scholarly journals Severe T2-high asthma in the biologics era: European experts' opinion

2019 ◽  
Vol 28 (152) ◽  
pp. 190054 ◽  
Author(s):  
Ian Pavord ◽  
Thomas Bahmer ◽  
Fulvio Braido ◽  
Borja G. Cosío ◽  
Marc Humbert ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Precision Medicine ◽  
Severe Asthma ◽  
Specialist Care ◽  
Current Management ◽  
Patient Referral ◽  
Existing Problems ◽  
Oral Corticosteroids ◽  
Chronic Use

The European Respiratory Biologics Forum gathered participants from 21 countries in Madrid, Spain, to discuss the management and treatment of severe asthma in the era of biologics. The current insights on the pathophysiology of severe asthma were discussed, as well as the role of respiratory biologics in clinical practice and strategies for eliminating chronic use of oral corticosteroids. The participants also highlighted the key challenges in identifying patients with severe asthma based on phenotypes, biomarkers and treatable traits, and the existing problems in patient referral to specialist care. The monitoring of treatment was debated and the need for a change towards precision medicine and personalised care was emphasised throughout the meeting. This review provides a summary of the discussions and highlights important concerns identified by the participants regarding the current management of severe asthma.

scholarly journals Omalizumab as alternative to chronic use of oral corticosteroids in severe asthma

2019 ◽  
Vol 150 ◽  
pp. 51-62 ◽  
Author(s):  
Paraskevi Katsaounou ◽  
Roland Buhl ◽  
Guy Brusselle ◽  
Pascal Pfister ◽  
Rafael Martínez ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Oral Corticosteroids ◽  
Chronic Use

Chronic Use of Oral Corticosteroids in Severe Asthmatics in the Belgian Severe Asthma Registry (BSAR)

2019 ◽  
Author(s):  
S. Vanwynsberghe ◽  
F. Schleich ◽  
R. Louis ◽  
O. Vandenplas ◽  
C. Pilette ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Oral Corticosteroids ◽  
Chronic Use

scholarly journals Pharmacogenetics of non-steroidal anti-inflammatory drugs: existing problems for clinical practice

2019 ◽  
pp. 204-209 ◽  
Author(s):  
M. V. Leonova ◽  
E. E. Alimova
Keyword(s):  
Clinical Practice ◽  
Gastrointestinal Bleeding ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Metabolizing Enzymes ◽  
Existing Problems ◽  
Drug Doses ◽  
Inflammatory Drugs ◽  
Clinically Significant ◽  
Cox 1

NSAIDs are the most commonly used drugs in clinical practice for pain relief in various diseases. To date, considerable scientific material has been accumulated on the pharmacogenetics of NSAIDs and the role of genetic factors that can influence the pharmacokinetics and pharmacodynamics of drugs, changing the efficacy and toxicity profile. The most clinically significant changes in pharmacokinetics in carriers of slow alleles of CYP2C9*3 have been identified for celecoxib and flurbiprofen, which determines the need for testing and lowering of drug doses. Studies were carried out to study the role of polymorphism of the metabolizing enzymes CYP2C9, CYP2C8, UGT in the development of gastrotoxicity and gastrointestinal bleeding during application NSAIDs, as well as diclofenac’s hepatotoxicity. The association of «slow» alleles CYP2C8*3 and CYP2C9*2,*3 with the risk of gastrointestinal bleeding associated with NSAID use, which are substrates of CYP2C9 and CYP2C8, is shown. The effect of variants of alleles PTGS1 (gene COX-1) and PTGS2 (gene COX-2) on pharmacodynamics, efficacy and toxicity of NSAIDs, in particular, the severity of the analgesic effect and cardiotoxicity of the drugs, was studied. In this way, pharmacogenetic predictors of adverse effects that patients can experience, and the need for dose adjustment based on the patient’s genotype, or individualizing the choice of alternative NSAIDs to increase the effectiveness of analgesia, have been determined.

scholarly journals Precision medicine in airway diseases: moving to clinical practice

2017 ◽  
Vol 50 (4) ◽  
pp. 1701655 ◽  
Author(s):  
Alvar Agustí ◽  
Mona Bafadhel ◽  
Richard Beasley ◽  
Elisabeth H. Bel ◽  
Rosa Faner ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Precision Medicine ◽  
Chronic Obstructive ◽  
European Respiratory Society ◽  
Obstructive Pulmonary Disease ◽  
Airway Diseases ◽  
Assessment And Treatment ◽  
Key Questions ◽  
Society Research

