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Difficult to treat asthma

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https://www.readbyqxmd.com/read/28877019/severe-and-difficult-to-treat-asthma-in-adults
#1
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
#2
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
#3
(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
#4
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-severe-or-difficult-to-treat-asthma-tenor-ii
#5
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/difficult-to-treat asthma, despite standard-of-care treatment. OBJECTIVE: 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/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
#6
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
#7
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
#8
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
#9
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
https://www.readbyqxmd.com/read/28424691/increased-autophagy-related-5-gene-expression-is-associated-with-collagen-expression-in-the-airways-of-refractory-asthmatics
#10
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/28400693/ludwig-s-angina-a-nightmare-worsened-by-adverse-drug-reaction-to-antibiotics
#11
Mohamed Hisham, Mundilipalayam N Sivakumar, R S Senthil Kumar, P Nandakumar
A 52-year-old obese gentleman presented to the hospital with complaints of fever and shortness of breath for 10 days. He was admitted in the ward and treated for acute exacerbation of asthma. He was shifted to the Intensive Care Unit (ICU) for persistent fever, neck swelling, airway obstruction and desaturation. Ludwig's angina was suspected and computed tomography of neck confirmed it. A difficult airway was anticipated and preceded with surgical tracheostomy. The patient had hypersensitivity reactions to piperacillin/tazobactam; hence, he was treated with clindamycin and metronidazole...
March 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28388228/clinical-management-of-severe-therapy-resistant-asthma
#12
Kian Fan Chung
Severe therapy-resistant asthma is an area where there has been recent advances in understanding that is percolating into improvements in management. Areas covered: This review covers the recent definition and approach to the diagnosis of severe asthma and its differentiation from difficult-to-treat asthma. The recent advances in phenotyping severe asthma and in ensuing changes in management approaches together with the introduction of new therapies are covered from a review of the recent literature. Expert commentary: After ascertaining the diagnosis of severe asthma, patients need to be treated adequately with existing therapies...
May 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/28370985/is-bronchial-thermoplasty-cost-effective-as-treatment-for-problematic-asthma-patients-singapore-s-perspective-on-a-global-model
#13
Hai V Nguyen, Saideep Bose, Shweta Mital, Anthony Chau Ang Yii, Shin Yuh Ang, Sean Shao Wei Lam, Devanand Anantham, Eric Finkelstein, Mariko Siyue Koh
BACKGROUND AND OBJECTIVE: Bronchial thermoplasty (BT) has been shown to be effective at reducing asthma exacerbations and improving asthma control for patients with severe persistent asthma but it is also expensive. Evidence on its cost-effectiveness is limited and inconclusive. In this study, we aim to evaluate the incremental cost-effectiveness of BT combined with optimized asthma therapy (BT-OAT) relative to OAT for difficult-to-treat and severe asthma patients in Singapore, and to provide a general framework for determining BT's cost-effectiveness in other healthcare settings...
August 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/28347832/the-genus-achyranthes-a-review-on-traditional-uses-phytochemistry-and-pharmacological-activities
#14
REVIEW
Xirui He, Xiaoxiao Wang, Jiacheng Fang, Yu Chang, Ning Ning, Hao Guo, Linhong Huang, Xiaoqiang Huang
ETHNOPHARMACOLOGICAL RELEVANCE: Achyranthes L. (Amaranthaceae), also known as Chaff Flower and Niuxi/, mainly includes two famous medicinal species namely A. bidentata and A. aspera. A. bidentata has been widely used as blood-activating and stasis-resolving medicine for the treatment of various diseases including amenorrhea, dysmenorrhea, lumbago, gonalgia, paraplegia, edema, stranguria, headache, dizziness, odontalgia, oral ulcer, hematemesis, and epistaxis. A. aspera has been widely used to treat various diseases, including gynecological disorder, asthma, ophthalmia, odontalgia, haemorrhoids, and abdominal tumor, and has been applied to difficult labour, wound healing, insect and snake bites...
May 5, 2017: Journal of Ethnopharmacology
https://www.readbyqxmd.com/read/28328592/status-asthmaticus-and-central-herniation-a-case-for-multidisciplinary-critical-care
#15
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...
June 1, 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
#16
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
#17
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...
September 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
#18
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
#19
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
#20
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
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