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Severe Persistent Asthma

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121. 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

122. Control of moderate-to-severe asthma with randomized ciclesonide doses of 160, 320 and 640 μg/day. (PubMed)

Control of moderate-to-severe asthma with randomized ciclesonide doses of 160, 320 and 640 μg/day. The inhaled corticoteroid (ICS) ciclesonide (Cic), controls asthma symptoms in the majority of patients at the recommended dose of 160 µg/day. However, the relationship between the level of asthma control and increasing doses of Cic is unknown. This study investigated whether long-term treatment with higher doses of Cic would further improve asthma symptoms in patients with uncontrolled asthma (...) was statistically significant in subjects who experience at least one exacerbation per year (LS mean: -0.586; 95% confidence interval: -1.110, -0.062, P=0.0285). Adverse events were low and consistent with the known safety profile of Cic.In patients with persistent, uncontrolled asthma, increasing the Cic dose from 160 to 640 µg/day provided no clear additional effect. Patients who experience more than one exacerbation per year may benefit from higher doses; however, further studies are necessary to confirm

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2017 Journal of asthma and allergy

123. Long-term future risk of severe exacerbations: distinct 5-year trajectories of problematic asthma. (PubMed)

Long-term future risk of severe exacerbations: distinct 5-year trajectories of problematic asthma. Assessing future risk of exacerbations is an important component of asthma management. Existing studies have investigated short- but not long-term risk. Problematic asthma patients with unfavorable long-term disease trajectory and persistently frequent severe exacerbations need to be identified early to guide treatment.To identify distinct trajectories of severe exacerbation rates among (...) found: 58.5% had rare intermittent severe exacerbations ("infrequent"), 32.0% had frequent severe exacerbations at baseline but improved subsequently ("nonpersistently frequent"), and 9.5% exhibited persistently frequent severe exacerbations, with the highest incidence of near-fatal asthma ("persistently frequent"). A clinical risk score composed of ≥2 severe exacerbations in the past year (+2 points), history of near-fatal asthma (+1 point), body mass index ≥25kg/m2 (+1 point), obstructive sleep

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2017 Allergy

124. Longterm clinical outcomes of omalizumab therapy in severe allergic asthma: Study of efficacy and safety. (PubMed)

Longterm clinical outcomes of omalizumab therapy in severe allergic asthma: Study of efficacy and safety. Omalizumab has been shown to be an effective add-on therapy for patients with uncontrolled severe persistent allergic asthma. There has been a steady accumulation of evidence on the long-term effectiveness of omalizumab; however, data on real-life outcomes beyond one year of treatment is limited. In this study, we report on long-term outcomes of omalizumab treatment. We collected data from (...) our severe asthma registry on hospitalisations, exacerbations, corticosteroid sparing, asthma control, lung function, biomarkers and side effects, to determine if the benefit was sustained and treatment was safe on the long term. Forty-five patients [mean age 44.9 years (range 19-69), females 37/45 (82%), mean duration of omalizumab treatment = 60.7 ± 30.9 months (range 23-121) were included in the analysis. We observed a reduction in the annual acute asthma related hospital admissions

2017 Respiratory medicine

125. BIOmarkers in Severe AsthMa Patients on Omalizumab Treatment

asthma. The aim of the study is to assess inflammatory biomarkers including: blood and sputum eosinophilia, periostin and IL-6 as long-term clinical outcomes of omalizumab therapy. Condition or disease Severe Asthma Detailed Description: Anti-IgE (omalizumab) has been shown to be an effective add-on therapy for patients with allergic severe asthma. In this observational study patients aged over 18 year with uncontrolled severe persistent asthma are selected for add-on therapy with omalizumab (...) BIOmarkers in Severe AsthMa Patients on Omalizumab Treatment BIOmarkers in Severe AsthMa Patients on Omalizumab Treatment - 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. BIOmarkers in Severe AsthMa Patients

2017 Clinical Trials

126. Prevalence of Severe Asthma in Spanish Hospitals

by (Responsible Party): GlaxoSmithKline Study Details Study Description Go to Brief Summary: Asthma is a chronic disease. Prevalence of asthma in 2014 among Spanish population was 5%, of which 10% were diagnosed with severe asthma. According to Spanish National Guideline for the Management of Asthma (GEMA) 4.1 criteria, asthma can be classified according to its severity (intermittent, mild persistent, moderate persistent or severe persistent) or level of asthma control (controlled, partly controlled (...) Software of big data is a powerful data treatment algorithm works closely with Spanish Data Protection Agency as an example on how to reuse clinical information without conflicting with necessary data privacy. The system will process a vast amount of information (big data), so that the impact of random errors will be minimized. Non-Severe Asthmatic Subjects Subjects with intermittent, persistent mild or moderate asthma. Other: Questionnaire Subjects will be given an Electronic Case Report Form (eCRF

