scholarly journals Clinical utility of fractional exhaled nitric oxide in severe asthma management

2020 ◽  
Vol 55 (3) ◽  
pp. 1901633 ◽  
Author(s):  
Andrew Menzies-Gow ◽  
Adel H. Mansur ◽  
Christopher E. Brightling
Keyword(s):  
Nitric Oxide ◽  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Healthcare Providers ◽  
Asthma Management ◽  
Cost Effective ◽  
Chronic Inflammatory Disease ◽  
Initial Diagnosis ◽  
Increased Risk ◽  
The Usa

Asthma is a chronic inflammatory disease of the airways, affecting over 350 million people worldwide and placing a significant burden on healthcare providers and wider society. Approximately 5–10% of asthma patients are diagnosed with severe asthma and typically are associated with increased risk of hospitalisation from exacerbations, increased morbidity, mortality and higher asthma-associated healthcare costs. Nitric oxide (NO) is an important regulator of immune responses and is a product of inflammation in the airways that is over-produced in asthma. Fractional exhaled NO (FeNO) is predominantly used as a predictor of response to inhaled corticosteroids (ICSs), to monitor adherence and as a diagnostic tool in ICS-naïve patients. In the UK, the National Institute for Health and Care Excellence (NICE) guidelines recommend the use of FeNO for the initial diagnosis of patients with suspected asthma. In the USA, American Thoracic Society (ATS) guidelines recommend FeNO as part of the initial diagnosis of asthma and for monitoring of airway inflammation. FeNO has also been shown to be a predictive factor for asthma exacerbations, with higher levels being associated with a greater number of exacerbations. In addition, higher levels of FeNO have been shown to be associated with a decline in lung function. FeNO testing is a cost-effective procedure and has been shown to improve patient management when combined with standard assessment methods. Recent evidence suggests that FeNO may also be useful as a surrogate biomarker for the assessment and management of severe asthma and to predict responsiveness to some biological therapies.

scholarly journals The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

2009 ◽  
Vol 35 (7) ◽  
pp. 635-644 ◽  
Author(s):  
Gustavo Javier Rodrigo ◽  
Vicente Plaza ◽  
Jesús Bellido-Casado ◽  
Hugo Neffen ◽  
María Teresa Bazús ◽  
...  
Keyword(s):  
Latin America ◽  
Severe Asthma ◽  
Latin American ◽  
Inhaled Corticosteroids ◽  
Pulmonary Function Tests ◽  
Tertiary Care ◽  
Asthma Management ◽  
Case Series ◽  
Acute Severe Asthma ◽  
The Mean

OBJECTIVE: Studies assessing the characteristics and management of patients hospitalized with asthma have been limited to a small number of facilities and have evaluated short time periods. The present study evaluated long-term changes among hospitalized asthma patients at a large number of facilities. METHODS: This was a retrospective, hospital-based observational case series, designated the Study of Severe Asthma in Latin America and Spain, which was conducted in Spain and in eight Latin-American countries. We reviewed the hospital records of 3,038 patients (age range, 15-69 years) hospitalized with acute severe asthma at one of nineteen tertiary-care hospitals in 1994, 1999 and 2004. RESULTS: Over time, the use of inhaled corticosteroids and long-acting β2 agonists increased significantly, whereas the use of theophylline as a controller medication decreased. The utilization of pulmonary function tests also increased. There was a significant reduction in the mean hospital stay (8.5 days, 7.4 days and 7.1 days in 1994, 1999 and 2004, respectively, p = 0.0001) and a significant increase in the mean of the lowest arterial pH at hospital admission. In contrast, there was a significant decrease in the proportion of cases in which PEF was determined in the emergency room (48.6% in 1994 vs. 43.5% in 2004, p = 0.0001). We found the quality of asthma management and care to be generally better in Spain than in Latin America. CONCLUSIONS: Although there have been certain improvements in the management of asthma between severe exacerbations and during hospitalization, asthma management remains suboptimal in Spain and, especially, in Latin America.

