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Kotoulas SC, Tsiouprou I, Domvri K, Ntontsi P, Pataka A, Porpodis K. Open and Closed Triple Inhaler Therapy in Patients with Uncontrolled Asthma. Adv Respir Med 2023; 91:288-300. [PMID: 37489386 PMCID: PMC10366885 DOI: 10.3390/arm91040023] [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: 04/29/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/26/2023]
Abstract
Long-acting muscarinic antagonists (LAMAs) are a class of inhalers that has recently been included as add-on therapy in the GINA guidelines, either in a single inhaler device with inhaled corticosteroids plus long-acting β2-agonists (ICS + LABA) (closed triple inhaler therapy) or in a separate one (open triple inhaler therapy). This review summarizes the existing evidence on the addition of LAMAs in patients with persistently uncontrolled asthma despite ICS + LABA treatment based on clinical efficacy in the reduction of asthma symptoms and exacerbations, the improvement in lung function, and its safety profile.
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Affiliation(s)
| | - Ioanna Tsiouprou
- Pulmonary Clinic of Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Georgios Papanikolaou", Leoforos Papanikolaou, Exohi, 57010 Thessaloniki, Greece
| | - Kalliopi Domvri
- Laboratory of Histology-Embryology, Medical School, Aristotle University of Thessaloniki, Leoforos Agiou Dimitriou, 54124 Thessaloniki, Greece
| | - Polyxeni Ntontsi
- 2nd University Department of Respiratory Medicine, Attikon Hospital, 1st Rimini Street, Haidari,12462 Athens, Greece
| | - Athanasia Pataka
- Respiratory Failure Clinic of Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Georgios Papanikolaou", Leoforos Papanikolaou, Exohi, 57010 Thessaloniki, Greece
| | - Konstantinos Porpodis
- Pulmonary Clinic of Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Georgios Papanikolaou", Leoforos Papanikolaou, Exohi, 57010 Thessaloniki, Greece
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2
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Cachim A, Pereira AM, Almeida R, Amaral R, Alves‐Correia M, Vieira‐Marques P, Chaves‐Loureiro C, Ribeiro C, Cardia F, Gomes J, Vidal C, Silva E, Rocha S, Rocha D, Marques ML, Páscoa R, Morais D, Cruz AM, Santalha M, Simões JA, da Silva S, Silva D, Gerardo R, Todo Bom F, Morete A, Vieira I, Vieira P, Monteiro R, Raimundo MR, Monteiro L, Neves Â, Santos C, Penas AM, Regadas R, Marques JV, Rosendo I, Aguiar MA, Fernandes S, Cardoso CS, Pimenta F, Meireles P, Gonçalves M, Fonseca JA, Jácome C. Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self-report and physician assessment. Clin Transl Allergy 2023; 13:e12210. [PMID: 36825517 PMCID: PMC9930432 DOI: 10.1002/clt2.12210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/27/2022] [Accepted: 09/30/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. METHODS This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100). RESULTS A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118-0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). CONCLUSIONS Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.
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Affiliation(s)
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal
| | - Rute Almeida
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal
| | - Rita Amaral
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Cardiovascular and Respiratory SciencesPorto Health SchoolPolytechnic Institute of PortoPortoPortugal,Department of Women's and Children's HealthPediatric ResearchUppsala UniversityUppsalaSweden
| | - Magna Alves‐Correia
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal
| | - Pedro Vieira‐Marques
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal
| | - Claudia Chaves‐Loureiro
- Pulmonology DepartmentHospitais da Universidade de CoimbraCentro Hospitalar e Universitário de CoimbraCoimbraPortugal,Clinical Academic Center of CoimbraCoimbraPortugal
| | - Carmelita Ribeiro
- Serviço ImunoalergologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Francisca Cardia
- Unidade de Saúde Familiar (USF) Terras de AzuraraAgrupamento de Centros de Saúde Dão LafõesMangualdePortugal
| | - Joana Gomes
- Serviço de Imunoalergologia, Unidade ICentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
| | - Carmen Vidal
- Servicio de AlergiaComplejo Hospitalario Universitario de SantiagoSantiago de CompostelaSpain
| | - Eurico Silva
- USF João SemanaAgrupamento de Centros de Saúde (ACES) Baixo VougaOvarPortugal
| | - Sara Rocha
- USF Arte NovaACES Baixo VougaOliveirinhaPortugal
| | - Diana Rocha
- USF Sá de MirandaACES Cávado II ‐ Gerês/CabreiraVila VerdePortugal
| | - Maria Luís Marques
- Serviço de ImunoalergologiaHospital da Senhora da OliveiraGuimarãesPortugal
| | - Rosália Páscoa
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Abel SalazarACES GaiaVila Nova de GaiaPortugal
| | - Daniela Morais
- USF CorgoACES Douro I ‐ Marão e Douro NorteVila RealPortugal
| | | | - Marta Santalha
- Serviço de PediatriaHospital da Senhora da OliveiraGuimarãesPortugal
| | - José Augusto Simões
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Caminhos do CértomaACES Baixo MondegoPampilhosaPortugal,Department of Medical SciencesUniversity of Beira InteriorCovilhãPortugal
| | - Sofia da Silva
- USF CuidarteUnidade Local de Saúde do Alto MinhoPortuzeloPortugal
| | - Diana Silva
- Faculty of MedicineUniversity of PortoPortoPortugal,Serviço de ImunoalergologiaCentro Hospitalar Universitário de São JoãoPortoPortugal
| | - Rita Gerardo
- Serviço de PneumologiaHospital Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugal
| | | | - Ana Morete
- Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal,Serviço de ImunoalergologiaHospital Infante D PedroCentro Hospitalar Baixo VougaAveiroPortugal
| | - Inês Vieira
- Unidade de Cuidados Saúde Personalizados Arnaldo SampaioACES Pinhal LitoralLeiriaPortugal
| | | | - Rosário Monteiro
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Homem do LemeACES Porto OcidentalPortoPortugal
| | | | - Luís Monteiro
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Esgueira+ACES Baixo VougaEsgueiraPortugal
| | | | - Carlos Santos
- USF Santo AntónioACES Cávado III ‐ Barcelos/EsposendeBarcelosPortugal
| | | | - Rita Regadas
- USF Aquilino RibeiroACES Douro II ‐ Douro SulMoimenta da BeiraPortugal
| | | | - Inês Rosendo
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Coimbra CentroACES Baixo MondegoCoimbraPortugal
| | | | - Sara Fernandes
- UCSP São João da PesqueiraACES Douro SulSão João da PesqueiraPortugal
| | - Carlos Seiça Cardoso
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF CondeixaACES Baixo MondegoCondeixa‐a‐NovaPortugal
| | | | | | | | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal,MEDIDA – Medicina, Educação, Investigação, Desenvolvimento e AvaliaçãoPortoPortugal
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal
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Xu D, Li J, Di A, Yang P, Xie X, Xu Y, He J. Sanfu herbal patch applied at acupoints in patients with bronchial asthma: statistical analysis plan for a randomised controlled trial. Trials 2022; 23:1025. [PMID: 36539844 PMCID: PMC9764530 DOI: 10.1186/s13063-022-06990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sanfu herbal patch (SHP) is widely used in the prevention and treatment of bronchial asthma in China, but its efficacy and mechanism of action are not completely clear. This trial aims to determine the efficacy of SHP and the underlying mechanism. METHODS/DESIGN We will conduct a multi-centre parallel randomised controlled trial consisting of 72 participants with bronchial asthma recruited and randomly allocated at a ratio of 1:1 into two groups. The patients in one group will receive three courses of SHP treatment, and the patients in the other group will receive placebo treatment, with 24 weeks of follow-up evaluation for both groups. The primary outcome, i.e. forced expiratory volume in the first second (FEV1), which refers to the change in FEV1 from the beginning of the baseline to the end of 3 treatment sessions (TSs), will be assessed and compared via Student's t test or the Mann-Whitney U test. Other outcomes will include questionnaire surveys and laboratory indicators. Detailed and complete statistical analyses in a double-blinded fashion will be provided for evaluating this trial. DISCUSSION The data we obtain will be examined based on the above statistical analysis, which will help to reduce the risk of external reporting bias and data-driven results. TRIAL REGISTRATION Chinese Clinical Trial Registry ( http://www.chictr.org.cn ), ChiCTR1900024616. Registered on 19 July 2019.
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Affiliation(s)
- Danghan Xu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Jialing Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Anqi Di
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Peidan Yang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Xiaoyan Xie
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
- Guangdong Provincial Hospital of Chinese Medicine, 510120, Guangzhou, China
| | - Yiming Xu
- School of Basic Medicine, Guangzhou Medical University, Guangzhou, 511436, China
| | - Jun He
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
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Mohamed AZELA, Shaaban LH, Gad SF, Azeem EA, Gamal Elddin W. Acute severe asthma in emergency department: clinical characteristics, risk factors, and predictors for poor outcome. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00160-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Severe asthma exacerbation can be a frightening experience to the patient and physician. Despite continuous efforts to frame management guidelines and advances in treatment, severe exacerbations still occur. In order to prevent and judicious management of asthma exacerbations, we should predict them first. This study aims to evaluate distinct clinical trajectories and management outcome of patients with severe asthma exacerbations and also evaluate predictors for poor outcome.
Methods
Patients suffering from acute asthma exacerbation and presented to emergency room (forty patients) were grouped into 2 groups (groups A and B) according to severity of exacerbation. Assessment included full clinical history, laboratory investigations (including eosinophil cell count and serum IgE level), Beck’s anxiety and depression inventory scales, assessment of asthma medication adherence and control level, and peak expiratory flow measurement (at presentation, 1 and 6 h after).
Results
Fifty-five percent of patients suffered from severe and life-threatening asthma exacerbations, 63.6% of them were females. The most important predictors for severe exacerbations were SO2 < 90% at baseline (OR = 4.56; 95% CI = 3.45–7.56; P < 0.001), PEFR after 1 h (OR= 3.34; 95%CI = 1.90–4.90; P < 0.001), and uncontrolled asthma (OR= 3.33; 95%CI = 2.50–5.05; P < 0.001). Predictors for hospitalization were old age (OR = 1.11; 95%CI = 1.09–2.11; P < 0.001), uncontrolled asthma (OR = 2.34; 95%CI = 2.01–4.40; P < 0.001), PEFR after 1 h (OR= 4.44; 95%CI= 3.24–7.68; P < 0.001), and SO2 <90% at baseline (OR= 5.67; 95%CI= 3.98–8.50; P < 0.001).
Conclusions
Severe asthma exacerbations can be predicted by old age, previous history of mechanical ventilation, obstructive sleep apnea, overuse of SABA, uncontrolled asthma, moderate to severe depression, eosinophilia, SO2 <90%, and low peak expiratory flow rates.
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Guilleminault L, Mounié M, Sommet A, Camus C, Didier A, Reber LL, Costa N, Conte C. Healthcare resource consumption prior to asthma-related death: a nationwide descriptive study. Ther Adv Respir Dis 2022; 16:17534666221130217. [PMID: 36239261 PMCID: PMC9577087 DOI: 10.1177/17534666221130217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although asthma mortality declined sharply until the mid-2000s, a stagnation in mortality has been observed over the past decade in different countries. OBJECTIVE The objective of this study is to describe healthcare resource consumption for patients who died from asthma in France. METHOD This study was conducted using data from the French National Health Data System. Patients who died from asthma between 2013 and 2017 were identified by the ICD10 codes J45 and J46. Health care consumption data were collected. Patients were categorized into four categories according to age: ⩾75, (18-75), (12-18), (0-12). Daily doses of ICS were categorized according to GINA guidelines. RESULTS A total of 3829 patients were included. No ICS or an inadequate ICS dose was observed in 43.8%, 50.6%, 48.1%, and 54.0% of patients aged ⩾75, (18-74), (12-18), and (0-12) years, respectively. Dispensation of six or more SABA canisters was observed in 37.2%, 49.0%, and 70.3% of patients aged of ⩾75, (18-75), and (12-18) years, respectively. Omalizumab dispensation rate was very low [1.1% and 2.8% in patients aged ⩾75 and (18-75) years)]. The proportion of patients with a pulmonologist office visit was 13.8% and 14.6% in patients ⩾75 and (18-75) years, respectively. A lung function test was noted in only 18.6%, 28.3%, and 25.9% of patients ⩾75, (18-75) and (12-18) years, respectively. CONCLUSION Half of the patients who died from asthma received inadequate ICS doses and only a small proportion had access to biological therapies. Less than 15% were referred to a specialist.
