Author: "Samantha Walker" / Topic: pulmonary and respiratory medicine - Searchworks@Jio Institute Digital Library Search Results

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1. Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post–COVID-19 Study

Author: Iain Stewart, Joseph Jacob, Peter M. George, Philip L. Molyneaux, Joanna C. Porter, Richard J. Allen, Shahab Aslani, J. Kenneth Baillie, Shaney L. Barratt, Paul Beirne, Stephen M. Bianchi, John F. Blaikley, James D. Chalmers, Rachel C. Chambers, Nazia Chadhuri, Christopher Coleman, Guilhem Collier, Emma K. Denneny, Annemarie Docherty, Omer Elneima, Rachael A. Evans, Laura Fabbri, Michael A. Gibbons, Fergus V. Gleeson, Bibek Gooptu, Neil J. Greening, Beatriz Guillen Guio, Ian P. Hall, Neil A. Hanley, Victoria Harris, Ewen M. Harrison, Melissa Heightman, Toby E. Hillman, Alex Horsley, Linzy Houchen-Wolloff, Ian Jarrold, Simon R. Johnson, Mark G. Jones, Fasihul Khan, Rod Lawson, Olivia Leavy, Nazir Lone, Michael Marks, Hamish McAuley, Puja Mehta, Dhruv Parekh, Karen Piper Hanley, Manuela Platé, John Pearl, Krisnah Poinasamy, Jennifer K. Quint, Betty Raman, Matthew Richardson, Pilar Rivera-Ortega, Laura Saunders, Ruth Saunders, Malcolm G. Semple, Marco Sereno, Aarti Shikotra, A. John Simpson, Amisha Singapuri, David J. F. Smith, Mark Spears, Lisa G. Spencer, Stefan Stanel, David R. Thickett, A. A. Roger Thompson, Mathew Thorpe, Simon L. F. Walsh, Samantha Walker, Nicholas David Weatherley, Mark E. Weeks, Jim M. Wild, Dan G. Wootton, Chris E. Brightling, Ling-Pei Ho, Louise V. Wain, and Gisli R. Jenkins
Subjects: Pulmonary and Respiratory Medicine, Critical Care and Intensive Care Medicine
Published: 2023

2. Exacerbation Profile and Risk Factors in a Type-2–Low Enriched Severe Asthma Cohort: A Clinical Trial to Assess Asthma Exacerbation Phenotypes

Author: P. Jane McDowell, John Busby, Catherine E. Hanratty, Ratko Djukanovic, Ashley Woodcock, Samantha Walker, Timothy Colin Hardman, Joseph R. Arron, David F. Choy, Peter Bradding, Chris E. Brightling, Rekha Chaudhuri, Douglas Cowan, Adel H. Mansur, Stephen J. Fowler, Sarah E. Diver, Peter Howarth, James Lordan, Andrew Menzies-Gow, Timothy Harrison, Douglas S. Robinson, Cecile T. J. Holweg, John G. Matthews, Ian D. Pavord, and Liam G. Heaney
Subjects: Male, Pulmonary and Respiratory Medicine, Phenotype, Adrenal Cortex Hormones, Risk Factors, Disease Progression, Humans, Female, Anti-Asthmatic Agents, Original Articles, Critical Care and Intensive Care Medicine, Biomarkers, Asthma
Abstract: Rationale: The past 25 years have seen huge progress in understanding of the pathobiology of type-2 (T2) asthma, identification of measurable biomarkers, and the emergence of novel monoclonal antibody treatments. Although present in a minority of patients with severe asthma, very little is known about the mechanisms underlying T2-low asthma, making it a significant unmet need in asthma research. Objectives: The objective of this study was to explore the differences between study exacerbators and nonexacerbators, to describe physiological changes at exacerbation in those who are T2 HIGH and T2 LOW at the time of exacerbation, and to evaluate the stability of inflammatory phenotypes when stable and at exacerbation. Methods: Exacerbation assessment was a prespecified secondary analysis of data from a 48-week, multicenter, randomized controlled clinical study comparing the use of biomarkers and symptoms to adjust steroid treatment in a T2-low severe asthma-enriched cohort. Participants were phenotyped as T2 LOW (fractional exhaled nitric oxide < 20 ppb and blood eosinophil count < 150 cells/ml) or T2 HIGH (fractional exhaled nitric oxide. 20 or blood eosinophil count. 150) at study enrollment and at each exacerbation. Here, we report the findings of the exacerbation analyses, including comparison of exacerbators and nonexacerbators, the physiological changes at exacerbation in those who had evidence of T2 biology at exacerbation versus those that did not, and the stability of inflammatory phenotypes when stable and at exacerbation.Measurements and Main Results: Of the 301 participants, 60.8% (183) had one or more self-reported exacerbations (total of 390). Exacerbators were more likely to be female, have a higher body mass index, and have more exacerbations requiring oral corticosteroid and unscheduled primary care attendances for exacerbations. At enrollment, 23.6% (71) were T2 LOW and 76.4% (230) T2 HIGH. The T2 LOW group had more asthma primary care attendances, were more likely to have a previous admission to HDU (high dependency unit)/ICU and to be receiving maintenance oral corticosteroids. At exacerbation, the T2 LOW events were indistinguishable from T2 HIGH exacerbations in terms of lung function (mean fall in T2 LOW FEV 1, 200 [400] ml vs. T2 HIGH 200 [300] ml; P = 0.93) and symptom increase (ACQ5: T2 LOW, 1.4 [0.8] vs. T2 HIGH, 1.3 [0.8]; P = 0.72), with no increase in T2 biomarkers from stable to exacerbation state in the T2 LOW exacerbations. The inflammatory phenotype within individual patients was dynamic; inflammatory phenotype at study entry did not have a significant association with exacerbation phenotype. Conclusions: Asthma exacerbations demonstrating a T2 LOW phenotype were physiologically and symptomatically similar to T2 HIGH exacerbations. T2 LOW asthma was an unstable phenotype, suggesting that exacerbation phenotyping should occur at the time of exacerbation. The clinically significant exacerbations in participants without evidence of T2 biology at the time of exacerbation highlight the unmet and pressing need to further understand the mechanisms at play in non-T2 asthma.
Published: 2022

3. Asthma innovations from the first International Collaborative Asthma Network forum

Author: Benjamin Gaston, Donna D. Gardner, Kenzie Mahan, Praveen Akuthota, Eneida A. Mendonca, Hannah Durrington, Nadzeya Marozkina, Rocio T. Martinez-Nunez, Dawn Newcomb, Benjamin Ainsworth, Arthur H. Owora, Kian Fan Chung, Samantha Walker, Stephen J. Fowler, Salman Siddiqui, Tonya Winders, Joe Zein, Nizar Jarjour, Yvonne J. Huang, Katherine N. Cahill, and Ratko Djukanovic
Subjects: Pulmonary and Respiratory Medicine
Abstract: Many patients have uncontrolled asthma despite available treatments. Most of the new asthma therapies have focused on Type-2 (T2) inflammation, leaving an unmet need for innovative research into mechanisms of asthma beyond T2 and immunity. An international group of investigators developed the International Collaborative Asthma Network (ICAN) with the goal of sharing innovative research on disease mechanisms, developing new technologies and therapies, organising pilot studies, and engaging early-stage career investigators from across the world. This report describes the purpose, development, and outcomes of the first ICAN forum.Abstracts were solicited from interdisciplinary early-stage career investigators with innovative ideas beyond T2 inflammation for asthma and were selected for presentation at the forum. Breakout sessions were conducted to discuss innovation, collaboration, and research translation.The abstracts were categorised into 1) general omics and big data analysis; 2) lung-brain axis and airway neurology; 3) sex differences; 4) paediatric asthma; 5) new therapeutic targets inspired by airway epithelial biology; 6) new therapeutics targeting airway and circulating immune mediators; and 7) lung anatomy, physiology, and imaging. Discussions revealed that research groups are looking for opportunities to further their findings using larger scale collaboration and the ability to translate theirin vitrofindings into clinical treatment.Through ICAN, teams that included interdisciplinary early-stage career investigators discussed innovation, collaboration, and translation in asthma and severe asthma research. With a combination of fresh ideas and energetic, collaborative, global participation, ICAN has laid a firm foundation and model for future collaborative global asthma research.
Published: 2023

4. Prevalence, risk factors and treatments for post-COVID-19 breathlessness: a systematic review and meta-analysis

Author: Bang Zheng, Luke Daines, Qing Han, John R. Hurst, Paul Pfeffer, Manu Shankar-Hari, Omer Elneima, Samantha Walker, Jeremy S. Brown, Salman Siddiqui, Jennifer K. Quint, Christopher E. Brightling, Rachael A. Evans, Louise V. Wain, Liam G. Heaney, and Aziz Sheikh
Subjects: Pulmonary and Respiratory Medicine, Dyspnea - diagnosis - epidemiology - therapy, Dyspnea, SDG 3 - Good Health and Well-being, Risk Factors, Prevalence, COVID-19, Humans, Female, Exercise Therapy
Abstract: Persistent breathlessness >28 days after acute COVID-19 infection has been identified as a highly debilitating post-COVID symptom. However, the prevalence, risk factors, mechanisms and treatments for post-COVID breathlessness remain poorly understood. We systematically searched PubMed and Embase for relevant studies published from 1 January 2020 to 1 November 2021 (PROSPERO registration number: CRD42021285733) and included 119 eligible papers. Random-effects meta-analysis of 42 872 patients with COVID-19 reported in 102 papers found an overall prevalence of post-COVID breathlessness of 26% (95% CI 23–29) when measuring the presence/absence of the symptom, and 41% (95% CI 34–48) when using Medical Research Council (MRC)/modified MRC dyspnoea scale. The pooled prevalence decreased significantly from 1–6 months to 7–12 months post-infection. Post-COVID breathlessness was more common in those with severe/critical acute infection, those who were hospitalised and females, and was less likely to be reported by patients in Asia than those in Europe or North America. Multiple pathophysiological mechanisms have been proposed (including deconditioning, restrictive/obstructive airflow limitation, systemic inflammation, impaired mental health), but the body of evidence remains inconclusive. Seven cohort studies and one randomised controlled trial suggested rehabilitation exercises may reduce post-COVID breathlessness. There is an urgent need for mechanistic research and development of interventions for the prevention and treatment of post-COVID breathlessness.
Published: 2022

5. Respiratory research in the UK: investing for the next 10 years

Author: Ian Hall, Samantha Walker, and Stephen T Holgate
Subjects: Pulmonary and Respiratory Medicine, Pulmonary Disease, Chronic Obstructive, Respiratory System, Humans, Asthma, United Kingdom
Published: 2022

6. Composite type-2 biomarker strategy versus a symptom–risk-based algorithm to adjust corticosteroid dose in patients with severe asthma: a multicentre, single-blind, parallel group, randomised controlled trial

Author: David C. Jackson, Catherine E. Hanratty, Kian Fan Chung, John G. Matthews, Ratko Djukanovic, Maria Nunez, Robert Niven, Douglas S. Robinson, Liam G Heaney, Michelle Bourne, Catherine Borg, Clare Connolly, Mary Bellamy, Val Hudson, Gareth M. Davies, Christopher E. Brightling, Beverley Hargadon, Traceyanne Grandison, Ian M. Adcock, Sebastian L. Johnston, Rekha Chaudhuri, Geraldine Jones, James Lordan, Andrew Menzies-Gow, Adnam Azim, Dominic E. Shaw, John Busby, Ashley Woodcock, Freda Yang, Peter Bradding, Christopher Corrigan, David F. Choy, Cecile T.J. Holweg, Douglas C. Cowan, Paula McCourt, Tim Harrison, Peter H. Howarth, AH Mansur, Joel Solis, Avril Horn, Joseph R. Arron, Gabrielle Gainsborough, Sarah E Davies, Stephen J. Fowler, Roisin Stone, Timothy C. Hardman, Ian D. Pavord, Samantha Walker, Richard W. Costello, and Katherine C. Smith
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.drug_class, Population, Nitric Oxide, Corrections, law.invention, 1117 Public Health and Health Services, 03 medical and health sciences, Leukocyte Count, 0302 clinical medicine, Randomized controlled trial, law, Adrenal Cortex Hormones, Risk Factors, medicine, Humans, Drug Dosage Calculations, Single-Blind Method, 030212 general & internal medicine, Anti-Asthmatic Agents, education, Asthma, education.field_of_study, investigators for the MRC Refractory Asthma Stratification Programme, business.industry, Cumulative dose, 1103 Clinical Sciences, Odds ratio, Articles, Middle Aged, medicine.disease, Eosinophils, 030228 respiratory system, Exhaled nitric oxide, Acute Disease, Corticosteroid, Biomarker (medicine), Female, business, Algorithm, Cell Adhesion Molecules, Algorithms, Biomarkers, 1199 Other Medical and Health Sciences
Abstract: Background: Asthma treatment guidelines recommend increasing corticosteroid dose to control symptoms and reduce exacerbations. This approach is potentially flawed because symptomatic asthma can occur without corticosteroid responsive type-2 (T2)-driven eosinophilic inflammation, and inappropriately high-dose corticosteroid treatment might have little therapeutic benefit with increased risk of side-effects. We compared a biomarker strategy to adjust corticosteroid dose using a composite score of T2 biomarkers (fractional exhaled nitric oxide [FENO], blood eosinophils, and serum periostin) with a standardised symptom–risk-based algorithm (control). Methods: We did a single-blind, parallel group, randomised controlled trial in adults (18–80 years of age) with severe asthma (at treatment steps 4 and 5 of the Global Initiative for Asthma) and FENO of less than 45 parts per billion at12 specialist severe asthma centres across England, Scotland, and Northern Ireland. Patients were randomly assigned (4:1) to either the biomarker strategy group or the control group by an online electronic case-report form, in blocks of ten, stratified by asthma control and use of rescue systemic steroids in the previous year. Patients were masked to study group allocation throughout the entirety of the study. Patients attended clinic every 8 weeks, with treatment adjustment following automated treatment-group-specific algorithms: those in the biomarker strategy group received a default advisory to maintain treatment and those in the control group had their treatment adjusted according to the steps indicated by the trial algorithm. The primary outcome was the proportion of patients with corticosteroid dose reduction at week 48, in the intention-to-treat (ITT) population. Secondary outcomes were inhaled corticosteroid (ICS) dose at the end of the study; cumulative dose of ICS during the study; proportion of patients on maintenance oral corticosteroids (OCS) at study end; rate of protocol-defined severe exacerbations per patient year; time to first severe exacerbation; number of hospital admissions for asthma; changes in lung function, Asthma Control Questionnaire-7 score, Asthma Quality of Life Questionnaire score, and T2 biomarkers from baseline to week 48; and whether patients declined to progress to OCS. A secondary aim of our study was to establish the proportion of patients with severe asthma in whom T2 biomarkers remained low when corticosteroid therapy was decreased to a minimum ICS dose. This study is registered with ClinicalTrials.gov, NCT02717689 and has been completed. Findings: Patients were recruited from Jan 8, 2016, to July 12, 2018. Of 549 patients assessed, 301 patients were included in the ITT population and were randomly assigned to the biomarker strategy group (n=240) or to the control group(n=61). 28·4% of patients in the biomarker strategy group were on a lower corticosteroid dose at week 48 compared with 18·5% of patients in the control group (adjusted odds ratio [aOR] 1·71 [95% CI 0·80–3·63]; p=0·17). In the per-protocol (PP) population (n=121), a significantly greater proportion of patients were on a lower corticosteroid dose at week 48 in the biomarker strategy group (30·7% of patients) compared with the control group (5·0% of patients; aOR 11·48 [95% CI 1·35–97·83]; p=0·026). Patient choice to not follow treatment advice was the principle reason for loss to PP analysis. There was no difference in secondary outcomes between study groups and no loss of asthma control among patients in the biomarker strategy group who reduced their corticosteroid dose. Interpretation: Biomarker-based corticosteroid adjustment did not result in a greater proportion of patients reducing corticosteroid dose versus control. Understanding the reasons for patients not following treatment advice in both treatment strategies is an important area for future research. The prevalence of T2 biomarker-low severe asthma was low.
Published: 2021

7. Patient symptoms and experience following COVID-19: results from a UK-wide survey

Author: Andrea Fallas, Keir E J Philip, Brigitte West, Jennifer K Quint, Andrew Cumella, Michael I. Polkey, Cheryl Cheung, Sara Buttery, Samantha Walker, Parris J Williams, Nicholas S Hopkinson, Imperial College London, and Guys & St Thomas NHS Foundation Trust
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Mental ability, Respiratory System, Declaration, Ethnic group, Disease, Diseases of the respiratory system, Post-Acute COVID-19 Syndrome, Surveys and Questionnaires, Patient experience, Health care, medicine, Humans, Psychiatry, Depression (differential diagnoses), Science & Technology, RC705-779, business.industry, SARS-CoV-2, Muscle weakness, COVID-19, Middle Aged, United Kingdom, Scholarship, Mood, Respiratory Research, Family medicine, Physical therapy, Anxiety, Medicine, Female, medicine.symptom, business, Life Sciences & Biomedicine
Abstract: SummaryObjectivesTo investigate the experience of people who continue to be unwell after acute COVID-19, often referred to as ‘long COVID’, both in terms of their symptoms and their interactions with healthcare.DesignWe conducted a mixed-methods analysis (quantitative and qualitative) of responses to a survey accessed through a UK online post-COVID support and information hub between April 2020 and December 2020 about people’s experiences after having acute COVID-19.ParticipantsOf 3290 respondents, 78% were female, median age range 45-54 years, 92.1% reported white ethnicity; 12.7% had been hospitalised. 494 respondents (16.5%) completed the survey between 4 and 8 weeks of the onset of their symptoms, 641 (21.4%) between 8 and 12 weeks and 1865 (62.1%) more than 12 weeks after.ResultsThe ongoing symptoms most frequently reported were; breathing problems (92.1%), fatigue (83.3%), muscle weakness or joint stiffness (50.6%), sleep disturbances (46.2%), problems with mental abilities (45.9%) changes in mood, including anxiety and depression (43.1%) and cough (42.3%). Symptoms did not appear to be related to the severity of the acute illness or to the presence of pre-existing medical conditions. Analysis of free text responses revealed three main themes (1) Experience of living with COVID-19 – physical and psychological symptoms that fluctuate unpredictably; (2) Interactions with healthcare; (3) Implications for the future – their own condition, society and the healthcare system and the need for researchConclusionPeople living with persistent problems after the acute phase of COVID-19 report multiple and varying symptoms that are not necessarily associated with initial disease severity or the presence of pre-existing health conditions. Many have substantial unmet needs and experience barriers to accessing healthcare. Consideration of patient perspective and experiences will assist in the planning of services to address this.Ethical approvalEthical approval was granted by Imperial College Research and Integrity Team (IREC; 20IC6625).What we already know on this subjectMany people who develop COVID-19 will go on to endure persistent symptoms past the acute phase of the disease, commonly termed long-COVID.Knowledge gaps exist regarding the lived experience and symptom frequency, in people with long-COVID, particularly in those who were not admitted to hospital during the acute phase of their illness.What this study addsThe findings from this large population, many of whom were not hospitalised during the acute phase of their illness, demonstrate the varying patterns and persistence of symptoms of long-COVID, which do not appear to be associated with severity of the acute phase of the disease or pre-existing medical conditions.Qualitative findings revealing the patient experience of long-COVID symptoms, healthcare, and suggestions for future research and service adaptation.
Published: 2021

