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Price E, Ahmad S, Althobiani MA, Ayoob T, Burgoyne T, De Soyza A, Dobson M, Echevarria C, Martin G, Mendes RG, Preston AM, Rahman NM, Sapey E, Usmani OS, Hurst JR. Development and evaluation of a tool to optimise inhaler selection prior to hospital discharge following an exacerbation of COPD. ERJ Open Res 2024; 10:00010-2024. [PMID: 38444664 PMCID: PMC10910267 DOI: 10.1183/23120541.00010-2024] [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: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Rates of mortality and re-admission after a hospitalised exacerbation of COPD are high and resistant to change. COPD guidelines do not give practical advice about the optimal selection of inhaled drugs and device in this situation. We hypothesised that a failure to optimise inhaled drug and drug delivery prior to discharge from hospital after an exacerbation would be associated with a modifiable increased risk of re-admission and death. We designed a study to 1) develop a practical inhaler selection tool to use at the point of hospital discharge and 2) implement this tool to understand the potential impact on modifying inhaler prescriptions, clinical outcomes, acceptability to clinicians and patients, and the feasibility of delivering a definitive trial to demonstrate potential benefit. Methods We iteratively developed an inhaler selection tool for use prior to discharge following a hospitalised exacerbation of COPD using surveys with multiprofessional clinicians and a focus group of people living with COPD. We surveyed clinicians to understand their views on the minimum clinically important difference (MCID) for death and re-admission following a hospitalised exacerbation of COPD. We conducted a mixed-methods implementation feasibility study using the tool at discharge, and collated 30- and 90-day follow-up data including death and re-admissions. Additionally, we observed the tool being used and interviewed clinicians and patients about use of the tool in this setting. Results We completed the design of an inhaler selection tool through two rounds of consultations with 94 multiprofessional clinicians, and a focus group of four expert patients. Regarding MCIDs, there was majority consensus for the following reductions from baseline being the MCID: 30-day readmissions 5-10%, 90-day readmissions 10-20%, 30-day mortality 5-10% and 90-day mortality 5-10%. 118 patients were assessed for eligibility and 26 had the tool applied. A change in inhaled medication was recommended in nine (35%) out of 26. Re-admission or death at 30 days was seen in 33% of the switch group and 35% of the no-switch group. Re-admission or death at 90 days was seen in 56% of the switch group and 41% of the no-switch group. Satisfaction with inhalers was generally high, and switching was associated with a small increase in the Feeling of Satisfaction with Inhaler questionnaire of 3 out of 50 points. Delivery of a definitive study would be challenging. Conclusion We completed a mixed-methods study to design and implement a tool to aid optimisation of inhaled pharmacotherapy prior to discharge following a hospitalised exacerbation of COPD. This was not associated with fewer re-admissions, but was well received and one-third of people were eligible for a change in inhalers.
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Affiliation(s)
- Evleen Price
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Shanaz Ahmad
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | - Tareq Ayoob
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | - Anthony De Soyza
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Melissa Dobson
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Carlos Echevarria
- Respiratory Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, UK
| | - Graham Martin
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Anne-Marie Preston
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Najib M. Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham NIHR Biomedical Research Unit, and HDR UK Medicines Driver Programme, Birmingham, UK
| | - Omar S. Usmani
- National Heart and Lung Institute, Imperial College London, London, UK
| | - John R. Hurst
- UCL Respiratory, University College London, London, UK
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Capstick TGD, Gudimetla S, Harris DS, Malone R, Usmani OS. Demystifying Dry Powder Inhaler Resistance with Relevance to Optimal Patient Care. Clin Drug Investig 2024; 44:109-114. [PMID: 38198116 PMCID: PMC10834657 DOI: 10.1007/s40261-023-01330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/11/2024]
Abstract
The selection of an inhaler device is a key component of respiratory disease management. However, there is a lack of clarity surrounding inhaler resistance and how it impacts inhaler selection. The most common inhaler types are dry powder inhalers (DPIs) that have internal resistance and pressurised metered dose inhalers (pMDIs) that use propellants to deliver the drug dose to the airways. Inhaler resistance varies across the DPIs available on the market, depending largely on the design geometry of the device but also partially on formulation parameters. Factors influencing inhaler choice include measures such as flow rate or pressure drop as well as inhaler technique and patient preference, both of which can lead to improved adherence and outcomes. For optimal disease outcomes, device selection should be individualised, inhaler technique optimised and patient preference considered. By addressing the common clinically relevant questions, this paper aims to demystify how DPI resistance should guide the selection of the right device for the right patient.
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Affiliation(s)
| | | | | | | | - Omar S Usmani
- National Heart and Lung Institute (NHLI), Imperial College London, London, Guy Scadding Building, Dovehouse Street, London, SW3 6LY, UK.
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Lavorini F, Usmani OS, Salvi S, Rote K, Gaur V, Gogtay J. A narrative review on the Synchrobreathe™: A novel breath-actuated pressurised metered-dose inhaler for the treatment of obstructive airway diseases. Respir Med 2023; 219:107435. [PMID: 38652077 DOI: 10.1016/j.rmed.2023.107435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 04/25/2024]
Abstract
Pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs), are widely used to deliver drugs for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Incorrect use of inhalers is one of the main obstacles to achieving better clinical control. Indeed, with pMDIs, patients fail to synchronise actuation with inhalation due to a lack of coordination and with DPIs insufficient inspiratory effort compromises drug deposition in lungs. More than 50% of patients desire to switch their pMDIs and DPIs for a better device. This led to the development of pressurised breath-actuated inhalers (BAIs) with the aim of combining the beneficial features of pMDIs and DPIs and mitigating their problems. BAIs, e.g., Synchrobreathe™, are designed such that they are activated by a low inhalation effort and mechanically actuate the dose in synchrony to inspiration, thereby resolving the need to coordinate actuation with inspiration. BAIs have advantages, including ease of use, high lung deposition of medication, and greater patient preference. We discussed the design features, operating procedure, and clinical evidence of the Synchrobreathe™ device (Cipla Ltd, India), a BAI available with a wide range of drug combinations. Studies have shown that a higher number of patients (68.19%) used the Synchrobreathe™ without any error than the pMDI (56.21%), and that the vast majority of them (92%) found it easy to understand and use. The Synchrobreathe™ is an innovative, easy-to-use inhaler that may overcome many limitations associated with pMDIs and DPIs, thus potentially improving management of obstructive airway diseases and patients' quality of life.
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Affiliation(s)
- Federico Lavorini
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London, Dovehouse Street, London, SW3 6LY, UK
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, Maharashtra, India; Faculty of Health Sciences, Symbiosis International (Deemed University), Pune, Maharashtra, India
| | - Kiran Rote
- Integrated Product Development, Cipla Ltd, Mumbai, Maharashtra, India
| | - Vaibhav Gaur
- Global Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India.
| | - Jaideep Gogtay
- Global Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India
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Sousa-Pinto B, Louis R, Anto JM, Amaral R, Sá-Sousa A, Czarlewski W, Brussino L, Canonica GW, Chaves Loureiro C, Cruz AA, Gemicioglu B, Haahtela T, Kupczyk M, Kvedariene V, Larenas-Linnemann DE, Okamoto Y, Ollert M, Pfaar O, Pham-Thi N, Puggioni F, Regateiro FS, Romantowski J, Sastre J, Scichilone N, Taborda-Barata L, Ventura MT, Agache I, Bedbrook A, Becker S, Bergmann KC, Bosnic-Anticevich S, Bonini M, Boulet LP, Brusselle G, Buhl R, Cecchi L, Charpin D, de Blay F, Del Giacco S, Ivancevich JC, Jutel M, Klimek L, Kraxner H, Kuna P, Laune D, Makela M, Morais-Almeida M, Nadif R, Niedoszytko M, Papadopoulos NG, Papi A, Patella V, Pétré B, Rivero Yeverino D, Robalo Cordeiro C, Roche N, Rouadi PW, Samolinski B, Savouré M, Shamji MH, Sheikh A, Suppli Ulrik C, Usmani OS, Valiulis A, Yorgancioglu A, Zuberbier T, Fonseca JA, Costa EM, Bousquet J. Adherence to inhaled corticosteroids and long-acting β2-agonists in asthma: A MASK-air study. Pulmonology 2023:S2531-0437(23)00130-7. [PMID: 37543524 DOI: 10.1016/j.pulmoe.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 08/07/2023] Open
Abstract
INTRODUCTION Adherence to controller medication is a major problem in asthma management, being difficult to assess and tackle. mHealth apps can be used to assess adherence. We aimed to assess the adherence to inhaled corticosteroids+long-acting β2-agonists (ICS+LABA) in users of the MASK-air® app, comparing the adherence to ICS+formoterol (ICS+F) with that to ICS+other LABA. MATERIALS AND METHODS We analysed complete weeks of MASK-air® data (2015-2022; 27 countries) from patients with self-reported asthma and ICS+LABA use. We compared patients reporting ICS+F versus ICS+other LABA on adherence levels, symptoms and symptom-medication scores. We built regression models to assess whether adherence to ICS+LABA was associated with asthma control or short-acting beta-agonist (SABA) use. Sensitivity analyses were performed considering the weeks with no more than one missing day. RESULTS In 2598 ICS+LABA users, 621 (23.9%) reported 4824 complete weeks and 866 (33.3%) reported weeks with at most one missing day. Higher adherence (use of medication ≥80% of weekly days) was observed for ICS+other LABA (75.1%) when compared to ICS+F (59.3%), despite both groups displaying similar asthma control and work productivity. The ICS+other LABA group was associated with more days of SABA use than the ICS+F group (median=71.4% versus 57.1% days). Each additional weekly day of ICS+F use was associated with a 4.1% less risk in weekly SABA use (95%CI=-6.5;-1.6%;p=0.001). For ICS+other LABA, the percentage was 8.2 (95%CI=-11.6;-5.0%;p<0.001). CONCLUSIONS In asthma patients adherent to the MASK-air app, adherence to ICS+LABA was high. ICS+F users reported lower adherence but also a lower SABA use and a similar level of control.
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Affiliation(s)
- B Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Louis
- Department of Pulmonary Medicine, CHU Liège, Liège, Belgium; GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - J M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - R Amaral
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Sá-Sousa
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - W Czarlewski
- Medical Consulting Czarlewski, Levallois, France; MASK-air, Montpellier, France
| | - L Brussino
- Department of Medical Sciences, University of Torino, Torino, Italy; Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy
| | - G W Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Center, Rozzano, Milan, Italy
| | - C Chaves Loureiro
- Department of Pneumology, University of Coimbra, Medicine Faculty, Coimbra, Portugal
| | - A A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - M Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - V Kvedariene
- Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - D E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Y Okamoto
- Chiba Rosai Hospital, Chiba, Japan; Chiba University Hospital, Chiba, Japan
| | - M Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg; Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - O Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - N Pham-Thi
- Ecole Polytechnique de Palaiseau, Palaiseau, France; IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France; Université Paris Cité, Paris, France
| | - F Puggioni
- IRCCS Humanitas Research Center, Personalized Medicine Asthma & Allergy, Rozzano, Milan, Italy
| | - F S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Romantowski
- Medical University of Gdańsk, Department of Allergology, Gdansk, Poland
| | - J Sastre
- Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain
| | - N Scichilone
- PROMISE Department, University of Palermo, Palermo, Italy
| | - L Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal; UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - M T Ventura
- Allergy and Clinical Immunology, University of Bari Medical School, Bari, Italy; Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy
| | - I Agache
- Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - A Bedbrook
- MASK-air, Montpellier, France; ARIA, Montpellier, France
| | - S Becker
- Department of Otorhinolaryngology, University of Tübingen, Tübingen, Germany
| | - K C Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - S Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia; Macquarie Medical School, Macquarie University, Macquarie Park, NSW, Australia
| | - M Bonini
- Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy; Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli - IRCCS, Rome, Italy; National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - L-P Boulet
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - R Buhl
- Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - L Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - D Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France
| | - F de Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France; Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - S Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - J C Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland; ALL-MED Medical Research Institute, Wroclaw, Poland
| | - L Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - H Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - D Laune
- KYomed INNOV, Montpellier, France
| | - M Makela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - R Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - M Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - A Papi
- Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - V Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy; Agency of Health ASL, Salerno, Italy; Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - B Pétré
- Department of Public Health, University of Liège, Liège, Belgium
| | - D Rivero Yeverino
- Servicio de Alergia e Inmunología clínica, Hospital Universitario de Puebla, Puebla, México
| | - C Robalo Cordeiro
- Department of Pneumology, University of Coimbra, Medicine Faculty, Coimbra, Portugal
| | - N Roche
- Pneumologie, AP-HP Centre Université de Paris Cité, Hôpital Cochin, Paris, France; UMR 1016, Institut Cochin, Paris, France
| | - P W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon; Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - B Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - M Savouré
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - M H Shamji
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
| | - A Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - C Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - O S Usmani
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK; Royal Brompton Hospital, Airways Disease Section, London, UK
| | - A Valiulis
- Interdisciplinary Research Group of Human Ecology, Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania; European Academy of Paediatrics (EAP/UEMS-SP), Brussel, Belgium
| | - A Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - T Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - J A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - E M Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - J Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France; University Hospital Montpellier, Montpellier, France.
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Usmani OS, Levy ML. Effective respiratory management of asthma and COPD and the environmental impacts of inhalers. NPJ Prim Care Respir Med 2023; 33:24. [PMID: 37393273 DOI: 10.1038/s41533-023-00346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/14/2023] [Indexed: 07/03/2023] Open
Affiliation(s)
- Omar S Usmani
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital and St Mary's Hospital, London, UK.
