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Refractory asthma

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https://www.readbyqxmd.com/read/29331328/pilot-clinical-trial-of-high-flow-oxygen-therapy-in-children-with-asthma-in-the-emergency-service
#1
Yolanda Ballestero, Jimena De Pedro, Nancy Portillo, Otilia Martinez-Mugica, Eunate Arana-Arri, Javier Benito
OBJECTIVES: To assess the efficacy of high-flow nasal cannula (HFNC) oxygen therapy and safety in children with asthma and moderate respiratory failure in the emergency department (ED). STUDY DESIGN: This was a prospective randomized pilot trial of children (aged 1-14 years) presenting to a tertiary academic pediatric ED with moderate-to-severe asthma exacerbations between September 2012 and December 2015. Patients with a pulmonary score (PS) ≥6 or oxygen saturation <94% with a face mask despite initial treatment (salbutamol/ipratropium bromide and corticosteroids) were randomized to HFNC or to conventional oxygen therapy...
January 11, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29310745/polyps-grommets-and-eosinophilic-granulomatosis-with-polyangiitis
#2
F G Kavanagh, W Hasan, D A Smyth, J E Fenton
OBJECTIVE: To explore the link between nasal polyposis, refractory otitis media with effusion and eosinophilic granulomatosis with polyangiitis. METHODS: A retrospective observational study was carried out of patients diagnosed with refractory otitis media with effusion necessitating grommet insertion and who had nasal polyps. Patients were evaluated to determine if they fulfilled the diagnostic criteria of eosinophilic granulomatosis with polyangiitis. RESULTS: Sixteen patients (10 males and 6 females) were identified...
January 9, 2018: Journal of Laryngology and Otology
https://www.readbyqxmd.com/read/29301919/a-randomised-clinical-trial-of-feedback-on-inhaler-adherence-and-technique-in-patients-with-severe-uncontrolled-asthma
#3
Imran Sulaiman, Garrett Greene, Elaine MacHale, Jansen Seheult, Matshediso Mokoka, Shona D'Arcy, Terence Taylor, Desmond M Murphy, Eoin Hunt, Stephen J Lane, Gregory B Diette, J Mark FitzGerald, Fiona Boland, Aoife Sartini Bhreathnach, Breda Cushen, Richard B Reilly, Frank Doyle, Richard W Costello
In severe asthma, poor control could reflect issues of medication adherence or inhaler technique, or that the condition is refractory. This study aimed to determine if an intervention with (bio)feedback on the features of inhaler use would identify refractory asthma and enhance inhaler technique and adherence.Patients with severe uncontrolled asthma were subjected to a stratified-by-site random block design. The intensive education group received repeated training in inhaler use, adherence and disease management...
January 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/29301585/a-randomised-pragmatic-trial-of-corticosteroid-optimization-in-severe-asthma-using-a-composite-biomarker-algorithm-to-adjust-corticosteroid-dose-versus-standard-care-study-protocol-for-a-randomised-trial
#4
Catherine E Hanratty, John G Matthews, Joseph R Arron, David F Choy, Ian D Pavord, P Bradding, Christopher E Brightling, Rekha Chaudhuri, Douglas C Cowan, Ratko Djukanovic, Nicola Gallagher, Stephen J Fowler, Tim C Hardman, Tim Harrison, Cécile T Holweg, Peter H Howarth, James Lordan, Adel H Mansur, Andrew Menzies-Gow, Sofia Mosesova, Robert M Niven, Douglas S Robinson, Dominick E Shaw, Samantha Walker, Ashley Woodcock, Liam G Heaney
BACKGROUND: Patients with difficult-to-control asthma consume 50-60% of healthcare costs attributed to asthma and cost approximately five-times more than patients with mild stable disease. Recent evidence demonstrates that not all patients with asthma have a typical type 2 (T2)-driven eosinophilic inflammation. These asthmatics have been called 'T2-low asthma' and have a minimal response to corticosteroid therapy. Adjustment of corticosteroid treatment using sputum eosinophil counts from induced sputum has demonstrated reduced severe exacerbation rates and optimized corticosteroid dose...