Cost Utility of Fractional Exhaled Nitric Oxide Monitoring for the Management of Children Asthma

2020 ◽  
Author(s):  
Jefferson Antonio Buendia ◽  
Rannery Acuña ◽  
carlos rodriguez
Keyword(s):  
Nitric Oxide ◽  
Markov Model ◽  
Standard Therapy ◽  
Asthma Management ◽  
Cost Effective ◽  
Cost Utility ◽  
Exhaled Nitric Oxide ◽  
Fractional Exhaled Nitric Oxide ◽  
Tertiary Center ◽  
The Cost

Abstract IntroductionFractional exhaled nitric oxide is a simple, non-invasive measurement of airway inflammation with minimal discomfort to the patient and with results available within a few minutes. This study aimed to evaluate the cost-effectiveness of asthma management using fractional exhaled nitric oxide monitoring in patients between 4 and 18 years of age.Methods A Markov model was used to estimate the cost-utility of asthma management using fractional exhaled nitric oxide monitoring versus asthma management without using fractional exhaled nitric oxide monitoring (standard therapy) in patients between 4 and 18 years of age. Cost data were obtained from a retrospective study on asthma from a tertiary center, in Medellin, Colombia, while probabilities of the Markov model and utilities were obtained from the systematic review of published randomized clinical trials. The analysis was carried out from a societal perspective.ResultsThe model showed that fractional exhaled nitric oxide monitoring was associated with a lower total cost than standard therapy (US $1,333 vs. US $1,452 average cost per patient) and higher QALYs (0.93 vs. 0.92 average per patient). The probability that fractional exhaled nitric oxide monitoring provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness-to-pay thresholds.Conclusion Asthma management using fractional exhaled nitric oxide monitoring was cost-effective for treating patients between 4 and 18 years of age with mild to moderate allergic asthma. Our study suggests evidence that could be used by decision-makers to improve clinical practice guidelines, but this should be replicated in different clinical settings.

scholarly journals Asthma and COVID-19: Emphasis on Adequate Asthma Control

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
David D. Nassoro ◽  
Leodegard Mujwahuzi ◽  
Issakwisa Habakkuk Mwakyula ◽  
Mwajabu K. Possi ◽  
Sylvester L. Lyantagaye
Keyword(s):  
Asthma Control ◽  
Seasonal Influenza ◽  
Inhaled Corticosteroids ◽  
Asthma Management ◽  
Cell Mediated Immunity ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Wide Availability ◽  
The Relationship ◽  
Increased Susceptibility

Asthmatics are at an increased risk of developing exacerbations after being infected by respiratory viruses such as influenza virus, parainfluenza virus, and human and severe acute respiratory syndrome coronaviruses (SARS-CoV). Asthma, especially when poorly controlled, is an independent risk factor for developing pneumonia. A subset of asthmatics can have significant defects in their innate, humoral, and cell-mediated immunity arms, which may explain the increased susceptibility to infections. Adequate asthma control is associated with a significant decrease in episodes of exacerbation. Because of their wide availability and potency to promote adequate asthma control, glucocorticoids, especially inhaled ones, are the cornerstone of asthma management. The current COVID-19 pandemic affects millions of people worldwide and possesses mortality several times that of seasonal influenza; therefore, it is necessary to revisit this subject. The pathogenesis of SARS-CoV-2, the virus that causes COVID-19, can potentiate the development of acute asthmatic exacerbation with the potential to worsen the state of chronic airway inflammation. The relationship is evident from several studies that show asthmatics experiencing a more adverse clinical course of SARS-CoV-2 infection than nonasthmatics. Recent studies show that dexamethasone, a potent glucocorticoid, and other inhaled corticosteroids significantly reduce morbidity and mortality among hospitalized COVID-19 patients. Hence, while we are waiting for more studies with higher level of evidence that further narrate the association between COVID-19 and asthma, we advise clinicians to try to achieve adequate disease control in asthmatics as it may reduce incidences and severity of exacerbations especially from SARS-CoV-2 infection.

Considerations for asthma management and viral transmission in the era of COVID-19

2021 ◽  
Vol 42 (1) ◽  
pp. 93-96 ◽  
Author(s):  
Mitchell M. Pitlick ◽  
Avni Y. Joshi
Keyword(s):  
Inhaled Corticosteroids ◽  
Pediatric Population ◽  
Asthma Management ◽  
Viral Transmission ◽  
Subsequent Investigation ◽  
Conflicting Evidence ◽  
Increased Risk ◽  
Recent Position ◽  
Continued Use ◽  
Inhaled Glucocorticoids

