Latest & greatest articles for asthma

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Top results for asthma

21. Inpatient Quality Improvement Interventions for Asthma: A Meta-analysis

Inpatient Quality Improvement Interventions for Asthma: A Meta-analysis 29622722 2018 05 03 1098-4275 141 5 2018 May Pediatrics Pediatrics Inpatient Quality Improvement Interventions for Asthma: A Meta-analysis. e20173334 10.1542/peds.2017-3334 Despite the availability of evidence-based guidelines for the management of pediatric asthma, health care utilization remains high. Systematically review the inpatient literature on asthma quality improvement (QI) and synthesize impact on subsequent (...) health care utilization. Medline and Cumulative Index to Nursing and Allied Health Literature (January 1, 1991-November 16, 2016) and bibliographies of retrieved articles. Interventional studies in English of inpatient-initiated asthma QI work. Studies were categorized by intervention type and outcome. Random-effects models were used to generate pooled risk ratios for health care utilization outcomes after inpatient QI interventions. Thirty articles met inclusion criteria and 12 provided data

EvidenceUpdates2018

22. Asthma

Asthma Autosynthesis - Trip Database or use your Google+ account Turning Research Into Practice My query is: English Français Deutsch Čeština Español Magyar Svenska ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words: Title only Anywhere in the document Timeframe: to: Combine searches by placing the search numbers in the top search box and pressing the search button

Trip Evidence Maps2018

23. Combined Analysis of Asthma Safety Trials of Long-Acting β<sub>2</sub>-Agonists.

Combined Analysis of Asthma Safety Trials of Long-Acting β2-Agonists. BACKGROUND: Safety concerns regarding long-acting β 2 -agonists (LABAs) in asthma management were initially identified in a large postmarketing trial in which the risk of death was increased. In 2010, the Food and Drug Administration (FDA) mandated that the four companies marketing LABAs for asthma perform prospective, randomized, controlled trials comparing the safety of combination therapy with a LABA plus (...) glucocorticoid alone. The primary outcome was a composite of asthma-related intubation or death. Post hoc secondary outcomes included serious asthma-related events and asthma exacerbations. RESULTS: Among the 36,010 patients in the intention-to-treat study, there were three asthma-related intubations (two in the inhaled-glucocorticoid group and one in the combination-therapy group) and two asthma-related deaths (both in the combination-therapy group) in 4 patients. In the secondary analysis of serious asthma

NEJM2018

24. Antibiotics for exacerbations of asthma.

Antibiotics for exacerbations of asthma. BACKGROUND: Asthma is a chronic respiratory condition that affects over 300 million adults and children worldwide. It is characterised by wheeze, cough, chest tightness, and shortness of breath. Symptoms typically are intermittent and may worsen over a short time, leading to an exacerbation. Asthma exacerbations can be serious, leading to hospitalisation or even death in rare cases. Exacerbations may be treated by increasing an individual's usual (...) medication and providing additional medication, such as oral steroids. Although antibiotics are sometimes included in the treatment regimen, bacterial infections are thought to be responsible for only a minority of exacerbations, and current guidance states that antibiotics should be reserved for cases in which clear signs, symptoms, or laboratory test results are suggestive of bacterial infection. OBJECTIVES: To determine the efficacy and safety of antibiotics in the treatment of asthma exacerbations

Cochrane2018

25. Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma.

Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma. BACKGROUND: 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. OBJECTIVES: 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. SEARCH METHODS: The Cochrane Airways Group conducted searches of the Cochrane Airways Group Register of Trials, most

Cochrane2018

26. Fluticasone/formoterol (flutiform k-haler) - for the regular treatment of asthma

Fluticasone/formoterol (flutiform k-haler) - for the regular treatment of asthma Abbreviated Submission fluticasone propionate/ formoterol fumarate 50microgram/5microgram, 125microgram/5microgram pressurised inhalation, suspension (Flutiform k-haler ® ) SMC2016 Napp Pharmaceuticals Ltd 4 May 2018 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHS Scotland. The advice (...) is summarised as follows: ADVICE: following an abbreviated submission fluticasone propionate/ formoterol fumarate (Flutiform k-haler ® ) is accepted for use within NHS Scotland. Indication under review: for the regular treatment of asthma where the use of a combination product [an inhaled corticosteroid (ICS) and a long-acting ß 2-agonist (LABA)] is appropriate: • For patients not adequately controlled with ICS as ‘as required’ inhaled short-acting ß2- agonist or • For patients already adequately controlled

