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Lazarinis N, Bossios A, Gülen T. COVID-19 vaccination in the setting of mastocytosis-Pfizer-BioNTech mRNA vaccine is safe and well tolerated. J Allergy Clin Immunol Pract 2022; 10:1377-1379. [PMID: 35123098 PMCID: PMC8810433 DOI: 10.1016/j.jaip.2022.01.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Nikolaos Lazarinis
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Apostolos Bossios
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Mastocytosis Center Karolinska, Karolinska Institutet and Karolinska University, Hospital Huddinge, Stockholm, Sweden.
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2
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Eger K, Paroczai D, Bacon A, Schleich F, Sergejeva S, Bourdin A, Vachier I, Zervas E, Katsoulis K, Papapetrou D, Kostikas K, Csoma Z, Heffler E, Canonica GW, Grisle I, Bieksiene K, Palacionyte J, Ten Brinke A, Hashimoto S, Smeenk FWJM, Braunstahl GJ, van der Sar S, Mihălţan F, Nenasheva N, Peredelskaya M, Zvezdin B, Čekerevac I, Hromiš S, Ćupurdija V, Lazic Z, Milenkovic B, Dimic-Janjic S, Yasinska V, Dahlén B, Bossios A, Lazarinis N, Aronsson D, Egesten A, Munir AKM, Ahlbeck L, Janson C, Škrgat S, Edelbaher N, Leuppi J, Jaun F, Rüdiger J, Pavlov N, Gianella P, Fischer R, Charbonnier F, Chaudhuri R, Smith SJ, Doe S, Fawdon M, Masoli M, Heaney L, Haitchi HM, Kurukulaaratchy R, Fulton O, Frankemölle B, Gibson T, Needham K, Howarth P, Djukanovic R, Bel E, Hyland M. The effect of the COVID-19 pandemic on severe asthma care in Europe: will care change for good? ERJ Open Res 2022; 8:00065-2022. [PMID: 35582679 PMCID: PMC8994963 DOI: 10.1183/23120541.00065-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has put pressure on healthcare services, forcing the reorganisation of traditional care pathways. We investigated how physicians taking care of severe asthma patients in Europe reorganised care, and how these changes affected patient satisfaction, asthma control and future care. Methods In this European-wide cross-sectional study, patient surveys were sent to patients with a physician-diagnosis of severe asthma, and physician surveys to severe asthma specialists between November 2020 and May 2021. Results 1101 patients and 268 physicians from 16 European countries contributed to the study. Common physician-reported changes in severe asthma care included use of video/phone consultations (46%), reduced availability of physicians (43%) and change to home-administered biologics (38%). Change to phone/video consultations was reported in 45% of patients, of whom 79% were satisfied or very satisfied with this change. Of 709 patients on biologics, 24% experienced changes in biologic care, of whom 92% were changed to home-administered biologics and of these 62% were satisfied or very satisfied with this change. Only 2% reported worsening asthma symptoms associated with changes in biologic care. Many physicians expect continued implementation of video/phone consultations (41%) and home administration of biologics (52%). Conclusions Change to video/phone consultations and home administration of biologics was common in severe asthma care during the COVID-19 pandemic and was associated with high satisfaction levels in most but not all cases. Many physicians expect these changes to continue in future severe asthma care, though satisfaction levels may change after the pandemic.
