Severe asthma

Mapping Intimacies ◽

10.1093/med/9780199657742.003.0002 ◽

2017 ◽

Author(s):

Anand Shah ◽

Andrew Menzies-Gow

Keyword(s):

Severe Asthma ◽

Correct Diagnosis ◽

Allergic Bronchopulmonary Aspergillosis ◽

Lost Work ◽

Inhaled Therapy ◽

Control Asthma ◽

Care Costs ◽

Significant Health ◽

Substantial Morbidity

Poorly controlled asthma is a common reason for referral to the respiratory clinic, and the majority of cases can be managed effectively by ensuring the correct diagnosis and ensuring good compliance with inhaled therapy. However, severe asthma affects up to 10% of patients with asthma and is associated with substantial morbidity and mortality, along with significant health-care costs from both inpatient treatment and lost work days. This chapter covers two cases of difficult-to-control asthma and highlights the role of detailed investigations when asthma control is not straightforward. It will cover the diagnostic criteria for allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization and discuss the role of omalizumab in managing severe asthma.

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Outpatient Management of Asthma in Children

Clinical Medicine Insights Pediatrics ◽

10.4137/cmped.s7867 ◽

2013 ◽

Vol 7 ◽

pp. CMPed.S7867 ◽

Cited By ~ 3

Author(s):

André Schultz ◽

Andrew C. Martin

Keyword(s):

Treatment Options ◽

Symptom Control ◽

Correct Diagnosis ◽

Asthma Management ◽

Asthma Severity ◽

Pediatric Health Care ◽

Asthma Symptoms ◽

Inhaled Therapy ◽

The Impact

The principal aims of asthma management in childhood are to obtain symptom control that allows individuals to engage in unrestricted physical activities and to normalize lung function. These aims should be achieved using the fewest possible medications. Ensuring a correct diagnosis is the first priority. The mainstay of asthma management remains pharmacotherapy. Various treatment options are discussed. Asthma monitoring includes the regular assessment of asthma severity and asthma control, which then informs decisions regarding the stepping up or stepping down of therapy. Delivery systems and devices for inhaled therapy are discussed, as are the factors influencing adherence to prescribed treatment. The role of the pediatric health care provider is to establish a functional partnership with the child and their family in order to minimize the impact of asthma symptoms and exacerbations during childhood.

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Correlation of aspergillus skin hypersensitivity with the duration and severity of asthma

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2017.826 ◽

2017 ◽

Vol 87 (3) ◽

Cited By ~ 2

Author(s):

Vishal Chopra ◽

Hardik Jain ◽

Akhil D. Goel ◽

Siddharth Chopra ◽

Ashrafjit S. Chahal ◽

...

Keyword(s):

Early Diagnosis ◽

Skin Test ◽

Severe Asthma ◽

Health Problem ◽

Allergic Bronchopulmonary Aspergillosis ◽

Moderate Asthma ◽

Skin Hypersensitivity ◽

Asthma Patients ◽

Significant Health

Asthma is a significant health problem worldwide and Allergic Bronchopulmonary aspergillosis (ABPA) complicates the course of 1-2% of patients of asthma. Aspergillus skin hypersensitivity (AH) is the first step for diagnosis of ABPA. This study was conducted to know the correlation of AH with severity and duration of asthma. Patients, age >15 years, of asthma attending this hospital from January 2015 to December 2015 were included. Asthma was diagnosed clinically and confirmed with spirometry. Of 282 patients 206 patients were AH positive. The AST-positivity in patients having severe asthma (96.8%) was higher than that in patients having mild (36.8%) and moderate asthma (80.4%). The median (IQR) duration of asthma of AH positive patients was 5.0 yrs. This study emphasized the need of ABPA screening by intradermal skin test especially in patients having severe asthma and/or those having asthma for longer duration in order for early diagnosis of ABPA.