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Wang R, Usmani OS, Chung KF, Sont J, Simpson A, Bonini M, Honkoop PJ, Fowler SJ. Domiciliary Fractional Exhaled Nitric Oxide and Spirometry in Monitoring Asthma Control and Exacerbations. J Allergy Clin Immunol Pract 2023; 11:1787-1795.e5. [PMID: 36801491 DOI: 10.1016/j.jaip.2023.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Domiciliary measurements of airflow obstruction and inflammation may assist healthcare teams and patients in determining asthma control and facilitate self-management. OBJECTIVE To evaluate parameters derived from domiciliary spirometry and fractional exhaled nitric oxide (Feno) in monitoring asthma exacerbations and control. METHODS Patients with asthma were provided with hand-held spirometry and Feno devices in addition to their usual asthma care. Patients were instructed to perform twice-daily measurements for 1 month. Daily symptoms and medication change were reported through a mobile health system. The Asthma Control Questionnaire was completed at the end of the monitoring period. RESULTS One hundred patients had spirometry, of which 60 were given additional Feno devices. Compliance rates for twice-daily measurements were poor (median [interquartile range], 43% [25%-62%] for spirometry; 30% [3%-48%] for Feno); at least 15% of patients took little or no spirometry measurements and 40% rarely measured Feno. The coefficient of variation (CV) values in FEV1 and Feno were higher, and the mean % personal best FEV1 lower in those who had major exacerbations compared with those without (P < .05). Feno CV and FEV1 CV were associated with asthma exacerbation during the monitoring period (area under the receiver-operating characteristic curve, 0.79 and 0.74, respectively). Higher Feno CV also predicted poorer asthma control (area under the receiver-operating characteristic curve, 0.71) at the end of the monitoring period. CONCLUSIONS Compliance with domiciliary spirometry and Feno varied widely among patients even in the setting of a research study. However, despite significant missing data, Feno and FEV1 were associated with asthma exacerbations and control, making these measurements potentially clinically valuable if used.
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Affiliation(s)
- Ran Wang
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital, London, United Kingdom
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital, London, United Kingdom
| | - Jacob Sont
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Andrew Simpson
- Department of Sport, Health and Exercise Science, The University of Hull, Hull, United Kingdom
| | - Matteo Bonini
- National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital, London, United Kingdom
| | - Persijn J Honkoop
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester, United Kingdom.
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Bousquet J, Shamji MH, Anto JM, Schünemann HJ, Canonica GW, Jutel M, Del Giacco S, Zuberbier T, Pfaar O, Fonseca JA, Sousa-Pinto B, Klimek L, Czarlewski W, Bedbrook A, Amaral R, Ansotegui IJ, Bosnic-Anticevich S, Braido F, Loureiro CC, Gemicioglu B, Haahtela T, Kulus M, Kuna P, Kupczyk M, Matricardi PM, Regateiro FS, Samolinski B, Sofiev M, Toppila-Salmi S, Valiulis A, Ventura MT, Barbara C, Bergmann KC, Bewick M, Blain H, Bonini M, Boulet LP, Bourret R, Brusselle G, Brussino L, Buhl R, Cardona V, Casale T, Cecchi L, Charpin D, Cherrez-Ojeda I, Chu DK, Cingi C, Costa EM, Cruz AA, Devillier P, Dramburg S, Fokkens WJ, Gotua M, Heffler E, Ispayeva Z, Ivancevich JC, Joos G, Kaidashev I, Kraxner H, Kvedariene V, Larenas-Linnemann DE, Laune D, Lourenço O, Louis R, Makela M, Makris M, Maurer M, Melén E, Micheli Y, Morais-Almeida M, Mullol J, Niedoszytko M, O'Hehir R, Okamoto Y, Olze H, Papadopoulos NG, Papi A, Patella V, Pétré B, Pham-Thi N, Puggioni F, Quirce S, Roche N, Rouadi PW, Sá-Sousa A, Sagara H, Sastre J, Scichilone N, Sheikh A, Sova M, Ulrik CS, Taborda-Barata L, Todo-Bom A, Torres MJ, Tsiligianni I, Usmani OS, Valovirta E, Vasankari T, Vieira RJ, Wallace D, Waserman S, Zidarn M, Yorgancioglu A, Zhang L, Chivato T, Ollert M. Patient-centred digital biomarkers for allergic respiratory diseases and asthma: the ARIA-EAACI approach. Allergy 2023. [PMID: 37042071 DOI: 10.1111/all.15740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/13/2023]
Abstract
Biomarkers for the diagnosis, treatment and follow-up of patients with rhinitis and/or asthma are urgently needed. Although some biologic biomarkers exist in specialist care for asthma, they cannot be largely used in primary care. There are no validated biomarkers in rhinitis or allergen immunotherapy (AIT) that can be used in clinical practice. The digital transformation of health and health care (including mHealth) places the patient at the centre of the health system and is likely to optimise the practice of allergy. ARIA (Allergic Rhinitis and its Impact on Asthma) and EAACI (European Academy of Allergy and Clinical Immunology) developed a Task Force aimed at proposing patient-reported outcome measures (PROMs) as digital biomarkers that can be easily used for different purposes in rhinitis and asthma. It first defined control digital biomarkers that should make a bridge between clinical practice, randomised controlled trials, observational real-life studies and allergen challenges. Using the MASK-air app as a model, a daily electronic combined symptom-medication score for allergic diseases (CSMS) or for asthma (e-DASTHMA), combined with a monthly control questionnaire, were embedded in a strategy similar to the diabetes approach for disease control. To mimic real-life, it secondly proposed quality-of-life digital biomarkers including daily EQ-5D visual analogue scales and the bi-weekly RhinAsthma Patient Perspective (RAAP). The potential implications for the management of allergic respiratory diseases were proposed.
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Affiliation(s)
- Jean Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- University Hospital Montpellier, France
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Poland
- ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Joao A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Anna Bedbrook
- MASK-air, Montpellier, France
- ARIA, Montpellier, France
| | - Rita Amaral
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - Fulvio Braido
- Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Chaves Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marek Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lotz, Poland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lotz, Poland
| | - Paolo M Matricardi
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (ICBR) Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | | | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
- Institute of Sciences of Food Production, National Research Council (Ispa-CNR), Bari, Italy
| | - Cristina Barbara
- Portuguese NaTional Programme for Respiratory Diseases, Direção -Geral da Saúde, Faculdade de Medicina de Lisboa, Instituto de Saúde Ambiental, Lisbon, Portugal
| | - Karl C Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Michael Bewick
- University of Central Lancashire Medical School, Preston, UK
| | - Hubert Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France
| | - Matteo Bonini
- Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy
- Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli - IRCCS, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | | | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino, Torino, Italy
- Mauriziano Hospital, Torino, Italy
| | - Roland Buhl
- Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
- ARADyAL Research Network, Barcelona, Spain
| | - Thomas Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, USA
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Denis Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France
| | - Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Guayas, Ecuador
| | - Derek K Chu
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cemal Cingi
- Eskisehir Osmangazi University, Medical Faculty, ENT Department, Eskisehir, Turkey
| | - Elisio M Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto (Porto4Ageing), Portugal
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - Philippe Devillier
- VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - Stephanie Dramburg
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Maia Gotua
- Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Zhanat Ispayeva
- Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and Clinical Immunology of the Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Helga Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Violeta Kvedariene
- Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Désirée E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | | | - Olga Lourenço
- Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU, Liège, Liège, Belgium
- GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - Mika Makela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Michael Makris
- Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Erik Melén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sach´s Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | | | | | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain
- Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | | | - Robyn O'Hehir
- Allergy, Asthma and Clinical Immunology, Alfred Health and Department of Immunology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Yoshitaka Okamoto
- Chiba Rosai Hospital, Chiba, Japan
- Chiba University Hospital, Chiba, Japan
| | - Heidi Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | | | - Alberto Papi
- Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy
- Agency of Health ASL, Salerno, Italy
- Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Benoit Pétré
- Department of Public Health, University of Liège, Liège, Belgium
| | - Nhân Pham-Thi
- Ecole Polytechnique de Palaiseau, Palaiseau, France
- IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France
- Université Paris Cité, Paris, France
| | - Francesca Puggioni
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Spain
| | - Nicolas Roche
- Pneumologie, AP-HP, Centre Université de Paris, Hôpital Cochin, Paris, France
| | - Philip W Rouadi
- Department of Otolaryngology, Head and Neck Surgery, Eye and Ear, University Hospital, Beirut, Lebanon
- Department of Otolaryngology, Head and Neck Surgery, Dar Al Shifa Hospital-, Salmiya, Kuwait
| | - Ana Sá-Sousa
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Joaquin Sastre
- Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, Madrid, Spain
| | | | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Milan Sova
- Department of Respiratory Medicine and Tuberculosis, University Hospital Brno, Czech Republic
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark
- Institute of Cinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Luis Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
- UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Ana Todo-Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria J Torres
- Allergy Unit, Málaga Regional University Hospital-IBIMA, Málaga, Spain
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Omar S Usmani
- Royal Brompton Hospital, Airways Disease Section, London, UK
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku, Turku, Finland
| | - Tuula Vasankari
- FIHLA, Finnish Lung Health Association, Helsinki, Finland
- Department of Clinical Medicine, Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Rafael José Vieira
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Dana Wallace
- Nova Southeastern University, College of Allopathic Medicine, Fort Lauderdale, Florida, USA
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases, Slovenia
- University of Ljubljana, Ljubljana, Slovenia
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Manisa, Turkey
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, Beijing, China
| | - Tomas Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Centre, Odense University Hospital, Research Center for Anaphylaxis (ORCA), Odense, Odense, Denmark
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Sousa-Pinto B, Jácome C, Pereira AM, Regateiro FS, Almeida R, Czarlewski W, Kulus M, Shamji MH, Boulet LP, Bonini M, Brussino L, Canonica GW, Cruz AA, Gemicioglu B, Haahtela T, Kupczyk M, Kvedariene V, Larenas-Linnemann D, Louis R, Niedoszytko M, Pham-Thi N, Puggioni F, Romantowski J, Sastre J, Scichilone N, Taborda-Barata L, Ventura MT, Vieira RJ, Agache I, Bedbrook A, Bergmann KC, Amaral R, Azevedo LF, Bosnic-Anticevich S, Brusselle G, Buhl R, Cecchi L, Charpin D, Loureiro CC, de Blay F, Del Giacco S, Devillier P, Jassem E, Joos G, Jutel M, Klimek L, Kuna P, Laune D, Luna Pech J, Makela M, Morais-Almeida M, Nadif R, Neffen HE, Ohta K, Papadopoulos NG, Papi A, Pétré B, Pfaar O, Yeverino DR, Cordeiro CR, Roche N, Sá-Sousa A, Samolinski B, Sheikh A, Ulrik CS, Usmani OS, Valiulis A, Vandenplas O, Vieira-Marques P, Yorgancioglu A, Zuberbier T, Anto JM, Fonseca JA, Bousquet J. Development and validation of an electronic daily control score for asthma (e-DASTHMA): a real-world direct patient data study. Lancet Digit Health 2023; 5:e227-e238. [PMID: 36872189 DOI: 10.1016/s2589-7500(23)00020-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Validated questionnaires are used to assess asthma control over the past 1-4 weeks from reporting. However, they do not adequately capture asthma control in patients with fluctuating symptoms. Using the Mobile Airways Sentinel Network for airway diseases (MASK-air) app, we developed and validated an electronic daily asthma control score (e-DASTHMA). METHODS We used MASK-air data (freely available to users in 27 countries) to develop and assess different daily control scores for asthma. Data-driven control scores were developed based on asthma symptoms reported by a visual analogue scale (VAS) and self-reported asthma medication use. We included the daily monitoring data from all MASK-air users aged 16-90 years (or older than 13 years to 90 years in countries with a lower age of digital consent) who had used the app in at least 3 different calendar months and had reported at least 1 day of asthma medication use. For each score, we assessed construct validity, test-retest reliability, responsiveness, and accuracy. We used VASs on dyspnoea and work disturbance, EQ-5D-VAS, Control of Allergic Rhinitis and Asthma Test (CARAT), CARAT asthma, and Work Productivity and Activity Impairment: Allergy Specific (WPAI:AS) questionnaires as comparators. We performed an internal validation using MASK-air data from Jan 1 to Oct 12, 2022, and an external validation using a cohort of patients with physician-diagnosed asthma (the INSPIRERS cohort) who had had their diagnosis and control (Global Initiative for Asthma [GINA] classification) of asthma ascertained by a physician. FINDINGS We studied 135 635 days of MASK-air data from 1662 users from May 21, 2015, to Dec 31, 2021. The scores were strongly correlated with VAS dyspnoea (Spearman correlation coefficient range 0·68-0·82) and moderately correlated with work comparators and quality-of-life-related comparators (for WPAI:AS work, we observed Spearman correlation coefficients of 0·59-0·68). They also displayed high test-retest reliability (intraclass correlation coefficients range 0·79-0·95) and moderate-to-high responsiveness (correlation coefficient range 0·69-0·79; effect size measures range 0·57-0·99 in the comparison with VAS dyspnoea). The best-performing score displayed a strong correlation with the effect of asthma on work and school activities in the INSPIRERS cohort (Spearman correlation coefficients 0·70; 95% CI 0·61-0·78) and good accuracy for the identification of patients with uncontrolled or partly controlled asthma according to GINA (area under the receiver operating curve 0·73; 95% CI 0·68-0·78). INTERPRETATION e-DASTHMA is a good tool for the daily assessment of asthma control. This tool can be used as an endpoint in clinical trials as well as in clinical practice to assess fluctuations in asthma control and guide treatment optimisation. FUNDING None.
