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Severe Persistent Asthma

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101. Persistent severe hypereosinophilic asthma is not associated with airway remodeling. Full Text available with Trip Pro

Persistent severe hypereosinophilic asthma is not associated with airway remodeling. Hypereosinophilic asthma (HEA) is considered as a specific severe asthma phenotype. Whether eosinophils have a link with airway remodeling characterized by pathological (thickening of the basement membrane), functional (persistent airflow impairment and decline in lung function) and imaging features (increase airway wall thickness at CT scan) is still debated. In a one year prospective cohort of 142 severe (...) asthma patients (according to IMI), 14 persistent HEA patients (defined by a persistent blood eosinophilia >500/mm(3) at two consecutive visits) were identified and compared with ten patients without any blood eosinophilia during the follow-up period (NEA, blood eosinophilia always <500/mm(3)). Airflow and lung volumes were recorded. Bronchial biopsies obtained at enrollment were stained for eosinophils (EG2) and basement membrane thickness (BM) was quantified. Imaging by CT scan acquisition

2015 Respiratory medicine

102. Randomised, double-blind, placebo-controlled crossover study to investigate different dosing regimens of olodaterol delivered via Respimat(®) in patients with moderate to severe persistent asthma. Full Text available with Trip Pro

Randomised, double-blind, placebo-controlled crossover study to investigate different dosing regimens of olodaterol delivered via Respimat(®) in patients with moderate to severe persistent asthma. A Phase II, multicentre, randomised, double-blind, placebo-controlled, crossover trial comparing the 24-h forced expiratory volume in 1 s (FEV1) time profile after 3 weeks' treatment with once-daily (QD) or twice-daily (BID) olodaterol (at the same total daily dose) versus placebo delivered via (...) Respimat® in patients with moderate to severe asthma.Patients were randomised to different sequences of olodaterol with 2-week washout, either as a total daily dose of 5 μg (5 μg QD [AM] or 2.5 μg BID) or placebo, or 10 μg (10 μg QD [AM] or 5 μg BID) or placebo. Primary end point was FEV1 area under the curve from 0 to 24 h (AUC0-24) response (defined as change from study baseline FEV1) after 3 weeks. Key secondary end points were FEV1 AUC0-12 and AUC12-24 responses.Two hundred and six patients

2015 Respiratory research Controlled trial quality: predicted high

103. Increased numbers of activated group 2 innate lymphoid cells in the airways of patients with severe asthma and persistent airway eosinophilia. Full Text available with Trip Pro

Increased numbers of activated group 2 innate lymphoid cells in the airways of patients with severe asthma and persistent airway eosinophilia. In patients with severe eosinophilic asthma, local maturation rather than systemic recruitment of mature cells might contribute to persistent airway eosinophilia. Group 2 innate lymphoid cells (ILC2s) are a major source of type 2 cytokines (IL-5 and IL-13) and can facilitate eosinophilic inflammatory responses in mouse models of asthma in the absence (...) of CD4+ lymphocytes, eosinophil lineage-committed progenitors (eosinophilopoietic progenitor cells [EoPs]), and mature eosinophils.Significantly greater numbers of total and type 2 cytokine-producing ILC2s were detected in blood and sputum of patients with severe asthma compared to mild asthmatics. In contrast, intracellular cytokine expression by CD4 cells and EoPs within the airways did not differ between the asthmatic groups. In patients with severe asthma, although sputum CD4+ cells were more

2015 Journal of Allergy and Clinical Immunology

104. Child and Adolescent Asthma Guidelines

of a life-threatening attack requiring urgent admission to intensive care, and a severe asthma attack requiring hospital admission (Table 6 and Figure 6). Table 6: Criteria for acute referral to hospital and/or hospital admission in children and adolescents. • Child with any feature of life-threatening asthma • Child with any feature of an acute severe attack persisting a er initial treatment • Child in whom other considerations suggest that admission may be appropriate: - Still have significant (...) , especially due to disadvantages that arise from inadequate income for the basics needed for wellbeing, and unhealthy indoor environments (homes which are crowded, cold, damp, mouldy, 1 smoke-exposed or with un? ued gas heating 2 ). Children aged 13–17 years usually do not have free primary healthcare visits or prescriptions. Maori and Paci? c children with asthma are more likely to have severe asthma symptoms and be hospitalised, but are less likely to be prescribed inhaled corticosteroid (ICS), have

