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CME Snapshot

Where are We Now In Moderate-to-Severe Asthma?

From Comprehensive Patient Evaluations to Individualized Evidence-based Care

Clinical Practice Guidelines

Global Strategy for Asthma Management and Prevention.

Global Initiative for Asthma, 2021.

GINA Guidance about COVID-19 and Asthma.

Global Initiative for Asthma, 2021.

Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline.

Holguin F, et al. Eur Respir J. 2020;55(1):1900588.

Clinical Practice Tools

Asthma Control Test (ACT)  

This 5-item questionnaire helps evaluate asthma control in children aged 12 years or older. A score of <20 on the ACT suggests asthma that is uncontrolled.

Asthma Control Questionnaire (ACQ)

This 7-question assessment tool measures asthma control over the past 7 days. Six questions are self-administered by the patient, and 1 question requires a clinician’s input. Scores range from 1 (totally controlled) to 6 (severely uncontrolled).

Juniper EF, et al. Eur Respir J. 1999;14(4):902-907.

Asthma Therapy Assessment Questionnaire (ATAQ)

This 4-question test assesses asthma control over the past 4 weeks. Each question has a possible score of 0 or 1; if the sum of the 4 question scores is >1, the patient’s asthma may be uncontrolled.

Vollmer WM, et al. Am J Respir Crit Care Med. 1999;160(5 Pt 1):1647-1652.

Clinical Tools to Assess Asthma Control in Children

Dinakar C, et al. Pediatrics. 2017:139(1):e20163438.

Centers for Disease Control and Prevention (CDC) Asthma Action Plans

These tools for asthma control were created following the evidence-based guidance published by the National Institutes of Health.       

American Academy of Pediatrics (AAP) Asthma Action Plan aged 0 to 5 years

These asthma action plans have been developed for children aged 0 to 5 years

American Academy of Pediatrics (AAP) Asthma Action Plan ≥6 years

These asthma action plans have been developed for children ≥6 years.

Shared Decision-Making Tool

The CHEST Foundation, Allergy and Asthma Network, and American College of Allergy, Asthma & Immunology (ACAAI) have developed a shared-decision making tool for adults with severe asthma so that they may work collaboratively with clinicians to improve self-management skills, choose the best treatment plan, and increase adherence.

Proper Inhaler Technique Demonstration Videos

Developed by the American Lung Association, these video tutorials may serve as a valuable resource to patients and caregivers, teaching the correct way to use multiple types of inhaler devices.

Clinical Practice Guidelines

Global Strategy for Asthma Management and Prevention.

Global Initiative for Asthma, 2021.

Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline.

Holguin F, et al. Eur Respir J. 2020;55(1):1900588.

Clinical Practice Tools

Clinical tools to assess asthma control in children.

Dinakar C, et al. Pediatrics. 2017:139(1):e20163438.

Assessing Asthma Control and Adjusting Therapy in Children.

The National Asthma Education and Prevention Program Expert Panel Report provides a stepwise approach to the assessment of asthma control in children as well as in adolescents within their 2007 Full Report (Figures 12-15).

Assessing Asthma Control and Adjusting Therapy in Children

The National Asthma Education and Prevention Program Expert Panel Report provides a stepwise approach to the assessment of asthma control in children as well as in adolescents within their 2007 Full Report (Figures 12-15).

Childhood Asthma Control Test (C-ACT)

This questionnaire includes 4 pictorial items and 3 verbal items and is appropriate for helping to assess asthma control in children 4 to 11 years old. A score of <19 on the C-ACT suggests asthma that is uncontrolled.

Asthma Control Test (ACT)  

This 5-item questionnaire helps evaluate asthma control in children aged 12 years or older. A score of <20 on the ACT suggests asthma that is uncontrolled.

Asthma Control Questionnaire (ACQ-6)

This 6-item questionnaire helps assess asthma control in children aged 6 to 16 years and has a recall window of 1 week. Scores range from 1 (totally controlled) to 6 (severely uncontrolled).