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Affiliation(s)
- Bernardo Sousa-Pinto
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cristina Jácome
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Margarida Pereira
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal; Patient Centred Innovation and Technology, Centro de Investigação em Tecnologias e Serviços de Saúde, Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra and Institute of Immunology, and Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Rute Almeida
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Marek Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College & National Institutes for Health Imperial Biomedical Research Centre, London, UK
| | | | - Matteo Bonini
- Department of Cardiovascular and Respiratory Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurological, Ear, Nose, and Throat, and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; National Heart and Lung Institute, Imperial College London, London, UK
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and Global Alliance Against Chronic Respiratory Diseases and WHO Planning Group, Salvador, Bahia, Brazil
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology and Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Desirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Renaud Louis
- Department of Pulmonary Medicine, Centre Hospitalier Universitaire Liege, and GIGA Infection, Immunity, Inflammation Laboratories research group, University of Liege, Liege, Belgium
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Nhân Pham-Thi
- Institut de Recherche bio-Médicale des Armées, Bretigny sur Orge, France; École Polytechnique de Palaiseau, Palaiseau, France; Université Paris Cité, Paris, France
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Jan Romantowski
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Joaquin Sastre
- Allergy Service, Fundacion Jimenez Diaz, Faculty of Medicine Universidad Autonoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | - Luis Taborda-Barata
- University of Beira Interior Air, Clinical & Experimental Lung Centre and Centro de Investigação em Ciências da Saúde-University of Beira Interior Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - Rafael José Vieira
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ioana Agache
- Faculty of Medicine, Transylvania University Brasov, Brasov, Romania
| | - Anna Bedbrook
- Allergic Rhinitis and its Impact on Asthma, Montpellier, France
| | - Karl C Bergmann
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - Rita Amaral
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, and Sydney Local Health District, Sydney, NSW, Australia
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Roland Buhl
- Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - Lorenzo Cecchi
- Struttura Organizzativa Semplice Allergology and Clinical Immunology Unita Sanitaria Locale, Toscana Centro, Prato, Italy
| | - Denis Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France
| | - Claudia Chaves Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Frédéric de Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France; Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital Duilio Casula, University of Cagliari, Cagliari, Italy
| | - Philippe Devillier
- Virologie et Immunologie Moléculaires Suresnes, Unités Mixtes de Recherche 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - Ewa Jassem
- Medical University of Gdańsk, Department of Pneumonology, Gdansk, Poland
| | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland; All-Medicine Medical Research Institute, Wroclaw, Poland
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | | | | | - Mika Makela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Rachel Nadif
- Université Paris-Saclay, Université Versailles-St Quentin, Université Paris-Sud, Paris, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, Villejuif, France
| | - Hugo E Neffen
- Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
| | - Ken Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan; JATA Fukujuji Hospital, Tokyo, Japan
| | | | - Alberto Papi
- Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Benoit Pétré
- Department of Public Health, University of Liege, Liege, Belgium
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Daniela Rivero Yeverino
- Allergy and Clinical Immunology Department, Hospital Universitario de Puebla, Puebla, Mexico
| | | | - Nicolas Roche
- Pneumologie, Assistance Publique - Hôpitaux de Paris, Centre Université de Paris Cité, Hôpital Cochin, Paris, France
| | - Ana Sá-Sousa
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal; Patient Centred Innovation and Technology, Centro de Investigação em Tecnologias e Serviços de Saúde, Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London, London, UK; Royal Brompton Hospital, Airways Disease Section, London, UK
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences and Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, Belgium; Université Catholique de Louvain, Yvoir, Belgium
| | - Pedro Vieira-Marques
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Türkiye
| | - Torsten Zuberbier
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Barcelona, Spain
| | - João A Fonseca
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Bousquet
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, Villejuif, France; University Hospital Montpellier, Montpellier, France.
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9
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Toumpanakis D, Usmani OS. Small airways disease in patients with alpha-1 antitrypsin deficiency. Respir Med 2023; 211:107222. [PMID: 36965591 DOI: 10.1016/j.rmed.2023.107222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023]
Abstract
Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder, characterized by panacinar emphysema mainly in the lower lobes, and predisposes to chronic obstructive pulmonary disease (COPD) at a younger age, especially in patients with concomitant cigarette smoking. Alpha-1 antitrypsin (a1-AT) is a serine protease inhibitor that mainly blocks neutrophil elastase and maintains protease/antiprotease balance in the lung and AATD is caused by mutations in the SERPINA1 gene that encodes a1-AT protein. PiZZ is the most common genotype associated with severe AATD, leading to reduced circulating levels of a1-AT. Besides its antiprotease function, a1-AT has anti-inflammatory and antioxidative effects and AATD results in defective innate immunity. Protease/antiprotease imbalance affects not only the lung parenchyma but also the small airways and recent studies have shown that AATD is associated with small airway dysfunction. Alterations in small airways structure with peripheral ventilation inhomogeneities may precede emphysema formation, providing a unique opportunity to detect early disease. The aim of the present review is to summarize the current evidence for the contribution of small airways disease in AATD-associated lung disease.
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Affiliation(s)
- Dimitrios Toumpanakis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; General State Hospital for Thoracic Diseases of Athens "Sotiria", Greece.
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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10
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Usmani OS, Bosnic-Anticevich S, Dekhuijzen R, Lavorini F, Bell J, Stjepanovic N, Swift SL, Roche N. Real-World Impact of Nonclinical Inhaler Regimen Switches on Asthma or COPD: A Systematic Review. J Allergy Clin Immunol Pract 2022; 10:2624-2637. [PMID: 35750323 DOI: 10.1016/j.jaip.2022.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Switching inhaler regimens can be driven by poor disease control but also by nonclinical factors, such as cost and environmental impact. The consequences of switching for nonclinical reasons are largely unclear. OBJECTIVE To systematically review the real-world consequences of switching inhaler regimens for nonclinical reasons in asthma and/or chronic obstructive pulmonary disease patients. METHODS Embase, MEDLINE, EBM Reviews, and EconLit were searched to November 21, 2020. Conference searches and reference checking were also performed. Real-world studies of asthma and/or chronic obstructive pulmonary disease patients undergoing a switch in inhaler regimen for any reason apart from clinical need were included. Two reviewers screened and extracted data. Key outcomes included symptom control, exacerbations, and patient-doctor relationships. RESULTS A total of 8,958 records were screened and 21 studies included. Higher-quality (matched comparative) studies were prioritized. Five matched studies (6 datasets) reported on symptom control: 5 datasets (n = 7,530) with unclear patient consent reported improved disease control following switching, and 1 dataset (n = 1,648) with non-consented patients reported significantly worsened disease control. Three matched studies (5 datasets, n = 10,084) reported on exacerbation rate ratios; results were heterogeneous depending on the definition used. Two studies (n = 137) reported that switching inhaler regimens could have a negative impact on the doctor-patient relationship, especially when the switches were non-consented. Study quality was generally low. CONCLUSIONS Switching inhaler regimens is a complex issue that can have variable clinical consequences and can harm the patient-doctor relationship. Limited high-quality evidence was identified, and study designs were heterogeneous. A robust framework is needed to guide the personalized switching of inhalers.
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Affiliation(s)
- Omar S Usmani
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Sinthia Bosnic-Anticevich
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Clinical Management, Woolcock Institute of Medical Research, Sydney, Australia
| | - Richard Dekhuijzen
- Faculty of Medical Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - John Bell
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | | | | | - Nicolas Roche
- Department of Respiratory Medicine, Cochin Hospital and Institute, APHP Centre University Paris Cité, Paris, France.
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11
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Deprato A, Ferrara G, Bhutani M, Melenka L, Murgia N, Usmani OS, Lacy P, Moitra S. Reference equations for oscillometry and their differences among populations: a systematic scoping review. Eur Respir Rev 2022; 31:31/165/220021. [PMID: 35831009 DOI: 10.1183/16000617.0021-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
Abstract
Respiratory oscillometry is gaining global attention over traditional pulmonary function tests for its sensitivity in detecting small airway obstructions. However, its use in clinical settings as a diagnostic tool is limited because oscillometry lacks globally accepted reference values. In this scoping review, we systematically assessed the differences between selected oscillometric reference equations with the hypothesis that significant heterogeneity existed between them. We searched bibliographic databases, registries and references for studies that developed equations for healthy adult populations according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A widely used Caucasian model was used as the standard reference and compared against other models using Bland-Altman and Lin's concordance correlational analyses. We screened 1202 titles and abstracts, and after a full-text review of 67 studies, we included 10 in our analyses. Of these, three models had a low-to-moderate agreement with the reference model, particularly those developed from non-Caucasian populations. Although the other six models had a moderate-to-high agreement with the standard model, there were still significant sex-specific variations. This is the first systematic analysis of the heterogeneity between oscillometric reference models and warrants the validation of appropriate equations in clinical applications of oscillometry to avoid diagnostic errors.
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Affiliation(s)
- Andy Deprato
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Giovanni Ferrara
- Alberta Respiratory Centre and Division of Pulmonary Medicine, Dept of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mohit Bhutani
- Alberta Respiratory Centre and Division of Pulmonary Medicine, Dept of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lyle Melenka
- Synergy Respiratory and Cardiac Care, Sherwood Park, AB, Canada
| | - Nicola Murgia
- Dept of Medicine, University of Perugia, Perugia, Italy
| | - Omar S Usmani
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.,Royal Brompton Hospital, London, UK
| | - Paige Lacy
- Alberta Respiratory Centre and Division of Pulmonary Medicine, Dept of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Subhabrata Moitra
- Alberta Respiratory Centre and Division of Pulmonary Medicine, Dept of Medicine, University of Alberta, Edmonton, AB, Canada
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12
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Ojanguren I, Satia I, Usmani OS. The Role of Viral Infections on Severe Asthma Exacerbations: Present and Future. Arch Bronconeumol 2022; 58:632-634. [PMID: 35312483 DOI: 10.1016/j.arbres.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/02/2022]
Affiliation(s)
- Iñigo Ojanguren
- Servei de Pneumologia, Hospital Universitari Vall d́Hebron, Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Vall d́Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Imran Satia
- Dept of Medicine, McMaster University, Hamilton, ON, Canada; Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom
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13
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Leving MT, van Boven JFM, Bosnic-Anticevich SZ, van Cooten J, Correia de Sousa J, Cvetkovski B, Dekhuijzen R, Dijk L, García Pardo M, Gardev A, Gawlik R, van der Ham I, Hartgers-Gubbels ES, Janse Y, Lavorini F, Maricoto T, Meijer J, Metz B, Price DB, Roman-Rodríguez M, Schuttel K, Stoker N, Tsiligianni I, Usmani OS, Kocks JH. Suboptimal Peak Inspiratory Flow and Critical Inhalation Errors are Associated with Higher COPD-Related Healthcare Costs. Int J Chron Obstruct Pulmon Dis 2022; 17:2401-2415. [PMID: 36185173 PMCID: PMC9521797 DOI: 10.2147/copd.s380736] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess the relationship between suboptimal Peak Inspiratory Flow (sPIF), inhalation technique errors, and non-adherence, with Healthcare Resource Utilisation (HCRU) in Chronic Obstructive Pulmonary Disease (COPD) patients receiving maintenance therapy via a Dry Powder Inhaler (DPI). Patients and methods The cross-sectional, multi-country PIFotal study included 1434 COPD patients (≥40 years) using a DPI for maintenance therapy. PIF was measured with the In-Check DIAL G16, and sPIF was defined as a typical PIF lower than required for the device. Inhalation technique was assessed by standardised evaluation of video recordings and grouped into 10 steps. Patients completed the “Test of Adherence to Inhalers” questionnaire. HCRU was operationalised as COPD-related costs for primary healthcare, secondary healthcare, medication, and total COPD-related costs in a 1-year period. Results Participants with sPIF had higher medication costs compared with those with optimal PIF (cost ratio [CR]: 1.07, 95% CI [1.01, 1.14]). Multiple inhalation technique errors were associated with increased HCRU. Specifically, “insufficient inspiratory effort” with higher secondary healthcare costs (CR: 2.20, 95% CI [1.37, 3.54]) and higher total COPD-related costs (CR: 1.16, 95% CI 1.03–1.31). “no breath-hold following the inhalation manoeuvre (<6 s)” with higher medication costs (CR: 1.08, 95% CI [1.02, 1.15]) and total COPD-related costs (CR 1.17, 95% CI [1.07, 1.28]), and “not breathing out calmly after inhalation” with higher medication costs (CR: 1.19, 95% CI [1.04, 1.37]). Non-adherence was not significantly associated with HCRU. Conclusion sPIF and inhalation technique errors were associated with higher COPD-related healthcare utilisation and costs in COPD patients on DPI maintenance therapy.
