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Asthma is one of the most common potentially serious medical problems to complicate pregnancy. Optimal management of asthma during pregnancy is thus important for both mother and baby. Treating asthmatic women requires understanding the effects of pregnancy on the course of asthma, and, conversely, the effects of asthma on pregnancy outcomes. Successful management also requires an understanding the barriers to asthma control in this population of patients. Evidence has shown that it is essential that the allergist-immunologist, obstetrician, and patient work as a team during pregnancy to achieve optimal maternal and neonatal outcomes.

The Cu-catalyzed electrochemical CO2 reduction enables the conversion of greenhouse gas emissions to fuels or platform chemicals, with prospects of storing intermittent energy from renewable sources. While current research in tuning catalyst activity and product selectivity is often mired in finding electrode engineering solutions, the importance of electrolyte engineering is mostly overlooked. This study presents a method for measuring local pH profiles in electrode-proximity and correlating them to cation-induced buffering effects. Magnetic Resonance Imaging (MRI) techniques were applied to evaluate the local pH values using spatially resolved 13C resonances of the CO2/HCO3–/CO32– equilibrium. The buffering effect of cation hydrolysis is substantiated by local shifts of the 23Na resonance of Na+ in NaHCO3 electrolytes. Steeper local pH gradients, compared to experiments with KHCO3, account for increased selectivity for acetate formation from solution-based reaction. Proven itself capable of elucidating the effect of cations on local pH values, our presented method supports tailoring the electrode–electrolyte interface to selectively generate value-added products.

The identification of patients at high risk for diseases provides clinicians essential information to better manage such patients. Persistent chronic cough (PCC) is a condition with high clinical burden and limited knowledge of the risk factors that drive the persistent symptoms.To understand the risk factors of PCC in patients with CC diagnosed by specialists.In this retrospective study, adults aged 18 to 85 years diagnosed with CC by a pulmonologist, allergist, otolaryngologist, or gastroenterologist in the period 2011 to 2016 were identified. PCC was defined by another CC code or at least 2 cough events at least 8 weeks but no more than 4 months apart in each of the 2 consecutive years beginning 1 year after the original CC diagnosis. Unadjusted and adjusted risk ratios with 95% CI for patient characteristics at baseline in relationship to PCC were estimated by Poisson regression models with robust error variance.Of the adults with CC, 3270 (27.4%) had PCC and 5302 (44.5%) did not have CC during follow-up; 3341 (28.1%) had CC in only 1 follow-up year and were excluded from the analysis. Compared with patients without PCC, patients with PCC were noted to have significantly increased adjusted risk ratios for the following baseline features: (1) demographic characteristics (elderly, females, and less educated); (2) comorbidities (chronic obstructive pulmonary disease, chronic sinusitis, bronchiectasis, pulmonary fibrosis, hypertension, depression, and cough complications); (3) medication dispensed (inhaled corticosteroids/long-acting beta-agonists, leukotriene modifiers, nasal corticosteroids, nasal short-acting muscarinic antagonists, proton pump inhibitors, antitussives with narcotics, and neuromodulators); and (4) specialist care, particularly with pulmonologists.Knowledge of the independent risk factors associated with PCC should aid clinicians in identifying such patients and improve their management.

An autoregressive–moving-average (ARMA) point process model is introduced, which combines self-exciting and shot-noise cluster mechanisms, both useful in a variety of applications. The process is analogous to the ARMA for integer-valued time series, sharing methodological and mathematical similarities. A maximum likelihood estimation procedure, based on MCEM (Monte Carlo Expectation Maximization), is derived and studied. This approach conveniently allows for: (i) trends in immigration/background intensity, (ii) multiple parametric specifications of memory functions and mark distributions, as well as (iii) cases where marks and immigrants are not observed. As such, the ARMA point process provides a flexible framework to disentangle cluster mechanisms in continuously observed count data., Econometrics and Statistics, 24, ISSN:2452-3062

