Adherence to inhaled corticosteroids and long-acting β2-agonists in asthma:A MASK-air study

Introduction Adherence to controller medication is a major problem in asthma management, being difficult to assess and tackle. mHealth apps can be used to assess adherence. We aimed to assess the adherence to inhaled corticosteroids+long-acting β2-agonists (ICS+LABA) in users of the MASK-air® app, comparing the adherence to ICS+formoterol (ICS+F) with that to ICS+other LABA. Materials and methods We analysed complete weeks of MASK-air® data (2015-2022; 27 countries) from patients with self-reported asthma and ICS+LABA use. We compared patients reporting ICS+F versus ICS+other LABA on adherence levels, symptoms and symptom-medication scores. We built regression models to assess whether adherence to ICS+LABA was associated with asthma control or short-acting beta-agonist (SABA) use. Sensitivity analyses were performed considering the weeks with no more than one missing day. Results In 2598 ICS+LABA users, 621 (23.9%) reported 4824 complete weeks and 866 (33.3%) reported weeks with at most one missing day. Higher adherence (use of medication ≥80% of weekly days) was observed for ICS+other LABA (75.1%) when compared to ICS+F (59.3%), despite both groups displaying similar asthma control and work productivity. The ICS+other LABA group was associated with more days of SABA use than the ICS+F group (median=71.4% versus 57.1% days). Each additional weekly day of ICS+F use was associated with a 4.1% less risk in weekly SABA use (95%CI=-6.5;-1.6%;p=0.001). For ICS+other LABA, the percentage was 8.2 (95%CI=-11.6;-5.0%;p<0.001). Conclusions In asthma patients adherent to the MASK-air app, adherence to ICS+LABA was high. ICS+F users reported lower adherence but also a lower SABA use and a similar level of control

Digitally‐Enabled, Patient‐Centred Care in Rhinitis and Asthma Multimorbidity: The ARIA‐MASK‐air ® Approach

MASK-air® , a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air® results should lead to change management in rhinitis and asthma.info:eu-repo/semantics/publishedVersio

Concepts for the development of person-centred, digitally-enabled, Artificial Intelligence-assisted ARIA care pathways (ARIA 2024)

The traditional healthcare model is focused on diseases (medicine and natural science) and does not acknowledge patients' resources and abilities to be experts in their own life based on their lived experiences. Improving healthcare safety, quality and coordination, as well as quality of life, are important aims in the care of patients with chronic conditions. Person-centred care needs to ensure that people's values and preferences guide clinical decisions. This paper reviews current knowledge to develop (i) digital care pathways for rhinitis and asthma multimorbidity and (ii) digitally-enabled person-centred care (1). It combines all relevant research evidence, including the so-called real-world evidence, with the ultimate goal to develop digitally-enabled, patient-centred care. The paper includes (i) Allergic Rhinitis and its Impact on Asthma (ARIA), a two-decade journey, (ii) Grading of Recommendations, Assessment, Development and Evaluation (GRADE), the evidence-based model of guidelines in airway diseases, (iii) mHealth impact on airway diseases, (iv) from guidelines to digital care pathways, (v) embedding Planetary Health, (vi) novel classification of rhinitis and asthma, (vi) embedding real-life data with population-based studies, (vii) the ARIA-EAACI strategy for the management of airway diseases using digital biomarkers, (viii) Artificial Intelligence, (ix) the development of digitally-enabled ARIA Person-Centred Care and (x) the political agenda. The ultimate goal is to propose ARIA 2024 guidelines centred around the patient in order to make them more applicable and sustainable

Contribution à la biologie des algues d'eau douce d'un étang breton. 2 : Les populations algales

L'auteur étudie l'influence des facteurs de l'environnement sur la croissance des algues d'un étang breton. Les populations algales sont analysées qualitativement et quantitativement. Le rôle possible du facteur anthropobiotique (élimination des microorganismes par vidange régulière de l'étang) est envisagé. L'influence des variations saisonnières des facteurs physico-chimiques sur les fluctuations du taux de croissance des espèces est discutée. L'auteur préconise l'étude des algues sur le terrain, dans des microstations bien délimitées, et en présence de variations d'amplitudes naturelles de quelques facteurs (rapport N.NO3/P.PO4 en particulier). Les résultats feront l'objet d'une note ultérieure

Contribution à la biologie des algues d'eau douce d'un étang breton. I : Le milieu naturel

