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Difficult to treat asthma

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https://www.readbyqxmd.com/read/29227721/chinese-guidelines-for-childhood-asthma-2016-major-updates-recommendations-and-key-regional-data
#1
Jianguo Hong, Yixiao Bao, Aihuan Chen, Changchong Li, Li Xiang, Chuanhe Liu, Zhimin Chen, Deyu Zhao, Zhou Fu, Yunxiao Shang
OBJECTIVE: With increased industrialization and urbanization in China, pediatric asthma is becoming more prevalent. Despite a growing body of evidence, there remains a significant unmet need for adequate management of childhood asthma. The Subspecialty Group of Respiratory Diseases of the Society of Pediatrics, the Chinese Medical Association, and the editorial board of the Chinese Journal of Pediatrics have recently updated the "Guidelines for diagnosis and optimal management of asthma in children," first published in 2008...
December 11, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/29220200/a-practical-approach-to-severe-asthma-in-children
#2
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/29206634/long-term-real-life-safety-of-omalizumab-in-patients-with-severe-uncontrolled-asthma-a-nine-year-study
#3
Danilo Di Bona, Irene Fiorino, Marialuisa Taurino, Flavia Frisenda, Elena Minenna, Carlo Pasculli, Georgios Kourtis, Anna Simona Rucco, Andrea Nico, Marcello Albanesi, Lucia Giliberti, Luciana D'Elia, Maria Filomena Caiaffa, Luigi Macchia
BACKGROUND: Randomized Controlled Trials showed that omalizumab exhibited a good safety and tolerability profile in patients with moderate-to-severe asthma. However, safety data of long-term treatment with omalizumab are scarce. Our aim was to assess the safety of omalizumab in patients under long-term treatment in a real-life setting. METHODS: Difficult-to-control asthmatic patients treated with omalizumab up to 9 years were retrospectively evaluated. Mild to severe adverse events any and reasons for discontinuation were recorded...
September 2017: Respiratory Medicine
https://www.readbyqxmd.com/read/29182799/inhaled-magnesium-sulfate-in-the-treatment-of-acute-asthma
#4
REVIEW
Rachel Knightly, Stephen J Milan, Rodney Hughes, Jennifer A Knopp-Sihota, Brian H Rowe, Rebecca Normansell, Colin Powell
BACKGROUND: Asthma exacerbations can be frequent and range in severity from mild to life-threatening. The use of magnesium sulfate (MgSO₄) is one of numerous treatment options available during acute exacerbations. While the efficacy of intravenous MgSO₄ has been demonstrated, the role of inhaled MgSO₄ is less clear. OBJECTIVES: To determine the efficacy and safety of inhaled MgSO₄ administered in acute asthma. SPECIFIC AIMS: to quantify the effects of inhaled MgSO₄ I) in addition to combination treatment with inhaled β₂-agonist and ipratropium bromide; ii) in addition to inhaled β₂-agonist; and iii) in comparison to inhaled β₂-agonist...
November 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29161088/mechanistic-basis-for-obesity-related-increases-in-ozone-induced-airway-hyperresponsiveness-in-mice
#5
Stephanie A Shore
Obesity is a risk factor for asthma, especially nonallergic asthma. Ozone, a common air pollutant, is a nonallergic asthma trigger. Importantly, ozone-induced decrements in lung function are greater in obese and overweight human subjects than in lean individuals. Obese mice also exhibit exaggerated pulmonary responses to ozone. Ozone causes greater increases in pulmonary resistance, in bronchoalveolar lavage neutrophils, and in airway hyperresponsiveness in obese than in lean mice. Our data indicate that IL-33 plays a role in mediating these events...
November 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29133975/severe-eosinophilic-asthma-from-the-pathogenic-role-of-interleukin-5-to-the-therapeutic-action-of-mepolizumab
#6
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/29127369/suppression-of-th17-polarized-airway-inflammation-by-rapamycin
#7
Oana Joean, Anja Hueber, Felix Feller, Adan Chari Jirmo, Matthias Lochner, Anna-Maria Dittrich, Melanie Albrecht
Because Th17-polarized airway inflammation correlates with poor control in bronchial asthma and is a feature of numerous other difficult-to-treat inflammatory lung diseases, new therapeutic approaches for this type of airway inflammation are necessary. We assessed different licensed anti-inflammatory agents with known or expected efficacy against Th17-polarization in mouse models of Th17-dependent airway inflammation. Upon intravenous transfer of in vitro derived Th17 cells and intranasal challenge with the corresponding antigen, we established acute and chronic murine models of Th17-polarised airway inflammation...
