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best practice for treatment of asthma

Maria C Mirabelli, Joy Hsu, W Adam Gower
BACKGROUND: Few epidemiologic population-based data are available to describe the wide range of health conditions that affect children with asthma. We conducted this study to identify common comorbidities of asthma during childhood and compare the prevalences of selected comorbidities among children with and without asthma. METHODS: We analyzed weighted data from the 2012 National Health Interview Survey child sample, a sample of 10,954 U.S. children aged 3-17 years...
July 2016: Respiratory Medicine
Antonella Muraro, Robert F Lemanske, Peter W Hellings, Cezmi A Akdis, Thomas Bieber, Thomas B Casale, Marek Jutel, Peck Y Ong, Lars K Poulsen, Peter Schmid-Grendelmeier, Hans-Uwe Simon, Sven F Seys, Ioana Agache
In this consensus document we summarize the current knowledge on major asthma, rhinitis, and atopic dermatitis endotypes under the auspices of the PRACTALL collaboration platform. PRACTALL is an initiative of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology aiming to harmonize the European and American approaches to best allergy practice and science. Precision medicine is of broad relevance for the management of asthma, rhinitis, and atopic dermatitis in the context of a better selection of treatment responders, risk prediction, and design of disease-modifying strategies...
May 2016: Journal of Allergy and Clinical Immunology
Vanessa E Murphy
UNLABELLED: Asthma is a common comorbidity during pregnancy and its prevalence is increasing in the community. Exacerbations are a major clinical problem during pregnancy with up to 45% of women needing to seek medical help, resulting in poor outcomes for mothers and their babies, including low birth weight and preterm delivery. The goals of effective asthma management in pregnancy are to maintain the best possible asthma control and prevent exacerbations. This is achieved by aiming to prevent day- and night-time symptoms, and maintain lung function and normal activity...
December 2015: Breathe
Simon B Drysdale, Christopher A Green, Charles J Sande
Respiratory syncytial virus (RSV) infection is ubiquitous with almost all infants having been infected by 2 years of age and lifelong repeated infections common. It is the second largest cause of mortality, after malaria, in infants outside the neonatal period and causes up to 200,000 deaths per year worldwide. RSV results in clinical syndromes that include upper respiratory tract infections, otitis media, bronchiolitis (up to 80% of cases) and lower respiratory tract disease including pneumonia and exacerbations of asthma or viral-induced wheeze...
April 2016: Therapeutic Advances in Infectious Disease
David Price, Andrew M Wilson, Alison Chisholm, Anna Rigazio, Anne Burden, Michael Thomas, Christine King
PURPOSE: Acute, severe asthma exacerbations can be difficult to predict and thus prevent. Patients who have frequent exacerbations are of particular concern. Practical exacerbation predictors are needed for these patients in the primary-care setting. PATIENTS AND METHODS: Medical records of 130,547 asthma patients aged 12-80 years from the UK Optimum Patient Care Research Database and Clinical Practice Research Datalink, 1990-2013, were examined for 1 year before (baseline) and 1 year after (outcome) their most recent blood eosinophil count...
2016: Journal of Asthma and Allergy
T Alterio, S Manti, L Colavita, L Marseglia, M Sturiale, M Miraglia Del Giudice, A Salpietro, C Cuppari
Allergic immunotherapy (AIT) today represents a therapeutic practice for the treatment of allergic diseases such as rhinitis or asthma and is recognized as the only treatment able to modify the natural history of the disease. Administering gradually increasing doses of the causative allergen, AIT, has the objective of achieving immune tolerance against allergens. One of the administration routes most used in clinical practice is represented by the sublingual route. Current research on sublingual immunotherapy (SLIT) is focused on confirming the efficacy for all the different relevant allergens, on a better definition of allergen extracts and the improvement of their immunological properties and safety, on the identification of best treatment regimens, and on the possibility of extending the clinical indications...
April 2015: Journal of Biological Regulators and Homeostatic Agents
Désirée Larenas-Linnemann
PURPOSE OF REVIEW: Allergen immunotherapy (AIT) is still the only causal treatment for allergic rhinitis and asthma. However, conventional subcutaneous AIT administration schedules are time-consuming and safety issues still play a role; for sublingual AIT, the best efficacy is still investigated and for food allergy the best efficacy-safety balance is not yet completely discovered. Investigators have made progress in these fields lately. (Figure is included in full-text article.) RECENT FINDINGS: Since January 2014, several (ultra) rush or cluster build-up phases with hypoallergic variants of extracts have been explored with success...
