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Severe Persistent Asthma

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101. Increased numbers of activated group 2 innate lymphoid cells in the airways of patients with severe asthma and persistent airway eosinophilia. (PubMed)

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 (...) abundant than ILC2s and EoPs, proportionally, ILC2s were the predominant source of type 2 cytokines. In addition, there were significantly greater numbers of sputum IL-5(+)IL-13(+) ILC2s in patients with severe asthma whose airway eosinophilia was greater than 3%, despite normal blood eosinophil numbers (<300/μL).Our findings suggest that ILC2s can promote the persistence of airway eosinophilia in patients with severe asthma through uncontrolled localized production of the type 2 cytokines IL-5 and IL

2015 Journal of Allergy and Clinical Immunology

102. Persistent severe hypereosinophilic asthma is not associated with airway remodeling. (PubMed)

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

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2015 Respiratory medicine

103. 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

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

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

2014 National Institute for Health and Clinical Excellence - Advice

105. Randomised controlled trial: In children and adolescents with mild persistent asthma, daily beclomethasone reduces treatment failure compared with rescue beclomethasone plus albuterol

persistent asthma (TREXA): a randomised, double-blind, placebo-controlled trial . Context Many studies have shown that regular use of inhaled corticosteroids improves asthma control in children with asthma. However, intermittent therapy with inhaled corticosteroids is common practice in the community 1 as many physicians and families are reluctant to administer inhaled corticosteroids long term. Several previous studies have examined this approach and have generally not found it to be convincingly (...) Randomised controlled trial: In children and adolescents with mild persistent asthma, daily beclomethasone reduces treatment failure compared with rescue beclomethasone plus albuterol In children and adolescents with mild persistent asthma, daily beclomethasone reduces treatment failure compared with rescue beclomethasone plus albuterol | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via

2011 Evidence-Based Medicine (Requires free registration)

106. Acute Effect of Salbutamol on Heart Rate and Blood Pressure During Exercise in Patients With Moderate or Severe Asthma and Healthy Subjects

frequently they have to use Short-Acting Beta2-Agonists. However, the cardiovascular effects of salbutamol during and after exercise remain poorly known. Objective: To evaluate the effect of salbutamol on heart rate and blood pressure during exercise in patients with moderate or severe asthma and healthy individuals. Methods: A randomized, double-blind, crossover study will be conducted which 13 individuals with moderate or severe persistent asthma and 13 healthy individuals aged between 20 to 59 years (...) Acute Effect of Salbutamol on Heart Rate and Blood Pressure During Exercise in Patients With Moderate or Severe Asthma and Healthy Subjects Acute Effect of Salbutamol on Heart Rate and Blood Pressure During Exercise in Patients With Moderate or Severe Asthma and Healthy Subjects - 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

2017 Clinical Trials

107. A Study of Reslizumab in Patients 12 Years of Age and Older With Severe Eosinophilic Asthma

A Study of Reslizumab in Patients 12 Years of Age and Older With Severe Eosinophilic Asthma A Study of Reslizumab in Patients 12 Years of Age and Older With Severe Eosinophilic 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. A Study of Reslizumab in Patients 12 Years of Age and Older With Severe Eosinophilic 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. Read our for details. ClinicalTrials.gov Identifier: NCT03052725 Recruitment Status : Terminated (Parent Studies didn't meet their primary endpoint so study was terminated.) First Posted

2017 Clinical Trials

108. Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma. (PubMed)

Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma. Severe asthma poses significant disease-related and economic burdens in the United States. Challenges in practice include how to define "severe asthma" for a given patient, knowing which are the right tests to perform and when, and having a better understanding of a patient's asthma phenotype. Furthermore, current guidelines do not address a clear, practical approach to treatment (...) that is based on a patient's asthma phenotype.To develop a consensus on the definition of severe asthma, the role of biomarkers and phenotyping severe asthma, and the use of newer biologic therapies and bronchial thermoplasty to help guide practicing clinicians.A roundtable meeting was convened with a panel of severe asthma experts to discuss areas in practice that are not adequately addressed by current guidelines, specifically phenotype-guided treatment.We describe a consensus on the definition of severe

2017 Asthma & Immunology

109. Diagnostic Value of Serum Baseline Tryptase Levels in Childhood Asthma and Its Correlation with Disease Severity. (PubMed)