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Affiliation(s)
| | - Michael Mounié
- Unité d’Evaluation Médico-Economique, Centre
Hospitalier Universitaire, Toulouse, France,INSERM-UMR 1295–Center for Epidemiology and
Research in POPulation health (CERPOP), Inserm, UPS, Université de Toulouse,
Toulouse, France
| | - Agnès Sommet
- Unité Méthodologie, Data Management, Analyses
Statistiques, Centre d’Investigation Clinique 1436, Service de pharmacologie
médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | | | - Alain Didier
- Pôle des Voies Respiratoires, Service de
Pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, Toulouse,
France,Toulouse Institute for Infectious and
Inflammatory Diseases (Infinity), Inserm U1291, CNRS U5282, University of
Toulouse, Toulouse, France,CRISALIS F-CRIN, Toulouse, France
| | - Laurent L. Reber
- Toulouse Institute for Infectious and
Inflammatory Diseases (Infinity), Inserm U1291, CNRS U5282, University of
Toulouse, Toulouse, France
| | - Nadège Costa
- Unité d’Evaluation Médico-Economique, Centre
Hospitalier Universitaire, Toulouse, France,INSERM-UMR 1295–Center for Epidemiology and
Research in POPulation health (CERPOP), Inserm, UPS, Université de Toulouse,
Toulouse, France
| | - Cécile Conte
- Unité Méthodologie, Data Management, Analyses
Statistiques, Centre d’Investigation Clinique 1436, Service de pharmacologie
médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
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6
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Para O, Montagnani A, Guidi S, Bertù L, Manfellotto D, Campanini M, Fontanella A, Dentali F. Hospitalization and mortality for acute exacerbation of asthma: an Italian population-based study. Intern Emerg Med 2022; 17:1107-1113. [PMID: 35103927 DOI: 10.1007/s11739-021-02923-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/23/2021] [Indexed: 11/27/2022]
Abstract
Asthma is an ever-increasing disease with a highly variable prevalence among different ethnic groups. Information on hospital admission for acute exacerbation of asthma in adult patients and data regarding short-term prognosis of these patients are limited. We, thus, performed an epidemiological study on hospital admission for asthma acute exacerbation in Italy using hospital discharge database records derived from all Italian hospitals. Patients > 15 years old were identified using clinical Modification (ICD-9-CM) codes. Information on baseline characteristics, vital status at discharge, duration of hospitalization, and up to five secondary discharge diagnoses was collected. Comorbidity was evaluated using the Charlson comorbidity index (CCI). During the observation period (2013-2014), 20,056 patients with asthma acute exacerbation were hospitalized. Median length of hospitalization was 7.9 days (interquartile range 4-10) and mean in-hospital mortality was 0.8%. In-hospital mortality and length of hospitalization varied among different regions (from 0 to 2.9% and from 6.5 to 8.9 days, respectively). Old age, invasive and non-invasive mechanical ventilation, and CCI resulted as significantly associated with higher in-hospital mortality. Our study results, on a large sample of patients, confirm that hospitalization for asthma acute exacerbation is not uncommon among Italian current population. Older age, high CCI, and use of ventilator support were associated with a higher mortality rate. These findings should be analyzed to set up appropriate health care policies on patients with asthma.
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Affiliation(s)
- Ombretta Para
- Internal Medicine 1, Careggi University Hospital, Florence, Italy.
| | - Andrea Montagnani
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Grosseto, Italy
| | - Stefano Guidi
- Internal Medicine 1, Careggi University Hospital, Florence, Italy
| | - Lorenza Bertù
- Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Dario Manfellotto
- Department of Internal Medicine, Fatebenefratelli Hospital, Rome, Italy
| | - Mauro Campanini
- Department of Internal Medicine, AOU Maggiore Della Carità, Novara, Italy
| | - Andrea Fontanella
- Department of Internal Medicine, Ospedale del Buon Consiglio, Naples, Italy
| | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy
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Omalizumab: An Optimal Choice for Patients with Severe Allergic Asthma. J Pers Med 2022; 12:jpm12020165. [PMID: 35207654 PMCID: PMC8878072 DOI: 10.3390/jpm12020165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/28/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Abstract
Omalizumab is the first monoclonal antibody that was globally approved as a personalized treatment option for patients with moderate-to-severe allergic asthma. This review summarizes the knowledge of almost two decades of use of omalizumab to answer some important everyday clinical practice questions, concerning its efficacy and safety and its association with other asthma-related and drug-related parameters. Evidence suggests that omalizumab improves asthma control and reduces the incidence and frequency of exacerbations in patients with severe allergic asthma. Omalizumab is also effective in those patients in reducing corticosteroid use and healthcare utilization, while it also seems to improve lung function. Several biomarkers have been recognized in predicting its efficacy in its target group of patients, while the optimal duration for evaluating its efficacy is between 16 and 32 weeks.
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8
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Management of Children with Acute Asthma Attack: A RAND/UCLA Appropriateness Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312775. [PMID: 34886505 PMCID: PMC8657661 DOI: 10.3390/ijerph182312775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 12/22/2022]
Abstract
Bronchial asthma is the most frequent chronic disease in children and affects up to 20% of the pediatric population, depending on the geographical area. Asthma symptoms vary over time and in intensity, and acute asthma attack can resolve spontaneously or in response to therapy. The aim of this project was to define the care pathway for pediatric patients who come to the primary care pediatrician or Emergency Room with acute asthmatic access. The project was developed in the awareness that for the management of these patients, broad coordination of interventions in the pre-hospital phase and the promotion of timely and appropriate assistance modalities with the involvement of all health professionals involved are important. Through the application of the RAND method, which obliges to discuss the statements derived from the guidelines, there was a clear increase in the concordance in the behavior on the management of acute asthma between primary care pediatricians and hospital pediatricians. The RAND method was found to be useful for the selection of good practices forming the basis of an evidence-based approach, and the results obtained form the basis for further interventions that allow optimizing the care of the child with acute asthma attack at the family and pediatric level. An important point of union between the primary care pediatrician and the specialist hospital pediatrician was the need to share spirometric data, also including the use of new technologies such as teleconsultation. Monitoring the progress of asthma through spirometry could allow the pediatrician in the area to intervene early by modifying the maintenance therapy and help the patient to achieve good control of the disease.
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9
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Raherison-Semjen C, Guilleminault L, Billiart I, Chenivesse C, De Oliveira A, Izadifar A, Lorenzo A, Nocent C, Oster JP, Padovani M, Perez T, Russier M, Steinecker M, Didier A. [Update of the 2021 recommendations for the management and follow-up of adult asthmatic patients under the guidance of the French Society of Pulmonology and the Paediatric Society of Pulmonology and Allergology. Long version]. Rev Mal Respir 2021; 38:1048-1083. [PMID: 34799211 DOI: 10.1016/j.rmr.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Affiliation(s)
- C Raherison-Semjen
- Université de Bordeaux, INSERM UMR 1219, Epicene Team, Bordeaux, France.
| | - L Guilleminault
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France; Institut toulousain des maladies infectieuses et inflammatoires (Infinity), INSERM, UMR1291, CNRS UMR5051, université Toulouse III, CRISALIS F-CRIN, Toulouse, France
| | | | - C Chenivesse
- CHRU de Lille, service de pneumo-allergologie, 59000 Lille, France
| | - A De Oliveira
- Sorbonne université, département de médecine générale, Paris, France
| | - A Izadifar
- Département de pneumologie, centre cardiologique du Nord, Saint-Denis, France
| | - A Lorenzo
- Sorbonne université, département de médecine générale, Paris, France
| | - C Nocent
- CHG Côte Basque, Bayonne, France
| | - J P Oster
- Service de pneumologie, centre hospitalier Louis-Pasteur, Colmar, France
| | - M Padovani
- Espace Santé Ii, La Seyne-sur-Mer, France
| | - T Perez
- CHRU de Lille, service d'explorations fonctionnelles, 59000 Lille, France
| | - M Russier
- Service de pneumo-allergologie, CHR Orléans, Orléans, France
| | - M Steinecker
- Sorbonne université, département de médecine générale, Paris, France
| | - A Didier
- Université de Bordeaux, INSERM UMR 1219, Epicene Team, Bordeaux, France; Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France
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10
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Tupper OD, Ulrik CS. Long-term predictors of severe exacerbations and mortality in a cohort of well-characterised adults with asthma. Respir Res 2021; 22:269. [PMID: 34670588 PMCID: PMC8529759 DOI: 10.1186/s12931-021-01864-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/11/2021] [Indexed: 01/05/2023] Open
Abstract
Background We aimed to explore long-term predictors of severe exacerbations and mortality in adults with well-characterised asthma. Study design and methods Adults (aged ≥ 15) with an objectively verified diagnosis of asthma were recruited from a Danish respiratory outpatient clinic between 1974 and 1990. All individuals were followed in Danish registries for vital status, hospital admissions for asthma and cause of death until end of 2017. Predictors of exacerbations were obtained from a repeated measures model. Standardised mortality rates (SMR) for all-causes were compared with the Danish background population. Hazard ratios for mortality were obtained from a cox proportional hazards model in a two-step process. Results At baseline, the cohort comprised 1071 patients (mean age 38, SD 16, 61% women), of whom 357 (33%) died during follow-up, with 93 (26%) dying from asthma (primary diagnosis). We found an SMR of 1.24 (95% CI 1.11–1.37, p < 0.001) for all-cause mortality. Baseline predictors for asthma-related death and repeated severe exacerbations were increasing age, ever smoker, FEV1 < 80% pred., high blood eosinophils, longer duration of symptoms and use of SABA > twice daily. Being non-atopic, having a positive histamine challenge test and symptoms more than twice a week were also predictors of repeated exacerbations. Conclusions Markers of poor asthma control, including high use of SABA, are predictors of long-term exacerbation rate and mortality over 30 years in patients with well-characterised asthma. Improving asthma control, including lung function and reducing use of reliever medication, is vital for improving the long-term outcome of asthma. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01864-z.
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Affiliation(s)
- Oliver Djurhuus Tupper
- Respiratory Research Unit, Department of Respiratory Medicine, Hvidovre Hospital, Copenhagen University Hospital-Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.
| | - Charlotte Suppli Ulrik
- Respiratory Research Unit, Department of Respiratory Medicine, Hvidovre Hospital, Copenhagen University Hospital-Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Bourdin A, Charriot J, Boissin C, Ahmed E, Suehs C, De Sevin A, Volpato M, Pahus L, Gras D, Vachier I, Halimi L, Hamerlijnck D, Chanez P. Will the asthma revolution fostered by biologics also benefit adult ICU patients? Allergy 2021; 76:2395-2406. [PMID: 33283296 DOI: 10.1111/all.14688] [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: 09/25/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Asthma exacerbations are inflammatory events that rarely result in full hospitalization following an ER visit. Unfortunately, certain patients require prolonged support, including occasional external lung support through ECMO or ECCOR (with subsequent further exposure to other life-threatening issues), and some die. In parallel, biologics are revolutionizing severe asthma management, mostly in T2 high patients. METHODS We extensively reviewed the current unmet needs surrounding ICU-admitted asthma exacerbations, with a focus on currently available drugs and the underlying biological processes involved. We explored whether currently available T2-targeting drugs can reasonably be seen as potential players not only for relapse prevention but also as candidate drugs for a faster resolution of such episodes. The patient's perspective was also sought. RESULTS About 30% of asthma exacerbations admitted to the ICU do not resolve within five days. Persistent severe airway obstruction despite massive doses of corticosteroids and maximal pharmacologically induced bronchodilation is the main cause of treatment failure. Previous ICU admission is the main risk factor for such episodes and may eventually be considered as a T2 surrogate marker. Fatal asthma cases are hallmarked by poorly steroid-sensitive T2-inflammation associated with severe mucus plugging. New, fast-acting T2-targeting biologics (already used for preventing asthma exacerbations) have the potential to circumvent steroid sensitivity pathways and decrease mucus plugging. This unmet need was confirmed by patients who reported highly negative, traumatizing experiences. CONCLUSIONS There is room for improvement in the management of ICU-admitted severe asthma episodes. Clinical trials assessing how biologics might improve ICU outcomes are direly needed.
