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Emergency treatment asthma

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https://www.readbyqxmd.com/read/28328592/status-asthmaticus-and-central-herniation-a-case-for-multidisciplinary-critical-care
#1
Joelle B Karlik, Tristan Stani, Stephanie Nonas, Aclan Dogan, Ansgar Brambrink
A 24-year-old woman with history of asthma was intubated emergently for acute status asthmaticus triggered by acute respiratory syncytial virus infection and treated with permissive hypercapnia. Her ventilation was complicated by auto-positive end-expiratory pressure and elevated peak airway, plateau, and central venous pressures. On hospital day 2, she was noted to have anisocoria. Imaging showed diffuse cerebral edema with central herniation. Difficult ventilation and hypercapnia directly contributed to her severe cerebral edema...
March 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28327480/pharmacotherapy-of-patients-with-stable-bronchial-asthma
#2
REVIEW
Ashutosh Nath Aggarwal
Several reliever and controller medications are available for managing patients with stable asthma. Inhaled corticosteroids (ICS) are the mainstay of treatment, and can be combined with long-acting beta-agonists (LABA) for patients with moderate or severe disease. An ICS-LABA combination is best administered as a single inhaler used for both maintenance and emergency use. A stepwise approach to therapy has recently been proposed as part of Indian guidelines for management of asthma. Clinicians should advise proper use of inhaled medications, and step up or step down treatment based on adequacy of asthma control...
November 2016: National Medical Journal of India
https://www.readbyqxmd.com/read/28327130/obstructive-sleep-apnoea-accelerates-fev1-decline-in-asthmatic-patients
#3
Tsai-Yu Wang, Yu-Lun Lo, Shu-Min Lin, Chien-Da Huang, Fu-Tasi Chung, Horng-Chyuan Lin, Chun-Hua Wang, Han-Pin Kuo
BACKGROUND: Although the prevalence of both obstructive sleep apnoea (OSA) and asthma are both increasing, little is known about the impact of OSA on the natural history of lung function in asthmatic patients. METHODS: A total of 466 patients from our sleep laboratory were retrospectively enrolled. Of them, 77 patients (16.5%) had asthma with regular follow-up for more than 5 years. Their clinical characteristics, pulmonary function, emergency room visits, and results of polysomnography results were analysed...
March 21, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28319473/precision-medicine-in-asthma-the-role-of-bronchial-thermoplasty
#4
Amber J Oberle, Praveen Mathur
PURPOSE OF REVIEW: The inflammatory makeup of severe asthma is heterogeneous. Identification of the predominant cellular endotype via biomarkers can aid in the selection of more advanced therapies. This review is clinically focused on how to use these biomarkers to help select between biologic agents and/or bronchial thermoplasty. RECENT FINDINGS: Several Th2 biomarkers exist for the detection of eosinophilic disease; however, the best biomarker for clinical practice is debatable depending upon local resources...
March 17, 2017: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/28306629/management-of-acute-asthma-exacerbations
#5
Erin K Stenson, Michael J Tchou, Derek S Wheeler
PURPOSE OF REVIEW: Herein, we review the current guidelines for the management of children with an acute asthma exacerbation. We focus on management in the emergency department, inpatient, and ICU settings. RECENT FINDINGS: The most recent statistics show that the prevalence of asthma during childhood has decreased in certain demographic subgroups and plateaued in other subgroups. However, acute asthma accounts for significant healthcare expenditures. Although there are few, if any, newer therapeutic agents available for management of acute asthma exacerbations, several reports leveraging quality improvement science have shown significant reductions in costs of care as well as improvements in outcome...
March 16, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28286057/quality-of-primary-care-for-children-with-disabilities-enrolled-in-medicaid
#6
Alyna T Chien, Karen A Kuhlthau, Sara L Toomey, Jessica A Quinn, Megumi J Okumura, Dennis Z Kuo, Amy J Houtrow, Jeanne Van Cleave, Mary Beth Landrum, Jisun Jang, Isabel Janmey, Michael J Furdyna, Mark A Schuster
OBJECTIVE: The quality of primary care delivered to Medicaid-insured children with disabilities (CWD) is unknown. We used the newly validated CWD algorithm (CWDA) to examine CWD prevalence among Medicaid enrollees 1 to 18 years old, primary care quality for CWD, and differences in primary care quality for CWD and non-CWD. METHODS: Cross-sectional study using 2008 Medicaid Analytic eXtract claims data from 9 states, including children with at least 11 months of enrollment (N = 2,671,922 enrollees)...
