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Severe Persistent Asthma

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41. Bronchial Thermoplasty for Severe Asthma

Technology Assessments No literature identified. Systematic Reviews and Meta-analyses 1. Torrego A, Sola I, Munoz AM, Roque IF, Yepes-Nunez JJ, onso-Coello P, et al. Bronchial thermoplasty for moderate or severe persistent asthma in adults. Cochrane Database Syst Rev. 2014 Mar 3;3:CD009910. PubMed: PM24585221 2. Wu Q, Xing Y, Zhou X, Wang D. Meta-analysis of the efficacy and safety of bronchial thermoplasty in patients with moderate-to-severe persistent asthma. J Int Med Res. 2011;39(1):10-22. PubMed (...) al. Safety of bronchial thermoplasty in patients with severe refractory asthma. Ann Allergy Asthma Immunol. 2013 Nov;111(5):402-7. PubMed: PM24125149 5. Wechsler ME, Laviolette M, Rubin AS, Fiterman J, Lapa e Silva JR, Shah PL, et al. Bronchial thermoplasty: Long-term safety and effectiveness in patients with severe persistent asthma. J Allergy Clin Immunol. 2013 Dec;132(6):1295-302. PubMed: PM23998657 6. Castro M, Rubin A, Laviolette M, Hanania NA, Armstrong B, Cox G, et al. Persistence

2014 Canadian Agency for Drugs and Technologies in Health - Rapid Review

42. Clinical and immunological profile of children aged 5-9 years with persistent egg allergy before oral immunotherapy with egg. A multicenter, randomized controlled trial of the Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP). (PubMed)

Clinical and immunological profile of children aged 5-9 years with persistent egg allergy before oral immunotherapy with egg. A multicenter, randomized controlled trial of the Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP). In children with egg protein allergy (EA), the probability of overcoming the allergy decreases with age, and the possibility of suffering severe adverse reactions as a consequence of dietetic transgressions results in worsened quality of life (...) . One treatment option in such cases is oral immunotherapy (OIT) with foods.We present a cohort of children with EA scheduled for OIT with pasteurized raw egg white, describing their clinical and allergic characteristics before the start of OIT.The median age was six years, and 93% of the patients also suffered other allergies (58% asthma and 38.6% allergy to more than two food groups). In the last year, 14.8% had suffered a severe reaction due to dietetic transgression with egg. The median IgE

2018 Allergologia et immunopathologia

43. Benralizumab for patients with mild to moderate, persistent asthma (BISE): a randomised, double-blind, placebo-controlled, phase 3 trial. (PubMed)

Benralizumab for patients with mild to moderate, persistent asthma (BISE): a randomised, double-blind, placebo-controlled, phase 3 trial. Benralizumab is a humanised, anti-interleukin 5 receptor α monoclonal antibody that directly and rapidly depletes eosinophils, reduces asthma exacerbations, and improves lung function for patients with severe eosinophilic asthma. The objective of this trial was to assess the safety and efficacy of benralizumab for patients with mild to moderate, persistent (...) in two (2%) patients each in the benralizumab (pancytopenia and a suicide attempt, both considered unrelated to treatment) and placebo (cervix carcinoma and colon adenoma) groups.This study suggests that active and modifiable disease processes might be ongoing in patients with mild to moderate, persistent asthma receiving ICS. Although the lung function improvement observed does not warrant use of benralizumab in this population because it did not reach the minimum clinically important difference

2018 The lancet. Respiratory medicine

44. A Multicentre, Randomized, Double-Blind, Placebo-Controlled, Crossover Study To Investigate the Efficacy, Safety, Tolerability, and Pharmacokinetics of Repeat Doses of Inhaled Nemiralisib in Adults with Persistent, Uncontrolled Asthma. (PubMed)

