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Severe Persistent Asthma

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141. Fevipiprant, a prostaglandin D2 receptor 2 antagonist, in patients with persistent eosinophilic asthma: a single-centre, randomised, double-blind, parallel-group, placebo-controlled trial. (PubMed)

Fevipiprant, a prostaglandin D2 receptor 2 antagonist, in patients with persistent eosinophilic asthma: a single-centre, randomised, double-blind, parallel-group, placebo-controlled trial. Eosinophilic airway inflammation is often present in asthma, and reduction of such inflammation results in improved clinical outcomes. We hypothesised that fevipiprant (QAW039), an antagonist of prostaglandin D2 receptor 2, might reduce eosinophilic airway inflammation in patients with moderate-to-severe (...) eosinophilic asthma.We performed a single-centre, randomised, double-blind, parallel-group, placebo-controlled trial at Glenfield Hospital (Leicester, UK). We recruited patients with persistent, moderate-to-severe asthma and an elevated sputum eosinophil count (≥2%). After a 2-week single-blind placebo run-in period, patients were randomly assigned (1:1) by the trial pharmacist, using previously generated treatment allocation cards, to receive fevipiprant (225 mg twice per day orally) or placebo

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2016 The lancet. Respiratory medicine

142. Cost of persistent asthma in Italy (PubMed)

of visits; drug use and duration, and indirect costs) were recorded.The cohort consisted of 817 patients with persistent asthma of different severity. They had a 42.96% male prevalence; a mean (±SE) age of 49.06 (±0.64) years; a mean 87.47% (±0.81) FEV1% pred. in baseline, and 69.16% of subjects had comorbidities. The mean (±SE) number of relapses was 0.91 (±0.09) per patient/year before the enrolment. After 12 months, FEV1% significantly improved by +6.31% (±0.45) from the corresponding baseline value (...) Cost of persistent asthma in Italy Asthma is a common disease of the airways with a significant burden for the society and for patients' quality of life. The Social Impact of Respiratory Integrated Outcomes (SIRIO) study estimated a mean cost of 1,177.40 € per patient/year in Italy, in 2007. The aim of the present study was to update the cost of persistent asthma patients in Italy.An observational, retrospective, bottom-up analysis was carried out starting from the data base operating

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2016 Multidisciplinary respiratory medicine

143. Neutrophil-like low-density granulocytes are elevated in patients with moderate to severe persistent asthma. (PubMed)

Neutrophil-like low-density granulocytes are elevated in patients with moderate to severe persistent asthma. Elevations in neutrophil-like low-density granulocytes (LDGs) are observed in association with disease severity in some autoimmune and other disorders. This study evaluated whether a similar association with disease severity is observed in asthma.To determine LDG levels in peripheral blood mononuclear cells of subjects with intermittent or mild persistent asthma, subjects with moderate (...) persistent or severe persistent (SP) asthma, and control subjects without a history or allergy or asthma.A brief medical history and physical examination, spirometry, and measurement of fraction of exhaled nitric oxide were performed. The LDGs were quantified by polychromatic flow cytometry.The LDGs displaying the same phenotype as those described previously for LDGs in other diseases were significantly elevated in peripheral blood mononuclear cells of subjects with moderate persistent or SP asthma

2014 Asthma & Immunology

144. A 62-year-old women with persistent severe asthma, skin rash, and eosinophilia. (PubMed)

A 62-year-old women with persistent severe asthma, skin rash, and eosinophilia. A 62-year-old white woman was admitted with shortness of breath, wheezing, and cough. While in the hospital a generalized pruritic skin rash developed on her trunk and upper and lower extremities. She did not have any fevers, chills, or night sweats. The patient was known to have chronic, difficult-to-control asthma despite being compliant with a treatment regimen consisting of inhaled albuterol, high-dose inhaled (...) steroids, salmeterol, and montelukast. Her medical history was significant for hypertension and gout. She had no family history of asthma. The patient was a life-long nonsmoker and did not drink alcohol. During this hospitalization, she was started on prednisone 40 mg/d po in addition to her home medications.

2014 Chest

146. Home-based respiratory rehabilitation in adult patients with moderate or severe persistent asthma. (PubMed)

Home-based respiratory rehabilitation in adult patients with moderate or severe persistent asthma. We assessed retrospectively the feasibility of a home-based respiratory rehabilitation (RR) program for asthmatics under optimal pharmacological treatment, as this type of care can reduce costs and offer a more patient-friendly approach for subjects with persistent asthma.Fifty-two patients with persistent asthma were recruited to the RR program (20 males, 32 females, 54 ± 11 (SD) years, forced (...) following the program, regardless of whether the patients had dropped out (p < 0.02) or not (p < 0.001). The distance walked during a 6-min walking test increased by 33 m (p < 0.001). Several indices measured during a cycle ergometer test increased significantly after RR: peak oxygen uptake (10%), oxygen uptake at ventilatory threshold (12%) and maximum load (19%), all at a similar maximum heart rate. Concerning quality of life assessment, the Short-Form-36 Item Health Survey revealed a non-significant

