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Latest & greatest articles for asthma
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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
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
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
A Randomized Trial of Itraconazole vs Prednisolone in Acute-Stage Allergic Bronchopulmonary Aspergillosis Complicating Asthma 29331473 2018 03 09 1931-3543 153 3 2018 Mar Chest Chest A Randomized Trial of Itraconazole vs Prednisolone in Acute-Stage Allergic Bronchopulmonary Aspergillosis Complicating Asthma. 656-664 S0012-3692(18)30077-1 10.1016/j.chest.2018.01.005 Whether itraconazole monotherapy is effective in the acute stage of allergic bronchopulmonary aspergillosis (ABPA) remains unknown (...) . The goal of this study was to compare the efficacy and safety of itraconazole and prednisolone monotherapy in ABPA. Treatment-naive subjects with ABPA complicating asthma (January 2012 to December 2013) were randomized to receive either oral itraconazole or prednisolone for 4 months. The study was not blinded. The primary outcomes were proportion of subjects exhibiting a composite response after 6 weeks, percent decline in IgE after treatment, and numbers of subjects experiencing exacerbation
Interventions for autumn exacerbations of asthma in children. BACKGROUND: Asthma exacerbations in school-aged children peak in autumn, shortly after children return to school following the summer holiday. This might reflect a combination of risk factors, including poor treatment adherence, increased allergen and viral exposure, and altered immune tolerance. Since this peak is predictable, interventions targeting modifiable risk factors might reduce exacerbation-associated morbidity and strain (...) upon health resources. The peak occurs in September in the Northern Hemisphere and in February in the Southern Hemisphere. OBJECTIVES: To assess the effects of pharmacotherapy and behavioural interventions enacted in anticipation of school return during autumn that are designed to reduce asthma exacerbations in children during this period. SEARCH METHODS: We searched the Cochrane Airways Group Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry
An algorithmic approach for the treatment of severe uncontrolled asthma An algorithmic approach for the treatment of severe uncontrolled asthma | European Respiratory Society Main menu User menu Search Search for this keyword Search for this keyword An algorithmic approach for the treatment of severe uncontrolled asthma Eleftherios Zervas , Konstantinos Samitas , Andriana I. Papaioannou , Petros Bakakos , Stelios Loukides , Mina Gaga ERJ Open Research 2018 4: 00125-2017; DOI: 10.1183 (...) /23120541.00125-2017 Eleftherios Zervas 7th Respiratory Medicine Dept and Asthma Center, Athens Chest Hospital “Sotiria”, Athens, Greece Konstantinos Samitas 7th Respiratory Medicine Dept and Asthma Center, Athens Chest Hospital “Sotiria”, Athens, Greece Andriana I. Papaioannou 2nd Respiratory Medicine Dept, Attikon Hospital, University of Athens, Athens, Greece Petros Bakakos 1st Respiratory Medicine Dept, Athens Chest Hospital “Sotiria”, University of Athens, Athens, Greece Stelios Loukides 2nd Respiratory
Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations. Background Asthma exacerbations occur frequently despite the regular use of asthma-controller therapies, such as inhaled glucocorticoids. Clinicians commonly increase the doses of inhaled glucocorticoids at early signs of loss of asthma control. However, data on the safety and efficacy of this strategy in children are limited. Methods We studied 254 children, 5 to 11 years of age, who had mild-to-moderate persistent (...) asthma and had had at least one asthma exacerbation treated with systemic glucocorticoids in the previous year. Children were treated for 48 weeks with maintenance low-dose inhaled glucocorticoids (fluticasone propionate at a dose of 44 μg per inhalation, two inhalations twice daily) and were randomly assigned to either continue the same dose (low-dose group) or use a quintupled dose (high-dose group; fluticasone at a dose of 220 μg per inhalation, two inhalations twice daily) for 7 days at the early
Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations. Background Asthma exacerbations are frightening for patients and are occasionally fatal. We tested the concept that a plan for patients to manage their asthma (self-management plan), which included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate, would reduce the incidence of severe asthma exacerbations among adults and adolescents with asthma. Methods We conducted (...) a pragmatic, unblinded, randomized trial involving adults and adolescents with asthma who were receiving inhaled glucocorticoids, with or without add-on therapy, and who had had at least one exacerbation in the previous 12 months. We compared a self-management plan that included an increase in the dose of inhaled glucocorticoids by a factor of 4 (quadrupling group) with the same plan without such an increase (non-quadrupling group), over a period of 12 months. The primary outcome was the time to a first
Budesonide/formoterol maintenance and reliever therapy in adolescent patients with asthma 29301922 2018 01 05 1399-3003 51 1 2018 Jan The European respiratory journal Eur. Respir. J. Budesonide/formoterol maintenance and reliever therapy in adolescent patients with asthma. 1701688 10.1183/13993003.01688-2017 Asthma control is often suboptimal in adolescents, but few studies have evaluated asthma treatments in this population.This post hoc analysis assessed the efficacy and safety of budesonide (...) /formoterol (BUD/FORM) maintenance and reliever therapy (MART) for treatment of persistent asthma in adolescent (age 12-17 years) subgroups within six randomised, double-blind trials. The primary end-point was time to first severe exacerbation. Secondary end-points included number of severe exacerbations, asthma-related symptoms, night-time awakenings, morning peak expiratory flow, forced expiratory volume in 1 s, as-needed medication use and five-item asthma control questionnaire scores.In adolescents (n
Pilot Clinical Trial of High-Flow Oxygen Therapy in Children with Asthma in the Emergency Service 29331328 2018 02 26 1097-6833 194 2018 Mar The Journal of pediatrics J. Pediatr. Pilot Clinical Trial of High-Flow Oxygen Therapy in Children with Asthma in the Emergency Service. 204-210.e3 S0022-3476(17)31513-5 10.1016/j.jpeds.2017.10.075 To assess the efficacy of high-flow nasal cannula (HFNC) oxygen therapy and safety in children with asthma and moderate respiratory failure in the emergency (...) department (ED). This was a prospective randomized pilot trial of children (aged 1-14 years) presenting to a tertiary academic pediatric ED with moderate-to-severe asthma exacerbations between September 2012 and December 2015. Patients with a pulmonary score (PS) ≥6 or oxygen saturation <94% with a face mask despite initial treatment (salbutamol/ipratropium bromide and corticosteroids) were randomized to HFNC or to conventional oxygen therapy. Pharmacologic treatment was at the discretion of attending
Is There Really a Link between Asthma and Reflux? Is There Really a Link between Asthma and Reflux? | Clinical Correlations Is There Really a Link between Asthma and Reflux? February 27, 2018 By Scott Statman, MD Peer Reviewed There is little doubt that an association between asthma and gastroesophageal reflux disease (GERD) exists. However clinicians have debated the nature of this relationship for decades. Asthma and GERD are among the most common disorders encountered by physicians, with 1 (...) and 2 respectively. Studies have shown that up to 80% of 3 and that people with GERD are nearly1.2 times more . 4 This may in fact be an underestimate as , 5 while ambulatory esophageal pH monitoring can detect abnormal acid reflux . 6 There are multiple biologically plausible theories to explain the connection between GERD and its extra-esophageal manifestations such as asthma. 5 The controversy lies in an inability of research to date to demonstrate neither a causal relationship between the two
Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial 29309483 2018 02 07 2168-6211 2018 Jan 08 JAMA pediatrics JAMA Pediatr Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial. e174938 10.1001/jamapediatrics.2017.4938 Poor adherence to recommended preventive asthma medications is common, leading to preventable morbidity. We developed (...) the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) program to build on school-based supervised therapy programs by incorporating telemedicine at school to overcome barriers to preventive asthma care. To evaluate the effect of the SB-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