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Affiliation(s)
- Marika T Leving
- General Practitioners Research Institute, Groningen, the Netherlands
| | - Job F M van Boven
- University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands
- University Medical Centre Groningen, Department of Clinical Pharmacy & Pharmacology, University of Groningen, Groningen, the Netherlands
- Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, the Netherlands
| | - Sinthia Z Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
- Sydney Local Health District, Sydney, Australia
| | - Joyce van Cooten
- General Practitioners Research Institute, Groningen, the Netherlands
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), PT Government Associate Laboratory, School of Medicine, University of Minho, Braga, Portugal
| | - Biljana Cvetkovski
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | | | - Lars Dijk
- General Practitioners Research Institute, Groningen, the Netherlands
| | - Marina García Pardo
- Primary Care Respiratory Research Unit, Instituto De Investigación Sanitaria De Baleares (IdISBa), Palma de Mallorca, Spain
| | - Asparuh Gardev
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Radosław Gawlik
- Department of Internal Medicine, Allergology, Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Iris van der Ham
- General Practitioners Research Institute, Groningen, the Netherlands
| | | | - Ymke Janse
- General Practitioners Research Institute, Groningen, the Netherlands
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Tiago Maricoto
- Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
| | - Jiska Meijer
- General Practitioners Research Institute, Groningen, the Netherlands
| | - Boyd Metz
- General Practitioners Research Institute, Groningen, the Netherlands
| | - David B Price
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Observational and Pragmatic Research Institute, Singapore
| | - Miguel Roman-Rodríguez
- Primary Care Respiratory Research Unit, Instituto De Investigación Sanitaria De Baleares (IdISBa), Palma de Mallorca, Spain
| | - Kirsten Schuttel
- General Practitioners Research Institute, Groningen, the Netherlands
| | - Nilouq Stoker
- General Practitioners Research Institute, Groningen, the Netherlands
| | - Ioanna Tsiligianni
- Department of Social Medicine, Health Planning Unit, Faculty of Medicine, University of Crete, Rethymno, Greece
| | - Omar S Usmani
- Airway Disease, National Heart and Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, London, UK
| | - Janwillem H Kocks
- General Practitioners Research Institute, Groningen, the Netherlands
- University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands
- Observational and Pragmatic Research Institute, Singapore
- Department of Pulmonology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Correspondence: Janwillem H Kocks, General Practitioners Research Institute, Professor Enno Dirk Wiersmastraat 5, Groningen, 9713 GH, the Netherlands, Tel +31 50 211 3898, Email
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14
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Dekhuijzen PNR, Levy ML, Corrigan CJ, Hadfield RM, Roche N, Usmani OS, Barnes PJ, Scullion JE, Lavorini F, Corbetta L, Kocks JWH, Cosio BG, Buhl R, Pedersen SE. Is Inhaler Technique Adequately Assessed and Reported in Clinical Trials of Asthma and Chronic Obstructive Pulmonary Disease Therapy? A Systematic Review and Suggested Best Practice Checklist. J Allergy Clin Immunol Pract 2022; 10:1813-1824.e1. [PMID: 35364340 DOI: 10.1016/j.jaip.2022.03.013] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Inhaled medications are central to treating asthma and chronic obstructive pulmonary disease (COPD), yet critical inhaler technique errors are made by up to 90% of patients. In the clinical research setting, recruitment of subjects with poor inhaler technique may give a false impression of both the benefits and the necessity of add-on treatments such as biologic therapies. OBJECTIVE To assess the frequency with which inhaler technique is assessed and reliably optimized before and during patient enrollment into randomized controlled trials (RCTs) addressing the efficacy of topical therapy, and the escalation of therapy for asthma and COPD. METHODS Systematic searches were conducted of PubMed and Embase for RCTs published in the past 10 years involving patients with a diagnosis of asthma or COPD undergoing escalation of baseline inhaled therapy (stepping up, changing, adding, switching, increasing, etc) or the introduction of biologic agents. RESULTS Searches highlighted 1,014 studies, 118 of which were eligible after the removal of duplicates as well as screening and full text review. Of these, only 14 (11.9%) included accessible information in the methods section or referred to such information in online supplements or protocols concerning assessment of participants' inhaler technique. We therefore developed the proposed Best Practice Inhaler Technique Assessment and Reporting Checklist. CONCLUSIONS Our study identifies a concerning lack of checking and correcting inhaler technique, or at least reporting that this was undertaken, before enrollment in asthma and COPD RCTs, which may affect the conclusions drawn. Mandating the use of a standardized checklist in RCT protocols and ensuring all published RCTs report checking and correcting inhaler technique before enrollment are important next steps.
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Affiliation(s)
| | | | - Chris J Corrigan
- Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom
| | - Ruth M Hadfield
- Macquarie University, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Nicolas Roche
- Cochin Hospital and Institute, APHP Centre, University of Paris, Paris, France
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Corbetta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, The Netherlands; Groningen Research Institute Asthma and COPD, Groningen, The Netherlands; Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Borja G Cosio
- Observational and Pragmatic Research Institute, Singapore
| | - Roland Buhl
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Spain
| | - Søren E Pedersen
- Pulmonary Department, Universitätsmedizin Mainz, Mainz, Germany; University of Southern Denmark, Odense, Denmark, Department of Pediatrics, Kolding Hospital, Kolding, Denmark
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15
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Usmani OS, Han MK, Kaminsky DA, Hogg J, Hjoberg J, Patel N, Hardin M, Keen C, Rennard S, Blé FX, Brown MN. Response. Chest 2022; 161:e249-e250. [PMID: 35396060 DOI: 10.1016/j.chest.2021.12.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 10/18/2022] Open
Affiliation(s)
- Omar S Usmani
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, England.
| | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI
| | - David A Kaminsky
- Pulmonary and Critical Care, University of Vermont Larner College of Medicine, Burlington, VT
| | - James Hogg
- James Hogg Research Centre, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | | | | | | | - Christina Keen
- Research and Early Development, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Stephen Rennard
- University of Nebraska Medical Center, Omaha, NE; Translational Science and Experimental Medicine, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Omaha, NE
| | - François-Xavier Blé
- Translational Science and Experimental Medicine, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Omaha, NE
| | - Mary N Brown
- Research and Early Development, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
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16
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Leving MT, Kocks J, Bosnic-Anticevich S, Dekhuijzen R, Usmani OS. Relationship between Peak Inspiratory Flow and Patient and Disease Characteristics in Individuals with COPD—A Systematic Scoping Review. Biomedicines 2022; 10:biomedicines10020458. [PMID: 35203667 PMCID: PMC8962311 DOI: 10.3390/biomedicines10020458] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 01/25/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
Optimal delivery of medication via dry powder inhalers, the most commonly prescribed inhaler type, is dependent on a patient achieving a minimum level of inspiratory flow during inhalation. However, measurement of peak inspiratory flow (PIF) against the simulated resistance of a dry powder inhaler is not frequently performed in clinical practice due to time or equipment limitations. Therefore, defining which patient characteristics are associated with lower PIF is critically important to help clinicians optimize their inhaler choice through a more personalized approach to prescribing. The objective of this scoping review was to systematically evaluate patient and disease characteristics determining PIF in patients with chronic obstructive pulmonary disease (COPD). Medline, Cochrane and Embase databases were systematically searched for relevant studies on PIF in patients with COPD published in English between January 2000 and May 2021. The quality of evidence was assessed using a modified Grading of Recommendations Assessment, Development and Evaluation checklist. Of 3382 citations retrieved, 35 publications were included in the review (nine scored as high quality, 13 as moderate, nine as low, and four as very low). Factors correlating with PIF in >70% of papers included both patient characteristics (lower PIF correlated with increased age, female gender, shorter height, decreased handgrip and inspiratory muscle strength, and certain comorbidities) and disease characteristics (lower PIF correlated with markers of lung hyperinflation, lower peak expiratory flow [PEF] and increased disease severity). Other factors correlating with adequate/optimal or improved PIF included education/counseling and exercise/inspiratory muscle training; impaired physical function and errors in inhalation technique/non-adherence were associated with low/suboptimal PIF. In conclusion, clinicians should measure PIF against the simulated resistance of a particular device wherever possible. However, as this often cannot be done due to lack of resources or time, the patient and disease characteristics that influence PIF, as identified in this review, can help clinicians to choose the most appropriate inhaler type for their patients.
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Affiliation(s)
- Marika T. Leving
- General Practitioners Research Institute, 9713 GH Groningen, The Netherlands;
- Correspondence:
| | - Janwillem Kocks
- General Practitioners Research Institute, 9713 GH Groningen, The Netherlands;
- GRIAC Research Institute, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore 573969, Singapore
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia;
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Local Health District, Sydney, NSW 2050, Australia
| | | | - Omar S. Usmani
- National Heart and Lung Institute (NHLI), Imperial College London, London SW3 6LY, UK;
- Royal Brompton Hospital, London SW3 6NP, UK
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17
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Louis R, Satia I, Ojanguren I, Schleich F, Bonini M, Tonia T, Rigau D, Ten Brinke A, Buhl R, Loukides S, Kocks JWH, Boulet LP, Bourdin A, Coleman C, Needham K, Thomas M, Idzko M, Papi A, Porsbjerg C, Schuermans D, Soriano JB, Usmani OS. European Respiratory Society Guidelines for the Diagnosis of Asthma in Adults. Eur Respir J 2022; 60:2101585. [PMID: 35169025 DOI: 10.1183/13993003.01585-2021] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022]
Abstract
Although asthma is very common affecting 5-10% of the population, the diagnosis of asthma in adults remains a challenge in the real world that results in both over- and under-diagnosis. A task force (TF) was set up by the European Respiratory Society to systematically review the literature on the diagnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendation for clinical practice.The TF defined eight PICO (Population, Index, Comparator, and Outcome) questions that were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, The TF utilised the outcomes to develop an evidenced-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences.The TF support the initial use of spirometry followed, and if airway obstruction is present, by bronchodilator reversibility testing. If initial spirometry fails to show obstruction, further tests should be performed in the following order: FeNO, PEF variability or in secondary care, bronchial challenge. We present the thresholds for each test that are compatible with a diagnosis of asthma in the presence of current symptoms.The TF reinforce the priority to undertake spirometry and recognise the value of measuring blood eosinophils and serum IgE to phenotype the patient. Measuring gas trapping by body plethysmography in patients with preserved FEV1/FVC ratio deserves further attention. The TF draw attention on the difficulty of making a correct diagnosis in patients already receiving inhaled corticosteroids, the comorbidities that may obscure the diagnosis, the importance of phenotyping, and the necessity to consider the patient experience in the diagnostic process.
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Affiliation(s)
- Renaud Louis
- CHU de Liege University Hospital Centre Ville, Liege, Belgium
- First author, Task force chair
| | - Imran Satia
- McMaster University, Hamilton, Canada
- All authors contributed equally
| | - Inigo Ojanguren
- Vall d'Hebron University Hospital Barcelona, Barcelona, Spain
- All authors contributed equally
| | - Florence Schleich
- Department of Pulmonary Medicine, University of Liege, Liège, Belgium
- All authors contributed equally
| | - Matteo Bonini
- Sapienza University of Rome, Rome, Italy
- All authors contributed equally
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - David Rigau
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Anne Ten Brinke
- CHU de Liege University Hospital Centre Ville, Liege, Belgium
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | | | | | - Louis-Philippe Boulet
- Pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Canada
| | | | | | | | - Mike Thomas
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Marco Idzko
- Department of Respiratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Celeste Porsbjerg
- Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen NV, Denmark
| | - Daniel Schuermans
- Respiratory Division, Academic Hospital UZBrussel, Brussels, Belgium
| | - Joan B Soriano
- Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain
| | - Omar S Usmani
- Asthma Lab, National Heart and Lung Institute, London, UK
- Corresponding author, Task force co-chair
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18
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Usmani OS, Baldi S, Warren S, Panni I, Girardello L, Rony F, Taylor G, DeBacker W, Georges G. Lung Deposition of Inhaled Extrafine Beclomethasone Dipropionate/Formoterol Fumarate/Glycopyrronium Bromide in Healthy Volunteers and Asthma: The STORM Study. J Aerosol Med Pulm Drug Deliv 2022; 35:179-185. [PMID: 35128939 PMCID: PMC9416540 DOI: 10.1089/jamp.2021.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: An extrafine formulation triple therapy combination of beclomethasone dipropionate (BDP), formoterol fumarate (FF), and glycopyrronium bromide (GB) has been developed for the maintenance treatment of asthma and chronic obstructive pulmonary disease. This study used gamma scintigraphy to evaluate the intrapulmonary and extrapulmonary in vivo deposition of BDP/FF/GB, and the intrapulmonary regional distribution of the deposited formulation. Methods: This open-label uncontrolled nonrandomized single-dose study recruited 10 healthy volunteers and 9 patients with asthma. After a krypton-81m (81mKr) ventilation scan was conducted, subjects inhaled study drug (four inhalations of BDP/FF/GB 100/6/12.5 μg radiolabeled using technetium-99 m [99mTc]) through pressurized metered-dose inhaler, and a series of scintigraphic images were taken. The primary objective was to evaluate intrapulmonary drug deposition of BDP/FF/GB, determined as the percentage of nominal (i.e., metered) dose. Secondary endpoints included central/peripheral deposition ratio (C/P), and the standardized central/peripheral ratio (sC/P; 99mTc aerosol C/P/81mKr gas C/P). Results: All participants completed the study, with all scintigraphy procedures performed at one site. In patients with asthma, mean ± standard deviation intrapulmonary deposition was 25.50% ± 6.81%, not significantly different to that in healthy volunteers (22.74% ± 9.19%; p = 0.4715). Approximately half of the lung dose was deposited in the peripheral region of the lung (fraction deposited 0.52 ± 0.07 and 0.49 ± 0.06 in healthy volunteers and patients with asthma, respectively), resulting in C/P ratios of 0.94 ± 0.25 and 1.06 ± 0.25, respectively, with sC/P ratios of 1.80 ± 0.40 and 1.94 ± 0.38. Deposition patterns were similar in the two populations. BDP/FF/GB was well tolerated. Conclusions: This study confirmed that the extrafine particles delivered by BDP/FF/GB penetrate the peripheral areas of the lungs, with a similar proportion of particles deposited in the central and peripheral regions. Importantly, the deposition patterns were similar in healthy volunteers and patients with asthma, suggesting that disease characteristics are unlikely to impact drug deposition. Clinical Trial Registration number: NCT03795350.
