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1. Less puffing, more breathing? Intermittent inhaled steroids for asthma

Less puffing, more breathing? Intermittent inhaled steroids for asthma March 4, 2019 (en français) Less puffing, more breathing? Intermittent inhaled steroids for asthma Clinical Question: In patients with mild persistent asthma, is intermittent use of inhaled corticosteroids (ICS) as effective as daily use? Bottom Line: In patients with mild persistent asthma, intermittent use of ICS or ICS/LABA is similar to daily ICS in preventing exacerbations but is associated with ~5 fewer weeks per year (...) waking, symptoms on waking, activity limitation, shortness of breath, wheeze: ? Proportion with improvement of = 0.5 points (minimally clinical important difference): 1,2 ? Budesonide/formoterol PRN 41%, daily ICS 46%, Number needed to harm (NNH)=20. ? Number of weeks with well controlled asthma: ? Budesonide/formoterol PRN 18 weeks versus 23 weeks. 1 ? Asthma Quality of Life Questionnaire: no clinically meaningful difference. 1,2 ? Adverse events: similar. 1,2 ? Total ICS exposure was ?60-70% lower

2019 Tools for Practice

2. Asthma: School-Based Self-Management Interventions for Children and Adolescents with Asthma

adolescents with asthma. A controlled trial. American Journal of Respiratory and Critical Care Medicine 2011;183(8):998–1006. Cicutto L, Murphy S, Coutts D, O’Rourke J, Lang G, Chapman C, et al. Breaking the access barrier: evaluating an asthma center’s efforts to provide education to children with asthma in schools. Chest 2005;128(4):1928–35. Cicutto L, To T, Murphy S. A randomized controlled trial of a public health nurse-delivered asthma program to elementary schools. Journal of School Health 2013;83 (...) on asthma control outcomes. Compared with controls, students in self-management intervention groups reported the following: Less need for the use of asthma reliever medications (6 studies) Fewer activity limitations (6 studies) Little or no change in self-reported day-time or night-time symptoms (12 studies) or measures of lung function (6 studies) Summary of Economic Evidence An economic review has not been conducted. Applicability Based on results from the review, the finding should be applicable

2020 Community Preventive Services Task Force

3. Managing Chronic Cough Due to Asthma and NAEB in Adults and Adolescents: CHEST Guideline and Expert Panel Report

and areas for future research. CHEST 2020; 158(1):68-96 KEYWORDS: asthma; bronchitis; cough ABBREVIATIONS: FENO= fractionalexhalednitric oxide;NAEB =non- asthmatic eosinophilic bronchitis; RCT = randomized controlled trial AFFILIATIONS: From the Centre de pneumologie (Drs Côté and Boulet), Québec Heart and Lung Institute, Laval University, Québec City, QC, Canada; Department of Respiratory Sciences (Drs Russell and Brightling), Institute for Lung Health, Glen?eld Hospital, Uni- versity of Leicester (...) Managing Chronic Cough Due to Asthma and NAEB in Adults and Adolescents: CHEST Guideline and Expert Panel Report Managing Chronic Cough Due to Asthma and NAEB in Adults and Adolescents CHEST Guideline and Expert Panel Report AndreanneCôté,MD;RichardJ.Russell,MBBS;Louis-PhilippeBoulet,MD;PeterG.Gibson,DMed;KefangLai,MD,PhD; Richard S. Irwin, MD, Master FCCP; and Christopher E. Brightling, PhD; on behalf of the CHEST Expert Cough Panel * BACKGROUND: Asthma and non-asthmatic eosinophilic

2020 American College of Chest Physicians

4. Lung function changes in patients with chronic obstructive pulmonary disease (COPD) and asthma exposed to secondhand smoke in outdoor areas. (Abstract)