December 2015: Current Opinion in Allergy and Clinical Immunology
Ayşe Baççıoğlu, Arzu Bakırtaş, Ferda Öner Erkekol, Ömer Kalaycı, Sevim Bavbek
BACKGROUND: Magnesium sulfate (MgSO4) is considered to be a well-tolerated, inexpensive, and effective medication for severe asthma exacerbations. We surveyed physicians who treat patients with asthma to evaluate the current knowledge and usage of MgSO4. METHODS: A self-administered questionnaire was e-mailed to members of the Turkish National Society of Allergy and Clinical Immunology and was distributed to participants of its annual congress. RESULTS: Of the 456 respondents (mean age: 36...
June 2016: Journal of Asthma: Official Journal of the Association for the Care of Asthma
Claire E Hayes, Henry J Nuss, Tung-Sung Tseng, Sarah Moody-Thomas
OBJECTIVE: The objective of this review is to explore how current research measures the effectiveness of inhaled corticosteroids (ICS) in smokers with asthma. DATA SOURCES: PubMed, CINAHL and PsycINFO databases were searched for combinations of terms relating to asthma, tobacco use and ICS effectiveness. STUDY SELECTIONS: The search was limited to articles published between 2004 and 2015, in English language. Studies met inclusion criteria if reporting the use of guideline-based asthma control indicators to measure the therapeutic effects of ICS or ICS combination therapies...
2015: Journal of Asthma: Official Journal of the Association for the Care of Asthma
Deborah Morrison, Frances S Mair, Rekha Chaudhuri, Marilyn McGee-Lennon, Mike Thomas, Neil C Thomson, Lucy Yardley, Sally Wyke
BACKGROUND: Around 300 million people worldwide have asthma and prevalence is increasing. Self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. We aimed to develop an evidence based, theory informed, online resource to support self-management in adults with asthma, called 'Living well with Asthma', as part of the RAISIN (Randomized Trial of an Asthma Internet Self-Management Intervention) study...
2015: BMC Medical Informatics and Decision Making
Marek Jutel, Ioana Agache, Sergio Bonini, A Wesley Burks, Moises Calderon, Walter Canonica, Linda Cox, Pascal Demoly, Antony J Frew, Robin O'Hehir, Jörg Kleine-Tebbe, Antonella Muraro, Gideon Lack, Désirée Larenas, Michael Levin, Harald Nelson, Ruby Pawankar, Oliver Pfaar, Ronald van Ree, Hugh Sampson, Alexandra F Santos, George Du Toit, Thomas Werfel, Roy Gerth van Wijk, Luo Zhang, Cezmi A Akdis
Allergen immunotherapy (AIT) has been used to treat allergic disease since the early 1900s. Despite numerous clinical trials and meta-analyses proving AIT efficacious, it remains underused and is estimated to be used in less than 10% of patients with allergic rhinitis or asthma worldwide. In addition, there are large differences between regions, which are not only due to socioeconomic status. There is practically no controversy about the use of AIT in the treatment of allergic rhinitis and allergic asthma, but for atopic dermatitis or food allergy, the indications for AIT are not well defined...
September 2015: Journal of Allergy and Clinical Immunology
Nobuyuki Hizawa
In the combined use of bronchodilators of different classes, ie, long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs), bronchodilation is obtained both directly, through LABA-mediated stimulation of β2-adrenergic receptors, and indirectly, through LAMA-mediated inhibition of acetylcholine action at muscarinic receptors. The clinical trial data for LABAs/LAMAs in the treatment of chronic obstructive pulmonary disease (COPD) continue to be promising, and these combinations will provide the convenience of delivering the two major bronchodilator classes, recommended as first-line maintenance options in COPD treatment guidelines...
2015: International Journal of Chronic Obstructive Pulmonary Disease
Anke Heida, Alie Dijkstra, Henk Groen, Anneke Muller Kobold, Henkjan Verkade, Patrick van Rheenen
BACKGROUND: To prevent clinical relapse in teenagers with inflammatory bowel disease (IBD) there is a need to monitor disease activity continuously. Timely optimisation of medical treatment may nip a preclinical relapse in the bud and change the natural course of IBD. Traditionally, disease monitoring is done during scheduled visits, but this is when most teenagers report full control. IBD care could be more efficient if patients were seen at times of clinical need. This study aims to examine the effectiveness of a web-assisted calprotectin-based treatment algorithm (IBD-live) compared with usual practices in teenagers with IBD...
