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Steroid sparing agents asthma

David Bilocca, B Hargadon, I D Pavord, R H Green, C E Brightling, P Bradding, A J Wardlaw, N Martin, A C Murphy, S Siddiqui
The use of oral methotrexate for refractory eosinophilic asthma in a tertiary asthma referral centre, Glenfield Hospital, Leicester, was evaluated between January 2006 and December 2014. The patients ( n = 61) were carefully phenotyped at baseline with markers of airway inflammation. In addition, a structured oral methotrexate proforma was utilized to evaluate response to therapy and adverse events. Oral steroid withdrawal was attempted 3 months after commencing treatment. Several outcomes were evaluated at 12 months, including both efficacy and adverse effects; 15% ( n = 9/61) responded by achieving a decrease in daily oral corticosteroid dose (mean 8...
January 1, 2017: Chronic Respiratory Disease
Vivi Q Nguyen, Charlotte S Ulrik
BACKGROUND: Maintenance therapy with oral corticosteroid (OCS) is used, although not based on evidence, for patients with severe asthma, but OCS is associated with serious adverse effects; therefore, management strategies aimed at steroid sparing are important. OBJECTIVE: To provide an update on the evidence for OCS-sparing strategies in adults with severe asthma. METHODS: A systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines...
November 2016: Allergy and Asthma Proceedings:
T Leu, S Rauthe, C Wirth, H-U Simon, V Kunzmann, H Hebestreit, S Kunzmann
Based on a case report an overview on the differential diagnostic considerations with respect to blood hypereosinophilia (HE) and hypereosinophilic syndromes (HES) in childhood is given. A 13-year-old boy was admitted for the clarification of an asthma. In the blood count an increased HE with 3 500/µl (30%) was found along with elevated total serum IgE and IL-5 level (2 000 IU/ml and 17 pg/ml). Lung function showed an obstruction (FEV1 38%). Radiologically the picture of bronchiectasis and mucus pluggine appeared...
November 2016: Klinische Pädiatrie
Evgenia Papathanassiou, Stelios Loukides, Petros Bakakos
Severe asthma is a discrete clinical entity characterised by recurrent exacerbations, reduced quality of life and poor asthma control as ordinary treatment regimens remain inadequate. Difficulty in managing severe asthma derives partly from the multiple existing phenotypes and our inability to recognise them. Though the exact pathogenetic pathway of severe allergic asthma remains unclear, it is known that numerous inflammatory cells and cytokines are involved, and eosinophils represent a key inflammatory cell mediator...
2016: European Clinical Respiratory Journal
Amit D Parulekar, Zuzana Diamant, Nicola A Hanania
PURPOSE OF REVIEW: Severe asthma is a heterogeneous syndrome that can be classified into distinct phenotypes and endotypes. In the type 2 (T2)-high endotype, multiple cytokines are produced that lead to eosinophilic inflammation. These cytokines and their receptors are targets for biologic therapies in patients with severe asthma who do not respond well to standard therapy with inhaled corticosteroids. RECENT FINDINGS: In the last decade, an increasing number of biologic therapies have been developed targeting T2 inflammation...
January 2017: Current Opinion in Pulmonary Medicine
Claudio Sorino, Sergio Agati, Giuseppe Milani, Annarosa Maspero
We present a case of a 49-year-old man, with a 10-year history of bronchial asthma and nasal polyposis, who developed acutely painful paraplegia and paresthesias. Laboratory data showed elevated blood creatine kinase levels and myoglobinuria, which were diagnostic for rhabdomyolysis but only partially explained the neurological deficit. Electrophysiological studies revealed a sensorimotor neuropathy of multiple mononeuritis type. The patient also had leucocytosis with marked eosinophilia and antineutrophil cytoplasmic autoantibodies...
June 30, 2014: BMJ Case Reports
Derrica Y Walker, Krystal L Edwards
PURPOSE: Current evidence on statin agents as potential alternatives or adjuncts to corticosteroid therapy for asthma is reviewed. SUMMARY: Research showing antiinflammatory and antioxidant effects of statins in animal models suggested that the cholesterol-lowering drugs might be useful in mitigating the adverse effects of long-term corticosteroid therapy in patients with asthma, but studies in humans have yielded mixed results. Two small placebo-controlled clinical trials indicated that statins were not effective in combating asthmatic inflammatory processes, and trials of statins as adjunctive therapy have indicated minimal steroid-sparing benefits...
