scholarly journals Duration of the efficacy of omalizumab after treatment discontinuation in ‘real life’ severe asthma

Thorax ◽  
2017 ◽  
Vol 73 (8) ◽  
pp. 782-784 ◽  
Author(s):  
Maria del Carmen Vennera ◽  
Carlos Sabadell ◽  
Cesar Picado
Keyword(s):  
Prospective Study ◽  
Asthma Control ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Real Life ◽  
First Year ◽  
Severe Asthma Exacerbation ◽  
Optimal Duration ◽  
Open Prospective Study

Efficacy of omalizumab in severe asthma is well documented; however, the optimal duration of the treatment remains unclear. In an open prospective study, we sought to assess the persistence of response in subjects withdrawing from omalizumab treatment. We evaluated 49 patients who voluntarily accepted to discontinue omalizumab treatment after 6 years of therapy. Asthma relapse was defined as any severe asthma exacerbation associated with loss of asthma control. Twelve patients relapsed in the first year of follow-up, and 7 within 13 and 48 months. These results suggest that the effects of 6 years of omalizumab may persist after discontinuation of therapy in 60% of patients for at least 4 years.

scholarly journals Does the occurrence of a severe asthma exacerbation change the rate of subsequent events?

2021 ◽  
Author(s):  
Tae Yoon Lee ◽  
John Petkau ◽  
Mohsen Sadatsafavi
Keyword(s):  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Failure Time ◽  
Asthma Management ◽  
Frailty Model ◽  
Severe Exacerbation ◽  
Adult Group ◽  
Old Patients ◽  
Severe Asthma Exacerbation

Background: Severe exacerbations requiring hospitalization are an important component of the natural history of asthma and a major source of its burden. Whether the occurrence of a severe exacerbation affects the rate of subsequent events has far-reaching implications in asthma management. Methods: Using the centralized administrative health databases of British Columbia, Canada (1997/01/01-2016/03/31), we created an incidence cohort of patients with at least one severe asthma exacerbation, defined as an episode of hospitalization with asthma as the primary diagnosis. We used an accelerated failure time joint frailty model for the time intervals between severe asthma exacerbations. Analyses were conducted separately for pediatric (< 14 years old) and adult (≥14 years old) patients. Results: There were 3,039 patients (mean age at baseline 6.4, 35% female) in the pediatric group and 5,459 patients (mean age at baseline 50.8, 68% female) in the adult group, with 16% and 15%, respectively, experiencing at least one severe asthma exacerbation during follow-up. The first follow-up severe asthma exacerbation was associated with an increase of 79% (95% CI: 15% - 186%) in the rate of the subsequent events for the pediatric group. The corresponding value was 186% (95% CI: 85% - 355%) for the adult group. For both groups, the effects of subsequent severe exacerbations were not statistically significant. Conclusion: Our findings suggest that among patients who have experienced their first severe asthma exacerbation, preventing the next event can drastically change the course of the disease and reduce the burden of future exacerbations.

scholarly journals Hormonal contraception and the risk of severe asthma exacerbation: 17-year population-based cohort study

Thorax ◽  
2020 ◽  
pp. thoraxjnl-2020-215540
Author(s):  
Bright I Nwaru ◽  
Holly Tibble ◽  
Syed A Shah ◽  
Rebecca Pillinger ◽  
Susannah McLean ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Population Based ◽  
Emergency Department Visits ◽  
Reproductive Age ◽  
Hormonal Contraceptives ◽  
Reproductive Age Women ◽  
Severe Asthma Exacerbation

BackgroundLongitudinal studies investigating impact of exogenous sex steroids on clinical outcomes of asthma in women are lacking. We investigated the association between use of hormonal contraceptives and risk of severe asthma exacerbation in reproductive-age women with asthma.MethodsWe used the Optimum Patient Care Research Database, a population-based, longitudinal, anonymised primary care database in the UK, to construct a 17-year (1 January 2000–31 December 2016) retrospective cohort of reproductive-age (16–45 years, n=83 084) women with asthma. Using Read codes, we defined use, subtypes and duration of use of hormonal contraceptives. Severe asthma exacerbation was defined according to recommendations of the European Respiratory Society/American Thoracic Society as asthma-related hospitalisation, accident and emergency department visits due to asthma and/or oral corticosteroid prescriptions. Analyses were done using multilevel mixed-effects Poisson regression with QR decomposition.ResultsThe 17-year follow-up resulted in 456 803 person-years of follow-up time. At baseline, 34% of women were using any hormonal contraceptives, 25% combined (oestrogen/progestogen) and 9% progestogen-only contraceptives. Previous (incidence rate ratio (IRR) 0.94, 95% CI 0.92 to 0.97) and current (IRR 0.96, 95% CI 0.94 to 0.98) use of any, previous (IRR 0.92, 95% CI 0.87 to 0.97) and current use of combined (IRR 0.93, 95% CI 0.91 to 0.96) and longer duration of use (3–4 years: IRR 0.94, 95% CI 0.92 to 0.97; 5+ years: IRR 0.91, 95% CI 0.89 to 0.93) of hormonal contraceptives, but not progestogen-only contraceptives, were associated with reduced risk of severe asthma exacerbation compared with non-use.ConclusionsUse of hormonal contraceptives may reduce the risk of severe asthma exacerbation in reproductive-age women. Mechanistic studies investigating the biological basis for the influence of hormonal contraceptives on clinical outcomes of asthma in women are required.Protocol registration numberEuropean Union electronic Register of Post-Authorisation Studies (EUPAS22967).

