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management of exacerbation of asthma adult

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https://www.readbyqxmd.com/read/29627424/asthma-across-the-lifespan-time-for-a-paradigm-shift
#1
Stanley J Szefler
We have a unique opportunity to significantly reduce the worldwide burden of asthma in children and impact respiratory outcomes in adults. However, this will require a paradigm shift that is directed at altering the natural history of asthma, reducing asthma exacerbations and preventing long-term adverse outcomes of childhood asthma. Attention should continue to be directed toward minimizing risk as well as impairment with a goal to achieve optimal control. Based on several NIH studies conducted over the last 10 years we now have the tools necessary to accomplish this goal...
April 5, 2018: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/29621204/prevalence-of-asthma-asthma-attacks-and-emergency-department-visits-for-asthma-among-working-adults-national-health-interview-survey-2011-2016
#2
Jacek M Mazurek, Girija Syamlal
In 2010, an estimated 8.2% of U.S. adults had current asthma, and among these persons, 49.1% had had an asthma attack during the past year (1). Workplace exposures can cause asthma in a previously healthy worker or can trigger asthma exacerbations in workers with current asthma* (2). To assess the industry- and occupation-specific prevalence of current asthma, asthma attacks, and asthma-related emergency department (ED) visits among working adults, CDC analyzed 2011-2016 National Health Interview Survey (NHIS) data for participants aged ≥18 years who, at the time of the survey, were employed at some time during the 12 months preceding the interview...
April 6, 2018: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/29567854/risk-factors-of-asthma-exacerbation-based-on-asthma-severity-a-nationwide-population-based-observational-study-in-south-korea
#3
Hye-Rim Kang, Hyun Jin Song, Jin Hyun Nam, Sung-Hyun Hong, So-Young Yang, SangEun Ju, Sang Won Lee, Tae-Bum Kim, Hye-Lin Kim, Eui-Kyung Lee
OBJECTIVES: Asthma exacerbation, associated with many risks factors, can reflect management failure. However, little is known about how risk factors are associated with exacerbation, according to asthma severity. We aimed to investigate differences in risk factors in patients with different asthma severity and evaluate whether risk factors differed between frequent exacerbators and patients with single exacerbation. DESIGN: Nationwide population-based observational study...
March 22, 2018: BMJ Open
https://www.readbyqxmd.com/read/29553281/assessing-medical-home-mechanisms-certification-asthma-education-and-outcomes
#4
Nathan D Shippee, Michael Finch, Douglas R Wholey
OBJECTIVES: Patient-centered medical homes (PCMHs) represent a widespread model of healthcare transformation. Despite evidence that PCMHs can improve care quality, the mechanisms by which they improve outcomes are relatively unexamined. We aimed to assess the mechanisms linking certification as a Health Care Home (HCH), a statewide PCMH initiative, with asthma care quality and outcomes. We compared direct certification effects versus indirect clinical effects (via improved care process)...
March 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29535852/nordic-consensus-statement-on-the-systematic-assessment-and-management-of-possible-severe-asthma-in-adults
#5
REVIEW
Celeste Porsbjerg, Charlotte Ulrik, Tina Skjold, Vibeke Backer, Birger Laerum, Sverre Lehman, Crister Janson, Thomas Sandstrøm, Leif Bjermer, Barbro Dahlen, Bo Lundbäck, Dora Ludviksdottir, Unnur Björnsdóttir, Alan Altraja, Lauri Lehtimäki, Paula Kauppi, Jussi Karjalainen, Hannu Kankaanranta
Although a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma ('difficult asthma') should undergo systematic assessment, in order to differentiate between true severe asthma, and 'difficult-to-treat' patients, in whom poor control is related to factors such as poor adherence or co-morbidities...
