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Severe Persistent Asthma

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21. 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

22. Mepolizumab (Nucala, GlaxoSmithKline plc.) for the Treatment of Severe Asthma with Eosinophilia: Effectiveness, Value, and Value-Based Price Benchmarks

, equally or more effective treatments nearing introduction into practice? ? Would other societal values accord substantially more or less priority to providing access to this treatment for this patient population? There are a number of treatments available for asthma. 4 Short-acting beta agonists (SABA), such as albuterol, are the primary treatment for mild intermittent asthma. ICS are usually added for persistent asthma. More severe asthma is treated with the combination of ICS and a LABA. Additional (...) , are the primary treatment for mild intermittent asthma. ICS are usually added for persistent asthma. More severe asthma is treated with the combination of ICS and a LABA. Additional therapies for severe asthma include leukotriene inhibitors, theophylline, and omalizumab. OCS are used for short-term therapy to control asthma exacerbations and chronically for severe asthma that cannot be controlled without OCS. Physicians try to avoid chronic OCS therapy because it is associated with many long-term

2017 California Technology Assessment Forum

23. Racial disparities in asthma-related health care use in the National Heart, Lung, and Blood Institute's Severe Asthma Research Program. (PubMed)

Racial disparities in asthma-related health care use in the National Heart, Lung, and Blood Institute's Severe Asthma Research Program. Despite advances in asthma care, disparities persist. Black patients are disproportionally affected by asthma and also have poorer outcomes compared with white patients.We sought to determine associations between black and white patients and asthma-related health care use, accounting for complex relationships.This study was completed as part of the National (...) Heart, Lung, and Blood Institute's Severe Asthma Research Program, a prospective observational cohort. Between November 2012 and February 2015, it enrolled 579 participants 6 years and older with 1 year of observation time and complete data. Inverse probability of treatment weighting was used to balance racial groups with respect to community and family socioeconomic variables and environmental exposure variables. The primary outcome was emergency department (ED) use for asthma. Secondary outcomes

2019 Journal of Allergy and Clinical Immunology

24. Inhaled corticosteroids in children with persistent asthma: dose-response effects on growth. (Full text)

Inhaled corticosteroids in children with persistent asthma: dose-response effects on growth. Inhaled corticosteroids (ICS) are the first-line treatment for children with persistent asthma. Their potential for growth suppression remains a matter of concern for parents and physicians.To assess whether increasing the dose of ICS is associated with slower linear growth, weight gain and skeletal maturation in children with asthma.We searched the Cochrane Airways Group Specialised Register of trials (...) months (nine comparisons; N = 944 children; MD 0.15, 95% CI -0.28 to -0.02; moderate-quality evidence) in favour of a higher ICS dose. No statistically significant group differences in change in height were observed at other time points, nor were such differences in weight, bone mass index and skeletal maturation reported with low quality of evidence due to imprecision.In prepubescent school-aged children with mild to moderate persistent asthma, a small but statistically significant group difference

2014 Cochrane PubMed

25. Asthma Symptoms, Interactive Physical Play, and Socio-emotional and Academic Outcomes in Urban Children with Persistent Asthma. (PubMed)

with persistent asthma; (2) determine if IPP varies with asthma severity (3) determine independent associations of both asthma severity and IPP with socio-emotional and academic outcomes.We analyzed data from children with persistent asthma enrolled in the SB-TEAM trial (Rochester, NY). Caregiver surveys assessed asthma severity, IPP participation (gym ≥3 days/week, running at recess, sports team participation), socio-emotional and academic outcomes. Bivariate and regression analyses assessed relationships (...) between variables.Of 324 children in the study (59% Black, 31% Hispanic, mean age 7.9), 53% participated in any IPP at school. Compared to those with mild persistent asthma, fewer children with moderate-severe asthma had no limitation in gym (44% vs. 58%, p < .01), and fewer ran at recess (29% vs. 42%, p < .01) or engaged in any IPP (48% vs. 58%, p = .046). Asthma severity was not associated with socio-emotional or academic outcomes. However, children participating in IPP had better positive peer

2018 Journal of Asthma

26. Economic analysis of temperature-controlled laminar airflow (TLA) for the treatment of patients with severe persistent allergic asthma. (Full text)

Economic analysis of temperature-controlled laminar airflow (TLA) for the treatment of patients with severe persistent allergic asthma. Chronic asthma is a significant burden for individual sufferers, adversely impacting their quality of working and social life, as well as being a major cost to the National Health Service (NHS). Temperature-controlled laminar airflow (TLA) therapy provides asthma patients at BTS/SIGN step 4/5 an add-on treatment option that is non-invasive and has been shown (...) by the National Institute for Health and Care Excellence (NICE). Sensitivity analysis indicates that ICER values range from £18 883/QALY for the least severe patients through to TLA being dominant, that is, cost saving as well as improving quality of life, for individuals with the most severe and poorly controlled asthma.Based on our results, Airsonett TLA is a cost-effective addition to treatment options for stage 4/5 patients. For high-risk individuals with more severe and less well controlled asthma

