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Severe Persistent Asthma

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161. 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)

162. 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

163. 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

164. 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

165. 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

166. 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

167. 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

168. 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

170. Longitudinal analysis to better characterize Asthma-COPD Overlap Syndrome (ACOS): Findings from an adult asthma cohort in Korea (COREA). (Abstract)

function was lower in patients with ACOS. In the longitudinal analysis, the mean change in lung function was high, and a greater decline in FEV1 was observed in patients with ACOS. In addition, we compared ACOS and severe asthma, and we also performed a cluster analysis and compared the results with our definition of ACOS. According to our definition, ACOS is an independent subtype with distinctive characteristics. Finally, a genome-wide association study (GWAS) was performed to identify genetic (...) Longitudinal analysis to better characterize Asthma-COPD Overlap Syndrome (ACOS): Findings from an adult asthma cohort in Korea (COREA). Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS), which has received much attention, has not been unanimously defined.In this study, we tried to demonstrate that longitudinally defined ACOS is more useful in the real world than blending patients with asthma and COPD.The study patients had undergone two consecutive pulmonary function

2019 Clinical and Experimental Allergy

171. Omalizumab Improves Quality of Life and Asthma Control in Chinese Patients With Moderate to Severe Asthma: A Randomized Phase III Study. Full Text available with Trip Pro

Omalizumab Improves Quality of Life and Asthma Control in Chinese Patients With Moderate to Severe Asthma: A Randomized Phase III Study. Omalizumab is the preferred add-on therapy for patients with moderate-to-severe persistent allergic asthma and has demonstrated efficacy and safety in various ethnicities. This study evaluated the efficacy and safety of omalizumab in Chinese patients with moderate-to-severe allergic asthma.This randomized, double-blind, parallel-group, placebo-controlled (...) with omalizumab vs placebo (LSM-TD=-0.21, P=0.048 and -0.12, P=0.011, respectively). Although the study was not powered to study differences in exacerbation rates (P=0.097), exacerbations in winter months were less frequent in the omalizumab vs placebo group (2 vs 21). Adverse event and severe adverse event rates were comparable between omalizumab and placebo.Omalizumab improves lung function, quality of life, and asthma control in Chinese patients with moderate-to-severe persistent allergic asthma and has

2016 Allergy, asthma & immunology research Controlled trial quality: predicted high

172. Protocol for a feasibility study to inform the development of a multicentre randomised controlled trial of asthma-tailored pulmonary rehabilitation versus usual care for individuals with severe asthma. Full Text available with Trip Pro

with severe asthma will be included if they have persistent symptoms despite being at step 4 or 5 of the British Thoracic Society guidelines. Stage 1: semistructured interviews will be used in a sample of 20-30 individuals with severe asthma to understand the experience and attitudes of this population towards exercise. Stage 2: eight focus groups of at least six healthcare professionals involved in the care of patients with severe asthma will be conducted to understand their attitudes towards exercise (...) Protocol for a feasibility study to inform the development of a multicentre randomised controlled trial of asthma-tailored pulmonary rehabilitation versus usual care for individuals with severe asthma. Pulmonary rehabilitation with core components of exercise training and multiprofessional education is an integral part of the management of patients with chronic lung disease. International guidelines for individuals with asthma recommend exercise as exercise improves symptoms, indices

2016 BMJ open Controlled trial quality: uncertain

173. Obesity increases the prevalence and the incidence of asthma and worsens asthma severity. (Abstract)

Obesity increases the prevalence and the incidence of asthma and worsens asthma severity. We aimed to explore the association between obesity and asthma prevalence, incidence and severity.The study included 32,644 adults, 52.6% female, from a representative sample of the 4th Portuguese National Health Survey. The following asthma definitions were used: ever asthma (ever medical doctor asthma diagnosis), current asthma (asthma within the last 12 months), current persistent asthma (required (...) asthma medication within the last 12 months), current severe asthma (attending an emergency department because of asthma within the last 12 months), and incident asthma (asthma diagnosis within the last 12 months). Body mass index was calculated based on self-reported weight and height and categorised according to WHO classification. Logistic regression models adjusted for confounders were performed.Prevalence of ever asthma was 5.3%, current asthma 3.5%, current persistent asthma 3.0%, current

