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Severe Persistent Asthma

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1. An evaluation of the effects of saffron supplementation on the asthma clinical symptoms and asthma severity in patients with mild and moderate persistent allergic asthma: a double-blind, randomized placebo-controlled trial. (PubMed)

An evaluation of the effects of saffron supplementation on the asthma clinical symptoms and asthma severity in patients with mild and moderate persistent allergic asthma: a double-blind, randomized placebo-controlled trial. Asthma is a heterogeneous disease which is usually associated with chronic airway inflammation. Saffron has anti-inflammatory effects and may has beneficial effects on asthma.The present study was intended to survey the effects of saffron supplementation on blood pressure (...) of clinical symptoms of the patients (i.e., frequency of the shortness of breath during the day and night time, use of salbutamol spray, waking up due to asthma symptoms and activity limitation) in comparison to the placebo (p < 0.001). Besides, asthma severity decreased almost significantly in the saffron group (p = 0.07). It was also found that saffron, in comparison with the placebo, significantly reduced the systolic and diastolic blood pressure, triglycerides and low density lipoprotein cholesterol

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2019 Respiratory research Controlled trial quality: uncertain

2. Bronchial thermoplasty for the treatment of severe persistent asthma

Bronchial thermoplasty for the treatment of severe persistent asthma Appl Applic Date o Context at www 1. An Ass thermop Departm 2. After co and cos for BT populat effectiv 3. MSAC severe a is defin combin procedu airways broncho compris The pat severe a that con lication N cant: of MSAC c t for decisio w.msac.gov. Purpose o essment Re plasty (BT) ment of Hea MSAC’s a onsidering t st-effectiven for the treat tion, its plac veness and r Summary noted that t asthma desp ned as the m ned with a lo (...) ure involvin s through a oscope unde ses three pro tient popula asthma who nfirmation r Pub No. 1384 s onsiderat on: MSAC m au of applica eport reques for severe p alth in Octo advice to t the availabl ness of bron tment of sev ce in the clin resulting un y of consid this applicat pite treatme maximal inha ong-acting b ng the delive single use c er moderate ocedures w ation for the ose asthma s required tha lic Sum – Bronc severe p Bos ion: MS makes its ad tion and l sting Medic persistent a ber

2015 Medical Services Advisory Committee

3. Omalizumab for the treatment of severe persistent allergic asthma: a systematic review and economic evaluation

Omalizumab for the treatment of severe persistent allergic asthma: a systematic review and economic evaluation Omalizumab for the treatment of severe persistent allergic asthma: a systematic review and economic evaluation Journals Library An error has occurred in processing the XML document An error occurred retrieving content to display, please try again. >> >> >> Page Not Found Page not found (404) Sorry - the page you requested could not be found. Please choose a page from the navigation

2013 NIHR HTA programme

4. Bronchial thermoplasty for the treatment of severe persistent asthma

Bronchial thermoplasty for the treatment of severe persistent asthma Bronchial thermoplasty for the treatment of severe persistent asthma Bronchial thermoplasty for the treatment of severe persistent asthma Medical Services Advisory Committee 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 Medical Services Advisory Committee. Bronchial thermoplasty (...) for the treatment of severe persistent asthma. Canberra: Medical Services Advisory Committee (MSAC). MSAC application 1384. 2015 Authors' objectives Bronchial thermoplasty (BT) is performed in a bronchoscopy/endoscopy suite and takes about an hour to complete each of the three required treatments. BT is usually conducted under moderate sedation. Post-procedure, patients are observed and monitored for approximately 2-4 hours. Authors' conclusions After considering the available evidence presented in relation

2015 Health Technology Assessment (HTA) Database.

5. Bronchial thermoplasty for moderate or severe persistent asthma in adults. (PubMed)

Bronchial thermoplasty for moderate or severe persistent asthma in adults. Bronchial thermoplasty is a procedure that consists of the delivery of controlled radiofrequency-generated heat via a catheter inserted into the bronchial tree of the lungs through a flexible bronchoscope. It has been suggested that bronchial thermoplasty works by reducing airway smooth muscle, thereby reducing the ability of the smooth muscle to bronchoconstrict. This treatment could then reduce asthma symptoms (...) and exacerbations, resulting in improved asthma control and quality of life.To determine the efficacy and safety of bronchial thermoplasty in adults with bronchial asthma.We searched the Cochrane Airways Group Specialised Register of Trials (CAGR) up to January 2014.We included randomised controlled clinical trials that compared bronchial thermoplasty versus any active control in adults with moderate or severe persistent asthma. Our primary outcomes were quality of life, asthma exacerbations and adverse

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2014 Cochrane

6. Confounders of severe asthma: diagnoses to consider when asthma symptoms persist despite optimal therapy (PubMed)

Confounders of severe asthma: diagnoses to consider when asthma symptoms persist despite optimal therapy Asthma can often be challenging to diagnose especially when patients present with atypical symptoms. Therefore, it is important to have a broad differential diagnosis for asthma to ensure that other conditions are not missed. Clinicians must maintain a high index of suspicion for asthma mimickers, especially when patients fail to respond to conventional therapy. The purpose of this review (...) is to briefly review some of the more common causes of asthma mimickers that clinicians should consider when the diagnosis of asthma is unclear.

