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Severe Persistent Asthma

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181. Predictors of frequent exacerbations in (ex)smoking and never smoking adults with severe asthma. (PubMed)

Predictors of frequent exacerbations in (ex)smoking and never smoking adults with severe asthma. Persistent eosinophilic airway inflammation is an important driver for asthma exacerbations in non-smokers with asthma. Whether eosinophilic inflammation is also a predictor of asthma exacerbations in (ex)smokers is not known.The aim was to investigate factors associated with frequent exacerbations in never smokers and (ex)smokers with asthma.(Ex)smoking (n = 83) and never smoking (n = 70) patients (...) , 95%CI: 1.2-2.1). In never smokers frequent exacerbations were independently associated with blood eosinophil count (OR 18.9, 95%CI: 1.8-202.1).This study shows that never smoking and (ex)smoking patients with severe asthma have different predictors of frequent exacerbations: higher blood neutrophils in (ex)smokers versus higher blood eosinophils in never smokers. This suggests that different types of systemic background inflammation play a role in the aetiology of exacerbations

2016 Respiratory medicine

182. Bronchial thermoplasty in severe asthma: food for thoughts. (PubMed)

widely discussed for its potential in the treatment of asthma, since it seems to be able to reduce the symptoms of asthma. The definitive study for BT (AIR2 trial) employed a randomized, double-blind, sham-controlled design and enrolled 288 subjects with severe persistent asthma from 30 US and international centers. The results of the AIR2 trial demonstrated clinically significant benefits of BT compared with the sham group at one year post-treatment, including an improvement in asthma-related (...) quality of life, 32% reduction in severe exacerbations, 84% reduction in emergency department visits for asthma symptoms, and a 66% reduction in time lost from work/school/other daily activities because of asthma symptoms. Preclinical work showed that ASM is reduced after BT by at least 3 years after treatment. The recent article from the ARI2 trial study group analyses the long-term safety and effectiveness of BT in patients with severe persistent asthma and demonstrates the 5-year durability

2016 Minerva medica

183. Clinical Utility of Fractional exhaled Nitric Oxide (FeNO) as a Biomarker to Predict Severity of Disease and Response to Inhaled Corticosteroid (ICS) in Asthma Patients (PubMed)

measurement is recommended in predicting asthma severity and Inhaled Corticosteroid (ICS) response but further research is required to understand its clinical utility and agreement with current recommendations in a specific population.To estimate FeNO levels in Tamilian patients with mild-to-moderate persistent asthma and to correlate with disease severity and ICS response.The study was a prospective cohort with a single group of 102 persistent asthma patients under standard ICS regimen for 8 weeks (...) Clinical Utility of Fractional exhaled Nitric Oxide (FeNO) as a Biomarker to Predict Severity of Disease and Response to Inhaled Corticosteroid (ICS) in Asthma Patients Bronchial asthma is a common chronic inflammatory airway disease diagnosed and is based on symptomatic history and Pulmonary Function Tests (PFT). Fractional exhaled Nitric Oxide (FeNO) is exclusively a non-invasive biomarker of on-going eosinophilic airway inflammation which remains unpredictable only with PFTs. FeNO

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2016 Journal of clinical and diagnostic research : JCDR

184. Mouse Sensitization and Exposure Are Associated with Asthma Severity in Urban Children (PubMed)

Mouse Sensitization and Exposure Are Associated with Asthma Severity in Urban Children Mouse sensitization and exposure are associated with uncontrolled asthma, but whether they are associated with asthma severity, an intrinsic disease characteristic and long-term outcome predictor, is unclear.To examine relationships between mouse sensitization and/or exposure and asthma severity in urban children.A total of 645 children (5-17 years) with uncontrolled asthma underwent mouse sensitization (...) evaluation. Sensitized children had mouse allergen measured in bedroom dust. Relationships between mouse sensitization, allergen levels, and asthma severity measures (treatment step and Composite Asthma Severity Index [CASI]) were examined using regression models adjusted for age, sex, atopy, study site, race, ethnicity, and insurance.The study population was predominantly minority (69.6% black, 20.8% Hispanic), low income (61.8%), and mouse sensitized (54.4%). Mean ± SD treatment step was 3.2 ± 1.6