2014 Journal of Asthma

147. The role of mepolizumab in atopic and nonatopic severe asthma with persistent eosinophilia. (PubMed)

The role of mepolizumab in atopic and nonatopic severe asthma with persistent eosinophilia. 24659543 2015 02 24 2017 11 16 1399-3003 44 1 2014 Jul The European respiratory journal Eur. Respir. J. The role of mepolizumab in atopic and nonatopic severe asthma with persistent eosinophilia. 239-41 10.1183/09031936.00220413 Ortega Hector H GlaxoSmithKline, Respiratory Medicine Development Center, Research Triangle Park, NC, USA hector.g.ortega@gsk.com. Chupp Geoffrey G Dept of Pulmonary and Critical (...) Steroids 37341-29-0 Immunoglobulin E 90Z2UF0E52 mepolizumab IM Adolescent Adult Aged Antibodies, Monoclonal, Humanized therapeutic use Asthma drug therapy Child Eosinophilia drug therapy Female Humans Hypersensitivity, Immediate blood drug therapy Immunoglobulin E blood immunology Inflammation Male Middle Aged Phenotype Randomized Controlled Trials as Topic Seasons Spirometry Steroids therapeutic use Treatment Outcome Young Adult 2014 3 25 6 0 2014 3 25 6 0 2015 2 25 6 0 ppublish 24659543

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2014 European Respiratory Journal

148. The chitinase-like protein YKL-40 is not a useful biomarker for severe persistent asthma in children. (PubMed)

The chitinase-like protein YKL-40 is not a useful biomarker for severe persistent asthma in children. The chitinase-like protein YKL-40 is thought to play a role in inflammation and tissue remodeling. In adults with severe asthma, YKL-40 is expressed in the airway and YKL-40 levels are elevated in the serum.To compare YKL-40 levels in children with severe persistent asthma with those in adults with severe persistent asthma and to determine whether YKL-40 levels correlate with increasing asthma (...) severity in childhood asthma.In this prospective, cross-sectional study, 23 adults and 19 children with severe persistent asthma, 23 children with moderate persistent asthma, and 19 children with mild persistent asthma were enrolled. The following data were collected on each patient: spirometry, exhaled nitric oxide, percutaneous skin testing results to aeroallergens, peripheral eosinophils, serum IgE levels, and serum YKL-40 levels.Compared with adults, children with severe persistent asthma had

2014 Asthma & Immunology

149. Effectiveness of omalizumab in severe persistent asthma under real-life conditions (PubMed)

Effectiveness of omalizumab in severe persistent asthma under real-life conditions 25022639 2015 04 10 2018 12 02 1715-5258 60 7 2014 Jul Canadian family physician Medecin de famille canadien Can Fam Physician Effectiveness of omalizumab in severe persistent asthma under real-life conditions. 643-5 D'Urzo Anthony D AD Associate Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario. Wong Jenny J Family medicine resident at McGill University (...) in Montreal, Que. eng Journal Article Comment Canada Can Fam Physician 0120300 0008-350X 0 Anti-Asthmatic Agents 0 Antibodies, Monoclonal IM Respir Med. 2009 Nov;103(11):1633-42 19619998 Anti-Asthmatic Agents therapeutic use Antibodies, Monoclonal therapeutic use Asthma drug therapy Female Humans Male 2014 7 16 6 0 2014 7 16 6 0 2015 4 11 6 0 ppublish 25022639 60/7/643 PMC4096265 Allergy. 2004 Jul;59(7):709-17 15180757 Thorax. 1992 Feb;47(2):76-83 1549827 Allergy. 2005 Mar;60(3):309-16 15679715 Clin Exp

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2014 Canadian Family Physician

150. 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 (...) are now being evaluated mainly in the adult severe asthma population, with some evidence of efficacy and short-term safety data (Table 4). Using established asthma medications Corticosteroid insensitivity As defined in this document, severe asthma involves CS insensitivity, with persistent lack of control despite CS therapy or worsening of asthma control on reduction or discontinuation of CS therapy. Thus, although CSs are the mainstay of treatment for milder forms of asthma, alternative molecular

2013 American Thoracic Society

151. Determinants of persistent asthma in young adults (PubMed)

). In individuals with late-onset asthma the determinant was use of ICS and/or LABA within 12 months (6.84; 2.09-22.37). Conclusions: Pulmonary function below predicted, severity of disease expressed by asthma score and use of ICS and/or LABA were all determinants for persistent early-onset asthma, whereas only use of ICS and/or LABA was a determinant in late-onset asthma. A high asthma score indicated insufficient disease control in a substantial proportion of these young adults. (...) Determinants of persistent asthma in young adults Objective: The aim of the study was to evaluate determinants for the prognosis of asthma in a population-based cohort of young adults. Design: The study was a nine-year clinical follow up of 239 asthmatic subjects from an enriched population-based sample of 1,191 young adults, aged 20-44 years, who participated in an interviewer-administered questionnaire and clinical examination at baseline in 2003-2006. From the interview, an asthma score

