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achieving asthma control

Verónica Giubergia, María J Ramirez Farías, Verónica Pérez, Adriana González, Nancy Crespi, Nora Fridman, Claudio Castaños
INTRODUCTION: Severe asthma accounts for 5-7% of all asthma cases. The World Health Organization proposed a follow-up protocol to classify cases into severe, treatment-resistant asthma (STRA) or severe, difficult-to-control asthma (SDCA). OBJECTIVE: To analyze the clinical, functional, and therapeutic characteristics of patients with STRA or SDCA. METHODS: Cross-sectional, observational, and analytical study to assess the diagnosis, the extent of control (clinical and functional), comorbidities, treatment adherence, inhalation technique, and environmental factors in patients with severe asthma...
April 1, 2018: Archivos Argentinos de Pediatría
C Incorvaia, C Cavaliere, F Frati, S Masieri
Allergic rhinitis (AR) was long considered a quite trivial disease, but the advance in epidemiological and clinical knowledge, with a major role for Allergic rhinitis and its Impact on Asthma (ARIA) initiative, substantially changed the scene. Now we know that AR has significant effects on patients’ quality of life and also has a relevant economic burden. The ARIA phenotypes related to the duration of symptoms and to the severity of AR are very useful in establishing the optimal strategy in each patient with AR, also according to the kind of allergens that cause rhinitis...
January 2018: Journal of Biological Regulators and Homeostatic Agents
Qi Gao, Huijie Huang, Kang Zhu, Xiaoying Liu, Xiaoling Hou, Hui Guan, Yongge Liu, Deli Xin, Li Xiang, Kunling Shen, Xin Ni
In the current study, we sought to track the clinical course of children under control-based asthma management and focused on respiratory pathogens monitoring. We prospectively explored influencing factors for asthma control. 121 children with uncontrolled asthma between 3-14 years of age were recruited. Common respiratory pathogens were detected with pharyngeal swabs and serum aeroallergen-specific IgE was measured. Numeric asthma control scores, airway resistance and fractional concentrations of exhaled nitric oxide (FENO) were evaluated...
February 2018: Iranian Journal of Allergy, Asthma, and Immunology
Anna Sztafińska, Joanna Jerzyńska, Włodzimierz Stelmach, Katarzyna Woicka-Kolejwa, Iwona Stelmach
Introduction: Omalizumab, a monoclonal anti-immunoglobulin E antibody, has been successfully used as a supplementary therapy to improve asthma control in children aged ≥ 6 years with severe persistent allergic asthma. Aim: To demonstrate the quality of life in children with severe asthma and their caregivers, and changes from baseline in forced expiratory volume in 1 s (FEV1 ) and daily inhaled corticosteroids (ICS) dose after 2-year treatment with omalizumab...
October 2017: Postȩpy Dermatologii i Alergologii
Virginia Mirra, Silvia Montella, Francesca Santamaria
BACKGROUND: The primary goal of asthma management is to achieve disease control for reducing the risk of future exacerbations and progressive loss of lung function. Asthma not responding to treatment may result in significant morbidity. In many children with uncontrolled symptoms, the diagnosis of asthma may be wrong or adherence to treatment may be poor. It is then crucial to distinguish these cases from the truly "severe therapy-resistant" asthmatics by a proper filtering process...
February 21, 2018: BMC Pediatrics
Sandy R Durrani, Vincent A Mukkada, Theresa W Guilbert
Eosinophilic esophagitis and asthma are frequently found as comorbid conditions in children and adults along with other manifestations of atopic diathesis. These two conditions have similar T helper 2 responses-driven pathophysiology and share common management strategies such as using systemic corticosteroids and targeted anti-cytokine biologic therapies. Review of the literature finds that asthma is often a comorbid condition in eosinophilic esophagitis in both children and adults; however, the EoE-asthma relationship remains poorly characterized mechanistically and clinically...
February 18, 2018: Clinical Reviews in Allergy & Immunology
Ravi K Viswanathan, William W Busse
Although airway inflammation is an intrinsic and key feature of asthma, this response varies in its intensity and translation to clinical characteristics and responsiveness to treatment. The observations that clinical heterogeneity is an important aspect of asthma and a feature that likely dictates and determines responses to treatment in severe asthma, patient responsiveness to medication is incomplete, and risks for exacerbation are increased. The development of biologics, which target selected and specific components of inflammation, has been a promising advance to achieve asthma control in patients with severe disease...