On February 21, 2017, a European Respiratory Society research seminar held in Barcelona discussed how to best apply precision medicine to chronic airway diseases such as asthma and chronic obstructive pulmonary disease. It is now clear that both are complex and heterogeneous diseases, that often overlap and that both require individualised assessment and treatment. This paper summarises the presentations and discussions that took place during the seminar. Specifically, we discussed the need for a new taxonomy of human diseases, the role of different players in this scenario (exposome, genes, endotypes, phenotypes, biomarkers and treatable traits) and a number of unanswered key questions in the field. We also addressed how to deploy airway precision medicine in clinical practice today, both in primary and specialised care. Finally, we debated the type of research needed to move the field forward.

scholarly journals Oral Corticosteroids in Asthma: A Review of Benefits and Risks

2007 ◽  
Vol 14 (suppl c) ◽  
pp. 1C-7C ◽  
Author(s):  
Robert Schellenberg ◽  
Jonathan D R Adachi ◽  
Dennis Bowie ◽  
Jacques Brown ◽  
Lyn Guenther ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Adverse Effects ◽  
Present Review ◽  
Evidence Based ◽  
Current Clinical Practice ◽  
Pharmacological Management ◽  
Integral Role ◽  
Oral Corticosteroids ◽  
Based Medicine

Oral corticosteroids (OCS) play an integral role in the pharmacological management of asthma, as well as a number of other inflammatory and autoimmune disorders. However, although their broad spectrum of effect is beneficial in controlling inflammation, it can also lead to undesirable effects on other cells, resulting in adverse effects. The purpose of the present review is to discuss the particular benefits of OCS and to outline the optimal role of these agents in the management of asthma, drawing on evidence-based medicine and current clinical practice guidelines. The mandate for the present review also covers an analysis of the risk:benefit ratio as it pertains to OCS use in asthma. The more common adverse effects will be discussed and weighed against the possible benefits.

scholarly journals Effectiveness and Safety of Bronchial Thermoplasty in Severe Asthma in Clinical Practice in Spain

2018 ◽  
Vol 3 (3) ◽  
pp. 1-9 ◽  
Author(s):  
Luis Puente-Maestu ◽  
Milagros Llanos Flores ◽  
Paola Benedetti ◽  
Ingrid Frías Benzant ◽  
Alicia Oliva Ramos ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Asthma Control ◽  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Invasive Procedure ◽  
First Year ◽  
Asthma Control Test ◽  
Bronchial Thermoplasty ◽  
Oral Corticosteroids ◽  
Predominantly Female

Background: Bronchial thermoplasty (BT) is a minimally invasive procedure consisting of application of thermal energy into the airways to produce ablation of the hypertrophic smooth muscle. It was approved for use in moderate-severe asthma in Spain in 2010. Objectives: The aims of the present study are to analyze the effectiveness and the safety of BT in clinical practice in our center. Methods: Participants had a confirmed diagnosis of severe asthma and poor control without therapeutic alternative. Effectiveness was measured by comparing exacerbations, admissions rates, asthma control, and medication 1 year prior and 1 year after BT was completed. All complications appearing during the procedure and in the first year were recorded. Results: Patients had a mean age of 51 (SD 8) years and were predominantly female (17/23). The average number of activations per patient was 147 (16). The number of severe exacerbations was reduced by 75% (p < 0.001). A 38% reduction in admissions per year was also observed (p = 0.03). The Asthma Control Test improved by 7.1 (3.7) points (p = 0.018). Before BT, the dose of inhaled corticosteroids was 1,621 (1,015) µg of budesonide-equivalent and the dose of oral corticosteroids was 15 (13) mg of prednisone-equivalent. There was a reduction in 430 (731) µg of budesonide-equivalent (p = 0.02) and 4 (11) mg of prednisone (p = 0.094). No changes in lung function were observed. Complications were related mostly to exacerbation of asthma in the days following the procedure. Conclusions: BT is effective and safe for severe uncontrolled bronchial asthma in real clinical practice.

scholarly journals The pragmatic role of nasal cytology: a point-of-care testing to implement precision medicine in clinical practice

2018 ◽  
Vol 65 (3) ◽  
pp. 179 ◽  
Author(s):  
Matteo Gelardi ◽  
Massimo Landi ◽  
Giorgio Ciprandi
Keyword(s):  
Clinical Practice ◽  
Precision Medicine ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Nasal Cytology

