Home telemonitoring (forced expiratory volume in 1 s) in children with severe asthma does not reduce exacerbations

Acute severe asthma, formerly known as status asthmaticus, is defined as severe asthma unresponsive to repeated courses of beta-agonist therapy. It is a medical emergency that requires immediate recognition and treatment. Albuterol in combination with ipratropium bromide in the emergency department (ED) has been shown to decrease the time spent in the ED and the hospitalization rates. The benefits of ipratropium are not sustained after admission to the hospital. Oral or parenteral corticosteroids should be administered to all patients with acute severe asthma as early as possible because clinical benefits may not occur for a minimum of 6 to 12 hours. Viral respiratory infections are a common trigger for acute asthma; other causes include medical nonadherence, allergen exposure (especially pets and mold [e.g., Alternaria species]) in individuals who are severely atopic, nonsteroidal anti-inflammatory exposure in patients with aspirin allergy, irritant inhalation (e.g., smoke, paint), exercise, and insufficient use of inhaled or oral corticosteroids. The patient's history should focus on the acute assessment of asthma control and morbidity, including current use of oral or inhaled corticosteroids; the number of hospitalizations, ED visits, intensive care unit admissions, and intubations; the frequency of albuterol use; the presence of nighttime symptoms; activity intolerance; current medications; exposure to allergens; and other significant medical conditions. Severe airflow obstruction may be predicted by accessory muscle use, difficulty speaking, refusal to recline < 30°, a pulse of >120 beats/min, and decreased breath sounds. More objective measures of airway obstruction via peak flow or forced expiratory volume in 1 second and pulse oximetry before oxygen administration usually are helpful. Pulse oximetry values of >90% are reassuring, although CO2 retention and a low partial pressure of oxygen may be missed.

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Characteristics and treatment regimens across ERS SHARP severe asthma registries

European Respiratory Journal ◽

10.1183/13993003.01163-2019 ◽

2019 ◽

Vol 55 (1) ◽

pp. 1901163 ◽

Cited By ~ 12

Author(s):

Job J.M.H. van Bragt ◽

Ian M. Adcock ◽

Elisabeth H.D. Bel ◽

Gert-Jan Braunstahl ◽

Anneke ten Brinke ◽

...

Keyword(s):

Severe Asthma ◽

Research Collaboration ◽

Forced Expiratory Volume ◽

European Respiratory Society ◽

Cross Sectional ◽

Aggregated Data ◽

Treatment Regimens ◽

Severe Asthmatic ◽

Definition Of ◽

The Uk

Little is known about the characteristics and treatments of patients with severe asthma across Europe, but both are likely to vary. This is the first study in the European Respiratory Society Severe Heterogeneous Asthma Research collaboration, Patient-centred (SHARP) Clinical Research Collaboration and it is designed to explore these variations. Therefore, we aimed to compare characteristics of patients in European severe asthma registries and treatments before starting biologicals.This was a cross-sectional retrospective analysis of aggregated data from 11 national severe asthma registries that joined SHARP with established patient databases.Analysis of data from 3236 patients showed many differences in characteristics and lifestyle factors. Current smokers ranged from 0% (Poland and Sweden) to 9.5% (Belgium), mean body mass index ranged from 26.2 (Italy) to 30.6 kg·m−2 (the UK) and the largest difference in mean pre-bronchodilator forced expiratory volume in 1 s % predicted was 20.9% (the Netherlands versus Hungary). Before starting biologicals patients were treated differently between countries: mean inhaled corticosteroid dose ranged from 700 to 1335 µg·day−1 between those from Slovenia versus Poland when starting anti-interleukin (IL)-5 antibody and from 772 to 1344 µg·day−1 in those starting anti-IgE (Slovenia versus Spain). Maintenance oral corticosteroid use ranged from 21.0% (Belgium) to 63.0% (Sweden) and from 9.1% (Denmark) to 56.1% (the UK) in patients starting anti-IL-5 and anti-IgE, respectively.The severe asthmatic population in Europe is heterogeneous and differs in both clinical characteristics and treatment, often appearing not to comply with the current European Respiratory Society/American Thoracic Society guidelines definition of severe asthma. Treatment regimens before starting biologicals were different from inclusion criteria in clinical trials and varied between countries.