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Affiliation(s)
- Katrien Eger
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Co-first authors
| | - Dora Paroczai
- Csongrad County Hospital and Dept of Pulmonology, University of Szeged, Szeged, Hungary
- Co-first authors
| | - Alison Bacon
- School of Psychology, University of Plymouth, Plymouth, UK
| | | | | | - Arnaud Bourdin
- PhyMedExp, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Isabelle Vachier
- PhyMedExp, CHU Montpellier, University of Montpellier, Montpellier, France
| | | | | | | | | | - Zsuzsanna Csoma
- National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital - Rozzano (MI), Italy
- Departmento of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital - Rozzano (MI), Italy
- Departmento of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | | | | | | | | | - Simone Hashimoto
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | - Natalia Nenasheva
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Marina Peredelskaya
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Biljana Zvezdin
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- Medical Faculty Novi Sad, University of Novi Sad, Bucharest, Romania
| | - Ivan Čekerevac
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sanja Hromiš
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Vojislav Ćupurdija
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Zorica Lazic
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Branislava Milenkovic
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade Medical faculty, Belgrade, Serbia
| | - Sanja Dimic-Janjic
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade Medical faculty, Belgrade, Serbia
| | - Valentyna Yasinska
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Dahlén
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Apostolos Bossios
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Nikolaos Lazarinis
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - David Aronsson
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Arne Egesten
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Abul Kashem Mohammad Munir
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Christer Janson
- Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sabina Škrgat
- Dept for Pulmonary Diseases, University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Joerg Leuppi
- Medical Faculty University of Basel and Cantonal Hospital Baselland, Liestal, Switzerland
| | - Fabienne Jaun
- Medical Faculty University of Basel and Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - Nikolay Pavlov
- Dept of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | | | - Simon Doe
- Royal Victoria Infirmary, Newcastle, UK
| | | | | | - Liam Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, Queens University Belfast, Belfast, UK
| | | | | | | | | | | | | | - Peter Howarth
- Global Medical Affairs, Specialty Medicine TA, GSK, Brentford, UK
| | | | - Elisabeth Bel
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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3
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Gauvreau GM, Davis BE, Scadding G, Boulet LP, Bjermer L, Chaker A, Cockcroft DW, Dahlén B, Fokkens W, Hellings P, Lazarinis N, O'Byrne PM, Tufvesson E, Quirce S, Van Maaren M, de Jongh FH, Diamant Z. Allergen Provocation Tests in Respiratory Research: Building on 50 Years of Experience. Eur Respir J 2022; 60:13993003.02782-2021. [PMID: 35086834 PMCID: PMC9403392 DOI: 10.1183/13993003.02782-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022]
Abstract
Allergen provocation test is an established model of allergic airway diseases, including asthma and allergic rhinitis, allowing the study of allergen-induced changes in respiratory physiology and inflammatory mechanisms in sensitised individuals as well as their associations. In the upper airways, allergen challenge is focused on the clinical and pathophysiological sequelae of the early allergic response and applied both as a diagnostic tool and in research settings. In contrast, the bronchial allergen challenge has almost exclusively served as a research tool in specialised research settings with a focus on the late asthmatic response and the underlying type 2 inflammation. The allergen-induced late asthmatic response is also characterised by prolonged airway narrowing, increased non-specific airway hyperresponsiveness and features of airway remodelling including the small airways, and hence, allows the study of several key mechanisms and features of asthma. In line with these characteristics, the allergen challenge has served as a valued tool to study the crosstalk of the upper and lower airways and in proof of mechanism studies of drug development. In recent years, several new insights into respiratory phenotypes and endotypes including the involvement of the upper and small airways, innovative biomarker sampling methods and detection techniques, refined lung function testing as well as targeted treatment options, further shaped the applicability of the allergen provocation test in precision medicine. These topics, along with descriptions of subject populations and safety, in line with the updated GINA2021, will be addressed in this paper.
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Affiliation(s)
- Gail M Gauvreau
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Beth E Davis
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Guy Scadding
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, University of Laval, Laval, Quebec, Canada
| | - Leif Bjermer
- Department of Clinical Sciences Lund, Respiratory medicine and Allergology, Lund University, Lund, Sweden
| | - Adam Chaker
- TUM School of Medicine, Dept. of Otolaryngology and Center of Allergy and Environment, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Donald W Cockcroft
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Barbro Dahlén
- Department of Medicine, Huddinge Karolinska Institutet, Stockholm, Sweden
| | - Wyste Fokkens
- Department of Otorhinolaryngology, Faculty of Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Hellings
- Department of Otorhinolaryngology, Faculty of Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Nikolaos Lazarinis
- Department of Medicine, Huddinge Karolinska Institutet, Stockholm, Sweden
| | - Paul M O'Byrne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ellen Tufvesson
- Department of Clinical Sciences Lund, Respiratory medicine and Allergology, Lund University, Lund, Sweden
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, and CIBER de Enfermedades Respiratorias CIBERES, Madrid, Spain
| | | | - Frans H de Jongh
- Faculty of Engineering Technology, University of Twente, Enschede, Netherlands
| | - Zuzana Diamant
- Department of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium.,Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden.,Department of Pharmacology & Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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4
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Tada I, Chaleckis R, Tsugawa H, Meister I, Zhang P, Lazarinis N, Dahlén B, Wheelock CE, Arita M. Correlation-Based Deconvolution (CorrDec) To Generate High-Quality MS2 Spectra from Data-Independent Acquisition in Multisample Studies. Anal Chem 2020; 92:11310-11317. [PMID: 32648737 DOI: 10.1021/acs.analchem.0c01980] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Data-independent acquisition mass spectrometry (DIA-MS) is essential for information-rich spectral annotations in untargeted metabolomics. However, the acquired MS2 spectra are highly complex, posing significant annotation challenges. We have developed a correlation-based deconvolution (CorrDec) method that uses ion abundance correlations in multisample studies using DIA-MS as an update of our MS-DIAL software. CorrDec is based on the assumption that peak intensities of precursor and fragment ions correlate across samples and exploits this quantitative information to deconvolute complex DIA spectra. CorrDec clearly improved deconvolution of the original MS-DIAL deconvolution method (MS2Dec) in a dilution series of chemical standards and a 224-sample urinary metabolomics study. The primary advantage of CorrDec over MS2Dec is the ability to discriminate coeluting low-abundance compounds. CorrDec requires the measurement of multiple samples to successfully deconvolute DIA spectra; however, our randomized assessment demonstrated that CorrDec can contribute to studies with as few as 10 unique samples. The presented methodology improves compound annotation and identification in multisample studies and will be useful for applications in large cohort studies.