2020 Asthma and Respiratory Foundation NZ

105. British guideline on the management of asthma

treatment Severe/life-threatening asthma attack Severe/life-threatening asthma attack ‘Red flags’ and indicators of other diagnoses Prominent systemic features (myalgia, fever, weight loss) Failure to thrive Unexpected clinical findings (eg crackles, clubbing, cyanosis, cardiac disease, monophonic wheeze or stridor) Unexplained clinical findings (eg focal signs, abnormal voice or cry, dysphagia, inspiratory stridor) Persistent non-variable breathlessness Symptoms present from birth or perinatal lung (...) in the Netherlands available to support GPs’ assessment reported that the service agreed with the GPs’ working diagnosis of asthma in 62% of cases, and was able to provide a diagnosis for 95% of the patients in whom GPs were uncertain. 15, 71 329 C Streamlined referral pathways should be developed for tests which are not routinely available in primary care. 3.5 Wheezing in preschool children and the future risk of developing persistent asthma Several factors are associated with a risk of developing persisting

2019 SIGN

106. Dupilumab (asthma) - Benefit assessment according to §35a Social Code Book V

: dupilumab, asthma, benefit assessment Extract of dossier assessment A19-74 Version 1.0 Dupilumab (asthma) 28 November 2019 Institute for Quality and Efficiency in Health Care (IQWiG) - 3 - Table of contents Page List of tables 4 List of abbreviations 5 2 Benefit assessment 6 2.1 Executive summary of the benefit assessment 6 2.2 Research question 10 2.3 Information retrieval and study pool 11 2.4 Research question 1: Adolescents aged 12 to 17 with inadequately controlled severe type 2 inflammation asthma (...) 12 2.4.1 Results on added benefit 13 2.4.2 Probability and extent of added benefit 13 2.4.3 List of included studies 13 2.5 Research question 2: Adults with inadequately controlled severe type 2 inflammation asthma 14 2.5.1 Results on added benefit 20 2.5.2 Probability and extent of added benefit 20 2.5.3 List of included studies 20 2.6 Probability and extent of added benefit – summary 20 References for English extract 22 Extract of dossier assessment A19-74 Version 1.0 Dupilumab (asthma) 28

2019 Institute for Quality and Efficiency in Healthcare (IQWiG)

107. Definition, Evaluation, and Treatment of Severe Asthma:

this approach are those who can produce sputum, demonstrate persistent or at least intermittent eosinophilia and have severe asthma with frequent exacerbations. Clinicians should recognize that different choices will be appropriate for different patients. 2B In children with severe asthma, we suggest treatment guided by clinical criteria alone rather than by clinical criteria and sputum eosinophil counts. conditional very low The recommendation not to use sputum eosinophil counts to guide therapy (...) which contribute to asthma symptoms and exacerbations [172]. International ERS/ATS Guidelines on Definition, Evaluation, and Treatment of Severe Asthma • 2013 Page 34 of 112 Evidence for rhinosinusitis has been reported to be as high at 75-80% [10, 173]. Nasal polyps are seen in a small subset of adults. Nasal polyps are unusual in asthmatic children and more often associated with cystic fibrosis and sometimes primary ciliary dyskinesia. Gastroesophageal reflux (GERD) is present in 60-80% [9-11, 33

2013 American Thoracic Society

108. Characteristics of Existing Asthma Self-Management Education Packages

as an alternative.) 11 Patient Population Several packages were designed for use in specific patient populations. A Breath of Life is intended to serve Latino communities, while Women Breathe Free is tailored to adult women with asthma. Packages produced by the Asthma and Allergy Foundation of America (AAFA), including Asthma Care for Adults, Wee Breathers, and You Can Control Asthma, emphasize their content is appropriate for multicultural, minority, and/or low-income communities. The packages we reviewed do (...) not indicate whether their materials are suited to clinical subgroups at higher risk for poor outcomes, such as patients with obesity or other significant comorbidity. Only three packages indicate they are designed for patients with “mild to severe” or “moderate to severeasthma, while the remaining packages do not explicitly address asthma severity. Setting AS-ME can be delivered in schools, patient homes, community sites, and healthcare facilities. The appropriate setting for each package depends

2020 Effective Health Care Program (AHRQ)

109. Omalizumab for the treatment of severe persistent allergic asthma in children aged 6 to 11 years

Omalizumab for the treatment of severe persistent allergic asthma in children aged 6 to 11 years Omalizumab for the treatment of severe persistent allergic asthma in children aged 6 to 11 years Omalizumab for the treatment of severe persistent allergic asthma in children aged 6 to 11 years National Institute for Health and Clinical Excellence Citation National Institute for Health and Clinical Excellence. Omalizumab for the treatment of severe persistent allergic asthma in children aged 6 to 11 (...) years. London: National Institute for Health and Clinical Excellence (NICE). Technology Appraisal Guidance 201. 2010 Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Anti-Allergic Agents; Antibodies, Monoclonal; Asthma; Childs Language Published English Country of organisation England English summary An English language summary is available. Address for correspondence National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA, UK

