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Maneechotesuwan K, Singh D, Fritscher LG, Dursunoglu N, Pg A, Phansalkar A, Aggarwal B, Pizzichini E, Chorazy J, Burnett H. Impact of inhaled fluticasone propionate/salmeterol on health-related quality of life in asthma: A network meta-analysis. Respir Med 2022; 203:106993. [DOI: 10.1016/j.rmed.2022.106993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
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Kerwin E, Barnes N, Gibbs M, Leather D, Forth R, Jacques L, Yates LJ. Fluticasone furoate/vilanterol once daily improves night-time awakenings in asthma patients with night symptoms: Post hoc analyses of three randomized controlled trials. J Asthma 2018; 55:890-897. [PMID: 28783413 DOI: 10.1080/02770903.2017.1362429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Symptoms, including night-time awakenings, affect the quality of life of people with asthma. Fluticasone furoate/vilanterol (FF/VI) reduces exacerbations, improves lung function, and rescue-free and symptom-free 24-hour periods in patients with asthma. These post hoc analyses compared daytime and night-time symptoms in patients with asthma who received FF/VI, versus FF, fluticasone propionate (FP) or placebo. METHODS Daytime and night-time symptoms were collected via electronic daily diary cards in three Phase III randomized studies of once-daily FF/VI in patients with uncontrolled asthma on inhaled corticosteroids (ICSs) ± long-acting beta2 agonists (n = 609/1039/586). Endpoints included change from baseline in symptom-free days and nights (analyzed by Analysis of Covariance, covariates: baseline, region, sex, age, and treatment), time for patients to achieve seven consecutive symptom-free nights (analyzed by Cox proportional hazards' model, covariates as above), and proportion of patients experiencing 100% symptom-free nights per week (analyzed by logistic regression, covariates: percentage of symptom-free nights, sex, age, and treatment). RESULTS Improvements in symptom-free days and nights were generally observed for all treatments. More patients who received FF/VI experienced 100% symptom-free nights in the last week of the treatment period than patients who received ICS alone or placebo. FF/VI also reduced time to achieve seven consecutive symptom-free nights. Patients with at least one night of symptoms at baseline experienced an additional 2.7 and 2.0 symptom-free nights per week with FF/VI 100/25 µg, versus 1.9 and 1.7 with FF alone; similar findings were seen with FF/VI 200/25 µg. CONCLUSIONS Benefits in terms of symptom-free days and nights were observed for patients receiving FF/VI versus comparators in these post hoc analyses.
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Affiliation(s)
- Edward Kerwin
- a Clinical Research Institute of Southern Oregon , Medford , OR , USA
| | - Neil Barnes
- b Respiratory Medical Franchise , GSK , Brentford , UK
| | - Michael Gibbs
- b Respiratory Medical Franchise , GSK , Brentford , UK
| | - David Leather
- b Respiratory Medical Franchise , GSK , Brentford , UK
| | - Richard Forth
- c Quantitative Sciences Division , GSK , Research Triangle Park, NC , USA
| | - Loretta Jacques
- d Respiratory Medicines Development Centre , GSK , Uxbridge , UK
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Zhang C, Yang P, Chen Y, Liu J, Yuan X. Expression of DACT1 in children with asthma and its regulation mechanism. Exp Ther Med 2018; 15:2674-2680. [PMID: 29456669 DOI: 10.3892/etm.2018.5706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 04/28/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to detect DACT1 expression levels in the lungs of children with asthma, and to investigate its role and molecular mechanisms in regulating the expression of inflammatory factors in RAW264.7 cells. DACT1, DACT2 and DACT3 expression was analyzed in biopsy specimens from 10 cases of newly diagnosed children with asthma and 10 healthy controls by reverse transcription-quantitative polymerase chain reaction, and their expression was confirmed in RAW264.7 cells. DACT1 expression was silenced by small interfering RNA or enhanced by transfection of pcDNA-3.1-DACT1 in RAW264.7 cells, and expression of β-catenin and inflammatory factors, interleukin (IL) 5, IL6 and IL13, was analyzed. Nuclear translocation of β-catenin was detected by western