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Affiliation(s)
- Arnaud Bourdin
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
- PhyMedExp Univ MontpellierCNRSINSERM, CHU Montpellier Montpellier France
| | - Jérémy Charriot
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
- PhyMedExp Univ MontpellierCNRSINSERM, CHU Montpellier Montpellier France
| | - Clément Boissin
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Engi Ahmed
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Carey Suehs
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
- Department of Medical Information Univ Montpellier, CHU Montpellier Montpellier France
| | - Arthur De Sevin
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Mathilde Volpato
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Laurie Pahus
- Aix Marseille UnivAPHM, Hôpital NORDCIC 9502Clinique des bronches allergies et sommeil, Chemin des Bourrely, 13015 Marseille France
- Aix Marseille UnivCNRSEFS, ADES Marseille France
- Aix Marseille UnivINSERM U1263INRA 1260 (C2VN) Marseille France
| | - Delphine Gras
- Aix Marseille UnivINSERM U1263INRA 1260 (C2VN) Marseille France
| | - Isabelle Vachier
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | - Laurence Halimi
- Department of Respiratory Diseases Univ Montpellier, CHU Montpellier Montpellier France
| | | | - Pascal Chanez
- Aix Marseille UnivAPHM, Hôpital NORDCIC 9502Clinique des bronches allergies et sommeil, Chemin des Bourrely, 13015 Marseille France
- Aix Marseille UnivINSERM U1263INRA 1260 (C2VN) Marseille France
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12
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Bosi A, Tonelli R, Castaniere I, Clini E, BeghÈ B. Acute severe asthma: management and treatment. Minerva Med 2021; 112:605-614. [PMID: 33634676 DOI: 10.23736/s0026-4806.21.07372-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with acute asthma attack usually access the emergency room with severe functional impairment, despite low perception of symptoms. In this scenario, early functional assessment is essential focusing on vital parameters and respiratory function, alongside perceived dyspnea. Impairment of ventilatory mechanics due to progressive dynamic pulmonary hyperinflation should be promptly treated with medical inhalation and/or intravenous therapy, reserving intensive treatment in case of non-response and/or worsening of the clinical conditions. Therapeutic planning at patient's discharge is no less important than treatment management during emergency room access as educating the patient about therapeutic adherence significantly impact long-term outcomes of asthma. With this review we aim at exploring current evidence on acute asthma attack management, focusing of pharmacological and ventilatory strategies of care and highlighting the importance of patient education once clinical stability allows discharge from the emergency department.
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Affiliation(s)
- Annamaria Bosi
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy
| | - Ivana Castaniere
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy
| | - Bianca BeghÈ
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy -
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13
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Nakwan N, Prateepchaiboon T. Predicting the requiring intubation and invasive mechanical ventilation among asthmatic exacerbation-related hospitalizations. J Asthma 2020; 59:507-513. [PMID: 33207982 DOI: 10.1080/02770903.2020.1853768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify the predictors of requiring intubation and invasive mechanical ventilation (IMV) in asthmatic exacerbation (AE)-related hospitalizations. METHODS This study was conducted in southern Thailand between October 2016 and September 2018. The characteristics and clinical findings of patients admitted for AE requiring intubation and IMV were analyzed. The variables were evaluated by univariate and multivariate analysis to identify the independent predictors. RESULTS A total of 509 patients with a median age of 53 years were included in the study. Being female (60.2%), having no previous use of a controller (64.5%), having a history of smoking, and having a high level of white blood cell count (14,820 cells/mm3) were the significantly more common characteristics of the patients requiring mechanical ventilation. Univariate analysis showed that being male (OR = 1.96 95% CI, 1.22-3.13), having a history of 1-2 AEs in the past 12 months (OR = 3.27 95% CI, 1.75-6.12), and having an absolute eosinophil count ≥300 cells/mm3 (OR = 1.68 95% CI, 1.05-2.69) were associated with patients requiring IMV, whereas the patients who were taking a reliever (OR = 0.36 95% CI, 0.23-0.57) and controller (OR = 0.42 95% CI, 0.27-0.68) were associated with a decreased risk of requiring intubation and IMV. In multivariate analysis, only 1-2 AEs within the past 12 months (OR = 3.12, 95% CI, 1.19-8.21) was an independent predictor of requiring intubation and IMV in patients with AE-related hospitalization (p = 0.021). CONCLUSIONS This study found that a history of 1-2 AEs in the past 12 months was a strong independent predictor for the requirement of intubation and IMV in patients hospitalized for AE-related conditions.
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Affiliation(s)
- Narongwit Nakwan
- Division of Pulmonology, Department of Medicine, Hat Yai Medical Education Center, Hat Yai Hospital, Songkhla, Thailand
| | - Tanaporn Prateepchaiboon
- Division of Pulmonology, Department of Medicine, Hat Yai Medical Education Center, Hat Yai Hospital, Songkhla, Thailand
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14
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Willson R, Makhecha S, Moore-Crouch R, Balfour-Lynn IM. Prescribing emergency oral steroids in asthma clinics. Arch Dis Child 2020; 105:993-995. [PMID: 31186291 DOI: 10.1136/archdischild-2018-316609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/03/2022]
Abstract
We retrospectively reviewed children who had been prescribed emergency oral corticosteroids (OCS) in a routine tertiary paediatric respiratory clinic appointment. We subsequently assessed adherence from prescription uptake of inhaled corticosteroids or combination inhalers in the 6 months prior to the episode. In 2 years, 25 children received 32 courses of prednisolone. Median adherence was 33%, but 28% for those with repeated OCS prescriptions. Prescribing acute OCS in a routine clinic is a red flag for potential poor adherence to preventer therapies, and may also indicate the child has poor perception of the severity of their symptoms. An assessment of adherence should be carried out and help given to the child and their family to improve poor adherence when detected.
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Affiliation(s)
- Rhian Willson
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | | | - Rachel Moore-Crouch
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Ian M Balfour-Lynn
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
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15
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Kulalert P, Phinyo P, Patumanond J, Smathakanee C, Chuenjit W, Nanthapisal S. Factors Associated with Failure of Intermittent Nebulization with Short-Acting Beta-Agonists in Children with Severe Asthma Exacerbation. J Asthma Allergy 2020; 13:275-283. [PMID: 32904643 PMCID: PMC7457559 DOI: 10.2147/jaa.s258549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Intermittent nebulization of short-acting beta-agonists (SABA) is the initial treatment of choice for children with asthma exacerbation. However, children with severe asthma exacerbation (SAE) may not show an adequate response and need aggressive stepwise therapy. We aimed to explore factors associated with a poor response to intermittent nebulized SABA in children with SAE. Methods A retrospective cohort study of children with SAE diagnosed according to the definition of the British Guidelines on the Management of Asthma, who were admitted at Hat Yai Hospital from January 1, 2015, to December 31, 2017. All children were treated with intermittent SABA nebulization. Treatment failure was defined as children needing escalated therapy. Logistic regression with confounding score adjustment was used to explore the predictors of treatment failure. Results One hundred thirty-three children were included in the analysis, 59 were in the failure group and 74 were in the success group. After adjusting for potential confounders, they were significantly associated with a previous history of intubation (adjusted OR 6.46, 95% CI 1.13 to 36.79, p=0.036), receiving <3 doses of nebulized salbutamol in the emergency room (ER, aOR 3.21, 95% CI 1.15 to 9.02, p=0.027), ER measured oxygen saturation (SpO2) <92% (adjusted OR 3.02, 95% CI 1.18 to 7.75, p=0.022), and exacerbation triggered by pneumonia (adjusted OR 2.67, 95% CI 1.19 to 6.00, p=0.017). Conclusion We identified four prognostic factors of treatment failure in children with SAE: a previous history of intubation; receiving <3 doses of nebulized salbutamol in the ER, SpO2 at ER <92%; and exacerbation triggered by pneumonia. Further prospective studies are required to confirm our findings before clinical implementation.
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Affiliation(s)
- Prapasri Kulalert
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Sira Nanthapisal
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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16
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Xie X, Xu D, Zhuang L, Liu H, Tan S, Lu Y, Su M, Chen J, Pan H, Lu L, Xu Y, Liao M, Xu Z, He J. Sanfu herbal patch applied at acupoints in patients with bronchial asthma: study protocol for a randomized controlled trial. Trials 2020; 21:684. [PMID: 32727619 PMCID: PMC7389380 DOI: 10.1186/s13063-020-04604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Bronchial asthma is one of the most common inflammatory airway disorders. As one of the main non-drug therapies, the Sanfu herbal patch (SHP) has been widely used to treat bronchial asthma, although the evidence for its efficacy and associated mechanism are inconclusive. The objective of this trial is to clarify the clinical efficacy and safety of the SHP in the treatment of bronchial asthma in the chronic persistent or clinical remission stage and to provide high-quality data for further research. Methods We propose a multicentre, double-blinded, parallel, randomized, placebo-controlled clinical trial involving 4 study hospitals in China. A total of 72 eligible participants will be randomized into an SHP group and a placebo group. They will receive an SHP for 3 treatment sessions. The primary outcome will be changes in forced expiratory volume in 1 s after 3 treatment sessions. Secondary outcomes will include the following: (1) the Asthma Quality of Life Questionnaire, Asthma Control Test, and Asthma Long-term Follow-up Scale; (2) levels of Metallothionein-2 and Transgelin-2 in blood and urine; and (3) levels of IL-5, IL-13, IL-23, IL-25, and thymic stromal lymphopoietin in blood. Analysis of the data will be performed at baseline, at the end of the 2nd and 3rd treatment sessions, and at the 24-week follow-up. The safety of the SHP will be evaluated at each treatment session. Discussion The aims of this trial are to determine whether the SHP is more effective than placebo in the treatment of patients with bronchial asthma, as well as whether the SHP works by reducing airway inflammation and reversing bronchoconstriction. Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR1900024616. Registered on 19 July 2019.