Juniper EF, et al. Eur Respir J. 2010;36(6):1410-1416

Test for Respiratory and Asthma Control in Kids (TRACK)

This 5-item questionnaire helps assess asthma control in children 0 to 5 years old. A score <80 is suggestive of asthma that is uncontrolled.

American Academy of Pediatrics (AAP) Asthma Action Plan aged 0 to 5 years

These asthma action plans have been developed for children aged 0 to 5 years

American Academy of Pediatrics (AAP) Asthma Action Plan ≥6 years

These asthma action plans have been developed for children ≥6 years.

Clinical Practice Guidelines

Global Strategy for Asthma Management and Prevention.

Global Initiative for Asthma, 2021.

Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline.

Holguin F, et al. Eur Respir J. 2020;55(1):1900588.

Patient Advocacy Organizations and Resources

American Academy of Pediatrics (AAP)

AAP’s healthychildren.org website is powered by pediatricians and is a trusted resource for parents of children with asthma and allergies. Resources include useful tips from pediatricians on mitigating triggers, evolving information on asthma therapies, patient education videos centered around the proper use of medication devices, and much more.

Asthma and Allergy Foundation of America (AAFA)

AAFA is dedicated to improving the quality of life for people with asthma and allergic diseases through education, advocacy, and research.

American College of Allergy, Asthma & Immunology (ACAAI)

The ACAAI fosters a culture of collaboration and congeniality in which members work toward the common goals of patient care, education, advocacy, and research.

American Lung Association

The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through education, advocacy, and research..

American Thoracic Society (ATS)

The mission of the ATS is to improve health worldwide by advancing research, clinical care, and public health in respiratory disease, critical illness, and sleep disorders.

Chest Foundation

The CHEST Foundation creates trusted patient education resources and disease awareness campaigns that empower patients to engage in better managing their health.

Suggested Readings

Understanding asthma phenotypes, endotypes, and mechanisms of disease.

Kuruvilla ME, et al. Clin Rev Allergy Immunol. 2019;56(2): 219-233.

Predictive biomarkers for asthma therapy.

Medrek SK, et al. Curr Allergy Asthma Rep. 2017;17(10):69.

Co-morbidities in severe asthma: clinical impact and management.

Porsbjerg C, Menzies-Gow A. Respirology. 2017;22(4):651-661.

Oral corticosteroid exposure and adverse effects in asthmatic patients.

Sullivan PW, et al. J Allergy Clin Immunol. 2018;141(1):110-116.e7.

New targeted therapies for uncontrolled asthma.

Sullivan PW, et al. J Allergy Clin Immunol. 2018;141(1):110-116.e7. Corren J. J Allergy Clin Immunol Pract. 2019;7(5):1394-1403

Which child with asthma is a candidate for biological therapies?

Bush A. J Clin Med. 2020;9(4):1237.

Omalizumab for the treatment of exacerbations in children with inadequately controlled allergic (IgE-mediated) asthma.

Lanier B, et al. J Allergy Clin Immunol. 2009;124(6):1210-1216.

Long-term safety and pharmacodynamics of mepolizumab in children with severe asthma with an eosinophilic phenotype.

Gupta A, et al. J Allergy Clin Immunol. 2019;144(5):1336-1342.e7.

Predictors of enhanced response with benralizumab for patients with severe asthma: pooled analysis of the SIROCCO and CALIMA studies.

FitzGerald JM, et al. Lancet Respir Med. 2018;6(1):51-64.

Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma.

Castro M, et al. N Engl J Med. 2018;378(26):2486-2496.

Dupilumab efficacy and safety in children with uncontrolled, moderate-to-severe asthma: the phase 3 VOYAGE study.

Bacharier LB, et al. ATS 2021. Abstract A1204.

Mepolizumab treatment in patients with severe eosinophilic asthma.

Ortega HG, et al. N Engl J Med. 2014;371(13):1198-1207.

Efficacy and safety of tezepelumab in adults and adolocesents with severe, uncontrolled asthma: results the phase 3 NAVIGATOR study.

Menzies-Gow A, et al J Allergy Clin Immunol.2021;147(2):AB249.

Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials.

Castro M, et al. Lancet Respir Med. 2015;3(5):355-366.