Background: As the global COVID-19 pandemic has unfolded, there has been much debate surrounding the optimal management of patients with asthma who are at risk of or contract COVID-19, whether asthma and steroids are risk factors for severe COVID-19, and how transmissible the virus is among children. Objective: The objective of this study is to provide allergists and other clinicians with pearls pertaining to the management of patients with asthma in the setting of the COVID-19 pandemic and to provide some information regarding the risk of transmission among the pediatric population. Methods: Utilizing the case of one of our own patients with asthma who developed COVID-19 as context, we review the recent literature discussing the risk of COVID-19 in patients with asthma, the management of asthma medications in the time of the pandemic, and the risk of viral transmission. Results: Despite initial reports that asthma was a risk factor for developing severe COVID-19, subsequent investigation has shown that this is likely not true. Additionally, the use of systemic or inhaled glucocorticoids does not appear to increase the risk of severe COVID-19, but there is no evidence guiding the use of biologic therapy. There is conflicting evidence regarding the ability of children to transmit the virus. Conclusion: We provide pearls that asthma does not appear to be associated with an increased risk of COVID-19 and continued use of inhaled corticosteroids appears to be safe. While there is no evidence guiding the use of biologic therapies, a recent position paper suggests that they should be continued unless a patient contracts COVID-19, at which point they should be held until clinical recovery occurs.

Overview of severe asthma, with emphasis on pediatric patients: a review for practitioners

2021 ◽  
pp. jim-2020-001752
Author(s):  
Arabelle Abellard ◽  
Andrea A Pappalardo
Keyword(s):  
Risk Factors ◽  
Health Disparities ◽  
Severe Asthma ◽  
Pediatric Population ◽  
Asthma Management ◽  
Persistent Asthma ◽  
Individual Characteristics ◽  
Severe Persistent Asthma ◽  
The Usa ◽  
Life Threatening

Asthma is the most common life-threatening chronic disease in children. Although guidelines exist for the diagnosis and treatment of asthma, treatment of severe, pediatric asthma remains difficult. Limited studies in the pediatric population on new asthma therapies, complex issues with adolescence and adherence, health disparities, and unequal access to guideline-based care complicate the care of children with severe, persistent asthma. The purpose of this review is to provide an overview of asthma, including asthma subtypes, comorbidities, and risk factors, to discuss diagnostic considerations and pitfalls and existing treatments, and then present existing and emerging therapeutic approaches to asthma management. An improved understanding of asthma heterogeneity, clinical characteristics, inflammatory patterns, and pathobiology can help further guide the management of severe asthma in children. More studies are needed in the pediatric population to understand emerging therapeutics application in children. Effective multimodal strategies tailored to individual characteristics and a commitment to address risk factors, modifiers, and health disparities may help reduce the burden of asthma in the USA.

Epicardial Fat: A New Therapeutic Target in Psoriasis

2020 ◽  
Vol 25 (46) ◽  
pp. 4914-4918 ◽  
Author(s):  
Preetha Kamath ◽  
Gabrielle Benesh ◽  
Paolo Romanelli ◽  
Gianluca Iacobellis
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Therapeutic Target ◽  
Independent Risk Factor ◽  
Cost Effective ◽  
Chronic Inflammatory Disease ◽  
Epicardial Fat ◽  
Effective Measure ◽  
Increased Risk ◽  
Epicardial Fat Tissue

: Psoriasis is a chronic inflammatory disease affecting over 8 million Americans. Importantly, patients with psoriasis are at an increased risk of developing atherosclerosis, coronary artery disease, and myocardial infarctions. Several studies have suggested that psoriasis may be an independent risk factor for cardiovascular disease given their shared inflammatory properties and pathogenic similarities. Epicardial fat is also linked to cardiovascular disease and may be an independent risk factor for atherosclerosis. It has been proposed that measuring epicardial fat tissue may serve as a useful subclinical measure of cardiovascular disease in psoriasis patients. Echocardiography has been increasingly adopted as an accurate, minimally invasive, and cost-effective measure of determining the volume and thickness of epicardial fat. Using echocardiographic measures of epicardial fat thickness as a marker of cardiovascular disease and therapeutic target in psoriasis patients may provide clinicians with a means to better manage and hopefully prevent deleterious downstream effects.

scholarly journals Biomarkers in the context of managing severe asthma

2019 ◽  
Vol 2 (1) ◽  
pp. 10-18
Author(s):  
Stanley J. Szefler
Keyword(s):  
Nitric Oxide ◽  
Severe Asthma ◽  
Clinical Application ◽  
Biologic Therapy ◽  
Asthma Management ◽  
Response To Treatment ◽  
Biologic Therapies ◽  
Uncontrolled Asthma ◽  
The Cost ◽  
Blood Eosinophils

