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Latest & greatest articles for asthma
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Clinical profile of patients with adult-onset eosinophilic asthma Adult-onset eosinophilic asthma is increasingly recognised as a severe and difficult-to-treat subtype of asthma. In clinical practice, early recognition of patients with this asthma subtype is important because it may have treatment implications. Therefore, physicians need to know the distinct characteristics of this asthma phenotype. The objective of the present study was to determine the characteristic profile of patients (...) with adult-onset eosinophilic asthma. 130 patients with adult-onset (>18 years of age) asthma and high blood eosinophil counts (≥0.3×109 L-1) were compared with 361 adult-onset asthma patients with low (<0.3×109 L-1) blood eosinophils. Measurements included a series of clinical, functional and imaging parameters. Patients with high blood eosinophils were more often male, had less well controlled asthma and higher exacerbation rates, despite the use of higher doses of inhaled corticosteroids. They had
Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler Asthma management guidelines recommend adding a long-acting β2-agonist (LABA) or increasing the dose of inhaled corticosteroid (ICS) as step-up therapy for patients with uncontrolled asthma on ICS monotherapy. However, it is uncertain which option works best, which ICS particle size is most effective, and whether LABA should be administered by separate or combination inhalers (...) . This historical, matched cohort study compared asthma-related outcomes for patients (aged 12-80 years) prescribed step-up therapy as a ≥50% extrafine ICS dose increase or add-on LABA, via either a separate inhaler or a fine-particle ICS/LABA fixed-dose combination (FDC) inhaler. Risk-domain asthma control was the primary end-point in comparisons of cohorts matched for asthma severity and control during the baseline year. After 1:2 cohort matching, the increased extrafine ICS versus separate ICS+LABA cohorts
Cinqair (reslizumab) - To treat severe asthma Cinqair (reslizumab) U.S. Department of Health and Human Services Search FDA Submit search Cinqair (reslizumab) Cinqair (reslizumab) Company: Teva Respiratory, LLC Application No.: 761033 Approval Date: 03/23/2016 Persons with disabilities having problems accessing the PDF files below may call (301) 796-3634 for assistance. (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) Date created: May 5, 2016
Efficacy of a House Dust Mite Sublingual Allergen Immunotherapy Tablet in Adults With Allergic Asthma: A Randomized Clinical Trial. The house dust mite (HDM) sublingual allergen immunotherapy (SLIT) tablet is a potential novel treatment option for HDM allergy-related asthma.To evaluate the efficacy and adverse events of the HDM SLIT tablet vs placebo for asthma exacerbations during an inhaled corticosteroid (ICS) reduction period.Double-blind, randomized, placebo-controlled trial conducted (...) between August 2011 and April 2013 in 109 European trial sites. The trial included 834 adults with HDM allergy-related asthma not well controlled by ICS or combination products, and with HDM allergy-related rhinitis. Key exclusion criteria were FEV1 less than 70% of predicted value or hospitalization due to asthma within 3 months before randomization. Efficacy was assessed during the last 6 months of the trial when ICS was reduced by 50% for 3 months and then completely withdrawn for 3 months.1:1:1
Measurement duration impacts variability but not impedance measured by the forced oscillation technique in healthy, asthma and COPD subjects The forced oscillation technique (FOT) is gaining clinical acceptance, facilitated by more commercial devices and clinical data. However, the effects of variations in testing protocols used in FOT data acquisition are unknown. We describe the effect of duration of data acquisition on FOT results in subjects with asthma, chronic obstructive pulmonary (...) disease (COPD) and healthy controls. FOT data were acquired from 20 healthy, 22 asthmatic and 18 COPD subjects for 60 s in triplicate. The first 16, 30 and 60 s of each measurement were analysed to obtain total, inspiratory and expiratory resistance of respiratory system (Rrs) and respiratory system reactance (Xrs) at 5 and 19 Hz. With increasing duration, there was a decrease in total and expiratory Rrs for healthy controls, total and inspiratory Rrs for asthmatic subjects and magnitude of total