November 10, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29121432/effectiveness-of-alpine-climate-treatment-for-children-with-difficult-to-treat-atopic-dermatitis-results-of-a-pragmatic-randomized-controlled-trial-davos-trial
#8
Karin Fieten, Renske Schappin, Wieneke Zijlstra, Lilian Figee, Jos Beutler, Florine Raymakers, Harmieke van Os-Medendorp, Rebecca Stellato, Maartje Vandewall, Joan Winkelhof, Monica Uniken Venema, Carla Bruijnzeel-Koomen, Lucia Rijssenbeek-Nouwens, Cornelis van der Ent, Els van Hoffen, Yolanda Meijer, Suzanne Pasmans
BACKGROUND: Alpine climate treatment has historically been used in Europe to treat atopic dermatitis (AD), but no randomized trials have been conducted to provide evidence for its effectiveness. OBJECTIVE: To investigate the long-term effectiveness of alpine climate treatment for children with difficult to treat AD. MATERIALS & METHODS: A pragmatic, open, randomized controlled trial was conducted. Children diagnosed with AD that was considered difficult to treat, aged between 8 and 18 years and willing to be treated in Switzerland were randomized to a six week personalized integrative multidisciplinary treatment period in a clinical setting in the alpine climate (Switzerland) or an outpatient setting in moderate maritime climate (Netherlands)...
November 9, 2017: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/29121247/prediction-of-individual-outcomes-for-asthma-sufferers
#9
B Storlie Curtis, E Branda Megan, R Gionfriddo Michael, D Shah Nilay, A Rank Matthew
We consider the problem of individual-specific medication level recommendation (initiation, removal, increase, or decrease) for asthma sufferers. Asthma is one of the most common chronic diseases in both adults and children, affecting 8% of the US population and costing $37-63 billion/year in the United States of America. Asthma is a complex disease, whose symptoms may wax and wane, making it difficult for clinicians to predict outcomes and prognosis. Improved ability to predict prognosis can inform decision making and may promote conversations between clinician and provider around optimizing medication therapy...
November 6, 2017: Biostatistics
https://www.readbyqxmd.com/read/29103801/guiding-principles-for-use-of-newer-biologics-and-bronchial-thermoplasty-for-patients-with-severe-asthma
#10
Michael S Blaiss, Mario Castro, Bradley E Chipps, Myron Zitt, Reynold A Panettieri, Michael B Foggs
BACKGROUND: Severe asthma poses significant disease-related and economic burdens in the United States. Challenges in practice include how to define "severe asthma" for a given patient, knowing which are the right tests to perform and when, and having a better understanding of a patient's asthma phenotype. Furthermore, current guidelines do not address a clear, practical approach to treatment that is based on a patient's asthma phenotype. OBJECTIVE: To develop a consensus on the definition of severe asthma, the role of biomarkers and phenotyping severe asthma, and the use of newer biologic therapies and bronchial thermoplasty to help guide practicing clinicians...
December 2017: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/28987810/chronic-rhinosinusitis-in-asia
#11
Yuan Zhang, Elien Gevaert, Hongfei Lou, Xiangdong Wang, Luo Zhang, Claus Bachert, Nan Zhang
Chronic rhinosinusitis (CRS), although possibly overdiagnosed, is associated with a high burden of disease and is often difficult to treat in those truly affected. Recent research has demonstrated that inflammatory signatures of CRS vary around the world, with less eosinophilic and more neutrophilic inflammation found in Asia compared with Europe and North America. Although in the Western world about 80% of nasal polyps carry a type 2 signature, this might be between 20% and 60% in China and Korea or Thailand, respectively...
October 4, 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28877019/severe-and-difficult-to-treat-asthma-in-adults
#12
REVIEW
Elliot Israel, Helen K Reddel
New England Journal of Medicine, Volume 377, Issue 10, Page 965-976, September 2017.
September 7, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28840001/bronchial-hyperreactivity-in-perimenstrual-asthma-is-associated-with-increased-th-2-response-in-lower-airways
#13
Szymon Skoczynski, Aleksandra Semik-Orzech, Ewa Sozanska, Wojciech Szanecki, Krzysztof Kołodziejczyk, Igor Radziewicz-Winnicki, Andrzej Witek, Władysław Pierzchała, Adam Barczyk
BACKGROUND: Perimenstrual asthma (PMA) is a commonly observed, usually difficult-to-treat asthma phenotype. The mechanisms underlying this phenomenon remain unexplained. The aim of the study was to assess the degree of airway hyperresponsiveness and its relationship to proinflammatory cytokines concentration in lower airways of PMA compared to non-PMA patients. METHODS: Premenopausal women with regular menstrual cycles diagnosed as: PMA (n=12), non-PMA asthmatics (n=9), and healthy controls (n=10) were prospectively followed for 10 weeks over two consecutive menstrual cycles...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28807925/what-is-the-evidence-for-different-management-options-for-difficult-to-treat-severe-asthma
#14
(no author information available yet)
No abstract text is available yet for this article.
