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Difficult to treat asthma

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https://www.readbyqxmd.com/read/28328592/status-asthmaticus-and-central-herniation-a-case-for-multidisciplinary-critical-care
#1
Joelle B Karlik, Tristan Stani, Stephanie Nonas, Aclan Dogan, Ansgar Brambrink
A 24-year-old woman with history of asthma was intubated emergently for acute status asthmaticus triggered by acute respiratory syncytial virus infection and treated with permissive hypercapnia. Her ventilation was complicated by auto-positive end-expiratory pressure and elevated peak airway, plateau, and central venous pressures. On hospital day 2, she was noted to have anisocoria. Imaging showed diffuse cerebral edema with central herniation. Difficult ventilation and hypercapnia directly contributed to her severe cerebral edema...
March 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28325523/total-management-of-chronic-obstructive-pulmonary-disease-copd-as-an-independent-risk-factor-for-cardiovascular-disease
#2
REVIEW
Katsuya Onishi
Patients with cardiovascular disease (CVD) often have multiple comorbid conditions that may interact with each other, confound the choice of treatments, and reduce mortality. Chronic obstructive pulmonary disease (COPD) is one of the most important comorbidities of CVD, which causes serious consequences in patients with ischemic heart disease, stroke, arrhythmia, and heart failure. COPD shares common risk factors such as tobacco smoking and aging with CVD, is associated with less physical activity, and produces systemic inflammation and oxidative stress...
March 18, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/28284783/the-allergist-s-role-in-detection-of-severe-alpha-1-antitrypsin-deficiency
#3
Theodore Kelbel, Darren Morris, Deirdre Walker, Maria Paula Henao, Timothy Craig
BACKGROUND: Alpha-1 antitrypsin deficiency (AATD) frequently presents as difficult to manage asthma or asthma with fixed obstruction and is well documented as being underdiagnosed in the population. OBJECTIVE: This study aimed to better describe allergists'/immunologists' involvement in the care of patients with AATD and whether they currently contribute to the underdiagnosis by lack of screening for the condition. METHODS: Using the Research Electronic Data Capture tool, we submitted a questionnaire to 500 patients with severe AATD (ZZ, SZ, ZNull, and FZ) through the Alpha-1 Foundation Research Registry to collect information about patient diagnosis and treatment patterns...
March 8, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28283854/management-of-the-asthma-copd-overlap-syndrome-acos-a-review-of-the-evidence
#4
REVIEW
Kristin L Hines, R Stokes Peebles
PURPOSE OF REVIEW: Examine the definition of the asthma-COPD overlap syndrome (ACOS) and current treatment strategies. RECENT FINDINGS: Patients with the ACOS have a lower quality of life and suffer from more complications than those affected by either disease alone. Diagnosis of ACOS is difficult because of the clinical similarities between the two diseases and the various phenotypes that comprise the syndrome. Defining treatment strategies for ACOS has been challenging because many clinical trials for asthma therapy have purposefully excluded patients with features of COPD, and COPD clinical trials have not included patients who might have an asthmatic component to their disease...
March 2017: Current Allergy and Asthma Reports
https://www.readbyqxmd.com/read/28248008/can-biomarkers-help-us-hit-targets-in-difficult-to-treat-asthma
#5
REVIEW
Michael Fricker, Liam G Heaney, John W Upham
Biomarkers may be a key foundation for the precision medicine of the future. In this article, we review current knowledge regarding biomarkers in difficult-to-treat asthma and their ability to guide the use of both conventional asthma therapies and novel (targeted) therapies. Biomarkers (as measured by tests including prednisolone and cortisol assays and the fractional exhaled nitric oxide (NO) suppression test) show promise in the assessment and management of non-adherence to inhaled and oral corticosteroids...
April 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/28159511/reslizumab-in-patients-with-inadequately-controlled-late-onset-asthma-and-elevated-blood-eosinophils
#6
Guy Brusselle, Matthew Germinaro, Sivan Weiss, James Zangrilli
INTRODUCTION: Asthma with adult onset and elevated blood eosinophils is a difficult-to-treat subgroup. This post hoc analysis evaluated reslizumab, an anti-interleukin-5 monoclonal antibody, in patients with late-onset eosinophilic asthma. METHODS: Data from two 52-week placebo-controlled trials of reslizumab IV 3 mg/kg every 4 weeks in patients aged 12-75 years with inadequately controlled asthma, ≥1 asthma exacerbation within 12 months, and screening blood eosinophils ≥400/μL (NCT01287039/NCT01285323) were stratified by age of asthma onset (<40 or ≥40 years)...