Lung function changes in patients with chronic obstructive pulmonary disease (COPD) and asthma exposed to secondhand smoke in outdoor areas. Background: Further evidence is needed on the effects that short- and long-term exposure to secondhand smoke (SHS) have on the respiratory health of patients with lung disease. Within the TackSHS project we aimed to assess the acute respiratory effects in lung function that result from short-term SHS exposure among patients with asthma and chronic (...) in exhaled CO between pre- and 24 h post-exposure neither in women (p = 0.210), nor in men (p = 0.169).A statistically significant decrease in forced vital capacity (FVC) was seen, overall, in asthma participants (p = 0.02) and in forced expiratory volume in the first second (FEV1), (p = 0.02), FVC (p = 0.04) and peak expiratory flow rate (PEFR) (p = 0.04) in female asthmatic participants. The observed decreases in respiratory measurements in COPD were not significant. There were no reported increases

2020 Journal of Asthma

5. Preliminary study: comparative effects of lung volume therapy between slow and fast deep-breathing techniques on pulmonary function, respiratory muscle strength, oxidative stress, cytokines, 6-minute walking distance, and quality of life in persons with C Full Text available with Trip Pro

Preliminary study: comparative effects of lung volume therapy between slow and fast deep-breathing techniques on pulmonary function, respiratory muscle strength, oxidative stress, cytokines, 6-minute walking distance, and quality of life in persons with C Lung volume therapy with the Voldyne® device can improve lung volume and has a nonsignificant benefit on respiratory muscle strength via the slow deep-breathing technique (SDBT); whereas respiratory muscle training with a respiratory muscle (...) trainer via the fast deep-breathing technique (FDBT) has produced a significant improvement in people with COPD. Thus, the aim of this study was to compare the efficiency of lung volume therapy with the Voldyne® device with the SDBT and FDBT on pulmonary function, respiratory muscle strength, oxidative stress, cytokines, walking capacity, and quality of life (QoL) in people with COPD.A total of 30 COPD patient volunteers with mild (stage I) to moderate (stage II) severity were randomized into two

2019 International journal of chronic obstructive pulmonary disease Controlled trial quality: uncertain

6. Asthma: diagnosis, monitoring and chronic asthma management

Suspected asthma describes a potential diagnosis of asthma based on symptoms and response to treatment that has not yet been confirmed with objective tests. Uncontrolled asthma Uncontrolled asthma Uncontrolled asthma describes asthma that has an impact on a person's lifestyle or restricts their normal activities. Symptoms such as coughing, wheezing, shortness of breath and chest tightness associated with uncontrolled asthma can significantly decrease a person's quality of life and may lead to a medical (...) be underdiagnosed in some cases. The diagnosis recommendations will improve patient outcomes and will be cost-effective to the NHS in the long-term; NICE's cost impact assessment projects a saving of approximately £12 million per year in England, before implementation costs. Initial clinical assessment should include questions about symptoms (wheezing, cough, breathing and chest problems) and any personal or family history of allergies, atopic disorders or asthma. Various tests can be used to support

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

7. Nitric oxide breath analysis for the management of asthma

Nitric oxide breath analysis for the management of asthma Nitric oxide breath analysis for the management of asthma Nitric oxide breath analysis for the management of asthma HAYES, Inc. Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation HAYES, Inc.. Nitric oxide breath analysis for the management of asthma. Lansdale: HAYES, Inc.. Directory Publication. 2016 Authors (...) ' objectives The measurement of nitric oxide (NO) concentration in expired breath has been introduced as an adjunct to or replacement for established clinical and laboratory assessments of asthma control to guide the management of asthma. Measurement of fractional exhaled nitric oxide (FENO) is a noninvasive diagnostic technique. The NO molecules exhaled in breath can be measured using a handheld electrochemical sensor or a large, stationary chemiluminescence gas analyzer. Controversy: NO, which