2017 Clinical Trials

127. Patterns of Neurocircuitry Activation In Severe Asthma

of persistent neurocircuitry activation. The investigators further propose that the detection of ongoing neurocircuitry activation occurs because of persistent and active airway inflammation in severe asthma. Finally, the investigators propose that the intensity of specific neurocircuitry activation will relate to the severity of underlying asthma. Study Design Go to Layout table for study information Study Type : Observational Actual Enrollment : 28 participants Observational Model: Cohort Time Perspective (...) Patterns of Neurocircuitry Activation In Severe Asthma Patterns of Neurocircuitry Activation In Severe 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. Patterns of Neurocircuitry Activation In Severe

2017 Clinical Trials

128. Effects of CPAP in Severe Therapy-resistant Asthma

Effects of CPAP in Severe Therapy-resistant Asthma Effects of CPAP in Severe Therapy-resistant 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. Effects of CPAP in Severe Therapy-resistant Asthma (CPAP (...) Fagundes Donadio, Pontificia Universidade Católica do Rio Grande do Sul Study Details Study Description Go to Brief Summary: The purpose of this study is to verify the effects of continuous positive airway pressure (CPAP) on exercise capacity of children and adolescents with severe therapy-resistant asthma (STRA). A randomized, controlled, crossover clinical trial will be conducted. We expect the use of CPAP to increase exercise capacity in children and adolescents with STRA. Condition or disease

2017 Clinical Trials

129. Natural killer cell–mediated inflammation resolution is disabled in severe asthma (PubMed)

had preserved functional responses. Together, our findings indicate that the immunology of the severe asthma airway is characterized by decreased NK cell cytotoxicity with increased numbers of target leukocytes, which is exacerbated by corticosteroids that further disable NK cell function. These failed resolution mechanisms likely contribute to persistent airway inflammation in severe asthma.Copyright © 2017, American Association for the Advancement of Science. (...) Natural killer cell–mediated inflammation resolution is disabled in severe asthma Severe asthma is typically characterized by chronic airway inflammation that is refractory to corticosteroids and associated with excess morbidity. Patients were recruited into the National Heart, Lung, and Blood Institute-sponsored Severe Asthma Research Program and comprehensively phenotyped by bronchoscopy. Bronchoalveolar lavage (BAL) cells were analyzed by flow cytometry. Compared with healthy individuals

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2017 Science immunology

130. Paradoxical bronchospasm from benzalkonium chloride (BAC) preservative in albuterol nebulizer solution in a patient with acute severe asthma. A case report and literature review of airway effects of BAC (PubMed)

Paradoxical bronchospasm from benzalkonium chloride (BAC) preservative in albuterol nebulizer solution in a patient with acute severe asthma. A case report and literature review of airway effects of BAC Nebulized bronchodilator solutions are available in the United States as both nonsterile and sterile-filled products. Sulfites, benzalkonium chloride (BAC), or chlorobutanol are added to nonsterile products to prevent bacterial growth. Bronchoconstriction from inhaled BAC is cumulative (...) of 3.5 days that probably caused persistent bronchospasm evidenced by failure to improve clinically and to increase peak expiratory flow rate (PEFR) from 125 L/min (27% of predicted value) to 300 L/min (68% of predicted value) within 2 hours of withdrawing BAC. The patient's respiratory status and PEFR improved dramatically once the nebulization solution was switched to BAC free lev-albuterol solution. The pediatric providers, particularly the emergency department physicians, intensivists

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2017 Respiratory Medicine Case Reports

131. Allergic sinusitis and severe asthma caused by occupational exposure to locust bean gum: Case report (PubMed)

was identified. His initial discrete episodes of sinusitis and acute bronchitis evolved into persistent asthma of increasing severity with exacerbations requiring repeated emergency room treatment. The case described in our report emphasizes the importance of clinician diagnosis of OA, and subsequent removal from exposure, such that asthma severity does not progress to near-fatal or fatal asthma in the sensitized worker. As demonstrated by this case report, identification of an occupational cause of asthma (...) Allergic sinusitis and severe asthma caused by occupational exposure to locust bean gum: Case report We present a case that highlights the difficulties with diagnosis and the dangers of occupational allergic sinusitis and asthma left unrecognized. We describe the case history of a man who experienced work-related symptoms 1 year after beginning work as a cheesemaker at a creamery, and whose respiratory symptoms progressively worsened over 16 years before an occupational cause of his asthma

