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ObjectivesTo describe a transparent approach to planning a digital intervention for adolescents to self-manage their asthma using breathing retraining (BRT), based on an existing, effective adult intervention (BREATHE). MethodsA theory-, evidence and Person-Based Approach was used to maximise the effectiveness and persuasiveness of the intervention. A scoping review and semi-structured interviews with target intervention users (N=18, adolescents aged 12-17yrs with asthma and parents) were carried out to explore user perspectives, barriers and facilitators towards the intended behaviours and potential intervention features. The combined evidence was used alongside and to inform theory-based activities and enabled iterative planning of the intervention. ResultsThe scoping review identified themes relating to user-specific self-management issues, content, education, training needs and features for a digital intervention. Interviews elicited potential barriers to intended behaviours such as the anticipated embarrassment of using BRT and concerns around remaining calm. Facilitators included BRT delivered by adolescents who share experiences of asthma and information for performing exercises discreetly. Relevant theoretical frameworks ensured that appropriate psychological constructs were targeted. A behavioural analysis identified six intervention functions and thirty behaviour change techniques. Logic modelling mapped the programme theory and mechanisms, which aims to improve adolescent asthma-related quality of life.ConclusionsThis research gives a transparent insight into the approach followed to plan a self-guided BRT intervention for adolescents and has led to identification of key behavioural issues, enabling relevant intervention content to be chosen. Insight has been given into adolescent perceptions of BRT, which facilitated development of the prototype intervention.

People with long term respiratory conditions are at greater risk of serious disease and death from COVID-19. To reduce transmission among the most vulnerable in the UK, avoiding face-to-face contact – termed ‘shielding’ - was advised for the most vulnerable on March 20th 2020. However, shielding measures are likely to also have certain adverse consequences for health and wellbeing, which could result in a ‘third wave’ of COVID-19 related morbidity and mortality among people with long-term conditions. Two online surveys were carried out by the Asthma UK (AUK) and British Lung Foundation (BLF) Partnership for one week in April 2020 and May 2020 to assess shielding’s practical and psychological effects. The surveys gained 9,605 (April) and 14,312 (May) responses. Anonymised data was analysed using Stata V.14. Respondents in both surveys were asked to rate their anxiety about COVID-19 on a scale from 0-10. In April, high levels of anxiety about COVID-19 were reported; mean (SD) anxiety score 8.03 (2.07); slightly higher in women than men, 8.13 (1.99) vs 7.55 (2.28). In May anxiety levels about COVID-19 had decreased to 7.41 (2.08), again higher in women than men, 7.53 (2.00) vs 7.01 (2.26). Anxiety was higher in the lowest income quintile, 7.67 (2.19), than other quintiles, with a mean score of 7.04 (2.02) in the highest income quintile. While the decrease in anxiety levels from April to May is encouraging, they remain high and measures to reduce the risk of COVID-19 continue to have profound impacts on people with lung disease. There is an urgent need to adapt services to mitigate negative health consequences in this vulnerable group.

Mobile healthcare (mHealth) has the potential to revolutionise the self-management of long-term medical conditions such as asthma. A user-centred design is integral if mHealth is to be embraced by patients and healthcare professionals.The aim of this study was to determine the perspectives of individuals with asthma and healthcare professionals on the use of mHealth for asthma self-management.We used a sequential exploratory mixed methods design; focus groups informed the development of questionnaires, which were disseminated to individuals with asthma and healthcare professionals.Focus group participants (18 asthma patients and five healthcare professionals) identified 12 potential uses of mHealth. Questionnaire results showed that individuals with asthma (n=186) most frequently requested an mHealth system to monitor asthma over time (72%) and to collect data to present to healthcare teams (70%). In contrast, healthcare professionals (n=63) most frequently selected a system alerting patients to deteriorating asthma control (86%) and advising them when to seek medical attention (87%). Individuals with asthma were less likely than healthcare professionals (pOur data provide strong support for mHealth for asthma self-management, but highlight fundamental differences between the perspectives of patients and healthcare professionals.

BACKGROUND: Asthma is a heterogeneous disease in which there is a differential response to asthma treatments. This heterogeneity needs to be evaluated so that a personalised management approach can be provided.OBJECTIVES: We stratified patients with moderate-to-severe asthma based on clinico-physiological parameters and performed an -omics analysis of sputum.METHODS: Partition-around-medoid clustering was applied to a training set of 266 asthma participants from the European U-BIOPRED adult cohort using 8 pre-specified clinic-physiological variables. This was repeated in a separate validation set of 152 asthmatics. The clusters were compared based on sputum proteomic and transcriptomic data.RESULTS: Four reproducible and stable clusters of asthmatics were identified. The training set cluster T1 consists of well-controlled moderate-to-severe asthmatics, while cluster T2 is a group of late-onset severe asthmatics with history of smoking and chronic airflow obstruction. Cluster T3 is similar to cluster T2 in terms of chronic airflow obstruction but is composed of non-smokers. Cluster T4 is predominantly composed of obese female uncontrolled severe asthmatics with increased exacerbations, but with normal lung function. The validation set exhibited similar clusters, demonstrating reproducibility of the classification. There were significant differences in sputum proteomics and transcriptomics between the clusters. The severe asthma clusters, T2, T3 and T4, had higher sputum eosinophilia than T1 with no differences in sputum neutrophil counts, exhaled nitric oxide and serum IgE levels.CONCLUSION: Clustering based on clinico-physiological parameters yielded 4 stable and reproducible clusters that associate with different pathobiological pathways.CLINICAL IMPLICATIONS: The definition of four distinct clusters of asthma linked to different pathobiological pathways provides a better template for the phenotyping and personalised treatment of severe asthma, where high unmet needs remain.CAPSULE SUMMARY: Unsupervised clustering of asthma on clinical features alone has led to the definition of four phenotypes. Sputum 'omics' analysis has revealed different biological pathways pointing towards potential new treatments.

