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Severe Persistent Asthma

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141. 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

142. 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

143. 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

144. 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

145. 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

146. 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

147. Child and Adolescent Asthma Guidelines

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

2017 Asthma and Respiratory Foundation NZ

148. 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)

149. 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)

150. 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

151. 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)

152. Role of Immunotherapy in the Treatment of Asthma

containing an allergen(s) is injected under the skin. Sublingual immunotherapy (SLIT), which may be dosed at home, consists of exposure to the allergen via an aqueous solution or tablet formulation placed under the tongue. In 2007, the Expert Panel Report (EPR-3) from The National Heart, Lung, and Blood Institute (NHBLI) 2 included SCIT as a therapy to be considered in cases of mild to moderate persistent asthma. A working group was convened in 2015 to select the most relevant topics for systematic (...) heterogeneity; and limited reporting. We detail below specific areas for future research. ES-7 Population • The overwhelming majority of studies that met inclusion criteria for this review included patients with mild to moderate asthma; there is a need to investigate the safety and efficacy of immunotherapy in patients with severe asthma. • Not all studies provided information about asthma severity or control of study patients. Because severity and control are potentially important modifiers of treatment

2018 Effective Health Care Program (AHRQ)

153. Management of Acute Exacerbation of Asthma Presenting to the Emergency Department or Urgent Care

for pedi pts, including some treatments beyond NAEPP guidelines; review NAEPP-recommended txts to provide full range of treatments available • Improved symptoms 1b • Current guidelines recommend treatment of moderate to severe asthma exacerbations with oral prednisone or dexamethasone. Oral prednisone/prednisolone (1–2 mg/kg/day) taken for a 3–5 day course or dexamethasone (0.3–0.6 mg/kg) given in either a one or two-dose regimen. • Evidence supports the use of dexamethasone in preference to prednisone (...) ). • Adherence was greater in the dexamethasone group (99.3% vs 96.0%, P < .05) • A high percentage of parents in the 2 groups expressed a preference for the 2-day treatment (93.8% vs 94.7%) • 2 doses of dex may be effective alternative to 5-day course prednisone/prednisolone for asthma exacerbation, as measured by persistence of symptoms & quality of life at day 7 Aljebab, 2018 Prospective Cohort Observational 255 Children (2–16 years) suffering from asthma or croup treated in the children's emergency

2018 Cincinnati Children's Hospital Medical Center

154. Effectiveness of omalizumab in severe persistent asthma under real-life conditions Full Text available with Trip Pro

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

2014 Canadian Family Physician

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

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

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

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

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

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

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

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

159. The role of mepolizumab in atopic and nonatopic severe asthma with persistent eosinophilia. Full Text available with Trip Pro

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

2014 European Respiratory Journal

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