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Omalizumab improves forced expiratory volume in 1 second in patients with severe asthma

Advances in Dermatology and Allergology ◽

10.5114/ada.2018.77241 ◽

2018 ◽

Vol 35 (5) ◽

pp. 495-497

Author(s):

Krzysztof Pałgan ◽

Magdalena Żbikowska-Götz ◽

Kinga Lis ◽

Elżbieta Chrzaniecka ◽

Zbigniew Bartuzi

Keyword(s):

Severe Asthma ◽

Forced Expiratory Volume

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Inadequate assessment of adherence to maintenance medication leads to loss of power and increased costs in trials of severe asthma therapy: results from a systematic literature review and modelling study

European Respiratory Journal ◽

10.1183/13993003.02161-2018 ◽

2019 ◽

Vol 53 (5) ◽

pp. 1802161 ◽

Cited By ~ 5

Author(s):

Matshediso C. Mokoka ◽

Melissa J. McDonnell ◽

Elaine MacHale ◽

Breda Cushen ◽

Fiona Boland ◽

...

Keyword(s):

Maintenance Therapy ◽

Sample Size ◽

Severe Asthma ◽

Statistical Power ◽

Objective Assessment ◽

Forced Expiratory Volume ◽

Self Report ◽

Mean Power ◽

Adherence Assessment ◽

Trial Outcomes

Adherence to inhaled maintenance therapy in severe asthma is rarely adequately assessed, and its influence on trial outcomes is unknown. We systematically determined how adherence to maintenance therapy is assessed in clinical trials of “add-on” therapy for severe asthma. We model the improvement in trial power that could be achieved by accurately assessing adherence.A systematic search of six major databases identified randomised trials of add-on therapy for severe asthma. The relationship between measuring adherence and study outcomes was assessed. An estimate of potential improvements in statistical power and sample size was derived using digitally recorded adherence trial data.87 randomised controlled trials enrolling 22 173 participants were included. Adherence assessment was not reported in 67 trials (n=13 931, 63%). Studies that reported adherence used a range of self-report and subjective methods. None of the studies employed an objective assessment of adherence. Studies that reported adherence had a significantly reduced pooled variance in forced expiratory volume in 1 s (FEV1) compared to those that did not assess adherence: s2=0.144 L2versus s2=0.168 L2, p<0.0001. Power to detect clinically relevant changes in FEV1 was significantly higher in trials that reported adherence assessment (mean power achieved 59% versus 49%). Modelling suggests that up to 50% of variance in FEV1 outcomes is attributable to undetected variations in adherence. Controlling for such variations could potentially halve the required sample size.Few trials of add-on therapy monitor adherence to maintenance inhaled therapy, resulting in a greater variance in trial outcomes and inadequate power for determining efficacy.

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Sputum Induction in Children and Adolescents with Problematic Severe Asthma: Success Rate, Safety and Tolerability

The Open Allergy Journal ◽

10.2174/1874838401508010007 ◽

2015 ◽

Vol 8 (1) ◽

pp. 7-13

Author(s):

Cristiane de Abreu T. Ricci ◽

Laura Maria de Lima B. F. Lasmar ◽

Paulo M. Pitrez ◽

Raimundo F. Mascarenhas ◽

Paulo A. M. Camargos

Keyword(s):

Success Rate ◽

Severe Asthma ◽

Pediatric Patients ◽

Isotonic Saline ◽

Cross Sectional Study ◽

Forced Expiratory Volume ◽

Sputum Induction ◽

Cross Sectional ◽

Inflammatory Processes ◽

Inflammatory Phenotypes

Background: In problematic severe asthma (PSA), inflammatory phenotypes can by identified by assessing cellularity in induced sputum (IS) samples. However, there have been few studies employing sputum induction (SI) in pediatric patients. Objectives: To assess the success rate, safety and tolerability of SI, as well as IS sample cellularity, in pediatric PSA patients. Methods: We conducted a cross-sectional study involving 44 pediatric PSA patients. We collected IS samples using inhalations of nebulized saline solution. On the basis of the post-bronchodilator forced expiratory volume in one second (FEV1, % of predicted), we administered nebulization with 4.5% hypertonic saline (for patients with an FEV1 ≥ 60%) or 0.9% isotonic saline (for those with an FEV1 < 60%). We classified IS samples as satisfactory if there was ≤ 20% squamous cell contamination and cell viability was > 50%. Results: The observed success rate was 75% (95% CI: 60-86). Most of the patients provided satisfactory samples, although multiple SI sessions were required in some cases (27%). In comparison with the IS samples containing > 20% squamous cells, those containing ≤ 20% showed significantly more neutrophils (P = 0.02) and eosinophils (P = 0.03). The most common adverse events were mild wheezing (in 14%) and salty taste (in 9%). In 8% of the sessions, there was a ≥ 20% decrease in FEV1. Conclusion: In our sample of pediatric patients with PSA, sputum induction was safe and generally well tolerated, suggesting that it could be useful in the assessment of inflammatory processes in such patients.