Tezepelumab in adults with uncontrolled asthma.

Corren J, et al. N Engl J Med. 2017;377(10):936-946 

Doctor-patient communication: a review.

Ha JF, Longnecker N. Ochsner J. 2010; 10(1): 38-43. 

Activity
Biologics for Moderate-to-Severe Asthma

Module 2

Activity
Evaluating Patients With Moderate-to-Severe Asthma

Module 1

Activity
A Case-Based Look at Managing Moderate-to-Severe Asthma

Module 3

Activity
Shared Decision-making in the Management of Moderate-to-Severe Asthma

Module 4

Relevant Resources

Chronic Obstructive Pulmonary Disease, Asthma, or Both

Differential Diagnosis and Comprehensive Management Strategies

Improving Outcomes in Chronic Obstructive Pulmonary Disease

Optimizing Maintenance Therapy Across Healthcare Settings

Clearing the Air

Improving Outcomes for Patients with COPD

Comprehensive Management of Chronic Obstructive Pulmonary Disease

Collaborative Approaches to Guideline-Concordant Patient Care

Clinical Updates in the Management of Severe Asthma

New Strategies for Individualizing Long-term Care

Improving Outcomes in Severe Asthma

A New Era in Precision Medicine

Caring for Patients with Severe Asthma

Evolving Best Practices to Optimize Outcomes

Clinical Issues in Severe Asthma

Consensus and Controversies on the Road to Precision Medicine

Breathing Life Into COPD Management

Ongoing Monitoring, Pulmonary Rehabilitation, and Individualized Care

Clinical Issues in Severe Asthma

Debates and Discussions About Personalizing Patient Management

Advancing the Care of Severe Asthma

Differential Diagnosis, Multidisciplinary Management, and Patient Engagement

Focusing on Patients With Severe Asthma

From Guideline Recommendations to Daily Clinical Decision-Making

Clearing the Air in Severe Asthma Management

Improving Patient Outcomes Through Shared Clinical Decision Making

Clearing the Air in Severe Asthma Management

Improving Patient Outcomes Through Shared Clinical Decision Making

Marching Forward in Atopic Dermatitis

Digging Deep on Shared Decision-Making

Airing It Out

A Case-Based Conversation on Managing Asthma and Chronic Rhinosinusitis With Nasal Polyposis

COPD in Managed Care

The Clinical and Utilization Benefits of Exacerbation Prevention

Finding the Right Path in Severe Asthma

Mechanistic Insights and Emerging Treatment Options

COPD Cases and Conversations

A Focus on Exacerbation Prevention

Demystifying New Evidence for COPD Management

Best Practices for Primary Care

Updates on Chronic Rhinosinusitis with Nasal Polyps

Evolving Best Practices for Patient Management

A Breath of Fresh Air in Pediatric Asthma

Shared Decision-making in the Era of Biologics

Swimming Upstream in Severe Asthma

New Pathways to Patient Management

COPD Cases & Conversations

Preventing COPD Exacerbations to Improve Outcomes

Clinical Issues in COVID-19

Debates and Discussions about Monoclonal Antibody Therapies

MINIMIZING PATIENT RISKS FROM COVID-19

An Update on Monoclonal Antibody Therapies

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  •  => 
Render methodrenderPartial
View file themes/desktop/views/common/_footer.php
View data
    null
Context ResourcesController
Context class ResourcesController
Inheritance Controller » CController » CBaseController
Defined in file protected/controllers/ResourcesController.php
Context properties
  •  => 
  •  => 
  •  => 
  •  => 
  •  => 
Route resources/view
Action CInlineAction (view)
Action params
  •  => 
Render methodrenderPartial
View file themes/desktop/views/common/elasticsearch.php
View data
    null
Context YiiDebugToolbarResourceUsage
Context class YiiDebugToolbarResourceUsage
Inheritance CWidget » CBaseController
Defined in file protected/extensions/malyshev/yii-debug-toolbar/widgets/YiiDebugToolbarResourceUsage.php
Context properties
  •  => 
  •  => 
  •  => 
Render methodrender
View file protected/extensions/malyshev/yii-debug-toolbar/widgets/views/resources.php
View data
  •  => 
SQL Queries from 1 connection (21/0.023153s)