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2016 The journal of allergy and clinical immunology. In practice

185. Severe asthma features in children: a case–control online survey (PubMed)

aged 6-17 years with severe asthma, defined according to the recent guidelines of the European Respiratory Society and the American Thoracic Society, and 78 age-matched peers with non-severe persistent asthma. The patients have been enrolled from 16 hospital-based pediatric pulmonology and allergy centers in Northern, Central, and Southern Italy. Logistic regression analysis assessed the relationship between patients' characteristics and severe asthma or non-severe persistent asthma.Features (...) with severe asthma than in subjects with non-severe persistent asthma (5.9 versus 6.6, p = 0.005). Self-perception of wellbeing was compromised in more than 40 % of patients in both groups. Children with severe asthma had lower spirometric z scores than non-severe asthmatic peers (all p < 0.001), although 56 % of them had a normal forced expiratory volume in 1 s. No differences were found between the two groups for parental education, home environment, patients' comorbidities, adherence to therapy

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2016 Italian journal of pediatrics

186. Role of biologics in severe eosinophilic asthma – focus on reslizumab (PubMed)

Role of biologics in severe eosinophilic asthma – focus on reslizumab Within the context of the heterogeneous phenotypic stratification of asthmatic population, many patients are characterized by moderate-to-severe eosinophilic asthma, not adequately controlled by relatively high dosages of inhaled and even oral corticosteroids. Therefore, these subjects can obtain significant therapeutic benefits by additional biologic treatments targeting interleukin-5 (IL-5), given the key pathogenic role (...) played by this cytokine in maturation, activation, proliferation, and survival of eosinophils. In particular, reslizumab is a humanized anti-IL-5 monoclonal antibody that has been found to be an effective and safe add-on therapy, capable of decreasing asthma exacerbations and significantly improving disease control and lung function in patients experiencing persistent allergic or nonallergic eosinophilic asthma, despite the regular use of moderate-to-high doses of inhaled corticosteroids

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2016 Therapeutics and clinical risk management

187. Eosinophilic bioactivities in severe asthma (PubMed)

Eosinophilic bioactivities in severe asthma Asthma is clearly related to airway or blood eosinophilia, and asthmatics with significant eosinophilia are at higher risk for more severe disease. Eosinophils actively contribute to innate and adaptive immune responses and inflammatory cascades through the production and release of diverse chemokines, cytokines, lipid mediators and other growth factors. Eosinophils may persist in the blood and airways despite guidelines-based treatment. This review (...) details eosinophil effector mechanisms, surface markers, and clinical outcomes associated with eosinophilia and asthma severity. There is interest in the potential of eosinophils or their products to predict treatment response with biotherapeutics and their usefulness as biomarkers. This is important as monoclonal antibodies are targeting cytokines and eosinophils in different lung environments for treating severe asthma. Identifying disease state-specific eosinophil biomarkers would help to refine

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2016 The World Allergy Organization journal

188. Mast cells are associated with exacerbations and eosinophilia in children with severe asthma. (PubMed)

in the previous year (symptomatic group), and 12 had few symptoms and a persistent obstructive pattern (paucisymptomatic group). Nine children without asthma were included as control subjects. We assessed mast cells in the submucosa and airway smooth muscle using c-kit antibodies and in the entire biopsy area using Giemsa.The number of submucosal mast cells was higher in the symptomatic group than in the paucisymptomatic group (p=0.02). The number of submucosal mast cells correlated with the number of severe (...) Mast cells are associated with exacerbations and eosinophilia in children with severe asthma. The role of mast cells in the pathogenesis of childhood asthma is poorly understood. We aimed to estimate the implication of airway mucosal mast cells in severe asthma and their relationship with clinical, functional, inflammatory and remodelling parameters.Bronchial biopsies were performed in 36 children (5-18 years) with severe asthma: 24 had frequent severe exacerbations and/or daily symptoms