2010 Health Technology Assessment (HTA) Database.

110. Asthma in children

be considered when evaluating a child with suspected asthma, especially in very young children or when high doses of inhaled corticosteroids are required. Definition Asthma is a chronic respiratory disorder characterised by variable airway inflammation, airway obstruction, and airway hyper-responsiveness. These features interact to determine the clinical symptom pattern of the individual. While the majority of asthmatic children have an intermittent symptom phenotype, the minority have persistent symptoms (...) , reflecting the underlying chronic inflammation. In older children, as in adults, this may lead to permanent structural alterations of the airway wall (airway remodelling) and potentially a more severe asthma phenotype. This topic covers the treatment of children up to 12 years of age. Children 12 years and older are treated the same as adults, except for emerging therapies such as bronchial thermoplasty. Please see our Asthma in adults topic for more information. History and exam presence of risk factors

2018 BMJ Best Practice

111. 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

112. Clinical management of severe acute respiratory infection when COVID-19 is suspected

is equivalent to = 65 mmHg (61). Remark 2: Norepinephrine is considered first-line in adult patients; epinephrine or vasopressin can be added to achieve the MAP target. Because of the risk of tachyarrhythmia, reserve dopamine for selected patients with low risk of tachyarrhythmia or those with bradycardia. Remark 3: In children, epinephrine is considered first-line, while norepinephrine can be added if shock persists despite optimal dose of epinephrine. Clinical management of severe acute respiratory (...) Clinical management of severe acute respiratory infection when COVID-19 is suspected Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance V 1.2. -1- This is the second edition (version 1.2) of this document for the novel coronavirus SARS-CoV-2, causing COVID-19 disease. It was originally adapted from the publication Clinical management of severe acute respiratory infection when MERS-CoV infection is suspected (WHO, 2019

2020 WHO Coronavirus disease (COVID-19) Pandemic

113. Clinical care of severe acute respiratory infections – Tool kit

Clinical care of severe acute respiratory infections – Tool kit COVID-19 Adaptation Clinical Care for Severe Acute Respiratory Infection ToolkitClinical Care for Severe Acute Respiratory Infection Toolkit COVID-19 AdaptationWHO/2019-nCoV/SARI_toolkit/2020.1 © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under (...) disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition ” . Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Clinical care for severe acute respiratory infection

2020 WHO Coronavirus disease (COVID-19) Pandemic

114. Asthma

that this will be so. Others report that their asthma symptoms are better when they are fit. Several reviews from the have recently been published on aspects of exercise for people (...) with asthma . Firstly, there’s a (EIA). The review used this term to describe asthma -like symptoms brought on by exercise, in people with or without underlying asthma . Beta 2 -agonists are drugs that open up the airways, making breathing easier. There are short-acting beta 2 -agonists (SABA) such as salbutamol, and long-acting (...) with mild/moderate, persistent asthma were randomized into two therapeutic groups: Group A - 31 patients underwent 10 real weekly acupuncture sessions, followed by a 3-week washout period and 10 sham weekly acupuncture sessions; and Group B - 43 patients underwent 10 sham 2015 16. Vitamin D supplements can reduce risk of asthma attacks NIHR DC | Signal - Vitamin D supplements can reduce risk of asthma attacks Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Vitamin D supplements can

2018 Trip Latest and Greatest

115. Are the 2019 Global Initiative for Asthma (GINA) strategy recommendations applicable to the Canadian context?

controller option in those with persistent asthma (Step 2) and have PRN budesonide/formoterol as an “other controller option” in those with poor adherence to daily medication? A: In recommending as-needed low dose ICS-formoterol as one of the two preferred controller options for Step 2, GINA placed high importance on the evidence from the two SYGMA studies (8000 patients) that this strategy reduced the risk of severe exacerbations to a similar extent as maintenance ICS, without the need for daily (...) strategies to improve asthma management, and qualitative research about the experience of living with mild or severe asthma. She has a strong focus on improving com- munication between patients and health professionals, and on making guidelines not only evidence-based, but also practical and practice-centered. CONTACT Anne Van Dam avandam@cts-sct.ca Canadian Thoracic Society, Ottawa, Ontario, Canada. 2019 Canadian Thoracic Society CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE https

2019 Canadian Thoracic Society

116. Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial Full Text available with Trip Pro

