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severe refractory asthma

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https://www.readbyqxmd.com/read/28638418/the-expression-of-stat3-and-stat5a-genes-in-severe-refractory-asthma
#1
Kayvan Saeedfar, Mehrdad Behmanesh, Esmaeil Mortaz, Mohammad Reza Masjedi
BACKGROUND: Despite being a high burden disorder, the pathogenesis of severe refractory asthma (SRA) is poorly understood. There are some evidences for the involvement of members of the signal transducer and activator of transcription (STAT) family, including STAT3 and STAT5a. Our study aimed to evaluate the gene expression of STAT3 and STAT5a in asthma and SRA to establish if there is an association. MATERIALS AND METHODS: Using quantitative real-time polymerase chain reactions (qRT-PCR), the transcript levels of STAT3 and STAT5a were evaluated in peripheral blood mononuclear lymphocytes (PBML) isolated from 13 patients with SRA, 14 with mild asthma, and 30 healthy volunteers...
2017: Tanaffos
https://www.readbyqxmd.com/read/28619778/in-patients-with-severe-uncontrolled-asthma-does-knowledge-of-adherence-and-inhaler-technique-using-electronic-monitoring-improve-clinical-decision-making-a-protocol-for-a-randomised-controlled-trial
#2
Matshediso C Mokoka, Lorna Lombard, Elaine M MacHale, Joanne Walsh, Breda Cushen, Imran Sulaiman, Damien Mc Carthy, Fiona Boland, Frank Doyle, Eoin Hunt, Desmond M Murphy, John Faul, Marcus Butler, Kathy Hetherington, J Mark FitzGerald, Job Fm van Boven, Liam G Heaney, Richard B Reilly, Richard W Costello
INTRODUCTION: Many patients with asthma remain poorly controlled despite the use of inhaled corticosteroids and long-acting beta agonists. Poor control may arise from inadequate adherence, incorrect inhaler technique or because the condition is refractory. Without having an objective assessment of adherence, clinicians may inadvertently add extra medication instead of addressing adherence. This study aims to assess if incorporating objectively recorded adherence from the Inhaler Compliance Assessment (INCA) device and lung function into clinical decision making provides more cost-effective prescribing and improves outcomes...
June 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28616286/severe-and-uncontrolled-asthma-in-china-a-cross-sectional-survey-from-the-australasian-severe-asthma-network
#3
Gang Wang, Fang Wang, Peter G Gibson, Michael Guo, Wei-Jie Zhang, Peng Gao, Hong-Ping Zhang, Erin S Harvey, Hui Li, Jie Zhang
BACKGROUND: Severe asthma is largely unexplored in the Chinese population. Patients with asthma underwent systematic evaluation, by investigating the characteristics of uncontrolled asthma and of asthma treated with three different controller therapies. METHODS: This multi-centre, real-world study was conducted from March 2014 to September 2015. Adults with stable asthma underwent assessment of medication use, asthma control, quality of life, psychological symptoms, work productivity and activity impairment, bronchodilator response and sputum induction...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28580744/management-of-severe-asthma-targeting-the-airways-comorbidities-and-risk-factors
#4
Peter G Gibson, Vanessa M McDonald
Severe asthma is a complex heterogeneous disease that is refractory to standard treatment and is complicated by multiple comorbidities and risk factors. In mild to moderate asthma, the burden of disease can be minimised by inhaled corticosteroids, bronchodilators and self-management education. In severe asthma, however, management is more complex. When patients with asthma continue to experience symptoms and exacerbations despite optimal management, severe refractory asthma (SRA) should be suspected and confirmed, and other aetiologies ruled out...