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Affiliation(s)
- Ipputa Tada
- Department of Genetics, The Graduate University for Advanced Studies, SOKENDAI, 1111 Yata, Mishima, Shizuoka 411-8540, Japan
| | - Romanas Chaleckis
- Gunma University Initiative for Advanced Research (GIAR), Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan.,Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, 171-77, Sweden
| | - Hiroshi Tsugawa
- RIKEN Center for Sustainable Resource Science, 1-7-22, Suehiro, Tsurumi, Yokohama, Kanagawa 240-0045, Japan.,RIKEN Center for Integrative Medical Sciences, 1-7-22, Suehiro, Tsurumi, Yokohama, Kanagawa 240-0045, Japan
| | - Isabel Meister
- Gunma University Initiative for Advanced Research (GIAR), Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan.,Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, 171-77, Sweden
| | - Pei Zhang
- Gunma University Initiative for Advanced Research (GIAR), Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan.,Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, 171-77, Sweden
| | - Nikolaos Lazarinis
- Division of Respiratory Medicine and Allergy, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, 141-86, Sweden
| | - Barbro Dahlén
- Division of Respiratory Medicine and Allergy, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, 141-86, Sweden
| | - Craig E Wheelock
- Gunma University Initiative for Advanced Research (GIAR), Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan.,Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, 171-77, Sweden
| | - Masanori Arita
- RIKEN Center for Sustainable Resource Science, 1-7-22, Suehiro, Tsurumi, Yokohama, Kanagawa 240-0045, Japan.,National Institute of Genetics, 1111 Yata, Mishima, Shizuoka 411-8540, Japan
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5
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Gauvreau GM, Arm JP, Boulet LP, Leigh R, Cockcroft DW, Davis BE, Mayers I, FitzGerald JM, Dahlen B, Killian KJ, Laviolette M, Carlsten C, Lazarinis N, Watson RM, Milot J, Swystun V, Bowen M, Hui L, Lantz AS, Meiser K, Maahs S, Lowe PJ, Skerjanec A, Drollmann A, O'Byrne PM. Efficacy and safety of multiple doses of QGE031 (ligelizumab) versus omalizumab and placebo in inhibiting allergen-induced early asthmatic responses. J Allergy Clin Immunol 2016; 138:1051-1059. [PMID: 27185571 DOI: 10.1016/j.jaci.2016.02.027] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/11/2016] [Accepted: 02/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Omalizumab is an established anti-IgE therapy for the treatment of allergic diseases that prevents IgE from binding to its receptor. QGE031 is an investigational anti-IgE antibody that binds IgE with higher affinity than omalizumab. OBJECTIVE This study compared the effects of QGE031 with those of omalizumab on clinical efficacy, IgE levels, and FcεRI expression in a clinical model of allergic asthma. METHODS Thirty-seven patients with mild allergic asthma were randomized to subcutaneous omalizumab, placebo, or QGE031 at 24, 72, or 240 mg every 2 weeks for 10 weeks in a double-blind, parallel-group multicenter study. Inhaled allergen challenges and skin tests were conducted before dosing and at weeks 6, 12, and 18, and blood was collected until 24 weeks after the first dose. RESULTS QGE031 elicited a concentration- and time-dependent change in the provocative concentration of allergen causing a 15% decrease in FEV1 (allergen PC15) that was maximal and approximately 3-fold greater than that of omalizumab (P = .10) and 16-fold greater than that of placebo (P = .0001) at week 12 in the 240-mg cohort. Skin responses reached 85% suppression at week 12 in the 240-mg cohort and were maximal at week 18. The top doses of QGE031 consistently suppressed skin test responses among subjects but had a variable effect on allergen PC15 (2-fold to 500-fold change). QGE031 was well tolerated. CONCLUSION QGE031 has greater efficacy than omalizumab on inhaled and skin allergen responses in patients with mild allergic asthma. These data support the clinical development of QGE031 as a treatment of asthma.