8. Factors affecting adherence with treatment advice in a clinical trial of patients with severe asthma

Author: James Lordan, Catherine E. Hanratty, Stephen J. Fowler, Robert Niven, Peter H. Howarth, Ian D. Pavord, Ratko Djukanovic, Douglas C. Cowan, Timothy C. Hardman, Douglas S. Robinson, Rekha Chaudhuri, David F. Choy, Joseph R. Arron, John Busby, Peter Bradding, Cecile T.J. Holweg, Christopher E. Brightling, Liam G Heaney, Samantha Walker, Andrew Menzies-Gow, Tim Harrison, AH Mansur, John G. Matthews, and Ashley Woodcock
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Multivariate analysis, business.industry, Attendance, MEDLINE, Ethnic group, Asthma, Advice (programming), Clinical trial, Adrenal Cortex Hormones, Internal medicine, medicine, Ethnicity, Biomarker (medicine), Humans, Single-Blind Method, Disease management (health), business, Minority Groups
Abstract: Background: understanding why patients with severe asthma do not follow healthcare provider (HCP) advice to adjust treatment is critical to achieving personalised disease management.Methods: we reviewed patient choice to follow HCP advice to adjust asthma treatment in a randomised, controlled, single-blind (study participant), multi-centre, parallel group 48-week clinical study comparing biomarker directed treatment adjustment to standard care in severe asthma.Results: of 1572 treatment advisories (301 participants), instructions were followed in 1377 cases (87.6%). Patients were more likely to follow advice to remain on treatment (96.7%) than to either reduce (70.3%) or increase (67.1%) their treatment, with 64% of patients following all treatment advice. Multivariate analysis associated belonging to an ethnic minority group (OR: 3.10; 95% CI: 1.68, 5.73) and prior study medication changes (≥2 OR: 2.77, 95% CI: 1.51, 5.10) with failure to follow treatment advice. In contrast, emergency room attendance in the prior year (OR: 0.54, 95% CI: 0.32, 0.92) was associated with following treatment advice. The largest effect was seen with transition onto or off oral corticosteroids (OR: 29.28; 95% CI: 16.07, 53.36) when compared to those requested to maintain treatment. Centre was also an important determinant regarding the likelihood of patients to follow treatment advice.Conclusions: belonging to an ethnic minority group and multiple prior treatment adjustments were associated with not following HCP treatment advice. Patients also responded differently to HCP advice across UK specialist centres. These findings have implications for generalisability for models of care in severe asthma and require further focussed studies.
Published: 2021

9. The Future of Asthma Care

Author: Brigitte West, Stephen T. Holgate, Samantha Walker, and Kay Boycott
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Disease entity, business.industry, Asthma treatment, Disease, medicine.disease, Asthma care, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Medicine, Eosinophilia, Sputum, 030212 general & internal medicine, medicine.symptom, business, Intensive care medicine, mHealth, Asthma
Abstract: Although once considered a single disease entity, asthma is now known to be a complex inflammatory disease engaging a range of causal pathways. The most frequent forms of asthma are identified by sputum/blood eosinophilia and activation of type 2 inflammatory pathways involving interleukins-3, -4, -5, and granulocyte-macrophage colony-stimulating factor. The use of diagnostics that identify T2 engagement linked to the selective use of highly targeted biologics has opened up a new way of managing severe disease. Novel technologies, such as wearables and intelligent inhalers, enable real-time remote monitoring of asthma, creating a unique opportunity for personalized health care.
Published: 2019

10. Next-generation care pathways for allergic rhinitis and asthma multimorbidity: a model for multimorbid non-communicable diseases -Meeting Report (Part 1)

Author: Elaine Colgan, Mario Sánchez-Borges, Jim Phillips, Ignacio J. Ansotegui, Bolesław Samoliński, Olga Lourenço, Giorgio Walter Canonica, F. Portejoie, Isabella Annesi-Maesano, Gabrielle L. Onorato, Victoria Cardona, João O. Malva, Eugene Cash, Christine Rolland, Hilary Pinnock, Samantha Walker, Yoshitaka Okamoto, Ana Maria Carriazo, Lorenzo Cecchi, Nikos G. Papadopoulos, Jean Bousquet, L. T. T. Le, João Fonseca, Oliver Pfaar, Luis Caraballo, Elísio Costa, Maritta Perala, Pablo Quinones-Delgado, Torsten Zuberbier, Holger J. Schünemann, Tomohisa Iinuma, Enrica Menditto, Maddalena Illario, Nils E. Billo, Arunas Valiulis, Sinthia Bosnic-Anticevich, Josep M. Antó, Nick A. Guldemond, Maria Teresa Ventura, Claus Bachert, Wytske Fokkens, Lars Münter, Mohamed H. Shamji, Ioana Agache, Ulysse Rodts, Daniel Laune, Sanna Toppila-Salmi, Joaquim Mullol, Ioanna Tsiligianni, Motohiro Ebisawa, Isabelle Bosse, Samuel Benveniste, Arzu Yorgancioglu, Alkis Togias, M. Bewick, Nhân Pham-Thi, Stephen R. Durham, Moises A. Calderon, Marina Erhola, Violeta Kvedariene, Omar S. Usmani, Alvaro A. Cruz, Anna Bedbrook, Abigail Phillips, Desiree Larenas-Linneman, Guy Brusselle, Gert Marien, Dana Wallace, David Somekh, Sian Williams, Wienczyslawa Czarlewski, Ludger Klimek, Piotr Kuna, Jean-Luc Fauquert, Rianne van der Kleij, Derek K. Chu, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Service de Pneumologie Allergologie [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pasteur [Paris], Transilvania University of Brasov, Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospital Quiròn Bizkaia Erandio, Universitat Pompeu Fabra [Barcelona] (UPF), CIBER de Epidemiología y Salud Pública (CIBERESP), Ghent University Hospital, Centre de Recherche en Informatique (CRI), MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], iQ4U consultants Ltd, University of Joensuu, The University of Sydney, Imperial College London, Humanitas Clinical and Research Center [Rozzano, Milan, Italy], Institute for Immunological Research (University of Cartagena), Vall d'Hebron University Hospital [Barcelona], Servicio Andaluz de Salud, Nova Southeastern University (NSU), Azienda Sanitaria di Prato, McMaster University [Hamilton, Ontario], DEPARTMENT OF HEALTH ( Social Services and Public Safety), Universidade do Porto, Universidade Federal da Bahia (UFBA), UCB Pharma, Colombes, Sagamihara National Hospital, National Institute for Health and Welfare [Helsinki], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), Faculdade de Medicina da Universidade do Porto (FMUP), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Chiba University Hospital, 'Federico II' University of Naples Medical School, Zentrum für Rhinologie und Allergologie [Wiesbaden, Germany], Medical University of Łódź (MUL), Vilnius University [Vilnius], Hospital Medica Sur [Mexico City, Mexico], KYomed INNOV, Ho Chi Minh City University of Technology (HCMUT), Faculty of Health Sciences and CICS-UB (Health Sciences Research Centre), University of Coimbra [Portugal] (UC), Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Department of Public Health [Copenhagen], Faculty of Health and Medical Sciences, University of Copenhagen = Københavns Universitet (KU)-University of Copenhagen = Københavns Universitet (KU), University of Manchester [Manchester], University of Athens Medical School [Athens], University of Oulu, Philipps University of Marburg, Cardiff University, University of Edinburgh, Regional Government for Equality, Medical University of Warsaw - Poland, Centro Medico-Docente La Trinidad, Department of Clinical Epidemiology and Biostatistics and Medicine, National Institute of Allergy and Infectious Diseases [Bethesda] (NIAID-NIH), National Institutes of Health [Bethesda] (NIH), University of Helsinki, University of Crete [Heraklion] (UOC), National Heart and Lung Institute [London] (NHLI), Imperial College London-Royal Brompton and Harefield NHS Foundation Trust, King's College Hospital (KCH), Leiden University Medical Center (LUMC), University of Bari Aldo Moro (UNIBA), Manisa Celal Bayar University, Humboldt-Universität zu Berlin, Association Asthme et Allergie, Health Services Management & Organisation (HSMO), University Hospital Montpellier, Montpellier, France, MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France, INSERM U 1168, VIMA, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, France, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France, EUFOREA, Brussels, Belgium, Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany, Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany, Allergy Department, Pasteur Institute, Paris, France, Faculty of Medicine, Transylvania University, Brasov, Romania, Epidemiology of Allergic and Respiratory Diseases, Department Institute Pierre Louis of Epidemiology and Public Health, INSERM, Sorbonne Universités, Medical School Saint Antoine, Paris, France, Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Erandio, Spain, ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain, Universitat Pompeu Fabra (UPF), Barcelona, Spain, CIBER Epidemiolog a y Salud Pública (CIBERESP), Barcelona, Spain, Upper Airways Research Laboratory, ENT Dept., Ghent University Hospital, Ghent, Belgium, National Center of Expertise in Cognitive Stimulation (CEN STIMCO), Broca Hospital, Paris, France, Mines ParisTech CRI - PSL Research University, Fontainebleau, France, iQ4U Consultants Ltd., London, United Kingdom, Joensuu, Finland, Woolcock Institute of Medical Research, University of Sydney, Woolcock Emphysema Centre, Sydney Local Health District, Glebe, NSW, Australia, La Rochelle, France, Dept. of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium, Imperial College London, National Heart and Lung Institute, London, United Kingdom, Personalized Medicine Clinic Asthma and Allergy, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy, Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia, Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia, Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron and ARADyAL Research Network, Barcelona, Spain, Regional Ministry of Health of Andalusia, Seville, Spain, College of Psychology, Nova Southeastern University, School-related Psychological Assessments and Clinical Interventions Clinic, Ft Lauderdale, FL, United States, SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy, Department of Health Research Methods, Evidence, and Impact, Division of Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada, Department of Health, Social Services and Public Safety, Belfast, United Kingdom, UCIBIO, REQUIMTE, Faculty of Pharmacy, Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork), University of Porto, Porto, Portugal, ProAR-Nucleo de Excelencia em Asma, Federal University of Bahia, Brasil and WHO GARD Executive Committee, Bahia, Brazil, Medical Consulting Czarlewski, Levallois, France, Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan, National Institute for Health and Welfare, Helsinki, Finland, CHU Clermont-Ferrand, Unité d’Allergologie de l’Enfant, Pôle Pédiatrique, Hôpital Estaing, Clermont-Ferrand, France, Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, Netherlands, CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina, Universidade do Porto, Medida, Lda, Porto, Portugal, Institute of Health Policy and Management iBMG, Erasmus University, Rotterdam, Netherlands, Dept. of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan, Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R and D and DISMET), Naples, Italy, Center for Rhinology and Allergology, Wiesbaden, Germany, Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland, Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania, Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius, Lithuania, Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico, KYomed INNOV, Montpellier, France, University of Medicine and Pharmacy, Hochiminh City, Viet Nam, Faculty of Health Sciences, CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal, CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy, Rhinology Unit and Smell Clinic, ENT Department, Hospital Cl nic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain, Danish Committee for Health Education, Copenhagen East, Denmark, Division of Infection, Immunity and Respiratory Medicine, Royal Manchester Children’s Hospital, University of Manchester, Manchester, United Kingdom, Allergy Department, 2nd Pediatric Clinic, Athens General Children’s Hospital 'P and A Kyriakou', University of Athens, Athens, Greece, University of Oulu, Faculty of Medicine, Oulun Yliopisto, Finland, Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Germany, Department of Health and Social Services, Welsh Government, Cardiff, United Kingdom, Centre For Empowering Patients and Communities, Dublin, Ireland, Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom, Agency for Social Services and Dependency, Regional Government for Equality, Social Policies and Conciliation of Andalucia, Seville, Spain, Association Asthme et Allergie, Paris, France, KanopyMed, Paris, France, Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland, Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidad, Caracas, Venezuela, Immunomodulation and Tolerance Group, Imperial College London, London, United Kingdom, Allergy and Clinical Immunology, Imperial College London, London, United Kingdom, European Health Futures Forum (EHFF), Dromahair, Ireland, Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States, Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland, Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece, International Primary Care Respiratory Group IPCRG, Aberdeen, United Kingdom, National Heart and Lung Institute (NHLI), Imperial College London, Royal Brompton Hospital, Airways Disease Section, London, United Kingdom, Asthma UK, London, United Kingdom, Nova Southeastern University, Fort Lauderdale, FL, United States, Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Institute of Health Sciences, Vilnius, Lithuania, Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands, University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy, Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey, Universitätsmedizin Berlin, Humboldt-Uniersität zu Berlin, Berlin, Germany, Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Berlin, Germany, uBibliorum, Ear, Nose and Throat, AII - Inflammatory diseases, Institut Pasteur [Paris] (IP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Hospital Quirónsalud Bizkaia [Bilbao], Mines Paris - PSL (École nationale supérieure des mines de Paris), Universidade do Porto = University of Porto, Sagamihara National Hospital [Kanagawa, Japan], University of Copenhagen = Københavns Universitet (UCPH)-University of Copenhagen = Københavns Universitet (UCPH), Philipps Universität Marburg = Philipps University of Marburg, Centro Médico Docente La Trinidad, Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro (UNIBA), Humboldt University Of Berlin, Salvy-Córdoba, Nathalie, Universiteit Leiden, Bousquet, J., Pham-Thi, N., Bedbrook, A., Agache, I., Annesi-Maesano, I., Ansotegui, I., Anto, J. M., Bachert, C., Benveniste, S., Bewick, M., Billo, N., Bosnic-Anticevich, S., Bosse, I., Brusselle, G., Calderon, M. A., Canonica, G. W., Caraballo, L., Cardona, V., Carriazo, A. M., Cash, E., Cecchi, L., Chu, D. K., Colgan, E., Costa, E., Cruz, A. A., Czarlewski, W., Durham, S., Ebisawa, M., Erhola, M., Fauquert, J. -L., Fokkens, W. J., Fonseca, J. A., Guldemond, N., Iinuma, T., Illario, M., Klimek, L., Kuna, P., Kvedariene, V., Larenas-Linneman, D., Laune, D., Le, L. T. T., Lourenco, O., Malva, J. O., Marien, G., Menditto, E., Mullol, J., Munter, L., Okamoto, Y., Onorato, G. L., Papadopoulos, N. G., Perala, M., Pfaar, O., Phillips, A., Phillips, J., Pinnock, H., Portejoie, F., Quinones-Delgado, P., Rolland, C., Rodts, U., Samolinski, B., Sanchez-Borges, M., Schunemann, H. J., Shamji, M., Somekh, D., Togias, A., Toppila-Salmi, S., Tsiligianni, I., Usmani, O., Walker, S., Wallace, D., Valiulis, A., Van Der Kleij, R., Ventura, M. T., Williams, S., Yorgancioglu, A., and Zuberbier, T.
Subjects: Pulmonary and Respiratory Medicine, Allergy, medicine.medical_specialty, Allergic and chronic respiratory diseases, [SDV.IMM] Life Sciences [q-bio]/Immunology, Allergic rhinitis - Asthma - Multimorbidity, Health care system, Health literacy, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Health care, medicine, Patient participation, mHealth, Asthma, Rhinitis, [SDV.EE]Life Sciences [q-bio]/Ecology, environment, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Newsletter of GARD Section, business.industry, Environmental exposure, medicine.disease, 3. Good health, Integrated care, [SDV.EE] Life Sciences [q-bio]/Ecology, environment, 030228 respiratory system, 13. Climate action, Family medicine, [SDV.IMM]Life Sciences [q-bio]/Immunology, 030211 gastroenterology & hepatology, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system for integrated care with organizational health literacy. MASK (Mobile Airways Sentinel NetworK) (1), a new development of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health) (2), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life integrated care pathways (ICPs) (3)-centred around the patient with rhinitis and using mHealth monitoring of environmental exposure (4).An expert meeting took place at the Pasteur Institute in Paris, December 3, 2018. The aim was to discuss next-generation care pathways: (I) Patient participation, health literacy and self-care through technology-assisted “patient activation”; (II) Implementation of care pathways by pharmacists and (III) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) assessed by mobile technology.The EU (5) and global political agendas are of great importance in supporting health care transformation. MASK has been recognized by DG Santé as a Good Practice (6) in the field of digitally-enabled, integrated, person-centred care.The one-day meeting objectives were clear (Figure 1). The meeting was followed by a workshop. The present paper reports the background of the two-day meeting.
Published: 2019

11. Moving towards a Treatable Traits model of care for the management of obstructive airways diseases

Author: Alvar Agusti, John Oppenheimer, Louisa Yates, Vanessa M. McDonald, Mike Thomas, Liam G Heaney, Ian D. Pavord, Fernando J. Martinez, Samantha Walker, Neil Barnes, David Leather, Alberto Papi, Alvaro A. Cruz, Hiromasa Inoue, and Peter G. Gibson
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Pulmonary disease, NO, Pulmonary Disease, Chronic Obstructive, Pharmacotherapy, Asthma, biomarkers,COPD, targeted therapy, Humans, Medicine, COPD, In patient, Precision Medicine, Intensive care medicine, Asthma, Evidence-Based Medicine, business.industry, biomarkers, medicine.disease, targeted therapy, respiratory tract diseases, Management strategy, Practice Guidelines as Topic, Female, business, Airway, Stepwise approach
Abstract: Asthma and chronic obstructive pulmonary disease (COPD) are two prevalent chronic airways diseases. Both are complex and heterogeneous. Traditionally, clinical guidelines have advocated a stepwise approach to pharmacotherapy of asthma and COPD, but there is increasing realization that both require a more personalized and precise management approach. To this end, a management strategy based on the so-called Treatable Traits has been proposed. Emerging evidence suggests that this model improves relevant outcomes in patients with chronic airway diseases but further research is needed to guide implementation. This review discusses the challenges, opportunities, and hurdles that its implementation will have to face.
Published: 2021

12. The long-term sequelae of COVID-19: an international consensus on research priorities for patients with pre-existing and new-onset airways disease