October 1, 2013: American Journal of Health-system Pharmacy: AJHP
R Agarwal, A Chakrabarti, A Shah, D Gupta, J F Meis, R Guleria, R Moss, D W Denning
Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus, manifesting with poorly controlled asthma, recurrent pulmonary infiltrates and bronchiectasis. There are estimated to be in excess of four million patients affected world-wide. The importance of recognizing ABPA relates to the improvement of patient symptoms, and delay in development or prevention of bronchiectasis, one manifestation of permanent lung damage in ABPA. Environmental factors may not be the only pathogenetic factors because not all asthmatics develop ABPA despite being exposed to the same environment...
August 2013: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
Hasan Yuksel, Ozge Yilmaz, Meral Karaman, H Alper Bagriyanik, Fatih Firinci, Muge Kiray, Ahmet Turkeli, Ozkan Karaman
BACKGROUND: Vascular endothelial growth factor (VEGF) is an important mediator of the neoangiogenesis component of remodeling in asthma. OBJECTIVE: To evaluate the influence of VEGF blockage on airway remodeling, specifically epithelium thickness, subepithelial smooth muscle thickness, number of mast and goblet cells, and basement membrane thickness, in a mouse model of chronic asthma. METHODS: We used 30 BALB/c mice. The control group was not exposed to ovalbumin or any medication (group 1)...
March 2013: Annals of Allergy, Asthma & Immunology
Katie S Adams, Denise K Lowe
OBJECTIVE: To review the literature evaluating the efficacy and steroid-sparing effect of tiotropium for inadequately controlled persistent asthma in adults. DATA SOURCES: Information was obtained through a search of MEDLINE/PubMed (1966-October 2012), using the terms asthma and tiotropium. A further review of reference citations was performed to identify other relevant articles. STUDY SELECTION AND DATA EXTRACTION: English-language case reports and clinical trials were reviewed...
January 2013: Annals of Pharmacotherapy
Jennifer Collins, Gabriele Devos, Golda Hudes, David Rosenstreich
BACKGROUND: Current therapy for allergic bronchopulmonary aspergillosis (ABPA) uses oral corticosteroids, exposing patients to the adverse effects of these agents. There are reports of the steroid-sparing effect of anti-IgE therapy with omalizumab for ABPA in patients with cystic fibrosis (CF), but there is little information on its efficacy against ABPA in patients with bronchial asthma without CF. OBJECTIVE: To examine the effects of omalizumab, measured by asthma control, blood eosinophilia, total serum immunoglobulin E (IgE), oral corticosteroid requirements, and forced expiratory volume spirometry in patients with ABPA and bronchial asthma...
2012: Journal of Asthma and Allergy
Sian Evans, Ramesh J Kurukulaaratchy
INTRODUCTION: Obesity and asthma have become increasingly prevalent conditions in recent years; they often coexist and place a significant burden on the National Health Service. Asthma in the obese is more difficult to treat than in those with a normal body mass index (BMI) and is associated with resistance to traditional asthma therapies and increased use of healthcare resources. Weight loss can improve asthma control in such patients. The degree of weight loss achieved through dietary strategies, however, is often only modestly successful in this group...
February 2013: Journal of Asthma: Official Journal of the Association for the Care of Asthma
Aarif O Eifan
Asthma is a heterogeneous disorder with a variable course. It begins very early in life and of different phenotypes. Mainstay treatment for asthma is corticosteroids as controller therapy and guidelines recommends the add-on and step-up or step-down strategies. This review will focus on the studies that enhanced our understandings of the effects of inhaled corticosteroids on the natural course of asthma in regard to symptoms control, protective effect on lung function and potential side effects encountered during the treatment...
2012: Anti-inflammatory & Anti-allergy Agents in Medicinal Chemistry
Diana Silva, Mariana Couto, Luís Delgado, André Moreira
BACKGROUND: Statins are known for their lipid-lowering effects and role in the treatment of atherosclerotic disease. They also have anti-inflammatory and immunomodulatory properties which could benefit asthma patients. We aimed to review the evidence on the efficacy and safety of statins in asthma-related outcomes. METHODS: A systematic review of the literature on the effects of statins on asthma-related outcomes was performed following a search of the National Guideline Clearinghouse, Cochrane, Scopus, and Pubmed Medline databases in January 2012...