In recent years, the interest in additive manufacturing technologies has increased significantly, most of them using powders as feedstock material. It is therefore essential to check the quality of the powder before processing in order to ensure the same quality of the printed components at all times. This kind of quality assurance of a powder should be carried out independently of the additive manufacturing technology used. Since there is a lack of standards in this field, various powder analysis methods are available, with which, in principle, the same characteristics can often be measured, at least nominally. To verify the validity of these methods, three different nickel-based powders used for additive manufacturing were examined in the present study using standard methods (apparent density, tap density, Hall flow rate, optical microscopy, scanning electron microscopy) and advanced characterization methods (dynamic image analysis, x-ray microcomputed tomography, adsorption measurement by Brunauer–Emmett–Teller method). A special focus has been given on particle size distribution, particle shape, specific surface area, and internal porosity. The results of these measurements were statistically compared. This study therefore provides an insight into the advantages and disadvantages of various optical characterization techniques.

Introduction: Asthma is one of the most common conditions that afflict pregnant women. Because uncontrolled asthma in pregnancy affects both maternal and offspring outcomes, careful attention to ma...

The highly diverse Solanaceae family contains several widely studied models and crop species. Fully exploring, appreciating, and exploiting this diversity requires additional model systems. Particularly promising are orphan fruit crops in the genus Physalis, which occupy a key evolutionary position in the Solanaceae and capture understudied variation in traits such as inflorescence complexity, fruit ripening and metabolites, disease and insect resistance, self-compatibility, and most notable, the striking inflated calyx syndrome (ICS), an evolutionary novelty found across angiosperms where sepals grow exceptionally large to encapsulate fruits in a protective husk. We recently developed transformation and genome editing in Physalis grisea (groundcherry). However, to systematically explore and unlock the potential of this and related Physalis as genetic systems, high-quality genome assemblies are needed. Here, we present chromosome-scale references for P. grisea and its close relative Physalis pruinosa and use these resources to study natural and engineered variations in floral traits. We first rapidly identified a natural structural variant in a bHLH gene that causes petal color variation. Further, and against expectations, we found that CRISPR–Cas9-targeted mutagenesis of 11 MADS-box genes, including purported essential regulators of ICS, had no effect on inflation. In a forward genetics screen, we identified huskless, which lacks ICS due to mutation of an AP2-like gene that causes sepals and petals to merge into a single whorl of mixed identity. These resources and findings elevate Physalis to a new Solanaceae model system and establish a paradigm in the search for factors driving ICS.

Background On June 30, 2015, the US Food and Drug Administration (FDA) began implementation of the Pregnancy and Lactation Labeling Rule (PLLR), which replaced the pregnancy letter category system (A, B, C, D, and X) with integrated narrative summaries of the risks of using a drug or biological product during pregnancy and lactation. The letter category system, first established in 1979, was regarded as overly simplistic and misinterpreted as a grading system. The PLLR labeling format was created to improve the presentation of available data on use of the drug during pregnancy and/or lactation. Objective To survey clinician awareness, assessment, and use of this new labeling format. Methods In January 2018, an online survey, developed in collaboration between the American Academy of Allergy, Asthma & Immunology and the FDA, was sent to a random sample of the US membership of the American Academy of Allergy, Asthma & Immunology. The survey content consisted of questions addressing the following: demographic characteristics, awareness and use of the PLLR, and value and understanding of the PLLR format on the basis of an example of the "Pregnancy" subsection of labeling. Results Of the 1500 members who received the survey via an email, 184 (12%) completed the survey. Respondents had a mean age of 56 years and treated on average 2 pregnant women per month. Less than half (46%) of the respondents were aware that the pregnancy letter category system was replaced with a narrative summary. After reading the example, most of the respondents (68%) did not feel that the narrative summary was concise. However, 71% of the respondents found the background risk and disease-associated risk information helpful. Most of the respondents (95%) continued to use the pregnancy letter category system to make prescribing decisions. Conclusions These survey results suggest that the PLLR format was not known by most prescribers and that the pregnancy letter category format is continuing to be used despite significant flaws in the old system. However, the survey did not address why prescribers were continuing to rely on the pregnancy letter category system. Whether this is due to the PLLR format itself or the lack of quality data to inform the safe use of medications in pregnancy cannot be determined from these survey results. The FDA will use these survey results to refine the communication of pregnancy safety information in labeling and will expand outreach efforts to educate health care providers in the new labeling system.