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2017 American Journal of Industrial Medicine

132. The Role of Imaging in the Assessment of Severe Asthma (PubMed)

clusters of asthmatics, and the use of co-registration to link CT images of airways with regional variation in ventilation in MRI. In addition, temporal studies have shown that some the ventilation defects found using MRI in asthmatics are intermittent and others are persistent, but both are associated with lower lung function.The role of imaging in severe asthma currently is primarily in the exclusion of comorbid or other conditions, or in the assessment for complications in the setting of acute (...) The Role of Imaging in the Assessment of Severe Asthma The present review aims to summarize the most recent evidence related to imaging and severe asthma, both with regard to advances in imaging research and to their current and potential clinical implications.Recent work in imaging in severe asthma has principally been using computed tomography (CT) and MRI, as well as the integration of the two. Some of the most notable findings include the use of CT imaging biomarkers to create unique

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2017 Current Opinion in Pulmonary Medicine

133. Airway autoimmune responses in severe eosinophilic asthma following low-dose Mepolizumab therapy (PubMed)

Airway autoimmune responses in severe eosinophilic asthma following low-dose Mepolizumab therapy Anti-interleukin (IL)-5 monoclonal antibodies as an eosinophil-depleting strategy is well established, with Mepolizumab being the first biologic approved as an adjunct treatment for severe eosinophilic asthma.A 62-year old woman diagnosed with severe eosinophilic asthma showed poor response to Mepolizumab therapy (100 mg subcutaneous dose/monthly) and subsequent worsening of symptoms. The treatment (...) in comparison to the target antigen. The resultant immune complexes could act as 'cytokine depots', protecting the potency of the 'bound' IL-5, thereby sustaining the eosinophilic inflammation within the target tissue. Molecular analysis of the sputum indicated the development of a polyclonal autoimmune response as well as an increase in group 2 innate lymphoid cells, two novel observations in severe eosinophilic asthma, which were associated with indices of disease severity and progression. This case

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2017 Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology

134. Targeted therapy in severe asthma today: focus on immunoglobulin E (PubMed)

the widest and most easily recognized asthma phenotype, present in up to two-thirds of adults with asthma. Immunoglobulin E (IgE) production is the primary and key cause of allergic asthma leading to persistent symptoms, exacerbations and a poor quality of life. Therefore, limiting IgE activity upstream could stop the entire allergic inflammation cascade in IgE-mediated allergic asthma. The anti-IgE treatment omalizumab has an accepted place in the management of severe asthma (Global Initiative (...) trial data and a decade of use in clinical practice has established omalizumab as a safe and effective targeted therapy for the treatment of patients with severe persistent IgE-mediated allergic asthma.

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2017 Drug design, development and therapy

135. [Influences of inhaling glucocorticoid on sIgA and HBD-2,3 in pharyngeal mucosa of and T cell subsets in blood of patients with chronic persistent asthma]. (PubMed)

[Influences of inhaling glucocorticoid on sIgA and HBD-2,3 in pharyngeal mucosa of and T cell subsets in blood of patients with chronic persistent asthma]. Objective:The aim of this study was to investigate the inhaled glucocorticoid therapy affects sIgA and HBD 2,3 secreted by mucous membrane of throat and T lymphocyte subsets in patients with chronic persistent asthma. Method:One hundred patients diagnosed with chronic persistent asthma were randomly divided into control group (submitted (...) to conventional non-hormonal therapy) and treatment group (submitted to inhaled glucocorticoid therapy) with 50 cases in each group. Ventolin aerosol had been promised in on demand use and the dosage of nonhormonal drugs should be adjusted according to the severity of illness in each group. No matter if asthma was fully under control or not, the observation would be terminated in 3 months. The secretion samples of pharyngeal mucosa and venous blood samples had been collected before and after treatment

2016 Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery

136. Influenza Vaccine Feasibility Study in Children With Persistent Asthma

protocol and associated documents and procedures, CISA is proposing to carry out a study at the three sites to assess the feasibility of recruiting, enrolling, retaining, and collecting clinical data on children 5-11 years with persistent asthma of varied levels of severity in an influenza vaccine safety study. Findings from this proposed feasibility study will facilitate improving the LAIV4 study in the future if it goes forward through the CISA Project or in another venue. In 2016-2017 season, FDA (...) children. Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 40 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Other Official Title: Feasibility Study to Assess the Safety of Quadrivalent, Live Attenuated Influenza Vaccine (LAIV4) Versus Quadrivalent Inactivated Influenza Vaccine (IIV4) in Children Aged 5-11 Years With Persistent Asthma of Varied Severity (Cell