Author: Davies Adeloye, Omer Elneima, Luke Daines, Krisnah Poinasamy, Jennifer K Quint, Samantha Walker, Chris E Brightling, Salman Siddiqui, John R Hurst, James D Chalmers, Paul E Pfeffer, Petr Novotny, Thomas M Drake, Liam G Heaney, Igor Rudan, Aziz Sheikh, Anthony De Soyza, Mohammad Abdollahi, Dhiraj Agarwal, Riyad Al-Lehebi, Peter J Barnes, Jagadeesh Bayry, Marcel Bonay, Louis J Bont, Arnaud Bourdin, Thomas Brown, Gaetano Caramori, Amy Hai Yan Chan, David H Dockrell, Simon Doe, Jamie Duckers, Anthony D'Urzo, Magnus Ekström, Cristóbal Esteban, Catherine M Greene, Atul Gupta, Jennifer L Ingram, Ee Ming Khoo, Fanny Wai San Ko, Gerard H Koppelman, Brian J Lipworth, Karin Lisspers, Michael Loebinger, Jose Luis Lopez-Campos, Matthew Maddocks, David Mannino, Miguel A Martinez-Garcia, Renae Mcnamara, Marc Miravitlles, Pisirai Ndarukwa, Alison Pooler, Chin Kook Rhee, Peter Schwarz, Dominick Shaw, Michael Steiner, Andrew Tai, Charlotte Suppli Ulrik, Paul Walker, and Michelle C Williams
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Consensus, Coronavirus disease 2019 (COVID-19), MEDLINE, New onset, long COVID, COPD, airway disease, asthma, Post-Acute COVID-19 Syndrome, medicine, Humans, Intensive care medicine, Depression (differential diagnoses), business.industry, SARS-CoV-2, Airways disease, Research, Comment, COVID-19, medicine.disease, Respiration Disorders, Sarcopenia, Anxiety, Ill health, Position Paper, medicine.symptom, business
Abstract: Persistent ill health after acute COVID-19-referred to as long COVID, the post-acute COVID-19 syndrome, or the post-COVID-19 condition-has emerged as a major concern. We undertook an international consensus exercise to identify research priorities with the aim of understanding the long-term effects of acute COVID-19, with a focus on people with pre-existing airways disease and the occurrence of new-onset airways disease and associated symptoms. 202 international experts were invited to submit a minimum of three research ideas. After a two-phase internal review process, a final list of 98 research topics was scored by 48 experts. Patients with pre-existing or post-COVID-19 airways disease contributed to the exercise by weighting selected criteria. The highest-ranked research idea focused on investigation of the relationship between prognostic scores at hospital admission and morbidity at 3 months and 12 months after hospital discharge in patients with and without pre-existing airways disease. High priority was also assigned to comparisons of the prevalence and severity of post-COVID-19 fatigue, sarcopenia, anxiety, depression, and risk of future cardiovascular complications in patients with and without pre-existing airways disease. Our approach has enabled development of a set of priorities that could inform future research studies and funding decisions. This prioritisation process could also be adapted to other, non-respiratory aspects of long COVID.
Published: 2021

13. Nrf2-interacting nutrients and COVID-19: time for research to develop adaptation strategies

Author: Bousquet, Jean, Cristol, Jean-Paul, Czarlewski, Wienczyslawa, Anto, Josep M, Martineau, Adrian, Haahtela, Tari, Fonseca, Susana C, Iaccarino, Guido, Blain, Hubert, Fiocchi, Alessandro, Canonica, G Walter, Fonseca, Joao A, Vidal, Alain, Choi, Hak-Jong, Kim, Hyun Ju, Le Moing, Vincent, Reynes, Jacques, Sheikh, Aziz, Akdis, Cezmi A, Zuberbier, Torsten, Amir Hamzah Abdul Latiff, Baharudin, Abdullah, Werner, Aberer, Nancy, Abusada, Ian, Adcock, Alejandro, Afani, Ioana, Agache, Xenofon, Aggelidis, Jenifer, Agustin, Cezmi, A Akdis, Mübeccel, Akdis, Mona, Al-Ahmad, Abou Al-Zahab Bassam, Hussam, Alburdan, Oscar, Aldrey-Palacios, Emilio Alvarez Cuesta, Hiba Alwan Salman, Ashraf, Alzaabi, Salma, Amade, Gene, Ambrocio, Rosana, Angles, Isabella, Annesi-Maesano, Ignacio, J Ansotegui, Josep, M Anto, Paula Ara Bardajo, Stefania, Arasi, Margarete, Arrais, Hasan, Arshad, Maria-Cristina, Artesani, Estrella, Asayag, Francesca, Avolio, Khuzama, Azhari, Claus, Bachert, Diego, Bagnasco, Ilaria, Baiardini, Nissera, Bajrović, Petros, Bakakos, Sergio Bakeyala Mongono, Christine, Balotro-Torres, Sergio, Barba, Cristina, Barbara, Elsa, Barbosa, Bruno, Barreto, Joan, Bartra, Xavier, Basagana, Eric, D Bateman, Lkhagvaa, Battur, Anna, Bedbrook, Martín Bedolla Barajas, Bianca, Beghé, Antra, Bekere, Elizabeth, Bel, Ali Ben Kheder, Mikael, Benson, Elena-Camelia, Berghea, Karl-Christian, Bergmann, Roberto, Bernardini, David, Bernstein, Mike, Bewick, Slawomir, Bialek, Artur, Białoszewski, Thomas, Bieber, Nils, E Billo, Maria-Beatrice, Bilo, Carsten, Bindslev-Jensen, Leif, Bjermer, Hubert, Blain, Irina, Bobolea, Malgorzata Bochenska Marciniak, Christine, Bond, Attilio, Boner, Matteo, Bonini, Sergio, Bonini, Sinthia, Bosnic-Anticevich, Isabelle, Bosse, Sofia, Botskariova, Jacques, Bouchard, Louis-Philippe, Boulet, Rodolphe, Bourret, Philippe, Bousquet, Fulvio, Braido, Andrew, Briggs, Christopher, E Brightling, Jan, Brozek, Luisa, Brussino, Roland, Buhl, Roxana, Bumbacea, Rosalva, Buquicchio, María-Teresa Burguete Cabañas, Andrew, Bush, William, W Busse, Jeroen, Buters, Fernan, Caballero-Fonseca, Moïses, A Calderon, Mario, Calvo, Paulo, Camargos, Thierry, Camuzat, R Canevari, F, Antonio, Cano, G Walter Canonica, Arnaldo, Capriles-Hulett, Luis, Caraballo, Vicky, Cardona, Kai-Hakon, Carlsen, Jonas Carmona Pirez, Jorge, Caro, Warner, Carr, Pedro, Carreiro-Martins, Fredelita, Carreon-Asuncion, Ana-Maria, Carriazo, Carme Carrion, Y Ribas, Thomas, Casale, Mary-Ann, Castor, Elizabeth, Castro, G Caviglia, A, Lorenzo, Cecchi, Alfonso Cepeda Sarabia, Maciej, Chalubinski, Ramanathan, Chandrasekharan, Yoon-Seok, Chang, Victoria, Chato-Andeza, Lida, Chatzi, Christina, Chatzidaki, Niels, H Chavannes, Claudia Chaves Loureiro, Aurora-Alejandra Chavez Garcia, Marta, Chelninska, Yuzhi, Chen, Lei, Cheng, Sharon, Chinthrajah, Tomas, Chivato, Ekaterine, Chkhartishvili, George, Christoff, Henry, Chrystyn, Derek, K Chu, Antonio, Chua, Alexander, Chuchalin, Kian Fan Chung, Alberto, Cicerán, Cemal, Cingi, Giorgio, Ciprandi, Ieva, Cirule, Ana-Carla, Coelho, Enrico, Compalati, Jannis, Constantinidis, Jaime Correia de Sousa, Elisio Manuel Costa, David, Costa, María Del Carmen Costa Domínguez, André, Coste, Cottini, M, Linda, Cox, Carlos, Crisci, Maria Angiola Crivellaro, Alvaro, A Cruz, John, Cullen, Adnan, Custovic, Biljana, Cvetkovski, Wienczyslawa, Czarlewski, Gennaro, D'Amato, Jane da Silva, Ronald, Dahl, Sven-Erik, Dahlen, Vasilis, Daniilidis, Louei Darjazini Nahhas, Ulf, Darsow, Janet, Davies, Frédéric de Blay, Giulia De Feo, Eloisa De Guia, José-Ricardo De la Torre Navarrete, Chato De Los Santos, Esteban De Manuel Keenoy, Govert De Vries, Diana, Deleanu, Pascal, Demoly, Judah, Denburg, Philippe, Devillier, Alain, Didier, Sanja Dimic Janjic, Maria, Dimou, Anh Tuan Dinh-Xuan, Ratko, Djukanovic, Maria Do Ceu Texeira, Dejan, Dokic, Margarita Gabriela Domínguez Silva, Habib, Douagui, Nikolaos, Douladiris, Maria, Doulaptsi, Gérard, Dray, Ruta, Dubakiene, Eve, Dupas, Stephen, Durham, Marzia, Duse, Mark, Dykewicz, Didier, Ebo, Natalija, Edelbaher, Thomas, Eiwegger, Patrik, Eklund, Yehia, El-Gamal, Zeinab, A El-Sayed, Shereen, S El-Sayed, Magda, El-Seify, Regina, Emuzyte, Lourdes, Enecilla, Marina, Erhola, Heidilita, Espinoza, Jesús Guillermo Espinoza Contreras, John, Farrell, Lenora, Fernandez, Paola Fimbres Jimenez, Antje Fink Wagner, Alessandro, Fiocchi, Wytske, J Fokkens, Lenia, Folletti, Joao, A Fonseca, Jean-François, Fontaine, Francesco, Forastiere, Jose Miguel Fuentes Pèrez, Emily, Gaerlan-Resureccion, Mina, Gaga, José Luis Gálvez Romero, Amiran, Gamkrelidze, Alexis, Garcia, Cecilia Yvonne García Cobas, María de la Luz Hortensia García Cruz, Valeria Garcia Ortiz, Jacques, Gayraud, Matteo, Gelardi, Bilun, Gemicioglu, Dimitra, Gennimata, Sonya, Genova, José, Gereda, Roy Gerth van Wijk, Antonio, Giuliano, René-Maximiliano, Gomez, Miguel-Ange Gonzalez Ballester, Sandra González Diaz, Maia, Gotua, Christos, Grigoreas, Ineta, Grisle, Marta, Guidacci, Nick, Guldemond, Zdenek, Gutter, Antonieta, Guzmán, Tari, Haahtela, Ramsa, Halloum, David, Halpin, Eckard, Hamelmann, Suleiman, Hammadi, Richard, Harvey, Enrico, Heffler, Joachim, Heinrich, Adnan, Hejjaoui, Birthe, Hellquist-Dahl, Luiana Hernández Velázquez, Mark, Hew, Elham, Hossny, Peter, Howarth, Martin, Hrubiško, Yunuen Rocío Huerta Villalobos, Marc, Humbert, Salina, Husain, Michael, Hyland, Guido, Iaccarino, Moustafa, Ibrahim, Nataliya, Ilina, Maddalena, Illario, Cristoforo, Incorvaia, Antonio, Infantino, Carla, Irani, Zhanat, Ispayeva, Juan Carlos Ivancevich, Edgardo Ej Jares, Deborah, Jarvis, Ewa, Jassem, Klemen, Jenko, Rubén Darío Jiméneracruz Uscanga, Sebastian, L Johnston, Guy, Joos, Maja, Jošt, Kaja, Julge, Ki-Suck, Jung, Jocelyne, Just, Marek, Jutel, Igor, Kaidashev, Omer, Kalayci, Fuat, Kalyoncu, Jeni, Kapsali, Przemyslaw, Kardas, Jussi, Karjalainen, Carmela, A Kasala, Michael, Katotomichelakis, Loreta, Kavaliukaite, Kazi, S Bennoor, Thomas, Keil, Paul, Keith, Musa, Khaitov, Nikolai, Khaltaev, You-Young, Kim, Bruce, Kirenga, Jorg, Kleine-Tebbe, Ludger, Klimek, Fanny, W Ko, Bernard Koffi N'Goran, Evangelia, Kompoti, Peter, Kopač, Gerard, Koppelman, Anja Koren Jeverica, Seppo, Koskinen, Mitja, Košnik, Tomasz, Kostka, Kosta, V Kostov, Marek, L Kowalski, Tanya, Kralimarkova, Karmen Kramer Vrščaj, Helga, Kraxner, Samo, Kreft, Vicky, Kritikos, Dmitry, Kudlay, Mikael, Kuitunen, Inger, Kull, Piotr, Kuna, Maciej, Kupczyk, Violeta, Kvedariene, Marialena, Kyriakakou, Nika, Lalek, Massimo, Landi, Stephen, Lane, Désiree, E Larenas-Linnemann, Susanne, Lau, Daniel, Laune, Jorge, Lavrut, Lan, Le, Martina, Lenzenhuber, Gualtiero, Leo, Marcus, Lessa, Michael, Levin, Jing, Li, Philip, Lieberman, Giuseppe, Liotta, Brian, Lipworth, Xuandao, Liu, Rommel, Lobo, Karin, C Lodrup Carlsen, Carlo, Lombardi, Renaud, Louis, Stelios, Loukidis, Olga, Lourenço, Jorge, A Luna Pech, Bojan, Madjar, Enrico, Maggi, Antoine, Magnan, Bassam, Mahboub, Alpana, Mair, Anke-Hilse Maitland van der Zee, Mika, Makela, Michael, Makris, Hans-Jorgen, Malling, Mariana, Mandajieva, Patrick, Manning, Manolis, Manousakis, Pavlos, Maragoudakis, Gianluigi, Marseglia, Gailen, Marshall, Mohammad Reza Masjedi, Jorge, F Máspero, Juan José Matta Campos, Marcus, Maurer, Sandra, Mavale-Manuel, Cem, Meço, Erik, Melén, Giovanni, Melioli, Elisabete, Melo-Gomes, Eli, O Meltzer, Enrica, Menditto, Andrew, Menzies-Gow, Hans, Merk, Jean-Pierre, Michel, Yann, Micheli, Neven, Miculinic, Luís, Midão, Florin, Mihaltan, Nikolaos, Mikos, Manlio, Milanese, Branislava, Milenkovic, Dimitrios, Mitsias, Bassem, Moalla, Giuliana, Moda, María Dolores Mogica Martínez, Yousser, Mohammad, Frances-Montserrat, Moharra, Mostafa, Moin, Mathieu, Molimard, Isabelle, Momas, Monique, Mommers, Alessandro, Monaco, Stephen, Montefort, Lucia-Elvira, Montenegro, Riccardo, Monti, Dory, Mora, Mario, Morais-Almeida, Ralph, Mösges, Badr Eldin Mostafa, Joaquim, Mullol, Lars, Münter, Antonella, Muraro, Ruth, Murray, Antonio, Musarra, Tihomir, Mustakov, Robert, Naclerio, Kari, C Nadeau, Rachel, Nadif, Alla, Nakonechna, Leyla, Namazova-Baranova, Gretchen, Navarro-Locsin, Hugo, Neffen, Kristof, Nekam, Angelos, Neou, Eustachio, Nettis, Daniel, Neuberger, Laurent, Nicod, Stefania, Nicola, Verena, Niederberger-Leppin, Marek, Niedoszytko, Antonio, Nieto, Ettore, Novellino, Elizabete, Nunes, Dieudonné, Nyembue, Robyn, E O'Hehir, Cvetanka, Odjakova, Ken, Ohta, Yoshitaka, Okamoto, Kimi, Okubo, Brian, Oliver, Gabrielle, L Onorato, Maria Pia Orru, Solange, Ouédraogo, Kampadilemba, Ouoba, Francisco-Javier, Padilla, Pier Luigi Paggiaro, Aris, Pagkalos, Pajno, Giovanni Battista, Gianni, Pala, P Palaniappan, S, Isabella, Pali-Schöll, Susanna, Palkonen, Stephen, Palmer, Carmen Panaitescu Bunu, Petr, Panzner, Nikos, G Papadopoulos, Vasilis, Papanikolaou, Alberto, Papi, Bojidar, Paralchev, Giannis, Paraskevopoulos, Hae-Sim, Park, Giovanni, Passalacqua, Vincenzo, Patella, Ian, Pavord, Ruby, Pawankar, Soren, Pedersen, Susete, Peleve, Simona, Pellegino, Ana, Pereira, Mariana, Pereira, Tamara, Pérez, Andrea, Perna, Diego, Peroni, Oliver, Pfaar, Nhân, Pham-Thi, Bernard, Pigearias, Isabelle, Pin, Konstantina, Piskou, Constantinos, Pitsios, Davor, Plavec, Dagmar, Poethig, Wolfgang, Pohl, Antonija Poplas Susic, Todor, A Popov, Fabienne, Portejoie, Paul, Potter, Lars, Poulsen, Alexandra, Prados-Torres, Fotis, Prarros, David, Price, Emmanuel, Prokopakis, Francesca, Puggioni, Elisa, Puig-Domenech, Robert, Puy, Klaus, Rabe, Silvia, Rabotti, Filip, Raciborski, Josephine, Ramos, Cristina, Recalcati, Marysia, T Recto, Shereen, M Reda, Frederico, S Regateiro, Norbert, Reider, Sietze, Reitsma, Susana, Repka-Ramirez, Erminia, Ridolo, Janet, Rimmer, Daniela Rivero Yeverino, José Angelo Rizzo, Carlos, Robalo-Cordeiro, Graham, Roberts, Karen, Robles, Nicolas, Roche, Mónica Rodríguez González, Eréndira Rodríguez Zagal, Giovanni, Rolla, Christine, Rolland, Regina, Roller-Wirnsberger, Miguel Roman Rodriguez, Antonino, Romano, Jan, Romantowski, Philippe, Rombaux, Joel, Romualdez, Jose, Rosado-Pinto, Nelson, Rosario, Lanny, Rosenwasser, Oliviero, Rossi, Menachem, Rottem, Philip, W Rouadi, Nikoleta, Rovina, Irma Rozman Sinur, Mauricio, Ruiz, Lucy Tania Ruiz Segura, Dermot, Ryan, Hironori, Sagara, Daiki, Sakai, Daiju, Sakurai, Wafaa, Saleh, Johanna, Salimaki, Konstantinos, Samitas, Boleslaw, Samolinski, María Guadalupe Sánchez Coronel, Mario, Sanchez-Borges, Jaime, Sanchez-Lopez, Melissa, Sansonna, Codrut, Sarafoleanu, Faradiba Sarquis Serpa, Joaquin, Sastre, Eleonora, Savi, Agne, Savonyte, Bisher, Sawaf, Glenis, K Scadding, Sophie, Scheire, Peter, Schmid-Grendelmeier, Juan Francisco Schuhl, Holger, Schunemann, Maria, Schvalbová, Jorgen, Schwarze, Nicola, Scichilone, Gianenrico, Senna, Cecilia, Sepúlveda, Elie, Serrano, Sara, Shamai, Aziz, Sheikh, Mike, Shields, Vasil, Shishkov, Nikos, Siafakas, Alexander, Simeonov, Estelle Fer Simons, Juan Carlos Sisul, Brigita, Sitkauskiene, Ingelbjorg, Skrindo, Tanja Soklič Košak, Dirceu, Solé, Martin, Sondermann, Talant, Sooronbaev, Manuel, Soto-Martinez, Manuel, Soto-Quiros, Barnaro Sousa Pinto, Milan, Sova, Michael, Soyka, Krzysztof, Specjalski, Annette, Sperl, Otto, Spranger, Sofia, Stamataki, Lina, Stefanaki, Cristiana, Stellato, Rafael, Stelmach, Timo, Strandberg, Petra, Stute, Abirami, Subramaniam, Charlotte Suppli Ulrik, Michael, Sutherland, Silvia, Sylvestre, Aikaterini, Syrigou, Luis Taborda Barata, Nadejda, Takovska, Rachel, Tan, Frances, Tan, Vincent, Tan, Ing Ping Tang, Masami, Taniguchi, Line, Tannert, Pongsakorn, Tantilipikorn, Jessica, Tattersall, Filippo, Tesi, Uta, Thieme, Carel, Thijs, Mike, Thomas, Teresa, To, Ana Maria Todo-Bom, Alkis, Togias, Peter-Valentin, Tomazic, Vesna, Tomic-Spiric, Sanna, Toppila-Salmi, Maria-José Torres Jaen, Elina, Toskala, Massimo, Triggiani, Nadja, Triller, Katja, Triller, Ioanna, Tsiligianni, Uberti, M, Ruxandra, Ulmeanu, Jure, Urbancic, Marilyn Urrutia Pereira, Martina, Vachova, Felipe, Valdés, Rudolf, Valenta, Marylin Valentin Rostan, Antonio, Valero, Arunas, Valiulis, Mina, Vallianatou, Erkka, Valovirta, Michiel Van Eerd, Eric Van Ganse, Marianne van Hage, Olivier, Vandenplas, Tuula, Vasankari, Dafina, Vassileva, Cesar Velasco Munoz, Maria Teresa Ventura, Cécilia, Vera-Munoz, Frédéric, Viart, Dilyana, Vicheva, Pakit, Vichyanond, Petra, Vidgren, Giovanni, Viegi, Claus, Vogelmeier, Leena Von Hertzen, Theodoros, Vontetsianos, Dimitris, Vourdas, Vu Tran Thien Quan, Martin, Wagenmann, Samantha, Walker, Dana, Wallace, Yun De Wang, Susan, Waserman, Katrin, Wehner, Magnus, Wickman, Sian, Williams, Dennis, Williams, Nicola, Wilson, Gary, Wong, Kent, Woo, Lucyna, Wozniak, John, Wright, Piotr, Wroczynski, Paraskevi, Xepapadaki, Plamen, Yakovliev, Masao, Yamaguchi, Kwok, Yan, Yoke Yeow Yap, Mais, Yassin, Barbara, Yawn, Panayiotis, Yiallouros, Arzu, Yorgancioglu, Shigemi, Yoshihara, Ian, Young, Osman, B Yusuf, Asghar, Zaidi, Fares, Zaitoun, Petra, Zalud, Heather, Zar, T Zedda, M, Mario, E Zernotti, Luo, Zhang, Nanshan, Zhong, Mihaela, Zidarn, Torsten, Zuberbier, Celia, Zubrinich, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Humboldt University Of Berlin, Berlin Institute of Health (BIH), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), IMIM-Hospital del Mar, Generalitat de Catalunya, Universitat Pompeu Fabra [Barcelona] (UPF), CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Global - Institute For Global Health [Barcelona] (ISGlobal), Center for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra [Barcelona] (UPF)-Catalunya ministerio de salud, Barts & The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Helsinki University Central Hospital [Finland] (HUCH), Departamento de Geociencias, Ambiente e Ordenamento do Territorio (DGAOT), Universidade do Porto = University of Porto, University of Naples Federico II = Università degli studi di Napoli Federico II, Euromov (EuroMov), Université de Montpellier (UM), IRCCS Ospedale Pediatrico Bambino Gesù [Roma], Istituto Clinico Humanitas [Milan] (IRCCS Milan), Humanitas University [Milan] (Hunimed), Center of Research in Health Technologies and Information Systems (CINTESIS), AgroParisTech, World Institute of Kimchi [Gwangju], Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), University of Edinburgh, Universität Zürich [Zürich] = University of Zurich (UZH), Humboldt-Universität zu Berlin, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), University of Helsinki, Universidade do Porto, University of Naples Federico II, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), MORNET, Dominique, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - (MGD) Service de pneumologie, Bousquet J., Cristol J.-P., Czarlewski W., Anto J.M., Martineau A., Haahtela T., Fonseca S.C., Iaccarino G., Blain H., Fiocchi A., Canonica G.W., Fonseca J.A., Vidal A., Choi H.-J., Kim H.J., Le Moing V., Reynes J., Sheikh A., Akdis C.A., Zuberbier T., Abdul Latiff A.H., Abdullah B., Aberer W., Abusada N., Adcock I., Afani A., Agache I., Aggelidis X., Agustin J., Akdis M., Al-Ahmad M., Al-Zahab Bassam A., Alburdan H., Aldrey-Palacios O., Alvarez Cuesta E., Alwan Salman H., Alzaabi A., Amade S., Ambrocio G., Angles R., Annesi-Maesano I., Ansotegui I.J., Ara Bardajo P., Arasi S., Arrais M., Arshad H., Artesani M.-C., Asayag E., Avolio F., Azhari K., Bachert C., Bagnasco D., Baiardini I., Bajrovic N., Bakakos P., Bakeyala Mongono S., Balotro-Torres C., Barba S., Barbara C., Barbosa E., Barreto B., Bartra J., Basagana X., Bateman E.D., Battur L., Bedbrook A., Bedolla Barajas M., Beghe B., Bekere A., Bel E., Ben Kheder A., Benson M., Berghea E.-C., Bergmann K.-C., Bernardini R., Bernstein D., Bewick M., Bialek S., Bialoszewski A., Bieber T., Billo N.E., Bilo M.-B., Bindslev-Jensen C., Bjermer L., Bobolea I., Bochenska Marciniak M., Bond C., Boner A., Bonini M., Bonini S., Bosnic-Anticevich S., Bosse I., Botskariova S., Bouchard J., Boulet L.-P., Bourret R., Bousquet P., Braido F., Briggs A., Brightling C.E., Brozek J., Brussino L., Buhl R., Bumbacea R., Buquicchio R., Burguete Cabanas M.-T., Bush A., Busse W.W., Buters J., Caballero-Fonseca F., Calderon M.A., Calvo M., Camargos P., Camuzat T., Canevari F., Cano A., Canonican G.W., Capriles-Hulett A., Caraballo L., Cardona V., Carlsen K.-H., Carmona Pirez J., Caro J., Carr W., Carreiro-Martins P., Carreon-Asuncion F., Carriazo A.-M., CarrionyRibas C., Casale T., Castor M.-A., Castro E., Caviglia A.G., Cecchi L., Cepeda Sarabia A., Chalubinski M., Chandrasekharan R., Chang Y.-S., Chato-Andeza V., Chatzi L., Chatzidaki C., Chavannes N.H., Chaves Loureiro C., Chavez Garcia A.-A., Chelninska M., Chen Y., Cheng L., Chinthrajah S., Chivato T., Chkhartishvili E., Christoff G., Chrystyn H., Chu D.K., Chua A., Chuchalin A., Chung K.F., Ciceran A., Cingi C., Ciprandi G., Cirule I., Coelho A.-C., Compalati E., Constantinidis J., Correia de Sousa J., Costa E.M., Costa D., del Carmen Costa Dominguez M., Coste A., Cottini M., Cox L., Crisci C., Crivellaro M.A., Cruz A.A., Cullen J., Custovic A., Cvetkovski B., D'Amato G., da Silva J., Dahl R., Dahlen S.-E., Daniilidis V., Darjazini Nahhas L., Darsow U., Davies J., de Blay F., De Feo G., De Guia E., De la Torre Navarrete J.-R., De los Santos C., De Manuel Keenoy E., De Vries G., Deleanu D., Demoly P., Denburg J., Devillier P., Didier A., Dimic Janjic S., Dimou M., Dinh-Xuan A.T., Djukanovic R., Do Ceu Texeira M., Dokic D., Dominguez Silva M.G., Douagui H., Douladiris N., Doulaptsi M., Dray G., Dubakiene R., Dupas E., Durham S., Duse M., Dykewicz M., Ebo D., Edelbaher N., Eiwegger T., Eklund P., El-Gamal Y., El-Sayed Z.A., El-Sayed S.S., El-Seify M., Emuzyte R., Enecilla L., Erhola M., Espinoza H., Espinoza Contreras J.G., Farrell J., Fernandez L., Fimbres Jimenez P., Fink Wagner A., Fokkens W.J., Folletti L., Fontaine J.-F., Forastiere F., Fuentes Perez J.M., Gaerlan-Resureccion E., Gaga M., Galvez Romero J.L., Gamkrelidze A., Garcia A., Garcia Cobas C.Y., de la Luz Hortensia Garcia Cruz M., Ortiz V.G., Gayraud J., Gelardi M., Gemicioglu B., Gennimata D., Genova S., Gereda J., Gerth van Wijk R., Giuliano A., Gomez R.-M., Gonzalez Ballester M.-A., Gonzalez Diaz S., Gotua M., Grigoreas C., Grisle I., Guidacci M., Guldemond N., Gutter Z., Guzman A., Halloum R., Halpin D., Hamelmann E., Hammadi S., Harvey R., Heffler E., Heinrich J., Hejjaoui A., Hellquist-Dahl B., Hernandez Velazquez L., Hew M., Hossny E., Howarth P., Hrubisko M., Huerta Villalobos Y.R., Humbert M., Husain S., Hyland M., Ibrahim M., Ilina N., Illario M., Incorvaia C., Infantino A., Irani C., Ispayeva Z., Ivancevich J.C., Jares E.E., Jarvis D., Jassem E., Jenko K., Jimeneracruz Uscanga R.D., Johnston S.L., Joos G., Jost M., Julge K., Jung K.-S., Just J., Jutel M., Kaidashev I., Kalayci O., Kalyoncu F., Kapsali J., Kardas P., Karjalainen J., Kasala C.A., Katotomichelakis M., Kavaliukaite L., Bennoor K.S., Keil T., Keith P., Khaitov M., Khaltaev N., Kim Y.-Y., Kirenga B., Kleine-Tebbe J., Klimek L., Ko F.W., Koffi N'Goran B., Kompoti E., Kopac P., Koppelman G., Koren Jeverica A., Koskinen S., Kosnik M., Kostka T., Kostov K.V., Kowalski M.L., Kralimarkova T., Kramer Vrscaj K., Kraxner H., Kreft S., Kritikos V., Kudlay D., Kuitunen M., Kull I., Kuna P., Kupczyk M., Kvedariene V., Kyriakakou M., Lalek N., Landi M., Lane S., Larenas-Linnemann D.E., Lau S., Laune D., Lavrut J., Le L., Lenzenhuber M., Leo G., Lessa M., Levin M., Li J., Lieberman P., Liotta G., Lipworth B., Liu X., Lobo R., Lodrup Carlsen K.C., Lombardi C., Louis R., Loukidis S., Lourenco O., Luna Pech J.A., Madjar B., Maggi E., Magnan A., Mahboub B., Mair A., Maitland van der Zee A.-H., Makela M., Makris M., Malling H.-J., Mandajieva M., Manning P., Manousakis M., Maragoudakis P., Marseglia G., Marshall G., Masjedi M.R., Maspero J.F., Matta Campos J.J., Maurer M., Mavale-Manuel S., Meco C., Melen E., Melioli G., Melo-Gomes E., Meltzer E.O., Menditto E., Menzies-Gow A., Merk H., Michel J.-P., Micheli Y., Miculinic N., Midao L., Mihaltan F., Mikos N., Milanese M., Milenkovic B., Mitsias D., Moalla B., Moda G., Mogica Martinez M.D., Mohammad Y., Moharra F.-M., Moin M., Molimard M., Momas I., Mommers M., Monaco A., Montefort S., Montenegro L.-E., Monti R., Mora D., Morais-Almeida M., Mosges R., Mostafa B.E., Mullol J., Munter L., Muraro A., Murray R., Musarra A., Mustakov T., Naclerio R., Nadeau K.C., Nadif R., Nakonechna A., Namazova-Baranova L., Navarro-Locsin G., Neffen H., Nekam K., Neou A., Nettis E., Neuberger D., Nicod L., Nicola S., Niederberger-Leppin V., Niedoszytko M., Nieto A., Novellino E., Nunes E., Nyembue D., O'Hehir R.E., Odjakova C., Ohta K., Okamoto Y., Okubo K., Oliver B., Onorato G.L., Orru M.P., Ouedraogo S., Ouoba K., Padilla F.-J., Paggiaro P.L., Pagkalos A., Pajno G., Pala G., Palaniappan S., Pali-Scholl I., Palkonen S., Palmer S., Panaitescu Bunu C., Panzner P., Papadopoulos N.G., Papanikolaou V., Papi A., Paralchev B., Paraskevopoulos G., Park H.-S., Passalacqua G., Patella V., Pavord I., Pawankar R., Pedersen S., Peleve S., Pellegino S., Pereira A., Pereira M., Perez T., Perna A., Peroni D., Pfaar O., Pham-Thi N., Pigearias B., Pin I., Piskou K., Pitsios C., Plavec D., Poethig D., Pohl W., Poplas Susic A., Popov T.A., Portejoie F., Potter P., Poulsen L., Prados-Torres A., Prarros F., Price D., Prokopakis E., Puggioni F., Puig-Domenech E., Puy R., Rabe K., Rabotti S., Raciborski F., Ramos J., Recalcati C., Recto M.T., Reda S.M., Regateiro F.S., Reider N., Reitsma S., Repka-Ramirez S., Ridolo E., Rimmer J., Rivero Yeverino D., Rizzo J.A., Robalo-Cordeiro C., Roberts G., Robles K., Roche N., Rodriguez Gonzalez M., Rodriguez Zagal E., Rolla G., Rolland C., Roller-Wirnsberger R., Roman Rodriguez M., Romano A., Romantowski J., Rombaux P., Romualdez J., Rosado-Pinto J., Rosario N., Rosenwasser L., Rossi O., Rottem M., Rouadi P.W., Rovina N., Rozman Sinur I., Ruiz M., Ruiz Segura L.T., Ryan D., Sagara H., Sakai D., Sakurai D., Saleh W., Salimaki J., Samitas K., Samolinski B., Sanchez Coronel M.G., Sanchez-Borges M., Sanchez-Lopez J., Sansonna M., Sarafoleanu C., Sarquis Serpa F., Sastre J., Savi E., Savonyte A., Sawaf B., Scadding G.K., Scheire S., Schmid-Grendelmeier P., Schuhl J.F., Schunemann H., Schvalbova M., Schwarze J., Scichilone N., Senna G., Sepulveda C., Serrano E., Shamai S., Shields M., Shishkov V., Siafakas N., Simeonov A., Simons E.F., Sisul J.C., Sitkauskiene B., Skrindo I., Soklic Kosak T., Sole D., Sondermann M., Sooronbaev T., Soto-Martinez M., Soto-Quiros M., Pinto B.S., Sova M., Soyka M., Specjalski K., Sperl A., Spranger O., Stamataki S., Stefanaki L., Stellato C., Stelmach R., Strandberg T., Stute P., Subramaniam A., Suppli Ulrik C., Sutherland M., Sylvestre S., Syrigou A., Taborda Barata L., Takovska N., Tan R., Tan F., Tan V., Tang I.P., Taniguchi M., Tannert L., Tantilipikorn P., Tattersall J., Tesi F., Thieme U., Thijs C., Thomas M., To T., Todo-Bom A.M., Togias A., Tomazic P.-V., Tomic-Spiric V., Toppila-Salmi S., Torres Jaen M.-J., Toskala E., Triggiani M., Triller N., Triller K., Tsiligianni I., Uberti M., Ulmeanu R., Urbancic J., Urrutia Pereira M., Vachova M., Valdes F., Valenta R., Valentin Rostan M., Valero A., Valiulis A., Vallianatou M., Valovirta E., Van Eerd M., Van Ganse E., van Hage M., Vandenplas O., Vasankari T., Vassileva D., Velasco Munoz C., Ventura M.T., Vera-Munoz C., Viart F., Vicheva D., Vichyanond P., Vidgren P., Viegi G., Vogelmeier C., Von Hertzen L., Vontetsianos T., Vourdas D., Tran Thien Quan V., Wagenmann M., Walker S., Wallace D., De Wang Y., Waserman S., Wehner K., Wickman M., Williams S., Williams D., Wilson N., Wong G., Woo K., Wozniak L., Wright J., Wroczynski P., Xepapadaki P., Yakovliev P., Yamaguchi M., Yan K., Yap Y.Y., Yassin M., Yawn B., Yiallouros P., Yorgancioglu A., Yoshihara S., Young I., Yusuf O.B., Zaidi A., Zaitoun F., Zalud P., Zar H., Zedda M.T., Zernotti M.E., Zhang L., Zhong N., and Zidarn M.
Subjects: MAPK/ERK pathway, ARIA group, Allergy, [SDV]Life Sciences [q-bio], NF-KAPPA-B, debelost, Review, Pharmacology, Resveratrol, PROTECTS, chemistry.chemical_compound, 0302 clinical medicine, RESPIRATORY SYNDROME CORONAVIRUS, ENDOPLASMIC-RETICULUM STRESS, Medicine and Health Sciences, Immunology and Allergy, Medicine, OXIDATIVE STRESS, COVID-19, Foods, Insulin resistance, Nrf2, Nutrients, Obesity, TRPA1, 2. Zero hunger, 0303 health sciences, RESPIRATORY, INSULIN-RESISTANCE, Muscle cell proliferation, SULFORAPHANE, 3. Good health, [SDV] Life Sciences [q-bio], 030220 oncology & carcinogenesis, SIGNALING PATHWAY, Signal transduction, Life Sciences & Biomedicine, Pulmonary and Respiratory Medicine, NRF2 ACTIVATORS, MUSCLE-CELL PROLIFERATION, Immunology, 610 Medicine & health, Lung injury, Settore MED/10 - Malattie Dell'Apparato Respiratorio, ACUTE LUNG INJURY, 03 medical and health sciences, COVID-19, Foods, Insulin resistance, Nrf2, Nutrients, Obesity, TRPA1, udc:616.9, odpornost proti inzulinu, SULFORAPHANE PROTECTS, Transcription factor, PI3K/AKT/mTOR pathway, 030304 developmental biology, Science & Technology, business.industry, SARS-CoV-2, food, medicine.disease, chemistry, hranila, SYNDROME CORONAVIRUS, business, hrana, GREEN TEA
Abstract: There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPARγ:Peroxisome proliferator-activated receptor, NFκB: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2α:Elongation initiation factor 2α). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT1R axis (AT1R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity.
Published: 2020