A Multicentre, Randomized, Double-Blind, Placebo-Controlled, Crossover Study To Investigate the Efficacy, Safety, Tolerability, and Pharmacokinetics of Repeat Doses of Inhaled Nemiralisib in Adults with Persistent, Uncontrolled Asthma. Phosphoinositide 3-kinase δ (PI3Kδ) is a lipid kinase involved in leukocyte recruitment and activation. Activation of PI3Kδ has been linked to airway inflammation and asthma pathogenesis. This randomized, double-blind, placebo-controlled, crossover study (...) investigated the efficacy, safety, tolerability, and pharmacokinetics of a PI3Kδ inhibitor, nemiralisib (GSK2269557), in patients with persistent, uncontrolled asthma. Patients (n = 50) received once-daily inhaled nemiralisib (1000 µg) or placebo for 28 days, with a crossover to the alternative treatment following a 4-week washout period. Spirometry demonstrated no discernible difference in trough forced expiratory volume in 1 second (FEV1) from baseline (adjusted posterior median 7 ml; 95% credible

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2018 The Journal of pharmacology and experimental therapeutics

45. Contribution of repeated infections in asthma persistence from preschool to school age: design and characteristics of the PreDicta cohort. (PubMed)

Contribution of repeated infections in asthma persistence from preschool to school age: design and characteristics of the PreDicta cohort. The PreDicta cohort was designed to prospectively evaluate wheeze/asthma persistence in preschoolers in association with viral/microbial exposures and immunological responses. We present the cohort design and demographic/disease characteristics and evaluate unsupervised and predefined phenotypic subgroups at inclusion.PreDicta is a 2-year prospective study (...) reversibility values were significantly different between groups. Viral infections were the most common triggers (89.2%) independent of severity, control, or atopy; however, overlapping phenotypes were also common. Severity and control clustered together in an unsupervised analysis, separating moderate from mild disease.The PreDicta cohort presented no differences in non-asthma related measures; however, it is well balanced regarding key phenotypic characteristics representative of "preschool asthma".© 2018

2018 Pediatric Allergy and Immunology

46. Feasibility and Acceptability of the Hailie Monitoring System in Children With Persistent Asthma

Feasibility and Acceptability of the Hailie Monitoring System in Children With Persistent Asthma Feasibility and Acceptability of the Hailie Monitoring System in 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 the maximum number of saved studies (100). Please remove one (...) or more studies before adding more. Feasibility and Acceptability of the Hailie Monitoring System in Children With Persistent Asthma The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03648450 Recruitment Status : Recruiting

2018 Clinical Trials

47. Persistent variations in national asthma mortality, hospital admissions and prevalence by socioeconomic status and region in England. (PubMed)

Persistent variations in national asthma mortality, hospital admissions and prevalence by socioeconomic status and region in England. The UK-wide National Review of Asthma Deaths sought to identify avoidable factors from the high numbers of deaths, but did not examine variation by socioeconomic status (SES) or region.We used asthma deaths in England over the period 2002-2015 obtained from national deaths registers, summarised by quintiles of Index of Multiple Deprivation (IMD) and Government (...) deprived quintile, mortality was 19% lower than those in the least deprived quintile (IRR 0.81 (95% CI 0.69 to 0.96). In older adults, this pattern was reversed (45-74 years: IRR 1.37 (1.24-1.52), ≥75 years: IRR 1.30 (1.22-1.39)). In 5-44 year olds the inverse trend with asthma mortality contrasted with large positive associations for admissions (IRR 3.34 (3.30-3.38)) and prevalence of severe symptoms (IRR 2.38 (1.70-3.33)). Prevalence trends remained after adjustment for smoking. IRRs for asthma

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2018 Thorax

48. Dupilumab improves symptoms, quality of life, and productivity in uncontrolled persistent asthma. (PubMed)

Dupilumab improves symptoms, quality of life, and productivity in uncontrolled persistent asthma. In a pivotal, phase 2b study (NCT01854047) in patients with uncontrolled persistent asthma, despite using medium-to-high-dose inhaled corticosteroids plus long-acting β2 agonists, dupilumab improved lung function, reduced severe exacerbations, and showed an acceptable safety profile.To assess the impact of dupilumab on asthma control, symptoms, quality of life (QoL), and productivity.Data are shown (...) for the intention-to-treat population receiving dupilumab 200/300 mg every 2 weeks (doses being assessed in phase 3; NCT02414854), or placebo. Predefined analyses of total scores were conducted at week 24 for the 5-item Asthma Control Questionnaire (ACQ-5), patient-reported morning/evening (AM/PM) asthma symptoms, Asthma Quality of Life Questionnaire (AQLQ), and asthma-related productivity loss. Responder rate analyses for these measures, subgroup analyses by baseline characteristics, and asthma-related