2016 BMJ open respiratory research PubMed

27. Squill Oxymel, a traditional formulation from Drimia Maritima (L.) Stearn, as an add-on treatment in patients with moderate to severe persistent asthma: a pilot, triple-blind, randomized clinical trial. (PubMed)

Squill Oxymel, a traditional formulation from Drimia Maritima (L.) Stearn, as an add-on treatment in patients with moderate to severe persistent asthma: a pilot, triple-blind, randomized clinical trial. In Traditional Iranian Medicine (TIM), Squill (Drimia maritima (L.) Stearn) Oxymel was utilized in the treatment of asthma. Squill has been reported to exert anti-inflammatory, anti-oxidant, anti-cholinergic, and mucus secretion modulating effects.This study aimed to make a preliminary (...) evaluation of the efficacy and safety of an add-on Squill Oxymel treatment in patients with moderate to severe persistent asthma.In a 6-week, triple-blind, randomized, placebo-controlled trial, 60 patients with stable moderate to severe persistent asthma were randomly allocated to receive either 10ml syrup of Squill Oxymel, simple oxymel, or a placebo 2 times a day, as an add-on to their routine treatment (inhaled corticosteroids and β2 agonists). Spirometry and plethysmography were performed on patients

2016 Journal of Ethnopharmacology

28. Systematic Review of Observational Studies and Rcts of Omalizumab in Severe Persistent Allergic Asthma and Meta-Analysis Feasibility Assessment. (Full text)

Systematic Review of Observational Studies and Rcts of Omalizumab in Severe Persistent Allergic Asthma and Meta-Analysis Feasibility Assessment. 27202007 2016 06 10 2016 05 21 1524-4733 17 7 2014 Nov Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research Value Health Systematic Review of Observational Studies and Rcts of Omalizumab in Severe Persistent Allergic Asthma and Meta-Analysis Feasibility Assessment. A589 10.1016/j.jval.2014.08.2014 S1098

2016 Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research PubMed

29. Omalizumab therapy in a 13-year-old boy with severe persistent asthma and concomitant eosinophilic esophagitis (Full text)

Omalizumab therapy in a 13-year-old boy with severe persistent asthma and concomitant eosinophilic esophagitis Eosinophilic esophagitis (EoE) has been defined as "asthma of the esophagus" for the large number of similarities between the two diseases. Omalizumab is an anti-Immunoglobulin E (IgE) antibody currently approved only in allergic IgE-mediated severe persistent uncontrolled asthma and in chronic spontaneous urticaria unresponsive to antihistamines, but it has been tried in other (...) steroid-dependent. Currently, he continues both treatments: omalizumab for asthma and topical steroid for EoE.This case report confirms that omalizumab is an effective treatment in patients with severe persistent, uncontrolled asthma. On the other hand, in our patient it did not produce persistent improvement neither on symptoms nor on biopsy findings of EoE. The outcome of this case might indicate different pathogenic mechanism(s) of the two diseases.

2016 Italian journal of pediatrics PubMed

30. Severe Persistent Asthma

Severe Persistent Asthma Severe Persistent Asthma Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Severe Persistent Asthma Severe (...) Persistent Asthma Aka: Severe Persistent Asthma , Severe Asthma From Related Chapters II. Criteria Continuous symptoms throughout the day, interfering with sleep and activity Frequent exacerbations (several times daily) Daily symptoms throughout the day Nightly symptoms For age <5 years, night awakenings more than once per week Beta Agonist use several times daily Oral s required 2 or more times per year s FEV1 or PEF <60% of predicted PEF variability > 30% FEV1 to FVC ratio decreased >5% (<75% for age 5

2018 FP Notebook

31. Relevance of specific IgE antibody titer to the prevalence, severity, and persistence of asthma among 19-year-olds in northern Sweden. (Full text)

Relevance of specific IgE antibody titer to the prevalence, severity, and persistence of asthma among 19-year-olds in northern Sweden. Although sensitization to indoor allergens is strongly associated with asthma, there are questions as to how this relates to asthma symptoms.We sought to study the relevance of IgE antibodies to cat and dog allergens in an area in which (1) the climate discourages cockroach, fungal, and mite growth and (2) dander allergens are known to be present in schools (...) with the diagnosis, severity, and persistence of asthma; however, a large proportion of patients with current asthma did not live in a house with a cat or dog.Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

2016 Journal of Allergy and Clinical Immunology PubMed

32. Severe and uncontrolled asthma in China: a cross-sectional survey from the Australasian Severe Asthma Network (Full text)

% CI =(0.14, 0.75)].Although there is a relatively low proportion of severe refractory asthma based on ERS/ATS criteria, two of five patients with asthma in China are uncontrolled, displaying more psychological symptoms and reduced work productivity. Substantial gain in asthma control is obtained by triple controller therapy and this may be a promising therapeutic option for persistent asthma. (...) Severe and uncontrolled asthma in China: a cross-sectional survey from the Australasian Severe Asthma Network Severe asthma is largely unexplored in the Chinese population. Patients with asthma underwent systematic evaluation, by investigating the characteristics of uncontrolled asthma and of asthma treated with three different controller therapies.This multi-centre, real-world study was conducted from March 2014 to September 2015. Adults with stable asthma underwent assessment of medication