June 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28569072/the-role-of-oral-methotrexate-as-a-steroid-sparing-agent-in-refractory-eosinophilic-asthma
#5
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
https://www.readbyqxmd.com/read/28514613/kit-inhibition-by-imatinib-in-patients-with-severe-refractory-asthma
#6
RANDOMIZED CONTROLLED TRIAL
Katherine N Cahill, Howard R Katz, Jing Cui, Juying Lai, Shamsah Kazani, Allison Crosby-Thompson, Denise Garofalo, Mario Castro, Nizar Jarjour, Emily DiMango, Serpil Erzurum, Jennifer L Trevor, Kartik Shenoy, Vernon M Chinchilli, Michael E Wechsler, Tanya M Laidlaw, Joshua A Boyce, Elliot Israel
BACKGROUND: Mast cells are present in the airways of patients who have severe asthma despite glucocorticoid treatment; these cells are associated with disease characteristics including poor quality of life and inadequate asthma control. Stem cell factor and its receptor, KIT, are central to mast-cell homeostasis. We conducted a proof-of-principle trial to evaluate the effect of imatinib, a KIT inhibitor, on airway hyperresponsiveness, a physiological marker of severe asthma, as well as on airway mast-cell numbers and activation in patients with severe asthma...
May 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28464704/prospects-for-new-and-emerging-therapeutics-in-severe-asthma-the-role-of-biologics
#7
Seçil Kepil Özdemir, Sevim Bavbek
Asthma is a common and heterogeneous disease. While current conventional therapies are effective in the majority of the patients, a significant subgroup remain uncontrolled despite these treatments. Different biological agents are currently approved or undergoing development for treatment of asthma, including anti-IgE, anti-interleukin (IL)-5, anti-IL-13, anti-IL-4 and anti-thymic stromal lymphopoietin agents. This review will focus on the currently available evidence regarding the new and emerging biological agents in severe asthma...
June 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/28461761/managing-the-pediatric-patient-with-refractory-asthma-a-multidisciplinary-approach
#8
REVIEW
James Cook, Fran Beresford, Valentina Fainardi, Pippa Hall, Georgie Housley, Angela Jamalzadeh, Michelle Nightingale, David Winch, Andrew Bush, Louise Fleming, Sejal Saglani
Children with asthma that is refractory to high levels of prescribed treatment are described as having problematic severe asthma. Those in whom persistent symptoms result from a failure of basic asthma management are described as having "difficult asthma", while those who remain symptomatic despite these factors having been addressed are described as having "severe therapy-resistant asthma" (STRA). The majority of children have difficult asthma; asthma that is poorly controlled because of a failure to get the basics of asthma management right...
2017: Journal of Asthma and Allergy
https://www.readbyqxmd.com/read/28446972/thermal-ablation-for-asthma-current-status-and-technique
#9
REVIEW
William Krmisky, Michal J Sobieszczyk, Saiyad Sarkar
Bronchial thermoplasty (BT) is a novel technique used in the treatment of severe asthma. A catheter is advanced through the bronchoscope and directed radiofrequency waves are applied to the segmental bronchi to reduce airway smooth muscle mass. Several randomized clinical trials demonstrate improvement in quality of life and reduction in exacerbation rates after treatment. BT is a safe and cost effective treatment option for severe asthma which is refractory to medical treatment. Further studies are needed in order to better describe the mechanism of action and the asthma subphenotype that was best benefit from this treatment...
March 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28427296/predictors-of-response-to-therapy-with-omalizumab-in-patients-with-severe-allergic-asthma-a-real-life-study
#10
Maria Kallieri, Andriana I Papaioannou, Evgenia Papathanasiou, Polyxeni Ntontsi, Spyridon Papiris, Stelios Loukides
OBJECTIVES: Omalizumab is a recombinant humanized IgG1 monoclonal anti-IgE antibody, used for the treatment of severe refractory allergic asthma. However, not all patients with IgE levels within the limits of administration, respond to treatment. The aim of the present study, was to determine clinical and inflammatory characteristics that could predict response to omalizumab. METHODS: We studied retrospectively patients treated with omalizumab as per GINA guidelines in one asthma tertiary referral center...