2017 Health Technology Assessment (HTA) Database.

8. Nitric oxide breath analysis for the diagnosis of asthma

Nitric oxide breath analysis for the diagnosis of asthma Nitric oxide breath analysis for the diagnosis of asthma Nitric oxide breath analysis for the diagnosis of asthma HAYES, Inc Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation HAYES, Inc. Nitric oxide breath analysis for the diagnosis of asthma. Lansdale: HAYES, Inc. Directory Publication. 2016 Authors (...) ' objectives The measurement of nitric oxide (NO) concentration in expired breath has been introduced as an adjunct to or replacement for the established clinical and laboratory assessments for the diagnosis of asthma. Measurement of fractional exhaled nitric oxide (FENO) is a noninvasive diagnostic technique. The NO molecules exhaled in breath can be measured using a handheld electrochemical sensor or a large, stationary chemiluminescence gas analyzer. Controversy: NO, which is normally produced

2017 Health Technology Assessment (HTA) Database.

9. Management of Severe Asthma: a European Respiratory Society/American Thoracic Society Guideline. Full Text available with Trip Pro

Management of Severe Asthma: a European Respiratory Society/American Thoracic Society Guideline. This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and the results were summarised in evidence (...) profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on 6 specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) Suggest using anti-IL5 and anti IL-5Rα for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest

2019 European Respiratory Journal

10. Resumption of pulmonary function testing during the post-peak phase of the COVID-19 Pandemic - a position statement from the Canadian Thoracic Society and the Canadian Society of Respiratory Therapists

Resumption of pulmonary function testing during the post-peak phase of the COVID-19 Pandemic - a position statement from the Canadian Thoracic Society and the Canadian Society of Respiratory Therapists 1 ‘In Press’. Submitted for publication in the CJRCCSM on July 12, 2020 Resumption of Pulmonary Function Testing during the Post-Peak Phase of the COVID-19 Pandemic A Position Statement from the Canadian Thoracic Society and the Canadian Society of Respiratory Therapists Sanja Stanojevic (...) the Canadian Thoracic Society website (https://cts-sct.ca/covid-19/) or Canadian Society of Respiratory Therapists website (https://www.csrt.com/position-statements/) for updates. The Canadian Association of Cardio- Pulmonary Technologists endorses this position statement. Pulmonary function tests (PFTs) are important for the diagnosis, management and monitoring of disease and there is an urgent need to safely resume services. Patients cannot wear a mask during the test and physical distancing of two

2020 CPG Infobase

11. Use of antibiotics and asthma medication for acute lower respiratory tract infections in people with and without asthma: retrospective cohort study. Full Text available with Trip Pro

Use of antibiotics and asthma medication for acute lower respiratory tract infections in people with and without asthma: retrospective cohort study. Antibiotics are overused in patients with acute lower respiratory tract infections (ALRTIs), but less is known about their use in patients with asthma, or the use of asthma medication for ALRTI in patients without asthma. Our aim was to describe the frequency, variation and drivers in antibiotic and asthma medication prescribing for ALRTI in adults (...) with and without asthma in primary care.A retrospective cohort analysis of patients aged ≥12 years, diagnosed with an ALRTI in primary care in 2014-15 was conducted using data from the Clinical Practice Research Datalink. Current asthma status, asthma medication and oral antibiotic use within 3 days of ALRTI infection was determined. Treatment frequency was calculated by asthma status. Mixed-effect regression models were used to explore between-practice variation and treatment determinants.There were 127,976

2020 Respiratory research

12. Three Major Efforts to Phenotype Asthma: Severe Asthma Research Program, Asthma Disease Endotyping for Personalized Therapeutics, and Unbiased Biomarkers for the Prediction of Respiratory Disease Outcome. (Abstract)

Three Major Efforts to Phenotype Asthma: Severe Asthma Research Program, Asthma Disease Endotyping for Personalized Therapeutics, and Unbiased Biomarkers for the Prediction of Respiratory Disease Outcome. The SARP, ADEPT, and U-BIOPRED programs are all significant efforts in characterizing asthma and reporting clusters that will assist in designing personalized therapies for asthma, and especially severe asthma. Key aspects of the design of these programs are summarized and major findings

2019 Clinics in Chest Medicine

13. Fetal umbilical, cerebral and pulmonary blood flow patterns in relation to lung function and asthma in childhood. The Generation R Study. Full Text available with Trip Pro