March 9, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28284473/positive-expiratory-pressure-for-the-treatment-of-acute-asthma-exacerbations-a-randomized-controlled-trial
#7
Nidhya Navanandan, Monica Federico, Rakesh D Mistry
OBJECTIVES: To evaluate the efficacy of brief, single administration of positive expiratory pressure (PEP) therapy in reducing clinical severity and need for additional second-line therapies and hospitalization in children presenting to the emergency department (ED) with acute asthma. STUDY DESIGN: This was a prospective randomized controlled trial of children 2-18 years of age presenting to a tertiary-care academic pediatric ED with moderate-to-severe asthma exacerbations from December 2014 to June 2016...
March 8, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28277854/economic-analysis-of-the-phase-iii-mensa-study-evaluating-mepolizumab-for-severe-asthma-with-eosinophilic-phenotype
#8
Anirban Basu, Anand Dalal, Giorgio Walter Canonica, Mark Forshag, Steven W Yancey, Saurabh Nagar, Christopher F Bell
BACKGROUND: Severe eosinophilic asthma patients are at risk of exacerbations, which are associated with substantial costs. Mepolizumab lowers eosinophil levels and reduces exacerbation risk in severe eosinophilic asthma. We evaluated asthma-related exacerbation costs in mepolizumab-treated patients (versus placebo). RESEARCH DESIGN AND METHODS: A within-trial economic analysis of the Mepolizumab as Adjunctive Therapy in Patients with Severe Asthma (MENSA) trial...
March 2, 2017: Expert Review of Pharmacoeconomics & Outcomes Research
https://www.readbyqxmd.com/read/28275137/a-ceacam6-high-airway-neutrophil-phenotype-and-ceacam6-high-epithelial-cells-are-features-of-severe-asthma
#9
Aarti Shikotra, David F Choy, Salman Siddiqui, Greer Arthur, Deepti R Nagarkar, Guiquan Jia, Adam K A Wright, Chandra M Ohri, Emma Doran, Claire A Butler, Beverley Hargadon, Alexander R Abbas, Janet Jackman, Lawren C Wu, Liam G Heaney, Joseph R Arron, Peter Bradding
Severe asthma represents a major unmet clinical need; understanding the pathophysiology is essential for the development of new therapies. Using microarray analysis, we previously found three immunological clusters in asthma: Th2-high, Th17-high, and Th2/17-low. Although new therapies are emerging for Th2-high disease, identifying molecular pathways in Th2-low disease remains an important goal. Further interrogation of our previously described microarray dataset revealed upregulation of gene expression for carcinoembryonic Ag cell adhesion molecule (CEACAM) family members in the bronchi of patients with severe asthma...
March 8, 2017: Journal of Immunology: Official Journal of the American Association of Immunologists
https://www.readbyqxmd.com/read/28274526/efficacy-of-long-term-omalizumab-therapy-in-patients-with-severe-asthma
#10
Junko Saji, Takahito Yamamoto, Motonaka Arai, Masamichi Mineshita, Teruomi Miyazawa
BACKGROUND: The efficacy of omalizumab, an anti-immunoglobulin E (IgE) antibody, has been studied in patients with severe bronchial asthma. We conducted a study to evaluate, on the basis of both objective and subjective measures, the efficacy of omalizumab as a long-term therapy in patients with severe and persistent asthma. METHODS: Omalizumab was administered subcutaneously every two or four weeks. The results of pulmonary function tests, Asthma Control Test (ACT) and Asthma Health Questionnaire (AHQ)-33 scores, the dosage of methylprednisolone during the 12-month treatment period, and the number of emergency visits prior to the start of treatment with omalizumab were compared in patients pre- and post-treatment with omalizumab...
