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Asthma controller withdrawal

Bhupendrasinh F Chauhan, Maya M Jeyaraman, Amrinder Singh Mann, Justin Lys, Ahmed M Abou-Setta, Ryan Zarychanski, Francine M Ducharme
BACKGROUND: Asthma management guidelines recommend low-dose inhaled corticosteroids (ICS) as first-line therapy for adults and adolescents with persistent asthma. The addition of anti-leukotriene agents to ICS offers a therapeutic option in cases of suboptimal control with daily ICS. OBJECTIVES: To assess the efficacy and safety of anti-leukotriene agents added to ICS compared with the same dose, an increased dose or a tapering dose of ICS (in both arms) for adults and adolescents 12 years of age and older with persistent asthma...
March 16, 2017: Cochrane Database of Systematic Reviews
Claus Vogelmeier, Heinrich Worth, Roland Buhl, Carl-Peter Criée, Nadine S Lossi, Claudia Mailänder, Peter Kardos
Many patients with chronic obstructive pulmonary disease (COPD) receive inhaled corticosteroids (ICSs) without a clear indication, and thus, the impact of ICS withdrawal on disease control is of great interest. DACCORD is a prospective, noninterventional 2-year study in the primary and secondary care throughout Germany. A subgroup of patients were taking ICS prior to entry - 1,022 patients continued to receive ICS for 2 years; physicians withdrew ICS on entry in 236 patients. Data from these two subgroups were analyzed to evaluate the impact of ICS withdrawal...
2017: International Journal of Chronic Obstructive Pulmonary Disease
Christopher Hd Lawrence, Isobel Yd Chen
Consistent with the Committee on Publication Ethics guidelines, we the above authors are initiating a partial retraction of our paper: Lawrence CHD, Chen IYD. The effect of scuba diving on airflow obstruction in divers with asthma. Diving and Hyperbaric Medicine. 2016 March;46(1):11-14. We wish to make the following statement: "Following independent statistical review of our paper we would like to withdraw the following: all subgroup statistical analysis including Table 1 and the statement "∗ P 〈 0.05, non-asthmatic controls vs Group A3 asthmatics" in the legend of Figure 2; the discussion statement: "We hope that these data will provide practitioners assessing and risk stratifying people with asthma prior to diving with a modest evidence basis on which to advise them of their relative risk of airflow obstruction compared to the normal population...
December 2016: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
David I Bernstein, Michael Gillespie, Sharon Song, Jonathan Steinfeld
OBJECTIVE: Evaluate fluticasone propionate (Fp) using a novel, inhalation-driven, multidose dry powder inhaler (MDPI) in patients with severe persistent asthma, versus placebo MDPI and Fp dry powder inhaler (DPI). METHODS: Patients with persistent asthma despite use of high-dose inhaled corticosteroids were randomized to Fp MDPI 50, 100, 200, or 400 mcg; Fp DPI 250 mcg; or placebo MDPI twice daily for 12 weeks. The primary outcome measure was change from baseline in trough forced expiratory volume in 1 second (FEV1) over the 12-week period, compared with placebo; secondary measures included change from baseline in peak expiratory flow (PEF), rescue inhaler use, and time to withdrawal due to meeting stopping criteria...
October 24, 2016: Journal of Asthma: Official Journal of the Association for the Care of Asthma
Dennis Ledford, William Busse, Benjamin Trzaskoma, Theodore A Omachi, Karin Rosén, Bradley E Chipps, Allan T Luskin, Paul G Solari
BACKGROUND: Few data are available to assist clinicians with decisions regarding long-term use of asthma therapies, including omalizumab. OBJECTIVE: We sought to evaluate the benefit and persistence of response in subjects continuing or withdrawing from long-term omalizumab treatment. METHODS: Evaluating the Xolair Persistency Of Response After Long-Term Therapy (XPORT) was a randomized, double-blind, placebo-controlled withdrawal study that included subjects with moderate-to-severe persistent asthma receiving long-term omalizumab...
November 5, 2016: Journal of Allergy and Clinical Immunology
Mitsuru Adachi, Caroline Goldfrad, Loretta Jacques, Yoshie Nishimura
BACKGROUND: For patients with well-controlled asthma, 'step down' of therapy is recommended. We evaluated Japanese patients switching from inhaled corticosteroid (ICS)/long-acting beta2-agonists (LABA; equivalent to fluticasone propionate [FP]/salmeterol [SAL] 250/50 μg twice daily [BD]) to fluticasone furoate (FF)/vilanterol (VI) 100/25 μg, then stepping down to ICS alone. METHODS: This phase III trial had two treatment periods (P): P1, patients with well-controlled asthma on FP/SAL 250/50 μg BD equivalent stepped across to once daily (OD) FF/VI 100/25 μg (open-label, eight weeks); P2, patients remaining 'well controlled' after P1 stepped down to FF 100 μg OD/FP 100 μg BD/FP 250 μg BD (randomized 1:1:1, double-blind, 12 weeks)...