14. Unmet needs in severe asthma subtyping and precision medicine trials: Bridging clinical and patient perspectives

Author: Scott Wagers, Samantha Walker, Stephen J. Fowler, Dominick E. Shaw, Ian D. Pavord, Tonya A. Winders, Louise Brown, Michael C. Peters, Salman Siddiqui, Monica Kraft, Nizar N. Jarjour, Loren C. Denlinger, Liam G Heaney, Praveen Akuthota, and Mario Castro
Subjects: Pulmonary and Respiratory Medicine, Adult, Male, medicine.medical_specialty, Bridging (networking), Pulmonary Perspective, Severe asthma, Critical Care and Intensive Care Medicine, Unmet needs, Immunophenotyping, medicine, Humans, Anti-Asthmatic Agents, Precision Medicine, Intensive care medicine, Aged, Aged, 80 and over, business.industry, Middle Aged, Precision medicine, Subtyping, Asthma, respiratory tract diseases, Practice Guidelines as Topic, Female, business
Abstract: Severe asthma affects a small proportion of asthma patients (~ 3-5%) and reflects a failure of conventional asthma medications to provide adequate control. Severe asthma is a disease of significant clinical heterogeneity, likely caused by different pathobiological mechanisms, frequently referred to as endotypes. In the last decade, multiple monoclonal therapies have been developed to target airway type-2 eosinophilic and/or allergic severe asthma. However, the underlying mechanisms of both type 2 immunity and eosinophilia (blood and airway) remain incompletely understood and offer a potential for novel therapies that target eosinophil maturation in the bone marrow and specific kinases expressed in type 2 cells, such as JAK-STAT inhibitors. Furthermore, some patients do not consistently demonstrate a type 2 disease clinical profile and display other inflammatory phenotypes at a given point in time. Targeting airway smooth muscle dysfunction, airway mucous, type-17 immunity and airway dysbiosis, may represent novel therapeutic approaches for severe asthma in the future. Unfortunately, the biomarkers for these subtypes of severe asthma are underdeveloped, rendering it difficult to conduct effective clinical trials. There are also barriers regarding the efficiency of standard clinical trials. Moving beyond these barriers will require innovation in trial design, effective partnerships with patient groups and effective multi-national trials consortia. There are current transatlantic opportunities to conduct clinical trials that could facilitate the development of common trial platforms to maximize overall efficiency and move the field of severe asthma forward.
Published: 2019