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2016 European Respiratory Journal

189. Impact of omalizumab on treatment of severe allergic asthma in UK clinical practice: a UK multicentre observational study (the APEX II study). (PubMed)

UK NHS centres, including specialist centres and district general hospitals in the UK.258 adult patients (aged ≥16 years; 65% women) with severe persistent allergic asthma treated with omalizumab were recruited, of whom 218 (84.5%) completed the study.The primary outcome measure was change in mean daily dose of oral corticosteroids (OCS) between the 12-month pre-omalizumab and post-omalizumab initiation periods. A priori secondary outcome measures included response to treatment, changes in OCS (...) Impact of omalizumab on treatment of severe allergic asthma in UK clinical practice: a UK multicentre observational study (the APEX II study). To describe the impact of omalizumab on asthma management in patients treated as part of normal clinical practice in the UK National Health Service (NHS).A non-interventional, mixed methodology study, combining retrospective and prospective data collection for 12 months pre-omalizumab and post-omalizumab initiation, respectively.Data were collected in 22

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2016 BMJ open

190. The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management

of subsequent and prior exacerbations. (SOE: Low) The association between FeNO levels and exacerbation risk is likely stronger in individuals (ages>5 years) with atopy. (SOE: Low) • In adults (ages >18) and children (ages 5 -18) with acute asthma exacerbations, FeNO levels do not correlate with exacerbation severity and were poorly reproducible. (SOE: Low) • In children (ages 5 - 12) and adolescents (ages 13 - 18), FeNO levels were inversely associated with adherence to asthma medications (mainly ICS). (SOE (...) diagnosis (SOE: insufficient). Limitations For several of the key questions (KQ 1.b-e), studies were quite heterogeneous in terms of design, population, control tests, control strategies, and outcome measures. For the diagnostic accuracy question (KQ 1.a), the main challenge relates to the lack of true gold standard for diagnosis. 3 Applicability The current literature reports on patients and settings similar to contemporary clinical practice. Clinicians considering FeNO as an adjunct to diagnose asthma

2018 Effective Health Care Program (AHRQ)

191. Effectiveness of Indoor Allergen Reduction in Management of Asthma

the effectiveness of specific combinations were supported by the evidence. • Important limitations of the evidence base include population heterogeneity (e.g., patient age and asthma severity), infrequent reporting of validated asthma outcome measures, poor data reporting, and variation in how interventions were implemented. • Further research is needed examining indoor allergen reduction interventions in comparative studies with sufficient population sizes to detect clinically meaningful differences (...) in relevant and validated asthma outcomes. Discussion We identified 60 randomized controlled trials (RCTs) and 8 additional studies (4 nonrandomized trials and 4 pre-post studies) that examined 8 types of interventions, alone or in combination, to reduce allergen levels in the home and improve the wellbeing of patients with asthma. There was a high level of heterogeneity across studies, particularly related to patient characteristics such as allergen sensitization and disease severity

2018 Effective Health Care Program (AHRQ)

192. Is There Really a Link between Asthma and Reflux?

, or the use of asthma medications. Problems with early studies included small sample size, short duration of study, and significant variation in asthma definition, intervention, and measurement of outcomes. 4,5 15 randomized 770 patients with moderate to severe persistent asthma despite treatment with inhaled corticosteroids (ICS) to receive either esomeprazole 40 mg twice daily (BID) or placebo for 14 weeks. Patients were stratified by presence of GERD and/or nocturnal respiratory symptoms. The results (...) in . 13 Caution must be used in interpreting this data since evidence suggests that impedance monitoring in patients on proton pump inhibitors (PPIs) does not correlate with traditional off-therapy markers of severe reflux . 14 Investigators have tried for many years to identify the effect of GERD treatments on poorly controlled asthma; however, no consistent outcomes have been elucidated. Anti-reflux treatments have not proven to consistently improve lung function, asthma symptoms, nocturnal asthma