This article provides highlights of the clinically impactful original studies and reviews published in The Journal of Allergy and Clinical Immunology: In Practice in 2019 on the subjects of anaphylaxis, asthma, dermatitis, drug allergy, food allergy, immunodeficiency, immunotherapy, rhinitis/sinusitis, and urticaria/angioedema/mast cell disorders. Within each topic, practical aspects of diagnosis and management are emphasized. Treatments discussed include lifestyle modifications, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We designed this review to help readers consolidate and use this extensive and practical knowledge for the benefit of their patients.

BACKGROUND: We previously reported the results of a trial of prenatal vitamin D supplementation to prevent asthma and recurrent wheeze in young children, which suggested that supplementation provided a protective effect at the age of 3 years. We followed the children through the age of 6 years to determine the course of asthma and recurrent wheeze. METHODS: In this follow-up study, investigators and participants remained unaware of the treatment assignments through the children’s sixth birthday. We aimed to determine whether, when maternal levels of 25-hydroxyvitamin D were taken into account, children born to mothers who had received 4400 IU of vitamin D(3) per day during pregnancy (vitamin D group) would have a lower incidence of asthma and recurrent wheeze at the age of 6 years than would those born to mothers who had received 400 IU of vitamin D(3) per day (control group). Time-to-event methods were used to compare the treatment groups with respect to time to the onset of asthma or recurrent wheeze. Multivariate methods were used to compare longitudinal measures of lung function between the treatment groups. RESULTS: There was no effect of maternal vitamin D supplementation on asthma and recurrent wheeze in either an intention-to-treat analysis or an analysis with stratification according to the maternal 25-hydroxyvitamin D level during pregnancy. There was no effect of prenatal vitamin D supplementation on most of the prespecified secondary outcomes. We found no effects of prenatal supplementation on spirometric indexes. Although there was a very small effect on airway resistance as measured by impulse oscillometry, this finding was of uncertain significance. CONCLUSIONS: Vitamin D supplementation during the prenatal period alone did not influence the 6-year incidence of asthma and recurrent wheeze among children who were at risk for asthma. (Funded by the National Heart, Lung, and Blood Institute; VDAART ClinicalTrials.gov number, NCT00920621.)

The electrochemical carbon dioxide reduction on copper attracted considerable attention within the last decade, since Cu is the only elemental transition metal that catalyses the formation of short-chain hydrocarbons and alcohols. Research in this field is mainly focused on understanding the reaction mechanism in terms of adsorbates and intermediates. Furthermore, dynamic changes in the micro-environment of the catalyst, i.e. local pH and [Formula: see text] concentration values, play an equivalently important role in the selectivity of product formation. In this study, we present an in operando [Formula: see text] nuclear magnetic resonance technique that enables the simultaneous measurement of pH and [Formula: see text] concentration in electrode vicinity during electroreduction. The influence of applied potential and buffer capacity of the electrolyte on the formation of formate is demonstrated. Theoretical considerations are confirmed experimentally and the importance of the interplay between catalyst and electrolyte is emphasised.