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Affiliation(s)
- Gail M Gauvreau
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan P Arm
- Novartis Pharmaceuticals, East Hanover, and Novartis Pharma AG, Basel, Switzerland
| | - Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
| | - Richard Leigh
- Departments of Medicine and Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Donald W Cockcroft
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Beth E Davis
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Irvin Mayers
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - J Mark FitzGerald
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Barbro Dahlen
- Karolinska Institutet, Department of Medicine, Karolinska University, Stockholm, Sweden
| | - Kieran J Killian
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michel Laviolette
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
| | - Christopher Carlsten
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nikolaos Lazarinis
- Karolinska Institutet, Department of Medicine, Karolinska University, Stockholm, Sweden
| | - Richard M Watson
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joanne Milot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
| | - Veronica Swystun
- Departments of Medicine and Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Miranda Bowen
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Linda Hui
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ann-Sofie Lantz
- Karolinska Institutet, Department of Medicine, Karolinska University, Stockholm, Sweden
| | - Karin Meiser
- Novartis Pharmaceuticals, East Hanover, and Novartis Pharma AG, Basel, Switzerland
| | | | - Philip J Lowe
- Novartis Pharmaceuticals, East Hanover, and Novartis Pharma AG, Basel, Switzerland
| | - Andrej Skerjanec
- Novartis Pharmaceuticals, East Hanover, and Novartis Pharma AG, Basel, Switzerland
| | - Anton Drollmann
- Novartis Pharmaceuticals, East Hanover, and Novartis Pharma AG, Basel, Switzerland.
| | - Paul M O'Byrne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Lazarinis N, Jørgensen L, Ekström T, Bjermer L, Dahlén B, Pullerits T, Hedlin G, Carlsen KH, Larsson K. Combination of budesonide/formoterol on demand improves asthma control by reducing exercise-induced bronchoconstriction. Thorax 2013; 69:130-6. [PMID: 24092567 PMCID: PMC3913208 DOI: 10.1136/thoraxjnl-2013-203557] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background In mild asthma exercise-induced bronchoconstriction (EIB) is usually treated with inhaled short-acting β2 agonists (SABAs) on demand. Objective The hypothesis was that a combination of budesonide and formoterol on demand diminishes EIB equally to regular inhalation of budesonide and is more effective than terbutaline inhaled on demand. Methods Sixty-six patients with asthma (>12 years of age) with verified EIB were randomised to terbutaline (0.5 mg) on demand, regular budesonide (400 μg) and terbutaline (0.5 mg) on demand, or a combination of budesonide (200 μg) + formoterol (6 μg) on demand in a 6-week, double-blind, parallel-group study (ClinicalTrials.gov identifier: NCT00989833). The patients were instructed to perform three to four working sessions per week. The main outcome was EIB 24 h after the last dosing of study medication. Results After 6 weeks of treatment with regular budesonide or budesonide+formoterol on demand the maximum post-exercise forced expiratory volume in 1 s fall, 24 h after the last medication, was 6.6% (mean; 95% CI −10.3 to −3.0) and 5.4% (−8.9 to −1.8) smaller, respectively. This effect was superior to inhalation of terbutaline on demand (+1.5%; −2.1 to +5.1). The total budesonide dose was approximately 2.5 times lower in the budesonide+formoterol group than in the regular budesonide group. The need for extra medication was similar in the three groups. Conclusions The combination of budesonide and formoterol on demand improves asthma control by reducing EIB in the same order of magnitude as regular budesonide treatment despite a substantially lower total steroid dose. Both these treatments were superior to terbutaline on demand, which did not alter the bronchial response to exercise. The results question the recommendation of prescribing SABAs as the only treatment for EIB in mild asthma.
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Affiliation(s)
- Nikolaos Lazarinis
- Division of Respiratory Medicine and Allergy, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, , Stockholm, Sweden
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