April 28, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28424691/increased-autophagy-related-5-gene-expression-is-associated-with-collagen-expression-in-the-airways-of-refractory-asthmatics
#11
Audrey H Poon, David F Choy, Fazila Chouiali, Rakhee K Ramakrishnan, Bassam Mahboub, Severine Audusseau, Andrea Mogas, Jeffrey M Harris, Joseph R Arron, Catherine Laprise, Qutayba Hamid
BACKGROUND: Fibrosis, particularly excessive collagen deposition, presents a challenge for treating asthmatic individuals. At present, no drugs can remove or reduce excessive collagen in asthmatic airways. Hence, the identification of pathways involved in collagen deposition would help to generate therapeutic targets to interfere with the airway remodeling process. Autophagy, a cellular degradation process, has been shown to be dysregulated in various fibrotic diseases, and genetic association studies in independent human populations have identified autophagy-related 5 (ATG5) to be associated with asthma pathogenesis...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28413387/successful-treatment-of-a-bullous-pemphigoid-patient-with-rituximab-who-was-refractory-to-corticosteroid-and-omalizumab-treatments
#12
Aslı Bilgiç Temel, Cumhur Ibrahim Bassorgun, Ayşe Akman-Karakaş, Erkan Alpsoy, Soner Uzun
Omalizumab is a humanized monoclonal antibody which is an FDA-approved treatment of severe allergic asthma and inhibits IgE binding to FcεRI. According to increasing evidence of IgE inhibition, omalizumab was suggested as a therapeutic approach for bullous pemphigoid (BP). Rituximab has been reported to be effective in various autoimmune diseases, including autoimmune bullous dermatoses. A specific protocol for the use of rituximab to treat BP patients is not yet available. There are only small case series and case reports about the efficacy and safety of rituximab in BP...
January 2017: Case Reports in Dermatology
https://www.readbyqxmd.com/read/28407269/clinical-functional-and-inflammatory-characteristics-in-patients-with-paucigranulocytic-stable-asthma-comparison-with-different-sputum-phenotypes
#13
P Ntontsi, S Loukides, P Bakakos, K Kostikas, G Papatheodorou, E Papathanassiou, G Hillas, N Koulouris, S Papiris, A I Papaioannou
BACKGROUND: According to induced sputum cell count, four different asthma phenotypes have been recognized (eosinophilic, neutrophilic, mixed and paucigranulocytic). The aim of this study was to detect functional and inflammatory characteristics of patients with paucigranulocytic asthma. METHODS: A total of 240 asthmatic patients were categorized into the four phenotypes according to cell counts in induced sputum. All patients underwent pulmonary function tests, and measurement of fraction of exhaled nitric oxide (FeNO)...
April 13, 2017: Allergy
https://www.readbyqxmd.com/read/28363401/neutrophilic-steroid-refractory-recurrent-wheeze-and-eosinophilic-steroid-refractory-asthma-in-children
#14
Tamazoust Guiddir, Philippe Saint-Pierre, Elsa Purenne-Denis, Nathalie Lambert, Yacine Laoudi, Rémy Couderc, Rahelé Gouvis-Echraghi, Flore Amat, Jocelyne Just
BACKGROUND: Little is known about inflammatory pathways of severe recurrent wheeze in preschool children and severe asthma in children. OBJECTIVES: The aim of the Severe Asthma Molecular Phenotype cohort was to characterize phenotypes of severe recurrent wheeze and severe asthma during childhood in terms of triggers (allergic or not), involved cells (eosinophil or neutrophil), and corticoid responsiveness. METHODS: Children with moderate-to-severe asthma and preschool children with moderate-to-severe recurrent wheeze were enrolled prospectively...
