SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted STRIVING TO CONTROL ASTHMA SYMPTOMS: A CONSTRUCTIVIST GROUNDED THEORY STUDY OF BEING A MOTHER OF A CHILD WITH ASTHMA IN SAUDI ARABIA(Saudi Digital Library, 2025) Alsunitan, Randa; Susan, Kirk; Christie, JaniceIntroduction: Asthma is a common chronic lung disease among children in Saudi Arabia. Parents play an important role in recognising, monitoring, and managing their children’s symptoms, which depends on their knowledge and skill, especially for young children. Yet, no study has been identified that explores mothers’ experiences of caring for a child with asthma in Saudi Arabia. Aim: To generate a Grounded Theory to explain the experiences and perceptions of being a mother of a child with asthma in Saudi Arabia. Methods: A Constructivist Grounded Theory approach was adopted, and 24 in-depth semi- structured interviews (n=22 mothers) were used to collect data from May 2022 to September 2023. Mothers in Saudi Arabia whose children were attending one of three hospitals in Qassim were initially convenience sampled, progressing to theoretical sampling until theoretical saturation was reached. Interviews were transcribed and translated into English and analysed using Charmaz’s principles: initial, focused, and theoretical coding, constant comparison, theoretical sampling and sensitivity, and memo-writing and diagramming. Results: The Grounded Theory, ‘Striving to Control Asthma Symptoms,’ was constructed from the data, which consists of a core category, ‘striving to control asthma symptoms,’ and two sub-categories: ‘managing the triggers of asthma symptoms’ and ‘using treatments to manage and prevent asthma symptoms.’ The theory explains mothers' experiences and the cultural beliefs and social influences that underpin their experiences. Mothers control asthma symptoms by preventing triggers and using preventive treatments, such as inhalers or traditional and religious methods. When symptoms appear, they manage them with either traditional or modern treatments. Conclusion: The emergent theory suggests that striving to control asthma symptoms is central to the mother’s experience in the Saudi context. It highlighted how cultural beliefs and social influences impact the management of asthma symptoms in Saudi Arabia. This study provides an in-depth understanding of Saudi mothers' experience of being a mother of a child with asthma. This understanding could assist healthcare professionals and policymakers in supporting mothers and providing better culturally tailored care.11 0Item Restricted Phenotyping Asthma Attacks: Clinical, Physiological and Inflammatory Characteristics of Acute Asthma(University of Nottingham, 2025-05) Aljehani, Mouaid; Martin, Matthew; Harrison, Tim; McKeever, TriciaAsthma is increasingly recognised as a heterogeneous disease, encompassing a range of phenotypes and endotypes. This evolving understanding of the pathophysiology of stable asthma has enabled the development of targeted anti-inflammatory treatments that have significantly improved clinical outcomes. Unfortunately, this is not the case with asthma attacks (AA), as they remain poorly understood and largely treated the same way since the 1950s. This is mainly owed to the lack of longitudinal investigations of asthma at the time of acute symptoms worsening and during periods of recovery, and the subsequent poor understanding of the pathophysiology of AAs. This is further confounded by the absence of a clear definition of these episodes, and the lack of easily performed lung function assessments and reliable attack-specific inflammatory biomarkers, which, collectively, has fostered a one-size-fits-all approach to managing these episodes irrespective of the underlying pathophysiological mechanism. This thesis aims to investigate asthma attacks, with a specific focus on objectively assessed airflow obstruction and the underlying inflammatory phenotypes that characterise these events. Additionally, it will explore the utility of point-of-care biomarkers in phenotyping inflammation during AAs and their potential role in guiding and predicting treatment responses.13 0Item Restricted Systematic Review of Asthma Exacerbations Impact on Children’s Quality of Life in Low-Income Countries and Lower-Middle-Income Countries(King's College London, 2024-09-25) Alrashed, Rana; Laurence, YokoBackground: Asthma is a major cause of morbidity and disability in children, especially in low-income countries and lower-middle-income countries (LICs and LMICs). This systematic review evaluates the impact of asthma exacerbations on the quality of life (QoL) of children and adolescents in LICs and LMICs. Methods: A comprehensive literature search was conducted in major medical databases, including PubMed, Medline, Embase, Global Health, and Cochrane Library. Studies involving children and adolescents aged 0-18 years residing in LICs and LMICs were included. The review considered a range of study designs, including cross-sectional studies, randomized controlled trials, systematic reviews, and meta-analyses. The quality of the included studies was assessed using the relevant Joanna Briggs Institute (JBI) checklists. Results: The review found seven relevant studies. The cross-sectional studies showed that poorly controlled asthma and frequent exacerbations have a significant negative impact on various aspects of children's QoL, including physical functioning, emotional well-being, and social interactions. The narrative review and