November 2016: Respiratory Medicine
Kazutaka Mori, Tomoyuki Fujisawa, Naoki Inui, Dai Hashimoto, Noriyuki Enomoto, Yutaro Nakamura, Shigeki Kuroishi, Koshi Yokomura, Mikio Toyoshima, Shiro Imokawa, Takashi Yamada, Toshihiro Shirai, Masafumi Masuda, Hiroshi Hayakawa, Kingo Chida, Takafumi Suda
BACKGROUND: The stepping down of asthma treatment can be considered when asthma symptoms have been well controlled with inhaled corticosteroids (ICSs)/long-acting β2 adrenergic agonists (LABAs). However, few data are available comparing the efficacy between two step-down strategies, to reduce ICS/LABA dose or to withdraw LABA continuing ICS, in well-controlled asthmatics. METHODS: This was a prospective multicentre randomized, two-arm, controlled study. Ninety-one asthmatic patients controlled by budesonide/formoterol combination (BFC) 320/9 μg twice daily were assigned to 2 stepping-down treatments as follows: the BFC group; BUD/FM 160/4...
October 2016: Respiratory Medicine
M Caminati, G Senna, G Stefanizzi, R Bellamoli, S Longhi, F Chieco-Bianchi, G Guarnieri, S Tognella, M Olivieri, C Micheletto, G Festi, E Bertocco, M Mazza, A Rossi, A Vianello
BACKGROUND: In patients with asthma, particularly severe asthma, poor adherence to inhaled drugs negatively affects the achievement of disease control. A better adherence rate is expected in the case of injected drugs, such as omalizumab, as they are administered only in a hospital setting. However, adherence to omalizumab has never been systematically investigated. The aim of this study was to review the omalizumab drop-out rate in randomized controlled trials (RCTs) and real-life studies...
August 25, 2016: BMC Pulmonary Medicine
Sunny Jabbal, Arvind Manoharan, William Anderson, Joseph Lipworth, Brian Lipworth
No abstract text is available yet for this article.
October 2016: Annals of Allergy, Asthma & Immunology
Sherif Gonem, Rachid Berair, Amisha Singapuri, Ruth Hartley, Marie F M Laurencin, Gerald Bacher, Björn Holzhauer, Michelle Bourne, Vijay Mistry, Ian D Pavord, Adel H Mansur, Andrew J Wardlaw, Salman H Siddiqui, Richard A Kay, Christopher E Brightling
BACKGROUND: Eosinophilic airway inflammation is often present in asthma, and reduction of such inflammation results in improved clinical outcomes. We hypothesised that fevipiprant (QAW039), an antagonist of prostaglandin D2 receptor 2, might reduce eosinophilic airway inflammation in patients with moderate-to-severe eosinophilic asthma. METHODS: We performed a single-centre, randomised, double-blind, parallel-group, placebo-controlled trial at Glenfield Hospital (Leicester, UK)...
September 2016: Lancet Respiratory Medicine
Ruwanthi Kolamunnage-Dona, Colin Powell, Paula Ruth Williamson
BACKGROUND: Clinical trials with longitudinally measured outcomes are often plagued by missing data due to patients withdrawing or dropping out from the trial before completing the measurement schedule. The reasons for dropout are sometimes clearly known and recorded during the trial, but in many instances these reasons are unknown or unclear. Often such reasons for dropout are non-ignorable. However, the standard methods for analysing longitudinal outcome data assume that missingness is non-informative and ignore the reasons for dropout, which could result in a biased comparison between the treatment groups...
April 28, 2016: Trials
Marjorie Slankard, Mary Ann Michelis, Mahesh Mansukhani, Barbara McGoey, Amy Paige, Howard Andrews, David Lederer, Stephen Canfield, Emily DiMango
INTRODUCTION: Long-acting beta agonists (LABAs) are effective for controlling asthma, however questions about their safety have led to concerns over use. Genetic polymorphisms at the 16 amino acid position of the beta-2 adrenergic receptor gene (B2AR) may be associated with increased risk. METHODS: A randomized, double blind study was conducted in patients with moderate to severe asthma being treated with combined inhaled corticosteroids/LABA (ICS/LABA), comparing the effect of LABA continuation versus withdrawal on asthma outcomes among patients stratified by B2AR genotype (Arg/Arg vs...
October 2016: Journal of Asthma: Official Journal of the Association for the Care of Asthma
Donald P Tashkin, Gary E Moore, Frank Trudo, Michael DePietro, Bradley E Chipps
BACKGROUND: The consistency of fixed airflow limitation status during treatment in patients with asthma is unknown. OBJECTIVE: The objective of this study was to determine the consistency of fixed airflow obstruction (FAO) status during treatment and effects on treatment response. METHODS: This post hoc analysis from a 12-week study (NCT00652002) assessed patients aged 12 years or more with moderate-to-severe asthma randomized to twice-daily budesonide/formoterol (BUD/FM) via pressurized metered-dose inhaler (pMDI) 320/9 μg, BUD pMDI 320 μg, FM 9 μg via dry-powder inhaler, or placebo...