2018: European Clinical Respiratory Journal
https://www.readbyqxmd.com/read/29520161/knowledge-on-self-management-and-levels-of-asthma-control-among-adult-patients-in-ho-chi-minh-city-vietnam
#6
Vinh Nhu Nguyen, Thuong Thi Hoai Huynh, Niels H Chavannes
Background: Most asthma patients in Vietnam have poorly controlled asthma. Besides reasons related to the health care system and health care providers, knowledge on the self-management of patients has also contributed to this situation. Purpose: To assess knowledge on asthma self-management among adult asthma patients in Ho Chi Minh City. Patients and methods: A cross-sectional study with convenience sampling was conducted among 322 ambulatory patients using questionnaires filled in via a face-to-face interview...
2018: International Journal of General Medicine
https://www.readbyqxmd.com/read/29504499/quadrupling-inhaled-glucocorticoid-dose-to-abort-asthma-exacerbations
#7
RANDOMIZED CONTROLLED TRIAL
Tricia McKeever, Kevin Mortimer, Andrew Wilson, Samantha Walker, Christopher Brightling, Andrew Skeggs, Ian Pavord, David Price, Lelia Duley, Mike Thomas, Lucy Bradshaw, Bernard Higgins, Rebecca Haydock, Eleanor Mitchell, Graham Devereux, Timothy Harrison
BACKGROUND: Asthma exacerbations are frightening for patients and are occasionally fatal. We tested the concept that a plan for patients to manage their asthma (self-management plan), which included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate, would reduce the incidence of severe asthma exacerbations among adults and adolescents with asthma. METHODS: We conducted a pragmatic, unblinded, randomized trial involving adults and adolescents with asthma who were receiving inhaled glucocorticoids, with or without add-on therapy, and who had had at least one exacerbation in the previous 12 months...
March 8, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29469993/asthma-among-adult-patients-presenting-with-dyspnea-to-the-emergency-department-an-observational-study
#8
Win Sen Kuan, Simon Craig, Anne-Maree Kelly, Gerben Keijzers, Sharon Klim, Colin A Graham, Peter Jones, Anna Holdgate, Charles Lawoko, Said Laribi
INTRODUCTION: Shortness of breath is a common presenting symptom to the emergency department (ED) that can arise from a myriad of possible diagnoses. Asthma is one of the major causes. OBJECTIVE: To describe the demographic features, clinical characteristics, management and outcomes of adults with an emergency department (ED) diagnosis of asthma who presented to an ED in the Asia Pacific region with a principal symptom of dyspnea. METHODS: Planned sub-study of patients with an ED diagnosis of asthma identified in the Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study...
February 22, 2018: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/29445292/late-onset-asthma-current-perspectives
#9
REVIEW
Tsunahiko Hirano, Kazuto Matsunaga
Because the pathophysiology of asthma has diverse characteristics, to manage the disease effectively, it is important for clinicians to distinguish among the clinical phenotypes. Among them, adult-onset asthma, that is, late-onset asthma (LOA), is increasing because of the aging of the population. The phenotype of LOA is largely divided into two types according to the presence or absence of eosinophilic inflammation, T-helper (Th)2- and non-Th2-associated LOA. Especially in Th2 LOA related to rhinosinusitis, as pulmonary function at onset is poor and asthma exacerbations occur frequently, it is important to detect this phenotype in the early phase by using a biomarker of Th2-type inflammation such as fractional exhaled nitric oxide (FE NO )...
2018: Journal of Asthma and Allergy
https://www.readbyqxmd.com/read/29427984/controlling-the-risk-domain-in-pediatric-asthma-through-personalized-care
#10
William C Anderson, Stanley J Szefler
Strategies to control the risk domain of NHLBI EPR-3 (National Heart, Lung, and Blood Institute Expert Panel Report-3) asthma guidelines, which includes exacerbations requiring systemic corticosteroids, reduction in lung growth, and progressive loss of lung function, and treatment-related adverse effects, are evolving in children and adolescents. Increasing evidence demonstrates that children and adolescents with asthma are at risk of a reduction in lung growth, leading to lower lung function and potentially chronic obstructive pulmonary disease as adults...