BACKGROUND: The Asthma Daytime Symptom Diary (ADSD) and the Asthma Nighttime Symptom Diary (ANSD) were developed to meet the need for standardized patient-reported measures of asthma symptoms to assess treatment trial outcomes in adults and adolescents. OBJECTIVE: To determine scoring and evaluate the measurement properties of the ADSD/ANSD. METHODS: Adolescents (12-17 years) and adults (18 + years) with asthma completed draft 8-item electronic versions of the ADSD/ANSD for 10 days alongside the Adult Asthma Symptom Daily Scales (AASDS) and a Patient Global Impression of Severity (PGIS). Using classical and modern psychometric methods, initial analyses evaluated the performance of ADSD/ ANSD items to inform scoring. Subsequent analyses evaluated the reliability and validity of ADSD/ANSD scores. RESULTS: A demographically and clinically diverse sample (n = 130 adolescents; n = 89 adults) was recruited. Item performance was generally strong. However, items assessing chest pressure and mucus/phlegm demonstrated redundancy and poorer performance and were removed. Principal-components analysis, confirmatory factor analysis, and item response theory supported combining items to form 6-item total ADSD/ANSD scores. Internal consistency (alpha = 0.94-0.95) and test-retest reliability (intraclass correlation coefficient = 0.86-0.95) were strong. Strong correlations (r = 0.72-0.80) were observed between ADSD scores and AASDS items assessing asthma symptom frequency, bother, and impact on activities. Significant differences (P < .001) in mean ADSD/ANSD scores were observed between groups categorized by asthma severity (PGIS), asthma control, inhaler use, nebulizer use, activity limitations, and nighttime awakenings. CONCLUSIONS: The ADSD/ANSD items and scores demonstrated strong reliability and validity. Implementation of the measures in interventional studies will enable the evaluation of responsiveness and meaningful within-patient change. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.

A decade ago, two-dimensional microscopic flow visualization proved the theoretically predicted existence of electroconvection roles as well as their decisive role in destabilizing the concentration polarization layer at ion-selective fluid/membrane interfaces. Electroconvection induces chaotic flow vortices injecting volume having bulk concentration into the ion-depleted diffusion layer at the interface. Experimental quantification of these important flow patterns have so far only been carried out in 2D. Numerical direct simulations suggest 3D features, yet experimental proof is lacking. 3D simulations are also limited in covering extended spacial and temporal scales. This study presents a new comprehensive experimental method for the time-resolved recording of the 3D electroconvective velocity field near a cation-exchange membrane. For the first time, the spatio-temporal velocity field can be visualized in 3D at multiples of the overlimiting current density. In contrast to today’s simulations, these experiments cover length and time scales typical for actual electrodialytic membrane processes. We visualize coherent vortex structures and reveal the changes in the velocity field and its statistics during the transition from vortex rolls to vortex rings with increasing current density. The transition is characterized by changes in the rotational direction, mean square velocity, and temporal energy spectrum with only little influence on the spatial spectrum. These findings indicate a more significant impact of EC’s structural change on the mean square velocities and temporal spectra than on the spatial spectra. This knowledge is a prerequisite for engineering ion-selective surfaces that will enable the operation of electrically driven processes beyond the diffusion-limited Nernst regime.

International audience; Background: Although rare, anaphylaxis during pregnancy implies a risk to both mothers and newborns.Objective: This systematic review is intended to identify key issues in the diagnosis and management of this condition to support prevention strategies and decrease the risk for death related to anaphylaxis during pregnancy.Methods: We searched MEDLINE, Cochrane, LILACS, SciELO, and Science Direct databases for manuscripts concerning the term "anaphylaxis during pregnancy," without language restrictions. We screened studies, extracted data, and assessed the risk for bias independently in duplicate.Results: We selected 12 articles. Frequency of anaphylaxis during maternity was estimated to be 1.5 to 3.8 per 100,000 pregnancies. Only one study provided anaphylaxis mortality data in pregnant women; the rate of anaphylaxis-related maternal mortality was estimated at 0.05/100,000 live births. No standard definition of anaphylaxis severity has been used. A total of 49% to 74% of anaphylaxis cases were described during caesarean section. Beta-lactam antibiotics (58%), latex (25%), and anesthetic agents (17%) were the main causes. In 17% of reports, causative agents were proven by allergy testing. Moreover, 72% of articles proposed the same management and treatment for a clinical episode of anaphylaxis during pregnancy as for nonpregnant patients, and the use of epinephrine in the patient's care during anaphylaxis in pregnancy.Conclusions: Few studies address anaphylaxis during pregnancy. Most have been produced by nonallergy specialists. Collaboration among different specialists involved in the care of pregnant women should be established to support preventive strategies and reduce avoidable deaths.

