Watchara Boonsawat

Insights, attitudes and perceptions about asthma and its treatment: Findings from a multinational survey of patients from 8 Asia-Pacific countries and Hong Kong

The Asthma Insight and Management (AIM) survey was conducted in North America, Europe, the Asia‐Pacific region and Latin America to characterize patients’ insights, attitudes and perceptions about their asthma and its treatment. We report findings from the Asia‐Pacific survey.

Relationship between asthma control status, the Asthma Control Test™ and urgent health-care utilization in Asia

Background and objective:  Accurate assessment of control is an integral part of asthma management. We investigated the relationship between control status derived from the Global Initiative for Asthma (GINA), the Asthma Control Test (ACT) and urgent health‐care utilization.

Insights, attitudes and perceptions about asthma and its treatment

The Asthma Insight and Management (AIM) survey was conducted in North America, Europe, the Asia‐Pacific region and Latin America to characterize patients’ insights, attitudes and perceptions about their asthma and its treatment. We report findings from the Asia‐Pacific survey.

Survey of asthma control in Thailand.

Objective:  The aim of the study was to determine whether asthma management in Thailand is succeeding in achieving the levels of control, specified in national and international asthma guidelines.

Characteristics of stable chronic obstructive pulmonary disease patients in the pulmonology clinics of seven Asian cities

Background and objectives Chronic obstructive pulmonary disease (COPD) is responsible for significant morbidity and mortality worldwide. We evaluated the characteristics of stable COPD patients in the pulmonology clinics of seven Asian cities and also evaluated whether the exposure to biomass fuels and dusty jobs were related to respiratory symptoms, airflow limitation, and quality of life in the COPD patients. Methods This cross-sectional observational study recruited 922 COPD patients from seven cities of Asia. The patients underwent spirometry and were administered questionnaires about their exposure to cigarette smoking, biomass fuels, and dusty jobs in addition to respiratory symptoms and health related quality of life. Results Of the patients, there appeared to be variations from city to city in the history of exposure to biomass fuels and dusty jobs and also in respiratory symptoms of cough, phlegm, wheeze, and dyspnea. These symptoms were more frequent in those COPD patients with a history of exposure to biomass fuels than without and those with a history of exposure to dusty jobs than without (P < 0.01 for all comparisons). Airflow limitation was more severe in those COPD patients with a history of exposure to biomass fuels than without (52.2% predicted versus 55.9% of post-bronchodilator forced expiratory volume in 1 second [FEV1], P = 0.009); quality of life was poorer in those with exposure to biomass fuels than without (40.4 versus 36.2 of the St George’s Respiratory Questionnaire [SGRQ] total score, P = 0.001). Airflow limitation was more severe in those COPD patients with a history of exposure to dusty jobs than without (51.2% predicted versus 57.3% of post-bronchodilator FEV1, P < 0.001); quality of life was poorer in those with dusty jobs than without (41.0 versus 34.6 of SGRQ score, P = 0.006). Conclusion In Asian cities, the characteristics of COPD patients vary and the history of exposure to biomass fuels or dusty jobs was related to frequency of symptoms, severe airflow limitation, and poor quality of life.

Conical-PEP is safe, reduces lung hyperinflation and contributes to improved exercise endurance in patients with COPD: a randomised cross-over trial

QUESTION Does a new positive expiratory pressure device (conical-PEP) decrease lung hyperinflation during exercise in patients with chronic obstructive pulmonary disease compared to normal breathing? Does it increase the duration of exercise? DESIGN A randomised, cross-over trial with concealed allocation. PARTICIPANTS Thirteen patients with moderate to severe chronic obstructive pulmonary disease (mean FEV1 61% predicted). INTERVENTION THE experimental intervention was conical-PEP breathing with a positive expiratory pressure of 4-20 cmH2O during 30% of 1 RM alternate knee extension exercise at 70% age-predicted HRmax to fatigue. The control intervention was normal breathing. OUTCOME MEASURES Total lung capacity (inspiratory capacity and slow vital capacity), breathlessness, and leg discomfort were measured pre and post exercise. Cardiorespiratory function was measured pre and during the last 30 s of exercise. Duration of exercise was recorded. RESULTS After the experimental intervention, inspiratory capacity increased 200 ml (95% CI 0 to 400) and slow vital capacity increased 200 ml (95% CI 0 to 400) more than the control intervention. Participants exercised for 107 s (95% CI -23 to 238) more during the experimental intervention than the control intervention. Conical-PEP breathing during exercise resulted in 6.1 fewer breaths/min (95% CI 1.4 to 10.8) than normal breathing; it did not have any adverse effects on CO2 retention or oxygen saturation. CONCLUSION The novel conical-PEP device decreases lung hyperinflation, is safe to use, and tends to increase the duration of exercise. TRIAL REGISTRATION NCT00741832.