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Affiliation(s)
- Xiaoyan Xie
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.,Department of Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Danghan Xu
- Department of Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Lixing Zhuang
- Department of Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Hui Liu
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Sui Tan
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Yanqing Lu
- The Fifth Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510095, China
| | - Meiyi Su
- The Fifth Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510095, China
| | - Jie Chen
- Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Haihua Pan
- Pingshan District Peoples' Hospital of Shenzhen, Shenzhen, 518118, China
| | - Lu Lu
- Lingnan Medical Research Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yiming Xu
- Guangzhou Medical University, Guangzhou, 515000, China
| | - Muxi Liao
- Department of Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Zhanqiong Xu
- Department of Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Jun He
- Department of Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
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17
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Kulalert P, Phinyo P, Patumanond J, Smathakanee C, Chuenjit W, Nanthapisal S. Continuous versus intermittent short-acting β2-agonists nebulization as first-line therapy in hospitalized children with severe asthma exacerbation: a propensity score matching analysis. Asthma Res Pract 2020; 6:6. [PMID: 32632352 PMCID: PMC7329360 DOI: 10.1186/s40733-020-00059-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Short-acting β2-agonist (SABA) nebulization is commonly prescribed for children hospitalized with severe asthma exacerbation. Either intermittent or continuous delivery has been considered safe and efficient. The comparative efficacy of these two modalities is inconclusive. We aimed to compare these two modalities as the first-line treatments. Methods An efficacy research with a retrospective cohort study design was conducted. Hospital records of children with severe asthma exacerbation admitted to Hat Yai Hospital between 2015 and 2017 were retrospectively collected. Children initially treated with continuous salbutamol 10 mg per hour or intermittent salbutamol 2.5 mg per dose over 1–4 h nebulization were matched one-to-one using the propensity score. Competing risk and risk difference regression was applied to evaluate the proportion of children who succeeded and failed the initial treatment. Restricted mean survival time regression was used to compare the length of stay (LOS) between the two groups. Results One-hundred and eighty-nine children were included. Of these children, 112 were matched for analysis (56 with continuous and 56 with intermittent nebulization). Children with continuous nebulization experienced a higher proportion of success in nebulization treatment (adjusted difference: 39.5, 95% CI 22.7, 56.3, p < 0.001), with a faster rate of success (adjusted SHR: 2.70, 95% CI 1.73, 4.22, p < 0.001). There was a tendency that LOS was also shorter (adjusted mean difference − 9.9 h, 95% CI -24.2, 4.4, p = 0.176). Conclusion Continuous SABA nebulization was more efficient than intermittent nebulization in the treatment of children with severe asthma exacerbation.
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Affiliation(s)
- Prapasri Kulalert
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Sira Nanthapisal
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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18
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Chang YL, Ko HK, Lu MS, Chou CL, Su KC, Hsu CC, Chou KT, Chen TJ, Perng DW, Chou YC. Independent risk factors for death in patients admitted for asthma exacerbation in Taiwan. NPJ Prim Care Respir Med 2020; 30:7. [PMID: 32193384 PMCID: PMC7081219 DOI: 10.1038/s41533-020-0164-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 01/09/2020] [Indexed: 12/22/2022] Open
Abstract
The independent risk factors for death in patients admitted for asthma exacerbation have not been thoroughly investigated. This study aimed to investigate these independent risk factors and the relationship between mortality and the prescription patterns of anti-asthmatic medications in patients admitted for asthma exacerbation. Using a nested case-control design, we identified 267 cases (death after asthma admission) and 1035 controls (survival after asthma admission) from the Taiwan National Health Insurance Research Database (NHIRD) from 2001 to 2010. Conditional logistic regressions were used to estimate the odds ratios (ORs) with 95% confidence intervals (CIs). We identified the independent risk factors for death as the comorbidities of pneumonia (aOR 3.82, 95% CI 2.41-6.05), genitourinary disease (aOR 1.75, 95% CI 1.17-2.62), septicemia (aOR 4.26, 95% CI 2.61-6.94), diabetes mellitus (aOR 2.10, 95% CI 1.30-3.38), arrhythmia (aOR 2.00, 95% CI 1.14-3.50), and a history of asthmatic hospitalization (aOR 4.48, 95% CI 2.77-7.25). Moreover, the use of short-acting β2-agonist (SABA) and the dosage of oral corticosteroids (OCSs) >70 mg prednisolone during previous hospitalization (all p < 0.05) and the dosage of OCSs ≥110 mg prednisolone/month (aOR 2.21, 95% CI 1.08-4.50) during outpatient treatment independently increased the risk of death. The inhaled corticosteroids (ICSs) ≥4 canisters/year (aOR 0.39, 95% CI 0.19-0.78) independently reduced the risk of death. Specific comorbidities, asthma severity, and prescription patterns of SABA, OCSs, and ICSs were independently associated with mortality in patients admitted for asthma exacerbation. These results can be utilized to help physicians identify asthmatic patients who are at a higher mortality risk and to refine the management of the condition.
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Affiliation(s)
- Yuh-Lih Chang
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Kuo Ko
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Meng-Shui Lu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Lin Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Kang-Cheng Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chen Hsu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Ta Chou
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yueh-Ching Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan.
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
- School of Pharmacy, Taipei Medical University, Taipei, Taiwan.
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19
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Abstract
Severe asthma is broadly defined as asthma requiring a high level of therapy, usually high doses of inhaled corticosteroids, to bring under control. Children who remain symptomatic despite such treatment are a heterogeneous population, and bear a high burden of disease and require high resource utilization. Children with severe asthma require a comprehensive evaluation, careful consideration of alternative diagnoses and comorbid conditions, assessment of medication adherence and environmental conditions, and frequent disease monitoring.
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20
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Le Conte P, Terzi N, Mortamet G, Abroug F, Carteaux G, Charasse C, Chauvin A, Combes X, Dauger S, Demoule A, Desmettre T, Ehrmann S, Gaillard-Le Roux B, Hamel V, Jung B, Kepka S, L’Her E, Martinez M, Milési C, Morawiec É, Oberlin M, Plaisance P, Pouyau R, Raherison C, Ray P, Schmidt M, Thille AW, Truchot J, Valdenaire G, Vaux J, Viglino D, Voiriot G, Vrignaud B, Jean S, Mariotte E, Claret PG. Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies. Ann Intensive Care 2019; 9:115. [PMID: 31602529 PMCID: PMC6787133 DOI: 10.1186/s13613-019-0584-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/21/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients. RESULTS The guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/-) and 7 a low level of evidence (GRADE 2+/-). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines. CONCLUSION The conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.
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Affiliation(s)
- Philippe Le Conte
- Service d’Accueil des Urgences, CHU de Nantes, 5 allée de l’île gloriette, 44093 Nantes Cedex 1, France
- PHU3, Faculté de Médecine 1, rue Gaston Veil, 44035 Nantes, France
| | - Nicolas Terzi
- Service de Médecine Intensive Réanimation, CHU de Grenoble Alpes, 38000 Grenoble, France
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
| | - Guillaume Mortamet
- Service de Réanimation Pédiatrique, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Fekri Abroug
- Service de réanimation, CHU de Monastir, Monastir, Tunisia
| | | | - Céline Charasse
- Pediatric Emergency Department, CHU Pellegrin Enfants, Bordeaux, France
| | - Anthony Chauvin
- Service des Urgences, Hôpital Lariboisière, APHP, Paris, France
| | - Xavier Combes
- Service des Urgences, CHU de la Réunion, Saint-Denis, France
| | - Stéphane Dauger
- Pediatric Intensive Care Unit, Robert Debré Hospital, APHP, Paris, France
| | - Alexandre Demoule
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France
| | | | - Stephan Ehrmann
- Médecine Intensive Réanimation, INSERM CIC 1415, réseau CRICS-TriggerSEP, CHRU de Tours and Centre d’Etude des Pathologies Respiratoires, INSERM U1100, faculté de médecine, Université de Tours, Tours, France
| | | | - Valérie Hamel
- Service des Urgences, CHU de Toulouse, Toulouse, France
| | - Boris Jung
- Service de MIR, CHU de Montpelliers, Montpellier, France
| | - Sabrina Kepka
- Service des Urgences, CHU de Strasbourg, Strasbourg, France
| | - Erwan L’Her
- Service de MIR, CHRU de Brest, Brest, France
| | - Mikaël Martinez
- Pôle Urgences, centre hospitalier du Forez, 42605 Montbrison, France
- Réseau d’urgence Ligérien Ardèche Nord (REULIAN), centre hospitalier Le Corbusier, 42700 Firminy, France
| | - Christophe Milési
- Département de Pédiatrie Néonatale et Réanimations, CHU de Montpellier, Montpellier, France
| | - Élise Morawiec
- Service de Pneumologie et Réanimation, GH Pitié-Salpêtrière, APHP, Paris, France
| | - Mathieu Oberlin
- Service des Urgences, centre hospitalier de Cahors, Cahors, France
| | | | - Robin Pouyau
- Pediatric Intensive Care Unit, Women‐Mothers and Children’s University Hospital, Lyon, France
| | | | - Patrick Ray
- Service des Urgences, CHU de Dijon, faculté de médecine de Dijon, Dijon, France
| | - Mathieu Schmidt
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié–Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651 Paris Cedex 13, France
| | - Arnaud W. Thille
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | | | | | - Julien Vaux
- SAMU 94, CHU Henri Mondor, AP-HP, Créteil, France
| | - Damien Viglino
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
- Service des Urgences Adultes, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Guillaume Voiriot
- Service de réanimation polyvalente, Hôpital Tenon, APHP, Paris, France
| | - Bénédicte Vrignaud
- Pediatric Emergency Department, Women and Children’, s University Hospital, Nantes, France
| | - Sandrine Jean
- Service de Réanimation Pédiatrique, APHP Hôpital Trousseau, 75012 Paris, France
| | - Eric Mariotte
- Service de Médecine Intensive Réanimation, APHP Hôpital Saint Louis, 75010 Paris, France
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Adeli M, El-Shareif T, Hendaus MA. Asthma exacerbation related to viral infections: An up to date summary. J Family Med Prim Care 2019; 8:2753-2759. [PMID: 31681638 PMCID: PMC6820381 DOI: 10.4103/jfmpc.jfmpc_86_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/01/2019] [Accepted: 08/27/2019] [Indexed: 12/21/2022] Open
Abstract
Asthma exacerbation can be a major life threatening event. Viruses have been pinned as the cause behind the vast majority of these exacerbations. The purpose of this short review is to explore the mechanisms behind these exacerbations, focusing mostly on viral infections as triggers. We will also be discussing the phenotypes prone to asthma exacerbation, the pathophysiology of viral induced asthma and ventilation patterns of asthmatic lungs. This manuscript will assist primary care physicians in delineating the proper pathophysiology of the disease as well as the management.
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Affiliation(s)
- Mehdi Adeli
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar.,Department of Pediatrics, Hamad General Corporation, Doha, Qatar.,Department of Clinical Pediatrics, Weill- Cornell Medicine, Doha, Qatar
| | | | - Mohamed A Hendaus
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar.,Department of Pediatrics, Hamad General Corporation, Doha, Qatar.,Department of Clinical Pediatrics, Weill- Cornell Medicine, Doha, Qatar
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22
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Bourdin A, Bjermer L, Brightling C, Brusselle GG, Chanez P, Chung KF, Custovic A, Diamant Z, Diver S, Djukanovic R, Hamerlijnck D, Horváth I, Johnston SL, Kanniess F, Papadopoulos N, Papi A, Russell RJ, Ryan D, Samitas K, Tonia T, Zervas E, Gaga M. ERS/EAACI statement on severe exacerbations in asthma in adults: facts, priorities and key research questions. Eur Respir J 2019; 54:13993003.00900-2019. [PMID: 31467120 DOI: 10.1183/13993003.00900-2019] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/17/2019] [Indexed: 01/05/2023]
Abstract
Despite the use of effective medications to control asthma, severe exacerbations in asthma are still a major health risk and require urgent action on the part of the patient and physician to prevent serious outcomes such as hospitalisation or death. Moreover, severe exacerbations are associated with substantial healthcare costs and psychological burden, including anxiety and fear for patients and their families. The European Academy of Allergy and Clinical Immunology (EAACI) and the European Respiratory Society (ERS) set up a task force to search for a clear definition of severe exacerbations, and to also define research questions and priorities. The statement includes comments from patients who were members of the task force.