Fetal umbilical, cerebral and pulmonary blood flow patterns in relation to lung function and asthma in childhood. The Generation R Study. Fetal growth restriction is associated with higher risks of childhood respiratory morbidity. Fetal blood flow adaptations might contribute to these associations. We examined the associations of fetal umbilical, cerebral and pulmonary blood flow with wheezing patterns, lung function and asthma in childhood.In a population-based prospective cohort study among (...) 903 children we measured fetal umbilical, cerebral and pulmonary blood flow by pulsed-wave-Doppler at a median gestational age of 30.3 (95% range 28.8-32.3) weeks. We obtained information about wheezing patterns until the age of 6-years by questionnaires. Lung function was measured by spirometry and information about current asthma was obtained by questionnaire at the age of 10-years.Results showed a non-significant relationship between a higher umbilical artery pulsatility index (PI

2019 Pediatric Allergy and Immunology

14. Tiotropium (Spiriva Respimat) - as add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma who experienced one or more severe asthma exacerbations in the preceding year

Tiotropium (Spiriva Respimat) - as add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma who experienced one or more severe asthma exacerbations in the preceding year Published 14 January 2019 www.scottishmedicines.org.uk Product update SMC2118 tiotropium 2.5 microgram solution for inhalation (Spiriva® Respimat®) Boehringer Ingelheim Limited 7 December 2018 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product (...) and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland. The advice is summarised as follows: ADVICE: following an abbreviated submission tiotropium (Spiriva® Respimat®) is accepted for use within NHSScotland. Indication under review: as add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma who experienced one or more severe asthma exacerbations in the preceding year. Tiotropium has previously been accepted for use

2019 Scottish Medicines Consortium

15. Breathing training for dysfunctional breathing in asthma: taking a multidimensional approach Full Text available with Trip Pro

Breathing training for dysfunctional breathing in asthma: taking a multidimensional approach Various breathing training programmes may be helpful for adults with asthma. The main therapeutic aim for many of these programmes is the correction of dysfunctional breathing. Dysfunctional breathing can be viewed practically as a multidimensional entity with the three key dimensions being biochemical, biomechanical and psychophysiological. The objectives of this review are to explore how each (...) of these dimensions might impact on asthma sufferers, to review how various breathing therapy protocols target these dimensions and to determine if there is evidence suggesting how breathing therapy protocols might be optimised. Databases and reference lists of articles were searched for peer-reviewed English language studies that discussed asthma or dysfunctional breathing and various breathing therapies. Biochemical, biomechanical and psychophysiological aspects of dysfunctional breathing can all potentially

2017 ERJ open research

16. Molecular detection of respiratory pathogens and typing of human rhinovirus of adults hospitalized for exacerbation of asthma and chronic obstructive pulmonary disease. Full Text available with Trip Pro

Molecular detection of respiratory pathogens and typing of human rhinovirus of adults hospitalized for exacerbation of asthma and chronic obstructive pulmonary disease. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and asthma are associated with a variety of precipitating factors including infection. This study assessed the infective viral etiologies by real-time multiplex polymerase chain reaction of patients hospitalized with AECOPD and asthma exacerbations (...) in asthma exacerbation was associated with a lower rate of readmissions at 30 and 60 days.Many respiratory viruses were associated with AECOPD and asthma exacerbation. HRV-A and HRV-C were the more common HRV associated with exacerbations. Identification of pathogens in NPA was associated with less readmissions for asthma patients at 30 and 60 days.ClinicalTrials.gov NCT02866357 .

