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Background: In patients with asthma, bronchoconstriction and airway inflammation both contribute to airway narrowing and airflow limitations, which lead to symptoms and exacerbations. Short-acting β₂-agonist (SABA)-only rescue therapy addresses only bronchoconstriction and is associated with increased morbidity and mortality. Current asthma management guidelines recommend concomitant treatment of symptoms and inflammation with a fast-acting bronchodilator and inhaled corticosteroid (ICS) as rescue therapy for patients ≥12 years of age. However, there is an education and outreach gap for the wider adoption of anti-inflammatory rescue therapy in clinical practice. Objective: AstraZeneca has developed an education program for health-care practitioners (HCPs) based on a Knowledge-to-Action Framework, with the aim of increasing HCPs' understanding of key disease-state concepts related to evidence-based management of asthma. Methods: A multichannel, evidence-based education program was presented at medical conferences across the United States between December 2022 and December 2023. Before and after each event, attendees were asked to complete a survey that rated their agreement with six disease-state concepts on a five-point Likert scale. These concepts related to the role of airway inflammation, fluctuations in inflammation, SABA and ICS therapy, and the risk of exacerbations. Postevent responses to the survey were assessed relative to pre-event responses and longitudinally over 12 months by using calculated odds ratios and 95% confidence intervals. Acceptance and/or understanding of a concept was defined as a rating of "agree" or "strongly agree" from at least 80% of respondents. Results: The proportion of respondents who agreed or strongly agreed with each concept was significantly higher postevent versus pre-event (p < 0.001). The 80% acceptance and/or understanding threshold was surpassed for all concepts after the event. Conclusion: The medical education program improved understanding and/or acceptance of key disease-state concepts related to asthma management among participating HCPs. Effective communication of disease management concepts may lead to improved patient health outcomes through more rapid acceptance of guideline-recommended medical therapies.

Background: Asthma in children is a leading cause of missed school days, emergency department visits, and hospitalizations. Approximately 40% of children with asthma experience uncontrolled disease and annual exacerbations. There is a need for a validated composite tool for children, such as the Asthma Impairment and Risk Questionnaire (AIRQ), which was developed to assess current control and predict exacerbations in adolescents and adults with asthma., Objective: To obtain feedback from children with asthma and their parents/caregivers to inform development of a version of the AIRQ for pediatric use (Peds-AIRQ)., Methods: Children with asthma aged 5 to 11 years and their parents/caregivers participated in cognitive interviews to elicit language describing asthma symptoms and exacerbations and to assess understanding and relevance of draft Peds-AIRQ questions. Physicians and parents/caregivers provided clinical information and performed assessments relative to the children's asthma morbidity., Results: There were 60 dyads that participated: children's mean (SD) age = 7.9 (1.9) years; 68% male, 45% non-White, 32% Hispanic, and 40% with public health insurance. Overall, 53% had well-controlled, 30% partly controlled, and 17% uncontrolled asthma, based on the Global Initiative for Asthma symptom control questions. Oral or injected corticosteroids were used for asthma by 53% of the children in the previous year. Participants found draft Peds-AIRQ items understandable and relevant. Seven impairment and 3 risk questions were retained for validation, along with 5 additional items containing wording or control threshold variations., Conclusion: This study supports the need for developing a composite (impairment and risk) control tool to assess children aged 5 to 11 years with asthma and identified suitable questions for the validation of a Peds-AIRQ., Competing Interests: Disclosures Dr Lanz is a consultant for Amgen, AstraZeneca, Cogent, Genentech, Grifols, Novartis, and Sanofi/Regeneron; is a speaker for Amgen/AstraZeneca