2018 Clinical Correlations

193. Asthma and Pest Control Study: Demonstrating Return-on-Investment for In-Home Pest Control for Children With Persistent Asthma

Persistent asthma (including mild, moderate or severe), according to National Heart Lung and Blood Institute (NHLBI) criteria: i. Experiencing symptoms more than 2 days per week in past month ii. Awaking at night due to symptoms more than 2 times per month iii. Use of SABA meds (i.e., albuterol) for symptom control (not prevention) more than 2 days per week in past month iv. Any interference with daily activity v. Having exacerbations requiring oral systemic corticosteroids 2 or more time per year Any (...) Asthma and Pest Control Study: Demonstrating Return-on-Investment for In-Home Pest Control for Children With Persistent Asthma Asthma and Pest Control Study: Demonstrating Return-on-Investment for In-Home Pest Control for Children With Persistent Asthma - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached

2015 Clinical Trials

194. Forced midexpiratory flow between 25% and 75% of forced vital capacity is associated with long-term persistence of asthma and poor asthma outcomes. (PubMed)

-75 decreased by 10% of predicted value.A reduced level of FEF25-75 at EGEA1 increased the risk of long-term asthma persistence (adjusted OR, 1.14; 95% CI, 1.00-1.29). In children the association remained significant after further adjustment for FEV1 and in participants with FEV1 of greater than 80% of predicted value. A reduced FEF25-75 level at EGEA1 was significantly associated with more severe bronchial hyperresponsiveness (P < .0001) and with current asthma a decade later, with an association (...) Forced midexpiratory flow between 25% and 75% of forced vital capacity is associated with long-term persistence of asthma and poor asthma outcomes. Whether small-airway obstruction contributes to the long-term evolution of asthma remains unknown.Our aim was to assess whether the level of forced midexpiratory flow between 25% and 75% of forced vital capacity (FEF25-75) was associated with the persistence of current asthma over 20 years and the subsequent risk for uncontrolled asthma

2015 Journal of Allergy and Clinical Immunology

195. Cognitive behavioural therapy (CBT) for adults and adolescents with asthma. (PubMed)

to 53. Study populations generally had persistent asthma, but severity and diagnostic measures varied. Three studies recruited participants with psychological symptomatology, although with different criteria. Interventions ranged from 4 to 15 sessions, and primary measurements were taken at a mean of 3 months (range 1.2 to 12 months).Participants given CBT had improved scores on the Asthma Quality of Life Questionnaire (AQLQ) (MD 0.55, 95% confidence interval (CI) 0.17 to 0.93; participants = 214 (...) adults with persistent asthma, CBT may improve quality of life, asthma control, and anxiety levels compared with usual care. Risks of bias, imprecision of effects, and inconsistency between results reduced our confidence in the results to low, and evidence was lacking regarding the effect of CBT on asthma exacerbations, unscheduled contacts, depression, and medication adherence. There was much variation between studies in how CBT was delivered and what constituted usual care, meaning the most optimal

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2016 Cochrane

196. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. (PubMed)

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. People with asthma may experience exacerbations or "attacks" during which their symptoms worsen and additional treatment is required. Written action plans may advocate doubling the dose of inhaled steroids in the early stages of an asthma exacerbation to reduce the severity of the attack and to prevent the need for oral steroids or hospital admission.To compare the clinical (...) journals and meeting abstracts.We included randomised controlled trials (RCTs) that compared increased versus stable doses of ICS for home management of asthma exacerbations. We included studies of children or adults with persistent asthma who were receiving daily maintenance ICS.Two review authors independently selected trials, assessed quality and extracted data. We contacted authors of RCTs for additional information.This review update added three new studies including 419 participants to the review