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Switching from omalizumab to mepolizumab: real-life experience from Southern Italy

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466620929231 ◽

2020 ◽

Vol 14 ◽

pp. 175346662092923 ◽

Cited By ~ 4

Author(s):

Giovanna Elisiana Carpagnano ◽

Corrado Pelaia ◽

Maria D’Amato ◽

Nunzio Crimi ◽

Nicola Scichilone ◽

...

Keyword(s):

Allergic Asthma ◽

Severe Asthma ◽

Southern Italy ◽

Life Experience ◽

Real Life ◽

Forced Expiratory Volume ◽

Asthma Control Test ◽

Eosinophilic Asthma ◽

Life Study ◽

First Choice

Background: Current availability of several biologic treatments for severe asthma makes it possible to choose the most appropriate for each patient. Sometimes a good percentage of patients with severe asthma may be eligible for biologics that target either the allergic phenotype or the eosinophilic one, but not all respond to that selected as first choice. The aim of our real-life study was to assess whether, for patients with severe eosinophilic allergic asthma, not previously controlled by the anti-IgE omalizumab, the shift to another biologic targeting interleukin-5, such as mepolizumab, may represent a good therapeutic choice. Methods: A total of 41 consecutive patients with severe, persistent allergic, eosinophilic asthma, uncontrolled despite treatment with omalizumab, were enrolled in seven certified Clinical Respiratory Units of Southern Italy (Catania, Catanzaro, Foggia, Bari, Palermo, and two University Respiratory Units of Naples) and shifted to mepolizumab without a wash-out period. Data at baseline, after at least 12 months of therapy with omalizumab, and after at least 12 months of treatment with mepolizumab were collected. Results: After at least 12 months of therapy with mepolizumab, patients experienced a significant decrease in the number of exacerbations/year (5.8 ± 1.8 versus 0.7 ± 0.9, p < 0.0001), an increment of asthma control test score (12 ± 2.7 versus 21.9 ± 2.7, p < 0.0001), an increase in pre-bronchodilator forced expiratory volume in 1 s (1.56 ± 0.45 l versus 1.86 ± 0.52 l, p < 0.0001), and a reduction of blood eosinophils (584 ± 196 cells/µl versus 82 ± 56 cells/µl, p < 0.0001). The percentage of patients who were dependent on corticosteroids significantly decreased from 46% at baseline to 5% during treatment with mepolizumab. Conclusion: Results of our real-life multicentric experience confirms that the shift to mepolizumab could be a good therapeutic strategy in severe eosinophilic allergic asthma not previously controlled by omalizumab. The reviews of this paper are available via the supplemental material section.

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Predictors of reversible airway obstruction with omalizumab in severe asthma: a real-life study

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466619841274 ◽

2019 ◽

Vol 13 ◽

pp. 175346661984127 ◽

Cited By ~ 5

Author(s):

Paolo Solidoro ◽

Filippo Patrucco ◽

Francesca de Blasio ◽

Luisa Brussino ◽

Michela Bellocchia ◽

...

Keyword(s):