January 31, 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28143691/changing-paradigms-in-the-treatment-of-severe-asthma-the-role-of-biologic-therapies
#7
Rohit K Katial, Greg W Bensch, William W Busse, Bradley E Chipps, Joshua L Denson, Anthony N Gerber, Joshua S Jacobs, Monica Kraft, Richard J Martin, Parameswaran Nair, Michael E Wechsler
Cytokine antagonists are monoclonal antibodies that offer new treatment options for refractory asthma but will also increase complexity because they are effective only for patients with certain asthma subtypes that remain to be more clearly defined. The clinical and inflammatory heterogeneity within refractory asthma makes it difficult to manage the disease and to determine which, if any, biologic therapy is suitable for a specific patient. The purpose of this article is to provide a data-driven discussion to clarify the use of biologic therapies in patients with refractory asthma...
January 28, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28115224/the-burden-of-obesity-in-asthma-and-copd-role-of-adiponectin
#8
REVIEW
Andrea Bianco, Ersilia Nigro, Maria Ludovica Monaco, Maria Gabriella Matera, Olga Scudiero, Gennaro Mazzarella, Aurora Daniele
The influence of obesity on development, severity and prognosis of both asthma and COPD is attracting growing interest. The impact of obesity on the respiratory system ranges from structural modifications (decline of total lung capacity) to humoral alterations. Adipose tissue strongly contributes to the establishment of an inflammatory state being an important source of adipokines. Amongst adipokines, adiponectin is an important component of organ cross talk with adipose tissue exerting protective effects on a variety of pathophysiological processes...
January 20, 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28027938/superimposed-pressure-oscillations-an-alternative-to-treat-airway-hyperresponsiveness-in-an-acute-sensitized-airways-mouse-model
#9
M J Jo-Avila, A M Al-Jumaily
The main driving mechanism during an asthma attack is the hyper-constrictions of airway smooth muscle (ASM), which reduces the airway lumen and makes normal breathing difficult. In spite of some noticeable side effects, bronchodilator drugs such as salbutamol are used to alleviate these symptoms by inducing temporary relaxation of the contracted ASM. In vitro studies have shown that mechanical oscillation can induce relaxation in isolated contracted ASM obtained from healthy subjects but not from asthmatics...
December 24, 2016: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/27942210/airflow-obstruction-is-it-asthma-or-is-it-copd
#10
REVIEW
Paola Rogliani, Josuel Ora, Ermanno Puxeddu, Mario Cazzola
Despite the availability of guideline recommendations, diagnostic confusion between COPD and asthma appears common, and often it is very difficult to decide whether the obstruction is caused by asthma or COPD in a patient with airway obstruction. However, there are well-defined features that help in differentiating asthma from COPD in the presence of fixed airflow obstruction. Nonetheless, the presentations of asthma and COPD can converge and mimic each other, making it difficult to give these patients a diagnosis of either condition...
2016: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/27920974/a-case-report-of-malignant-obesity-hypoventilation-syndrome-a-weighty-problem-in-our-icus
#11
Michael Tatusov, Joshua J Joseph, Brian M Cuneo
INTRODUCTION: The obesity epidemic is reflected by increasing numbers of morbidly obese patients being admitted to intensive care units (ICUs). These are complicated patients whose care involves many diagnostic and treatment challenges. We are presenting a fatal case of super obesity, hypoventilation, and multi-organ failure known as malignant obesity hypoventilation syndrome (MOHS). CASE PRESENTATION: 35 year old African American gentleman with a body mass index (BMI) of 115 kg/m(2) presented to the hospital with respiratory distress...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/27905828/procedural-and-short-term-safety-of-bronchial-thermoplasty-in-clinical-practice-evidence-from-a-national-registry-and-hospital-episode-statistics
#12
Julie Burn, Andrew J Sims, Kim Keltie, Hannah Patrick, Sally A Welham, Liam G Heaney, Robert Niven
OBJECTIVE: Bronchial thermoplasty (BT) is a novel treatment for severe asthma. Its mode of action and ideal target patient group remain poorly defined, though clinical trials provided some evidence on efficacy and safety. This study presents procedural and short-term safety evidence from routine UK clinical practice. METHODS: Patient characteristics and safety outcomes (procedural complications, 30-day readmission and A&E attendance, length of stay) were assessed using two independent data sources, the British Thoracic Society UK Difficult Asthma Registry (DAR) and Hospital Episodes Statistics (HES) database...
December 1, 2016: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/27865877/cough-in-the-athlete-chest-guideline-and-expert-panel-report
#13
Louis-Philippe Boulet, Julie Turmel, Richard S Irwin
BACKGROUND: Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess the following in this population: (1) the main causes of acute and recurrent cough, either exercise-induced or not, (2) how cough is assessed, and (3) how cough is treated in this population. From the systematic review, suggestions for management were developed. METHODS: This review was performed according to the CHEST methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework until April 2015...