Scottish Medicines Consortium2018

27. Allergen-Specific Immunotherapy in the Treatment of Pediatric Asthma: A Systematic Review

Allergen-Specific Immunotherapy in the Treatment of Pediatric Asthma: A Systematic Review 29572287 2018 06 08 1098-4275 141 5 2018 May Pediatrics Pediatrics Allergen-Specific Immunotherapy in the Treatment of Pediatric Asthma: A Systematic Review. e20173833 10.1542/peds.2017-3833 Treatment options for allergic asthma include allergen avoidance, pharmacotherapy, and allergen immunotherapy. Summarize and update current evidence for the efficacy and safety of subcutaneous immunotherapy (SCIT (...) ) and sublingual immunotherapy (SLIT) in pediatric allergic asthma. PubMed, Embase, Cochrane Central Register of Controlled Trials (January 1, 2005, through May 8, 2017), ClinicalTrials.gov, and the US Food and Drug Administration Adverse Event Reporting System. We reevaluated trials from our 2013 systematic review. We included studies with children ≤18 years of age in which researchers reported on prespecified outcomes and had an intervention arm receiving aeroallergen SCIT or SLIT. Only randomized controlled

EvidenceUpdates2018

28. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma.

Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma. Background Dupilumab is a fully human anti-interleukin-4 receptor α monoclonal antibody that blocks both interleukin-4 and interleukin-13 signaling. We assessed its efficacy and safety in patients with uncontrolled asthma. Methods We randomly assigned 1902 patients 12 years of age or older with uncontrolled asthma in a 2:2:1:1 ratio to receive add-on subcutaneous dupilumab at a dose of 200 or 300 mg every 2 weeks (...) or matched-volume placebos for 52 weeks. The primary end points were the annualized rate of severe asthma exacerbations and the absolute change from baseline to week 12 in the forced expiratory volume in 1 second (FEV 1 ) before bronchodilator use in the overall trial population. Secondary end points included the exacerbation rate and FEV 1 in patients with a blood eosinophil count of 300 or more per cubic millimeter. Asthma control and dupilumab safety were also assessed. Results The annualized rate

NEJM2018

29. Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe Asthma.

Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe Asthma. Background Dupilumab is a fully human anti-interleukin-4 receptor α monoclonal antibody that blocks both interleukin-4 and interleukin-13 signaling. Its effectiveness in reducing oral glucocorticoid use in patients with severe asthma while maintaining asthma control is unknown. Methods We randomly assigned 210 patients with oral glucocorticoid-treated asthma to receive add-on dupilumab (at a dose of 300 mg) or placebo (...) group (14% vs. 1%). Conclusions In patients with glucocorticoid-dependent severe asthma, dupilumab treatment reduced oral glucocorticoid use while decreasing the rate of severe exacerbations and increasing the FEV 1 . Transient eosinophilia was observed in approximately 1 in 7 dupilumab-treated patients. (Funded by Sanofi and Regeneron Pharmaceuticals; LIBERTY ASTHMA VENTURE ClinicalTrials.gov number, NCT02528214 .).

NEJM2018

30. As-Needed Budesonide-Formoterol versus Maintenance Budesonide in Mild Asthma.

As-Needed Budesonide-Formoterol versus Maintenance Budesonide in Mild Asthma. BACKGROUND: Patients with mild asthma often rely on inhaled short-acting β 2 -agonists for symptom relief and have poor adherence to maintenance therapy. Another approach might be for patients to receive a fast-acting reliever plus an inhaled glucocorticoid component on an as-needed basis to address symptoms and exacerbation risk. METHODS: We conducted a 52-week, double-blind, multicenter trial involving patients 12 (...) years of age or older who had mild asthma and were eligible for treatment with regular inhaled glucocorticoids. Patients were randomly assigned to receive twice-daily placebo plus budesonide-formoterol (200 μg of budesonide and 6 μg of formoterol) used as needed or budesonide maintenance therapy with twice-daily budesonide (200 μg) plus terbutaline (0.5 mg) used as needed. The primary analysis compared budesonide-formoterol used as needed with budesonide maintenance therapy with regard

