Category: Our News

REG is pleased to announce that the next REG Summit will be held from

17 - 19 March 2022.

More information will be made available in the coming months on the REG Summit website www.regsummit2022.org

 

 

 

 

 

 

Catch up now with the Sessions with Video On Demand!

All sessions have been recorded and are available to view  - click on the link and follow the instructions to access the videos.
https://lnkd.in/dPazDwx

 

 

 

 

 

Childhood asthma outcomes during the COVID‐19 pandemic: Findings from the PeARL multinational cohort

Members of the Paediatric Asthma in Real Life (PeARL) think tank initiative have recently published a paper showing a positive impact of the COVID-19 pandemic on childhood asthma.

The study included 1,054 children with asthma and 505 non-asthmatic control subjects, from 25 paediatric departments across 15 countries. During the pandemic children with asthma had no increase in risk of episodes of pyrexia, lower respiratory tract infections, emergency department visits or hospitalisations for any reason, compared to those children without asthma.

Furthermore, in comparison to the previous year children with asthma had fewer upper respiratory tract infections, episodes of pyrexia, emergency visits and hospital admissions for any reason, asthma attacks and hospitalisation due to asthma. Two thirds of the children had improved asthma control, with 33.2% having an improvement that exceeded the minimally clinically important difference. Lung function measures were also improved during the pandemic.

It is predicted that the improvements seen are the result of social distancing, home sheltering and reduced school attendance, which have reduced exposure to asthma triggers (e.g., outdoor allergens, viral infections, physical exercise and air pollution). Increased medication adherence may have also played a role; indeed, self-reports of adherence were increased in the study population during the pandemic.

These data do not support the hypothesis that childhood asthma is a risk factor for COVID-19. Importantly, they highlight the potential to improve childhood asthma outcomes through environmental control, e.g., wearing of masks.

https://doi.org/10.1111/all.14787

 

 

 

 

Catch up with the latest REG news and happenings in our  March 2021 Newsletter

 

A real-life comparative effectiveness study into the addition of antibiotics to the management of asthma exacerbations in primary care

A comparative effectiveness study utilising historic electronic medical records from the Optimum Patient Care Research Database (opcrd.co.uk) was conducted to assess the effectiveness of the addition of antibiotics alongside oral corticosteroids for treating asthma exacerbations. The results of this study by the REG Child Health Working Group have been published in the European Respiratory Journal.

The study highlights a high level of antibiotic prescribing in relation to asthma exacerbations, despite this being contrary to guideline recommendations.

Previous randomised controlled trial data has suggested a potentially beneficial effect of antibiotics, in particular macrolides, in asthma exacerbations treated in secondary care. In the large heterogeneous primary care population in this study the use of antibiotics alongside oral corticosteroids for treating asthma exacerbations was associated with a small reduced risk of having a further respiratory consultation in the following two weeks, compared to oral corticosteroids alone. This small effect was seen in those prescribed penicillins, but not in those prescribed macrolides.

Given the small magnitude of the effect and considering the risk of side effects, the cost and most importantly risk of antibiotic resistance associated with the addition of antibiotics it was concluded that the routine addition of antibiotics to oral corticosteroids for the management of asthma exacerbations appears to confer little clinical benefit.

https://erj.ersjournals.com/content/early/2020/12/10/13993003.03599-2020

 

 

 

Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life

In patients with COPD inhaled corticosteroids (ICS) are indicated to prevent exacerbations, but they are frequently overprescribed, and withdrawal of ICS is recommended by international guidelines to prevent side effects in patients where ICS is not indicated.

Utilising real-world primary care data from the UK’s Optimum Patient Care Research Database (OPCRD) members of REG’s COPD Working Group have conducted a comparative effectiveness study to assess the effect of ICS withdrawal versus continuation on triple therapy in patients with COPD.

In the primary care population included in this study, composed mostly of infrequent exacerbators, cessation of ICS in patients on triple therapy was not associated with an increased risk of having an exacerbation. However, the subgroup of patients who experience more frequent exacerbations and have high blood eosinophil counts should not have ICS withdrawn.

The results of this study have been published in Respiratory Research -

https://doi.org/10.1186/s12931-021-01615-0

 

 

Exemptions of respiratory patients to use face masks are not evidence-based, and it may carry associated risks of severe COVID-19

There have been many false health news, hoaxes and biased information about the ongoing COVID-19 pandemic circulating on the net, and also in printed media and on TV. However, sometimes confusion and misinformation occur through official channels. And it can have serious consequences.