January 4, 2018: Trials
https://www.readbyqxmd.com/read/29300536/autoimmune-polyendocrine-syndrome-type-2-in-patient-with-severe-allergic-asthma-treated-with-omalizumab
#5
Anna Rams, Marek Żółciński, Weronika Zastrzeżyńska, Stanisław Polański, Agnieszka Serafin, Joanna Wilańska, Jacek Musiał, Stanisława Bazan-Socha
Asthma therapy with monoclonal antibodies is a promising and effective approach for those with a severe and refractory type of disease. Although such a targeted therapy is considered to be safe, unusual complications may occur. We present a case of a 45 year-old female patient with severe allergic asthma and chronic spontaneous urticaria, who developed autoimmune polyendocrine syndrome type 2 (APS-2) after 26 months of omalizumab administration. The patient was diagnosed with primary adrenal insufficiency (Addison's disease) and Hashimoto's thyroiditis accompanied by autoimmune atrophic gastritis...
January 4, 2018: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/29288573/omalizumab-treats-chronic-rhinosinusitis-with-nasal-polyps-and-asthma-together-a-real-life-study
#6
T Bidder, J Sahota, C Rennie, V J Lund, D S Robinson, H H Kariyawasam
INTRODUCTION: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma often coexist and thus treating both with one intervention is an attractive strategy. OBJECTIVE: To prospectively evaluate whether treatment with the monoclonal antibody against IgE Omalizumab for severe allergic asthma also effectively treats co-existent CRSwNP. METHODS: SNOT-22 and the ACQ-7 scores were recorded at 4 and 16 weeks of treatment in a cohort of patients with both CRSwNP and severe refractory allergic asthma treated with Omalizumab (n=13) according to UK guidelines for their severe asthma...
December 30, 2017: Rhinology
https://www.readbyqxmd.com/read/29282192/mast-cell-activation-syndrome
#7
Owen N Kramer, Marla S Barkoff, Claudia Hernandez
A 51-year-old woman with a history of asthma and Hashimoto's thyroiditis presented to the dermatology service with a chief complaint of "itchy bumpy rashes" that persisted beyond 24 hours. She noted that, 3 days prior to the onset of urticaria, a pyrroloquinoline quinone supplement had been started. The urticaria was accompanied by variable episodes of transient facial swelling and difficulty breathing. The patient noted that exposure to fish, nuts, and nonsteroidal anti-inflammatory drugs triggered facial swelling...
2017: Skinmed
https://www.readbyqxmd.com/read/29230220/induction-of-human-lung-mast-cell-apoptosis-by-granule-permeabilization-a-novel-approach-for-targeting-mast-cells
#8
Aida Paivandy, Martin Sandelin, Helena Igelström, Per Landelius, Christer Janson, Fabio R Melo, Gunnar Pejler
Mast cells are implicated as detrimental players in inflammatory lung diseases, particularly asthma. Mast cells respond to activating stimuli by releasing a wide panel of pro-inflammatory compounds that can contribute profoundly to the pathology, and there is currently an unmet need for strategies that efficiently ameliorate harmful effects of mast cells under such conditions. Here, we sought to evaluate a novel concept for targeting human lung mast cells, by assessing the possibility of selectively depleting the lung mast cells by induction of apoptosis...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/29229196/impact-of-allergy-on-phenotypic-and-endotypic-profiles-of-nasal-polyposis
#9
G Mortuaire, I Gengler, M Balden, M Capron, G Lefèvre
OBJECTIVES: To assess the impact of allergy on clinical presentations (phenotypes) and inflammatory patterns (endotypes) of chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: A single-center prospective study was conducted over an 18-month period. Fifty-seven patients with refractory CRSwNP were included. The diagnosis of allergy was based on concordant skin prick tests and symptoms. Phenotypes were determined on symptom severity score, polyp size classification and Lund-Mackay CT staging...
December 8, 2017: European Annals of Otorhinolaryngology, Head and Neck Diseases
https://www.readbyqxmd.com/read/29220200/a-practical-approach-to-severe-asthma-in-children
#10
Emily E Barsky, Lauren M Giancola, Sachin N Baxi, Jonathan M Gaffin
Severe asthma accounts for only a small proportion of the children with asthma, but a disproportionately high amount of resource utilization and morbidity. It is a heterogeneous entity and requires a step-wise, evidence based approach to evaluation and management by pediatric subspecialists. The first step is to confirm the diagnosis by eliciting confirmatory history and objective evidence of asthma and excluding possible masquerading diagnoses. The next step is to differentiate difficult-to-treat asthma, asthma which can be controlled with appropriate management, from asthma which requires the highest level of therapy to maintain control or remains uncontrolled despite management optimization...