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Affiliation(s)
- Omar S Usmani
- NHLI Imperial College London, London, United Kingdom
| | | | - Simon Warren
- Cardiff Scintigraphics Ltd., Cardiff, United Kingdom
| | | | | | | | - Glyn Taylor
- Cardiff Scintigraphics Ltd., Cardiff, United Kingdom
| | - Wilfried DeBacker
- Department of Respiratory Medicine, University of Antwerp, Antwerpen, Belgium
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19
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Ohar JA, Ferguson GT, Mahler DA, Drummond MB, Dhand R, Pleasants RA, Anzueto A, Halpin DMG, Price DB, Drescher GS, Hoy HM, Haughney J, Hess MW, Usmani OS. Measuring Peak Inspiratory Flow in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2022; 17:79-92. [PMID: 35023914 PMCID: PMC8747625 DOI: 10.2147/copd.s319511] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
Dry powder inhalers (DPIs) are breath actuated, and patients using DPIs need to generate an optimal inspiratory flow during the inhalation maneuver for effective drug delivery to the lungs. However, practical and standardized recommendations for measuring peak inspiratory flow (PIF)—a potential indicator for effective DPI use in chronic obstructive pulmonary disease (COPD)—are lacking. To evaluate recommended PIF assessment approaches, we reviewed the Instructions for Use of the In-Check™ DIAL and the prescribing information for eight DPIs approved for use in the treatment of COPD in the United States. To evaluate applied PIF assessment approaches, we conducted a PubMed search from inception to August 31, 2021, for reports of clinical and real-life studies where PIF was measured using the In-Check™ DIAL or through a DPI in patients with COPD. Evaluation of collective sources, including 47 applicable studies, showed that instructions related to the positioning of the patient with their DPI, instructions for exhalation before the inhalation maneuver, the inhalation maneuver itself, and post-inhalation breath-hold times varied, and in many instances, appeared vague and/or incomplete. We observed considerable variation in how PIF was measured in clinical and real-life studies, underscoring the need for a standardized method of PIF measurement. Standardization of technique will facilitate comparisons among studies. Based on these findings and our clinical and research experience, we propose specific recommendations for PIF measurement to standardize the process and better ensure accurate and reliable PIF values in clinical trials and in daily clinical practice.
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Affiliation(s)
- Jill A Ohar
- Section of Pulmonary, Critical Care, Allergy, and Immunology, School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
| | | | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rajiv Dhand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Roy A Pleasants
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Quality, University of Michigan, Ann Arbor, MI, USA
| | - Antonio Anzueto
- Pulmonology Section, University of Texas Health, and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - David B Price
- Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Observational and Pragmatic Research Institute, Singapore
| | - Gail S Drescher
- Pulmonary Services Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Haley M Hoy
- Transplant Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John Haughney
- Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
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20
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Stanford GE, Jones M, Charman SC, Bilton D, Usmani OS, Davies JC, Simmonds NJ. Clinimetric analysis of outcome measures for airway clearance in people with cystic fibrosis: a systematic review. Ther Adv Respir Dis 2022; 16:17534666221122572. [PMID: 36066081 PMCID: PMC9459493 DOI: 10.1177/17534666221122572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Airway clearance techniques (ACTs) are integral to cystic fibrosis (CF)
management. However, there is no consensus as to which outcome measures
(OMs) are best for assessing ACT efficacy. Objectives: To summarise OMs that have been assessed for their clinimetric properties
(including validity, feasibility, reliability, and reproducibility) within
the context of ACT research in CF. Design and Methods: A systematic review was conducted according to Preferred Reporting Items for
Systematic Review and Meta-Analysis Protocols (PRISMA) standards. Any
parallel or cross-over randomised controlled trial (RCT) investigating
outcome measures for ACT in the CF population were eligible for inclusion.
The search was performed in five medical databases, clinicaltrials.gov, and
abstracts from international CF conferences. The authors planned to
independently assess study quality and risk of bias using the
COnsensus-based Standards
for the selection of health status Measurement
InstrumeNts (COSMIN) risk
of bias checklist with external validity assessment based upon study details
(participants and study intervention). Two review authors (GS and MJ)
independently screened search results against inclusion criteria, and
further data extraction were planned but not required. Results: No completed RCTs from the 187 studies identified met inclusion criteria for
the primary or post hoc secondary objective. Two ongoing trials were
identified. Discussion and conclusion: This empty systematic review highlights that high-quality RCTs are urgently
needed to investigate and validate the clinimetric properties of OMs used to
assess ACT efficacy. With the changing demographics of CF combined with the
introduction of cystic fibrosis transmembrane conductance regulator (CFTR)
modulator therapies, an accurate assessment of the current benefit of ACT or
the effect of ACT withdrawal is a high priority for clinical practice and
future research; OMs which have been validated for this purpose are
essential. Registration: This systematic review was registered on the PROSPERO database
(CRD42020206033).
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Affiliation(s)
- Gemma E Stanford
- Research Fellow and Highly Specialist Physiotherapist, Department of Adult Cystic Fibrosis, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Mandy Jones
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | | | - Diana Bilton
- National Heart and Lung Institute, Imperial College, London, UK.,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College, London, UK.,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Jane C Davies
- National Heart and Lung Institute, Imperial College, London, UK.,Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Nicholas J Simmonds
- Department of Adult Cystic Fibrosis, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK.,Omar S. Usmani is now affiliated to Imperial College Respiratory Research Unit, St. Mary's Hospital, London, UK
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21
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Kouri A, Dandurand RJ, Usmani OS, Chow CW. Exploring the 175-year history of spirometry and the vital lessons it can teach us today. Eur Respir Rev 2021; 30:30/162/210081. [PMID: 34615699 DOI: 10.1183/16000617.0081-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022] Open
Abstract
175 years have elapsed since John Hutchinson introduced the world to his version of an apparatus that had been in development for nearly two centuries, the spirometer. Though he was not the first to build a device that sought to measure breathing and quantify the impact of disease and occupation on lung function, Hutchison coined the terms spirometer and vital capacity that are still in use today, securing his place in medical history. As Hutchinson envisioned, spirometry would become crucial to our growing knowledge of respiratory pathophysiology, from Tiffeneau and Pinelli's work on forced expiratory volumes, to Fry and Hyatt's description of the flow-volume curve. In the 20th century, standardization of spirometry further broadened its reach and prognostic potential. Today, spirometry is recognized as essential to respiratory disease diagnosis, management and research. However, controversy exists in some of its applications, uptake in primary care remains sub-optimal and there are concerns related to the way in which race is factored into interpretation. Moving forward, these failings must be addressed, and innovations like Internet-enabled portable spirometers may present novel opportunities. We must also consider the physiologic and practical limitations inherent to spirometry and further investigate complementary technologies such as respiratory oscillometry and other emerging technologies that assess lung function. Through an exploration of the storied history of spirometry, we can better contextualize its current landscape and appreciate the trends that have repeatedly arisen over time. This may help to improve our current use of spirometry and may allow us to anticipate the obstacles confronting emerging pulmonary function technologies.
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Affiliation(s)
- Andrew Kouri
- Division of Respirology, Dept of Medicine, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Ronald J Dandurand
- Lakeshore General Hospital, Quebec, Canada.,Dept of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada.,Montreal Chest Institute, Meakins-Christie Labs and Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, Montreal, Canada
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Chung-Wai Chow
- Dept of Medicine, University of Toronto, Toronto, Canada.,Division of Respirology and Multi-Organ Transplant Programme, Dept of Medicine, Toronto General Hospital, University Health Network, Toronto, Canada
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22
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Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes CoronaVirus Disease 2019 (COVID-19), has resulted in a worldwide pandemic and currently represents a major public health crisis. It has caused outbreaks of illness through person-to-person transmission of the virus mainly via close contacts, and droplets produced by an infected person's cough or sneeze. Aerosolised inhaled therapy is the mainstay for treating obstructive airway diseases at home and in healthcare settings, but there is heightened particular concern about the potential risk for transmission of SARS-CoV-2 in the form of aerosolised respiratory droplets during the nebulised treatment of patients with COVID-19. As a consequence of this concern, the use of hand-held inhalers, especially pressurised metered dose inhalers, has risen considerably as an alternative to nebulisers, and this switch has led to inadequate supplies of inhalers in some countries. However, there is no evidence supporting an increased risk of viral transmission during nebulisation in COVID-19 patients. Furthermore, some patients may be unable to adequately use their new device and may not benefit fully from the switch to treatment via hand-held inhalers. Thus, there is no compelling reason to alter aerosol delivery devices for patients with established nebuliser-based regimens. The purpose of this paper is to discuss the current evidence and understanding of the use of aerosolised inhaled therapies during the SARS-CoV-2 pandemic and to provide some guidance on the measures to be taken to minimise the risk of transmitting infection, if any, during aerosol therapies.
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Affiliation(s)
- Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Omar S Usmani
- Imperial College London and Royal Brompton Hospital, National Heart and Lung Institute, London, UK
| | - Rajiv Dhand
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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23
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van Boven JFM, Dierick BJH, Usmani OS. When biology meets behaviour: can medication adherence mask the contribution of pharmacogenetic effects in asthma? Eur Respir J 2021; 58:58/3/2100304. [PMID: 34475112 DOI: 10.1183/13993003.00304-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Job F M van Boven
- Dept of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands .,Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, The Netherlands
| | - Boudewijn J H Dierick
- Dept of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Omar S Usmani
- Imperial College London and Royal Brompton Hospital, London, UK
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24
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Usmani OS, Dhand R, Lavorini F, Price D. Why We Should Target Small Airways Disease in Our Management of Chronic Obstructive Pulmonary Disease. Mayo Clin Proc 2021; 96:2448-2463. [PMID: 34183115 DOI: 10.1016/j.mayocp.2021.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/12/2021] [Accepted: 03/16/2021] [Indexed: 12/23/2022]
Abstract
For more than 50 years, small airways disease has been considered a key feature of chronic obstructive pulmonary disease (COPD) and a major cause of airway obstruction. Both preventable and treatable, small airways disease has important clinical consequences if left unchecked. Small airways disease is associated with poor spirometry results, increased lung hyperinflation, and poor health status, making the small airways an important treatment target in COPD. The early detection of small airways disease remains the key barrier; if detected early, treatments designed to target small airways may help reduce symptoms and allow patients to maintain their activities. Studies are needed to evaluate the possible role of new drugs and novel drug formulations, inhalers, and inhalation devices for treating small airways disease. These developments will help to improve our management of small airways disease in patients with COPD.
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Affiliation(s)
- Omar S Usmani
- National Heart and Lung Institute, Imperial College London, and Royal Brompton Hospital, Airways Disease Section, London, UK.
| | - Rajiv Dhand
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - David Price
- Observational and Pragmatic Research Institute, Singapore; Optimum Patient Care, Cambridge, UK; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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25
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Garner JL, Biddiscombe MF, Meah S, Lewis A, Buttery SC, Hopkinson NS, Kemp SV, Usmani OS, Shah PL, Verbanck S. Endobronchial Valve Lung Volume Reduction and Small Airway Function. Am J Respir Crit Care Med 2021; 203:1576-1579. [PMID: 33596397 DOI: 10.1164/rccm.202010-3939le] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Justin L Garner
- Royal Brompton Hospital London, United Kingdom.,Chelsea & Westminster Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Martyn F Biddiscombe
- Royal Brompton Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Sally Meah
- Royal Brompton Hospital London, United Kingdom
| | - Adam Lewis
- Royal Brompton Hospital London, United Kingdom.,Brunel University London Uxbridge, United Kingdom
| | - Sara C Buttery
- Royal Brompton Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Nicholas S Hopkinson
- Royal Brompton Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Samuel V Kemp
- Royal Brompton Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Omar S Usmani
- Royal Brompton Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Pallav L Shah
- Royal Brompton Hospital London, United Kingdom.,Chelsea & Westminster Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Sylvia Verbanck
- Vrije Universiteit Brussel (VUB) Brussels, Belgium.,Universitair Ziekenhuis Brussel (UZ Brussel) Brussels, Belgium
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26
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Usmani OS, Han MK, Kaminsky DA, Hogg J, Hjoberg J, Patel N, Hardin M, Keen C, Rennard S, Blé FX, Brown MN. Seven Pillars of Small Airways Disease in Asthma and COPD: Supporting Opportunities for Novel Therapies. Chest 2021; 160:114-134. [PMID: 33819471 DOI: 10.1016/j.chest.2021.03.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 12/29/2022] Open
Abstract
Identification of pathologic changes in early and mild obstructive lung disease has shown the importance of the small airways and their contribution to symptoms. Indeed, significant small airways dysfunction has been found prior to any overt airway obstruction being detectable by conventional spirometry techniques. However, most therapies for the treatment of obstructive lung disease target the physiological changes and associated symptoms that result from chronic lung disease, rather than directly targeting the specific underlying causes of airflow disruption or the drivers of disease progression. In addition, although spirometry is the current standard for diagnosis and monitoring of response to therapy, the most widely used measure, FEV1 , does not align with the pathologic changes in early or mild disease and may not align with symptoms or exacerbation frequency in the individual patient. Newer functional and imaging techniques allow more effective assessment of small airways dysfunction; however, significant gaps in our understanding remain. Improving our knowledge of the role of small airways dysfunction in early disease in the airways, along with the identification of novel end points to measure subclinical changes in this region (ie, those not captured as symptoms or identified through standard FEV1), may lead to the development of novel therapies that directly combat early airways disease processes with a view to slowing disease progression and reversing damage. This expert opinion paper discusses small airways disease in the context of asthma and COPD and highlights gaps in current knowledge that impede earlier identification of obstructive lung disease and the development and standardization of novel small airways-specific end points for use in clinical trials.