February 2018: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29411860/self-management-for-bronchiectasis
#11
REVIEW
Carol Kelly, Seamus Grundy, Dave Lynes, David Jw Evans, Sharada Gudur, Stephen J Milan, Sally Spencer
BACKGROUND: Bronchiectasis is a long term respiratory condition with an increasing rate of diagnosis. It is associated with persistent symptoms, repeated infective exacerbations, and reduced quality of life, imposing a burden on individuals and healthcare systems. The main aims of therapeutic management are to reduce exacerbations and improve quality of life. Self-management interventions are potentially important for empowering people with bronchiectasis to manage their condition more effectively and to seek care in a timely manner...
February 7, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29404176/the-reliability-and-validation-of-the-turkish-version-of-the-asthma-self-management-knowledge-questionnaire
#12
Arzu Baygül, Ayşe Bilge Öztürk, Leyla Pur Özyiğit, Havva Keskin, Gül Karakaya, Fuat Kalyoncu, Mustafa Şükrü Şenocak
OBJECTIVES: There is no validated questionnaire in Turkish to assess asthma knowledge. In this study, we aimed to evaluate the reliability and validity of the Turkish version of the Asthma Self-Management Knowledge Questionnaire (AKQ) among asthmatic adults. MATERIAL AND METHODS: The AKQ was translated into Turkish by two medical-text translators, followed by back translation and final review by two clinicians with experience in asthma management. The Turkish Asthma Self-Management Questionnaire was then applied to 202 adult asthma patients, and additional demographic and clinical features of the patients were collected for analysis...
October 2017: Turkish Thoracic Journal
https://www.readbyqxmd.com/read/29368127/efficacy-and-safety-of-tiotropium-in-children-and-adolescents
#13
REVIEW
Eckard Hamelmann, Stanley J Szefler
Asthma is one of the most common chronic diseases in children, with a high proportion of patients demonstrating poor control despite the availability of disease management guidelines. Global Initiative for Asthma guidelines include tiotropium as an add-on therapy option at Steps 4 and 5 in patients aged ≥ 12 years with a history of exacerbations, and tiotropium delivered via the Respimat® Soft Mist™ Inhaler has recently been approved for use as once-daily maintenance therapy for children with asthma over the age of 6 years in the USA...
January 24, 2018: Drugs
https://www.readbyqxmd.com/read/29273246/asthma
#14
REVIEW
Alberto Papi, Christopher Brightling, Søren E Pedersen, Helen K Reddel
Asthma-one of the most common chronic, non-communicable diseases in children and adults-is characterised by variable respiratory symptoms and variable airflow limitation. Asthma is a consequence of complex gene-environment interactions, with heterogeneity in clinical presentation and the type and intensity of airway inflammation and remodelling. The goal of asthma treatment is to achieve good asthma control-ie, to minimise symptom burden and risk of exacerbations. Anti-inflammatory and bronchodilator treatments are the mainstay of asthma therapy and are used in a stepwise approach...
February 24, 2018: Lancet
https://www.readbyqxmd.com/read/29238240/the-effect-of-dpp-4-inhibitors-on-asthma-control-an-administrative-database-study-to-evaluate-a-potential-pathophysiological-relationship
#15
Gene Colice, David Price, Maria Gerhardsson de Verdier, Karma Rabon-Stith, Christopher Ambrose, Katherine Cappell, Debra E Irwin, Paul Juneau, Anna Vlahiotis
Rationale: DPP-4 may regulate immunological pathways implicated in asthma. Assessing whether DPP-4 inhibitor (DPP-4i) use might affect asthma control is clinically important because DPP-4i use in type 2 diabetes mellitus management (T2DM) is increasing. This study evaluated associations between DPP-4i use and asthma control. Methods: This was a retrospective, observational, matched cohort study using administrative claims in the MarketScan® Commercial Claims and Encounters (Commercial) and Medicare Supplemental and Coordination of Benefits (Medicare Supplemental) databases...