15. Next-generation care pathways for allergic rhinitis and asthma multimorbidity: A model for multimorbid non-communicable diseases—Meeting Report (Part 2)

Author: Josep M. Antó, Nick A. Guldemond, Ulysse Rodts, Bolesław Samoliński, Olga Lourenço, Mohamed H. Shamji, Tomohisa Iinuma, Rianne van der Kleij, Alkis Togias, W. J. Fokkens, Gert Marien, Derek K. Chu, Mario Sánchez-Borges, Daniel Laune, Desiree Larenas-Linneman, Anna Bedbrook, Guy Brusselle, Joaquim Mullol, Lars Münter, Ludger Klimek, Sanna Toppila-Salmi, Eugene Cash, Christine Rolland, Ioanna Tsiligianni, Isabelle Bosse, Dana Wallace, Motohiro Ebisawa, Abigail Phillips, Torsten Zuberbier, G. Walter Canonica, Elísio Costa, Samuel Benveniste, Yoshitaka Okamoto, Holger J. Schünemann, Moises A. Calderon, Sinthia Bosnic-Anticevich, Mike Bewick, Elaine Colgan, Arunas Valiulis, Sian Williams, Samantha Walker, Ignacio J. Ansotegui, David Somekh, Isabella Annesi-Maesano, Victoria Cardona, Wienczyslawa Czarlewski, Claus Bachert, Ana Maria Carriazo, João Fonseca, Nils Billo, Violeta Kvedariene, Ioana Agache, Maria Teresa Ventura, Jim Phillips, Piotr Kuna, Hilary Pinnock, Lorenzo Cecchi, F. Portejoie, Jean-Luc Fauquert, Alvaro A. Cruz, Jean Bousquet, Nikos Papadopoulos, Omar S. Usmani, Gabrielle L. Onorato, Arzu Yorgancioglu, Pablo Quinones-Delgado, Oliver Pfaar, Luis Caraballo, Stephen R. Durham, L. T. T. Le, João O. Malva, Maritta Perala, Enrica Menditto, Nhân Pham-Thi, Marina Erhola, Maddalena Illario, Ear, Nose and Throat, AII - Inflammatory diseases, University Hospital Montpellier, Montpellier, France, MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France, INSERM U1168, VIMA, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, France, Université Versailles St-Quentin-en Yvelines, UMR-S 1168, Montigny le Bretonneux, France, Euforea, Brussels, Belgium, Charité, Universitätsmedizin Berlin, Humboldt-Universitätzu Berlin, Berlin, Germany, Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany, EUFOREA, Brussels, Belgium, Allergy Department, Pasteur Institute, Paris, France, Faculty of Medicine, Transylvania University, Brasov, Romania, Epidemiology of Allergic and Respiratory Diseases, Department Institute Pierre Louis of Epidemiology and Public Health, INSERM and Sorbonne Universités, Medical School Saint Antoine, Paris, France, Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Erandio, Spain, ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain, Universitat Pompeu Fabra (UPF), Barcelona, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain, Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium, National Center of Expertise in Cognitive Stimulation (CEN STIMCO), Broca Hospital, Paris, France, Mines ParisTech CRI - PSL Research University, Fontainebleau, France, iQ4U Consultants Ltd, London, United Kingdom, Independent Consultant, Joensuu, Finland, Woolcock Institute of Medical Research, University of Sydney, Woolcock Emphysema Centre, Sydney Local Health District, Glebe, NSW, Australia, Allergist, La Rochelle, France, Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium, Imperial College London-National Heart and Lung Institute, London, United Kingdom, Personalized Medicine Clinic Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy, Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia, Foundation for the Development of Medical and Biological Sciences, Cartagena, Colombia, Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron and ARADyAL research network, Barcelona, Spain, Regional Ministry of Health of Andalusia, Seville, Spain, College of Psychology, Nova Southeastern University, School-related Psychological Assessments and Clinical Interventions Clinic, Ft Lauderdale, FL, United States, SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy, Department of Health Research Methods, Evidence, and Impact, Division of Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada, Department of Health, Social Services and Public Safety, Northern Ireland, Belfast, United Kingdom, UCIBIO, REQUIMTE, Faculty of Pharmacy, and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork), University of Porto, Porto, Portugal, ProAR-Nucleo de Excelencia em Asma, Federal University of Bahia, Brasil and WHO GARD Executive Committee, Bahia, Brazil, Medical Consulting Czarlewski, Levallois, France, Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan, National Institute for Health and Welfare, Helsinki, Finland, CHU Clermont-Ferrand, Unité d’Allergologie de l’Enfant, Pôle Pédiatrique, Hôpital Estaing, Clermont-Ferrand, France, Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, Netherlands, CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Medida, Lda Porto, Portugal, Institute of Health Policy and Management iBMG, Erasmus University, Rotterdam, Netherlands, Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan, Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R and D and DISMET), Naples, Italy, Center for Rhinology and Allergology, Wiesbaden, Germany, Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland, Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Institute of Clinical Medicine, Clinic of Chest diseases and Allergology, Faculty of Medicine, Vilnius, Lithuania, Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico, KYomed INNOV, Montpellier, France, University of Medicine and Pharmacy, Hochiminh City, Viet Nam, Faculty of Health Sciences and CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal, CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy, Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain, Danish Committee for Health Education, Copenhagen East, Denmark, Division of Infection, Immunity and Respiratory Medicine, Royal Manchester Children’s Hospital, University of Manchester, Manchester, United Kingdom, Allergy Department, 2nd Pediatric Clinic, Athens General Children’s Hospital 'P and A Kyriakou', University of Athens, Athens, Greece, University of Oulu, Faculty of Medicine, Oulun Yliopisto, Finland, Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Germany, Department of Health and Social Services, Welsh Government, Cardiff, United Kingdom, Centre For Empowering Patients and Communities, Dublin, Ireland, Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The, University of Edinburgh, Edinburgh, United Kingdom, Agency for Social Services and Dependency, Regional Government for Equality, Social Policies and Conciliation of Andalucia, Seville, Spain, Association Asthme et Allergie, Paris, France, KanopyMed, Paris, France, Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland, Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidad, Caracas, Venezuela, Immunomodulation and Tolerance Group, Imperial College London, and, Allergy and Clinical Immunology, Imperial College London, London, United Kingdom, European Health Futures Forum (EHFF), Dromahair, Ireland, Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States, Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland, Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece, International Primary Care Respiratory Group IPCRG, Aberdeen, United Kingdom, National Heart and Lung Institute (NHLI), Imperial College London, Royal Brompton Hospital, Airways Disease Section, London, United Kingdom, Asthma UK, London, United Kingdom, Nova Southeastern University, Fort Lauderdale, FL, United States, Vilnius University Faculty of Medicine, Institute of Clinical Medicine, Institute of Health Sciences, Vilnius, Lithuania, Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands, University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy, Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Berlin, Germany, CHU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, Montpellier Cedex 5, 34295, France, [Bousquet, Jean] Univ Hosp Montpellier, Montpellier, France, [Bousquet, Jean] Fdn Partenariale FMC VIA LR, MACVIA France, Montpellier, France, [Bedbrook, Anna] Fdn Partenariale FMC VIA LR, MACVIA France, Montpellier, France, [Onorato, Gabrielle L.] Fdn Partenariale FMC VIA LR, MACVIA France, Montpellier, France, [Portejoie, Fabienne] Fdn Partenariale FMC VIA LR, MACVIA France, Montpellier, France, [Bousquet, Jean] INSERM, Ageing & Chron Dis Epidemiol & Publ Hlth Approach, VIMA, U1168, Villejuif, France, [Bousquet, Jean] Univ Versailles St Quentin En Yvelines, UMR S 1168, Montigny Le Bretonneux, France, [Bousquet, Jean] Euforea, Brussels, Belgium, [Fokkens, Wytske J.] Euforea, Brussels, Belgium, [Marien, Gert] Euforea, Brussels, Belgium, [Bousquet, Jean] Humboldt Univ, Univ Med Berlin, Charite, Berlin, Germany, [Bousquet, Jean] Berlin Inst Hlth, Comprehens Allergy Ctr, Dept Dermatol & Allergy, Berlin, Germany, [Zuberbier, Torsten] Berlin Inst Hlth, Comprehens Allergy Ctr, Dept Dermatol & Allergy, Berlin, Germany, [Nhan Pham-Thi] Pasteur Inst, Allergy Dept, Paris, France, [Agache, Ioana] Transylvania Univ, Fac Med, Brasov, Romania, [Annesi-Maesano, Isabella] INSERM, Depet Inst Pierre Louis Epidemiol & Publ, Epidemiol Allerg & Resp Dis, Paris, France, [Annesi-Maesano, Isabella] Sorbonne Univ, Med Sch St Antoine, Paris, France, [Ansotegui, Ignacio] Hosp Quironsalud Bizkaia, Dept Allergy & Immunol, Erandio, Spain, [Anto, Josep M.] Ctr Res Environm Epidemiol CREAL, ISGlobAL, Barcelona, Spain, [Anto, Josep M.] Univ Pompeu Fabra, Barcelona, Spain, [Anto, Josep M.] CIBERESP, Barcelona, Spain, [Bachert, Claus] Ghent Univ Hosp, ENT Dept, Upper Airways Res Lab, Ghent, Belgium, [Benveniste, Samuel] Broca Hosp, Natl Ctr Expertise Cognit Stimulat CEN STIMCO, Paris, France, [Benveniste, Samuel] PSL Res Univ, Mines ParisTech CRI, Fontainebleau, France, [Bewick, Mike] iQ4U Consultants Ltd, London, England, [Bosnic-Anticevich, Sinthia] Univ Sydney, Woolcock Inst Med Res, Glebe, NSW, Australia, [Bosnic-Anticevich, Sinthia] Woolcock Emphysema Ctr, Glebe, NSW, Australia, [Bosnic-Anticevich, Sinthia] Sydney Local Hlth Dist, Glebe, NSW, Australia, [Brusselle, Guy] Ghent Univ Hosp, Dept Resp Med, Ghent, Belgium, [Calderon, Moses A.] Imperial Coll London, Natl Heart & Lung Inst, London, England, [Usmani, Omar] Imperial Coll London, Natl Heart & Lung Inst, London, England, [Canonica, G. Walter] IRCCS, Humanitas Clin & Res Ctr, Personalized Med Clin Asthma & Allergy, Rozzano, MI, Italy, [Canonica, G. Walter] Humanitas Univ, Dept Biomed Sci, Pieve Emanuele, MI, Italy, [Caraballo, Luis] Univ Cartagena, Inst Immunol Res, Campus Zaragocilla, Cartagena, Colombia, [Caraballo, Luis] Fdn Dev Med & Biol Sci Fundemeb, Cartagena, Colombia, [Cardona, Victoria] Hosp Valle De Hebron, Dept Internal Med, Allergy Sect, Barcelona, Spain, [Cardona, Victoria] ARADyAL Res Network, Barcelona, Spain, [Maria Carriazo, Ana] Reg Minist Hlth Andalusia, Seville, Spain, [Cash, Eugene] Nova Southeastern Univ, Coll Psychol, Ft Lauderdale, FL 33314 USA, [Cash, Eugene] Sch Related Psychol Assessments & Clin Intervent, Ft Lauderdale, FL USA, [Cecchi, Lorenzo] USL Toscana Ctr, SOS Allergol & Clin Immunol, Prato, Italy, [Schunemann, Holger J.] USL Toscana Ctr, SOS Allergol & Clin Immunol, Prato, Italy, [Chu, Derek K.] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Dept Med, Div Immunol & Allergy, Hamilton, ON, Canada, [Colgan, Elaine] Dept Hlth Social Serv & Publ Safety, Belfast, Antrim, North Ireland, [Costa, Elisio] Univ Porto, UCIBIO, Fac Pharm, REQUIMTE, Porto, Portugal, [Costa, Elisio] Univ Porto, AgeUPNetWork, Competence Ctr Act & Hlth Ageing, Porto, Portugal, [Cruz, Alvaro A.] Univ Fed Bahia, ProAR Nucleo Excelencia Asma, Salvador, BA, Brazil, [Cruz, Alvaro A.] WHO GARD Execut Comm, Salvador, BA, Brazil, [Czarlewski, Wienczyslawa] Med Consulting Czarlewski, Levallois Perret, France, [Durham, Stephen] Imperial Coll London, Natl Heart & Lung Inst, Allergy & Clin Immunol Sect, London, England, [Ebisawa, Motohiro] Natl Hosp Org, Sagamihara Natl Hosp, Clin Res Ctr Allergy & Rheumatol, Sagamihara, Kanagawa, Japan, [Erhola, Marina] Natl Inst Hlth & Welf, Helsinki, Finland, [Fauquert, Jean-Luc] CHU Clermont Ferrand, Hop Estaing, Pole Pediat, Unit Allergol Enfant, Clermont Ferrand, France, [Fokkens, Wytske J.] Amsterdam Univ Med Ctr, Dept Otorhinolaryngol, AMC, Amsterdam, Netherlands, [Fonseca, Joao A.] Univ Porto, Ctr Res Hlth Technol & Informat Syst, Fac Med, CINTESIS, Porto, Portugal, [Fonseca, Joao A.] Medida Lda, Porto, Portugal, [Guldemond, Nick] Erasmus Univ, Inst Hlth Policy & Management iBMG, Rotterdam, Netherlands, [Iinuma, Tomohisa] Chiba Univ Hosp, Dept Otorhinolaryngol, Chiba, Japan, [Okamoto, Yoshitaka] Chiba Univ Hosp, Dept Otorhinolaryngol, Chiba, Japan, [Illario, Maddalena] Campania Reg, Div Hlth Innovat, Naples, Italy, [Illario, Maddalena] Federico II Univ Hosp Naples, R&D, Naples, Italy, [Illario, Maddalena] Federico II Univ Hosp Naples, DISMET, Naples, Italy, [Klimek, Ludger] Ctr Rhinol & Allergol, Wiesbaden, Germany, [Kuna, Piotr] Med Univ Lodz, Barlicki Univ Hosp, Div Internal Med Asthma & Allergy, Lodz, Poland, [Kvedariene, Violeta] Vilnius Univ, Fac Med, Dept Pathol, Inst Biomed Sci, Vilnius, Lithuania, [Kvedariene, Violeta] Fac Med, Inst Clin Med, Clin Chest Dis & Allergol, Vilnius, Lithuania, [Larenas-Linneman, Desiree] Med Sur Clin Fdn & Hosp, Ctr Excellence Asthma & Allergy, Mexico City, DF, Mexico, [Laune, Daniel] KYomed INNOV, Montpellier, France, [Le, Lan T. T.] Univ Med & Pharm, Hochiminh City, Vietnam, [Lourenco, Olga] Univ Beira Interior, Fac Hlth Sci, Covilha, Portugal, [Lourenco, Olga] Univ Beira Interior, Hlth Sci Res Ctr, CICS UBI, Covilha, Portugal, [Malva, Joao O.] Univ Coimbra, Fac Med, Coimbra Inst Clin & Biomed Res iCBR, Coimbra, Portugal, [Malva, Joao O.] Ageing Coimbra EIP AHA Reference Site, Coimbra, Portugal, [Menditto, Enrica] Univ Naples Federico II, Ctr Pharmacoecon, CIRFF, Naples, Italy, [Mullol, Joaquim] Hosp Clin Barcelona, ENT Dept, Rhinol Unit, Barcelona, Spain, [Mullol, Joaquim] Hosp Clin Barcelona, ENT Dept, Smell Clin, Barcelona, Spain, [Mullol, Joaquim] Univ Barcelona, CIBERES, IDIBAPS, Clin & Expt Resp Immunoallergy, Barcelona, Spain, [Munter, Lars] Danish Comm Hlth Educ, Copenhagen East, Denmark, [Papadopoulos, Nikos G.] Univ Manchester, Royal Manchester Childrens Hosp, Div Infect Immun & Resp Med, Manchester, Lancs, England, [Papadopoulos, Nikos G.] Univ Athens, Athens Gen Childrens Hosp P&A Kyriakou, Allergy Dept, Pediat Clin 2, Athens, Greece, [Perala, Maritta] Univ Oulu, Fac Med, Oulu, Finland, [Pfaar, Oliver] Phillipps Univ Marburg, Univ Hosp Marburg, Sect Rhinol & Allergy, Dept Otorhinolaryngol Head & Neck Surg, Marburg, Germany, [Phillips, Abigail] Welsh Govt, Dept Hlth & Social Serv, Cardiff, S Glam, Wales, [Phillips, Jim] Ctr Empowering Patients & Communities, Dublin, Ireland, [Pinnock, Hilary] Univ Edinburgh, Asthma UK Ctr Appl Res, Usher Inst Populat Hlth Sci & Informat, Edinburgh, Midlothian, Scotland, [Quinones-Delgado, Pablo] Agcy Social Serv & Dependency, Reg Govt Equal Social Policies & Conciliat Andalu, Seville, Spain, [Rolland, Christine] Assoc Asthme & Allergie, Paris, France, [Rodts, Ulysse] KanopyMed, Paris, France, [Samolinski, Boleslaw] Med Univ Warsaw, Dept Prevent Environm Hazards & Allergol, Warsaw, Poland, [Sanchez-Borges, Mario] Ctr Medicodocente La Trinidad, Allergy & Clin Immunol Dept, Caracas, Venezuela, [Shamji, Mohamed] Imperial Coll London, Immunomodulat & Tolerance Grp, London, England, [Shamji, Mohamed] Imperial Coll London, Allergy & Clin Immunol, London, England, [Somekh, David] EHFF, Dromahair, Ireland, [Togias, Alkis] NIAID, DAIT, NIH, 9000 Rockville Pike, Bethesda, MD 20892 USA, [Toppila-Salmi, Sanna] Helsinki Univ Hosp, Skin & Allergy Hosp, Helsinki, Finland, [Toppila-Salmi, Sanna] Univ Helsinki, Helsinki, Finland, [Tsiligianni, Ioanna] Univ Crete, Fac Med, Dept Social Med, Hlth Planning Unit, Iraklion, Greece, [Tsiligianni, Ioanna] Int Primary Care Resp Grp, Aberdeen, Scotland, [Williams, Sian] Int Primary Care Resp Grp, Aberdeen, Scotland, [Usmani, Omar] Royal Brompton Hosp, Airways Dis Sect, London, England, [Walker, Samantha] Asthma UK, London, England, [Wallace, Dana] Nova Southeastern Univ, Ft Lauderdale, FL 33314 USA, [Valiulis, Arunas] Vilnius Univ, Inst Clin Med, Fac Med, Vilnius, Lithuania, [Valiulis, Arunas] Inst Hlth Sci, Vilnius, Lithuania, [Van der Kleij, Rianne] Leiden Univ, Dept Publ Hlth & Primary Care, Med Ctr, Leiden, Netherlands, [Ventura, Maria Teresa] Univ Bari, Unit Geriatr Immunoallergol, Med Sch, Bari, Italy, [Yorgancioglu, Arzu] Celal Bayar Univ, Fac Med, Dept Pulm Dis, Manisa, Turkey, [Zuberbier, Torsten] Univ Med Berlin, Berlin, Germany, [Zuberbier, Torsten] Free Univ Berlin, Berlin, Germany, [Zuberbier, Torsten] Humboldt Uniersitat Berlin, Berlin, Germany, [Zuberbier, Torsten] GA2LEN, Berlin, Germany, Mylan, GSK, ALK, Novartis, Sanofi, Stallergenes-Greer, Uriach, Health Services Management & Organisation (HSMO), Bousquet, J., Pham-Thi, N., Bedbrook, A., Agache, I., Annesi-Maesano, I., Ansotegui, I., Anto, J. M., Bachert, C., Benveniste, S., Bewick, M., Billo, N., Bosnic-Anticevich, S., Bosse, I., Brusselle, G., Calderon, M. A., Canonica, G. W., Caraballo, L., Cardona, V., Carriazo, A. M., Cash, E., Cecchi, L., Chu, D. K., Colgan, E., Costa, E., Cruz, A. A., Czarlewski, W., Durham, S., Ebisawa, M., Erhola, M., Fauquert, J. -L., Fokkens, W. J., Fonseca, J. A., Guldemond, N., Iinuma, T., Illario, M., Klimek, L., Kuna, P., Kvedariene, V., Larenas-Linneman, D., Laune, D., Le, L. T. T., Lourenco, O., Malva, J. O., Marien, G., Menditto, E., Mullol, J., Munter, L., Okamoto, Y., Onorato, G. L., Papadopoulos, N. G., Perala, M., Pfaar, O., Phillips, A., Phillips, J., Pinnock, H., Portejoie, F., Quinones-Delgado, P., Rolland, C., Rodts, U., Samolinski, B., Sanchez-Borges, M., Schunemann, H. J., Shamji, M., Somekh, D., Togias, A., Toppila-Salmi, S., Tsiligianni, I., Usmani, O., Walker, S., Wallace, D., Valiulis, A., Van der Kleij, R., Ventura, M. T., Williams, S., Yorgancioglu, A., Zuberbier, T., and uBibliorum
Subjects: 0301 basic medicine, Pulmonary and Respiratory Medicine, Allergy, medicine.medical_specialty, Aria, Allergic rhinitis - Asthma - Multimorbidity, Health literacy, Chronic respiratory-diseases, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Health care, medicine, Self-management, Global alliance, Intensive care medicine, mHealth, Asthma, Newsletter of GARD Section, business.industry, Environmental exposure, medicine.disease, 3. Good health, Integrated care, 030104 developmental biology, Impact, 030228 respiratory system, 13. Climate action, business
Abstract: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. MASK (Mobile Airways Sentinel NetworK) (1), a new development of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative (2), and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health) (3), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs—centred around the patient with rhinitis and using mHealth monitoring of environmental exposure. An expert meeting took place at the Pasteur Institute in Paris, December 3, 2018. The aim was to discuss nextgeneration care pathways following an ongoing political agenda (4,5): (I) patient participation, health literacy and self-care through technology-assisted “patient activation”; (II) implementation of care pathways by pharmacists and (III) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) assessed by mobile technology. The present document reviews the workshop report and follows on from Part 1.
Published: 2019