February 2018: Seminars in Respiratory and Critical Care Medicine
Enrico Heffler, Lorena Nascimento Girardi Madeira, Matteo Ferrando, Francesca Puggioni, Francesca Racca, Luca Malvezzi, Gianni Passalacqua, Giorgio Walter Canonica
Asthma is a common inflammatory airway disease for which the most commonly used controller medications are inhaled corticosteroids (ICS). Asthma control is difficult to achieve in individuals with severe asthma, which comprise 5-10% of individuals with asthma, even with high doses of ICS and other anti-inflammatory drugs. In this clinical context, the adverse effects of ICS (including hypothalamic-pituitary-adrenal axis suppression, reduction in growth velocity, osteoporosis, diabetes, and respiratory infections) become more probable and impacting on the quality of life of severe asthmatics...
February 2, 2018: Journal of Allergy and Clinical Immunology in Practice
Bruce K Rubin, Wei Zhao, Tonya A Winders
One of the most important causes of asthma morbidity, hospital admissions, and death is non-adherence to prescribed therapy. It is generally assumed that adherence rates can be increased with asthma education, although well conducted studies have not always supported this assumption. Education can be achieved, or can fail, in many ways and no two patients have the same needs or perceived needs. In order to better understand what children with asthma and their parents or caregivers would desire as support from their physician providers, we conducted a survey of nearly 1000 parents of asthmatic children affiliated with the Asthma and Allergy Network...
November 16, 2017: Paediatric Respiratory Reviews
Meng Wang, Yuan Yao, Shanqun Jiang, Fang Tao, Rui Tang, Jinlu Sun
Asthma is one of the most significant diseases worldwide and causes overwhelming costs physically and economically. The heterogeneity of asthma has been a hot topic, and an increasing amount of research has been conducted on this issue. The study of asthma has revealed various groups of asthma patients who share phenotypic characteristics that naturally elicit the need for personalized asthma therapy. Clinical evidence has shown that a 'one size fits all' approach does not apply to all asthma patients because of the large variability in treatment responses to asthma medication...
January 28, 2018: Current Drug Metabolism
Eckard Hamelmann, Stanley J Szefler
Asthma is one of the most common chronic diseases in children, with a high proportion of patients demonstrating poor control despite the availability of disease management guidelines. Global Initiative for Asthma guidelines include tiotropium as an add-on therapy option at Steps 4 and 5 in patients aged ≥ 12 years with a history of exacerbations, and tiotropium delivered via the Respimat® Soft Mist™ Inhaler has recently been approved for use as once-daily maintenance therapy for children with asthma over the age of 6 years in the USA...
January 24, 2018: Drugs
Polyxeni Ntontsi, Evgenia Papathanassiou, Stelios Loukides, Petros Bakakos, Georgios Hillas
The identification of patients with severe asthma who will benefit from a personalized management approach remains an unmet need. Interleukin-13 (IL-13) is a cytokine possessing a significant role in asthma pathogenesis and progression of disease. Humanised monoclonal antibodies against IL-13 and IL-13 and IL-4 receptors are mainly proposed as add-on therapy in patients with TH2-high inflammation with uncontrolled asthma despite maximum therapy. Areas covered: The role of IL-13 in airway inflammation in severe asthma, the targeted anti-IL-13 therapies and biomarkers that predict response to anti-IL-13 treatment are discussed...
January 19, 2018: Expert Opinion on Investigational Drugs
Gregory G King, Alan James, Louise Harkness, Peter A B Wark
Severe asthma is defined by the high treatment requirements to partly or fully control the clinical manifestations of disease. It remains a problem worldwide with a large burden for individuals and health services. The key to improving targeted treatments, reducing disease burden and improving patient outcomes is a better understanding of the pathophysiology and mechanisms of severe disease. The heterogeneity, complexity and difficulties in undertaking clinical studies in severe asthma remain challenges to achieving better understanding and better outcomes...
January 9, 2018: Respirology: Official Journal of the Asian Pacific Society of Respirology
S Diver, R J Russell, C Brightling
Asthma is a common chronic inflammatory condition of the airways affecting over 300 million people worldwide. In 5-10% of cases it is severe, with disproportionate healthcare resource utilisation including costs associated with frequent exacerbations and the long-term health effects of systemic steroids. Characterisation of inflammatory pathways in severe asthma has led to development of targeted biological and small molecule therapies which aim to achieve disease control whilst minimising corticosteroid-associated morbidity...
