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Severe persistent asthma

Samuel Y Ash, Alejandro A Diaz
PURPOSE OF REVIEW: The present review aims to summarize the most recent evidence related to imaging and severe asthma, both with regard to advances in imaging research and to their current and potential clinical implications. RECENT FINDINGS: Recent work in imaging in severe asthma has principally been using computed tomography (CT) and MRI, as well as the integration of the two. Some of the most notable findings include the use of CT imaging biomarkers to create unique clusters of asthmatics, and the use of co-registration to link CT images of airways with regional variation in ventilation in MRI...
October 20, 2016: Current Opinion in Pulmonary Medicine
Luzmercy Perez, Knashawn H Morales, Heather Klusaritz, Xiaoyan Han, Jingru Huang, Marisa Rogers, Ian M Bennett, Cynthia S Rand, Grace Ndicu, Andrea J Apter
BACKGROUND: Self-management of moderate/severe asthma depends upon patients' ability to: 1) navigate (access health care to obtain diagnoses and treatment), 2) use inhaled corticosteroids (ICS) properly, and 3) understand ICS function. OBJECTIVE: To test whether navigation skills (medication recall, knowledge of copay requirements ability to provide information needed for a medical visit about a persistent cough unresponsive to medication), are related to other self-management skills and to health literacy...
October 12, 2016: Journal of Allergy and Clinical Immunology
Konrad Pazdrak, Christof Straub, Rosario Maroto, Susan Stafford, Wendy I White, William J Calhoun, Alexander Kurosky
The mechanisms contributing to persistent eosinophil activation and poor eosinopenic response to glucocorticoids in severe asthma are poorly defined. We examined the effect of cytokines typically overexpressed in the asthmatic airways on glucocorticoid signaling in in vitro activated eosinophils. An annexin V assay used to measure eosinophil apoptosis showed that cytokine combinations of IL-2 plus IL-4 as well as TNF-α plus IFN-γ, or IL-3, GM-CSF, and IL-5 alone significantly diminished the proapoptotic response to dexamethasone...
October 14, 2016: Journal of Immunology: Official Journal of the American Association of Immunologists
Steven Maltby, Peter G Gibson, Heather Powell, Vanessa M McDonald
BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) are common airway diseases. Individuals with overlapping asthma and COPD experience increased health impairment and severe disease exacerbations. Efficacious treatment options are required for this population. Omalizumab (anti-IgE) therapy is effective in patients with severe, persistent asthma, but limited data are available on efficacy in populations with overlapping asthma and COPD. METHODS: Data from the Australian Xolair Registry (AXR) was used to compare treatment responses in individuals with asthma-COPD overlap to severe asthma alone...
October 11, 2016: Chest
Rolf Merget, Ngoc Pham, Maike Schmidtke, Swaantje Casjens, Vera van Kampen, Ingrid Sander, Olaf Hagemeyer, Kirsten Sucker, Monika Raulf, Thomas Brüning
PURPOSE: Medical surveillance of workers in precious metals refineries and catalyst production plants is well established in many countries as a measure to prevent occupational asthma due to platinum (Pt) salts. It was the aim of this study to evaluate the impact of medical surveillance and to define prognostic factors with an emphasis on exposure determinants. METHODS: As part of an observational longitudinal study, 96 workers from German precious metals refineries and catalyst production plants with Pt salt allergy underwent a second examination several years (median 67 months) after the initial diagnosis was made...
October 12, 2016: International Archives of Occupational and Environmental Health
Anne Borgmeyer, Patrick M Ercole, Angela Niesen, Robert C Strunk
OBJECTIVES: Information is lacking regarding recognition and treatment of overweight and obesity in children hospitalized for asthma. The study objectives were to determine the current practice of recognition, diagnosis, and treatment of overweight and obesity for children hospitalized for asthma and to describe demographic, asthma, and weight characteristics for these patients. METHODS: A retrospective record review was conducted for children admitted to the hospital with asthma in 2012...
October 12, 2016: Hospital Pediatrics
Anna James, Katarina Stenberg Hammar, Lovisa Reinius, Jon R Konradsen, Sven-Erik Dahlén, Cilla Söderhäll, Gunilla Hedlin
BACKGROUND: The chitinase-like protein YKL-40 (CHI3L1) is elevated in the circulation of adults and schoolchildren with chronic severe asthma. It is unknown whether YKL-40 is altered in younger, preschool children with wheeze, acute or chronic. We therefore examined YKL-40 in preschool children during an acute episode of wheeze and during remission, in comparison to healthy controls. METHODS: Blood was obtained from 128 children (aged 6 to 44 months) at the emergency department during an acute episode of wheeze, and at two follow-up visits (approximately 3 months and 1 year later), as well as from 100 age-matched healthy controls on one occasion...