The use of a Single inhaler containing the combination of an inhaled corticosteroid (ICS) and formoterol, a specific long-acting bronchodilator (LABA), for both Maintenance And quick Relief Therapy (SMART, or MART) is recommended by both the Global Initiative for Asthma (GINA) and the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee in Steps 3 and 4 of asthma management. This article provides practical advice about implementation of SMART in clinical practice based on evidence and clinical experience. Fundamental to SMART is that ICS-formoterol provides similarly quick relief of asthma symptoms as short-acting beta2-agonist (SABA) such as albuterol, while reducing the risk of severe asthma exacerbations, at an overall lower ICS exposure. Most SMART clinical trials were in adults and adolescents (≥12 years), using budesonide-formoterol 160/4.5 mcg (delivered dose), 1 inhalation once or twice daily (Step 3) and 2 inhalations twice daily (Step 4). For both Step 3 and 4, patients also take additional inhalations of budesonide-formoterol 160/4.5 mcg, 1 inhalation whenever needed for symptom relief, up to a maximum for adults/adolescents of 12 total inhalations in any single day (delivering 54mcg formoterol). The efficacy and safety of SMART with budesonide-formoterol and beclometasone-formoterol have been confirmed, but other ICS-long-acting bronchodilator combinations have not been studied. The SMART regimen should be introduced with a careful explanation of its role in self-management and preferably with a customized written asthma action plan. The cost to patients and availability of SMART treatment will depend on prescribed dose and national/local payer agreements.

Acne-like skin reactions frequently occur in patients undergoing treatment with drugs inhibiting the epidermal growth factor receptor. Recently, the effects of vitamin K1 containing cream (Reconval K1) as prophylactic skin treatment in addition to doxycycline were explored in a double-blind randomized phase II trial (EVITA) in patients with metastatic colorectal cancer receiving cetuximab. EVITA demonstrated a trend towards less severe skin rash in Reconval K1-treated patients using the tripartite WoMo skin reaction grading score as a thorough tool for quantification of drug related skin reactions. This gender-specific analysis of the EVITA trial evaluated the application of the WoMo score for assessment of epidermal growth factor receptor (EGFR)-related skin toxicities according to treatment arm and gender. To show the robustness of results parametric and non-parametric statistical analyses were conducted. All three parts of the WoMo score independently demonstrated the superiority of the treatment arm (Reconval K1) regarding a significant reduction in acneiform skin reactions in women. Men did not benefit from Reconval K1 cream at any time point in none of the WoMo score analyses. The treatment effect in women was confirmed by the use of skin rash categories based on the final WoMo overall score and mixed effect longitudinal multiple linear regression analysis. The WoMo score represents a sensitive tool for studies exploiting treatments against EGFR mediated acne-like skin rash. Part C of the WoMo score seems to be sufficient for quantification of drug related skin toxicities in further studies. Standard WoMo skin reaction score values for future studies are provided., publishedVersion

OBJECTIVE: To provide updated prevalence estimates of asthma and asthma medication use for women of childbearing age in the United States. METHODS: Using data from 11,383 women aged 18–44, including a subset of 1,245 pregnant women, enrolled in the National Health and Nutrition Examination Survey (2001–2016), we assessed the age-adjusted prevalence of self-reported diagnosed asthma. For women aged 18–44, we stratified by year, demographics, and other characteristics. Furthermore, we assessed asthma medication use among women aged 18–44 with asthma. RESULTS: After age-adjustment, 9.9% (95% confidence interval (CI) 9.2%, 10.7%) of women aged 18–44 and 10.9% (95% CI 7.2%, 14.6%) of pregnant women reported having asthma. Asthma prevalence was highest in 2015–2016 (12.0% 95% CI 9.8%, 14.3%) and lowest in 2003–2004 (8.6% 95% CI 6.4%, 10.8%). Women aged 18–44 with Medicaid or State Children’s Health Insurance Program insurance coverage (16.8% 95% CI 14.5%, 19.2%), obesity (14.4% 95% CI 12.9%, 15.8%), diabetes (18.7% 95% CI 12.1%, 25.2%), hypertension (16.6% 95% CI 14.2%, 19.0%), and current smokers (12.8% 95% CI 11.4%, 14.2%) had the highest asthma prevalence. Of women with asthma, 38.3% (95% CI 34.5%, 42.1%) reported using asthma medications in the past 30 days. CONCLUSIONS: Among women of childbearing ages, asthma burden varies across demographic and clinical characteristics and has increased in recent years.