16. National and regional asthma programmes in Europe

Author: Susanna Palkonen, Olof Selroos, Tari Haahtela, Nikolaos G. Papadopoulos, Leanne Metcalf, Gunilla Hedlin, J Rosado-Pinto, Antonio Moreno-Galdó, Pippa Powell, Mark FitzGerald, Jean Bousquet, Piotr Kuna, David Brennan, Renaud Louis, Javier Contreras, Piotr Łacwik, Sebastian L. Johnston, Samantha Walker, and Maciej Kupczyk
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Time Factors, Quality management, National Health Programs, Health Services Accessibility, Regional Health Planning, Indirect costs, Quality of life (healthcare), Health care, medicine, Humans, Program Development, Quality Indicators, Health Care, Asthma, lcsh:RC705-779, business.industry, lcsh:Diseases of the respiratory system, medicine.disease, Quality Improvement, 3. Good health, Europe, Treatment Outcome, Family medicine, General partnership, Action plan, Practice Guidelines as Topic, Sick leave, Physical therapy, business
Abstract: This review presents seven national asthma programmes to support the European Asthma Research and Innovation Partnership in developing strategies to reduce asthma mortality and morbidity across Europe. From published data it appears that in order to influence asthma care, national/regional asthma programmes are more effective than conventional treatment guidelines. An asthma programme should start with the universal commitments of stakeholders at all levels and the programme has to be endorsed by political and governmental bodies. When the national problems have been identified, the goals of the programme have to be clearly defined with measures to evaluate progress. An action plan has to be developed, including defined re-allocation of patients and existing resources, if necessary, between primary care and specialised healthcare units or hospital centres. Patients should be involved in guided self-management education and structured follow-up in relation to disease severity. The three evaluated programmes show that, thanks to rigorous efforts, it is possible to improve patients' quality of life and reduce hospitalisation, asthma mortality, sick leave and disability pensions. The direct and indirect costs, both for the individual patient and for society, can be significantly reduced. The results can form the basis for development of further programme activities in Europe.
Published: 2015

17. Addressing unmet needs in understanding asthma mechanisms: From the European Asthma Research and Innovation Partnership (EARIP) Work Package (WP)2 collaborators

Author: Jürgen Schwarze, Jaclyn A. Smith, Michael R. Edwards, Paul Cullinan, Catherine M. Hawrylowicz, Georgina Xanthou, Evangelos Andreakos, Benjamin J. Marsland, J. M. Edwards, Marek Lommatzsch, Samantha Walker, Maria G. Belvisi, René Lutter, Mike Thomas, Sejal Saglani, J. Christian Virchow, Sebastian L. Johnston, Kian Fan Chung, Chrysanthi Skevaki, David A. Jackson, Mark H. Almond, Ben Ainsworth, Miriam F. Moffatt, William O.C.M. Cookson, AII - Inflammatory diseases, Pulmonology, and Experimental Immunology
Subjects: Pulmonary and Respiratory Medicine, Gerontology, medicine.medical_specialty, Work package, Biomedical Research, Consensus Development Conferences as Topic, Alternative medicine, Disease, Review, Unmet needs, 03 medical and health sciences, 0302 clinical medicine, Journal Article, Medicine, Humans, 030212 general & internal medicine, Productivity, Asthma, business.industry, medicine.disease, 3. Good health, respiratory tract diseases, Europe, 030228 respiratory system, General partnership, Needs assessment, Physical therapy, Disease Progression, business, Needs Assessment
Abstract: Asthma is a heterogeneous, complex disease with clinical phenotypes that incorporate persistent symptoms and acute exacerbations. It affects many millions of Europeans throughout their education and working lives and puts a heavy cost on European productivity. There is a wide spectrum of disease severity and control. Therapeutic advances have been slow despite greater understanding of basic mechanisms and the lack of satisfactory preventative and disease modifying management for asthma constitutes a significant unmet clinical need. Preventing, treating and ultimately curing asthma requires co-ordinated research and innovation across Europe. The European Asthma Research and Innovation Partnership (EARIP) is an FP7-funded programme which has taken a co-ordinated and integrated approach to analysing the future of asthma research and development. This report aims to identify the mechanistic areas in which investment is required to bring about significant improvements in asthma outcomes.
Published: 2017

18. Patient-centered Asthma

Author: Samantha Walker and Emily Humphreys
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Medicine, Severe disease, Critical Care and Intensive Care Medicine, business, medicine.disease, Intensive care medicine, Asthma, Patient centered
Published: 2014

19. The future of asthma research and development: a roadmap from the European Asthma Research and Innovation Partnership (EARIP)

Author: Marc P. van der Schee, Dominique Hamerlijnck, Sarah Masefield, Samantha Walker, Liliana Silva, Stephen T. Holgate, Mina Gaga, J. M. Edwards, Kjeld S. Hansen, Karin Lisspers, Ian M. Adcock, Pippa Powell, John G. Matthews, Commission of the European Communities, APH - Methodology, Pulmonology, and AII - Inflammatory diseases
Subjects: Pulmonary and Respiratory Medicine, Organizational innovation, Biomedical Research, Respiratory Medicine and Allergy, Respiratory System, MEDLINE, 03 medical and health sciences, 0302 clinical medicine, MANAGEMENT, Medicine, Humans, 030212 general & internal medicine, Lungmedicin och allergi, Asthma, CURE, TOOLS, Medical education, Asthma therapy, Science & Technology, business.industry, PREVENT, 11 Medical And Health Sciences, medicine.disease, Organizational Innovation, respiratory tract diseases, Europe, 030228 respiratory system, General partnership, DELPHI EXERCISE, EAACI, business, EU, Life Sciences & Biomedicine, PRIORITIES
Abstract: A coordinated European multi-stakeholder approach to asthma research Asthma is highly prevalent and associated with high morbidity and mortality. It affects 30-50 million people in Europe, often starting in infancy and persisting throughout life. Asthma is a major global health challenge, affecting more than 300 million people worldwide and at least 10% of all Europeans [1]. People with asthma live at risk of life-threatening asthma attacks, leading to over 500 000 hospitalisations each year. Approximately 5-10% of asthma cases are so severe that current treatments do not work. The Framework Programme 7-funded European Asthma Research and Innovation Partnership (EARIP; www.EARIP.eu) was established in 2013 to harmonise efforts to reduce mortality and morbidity from asthma by agreeing the most important research priorities across relevant stakeholders in Europe. This is essential to address the significant impact of asthma on the individual, healthcare systems and national and European economies, outlined in the accompanying editorial in this issue of the European Respiratory Journal [2]. EARIP produced an evidence- and consensus-based list of the research priorities (a "roadmap") and investment needed to reduce asthma deaths and hospitalisations. By identifying the priorities, a coordinated effort can be made to fast-track change to better manage, prevent and cure asthma [3]. The roadmap will be the foundation on which future EU, national and international research funding programmes can transform asthma outcomes throughout Europe. The roadmap is the product of a comprehensive multi-stage process, led by the European Lung Foundation and Asthma UK (figure 1) [4]. Multiple stakeholder groups informed the roadmap process to ensure scientific accuracy, clinical relevance and outcomes that reflect the priorities of patients and caregivers, with an overarching steering board. A final consensus workshop brought together 28 experts from 15 European countries comprising: patients, patient organisations, primary healthcare professionals (HCPs), secondary HCPs, researchers, industry representatives and policy influencers. A full list of the roadmap contributors is available at www.EARIP.eu/roadmap. The rest of this article describes its development and outcomes.
Published: 2016

20. Asthma research in Europe: a transformative agenda for innovation and competitiveness

Author: Maciek Kupczyk, Samantha Walker, John H. Riley, Aggeliki Androutsopoulou, David Myles, Sebastian L. Johnston, Thomas R. Martin, Sven-Erik Dahlén, Luis Garcia-Marcos, Susanna Palkonen, Cezmi A. Akdis, Pippa Powell, Nikolaos G. Papadopoulos, Ratko Djukanovic, J. M. Edwards, University of Zurich, and Papadopoulos, Nikolaos G
Subjects: Pulmonary and Respiratory Medicine, Economic growth, Biomedical Research, Respiratory System, 610 Medicine & health, 03 medical and health sciences, 0302 clinical medicine, 10183 Swiss Institute of Allergy and Asthma Research, medicine, Humans, 030212 general & internal medicine, health care economics and organizations, Asthma, Science & Technology, business.industry, 1. No poverty, 11 Medical And Health Sciences, medicine.disease, 3. Good health, Europe, Transformative learning, 030228 respiratory system, 2740 Pulmonary and Respiratory Medicine, business, Life Sciences & Biomedicine
Abstract: Asthma is highly prevalent, often starting in infancy and persisting throughout life, and is associated with high morbidity and burden. It is a major global health challenge with growing impact, affecting more than 300 million people worldwide and at least 10% of all Europeans [1]. Furthermore, it is the most prevalent long-term condition in children [2]. Approximately 5–10% of asthma cases are so severe that current treatments do not work, and over five million people in the European Union (EU) fall into this category. People with asthma live at risk of life-threatening asthma attacks, leading to at least 500 000 hospitalisations worldwide each year [3]. A European study estimated that unscheduled care and rescue medication accounted for 47% of the total cost-per-patient in infants, 45% in children and 56% in adults [4]. This results in high socio-economic impact, estimated at more than €70 billion annually [1]. This includes the costs of direct primary and hospital healthcare (estimated to be close to €20 billion per annum), costs due to lost productivity (€14 billion) [1], and the monetised value of disability-adjusted life-years (DALYs) lost (over €38 billion) [1]. Close to 1 million DALYs are lost due to asthma in Europe every year [5]. Despite the fact that the direct and indirect costs of asthma are substantial and continue to rise, asthma remains under-prioritised in the EU research agenda. Only 0.5% of the Seventh Framework Programme (FP7) health research budget was devoted to asthma and chronic obstructive pulmonary disease (COPD) (€30 million) [5]. In comparison, some 5.4 times this amount (over €163 million) was spent on cardiovascular conditions and some 20.6 times (over €618 million) on brain research. Asthma, with its high global prevalence and an associated multi-billion global market for treatments, plus its historical underfunding and the demand for new treatments and diagnostics, represents an enormous opportunity to drive substantial economic growth. This paper sets out how the EU may capitalise on this via investment in research with high commercial potential that can radically improve the EUs research agenda and public health.
Published: 2016

21. Assessing the risk of attack in the management of asthma: A review and proposal for revision of the current control-centred paradigm

Author: Mike Thomas, Ian D. Pavord, Jodie L. Fellows, Samantha Walker, John D Blakey, and Kerry Woolnough
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Clinical Review, Control (management), asthma attack, Alternative medicine, MEDLINE, Asthma management, Risk Assessment, Health care, medicine, Humans, Disease management (health), Intensive care medicine, Lung function, Asthma, risk, asthma guidelines, Primary Health Care, business.industry, Public Health, Environmental and Occupational Health, Disease Management, medicine.disease, asthma control, respiratory tract diseases, Physical therapy, Disease Progression, business, management
Abstract: Asthma guidelines focus on day-to-day control of symptoms. However, asthma attacks remain common. They continue to cause mortality and considerable morbidity, and are a major financial burden to the UK National Health Service (NHS) and the wider community. Asthma attacks have chronic consequences, being associated with loss of lung function and significant psychological morbidity. In this article we argue that addressing daily symptom control is only one aspect of asthma treatment, and that there should be a more explicit focus on reducing the risk of asthma attacks. Management of future risk by general practitioners is already central to other conditions such as ischaemic heart disease and chronic renal impairment. We therefore propose a revised approach that separately considers the related domains of daily control and future risk of asthma attack. We believe this approach will have advantages over the current 'stepwise' approach to asthma management. It should encourage individualised treatment, including non-pharmacological measures, and thus may lead to more efficacious and less harmful management strategies. We speculate that this type of approach has the potential to reduce morbidity and healthcare costs related to asthma attacks. © 2013 Primary Care Respiratory Society UK. All rights reserved.
Published: 2016

22. Asthma-specific health-related quality of life of people in Great Britain: A national survey

Author: David Price, Jane Upton, Emily Humphreys, Samantha Walker, and Carine Lewis
Subjects: Pulmonary and Respiratory Medicine, Adult, Male, medicine.medical_specialty, Adolescent, Cross-sectional study, Health Status, Population, Asthma treatment, Poor quality, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Quality of life, immune system diseases, Environmental health, Surveys and Questionnaires, Immunology and Allergy, Medicine, Humans, 030212 general & internal medicine, education, Asthma, Aged, Health related quality of life, education.field_of_study, business.industry, Middle Aged, medicine.disease, Health Surveys, humanities, United Kingdom, respiratory tract diseases, Hospitalization, 030228 respiratory system, Socioeconomic Factors, Pediatrics, Perinatology and Child Health, Physical therapy, Quality of Life, Regression Analysis, Female, business
Abstract: Although the ultimate goal of asthma treatment is to improve asthma-specific Health-Related Quality-Of-Life (HRQOL), in the UK population this is insufficiently studied. National asthma-specific HRQOL data is needed to inform strategies to address this condition.To benchmark asthma-specific HRQOL in a national survey of adults with asthma, and explore differences in this measure within subsections of the population.We analysed answers to the Marks Asthma Quality-of-Life Questionnaire (AQLQ-M) from a representative sample of 658 adults with asthma. Respondents answered asthma-specific questions to assess control, previous hospital admissions, asthma attacks and an indicator of severity. Higher scores indicate poorer HRQOL (maximum = 60). The highest quintile formed a subgroup 'Poor HRQOL'. Data were weighted to correct for any biases caused by differential non-response. Chi-square analyses were used to determine differences between good and poor quality of life and regression analyses performed to determine what factors are associated with poor HRQOL.The response rate was 49%. AQLQ-M median (IQR) scores were 5 (2-13) for the total sample (poor HRQOL = 21, good HRQOL = 3). Significant differences between good and poor HRQOL were observed in smoking status, SES, employment status and co-morbidities, but no differences were found between age groups. Those with poorly controlled asthma were significantly more likely to have poor HRQOL, ≥1 breathing related hospital admission or ≥1 asthma attack.This article provides benchmarking data on asthma-specific HRQOL. Improved strategies are needed to target interventions towards people experiencing poor HRQOL.
Published: 2016

23. Research in progress: Medical Research Council United Kingdom Refractory Asthma Stratification Programme (RASP-UK)

Author: AH Mansur, Douglas C. Cowan, Lisa Pierre, Ashley Woodcock, Christopher E. Brightling, Dirk E. Smith, Sebastian L. Johnston, Rekha Chaudhuri, Ian Sabroe, Kian Fan Chung, Liam G Heaney, John G. Matthews, Ian M. Adcock, Richard W. Costello, David Supple, James L. Lordan, Robert Niven, Peter H. Howarth, Christopher Corrigan, Tim Harrison, Samantha Walker, David F. Choy, Ratko Djukanovic, Timothy C. Hardman, Glenn Crater, Frank Keane, Christopher S. Stevenson, Peter Bradding, Jeannette Bigler, Matthew C. Catley, Andrew Menzies-Gow, Richard D. May, Ian D. Pavord, Joseph R. Arron, Val Hudson, and Peter Coyle
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Pathology, Biomedical Research, Respiratory System, Alternative medicine, Chest Clinic, Risk Assessment, Anti-asthmatic Agent, 03 medical and health sciences, 0302 clinical medicine, Eosinophilic, medicine, Humans, Anti-Asthmatic Agents, 030212 general & internal medicine, Disease management (health), Intensive care medicine, Asthma, Science & Technology, business.industry, Disease Management, 1103 Clinical Sciences, Medical research, medicine.disease, United Kingdom, 3. Good health, respiratory tract diseases, Asthma Mechanisms, 030228 respiratory system, Patient Compliance, Biomarker (medicine), Risk assessment, business, Life Sciences & Biomedicine
Abstract: The UK Refractory Asthma Stratification Programme (RASP-UK) will explore novel biomarker stratification strategies in severe asthma to improve clinical management and accelerate development of new therapies. Prior asthma mechanistic studies have not stratified on inflammatory phenotype and the understanding of pathophysiological mechanisms in asthma without Type 2 cytokine inflammation is limited. RASP-UK will objectively assess adherence to corticosteroids (CS) and examine a novel composite biomarker strategy to optimise CS dose; this will also address what proportion of patients with severe asthma have persistent symptoms without eosinophilic airways inflammation after progressive CS withdrawal. There will be interactive partnership with the pharmaceutical industry to facilitate access to stratified populations for novel therapeutic studies.
Published: 2016