meta-analysis supported these findings, emphasizing the considerable burden of asthma on the overall well-being of children in low-resource settings. The randomized controlled trial provided evidence that targeted interventions, such as comprehensive asthma education and management programs, have the potential to improve the QoL of affected children. Conclusions: This systematic review emphasizes the significant negative impact of asthma exacerbations on the quality of life of children in LICs and LMICs. Factors such as socioeconomic status, access to healthcare, and environmental exposures were identified as key determinants of the QoL in this population. The findings emphasize the urgent need for interventions and policies to address the challenges faced by children with asthma in LICs and LMICs and improve their overall well-being.6 0Item Restricted A study to explore how a Physiologist-led home spirometry service (PLHSS) can help identify different asthma phenotypes for an improved patient centred approach.(University College London, 2024-08) Alrashed, Reem; Roy, KayBackground Varying presentations and variability in asthmatics lead to treatment delays and quantitative measurements are to achieve an optimised and personalized management plan. Optimal care relies on an accurate diagnosis. Due to the variable physiology, single tests do not provide enough information about the patient’s condition as peak flows and spirometry can vary between days, seasons and in response to triggers. Asthma can be severe or difficult-to-treat, and many conditions coexist mimicking its symptoms which makes it difficult to determine which aspect is contributing most to the patient’s presentation. A physiology-led home spirometry service (PLHSS) obtaining quality assured spirometry (QAS) ensures spirometry including airflow obstruction is captured with the best patient effort which can help associate patients’ spirometry to their symptoms to objectively evaluate asthma control and determine the most appropriate management. This study will evaluate the value of PLHSS in the management of asthmatics in the outpatient clinic. Methods 20 patients were monitored over 12 weeks in the asthma clinic and onboarded to NuvoAir-PLHSS. Patients were coached by a respiratory physiologist on performing QAS four-times-weekly and when symptomatic. Data are evaluated and reported on a digital platform. Results High (>20%) variability of FEV1 was identified in 11 patients out of 20. 60% of patients had confirmation of a management plan after the first clinic appointment and within a month of initiating the PLHSS as they were referred for biologics or other therapies such as speech-and- language. All patients reported that PLHSS was easy to use and 88% reported it helped their understanding of doing tests with guidance and explanation of what spirometry measured and its importance. Conclusion PLHSS can improve aspects of patient care in an outpatient pathway and clinic utilisation, ensuring treatment plans are formulated sooner, quicker discharges and referrals are made, and severe patients are seen earlier.9 0Item Restricted Delivering a carbon net zero NHS at UCLH through more sustainable inhaler prescribing in the trust(University College London, 2024) Aldosari, Bodour; Roy, KayBackground Climate change, driven by anthropogenic greenhouse gas emissions, significantly impacts global health. The National Health Service (NHS) is committed to achieve net-zero carbon emissions by 2040, targeting reductions in healthcare-related emissions, including those from respiratory inhalers. Short acting beta agonist (SABA) are major contributors to the NHS’s carbon footprint due to their propellant gases. The North Central London has set key performance indicators to increase the use of lower-carbon inhalers. This project aims to primarily optimize asthma care within University College London Hospital (UCLH) by implementing sustainable inhaler prescribing practices in the emergency department (ED) and acute medical unit (AMU), aligning with these environmental goals. Methods Inhaler-sustainability champions delivered a regular education programme with interval performance of prescribing reported, following BTS-asthma 4 and surveys evaluating staff confidence pre- and post-training. Carbon footprint in NCL was calculated at community practice level and department level within UCLH to identify where more attention required. Teaching supported good disease management through prescribing of inhaled steroids and reduction in Salbutamol over-reliance with effective inhaler technique and adherence checks. We collected data pre and post interventions such as teaching to assess the impact of the educational interventions on clinical practice. Results There was an 18% and 40% reduction in SABA prescriptions in the ED and AMU respectively, cutting down carbon emissions by over 1,640 kg. Maintenance and reliever therapy prescriptions increased by 8.6% and 48% in ED and AMU, respectively. The Asthma 4 bundle application improved in the AMU. A staff surveys revealed overall improvement in knowledge and understanding after the educational intervention. Conclusion The implementation of sustainable inhaler prescribing practices in the ED and AMU at UCLH has led to a reduction in carbon emissions and improvements in clinical practice. Additionally, the educational interventions resulted in enhanced staff knowledge and understanding around optimal asthma care. These outcomes highlight the potential for such quality improvement initiatives in achieving both clinical excellence and environmental sustainability within healthcare settings8 0Item Restricted Role of C-reactive protein in airway smooth muscle dysfunction relevant to obstructive lung disease.