January 8, 2018: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
H Paramesh
Air pollution, global warming and climate change are the major contributing factors in causing the increase prevalence of allergic airway diseases like asthma and allergic rhinitis and they will be the defining issues for health system in the twenty-first century. Asthma is an early onset non-communicable environmental disease with global epidemic and contributes a greatest psycho socio economic burden. Nearly 8 million global deaths are from air pollution. Over one billion population are the sufferers during 2015 and will increase to 4 billion by 2050...
January 9, 2018: Indian Journal of Pediatrics
Satnam Kaur, Varinder Singh
Asthma is a major pediatric respiratory morbidity requiring long-term management. A thorough knowledge of long-term medication side-effects in children is, thus, essential for every physician dealing with childhood asthma. Establishing diagnosis and initiating treatment is just a beginning of the journey. Ongoing monitoring is an essential component of comprehensive asthma management programme. Monitoring includes not only assessment of asthma control but also checking for adherence to treatment, technique of inhaler device use, associated co-morbities, if any, and potential environmental exposure...
January 6, 2018: Indian Journal of Pediatrics
Nulma S Jentzsch, Gabriela C G Silva, Guilherme M S Mendes, Paul L P Brand, Paulo Camargos
OBJECTIVE: There is a scarcity of studies that assessed the association between adherence to combination therapy and asthma control in pediatric patients. The authors investigated the association between adherence to fluticasone propionate/salmeterol xinafoate combination-metered aerosol and the level of asthma control in children. METHODS: This was a prospective observational study of 84 patients aged 5-16 years with moderate persistent asthma, who remained uncontrolled despite the use of 1000μg/day of inhaled nonextrafine-hydrofluoric alkane-beclomethasone dipropionate in the three months prior to study enrollment...
December 20, 2017: Jornal de Pediatria
Alberto Papi, Christopher Brightling, Søren E Pedersen, Helen K Reddel
Asthma-one of the most common chronic, non-communicable diseases in children and adults-is characterised by variable respiratory symptoms and variable airflow limitation. Asthma is a consequence of complex gene-environment interactions, with heterogeneity in clinical presentation and the type and intensity of airway inflammation and remodelling. The goal of asthma treatment is to achieve good asthma control-ie, to minimise symptom burden and risk of exacerbations. Anti-inflammatory and bronchodilator treatments are the mainstay of asthma therapy and are used in a stepwise approach...
December 19, 2017: Lancet
Mônica Versiani Nunes Pinheiro de Queiroz, Cristina Gonçalves Alvim, Álvaro A Cruz, Laura Maria de Lima Belizário Facury Lasmar
Background: In severe asthma, high doses of inhaled corticosteroids (ICS) are used in order to achieve clinical and functional control. This study aimed to evaluate lung function in outpatients (children and adolescents) with severe asthma in Brazil, all of whom were treated with high doses of ICS. We evaluated all spirometry tests together and by ICS dose: 800 and > 800 µg/day. Methods: This was a 3-year longitudinal study in which we analyzed 384 spirometry tests in 65 severe asthma patients (6-18 years of age), divided into two groups by the dose of ICS (budesonide or equivalent): 800 and > 800 µg/day...
2017: Clinical and Translational Allergy
Anne Bruton, Amanda Lee, Lucy Yardley, James Raftery, Emily Arden-Close, Sarah Kirby, Shihua Zhu, Manimekalai Thiruvothiyur, Frances Webley, Lyn Taylor, Denise Gibson, Guiqing Yao, Mark Stafford-Watson, Jenny Versnel, Michael Moore, Steve George, Paul Little, Ratko Djukanovic, David Price, Ian D Pavord, Stephen T Holgate, Mike Thomas
BACKGROUND: Despite effective pharmacotherapy, asthma continues to impair quality of life for most patients. Non-pharmacological approaches, including breathing retraining, are therefore of great interest to patients. However, clinicians rarely advocate breathing retraining and access to this intervention is restricted for most patients due to the limited availability of suitable physiotherapists and poor integration of breathing retraining into standard care. We aimed to assess the effectiveness of a digital self-guided breathing retraining intervention...
December 13, 2017: Lancet Respiratory Medicine
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