Randomized Trial of Dexamethasone Versus Prednisone for Children with Acute Asthma Exacerbations 29173304 2017 12 11 2017 12 11 1097-6833 191 2017 Dec The Journal of pediatrics J. Pediatr. Randomized Trial of Dexamethasone Versus Prednisone for Children with Acute Asthma Exacerbations. 190-196.e1 S0022-3476(17)31090-9 10.1016/j.jpeds.2017.08.030 To determine whether 2 doses of dexamethasone is as effective as 5 days of prednisolone/prednisone therapy in improving symptoms and quality (...) of life of children with asthma exacerbations admitted to the emergency department (ED). We conducted a randomized, noninferiority trial including patients aged 1-14 years who presented to the ED with acute asthma to compare the efficacy of 2 doses of dexamethasone (0.6 mg/kg/dose, experimental treatment) vs a 5-day course of prednisolone/prednisone (1.5 mg/kg/d, followed by 1 mg/kg/d on days 2-5, conventional treatment). Two follow-up telephone interviews were completed at 7 and 15 days. The primary outcome
Acute asthma exacerbation in adults Acute asthma exacerbation in adults - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Acute asthma exacerbation in adults Last reviewed: August 2018 Last updated: June 2018 Summary Presents as an acute or subacute episode of progressive worsening of symptoms, such as shortness of breath, wheezing, cough, and chest tightness. Pulse rate, respiratory rate, subjective assessment (...) , mechanical ventilation. Pneumonia, pneumothorax, pneumomediastinum, and respiratory failure are complications. Definition An asthma exacerbation is an acute or subacute episode of progressive worsening of symptoms of asthma, including shortness of breath, wheezing, cough, and chest tightness. Exacerbations are marked by decreases from baseline in objective measures of pulmonary function, such as peak expiratory flow rate and FEV1. History and exam presence of risk factors cough wheezing
Asthma in adults Asthma in adults - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Asthma in adults Last reviewed: August 2018 Last updated: June 2018 Summary Patients present with recurrent episodes of shortness of breath, chest tightness, wheezing, or coughing. Examination typically demonstrates an expiratory wheeze; however, in severe asthma there is poor air entry and the chest is silent. Treatment is step-wise (...) , based on symptoms. Patients may need to monitor their peak expiratory flow daily and should be aware of the warning signs of a severe attack. Some patients may develop progressive, irreversible obstructive lung disease. Definition Asthma is a chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity. Many cellular components are involved in the asthmatic pathway, including mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial
Occupational asthma Occupational asthma - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Occupational asthma Last reviewed: August 2018 Last updated: September 2018 Summary Should be suspected in all adult patients with asthma. An occupational history should be taken to identify work-related causes. Details of work exposures should be obtained from material safety data sheets and other material available (...) to the patient from their workplace. Objective evidence of asthma should be obtained from spirometry, a bronchodilator response, and/or a methacholine challenge. Tests should be performed when the patient is symptomatic and/or within days of having exposure to a suspected aetiological agent. If sensitiser-induced occupational asthma is suspected, additional testing of asthma should be done, preferably while the patient is still working. Whenever possible an immunological response to a suspected work
Acute asthma exacerbation in children Acute asthma exacerbation in children - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Acute asthma exacerbation in children Last reviewed: August 2018 Last updated: July 2018 Summary Asthma exacerbations present with acute or sub-acute onset of wheeze and respiratory distress, the symptoms and signs of which vary depending on the developmental and maturational age of the child (...) , intravenous bronchodilators, and intramuscular adrenaline (if anaphylaxis is present). Severe and life-threatening cases may require non-invasive ventilation or intubation, and the intensive care team should be involved as early as possible. In children not responding to standard asthmatic treatment, other differential diagnoses should be considered. On discharge from hospital, a clear asthma management plan and asthma education is essential to optimise asthma control and prevent future exacerbations