2018 Asthma & Immunology

49. Maternal asthma severity and control during pregnancy and risk of offspring asthma. (PubMed)

were offspring early-onset transient, early-onset persistent, and late-onset asthma. We estimated prevalence ratios (PRs) of each phenotype of asthma using a log-binomial model with 95% CIs.Higher prevalence of early-onset persistent asthma was observed among children of asthmatic mothers with mild uncontrolled (PR, 1.19; 95% CI, 1.05-1.35), moderate-to-severe controlled (PR, 1.33; 95% CI, 1.09-1.63), and moderate-to-severe uncontrolled asthma (PR, 1.37; 95% CI, 1.17-1.61) compared with those (...) Maternal asthma severity and control during pregnancy and risk of offspring asthma. Severe and uncontrolled asthma during pregnancy has been linked to several unfavorable perinatal outcomes. However, current knowledge on the association between the severity and control of maternal asthma and offspring asthma is sparse.We sought to investigate the extent to which offspring asthma is influenced by maternal asthma severity and control during pregnancy.We performed a prospective population-based

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2017 Journal of Allergy and Clinical Immunology

50. Association of plasma soluble CD14 level with asthma severity in adults: a case control study in China. (PubMed)

level in asthma patients (n = 910) and healthy controls (n = 881) was quantified by commercially available enzyme-linked immunosorbent assay (ELISA) kits. The asthma cases were subdivided into intermittent asthma (n = 537), mild (n = 246), moderate (n = 96) and severe (n = 31) persistent asthma patients. Association between plasma sCD14 level and asthma severity, lung function parameters as well as asthma symptoms and signs in adults were performed using multivariate logistic regression models.We (...) observed significant relationships of plasma sCD14 level with asthma severity, lung function parameters as well as asthma symptoms and signs in adults. After adjusting for multiple potential confounders, each one-unit increase in log sCD14 was significantly associated with 67, 82, 79 and 85% reduced ORs for intermittent asthma, mild, moderate and severe persistent asthma, respectively (all P < 0.0001). Compared with the participants of FEV1/FVC ≥75%, each one-unit increase in log sCD14

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2019 Respiratory research

51. T Cells in Severe Childhood Asthma. (PubMed)

to date that explored the immune landscape of the inflamed lower airways have focused on adults. T cells are pivotal to the inception and persistence of inflammatory processes in the diseased lungs, despite a contemporary shift in focus to immune events at the epithelial barrier. This article outlines current knowledge on the types of T cells and related cell types that are implicated in severe asthma. The potential for environmental exposures and other inflammatory cues to condition the immune (...) T Cells in Severe Childhood Asthma. Severe asthma in children is a debilitating condition that accounts for a disproportionately large health and economic burden of asthma. Reasons for the lack of a response to standard anti-inflammatory therapies remain enigmatic. Work in the last decade has shed new light on the heterogeneous nature of asthma, and the varied immunopathologies of severe disease, which are leading to new treatment approaches for the individual patient. However, most studies

2019 Clinical and Experimental Allergy

52. Andy Whittamore: People with severe asthma are slipping through the net

with difficult and severe asthma. People with severe asthma have persistent symptoms that don’t respond to conventional, high dose preventative treatments. It can often be difficult to differentiate between severe and “difficult” asthma, which is often the result of poor adherence to medication, other comorbidities, or the wrong diagnosis. [1] Each person not assessed and treated for severe asthma will miss opportunities to improve their health and wellbeing, and get the quality of care that they need (...) Andy Whittamore: People with severe asthma are slipping through the net Andy Whittamore: People with severe asthma are slipping through the net - The BMJ ---> An estimated 200,000 people in the UK may have severe asthma and not even know it, according to a . The effectiveness of reliever inhalers and oral steroids for asthma symptoms in most people has instilled a complacency in the medical profession, but this misconception that asthma is fixed is concealing a huge number of patients