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Affiliation(s)
- Omar S Usmani
- National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital, London, UK.
| | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI
| | - David A Kaminsky
- Pulmonary and Critical Care, University of Vermont Larner College of Medicine, Burlington, VT
| | - James Hogg
- James Hogg Research Centre, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | | | | | | | - Christina Keen
- Research and Early Development, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Stephen Rennard
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Translational Science and Experimental Medicine, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - François-Xavier Blé
- Translational Science and Experimental Medicine, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Mary N Brown
- Research and Early Development, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Boston, MA
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Usmani OS, Mignot B, Kendall I, Maria RD, Cocconi D, Georges G, Scichilone N. Predicting Lung Deposition of Extrafine Inhaled Corticosteroid-Containing Fixed Combinations in Patients with Chronic Obstructive Pulmonary Disease Using Functional Respiratory Imaging: An In Silico Study. J Aerosol Med Pulm Drug Deliv 2021; 34:204-211. [PMID: 33052749 PMCID: PMC8219200 DOI: 10.1089/jamp.2020.1601] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Functional respiratory imaging (FRI) is a computational fluid dynamics-based technique using three-dimensional models of human lungs and formulation profiles to simulate aerosol deposition. Methods: FRI was used to evaluate lung deposition of extrafine beclomethasone dipropionate (BDP)/formoterol fumarate (FF)/glycopyrronium bromide (GB) and extrafine BDP/FF delivered through pressurized metered dose inhalers and to compare results with reference gamma scintigraphy data. FRI combined high-resolution computed tomography scans of 20 patients with moderate-to-severe chronic obstructive pulmonary disease (mean forced expiratory volume in 1 second 42% predicted) with in silico computational flow simulations, and incorporated drug delivery parameters to calculate aerosol airway deposition. Inhalation was simulated using profiles obtained from real-life measurements. Results: Total lung deposition (proportion deposited in intrathoracic region) was similarly high for both products, with mean ± standard deviation (SD) values of 31.0% ± 5.7% and 28.1% ± 5.2% (relative to nominal dose) for BDP/FF/GB and BDP/FF, respectively. Pairwise comparison of the deposition of BDP and FF gave a mean intrathoracic BDP/FF/GB:BDP/FF deposition ratio of 1.10 (p = 0.0405). Mean intrathoracic, central and peripheral deposition ratios for BDP were 1.09 (95% confidence interval [CI]: 1.05-1.14), 0.92 (95% CI: 0.89-0.96), and 1.20 (95% CI: 1.15-1.26), respectively, and for FF were 1.11 (95% CI: 1.07-1.15), 0.94 (95% CI: 0.91-0.98), and 1.21 (95% CI: 1.15-1.27), within the bioequivalence range (0.80-1.25) for intrathoracic and central regions, and slightly exceeding the upper boundary in the peripheral region. Mean ± SD central:peripheral deposition (C:P) was 0.48 ± 0.13 for BDP/FF/GB and 0.62 ± 0.17 for BDP/FF, indicating a higher proportion of drug deposition in the small airways than in the large airways. Conclusion: FRI demonstrated similar deposition patterns for extrafine BDP/FF/GB and BDP/FF, with both having a high lung deposition. Moreover, the deposition patterns of BDP and FF were similar in both products. Furthermore, the C:P ratios of both products indicated a high peripheral deposition, supporting small airway targeting and delivery of these two extrafine fixed combinations, with a small difference in ratios potentially due to mass median aerodynamic diameters.
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Affiliation(s)
- Omar S. Usmani
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | | | | | - Roberta De Maria
- Chemistry Manufacturing and Controls, Chiesi Farmaceutici SpA, Parma, Italy
| | - Daniela Cocconi
- Chemistry Manufacturing and Controls, Chiesi Farmaceutici SpA, Parma, Italy
| | - George Georges
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant Excellence and Internal and Specialized Medicine (Promise), G. D'Alessandro, University of Palermo, Palermo, Italy
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Kocks JWH, Andringa HJH, van Heijst E, Louis R, Ojanguren Arranz I, Riemersma RA, Ryan D, Usmani OS, Flokstra-de Blok BMJ. Aeroallergen sensitization for detecting asthma in primary care: A diagnostic test accuracy study. Clin Exp Allergy 2021; 51:1080-1084. [PMID: 33914988 PMCID: PMC8453944 DOI: 10.1111/cea.13888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, the Netherlands.,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Heinze J H Andringa
- General Practitioners Research Institute, Groningen, the Netherlands.,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ellen van Heijst
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Astma/COPD dienst, CERTE Laboratories, Groningen, the Netherlands
| | - Renaud Louis
- Department of Pneumology, CHU Liege, GIGA I3 Liege University, Liege, Belgium
| | - Inigo Ojanguren Arranz
- Servei de Pneumología, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona (UAB, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | | | - Dermot Ryan
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Bertine M J Flokstra-de Blok
- General Practitioners Research Institute, Groningen, the Netherlands.,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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29
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Moitra S, Moitra S, Ghosh AK, Sengupta S, Das PK, Das A, Mitra R, Murgia N, Usmani OS. Reference values of impulse oscillometry (IOS) for healthy Indian adults. Int J Tuberc Lung Dis 2021; 24:536-539. [PMID: 32398207 DOI: 10.5588/ijtld.19.0796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Subhabrata Moitra
- ISGlobal, Barcelona, Spain, CIBER Epidemiologia y Salud Publica (CIBERSP), Barcelona, Spain, Universitat Pompeu Fabra, Barcelona, Spain
| | - Saibal Moitra
- Division of Pulmonary Medicine, Charnock Hospital, Kolkata, India, Department of Pneumology, Allergy & Asthma Research Centre, Kolkata, India
| | - A K Ghosh
- Department of Statistics, Presidency University, Kolkata, India
| | - S Sengupta
- Division of Pulmonary Medicine, Charnock Hospital, Kolkata, India
| | - P K Das
- Division of Pulmonary Medicine, Charnock Hospital, Kolkata, India, Department of Pneumology, Allergy & Asthma Research Centre, Kolkata, India
| | - A Das
- Department of Respiratory Medicine, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - R Mitra
- Department of Pulmonary Medicine, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, India
| | - N Murgia
- Department of Medicine, University of Perugia, Perugia, Italy
| | - O S Usmani
- National Heart and Lung Institute, Imperial College London, London, UK, ,
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Usmani OS, Hickey AJ, Guranlioglu D, Rawson K, Stjepanovic N, Siddiqui S, Dhand R. The Impact of Inhaler Device Regimen in Patients with Asthma or COPD. J Allergy Clin Immunol Pract 2021; 9:3033-3040.e1. [PMID: 33901714 DOI: 10.1016/j.jaip.2021.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
Many inhaler devices with varying handling requirements for optimal use are available for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Patients may be prescribed different device types for reliever and maintenance medications, which may lead to confusion and suboptimal device use. We aimed to understand whether simplifying inhaler regimens by employing a single device type in patients who use multiple devices or prescribing a device with which a patient was already experienced could improve clinical and economic outcomes in asthma and COPD management. A targeted literature search was performed and additional articles were identified through hand searching citations within screened publications. A total of 114 articles were included in the final review. Findings suggest that simplifying inhaler regimens by applying the same type of inhaler for concomitant inhaled medications over time minimizes device misuse, leading to improved clinical outcomes and reduced health care use in patients with asthma or COPD. Physicians should consider a patient's suitability for a device and training needs when prescribing an inhaled medication and before changing the medication type or dose, especially when suboptimal treatment outcomes are observed. Further research is required to determine whether consistent use of the same device type is associated with better treatment adherence and persistence in patients with asthma or COPD. Nevertheless, this literature review identified clinical benefits and reduced health care use with simplified inhaler regimens.
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Affiliation(s)
- Omar S Usmani
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom.
| | - Anthony J Hickey
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | - Rajiv Dhand
- Graduate School of Medicine, University of Tennessee, Knoxville, TN
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31
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Dreher M, Price D, Gardev A, Peeters P, Arora S, van der Sar-van der Brugge S, Dekhuijzen R, Usmani OS. Patient perceptions of the re-usable Respimatt ® Soft Mist™ inhaler in current users and those switching to the device: A real-world, non-interventional COPD study. Chron Respir Dis 2021; 18:1479973120986228. [PMID: 33522304 PMCID: PMC7868496 DOI: 10.1177/1479973120986228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PLAIN LANGUAGE SUMMARY Inhalers are often used to treat patients with chronic obstructive pulmonary disease (COPD). However, there are many available, which can lead to confusion and poor inhaler technique. It is important for a patient to be happy with their inhaler. This study looked at how patients liked the re-usable Respimat® Soft Mist™ inhaler vs. their previous inhaler. It also asked whether they would be willing to continue using the device at the end of the study period.After 4-6 weeks of using the re-usable device, patients reported that they were happy with the inhaler and most would be willing to carry on using it.Overall, these results show that doctors can prescribe Respimat re-usable to patients, even if the patient has not used the inhaler before.
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Affiliation(s)
- Michael Dreher
- Department of Pneumology and Intensive Care Medicine, 39058University Hospital Aachen; RWTH Aachen University, Aachen, Germany
| | - David Price
- Observational and Pragmatic Research Institute, Singapore.,Optimum Patient Care, Cambridge, UK.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Asparuh Gardev
- 60325Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | | | | | | | - Omar S Usmani
- National Heart and Lung Institute (NHLI), 4615Imperial College London, London, UK
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32
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Usmani OS, Roche N, Jenkins M, Stjepanovic N, Mack P, De Backer W. Consistent Pulmonary Drug Delivery with Whole Lung Deposition Using the Aerosphere Inhaler: A Review of the Evidence. Int J Chron Obstruct Pulmon Dis 2021; 16:113-124. [PMID: 33500616 PMCID: PMC7822085 DOI: 10.2147/copd.s274846] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 11/23/2022] Open
Abstract
Metered dose inhalers (MDIs) are one of the most common device types for delivering inhaled therapies. However, there are several technical challenges in development and drug delivery of these medications. In particular, suspension-based MDIs are susceptible to suspension heterogeneity, in vitro drug–drug interactions, and patient handling errors, which may all affect drug delivery. To overcome these challenges, new formulation approaches are required. The AerosphereTM inhaler, formulated using co-suspension delivery technology, combines drug crystals with porous phospholipid particles to create stable, homogenous suspensions that dissolve once they reach the airways. Two combination therapies using this technology have been developed for the treatment of COPD: glycopyrrolate/formoterol fumarate (GFF MDI; dual combination) and budesonide/glycopyrrolate/formoterol fumarate (BGF MDI; triple combination). Here, we review the evidence with a focus on studies assessing dose delivery, lung deposition, and effects on airway geometry. In vitro assessments have demonstrated that the Aerosphere inhaler provides consistent dose delivery, even in the presence of simulated patient handling errors. Combination therapies delivered with this technology also show a consistent fine particle fraction (FPF) and an optimal particle size distribution for delivery to the central and peripheral airways even when multiple drugs are delivered via the same inhaler. Studies using gamma scintigraphy and functional respiratory imaging have demonstrated that GFF MDI is effectively deposited in the central and peripheral airways, and provides clinically meaningful benefits on airway volume and resistance throughout the lung. Overall, studies suggest that the Aerosphere inhaler, formulated using co-suspension delivery technology, may offer advantages over traditional formulations, including consistent delivery of multiple components across patient handling conditions, optimal particle size and FPF, and effective delivery to the central and peripheral airways. Future studies may provide additional evidence to further characterize the clinical benefits of these technical improvements in MDI drug delivery.
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Affiliation(s)
- Omar S Usmani
- National Heart and Lung Institute (NHLI), Imperial College London, and Royal Brompton Hospital, London, UK
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital, University Paris Descartes, Paris, France
| | | | | | | | - Wilfried De Backer
- Department of Pulmonary Medicine, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
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33
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Pleasants RA, Tilley SL, Hickey AJ, Usmani OS. User-life of ICS/LABA inhaler devices should be considered when prescribed as relievers. Eur Respir J 2021; 57:57/1/2003921. [PMID: 33446577 DOI: 10.1183/13993003.03921-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/16/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Roy A Pleasants
- University of North Carolina at Chapel Hill, Division of Pulmonary Diseases and Critical Care Medicine, Chapel Hill, NC, USA
| | - Stephen L Tilley
- University of North Carolina at Chapel Hill, Division of Pulmonary Diseases and Critical Care Medicine, Chapel Hill, NC, USA
| | - Anthony J Hickey
- RTI International, Engineered Systems, Research Triangle Park, NC, USA.,University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Omar S Usmani
- Imperial College London and Royal Brompton Hospital, National Heart and Lung Institute, London, UK
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34
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Soni S, Garner JL, O'Dea KP, Koh M, Finney L, Tirlapur N, Srikanthan K, Tenda ED, Aboelhassan AM, Singh S, Wilson MR, Wedzicha JA, Kemp SV, Usmani OS, Shah PL, Takata M. Intra-alveolar neutrophil-derived microvesicles are associated with disease severity in COPD. Am J Physiol Lung Cell Mol Physiol 2020; 320:L73-L83. [PMID: 33146567 DOI: 10.1152/ajplung.00099.2020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Despite advances in the pathophysiology of chronic obstructive pulmonary disease (COPD), there is a distinct lack of biochemical markers to aid clinical management. Microvesicles (MVs) have been implicated in the pathophysiology of inflammatory diseases including COPD, but their association to COPD disease severity remains unknown. We analyzed different MV populations in plasma and bronchoalveolar lavage fluid (BALF) taken from 62 patients with mild to very severe COPD (51% male; mean age: 65.9 yr). These patients underwent comprehensive clinical evaluation (symptom scores, lung function, and exercise testing), and the capacity of MVs to be clinical markers of disease severity was assessed. We successfully identified various MV subtype populations within BALF [leukocyte, polymorphonuclear leukocyte (PMN; i.e., neutrophil), monocyte, epithelial, and platelet MVs] and plasma (leukocyte, PMN, monocyte, and endothelial MVs) and compared each MV population to disease severity. BALF neutrophil MVs were the only population to significantly correlate with the clinical evaluation scores including forced expiratory volume in 1 s, modified Medical Research Council dyspnea score, 6-min walk test, hyperinflation, and gas transfer. BALF neutrophil MVs, but not neutrophil cell numbers, also strongly correlated with BODE index. We have undertaken, for the first time, a comprehensive evaluation of MV profiles within BALF/plasma of COPD patients. We demonstrate that BALF levels of neutrophil-derived MVs are unique in correlating with a number of key functional and clinically relevant disease severity indexes. Our results show the potential of BALF neutrophil MVs for a COPD biomarker that tightly links a key pathophysiological mechanism of COPD (intra-alveolar neutrophil activation) with clinical severity/outcome.