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The role of antifungals in the management of patients with severe asthma

Clinical and Translational Allergy ◽

10.1186/s13601-020-00353-8 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

W. Garth Rapeport ◽

Kazuhiro Ito ◽

David W. Denning

Keyword(s):

Asthma Control ◽

Severe Asthma ◽

Alternative Therapy ◽

Fungal Spores ◽

Allergic Bronchopulmonary Aspergillosis ◽

Airflow Obstruction ◽

Therapeutic Benefit ◽

High Dose ◽

Dosing Regimens

Abstract In patients with asthma, the inhalation of elevated amounts of fungal spores and hyphae may precipitate the onset of asthma or worsen control to the extent of being life-threatening. Sensitisation to fungi, especially Aspergillus fumigatus, is found in 15% to 48% of asthmatics in secondary care and is linked to worse asthma control, hospitalisation, bronchiectasis and fixed airflow obstruction, irrespective of whether allergic bronchopulmonary aspergillosis (ABPA) is diagnosed. ABPA represents a florid response to the presence of Aspergillus spp. but up to 70% of patients with severe asthma exhibit sensitisation to different fungi without meeting the diagnostic criteria for ABPA. The presence of persistent endobronchial colonisation with fungi, especially A. fumigatus, is linked to significantly higher rates of radiological abnormalities, lower post-bronchodilator FEV1 and significantly less reversibility to short acting bronchodilators. The therapeutic benefit for antifungal intervention in severe asthma is based on the assumption that reductions in airway fungal burden may result in improvements in asthma control, lung function and symptoms (especially cough). This contention is supported by several prospective studies which demonstrate the effectiveness of antifungals for the treatment of ABPA. Significantly, these studies confirm lower toxicity of treatment with azoles versus high dose oral corticosteroid dosing regimens for ABPA. Here we review recent evidence for the role of fungi in the progression of severe asthma and provide recommendations for the use of antifungal agents in patients with severe asthma, airways fungal infection (mycosis) and fungal colonisation. Documenting fungal airways colonisation and sensitisation in those with severe asthma opens up alternative therapy options of antifungal therapy, which may be particularly valuable in low resource settings.

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Dupilumab Efficacy in Patients With Uncontrolled, Moderate-to-Severe Asthma and Serologic Evidence of Allergic Bronchopulmonary Aspergillosis

10.1055/s-0039-3403257 ◽

2020 ◽

Author(s):

J Corren ◽

L Sher ◽

X Zhu ◽

MS Rice ◽

Y Deniz ◽

...

Keyword(s):

Severe Asthma ◽

Allergic Bronchopulmonary Aspergillosis ◽

Serologic Evidence

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Suva Residents’ Views on Cancer, Diabetes and HIV in The Fiji Times

The Journal of Pacific Studies ◽

10.33318/jpacs.2020.40(1)-4 ◽

2020 ◽

Vol 40 (1) ◽

Author(s):

Farzana Gounder

Keyword(s):

Chronic Illnesses ◽

Structural Reforms ◽

Letters To The Editor ◽

Medical Responsibility ◽

Grassroots Support ◽

Preliminary Study ◽

Socially Relevant ◽

Situated Approach ◽

Significant Health

The burden of preventable diseases is increasing in the South Pacific Island Countries and Territories. In Fiji, significant media attention and national finances are spent on public dissemination of the modifiable risk factors of chronic illnesses. However, little is known about lay societal perceptions of chronic illnesses and of people living with these illnesses. This preliminary study takes an area-situated approach to lay knowledge and examines Suva residents’ moral evaluations associated with socially significant health concerns in Fiji. Using the case studies of HIV, cancer, and diabetes, the research employs content analysis to examine 144 Suva residents’ Letters to the Editor, published between 2000 and 2019 in The Fiji Times. The findings indicate that letter writers on chronic illnesses are power sensitive, interested in governmental responsibility, and aware of the role of stigma in creating inequitable health outcomes. The study’s findings locate chronic illness as not only a medical responsibility but also a social justice and human rights concern that requires a multisectoral approach, with community-tailored responses at the heart of all discussions. The lay-societal recognition of the three illnesses as being socially relevant suggests grassroots support for policies directed towards structural reforms for the prevention and management of these illnesses.

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Factors Associated with Clinician Adherence to USPSTF Diabetes Screening Recommendations

Journal of Primary Care & Community Health ◽

10.1177/21501327211016579 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110165

Author(s):

Elaine Seaton Banerjee ◽

Kyle Shaak ◽

Nicole Burgess ◽

Melanie Johnson ◽

Beth Careyva

Keyword(s):