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2018 The World Allergy Organization journal

7. Addition of anti-leukotriene agents to inhaled corticosteroids for adults and adolescents with persistent asthma. (PubMed)

taking tapering doses of ICS alone (RR 2.44, 95% CI 1.52 to 3.92; 621 participants; two studies; moderate quality), but deaths were too infrequent for researchers to draw any conclusions about mortality. Data showed no improvement in lung function nor in asthma control measures.For adolescents and adults with persistent asthma, with suboptimal asthma control with daily use of ICS, the addition of anti-leukotrienes is beneficial for reducing moderate and severe asthma exacerbations and for improving (...) Addition of anti-leukotriene agents to inhaled corticosteroids for adults and adolescents with persistent asthma. 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.To assess the efficacy and safety of anti-leukotriene agents added to ICS compared with the same dose

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2017 Cochrane

8. Omalizumab in patients with severe asthma and persistent sputum eosinophilia. (PubMed)

Omalizumab in patients with severe asthma and persistent sputum eosinophilia. Omalizumab, a recombinant humanized monoclonal antibody targeting the IgE molecule, is the first biologic approved for moderate-to-severe allergic asthmatics, who remain uncontrolled despite high dose inhaled corticosteroid and bronchodilators. Steroid-sparing effect of omalizumab has not been demonstrated in asthmatics with persistent airway eosinophilia in a randomised controlled trial till date. From this double

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2019 Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology Controlled trial quality: predicted high

9. Tiotropium (Spiriva Respimat) add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma

Tiotropium (Spiriva Respimat) add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma Tiotropium (Spiriva ® Respimat ® ). Reference number 1882. Page 1 of 3 AWMSG Secretariat Assessment Report – Limited submission Tiotropium (Spiriva ® Respimat ® ) 2.5 microgram, inhalation solution Company: Boehringer Ingelheim Ltd Licensed indication under consideration: add-on maintenance bronchodilator treatment in patients aged 6 years to < 18 years with severe (...) asthma who experienced one or more severe asthma exacerbations in the preceding year Date of licence extension: 12 April 2018 Comparator(s) The company stated that there is no comparator and that tiotropium (Spiriva ® Respimat ® ) is an add-on treatment. Limited submission details ? The limited submission criteria were met based on a minor licence extension. Clinical effectiveness ? Tiotropium (Spiriva ® Respimat ® ) was recommended by the All Wales Medicines Strategy Group in 2017 as an add

2018 All Wales Medicines Strategy Group

10. Reslizumab for treating severe eosinophilic asthma

The committee noted that the NICE scope included omalizumab as a comparator in a small 'overlap' population of people who also had severe persistent allergic IgE-mediated asthma, and therefore could have either reslizumab or omalizumab. It heard that clinicians would decide which drug is most appropriate based on the person's phenotype. For predominantly eosinophilic symptoms, such as nasal polyps and sinusitis, people would be offered reslizumab. However, the committee noted the comment from a consultee (...) Reslizumab for treating severe eosinophilic asthma Reslizumab for treating se Reslizumab for treating sev vere ere eosinophilic asthma eosinophilic asthma T echnology appraisal guidance Published: 4 October 2017 nice.org.uk/guidance/ta479 © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guidance represent the view of NICE, arrived at after careful

2017 National Institute for Health and Clinical Excellence - Technology Appraisals

11. Mepolizumab for treating severe refractory eosinophilic asthma

+ SIRIUS DREAM + MENSA + SIRIUS (75 mg intravenously or 100 mg subcutaneously) Not possible Mepolizumab compared with omalizumab Mepolizumab compared with omalizumab 4.9 The committee noted that the company had identified omalizumab as a comparator in a small 'overlap' population who also had severe persistent allergic IgE-mediated asthma and therefore could have either mepolizumab or omalizumab. The committee noted that the company stated that mepolizumab was likely to be a cost-saving option compared (...) Mepolizumab for treating severe refractory eosinophilic asthma Mepolizumab for treating se Mepolizumab for treating sev vere ere refr refractory eosinophilic asthma actory eosinophilic asthma T echnology appraisal guidance Published: 25 January 2017 nice.org.uk/guidance/ta431 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guidance represent