Budesonide/formoterol maintenance and reliever therapy via Turbuhaler versus fixed‐dose budesonide/formoterol plus terbutaline in patients with asthma: Phase III study results

To evaluate the efficacy and tolerability of budesonide/formoterol as maintenance and reliever therapy versus budesonide/formoterol maintenance plus terbutaline in adults with persistent asthma not adequately controlled with inhaled corticosteroid (ICS) therapy alone.

Frailty syndrome in ambulatory patients with COPD

Frailty is a state of increased risk of unfavorable outcomes when exposed to stressors, and COPD is one of the several chronic illnesses associated with the condition. However, few studies have been conducted regarding the prevalence of COPD and its related factors in Southeast Asia. The objectives of this study were to determine the prevalence of frailty in COPD patients and to identify the associated factors in these populations. A cross-sectional study of COPD patients who attended a COPD clinic was conducted from May 2015 to December 2016. Baseline characteristics were collected, and the diagnosis of frailty was based on the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. Descriptive statistics were used to analyze baseline data. Factors associated with frailty were analyzed using univariate and multivariate regression analyses. The results showed that the prevalence rates of frailty and pre-frailty were 6.6% (eight out of 121 cases) and 41.3% (50 out of 121 cases), respectively, among COPD patients. Fatigue was the most common component of the FRAIL scale that was found more frequently in frail patients than in non-frail patients (odds ratio [OR] 91.9). Factors associated with frailty according to multivariate analyses were comorbid cancer (adjusted OR [AOR] 45.8), at least two instances of nonelective admission over the past 12 months (AOR 112.5), high waist circumference (WC) (AOR 1.3), and presence of sarcopenia (AOR 29.5). In conclusion, frailty affected 6.6% of stable COPD patients. Cancer, two or more instances of nonelective hospitalization over the past 12 months, high WC, and presence of sarcopenia were associated with frailty. Early identification and intervention in high-risk patients is recommended to prevent or delay the adverse outcomes of frailty.

Combined salmeterol/fluticasone propionate versus fluticasone propionate alone in mild asthma : a placebo-controlled comparison.

AbstractBackground and objective: Combined therapy with inhaled corticosteroids (ICSs) and long-acting β2-adrenoceptor agonists (LABAs) is the recommended approach for the treatment of patients with asthma that is uncontrolled on ICSs alone. Additional studies are needed to assess the safety and efficacy of combination treatment with ICSs and LABAs in patients with mild asthma. The aim of this study was to compare the efficacy and tolerability of once-daily salmeterol/ fluticasone propionate combination (SFC) with once-daily fluticasone propionate (FP) over a 12-week treatment period in patients with mild persistent asthma. Methods: This was a randomized, double-blind, placebo-controlled, parallel-group, multicentre study carried out in primary care or at a hospital outpatient department and included patients 12–79 years of age with mild persistent asthma (n = 458). After a 2-week run-in period, patients were randomized to receive SFC 50 μg/100 μg (n = 149), FP 100 μg (n = 154) or placebo (n = 155) once daily in the morning for 12 weeks. The primary efficacy endpoint was patient-recorded pre-dose mean morning peak expiratory flow (PEF). Other assessments included asthma symptom scores, use of rescue medication and investigator-recorded exacerbations. Lung function was measured and assessed during clinic visits. Results: For the primary efficacy endpoint of mean change in morning PEF, SFC achieved significantly greater increases from baseline than both placebo (difference in adjusted means 23 L/min; 95% CI 15.0, 30.3; p < 0.001) and FP (difference in adjusted means 14 L/min; 95% CI 6.3, 21.7; p < 0.001). Compared with those who received FP, patients in the SFC group demonstrated significantly greater improvements in mean evening PEF (95% CI 11.7, 28.1; p < 0.001), forced expiratory volume in 1 second (95% CI 0.093, 0.257; p < 0.001), forced expiratory flow between 25% and 75% of forced vital capacity (95% CI 0.242, 0.617; p < 0.001), the percentage of symptom-free days (95% CI 0.34, 0.87; p = 0.011), and the percentage of rescue medication-free days (95% CI 0.34, 0.90; p = 0.018). During weeks 5–12, 52% of patients in the SFC group achieved ‘well controlled’ asthma, compared with 42% and 26% of patients in the FP and placebo groups, respectively. Only one patient (receiving placebo) had a severe asthma exacerbation during the study; the frequency of adverse events was similar across the three treatment groups. Conclusion: Once-daily SFC 50 μg/100 μg provided significantly greater improvements in lung function and in asthma symptoms than once-daily FP 100 μg alone in patients with mild persistent asthma. However, twice-daily treatment with either SFC or ICSs plus short acting β2-adrenoceptor agonists could be required to achieve guideline-defined asthma control in some patients.

TIOtropium Safety and Performance In Respimat® (TIOSPIRTM): Analysis of Asian cohort of COPD patients

The TIOtropium Safety and Performance In Respimat (TIOSPIR) trial showed similar safety and exacerbation efficacy profiles for tiotropium Respimat and HandiHaler in patients with COPD. The TIOSPIR results for patients in Asia are presented here.