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2016 Cochrane

197. British guideline on the management of asthma

% of cases, and was able to provide a diagnosis for 95% of the patients in whom GPs were uncertain. 16,72 3 • Diagnosis 332 | British guideline on the management of asthma C Streamlined referral pathways should be developed for tests not available or appropriate in primary care. 3.5 WHEEZING IN PRE-SCHOOL CHILDREN AND THE FUTURE RISK OF DEVELOPING PERSISTENT ASTHMA Several factors are associated with a high (or low) risk of developing persisting wheezing or asthma through childhood. 77,85 The presence (...) of presentation. Sex Male sex is a risk factor for asthma in pre-pubertal children. Female sex is a risk factor for the persistence of asthma in the transition from childhood to adulthood. 90,91 Boys with asthma are more likely to grow out of their asthma during adolescence than girls. 64,86,90,92-105 Severity and frequency of previous wheezing episodes Frequent or severe episodes of wheezing in childhood are associated with recurrent wheeze that persists into adolescence. 75,78,86,88,94,106-108 Coexistence

2016 SIGN

198. Diagnostic Evaluation of Infants with Recurrent or Persistent Wheezing: An Official ATS Clinical Practice Guideline

). In most cases, wheezing episodes are mild and easily treated (2). However, some infants will develop persistent or recurrent wheezing, which is often severe (3). These infants are frequently referred to pediatric pulmonology specialists for further evaluation and treatment. Guidelines for diagnostic testing exist for older children with asthma (4), but such guidelines are lacking for wheezing infants. In a 2009 survey of Assembly on Pediatrics members of the American Thoracic Society (ATS), infantile (...) before age 3 years (1). In some infants, this is a sign of early-onset asthma (6), whereas other infants may wheeze because of diminished airway function or innate immune responses (7, 8). For the majority of infants, these wheezing episodes are mild, episodic, and easily treated. However, some infants will develop severe recurrent or persistent wheezing. Guidelines for the evaluation and treatment of asthma in older children and the general approach to the evaluation of infantile wheezing have

2016 American Thoracic Society

199. Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma. (PubMed)

Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma. Health care costs increase in patients with more severe asthma, but the effect of asthma exacerbations on costs among patients with more severe asthma has not been quantified.This study compared direct health care costs between patients with moderate/severe persistent asthma with and without exacerbations.Patients who had an asthma diagnosis (International Classification (...) of Diseases-ninth revision-Clinical Modification code 493.x), were 12 to 64 years old, and were receiving controller therapy were identified from a large administrative claims database. Patients were categorized as having moderate/severe persistent asthma and were further evaluated for exacerbations during a 12-month exacerbation identification period. Patients with 1 or more exacerbations (asthma-related inpatient or emergency department visit or corticosteroid prescription) were matched to patients

2012 Journal of Allergy and Clinical Immunology

200. Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period

decreased because of a reduction in cerebral and respi- ratory complications (5, 6). Individuals and institu- tions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Treatment with first-line agents should be expeditious and occur as soon as possible within 30–60 minutes of confirmed severe hypertension (blood pressure greater than 160/ 110 mm Hg and persistent for 15 minutes) to reduce theriskofmaternalstroke(7–9 (...) or a hypertensive exacerba- tion with acutely worsening, difficult to control, severe hypertension. Acute-onset, severe hypertension that is accu- rately measured using standard techniques and is persistent for 15 minutes or more is considered a hypertensive emergency. It is well known that severe hypertension can cause central nervous system injury. As stated in the Confidential Enquiries report from the United Kingdom, two thirds of the maternal deaths during 2003–2005 resulted from cerebral hemorrhage

2019 American College of Obstetricians and Gynecologists

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