Gestational Diabetes ◽

Adult Population ◽

Correct Diagnosis ◽

Retrospective Chart Review ◽

Diabetes Screening ◽

Factors Associated ◽

The Us ◽

History Of ◽

Missed Diagnosis ◽

Significant Health

Introduction/Objectives: Diabetes and prediabetes impact nearly half of the US adult population and are associated with significant health risks but may be underdiagnosed. Effective screening may improve diagnosis and give patients opportunity to manage their disease. The purpose of this study was to determine screening rates, identify characteristics predictive of screening, and evaluate correct diagnosis of diabetes and prediabetes. Methods: Retrospective chart review of 71 433 patients eligible for diabetes screening, defined by completing A1c test within the 3-year study period. Results: A total of 31.3% of eligible patients received diabetes screening. Factors associated with screening include older age, female sex, non-white race, Hispanic ethnicity, Medicare or Medicaid insurance, higher BMI, and having a medical comorbidity. History of prediabetes or gestational diabetes were the strongest predictors for diabetes screening, but history of gestational diabetes was under-documented. Of those screened, 10.4% had a result consistent with diabetes and 51.8% had a result consistent with prediabetes. However, 52.9% of these patients had a missed diagnosis. Conclusions: Findings of this study indicate the need for uniform coverage for diabetes screening for all insurances, increased documentation of gestational diabetes to improve screening for patients with this history, and improving accurate diagnosis after screening is completed.

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Role of Circulating Immune Complexes in the Pathogenesis of Canine Leishmaniasis: New Players in Vaccine Development

Microorganisms ◽

10.3390/microorganisms9040712 ◽

2021 ◽

Vol 9 (4) ◽

pp. 712

Author(s):

Cristina Cacheiro-Llaguno ◽

Nuria Parody ◽

Marta R. Escutia ◽

Jerónimo Carnés

Keyword(s):

Immune Complexes ◽

Vaccine Development ◽

Correct Diagnosis ◽

Circulating Immune Complexes ◽

Response To Treatment ◽

Canine Leishmaniasis ◽

Leishmania Infection ◽

Serum Samples ◽

Humoral Immune

During canine visceral leishmaniasis (CanL), due to Leishmania infantum (L. infantum), uncontrolled infection leads to a strong humoral immune response. As a consequence of the production of high antibody levels and the prolonged presence of parasite antigens, circulating immune complexes (CIC) are formed, which can be deposited in certain organs and tissues, inducing vasculitis, uveitis, dermatitis and especially glomerulonephritis and renal failure. A method to detect CIC and quantify their levels in serum samples from dogs infected with L. infantum has been recently described. It allowed demonstration of a correlation between CIC levels and disease severity. Thus, CIC measurement may be useful for diagnosis, assessment of disease progression and monitoring response to treatment. This is an interesting finding, considering that there remains an urgent need for identification of novel biomarkers to achieve a correct diagnosis and for optimal disease staging of dogs suffering from Leishmania infection. The objective of the present review is to shed light on the role of CIC in CanL, as well as to highlight their potential use not only as diagnostic and prognostic biomarkers but also as a valuable tool in vaccine development and new immunotherapy strategies to prevent or control disease outcome.

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Eignung der Kapillarmikroskopie zur Diagnostik und Differenzierung einer ILD

Karger Kompass Pneumologie ◽

10.1159/000514899 ◽

2021 ◽

pp. 1-3

Author(s):

Sabine Adler

Keyword(s):

Computed Tomography ◽

Creatine Phosphokinase ◽

Correct Diagnosis ◽

Diagnostic Assessment ◽

Idiopathic Inflammatory Myopathies ◽

Inflammatory Myopathies ◽

Nailfold Videocapillaroscopy ◽

High Resolution Computed Tomography ◽

Diagnostic Role

Nailfold videocapillaroscopy (NVC) is an easy tool used for the assessment of patients with Raynaud’s phenomenon (RP) as possibly associated with systemic sclerosis (SSc). Recent insights have also highlighted its role in the diagnostic assessment of idiopathic inflammatory myopathies (IIMs). The aim of this study is to describe the diagnostic role of NVC in a series of 361 consecutive patients with interstitial lung disease (ILD). All the patients were assessed by clinical pulmonary and rheumatic examinations, blood exams, high-resolution computed tomography and NVC. NVC was considered positive only in the presence of avascular areas or giant capillaries, but also, the presence of bushy capillaries (BCs) was recorded. NVC was positive in 17.7% of ILD patients and in 78.1% of ILD patients associated with a diagnosis of connective tissue disease (CTD). In 25% of SSc-ILD patients, NVC proved necessary for a correct diagnosis. The presence of BCs and/or NVC positivity in ILD patients with normal levels of creatine phosphokinase is associated with amyopathic IIM, regardless the presence of RP. In conclusion, NVC is useful for the diagnostic assessment of incomplete forms of CTD and in amyopathic IIMs. NVC should be considered in the diagnostic assessment of ILD patients regardless of the presence of RP.

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