2017: Pragmatic and Observational Research
https://www.readbyqxmd.com/read/29207999/corticosteroid-plus-%C3%AE-2-agonist-in-a-single-inhaler-as-reliever-therapy-in-intermittent-and-mild-asthma-a-proof-of-concept-systematic-review-and-meta-analysis
#16
REVIEW
Gang Wang, Xin Zhang, Hong Ping Zhang, Lei Wang, De Ying Kang, Peter J Barnes, Gang Wang
BACKGROUND: Current guidelines recommend a single inhaler maintenance and reliever therapy (SMART) regimen for moderate to severe asthma. However, evidence for the inhaled corticosteroid plus fast-onset-acting β2 -agonist (ICS/FABA) as reliever therapy in management of intermittent and mild asthma patients is lacking. OBJECTIVE: To systematically explore efficacy and safety of the proof-of-concept of the ICS plus FABA regimen in a single inhaler as reliever therapy across children and adults with intermittent and mild persistent asthma...
December 6, 2017: Respiratory Research
https://www.readbyqxmd.com/read/29169365/physician-perspectives-on-the-burden-and-management-of-asthma-in-six-countries-the-global-asthma-physician-survey-gaps
#17
Kenneth R Chapman, David Hinds, Peter Piazza, Chantal Raherison, Michael Gibbs, Timm Greulich, Kenneth Gaalswyk, Jiangtao Lin, Mitsuru Adachi, Kourtney J Davis
BACKGROUND: Despite recognition of asthma as a growing global issue and development of global guidelines, asthma treatment practices vary between countries. Several studies have reported patients' perspectives on asthma control. This study presents physicians' perspectives and strategies for asthma management. METHODS: Physicians seeing ≥4 adult patients with asthma per month in Australia, Canada, China, France, Germany, and Japan were surveyed (N=1809; ≈300 per country)...
November 23, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29105786/influenza-burden-prevention-and-treatment-in-asthma-a-scoping-review-by-the-eaaci-influenza-in-asthma-task-force
#18
REVIEW
J Schwarze, P Openshaw, A Jha, S R Del Giacco, D Firinu, O Tsilochristou, G Roberts, A Selby, C Akdis, I Agache, A Custovic, E Heffler, G Pinna, M Khaitov, A Nikonova, N Papadopoulos, A Akhlaq, U Nurmatov, H Renz, A Sheikh, C Skevaki
To address uncertainties in the prevention and management of influenza in people with asthma, we performed a scoping review of the published literature on influenza burden; current vaccine recommendations; vaccination coverage; immunogenicity, efficacy, effectiveness, and safety of influenza vaccines; and the benefits of antiviral drugs in people with asthma. We found significant variation in the reported rates of influenza detection in individuals with acute asthma exacerbations making it unclear to what degree influenza causes exacerbations of underlying asthma...
November 6, 2017: Allergy
https://www.readbyqxmd.com/read/29101938/practical-considerations-for-the-diagnosis-and-management-of-asthma-in-older-adults
#19
REVIEW
Barbara P Yawn, MeiLan K Han
Although often considered a disease of childhood, the prevalence of asthma in US adults aged 65 years or older is similar to that in children, with the number of older patients needing care for asthma likely to continue to increase. As with most chronic diseases, there are challenges associated with the diagnosis and management of asthma in an older population. This review discusses these challenges, suggesting practical management strategies for primary care physicians and their teams. Asthma comprises a spectrum of phenotypes, some associated with adult onset...
November 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29080708/classification-of-cough-as-a-symptom-in-adults-and-management-algorithms-chest-guideline-and-expert-panel-report
#20
Richard S Irwin, Cynthia L French, Anne B Chang, Kenneth W Altman
BACKGROUND: We performed systematic reviews using the population, intervention, comparison, outcome (PICO) format to answer the following key clinical question: Are the CHEST 2006 classifications of acute, subacute and chronic cough and associated management algorithms in adults that were based on durations of cough useful? METHODS: We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework...
January 2018: Chest
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