NEJM2018

31. Inhaled Combined Budesonide-Formoterol as Needed in Mild Asthma.

Inhaled Combined Budesonide-Formoterol as Needed in Mild Asthma. BACKGROUND: In patients with mild asthma, as-needed use of an inhaled glucocorticoid plus a fast-acting β 2 -agonist may be an alternative to conventional treatment strategies. METHODS: We conducted a 52-week, double-blind trial involving patients 12 years of age or older with mild asthma. Patients were randomly assigned to one of three regimens: twice-daily placebo plus terbutaline (0.5 mg) used as needed (terbutaline group (...) ), twice-daily placebo plus budesonide-formoterol (200 μg of budesonide and 6 μg of formoterol) used as needed (budesonide-formoterol group), or twice-daily budesonide (200 μg) plus terbutaline used as needed (budesonide maintenance group). The primary objective was to investigate the superiority of as-needed budesonide-formoterol to as-needed terbutaline with regard to electronically recorded weeks with well-controlled asthma. RESULTS: A total of 3849 patients underwent randomization, and 3836 (1277

NEJM2018

32. Effectiveness of indoor allergen reduction in asthma management: A systematic review

Effectiveness of indoor allergen reduction in asthma management: A systematic review 29452202 2018 05 07 1097-6825 141 5 2018 May The Journal of allergy and clinical immunology J. Allergy Clin. Immunol. Effectiveness of indoor allergen reduction in asthma management: A systematic review. 1854-1869 S0091-6749(18)30223-9 10.1016/j.jaci.2018.02.001 This review will inform updated National Asthma Education and Prevention Program clinical practice guidelines. We sought to evaluate the effectiveness (...) of allergen reduction interventions on asthma outcomes. We systematically searched the "gray literature" and 5 bibliographic databases. Eligible studies included systematic reviews, randomized controlled trials, and nonrandomized interventional studies. Risk of bias was assessed by using the Cochrane Risk of Bias instrument and the Newcastle-Ottawa scale. The evidence base was assessed by using the approach of the Agency for Healthcare Research and Quality's Evidence-based Practice Center program. Fifty

EvidenceUpdates2018

33. GP letter to improve medication adherence did not reduce unplanned care for children with asthma

GP letter to improve medication adherence did not reduce unplanned care for children with asthma NIHR DC | Signal - GP letter to improve medication adherence did not reduce unplanned care for children with asthma Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal GP letter to improve medication adherence did not reduce unplanned care for children with asthma Published on 14 March 2017 A one-off GP letter reminding parents of children with asthma to use their medications over (...) the August summer holiday did not prevent a characteristic annual peak in unplanned care on returning to school in September, but did lead to more prescriptions. Unplanned care represents visits to the GP or accident and emergency that is not part of the child’s asthma care plan. They do not include scheduled medical review or visits for repeat prescriptions. The letter prompted about a third more parents to collect inhaler prescriptions in August than parents receiving no letter. But this failed

NIHR Dissemination Centre2018

34. The nitric oxide breath test offers little benefit when monitoring asthma

The nitric oxide breath test offers little benefit when monitoring asthma NIHR DC | Signal - The nitric oxide breath test offers little benefit when monitoring asthma Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal The nitric oxide breath test offers little benefit when monitoring asthma Published on 10 January 2017 Using exhaled nitric oxide levels to guide the dose of asthma medication at regular clinic visits may reduce flare-ups but does not improve overall symptoms (...) or quality of life. In this review hospitalisations and the total inhaled steroid doses were unaffected by the intervention. Measuring the amount of fractional exhaled nitric oxide (FeNO) in the breath of people with asthma detects lung inflammation. If inflammation increases, this may indicate that a flare-up is likely and preventative action can be taken. The aim is to ensure medication corresponds to symptom severity, the ideal being the minimum dose needed to control symptoms. The usual monitoring

NIHR Dissemination Centre2018

35. Antibiotics are probably of no benefit for acute asthma attack

Antibiotics are probably of no benefit for acute asthma attack NIHR DC | Signal - Study shows no benefit of an antibiotic for acute asthma Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Study shows no benefit of an antibiotic for acute asthma Published on 21 December 2016 The antibiotic azithromycin did not reduce symptoms or change other outcomes in adults seeking emergency care for an acute asthma attack. However people not already taking antibiotics were hard to find (...) and the trial failed to enrol enough people to answer the research question. In this UK-based trial, people with asthma who received azithromycin on top of standard treatment with corticosteroids had no better symptoms ten days later than people who received corticosteroids alone. Almost half of almost 4,600 potential participants had already been given antibiotics. This study shows that many people are being prescribed antibiotics to treat an asthma attack despite British guidance stating that antibiotics