One of them is the exemption for respiratory patients to use a facemask, mandatory elsewhere for everyone both in shared outdoor and indoor spaces since May 2020. The Spanish and British laws state: "Those persons who present some type of respiratory difficulty that may be aggravated by the use of the mask, and those whose use is contraindicated for health or disability reasons, are excepted from this obligation."

At the Respiratory Effectiveness Group (REG at https://www.regresearchnetwork.org/), an independent global group of medical doctors and researchers in Spain, the United Kingdom and many of the EU member states, the United States, Canada and Australia, among others, have reviewed the available evidence.

In an article published today in the European Respiratory Journal (accessible from https://doi.org/10.1183/13993003.03325-2020), one of the most prestigious international journals in the respiratory arena, it was concluded that there is no evidence to support this exception, and that patients with a respiratory disease are at a high risk of suffering severe COVID-19, in Spain, the UK and elsewhere. We must succeed in eliminating this exception.

Dr Joan B Soriano, medical epidemiologist at the Respiratory Dept. of Hospital La Princesa in Madrid, Spain, member of the WHO COVID-19 Clinical Network Knowledge Exchange Team, and primary author stated: “Patients with asthma, COPD or other respiratory diseases should wear the mask without exceptions. If they have respiratory failure or with a feeling of shortness of breath when putting it on, they should most likely limit their activity, especially outdoors.”

Not using a mask to avoid an asthma attack, or exacerbations of COPD, or of other respiratory diseases, due to an alleged increase in inspiratory pressures through a mask, is unfounded.

Professor Sinthia Bosnic-Anticevich, from the Woolcock Institute at The University of Sydney, who is President of REG and also co-author, also stated: “Please, if you or a relative of yours, have asthma, COPD or other chronic respiratory disease, wear a mask to protect yourself and others. This is a new virus and a new disease, but clear information and individual decisions are critical to defeating this pandemic.”

It is estimated there are 545 million people worldwide suffering a chronic respiratory disease, and not wearing a face mask may carry increased risk of personal and group infection.

Publication citation:

Soriano JB, Anzueto A, Bosnic Anticevich S, et al. Face masks, respiratory patients and COVID-19. Eur Respir J 2020; in press

Online from Tuesday 29th September 2020 08:00AM GMT

https://erj.ersjournals.com/content/early/2020/09/09/13993003.03325-2020

 

Catch up with the latest REG news and happenings in our  September 2020 Newsletter

The COPD Working Group has published the final results of their 21-month international, multicentre study that recruited 349 patients, from 11 centres in 7 countries. The study was designed to validate the predictive value of the concept of clinical control in COPD in terms of exacerbation risk.

Patients were considered controlled according to clinical criteria if they were clinically stable, which was defined as having no exacerbations in the previous 3 months, and low impact, which was assessed according to sputum (presence and colour), breathlessness, daily physical activity and rescue medication use.

Up to 65% of patients were classified as controlled when using clinical criteria compared to 38% being classified as controlled when using CAT score. Patients defined as controlled based on clinical criteria or CAT scores had significantly less exacerbations during follow‐up. Control status by clinical criteria was found to be a better predictor of exacerbations compared to CAT criteria. A manuscript of these results has been published in Respirology

Predictive Value of Control of COPD for Risk of Exacerbations: An International Prospective Study - https://doi.org/10.1111/resp.13811

In a second manuscript in Archivos de Bronconeumologia, the authors describe the short-term predictive value of COPD control, with the results showing a significantly increased risk of moderate or severe exacerbations during the following 6 months in patients who are classified as uncontrolled

Changes in Control Status of COPD over Time and Their Consequences: A Prospective International Study - https://doi.org/10.1016/j.arbres.2020.06.003

The proposed concept of control, using easy-to-obtain clinical criteria, can be used in clinical practice at each clinical visit as a complement to the current recommendations proposed by guidelines.

Grateful acknowledgement of Novartis for their support of this project.

 

 

The Pediatric Asthma in Real Life (PeARL) Think Tank is an REG initiative.

A global survey was conducted with international experts in pediatric asthma to identify and prioritize unmet clinical needs in pediatric asthma, which could be used to guide future research and policy activities.

A total of 57 unmet clinical need topics identified by international experts were prioritized by 412 participants from 5 continents and 60 countries. Prevention of disease progression and prediction of future risk, including persistence into adulthood, emerged as the most urgent research questions.

There was good agreement across different stakeholder groups in all domains with some notable exceptions that highlight the importance of involving the whole range of stakeholders in formulation of recommendations.

https://www.sciencedirect.com/science/article/abs/pii/S2213219820301471?dgcid=author