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Affiliation(s)
- Arnaud Bourdin
- Université de Montpellier, CHU Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Leif Bjermer
- Dept of Respiratory Medicine and Allergy, Lung and Allergy research Unit, Lund, Sweden
| | - Christopher Brightling
- Dept of Infection, Immunity and Inflammation, Institute for Lung Health, NIHR BRC Respiratory Medicine, University of Leicester, Leicester, UK
| | - Guy G Brusselle
- Dept of Respiratory Diseases, Ghent University Hospital, Ghent, Belgium
| | | | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College, London, UK
| | - Adnan Custovic
- Dept of Paediatrics, Imperial College London, London, UK
| | - Zuzana Diamant
- Dept of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden.,Respiratory and Allergy Research, QPS Netherlands, The Netherlands
| | - Sarah Diver
- Dept of Respiratory Sciences, College of Life Sciences, Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Ratko Djukanovic
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Ildikó Horváth
- National Koranyi Institute for Pulmonology, and Dept of Public Health, Semmelweis University, Budapest, Hungary
| | | | | | - Nikos Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Dept, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Richard J Russell
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Dermot Ryan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.,Woodbrook Medical Centre, Loughborough, UK
| | | | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital, Athens, Greece
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23
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Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management. J Clin Med 2019; 8:jcm8091283. [PMID: 31443563 PMCID: PMC6780340 DOI: 10.3390/jcm8091283] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
Asthma is a chronic airway inflammatory disease that is associated with variable expiratory flow, variable respiratory symptoms, and exacerbations which sometimes require hospitalization or may be fatal. It is not only patients with severe and poorly controlled asthma that are at risk for an acute severe exacerbation, but this has also been observed in patients with otherwise mild or moderate asthma. This review discusses current aspects on the pathogenesis and pathophysiology of acute severe asthma exacerbations and provides the current perspectives on the management of acute severe asthma attacks in the emergency department and the intensive care unit.
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25
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Chen W, Johnson KM, FitzGerald JM, Sadatsafavi M, Leslie WD. Long-term effects of inhaled corticosteroids on bone mineral density in older women with asthma or COPD: a registry-based cohort study. Arch Osteoporos 2018; 13:116. [PMID: 30374631 DOI: 10.1007/s11657-018-0537-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/22/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED We assessed the association between long-term inhaled corticosteroid (ICS) use and bone mineral density (BMD) in older women with chronic respiratory disease. Women with > 50% adherence to ICS use had very slightly accelerated BMD loss at the total hip compared with those with lower or ICS use. INTRODUCTION This study evaluated the impact of long-term ICS therapy on bone loss in older women with asthma or chronic obstructive pulmonary disease (COPD). METHODS We used a population-based bone densitometry registry linked with administrative health data covering the province of Manitoba, Canada (1999-2013), to identify women aged > 40 years who had diagnosed asthma or COPD. ICS exposure was defined as cumulative dispensed days and medication possession ratio (MPR). Associations were examined both cross-sectionally and longitudinally, and results were covariate adjusted. RESULTS Among 6561 women with asthma and/or COPD (mean age 65 years [SD = 11]), compared to no ICS treatment, those in the highest tertile of prior ICS use (≥ 720 days) had lower BMD at the femoral neck (- 0.09 T-score, 95% CI - 0.16, - 0.02) and total hip (- 0.14 T-score, 95% CI - 0.22, - 0.05), but not at the lumbar spine. Over a mean of 5 years of follow-up, the highest tertile of ICS exposure (MPR > 0.5) was associated with a - 0.02 SD/year (95% CI - 0.04, - 0.01) greater decline in total hip BMD relative to non-users, with no significant effect at the femoral neck or lumbar spine. Middle and lower tertiles of ICS use were not associated with baseline or longitudinal change in BMD. CONCLUSIONS The highest tertile of ICS use was associated with a slightly lower hip BMD at baseline and slightly greater reduction in total hip BMD over time in older women with asthma or COPD. No adverse effects on BMD were seen from low to moderate ICS exposure.
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Affiliation(s)
- Wenjia Chen
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, 4th Floor, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Kate M Johnson
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, 4th Floor, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - J Mark FitzGerald
- Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, 4th Floor, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, 7th Floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, C5121, 409 Tache Avenue, St. Boniface General Hospital, Winnipeg, MB, R2H 2A6, Canada.
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26
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Suzuki C, Lopes da Silva N, Kumar P, Pathak P, Ong SH. Cost-effectiveness of omalizumab add-on to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting. J Med Econ 2017; 20:832-839. [PMID: 28532191 DOI: 10.1080/13696998.2017.1333513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Omalizumab add-on to standard-of-care therapy has proven to be efficacious in severe asthma patients for whom exacerbations cannot be controlled otherwise. Moreover, evidence from different healthcare settings suggests reduced healthcare resource utilization with omalizumab. Based on these findings, this study aimed to assess the cost-effectiveness of the addition of omalizumab to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting. METHODS A previously published Markov model was adapted using Brazil-specific unit costs to compare the costs and outcomes of the addition of omalizumab to standard-of-care therapy vs standard-of-care therapy alone. Model inputs were largely based on the eXpeRience study. Costs and health outcomes were calculated for lifetime-years and were annually discounted at 5%. Both one-way and probabilistic sensitivity analyses were performed. RESULTS An additional cost of R$280,400 for 5.20 additional quality-adjusted life-years was estimated with the addition of omalizumab to standard-of-care therapy, resulting in an incremental cost-effectiveness ratio of R$53,890. One-way sensitivity analysis indicated that discount rates, standard-of-care therapy exacerbation rates, and exacerbation-related mortality rates had the largest impact on incremental cost-effectiveness ratios. LIMITATIONS Assumptions of lifetime treatment adherence and rate of future exacerbations, independent of previous events, might affect the findings. The lack of Brazilian patients in the eXpeRience study may affect the findings, although sample size and baseline characteristics suggest that the modeled population closely resembles Brazilian severe allergic asthma patients. CONCLUSION Results indicate that omalizumab as an add-on therapy is more cost-effective than standard-of-care therapy alone for Brazilian patients with uncontrolled severe allergic asthma, based on the World Health Organization's cost-effectiveness threshold of up to 3-times the gross domestic product.
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Affiliation(s)
| | | | - Praveen Kumar
- b Novartis Healthcare Private Ltd , Hyderabad , India
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Doshi V, Shenoy S, Ganesh A, Lankala S, Henkle J. Near Fatal Asthma in an Inner City Population. Am J Ther 2017; 23:e1375-e1380. [PMID: 25285796 DOI: 10.1097/mjt.0000000000000152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Near-fatal asthma (NFA) is highly prevalent in inner city population. Patients who present with NFA require timely intervention, which necessitates knowledge of appropriate associated risk factors. The purpose of the study was to look and identify the salient features of an asthma exacerbation that are more likely to be associated with NFA in inner city population. We conducted a retrospective analysis of patients who were discharged from the hospital with a diagnosis of acute asthma exacerbation. Two hundred eighteen patients were included in the study. Patients who required intubation during the course of their hospitalization were defined as NFA and the rest were defined as non-near-fatal asthma (NNFA). Multiple patient parameters were compared between the 2 groups; 60 patients met the definition of NFA. There was no difference between NFA and NNFA groups with respect to sex, race, and history of smoking and asthma treatment modalities before presentation. NFA was seen more commonly in heroin (40% vs. 25.9%; P < 0.05) and cocaine users (28.3% vs. 16.5%; P < 0.05). A history of exacerbation requiring intensive care unit (ICU) care was more common among the NFA patients (55% vs. 40.5%; P = 0.05). A history of intubation for an exacerbation was more commonly seen in patients presenting with NFA (51.7% vs. 35.4%; P < 0.05). The NNFA group was more likely to have a primary care physician and to be discharged home (65.6% vs. 51.7%, P < 0.05; and 71.7 vs. 79.1%, P < 0.05). In a multi-logistic regression model, including age, sex, race, heroin and cocaine use, history of intubation and ICU admission, medications, use of noninvasive ventilation, primary care physician, and pH <7.35, PCO2 >45 mm Hg, and FiO2 >40% on initial blood gas, NFA was predicted only by PaCO2 >45 [odds ratio (OR = 6.7; P < 0.001)] and FiO2 >40% (OR = 3.5; P = 0.002). Use of noninvasive ventilation was a negative predictor of NFA (OR = 0.2; P < 0.001). Asthmatic patients who carry a history of intubation with mechanical ventilation for an asthma exacerbation, admissions to the ICU, or those who indulge in recreational drugs like cocaine or heroin should be closely monitored for clinical deterioration.
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Affiliation(s)
- Viral Doshi
- 1University of Oklahoma School of Medicine, Oklahoma City, OK; 2University of Arizona, Tucson, AZ; 3Banner Good Samaritan Hospital, Phoenix, AZ; and 4Division of Pulmonary and Critical Care Medicine, Southern Illinois University School of Medicine, Springfield, IL
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28
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To T, Zhu J, Williams DP, Feldman L, Simatovic J, Gershon A, Lougheed MD, Licskai C, Dell S. Frequency of health service use in the year prior to asthma death. J Asthma 2017; 53:505-9. [PMID: 27153342 DOI: 10.3109/02770903.2015.1064949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE High frequency health service use (HSU) is associated with poorly controlled asthma, and is a recognized risk factor for near-fatal or fatal asthma. The objective of this study was to describe the frequency of HSU in the year prior to asthma death. METHODS Individuals aged 0-99 years who died from asthma from April 1996 to December 2011 in Ontario, Canada were identified as cases. Cases were matched to 4-5 live asthma controls by age, sex, rural/urban residence, socioeconomic status, duration of asthma and a co-diagnosis of COPD. HSU records in the year prior to death [hospitalization, emergency department (ED) and outpatient visits] were assembled. The association of prior HSU and asthma death was measured by conditional logistic regression models. RESULTS From 1996 to 2011, 1503 individuals died from asthma. While the majority of cases did not have increased HSU as defined in the study, compared to matched live asthma controls, the cases were 8-fold more likely to have been hospitalized two or more times (OR = 7.60; 95% CI: 4.90, 11.77), 13-fold more likely to have had three or more ED visits (OR = 13.28; 95% CI: 7.55, 23.34) and 4-fold more likely to have had five or more physician visits for asthma (OR = 4.41; 95% CI: 3.58, 5.42). CONCLUSIONS Frequency of HSU in the year prior was substantially higher in those died from asthma. Specifically, more than one asthma hospital admission, three ED visits or five physician visits increased the asthma mortality risk substantially and exponentially.
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Affiliation(s)
- Teresa To
- a Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto , Canada .,b Institute for Clinical Evaluative Sciences , Toronto , Canada .,c Dalla Lana School of Public Health, University of Toronto , Toronto , Canada .,d Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Canada
| | - Jingqin Zhu
- a Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto , Canada .,b Institute for Clinical Evaluative Sciences , Toronto , Canada
| | - Devon P Williams
- a Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto , Canada
| | - Laura Feldman
- a Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto , Canada .,c Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
| | - Jacqueline Simatovic
- a Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto , Canada
| | - Andrea Gershon
- a Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto , Canada .,b Institute for Clinical Evaluative Sciences , Toronto , Canada .,d Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Canada .,e Sunnybrook Health Sciences Centre , Toronto , Canada
| | - M Diane Lougheed
- f ICES - Queen's , Kingston , Canada .,g Department of Medicine , Queen's University , Kingston , Canada , and
| | - Christopher Licskai
- h Schulich School of Medicine & Dentistry, Western University , London , Canada
| | - Sharon Dell
- a Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto , Canada .,d Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Canada
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Sanfu acupoint herbal patching for stable asthma: A systematic review and meta-analysis of randomised controlled trials. Complement Ther Med 2016; 30:40-53. [PMID: 28137526 DOI: 10.1016/j.ctim.2016.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 10/06/2016] [Accepted: 11/18/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Sanfu acupoint herbal patching (SAHP) is extensively used in people with stable asthma in China. However, the evidence available is scarce. This systematic review aims to evaluate the preventive and therapeutic effect and safety of SAHP in people with stable asthma. METHODS We searched seven electronic databases for randomised controlled trials (RCTs). The Cochrane risk of bias tool was utilised to evaluate the methodological quality of the included studies and RevMan 5.3 and GRADEpro 3.6.1 were applied to perform data analyses. RESULTS A total of 34 RCTs involving 3313 participants were included. The overall methodological quality of the trials was of high risk of bias. SAHP plus conventional therapy (CT) decreased the mean frequency (times per year) of asthma exacerbations compared with CT alone (MD: -1.42; 95% CI: -2.19 to -0.65; 7 RCTs), and similar effect was found for SAHP versus sham SAHP (MD: 0.42; 95%CI: 0.26-0.69; 1 RCT). For lung function (including PEF%, FEV1% and FEV1/FVC), SAHP plus CT showed better effect than CT alone, and so did SAHP versus sham SAHP on PEF and PEF%. Adverse effects in the SAHP groups were reported to be mild and well tolerated. CONCLUSIONS SAHP alone or combined with CT appears to be more effective than sham SAHP or CT on reduction of asthma exacerbations, improving lung function, and SAHP seems to be safe. However, the findings should be interpreted with caution due to limitations in trial quality. Further, rigorously designed, large-scale trials are warranted for robust evidence.
