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Severe Persistent Asthma

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141. Diagnostic Value of Serum Baseline Tryptase Levels in Childhood Asthma and Its Correlation with Disease Severity. Full Text available with Trip Pro

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

2017 International Archives of Allergy and Immunology

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

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

143. Control of moderate-to-severe asthma with randomized ciclesonide doses of 160, 320 and 640 μg/day. Full Text available with Trip Pro

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

2017 Journal of asthma and allergy Controlled trial quality: predicted high

144. Beyond epithelial-to-mesenchymal transition: common suppression of differentiation programs underlies epithelial barrier dysfunction in mild, moderate and severe asthma. Full Text available with Trip Pro

deprivation in normal human bronchial epithelial cells cultured in organotypic conditions closely approximated gene expression in asthmatic epithelial brushings.The comparative analysis of publically available transcriptomes demonstrated that epithelial barrier dysfunction in asthma is characterized by persistent underlying de-differentiation program with complex etiology. The lasting alteration of the asthmatic epithelial cell transcriptome implicates regulation involving metabolism and epigenetics (...) 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

2017 Allergy

145. Long-term future risk of severe exacerbations: distinct 5-year trajectories of problematic asthma. Full Text available with Trip Pro

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

2017 Allergy

146. Predictive factors for moderate or severe exacerbations in asthma patients receiving outpatient care. Full Text available with Trip Pro

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

2017 BMC pulmonary medicine

147. Longterm clinical outcomes of omalizumab therapy in severe allergic asthma: Study of efficacy and safety. Full Text available with Trip Pro

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

148. Possible ABPA with persistent symptoms

consider her a candidate for allergen immunotherapy considering everything else has been tried? A: Persistent airway complaints, reduced lung function and need for systemic corticosteroids are criteria for severe persistent asthma, assuming that asthma is the diagnosis (1). The characteristics described support a Type 2 asthma with increased IgE and specific-IgE. Peripheral blood eosinophil count and exhaled FeNO would be helpful in confirming Type 2 airway disease. Bronchiectasis is not expected (...) with asthma. Although allergic bronchopulmonary aspergillosis (ABPA) is suspected, I am skeptical of the diagnosis with total IgE at 403 kU/L, since typically the values would be >1000 kU/L. If the bronchiectasis is central and the IgG to aspergillus antigen is very positive (> 20-30 mg/L), the diagnosis of ABPA may indeed be correct (2). You may want to consider cystic fibrosis as well. In summary, I would be less comfortable with allergen immunotherapy in a patient with severe, persistent, Type 2 asthma

2020 American Academy of Allergy, Asthma & Immunology - Ask the Expert

149. A primary care based asthma program improves recognition and treatment of persistent asthma in inner-city children compared to routine care. (Abstract)

A primary care based asthma program improves recognition and treatment of persistent asthma in inner-city children compared to routine care. To examine whether a primary care-based asthma program that applies the Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-2007 criteria to classify asthma severity increases detection of persistent asthma in inner-city children and affects "step of care" compared to routine care.A retrospective chart review was conducted (...) . 53% were male. The majority of children were Latino (45.6%) or African American (35.4%). At the asthma program visit, more children were identified with moderate or severe persistent asthma based upon clinical questions (47.9%), spirometry (56.9%) or combined criteria (75.3%) than had been identified during routine care (15.2%); all p < .05. After the asthma program visit, more children were prescribed controller medications (82.3% vs 63.3%; p < .05) and 40.6% had their medication plan stepped

2016 Journal of Asthma

150. Investigate the Effect of the CREON2000A on Asthma Control in Children With Mild to Moderate Persistent Asthma

ratio of 1:1. The study population is children between the ages 6 to 17 years, with mild to moderate persistent asthma. The purpose of the study is to determine whether the CREON2000A, an environmental control device, will decrease asthma severity, as measured by the Composite Asthma Severity Index (CASI), in children with mild to moderate persistent allergic asthma over a twelve month period. Condition or disease Intervention/treatment Phase Asthma Device: CREON2000A Device: Sham Not Applicable (...) Detailed Description: The pilot study (Protocol #PA-01-052; Health Effects of CREON2000 in Asthmatic Children. IB ID# GI 1001) offered preliminary evidence that the CREON2000A system may be beneficial in asthma. This study is a follow-up, using children, aged 6 to 17 with mild to moderate persistent asthma, as the subjects of the study. Children are usually treated with fewer controller medications and have fewer confounding co-morbidities making it more likely to detect a therapeutic benefit from

