Mobile technology offers novel insights into the control and treatment of allergic rhinitis: The MASK study.

Background: Mobile health can be used to generate innovativeinsights into optimizing treatment to improve allergic rhinitis(AR) control.Objectives: A cross-sectional real-world observational studywas undertaken in 22 countries to complement a pilot study andprovide novel information on medication use, disease control,and work productivity in the everyday life of patients with AR.Methods: A mobile phone app (Allergy Diary, which is freelyavailable on Google Play and Apple stores) was used to collect thedata of daily visual analogue scale (VAS) scores for (1) overallallergic symptoms; (2) nasal, ocular, and asthma symptoms; (3)work; and (4) medication use by using a treatment scroll listincluding all allergy medications (prescribed and over-the-counter) customized for 22 countries. The 4 most commonintranasal medications containing intranasal corticosteroids and8oralH1-antihistamines were studied.Results: Nine thousand one hundred twenty-two users filled in112,054 days of VASs in 2016 and 2017. Assessment of days wasinformative. Control of days with rhinitis differed between no(best control), single (good control for intranasal corticosteroid–treated days), or multiple (worst control) treatments. Users withthe worst control increased the range of treatments being used.The same trend was found for asthma, eye symptoms, and workproductivity. Differences between oral H1-antihistamines werefound.Conclusions: This study confirms the usefulness of theAllergyDiaryin accessing and assessing behavior in patients with AR.This observational study using a very simple assessment tool(VAS) on a mobile phone had the potential to answer questionspreviously thought infeasibl

European Respiratory Society short guidelines for the use of as-needed ICS/formoterol in mild asthma

: Recent clinical trials of as-needed fixed-dose combination of inhaled corticosteroid (ICS)/formoterol have provided new evidence that may warrant a reconsideration of current practice. A Task Force was set up by the European Respiratory Society to provide evidence-based recommendations on the use of as-needed ICS/formoterol as treatment for mild asthma. The Task Force defined two questions that were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. The Task Force utilised the outcomes to develop recommendations for a pragmatic guideline for everyday clinical practice. The Task Force suggests that adults with mild asthma use as-needed ICS/formoterol instead of regular ICS maintenance treatment plus as-needed short-acting β2-antagonist (SABA) and that adolescents with mild asthma use either as-needed ICS/formoterol or ICS maintenance treatment plus as-needed SABA (conditional recommendation; low certainty of evidence). The recommendation for adults places a relatively higher value on the reduction of systemic corticosteroid use and the outcomes related to exacerbations, and a relatively lower value on the small differences in asthma control. Either treatment option is suggested for adolescent patients as the balance is very close and data more limited. The Task Force recommends that adult and adolescent patients with mild asthma use as-needed ICS/formoterol instead of as-needed SABA (strong recommendation; low certainty of evidence). This recommendation is based on the benefit of as-needed ICS/formoterol in mild asthma on several outcomes and the risks related to as-needed SABA in the absence of anti-inflammatory treatment. The implementation of this recommendation is hampered in countries (including European Union countries) where as-needed ICS/formoterol is not approved for mild asthma

General population-based lung function trajectories over the life course: an accelerated cohort study

Background: Lung function is a key determinant of health, but current knowledge on lung function growth and decline over the life course is based on fragmented, potentially biased data. We aimed to empirically derive general population-based life course lung function trajectories, and to identify breakpoints and plateaus. Methods: We created an accelerated cohort by pooling data from eight general population-based child and adult cohort studies from Europe and Australia. We included all participants with information on lung function, smoking status, BMI, and asthma diagnosis status from at least two visits. We used cross-classified three-level linear mixed models to derive sex-specific life course trajectories of FEV1, forced vital capacity (FVC), and FEV1/FVC ratio based on observations at ages 4-80 years, and Bayesian time-series decomposition to identify breakpoints and plateaus. We repeated sex-specific analyses with separate stratification for asthma status (never had asthma vs persistent asthma, where persistent was defined as the risk factor being present at all participant visits) and smoking status (never smoker vs persistent smoker). Findings: The accelerated cohort included 30 438 participants born between 1901 and 2006 (15 703 [51·6%] female and 14 735 [48·4%] male; mean age 26 [SD 16] years), who provided a total of 87 666 observations (range 2-8 observations per participant). In female participants, FEV1 increased non-linearly in two phases, at a mean of 234 (95% CI 223 to 245) mL/year until age 13 (95% credible interval [CrI] 12 to 15) years, then at 99 (76 to 122) mL/year until a peak at age 20 (18 to 22) years, and subsequently decreased throughout the rest of adulthood (-26 [-27 to -25] mL/year). In male participants, the pattern was similar, with an increase in FEV1 of 271 (263 to 280) mL/year until age 16 (14 to 18) years, which slowed to 108 (93 to 124) mL/year until reaching a maximum at age 23 (21 to 25) years, decreasing thereafter (-38 [-39 to -37] mL/year), representing a later peak than in female participants. In female participants, FVC increased non-linearly in two phases, at 232 (95% CI 222 to 243) mL/year until age 14 (95% CrI 12 to 15) years, then at 77 (59 to 94) mL/year until peaking at age 20 (19 to 22) years, after which it decreased throughout the rest of adulthood (-26 [-27 to -25] mL/year). In male participants, FVC also increased in two phases, at 326 (315 to 337) mL/year until age 15 (13 to 17) years, then at 156 (144 to 168) mL/year until a peak at 23 (19 to 30) years, and subsequently declined in two phases (-22 [-29 to -14] mL/year until age 42 [38 to 50] years, then -36 [-38 to -34] mL/year thereafter). No plateau after the peak was observed for either lung function parameter in both sexes. FEV1/FVC ratio decreased throughout life from the starting age of 4 years in both sexes with some distinct patterns. Stratified analysis showed that persistent asthma (vs never had asthma) was related to an earlier FEV1 peak, lower FEV1 throughout adulthood, and lower FEV1/FVC ratio across the life course in both sexes. Persistent smoking (vs never smoking) was related to an accelerated decrease in FEV1 and FEV1/FVC ratio during adulthood in both sexes. No statistically significant plateau was observed in any lung function parameter across the strata of asthma or smoking status. Interpretation: In both sexes, FEV1 and FVC increased in two phases, with a fast increase until around age 13-16 years, and then a slower increase until a peak. Neither parameter showed a plateau phase after the peak, and decreases started earlier than previously described. FEV1/FVC ratio decreased throughout life. These observations provide an essential, but previously unavailable, framework to assess and monitor lung health over the life course. Funding: EU Horizon 2020, Wellcome, European Respiratory Society, AstraZeneca, Chiesi, GSK, Menarini Group, and Sanofi

Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence.

The selection of pharmacotherapy for patients with allergic rhinitis aims to control the disease and depends on many factors. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines have considerably improved the treatment of allergic rhinitis. However, there is an increasing trend toward use of real-world evidence to inform clinical practice, especially because randomized controlled trials are often limited with regard to the applicability of results. The Contre les Maladies Chroniques pour un Vieillissement Actif (MACVIA) algorithm has proposed an allergic rhinitis treatment by a consensus group. This simple algorithm can be used to step up or step down allergic rhinitis treatment. Next-generation guidelines for the pharmacologic treatment of allergic rhinitis were developed by using existing GRADE-based guidelines for the disease, real-world evidence provided by mobile technology, and additive studies (allergen chamber studies) to refine the MACVIA algorithm