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D’Amato G, Vitale C, Molino A, Stanziola A, Sanduzzi A, Vatrella A, Mormile M, Lanza M, Calabrese G, Antonicelli L, D’Amato M. Asthma-related deaths. Multidiscip Respir Med 2016; 11:37. [PMID: 27752310 PMCID: PMC5059970 DOI: 10.1186/s40248-016-0073-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/17/2016] [Indexed: 11/10/2022] Open
Abstract
Despite major advances in the treatment of asthma and the development of several asthma guidelines, people still die of asthma currently. According to WHO estimates, approximately 250,000 people die prematurely each year from asthma. Trends of asthma mortality rates vary very widely across countries, age and ethnic groups. Several risk factors have been associated with asthma mortality, including a history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalization or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids (a marker of event severity), not currently using inhaled corticosteroids, a history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma. Preventable factors have been identified in the majority of asthma deaths. Inadequate education of patients on recognising risk and the appropriate action needed when asthma control is poor, deficiencies in the accuracy and timing of asthma diagnosis, inadequate classification of severity and treatment, seem to play a part in the majority of asthma deaths. Improvements in management, epitomized by the use of guided self-management systems of care may be the key goals in reducing asthma mortality worldwide.
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Affiliation(s)
- Gennaro D’Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Speciality “A. Cardarelli” Hospital, Napoli, Italy
| | - Carolina Vitale
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Antonio Molino
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Anna Stanziola
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Alessandro Sanduzzi
- Second Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | | | - Mauro Mormile
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Maurizia Lanza
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Giovanna Calabrese
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Leonardo Antonicelli
- Service of Immunoallergology, University Hospital “Ospedali Riuniti”, Ancona, Italy
| | - Maria D’Amato
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
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Yancey SW, Ortega HG, Keene ON, Mayer B, Gunsoy NB, Brightling CE, Bleecker ER, Haldar P, Pavord ID. Meta-analysis of asthma-related hospitalization in mepolizumab studies of severe eosinophilic asthma. J Allergy Clin Immunol 2016; 139:1167-1175.e2. [PMID: 27726946 DOI: 10.1016/j.jaci.2016.08.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 07/25/2016] [Accepted: 08/09/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies show that mepolizumab can reduce the frequency of clinically significant exacerbations in patients with severe eosinophilic asthma, compared with placebo. However, important events such as hospitalizations and emergency room visits are rare and difficult to characterize in single studies. OBJECTIVE We sought to compare hospitalization or hospitalization and/or emergency room visit rates in patients with severe eosinophilic asthma treated with mepolizumab or placebo in addition to standard of care for at least 24 weeks. METHODS This study was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. PubMed and the GSK Clinical Study Register were searched for suitable studies. The primary end points were the rate of exacerbations requiring hospitalization and the rate of exacerbations requiring hospitalization/emergency room visit. The proportion of patients with 1 or more event was also assessed. All mepolizumab doses were combined and individual patient-level data were analyzed. RESULTS Four studies (n = 1388) were eligible for inclusion. Mepolizumab significantly reduced the rate of exacerbations requiring hospitalization (relative rate, 0.49; 95% CI, 0.30-0.80; P = .004) and hospitalization/emergency room visit (relative rate, 0.49; 95% CI, 0.33-0.73; P < .001) versus placebo. Significant reductions of 45% and 38% were also observed for the proportion of patients experiencing 1 or more hospitalization and hospitalization and/or emergency room visit, respectively. CONCLUSIONS Mepolizumab approximately halved exacerbations requiring hospitalization and/or emergency room visits compared with placebo in patients with severe eosinophilic asthma. This treatment addresses a key outcome in a patient population with a high unmet need (GSK Study 204664).
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Affiliation(s)
- Steven W Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC.
| | - Hector G Ortega
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC
| | - Oliver N Keene
- Clinical Statistics, GSK, Stockley Park, Uxbridge, United Kingdom
| | - Bhabita Mayer
- Clinical Statistics, GSK, Stockley Park, Uxbridge, United Kingdom
| | - Necdet B Gunsoy
- Clinical Statistics, GSK, Stockley Park, Uxbridge, United Kingdom
| | | | - Eugene R Bleecker
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Pranabashis Haldar
- Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - Ian D Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Lugogo N, Domingo C, Chanez P, Leigh R, Gilson MJ, Price RG, Yancey SW, Ortega HG. Long-term Efficacy and Safety of Mepolizumab in Patients With Severe Eosinophilic Asthma: A Multi-center, Open-label, Phase IIIb Study. Clin Ther 2016; 38:2058-2070.e1. [PMID: 27553751 DOI: 10.1016/j.clinthera.2016.07.010] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/08/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Patients with severe eosinophilic asthma often experience recurrent asthma exacerbations despite intensive inhaled corticosteroid therapy. In 2 previous double-blind studies (MENSA [NCT01691521] and SIRIUS [NCT01691508]), treatment with intravenous or subcutaneous mepolizumab was associated with significantly reduced annualized exacerbation rates and oral corticosteroid (OCS) requirements compared with placebo. The purpose of this study was to assess the long-term safety and efficacy of subcutaneous mepolizumab treatment in patients with severe eosinophilic asthma. METHODS COSMOS was a 52-week, open-label extension study in patients who received mepolizumab or placebo in MENSA or SIRIUS. Patients received subcutaneous mepolizumab regardless of prior treatment allocation and continued to receive appropriate standard-of-care asthma therapy throughout. The primary objective was to assess the long-term safety of mepolizumab; end points included adverse events (AEs) and serious AEs (SAEs). Efficacy assessments included the annualized exacerbation rate and durability of response (defined as the exacerbation rate and OCS dose reduction when combined with MENSA and SIRIUS data, respectively). FINDINGS In total, 558 (86%; previous mepolizumab: 358; previous placebo: 200) and 94 (14%; previous mepolizumab: 58, previous placebo: 36) patients experienced on-treatment AEs and SAEs, respectively. No fatal AEs were reported. Totals of 13 (2%) and 29 (4%) patients experienced systemic and local site reactions, respectively. There were no reports of mepolizumab-related anaphylaxis. Mepolizumab treatment was shown to exert a durable response, with patients who previously received mepolizumab in MENSA or SIRIUS maintaining reductions in exacerbation rate and OCS dosing throughout COSMOS. Patients who previously received placebo in MENSA or SIRIUS demonstrated improvements in these end points following treatment with mepolizumab in COSMOS. IMPLICATIONS These data demonstrate a favorable safety profile of mepolizumab and indicate a durable and stable effect over time, supporting long-term treatment in patients with severe eosinophilic asthma. ClinicalTrials.gov identifier: NCT01842607.
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Affiliation(s)
- Njira Lugogo
- Duke Asthma, Allergy and Airway Center, Duke Medicine, Durham, North Carolina
| | - Christian Domingo
- Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pascal Chanez
- Respiratory Medicine, Inserm U1067, Aix-Marseille University, Marseille, France
| | - Richard Leigh
- Airways Inflammation Research Group, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martyn J Gilson
- Respiratory Therapeutic Area, GlaxoSmithKline, Stockley Park, Uxbridge, United Kingdom
| | - Robert G Price
- Clinical Statistics, GlaxoSmithKline, Stockley Park, Uxbridge, United Kingdom
| | - Steven W Yancey
- Respiratory Therapeutic Area, GlaxoSmithKline, Research Triangle Park, North Carolina.
| | - Hector G Ortega
- Respiratory Therapeutic Area, GlaxoSmithKline, Research Triangle Park, North Carolina
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McDowell KM, Kercsmar CM, Huang B, Guilbert TW, Kahn RS. Medical and Social Determinants of Health Associated with Intensive Care Admission for Asthma in Children. Ann Am Thorac Soc 2016; 13:1081-8. [PMID: 27144510 PMCID: PMC5015749 DOI: 10.1513/annalsats.201512-798oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/27/2016] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Risk factors for severe asthma exacerbations in children requiring admission to the intensive care unit (ICU) may occur in variety of medical, environmental, economic, and socioeconomic domains. OBJECTIVES We sought to characterize medical and sociodemographic risk factors among children who required admission to the intensive care unit for asthma. METHODS Data were obtained from the Greater Cincinnati Asthma Risk Study, a population-based, prospective, observational cohort of children admitted for treatment of acute asthma or bronchodilator-responsive wheezing. Data collected on 774 children included race, socioeconomic status, allergen sensitization, environmental exposures, psychosocial strain, and financial hardship. Analyses compared children admitted to the ICU to those admitted to a medical inpatient unit. MEASUREMENTS AND MAIN RESULTS One hundred sixty-one (20.9%) children required admission to intensive care. There was no difference in sex, race, insurance status, caregiver educational level, income, financial strain, psychological distress, or marital status between the ICU and non-ICU cohorts. Risk for medication nonadherence assessed by parent report was not different between groups. Although previous hospital admission or emergency department visit history did not differ between the groups, prior ICU admission was more common among those admitted to the ICU at the index admission (27 vs. 16%, P = 0.002). Children requiring intensive care admission were more likely to be sensitized to multiple aeroallergens. Exposure to cigarette smoke (measured as salivary cotinine), although a risk factor for hospital admission, was negatively associated with risk of ICU admission. CONCLUSIONS Social and economic risk factors typically predictive of increased asthma morbidity, including exposure to tobacco smoke, were not associated with ICU admission among a population of children admitted to the hospital for treatment of acute asthma. Intrinsic disease factors, including allergic sensitization, may be more important predictors of ICU admission.
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Affiliation(s)
| | | | - Bin Huang
- Department of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Robert S. Kahn
- Division of General and Community Pediatrics, Department of Pediatrics, and
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Moghaddas F, Smith C, Pilcher D, O'Hehir R, Hew M, Dabscheck E. Need for intensive care in patients admitted for asthma: Red flags from the social history. Respirology 2016; 21:1251-4. [PMID: 27321760 DOI: 10.1111/resp.12831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/03/2016] [Accepted: 03/13/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Asthma deaths in Australia are associated with illicit substance abuse, mental health problems and social issues. However, a large proportion of these deaths occurs out of hospital and is difficult to avert by the time the individuals seek medical attention. We hypothesized that these characteristics may also increase the risk for a patient to require intensive care admission when they present to emergency departments. METHODS We studied consecutive patients admitted to a tertiary metropolitan hospital with a primary diagnosis of asthma between January 2010 and January 2014. Clinical and demographical data were obtained from chart review. The patient's postcode was used as a surrogate for socioeconomic status. RESULTS There were 482 asthma patients admitted during the study period, of which 39 required intensive care. Ten patients admitted to intensive care (26%) used illicit drugs compared with 29 (7%) of those admitted to the ward (adjusted odds ratio: 3.6, P = 0.012). For illicit users, nonadherence to preventer therapy was associated with an even higher risk of intensive care unit admission. Socioeconomic index was lower in the group requiring intensive care admission. The frequency of psychiatric diagnoses was similar in both groups. CONCLUSION Among patients admitted to hospital for asthma, illicit substance abuse is a strong independent risk factor for intensive care requirement. Preventer therapy nonadherence further increases this risk. Lower socioeconomic status is also associated with increased risk. These historical features should be actively sought on admission and may serve as useful 'red flags' to prompt consideration of intensive monitoring.