July 2016: Journal of Allergy and Clinical Immunology in Practice
Aditya Lal Vallath, Anuradha Rajiv Joshi, Savita Madhukar Vaidya
INTRODUCTION: It has now been proven that tobacco abuse is the leading cause for various carcinomas such as oral, lung and oesophageal. It also leads to atherosclerosis of major vessels, development of hypertension, autoimmune disorders, COPD, bronchitis, asthma, bronchiectasis, etc. Most smokers are dependent on nicotine and abstinence from smoking results in tobacco withdrawal and craving. It also affects cognitive skills and reaction time. Many students in professional college have the habit of smoking...
December 2015: Journal of Clinical and Diagnostic Research: JCDR
Bhupendrasinh F Chauhan, Caroline Chartrand, Muireann Ni Chroinin, Stephen J Milan, Francine M Ducharme
BACKGROUND: Long-acting beta2-agonists (LABA) in combination with inhaled corticosteroids (ICS) are increasingly prescribed for children with asthma. OBJECTIVES: To assess the safety and efficacy of adding a LABA to an ICS in children and adolescents with asthma. To determine whether the benefit of LABA was influenced by baseline severity of airway obstruction, the dose of ICS to which it was added or with which it was compared, the type of LABA used, the number of devices used to deliver combination therapy and trial duration...
2015: Cochrane Database of Systematic Reviews
M M S Sneeboer, N Fens, M A van de Pol, C J Majoor, J C M Meijers, P W Kamphuisen, R Lutter, P J Sterk, E H D Bel
BACKGROUND: Epidemiologic studies have shown that patients with severe asthma have increased risk of pulmonary embolism, in particular patients with frequent asthma exacerbations. Therefore, we hypothesized that asthma exacerbations are associated with increased haemostatic activity. OBJECTIVE: To investigate whether induced loss of asthma control is associated with changes in coagulation and fibrinolytic parameters in peripheral blood. METHODS: We performed a prospective, inhaled steroid withdrawal study in 23 patients with moderate to moderately severe asthma, consisting of a baseline visit and a visit after loss of asthma control...
March 2016: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
H Akturk, E Karakoc-Aydiner, A Ozen, S Baris, T Akkoc, N N Bahceciler, I Barlan
AIM: There is limited data for predicting the risk of exacerbations following the cessation of inhaled steroids(ICS) in well controlled childhood asthma. In current study, clinical, functional and inflammatory parameters at the time of ICS withdrawal were investigated in that respect. METHODS: Forty children asymptomatic for at least 3 months on low dose ICS's were enrolled and ICS were discontinued in summer. At enrolment symptom/medication diary, pulmonary function parameters, methacholine provocation testing, peripheral blood eosinophilia, serum total and allergen-specific IgE levels and skin prick testing were performed...
September 10, 2015: Minerva Pediatrica
Gustavo J Rodrigo, José A Castro-Rodríguez
BACKGROUND: The role of tiotropium for the treatment of adolescents with asthma has not yet been clearly defined. OBJECTIVE: To assess the efficacy and safety of inhaled tiotropium in adolescents with moderate to severe symptomatic asthma. METHODS: Randomized, placebo-controlled trials were included in this systematic review. Primary outcomes were peak and trough forced expiratory volume in 1 second (FEV1). RESULTS: Three studies (approximately 1,000 patients) were included...
September 2015: Annals of Allergy, Asthma & Immunology
Jimmy Chong, Cheyaanthan Haran, Bhupendrasinh F Chauhan, Innes Asher
BACKGROUND: International guidelines advocate using daily inhaled corticosteroids (ICS) in the management of children and adults with persistent asthma. However, in real world clinical settings, these medicines are often used at irregular intervals by patients. Recent evidence suggests that the use of intermittent ICS, with treatment initiated at the time of early symptoms, may still have benefits for reducing the severity of an asthma exacerbation. OBJECTIVES: To compare the efficacy and safety of intermittent ICS versus placebo in the management of children and adults diagnosed with, or suspected to have, symptoms of mild persistent asthma...
2015: Cochrane Database of Systematic Reviews
Cristoforo Incorvaia, Philippe Moingeon, Serena Buttafava, Franco Frati
The treatment of respiratory allergy is based on several drugs with different mechanisms of action, which encompass an effect only on symptoms, limited factors of inflammation or the whole process of inflammation. Dissecting the different treatments by their mechanism of action is relevant for the management of allergic patients. Corticosteroids, administered as nasal sprays in rhinitis or by inhalation devices in asthma, and allergen immunotherapy (AIT) are the most effective treatments for respiratory allergy, achieving the control on inflammation by a number of cellular and molecular mechanisms...
2015: Expert Review of Clinical Immunology
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