(University of Leicester, 2024-07-31) Alanazi, Amani; Saunders, RuthC-reactive protein (CRP), is an inflammation marker, often elevated in airways conditions such as asthma and COPD. This research investigated the impact of CRP on airway smooth muscle (ASM) cells, which are crucial in the airway remodelling and hyperresponsiveness which is observed in these conditions. By using primary human ASM cells, this study has shown that purified CRP reduced cell number, increased cell size and intracellular complexity, and maintained cell viability. However, these findings were not replicated with recombinant CRP, which lacks endotoxin, suggesting that endotoxin contamination in the purified CRP may have played a role. Lipopolysaccharide (LPS) treatment, an endotoxin component, resulted in increased intracellular complexity but did not completely replicate the other effects of purified CRP on ASM cells. Moreover, a CRP-neutralizing antibody did not reverse the changes induced by purified CRP, indicating the potential involvement of contaminants. The differences between purified and recombinant CRP highlight the challenges in isolating the true effects of CRP from those of other inflammatory agents. Future research will give priority to endotoxin removal or neutralization, using higher concentrations of both CRP and the neutralizing antibody. Additionally, the study will focus on exploring potential synergistic effects between CRP and LPS on ASM cells. Further investigations are needed to fully understand the role of CRP in the ASM dysfunction and the underlying mechanisms, including apoptosis, hypertrophy, and mediator secretion. In conclusion, this study suggests that CRP has the potential to contribute to ASM dysfunction but underscores the importance of strict experimental controls to distinguish its effects from potential contaminants like endotoxin. The research emphasizes the need for further exploration of the complex interplay between CRP, endotoxin, and ASM cells to elucidate their individual or combined contribution to ASM dysfunction in lung diseases.85 0Item Restricted The Effectiveness of Heat and Moisture Exchanger Masks in Controlling Exercise-Induced Bronchoconstriction During Exercise in Asthma Patients: A Systematic Review and Meta-Analysis(Cardiff University, 2024-05-23) Alnajimi, Rana; Edwards, DeborahObjective: This systematic review and meta-analysis aim to evaluate the effectiveness of heat and moisture exchanger (HME) masks in controlling exercise-induced bronchoconstriction (EIB) during exercise in asthma patients. EIB, characterized by airway narrowing triggered by physical activity, affects a significant proportion of individuals with asthma, impeding their ability to engage in physical activities that can otherwise benefit their condition. Methods: A comprehensive search of databases including AMED, PEDro, CINAHL, CENTRAL, MEDLINE, and Embase was conducted to identify relevant randomized controlled trials (RCTs). The studies were screened, and data were extracted and analyzed using the JBI tool. Five studies met the inclusion criteria and were subjected to critical appraisal using the Cochrane Risk of Bias 2 tool. Data were synthesized, and a meta-analysis was performed to determine the effect of HME masks on post-exercise FEV1 decline. Results: The meta-analysis revealed that HME masks significantly reduced the decline in FEV1 post-exercise compared to placebo, with a standardized mean difference (SMD) of -0.775 (95% CI: -1.339 to -0.211, p = 0.007). Sensitivity analyses confirmed the robustness of the results, showing an SMD of -0.626 (95% CI: -1.105 to -0.147, p = 0.01) after excluding a high-bias study. Analyses focusing on sub-zero temperatures further supported the masks' efficacy, indicating a significant benefit with a mean difference of -15.014 (95% CI: -22.887 to -7.140, p < 0.001). Conclusions: The findings suggest that HME masks can effectively mitigate EIB in asthma patients during exercise, particularly in cold environments. However, due to the limited number of studies and moderate-quality evidence, definitive recommendations cannot be made. Further research is required to explore the long-term effectiveness and potential adverse outcomes associated with HME mask use.35 0Item Restricted Systemic Inflammation, Arterial Stiffness, and Vascular Endothelial Dysfunction in Patients with Chronic Lung Disease(University of Dundee, 2024-05-22) Arafah, Abdullah M.; Khan, FaiselChronic lung disease (CLD) is considered a heterogeneous, complex, and multicomponent condition. Types of CLD include bronchiectasis, chronic obstructive pulmonary disease (COPD), and asthma. Cardiovascular events and peripheral vascular disease are highly prevalent among patients who are known to have CLD. It is increasingly acknowledged that cardiovascular comorbidities contribute to the disease’s severity. The underlying mechanisms that link CLD and cardiovascular disease (CVD) are inadequately understood. Systemic inflammation is a key component that could describe the link between CLD and CVD. Changes in vascular endothelial function accompany the increased cardiovascular events in CLD. Atherosclerosis and calcification of macrovascular and microvascular lead to further decrease vascular