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Affiliation(s)
- Fiona Moghaddas
- Allergy, Asthma and Clinical Immunology Service, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Catherine Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Pilcher
- Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Robyn O'Hehir
- Allergy, Asthma and Clinical Immunology Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eli Dabscheck
- Allergy, Asthma and Clinical Immunology Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Sekiya K, Nakatani E, Fukutomi Y, Kaneda H, Iikura M, Yoshida M, Takahashi K, Tomii K, Nishikawa M, Kaneko N, Sugino Y, Shinkai M, Ueda T, Tanikawa Y, Shirai T, Hirabayashi M, Aoki T, Kato T, Iizuka K, Homma S, Taniguchi M, Tanaka H. Severe or life-threatening asthma exacerbation: patient heterogeneity identified by cluster analysis. Clin Exp Allergy 2016; 46:1043-55. [PMID: 27041475 DOI: 10.1111/cea.12738] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Severe or life-threatening asthma exacerbation is one of the worst outcomes of asthma because of the risk of death. To date, few studies have explored the potential heterogeneity of this condition. OBJECTIVES To examine the clinical characteristics and heterogeneity of patients with severe or life-threatening asthma exacerbation. METHODS This was a multicentre, prospective study of patients with severe or life-threatening asthma exacerbation and pulse oxygen saturation < 90% who were admitted to 17 institutions across Japan. Cluster analysis was performed using variables from patient- and physician-orientated structured questionnaires. RESULTS Analysis of data from 175 patients with severe or life-threatening asthma exacerbation revealed five distinct clusters. Cluster 1 (n = 27) was younger-onset asthma with severe symptoms at baseline, including limitation of activities, a higher frequency of treatment with oral corticosteroids and short-acting beta-agonists, and a higher frequency of asthma hospitalizations in the past year. Cluster 2 (n = 35) was predominantly composed of elderly females, with the highest frequency of comorbid, chronic hyperplastic rhinosinusitis/nasal polyposis, and a long disease duration. Cluster 3 (n = 40) was allergic asthma without inhaled corticosteroid use at baseline. Patients in this cluster had a higher frequency of atopy, including allergic rhinitis and furred pet hypersensitivity, and a better prognosis during hospitalization compared with the other clusters. Cluster 4 (n = 34) was characterized by elderly males with concomitant chronic obstructive pulmonary disease (COPD). Although cluster 5 (n = 39) had very mild symptoms at baseline according to the patient questionnaires, 41% had previously been hospitalized for asthma. CONCLUSIONS & CLINICAL RELEVANCE This study demonstrated that significant heterogeneity exists among patients with severe or life-threatening asthma exacerbation. Differences were observed in the severity of asthma symptoms and use of inhaled corticosteroids at baseline, and the presence of comorbid COPD. These findings may contribute to a deeper understanding and better management of this patient population.
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Affiliation(s)
- K Sekiya
- Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan.,Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - E Nakatani
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Y Fukutomi
- Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
| | - H Kaneda
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - M Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - M Yoshida
- Department of Internal Medicine, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - K Takahashi
- Department of Respiratory Diseases and Chest Surgery, Otsu Red Cross Hospital, Otsu, Japan
| | - K Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - M Nishikawa
- Department of Respiratory Medicine, Fujisawa City Hospital, Fujisawa, Japan
| | - N Kaneko
- Department of Pulmonary Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Y Sugino
- Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan
| | - M Shinkai
- Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - T Ueda
- The Department of Respiratory Medicine, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Y Tanikawa
- Department of Respiratory Medicine and Clinical Immunology, Toyota Kosei Hospital, Toyota, Japan
| | - T Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - M Hirabayashi
- Department of Respiratory Diseases, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - T Aoki
- Department of Internal Medicine, Respiratory Division, Tokai University School of Medicine, Isehara, Japan
| | - T Kato
- Department of Respiratory Medicine and Allergology, Kariya Toyota General Hospital, Kariya, Japan
| | - K Iizuka
- Internal Medicine, Public Tomioka General Hospital, Tomioka, Japan
| | - S Homma
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - M Taniguchi
- Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
| | - H Tanaka
- NPO Sapporo Cough Asthma and Allergy Center, Sapporo, Japan
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Raherison C, Bourdin A, Bonniaud P, Deslée G, Garcia G, Leroyer C, Taillé C, De Blic J, Dubus JC, Tillié-Leblond I, Chanez P. Updated guidelines (2015) for management and monitoring of adult and adolescent asthmatic patients (from 12 years and older) of the Société de Pneumologie de Langue Française (SPLF) (Full length text). Rev Mal Respir 2016; 33:279-325. [PMID: 27147308 DOI: 10.1016/j.rmr.2016.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Raherison
- Inserm U1219, ISPED, service des maladies respiratoires, pôle cardio-thoracique, CHU de Bordeaux, université de Bordeaux, 33000 Bordeaux, France.
| | - A Bourdin
- Inserm U1046, département de pneumologie et addictologie, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, université Montpellier 1, 34000 Montpellier, France
| | - P Bonniaud
- Inserm U866, service de pneumologie et soins intensifs respiratoires, CHU de Bourgogne, université de Bourgogne, 21079 Dijon, France
| | - G Deslée
- Service de pneumologie, CHU Maison-Blanche, université de Reims - Champagne-Ardennes, 51000 Reims, France
| | - G Garcia
- Inserm, UMRS 999, service de pneumologie, département hospitalo-universitaire (DHU) thorax innovation, hôpital de Bicêtre, Centre national de référence de l'hypertension pulmonaire sévère, faculté de médecine, université Paris-Sud, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - C Leroyer
- Département de médecine interne et de pneumologie, CHU de la Cavale-Blanche, université de Bretagne Occidentale, 29000 Brest, France
| | - C Taillé
- Service de pneumologie, département hospitalo-universitaire FIRE, centre de compétence des maladies pulmonaires rares, hôpital Bichat, université Paris-Diderot, AP-HP, 75018 Paris, France
| | - J De Blic
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants-Malades, 75743 Paris, France
| | - J-C Dubus
- Unité de pneumologie et médecine infantile, hôpital Nord, 13000 Marseille, France
| | - I Tillié-Leblond
- Service de pneumo-allergologie, CHRU de Lille, 59000 Lille, France
| | - P Chanez
- UMR 7333 Inserm U 1067, service de pneumologie, hôpital Nord, université Aix Marseille, AP-HM, 13000 Marseille, France
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38
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Wang Z, May SM, Charoenlap S, Pyle R, Ott NL, Mohammed K, Joshi AY. Effects of secondhand smoke exposure on asthma morbidity and health care utilization in children: a systematic review and meta-analysis. Ann Allergy Asthma Immunol 2015; 115:396-401.e2. [DOI: 10.1016/j.anai.2015.08.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/25/2015] [Accepted: 08/03/2015] [Indexed: 01/29/2023]
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 527] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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Assessing the risks and benefits of step-down asthma care: a case-based approach. Curr Allergy Asthma Rep 2015; 15:503. [PMID: 25687171 DOI: 10.1007/s11882-014-0503-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Guidelines have called for pharmacologic stepped care to improve asthma treatment. Therapeutic options which have been approved provide physicians and their patients alternatives for stepping up asthma treatment to achieve control. However, few studies have been performed to identify and characterize procedures for optimal stepping-down treatment in patients with asthma. The resulting uncertainty as well as a lack of prioritization for asthma reassessment once control has been maintained has led to a lack of well-defined procedures for stepping down asthma treatment. However, recent studies provide guidance regarding the risks of stepping down asthma medications. This review uses case-based examples to demonstrate how health care providers may engage patients in discussions regarding guideline recommendations to promote individualized asthma care.
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Abstract
KEY POINTS The 2014 UK National Review of Asthma Deaths identified potentially preventable factors in two-thirds of the medical records of cases scrutinised45% of people who died from asthma did not call for or receive medical assistance in their final fatal attackOverall asthma management, acute and chronic, in primary and secondary care was judged to be good in less than one-fifth of those who diedThere was a failure by doctors and nurses to identify and act on risk factors for asthma attacks and asthma deathThe rationale for diagnosing asthma was not evident in a considerable number of cases, and there were inaccuracies related to the completion of medical certificates of the cause of death in over half of the cases considered for the UK National Review of Asthma Deaths. EDUCATIONAL AIMS To increase awareness of some of the findings of the recent UK National Review of Asthma Deaths and previous similar studiesTo emphasise the need for accurate diagnosis of asthma, and of the requirements for completion of medical certificates of the cause of deathTo consider areas for improving asthma care and prevention of attacks and avoidable deaths. SUMMARY Despite the development and publication of evidence-based asthma guidelines nearly three decades ago, potentially preventable factors are repeatedly identified in studies of the care provided for patients who die from asthma. The UK National Review of Asthma Deaths (NRAD), a confidential enquiry, was no exception: major preventable factors were identified in two-thirds of asthma deaths. Most of these factors, such as inappropriate prescription and failure to provide patients with personal asthma action plans (PAAPs), could possibly have been prevented had asthma guidelines been implemented. NRAD involved in-depth scrutiny by clinicians of the asthma care for 276 people who were classified with asthma as the underlying cause of death in real-life. A striking finding was that a third of these patients did not actually die from asthma, and many had no recorded rationale for an asthma diagnosis. The apparent complacency with respect to asthma care, highlighted in NRAD, serves as a wake-up call for health professionals, patients and their carers to take asthma more seriously. Based on the NRAD evidence, the report made 19 recommendations for change. The author has selected six areas related to the NRAD findings for discussion and provides suggestions for change in the provision of asthma care. The six areas are: systems for provision and optimisation of asthma care, diagnosis, identifying risk, implementation of guidelines, improved patient education and self-management, and improved quality of completion of medical certificates of the cause of death.
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Kenyon CC, Fieldston ES, Luan X, Keren R, Zorc JJ. Safety and effectiveness of continuous aerosolized albuterol in the non-intensive care setting. Pediatrics 2014; 134:e976-82. [PMID: 25266428 DOI: 10.1542/peds.2014-0907] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the design features, utilization, and outcomes of a protocol treating children with status asthmaticus with continuous albuterol in the inpatient setting. METHODS We performed a retrospective cohort analysis of children ages 2 to 18 treated in the non-intensive care, inpatient setting on a standardized treatment protocol for status asthmaticus from July 2011 to June 2013. We assessed characteristics associated with continuous albuterol therapy and, for those treated, duration of therapy and the proportion who clinically deteriorated (ICU transfer or progression to enhanced respiratory support) or who were identified as having hypokalemia or an arrhythmia. Using multivariable logistic regression, we determined which factors were associated with clinical deterioration or prolonged (>24 hours) continuous albuterol. RESULTS Of 3003 children meeting study criteria, 1298 (43%) received continuous albuterol. Older age, black race, lower initial oxygen saturation, and higher initial age-standardized heart rate and respiratory rate were associated with initiation of continuous albuterol therapy (P < .001 for all). Median duration of therapy was 14.4 hours (interquartile range, 7.7, 24.6); 340 children (26%) experienced prolonged therapy. Seventy children (5%) experienced clinical deterioration, and 33 children (3%) had identified hypokalemia or arrhythmia. Comorbid pneumonia and emergency department administration of intravenous magnesium or subcutaneous terbutaline were associated with prolonged therapy and clinical deterioration. CONCLUSIONS With appropriate support structures and care processes, continuous albuterol can be delivered effectively in the non-ICU, inpatient setting with low rates of adverse outcomes. Certain initial clinical characteristics may help identify patients needing more intensive therapy.