2017 National Institute for Health and Clinical Excellence - Technology Appraisals

12. Omalizumab Treatment for Atopic Severe Persistant Asthma: A Single-Center, Long-Term, Real-Life Experience with 38 Patients (PubMed)

Omalizumab Treatment for Atopic Severe Persistant Asthma: A Single-Center, Long-Term, Real-Life Experience with 38 Patients Omalizumab is a monoclonal antibody that is used as add-on therapy for treating moderate-to-severe persistant atopic asthma in patients with persistant symptoms and frequent exacerbations, despite step 4 treatment according to GINA guidelines. Real-life studies on omalizumab treatment are limited in Turkey. Thus, the present study aims to assess the clinical efficacy (...) and treatment outcomes of omalizumab in patients with atopic severe persistant asthma.Patients with atopic severe persistant asthma who were treated with omalizumab between 2009 and 2017 were retrospectively evaluated. Baseline and last results of the following variables were compared: symptom scores (GINA categorical), controller medications, blood eosinophil counts, forced expiratory volume in 1 second (FEV1) values, and the number of exacerbations that were treated with systemic corticosteroids

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2018 Turkish Thoracic Journal

13. Serum vitamin A, zinc and visual function in children with moderate to severe persistent asthma. (PubMed)

Serum vitamin A, zinc and visual function in children with moderate to severe persistent asthma. Asthma is a common childhood disorder with complex pathobiologic components that may include aspects of nutritional deficit. The contribution of vitamin deficiency, specifically vitamin A, as part of the disease complex has not been well studied, particularly among at risk children. In this study, we examined the prevalence of vitamin A as well as zinc deficiency in conjunction with visual function (...) among an urban pediatric population sample with moderate-severe persistent asthma.A cross-sectional case-control assessment of serum vitamin A, zinc and visual function among urban children with and without asthma was undertaken. Inclusion criteria involved (1) well-controlled pediatric asthmatic patients between the ages of 8-18 with corrected vision of at least 20/25 in each eye and (2) chronic use of a combination beta agonist-steroid inhaler. Visual function was assessed by Snellen visual acuity

2018 Journal of Asthma

14. Effectiveness and safety of omalizumab in severe, persistent IgE-mediated asthma in pediatric and adult patients: a real-world observational study in Egyptian population. (PubMed)

Effectiveness and safety of omalizumab in severe, persistent IgE-mediated asthma in pediatric and adult patients: a real-world observational study in Egyptian population. Real-world studies on the effectiveness of omalizumab in Egyptian population with asthma are limited. This study aimed to evaluate the real-world effectiveness and safety of omalizumab as an add-on treatment in pediatric and adult patients with severe, persistent allergic asthma in Egypt.The primary endpoint of this 16-week (...) observed in the safety analysis of omalizumab as add-on treatment.Outcomes of this real-world study were consistent with previous effectiveness and safety studies of omalizumab. Omalizumab was effective and well tolerated for the management of severe, persistent IgE-mediated asthma in pediatric and adult patients in Egypt.

2018 Journal of Asthma

15. Benralizumab (Fasenra) - treatment in adult patients with severe eosinophilic asthma

the submitting company. ? Symptoms of severe asthma include difficulty breathing and limited mobility, leaving many people housebound. Persistent symptoms may also lead to sleep deprivation, feelings of despair and depression, low activity levels, weight gain and increased dependence on family and carers. Additionally, repeated hospital admissions may lead to further social isolation and economic disadvantage. ? People with severe asthma require intensive therapies to control symptoms and prevent attacks (...) Benralizumab (Fasenra) - treatment in adult patients with severe eosinophilic asthma 1 Published 10 June 2019 1 SMC2155 benralizumab 30mg solution for injection in pre filled syringe (Fasenra®) AstraZeneca UK Limited 10 May 2019 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 a full submission