November 2012: Journal of Asthma: Official Journal of the Association for the Care of Asthma
Christopher H Fanta, Aidan A Long
Patients with severe asthma have considerable morbidity related to their asthma and are at risk for serious, life-threatening exacerbations. Their management requires an intensive and comprehensive approach, including attention to reducing exposure to environmental inciters of airway inflammation and triggers of symptoms, patient education (including an asthma action plan), and opportunity for close patient-provider communication. Approved medical options include the lipoxygenase inhibitor, zileuton; the anti-immunoglobulin E monoclonal antibody, omalizumab; and bronchial thermoplasty...
July 2012: Allergy and Asthma Proceedings:
F Schleich, R Louis
Asthma is a chronic inflammatory disease of the airways. The inflammatory process is driven by different pathways involving cytokines and other protein mediators. Patients with severe asthma are at high risk of severe exacerbations and death and have few therapeutic options available. Therefore, biological agents have been developed to help patients with refractory asthma by interfering with several compounds of the asthma inflammatory cascade. In addition to decreasing exacerbations, some of those treatments have a steroid sparing role and many beneficial effects in asthmatics...
2012: Revue Médicale de Liège
Mitsuhiro Kamimura, Shinyu Izumi, Yoichiro Hamamoto, Akane Morita, Emiko Toyota, Nobuyuki Kobayashi, Koichiro Kudo
BACKGROUND: The particle distribution might differ between nebulizer therapy and metered-dose inhaler (MDI) or dry powder inhaler (DPI) therapy because the particles repeatedly enter/re-enter the airways with the nebulizer. Inhaled corticosteroids (ICS) were administered with a nebulizer to assess the benefit of changes in the distribution of particles in patients with cough variant asthma (CVA) and cough-predominant asthma (CPA). METHODS: Patients whose symptoms were not controlled by their current therapy were enrolled...
September 2012: Allergology International: Official Journal of the Japanese Society of Allergology
Cynthia B Robinson, Joanne Leonard, Reynold A Panettieri
Although reversible airway obstruction in part defines asthma, lung function as measured by spirometry alone inadequately predicts the value of new therapeutic agents in the treatment of severe asthma. Our objectives are 1) to review whether pulmonary function and bronchodilator reversibility are endpoints for drug discovery and 2) to identify parameters that predict efficacy in drug development in severe asthma. An English language literature search using MedLine and PubMed was conducted from 1997 to present concerning pathophysiology, diagnosis and therapy of severe asthma using the terms "severe asthma," "irreversible asthma," "difficult asthma," "airway remodeling," "fixed airway obstruction," "reversibility" and "bronchodilator reversibility" as index terms...
August 2012: Pharmacology & Therapeutics
Joan Sweeney, Chris E Brightling, Andrew Menzies-Gow, Robert Niven, Chris C Patterson, Liam G Heaney
Refractory asthma represents a significant unmet clinical need. Data from a national online registry audited clinical outcome in 349 adults with refractory asthma from four UK specialist centres in the British Thoracic Society Difficult Asthma Network. At follow-up, lung function improved, with a reduction in important healthcare outcomes, specifically hospital admission, unscheduled healthcare visits and rescue courses of oral steroids. The most frequent therapeutic intervention was maintenance oral corticosteroids and most steroid sparing agents (apart from omalizumab) demonstrated minimal steroid sparing benefit...
August 2012: Thorax
C Domingo, A Moreno, R Mirapeix
Asthma is a major problem worldwide, which is estimated to affect 300 million individuals. The global prevalence ranges from 1% to 18% of the population. The incidence, morbidity and mortality of the condition have increased over the last 50 years despite the development of new anti-asthmatic drugs. Fewer than 1% of the asthmatic population are steroid-dependent, but these patients consume most of the resources and time at asthma units. The consensus documents published by professional societies all support a stepwise therapeutic approach for asthma...
July 2011: Internal Medicine Journal
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