Asthma affects >30m people in the European Union and is associated with considerable morbidity and an estimated annual cost of >€72.2 billion. Recent scientific breakthroughs and technological advances present an opportunity to transform asthma outcomes with the right focus and investment. Here we describe the development of a 9roadmap9 for investment based on unmet need in asthma through the FP7-funded European Asthma Research and Innovation Partnership. Eight expert working groups comprising world-leading researchers, clinicians, pharmaceutical company personnel and people with asthma carried out reviews of the scientific literature and identified research priorities in key areas of basic, translational and applied asthma science through large scale surveys and e-Delphi consensus-building exercises. Representatives from each group then met to agree a single, coordinated agenda for asthma research and development (RD the need for development of novel diagnostic technologies to allow the development of personalised intervention strategies; and maximising the potential of digital platforms to transform adherence and self-management. Emerging fields within phenotyping, diagnostics and e-health appear to show the most promise to transform asthma outcomes. We will now work with the European Commission and individual European member states to explore models for investment in asthma R&D that will drive innovation, health and wealth and have clear value for European and international research bodies, industry and collaboration.

Rationale: mHealth systems are promising tools for supporting asthma self-management. Accommodating end-user needs and preferences in their design may improve uptake and compliance. Aim: To assess the opinions of people with asthma and HCPs on the use of mHealth self-management systems. Methods: A questionnaire was developed following framework analysis of transcripts from four focus groups, conducted with people with asthma and HCPs. Chi-square tests tested differences in response frequency between individuals with asthma and HCPs and between people with controlled and uncontrolled asthma. Results: 186 individuals with asthma (91 uncontrolled) and 63 HCPs completed questionnaires. Individuals with asthma most frequently requested a mHealth system to monitor asthma over time (72%) and to collect data to present to healthcare teams (70%). A system alerting patients to deteriorating asthma control (86%) and advising them when to seek medical attention (87%) were most frequently selected by HCPs. Individuals with asthma were less likely than HCPs (P≤0.001) to believe that measuring medication adherence, inhaler technique and respiratory symptoms could help them achieve better asthma control. Furthermore, individuals with uncontrolled asthma were more likely to believe that alerts to adverse environmental conditions (P Conclusion: Our data highlight different end-user opinions with regards to mHealth systems for asthma self-management. New mHealth systems should accommodate the views of HCPs and people with controlled and uncontrolled asthma.

Asthma affects 30million people in Europe throughout their education and working lives and puts a heavy cost on EU productivity. Preventing 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 will take a co-ordinated and integrated approach to the future of research and development by creating a roadmap that describes what is needed to reduce asthma9s impact on individuals and healthcare systems in Europe. The first step in this process was to understand the importance people with asthma place on various research topics; this can indicate which topics are likely to achieve the greatest impact. Respondents were asked to indicate the importance of 51 research topics across 5 research themes via an online survey. The survey was open for 4 weeks in July 2014 and promoted in 8 languages to a network of >160 patient organisations in Europe. Data were reported using descriptive statistics, and comparisons by theme and demographics analysed. 1904 surveys from 20 European countries were analysed: >97% of respondents expressed an opinion on each topic, with the majority viewed as important or very important (>90%). Differences could be seen between topics in different research themes, and comparisons between respondent demographics yielded important results. People with asthma view all research areas as important to their care; however some have greater importance. These findings will inform a stakeholder consensus workshop at ERS 2016 and input into the roadmap. This will be used by clinicians, researchers, industry and patient groups to lobby for change and EU investment in asthma.

Profound neuronal dysfunction in the entorhinal cortex contributes to early loss of short-term memory in Alzheimer’s disease1–3. Here we show broad neuroprotective effects of entorhinal brain-derived neurotrophic factor (BDNF) administration in several animal models of Alzheimer’s disease, with extension of therapeutic benefits into the degenerating hippocampus. In amyloid-transgenic mice, BDNF gene delivery, when administered after disease onset, reverses synapse loss, partially normalizes aberrant gene expression, improves cell signaling and restores learning and memory. These outcomes occur independently of effects on amyloid plaque load. In aged rats, BDNF infusion reverses cognitive decline, improves age-related perturbations in gene expression and restores cell signaling. In adult rats and primates, BDNF prevents lesion-induced death of entorhinal cortical neurons. In aged primates, BDNF reverses neuronal atrophy and ameliorates age-related cognitive impairment. Collectively, these findings indicate that BDNF exerts substantial protective effects on crucial neuronal circuitry involved in Alzheimer’s disease, acting through amyloid-independent mechanisms. BDNF therapeutic delivery merits exploration as a potential therapy for Alzheimer’s disease.