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severe 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/29301919/a-randomised-clinical-trial-of-feedback-on-inhaler-adherence-and-technique-in-patients-with-severe-uncontrolled-asthma
#2
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
#3
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
#4
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
#5
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/29229196/impact-of-allergy-on-phenotypic-and-endotypic-profiles-of-nasal-polyposis
#6
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
#7
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
#8
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/29193785/contribution-of-hiatal-hernia-to-asthma-in-patients-with-gastroesophageal-reflux-disease
#9
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
#10
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
#11
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
#12
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/29133975/severe-eosinophilic-asthma-from-the-pathogenic-role-of-interleukin-5-to-the-therapeutic-action-of-mepolizumab
#13
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
#14
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
https://www.readbyqxmd.com/read/29033571/bronchial-thermoplasty-and-the-role-of-airway-smooth-muscle-are-we-on-the-right-direction
#15
REVIEW
Francesco Menzella, Mirco Lusuardi, Carla Galeone, Nicola Facciolongo
Asthma is characterized by inflammation of the airways that includes eosinophils, basal membrane thickening, epithelial sloughing, vascular changes, smooth muscle hypertrophy and hyperplasia, and mucous gland hyperplasia. Recently, there have been studies on the role of hypersensitivity and inflammation in asthma, but the role of bronchial smooth muscle remains unclear. Bronchial thermoplasty is an endoscopic procedure that is approved by the US Food and Drug Administration (FDA) for the treatment of severe refractory asthma, based on the local delivery of radio frequency at 65°C to the airways, with the aim of controlling bronchospasm through a reduction of airway smooth muscle (ASM)...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29017221/-biologicals-in-the-treatment-of-bronchial-asthma
#16
I Haasler, C Taube
Biologicals are a therapeutic option for patients with severe asthma. Difficult asthma in patients with untreated comorbidities or persistent trigger factors is much more common than severe refractory asthma. Optimized medical treatment, adherence to medication, elimination of trigger factors and treatment of comorbidities are essential before escalating the therapy with a biological. A careful phenotyping of patient with severe asthma is necessary because all available biological are only effective in certain phenotypes of the disease...
October 2017: Pneumologie
https://www.readbyqxmd.com/read/28966754/comparison-of-interleukin-33-serum-levels-in-asthmatic-patients-with-a-control-group-and-relation-with-the-severity-of-the-disease
#17
Tooba Momen, Hamid Ahanchian, Mohsen Reisi, Seyedeh Azra Shamsdin, Armindokht Shahsanai, Majid Keivanfar
BACKGROUND: The relation between interleukin-33 (IL-33) and asthma is not precisely known yet. The present study set to compare the serum level of IL-33 in patients with asthma and controls and study the relation with the severity of disease. METHODS: The serum level of IL-33 and total IgE in 89 asthmatic patients and 57 controls were analyzed. The association of levels of IL-33 with the severity of disease, levels of total IgE, measures of spirometry (forced expiratory volume in 1 s [FEV1]), age, sex, presence or absence of other allergic diseases, and the disease duration was evaluated...
2017: International Journal of Preventive Medicine
https://www.readbyqxmd.com/read/28939412/th1-signatures-are-present-in-the-lower-airways-of-children-with-severe-asthma-regardless-of-allergic-status
#18
Julia A Wisniewski, Lyndsey M Muehling, Jacob D Eccles, Brian J Capaldo, Rachana Agrawal, Debbie-Ann Shirley, James T Patrie, Lisa J Workman, Alexander J Schuyler, Monica G Lawrence, W Gerald Teague, Judith A Woodfolk
BACKGROUND: The pathogenesis of severe asthma in childhood remains poorly understood. OBJECTIVE: To construct the immunological landscape in the airways of children with severe asthma. METHODS: Comprehensive analysis of multiple cell types and mediators was performed by flow cytometry and multiplex assay using bronchoalveolar lavage (BAL) specimens (n=68) from 52 highly characterized allergic and non-allergic children (0.5-17 years) with severe treatment-refractory asthma...
September 19, 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28933516/anti-il5-therapies-for-asthma
#19
REVIEW
Hugo A Farne, Amanda Wilson, Colin Powell, Lynne Bax, Stephen J Milan
BACKGROUND: This review is the first update of a previously published review in The Cochrane Library (Issue 7, 2015). Interleukin-5 (IL-5) is the main cytokine involved in the activation of eosinophils, which cause airway inflammation and are a classic feature of asthma. Monoclonal antibodies targeting IL-5 or its receptor (IL-5R) have been developed, with recent studies suggesting that they reduce asthma exacerbations, improve health-related quality of life (HRQoL) and lung function...
September 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28933002/mepolizumab-for-treating-severe-eosinophilic-asthma-an-evidence-review-group-perspective-of-a-nice-single-technology-appraisal
#20
REVIEW
Iñigo Bermejo, Matt Stevenson, Katy Cooper, Sue Harnan, Jean Hamilton, Mark Clowes, Christopher Carroll, Tim Harrison, Shironjit Saha
As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the company (GlaxoSmithKline) that manufactures mepolizumab (Nucala(®)) to submit evidence on the clinical and cost effectiveness of mepolizumab for the treatment of severe eosinophilic asthma. The School of Health and Related Research Technology Appraisal Group (ScHARR-TAG) at the University of Sheffield was commissioned to act as the independent evidence review group (ERG). The ERG produced a review of the evidence for the clinical and cost effectiveness of mepolizumab as add-on to standard of care (SoC) compared with SoC and omalizumab, based upon the company's submission to NICE...
September 20, 2017: PharmacoEconomics
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