A large number of clinically impactful studies and reviews were published in this journal in 2018. This article provides highlights of the original research published in 2018 issues of The Journal of Allergy and Clinical Immunolgy: In Practice on the subjects of anaphylaxis, asthma, dermatitis, drug allergy, eosinophilic disorders, food allergy, immune deficiency, rhinitis, and urticaria/angioedema and mast cell disorders. Within each topic, practical aspects of diagnosis and management are emphasized. Treatments discussed include lifestyle modifications, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help readers consolidate and use this extensive and practical knowledge for the benefit of patients.

Background While familial clustering of asthma is known, few studies have reported on the relative roles of paternal and maternal asthma and the role of maternal asthma control in pregnancy on the risk for asthma in the child. Objective We aimed to investigate the relative roles of paternal asthma, maternal asthma, and maternal asthma control during pregnancy on the risk of asthma or recurrent wheeze in 3-year-old children and how prenatal and cord blood vitamin D status might affect this risk. Methods Data from 806 women, their partners (biologic fathers of the infants), and their children participated in the Vitamin D Antenatal Asthma Reduction Trail (VDAART, clinicaltrials.gov identification number NCT00920621) were used for this cohort analysis. The parental report of physician-diagnosed asthma or recurrent wheeze in offspring was the main outcome. Weibull regression models for interval-censored event times were used to estimate the main variables of interests and additional covariates on the outcome. Results The highest risk was observed among children with both parents being asthmatic relative to non-asthmatic parents (aHR = 2.30, 95% CI: 1.35-3.84), and less so if only the mother was asthmatic (aHR = 1.70, 95% CI: 1.17-2.40). In the subset of children born to asthmatic mothers, the risk for asthma was higher in those who were born to mothers whose asthma was uncontrolled (aHR = 1.60, 95% CI: 1.02-2.54). Children whose mothers had sufficient vitamin D status (25Hydroxyvitamin D ≥ 30 ng/mL) at early and late pregnancy and had cord blood vitamin D sufficiency demonstrated a lower risk of asthma/recurrent wheeze than children who had insufficient cord blood vitamin D status at birth (aHR = 0.47, 95% CI: 0.27-0.83). Conclusion and clinical relevance Careful attention to maternal asthma control, monitoring vitamin D status, and correcting insufficiency at early pregnancy and maintaining the sufficiency status throughout pregnancy have potential preventive roles in offspring asthma or recurrent wheeze.

We investigate a deterministic criterion to determine whether a diffusive local martingale with a single jump (``crash'') is a uniformly integrable martingale. We allow the jump hazard rate and the...

BackgroundAsthma exerts a substantial burden on patients and health care systems. To facilitate preventive care for asthma management and improve patient outcomes, we recently developed two machine learning models, one on Intermountain Healthcare data and the other on Kaiser Permanente Southern California (KPSC) data, to forecast asthma-related hospital visits, including emergency department visits and hospitalizations, in the succeeding 12 months among patients with asthma. As is typical for machine learning approaches, these two models do not explain their forecasting results. To address the interpretability issue of black-box models, we designed an automatic method to offer rule format explanations for the forecasting results of any machine learning model on imbalanced tabular data and to suggest customized interventions with no accuracy loss. Our method worked well for explaining the forecasting results of our Intermountain Healthcare model, but its generalizability to other health care systems remains unknown.ObjectiveThe objective of this study is to evaluate the generalizability of our automatic explanation method to KPSC for forecasting asthma-related hospital visits.MethodsThrough a secondary analysis of 987,506 data instances from 2012 to 2017 at KPSC, we used our method to explain the forecasting results of our KPSC model and to suggest customized interventions. The patient cohort covered a random sample of 70% of patients with asthma who had a KPSC health plan for any period between 2015 and 2018.ResultsOur method explained the forecasting results for 97.57% (2204/2259) of the patients with asthma who were correctly forecasted to undergo asthma-related hospital visits in the succeeding 12 months.ConclusionsFor forecasting asthma-related hospital visits, our automatic explanation method exhibited an acceptable generalizability to KPSC.International Registered Report Identifier (IRRID)RR2-10.2196/resprot.5039