2018 The BMJ Blog

53. Documentation of asthma control and severity in pediatrics: analysis of national office-based visits. (PubMed)

) regions had higher odds of documented asthma control status, whereas undocumented asthma severity (OR = 0.02), and visits in spring (OR = 0.34), had lower odds. Osteopathic doctors (OR = 0.18), visits in the Northeast region (OR = 0.23), chronic sinusitis (OR = 0.08), and undocumented asthma control status (OR = 0.03) had lower odds of documented asthma severity, whereas visits in spring (OR = 3.88) and autumn (OR = 3.32) had higher odds. Moderate/severe persistent asthma (OR = 15.35) had higher odds (...) Documentation of asthma control and severity in pediatrics: analysis of national office-based visits. To evaluate the extent of documentation of asthma control and severity and associated characteristics among pediatric asthma patients in office-based settings.This cross-sectional study utilized data from the 2012-2015 National Ambulatory Medical Care Survey (NAMCS). Patients aged 6-17 years with a diagnosis of asthma were included. Weighted descriptive analysis examined the extent

2019 Journal of Asthma

54. Comparison of severity of asthma hospitalization between African American and Hispanic children in the Bronx. (PubMed)

more likely to have severe persistent asthma (12% vs. 7%, p = .02). They were also more likely to require magnesium sulfate (45% vs. 32%, p < .001) and admission to the ICU from the emergency department (ED) (14% vs. 8%, p = .01), which were independent of asthma severity. There was no significant difference in LOS or other characteristics of hospitalization.African American children hospitalized for asthma have more severe exacerbations compared to Hispanic children, which is independent (...) Comparison of severity of asthma hospitalization between African American and Hispanic children in the Bronx. There are racial and ethnic disparities in childhood asthma burden and outcomes. Although there have been comparisons between whites and minorities, there are few between minority groups. This study aimed to compare characteristics of asthma hospitalizations in African American and Hispanic children.A retrospective chart review was conducted to compare asthma characteristics between

2019 Journal of Asthma

55. Changes in asthma severity in the first year of school and difficulty learning to read. (PubMed)

and covariates of achievement at school entry (T1) and 12 months later (T2). Asthma severity scores at T1 and T2 showed that in 27 of 51 children with asthma, symptoms improved over the year, whereas in 24, symptoms persisted or worsened. Word and story reading were assessed at T1 and T2. We compared reading achievement at both timepoints between children with asthma and children who had no reported respiratory symptoms between birth and T2 (controls, N = 74), and between those with persistent versus (...) Changes in asthma severity in the first year of school and difficulty learning to read. Asthma is a risk factor for poor early reading in children, for reasons that are unclear. This analysis examines the relationship between changes in asthma severity during the first year of school and being in the lowest quartile of reading achievement after 1 year of school.We used previously unreported data from our cohort study. Parent interviews and teacher questionnaires enquired about asthma

2019 Journal of Asthma

56. Serum levels of IL-5, IL-6, IL-8, IL-13 and IL-17A in pre-defined groups of adult patients with moderate and severe bronchial asthma. (PubMed)

Serum levels of IL-5, IL-6, IL-8, IL-13 and IL-17A in pre-defined groups of adult patients with moderate and severe bronchial asthma. Bronchial asthma (BA) is a complex disease characterised by persistent inflammation. Exhaled nitric oxide (FeNO) and blood eosinophil count (b-Eos) are biomarkers for type 2 endotype of BA.To analyse a panel of serum interleukins and total IgE in predefined by FeNO and b-Eos groups of moderate and severe BA patients.Serum levels of IL-5, IL-6, IL-8, IL-13 and IL (...) are involved in the persistent type 2 immune response in moderate and severe BA. We have identified a pattern of refractory, severe type 2/IL-17A high BA in the real clinical practice.Copyright © 2019 Elsevier Ltd. All rights reserved.