Diagnostic Value of Serum Baseline Tryptase Levels in Childhood Asthma and Its Correlation with Disease Severity. The aim of this study was to explore whether serum baseline tryptase (sBT) levels might be a useful marker not only for the accurate diagnosis of childhood asthma, but also for the prediction of disease severity.A total of 114 asthmatic children were enrolled in this study, 36 of whom had mild intermittent asthma, 38 had mild persistent asthma, and 40 had moderate to severe (...) persistent asthma. Additionally, 34 age-matched healthy children were enrolled as controls. The sBT levels of these populations were measured using a fluoroenzymeimmunoassay kit. The diagnostic performance of sBT levels and their correlation with asthma severity were systematically investigated using receiver operating characteristic (ROC) analysis and correlation analysis.Children with mild and moderate to severe persistent asthma had significantly increased sBT levels as compared to those with mild

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2017 International Archives of Allergy and Immunology

110. Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children. (PubMed)

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

111. Spontaneous Pneumomediastinum Complicating Severe Acute Asthma Exacerbation in Adult Patients. (PubMed)

and December 31, 2016 for severe acute asthma exacerbation underwent a diagnostic protocol including a standard chest X-ray and continuous monitoring of arterial oxygen saturation (SaO2) during the first 24 hours following admission. The patients showing persistence or deterioration of oxyhemoglobin desaturation were prescribed a chest Computed Tomographic (CT) scan.Five out of the 45 patients (11.1%) with severe acute asthma exacerbation were diagnosed with PNM, in one case on the basis of an X-ray image (...) Spontaneous Pneumomediastinum Complicating Severe Acute Asthma Exacerbation in Adult Patients. The real incidence of pneumomediastinum (PNM) in adult patients with severe acute asthma exacerbation continues to be unknown. The current study aims to investigate the occurrence of PNM in an adult population of patients presenting a severe asthma attack and to evaluate the risk factors associated to its development.The 45 consecutive subjects who were admitted to our Division between January 1, 2015

2017 Journal of Asthma

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

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

113. Association between respiratory syncytial viral disease and the subsequent risk of the first episode of severe asthma in different subgroups of high-risk Australian children: a whole-of-population-based cohort study. (PubMed)

Association between respiratory syncytial viral disease and the subsequent risk of the first episode of severe asthma in different subgroups of high-risk Australian children: a whole-of-population-based cohort study. To determine the contribution of respiratory syncytial virus (RSV) to the subsequent development of severe asthma in different subgroups of children at risk of severe RSV disease.The study was conducted in New South Wales (NSW), Australia.The study comprised all children born (...) in NSW between 2000 and 2010 with complete follow-up till 31 December 2011. The cohort was divided into three subgroups: (1) non-Indigenous high-risk children: non-Indigenous children born preterm or born with a low birth weight; (2) Indigenous children: children of mothers whose Indigenous status was recorded as Aboriginal and/or Torres Strait Islander and (3) non-Indigenous standard risk children: all other non-Indigenous term children.Risk of development of severe asthma in different subgroups

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2017 BMJ open

114. Long-term effect of weight loss induced by bariatric surgery on asthma control and health related quality of life in asthmatic patients with severe obesity: A pilot study. (PubMed)

unchanged in CG. As compared with the pre-surgery values, the percentage of predicted FEV1 and FVC significantly increased at five-year follow-up from surgery in TG, while it remained unchanged in CG.In severe obese asthmatic patients, the significant improvement of asthma control test and HRQoL, observed one year after LAGB, persists five years after surgery.Copyright © 2017 Elsevier Ltd. All rights reserved. (...) Long-term effect of weight loss induced by bariatric surgery on asthma control and health related quality of life in asthmatic patients with severe obesity: A pilot study. The weight loss induced by bariatric surgery (BS) improves asthma clinical control evaluated usually after a short time. The long-term effects of weight loss attained by BS on asthma control and health related-quality of life (HRQoL) in patients affected by asthma and obesity are not known.To investigate the five-year effect