December 8, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29212551/extracorporeal-membrane-oxygenation-for-life-threatening-asthma-refractory-to-mechanical-ventilation-analysis-of-the-extracorporeal-life-support-organization-registry
#11
Hye Ju Yeo, Dohyung Kim, Doosoo Jeon, Yun Seong Kim, Peter Rycus, Woo Hyun Cho
BACKGROUND: The use of extracorporeal membrane oxygenation (ECMO) in cases of near-fatal asthma (NFA) has increased, but the benefits and potential complications of this therapy have yet to be fully investigated. METHODS: Cases were extracted from the Extracorporeal Life Support Organization Registry between March 1992 and March 2016. All patients with a diagnosis of asthma (according to the International Classification of Diseases 9th edition), who also received ECMO, were extracted...
December 6, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29210504/endoscopic-modified-lothrop-procedure-after-failure-of-primary-endoscopic-sinus-surgery-a-meta-analysis
#12
Waleed M Abuzeid, Mayand Vakil, Juan Lin, Judd Fastenberg, Nadeem A Akbar, Marvin P Fried, Christina H Fang
BACKGROUND: The endoscopic modified Lothrop procedure (EMLP) has been used as a salvage technique for frontal sinusitis following failed endoscopic sinus surgery (ESS). We aim to examine the safety and efficacy of the EMLP following failure of primary ESS. METHODS: All English-language publications from 2000 to 2016 reporting the use of EMLP after primary ESS were identified using the PubMed database and evaluated per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines...
December 6, 2017: International Forum of Allergy & Rhinology
https://www.readbyqxmd.com/read/29193785/contribution-of-hiatal-hernia-to-asthma-in-patients-with-gastroesophageal-reflux-disease
#13
Zhi-Tong Li, Feng Ji, Xin-Wei Han, Lin-Xia Gu, Li Wang, Yong-Qiang Yue, Zhong-Gao Wang
BACKGROUND: To determine the correlation between asthma and hiatal hernia (HH) in patients with gastroesophageal reflux disease (GERD)-related asthma requiring laparoscopic anti-reflux surgery. METHODS: One hundred and thirty-six GERD patients with medically refractory asthma with (80 patients) or without HH (56 patients) were enrolled. Gastroesophageal reflux disease was assessed by endoscopy, esophageal manometry, reflux monitoring and symptom questionnaires, and treated with laparoscopic Nissen fundoplication (LNF) or LNF with concomitant hiatal hernia repair (LNF-HHR)...
November 28, 2017: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/29184413/near-fatal-asthma-responsive-to-mepolizumab-after-failure-of-omalizumab-and-bronchial-thermoplasty
#14
Francesco Menzella, Carla Galeone, Mirco Lusuardi, Anna Simonazzi, Claudia Castagnetti, Patrizia Ruggiero, Nicola Facciolongo
Severe asthma affects between 5% and 10% of patients with asthma worldwide and requires best standard therapies at maximal doses, but there is a subgroup of patients refractory to all treatments. We share a case report of a 53-year-old woman with a history of severe allergic asthma that progressively worsened over the years despite the best therapy. She had been hospitalized 35 times, including nine admissions to the respiratory intensive care unit due to severe exacerbations. To rule out other possible diagnoses, several investigations were performed, such as computed tomography scan of the chest and neck, fiberoptic laryngoscopy, antineutrophil cytoplasmic antibodies, and complete blood cell count...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29176991/asthma-biomarkers-in-the-age-of-biologics
#15
REVIEW
Harold Kim, Anne K Ellis, David Fischer, Mary Noseworthy, Ron Olivenstein, Kenneth R Chapman, Jason Lee
The heterogeneous nature of asthma has been understood for decades, but the precise categorization of asthma has taken on new clinical importance in the era of specific biologic therapy. The simple categories of allergic and non-allergic asthma have given way to more precise phenotypes that hint at underlying biologic mechanisms of variable airflow limitation and airways inflammation. Understanding these mechanisms is of particular importance for the approximately 10% of patients with severe asthma. Biomarkers that aid in phenotyping allow physicians to "personalize" treatment with targeted biologic agents...