blot analysis, and the effect of DACT1 on β-catenin was investigated with rescue experiments. Regulation of the Wnt signaling pathway by DACT1 and β-catenin was analyzed in RAW264.7 cells after recombinant Wnt5A stimulation. DACT1, DACT2 and DACT3 were significantly upregulated in specimens from children with asthma compared with controls (P<0.05) and the expression of DACT1 was significantly more increased compared with DACT2 and DACT3 (P<0.05). Inhibition of DACT1 expression significantly suppressed IL5, IL6 and IL13 mRNA expression levels compared with the control (P<0.05), while upregulated DACT1 expression significantly increased IL5, IL6 and IL13 mRNA expression (P<0.05). DACT1 inhibited the expression and nuclear translocation of β-catenin, while overexpression of β-catenin significantly inhibited the biological function of DACT1 (P<0.05). Overexpression of β-catenin also significantly suppressed the upregulation of IL5, IL6 and IL13 mRNA induced by pcDNA3.1-DACT1 transfection (P<0.05). Following the addition of Wnt5A, overexpression of DACT1 inhibited the expression and nuclear translocation of β-catenin, and upregulated IL5, IL6 and IL13 mRNA expression. In conclusion, DACT1 was indicated to be upregulated in lung tissues from children with asthma, which could induce higher pro-inflammatory factor expression. DACT1 may act via inhibiting the expression and nuclear translocation of β-catenin, a factor in the Wnt signaling pathway. The present results suggested that DACT1 may be a potential target for the treatment of asthma.
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Affiliation(s)
- Cunxue Zhang
- Department of Pediatrics, The First People's Hospital of Jining, Jining, Shandong 272000, P.R. China
| | - Peili Yang
- Department of Pediatrics, The First People's Hospital of Jining, Jining, Shandong 272000, P.R. China
| | - Yan Chen
- Department of Pediatrics, The First People's Hospital of Jining, Jining, Shandong 272000, P.R. China
| | - Jing Liu
- Institute of Stem Cell and Regenerative Medicine, Medical College, Xiamen University, Xiamen, Fujian 361102, P.R. China
| | - Xiutai Yuan
- Department of Pediatrics, The First People's Hospital of Jining, Jining, Shandong 272000, P.R. China
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Di Marco F, Sferrazza Papa GF, Radovanovic D, Santus P. Avoiding misdiagnosis in patients with dyspnea and wheezing: a case report illustrating the clinical implications of fixation error. Clin Mol Allergy 2017; 15:3. [PMID: 28190974 PMCID: PMC5296954 DOI: 10.1186/s12948-017-0060-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/02/2017] [Indexed: 01/12/2023] Open
Abstract
Background Bronchial asthma is a heterogeneous respiratory condition which can be mimicked by a wide range of pathologies including upper airways stenosis. The accurate diagnosis of asthma, as with other conditions, may be influenced by fixation errors, which are common in medicine and occur when a physician concentrates on only one element of a clinical case without considering other relevant aspects. Here we report a challenging case characterized by the contemporaneous presence of a common disease, asthma, together with a rare respiratory disease, idiopathic tracheal stenosis. Case presentation The 56-year-old female patient, a former smoker, was referred to our outpatient clinic for exertional dyspnea and persistent wheezing. There were no other respiratory or systemic symptoms over the past three months, and a psychological component was suspected. Spirometry with flow-volume evaluation and bronchoscopy were the key elements to establish the diagnoses and provide treatments. Once the diagnosis of asthma was confirmed, the combination of the anti-inflammatory corticosteroid fluticasone and the rapid-acting bronchodilator formoterol in a single inhaler effectively controlled the patient’s symptoms, confirming the favorable efficacy and safety profile which are reflected in the recommendations of the international guidelines. Conclusions In this paper we describe the clinical investigations and interventions that eventually confirmed a diagnosis of asthma complicated by an idiopathic tracheal stenosis and led to effective treatment of the patient. Awareness of fixation error may avoid misdiagnosis in patients with respiratory disease and a complicated history at presentation.
