Detecting small airways dysfunction in asthma: Rationale, findings, and future of ATLANTIS.

Small airway dysfunction (SAD) is both common and clinically relevant in patients with asthma. However, there is no recognized 'gold standard' approach for the identification of SAD in clinical practice. The ATLANTIS (AssessmenT of smalL Airways involvemeNT In aSthma) study was a prospective (1 year follow-up), multi-center, international observational study that aimed to identify the best, or best combination of biomarkers, physiological tests, and imaging markers for the determination of the presence of SAD, and to evaluate the contribution of SAD across all asthma severities to meaningful clinical asthma outcomes.

Adherence to inhaled corticosteroid medications following an asthma exacerbation and the risk of subsequent exacerbations.

Background: Data on the duration of improved adherence to controller medications after an exacerbation and its impact on asthma outcomes are inconsistent.

Objective: To describe levels and changes in adherence to inhaled corticosteroid (ICS)-containing medication following a severe exacerbation and association with future exacerbation risk.

Methods: This retrospective cohort study used data from Optum's de-identified Clinformatics® Data Mart Database (October 2015-December 2023).

The Burden of COPD with Type 2 Inflammation in North-West Continental Europe.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease that places a huge burden on patients, health systems and societies. Yet despite this, COPD is often neglected: it is frequently underdiagnosed or misdiagnosed, and since tobacco exposure is a primary risk factor for its development, patients are often stigmatized and marginalized because they are perceived as having a "self-inflicted" disease. COPD is primarily understood to be a functional disorder with chronic airway obstruction, yet there are several underlying inflammatory pathways.

Using 21 century diagnostics to overcome barriers for lung function testing in primary care: it is time to consider oscillometry.

Obstructive airways diseases, including asthma and COPD as the most commonly encountered respiratory diseases in primary care, are both diagnosed by lung function testing using spirometry as the gold standard. However, this test is not always available in primary care practices and if it is, it is a difficult test to perform, requiring extensive operator training and patient co-operation with multiple forced manoeuvres. These barriers can lead to underdiagnosis and misdiagnosis, which further contributes to increased suffering and mortality associated with asthma and COPD.

ReferID and AsthmaOptimiser: Digital tools to support structured asthma consultations in primary care.

Globally, many patients with severe or uncontrolled asthma receive inadequate treatment, which contributes to significant disease burden, healthcare resource utilisation, and decreased health-related quality of life. There is a need to develop a tool that can support identification of patients with severe or uncontrolled asthma, optimise their management in primary care, and facilitate appropriate referrals to severe asthma specialists. We describe the development of two novel digital tools to improve asthma management in the United Kingdom and the Netherlands: ReferID and AsthmaOptimiser.

Holistic Impact of CKD: A Clinical, Economic, and Environmental Analysis by IMPACT CKD.

Introduction: Chronic kidney disease (CKD) is a growing global health problem driven by aging and the rise of comorbidities, including diabetes and hypertension. Although clinical and economic burdens have been reported, there is a lack of information on the multidimensional impact of CKD across countries with varying demographics and health system archetypes.

Methods: The validated IMPACT CKD model was used to project the clinical, health care resource use (HCRU), economic, patient, societal, and environmental burden of CKD in 8 countries (Australia, Brazil, China, Germany, Netherlands, Spain, United Kingdom, and United States) over 10 years (baseline: 2022; simulated years: 2023-2032).

CodeX effectively identifies high-risk patients with asthma or COPD in Dutch primary care, supporting guideline-driven treatment.

Background: Prevention of lung attacks (LAs)/exacerbation is an important treatment goal in both asthma and chronic obstructive pulmonary disease (COPD). However, LAs are often not registered as such in medical records.

Objectives: Development and evaluation of CodeX Asthma and COPD.

Treatable Traits in Patients with Obstructive Lung Diseases in a Well-Established Asthma/COPD Service for Primary Care.

Purpose: The primary objective of this study was to assess the prevalence of treatable traits (TTs) in patients with obstructive lung diseases in a primary care setting and how these TTs co-occur. The secondary objective was to assess the stability of TTs and the effect of management advice on changes in traits and health outcomes.

Patients And Methods: Data from the Dutch asthma/COPD service (2007-2023) were studied retrospectively.

Effectiveness of a systematic home-based albuminuria screening programme to detect chronic kidney disease in high-risk individuals in primary care (SALINE): a cross-sectional screening study.

Background: Although guidelines recommend opportunistic screening for chronic kidney disease (CKD) in individuals with established risk factors, such as diabetes, hypertension, or cardiovascular disease, screening for CKD in these individuals remains suboptimal. This study aimed to evaluate the effectiveness of a systematic home-based albuminuria screening program in primary care patients at risk for CKD.

Methods: A cross-sectional screening study was performed in ten general practices and five pharmacies in the Netherlands from November 2021 to May 2024.

Asthma control and opportunities to optimize management and the healthcare provider experience using the AsthmaOptimiser online tool in Dutch general practice: the CAPTURE study.

Patients seen in general practices can achieve improved asthma control with better identification of factors that contribute to uncontrolled asthma. Information is lacking on the proportion of patients with uncontrolled asthma, associated patient characteristics, and opportunities to improve management. The objectives of this study were to determine the proportion of general practice patients with uncontrolled asthma, as assessed during a regular consultation with the AsthmaOptimiser digital tool, identify the opportunities for improved management, and to evaluate the usability of this tool which is based on treatment recommendations from GINA.

Long-Term Effectiveness of a Digital Inhaler on Medication Adherence and Clinical Outcomes in Adult Asthma Patients in Primary Care: The Cluster Randomized Controlled ACCEPTANCE Trial.