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2018 European clinical respiratory journal

152. Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma. (PubMed)

Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma. Acute asthma is a common cause of presentations to acute care centres, such as the emergency department (ED), and while the majority of patients can be discharged, relapse requiring additional medical care is common. Systemic corticosteroids are a major part in the treatment of moderate to severe acute asthma; however, there is no clear evidence regarding the most (...) effective route of administration for improving outcomes in patients discharged from acute care.To examine the effectiveness and safety of a single dose of intramuscular (IM) corticosteroids provided prior to discharge compared to a short course of oral corticosteroids in the treatment of acute asthma patients discharged from an ED or equivalent acute care setting.The Cochrane Airways Group conducted searches of the Cochrane Airways Group Register of Trials, most recently on 14 March 2018. In addition

2018 Cochrane

153. 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

154. Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial

-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

155. Efficacy and Safety of Tiotropium in the Treatment of Severe Persistent Asthma:Meta-analysis. (PubMed)

Efficacy and Safety of Tiotropium in the Treatment of Severe Persistent Asthma:Meta-analysis. To evaluate the efficacy and safety of tiotropium in treatment of severe persistent asthma.Reports of randomized controlled trials (RCTs) describing tiotropium for treatment of severe persistent asthma published from January 1946 to February 2015 were searched in Cochrane Library, ClinicalTrials.gov, PubMed, Ovid Medline, CNKI, and CSJD. The data of the included RCTs were extracted and the data quality (...) tiotropium group and placebo group were reported in these included studies (P>0.05).Tiotropium for severe persistent asthma treatment can improve FEV1, FVC, and PEF but may not improve the quality of life of the patients. Tiotropium is well tolerated and can be an add-on therapy for severe persistent asthma.

2016 Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae

156. 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

157. Chronic Asthma

(BUD/FORM) as a reliever, in lieu of increasing the ICS dose for moderate asthma with poor control, in ages =12 y.o. who are on a fixed-dose ICS/LAßA combination (see Table 10). ? The level of pharmacotherapy required to maintain disease control will provide clues as to disease severity (see Table 4). ? Consider step-down therapy only if exacerbation risk is low and asthma is well-controlled for at least three months. ? The ability to distinguish various clinical presentations of asthma (...) is an emerging science (see Appendix D) but in time will inform the precise use of LTRA and biologics such as monoclonal antibodies to IgE omalizumab (Xolair ® ) and interleukins e.g. mepolizumab 8 (Nucala ® ), reslizumab (Cinqair ® ), benralizumab et al 9 Note: Biologics require Alberta Blue Cross Special Authorization. Chronic Asthma | April 2018 Clinical Practice Guideline Page 6 of 23 Recommendations Table 4: Asthma control therapy based on disease severity (See Table 5 for suggested initial regimen

2018 Toward Optimized Practice

158. BTS/SIGN 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 British Thoracic Society

159. Omalizumab for the treatment of severe persistent allergic asthma

Omalizumab for the treatment of severe persistent allergic asthma Omalizumab for the treatment of severe persistent allergic asthma Omalizumab for the treatment of severe persistent allergic asthma Jones J, Shepherd J, Hartwell D, Harris P, Cooper K, Takeda A, Davidson P Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Jones J, Shepherd J (...) , Hartwell D, Harris P, Cooper K, Takeda A, Davidson P. Omalizumab for the treatment of severe persistent allergic asthma. Health Technology Assessment 2009; 13(Suppl 2 Article 5): 31-39 Final publication URL Additional data URL Indexing Status Subject indexing assigned by NLM MeSH Anti-Asthmatic Agents /economics /therapeutic use; Antibodies, Anti-Idiotypic; Antibodies, Monoclonal /economics /therapeutic use; Antibodies, Monoclonal, Humanized; Asthma /drug therapy; Cost-Benefit Analysiss; Omalizumab

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2009 Health Technology Assessment (HTA) Database.

160. Asthma

). Symptoms that are present from birth. Excessive vomiting or posseting. Evidence of severe upper respiratory tract infection. Persistent wet or productive cough. A family history of unusual chest disease. Nasal polyps. Basis for recommendation The recommendations on diagnosis of asthma are based on expert opinion in the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) British guideline on the management of asthma [ ], the Global Initiative for Asthma (GINA) guideline (...) stepwise treatment, depending on the person's age, and the severity of their asthma symptoms, may include: An inhaled corticosteroid (ICS) at a low dose in adults/paediatric low dose in children. Add-on therapies, such as a leukotriene receptor antagonist, or a long-acting inhaled beta- 2 agonist, a maintenance and reliever therapy regimen, increased doses of ICS, theophylline, and/or a long-acting muscarinic agent. If symptoms are still not adequately controlled, consider referral to a specialist

2017 Prodigy

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