March 2017: Respiratory Investigation
https://www.readbyqxmd.com/read/28270657/the-impact-of-poor-asthma-control-among-asthma-patients-treated-with-inhaled-corticosteroids-plus-long-acting-%C3%AE-2-agonists-in-the-united-kingdom-a-cross-sectional-analysis
#11
Ian D Pavord, Nicola Mathieson, Anna Scowcroft, Riccardo Pedersini, Gina Isherwood, David Price
There are several new treatment options for patients whose asthma remains uncontrolled on free-dose and fixed-dose combinations of inhaled corticosteroids plus long-acting β2-agonists (ICS+LABA). In order to evaluate the likely impact of these treatments, we assessed the effect of uncontrolled asthma on healthcare and patient burden within the UK among adult patients treated with ICS+LABA. Data obtained from 2010-2011 UK National Health and Wellness Surveys identified 701 patients treated with ICS+LABA. Patients with not well-controlled asthma (Asthma Control Test™ score <20) were compared with well-controlled asthma (score ≥ 20) patients on multiple measures...
December 2017: NPJ Primary Care Respiratory Medicine
https://www.readbyqxmd.com/read/28262319/initiation-of-an-inhaled-corticosteroid-during-a-pediatric-emergency-visit-for-asthma-a%C3%A2-randomized-clinical-trial
#12
Esther M Sampayo, Maryann Mazer-Amirshahi, Elizabeth A Camp, Joseph J Zorc
STUDY OBJECTIVE: We determine whether prescribing an inhaled corticosteroid during a pediatric emergency department (ED) asthma visit increases ongoing use and improves outcomes. METHODS: This randomized trial enrolled children aged 1 to 18 years, with persistent asthma not previously prescribed a controller medication, and who were being discharged after ED asthma treatment. Intervention subjects received a 1-month prescription for an inhaled corticosteroid (fluticasone or budesonide by age) in addition to standard asthma therapy and instructions given to all patients...
February 24, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28262075/minimising-wheeze-in-the-under-threes-developing-a-respiratory-assessment-clinic-for-children
#13
Elizabeth Jane Wood
A reluctance to diagnose asthma in children under three who have recurrent cough and wheeze causes delays in the commencement of appropriate asthma treatment. Timely inhaled corticosteroid use may reduce asthma exacerbations and unnecessary visits to the emergency department and GPs. To address this delay, an advanced nurse practitioner in one children's community nursing team set up a respiratory assessment clinic for children under three who had recurrent respiratory difficulties. This article describes the rationale and the evidence base that supports a clinic of this kind and reports on its initial results...
March 6, 2017: Nursing Children and Young People
https://www.readbyqxmd.com/read/28261576/personalized-medicine-in-allergic-asthma-at-the-crossroads-of-allergen-immunotherapy-and-biologicals
#14
REVIEW
Benedikt Fritzsching
Major allergic disease can be viewed as clinical syndromes rather than discrete disease entities. Emerging evidence indicates that allergic asthma includes several disease phenotypes. Immunological deviation toward high T helper cell type 2 cytokine levels has been demonstrated for a subgroup of pediatric asthma patients, and now, several novel monoclonal antibodies have been approved for treatment of this subgroup as a stratified approach of "personalized" medicine in allergy. Introduction of component-based IgE testing before allergen immunotherapy (AIT), i...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28261214/the-influence-of-the-microbiome-on-early-life-severe-viral-lower-respiratory-infections-and-asthma-food-for-thought
#15
REVIEW
Jason P Lynch, Md Al Amin Sikder, Bodie F Curren, Rhiannon B Werder, Jennifer Simpson, Páraic Ó Cuív, Paul G Dennis, Mark L Everard, Simon Phipps
Severe viral lower respiratory infections are a major cause of infant morbidity. In developing countries, respiratory syncytial virus (RSV)-bronchiolitis induces significant mortality, whereas in developed nations the disease represents a major risk factor for subsequent asthma. Susceptibility to severe RSV-bronchiolitis is governed by gene-environmental interactions that affect the host response to RSV infection. Emerging evidence suggests that the excessive inflammatory response and ensuing immunopathology, typically as a consequence of insufficient immunoregulation, leads to long-term changes in immune cells and structural cells that render the host susceptible to subsequent environmental incursions...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28251880/choosing-wisely-canada%C3%A2-five-tests-procedures-and-treatments-to-question-in-emergency-medicine
#16
Amy H Y Cheng, Sam Campbell, Lucas B Chartier, Tom Goddard, Kirk Magee, Jill McEwen, Atul K Kapur, Brian R Holroyd, Suneel Upadhye, Stephanie Couperthwaite, Brian H Rowe
OBJECTIVES: Choosing Wisely Canada (CWC) is an initiative to encourage patient-physician discussions about the appropriate, evidence based use of medical tests, procedures and treatments. We present the Canadian Association of Emergency Physicians' (CAEP) top five list of recommendations, and the process undertaken to generate them. METHODS: The CAEP Expert Working Group (EWG) generated a candidate list of 52 tests, procedures, and treatments in emergency medicine whose value to care was questioned...