PREDICTORS OF A FUTURE SEVERE ASTHMA EXACERBATION AFTER A DECADE FOLLOW-UP: RESULTS FROM TENOR II

2018 ◽  
Vol 121 (5) ◽  
pp. S44-S45
Author(s):  
T. Haselkorn ◽  
S. Szefler ◽  
B. Chipps ◽  
E. Bleecker ◽  
D. Mink ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Severe Asthma Exacerbation

Regular follow-up visits reduce the risk for severe asthma exacerbation required admission

2017 ◽  
Author(s):  
Min Kwang Byun ◽  
Hye Jung Park ◽  
Hyung Jung Kim ◽  
Chul Min Ahn ◽  
Chin Kook Rhee ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Severe Asthma Exacerbation

Abstract WP230: Real-life Detection Rate of Insertable Cardiac Monitors in Patients with ESUS

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lars-Peder M Pallesen ◽  
Julia Mayer ◽  
Kristian Barlinn ◽  
Jessica Barlinn ◽  
Alexandra Prakapenia ◽  
...  
Keyword(s):  
Detection Rate ◽  
Real Life ◽  
Treatment Modalities ◽  
First Year ◽  
Eligibility Criteria ◽  
Strauss Syndrome ◽  
Life Detection ◽  
Baseline Characteristics ◽  
Churg Strauss

Introduction: It has recently been shown that insertable cardiac monitors (ICM) reveal intermittent atrial fibrillation (AF) in up to 12.4% of patients with embolic stroke of undetermined source (ESUS) at 1 year follow-up. We sought to analyze the detection rate of intermittent AF with ICM in real-life clinical practice. Methods: We prospectively studied consecutive patients with ESUS who received an ICM (NeuroLinq®) from 01/2014 to 06/2015). Baseline characteristics, treatment modalities and AF detection rate in the first year following ICM placement was assessed. Results: We enrolled 75 ESUS patients (64% men, median age 61 years) who underwent ICM placement. Two patients were excluded due to diagnosis of prion disease and Churg-Strauss syndrome after placement of ICM. Sixty-nine of 73 (95%) patients complied with the eligibility criteria adopted by the CRYSTAL-AF study. Intermittent AF was detected in 14 (19%) patients with a median time from ICM placement to diagnosis of 57 (range, 312) days. Conclusions: Our data suggest that the real-life detection rate of intermittent AF with ICM placed in patients with ESUS is comparable to that one observed under clinical trial conditions.

scholarly journals The upper-airway microbiota and loss of asthma control among asthmatic children

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Yanjiao Zhou ◽  
Daniel Jackson ◽  
Leonard B. Bacharier ◽  
David Mauger ◽  
Homer Boushey ◽  
...  
Keyword(s):  
Asthma Control ◽  
Asthma Exacerbation ◽  
Upper Airway ◽  
Severe Exacerbation ◽  
Asthmatic Children ◽  
Time Points ◽  
Asthma Exacerbations ◽  
Severe Asthma Exacerbation ◽  
Airway Microbiome ◽  
One Year

AbstractThe airway microbiome has an important role in asthma pathophysiology. However, little is known on the relationships between the airway microbiome of asthmatic children, loss of asthma control, and severe exacerbations. Here we report that the microbiota’s dynamic patterns and compositions are related to asthma exacerbations. We collected nasal blow samples (n = 319) longitudinally during a clinical trial at 2 time-points within one year: randomization when asthma is under control, and at time of early loss of asthma control (yellow zone (YZ)). We report that participants whose microbiota was dominated by the commensal Corynebacterium + Dolosigranulum cluster at RD experience the lowest rates of YZs (p = 0.005) and have longer time to develop at least 2 episodes of YZ (p = 0.03). The airway microbiota have changed from randomization to YZ. A switch from the Corynebacterium + Dolosigranulum cluster at randomization to the Moraxella- cluster at YZ poses the highest risk of severe asthma exacerbation (p = 0.04). Corynebacterium’s relative abundance at YZ is inversely associated with severe exacerbation (p = 0.002).

Is There Benefit in Identifying Asthma Triggers During an Exacerbation?

2019 ◽  
Vol 59 (2) ◽  
pp. 142-147
Author(s):  
Pushpom James ◽  
Anna Cornish ◽  
Kaylan Brady ◽  
Jennifer Morrison ◽  
Yvonne Giunta ◽  
...  
Keyword(s):  
Prospective Study ◽  
Asthma Control ◽  
Asthma Exacerbation ◽  
Pediatric Patients ◽  
Objective Assessment ◽  
Specific Ige ◽  
Total Ige ◽  
Symptom Resolution ◽  
A Prospective Study ◽  
Asthma Triggers

Introduction. Allergen-specific IgE (sIgE) testing provides an objective assessment of sensitization to an allergen. Goal. To identify the time when serum measurements of sIgE would be most sensitive. Methods. This was a prospective study conducted between September 1, 2015, and February 25, 2019. Subjects ≥5 and ≤18 years of age, seen in the ED or admitted with an asthma exacerbation, were tested for total IgE and 8 perennial sIgE levels. Subjects with elevated sIgE were tested again after symptom resolution. Results. A total of 104 subjects were enrolled; 50 subjects were eligible for inclusion in the analysis. There were statistically significant differences between the visits for all sIgE, except Alternaria alternatum. Conclusions. In pediatric patients, serum sIgE levels measured during an asthma exacerbation were elevated compared with when their asthma was in better control. sIgE testing during an asthma exacerbation may help identify asthma triggers, mitigate exposure, and hence improve asthma control.

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