scholarly journals Bronchial thermoplasty: a new therapeutic option for the treatment of severe, uncontrolled asthma in adults

2014 ◽  
Vol 23 (134) ◽  
pp. 510-518 ◽  
Author(s):  
Marie-Christine Dombret ◽  
Khuder Alagha ◽  
Louis Philippe Boulet ◽  
Pierre Yves Brillet ◽  
Guy Joos ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Therapeutic Option ◽  
Personalised Medicine ◽  
Asthma Management ◽  
Pharmaceutical Products ◽  
Mechanisms Of Action ◽  
Bronchial Thermoplasty ◽  
Overall Evaluation ◽  
Promising Treatment

Bronchial thermoplasty is a young yet promising treatment for severe asthma whose benefit for long-term asthma control outweighs the short-term risk of deterioration and hospitalisation in the days following the treatment. It is an innovative treatment whose clinical efficacy and safety are beginning to be better understood. Since this is a device-based therapy, the overall evaluation of risk–benefit is unlike that of pharmaceutical products; safety aspects, regulatory requirements, study design and effect size assessment may be unfamiliar. The mechanisms of action and optimal patient selection need to be addressed in further rigorous clinical and scientific studies. Bronchial thermoplasty fits in perfectly with the movement to expand personalised medicine in the field of chronic airway disorders. This is a device-based complimentary asthma treatment that must be supported and developed in order to meet the unmet needs of modern severe asthma management. The mechanisms of action and the type of patients that benefit from bronchial thermoplasty are the most important challenges for bronchial thermoplasty in the future.

Long-term modulation of airway remodeling in severe asthma following bronchial thermoplasty

2021 ◽  
pp. 2100622
Author(s):  
Nicholas Jendzjowsky ◽  
Austin Laing ◽  
Michelle Malig ◽  
John Matyas ◽  
Elaine de Heuvel ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Smooth Muscle Cells ◽  
Severe Asthma ◽  
Airway Smooth Muscle ◽  
Thermal Injury ◽  
Airway Remodeling ◽  
Post Treatment ◽  
Bronchial Epithelial ◽  
Bronchial Thermoplasty

RationaleBronchial thermoplasty is a mechanical therapeutic intervention that has been advocated as an effective treatment option for severe asthma. The mechanism is promoted as being related to the attenuation of airway smooth muscle which has been shown to occur in the short-term. However, long-term studies of the effects of bronchial thermoplasty on airway remodeling are few with only limited assessment of airway remodeling indices.ObjectivesTo evaluate the effect of bronchial thermoplasty on (a) airway epithelial and smooth muscle cells in culture, and (b), airway remodeling in patients with severe asthma who have been prescribed bronchial thermoplasty up to 12-months post-treatment.MethodsThe distribution of heat within the airway by bronchial thermoplasty was assessed in a porcine model. Culture of human airway smooth muscle cells and bronchial epithelial cells evaluated the impact of thermal injury. Histological evaluation and morphometric assessment were performed on bronchial biopsies obtained from severe asthma patients at baseline, 6-weeks, and 12-months following bronchial thermoplasty.ResultsBronchial thermoplasty resulted in heterogenous heating of the airway wall. Airway smooth muscle cell cultures sustained thermal injury, whilst bronchial epithelial cells were relatively resistant to heat. Airway smooth muscle and neural bundles were significantly reduced at 6-weeks and 12-months post-treatment. At 6-weeks post treatment, submucosal collagen was reduced, and vessel density increased, with both indices returning to baseline at 12-months. Goblet cell numbers, submucosal gland area and subbasement membrane thickness, were not significantly altered at any timepoint examined.ConclusionsBronchial thermoplasty primarily affects airway smooth muscle and nerves with the effects still present at 12-months post-treatment.

scholarly journals Long-term outcomes of bronchial thermoplasty in subjects with severe asthma: a comparison of 3-year follow-up results from two prospective multicentre studies

2017 ◽  
Vol 50 (2) ◽  
pp. 1700017 ◽  
Author(s):  
Geoffrey Chupp ◽  
Michel Laviolette ◽  
Lauren Cohn ◽  
Charlene McEvoy ◽  
Sandeep Bansal ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Long Term Outcomes ◽  
Multicentre Studies ◽  
Bronchial Thermoplasty

scholarly journals Long-Lasting Response after Pembrolizumab in a Patient with Metastatic Triple-Negative Breast Cancer

Breast Care ◽  
2019 ◽  
Vol 15 (4) ◽  
pp. 428-432
Author(s):  
Paloma Peinado ◽  
Carmen Ramírez ◽  
José Angel García-Sáenz ◽  
Alejandro Pascual ◽  
Jesús Fuentes-Antrás ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Therapeutic Option ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Case Presentation ◽  
Short Overall Survival ◽  
Promising Treatment

Introduction: Breast cancer is the first cause of cancer death in women. The triple-negative subtype is associated with aggressive behavior and poor prognosis. Chemotherapy is the main therapeutic option available for these patients, but it is usually associated with short overall survival. Case Presentation: We report the case of a patient diagnosed with metastatic triple-negative breast cancer with an impressive long-lasting tumor response and long-term survival after pembrolizumab monotherapy. Conclusion: Immunotherapy is emerging as a promising treatment for some breast cancer patients. Nevertheless, monotherapy studies have shown a very limited activity. Nowadays, there is no good predictor biomarker. Further investigations are needed to identify the subgroup of patients who can benefit from checkpoint inhibitor treatment.