March 2, 2017: CJEM
https://www.readbyqxmd.com/read/28245723/asthma-exacerbations-factors-related-to-longer-hospital-stay
#17
Francisco-Javier Gonzalez-Barcala, Uxio Calvo-Alvarez, Francisco-Javier Salgado-Castro, David Facal, Maria-Teresa Garcia-Sanz, Xavier Muñoz, Nuria Garcia-Couceiro, Olalla Paz-Neira, Esther San-Jose, Luis Valdes-Cuadrado, Jose-Martin Carreira
BACKGROUND: Hospital admissions account for a significant part of asthma cost, but with significant differences between geographic areas. AIMS: The aim of our study is to analyse hospital admissions due to asthma, as well as the factors associated with longer hospital stays. METHODS: A review was retrospectively carried out on all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010...
March 1, 2017: Acta Clinica Belgica
https://www.readbyqxmd.com/read/28241820/examining-the-role-of-abc-lipid-transporters-in-pulmonary-lipid-homeostasis-and-inflammation
#18
REVIEW
Amanda B Chai, Alaina J Ammit, Ingrid C Gelissen
Respiratory diseases including asthma and chronic obstructive pulmonary disease (COPD) are characterised by excessive and persistent inflammation. Current treatments are often inadequate for symptom and disease control, and hence new therapies are warranted. Recent emerging research has implicated dyslipidaemia in pulmonary inflammation. Three ATP-binding cassette (ABC) transporters are found in the mammalian lung - ABCA1, ABCG1 and ABCA3 - that are involved in movement of cholesterol and phospholipids from lung cells...
February 28, 2017: Respiratory Research
https://www.readbyqxmd.com/read/28223227/mitogen-activated-protein-kinases-as-therapeutic-targets-for-asthma
#19
REVIEW
MirHojjat Khorasanizadeh, Mahsa Eskian, Erwin W Gelfand, Nima Rezaei
Corticosteroid-resistant asthmatics, although comprising only a portion of the asthma population, account for most of the morbidity, mortality and economic burden associated with asthma. Moreover, corticosteroids are not effective inhibitors of airway remodeling changes, and their long-term use is associated with debilitating systemic side effects. Therefore, potent and safe novel therapeutic alternatives, targeting basic pathophysiological mechanisms responsible for the severe asthmatic phenotype are urgently needed...
February 14, 2017: Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28208047/targeted-therapy-for-chronic-respiratory-disease-a-new-paradigm
#20
Peter G Gibson, Matthew J Peters, Claire E Wainwright
Targeted therapy has emerged as a highly effective treatment approach for chronic respiratory diseases. Many of these conditions have dismal outcomes; however, targeted therapy shows great results for the subgroup who respond. This represents a new way to approach these conditions and offers great promise as a future treatment direction. In severe eosinophilic asthma, therapy that targets the interleukin-5 pathway with monoclonal antibodies leads to a 50% reduction in asthma exacerbations in previously refractory disease...
February 20, 2017: Medical Journal of Australia
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