Airway Obstruction ◽

Allergic Asthma ◽

Severe Asthma ◽

Airway Remodeling ◽

Real Life ◽

Forced Expiratory Volume ◽

Life Study ◽

Reversible Airway Obstruction ◽

Number Of Patients ◽

Severe Allergic Asthma

Background: Omalizumab may modulate airway remodeling in severe asthma. Using forced expiratory volume in 1 second (FEV1) as a surrogate of airway remodeling, we aimed to investigate if an omalizumab add-on in severe allergic asthma may lead to a persistent reversal of airway obstruction and to evaluate the potential biomarkers of airway obstruction reversibility. Methods: Data were collected before (T0) and after omalizumab add-on for 1 year (T1, 32 patients), 2 years (T2, 26 patients) and 4 years (T4, 13 patients). All patients had baseline FEV1 below 80 % predicted (60.5 ± 12.5 %). After omalizumab, 18 patients showed FEV1 normalization (reversible airway obstruction; RAO+) already at T1 (88.7 ± 14.9 %, p < 0.0001) that persisted up to T4 (83.2 ± 7.9, p < 0.01), while 14 patients (RAO−) had FEV1 persistently decreased, from T1 (65.2 ± 8.4%, p < 0.05) up to T4 (61.4 ± 6.2%, not significant). Both groups had significant improvement of symptoms and exacerbations after omalizumab at T1, which persisted up to T4. The comparison between pretreatment characteristics of the two groups showed that RAO+ patients, had higher values of circulating eosinophils, exhaled nitric oxide (FENO), prevalence of rhinitis and nasal polyps, need of oral corticosteroids, shorter asthma duration, higher FEV1 and response to albuterol test. The optimal cut-off points predicting FEV1 normalization after omalizumab add-on were 30.5 ppb for FENO and 305 cells/µl for eosinophils. Conclusions: This study suggests that omalizumab add-on contributes to the persistent reversal of airway obstruction in a consistent number of patients with severe allergic asthma, and this beneficial effect is predicted by elevated pretreatment FENO and circulating eosinophils.

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Prevalence of Asthma-COPD Overlap in COPD and Severe Asthma Cohorts

10.21203/rs.3.rs-851216/v1 ◽

2021 ◽

Author(s):

Hyonsoo Joo ◽

So-Young Park ◽

So Young Park ◽

Seo Young Park ◽

Sang-Heon Kim ◽

...

Keyword(s):

Severe Asthma ◽

Eosinophil Count ◽

Clinical Manifestations ◽

Forced Expiratory Volume ◽

Smoking History ◽

Chronic Obstructive ◽

Blood Eosinophil ◽

Obstructive Pulmonary Disease ◽

Blood Eosinophil Count ◽

Bronchodilator Response

Abstract Background: Asthma and chronic obstructive pulmonary disease (COPD) are airway diseases with similar clinical manifestations, despite differences in pathophysiology. Asthma-COPD overlap (ACO) is a condition characterized by overlapping clinical features of both diseases. There have been few reports regarding the prevalence of ACO in COPD and severe asthma cohorts. ACO is heterogeneous; patients can be classified on the basis of phenotype differences. This study was performed to analyze the prevalence of ACO in COPD and severe asthma cohorts. In addition, this study compared baseline characteristics among ACO patients according to phenotype.Methods: Patients with COPD were prospectively enrolled into the Korean COPD subgroup study (KOCOSS) cohort. Patients with severe asthma were prospectively enrolled into the Korean Severe Asthma Registry (KoSAR). ACO was defined in accordance with the updated Spanish criteria. In the COPD cohort, ACO was defined as bronchodilator response (BDR) ≥ 15% and ≥ 400 mL from baseline or blood eosinophil count ≥ 300 cells/μL. In the severe asthma cohort, ACO was defined as age ≥ 35 years, smoking ≥ 10 pack-years, and post-bronchodilator forced expiratory volume in 1 s/forced vital capacity < 0.7. Patients with ACO were divided into four groups according to smoking history (threshold: 20 pack-years) and blood eosinophil count (threshold: 300 cells/μL).Results: The prevalence of ACO significantly differed between the COPD and severe asthma cohorts (19.8% [365/1839] vs. 12.5% [104/832], respectively, P < 0.001). The numbers of patients in each group were as follows: Group A (smoking 10–20 pack-years and blood eosinophil count ≥ 300 cells/μL), 42 (9.1%); Group B (smoking 10–20 pack-years and eosinophil count < 300 cells/μL), 17 (3.7%); Group C (smoking ≥ 20 pack-years and eosinophil count ≥ 300 cells/μL), 341 (73.8%); and Group D (smoking ≥ 20 pack-years and eosinophil count < 300 cells/μL), 62 (13.4%). Age, sex, BDR, comorbidities, and medications significantly differed among the four groups.Conclusion: The prevalence of ACO differed between COPD and severe asthma cohorts. ACO patients can be classified into four phenotype groups, such that each phenotype exhibits distinct characteristics.

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