24. Management of allergic and non-allergic rhinitis: a primary care summary of the BSACI guideline

Author: Jenny Willington, E. Angier, Samantha Walker, Steve Holmes, and Glenis Scadding
Subjects: Adult, Pulmonary and Respiratory Medicine, Allergy, medicine.medical_specialty, Rhinitis, Allergic, Perennial, Referral, Non-allergic rhinitis, Histamine Antagonists, MEDLINE, Primary care, Guideline, Diagnosis, Differential, Pregnancy, Asthma control, medicine, Humans, Child, Intensive care medicine, Rhinitis, Asthma, Primary Health Care, business.industry, Public Health, Environmental and Occupational Health, Rhinitis, Allergic, Seasonal, medicine.disease, Pregnancy Complications, Physical therapy, Female, business
Abstract: Rhinitis is a common problem in primary care which is often managed sub-optimally. It causes considerable morbidity and has been shown to have a detrimental impact on people's ability to concentrate at school and at work. Rhinitis and asthma often present together, and symptomatic rhinitis can be associated with poor asthma control and increased risk of exacerbations. There is therefore a clear need to recognise and treat rhinitis according to guideline recommendations. This article is a primary care summary of the British Society for Allergy & Clinical Immunology (BSACI) Standards of Care Committee guideline on the management of rhinitis, written by a multi-disciplinary group of clinicians. It takes into account the time restrictions on assessment and the tests and equipment available in primary care, as well as the need for practical, clear and intuitive strategies for investigation and management. It recommends a stepwise approach to treatment, and highlights the relevance of less frequently prescribed treatments, including nasal douching leukotriene receptor antagonists and anticholinergics. Red flag symptoms are identified, together with indicators for referral. As with many other long term conditions, good communication between primary and secondary care in terms of timely and appropriate referral is a key factor for success.
Published: 2010

25. Is it unfair to hayfever sufferers to have to sit examinations during periods of high pollen counts?

Author: Samantha Walker, Victoria Hammersley, and Aziz Sheikh
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Time Factors, Adolescent, medicine.disease_cause, Severity of Illness Index, Aerobiology, Cognition, Cost of Illness, Pollen, Prevalence, medicine, Humans, Immunology and Allergy, Attention, Students, Courtesy, business.industry, Public Health, Environmental and Occupational Health, Rhinitis, Allergic, Seasonal, Prognosis, United Kingdom, Educational Measurement, Seasons, business, Demography
Abstract: Pollen counts courtesy of the National Pollen and Aerobiology Research Unit.Crucial examinations take place during adolescence in most societies, which can have a major impact on an individual’s ca...
Published: 2010

26. Service evaluation of a UK primary care-based allergy clinic: quality improvement report

Author: Samantha Walker, Angie Woods, Mark L Levy, and Aziz Sheikh
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Referral, MEDLINE, Ambulatory Care Facilities, State Medicine, Patient satisfaction, Ambulatory care, Allergy and Immunology, London, Health care, Hypersensitivity, Humans, Medicine, Referral and Consultation, Original Research, Quality of Health Care, Primary Health Care, business.industry, Incidence (epidemiology), Public Health, Environmental and Occupational Health, Health services research, United Kingdom, Patient Satisfaction, Family medicine, Workforce, Health Services Research, business
Abstract: Introduction Allergic diseases are common, increasing, and associated with significant morbidity and occasional, but potentially avoidable, mortality. There is widespread public, professional and government agreement about the poor quality of care received by many patients with allergic diseases in the UK. Many remain undiagnosed, few have access to specialist services, and the majority of primary care health professionals have no allergy training. We report an evaluation of a novel, UK NHS-funded primary care-based allergy service in North West London. Methods The clinic was run by a specialist allergy nurse and a general practitioner (GP) with a special interest in respiratory disease and allergy. Referrals from local GPs were made on dedicated proformas and handled according to developed and agreed community care pathways. Results 141/151 (93%) of those referred attended the clinic. On average, patients waited 15.7 (SD 15.67) days from referral to an offer of an appointment and were seen 18.11 (SD18.07) days from the date of referral. The majority of patients were referred for hives or wheals (61;40%), suspected food allergy (28;40%), multiple reasons, (19;12%) or rhinitis (19;12%). Skin prick and specific-IgE tests were performed on 69 (49%) and 19 (14%) patients respectively, with 4 (0.3%) patients having both. We estimated an overall saving of at least pound13,580 to the local health economy - through reduced secondary care referrals - during the nine months' duration of the clinic. Assessed using a validated patient satisfaction questionnaire, most patients rated their satisfaction with the service with an overall median score of 75% (IQR 65.64-82.32). Conclusions A primary care allergy service provided by appropriately trained personnel can cater adequately for the majority of primary care referrals. This model provides a pathway of care that supports self-directed care, reduces inappropriate referrals, and encourages care in the local community. The model is one that could easily be developed further into a clinical assessment service for allergy including respiratory based (asthma) problems. This would expand the scope and ensure value for money as well as responding to a clinical need with significant incidence locally. The UK Department of Health should consider rolling out this primary care-based model nationally.
Published: 2009

27. National survey on the roles and training of primary care respiratory nurses in the UK in 2006: are we making progress?

Author: Hazel Madoc-Sutton, Aziz Sheikh, Samantha Walker, Jane Upton, Monica Fletcher, and Timothy L Frank
Subjects: Pulmonary and Respiratory Medicine, COPD, medicine.medical_specialty, Primary Health Care, business.industry, education, Public Health, Environmental and Occupational Health, Pulmonary disease, Primary care, medicine.disease, Ambulatory Care Facilities, Nurse's Role, Asthma, United Kingdom, respiratory tract diseases, Pulmonary Disease, Chronic Obstructive, Surveys and Questionnaires, Family medicine, General practice, medicine, Humans, Education, Nursing, business, Original Research
Abstract: OBJECTIVES: To describe nurse-led UK general practice asthma and chronic obstructive pulmonary disease (COPD) care, and the training undertaken to support it. METHODS: Questionnaires were sent to 500 randomly-selected UK asthma and COPD practice nurses. RESULTS: 382 nurses (76%) completed the practice characteristics section, 389 (78%) described their asthma roles and training, and 368 (74%) described their COPD roles and training. 96 practices (25%; 95%CI 21–29%) ran designated asthma clinics, 87 (23%; 95%CI 19–27%) ran designated COPD clinics, and 170 (45%; 95%CI 40–49%) did not run designated respiratory clinics. Of the 255 nurses with an advanced asthma role, 51 (20%; 95%CI 15–25%) did not have accredited asthma training. Of the 215 nurses with an advanced COPD role, 111 (52%; 95%CI 45–58%) did not have accredited COPD training. CONCLUSION: Patients are increasingly being seen outside of designated asthma or COPD clinics, often by nurses with an advanced role. It is important that nurses have the training to fulfil this role.
Published: 2007

28. Patient-reported side effects, concerns and adherence to corticosteroid treatment for asthma, and comparison with physician estimates of side-effect prevalence: a UK-wide, cross-sectional study

Author: Jane Upton, Rob Horne, Samantha Walker, Leanne Metcalf, Jenny Versnel, and Vanessa Cooper
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Drug-Related Side Effects and Adverse Reactions, Side effect, Cross-sectional study, Contusions, Concordance, Psychological intervention, Administration, Oral, Weight Gain, Article, Physicians, Primary Care, Medication Adherence, Adrenal Cortex Hormones, Candidiasis, Oral, Surveys and Questionnaires, Internal medicine, Administration, Inhalation, Prevalence, medicine, Sore throat, Humans, Primary nursing, Aged, Asthma, Primary Care Nursing, Primary Health Care, business.industry, Mental Disorders, Stomatognathic Diseases, Public Health, Environmental and Occupational Health, Pharyngitis, Middle Aged, medicine.disease, United Kingdom, Cross-Sectional Studies, Physical therapy, Female, Self Report, medicine.symptom, business
Abstract: Background: Non-adherence to corticosteroid treatment has been shown to reduce treatment efficacy, thus compromising asthma control. Aims: To examine the experiences of treatment side effects, treatment concerns and adherence to inhaled (ICS) and oral corticosteroids (OCS) among people with asthma and to identify the degree of concordance between clinician estimates of side effects and the prevalence reported by patients. Methods: Asthma UK members were sent validated questionnaires assessing treatment concerns, experiences of side effects and adherence. Questionnaires measuring clinicians’ estimates of the prevalence of corticosteroid side effects were completed online. Results: Completed questionnaires were returned by 1,524 people taking ICS, 233 taking OCS and 244 clinicians (67% of clinicians were primary care nurses). Among people with asthma, 64% of those taking ICS and 88% of those taking OCS reported ⩾1 side effect. People reporting high adherence to ICS (t=−3.09, Pt=1.86, Pr=0.46, Pr=0.50, Pt=6.90, Pt=1.71; P Conclusions: An unexpectedly large proportion of people with asthma experienced side effects and had strong concerns about their treatment, which compromised adherence. These findings have implications for the design of interventions to optimise asthma control through improved adherence.
Published: 2015

29. International Primary Care Respiratory Group (IPCRG) Guidelines: Management of allergic rhinitis

Author: Dermot Ryan, M. P. Orru, J. Bouchard, Samantha Walker, David Price, J. Keenan, Christine Bond, Mark L Levy, R. Costa, and Margaret C Watson
Subjects: Pulmonary and Respiratory Medicine, Pregnancy, medicine.medical_specialty, Pediatrics, business.industry, Public Health, Environmental and Occupational Health, Primary care, Treatment goals, Guideline, medicine.disease, Nasal decongestant, Epidemiology, medicine, Respiratory system, Intensive care medicine, business, Asthma
Abstract: The association between the upper and lower airways has been recognised for almost 2000 years. Epidemiological data suggest that most asthma patients also suffer from allergic rhinitis, and that both diseases share similar trigger factors and pathophysiology. This IPCRG Guideline on the management of rhinitis in primary care is fully consistent with the ARIA guidelines. It highlights the treatment goals and the classification of the condition according to symptom frequency (intermittent or persistent) and severity (mild or moderate-severe). It covers the need for allergen avoidance, pharmacologic therapy including immunotherapy, alternative therapies, management of ocular symptoms, the management of co-existing allergic rhinitis and asthma, and the need for follow-up and ongoing care for patients with rhinitis.
Published: 2006

30. Management of allergic problems in primary care: time for a rethink?

Author: Samantha Walker, Aziz Sheikh, Dermot Ryan, Adrian Morris, and Mark L Levy
Subjects: Discussion Paper, Pulmonary and Respiratory Medicine, Service (business), Allergy, education.field_of_study, medicine.medical_specialty, Pediatrics, business.industry, Population, Public Health, Environmental and Occupational Health, Specialty, Primary care, medicine.disease, Pharmacotherapy, Food allergy, medicine, Allergists, education, business, Intensive care medicine
Abstract: Allergic diseases affect 20-30% of the UK population and when severe are associated with considerable morbidity and occasional mortality. Initiatives to improve allergy services in the UK have been led by consultant allergists and have focussed on increasing the number of hospital training posts to improve access to specialist services. A high profile campaign to raise awareness of the lack of allergy services has so far failed to generate further training numbers for allergy as a single specialty. Although the campaign to improve tertiary allergy services continues, most mild or moderate allergy symptoms (e.g. hayfever, allergic asthma, urticaria and some food allergy problems), can be managed successfully in primary care with appropriate interest and training. Despite the high and increasing numbers of patients with allergy and the ease with which the majority of symptoms can be controlled, many doctors in primary care are reluctant to take a more proactive approach to managing allergic conditions. This appears to be due to concerns about overburdening an already busy service, but may also be due to recommendations from allergy specialists which have implied that high quality allergy care is not possible without identification of specific allergic triggers using skin prick tests or blood tests. In reality, symptoms can usually be controlled using pharmacotherapy, although a working knowledge of the appropriate guidelines is helpful. In this paper, we propose minimum levels of knowledge for all practitioners in order to raise the standards of primary care allergy management, and provide recommendations for training for those wishing to manage successfully more difficult allergy cases and allergy diagnosis.
Published: 2005

31. Self reported rhinitis is a significant problem for patients with asthma

Author: Samantha Walker and Aziz Sheikh
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, High prevalence, Itchy eyes, business.industry, Public Health, Environmental and Occupational Health, Baseline survey, Primary care, medicine.disease, medicine.anatomical_structure, Internal medicine, Physical therapy, Medicine, National database, business, Nose, Original Research, Asthma, Nasal symptoms
Abstract: Summary Background: There is increasing interest in the possibility that rhinitis and asthma are intricately interlinked. The aim of this baseline audit was to investigate the prevalence and characteristics of rhinitis symptoms in a large-scale UK primary care-based survey of patients with asthma. Methods: A questionnaire about the presence/absence and type of nasal symptoms, seasonal variations, and trigger factors was developed and piloted. This was then distributed among approximately 10,500 patients with clinician-diagnosed asthma via a national database of practice nurses. Results: We achieved a response from 7,129 patients (68%). Of these, 76% ( n = 5,420) had symptoms indicative of rhinitis as shown by the presence of more than one of the following: nasal blockage; runny nose; sneezing; and itchy eyes, ears or palate. 58% reported predominantly seasonal symptoms and 42% predominantly perennial symptoms. Sneezing was reported in a significantly greater proportion of patients with seasonal (66%) than perennial (58%) symptoms, together with itchy eyes/ears/palate (seasonal 60%, perennial 48%) and rhinorrhoea (56%, 51%) (all p ≤ 0.001). Symptoms of nasal blockage were more commonly reported in the group with perennial symptoms (perennial 61%, seasonal 53%) ( p Conclusions: In this large national baseline survey, 76% of patients with asthma reported symptoms indicative of rhinitis. In view of the very high prevalence of rhinitis among people with asthma, we suggest that the diagnosis of rhinitis is considered in all those with asthma.
Published: 2005

32. Patient-reported outcome measures for asthma:A systematic review

Author: Rebecca Knibb, Allison Worth, Victoria Hammersley, Samantha Walker, Anthony E.J. Dubois, Bertine Flokstra-de-Blok, Aziz Sheikh, Audrey DunnGalvin, and Groningen Research Institute for Asthma and COPD (GRIAC)
Subjects: Adult, Pulmonary and Respiratory Medicine, medicine.medical_specialty, MEDLINE, Review Article, Quality of life (healthcare), Surveys and Questionnaires, Medicine, Humans, Intensive care medicine, Child, Pediatric asthma, Asthma, business.industry, Outcome measures, Public Health, Environmental and Occupational Health, medicine.disease, female genital diseases and pregnancy complications, Clinical Practice, Patient Outcome Assessment, Treatment Outcome, International policy, Physical therapy, Quality of Life, Patient-reported outcome, business
Abstract: BACKGROUND: Patient-reported outcome measures (PROMs) are measures of the outcome of treatment(s) reported directly by the patient or carer. There is increasing international policy interest in using these to assess the impact of clinical care. AIMS: To identify suitably validated PROMs for asthma and examine their potential for use in clinical settings. METHODS: We systematically searched MEDLINE, EMBASE and Web of Science databases from 1990 onwards to identify PROMs for asthma. These were critically appraised, then narratively synthesised. We also identified the generic PROMs commonly used alongside asthma-specific PROMs. RESULTS: We identifi ed 68 PROMs for asthma, 13 of which were selected through screening as being adequately developed to warrant full-quality appraisal: 8 for adults, 4 for children and 1 for a child's caregiver. The PROMs found to be sufficiently well validated to offer promise for use in clinical settings were the Asthma Quality of Life Questionnaire (AQLQ) and mini-AQLQ for adults, and Pediatric Asthma Quality of Life Questionnaire for children. Rhinasthma was considered promising in simultaneously assessing the impact of asthma and rhinitis in those with coexistent disease. We identified 28 generic PROMs commonly used in conjunction with asthma-specific instruments. CONCLUSIONS: We identified asthma PROMs that offer the greatest potential for use in clinical settings. Further work is needed to assess whether these are fit-for-purpose for use in clinical practice with individual patients. In particular, there is a need to ensure these are validated for use in clinical settings, acceptable to patients, caregivers and clinicians, and yield meaningful outcomes. © 2014 Primary Care Respiratory Society/Macmillan Publishers Limited.
Published: 2014

33. Asthma in the workplace: a case-based discussion and review of current evidence

Author: Alister Scott, David Fishwick, Samantha Walker, and Chris Barber
Subjects: Pulmonary and Respiratory Medicine, Adult, Male, medicine.medical_specialty, Occupational Medicine, MEDLINE, Alternative medicine, sensitiser, Occupational safety and health, Occupational medicine, Nursing, Case-based Learning, Asthma control, Occupational Exposure, medicine, Humans, aggravation, occupational, Occupational Health, Asthma, irritation, business.industry, Public Health, Environmental and Occupational Health, asthma, medicine.disease, Clinical Practice, Occupational Diseases, Identification (information), workplace, Family medicine, business
Abstract: The relationship between asthma and the workplace is important to consider in all cases of adult asthma. Early identification of a cause in the workplace offers an opportunity to improve asthma control significantly and reduce the need for long-term medication if further exposures to the cause can be avoided. This typical but fictitious case is designed to give the reader clinical information in the order this would normally be received in clinical practice, with a real-time commentary about management decisions. Pertinent recent guidance is cited to stress the importance of evidence-based practice.
Published: 2013

34. Systematic review of the effects of domestic paints on asthma related symptoms in people with or without asthma

Author: Cristina Canova, Paul Cullinan, Deborah Jarvis, and Samantha Walker
Subjects: Pulmonary and Respiratory Medicine, Adult, Risk, Veterinary medicine, medicine.medical_specialty, Volatile Organic Compounds, business.industry, Respiratory Tract Diseases, Air Pollutants, Occupational, medicine.disease, Asthma, Environmental health, Air Pollution, Indoor, Pediatrics, Perinatology and Child Health, Epidemiology, Paint, Immunology and Allergy, Medicine, Humans, business, Child, Epidemiologic Methods
Abstract: The association of respiratory problems with chemical emissions from common indoor materials has been studied but the specific effect of domestic paint has not been widely investigated. The aim of this review is to provide a comprehensive evaluation of experimental, occupational and epidemiological studies that examine the adverse respiratory effects of exposure to domestic paints.A literature search of PubMed together with consultation with an expert resulted in 997 articles published up to May 2011 of which 3 experimental, 4 occupational and 13 epidemiological studies met selection criteria and were included in the review.The occupational literature suggested that work as a (non-spray) painter increases the risk of asthma, but it provides little insight to the risks of painting in the domestic setting. All epidemiological studies, except one, reported associations with some asthma-like symptoms. In children at least there was evidence that painting was associated with wheezing, but the study designs and the exposure assessment were unsuitable to differentiate between acute and longer terms affects. We found the epidemiological evidence to be weak and certainly insufficient to infer causality.The variable quality of the exposure assignment and heterogeneous study design makes it difficult to draw firm conclusions on whether domestic paint exposures cause or exacerbate asthma in children and/or adults.
Published: 2013