2016 Clinical nutrition (Edinburgh, Scotland)

174. Vitamin D to Prevent Severe Asthma Exacerbations (Vit-D-Kids Asthma)

). On the basis of those findings, the investigators hypothesize that vitamin D reduces the incidence of severe asthma exacerbations in high-risk school-aged children who have a serum vitamin D level <30 ng/ml and who are being treated with ICS for persistent asthma. The investigators further hypothesize that this protective effect results from reduced incidence of common viral illnesses or enhanced response to ICS. These hypotheses will be tested in a 48-week randomized double-masked placebo-controlled trial (...) Vitamin D to Prevent Severe Asthma Exacerbations (Vit-D-Kids Asthma) Vitamin D to Prevent Severe Asthma Exacerbations (Vit-D-Kids 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. Vitamin D to Prevent

2016 Clinical Trials

175. Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period

decreased because of a reduction in cerebral and respi- ratory complications (5, 6). Individuals and institu- tions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Treatment with first-line agents should be expeditious and occur as soon as possible within 30–60 minutes of confirmed severe hypertension (blood pressure greater than 160/ 110 mm Hg and persistent for 15 minutes) to reduce theriskofmaternalstroke(7–9 (...) or a hypertensive exacerba- tion with acutely worsening, difficult to control, severe hypertension. Acute-onset, severe hypertension that is accu- rately measured using standard techniques and is persistent for 15 minutes or more is considered a hypertensive emergency. It is well known that severe hypertension can cause central nervous system injury. As stated in the Confidential Enquiries report from the United Kingdom, two thirds of the maternal deaths during 2003–2005 resulted from cerebral hemorrhage

2019 American College of Obstetricians and Gynecologists

176. Asthma in adults: beclometasone/formoterol dry powder inhaler (Fostair NEXThaler)

reaction with beclometasone/formoterol dry powder inhaler is tremor. In an 8-week RCT, 6 severe asthma exacerbations were observed in the non-extrafine beclometasone group, 4 in the extrafine beclometasone/ formoterol dry powder inhaler group and 3 in the extrafine beclometasone/formoterol pressurised metered dose inhaler group. The proportion of people experiencing treatment emergent adverse events was low and similar across all 3 treatment groups. Adverse events included headache, nasopharyngitis (...) NEXThaler (75.4%) compared with an Accuhaler (16.9%; p<0.001) or a Turbohaler (7.7%; p<0.001). Asthma in adults: beclometasone/formoterol dry powder inhaler (Fostair NEXThaler) (ESNM53) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 26In Kanniess et al. (2014), 26 asthma exacerbations were reported during the trial, 13 of which were classed as severe. Of these, 6 were observed in the non-extrafine beclometasone

2015 National Institute for Health and Clinical Excellence - Advice

177. Asthma: tiotropium (Spiriva Respimat)

controlled trials (RCTs; total n=912) of identical design evaluated tiotropium (Spiriva Respimat) in adults with poorly controlled asthma and persistent airflow obstruction who were already treated with an inhaled corticosteroid (ICS) and a long-acting beta-2 agonist (LABA). Tiotropium improved peak and trough forced expired volume in 1 second (FEV1) and lengthened the time to first severe exacerbation compared with placebo. Differences between add-on therapy with tiotropium and placebo in patient (...) control despite daily therapy with an ICS (at least 800 micrograms of budesonide per day or equivalent [median dose 800 microgram/day]) and a LABA were enrolled. Participants were required to have an Asthma Control Questionnaire 7 (ACQ-7) score of 1.5 or higher (scores on ACQ-7 range between 0 [totally controlled] and 6 [severely uncontrolled], with a minimal clinically important difference of 0.5) and show persistent airflow limitation (defined as a post-bronchodilator forced expired volume in 1

2015 National Institute for Health and Clinical Excellence - Advice

178. 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

179. Effectiveness and Safety of Bronchial Thermoplasty in Management of Asthma

. This was one of the six high-priority topics within asthma identified by an National Heart, Lung, and Blood Institute Advisory Council Asthma Expert Working Group. 1 The objective of the systematic review is to assess the effectiveness and safety of bronchial thermoplasty (BT) in adults with asthma. Background Patients with severe, persistent asthma are managed with multiple medications that may include inhaled, orally administered, and biologic therapeutics. Some of these patients might be eligible for BT (...) , an interventional treatment option that involves the delivery of controlled radiofrequency thermal energy to the walls of accessible proximal airways with the intent of reducing excess airway smooth muscle tissue in the airways and reducing the frequency of severe asthma exacerbations on a long-term basis. In April 2010, the U.S. Food and Drug Administration approved the Alair BT system for use in patients 18 years of age or older with severe, persistent asthma. This report’s main objective is to conduct

2017 Effective Health Care Program (AHRQ)

180. Omalizumab for the treatment of severe persistent allergic asthma Full Text available with Trip Pro

, 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 (...) 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

2009 Health Technology Assessment (HTA) Database.

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