2016 Clinical Trials

137. To Determine the Measurement Properties of the ACT in an African American Adolescent Population With Persistent Asthma

medication use for asthma requiring at least low-dose inhaled corticosteroids (ICS). Asthma may range from mild persistent through severe persistent asthma, to include subjects that may require daily or every other day oral corticosteroids for control of asthma symptoms Exclusion Criteria: Children younger than age 12 and older than 18 Children unable to perform spirometry Medical history or underlying health problems that may preclude participation in the protocol per the study physician (including (...) To Determine the Measurement Properties of the ACT in an African American Adolescent Population With Persistent Asthma To Determine the Measurement Properties of the ACT in an African American Adolescent Population 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

2016 Clinical Trials

138. Efficacy and safety of a CXCR2 antagonist, AZD5069, in patients with uncontrolled persistent asthma: a randomised, double-blind, placebo-controlled trial. (PubMed)

Efficacy and safety of a CXCR2 antagonist, AZD5069, in patients with uncontrolled persistent asthma: a randomised, double-blind, placebo-controlled trial. Airway neutrophilic inflammation is a pathological feature in some patients with severe asthma. Stimulation of the chemokine receptor CXCR2 mediates neutrophil migration into the airways. We investigated the safety and efficacy of AZD5069, a CXCR2 antagonist, as an add-on therapy in patients with uncontrolled severe asthma.In this multicentre (...) , randomised, double-blind, placebo-controlled, dose-finding trial, we enrolled patients aged 18 years or older with uncontrolled asthma despite combination therapy with long-acting β2 agonists and medium-dose or high-dose inhaled corticosteroids. Patients were randomised in a 1:1:1:1 ratio via an interactive voice-response or web-response system to receive 5, 15, or 45 mg oral AZD5069 twice daily or matched placebo. The primary endpoint was the number of severe asthma exacerbations in 6 months. Safety

2016 The lancet. Respiratory medicine

139. Dupilumab efficacy and safety in adults with uncontrolled persistent asthma despite use of medium-to-high-dose inhaled corticosteroids plus a long-acting β2 agonist: a randomised double-blind placebo-controlled pivotal phase 2b dose-ranging trial. (PubMed)

μL (71·2-80·7%), and the subgroup with fewer than 300 eosinophils per μL (59·9-67·6%). The most common adverse events with dupilumab compared with placebo were upper respiratory tract infections (33-41% vs 35%) and injection-site reactions (13-26% vs 13%).Dupilumab increased lung function and reduced severe exacerbations in patients with uncontrolled persistent asthma irrespective of baseline eosinophil count and had a favourable safety profile, and hence in addition to inhaled corticosteroids (...) Dupilumab efficacy and safety in adults with uncontrolled persistent asthma despite use of medium-to-high-dose inhaled corticosteroids plus a long-acting β2 agonist: a randomised double-blind placebo-controlled pivotal phase 2b dose-ranging trial. Dupilumab, a fully human anti-interleukin-4 receptor α monoclonal antibody, inhibits interleukin-4 and interleukin-13 signalling, key drivers of type-2-mediated inflammation. Adults with uncontrolled persistent asthma who are receiving medium-to-high

2016 Lancet (London, England)

140. Allergy testing in children with persistent asthma: Comparison of four diagnostic methods. (PubMed)

Allergy testing in children with persistent asthma: Comparison of four diagnostic methods. Multiple allergic sensitizations are common in persistent childhood asthma, and thorough assessment of allergy is crucial for optimal care of these children. Microarray testing offers opportunities for improved sIgE characterization, which has been projected to be useful in the management of multisensitized patients.The aim of this study was to investigate the accuracy and information obtained by two (...) microarray platforms applied on a well-characterized pediatric asthma cohort.Seventy-one children were recruited from a nationwide Swedish study on severe childhood asthma. Severe (n = 40) and controlled (n = 31) asthmatics were assessed for allergic sensitization by two microarray systems (Microtest and ISAC) and by two standard diagnostic methods (ImmunoCAP and skin prick test). Data on clinical history, physical examination, spirometry, asthma control test, and doctor's diagnosis were collected

2016 Allergy

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