L'auteur rappelle le but de ses recherches : préciser l'intervention du milieu environnant sur la composition et la dynamique saisonnière des populations algales d'un étang. Cette première partie est consacrée à la définition du milieu naturel choisi (étang de Planche-Roger). En effet, si l'on veut comprendre l'influence des facteurs du milieu sur la croissance des algues en place, il est nécessaire de décrire les variations de ces facteurs au cours d'un cycle complet de végétation. L'étude des propriétés physico-chimiques des eaux montre tout d'abord que l'étang peut être classé dans le groupe des masses aquatiques " Oligotrophes ", peu minéralisées, tamponnées essentiellement par du gaz carbonique et des bicarbonates. D'autre part on retrouve les variations saisonnières classiques pour chaque élément dans toutes les stations de l'étang. Il était cependant très difficile de manoeuvrer toutes les données de l'analyse. A cet effet l'auteur représente simultanément dans un espace à faible dimension l'ensemble des stations choisies et des facteurs de l'environnement en respectant au mieux les données initiales. Ce traitement mathématique des " Correspondances " permet de retrouver les valeurs saisonnières fournies par l'analyse (par exemple : l'antagonisme entre l'oxygène d'une part, le gaz carbonique et le fer d'autre part). Enfin ce procédé montre bien que dans un étang donné, des stations très proches peuvent évoluer différemment ; tout paraissant dépendre de la profondeur, de la circulation des eaux, de la richesse en groupements végétaux, enfin des facteurs anthropo- et anthropozoobiotique (milieux souillés par l'homme ou les animaux)

La recherche sur l'environnement dans la cohorte Constances

International audienc

Worldwide prevalence of rhinitis in adults:a review of definitions and temporal evolution

Abstract Introduction: Although rhinitis is among the most common diseases worldwide, rhinitis prevalence in the general adult population is unclear and definitions differ widely. Objective: To summarize the literature on rhinitis prevalence in the general adult population and to assess: (1) the prevalence according to different rhinitis definitions overall and in different regions of the world, and (2) the evolution of rhinitis prevalence over time. Methods: We conducted an extensive literature review of publications including rhinitis prevalence using Pubmed and Scopus databases up to October 2020. We classified the definitions into three categories: unspecified rhinitis, allergic rhinitis (AR), and nonallergic rhinitis (NAR). Results: Among 5878 articles screened, 184 articles were included, presenting 156 different definitions of rhinitis. Rhinitis prevalence ranged from 1% to 63%. The overall median prevalences of unspecified rhinitis, AR and NAR were 29.4%, 18.1% and 12.0%, and they varied according to the geographical location. Rhinitis prevalence tended to increase over time. Conclusions: This review highlights the great heterogeneity of the definitions. The majority of studies had focused on AR, while only a few epidemiological data exist on NAR. We found geographical variability in rhinitis prevalence. Most of studies reported an increase of rhinitis prevalence over the last decades

Dwelling visible mould exposure increased asthma symptom score in the CONSTANCES cohort

International audienceAssociations between dwelling mould contamination and asthma outcomes have been scarcely studied in adult population-based studies. We studied these associations in adults from the French population-based CONSTANCES cohort.Presence of visible mould (yes/no) and mouldy area size in the bathroom, kitchen, living room or/and bedroom was collected from the 2019 self-questionnaire. Self-reported respiratory outcomes were assessed in participants attending the 2019-2021 follow-up. Current asthma was defined among ever-asthmatics by the report of asthma attacks, treatment or symptoms in the last 12 months. Asthma symptom score (range:0-5, Sunyer ERJ 2007) was the sum of five respiratory symptoms in the last 12 months. Logistic and negative binomial models adjusted for age, sex, smoking, education and occupant-surface ratio were used.Visible moulds were reported by 21.2% of the 21,003 participants (mean age: 48 years, 51% women, 8% current asthma, 33% living in flats). The report of visible mould was associated with current asthma (adjusted(a)OR=1.27[95%CI 1.12-1.43]) and higher asthma symptom score (mean score ratio (MSR)=1.37[95%CI 1.28-1.47]). The association with the symptom score was stronger for occupants living in flats than in houses (MSR=1.54[1.37-1.72] vs. 1.28[1.17-1.40]), similar in both sexes, and significant even among never-asthmatics (MSR=1.36[1.26-1.47]). Positive and significant associations were also found for each asthma symptom (aOR ranging from 1.34 to 1.49), with highest aORs observed also for flats.Visible mould exposure was associated with increased asthma symptom score in adults, highlighting the need of preventive measures to reduce the burden of this disease