-TEAM program on asthma morbidity among urban children with persistent asthma.In this randomized clinical trial, children with persistent asthma aged 3 to 10 years in the Rochester City School District in Rochester, New York, were stratified by preventive medication use at baseline and randomly assigned to the SB-TEAM program or enhanced usual care for 1 school year. Participants were enrolled at the beginning of the school year (2012-2016), and outcomes were assessed through the end of the school (...) was 7.8 (1.7) years. Demographic characteristics and asthma severity in the 2 groups were similar at baseline. Among children in the SB-TEAM group, 196 (98.0%) had 1 or more telemedicine visits, and 165 (82.5%) received supervised therapy through school. We found that children in the SB-TEAM group had more symptom-free days per 2 weeks postintervention compared with children in the enhanced usual care group (11.6 vs 10.97; difference, 0.69; 95% CI, 0.15-1.22; P = .01), with the largest difference

2018 EvidenceUpdates

117. Airway pathology in severe asthma is related to airflow obstruction but not symptom control. (Abstract)

Airway pathology in severe asthma is related to airflow obstruction but not symptom control. Patients with asthma present structural and inflammatory alterations that are believed to play a role in disease severity. However, airway remodeling and inflammation have not been extensively investigated in relation to both symptom control and airflow obstruction in severe asthmatics. We aimed to investigate several inflammatory and structural pathological features in bronchial biopsies of severe (...) asthmatics that could be related to symptom control and airflow obstruction after standardized treatment.Fifty severe asthmatics received prednisone 40 mg/d for 2 weeks and maintenance therapy with budesonide/formoterol 400/12 μg twice daily + budesonide/formoterol 200/6 μg as needed for 12 weeks. Endobronchial biopsies were performed at the end of 12 weeks. We performed extensive immunopathological analyses of airway tissue inflammation and remodeling features in patients stratified by asthma symptom

2017 Allergy

118. Sputum autoantibodies in severe eosinophilic asthma. Full Text available with Trip Pro

Sputum autoantibodies in severe eosinophilic asthma. The persistence of eosinophils in sputum despite high doses of corticosteroids indicates disease severity in asthmatic patients. Chronic inflamed airways can lose tolerance over time to immunogenic entities released on frequent eosinophil degranulation, which further contributes to disease severity and necessitates an increase in maintenance corticosteroids.We sought to investigate the possibility of a polyclonal autoimmune event (...) in the airways of asthmatic patients and to identify associated clinical and molecular characteristics.The presence of autoantibodies against eosinophil peroxidase (EPX) and anti-nuclear antibodies was investigated in patients with eosinophilic asthma maintained on high-dose corticosteroids, prednisone, or both. The ability of sputum immunoglobulins to induce eosinophil degranulation in vitro was assessed. In addition, the associated inflammatory microenvironment in patients with detectable autoantibodies

2017 Journal of Allergy and Clinical Immunology

119. Long-term outcomes of bronchial thermoplasty in subjects with severe asthma: a comparison of 3-year follow-up results from two prospective multicentre studies. Full Text available with Trip Pro

data is needed.This article compares outcomes in bronchial thermoplasty subjects with 3 years of follow-up from the ongoing, post-market PAS2 (Post-FDA Approval Clinical Trial Evaluating Bronchial Thermoplasty in Severe Persistent Asthma) study with those from the AIR2 trial.279 subjects were treated with bronchial thermoplasty in the PAS2 study. We compared the first 190 PAS2 subjects with the 190 bronchial thermoplasty-treated subjects in the AIR2 trial at 3 years of follow-up. The PAS2 subjects (...) Long-term outcomes of bronchial thermoplasty in subjects with severe asthma: a comparison of 3-year follow-up results from two prospective multicentre studies. Bronchial thermoplasty is an endoscopic therapy for severe asthma. The previously reported, randomised sham-controlled AIR2 (Asthma Intervention Research 2) trial showed a significant reduction in severe asthma exacerbations, emergency department visits and hospitalisations after bronchial thermoplasty. More "real-world" clinical outcome

2017 European Respiratory Journal

120. Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children. Full Text available with Trip Pro

Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children. International guidelines recommend that severe asthma can only be diagnosed after contributory factors, including adherence, have been addressed. Accurate assessment of adherence is difficult in clinical practice. We hypothesised that electronic monitoring in children would identify nonadherence, thus delineating the small number with true severe asthma.Asthmatic children (...) already prescribed inhaled corticosteroids were prospectively recruited and persistence of adherence assessed using electronic monitoring devices. Spirometry, airway inflammation and asthma control were measured at the start and end of the monitoring period.93 children (62 male; median age 12.4 years) were monitored for a median of 92 days. Median (range) monitored adherence was 74% (21-99%). We identified four groups: 1) good adherence during monitoring with improved control, 24% (likely previous

2017 European Respiratory Journal

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