August 14, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28803186/asthma-exacerbations-and-triggers-in-children-in-tenor-impact-on-quality-of-life
#15
Bradley E Chipps, Tmirah Haselkorn, Karin Rosén, David R Mink, Benjamin L Trzaskoma, Allan T Luskin
BACKGROUND: Data examining associations between asthma exacerbations, triggers, and asthma-related quality of life (QOL) in children with severe/difficult-to-treat asthma are unavailable. OBJECTIVE: To evaluate real-world data on relationships between asthma exacerbations, triggers, and QOL in children using data from TENOR (The Epidemiology and Natural History of Asthma Outcomes and Treatment Regimens), a 3-year observational study of patients with severe/difficult-to-treat asthma, including those aged 6 to 12 years...
August 9, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28797732/more-than-a-decade-follow-up-in-patients-with-severe-or-difficult-to-treat-asthma-the-epidemiology-and-natural-history-of-asthma-outcomes-and-treatment-regimens-tenor-ii
#16
Bradley E Chipps, Tmirah Haselkorn, Brandee Paknis, Benjamin Ortiz, Eugene R Bleecker, Farid Kianifard, Aimee J Foreman, Stanley J Szefler, Robert S Zeiger
BACKGROUND: The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR I) study demonstrated high morbidity in patients with severe or difficult-to-treat asthma despite standard-of-care treatment. OBJECTIVE: We sought to determine the long-term natural history of disease and outcomes in patients in TENOR I after more than a decade. METHODS: TENOR I was a multicenter observational study (2001-2004) of 4756 patients with severe or difficult-to-treat asthma...
August 7, 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28780940/diagnosis-and-management-of-anaphylaxis-in-precision-medicine
#17
REVIEW
Mariana Castells
Anaphylaxis is the most severe and frightening of the allergic reactions, placing patients at high risk and demanding prompt recognition and immediate management by health care providers. Yet because its symptoms imitate those of other diseases, such as asthma and urticaria, current data suggest that its diagnosis is often missed, with underuse of tryptase measurement; its treatment is delayed, with little use of epinephrine; and its underlying cause or causes are poorly investigated. Deaths from anaphylaxis are difficult to investigate because of miscoding...
August 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28646903/human-adipose-tissue-mesenchymal-stromal-cells-and-their-extracellular-vesicles-act-differentially-on-lung-mechanics-and-inflammation-in-experimental-allergic-asthma
#18
Ligia Lins de Castro, Debora Gonçalves Xisto, Jamil Zola Kitoko, Fernanda Ferreira Cruz, Priscilla Christina Olsen, Patricia Albuquerque Garcia Redondo, Tatiana Paula Teixeira Ferreira, Daniel Jay Weiss, Marco Aurélio Martins, Marcelo Marcos Morales, Patricia Rieken Macedo Rocco
BACKGROUND: Asthma is a chronic inflammatory disease that can be difficult to treat due to its complex pathophysiology. Most current drugs focus on controlling the inflammatory process, but are unable to revert the changes of tissue remodeling. Human mesenchymal stromal cells (MSCs) are effective at reducing inflammation and tissue remodeling; nevertheless, no study has evaluated the therapeutic effects of extracellular vesicles (EVs) obtained from human adipose tissue-derived MSCs (AD-MSC) on established airway remodeling in experimental allergic asthma...
June 24, 2017: Stem Cell Research & Therapy
https://www.readbyqxmd.com/read/28508234/surgical-treatment-of-extraesophageal-manifestations-of-gastroesophageal-reflux-disease
#19
REVIEW
Feroze Sidwa, Alessandra L Moore, Elaine Alligood, P Marco Fisichella
OBJECTIVE: To review the current literature on the role of antireflux surgery (ARS) for the treatment of extraesophageal manifestations of GERD. The extraesophageal manifestations of gastroesophageal reflux disease (GERD) include chronic cough, laryngopharyngeal reflux, and asthma. They are responsible for significant morbidity in affected patients and a high economic burden on healthcare resources. We recently published a larger review on the symptoms, diagnosis, medical, and surgical treatment of the extraesophageal manifestations of GERD...
May 15, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28434014/prospective-open-label-evaluation-of-long-term-low-dose-doxycycline-for-difficult-to-treat-chronic-rhinosinusitis-with-nasal-polyps
#20
RANDOMIZED CONTROLLED TRIAL
A C Pinto Bezerra Soter, T F Bezerra, R Pezato, T R Teles Abdo, R M Pilan, F R Pinna, P Gevaert, T van Zele, C Bachert, R L Voegels
BACKGROUND: This study aimed to assess clinical outcomes of long-term low-dose oral doxycycline therapy in difficult-to-treat chronic rhinosinusitis with polyps (CRSwNP). METHODS: This was a prospective, open-label study of 60 patients with difficult-to-treat CRSwNP who had undergone endoscopic sinus surgery. Patients were divided into two groups: 28 received nasal steroids, saline irrigation, and doxycycline (200 mg on the first day, followed by 100 mg once daily) for 12 weeks, while 30 received only nasal steroids and saline irrigation...
June 1, 2017: Rhinology
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