Only recently have asthma strategies addressed biomarkers in asthma management, for example, as applied in the identification of severe asthmatics likely to respond to biologic therapy. Three biomarkers are readily available for clinical application in managing severe asthma including blood eosinophils, exhaled nitric oxide and serum IgE. While we have a limited number of biomarkers for clinical application, the available biomarkers have ushered in the era of personalized medicine for asthma. These three biomarkers are readily available for application in the clinic setting to select medications and to monitor response to treatment as well as medication adherence. These biomarkers can be used to modify the cost of uncontrolled asthma and also used to select those patients likely to respond to the available biologic therapies for severe asthma.

scholarly journals Managing problematic severe asthma: beyond the guidelines

2017 ◽  
Vol 103 (4) ◽  
pp. 392-397 ◽  
Author(s):  
Katharine C Pike ◽  
Mark L Levy ◽  
John Moreiras ◽  
Louise Fleming
Keyword(s):  
Young People ◽  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Symptom Control ◽  
Asthma Management ◽  
Children And Young People ◽  
Leading Role ◽  
Children With Asthma ◽  
Individualised Care ◽  
New Treatments

This review discusses issues related to managing problematic severe asthma in children and young people. A small minority of children have genuinely severe asthma symptoms which are difficult to control. Children with genuinely severe asthma need investigations and treatments beyond those described within conventional guidelines. However, the majority of children with poor symptom control despite high-intensity treatment achieve improvement in their asthma control once attention has been paid to the basics of asthma management. Basic asthma management requires optimisation of inhaler technique and treatment adherence, avoidance of environmental triggers and self-management education. It is also important that clinicians recognise risk factors that predispose patients to asthma exacerbations and potentially life-threatening attacks. These correctable issues need to be tackled in partnership with children and young people and their families. This requires a coordinated approach between professionals across healthcare settings. Establishing appropriate infrastructure for coordinated asthma care benefits not only those with problematic severe asthma, but also the wider asthma population as similar correctable issues exist for children with asthma of all severities. Investigation and management of genuine severe asthma requires specialist multidisciplinary expertise and a systematic approach to characterising patients’ asthma phenotypes and delivering individualised care. While inhaled corticosteroids continue to play a leading role in asthma therapy, new treatments on the horizon might further support phenotype-specific therapy.

scholarly journals Cost utility of fractional exhaled nitric oxide monitoring for the management of children asthma

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jefferson Antonio Buendía ◽  
Ranniery Acuña-Cordero ◽  
Carlos E. Rodriguez-Martinez
Keyword(s):  
Nitric Oxide ◽  
Markov Model ◽  
Standard Therapy ◽  
Asthma Management ◽  
Cost Effective ◽  
Cost Utility ◽  
Exhaled Nitric Oxide ◽  
Fractional Exhaled Nitric Oxide ◽  
Tertiary Center ◽  
The Cost

Abstract Introduction Fractional exhaled nitric oxide is a simple, non-invasive measurement of airway inflammation with minimal discomfort to the patient and with results available within a few minutes. This study aimed to evaluate the cost-effectiveness of asthma management using fractional exhaled nitric oxide monitoring in patients between 4 and 18 years of age. Methods A Markov model was used to estimate the cost-utility of asthma management using fractional exhaled nitric oxide monitoring versus asthma management without using fractional exhaled nitric oxide monitoring (standard therapy) in patients between 4 and 18 years of age. Cost data were obtained from a retrospective study on asthma from a tertiary center, in Medellin, Colombia, while probabilities of the Markov model and utilities were obtained from the systematic review of published randomized clinical trials. The analysis was carried out from a societal perspective. Results The model showed that fractional exhaled nitric oxide monitoring was associated with a lower total cost than standard therapy (US $1333 vs. US $1452 average cost per patient) and higher QALYs (0.93 vs. 0.92 average per patient). The probability that fractional exhaled nitric oxide monitoring provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness-to-pay thresholds. Conclusion Asthma management using fractional exhaled nitric oxide monitoring was cost-effective for treating patients between 4 and 18 years of age with mild to moderate allergic asthma. Our study suggests evidence that could be used by decision-makers to improve clinical practice guidelines, but this should be replicated in different clinical settings.

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