and Sanofi/Regeneron; and receives research grants from Regeneron, Sanofi, Genentech/Roche, and AstraZeneca. Dr Chipps has served as an advisor, consultant, and speaker for AstraZeneca, Boehringer Ingelheim, Circassia, Genentech, Novartis, Regeneron, and Sanofi. Dr Zeiger has received grants from Aerocrine, Genentech, MedImmune/AstraZeneca, Merck, GlaxoSmithKline, ALK Pharma, Teva, Sanofi, and the National Heart, Lung, and Blood Institute, has received consultant fees from AstraZeneca, Bayer, Genentech/Novartis, Merck, and Regeneron, and holds warrant shares in DBV Technologies. Dr Bacharier is a consultant for AstraZeneca, GlaxoSmithKline, Regeneron Pharmaceuticals Inc, Sanofi, Recludix, and Avillion; is a speaker for Sanofi and Regeneron; is a member of the data and safety monitoring board for AstraZeneca, Cystic Fibrosis Foundation/Vertex, Aravax, and DBV Technologies; and receives research support from the National Institutes of Health, AstraZeneca, and Sanofi. Dr Guilbert is a consultant for Amgen, AstraZeneca, Genentech, OM Pharma, Regeneron, and Sanofi; receives grants from Amgen, AstraZeneca, GlaxoSmithKline, OM Pharma, Regeneron, and Sanofi; and receives personal fees from Advent.com, AiCME, AstraZeneca, Genentech, OM Pharma, PlatformQ health, and Polarean. Dr Murphy has served as a consultant and is a speaker for AstraZeneca, Boehringer Ingelheim, Genentech, Greer, Merck, Mylan, Novartis, Regeneron, Sanofi, OptiNose, and Teva. Ms Winders is a consultant/speaker for ALK, AstraZeneca, Chiesi, Genentech, GlaxoSmithKline, Roche, Sanofi, and Regeneron. Dr Mohammad has participated on an advisory board for AstraZeneca. Ms LeNoir has participated on an advisory board for AstraZeneca and is a board member at Digital Health Equitable Alliance and African American Wellness Project. Dr Gilbert and Mr Eudicone are employees of AstraZeneca, the sponsor of this study, and may hold stock or stock options. Dr Coyne and Ms Harding are employees of Evidera, which was contracted by AstraZeneca for study design support, to collect and analyze data for this study, and to provide medical writing support. Dr George has served as a consultant to AstraZeneca, Insmed, and Teva and has served as a speaker for AstraZeneca and Regeneron., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The optimal approach towards managing serum potassium (sK + ) and hemodialysate potassium concentrations is uncertain. To study this, adults receiving hemodialysis for three months or more with hyperkalemia (pre-dialysis sK + 5.1-6.5 mmol/l) had cardiac monitors implanted and were randomized to either eight weeks of 2.0 mmol/l potassium/1.25 mmol/l calcium dialysate without sodium zirconium cyclosilicate (SZC) (2.0 potassium/noSZC) or 3.0 mmol/l potassium/1.25 mmol/l calcium dialysate combined with SZC (3.0 potassium/SZC) on non-dialysis days to maintain pre-dialysis sK + 4.0-5.5 mmol/l, followed by treatment crossover for another eight weeks. The primary outcome was the rate of adjudicated atrial fibrillation (AF) episodes of at least 2 minutes duration. Secondary outcomes included clinically significant arrhythmias (bradycardia, ventricular tachycardia, and/or asystole) and the proportion of sK + measurements within an optimal window of 4.0-5.5 mmol/l. Among 88 participants (mean age: 57.1 years; 51% male; mean pre-dialysis sK + : 5.5 mmol/l) with 25.5 person-years of follow-up, 296 AF episodes were detected in nine patients. The unadjusted AF rate was lower with 3.0 potassium/SZC versus 2.0 potassium/noSZC; 9.7 vs. 13.4/person-year (modeled rate ratio 0.52; 95% confidence interval 0.41-0.65). Clinically significant arrhythmias were reduced with 3.0 potassium/SZC vs. 2.0 potassium/noSZC (6.8 vs. 10.2/person-year modeled rate ratio 0.47; 0.38; 0.58). Fewer sK + measurements outside the optimal window occurred with 3.0 potassium/SZC (modeled odds ratio: 0.27; 0.12-0.35). Hypokalemia was less frequent (33 vs. 58 patients) with 3.0 potassium/SZC compared with 2.0 potassium/noSZC. Thus, in patients with hyperkalemia on maintenance hemodialysis, a combination of hemodialysate potassium 3.0 mmol/l and SZC on non-hemodialysis days reduced the rates of AF, other clinically significant arrhythmias, and post-dialysis hypokalemia compared with hemodialysate potassium 2.0/noSZC., (Copyright © 2024 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)