February 2017: Chest
https://www.readbyqxmd.com/read/27824606/omalizumab-reduces-bronchial-mucosal-ige-and-improves-lung-function-in-non-atopic-asthma
#14
Prathap Pillai, Yih-Chih Chan, Shih-Ying Wu, Line Ohm-Laursen, Clare Thomas, Stephen R Durham, Andrew Menzies-Gow, Raj K Rajakulasingam, Sun Ying, Hannah J Gould, Chris J Corrigan
Omalizumab therapy of non-atopic asthmatics reduces bronchial mucosal IgE and inflammation and preserves/improves lung function when disease is destabilised by staged withdrawal of therapy.18 symptomatic, non-atopic asthmatics were randomised (1:1) to receive omalizumab or identical placebo treatment in addition to existing therapy for 20 weeks. Bronchial biopsies were collected before and after 12-14 weeks of treatment, then the patients destabilised by substantial, supervised reduction of their regular therapy...
December 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/27797861/diagnosis-of-cystic-fibrosis-in-a-patient-of-egyptian-background
#15
Rie Yoshida, Bobby Ruge
Cystic fibrosis (CF) is the most common genetically inherited condition in European-derived populations. However, it is being increasingly recognised in other populations, including people of Asian, Black African and Caribbean descent. We present a case detailing the diagnosis of CF in a 12-year-old patient of Egyptian background who had been treated for difficult asthma. In doing so, we aim to highlight the importance of considering CF in all patients, regardless of ethnicity.
October 20, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27736038/multidisciplinary-treatment-in-children-with-problematic-severe-asthma-a-prospective-evaluation
#16
Marieke Verkleij, Anita Beelen, Bart E van Ewijk, Rinie Geenen
OBJECTIVE: For children with problematic severe asthma, achieving adequate control of asthma is difficult. The aim of this prospective observational study was to evaluate the effects of intensive multidisciplinary inpatient treatment on multiple outcome variables in children with problematic severe asthma. METHODS: Participants were 89 children with problematic severe asthma (mean age 13.6 ± 2.5 years) treated in tertiary care clinics at high altitude (Switzerland) or sea level (Netherlands) and their parents (85 mothers, 55 fathers)...
October 13, 2016: Pediatric Pulmonology
https://www.readbyqxmd.com/read/27734646/cavitary-lung-lesions-in-a-difficult-to-treat-asthma-patient
#17
R Ragesh, Animesh Ray, Agrima Mian, Surabhi Vyas, S K Sharma
We describe an interesting case of severe asthma who was not showing satisfactory response to standard treatment. Investigations revealed him to be suffering from allergic bronchopulmonary aspergillosis (ABPA). After starting systemic steroids he showed marked improvement initially only to have recurrent symptoms within a year. He was investigated further and found to have chronic pulmonary aspergillosis in the form of chronic cavitary pulmonary aspergillosis (CCPA) and aspergilloma as also the presence of selective IgA deficiency...
April 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/27730197/clinical-profile-of-patients-with-adult-onset-eosinophilic-asthma
#18
Jantina C de Groot, Huib Storm, Marijke Amelink, Selma B de Nijs, Edwin Eichhorn, Bennie H Reitsma, Elisabeth H D Bel, Anneke Ten Brinke
Adult-onset eosinophilic asthma is increasingly recognised as a severe and difficult-to-treat subtype of asthma. In clinical practice, early recognition of patients with this asthma subtype is important because it may have treatment implications. Therefore, physicians need to know the distinct characteristics of this asthma phenotype. The objective of the present study was to determine the characteristic profile of patients with adult-onset eosinophilic asthma. 130 patients with adult-onset (>18 years of age) asthma and high blood eosinophil counts (≥0...
April 2016: ERJ Open Research
https://www.readbyqxmd.com/read/27726946/meta-analysis-of-asthma-related-hospitalization-in-mepolizumab-studies-of-severe-eosinophilic-asthma
#19
Steven W Yancey, Hector G Ortega, Oliver N Keene, Bhabita Mayer, Necdet B Gunsoy, Christopher E Brightling, Eugene R Bleecker, Pranabashis Haldar, Ian D Pavord
BACKGROUND: Studies show that mepolizumab can reduce the frequency of clinically significant exacerbations in patients with severe eosinophilic asthma, compared with placebo. However, important events such as hospitalizations and emergency room visits are rare and difficult to characterize in single studies. OBJECTIVE: We sought to compare hospitalization or hospitalization and/or emergency room visit rates in patients with severe eosinophilic asthma treated with mepolizumab or placebo in addition to standard of care for at least 24 weeks...
October 4, 2016: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/27692867/targeting-single-molecules-in-asthma-benefits-few
#20
REVIEW
Amy Chang, Ynuk Bossé
Asthma is a lung disorder triggered by various airborne factors in susceptible individuals. Although generally controlled, asthma can be severe and difficult to treat. Presently, increasing numbers of pharmaceuticals capable of blocking or mimicking specific endogenous molecules are undergoing clinical trials in asthmatic individuals whose symptoms are poorly controlled despite adherence to guideline therapies. Unfortunately, only a few, meticulously selected patients have been found to minimally benefit. These findings not only confirm that the molecular pathogenesis of severe asthma is variable between patients but also suggest that each molecular defect is likely to contribute little on its own in each patient...
November 2016: Trends in Molecular Medicine
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