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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
Bronchial thermoplasty for asthma Final Bronchial Thermoplasty for Asthma: Findings & Decision Page 1 of 3 Health Technology Clinical Committee Findings and Decision Topic: Bronchial Thermoplasty for Asthma Meeting Date: May 20, 2016 Final Adoption: July 8, 2016 Meeting materials and transcript are available on the HTA website: www.hca.wa.gov/hta/meetingmaterials/Forms/ExtMeetingMaterials.aspx Number and Coverage Topic: 20160520A – Bronchial Thermoplasty for Asthma HTCC Coverage Determination (...) : Bronchial thermoplasty for asthma is not a covered benefit. HTCC Reimbursement Determination: Limitations of Coverage: NA Non-Covered Indicators: NA Agency Contact Information: Agency Phone Number Labor and Industries 1-800-547-8367 Public Employees Health Plan 1-800-200-1004 Washington State Medicaid 1-800-562-3022 WA - Health Technology Assessment May 20, 2016 Final Bronchial Thermoplasty for Asthma: Findings & Decision Page 2 of 3 HTCC Coverage Vote and Formal Action: Committee Decision Based
Pills vs. Puffers: Leukotriene receptor antagonists for childhood asthma Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 4,000 family physicians, family medicine residents and medical students in Alberta. Established over fifty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary care research (...) . www.acfp.ca January 18, 2016 Pills vs. Puffers: Leukotriene receptor antagonists for childhood asthma Clinical Question: Are leukotriene receptor antagonists (LTRAs) effective in pediatric asthma? Bottom-line: Using leukotriene receptor antagonists instead of inhaled corticosteroids as monotherapy will lead to one more exacerbation in every 21 patients. As add-on to inhaled corticosteroids, leukotriene receptor antagonists are inferior to long acting beta-agonists (LABAs), and show similar outcomes
Dexamethasone Versus Prednisone for Pediatric Asthma: Will the results take your breath away? Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 4,400 family physicians, family medicine residents and medical students in Alberta. Established over sixty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary (...) care research. www.acfp.ca May 9, 2016 Dexamethasone Versus Prednisone for Pediatric Asthma: Will the results take your breath away? Clinical Question: Are 1-2 doses of dexamethasone as effective as the standard five day prednisone regimen for treatment of pediatric asthma exacerbations? Bottom-line: Treatment of pediatric asthma exacerbations with short-course dexamethasone (0.6 mg/kg x 1-2 doses) is a safe and effective alternative to traditional five day courses of prednisone. For every ~20
2014;60:99–107. 6 Kannan JA, Bernstein DI, Bernstein CK, Ryan PH, Bernstein JA, Villareal MS, Smith AM, Lenz PH, Epstein TG. Signi?cant predictors of poor quality of life in older asthmatics. Ann Allergy Asthma Immunol 2015;115:198–204. 7 Moorman JE, Akinbami LJ, Bailey CM, Zahran HS, King ME, Johnson CA, Liu X. National surveillance of asthma: United States, 2001- 2010. Vital Health Stat 3 2012;35:1–58. 8 Tsai CL, Lee WY, Hanania NA, Camargo CA Jr. Age-related differences in clinical outcomes (...) Evaluation and Management of Asthma in the Elderly AMERICANTHORACICSOCIETY DOCUMENTS AnOf?cialAmericanThoracicSocietyWorkshopReport:Evaluation andManagementofAsthmaintheElderly Gwen S. Skloot, Paula J. Busse, Sidney S. Braman, Elizabeth J. Kovacs, Anne E. Dixon, Carlos A. Vaz Fragoso, Nicola Scichilone, Y. S. Prakash, Christina M. Pabelick, Sameer K. Mathur, Nicola A. Hanania, Wendy C. Moore, PeterG.Gibson,SusanZieman,andBetinaB.Ragless;onbehalfoftheATSadhocCommitteeonAsthmaintheElderly
Asthma, Diagnosis and Management of Asthma, Diagnosis and Management of | ICSI The MN Health Collaborative includes physicians and other representatives from major healthcare organizations working together to address major health topics affecting Minnesota communities today. ICSI has been developing evidence-based clinical practice guidelines to improve patient care since 1993. ICSI helps forward-focused Minnesota health organizations find ways to redefine and redesign systems and the market (...) . Together, we aim to improve care and reduce costs for our patients, families and communities. e Guidelines Asthma, Diagnosis and Management of Revision Date: December 2016 / Eleventh Edition Endorsement Summary The ICSI Diagnosis and Management of Asthma guideline work group endorsed 2016 Global Strategy for Asthma Management and Prevention Report with added qualifications/comments. This report addresses the diagnosis and management of asthma in the pediatric and adult population. The GINA website
A repeated short educational intervention improves asthma control and quality of life We assessed the effectiveness of an asthma educational programme based on a repeated short intervention (AEP-RSI) to improve asthma control (symptom control and future risk) and quality of life. A total of 230 adults with mild-to-moderate persistent uncontrolled asthma participated in a 1-year cluster randomised controlled multicentre study. The AEP-RSI was given in four face-to-face sessions at 3-month (...) intervals, and included administration of a written personalised action plan and training on inhaler technique. Centres were randomised to the AEP-RSI (intervention) group or usual clinical practice group. Specialised centres using a standard educational programme were the gold standard group. A significant improvement in the Asthma Control Test score was observed in all three groups (p<0.001), but improvements were higher in the intervention and gold standard groups than in the usual clinical practice
cases), observational study, performed using biopsy samples (quality: 4/5), an inverse association between H. pylori and pediatric asthma was demonstrated ( P < 0.005). Association between Helicobacter pylori infection and Asthma in paediatric population. Ref. Method for assessing H. pylori infection Association No. of asthmatic/No. of control Age Quality Annagür et al [ ] Serological Seropositivity was similar in acute exacerbations and stable asthmatics 79/36 5-15 3/5 Zevit et al [ ] 13 C-urea (...) not confirmed by two monocentric studies: (4) an Iranian study [ ] , sample size: 196 participants, follow-up: 13 mo, cross-sectional study (quality: 2/5) performed in 98 asthmatic Iranian children, that found a similar H. pylori prevalence in cases and controls; and (5) an European study [ ] , sample size: 3797, prospective (quality: 3/5) performed in 3062 children, was found an association between H. pylori and risk of asthma (OR = 1.75, 95%CI: 1.07-2.87); children infected by CagA- H. pylori strain had