Background: Digital inhalers can support medication adherence and asthma control in the short-term. Yet, long-term benefits are unknown.

Objective: To investigate the clinical effects, usability, and cost-effectiveness of a digital inhaler.

Impulse oscillometry-derived equation for prediction of abnormal FEV/FVC ratio for COPD screening in Chinese population: a multicenter cross-sectional study.

Background: The diagnosis of chronic obstructive pulmonary disease (COPD) is based on spirometry that requires a forced expiratory manoeuvre, which is laborious and difficult for mass screening. Impulse oscillometry (IOS) is easier than spirometry and performed with tidal breathing. We sought to develop an equation for predicting forced expiratory volume in 1 s (FEV)/forced vital capacity (FVC) and screening COPD using IOS parameters.

Neutrophilic inflammation in sputum or blood does not define a clinically distinct asthma phenotype in ATLANTIS.

Introduction: Neutrophilic asthma has been suggested to be a clinically distinct phenotype characterised by more severe airflow obstruction and higher exacerbation risk. However, this has only been assessed in few and smaller studies, using different cut-offs to define neutrophilia, and with conflicting results. We used data from ATLANTIS, an observational longitudinal study including a large number of patients with asthma and healthy controls.

A conceptual framework to assess the health, socioeconomic and environmental burden of chronic kidney disease.

Chronic kidney disease (CKD) is a global health challenge that affects patients, caregivers, healthcare systems, the environment and national economies. Despite its far-reaching impact, there is no framework to systematically evaluate national CKD prevention and management programmes or evaluate the societal burden of disease. This paper has two objectives: first, to introduce a comprehensive framework to assess national programmes, which recognises gaps and weaknesses and identifies feasible policy interventions to reduce overall CKD burden; second, to present some key challenges and success stories in delivering CKD services delivered in eight different country settings.

Preserved Ratio Impaired Spirometry in US Primary Care Patients Diagnosed with Chronic Obstructive Pulmonary Disease.

Background: Preserved ratio impaired spirometry (PRISm) represents a population with spirometry results that do not meet standardized COPD obstruction criteria, yet present with high respiratory symptom burden and might benefit from respiratory management and treatment. We aimed to determine prevalence of PRISm in US primary care patients diagnosed with COPD, describe their demographic, clinical, and CT scan characteristics.

Methods: An observational registry study utilizing the US APEX COPD registry, composed of patients diagnosed with COPD aged 35+ years.

[Coughing].

Coughing may impair the quality of life, for instance by interfering with sleep or social interactions. Acute cough is almost invariably caused by a viral respiratory tract infection and seldom warrants medical consultation or treatment. Red flags in cough (haemoptysis, high fever or severe illness) may be indicative of a life threatening underlying disease.

Uncovering patterns of inhaler technique and reliever use: the value of objective, personalized data from a digital inhaler.

Electronic inhalers provide information about patterns of routine inhaler use. During a 12-week study, 360 asthma patients using albuterol Digihaler generated 53,083 inhaler events that were retrospectively analyzed. A total of 41,528 (78%) of the recorded inhalation events were suitable for flow analysis (having a PIF ≥ 18 L/min and <120 L/min).

Usability and feasibility of the Test of Adherence to Inhalers (TAI) Toolkit in daily clinical practice: The BANANA study.

The Test of Adherence to Inhalers (TAI) Toolkit links an adherence measurement instrument (the TAI) to proven effective interventions for different causes of non-adherence to inhaled medication. This study aimed to assess the usability and feasibility of the TAI Toolkit in clinical practice. The TAI Toolkit was piloted in eight primary and secondary care settings.

Implications of Cardiopulmonary Risk for the Management of COPD: A Narrative Review.

Chronic obstructive pulmonary disease (COPD) constitutes a major global health burden and is the third leading cause of death worldwide. A high proportion of patients with COPD have cardiovascular disease, but there is also evidence that COPD is a risk factor for adverse outcomes in cardiovascular disease. Patients with COPD frequently die of respiratory and cardiovascular causes, yet the identification and management of cardiopulmonary risk remain suboptimal owing to limited awareness and clinical intervention.

Does mixing inhaler devices lead to unchecked inhaler technique errors in patients with COPD? Findings from the cross-sectional observational MISMATCH study.

Background: Patients with chronic obstructive pulmonary disease (COPD) may be prescribed multiple inhalers that require different techniques for optimal performance. Mixing devices has been associated with poorer COPD outcomes suggesting that it leads to inappropriate inhaler technique. However, empirical evidence is lacking.

The Design of a Persuasive Game to Motivate People with Asthma in Adherence to Their Maintenance Medication.

Objective: This study aimed to design a persuasive game, using objective adherence data, to motivate people with asthma to adhere to their medication regimen.

Methods: A participatory user-centered design approach was employed, involving end-users and other stakeholders throughout the study. The approach consisted of four phases.

Overcoming the Digital Divide for Older Patients With Respiratory Disease: Focus Group Study.

Background: The need for and adoption of eHealth programs are growing worldwide. However, access can be limited among patients with low socioeconomic backgrounds, often resulting in a so-called "digital divide" due to a mismatch between eHealth and target populations that can gain benefit. This digital divide can result in unsuccessful eHealth implementations, which is of critical importance to health care.

The Use of eHealth for Pharmacotherapy Management With Patients With Respiratory Disease, Cardiovascular Disease, or Diabetes: Scoping Review.

Background: eHealth is increasingly considered an important tool for supporting pharmacotherapy management.

Objective: We aimed to assess the (1) use of eHealth in pharmacotherapy management with patients with asthma or chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD); (2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes; and (3) key factors contributing to the success of eHealth interventions for pharmacotherapy management.

Methods: We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review) statement.