysiology of type 2 inflammation. These therapies offer hope for improved management of type 2 inflammatory airway diseases.

[ARIA (Allergic Rhinitis and its Impact on Asthma). Achievements in 10 years and future needs in Latin America]. / ARIA (Rinitis Alérgica y su Impacto en Asma). Logros en 10 años y necesidades futuras en América Latina.

Allergic rhinitis and asthma represent global problems of public health affecting all age groups; asthma and allergic rhinitis frequently coexist in the same patients. In Latin American prevalence of allergic rhinitis, although variable, is very high. Allergic rhinitis and its Impact on Asthma (ARIA) started during a workshop of the World Health Organization performed in 1999 and was published in 2001. ARIA proposed a new classification of allergic rhinitis in intermittent or persistent and mild or moderate-severe. This approach of classification reflects more nearly the impact of allergic rhinitis in patients. In its review of 2010 ARIA developed guidelines for diagnosis and treatment of allergic rhinitis and of clinical practices for management of comorbidities of allergic rhinitis and asthma based on GRADE (Grading of Recommendations, Development and Evaluation). ARIA has been spread and implemented in more than 50 countries. In Latin American an intense activity has been developed to spread these recommendations in almost all the countries of the region and it is important to record the obtained goals in the diffusion and implementation of ARIA, as well as to identify the unsatisfied needs from the clinical, research and implementation points of view. Final objective is to reinforce the priority that allergy and asthma should have, especially in children, in the programs of public health, as they have been prioritized in European Union in 2011.

La rinitis alérgica y el asma representan problemas globales de salud pública que afectan a todos los grupos etarios; el asma y la rinitis alérgica frecuentemente coexisten en los mismos pacientes. En América Latina la prevalencia de rinitis alérgica, aunque variable, es muy elevada. La iniciativa Rinitis Alérgica y su Impacto en Asma (globalmente conocida como ARIA, de su nombre en inglés Allergic Rhinitis and its Impact on Asthma) comenzó durante un taller de la Organización Mundial de la Salud (OMS) realizado en 1999 que se publicó en el año 2001. ARIA propuso una nueva clasificación de rinitis alérgica en intermitente o persistente y leve o moderada-severa. Este esquema de clasificación refleja más estrechamente el impacto de la rinitis alérgica en los pacientes. En su revisión de 2010, la guía ARIA desarrolló pautas para el diagnóstico y tratamiento de la rinitis alérgica y de prácticas clínicas para el manejo de las comorbilidades de la rinitis alérgica y el asma basadas en GRADE (Gradación de Recomendaciones, Desarrollo y Evaluación). ARIA se ha diseminado e implantado en más de 50 países. En América Latina se ha desarrollado una intensa actividad para diseminar estas recomendaciones en casi todos los países de la región y es importante llevar un registro de los logros obtenidos en la difusión e implantación de ARIA, además de identificar las necesidades insatisfechas desde el punto de vista clínico, de la investigación y de la implantación. El objetivo final es reforzar la prioridad que deben tener la alergia y el asma ­especialmente en niños­ en los programas de Salud Pública, tal como los priorizó la Unión Europea en 2011.