compliance. These structural changes in the vascular wall contribute to increased arterial stiffness observed in patients with CLD. Endothelial dysfunction and arterial stiffness are early signs of vascular disease and the development of cardiovascular events. Chronic systemic inflammation plays a vital role in linking CLD to the development of endothelial dysfunction and arterial stiffness. Therefore, this study aims to investigate the association between CLD and CVD. To successfully achieve the aims of this project, four work packages were employed, including a systematic review, a retrospective study, a Mendelian randomisation study, and a cross-section study involving the BRIDGE study. The systematic review study related to arterial stiffness in patients with CLD using various pulse wave velocity (PWV) methods, which assessed and summarised the outcomes of all relevant studies regarding the link between CLD and CVD. The retrospective study analysed anonymous data from the SUMMIT study to assess the vascular function in patients with CLD in the presence of CVD and type 2 diabetes mellitus, and shows a significantly greater PWV; p-value = 0.015 and carotid intima-media thickness (CIMT) in the CLD patients; p-value = 0.001. The Mendelian randomisation study investigated potential genetic causal links between CLD and arterial stiffness, which shows a significant association; p-value = 0.021. The cross-section study and BRIDGE study utilised biomarkers to determine if there are shared pathways that contribute to the development and progression of CLD and CVD, and shows significant differences in PWV, and microvascular function; p-value = 0.001, blood biomarkers include adiponectin, VCAM-1, GDF-15, coagulation factor III, syndecan-1, and matrix metalloproteinase (MMP-10); p-value = 0.001. In conclusion, this study revealed a significant association between CLD and CVD. Therefore, monitoring CVD risk, including assessment of endothelial dysfunction and arterial stiffness, in patients with CLD might be helpful for risk stratification and for identifying future CVD pathologies and disease progression. This emphasises the need to identify and manage comorbid CLD and CVD to target new or existing therapeutic approaches to control systemic inflammation and improve overall lung and cardiovascular health.9 0Item Restricted Real-Life Effectiveness of Benralizumab Compared to Other Biological Therapies for Severe Asthma.(Saudi Digital Library, 2023-08-25) Almarhabi, Mohammed; Mansur, Adel; Ellis, PaulBackground: Severe asthma affects a small proportion of patients, remaining uncontrolled despite high-dose medications. It encompasses phenotypes including allergic, non-allergic, eosinophilic, and neutrophilic severe asthma. Biologic therapies such as anti-IgE, anti-IL5, and anti-IL4 may be used for severe asthma. The aim of this research is to evaluate and compare the efficacy of benralizumab in the treatment of severe asthma and eosinophilic asthma to that of other biological therapies, including dupilumab, reslizumab, mepolizumab, and omalizumab. Methods: In a cross-sectional study utilising the Birmingham Regional Severe Asthma Registry data, outcomes of benralizumab versus other biologic treatments were compared in terms of oral corticosteroid use, FeNO levels, blood eosinophils count, lung function, quality of life indices, emergency visits, and hospital admissions. Parametric (t-test) or non-parametric (Kruskal-Wallis) analyses were undertaken to compare continuous variables depending on data distribution, whilst cross-tabulation was performed to compare categorical data underwent evaluation via cross-tabulation (Chi-square tests). Results: The study included 516 patients using biological treatments, distributed across the following groups, benralizumab (n=97), omalizumab (n=196), dupilumab (n=16), and mepolizumab (n=207). Medians, accompanied by p-values were utilised to compare outcomes across the biologics. Just around 29.9% of benralizumab remained on oral steroids, similar to other biologics (25-31%). Benralizumab, dupilumab, and omalizumab showed an FEV1% improvement ranging from 77% to 102.5% compared to pre-biological treatment database 71.2%. While all biologics demonstrated clinically meaningful improvements in quality-of-life scores greater than 55 compared to the pre-biological treatments database, the differences in pre-bronchodilator FEV1 and quality-of-life scores among biologics were not statistically significant. Unique to benralizumab was an elevated FeNO level with a median of 48 ppb (IQR 9, 239) and a reduced blood eosinophil count to a median of 0 x109 /L (IQR 0, 2), aligning with its anti-IL5 mechanism and distinguishing it from anti-IL4 and anti-IgE medications. Furthermore, emergency visits decreased across biologics, with benralizumab, dupilumab and mepolizumab reducing median visits to 0 and omalizumab lowering to 1 visit, compared to 5 median visits pre-biologics database. Furthermore, all biologics, on average, reduced hospital admissions to a median of 0 hospital admission, down from a median of 1 in the pre-biological treatment database. Conclusion: Real-world data suggest that benralizumab may demonstrate differences in FeNO levels and blood eosinophils. However, other clinical outcomes appeared consistent when compared with other biologics in patients with severe asthma. In general, all biologics including benralizumab showed improvements in clinical outcomes when compared to the pre-biologics database.60 0