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Forced steroid titration asthma

Catherine E Hanratty, John G Matthews, Joseph R Arron, David F Choy, Ian D Pavord, P Bradding, Christopher E Brightling, Rekha Chaudhuri, Douglas C Cowan, Ratko Djukanovic, Nicola Gallagher, Stephen J Fowler, Tim C Hardman, Tim Harrison, Cécile T Holweg, Peter H Howarth, James Lordan, Adel H Mansur, Andrew Menzies-Gow, Sofia Mosesova, Robert M Niven, Douglas S Robinson, Dominick E Shaw, Samantha Walker, Ashley Woodcock, Liam G Heaney
BACKGROUND: Patients with difficult-to-control asthma consume 50-60% of healthcare costs attributed to asthma and cost approximately five-times more than patients with mild stable disease. Recent evidence demonstrates that not all patients with asthma have a typical type 2 (T2)-driven eosinophilic inflammation. These asthmatics have been called 'T2-low asthma' and have a minimal response to corticosteroid therapy. Adjustment of corticosteroid treatment using sputum eosinophil counts from induced sputum has demonstrated reduced severe exacerbation rates and optimized corticosteroid dose...
January 4, 2018: Trials
Stephanie Korn, Claus Vogelmeier, Roland Buhl
BACKGROUND: An inhaled corticosteroid (ICS) or an ICS/long-acting beta(2)-agonist (LABA) combination plus short-acting beta(2)-agonist (SABA) as needed for symptom relief is recommended for persistent asthma. Additionally, budesonide/formoterol maintenance and reliever therapy (Symbicort) SMART, AstraZeneca, Sweden) has been approved for adults in the European Union. This option is well tolerated and offers greater reductions in asthma exacerbations together with similar improvements in daily symptom control, at a lower overall steroid load, compared with fixed-dose ICS/LABA plus SABA...
May 15, 2008: Medizinische Klinik
Y H Khor, B N Feltis, D W Reid, C Ward, D P Johns, R Wood-Baker, E H Walters
BACKGROUND: Back-titration of inhaled corticosteroid (ICS) dose in well-controlled asthma patients is emphasized in clinical guidelines, but there are few published data on the airway cell and cytokine changes in relation to ICS reduction. In our study, 20 mild-to-moderate persistent (inspite of low-moderate dose ICS treatment) asthmatic subjects prospectively rendered largely asymptomatic by high-dose ICS were assessed again by clinical, physiological, and airway inflammatory indices after 4-8 weeks of reduced ICS treatment...
August 2007: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
Chitra Dinakar
PURPOSE OF REVIEW: The focus in managing asthma has undergone a paradigm shift from the concept of assessing severity to assessing control. The recent Practice Parameter on attaining optimal asthma control highlights the need to titrate the step-care management of asthma to the level of control assessed at each clinic encounter. RECENT FINDINGS: Recent advances in the monitoring of asthma control in children include the use of questionnaires such as the Childhood Asthma Control Test, use of biomarkers such as fractional concentration of exhaled nitric oxide, sophisticated hand-held electronic monitoring of lung function such as peak flow and forced expiratory volume, indicators of lung growth and bronchial hyper-responsiveness such as post-bronchodilator forced expiratory volume, outcomes-utilization data, markers of atopy, and electronic measures of adherence...
April 2006: Current Opinion in Allergy and Clinical Immunology
Mariëlle W Pijnenburg, E Marije Bakker, Wim C Hop, Johan C De Jongste
RATIONALE: Corticosteroids are the antiinflammatory treatment of choice in asthma. Treatment guidelines are mainly symptom-driven but symptoms are not closely related to airway inflammation. The fraction of nitric oxide in exhaled air (FENO) is a marker of airway inflammation in asthma. OBJECTIVE: We evaluated whether titrating steroids on FENO improved asthma management in children. METHODS: Eighty-five children with atopic asthma, using inhaled steroids, were allocated to a FENO group (n=39) in which treatment decisions were made on both FENO and symptoms, or to a symptom group (n=46) treated on symptoms only...