and needs to be injected under the skin. Some studies have suggested that lebrikizumab can help control severe asthma when other drugs have failed to do so. More studies are trying to show how well lebrikizumab works and whether it is safe to use. If lebrikizumab is licenced for use in the UK, it could be a new treatment option for patients with severe asthma. Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Anti-Asthmatic Agents; Antibodies, Monoclonal; Asthma; Humans (...) Lebrikizumab for severe asthma - second line Lebrikizumab for severe asthma – second line Lebrikizumab for severe asthma – second line NIHR HSRIC Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation NIHR HSRIC. Lebrikizumab for severe asthma – second line. Birmingham: NIHR Horizon Scanning Research&Intelligence Centre. Horizon Scanning Review. 2016 Authors
Roflumilast combined with montelukast versus montelukast alone as add-on treatment in patients with moderate-to-severe asthma Roflumilast, a selective phosphodiesterase 4 inhibitor, has been shown to provide modest improvements in lung function in patients with mild-to-moderate asthma, but its efficacy in patients with moderate-to-severe asthma has not been assessed. We hypothesized that this drug might provide benefit if combined with montelukast, a leukotriene receptor antagonist, in patients (...) ) or placebo plus 10 mg of montelukast followed by 500 μg of roflumilast plus 10 mg of montelukast (sequence BA). All patients had a diagnosis of bronchial asthma inadequately controlled by at least a medium-dose inhaled corticosteroid plus a long-acting β-agonist.The analysis of FEV1 change from baseline to week 4 showed a statistically significant and clinically meaningful treatment difference of 100 mL for roflumilast plus montelukast versus placebo plus montelukast. Also, improvements in patient
Tiotropium add-on therapy in adolescents with moderate asthma: A 1-year randomized controlled trial Results from phase III clinical trials in adults and phase II clinical trials in children and adolescents demonstrate that tiotropium is an effective treatment when added to inhaled corticosteroid (ICS) maintenance therapy.We sought to assess the efficacy and safety of once-daily tiotropium Respimat added to ICSs with or without a leukotriene receptor antagonist in a phase III trial in adolescent (...) the study.Improvement in peak FEV1 within 3 hours after dosing at 24 weeks (primary end point) was statistically significant with both tiotropium doses compared with placebo: 5 μg of tiotropium, 174 mL (95% CI, 76-272 mL); 2.5 μg of tiotropium, 134 mL (95% CI, 34-234 mL). Significant improvements in trough FEV1 at week 24 (a secondary end point) were observed with the 5-μg dose only. Trends for improvement in asthma control and health-related quality of life over the 48-week treatment period were observed.Once
Factors associated with medication adherence in school-aged children with asthma Adherence to preventive asthma treatment is poor, particularly in children, yet the factors associated with adherence in this age group are not well understood. Adherence was monitored electronically over 6 months in school-aged children who attended a regional emergency department in New Zealand for an asthma exacerbation and were prescribed twice-daily inhaled corticosteroids. Participants completed (...) questionnaires including assessment of family demographics, asthma responsibility and learning style. Multivariable analysis of factors associated with adherence was conducted. 101 children (mean (range) age 8.9 (6-15) years, 51% male) participated. Median (interquartile range) preventer adherence was 30% (17-48%) of prescribed. Four explanatory factors were identified: female sex (+12% adherence), Asian ethnicity (+19% adherence), living in a smaller household (-3.0% adherence per person in the household