October 12, 2016: Pediatric Allergy and Immunology
Jennifer Hill, Trever Burnett, Rohit Katial
Aspirin-exacerbated respiratory disease (AERD) is a clinical syndrome characterized by severe persistent asthma, hyperplastic eosinophilic sinusitis with nasal polyps, and an intolerance to aspirin and other NSAIDs that preferentially inhibit COX-1. For more than 30 years, aspirin desensitization has proven to be of significant long-term benefit in carefully selected patients with AERD. Despite this, the exact mechanisms behind the therapeutic effects of aspirin desensitization remain poorly understood. In this article, we review the current understanding of the mechanisms of aspirin desensitization and discuss future areas of investigation...
November 2016: Immunology and Allergy Clinics of North America
Asako Oka, Tsunahiko Hirano, Yoshikazu Yamaji, Kosuke Ito, Keiji Oishi, Nobutaka Edakuni, Reo Kawano, Kazuto Matsunaga
BACKGROUND: Characterizing associations between the upper and lower airways is important for asthma management. OBJECTIVES: This study aimed to assess the determinants of incomplete asthma control in patients with allergic rhinitis (AR) and asthma. METHODS: Multiple factors including age, sex, atopy, smoking history, medication use, Asthma Control Questionnaire (ACQ) score, FEV1, fraction of exhaled nitric oxide (Feno), and rhinitis questionnaire score were examined...
October 1, 2016: Journal of Allergy and Clinical Immunology in Practice
Caroline Bengtsson, Eva Lindberg, Lars Jonsson, Mats Holmström, Fredrik Sundbom, Jan Hedner, Andrei Malinovschi, Roelinde Middelveld, Bertil Forsberg, Christer Janson
STUDY OBJECTIVES: To analyse the prevalence of sleep problems in subjects with CRS and to determine whether the disease severity of CRS affects sleep quality. METHODS: Questionnaires were sent to a random sample of 45 000 adults in four Swedish cities. Questions on CRS, asthma, allergic rhinitis, co-morbidities, tobacco use, educational level and physical activity were included. CRS was defined according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) epidemiological criteria...
September 26, 2016: Sleep
D C Watchorn, A Sahadevan, J J Egan, S J Lane
There is an unmet need for new therapies in severe persistent asthma. Bronchial thermoplasty is a bronchoscopic procedure which employs radiofrequency energy to reduce airway smooth muscle and has been demonstrated to improve symptomatic control in severe persistent asthma in other populations. Seven patients have completed bronchial thermoplasty at a tertiary referral centre in Ireland. Asthma Control Test scores and data on hospitalisations, exacerbations, maintenance corticosteroid requirements, rescue bronchodilator use and peak expiratory flow rate (PEFR) were compared one year before and one year post treatment...
2016: Irish Medical Journal
K Hutchinson, C Kerley, L Cormican, Y Rochev, J Faul
Since Vitamin D has anti-inflammatory effects we wondered whether the association between low serum 25OHD and airway obstruction in moderate persistent asthma might be explained by inflammatory pathways that worsen asthma. All subjects examined were Irish Caucasians with moderate persistent asthma and none took systemic steroid therapy. In addition to computerized spirometry, we measured BMI, serum 25-hydroxyvitamin D (25OHD), total IgE, Eosinophil Cationic Protein (ECP), and high sensitive C- reactive protein (hs-CRP)...
2016: Irish Medical Journal
Robert S Zeiger, Michael Schatz, Anand A Dalal, Wansu Chen, Ekaterina Sadikova, Robert Y Suruki, Aniket A Kawatkar, Lei Qian
BACKGROUND: Severe uncontrolled asthma (SUA) is associated with increased asthma exacerbations. Whether high blood eosinophil counts are related to this burden is uncertain. OBJECTIVES: To determine the relationship of blood eosinophil counts to asthma exacerbations, utilization, and cost in patients with SUA. METHODS: Patients with persistent asthma (age ≥ 12 years) were identified administratively with SUA in phase I by evidencing (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β2-agonist; and (3) 3 or more dispensed non-ICS controllers...
September 21, 2016: Journal of Allergy and Clinical Immunology in Practice
Kayleigh M Kew, Marina Nashed, Valdeep Dulay, Janelle Yorke
BACKGROUND: People with asthma have a higher prevalence of anxiety and depression than the general population. This is associated with poorer asthma control, medication adherence, and health outcomes. Cognitive behavioural therapy (CBT) may be a way to improve the quality of life of people with asthma by addressing associated psychological issues, which may lead to a lower risk of exacerbations and better asthma control. OBJECTIVES: To assess the efficacy of CBT for asthma compared with usual care...