2019 Scottish Medicines Consortium

16. Recognition and management of severe asthma - Position Statement

years. Moreover, several studies using endobronchial biopsies in humans with asthma have demonstrated consistent reductions in ASM followingBT. 124–126 Othereffectsonairwayremodelinginclude decreased type 1 collagen deposition and a reduction in reticular basement membrane thickness which persist long- term. 124,126 Bronchial epithelial structure, however, is not mod- i?ed.RecentevidencesuggestsaneffectofBTonairwayneuro- logical structures such as a decrease in autonomic nerve ?bers in the bronchial (...) Recognition and management of severe asthma - Position Statement CTS GUIDELINESAND POSITIONPAPERS Recognitionandmanagementofsevereasthma:ACanadianThoracicSocietyposition statement J.MarkFitzGerald a ,CatherineLemiere b ,M.DianeLougheed c ,FrancineM.Ducharme d ,SharonD.Dell e ,ClareRamsey f , M.ConnieL.Yang g ,Andr eanneC^ ot e h ,WadeWatson i ,RonOlivenstein j ,AnneVanDam k ,CristinaVilla-Roel l ,and RolandGrad m a Department of Medicine, University of British Columbia, Vancouver, Canada; b

2018 Canadian Thoracic Society

17. The Airsonett temperature-controlled laminar airflow device for persistent allergic asthma

improvement in asthma-related quality of life in people with severe persistent allergic asthma when Airsonett was compared with a placebo device. There was no statistically significant difference in asthma medication usage or exacerbation rates, which were secondary outcome measures in 1 randomised controlled trial. Adv Adverse e erse ev vents and safety ents and safety The device is non-invasive and non-pharmaceutical. No treatment-related adverse events were identified. © NICE 2018. All rights reserved (...) allergens, particularly those with severe persistent allergic asthma. It was previously marketed under the name Protexo, and may also be referred to as Airsonett Airshower. All of these names refer to the same model of the device. The device consists of a base unit containing an air intake, filter and cooler, neck pipes, and an air supply nozzle. The base unit stands next to the patient's bed and the air supply nozzle is positioned above their head. The device is principally designed to operate

2014 National Institute for Health and Clinical Excellence - Advice

18. Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trial. (PubMed)

Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trial. Exacerbations of asthma cause a substantial global illness burden. Adults with uncontrolled persistent asthma despite maintenance treatment require additional therapy. Since macrolide antibiotics can be used to treat persistent asthma, we aimed to assess the efficacy and safety of oral azithromycin as add-on therapy (...) in patients with uncontrolled persistent asthma on medium-to-high dose inhaled corticosteroids plus a long-acting bronchodilator.We did a randomised, double-blind, placebo controlled parallel group trial to determine whether oral azithromycin decreases the frequency of asthma exacerbations in adults (≥18 years) with symptomatic asthma despite current use of inhaled corticosteroid and long-acting bronchodilator, and who had no hearing impairment or abnormal prolongation of the corrected QT interval

2017 Lancet Controlled trial quality: predicted high

19. Alair bronchial thermoplasty system for adults with severe difficult to control asthma

severe persistent allergic asthma, prevalence is highest in children aged 5 to 15 years, and decreases in adulthood until age 55 to 64 years when it rises again. In adults, asthma is more common in women than men (Simpson 2010). Asthma exacerbations lead to costs of £800 million on pharmaceuticals, a direct cost to the NHS of £1 billion and indirect societal costs Alair bronchial thermoplasty system for adults with severe difficult to control asthma (MIB71) © NICE 2018. All rights reserved. Subject (...) therapeutic need (NHS England standard contract 2013). Current NHS standard therapy for severe asthma is inhaled high-dose corticosteroids, long-acting beta 2 agonists, leukotriene receptor antagonists, theophyllines, oral corticosteroids and smoking cessation if clinically appropriate (NICE asthma pathway 2016). NICE's technology appraisal guidance on omalizumab for treating severe persistent allergic asthma recommends the drug as an option when given as an add-on to optimised standard therapy in people

2016 National Institute for Health and Clinical Excellence - Advice

20. A trial of oral corticosteroids for persistent systemic and airway inflammation in severe asthma (PubMed)

A trial of oral corticosteroids for persistent systemic and airway inflammation in severe asthma The fraction of exhaled nitric oxide (FeNO) and blood eosinophils, markers of local and systemic eosinophilic inflammation, respectively, are increased in asthmatic patients. Little is known concerning the relationship between the FeNO levels and blood eosinophils in asthmatics.Twenty severe asthmatics with persistent FeNO elevation (≥40 ppb) and blood eosinophilia (≥3%) despite maintenance therapy (...) eosinophils. There were significant differences in the ACQ score between the steroid response group and poor response group (P < 0.005). The group in which both FeNO and blood eosinophils were suppressed fulfilled the change in score of ≥0.5 on the ACQ.In the patients with severe asthma, responses to systemic corticosteroids were variable in terms of FeNO and blood eosinophils. It was necessary to suppress both persistent eosinophilia and high FeNO for the improvement of asthma control.© 2017 The Authors

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2017 Immunity, Inflammation and Disease

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