Antecedentes: La medicina de precisión es una estrategia actualizada que apunta a individualizar los mecanismos fisiopatológicos precisos. Entonces, la medicina de precisión es la base de la medicina personalizada, como definir el tratamiento apropiado en cada paciente. La citología nasal solo necesita un microscopio óptico, tinturas, gafas y curetas. El procedimiento puede durar muy pocos minutos usando tinción rápida, por lo tanto, se puede considerar una prueba confiable en el punto de atención en el consultorio.Métodos: Estudio transversal que incluyó 5030 pacientes ambulatorios con trastornos nasales: 2612 hombres y 2418 mujeres, edad promedio de 36.8 ± 17.1 años, quienes fueron atendidos en un periodo de cinco años. Los pacientes se subdividieron conforme a la prueba cutánea y la citología nasal en sujetos con rinitis alérgica y con rinitis no alérgica. Las formas celulares se subdividieron en función del citotipo: rinitis no alérgica con predominio de infiltración eosinofílica (NARNE, neutrófilos > 50 % con esporas y bacterias ausentes); rinitis no alérgica con eosinófilos (NARES, eosinófilos > 20%); rinitis no alérgica con predominio de infiltrado de mastocitos (NARMA, mastocitos > 10 %) y rinitis no alérgica con eosinófilos y mastocitos (NARESMA, eosinófilos > 20 % y mastocitos > 10 %).Resultados: 453 (9 %) sujetos tuvieron citología negativa a nasal, 1056 (21 %) rinitis alérgica, 538 (10.7%) NARES, 493 (9.8%) poliposis nasal, 251 (5%) rinosinusitis, 221 (4.4%) NARESMA, 201 (4%) rinitis infecciosa; 131 (2.6%) NARMA y 89 (1.8%) NARNE; los sujetos restantes tenían un perfil inflamatorio-infeccioso misceláneo.Conclusiones: La citología nasal proporciona información rápida sobre el fenotipo y endotipo y puede repetirse en el seguimiento para evaluar los cambios posteriores al tratamiento.

scholarly journals Role of Actionable Genes in Pursuing a True Approach of Precision Medicine in Monogenic Diabetes

Genes ◽  
2022 ◽  
Vol 13 (1) ◽  
pp. 117
Author(s):  
Antonella Marucci ◽  
Irene Rutigliano ◽  
Grazia Fini ◽  
Serena Pezzilli ◽  
Claudia Menzaghi ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Precision Medicine ◽  
Genetic Disorder ◽  
Single Gene ◽  
Neonatal Diabetes ◽  
Monogenic Diabetes ◽  
Maturity Onset Diabetes ◽  
Patients With Diabetes ◽  
Clinical Strategy

Monogenic diabetes is a genetic disorder caused by one or more variations in a single gene. It encompasses a broad spectrum of heterogeneous conditions, including neonatal diabetes, maturity onset diabetes of the young (MODY) and syndromic diabetes, affecting 1–5% of patients with diabetes. Some of these variants are harbored by genes whose altered function can be tackled by specific actions (“actionable genes”). In suspected patients, molecular diagnosis allows the implementation of effective approaches of precision medicine so as to allow individual interventions aimed to prevent, mitigate or delay clinical outcomes. This review will almost exclusively concentrate on the clinical strategy that can be specifically pursued in carriers of mutations in “actionable genes”, including ABCC8, KCNJ11, GCK, HNF1A, HNF4A, HNF1B, PPARG, GATA4 and GATA6. For each of them we will provide a short background on what is known about gene function and dysfunction. Then, we will discuss how the identification of their mutations in individuals with this form of diabetes, can be used in daily clinical practice to implement specific monitoring and treatments. We hope this article will help clinical diabetologists carefully consider who of their patients deserves timely genetic testing for monogenic diabetes.

The miR-21 potential of serving as a biomarker for liver diseases in clinical practice

2020 ◽  
Vol 48 (5) ◽  
pp. 2295-2305
Author(s):  
Jiawei Zhang ◽  
Dandan Li ◽  
Rui Zhang ◽  
Peng Gao ◽  
Rongxue Peng ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Liver Diseases ◽  
Hepatic Disease ◽  
Noninvasive Detection ◽  
Diagnosis And Prognosis ◽  
Expected Performance ◽  
Potential Biomarker ◽  
Disease Condition ◽  
Complex Regulatory Network

The role of miR-21 in the pathogenesis of various liver diseases, together with the possibility of detecting microRNA in the circulation, makes miR-21 a potential biomarker for noninvasive detection. In this review, we summarize the potential utility of extracellular miR-21 in the clinical management of hepatic disease patients and compared it with the current clinical practice. MiR-21 shows screening and prognostic value for liver cancer. In liver cirrhosis, miR-21 may serve as a biomarker for the differentiating diagnosis and prognosis. MiR-21 is also a potential biomarker for the severity of hepatitis. We elucidate the disease condition under which miR-21 testing can reach the expected performance. Though miR-21 is a key regulator of liver diseases, microRNAs coordinate with each other in the complex regulatory network. As a result, the performance of miR-21 is better when combined with other microRNAs or classical biomarkers under certain clinical circumstances.

Sign in / Sign up

Export Citation Format

Share Document