September 21, 2016: Cochrane Database of Systematic Reviews
Annica Önell, Anna Whiteman, Björn Nordlund, Francesca Baldracchini, Giorgio Mazzoleni, Gunilla Hedlin, Hans Grönlund, Jon R Konradsen
BACKGROUND: Multiple allergic sensitizations are common in persistent childhood asthma, and thorough assessment of allergy is crucial for optimal care of these children. Microarray testing offers opportunities for improved sIgE characterization, which has been projected to be useful in the management of multi-sensitized patients. OBJECTIVE: The aim of this study was to investigate the accuracy and information obtained by two microarray platforms applied on a well-characterized pediatric asthma cohort...
September 17, 2016: Allergy
Nathan P Falk, Scott W Hughes, Blake C Rodgers
Chronic asthma is a major health concern for children and adults worldwide. The goal of treatment is to prevent symptoms by reducing airway inflammation and hyperreactivity. Step-up therapy for symptom control involves initiation with low-dose treatment and increasing intensity at subsequent visits if control is not achieved. Step-down therapy starts with a high-dose regimen, reducing intensity as control is achieved. Multiple randomized controlled trials have shown that inhaled corticosteroids are the most effective monotherapy...
September 15, 2016: American Family Physician
Roberto W Dal Negro, Massimiliano Povero
BACKGROUND: Inhalation devices represent per sé critical factors because they can affect the therapeutic outcomes independently of the drug used. The role of patients' usability and preference (PUP) for Dry Powder Inhalers (DPIs) is high indeed because they can influence the extent of the adherence to treatment and the therapeutic outcomes. Aim of the study was to assess and compare the PUP of three different DPIs in out-patients with persistent airflow limitation due to asthma or COPD...
2016: Multidisciplinary Respiratory Medicine
Monica Bidwal, Kajua Lor, Junhua Yu, Eric Ip
BACKGROUND: Adherence with asthma medications is less than optimal, measuring approximately 30-50%. Several factors have been shown to contribute to medication non-adherence including low-socioeconomic status, low literacy, medication cost, access to care, and language barriers. Community Health Clinic Ole has attempted to reduce medication adherence barriers associated with cost, access to care, and language by 1) allowing medications to be obtained from the clinic at a reduced cost via the 340B drug pricing program and patient assistance programs, and 2) providing one-on-one consultations from bilingual Spanish-speaking clinicians...
August 3, 2016: Research in Social & Administrative Pharmacy: RSAP
Elif Tanrıverdi, Mehmet Akif Özgül, Oğuz Uzun, Şule Gül, Mustafa Çörtük, Zehra Yaşar, Murat Acat, Naciye Arda, Erdoğan Çetinkaya
Tracheobronchial amyloidosis is a rare presentation and accounts for about 1% of benign tumors in this area. The diagnosis of disease is delayed due to nonspecific pulmonary symptoms. Therapeutic approaches are required to control progressive pulmonary symptoms for most of the patients. Herein, we report a case of a 68-year-old man admitted with progressive dyspnea to our institution for further evaluation and management. He was initially diagnosed with and underwent management for bronchial asthma for two years but had persistent symptoms despite optimal medical therapy...
2016: Case Reports in Medicine
Vincent Cottin, Elisabeth Bel, Paolo Bottero, Klaus Dalhoff, Marc Humbert, Romain Lazor, Renato A Sinico, Pasupathy Sivasothy, Michael E Wechsler, Matthieu Groh, Sylvain Marchand-Adam, Chahéra Khouatra, Benoit Wallaert, Camille Taillé, Philippe Delaval, Jacques Cadranel, Philippe Bonniaud, Grégoire Prévot, Sandrine Hirschi, Anne Gondouin, Bertrand Dunogué, Gérard Chatté, Amandine Briault, David Jayne, Loïc Guillevin, Jean-François Cordier
The respiratory manifestations of eosinophilic granulomatosis with polyangiitis (EGPA) have not been studied in detail.In this retrospective multicentre study, EGPA was defined by asthma, eosinophilia and at least one new onset extra-bronchopulmonary organ manifestation of disease.The study population included 157 patients (mean±sd age 49.4±14.1 years), with a mean±sd blood eosinophil count of 7.4±6.4×10(9) L(-1) at diagnosis. There was a mean±sd of 11.8±18.2 years from the onset of asthma to the diagnosis of EGPA, of 1...
September 1, 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
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