NIHR Dissemination Centre2018

36. Vitamin D supplements can reduce risk of asthma attacks

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 reduce risk of asthma attacks Published on 6 December 2016 People with mild to moderate asthma experience fewer severe asthma attacks if they take vitamin D supplements. This review found that the average number of asthma attacks was equivalent to about one every four years (...) in those taking vitamin D, compared to nearly one every two years in those taking a placebo. Half as many people attended hospital for asthma treatment each year when taking vitamin D (3%) compared with those not taking vitamin D (6%). These reductions were clinically and statistically significant. There are a few unknowns still. It’s not clear if these results apply to everyone or just those with low levels of vitamin D. Also, these results apply to adults with mild to moderate asthma when taken

NIHR Dissemination Centre2018

37. Intermittent inhaled steroids reduce asthma attacks in wheezing preschool children

Intermittent inhaled steroids reduce asthma attacks in wheezing preschool children NIHR DC | Signal - Intermittent inhaled steroids reduce asthma attacks in wheezing preschool children Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Intermittent inhaled steroids reduce asthma attacks in wheezing preschool children Published on 22 November 2016 Regular daily steroid inhalers reduce the number of severe asthma exacerbations requiring soluble tablets or injections in wheezing (...) preschool children by about a third. Intermittent high-dose steroid inhalers, given only when symptoms of a cold begin, were also effective for children with occasional asthma or wheezing triggered by a virus. This strategy may reduce the overall dose of steroids given to these children, though adverse effects may still occur. Wheezing is initially treated with a β2 agonist inhaler which opens up the airways. UK guidelines recommend adding in a daily low-dose steroid inhaler if symptoms are persistent

NIHR Dissemination Centre2018

38. Combination inhaler treatment in emergency departments may reduce admissions for asthma attacks

Combination inhaler treatment in emergency departments may reduce admissions for asthma attacks NIHR DC | Signal - Combination inhaler treatment in emergency departments may reduce admissions for asthma attacks Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Combination inhaler treatment in emergency departments may reduce admissions for asthma attacks Published on 30 May 2017 Using a combination of two inhaled drugs to open the airways may modestly reduce the need to admit (...) an adult with asthma attack to hospital, though the underlying evidence is weak. The first-line treatment for an asthma attack is an inhaled β2 agonist, like salbutamol. This Cochrane review compared emergency department treatment with this drug alone, or combined with an inhaled short-acting anticholinergic, like ipratropium bromide. Pooled results from 16 trials included found that combination therapy would mean about 65 fewer patients per 1000 are admitted to hospital. As most underlying trials were

NIHR Dissemination Centre2018

39. Breathing exercises improve asthma and can be learned by DVD

Breathing exercises improve asthma and can be learned by DVD NIHR DC | Signal - Breathing exercises improve asthma and can be learned by DVD Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Breathing exercises improve asthma and can be learned by DVD Published on 7 November 2017 Breathing exercises taught by a physiotherapist in person or on DVD both improved the quality of life of adults with poorly controlled asthma to a small but similar extent. The DVD was the cheapest (...) option, and it could lead to inexpensive internet delivery in the future. This NIHR-funded trial recruited 655 UK adults with poorly controlled asthma. It showed about 63% of those receiving the breathing exercises had clinically important improvements in their asthma-related quality of life over a year, compared to 56% who improved receiving usual care. Exercises did not improve formally measured lung function, suggesting the underlying biology of the asthma was unchanged. The findings imply

NIHR Dissemination Centre2018

40. Asthma self-management programmes can reduce unscheduled care

Asthma self-management programmes can reduce unscheduled care NIHR DC | Signal - Asthma self-management programmes can reduce unscheduled care Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Asthma self-management programmes can reduce unscheduled care Published on 20 June 2017 People with asthma who receive supported self-management are less likely to attend A&E or be admitted to hospital. The interventions are unlikely to increase overall costs for healthcare services. Those (...) who self-manage are also likely to have more controlled asthma and a better quality of life. This extensive overview of systematic reviews included evidence from 270 randomised controlled trials exploring the effects of asthma self-management on healthcare utilisation and costs. Self-management programmes were slightly more expensive, but this cost was likely to be offset by reducing unplanned medical visits and improving patient quality of life. Trials covered different self-care education

NIHR Dissemination Centre2018