2019 Respiratory medicine

57. Long-Term Azithromycin Reduces Haemophilus influenzae and Increases Antibiotic Resistance in Severe Asthma. (PubMed)

Long-Term Azithromycin Reduces Haemophilus influenzae and Increases Antibiotic Resistance in Severe Asthma. Rationale The macrolide antibiotic, azithromycin, reduces exacerbations in adults with persistent symptomatic asthma. However, owing to the pleotropic properties of macrolides, unintended bacteriological consequences such as augmented pathogen colonization or dissemination of antibiotic-resistant organisms can occur, calling into question the long-term safety of azithromycin maintenance (...) therapy. Objectives To assess the effects of azithromycin on the airway microbiota, pathogen abundance, and carriage of antibiotic-resistance genes. Methods 16S rRNA sequencing and quantitative PCR (qPCR) were performed to assess the effect of azithromycin on sputum microbiology from participants of the AMAZES trial: a 48-week, double-blind, placebo-controlled trial of thrice-weekly 500mg oral azithromycin in adults with persistent uncontrolled asthma. Pooled-template shotgun metagenomic sequencing

2019 American Journal of Respiratory and Critical Care Medicine

58. Pulmonary type2 innate lymphoid cells in paediatric severe asthma: phenotype and response to steroids. (PubMed)

Pulmonary type2 innate lymphoid cells in paediatric severe asthma: phenotype and response to steroids. Children with severe therapy resistant asthma (STRA) have poor control despite maximal treatment, while those with difficult asthma (DA) have poor control from failure to implement basic management including adherence to therapy. Although recognised as clinically distinct, the airway molecular phenotype, including the role of ILCs and their response to steroids in DA and STRA (...) following intramuscular triamcinolone and in vitro with steroids. Asthma attacks and symptoms also reduced after systemic steroids despite persistence of steroid resistant IL-17+ cells and eosinophils.Paediatric STRA and DA have distinct airway molecular phenotypes with STRA characterised by elevated type2 cells. Systemic corticosteroids but not maintenance inhaled steroids resulted in improved symptom control and exacerbations concomitant with a reduction in functional ILC2s despite persistently

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2019 European Respiratory Journal

59. Lost in the transition from pediatric to adult healthcare? Experiences of young adults with severe asthma. (PubMed)

Lost in the transition from pediatric to adult healthcare? Experiences of young adults with severe asthma. Objective: Asthma is a multifaceted disease, and severe asthma is likely to be persistent. Patients with severe asthma have the greatest burden and require more healthcare resources than those with mild-to-moderate asthma. The majority with asthma can be managed in primary care, while some patients with severe asthma warrant referral for expert advice regarding management. In adolescence (...) , this involves a transition from pediatric to adult healthcare. This study aimed to explore how young adults with severe asthma experienced the transition process. Methods: Young adults with severe asthma were recruited from an ongoing Swedish population-based cohort. Qualitative data were obtained through individual interviews (n = 16, mean age 23.4 years), and the transcribed data were analyzed with systematic text condensation. Results: Four categories emerged based on the young adults' experiences: "I

2019 Journal of Asthma

60. Combination of immunotherapies for severe allergic asthma. (PubMed)

Combination of immunotherapies for severe allergic asthma. Introduction: Difficult-to-treat or severe persistent asthma accounts for 5-10% of the asthma population worldwide. However, this group of patients creates a higher burden on health systems due to their morbidity and need for long-term and additional treatment. Biological drugs constitute an alternative therapy in the treatment of patients with refractory asthma. In cases where inhalant allergy is part of the pathomechanism, allergen (...) -specific immunotherapy (SIT) is a causative treatment option for allergic asthma. However, SIT is contraindicated for uncontrolled asthma and cannot be administered according to the guidelines. This is due to the risk of further worsening of uncontrolled asthma during treatment. Case study: We herein report a case of a 67-year-old male with severe allergic asthma who was successfully treated with SIT after asthma control was achieved by using target treatments. Results: Complete control of asthma

2019 Journal of Asthma

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