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Affiliation(s)
- Sanooj Soni
- Division of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Justin L Garner
- Royal Brompton Hospital, Respiratory Medicine, London, United Kingdom.,Chelsea and Westminster Hospital, Respiratory Medicine, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | - Kieran P O'Dea
- Division of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Marissa Koh
- Division of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Lydia Finney
- Royal Brompton Hospital, Respiratory Medicine, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | - Nikhil Tirlapur
- Division of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Karthi Srikanthan
- Royal Brompton Hospital, Respiratory Medicine, London, United Kingdom.,Chelsea and Westminster Hospital, Respiratory Medicine, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | - Eric D Tenda
- Royal Brompton Hospital, Respiratory Medicine, London, United Kingdom.,Chelsea and Westminster Hospital, Respiratory Medicine, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | - Arafa M Aboelhassan
- Royal Brompton Hospital, Respiratory Medicine, London, United Kingdom.,Chelsea and Westminster Hospital, Respiratory Medicine, London, United Kingdom
| | - Suveer Singh
- Royal Brompton Hospital, Respiratory Medicine, London, United Kingdom.,Chelsea and Westminster Hospital, Respiratory Medicine, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | - Michael R Wilson
- Division of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Jadwiga A Wedzicha
- Royal Brompton Hospital, Respiratory Medicine, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | - Samuel V Kemp
- Royal Brompton Hospital, Respiratory Medicine, London, United Kingdom
| | - Omar S Usmani
- Royal Brompton Hospital, Respiratory Medicine, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | - Pallav L Shah
- Royal Brompton Hospital, Respiratory Medicine, London, United Kingdom.,Chelsea and Westminster Hospital, Respiratory Medicine, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | - Masao Takata
- Division of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
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Usmani OS, Scichilone N, Mignot B, Belmans D, Van Holsbeke C, De Backer J, De Maria R, Cuoghi E, Topole E, Georges G. Airway Deposition of Extrafine Inhaled Triple Therapy in Patients with COPD: A Model Approach Based on Functional Respiratory Imaging Computer Simulations. Int J Chron Obstruct Pulmon Dis 2020; 15:2433-2440. [PMID: 33116458 PMCID: PMC7548261 DOI: 10.2147/copd.s269001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction There is a clear correlation between small airways dysfunction and poor clinical outcomes in patients with chronic obstructive pulmonary disease (COPD), and it is therefore important that inhalation therapy (both bronchodilator and anti-inflammatory) can deposit in the small airways. Two single-inhaler triple therapy (SITT) combinations are currently approved for the maintenance treatment of COPD: extrafine formulation beclomethasone dipropionate/formoterol fumarate/glycopyrronium bromide (BDP/FF/GB), and non-extrafine formulation fluticasone furoate/vilanterol/umeclidinium (FluF/VI/UMEC). This study evaluated the lung deposition of the inhaled corticosteroid (ICS), long-acting β2-agonist (LABA), and long-acting muscarinic antagonist (LAMA) components of these two SITTs. Materials and Methods Lung deposition was estimated in-silico using functional respiratory imaging, a validated technique that uses aerosol delivery performance profiles, patients’ high-resolution computed tomography (HRCT) lung scans, and patient-derived inhalation profiles to simulate aerosol lung deposition. Results HRCT scan data from 20 patients with COPD were included in these analyses, who had post-bronchodilator forced expiratory volume in 1 second (FEV1) ranging from 19.3% to 66.0% predicted. For intrathoracic deposition (as a percentage of the emitted dose), deposition of the ICS component was higher from BDP/FF/GB than FluF/VI/UMEC; the two triple therapies had similar performance for both the LABA component and the LAMA component. Peripheral deposition of all three components was higher with BDP/FF/GB than FluF/VI/UMEC. Furthermore, the ratios of central to peripheral deposition for all three components of BDP/FF/GB were <1, indicating greater peripheral than central deposition (0.48±0.13, 0.48±0.13 and 0.49±0.13 for BDP, FF and GB, respectively; 1.96±0.84, 0.97±0.34 and 1.20±0.48 for FluF, VI and UMEC, respectively). Conclusions Peripheral (small airways) deposition of all three components (ICS, LABA, and LAMA) was higher from BDP/FF/GB than from FluF/VI/UMEC, based on profiles from patients with moderate to very severe COPD. This is consistent with the extrafine formulation of BDP/FF/GB.
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Affiliation(s)
- Omar S Usmani
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK
| | - Nicola Scichilone
- PROMISE Department of Medicine, University of Palermo, Palermo, Italy
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36
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Kerkhof M, Chaudhry I, Pavord ID, Miravitlles M, Kook Rhee C, Halpin DM, Usmani OS, Jones R, Kocks J, Alacqua M, Morris T, Kaplan A, Price DB. Blood eosinophil count predicts treatment failure and hospital readmission for COPD. ERJ Open Res 2020; 6:00188-2020. [PMID: 33693048 PMCID: PMC7927786 DOI: 10.1183/23120541.00188-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/15/2020] [Accepted: 08/28/2020] [Indexed: 11/05/2022] Open
Abstract
We examined associations between blood eosinophil counts (BEC) and risk of treatment failure or hospital readmission following acute oral corticosteroid (OCS)-treated COPD exacerbations. We conducted studies from the Optimum Patient Care Research Database (OPCRD) (www.optimumpatientcare.org/opcrd) and Clinical Practice Research Datalink (CPRD) (www.cprd.com/home/), validated databases for medical research, with linked Hospital Episode Statistics (HES) data for ∼20 000 COPD patients aged ≥40 years. For patients with OCS-treated COPD exacerbations treated in primary care, with BECs recorded on first day of OCS treatment (Cohort 1), we assessed treatment failure (COPD-related hospitalisations and OCS prescriptions beyond index OCS course). For patients hospitalised for COPD exacerbations, with BEC measured over an exacerbation-free period during the year prior to admission (Cohort 2), we assessed readmission rate. Cox proportional hazards regression analysis was adjusted for confounders to estimate the association between BEC and treatment outcomes. Of patients treated with OCS for COPD exacerbations in primary care (Cohort 1), 44% experienced treatment failure following single OCS courses, and 10% (255/2482) were hospitalised for ≤6 weeks. Greater BEC was associated with reduced hospital-admission risk (hazard ratio [HR]=0.26; 95% CI: 0.12-0.56, per 100 cells·µL-1 increase). BEC increases of ≥200 cells·µL-1 from exacerbation-free periods to exacerbations were associated with least hospitalisation risk (HR=0.32; 95% CI: 0.15-0.71) versus no BEC change. For patients hospitalised for COPD exacerbations (Cohort 2), 4-week hospital readmission was 12% (1189/10 245). BEC increases during an exacerbation-free period within the past year were associated with reduced risk of short-term readmission (HR=0.78; 95% CI: 0.63-0.96). Greater BEC predicted better outcomes for patients with OCS-treated COPD exacerbations, whether community or hospital managed. Eosinopenia predicted worse outcomes.
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Affiliation(s)
- Marjan Kerkhof
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Isha Chaudhry
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Ian D. Pavord
- Oxford Respiratory NIHR BRC, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Chin Kook Rhee
- College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - David M.G. Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Rupert Jones
- The Peninsula College of Medicine and Dentistry, Plymouth, UK
| | - Janwillem Kocks
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | | | | | - Alan Kaplan
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Family Physician Airways Group of Canada, Richmond Hill, ON, Canada
| | - David B. Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- University of Aberdeen, Aberdeen, UK
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Haughney J, Lee AJ, McKnight E, Pertsovskaya I, O'Driscoll M, Usmani OS. Peak Inspiratory Flow Measured at Different Inhaler Resistances in Patients with Asthma. J Allergy Clin Immunol Pract 2020; 9:890-896. [PMID: 33011302 DOI: 10.1016/j.jaip.2020.09.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/03/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients' peak inspiratory flow rate (PIFR) may help clinicians select an inhaler device. OBJECTIVE To determine the proportion of patients with asthma who could generate correct PIFRs at different inhaler resistance settings. METHODS During a UK asthma review service, patients' PIFR was checked at resistance settings matching their current preventer inhaler device, at R5 (high-resistance dry powder inhaler [DPI]) and at R0 (low resistance, pressurized metered dose inhaler [pMDI]). Correct PIFR ("pass") was defined for R5 as 30 to 90 L/min and for R0 as 20 to 60 L/min. A logistic regression model examined the independent predictors of incorrect PIFR ("fail") at R5 and R0. Asthma severity was assessed retrospectively from treatment level. RESULTS A total of 994 adults (females 64.3%) were included, of whom 90.4% currently used a preventer inhaler (71.5% pMDI). PIFR pass rates were 93.7% at R5 compared with 70.5% at R0 (P < .0001). All patients failing the R0 PIFR breathed in too fast (>60 L/min), and 20% of patients currently using pMDI failed for this reason. Independent risk factors for failing R5 were female sex, older age group, and current preventer pMDI and for failing R0 included male sex, younger age group, current preventer DPI, and mild versus severe asthma. CONCLUSIONS This study demonstrates that most patients with asthma can achieve adequate inspiratory flow to activate high-resistance DPIs, whereas approximately a third of patients breathe in too fast to achieve recommended inspiratory flows for correct pMDI use, including one-fifth of patients who currently use a pMDI preventer.
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Affiliation(s)
- John Haughney
- Queen Elizabeth University Hospital, Glasgow, United Kingdom.
| | - Amanda J Lee
- Medical Statistics Team, University of Aberdeen, Aberdeen, United Kingdom
| | - Eddie McKnight
- National Services for Health Improvement Ltd, Swaffham, United Kingdom
| | - Inna Pertsovskaya
- National Services for Health Improvement Ltd, Swaffham, United Kingdom
| | | | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom
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Bakakos A, Loukides S, Usmani OS, Bakakos P. Biologics in severe asthma: the overlap endotype - opportunities and challenges. Expert Opin Biol Ther 2020; 20:1427-1434. [PMID: 32779950 DOI: 10.1080/14712598.2020.1809651] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Patients with severe asthma experience a significant burden of symptoms, disease exacerbations and medication side-effects. Severe asthma interferes with the patients' quality of life and has high health-care costs. New targeted biologic therapies have improved the management of severe asthma by significantly reducing exacerbations and maintenance corticosteroid use, and also improving lung function and patient quality of life. AREAS COVERED Not all severe asthmatics are eligible for such therapies. Those with allergic and eosinophilic asthma, usually referred to as 'T2-high' asthma benefit from anti-IgE and anti-IL-5/5 R antibodies respectively, whereas some asthmatics are eligible for both: 'overlap' endotype. In this review, we present briefly the monoclonal antibodies that have been approved in the management of severe asthma and we focus on the 'overlap' endotype. EXPERT OPINION Since these therapies are costly, it is extremely important to choose the right treatment for the right patient especially in the 'overlapping' one. The decision is mainly based on the judgment of the clinician and is often driven by the most easily obtainable biomarker, thus the blood eosinophil count. Comorbidities, patient's input and administration frequency may aid the decision of choosing one over another biologic.
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Affiliation(s)
- A Bakakos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens , Athens Greece
| | - S Loukides
- 2 University Department of Respiratory Medicine, National and Kapodistrian University of Athens , Athens Greece
| | - O S Usmani
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, & Royal Brompton Hospital , UK
| | - P Bakakos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens , Athens Greece
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Affiliation(s)
- Omar S Usmani
- National Heart and Lung InstituteImperial College LondonLondon, United Kingdom
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40
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Usmani OS, Matthews JC, Wright MD, Meah S, Underwood SR, Barnes PJ, Shallcross DE, Biddiscombe MF. No Evidence That Electric Charge Increases Inhaled Ultrafine Particle Deposition in Human Lungs. Am J Respir Crit Care Med 2020; 201:1301-1303. [PMID: 31995394 DOI: 10.1164/rccm.201912-2502le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Sally Meah
- Imperial College LondonLondon, United Kingdom
| | - S Richard Underwood
- Royal Brompton Hospital & Harefield NHS Foundation TrustLondon, United Kingdom
| | | | | | - Martyn F Biddiscombe
- Imperial College LondonLondon, United Kingdom.,Royal Brompton Hospital & Harefield NHS Foundation TrustLondon, United Kingdom
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Israel S, Kumar A, DeAngelis K, Aurivillius M, Dorinsky P, Roche N, Usmani OS. Pulmonary deposition of budesonide/glycopyrronium/formoterol fumarate dihydrate metered dose inhaler formulated using co-suspension delivery technology in healthy male subjects. Eur J Pharm Sci 2020; 153:105472. [PMID: 32682074 DOI: 10.1016/j.ejps.2020.105472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
This gamma scintigraphy imaging study assessed pulmonary, extrathoracic and regional lung deposition patterns of a radiolabelled inhaled corticosteroid/long-acting muscarinic antagonist/long-acting β2-agonist triple fixed-dose combination budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF 320/14.4/10 μg), delivered by pressurised metered dose inhaler (pMDI) using innovative co-suspension delivery technology (Aerosphere™). In this Phase I, randomised, single-centre, single-dose, two-period, crossover study (NCT03740373), 10 healthy male adults received two actuations of BGF MDI (160/7.2/4.8 μg per actuation) radiolabelled with 99mTc, not exceeding 5 MBq per actuation. Immediately following each inhalation, subjects performed a 10- or 3-second breath-hold, then exhaled into an exhalation filter. The primary objective was to assess the pulmonary deposition of BGF MDI following the 10-second breath-hold. The secondary objectives were to assess deposition after the 3-second breath-hold and lung regional and extrathoracic deposition after each breath-hold length. Imaging of the lungs, stomach, head and neck was recorded by gamma scintigraphy immediately after exhalation. The mean BGF MDI emitted dose deposited in the lungs was 37.7% for the 10-second breath-hold and 34.5% for the 3-second breath-hold. Emitted dose detected in the exhalation filter was ≤0.4% for both breath-hold lengths. The mean normalised peripheral/central ratio was 0.65 and 0.75 for the 10- and 3-second breath-holds, respectively, while the standardised central/peripheral ratios were 1.79 and 1.40, respectively. There were no new or unexpected safety findings. In conclusion, BGF MDI was efficiently deposited in the central and the peripheral regions of the lungs, with similar regional deposition patterns following a 10- and 3-second breath-hold.