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Affiliation(s)
- Fabiano Di Marco
- Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Francesco Sferrazza Papa
- Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Casa di Cura del Policlinico, Dipartimento di Scienze Neuroriabilitative, Milan, Italy
| | - Dejan Radovanovic
- Dipartimento Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Lung Unit, Ospedale L. Sacco-ASST Fatebenefratelli Sacco, Via G.B. Grassi, 74, 20157 Milan, Italy
| | - Pierachille Santus
- Dipartimento Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Lung Unit, Ospedale L. Sacco-ASST Fatebenefratelli Sacco, Via G.B. Grassi, 74, 20157 Milan, Italy
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Cortese S, Gatta A, Della Valle L, Mangifesta R, Di Giampaolo L, Cavallucci E, Petrarca C, Paganelli R, Di Gioacchino M. Fluticasone/formoterol association favors long-lasting decrease in bronchial reactivity to methacholine and weekly PEF variability. Int J Immunopathol Pharmacol 2016; 29:769-774. [PMID: 27272161 PMCID: PMC5806849 DOI: 10.1177/0394632016650896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/20/2016] [Indexed: 11/15/2022] Open
Abstract
Inhaled corticosteroids (ICS)/long-acting beta-agonists (LABA) association offers a better asthma control than a higher steroid dose with short-acting beta-agonists as needed. In this study, we evaluated the effect of the association on bronchial hyperreactivity (BHR) and peak expiratory flow (PEF) variability, as such parameters are positively correlated with increased asthma morbidity and exacerbations. Thirty-six adult patients with mild persistent asthma were enrolled. After a 7-day run-in, they were randomly assigned to three therapy regimens for 6 weeks: Group 1, fluticasone 125 μg + formoterol 5 μg in the same device; Group 2, fluticasone 125 μg + formoterol 12 μg as needed; Group 3, fluticasone 250 μg + formoterol 12 μg as needed. We evaluated changes induced in weekly PEF variability (measured during the entire study and 4 weeks of follow-up) and pre- and post-study PD20 methacholine (MCH). Weekly PEF variability decreased in all groups during treatment with the greatest reduction in Group 1, followed by Group 3, and finally Group 2. During the follow-up, no significant changes were detected in Group 1, whereas a trend towards an increased variability was found in Groups 2 and 3. Post-treatment PD20 MCH was significantly higher versus the pre-treatment. The increase observed in Group 1 was significantly higher compared to Groups 2 and 3 and that observed in Group 3 in respect to Group 2. The study proves that both BHR and PEF variability are influenced by ICS. This effect was greater with fluticasone/formoterol association compared to fluticasone alone with formoterol as needed even at higher steroid dose.
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Affiliation(s)
- Sara Cortese
- Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Alessia Gatta
- Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Loredana Della Valle
- Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Rocco Mangifesta
- Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Luca Di Giampaolo
- Department of Medical Oral and Biotechnological Science, G. d'Annunzio University, Chieti, Italy
| | - Enrico Cavallucci
- Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Claudia Petrarca
- Immunotoxicology and Allergy Unit, CeSI, G. d'Annunzio University Foundation, Chieti, Italy
| | - Roberto Paganelli
- Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Mario Di Gioacchino
- Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
- Immunotoxicology and Allergy Unit, CeSI, G. d'Annunzio University Foundation, Chieti, Italy
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Wolthers OD. Budesonide + formoterol fumarate dihydrate for the treatment of asthma. Expert Opin Pharmacother 2016; 17:1023-30. [PMID: 27070946 DOI: 10.1517/14656566.2016.1165207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION One of the most widely used fixed combinations in asthma management is dry powder budesonide+formoterol fumarate dihydrate which is commercially available as Symbicort Turbuhaler(®) (and generic products), Easyhaler Bufomix(®) and DuoRespSpiromax(®) inhaler. The aim of this paper was to review the fixed dry powder combination of inhaled budesonide+formoterol fumarate dihydrate for asthma treatment in adolescents and adults. AREAS COVERED A literature search using relevant search terms, reference lists for reviews and meta-analyses was performed. EXPERT OPINION In symptomatic adolescent and adult patients with asthma maintenance and reliever therapy with a single-inhaler fixed combination of dry powder budesonide+formoterol fumarate dihydrate is an evidenced option. The combination treatment is convenient to patients. It reduces the number of exacerbations requiring treatment with oral corticosteroids. In some patients the strategy may also reduce the total intake of inhaled corticosteroids over time. Whether important outcome measures of asthma treatment, such as hospital admission and emergency room visit rates, may be reduced is less well documented since the published studies may have been influenced by publication bias. Non-pharmaceutical company-sponsored research evaluating such measures is needed. There is no evidence for the use of single inhaler fixed combinations of inhaled corticosteroids+long-acting β(2)-agonists in children (<12 years of age), and budesonide+formoterol fumarate dihydrate should not be prescribed to the age group.