Connection ID: db (CDbConnection)

Driver mysql
Server Version 5.5.59-0ubuntu0.14.04.1
Uptime 14w 1d 5h 43m 14s
Threads 1
Questions 40785859
Slow queries 13
Opens 195
Flush tables 1
Open tables 167
Queries per second avg 4.756
Query Count Total (s) Avg. (s) Min. (s) Max. (s)
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
1 0.003777 0.003777 0.003777 0.003777
SELECT r.id, COUNT(r.id) relevance FROM resources r join `resource_topics` rtj on rtj.`resource_id`=r.id WHERE rtj.`topic_id` in (SELECT topic_id from `resource_topics` rt where rt.`resource_id`=:rid AND rt.topic_id>0) AND r.id <> :rid AND r.status = 'active' Group by r.id order by relevance DESC, r.`createDate` DESC
1 0.003079 0.003079 0.003079 0.003079
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2491752
1 0.002906 0.002906 0.002906 0.002906
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
1 0.001837 0.001837 0.001837 0.001837
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (180, 181, 172, 169, 168, 163, 151, 144, 142, 138, 137, 136, 126, 117, 116, 104, 92, 90, 79, 68, 63, 62, 57, 54, 53, 47, 34, 32)
1 0.001655 0.001655 0.001655 0.001655
SHOW COLUMNS FROM `resources`
1 0.001391 0.001391 0.001391 0.001391
SHOW COLUMNS FROM `users`
1 0.001327 0.001327 0.001327 0.001327
SHOW COLUMNS FROM `activities`
1 0.001277 0.001277 0.001277 0.001277
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
2 0.001134 0.000567 0.000299 0.000835
SHOW COLUMNS FROM `resource_videos`
1 0.001018 0.001018 0.001018 0.001018
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
2 0.000947 0.000473 0.000452 0.000495
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
2 0.000915 0.000458 0.000323 0.000592
SHOW CREATE TABLE `resources`
1 0.000342 0.000342 0.000342 0.000342
SHOW CREATE TABLE `activities`
1 0.000339 0.000339 0.000339 0.000339
SHOW CREATE TABLE `users`
1 0.000323 0.000323 0.000323 0.000323
SELECT * FROM `resources` `t` WHERE `t`.`id`=171 LIMIT 1
1 0.000316 0.000316 0.000316 0.000316
SHOW CREATE TABLE `resource_videos`
1 0.000311 0.000311 0.000311 0.000311
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
1 0.000259 0.000259 0.000259 0.000259
# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000835
1
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
0.000592
2
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000299
3
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
0.000323
4
SHOW COLUMNS FROM `resources`
0.001391
5
SHOW CREATE TABLE `resources`
0.000342
6
SELECT * FROM `resources` `t` WHERE `t`.`id`=171 LIMIT 1
0.000316
7
SHOW COLUMNS FROM `resource_videos`
0.001018
8
SHOW CREATE TABLE `resource_videos`
0.000311
9
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
0.000259
10
SHOW COLUMNS FROM `activities`
0.001277
11
SHOW CREATE TABLE `activities`
0.000339
12
SHOW COLUMNS FROM `users`
0.001327
13
SHOW CREATE TABLE `users`
0.000323
14
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000495
15
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.003777
16
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000452
17
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2491752
0.002906
18
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
0.001837
19
SELECT r.id, COUNT(r.id) relevance FROM resources r join `resource_topics` rtj on rtj.`resource_id`=r.id WHERE rtj.`topic_id` in (SELECT topic_id from `resource_topics` rt where rt.`resource_id`=:rid AND rt.topic_id>0) AND r.id <> :rid AND r.status = 'active' Group by r.id order by relevance DESC, r.`createDate` DESC
0.003079
20
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (180, 181, 172, 169, 168, 163, 151, 144, 142, 138, 137, 136, 126, 117, 116, 104, 92, 90, 79, 68, 63, 62, 57, 54, 53, 47, 34, 32)
0.001655
Log Messages
Message (details) Level Category Time