March 28, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28348726/targeting-patients-with-asthma-for-omalizumab-therapy-choosing-the-right-patient-to-get-the-best-value-for-money
#15
REVIEW
Abir Al Said, Breda Cushen, Richard W Costello
The asthma syndrome has many manifestations, termed phenotypes, that arise by specific cellular and molecular mechanisms, termed endotypes. Understanding an individual's asthma phenotype helps clinicians make rational therapeutic decisions while the understanding of endotypes has led to the development of specific precision medications. Allergic asthma is an example of an asthma phenotype and omalizumab, a monoclonal antibody that neutralizes serum immunoglobulin (Ig)E, is a specific targeted treatment which was developed as a result of an understanding of the endotype of allergic asthma...
February 2017: Therapeutic Advances in Chronic Disease
https://www.readbyqxmd.com/read/28263381/obesity-promotes-prolonged-ovalbumin-induced-airway-inflammation-modulating-t-helper-type-1-th1-th2-and-th17-immune-responses-in-balb-c-mice
#16
F M C Silva, E E Oliveira, A C C Gouveia, A S S Brugiolo, C C Alves, J O A Correa, J Gameiro, J Mattes, H C Teixeira, A P Ferreira
Clinical and epidemiological studies indicate that obesity affects the development and phenotype of asthma by inducing inflammatory mechanisms in addition to eosinophilic inflammation. The aim of this study was to assess the effect of obesity on allergic airway inflammation and T helper type 2 (Th2) immune responses using an experimental model of asthma in BALB/c mice. Mice fed a high-fat diet (HFD) for 10 weeks were sensitized and challenged with ovalbumin (OVA), and analyses were performed at 24 and 48 h after the last OVA challenge...
July 2017: Clinical and Experimental Immunology
https://www.readbyqxmd.com/read/28260352/extra-esophageal-presentation-of-gerd-new-understanding-in-a-new-era
#17
Irene Martinucci, Eleonora Albano, Santino Marchi, Corrado Blandizzi
Associations of gastroesophageal reflux disease (GERD) with extraesophageal manifestations, such as chronic cough, asthma, and laryngitis, are reported frequently, and there is a strong evidence of biological plausibility in support of this relationship. On the other hand, extraesophageal reflux disease (EERD) is usually multifactorial in nature with reflux being just one of the several potential contributing cofactors. Moreover, the accuracy of currently available diagnostic tests for EERD is suboptimal, and therefore the causal relationship between GERD and EERD remains far from being conclusively proven...
March 3, 2017: Minerva Gastroenterologica e Dietologica
https://www.readbyqxmd.com/read/28208047/targeted-therapy-for-chronic-respiratory-disease-a-new-paradigm
#18
REVIEW
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
https://www.readbyqxmd.com/read/28197221/factors-leading-to-refractory-asthma-in-patients-from-saudi-arabia
#19
Amal M Al-Moamary, Mohamed S Al-Hajjaj, Mohamed S Al Moamary
AIM: The aim of this study was to study the clinical characteristic of patient with refractory asthma (RA) from Saudi Arabia. METHODS: This paper prospectively studied in a university hospital factors leading to RA in a cohort of patients who have inadequately controlled asthma or with frequent exacerbations despite optimum controller therapy. It also studied patients with asthma that requires extended periods of oral steroids to control. RESULTS: The mean age was 45...
January 2017: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/28187115/clinical-course-of-enterovirus-d68-in-hospitalized-children
#20
Jennifer E Schuster, Rangaraj Selvarangan, Ferdaus Hassan, Kayla B Briggs, Lindsay Hays, Jenna O Miller, Barbara Pahud, Henry T Puls, Mary Ann Queen, Marita T Thompson, Gina Weddle, Mary Anne Jackson
BACKGROUND: Enterovirus D68 (EV-D68) has been sporadically reported as a cause of respiratory tract infections. In 2014, an international outbreak of EV-D68 occurred and caused severe respiratory disease in the pediatric population. METHODS: A retrospective chart review was performed of children admitted to Children's Mercy Hospital from August 1, 2014, to September 15, 2014, with positive multiplex polymerase chain reaction testing for EV/rhinovirus (RV). Specimens were subsequently tested for EV-D68, and clinical data were obtained from the medical records...
March 2017: Pediatric Infectious Disease Journal
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