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Affiliation(s)
- Ole D Wolthers
- a Asthma and Allergy Clinic , Children´s Clinic Randers , Randers , Denmark
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Kanniess F, Diamant Z, Lomax M. Effects of low- versus high-dose fluticasone propionate/formoterol fumarate combination therapy on AMP challenge in asthmatic patients: A double-blind, randomised clinical trial. Pulm Pharmacol Ther 2016; 37:65-72. [PMID: 26912209 DOI: 10.1016/j.pupt.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/22/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The dose-response relationship between two dose levels of fluticasone/formoterol (flutiform(®), 100/10 μg and 500/20 μg) was evaluated in asthmatic patients. Non-invasive inflammatory markers were used including adenosine monophosphate (AMP) challenge (primary endpoint), and sputum eosinophils and fractional exhaled nitric oxide (FeNO) (secondary endpoints). METHODS Patients aged ≥18 years with forced expiratory volume in 1 s (FEV1) ≥60% predicted and who required a dose of <60 mg AMP to elicit a 20% drop in FEV1 (AMP PD20) were randomised in this incomplete block, crossover study to receive 2 of 3 treatments b.i.d.: fluticasone/formoterol 500/20 μg (high dose), 100/10 μg (low dose) or placebo, during 2 periods of 28 ± 3 days each, separated by 2-3 weeks. AMP challenges were performed pre-dose and 12 h after last dose at the end of each treatment period. A series of post hoc analyses were performed only in patients allocated to both fluticasone/formoterol doses, who completed the study and had evaluable AMP PD20 data for both treatments ("fluticasone/formoterol subgroup"). Changes in AMP PD20 FEV1, percentage sputum eosinophils and FeNO levels (Day 1 vs Day 28) between treatments were compared by an analysis of covariance (ANCOVA). RESULTS Sixty-two patients were randomised and 46 completed the study. Fifteen patients received both high- and low-dose fluticasone/formoterol (post hoc subgroup). The difference in AMP PD20 for the overall population was not statistically significant between high- and low-dose fluticasone/formoterol (LS mean fold difference: 1.3; p = 0.489), although both dose levels were superior to placebo: high-dose vs placebo LS mean fold difference: 4.4, p < 0.001; low-dose vs placebo LS mean fold difference: 3.5, p < 0.001. In the post hoc subgroup, the difference in AMP PD20 between the doses was statistically significant in favour of the high-dose (LS mean fold difference: 2.4, p = 0.012). Other inflammatory parameters (sputum eosinophil counts and FeNO) showed small differences and statistically non-significant changes between high- and low-dose fluticasone/formoterol. CONCLUSIONS A significant dose-response was found between low- and high-dose fluticasone/formoterol in the post hoc subgroup (patients who received both doses), but not in the overall population, with the higher dose demonstrating a greater reduction in airway responsiveness to AMP.
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Affiliation(s)
- Frank Kanniess
- Practice for Allergy and Family Medicine, Reinfeld, Germany.
| | - Zuzana Diamant
- Department of Respiratory Medicine and Allergology, Skane University Hospital, Institute for Clinical Science, Lund University, Lund, Sweden; University of Groningen, University Medical Centre Groningen, Department of General Practice, Department of Clinical Pharmacy & Pharmacology, Groningen, Netherlands; QPS-Netherlands, Groningen, Netherlands.
| | - Mark Lomax
- Mundipharma Research Ltd, Cambridge, UK.
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Combination treatment in asthma: Reviewing old and new options. Pulm Pharmacol Ther 2015; 34:72-4. [PMID: 26365488 DOI: 10.1016/j.pupt.2015.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/28/2015] [Accepted: 08/29/2015] [Indexed: 11/24/2022]
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