2015: Trials
Christopher G Chute, Lacey A Hart, Alex K Alexander, Daniel W Jensen
INTRODUCTION: The Southeastern (SE) Minnesota Beacon organized all the health care providers, county public health organizations, and school districts in the deployment and integration of health information exchange (HIE) and targeted health communication around childhood asthma and diabetes. The community cooperated to establish a clinical data repository for all residents in the 11-county region. Through this community of practice approach that involved traditional and nontraditional providers, the SE Minnesota Beacon was able to realize unique applications of this technology...
2014: EGEMS
Michael Schivo, Chinh Phan, Samuel Louie, Richart W Harper
Critical asthma syndrome represents the most severe subset of asthma exacerbations, and the critical asthma syndrome is an umbrella term for life-threatening asthma, status asthmaticus, and near-fatal asthma. According to the 2007 National Asthma Education and Prevention Program guidelines, a life-threatening asthma exacerbation is marked by an inability to speak, a reduced peak expiratory flow rate of <25 % of a patient's personal best, and a failed response to frequent bronchodilator administration and intravenous steroids...
February 2015: Clinical Reviews in Allergy & Immunology
Mariëlle W Pijnenburg, Eugenio Baraldi, Paul L P Brand, Kai-Håkon Carlsen, Ernst Eber, Thomas Frischer, Gunilla Hedlin, Neeta Kulkarni, Christiane Lex, Mika J Mäkelä, Eva Mantzouranis, Alexander Moeller, Ian Pavord, Giorgio Piacentini, David Price, Bart L Rottier, Sejal Saglani, Peter D Sly, Stanley J Szefler, Thomy Tonia, Steve Turner, Edwina Wooler, Karin C Lødrup Carlsen
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma...
April 2015: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Alexandra C H Nowakowski, Henry J Carretta, Julie K Dudley, Jamie R Forrest, Abbey N Folsom
OBJECTIVE: To assess gaps in emergency department (ED) asthma management at Florida hospitals. DESIGN: Survey instrument with open- and closed-ended questions. Topics included availability of specific asthma management modalities, compliance with national guidelines, employment of specialized asthma care personnel, and efforts toward performance improvement. SETTING: Emergency departments at 10 large hospitals in the state of Florida. PARTICIPANTS: Clinical care providers and health administrators from participating hospitals...
July 2016: Journal of Public Health Management and Practice: JPHMP
Francesco Menzella, Mirco Lusuardi, Carla Galeone, Luigi Zucchi
Patients with severe asthma or COPD have often a suboptimal symptom control due to inadequate treatment. A better understanding of pathogenetic mechanisms, phenotypes, endotypes and the new technologies available in the fields of molecular biology and immunogenetics have made it possible to synthesize specific monoclonal antibodies virtually able to interact with any target antigen, or to open a way for new therapeutic target options. At the moment, the only biologic drug available in clinical practice is omalizumab...
2015: Multidisciplinary Respiratory Medicine
Wim M van Aalderen, Luis Garcia-Marcos, Monika Gappa, Warren Lenney, Søren Pedersen, Richard Dekhuijzen, David Price
Inhaled medications are the cornerstone of treatment in early childhood wheezing and paediatric asthma. A match between patient and device and a correct inhalation technique are crucial for good asthma control. The aim of this paper is to propose an inhaler strategy that will facilitate an inhaler choice most likely to benefit different groups of children. The main focus will be on pressurised metered dose inhalers and dry powder inhalers. In this paper we will discuss (1) practical difficulties with the devices and with inhaled therapy and (2) the optimal location for deposition of medicines in the lungs, and (3) we will propose a practical and easy way to make the best match between the inhaler device and the individual patient...
2015: NPJ Primary Care Respiratory Medicine
In Obumneme-Anyim, T Oguonu, Ac Ayuk, Kk Iloh, Ik Ndu
BACKGROUND: Asthma is a chronic airway disease that has a significant impact on patients with substantial global socioeconomic burden. Appropriate knowledge by health care practitioners is important in the management of asthma. AIM: The aim was to assess the knowledge of asthma among doctors practicing in health care facilities in three South-Eastern states of Nigeria. SUBJECTS AND METHODS: This was a descriptive cross-sectional study. The participants were selected using multi-staged sampling method and interviewed with structured, self-administered questionnaires...
September 2014: Annals of Medical and Health Sciences Research
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