2017 Journal of thoracic disease PubMed

33. Asthma: diagnosis, monitoring and chronic asthma management

and QS181. Ov Overview erview This guideline covers diagnosing, monitoring and managing asthma in adults, young people and children. It aims to improve the accuracy of diagnosis, help people to control their asthma and reduce the risk of asthma attacks. It does not cover managing severe asthma or acute asthma attacks. The investment and training required to implement the guideline will take time. In the meantime, primary care services should implement what they can of the recommendations, using (...) people with asthma by their relative likelihood of experiencing negative clinical outcomes (for example, severe exacerbations or hospitalisations). Factors including non-adherence to asthma medicines, psychosocial problems and repeated episodes of unscheduled care can be used to guide risk stratification. Once the population is stratified, the delivery of care for the population can be targeted with the aim of improving the care of the strata with the highest risk. Suspected asthma Suspected asthma

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

34. Asthma exacerbations and socio-economic status in French adults with persistent asthma: a prospective cohort study. (PubMed)

Asthma exacerbations and socio-economic status in French adults with persistent asthma: a prospective cohort study. Adults disadvantaged by poor socio-economic status (SES) are more severely affected by asthma compared to those with better SES. We aimed to determine whether the frequency of asthma exacerbations (AEx), as well as aspects related to AEx management, differed based on SES in patients treated with daily treatments.This study, part of the prospective observational cohort ASTRO-LAB (...) , included French adult patients with persistent asthma. Patients were considered as low SES if they benefited from publicly funded special health insurance and/or were perceived as low SES by their general practitioner. AEx was defined as at least one of the following: asthma-related oral corticosteroid course, medical contact, hospitalization, and death. We examined associations between SES and AEx frequency, perceived triggering factors and type of medical contact after AEx.In our sample of 255

2017 Journal of Asthma

35. Liberty Asthma QUEST: Phase 3 Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study to Evaluate Dupilumab Efficacy/Safety in Patients with Uncontrolled, Moderate-to-Severe Asthma (Full text)

atopic dermatitis. Following positive phase 2 results in asthma, the phase 3 Liberty Asthma QUEST trial was initiated to provide further evidence for dupilumab efficacy and safety in patients with uncontrolled, moderate-to-severe asthma.Liberty Asthma QUEST is a phase 3, multinational, multicenter, randomized, double-blind, placebo-controlled, parallel-group trial (NCT02414854) in patients with persistent asthma who are receiving continuous treatment with inhaled corticosteroids (ICS) plus one or two (...) endpoints were annualized rate of severe exacerbation events during the 52-week treatment period and absolute change from baseline in pre-bronchodilator FEV1 at week 12.Uncontrolled asthma patients with persistent symptoms represent a population of significant unmet need, for whom new treatments are required. Patients with severe asthma are at high risk of asthma exacerbations, and face an accelerated decline in lung function and impaired quality of life. QUEST examines the efficacy of dupilumab

2018 Advances in therapy PubMed

36. Perceptions of Severe Asthma and Asthma-COPD Overlap Syndrome Among Specialists: A Questionnaire Survey (Full text)

in their practice was 13.9%±11.0%. Asthma aggravation by stepping down treatment was the most common subtype, followed by frequent exacerbation, uncontrolled asthma despite higher treatment steps, and serious exacerbation. ACOS was estimated to account for 20.7% of asthma, 38.0% of severe asthma, and 30.1% of COPD cases. A history of smoking, persistently low forced expiratory volume in 1 second (FEV1), and low FEV1 variation were most frequently classified as the major criteria for the diagnosis of ACOS among (...) Perceptions of Severe Asthma and Asthma-COPD Overlap Syndrome Among Specialists: A Questionnaire Survey Severe asthma and asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) are difficult to control and are often associated with poor clinical outcomes. However, much is not understood regarding the diagnosis and treatment of severe asthma and ACOS. To evaluate the current perceptions of severe asthma and COPD among asthma and COPD specialists, we designed an e-mail

2018 Allergy, asthma & immunology research PubMed

37. Severity of asthma score predicts clinical outcomes in patients with moderate to severe persistent asthma (PubMed)

Severity of asthma score predicts clinical outcomes in patients with moderate to severe persistent asthma The severity of asthma (SOA) score is based on a validated disease-specific questionnaire that addresses frequency of asthma symptoms, use of systemic corticosteroids, use of other asthma medications, and history of hospitalization/intubation for asthma. SOA does not require measurements of pulmonary function. This study compared the ability of SOA to predict clinical outcomes in the EXCELS (...) (Epidemiological Study of Xolair [omalizumab]: Evaluating Clinical Effectiveness and Long-term Safety in Patients with Moderate to Severe Asthma) patient population vs three other asthma assessment tools. EXCELS is a large, ongoing, observational study of patients with moderate to severe persistent asthma and reactivity to perennial aeroallergens.Baseline scores for SOA, asthma control test (ACT), work productivity and impairment index-asthma (WPAI-A), and FEV(1) % predicted were compared for their ability

2012 EvidenceUpdates

38. 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

39. 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

40. 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

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