Long-term effects of bronchial thermoplasty on airway smooth muscle and collagen deposition in severe asthma

2016 ◽  
Author(s):  
Jamila Chakir ◽  
Ikhlass Haj Salem ◽  
Louis-Philippe Boulet ◽  
Sabrina Biardel ◽  
Noel Lampron ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Severe Asthma ◽  
Airway Smooth Muscle ◽  
Collagen Deposition ◽  
Long Term Effects ◽  
Bronchial Thermoplasty

scholarly journals Chronic pain: the burden of disease and treatment innovations

Reumatismo ◽  
2015 ◽  
Vol 67 (2) ◽  
pp. 35 ◽  
Author(s):  
S. Monti ◽  
R. Caporali
Keyword(s):  
Chronic Pain ◽  
Therapeutic Option ◽  
Therapeutic Strategies ◽  
Mechanisms Of Action ◽  
Low Back ◽  
Good Tolerability ◽  
Noradrenaline Reuptake ◽  
Μ Opioid Receptor ◽  
Effective Analgesia

Musculoskeletal conditions are the most frequent cause of chronic pain and affect around 1 in 5 adults in Europe. When chronic pain occurs, it becomes disease itself, with substantial clinical, social and economic impact. Effi cacy and tolerability problems are encountered with all therapeutic strategies available to treat musculoskeletal pain. This often limits effective analgesia and patients’ long term compliance, with the result that chronic pain is persistently underestimated and undertreated. Tapentadol is a novel, centrally acting analgesic that has been recently commercialized for the treatment of chronic pain. This new molecule, by combining two distinct mechanisms of action, μ-opioid receptor agonism (MOR) and noradrenaline reuptake inhibition (NRI), introduces a new pharmacological class called MOR-NRI. Several studies demonstrated promising results in the management of both nociceptive and neuropathic pain and good tolerability profi le, particularly concerning side effects, compared to traditional opioids. This novel analgesic represents a possible therapeutic option also in the rheumatologic fi eld, particularly in the treatment of osteoarthritis and low back pain.

Biomarkers in asthma - interpretation and utility in current asthma management

2021 ◽  
Vol 17 ◽  
Author(s):  
Polliana Mihaela Leru
Keyword(s):  
Severe Asthma ◽  
Asthma Management ◽  
Initial Therapy ◽  
Variable Response ◽  
Clinical Criteria ◽  
Disease Biology ◽  
Therapeutic Choice ◽  
Blood Eosinophils

: Asthma is a complex and highly heterogeneous disorder, having many clinical phenotypes and underlining mechanisms, a broad spectrum of severity and variable response to controller therapy. Intensive research has been focused on identification and validation of the most appropriate biomarkers in the clinical management of asthma, mostly addressed to severe and refractory cases. The use of reliable biomarkers in severe asthma can contribute to better understanding of disease biology, diagnosis and screening, by a refined characterization of particular phenotypes and endotypes, assessment of severity, control and prognosis. There is an increasing interest to validate biomarkers able to indicate the adequate therapeutic choice from the class of biological agents, most of them targeting T2 inflammation. Using a reliable and validated biomarker, the clinician can monitor the response to initial therapy and early identify a severe phenotype. The aim of this paper is to review the clinical utility of relevant biomarkers currently used in asthma management. Indication for a more advanced and efficient therapy, such as monoclonal antibodies and selection of the optimal molecule is based on biomarkers and clinical criteria, according to the most recent experts’ recommendations. Peripheral blood eosinophils is considered an important biomarker for selection and identification of responders to anti-eosinophil biological therapy. Reallife long-term studies to confirm the precise use and cutoffs of the already approved biomarkers for T2 phenotypes and to identify reliable biomarkers for non- T2 severe asthma are still unmet needs in asthma management.

Applying personalized medicine to adult severe asthma

2021 ◽  
Vol 42 (1) ◽  
pp. e8-e16 ◽  
Author(s):  
Angelica Tiotiu
Keyword(s):  
Personalized Medicine ◽  
Severe Asthma ◽  
Negative Impact ◽  
Target Therapy ◽  
Asthma Management ◽  
Future Research ◽  
Biologic Therapies ◽  
Eosinophilic Asthma ◽  
Definition Of ◽  
Structured Approach

Background: Severe asthma is a heterogeneous disease that consists of various phenotypes driven by different pathways. Associated with significant morbidity, an important negative impact on the quality of life of patients, and increased health care costs, severe asthma represents a challenge for the clinician. With the introduction of various antibodies that target type 2 inflammation (T2) pathways, severe asthma therapy is gradually moving to a personalized medicine approach. Objective: The purpose of this review was to emphasize the important role of personalized medicine in adult severe asthma management. Methods: An extensive research was conducted in medical literature data bases by applying terms such as “severe asthma” associated with “structured approach,” “comorbidities,” “biomarkers,” “phenotypes/endotypes,” and “biologic therapies.” Results: The management of severe asthma starts with a structured approach to confirm the diagnosis, assess the adherence to medications and identify confounding factors and comorbidities. The definition of phenotypes or endotypes (phenotypes defined by mechanisms and identified through biomarkers) is an important step toward the use of personalized medicine in asthma. Severe allergic and nonallergic eosinophilic asthma are two defined T2 phenotypes for which there are efficacious targeted biologic therapies currently available. Non-T2 phenotype remains to be characterized, and less efficient target therapy exists. Conclusion: Despite important progress in applying personalized medicine to severe asthma, especially in T2 inflammatory phenotypes, future research is needed to find valid biomarkers predictive for the response to available biologic therapies to develop more effective therapies in non-T2 phenotype.

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