2017: Allergy, Asthma, and Clinical Immunology
https://www.readbyqxmd.com/read/29176061/exhaled-breath-temperature-in-optimally-treated-asthmatics-severity-and-underlying-mechanisms
#16
Polyxeni Ntontsi, Petros Bakakos, Evgenia Papathanasiou, Zoi Tsilogianni, Konstantinos Kostikas, Georgios Hillas, Georgios Papatheodorou, Nikolaos G Koulouris, Spyridon Papiris, Stelios Loukides
ABSTRACT Introduction: Increased vascularity may lead to loss of heat in the airways and may modulate Exhaled breath temperature (EBT). Increased EBT has been associated with uncontrolled asthma. Aim: We wanted to determine whether the measurement of EBT in optimally treated asthmatic patients is influenced by the increased vascular permeability and whether Vascular endothelial growth factor (VEGF) is implicated in the above process. Furthermore, to assess the impact of asthma severity on EBT values...
November 27, 2017: Journal of Breath Research
https://www.readbyqxmd.com/read/29155876/docking-analysis-and-the-possibility-of-prediction-efficacy-for-an-anti-il-13-biopharmaceutical-treatment-with-tralokinumab-and-lebrikizumab-for-bronchial-asthma
#17
Yutaka Nakamura, Aki Sugano, Mika Ohta, Yutaka Takaoka
Interleukin-13 (IL-13) is associated with allergic airway inflammation and airway remodeling. Our group found a variant with a single nucleotide polymorphism in the IL13 gene at position +2044G>A (rs20541) that was expected to result in the non-conservative replacement of a positively charged arginine (R) with a neutral glutamine (Q) at position 144. IL-13Q144 was associated with augmented allergic airway inflammation and bronchial asthma remodeling. There is some indication that anti-IL-13 monoclonal antibodies can demonstrate a positive effect on the clinical course of refractory asthmatic patients...
2017: PloS One
https://www.readbyqxmd.com/read/29150349/frontal-sinus-revision-rate-after-nasal-polyposis-surgery-including-frontal-recess-clearance-and-middle-turbinectomy-a-long-term-analysis
#18
Hakim Benkhatar, Idir Khettab, Philippe Sultanik, Ollivier Laccourreye, Pierre Bonfils
OBJECTIVE: To determine the frontal sinus revision rate after nasal polyposis (NP) surgery including frontal recess clearance (FRC) and middle turbinectomy (MT), to search for predictive factors and to analyse surgical management. METHODS: Longitudinal analysis of 153 patients who consecutively underwent bilateral sphenoethmoidectomy with FRC and MT for NP with a minimum follow-up of 7 years. Decision of revision surgery was made in case of medically refractory chronic frontal sinusitis or frontal mucocele...
November 14, 2017: Auris, Nasus, Larynx
https://www.readbyqxmd.com/read/29133975/severe-eosinophilic-asthma-from-the-pathogenic-role-of-interleukin-5-to-the-therapeutic-action-of-mepolizumab
#19
REVIEW
Corrado Pelaia, Alessandro Vatrella, Maria Teresa Busceti, Luca Gallelli, Rosa Terracciano, Rocco Savino, Girolamo Pelaia
Mepolizumab is an anti-interleukin-5 (IL-5) humanized monoclonal antibody that has been recently approved as an add-on biological treatment for severe eosinophilic asthma, by both the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Moreover, mepolizumab is also currently included within the step 5 of the Global Initiative for Asthma guidelines, as an add-on therapy for severe uncontrolled asthma. The relevant therapeutic benefits detectable in patients with refractory eosinophilic asthma receiving mepolizumab depend on the pivotal pathogenic role played by IL-5 in these subjects...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/29120588/association-between-serpinb2-gene-expression-by-real-time-pcr-in-respiratory-epithelial-cells-and-atopic-bronchial-asthma-severity
#20
Nissreen E ELBadawy, Randa S Abdel-Latif, Hoda A El-Hady
Atopic bronchial asthma is chronic respiratory diseases of high frequency and high morbidity and mortality especially in patients refractory to the ordinary medical management. This study aimed to investigate the association between Serpin family B Member 2 (SERPINB2) gene expression and bronchial asthma severity. A total of 127 adult patients with asthma were enrolled in this study. Allergic respiratory symptoms were assessed and patients were classified according to Global Initiative for Asthma (GINA) criteria...
January 2017: Egyptian Journal of Immunology
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