October 1, 2005: American Journal of Respiratory and Critical Care Medicine
N P Adams, J B Bestall, R Malouf, T J Lasserson, P W Jones
BACKGROUND: Inhaled beclomethasone dipropionate (BDP) has been, together with inhaled budesonide, the mainstay of anti-inflammatory therapy for asthma for many years. A range of new prophylactic therapies for asthma is becoming available and BDP has been reformulated using a hydrofluoroalkane-134a (HFA) propellant which is free from chlorofluorocarbon (CFC). OBJECTIVES: The objectives of this review were to: (1) Compare the efficacy of BDP with placebo with both CFC and HFA propellants in the treatment of chronic asthma...
2005: Cochrane Database of Systematic Reviews
Paul M Lehrer, Evgeny Vaschillo, Bronya Vaschillo, Shou-En Lu, Anthony Scardella, Mahmood Siddique, Robert H Habib
STUDY OBJECTIVES: We evaluated the effectiveness of heart rate variability (HRV) biofeedback as a complementary treatment for asthma. PATIENTS: Ninety-four adult outpatient paid volunteers with asthma. SETTING: The psychophysiology laboratory at The University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, and the private outpatient offices of participating asthma physicians. INTERVENTIONS: The interventions were as follows: (1) a full protocol (ie, HRV biofeedback and abdominal breathing through pursed lips and prolonged exhalation); (2) HRV biofeedback alone; (3) placebo EEG biofeedback; and (4) a waiting list control...
August 2004: Chest
F Buchvald, H Eiberg, H Bisgaard
BACKGROUND: Nitric oxide in exhaled air is regarded as an inflammation marker, and may be used to monitor the anti-inflammatory control from inhaled corticosteroids (ICSs). However, this response to ICSs exhibits a heterogeneous pattern. OBJECTIVE: The study aimed to describe the independent variables associated with the heterogeneity in the response of exhaled nitric oxide to ICSs. METHODS: Exhaled nitric oxide (FeNO), lung function, bronchial hyper-responsiveness (BHR), specific IgE to common inhalant allergens, blood eosinophils, other atopic manifestations and variants in nitric oxide synthethase 1 (NOS1) gene were studied in a double-blind, placebo-controlled crossover comparison of budesonide (BUD) Turbohaler 1600 mcg daily vs...
December 2003: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
Y Tohda, M Fujimura, H Taniguchi, K Takagi, T Igarashi, H Yasuhara, K Takahashi, S Nakajima
BACKGROUND: Oral leukotriene receptor antagonists have been shown to have efficacy in chronic asthma. OBJECTIVE: To determine whether the addition of montelukast could lead to a reduction in inhaled corticosteroid dose without a significant decrease in peak expiratory flow rate (PEFR). METHODS: After a 4-week run-in period, 191 moderate-to-severe asthmatic patients whose asthma had been well controlled with daily inhaled corticosteroid therapy (beclometasone dipropionate 800 to 1600 micro g/day), were randomly assigned to one of two treatments - placebo (n = 98) or montelukast 10 mg once daily (n = 93) - for a 24-week, multicentre, double-blind, treatment period...
August 2002: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
Jörg D Leuppi, John D Brannan, Sandra D Anderson
The use of histamine and methacholine is well established for identifying airway hyperresponsiveness (AHR) but the AHR to these agents is not specific for asthma diagnosis. Further, these agents do not identify or exclude exercise-induced asthma (EIA) so they are inappropriate for some occupational and sporting assessments. Measurement of AHR by pharmacological agents has other limitations in that a positive response does not necessarily identify a person who will respond to inhaled steroids and responses do not differentiate between doses of steroids...
April 6, 2002: Swiss Medical Weekly
T J Barlow, P Graham, J M Harris, J P Hartley, C W Turton
Forty adult patients with chronic asthma completed a 3-month double-blind crossover study to compare the effect of sustained-release theophylline given both as a fixed 300 mg twice daily dose (standard) and an individually titrated dose (titrated) with placebo. Theophylline was given in addition to other usual therapy, inhaled bronchodilators, inhaled steroids and, in 12 patients, oral steroids. The 3-month period was preceded by a run-in phase to determine the dose of theophylline which each subject required to achieve peak serum levels of 12-20 mg/litre and trough levels of 8-12 mg/litre...
July 1988: British Journal of Diseases of the Chest
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