35. Poor asthma control?--then look up the nose. The importance of co-morbid rhinitis in patients with asthma

Author: Glenis Scadding and Samantha Walker
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Eosinophilic asthma, Severity of Illness Index, Allergen challenge, Case-based Learning, immune system diseases, Asthma control, Severity of illness, medicine, Humans, In patient, Nose, Asthma, Rhinitis, business.industry, Public Health, Environmental and Occupational Health, Rhinitis, Allergic, Seasonal, respiratory system, medicine.disease, Dermatology, Co morbid, respiratory tract diseases, medicine.anatomical_structure, business
Abstract: Summary: Many factors can impair asthma control. One which is frequently overlooked is rhinitis. Asthma patients with significant rhinitis are over four times more likely to have poorly controlled asthma than those without. Over 80% of patients with asthma have rhinitis, which may be allergic or inflammatory/non-allergic. Both types of rhinitis share pathophysiological similarities with eosinophilic asthma, cause bronchial hyper-reactivity, and are predisposing factors for the subsequent development of asthma. Nasal allergen challenge in allergic rhinitis results in inflammation in the bronchi as well as the nose, and the reverse is also true. This article reviews briefly the evidence for the link between asthma and rhinitis, advocates looking for rhinitis when patients present with poorly controlled asthma, and provides guidance for the diagnosis and treatment of rhinitis.
Published: 2012

36. P147 Evidence of modifiable prescription factors in primary asthma care

Author: A Chisholm, David Price, Samantha Walker, E Humphreys, Victoria Carter, and C Lewis
Subjects: Pulmonary and Respiratory Medicine, Budesonide, COPD, Pediatrics, medicine.medical_specialty, education.field_of_study, business.industry, Medical record, Population, medicine.disease, Asthma care, medicine, Formoterol, Medical prescription, business, education, Asthma, medicine.drug
Abstract: Background In 2014, the Royal College of Physicians published the National Review of Asthma Deaths. This confidential enquiry into 195 confirmed asthma deaths in the UK highlighted that two thirds of these deaths were associated with potentially modifiable prescription factors including excessive short-acting beta agonist (SABA) use without review and prescription of long acting beta agonists (LABA) without inhaled corticosteroids (ICS), the latter of which have been associated with higher mortality. 1 Aim The aim of this project was to determine how widespread these two modifiable prescription factors are in the treatment of asthma in UK general practice. Methods Primary Care data were obtained from the Optimum Patient Care Research Database (OPCRD). Extraction criteria included patients with a current diagnosis of asthma, at least two years of continuous medical records and at least one asthma prescription in the preceding 12 months. Those who: had a comorbid diagnosis of COPD, had received no treatment for the past 12 months and children Results 94,955 asthma patients met the inclusion criteria, of which 12661 (13%) were children. LABAs with no ICS had been prescribed to 402 patients (0.4%). A total of 5032 patients (5.3%) had been prescribed ≥ 12 SABA inhalers, ranging from 13–136 inhalers of which 1965 (39%) had not had an asthma review. Among these, 117 were children, 0.92% of the total. Conclusion These data, covering a large GP population, suggest evidence of non-guideline recommended prescribing which might contribute to increased risk to asthma patients. Prescribers should consider implementing system alerts to identify and review such prescribing behaviours. Reference 1 Lee C, Corren J. Budesonide/formoterol in the treatment of asthma. Expert Rev Respir Med 2008; 2 :551–64
Published: 2015

37. Diagnosing allergy in primary care: are the history and clinical examination sufficient?

Author: Aziz Sheikh, Samantha Walker, and Chris Morton
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Allergy, medicine.diagnostic_test, business.industry, Public Health, Environmental and Occupational Health, Physical examination, Primary care, Immunoglobulin E, Immunologic Tests, medicine.disease, Editorial, Ambulatory care, Family medicine, Hypersensitivity, Medicine, Humans, business
Abstract: The basis of any diagnosis of allergy requires a good history and examination, which should then provide a certain degree of confidence as to whether or not allergy is present. However, the diagnosis cannot be confirmed on the basis of symptoms alone, because both allergic and non-allergic conditions can present with similar symptoms. Based on prevalence figures, about half of the patients presenting with allergic symptoms in primary care may be non-allergic. Therefore, allergy testing in the form of specific IgE (sIgE) measurement and/or skin prick testing is an invaluable aid in demonstrating both the presence and severity of such an allergy. The usefulness of such tests extends beyond just the positive or negative result. Often, more information can be gleaned by using the test results in a form of a continuous variable in order to determine the likelihood that allergy can be attributed as an explanation for patients' symptoms and disease. In this review, we describe the rationale for utilising specific IgE antibody tests in diagnosing allergy. Furthermore, to optimize the information gained from allergy testing, we describe how to employ one particular well-validated IgE testing system for determining the likelihood that an individual patient's disease can be attributed to allergy.
Published: 2006

38. Management of urticaria

Author: Samantha Walker and Aziz Sheikh
Subjects: Pulmonary and Respiratory Medicine, Medical education, Stop, Think, business.industry, Community health, General practice, Public Health, Environmental and Occupational Health, Medicine, Primary care, business
Abstract: a Director of Research, National Respiratory Training Centre, The Athenaeum, 10 Church Street, Warwick CV34 4AB, UK b Senior Lecturer (hon.), University of Edinburgh, UK c Professor of Primary Care Research and Development, Primary Care Research and Development, Division of Community Health Sciences and General Practice, University of Edinburgh, UK d Research Advisor, National Respiratory Training Centre, The Athenaeum, 10 Church Street, Warwick CV34 4AB, UK
Published: 2005

39. Primary care management of anaphylaxis

Author: Aziz Sheikh, Samantha Walker, and Sukhmeet S Panesar
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Allergic reaction, business.industry, Drug allergy, Public Health, Environmental and Occupational Health, Disease, Primary care, medicine.disease, Personal Opinion, Medicine, Anaphylactoid reactions, business, Serum tryptase, Intensive care medicine, Anaphylaxis, Asthma
Abstract: Introduction Anaphylaxis is severe systemic allergic reaction, which is potentially life threatening. It is estimated that there are between 20–30 deaths from anaphylaxis in the UK each year, many of which are potentially preventable.(1) This figure is however likely to represent something of an underestimate because deaths from drug allergy and a proportion of deaths in those with a history of asthma and unexpected deaths may have been misclassified. There are two main mechanisms involved, namely anaphylactic (IgE-mediated) and anaphylactoid (pseudoallergic non IgE-mediated) reactions. In both anaphylactic and anaphylactoid reactions, a very similar clinical picture develops requiring identical immediate management; the precise mechanism involved may however be important in guiding investigations in order to identify possible trigger(s) as IgE-mediated disease is amenable to investigation using skin-prick testing and measurements of serum-specific IgE.(2) Serum tryptase measurements taken during the acute episode can help differentiate between anaphylactic and anaphylactoid reactions and should if possible be taken by the attending GP.
Published: 2003

40. Asthma action plans in action; nurses' roles in promoting self-management

Author: Samantha Walker
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Self-management, business.industry, Communication, Public Health, Environmental and Occupational Health, Middle Aged, medicine.disease, Asthma, Self Care, Editorial, Nursing, Action (philosophy), Surveys and Questionnaires, Physical therapy, Self care, Humans, Medicine, Female, Nurse Practitioners, Nurse-Patient Relations, business
Abstract: To investigate the feasibility of improving asthma management - in particular, the implementation of individualised asthma action plans (AAPs) for poorly-controlled adult asthma patients - by providing training in asthma-focused clinical and communication skills for practice nurses who deliver asthma clinics.A pragmatic, cluster randomised trial with an intervention (an interactive seminar) delivered at practice level (n=13 practices; 6=intervention, 7=control). The impact of the intervention was assessed against patient outcomes: routinely available asthma outcome measures (beta2-agonist prescription rate and number of oral steroid courses) for asthma patients identified as being poorly-controlled from practice records; and questionnaire data - Mini Asthma Quality of Life Questionnaire (AQLQ) and the Asthma Control Questionnaire (ACQ) - from a subset of consenting patients. Data was collected at baseline and at 6-month follow-up. ANALYSISs: Routine data was analysed for 629 patients. 236 (37%) of these patients consented to provide questionnaire data at baseline, with 75% returning questionnaires at follow-up. After adjustment for baseline and practice, there was a significant difference at followup between intervention and control practices on the Mini AQLQ only (p=0.03). Estimates for subsequent sample sizes to inform future trials of asthma training were identified.Training designed to support practice nurses in implementing individualised AAPs impacted on one patient outcome only. This disappointing outcome may have been due to many different factors such as outcome measure limitations, data collection problems, and underestimating the complexity of supporting practice nurses in behaviour change.
Published: 2007

41. S62 A Systematic Review of Factors Associated with Future Asthma Attacks to Inform a Risk Assessment Questionnaire

Author: Vidya Navaratnam, A C James, Ma'en Obeidat, Z W Yeoh, Thomas D. Stringfellow, K Woulnough, Samantha Walker, Ian D. Pavord, Mike Thomas, John D Blakey, and Jodie L. Fellows
Subjects: Pulmonary and Respiratory Medicine, Pediatrics, medicine.medical_specialty, business.industry, Psychological intervention, Odds ratio, Emergency department, medicine.disease, Checklist, Systematic review, Emergency medicine, medicine, business, Risk assessment, Body mass index, Asthma
Abstract: Asthma attacks occur across all subtypes and severities of disease. Accurate quantification of asthma attack risk would enable targeting of interventions with a potential reduction in morbidity, mortality, and costs. We aimed to develop a risk assessment questionnaire underpinned by a systematic literature review. We searched major databases up to February 2012 using the terms: asthm* AND (exacerbati* OR admission) AND (risk OR predic* OR associat*) NOT review. Included studies were those in individuals >12 years old with doctor-diagnosed asthma on treatment. Outcomes were asthma attacks defined as: deterioration of symptoms, fall in objective measures of airflow, and need for a short course of augmented asthma therapy OR admission to hospital OR attendance at emergency department. Statistical analysis was carried out using RevMan 5 and SPSS 19. 3536 unique publications were retrieved. After title screening and comparison of abstracts against a standard checklist and age criteria, data extraction was undertaken in duplicate on the remaining 143 papers (see figure). Of 18 major research themes identified, 8 factors had a consistent and clinically important (OR>1.25) association with asthma attacks across publications free from major bias. The questionnaire derived from these factors is shown below. Simplified weighting is proportional to the effect size when expressed as an odds ratio (in brackets). I smoke (3) I take fewer than 8 out of 10 prescribed doses of my regular preventer medication (3) In the last month I have used my reliever inhaler more than once per day on average (3) I sneeze, or get a runny, or a blocked nose when I do not have a cold (2) In the last 5 years, I have attended a hospital emergency department or been admitted to hospital because of asthma (2) I have a body mass index of ≥ 30 (1) I have not received asthma related education or a written asthma management plan (1) I left school before sitting my A-levels/highers (1) In summary, we systematically identified factors from the literature that are independently associated with the risk of asthma attack. These factors inform a questionnaire which will require validation and subsequent impact assessment.
Published: 2012

42. P15 Concerns about corticosteroids among people with asthma: implications for clinical interventions

Author: Jenny Versnel, V Cooper, Samantha Walker, J Upton, L Metcalf, and Rob Horne
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Inhaler, media_common.quotation_subject, Psychological intervention, Alternative medicine, Inhaled corticosteroids, medicine.disease, Sore throat, Oral thrush, Physical therapy, Medicine, medicine.symptom, Worry, business, Intensive care medicine, Asthma, media_common
Abstract: Introduction and Objectives Despite the effectiveness of inhaled and systemic corticosteroids in controlling and preventing asthma exacerbations, suboptimal rates of adherence to treatment have been well documented. Previous studies have highlighted the importance of patients′ beliefs about their medicine in determining their adherence to inhaled corticosteroids. The aim of this study was to examine in-depth people′s concerns about inhaled and systemic corticosteroids for asthma and their relation to treatment adherence, and to assess the use of and satisfaction with available sources of information about corticosteroids to inform the development of interventions to support patients. Method Validated questionnaires measuring concerns about steroid inhalers and tablets (Beliefs about Medicine Questionnaire), satisfaction with information (Satisfaction with Information about Medicines Scale) and adherence (Medication Adherence Report Scale) were sent to Asthma UK members or completed online via the Asthma UK website. Results 2659 people returned questionnaires. Respondents reported a range of concerns about steroid medicines. The most prevalent concerns about steroid inhalers were about potential long-term effects (60%) side effects (sore throat or oral thrush (43%); effects on the voice (37%)) and becoming dependent on the inhaler (36%). The most prevalent concerns about steroid tablets were about long-term effects (81%), side effects (concerns about weight gain (66%); weakened bones (65%)) and general worry about taking the tablets (62%). People had stronger concerns about steroid tablets compared to steroid inhalers (p Conclusion People with asthma had a range of concerns about steroid medicines which impacted negatively on adherence. For many, treatment concerns had not been alleviated by the available information sources. Developing and implementing interventions that address patients′ concerns about the side effects of corticosteroids may improve adherence to asthma treatment and improve asthma control.
Published: 2010

43. Asthma inhalers and patient choice

Author: J. Coomber, B. Karbal, A. Hardy, Monica Fletcher, and Samantha Walker
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Patient choice, Inhaler, Public Health, Environmental and Occupational Health, Abstact, medicine.disease, Patient preference, Preference, Likert scale, Postal questionnaire, Family medicine, medicine, Treatment decision making, business, Asthma
Abstract: Asthma-trained nurses view patient preference as the most important consideration when selecting inhaler devices [1]. This is because they perceive that actively involving patients in treatment decisions and taking into account their device preferences can improve adherence to treatment. The aim of this study was to explore patients' perceptions of their inhalers in relation to choice and preference. A postal questionnaire identifying potential influences on adherence was constructed using statements from interviews with asthma patients and then piloted among a wider sample to identify ambiguities and errors. The final questionnaire was sent to 757 asthma patients on preventer therapy randomly selected from 69 general practices who were asked to give their responses to each statement on a Likert scale of 1 (strongly disagree) to 5 (strongly agree). 332 (44%) replies to the questionnaire were received. Although almost half of the respondents (46.7%) stated that they were confident that they could choose the most suitable inhaler devices for themselves, only two-fifths (38.2%) said they would take this opportunity if it was offered. Only one third (32.4%) of the patients reported that they had been offered a choice of inhaler devices. Two-fifths (39.3%) said they would prefer to use particular inhalers and two-thirds (59.3%) would prefer to take only one inhaler. In this study, the majority of patients expressed an interest in choosing their inhaler devices, although most had not had the opportunity. Patient choice should be encouraged, whilst simplifying patients' medication regimens may assist in asthma self-management.

44. Effect of cyclosporin a on the allergen-induced late asthmatic reaction

Author: Stephen R. Durham, A. B. Kay, Onn Min Kon, B.S. Sihra, Samantha Walker, and Neil Barnes
Subjects: Pulmonary and Respiratory Medicine, Adult, Hypersensitivity, Immediate, Male, Allergy, Inflammation, Immunoglobulin E, Bronchial Provocation Tests, Leukocyte Count, Double-Blind Method, Cyclosporin a, Forced Expiratory Volume, medicine, Humans, Hypersensitivity, Delayed, Asthma, Cross-Over Studies, biology, business.industry, Degranulation, Middle Aged, medicine.disease, Crossover study, Eosinophils, Delayed hypersensitivity, Immunology, Papers, biology.protein, Cyclosporine, Female, medicine.symptom, business, Immunosuppressive Agents
Abstract: BACKGROUND: The allergen-induced late asthmatic reaction (LAR) is associated with mucosal inflammation involving several cell types including activated T lymphocytes and eosinophils. In contrast, the early asthmatic reaction (EAR) is considered to results from rapid allergen-induced release of bronchoconstrictor mediators from IgE sensitised mast cells. Cyclosporin A has efficacy in chronic severe corticosteroid-dependent asthma and is believed to act principally by inhibiting cytokine mRNA transcription in T lymphocytes. However, it has effects on other cell types in vitro, including the inhibition of exocytosis/degranulation events in mast cells. It was therefore hypothesised that cyclosporin A would attenuate both the EAR and LAR in subjects with mild asthma. METHODS: Twelve sensitised atopic asthmatic subjects with documented dual asthmatic responses were studied in a double blind, placebo controlled, crossover trial. On two separate study visits subjects received two oral doses of either cyclosporin A or matched placebo before inhaled allergen challenges. The forced expiratory volume in one second (FEV1) was measured half hourly for eight hours and blood eosinophil counts were analysed three, six, and 24 hours after the challenge. Treatment effects on blood eosinophil counts as well as the EAR and LAR, respectively defined as the areas under the curve (AUC) of FEV1 changes from baseline between 0-1 and 4-8 hours after challenge, were compared by non-parametric crossover analysis. RESULTS: Cyclosporin A reduced both the LAR (median AUC -41.9 1.h (interquartile range -82.7 to -12.4) for cyclosporin A and -84.5 1.h (-248.9 to -39.1) for placebo; p = 0.007) and the late increase in blood eosinophils (median 0.2 x 10(9)/1 (0.15 to 0.4) for cyclosporin A and 0.4 x 10(9)/1 (0.25 to 0.55) for placebo; p = 0.024) but had no effect on the EAR. The reduction of the LAR by cyclosporin A correlated significantly with prechallenge blood concentrations of cyclosporin A (r = 0.6, p = 0.028). CONCLUSIONS: These data are consistent with the concept that cyclosporin A has anti-inflammatory actions in asthma resulting from inhibition of mRNA transcription of eosinophil-active cytokines, predominantly in T lymphocytes. Cyclosporin A, possibly in its inhaled form, or other agents which prevent cytokine gene transcription may therefore have potential in ameliorating the inflammatory component of asthma.

45. Prevalence of hayfever symptoms and diagnosis in UK teenagers

Author: Samantha Walker, Aziz Sheikh, Monica Fletcher, and S. Khan-Wasti
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Allergy, High prevalence, Health professionals, West midlands, business.industry, education, Public Health, Environmental and Occupational Health, Abstact, medicine.disease, Taking medication, Family medicine, Grass pollen, medicine, business, Respiratory health, Asthma
Abstract: Hayfever is a common condition which reaches peak prevalence in adolescence. Symptoms occur during periods of high grass pollen exposure (May/June in the UK), at a time when important examinations take place. Despite evidence that allergic rhinitis itself, as well as the medication taken to treat it, can interfere with learning and concentration, symptoms are often trivialised by patients and health professionals. The aim of this study was to investigate the prevalence of self-reported hayfever diagnosis, hayfever symptoms, respiratory health and use of allergy medication in UK secondary school children. All students aged 15/16 (n = 3286) in 14 schools in the West Midlands area of the UK were invited to participate via parental letter and consent. A pre-piloted questionnaire asking about respiratory health, smoking and hayfever treatment was developed (using, where appropriate, validated questions from the ISAAC study) and piloted among a group of 16 year olds to identify ambiguities and errors. The resulting questionnaire was distributed to all year 11 students in April 2004. 3189/3286 (97%) students agreed to participate in the study, and questionnaires were completed and returned by 2282 (72%). 51% (1153) students reported symptoms indicative of hayfever although only 21% (485) reported a diagnosis of hayfever by their nurse or doctor. 25% (570) reported a diagnosis of asthma, whilst 20% (461) smoked cigarettes. 22% (502) reported taking medication for their hayfever. Of responders, 51% of UK 15/16 year olds report symptoms indicative of hayfever, although only 21% reported having had a confirmed diagnosis. Those children without a formal diagnosis may have untreated symptoms which could impact on exam performance and other social and psychological outcomes. The high prevalence of hayfever symptoms in this age group, and their potentially disruptive nature, should prompt health professionals to diagnose and treat hayfever symptoms more appropriately.

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