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Affiliation(s)
- Samuel Israel
- Simbec Research Ltd, Merthyr Tydfil, South Wales, CF48 4DR, UK
| | - Ashish Kumar
- Kelly Services Global LLC, Suite 401A, 999W. Big Beaver Rd., Troy, MI, 48084, USA
| | - Kiernan DeAngelis
- Formerly of AstraZeneca, 4222 Emperor Blvd, Suite 560, Durham, NC, 27703, USA
| | | | - Paul Dorinsky
- AstraZeneca, 4222 Emperor Blvd, Suite 560, Durham, NC, 27703, USA.
| | - Nicolas Roche
- Respiratory Medicine, Hôpital Cochin (AP-HP), University Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Omar S Usmani
- National Heart and Lung Institute (NHLI), Imperial College London & Royal Brompton Hospital, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK
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42
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Abstract
Inhalation therapy is integral in the management of patients with chronic obstructive pulmonary disease (COPD). Specifically, intravenous augmentation therapy is available to patients with alpha-1 antitrypsin deficiency (AATD), although there is insufficient alpha-1 antitrypsin (AAT) delivery to the lungs to modify airways inflammation. In contrast, the inhaled route allows replacement therapy to reach the target site of action and with higher AAT levels. Patients certainly support the inhalation route as an alternative to intravenous injections, obviating repetitive needle insertion and allowing treatment empowerment rather than dependency on traveling to specialized units. The difficulty with inhalation has been the ability to target the formulation to the pathophysiological site of disease: the emphysematous lung parenchyma of the small alveolated airways. Recent advances have suggested nebulizers as being able to deliver an adequate dose, consistently and reproducibly, and, coupled with developments in formulation science, allowed replacement therapy to reach the epithelial lining fluid of the small airways. The bench science has been translated to the first randomized, placebo-controlled clinical trial to study the effects of nebulized AAT, which, although not meeting the primary endpoint of prolonging time to first exacerbation, showed this treatment modality was safe and achievable in a large patient cohort. Indeed, learning from this trial suggests the importance of choosing the right clinical endpoints, and recent key advances in lung physiology indices allow better assessment of the "silent zone" of small airways disease. Knowledge from other respiratory diseases will complement treating patients with AATD, where there is considerable innovation in aerosol science and inhalation medicine directed at utilizing the inhaled route. Indeed, it could be postulated that the inhaled route may not only achieve local pulmonary therapeutic benefit, but through systemic absorption and controlled pharmacokinetic profiling, the formulation may reach and treat liver disease.
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Affiliation(s)
- Omar S Usmani
- National Heart and Lung Institute, Imperial College London, United Kingdom
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43
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Keeley D, Scullion JE, Usmani OS. Minimising the environmental impact of inhaled therapies: problems with policy on low carbon inhalers. Eur Respir J 2020; 55:55/5/2001122. [PMID: 32461340 DOI: 10.1183/13993003.01122-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 12/27/2022]
Affiliation(s)
| | | | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London, London, UK
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44
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Verbanck S, Biddiscombe MF, Usmani OS. Inhaled aerosol dose distribution between proximal bronchi and lung periphery. Eur J Pharm Biopharm 2020; 152:18-22. [PMID: 32361031 DOI: 10.1016/j.ejpb.2020.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/11/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
Modern inhaled drug discovery programs assess dose delivery to proximal and distal airways using rudimentary imaging indices, where relative deposition is estimated by generically defined 'central' and 'peripheral' lung regions. Utilizing recent data linking the proximal airway topology to a characteristic pattern of aerosol lung deposition, we provide a direct measure of dose distribution between the proximal bronchi and the distal lung. We analyzed scintigraphic lung images of twelve asthma patients following inhalation of 1.5-, 3- and 6-µm monodisperse drug particles at breathing flows of 30- and 60-L/min. We explicitly used the central hot-spots associated with each patient's specific bronchial topology to obtain a direct measure of aerosol deposition in the proximal bronchi, rather than applying standard templates of lung boundaries. Maximum deposition in the central bronchi (as % of lung deposition) was 52 ± 10(SD)% (6 µm;60 L/min). Minimum central deposition was 17 ± 2(SD)% (1.5 µm;30 L/min) where the 83% aerosol 'escaping' deposition in the central bronchi reached 75 ± 17(SD)% of the lung area that could be reached by Krypton gas. For all particle sizes, hot-spots appeared in the same patient-specific central airway location, with greatest intensity at 60 L/min. For a range of respirable aerosol sizes and breathing flows, we have quantified deposited dose in the proximal bronchi and their distal lung reach, constituting a platform to support therapeutic inhaled aerosol drug development.
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Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZBrussel, Brussels, Belgium.
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45
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Bloom CI, Douglas I, Usmani OS, Quint JK. Inhaled Corticosteroid Treatment Regimens and Health Outcomes in a UK COPD Population Study. Int J Chron Obstruct Pulmon Dis 2020; 15:701-710. [PMID: 32308379 PMCID: PMC7136662 DOI: 10.2147/copd.s241568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/10/2020] [Indexed: 01/23/2023] Open
Abstract
Background Inhaled corticosteroids (ICS) are a prevailing treatment option for COPD patients but recent guidelines have relegated their use predominantly to patients with frequent exacerbations. Yet large numbers of patients worldwide are currently treated with ICS-containing regimens. We wished to determine in routine clinical practice how common ICS withdrawal is and the differences in health outcomes between patients managed on ICS-containing and non-ICS containing regimens. Patients and Methods COPD patients were identified from the UK primary care electronic healthcare records, between 2014 and 2018. Patients were grouped into three treatment regimens: long-acting beta-agonist (LABA) and inhaled corticosteroids (ICS), LABA and long-acting muscarinic antagonist (LAMA), and triple therapy (LABA, LAMA and ICS). Annual incidence of ICS withdrawal was measured. Multivariable logistic regression was used to identify patient factors associated with withdrawal. Multivariable Poisson regression was used to assess the association of exacerbations and hospitalised pneumonia between the ICS-containing regimens (LABA-ICS and triple therapy) and patients prescribed LABA-LAMA. Results Of 117,046 patients, around three-quarters were prescribed ICS-containing inhalers but ICS withdrawal occurred annually in only approximately 2–3% of patients. Exacerbations in the past year, but not a past history of pneumonia, were associated with ICS withdrawal. A total of 31,034 patients using three treatment regimens (LABA-ICS, LABA-LAMA or triple therapy) were assessed for their relative risk of exacerbations and pneumonia; the exacerbation risk was slightly lower in LABA-ICS users but the same in triple therapy users, as compared to LABA-LAMA users (LABA-ICS adjusted IRR=0.82 (95% CI 0.73–0.93), triple adjusted IRR=0.99 (95% CI 0.88–1.11)). There was no difference in the pneumonia risk (LABA-ICS adjusted IRR=0.96 (95% CI 0.71–1.31), triple adjusted IRR=1.16 (95% CI 0.87–1.57)). Conclusion Use of ICS-containing inhaled medication is prevalent across the UK while ICS withdrawal from established treatment was relatively uncommon. Exacerbations and pneumonia risk was similar between the ICS-containing and non-ICS containing treatment regimens.
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Affiliation(s)
- Chloe I Bloom
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK
| | - Ian Douglas
- London School of Hygiene and Tropical Medicine, London, UK
| | - Omar S Usmani
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK
| | - Jennifer K Quint
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK
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46
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Cazzola M, Cavalli F, Usmani OS, Rogliani P. Advances in pulmonary drug delivery devices for the treatment of chronic obstructive pulmonary disease. Expert Opin Drug Deliv 2020; 17:635-646. [DOI: 10.1080/17425247.2020.1739021] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mario Cazzola
- Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Francesco Cavalli
- Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Omar S. Usmani
- Imperial College London and Royal Brompton Hospital, Airways Disease Section, National Heart and Lung Institute (NHLI), London, UK
| | - Paola Rogliani
- Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
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Satia I, Nagashima A, Usmani OS. Exploring the role of nerves in asthma; insights from the study of cough. Biochem Pharmacol 2020; 179:113901. [PMID: 32156662 DOI: 10.1016/j.bcp.2020.113901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/03/2020] [Indexed: 12/30/2022]
Abstract
Cough in asthma predicts disease severity, prognosis, and is a common and troublesome symptom. Cough is the archetypal airway neuronal reflex, yet little is understood about the underlying neuronal mechanisms. It is generally assumed that symptoms arise because of airway hyper-responsiveness and/or airway inflammation, but despite using inhaled corticosteroids and bronchodilators targeting these pathologies, a large proportion of patients have persistent coughing. This review focuses on the prevalence and impact of cough in asthma and explores data from pre-clinical and clinical studies which have explored neuronal mechanisms of cough and asthma. We present evidence to suggest patients with asthma have evidence of neuronal dysfunction, which is further heightened and exaggerated by both bronchoconstriction and airway eosinophilia. Identifying patients with excessive coughing with asthma may represent a neuro-phenotype and hence developing treatment for this symptom is important for reducing the burden of disease on patients' lives and currently represents a major unmet clinical need.
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Affiliation(s)
- I Satia
- McMaster University, Department of Medicine, Division of Respirology, Canada; Firestone Institute for Respiratory Health, St Joseph's Hospital, Canada; University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - A Nagashima
- McMaster University, Department of Medicine, Division of Respirology, Canada
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48
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Keeley D, Scullion JE, Usmani OS. Minimising the environmental impact of inhaled therapies: problems with policy on low carbon inhalers. Eur Respir J 2020; 55:55/2/2000048. [PMID: 32108081 DOI: 10.1183/13993003.00048-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 01/27/2023]
Affiliation(s)
| | | | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London, London, UK
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Lavorini F, Barreto C, van Boven JFM, Carroll W, Conway J, Costello RW, Dahl BH, Dekhuijzen RPN, Holmes S, Levy M, Molimard M, Roche N, Román-Rodriguez M, Scichilone N, Scullion J, Usmani OS. Spacers and Valved Holding Chambers-The Risk of Switching to Different Chambers. J Allergy Clin Immunol Pract 2020; 8:1569-1573. [PMID: 31927099 DOI: 10.1016/j.jaip.2019.12.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/09/2019] [Accepted: 12/29/2019] [Indexed: 10/25/2022]
Abstract
Spacers are pressurized metered-dose inhaler (pMDI) accessory devices developed to reduce problems of poor inhaler technique with pMDIs. Spacers that feature a 1-way inspiratory valve are termed valved holding chambers (VHCs); they act as aerosol reservoirs, allowing the user to actuate the pMDI device and then inhale the medication in a 2-step process that helps users overcome challenges in coordinating pMDI actuation with inhalation. Both spacers and VHCs have been shown to increase fine particle delivery to the lungs, decrease oropharyngeal deposition, and reduce corticosteroid-related side effects such as throat irritation, dysphonia, and oral candidiasis commonly seen with the use of pMDIs alone. Spacers and VHCs are not all the same, and also are not interchangeable: the performance may vary according to their size, shape, material of manufacture and propensity to become electrostatically charged, their mode of interface with the patient, and the presence or otherwise of valves and feedback devices. Thus, pairing of a pMDI plus a spacer or a VHC should be considered as a unique delivery system. In this Rostrum we discuss the risk potential for a patient getting switched to a spacer or VHC that delivers a reduced dose medication.
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Affiliation(s)
- Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Celeste Barreto
- Departamento de Pediatria, Hospital de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Job F M van Boven
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Will Carroll
- Department of Paediatrics, University Hospital of North Midlands NHS Trust, Stoke-On-Trent, United Kingdom
| | - Joy Conway
- Computationally Intensive Imaging, University of Southampton, Southampton, United Kingdom
| | | | - Birthe Hellqvist Dahl
- Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Stephen Holmes
- Park Medical Practice, Shepton Mallet, Somerset, United Kingdom
| | - Mark Levy
- Harrow Primary Care Trust, London, United Kingdom
| | - Mathieu Molimard
- Département de Pharmacologie, CHU de Bordeaux, Universite Bordeaux, Bordeaux, France
| | - Nicholas Roche
- Respiratory Medicine, Cochin Hospital APHP, University Paris Descartes, Paris, France
| | - Miguel Román-Rodriguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de las Islas Baleares, Mallorca, Spain
| | - Nicola Scichilone
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Jane Scullion
- University Hospitals of Leicester, Leicester, United Kingdom
| | - Omar S Usmani
- Imperial College London & Royal Brompton Hospital, London, United Kingdom
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Hakim A, Khan Y, Esteban I, Meah S, Miller-Larsson A, Barnes PJ, Usmani OS. Low-Dose Budesonide/Formoterol Counteracts Airway Inflammation and Improves Lung Function in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2020; 199:662-664. [PMID: 30540486 DOI: 10.1164/rccm.201808-1590le] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Amir Hakim
- 1 Imperial College London London, United Kingdom and
| | - Younis Khan
- 1 Imperial College London London, United Kingdom and
| | | | - Sally Meah
- 1 Imperial College London London, United Kingdom and
| | | | | | - Omar S Usmani
- 1 Imperial College London London, United Kingdom and
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