2019 Respiratory research

17. Pulmonary epithelial barrier and immunological functions at birth and in early life - key determinants of the development of asthma?  A description of the protocol for the Breathing Together study Full Text available with Trip Pro

Pulmonary epithelial barrier and immunological functions at birth and in early life - key determinants of the development of asthma?  A description of the protocol for the Breathing Together study Background.  Childhood asthma is a common complex condition whose aetiology is thought to involve gene-environment interactions in early life occurring at the airway epithelium, associated with immune dysmaturation.  It is not clear if abnormal airway epithelium cell (AEC) and cellular immune system (...) functions associated with asthma are primary or secondary.  To explore this, we will (i) recruit a birth cohort and observe the evolution of respiratory symptoms; (ii) recruit children with and without asthma symptoms; and (iii) use existing data from children in established STELAR birth cohorts.    Novel pathways identified in the birth cohort will be sought in the children with established disease.  Our over-arching hypothesis is that epithelium function is abnormal at birth in babies who subsequently

2018 Wellcome open research

18. Pulmonary deposition of fluticasone propionate/formoterol in healthy volunteers, asthmatics and COPD patients with a novel breath-triggered inhaler. Full Text available with Trip Pro

Pulmonary deposition of fluticasone propionate/formoterol in healthy volunteers, asthmatics and COPD patients with a novel breath-triggered inhaler. A combination of fluticasone propionate/formoterol fumarate (FP/FORM) has been incorporated within a novel, breath-triggered device, named K-haler®. This low resistance device requires a gentle inspiratory effort to actuate it, triggering at an inspiratory flow rate of approximately 30 L/min; thus avoiding the need for coordination of inhalation (...) with manual canister depression. The aim of the study was to evaluate total and regional pulmonary deposition of FP/FORM when administered via the K-haler device.Twelve healthy subjects, 12 asthmatics, and 12 COPD patients each received a single dose of 2 puffs 99mtechnetium-labelled FP/FORM 125/5 μg. A gamma camera was used to obtain anterior and posterior two-dimensional images of drug deposition. Prior transmission scans (using a99mtechnetium flood source) allowed the definition of regions of interest

2018 Respiratory medicine

19. Using the Inflammacheck Device to Measure the Level of Exhaled Breath Condensate Hydrogen Peroxide in Patients With Asthma and Chronic Obstructive Pulmonary Disease (The EXHALE Pilot Study): Protocol for a Cross-Sectional Feasibility Study Full Text available with Trip Pro

Using the Inflammacheck Device to Measure the Level of Exhaled Breath Condensate Hydrogen Peroxide in Patients With Asthma and Chronic Obstructive Pulmonary Disease (The EXHALE Pilot Study): Protocol for a Cross-Sectional Feasibility Study Asthma and Chronic Obstructive Pulmonary Disease (COPD) are common conditions that affect over 5 million people in the United Kingdom. These groups of patients suffer significantly from breathlessness and recurrent exacerbations that can be difficult (...) severity and symptom control in patients with asthma and COPD and volunteers with no history of lung disease. Participants will be asked to provide an exhaled breath sample for measurement of their EBC H2O2 using Inflammacheck. The result will be correlated with disease stage, spirometry, fractional exhaled nitric oxide (FeNO), and symptom control scores.This study's recruitment is ongoing; it is anticipated that the results will be available in 2018.The EXhaled Hydrogen peroxide As a marker of Lung

2018 JMIR Research Protocols

20. A descriptive follow-up interview study assessing patient-centred outcomes: Salford Lung Study in Asthma (SLS Asthma). Full Text available with Trip Pro

A descriptive follow-up interview study assessing patient-centred outcomes: Salford Lung Study in Asthma (SLS Asthma). The Salford Lung Study in Asthma (SLS Asthma) was a multicentre, randomised, controlled, open-label trial that assessed initiating once-daily, single-inhaler fluticasone furoate/vilanterol (FF/VI) 100 μg/25 μg or 200 μg/25 μg versus continuing usual care. A subgroup (n = 400) from SLS Asthma was enrolled in this exploratory, interview-based follow-up study. Quantitative (...) and qualitative data were collected via questionnaires. The primary objective was to capture patient-centred outcomes (symptom experience, quality of life [QoL], disease management behaviours) and patient experience. Secondary objectives were to assess the correlation of patient-reported outcomes with pre-defined variables from SLS Asthma (Asthma Control Test [ACT] score). The follow-up sample was representative of the SLS Asthma population; half reported asthma improvement during the study. Breathlessness

2019 NPJ primary care respiratory medicine Controlled trial quality: uncertain

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