Adult-onset asthma and periocular xanthogranulomas associated with systemic IgG4-related disease The aim of this study was to report a case of Adult-Onset Asthma with Periocular Xanthogranulomas (AAPOX) associated with systemic IgG4-related disease (IgG4-RD).A 57-year-old man presented with bilateral periorbital swelling for 1 year. Histopathology of a left orbital biopsy showed fibro vascular connective tissue inundated with foamy, lipid-laden histiocytes and touton giant cells
Are long-acting muscarinic antagonists (LAMAs) effective in adults with poorly controlled asthma? Are long-acting muscarinic antagonists (LAMAs) effective in adults with poorly controlled asthma? - Evidently Cochrane Search and hit Go By March 24, 2016 // A blog for clinicians written by Lynda Ware, giving an overview of four recent Cochrane reviews assessing the effectiveness of LAMAs in asthma care. In the UK 5.4 million people are receiving treatment for asthma. This equates to 1:11 children (...) and 1:12 adults. In 2014 1216 people died from asthma, or, put another way, about 3 people every day. In addition, a patient was hospitalised every 8 minutes as a result of asthma. The cost to the NHS is around £1billion pounds per year. All this is happening despite our greatly improved understanding of the disease and of its treatment. Is there a role for LAMAs in asthma management? Long-acting muscarinic antagonists (LAMAs) are known to be effective in chronic obstructive pulmonary disease
Safety of Fluticasone plus Salmeterol in Asthma - Reassuring Data, but No Final Answer. 26946980 2016 05 25 2018 12 02 1533-4406 374 19 2016 May 12 The New England journal of medicine N. Engl. J. Med. Safety of Fluticasone plus Salmeterol in Asthma--Reassuring Data, but No Final Answer. 1887-8 10.1056/NEJMe1601040 Martinez Fernando D FD From the Arizona Respiratory Center, University of Arizona, Tucson. eng Editorial Comment 2016 03 06 United States N Engl J Med 0255562 0028-4793 0 (...) Bronchodilator Agents 0 Fluticasone-Salmeterol Drug Combination CUT2W21N7U Fluticasone AIM IM N Engl J Med. 2016 May 12;374(19):1822-30 26949137 Asthma drug therapy Bronchodilator Agents therapeutic use Female Fluticasone therapeutic use Fluticasone-Salmeterol Drug Combination therapeutic use Humans Male 2016 3 8 6 0 2016 3 8 6 0 2016 5 26 6 0 ppublish 26946980 10.1056/NEJMe1601040
Serious Asthma Events with Fluticasone plus Salmeterol versus Fluticasone Alone. The safe and appropriate use of long-acting beta-agonists (LABAs) for the treatment of asthma has been widely debated. In two large clinical trials, investigators found a potential risk of serious asthma-related events associated with LABAs. This study was designed to evaluate the risk of administering the LABA salmeterol in combination with an inhaled glucocorticoid, fluticasone propionate.In this multicenter (...) , randomized, double-blind trial, adolescent and adult patients (age, ≥12 years) with persistent asthma were assigned to receive either fluticasone with salmeterol or fluticasone alone for 26 weeks. All the patients had a history of a severe asthma exacerbation in the year before randomization but not during the previous month. Patients were excluded from the trial if they had a history of life-threatening or unstable asthma. The primary safety end point was the first serious asthma-related event (death
during exacerbations is effective in long-term asthma control. Chest . 2000;117:440-446. 25 Garrett J, Williams S, Wong C, Holdaway D. Treatment of acute asthmatic exacerbations with an increased dose of inhaled steroid. Arch Dis Child . 1998;79:12-17. 26 Harrison T, Oborne J, Newton S, Tattersfield A. Doubling the dose of inhaled corticosteroid to prevent asthma exacerbations: randomised controlled trial. Lancet . 2004;363:271-275. 27 Oborne J, Mortimer K, Hubbard RB, Tattersfield AE, Harrison TW (...) micrograms/day with inhaled beclomethasone dipropionate 400 micrograms/day in mild and moderate asthma. Arch Dis Child . 1993;69:206-211. 32 Hoekx JC, Hedlin G, Pedersen W, Sorva R, Hollingworth K, Efthimiou J. Fluticasone propionate compared with budesonide: a double-blind trial in asthmatic children using powder devices at a dosage of 400 microg x day(-1). Eur Respir J . 1996;9:2263-2272. 33 Pedersen S, Garcia Garcia ML, Manjra A, Theron I, Engelstatter R. A comparative study of inhaled ciclesonide 160
Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study There exists a paucity of data for socially disadvantaged populations describing patterns and predictors of asthma control status and exacerbations during pregnancy, and their relationship to adverse perinatal outcomes. Asthmatic women (n=189) were followed prospectively during pregnancy, with visits at 12, 20, 28 and 36 weeks gestation. Data on loss of control, recurrent (...) uncontrolled asthma and moderate/severe exacerbations were collected at each visit and their relationship to perinatal outcomes examined following stratification for fetal sex. 50% of asthmatic women experienced a loss of control or moderate/severe exacerbation during pregnancy, with 22% of women experiencing a moderate/severe exacerbation. Factors associated with an increased risk of women experiencing recurrent uncontrolled asthma during pregnancy included smoking (relative risk 2.92, 95% CI 1.53-5.58
Effect of Prenatal Supplementation With Vitamin D on Asthma or Recurrent Wheezing in Offspring by Age 3 Years: The VDAART Randomized Clinical Trial. Asthma and wheezing begin early in life, and prenatal vitamin D deficiency has been variably associated with these disorders in offspring.To determine whether prenatal vitamin D (cholecalciferol) supplementation can prevent asthma or recurrent wheeze in early childhood.The Vitamin D Antenatal Asthma Reduction Trial was a randomized, double-blind (...) , placebo-controlled trial conducted in 3 centers across the United States. Enrollment began in October 2009 and completed follow-up in January 2015. Eight hundred eighty-one pregnant women between the ages of 18 and 39 years at high risk of having children with asthma were randomized at 10 to 18 weeks' gestation. Five participants were deemed ineligible shortly after randomization and were discontinued.Four hundred forty women were randomized to receive daily 4000 IU vitamin D plus a prenatal vitamin
Long-Term Effect of Sublingual and Subcutaneous Immunotherapy in Dust Mite-Allergic Children With Asthma/Rhinitis: A 3-Year Prospective Randomized Controlled Trial. Specific allergen immunotherapy is the only treatment modality that might change the natural course of allergic diseases in childhood. We sought to prospectively compare the long-term clinical and immunological effects of sublingual (SLIT) and subcutaneous (SCIT) immunotherapy compared with pharmacotherapy alone.In this single (...) -center, prospective randomized controlled trial, 48 children with mild persistent asthma with/without rhinitis, monosensitized to house dust mites (HDMs) were followed for 3 years. At baseline and years 1 and 3 of follow-up, patients were evaluated and compared for total rhinitis (TRSS) and asthma (TASS) symptom scores, total symptom scores (TSS), total medication scores (TMS), safety profiles, skin-nasal-bronchial reactivity, and immunological parameters.A significant reduction was observed in TASS
Fractional exhaled Nitric Oxide monitoring in paediatric asthma management Diagnostic Evidence Co-operative Oxford NIHR Diagnostic Evidence Cooperative Oxford www.oxford.dec.nihr.ac.uk Clinical Questions: Does monitoring of childhood asthma using fractional exhaled nitric oxide (FeNO): a. reduce asthma exacerbations b. reduce steroid prescriptions c. improve asthma-related quality of life Background, Current practice and Advantages over Existing Technology: Current recommendations (...) are that children with asthma should be reviewed 6 monthly at minimum ac- cording to The National Heart, Lung and Blood Institute (NHLBI) guidelines in America (1), or annually ac- cording to The Scottish Intercollegiate Guideline Network (SIGN) (2) and the National Institute for Health and Care Excellence (NICE) (3) in the UK. NICE and SIGN suggest this review should include an assessment of control by monitoring the severity and frequency of exacerbations, inhaler adherence and technique plus a symptom score