2016 Clinical Trials

151. 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

152. Less puffing, more breathing? Intermittent inhaled steroids for asthma

of well-controlled asthma. Overall adverse events are similar. Evidence: • Focusing on two large (~4000 patients each), industry managed, randomized, double- blind, placebo-controlled trials (RCTs) in mild persistent asthma (controlled on low- dose daily ICS or uncontrolled with Short-Acting Beta-Agonist alone). 1,2 Mean age ~40; ~20% had severe exacerbation in preceding year. Included patients randomized to budesonide/formoterol PRN or budesonide 200mcg BID + terbutaline PRN after a 2- 4-week run (...) with intermittent treatment. 1,2 • Previous systematic review 3 (6 RCTs; 1211 children and adults) of intermittent versus daily ICS (excluded ICS/LABA combination trials) found: o No difference in risk of exacerbation. o Fewer asthma-controlled days with intermittent versus daily ICS. o For children: daily ICS resulted in ~0.5cm less growth (height) at ~1 year. 3 Context: • Up to 75% of asthmatics have mild asthma. 4 • Guidelines recommend daily ICS for mild persistent asthma, 5 but only ~50% adhere. 6

2019 Tools for Practice

153. Forced midexpiratory flow between 25% and 75% of forced vital capacity is associated with long-term persistence of asthma and poor asthma outcomes. Full Text available with Trip Pro

-75 decreased by 10% of predicted value.A reduced level of FEF25-75 at EGEA1 increased the risk of long-term asthma persistence (adjusted OR, 1.14; 95% CI, 1.00-1.29). In children the association remained significant after further adjustment for FEV1 and in participants with FEV1 of greater than 80% of predicted value. A reduced FEF25-75 level at EGEA1 was significantly associated with more severe bronchial hyperresponsiveness (P < .0001) and with current asthma a decade later, with an association (...) Forced midexpiratory flow between 25% and 75% of forced vital capacity is associated with long-term persistence of asthma and poor asthma outcomes. Whether small-airway obstruction contributes to the long-term evolution of asthma remains unknown.Our aim was to assess whether the level of forced midexpiratory flow between 25% and 75% of forced vital capacity (FEF25-75) was associated with the persistence of current asthma over 20 years and the subsequent risk for uncontrolled asthma

2015 Journal of Allergy and Clinical Immunology

154. Asthma and Pest Control Study: Demonstrating Return-on-Investment for In-Home Pest Control for Children With Persistent Asthma

Persistent asthma (including mild, moderate or severe), according to National Heart Lung and Blood Institute (NHLBI) criteria: i. Experiencing symptoms more than 2 days per week in past month ii. Awaking at night due to symptoms more than 2 times per month iii. Use of SABA meds (i.e., albuterol) for symptom control (not prevention) more than 2 days per week in past month iv. Any interference with daily activity v. Having exacerbations requiring oral systemic corticosteroids 2 or more time per year Any (...) Asthma and Pest Control Study: Demonstrating Return-on-Investment for In-Home Pest Control for Children With Persistent Asthma Asthma and Pest Control Study: Demonstrating Return-on-Investment for In-Home Pest Control for 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

2015 Clinical Trials

155. Unraveling the Pathophysiology of the Asthma COPD Overlap Syndrome: Unsuspected mild centrilobular emphysema is responsible for loss of lung elastic recoil in never smoked asthmatics with persistent expiratory airflow limitation. Full Text available with Trip Pro

Unraveling the Pathophysiology of the Asthma COPD Overlap Syndrome: Unsuspected mild centrilobular emphysema is responsible for loss of lung elastic recoil in never smoked asthmatics with persistent expiratory airflow limitation. Investigators believe most patients with asthma have reversible airflow obstruction with treatment, despite airway remodeling and hyperresponsiveness. There are smokers with chronic expiratory airflow obstruction despite treatment who have features of both asthma (...) and COPD. Some investigators refer to this conundrum as the asthma-COPD overlap syndrome (ACOS). Furthermore, a subset of treated nonsmokers with moderate to severe asthma have persistent expiratory airflow limitation, despite partial reversibility. This residuum has been assumed to be due to large and especially small airway remodeling. Alternatively, we and others have described reversible loss of lung elastic recoil in acute and persistent loss in patients with moderate to severe chronic asthma who

2015 Chest

156. Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma. (Abstract)

Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma. Health care costs increase in patients with more severe asthma, but the effect of asthma exacerbations on costs among patients with more severe asthma has not been quantified.This study compared direct health care costs between patients with moderate/severe persistent asthma with and without exacerbations.Patients who had an asthma diagnosis (International Classification (...) of Diseases-ninth revision-Clinical Modification code 493.x), were 12 to 64 years old, and were receiving controller therapy were identified from a large administrative claims database. Patients were categorized as having moderate/severe persistent asthma and were further evaluated for exacerbations during a 12-month exacerbation identification period. Patients with 1 or more exacerbations (asthma-related inpatient or emergency department visit or corticosteroid prescription) were matched to patients

2012 Journal of Allergy and Clinical Immunology

157. The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management

• Depending on the FeNO cutoff, the likelihood of having asthma in people ages 5 years and older increases by 2.8 to 7.0 times given a positive FeNO test result. • FeNO is modestly more accurate in diagnosing steroid-naïve asthmatics, children (ages 5-18), and nonsmokers than other patients suspected to have asthma. • FeNO results can predict which patients will respond to inhaled corticosteroid therapy. • Using FeNO to manage long-term control medications including dose titration, weaning, and monitoring (...) of subsequent and prior exacerbations. (SOE: Low) The association between FeNO levels and exacerbation risk is likely stronger in individuals (ages>5 years) with atopy. (SOE: Low) • In adults (ages >18) and children (ages 5 -18) with acute asthma exacerbations, FeNO levels do not correlate with exacerbation severity and were poorly reproducible. (SOE: Low) • In children (ages 5 - 12) and adolescents (ages 13 - 18), FeNO levels were inversely associated with adherence to asthma medications (mainly ICS). (SOE

2018 Effective Health Care Program (AHRQ)

158. Effectiveness of Indoor Allergen Reduction in Management of Asthma

the effectiveness of specific combinations were supported by the evidence. • Important limitations of the evidence base include population heterogeneity (e.g., patient age and asthma severity), infrequent reporting of validated asthma outcome measures, poor data reporting, and variation in how interventions were implemented. • Further research is needed examining indoor allergen reduction interventions in comparative studies with sufficient population sizes to detect clinically meaningful differences (...) in relevant and validated asthma outcomes. Discussion We identified 60 randomized controlled trials (RCTs) and 8 additional studies (4 nonrandomized trials and 4 pre-post studies) that examined 8 types of interventions, alone or in combination, to reduce allergen levels in the home and improve the wellbeing of patients with asthma. There was a high level of heterogeneity across studies, particularly related to patient characteristics such as allergen sensitization and disease severity

2018 Effective Health Care Program (AHRQ)

159. Is There Really a Link between Asthma and Reflux?

, or the use of asthma medications. Problems with early studies included small sample size, short duration of study, and significant variation in asthma definition, intervention, and measurement of outcomes. 4,5 15 randomized 770 patients with moderate to severe persistent asthma despite treatment with inhaled corticosteroids (ICS) to receive either esomeprazole 40 mg twice daily (BID) or placebo for 14 weeks. Patients were stratified by presence of GERD and/or nocturnal respiratory symptoms. The results (...) in . 13 Caution must be used in interpreting this data since evidence suggests that impedance monitoring in patients on proton pump inhibitors (PPIs) does not correlate with traditional off-therapy markers of severe reflux . 14 Investigators have tried for many years to identify the effect of GERD treatments on poorly controlled asthma; however, no consistent outcomes have been elucidated. Anti-reflux treatments have not proven to consistently improve lung function, asthma symptoms, nocturnal asthma

2018 Clinical Correlations

160. Intermittent Inhaled Corticosteroids and Long-Acting Muscarinic Antagonists for Asthma

of intermittent inhaled corticosteroids in different populations of patients with asthma and to assess whether adding long-acting muscarinic antagonists improves outcomes for patients with uncontrolled, persistent asthma. Key Messages • In children less than 5 years old with recurrent wheezing, intermittent use of inhaled corticosteroids during an upper respiratory tract infection decreases asthma exacerbations • In patients 12 years and older with persistent asthma: o using inhaled corticosteroids (...) intermittently may be as effective as using them as a controller medication o using inhaled corticosteroids and long-acting beta-agonists together as controller and quick relief therapy reduces asthma exacerbations compared to using inhaled corticosteroids alone or with long-acting beta agonist as a controller • In patients 12 years and older with uncontrolled, persistent asthma, adding long-acting muscarinic antagonist to: o inhaled corticosteroids reduces exacerbations and improves lung function o inhaled

2018 Effective Health Care Program (AHRQ)

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