Rationale: Asthma in children generally starts as being mild but may progress to being severe and may stay severe for unknown reasons. Objectives: To identify factors in childhood that predict the persistence of severe asthma in late adolescence and early adulthood. Methods: The CAMP (Childhood Asthma Management Program) is, to our knowledge, the largest and longest asthma trial to date; it includes 1,041 children aged 5–12 years with mild to moderate asthma. We evaluated 682 program participants with analyzable data in late adolescence (age, 17–19 yr) and early adulthood (age, 21–23 yr). Measurements and Main Results: To best capture the cases of severe asthma, a status of severe asthma was defined by using criteria from the American Thoracic Society and the National Asthma Education and Prevention Program. Logistic regression with stepwise elimination was used to analyze the clinical features, biomarkers, and lung function that are predictive of the persistence of severe asthma. In late adolescence and early adulthood, 12% and 19% of the participants had severe asthma, respectively; only 6% at both time points had severe cases. For every 5% decrease in the postbronchodilator FEV(1)/FVC ratio in childhood, the odds of the persistence of severe asthma increased by 2.36-fold (95% confidence interval [CI], 1.70–3.28; P

Asthma is one of the most common underlying diseases in women of reproductive age that can lead to potentially serious medical problems during pregnancy and lactation. A group of key stakeholders across multiple relevant disciplines was invited to take part in an effort to prioritize, strategize, and mobilize action steps to fill important gaps in knowledge regarding asthma medication safety in pregnancy and lactation. The stakeholders identified substantial gaps in the literature on the safety of asthma medications used during pregnancy and lactation and prioritized strategies to fill those gaps. Short-term action steps included linking data from existing complementary study designs (US and international claims data, single drug pregnancy registries, case-control studies, and coordinated systematic data systems). Long-term action steps included creating an asthma disease registry, incorporating the disease registry into electronic health record systems, and coordinating care across disciplines. The stakeholders also prioritized establishing new infrastructures/collaborations to perform research in pregnant and lactating women and to include patient perspectives throughout the process. To address the evidence gaps, and aid in populating product labels with data that inform clinical decision making, the consortium developed a plan to systematically obtain necessary data in the most efficient and timely manner.

To assess whether the content of the Asthma Control Test (ACT) served as a valid measure of asthma control (i.e., content validity) by mapping ACT items to the National Heart, Lung and Blood Institute (NHLBI) guideline asthma control definitions, and to language used by patients to describe their asthma.PubMed and EMBASE databases were used for a structured literature analysis.Full-text, English-language articles that reported findings from qualitative studies conducted in adults, focusing on patient descriptors of asthma symptoms, impacts, or severity, were included. Pediatric studies, studies conducted in patients without asthma, and studies that did not contain qualitative data were excluded.ACT items reflected all domains of asthma impairment described in the NHLBI guidelines, except pulmonary function. Following the literature review, 28 full-text publications were identified that included patient descriptors that could be mapped to ACT items. For example, per ACT Item 1, patients described having trouble at work, school, and completing household chores; and, per ACT Item 2, patients used the phrase "short of breath" to describe asthma-associated symptoms.ACT item content corresponded well with the NHLBI guideline definitions of the impairment domain of asthma control (focused on asthma symptoms and impact), and we identified numerous examples in the literature indicating that ACT concepts and item content mirror the language patients use when discussing asthma symptoms and impact, and their degree of asthma control. This provides further evidence to support content validity of the ACT as a measure of asthma control.