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Affiliation(s)
- Chén C Kenyon
- Divisions of General Pediatrics, Center for Pediatric Clinical Effectiveness, and
| | - Evan S Fieldston
- Divisions of General Pediatrics, Center for Pediatric Clinical Effectiveness, and
| | - Xianqun Luan
- Divisions of General Pediatrics, Center for Pediatric Clinical Effectiveness, and
| | - Ron Keren
- Divisions of General Pediatrics, Center for Pediatric Clinical Effectiveness, and
| | - Joseph J Zorc
- Division of Emergency Medicine, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Al-Dorzi HM, Al-Shammary HA, Al-Shareef SY, Tamim HM, Shammout K, Al Dawood A, Arabi YM. Risk factors, management and outcomes of patients admitted with near fatal asthma to a tertiary care hospital in Riyadh. Ann Thorac Med 2014; 9:33-8. [PMID: 24551016 PMCID: PMC3912685 DOI: 10.4103/1817-1737.124441] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 09/12/2013] [Indexed: 11/23/2022] Open
Abstract
RATIONALE: Near-fatal asthma (NFA) has not been well studied in Saudi Arabia. We evaluated NFA risk factors in asthmatics admitted to a tertiary-care hospital and described NFA management and outcomes. MATERIALS AND METHODS: This was a retrospective study of NFA patients admitted to an ICU in Riyadh (2006-2010). NFA was defined as a severe asthma attack requiring intubation. To evaluate NFA risk factors, randomly selected patients admitted to the ward for asthma exacerbation were used as controls. Collected data included demographics, information on prior asthma control and various NFA treatments and outcomes. RESULTS: Thirty NFA cases were admitted to the ICU in the five-year period. Compared to controls (N = 120), NFA patients were younger (37.5 ± 19.9 vs. 50.3 ± 23.1 years, P = 0.004) and predominantly males (70.0% vs. 41.7%, P = 0.005) and used less inhaled steroids/long-acting ß2-agonists combination (13.6% vs. 38.7% P = 0.024. Most (73.3%) NFA cases presented in the cool months (October-March). On multivariate analysis, age (odds ratio [OR] 0.96; 95% confidence interval [CI], 0.92-0.99, P = 0.015) and the number of ED visits in the preceding year (OR, 1.25; 95% CI, 1.00-1.55) were associated with NFA. Rescue NFA management included ketamine (50%) and theophylline (19%) infusions. NFA outcomes included: neuromyopathy (23%), mechanical ventilation duration = 6.4 ± 4.7 days, tracheostomy (13%) and mortality (0%). Neuromuscular blockade duration was associated with neuromyopathy (OR, 3.16 per one day increment; 95% CI, 1.27-7.83). CONCLUSIONS: In our study, NFA risk factors were younger age and higher number of ED visits. NFA had significant morbidity. Reducing neuromuscular blockade duration during ventilator management may decrease neuromyopathy risk.
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Affiliation(s)
- Hasan M Al-Dorzi
- Department of Intensive Care, King Abdulaziz Medical City and College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
| | - Haifa A Al-Shammary
- Nursing College, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
| | - Salha Y Al-Shareef
- Nursing College, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
| | - Hani M Tamim
- Department of Epidemiology and Biostatistics, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
| | - Khaled Shammout
- Department of Intensive Care, King Abdulaziz Medical City and College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
| | - Abdulaziz Al Dawood
- Department of Intensive Care, King Abdulaziz Medical City and College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
| | - Yaseen M Arabi
- Department of Intensive Care, King Abdulaziz Medical City and College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
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Mourad ST, Elganady AA, Mohamed EE, Elgammal AM. Assessment of the effect of implementation of global initiatives for asthma (GINA) guidelines in the outcome of asthma exacerbation in the emergency department. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2012. [DOI: 10.1016/j.ejcdt.2012.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Carroll CL, Sala KA, Zucker AR, Schramm CM. β2-adrenergic receptor haplotype linked to intubation and mechanical ventilation in children with asthma. J Asthma 2012; 49:563-8. [PMID: 22793522 DOI: 10.3109/02770903.2012.701362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIMS Children with asthma and respiratory failure comprise a small but significant subset of children with acute asthma. In addition to clinical and historical factors that have been associated with respiratory failure, there may also be genetic factors that predispose some asthmatic children to intubation and mechanical ventilation. However, this has not previously been assessed in this population. We hypothesized that genetic polymorphisms of the β(2)-adrenergic receptor (ADRβ(2)) are associated with intubation and mechanical ventilation in children with asthma. MATERIALS AND METHODS We performed genotyping of the ADRβ(2) in a pooled cohort of 104 children admitted to the intensive care unit (ICU) with a severe asthma exacerbation between 2002 and 2008. Genotype of the ADRβ(2) was compared with intubation for respiratory failure. RESULTS At amino acid position 16, 33% (n = 34) of children were homozygous for the glycine allele (Gly16Gly), 15% (n = 16) were homozygous for the arginine allele (Arg16Arg), and 52% (n = 54) were heterozygous (Arg16Gly). At amino acid position 27, 54% (n = 56) of children were homozygous for the glutamine allele (Gln27Gln), 8% (n = 8) were homozygous for the glutamic acid allele (Glu27Glu), and 38% (n = 40) were heterozygous (Gln27Glu). The haplotypes at these positions were Arg16Gly-Gln27Gln (29%, n = 30), Arg16Gly-Gln27Glu (22%, n = 23), Gly16Gly-Gln27Glu (16%, n = 17), Arg16Arg-Gln27Gln (16%, n = 17), Gly16Gly-Gln27Gln (9%, n = 9), and Gly16Gly-Glu27Glu (8%, n = 8). Twelve children in this cohort were intubated for respiratory failure. Intubation was not associated with age, obesity, race/ethnicity, or NHBLI asthma classification. However, children with the Arg16Gly-Gln27Gln haplotype were significantly more likely to be intubated and mechanical ventilated (OR = 4.2; 95% CI = 1.2-14.5; p = .036) than children with other haplotypes of the ADRβ(2). When examining the subset of intubated children, those with the Arg16Gly-Gln27Gln haplotype trended towards longer ICU length of stay (329 ± 270 vs. 124 ± 57 hours; p = .09), but this was not statistically significant. CONCLUSIONS Children with the Arg16Gly-Gln27Gln haplotype of the ADRβ(2) were four times more likely to be intubated and mechanically ventilated during severe asthma exacerbations. Genetic factors may influence the development of a more severe asthma phenotype during acute exacerbations.
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Affiliation(s)
- Christopher L Carroll
- Department of Pediatrics, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA.
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Abstract
While asthma is extremely common, fatal and near fatal asthma is rare and often preventable if there is early recognition of symptom progression and appropriate intervention. In the past decade, asthma mortality has progressively declined in association with the widespread use of inhaled corticosteroids and asthma care plans. Management of life threatening asthma requires patient education to ensure the proper use of medications and to enable the patient to recognize when additional therapy for poorly controlled asthma is required. There is some evidence that suggests that the overly aggressive use of asthma medications when treating a severe exacerbation may contribute to morbidity. Because of the risks of air trapping and barotrauma associated with partial airway obstruction, it is best to avoid mechanical ventilation if possible but when this is used, low tidal volumes, longer exhalation times, and permissive hypercarbia can minimize these risks. There is the promise that a better understanding of asthma immunology and severe asthma "phenotypes" will lead to better prevention and therapy.
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Affiliation(s)
- Bruce K Rubin
- Virginia Commonwealth University Department of Pediatrics and the Children's Hospital of Richmond, Richmond, VA 23298, USA.
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Akinbami LJ, Sullivan SD, Campbell JD, Grundmeier RW, Hartert TV, Lee TA, Smith RA. Asthma outcomes: healthcare utilization and costs. J Allergy Clin Immunol 2012; 129:S49-64. [PMID: 22386509 PMCID: PMC4277846 DOI: 10.1016/j.jaci.2011.12.984] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 12/23/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Measures of healthcare utilization and indirect impact of asthma morbidity are used to assess clinical interventions and estimate cost. OBJECTIVE National Institutes of Health institutes and other federal agencies convened an expert group to propose standardized measurement, collection, analysis, and reporting of healthcare utilization and cost outcomes in future asthma studies. METHODS We used comprehensive literature reviews and expert opinion to compile a list of asthma healthcare utilization outcomes that we classified as core (required in future studies), supplemental (used according to study aims and standardized), and emerging (requiring validation and standardization). We also have identified methodology to assign cost to these outcomes. This work was discussed at an National Institutes of Health-organized workshop in March 2010 and finalized in September 2011. RESULTS We identified 3 ways to promote comparability across clinical trials for measures of healthcare utilization, resource use, and cost: (1) specify the study perspective (patient, clinician, payer, and society); (2) standardize the measurement period (ideally 12 months); and (3) use standard units to measure healthcare utilization and other asthma-related events. CONCLUSIONS Large clinical trials and observational studies should collect and report detailed information on healthcare utilization, intervention resources, and indirect impact of asthma, so that costs can be calculated and cost-effectiveness analyses can be conducted across several studies. Additional research is needed to develop standard, validated survey instruments for collection of provider-reported and participant-reported data regarding asthma-related health care.
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Affiliation(s)
- Lara J Akinbami
- National Center for Health Statistics, Center for Disease Control and Prevention, Hyattsville, MD, USA
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Bruzzese JM, Stepney C, Fiorino EK, Bornstein L, Wang J, Petkova E, Evans D. Asthma self-management is sub-optimal in urban Hispanic and African American/black early adolescents with uncontrolled persistent asthma. J Asthma 2011; 49:90-7. [PMID: 22149141 DOI: 10.3109/02770903.2011.637595] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Youth as young as 11 are given responsibility to manage their asthma. Yet, little is known regarding early adolescents' asthma self-management behaviors. This study characterizes urban early adolescents' asthma self-management behaviors and perceived responsibility to manage asthma, exploring demographic differences and examining the relationship between asthma responsibility and disease management. METHODS About 317 Hispanic and African American/Black early adolescents (mean age = 12.71) with persistent, uncontrolled asthma reported prevention and symptom management steps, and responsibility for asthma care. We used Poisson, cumulative logistic, logistic, and linear mixed-effects regression models to assess the relationships among demographic predictors, prevention and management behaviors, and responsibility for asthma care. RESULTS Fifty percent took 7-9 prevention steps; few saw physicians when asymptomatic or took daily medication. When symptomatic, 92% used medication to treat symptoms and 56% sought medical attention. Controlling for asthma responsibility, fewer older youth reported observing how they feel when asthma is likely to start, observing symptom changes, or asking for help. More boys reported taking medication daily or upon trigger exposure. Controlling for age, gender, and race/ethnicity, those reporting more asthma responsibility were less likely to report taking management steps, seeking preventive care, asking for help, or going to a doctor/hospital for their asthma. CONCLUSIONS Early adolescents' asthma self-management is suboptimal. With increasing age, they are less observant regarding their asthma and less likely to seek help. Although they perceive themselves to have greater responsibility for managing their asthma, early adolescents do less to care for their asthma, suggesting they are being given responsibility for asthma care prematurely.
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Affiliation(s)
- Jean-Marie Bruzzese
- Department of Child and Adolescent Psychiatry, NYU Child Study Center, New York University School of Medicine, New York, NY 10016, USA.
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Abstract
Asthma is a common disease encountered in internal medicine practice. In most cases, the diagnosis and management of asthma is straightforward; however, the management of severe asthma may require subspecialty consultation. Abnormal responses of resident cells to infections and antigens may cause asthma in early life and may chronically perpetuate asthma. The natural history of asthma remains poorly understood. In this article, the authors focus on the diagnosis and management of asthma in adults.
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Affiliation(s)
- Rodolfo M Pascual
- Section on Pulmonary, Critical Care, Allergy & Immunologic Diseases, Department of Internal Medicine, Center for Genomics and Personalized Medicine Research, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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