2017 Respiratory medicine

115. Duration of the efficacy of omalizumab after treatment discontinuation in 'real life' severe asthma. (PubMed)

Duration of the efficacy of omalizumab after treatment discontinuation in 'real life' severe asthma. Efficacy of omalizumab in severe asthma is well documented; however, the optimal duration of the treatment remains unclear. In an open prospective study, we sought to assess the persistence of response in subjects withdrawing from omalizumab treatment. We evaluated 49 patients who voluntarily accepted to discontinue omalizumab treatment after 6 years of therapy. Asthma relapse was defined as any (...) severe asthma exacerbation associated with loss of asthma control. Twelve patients relapsed in the first year of follow-up, and 7 within 13 and 48 months. These results suggest that the effects of 6 years of omalizumab may persist after discontinuation of therapy in 60% of patients for at least 4 years.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

2017 Thorax

116. Long-term outcomes of bronchial thermoplasty in subjects with severe asthma: a comparison of 3-year follow-up results from two prospective multicentre studies. (PubMed)

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

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2017 European Respiratory Journal

117. Efficacy and safety of omalizumab in children and adolescents with moderate-to-severe asthma: A systematic literature review. (PubMed)

and safety as add-on treatment in children 6 to 11 years old with moderate-to-severe persistent allergic asthma. RWS data confirmed these findings in an extended patient population of children and adolescents that is more generalizable to the actual day-to-day management of these patients. (...) Efficacy and safety of omalizumab in children and adolescents with moderate-to-severe asthma: A systematic literature review. There are limited pediatric data about the use of omalizumab, especially the effectiveness and safety of omalizumab in the real-world management of allergic asthma.The objective of this study was to summarize the safety and efficacy of omalizumab in both randomized clinical trials (RCT) used for U.S. Food and Drug Administration registration and real-world studies (RWS

2017 Allergy and Asthma Proceedings

118. Beyond epithelial-to-mesenchymal transition: common suppression of differentiation programs underlies epithelial barrier dysfunction in mild, moderate and severe asthma. (PubMed)

Beyond epithelial-to-mesenchymal transition: common suppression of differentiation programs underlies epithelial barrier dysfunction in mild, moderate and severe asthma. Epithelial barrier dysfunction is a central feature in the pathogenesis of allergic disease. Epithelial-to-mesenchymal transition (EMT) has been proposed as one mechanism afflicting barrier in asthma. However, genes and pathways involved in aberrant epithelial-mesenchymal signaling, and their relationship to asthma severity (...) in asthma, overrepresented by insufficiency in insulin and Notch signaling, but with the absence of conventional EMT markers. We identified EFNB2, FGFR1, FGFR2, INSR, IRS2, NOTCH2, TLE1, and NTRK2 as novel markers central to dysregulation of epithelial-mesenchymal signaling, but surprisingly overlooked in asthma research. We found that this "core" signature of asthma is shared by mild, moderate, and severe forms of disease, progressing with severity. Loss of epithelial differentiation induced by insulin

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2017 Allergy

119. Sputum autoantibodies in severe eosinophilic asthma. (PubMed)

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 (...) structures (B-cell activating factor and B cell-attracting chemokine 1). Immunoprecipitated sputum immunoglobulins from patients with increased autoantibody levels triggered eosinophil degranulation in vitro, with release of extensive histone-rich extracellular traps, an event unsuppressed by dexamethasone and possibly contributing to the steroid-unresponsive nature of these eosinophilic patients.This study identifies an autoimmune endotype of severe asthma that can be identified by the presence

2017 Journal of Allergy and Clinical Immunology

120. Predictive factors for moderate or severe exacerbations in asthma patients receiving outpatient care. (PubMed)

Predictive factors for moderate or severe exacerbations in asthma patients receiving outpatient care. Asthma exacerbations are important events that affect disease control, but predictive factors for severe or moderate exacerbations are not known. The objective was to study the predictive factors for moderate (ME) and severe (SE) exacerbations in asthma patients receiving outpatient care.Patients aged > 12 years with asthma were included in the study and followed-up at 4-monthly intervals over (...) a 12-month period. Clinical (severity, level of control, asthma control test [ACT]), atopic, functional, inflammatory, SE and ME parameters were recorded. Univariate analysis was used to compare data from patients presenting at least 1 SE or ME during the follow-up period vs no exacerbations. Statistically significant (p <0.1) factors were then subjected to multiple analysis by binary logistic regression.A total of 330 patients completed the study, most of whom were atopic (76%), women (nearly 70

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2017 BMC pulmonary medicine

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