Effect of MgSO4 on FEV1 in stable severe asthma patients with chronic airflow limitation

2009 ◽  
Vol 22 (4) ◽  
pp. 256-261 ◽  
Author(s):  
Alinda MG Zandsteeg ◽  
Petra Hirmann ◽  
Henk R Pasma ◽  
Jan-Peter Yska ◽  
Anneke ten Brinke
Keyword(s):  
Severe Asthma ◽  
Airflow Limitation ◽  
Asthma Patients

scholarly journals Comparing Patient Characteristics, Clinical Outcomes, and Biomarkers of Severe Asthma Patients in Taiwan

Biomedicines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 764
Author(s):  
Shih-Lung Cheng ◽  
Kuo-Chin Chiu ◽  
Hsin-Kuo Ko ◽  
Diahn-Warng Perng ◽  
Hao-Chien Wang ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Clinical Characteristics ◽  
Linear Models ◽  
Patient Characteristics ◽  
Emergency Department Visits ◽  
Receiver Operating Characteristic Curves ◽  
Increased Risk ◽  
Significant Difference ◽  
Asthma Patients ◽  
Patients At Risk

Purpose: To understand the association between biomarkers and exacerbations of severe asthma in adult patients in Taiwan. Materials and Methods: Demographic, clinical characteristics and biomarkers were retrospectively collected from the medical charts of severe asthma patients in six hospitals in Taiwan. Exacerbations were defined as those requiring asthma-specific emergency department visits/hospitalizations, or systemic steroids. Enrolled patients were divided into: (1) those with no exacerbations (non-exacerbators) and (2) those with one or more exacerbations (exacerbators). Receiver operating characteristic curves were used to determine the optimal cut-off value for biomarkers. Generalized linear models evaluated the association between exacerbation and biomarkers. Results: 132 patients were enrolled in the study with 80 non-exacerbators and 52 exacerbators. There was no significant difference in demographic and clinical characteristics between the two groups. Exacerbators had significantly higher eosinophils (EOS) counts (367.8 ± 357.18 vs. 210.05 ± 175.24, p = 0.0043) compared to non-exacerbators. The optimal cut-off values were 292 for EOS counts and 19 for the Fractional exhaled Nitric Oxide (FeNO) measure. Patients with an EOS count ≥ 300 (RR = 1.88; 95% CI, 1.26–2.81; p = 0.002) or FeNO measure ≥ 20 (RR = 2.10; 95% CI, 1.05–4.18; p = 0.0356) had a significantly higher risk of exacerbation. Moreover, patients with both an EOS count ≥ 300 and FeNO measure ≥ 20 had a significantly higher risk of exacerbation than those with lower EOS count or lower FeNO measure (RR = 2.16; 95% CI, 1.47–3.18; p = < 0.0001). Conclusions: Higher EOS counts and FeNO measures were associated with increased risk of exacerbation. These biomarkers may help physicians identify patients at risk of exacerbations and personalize treatment for asthma patients.

scholarly journals Trends in oral corticosteroids use in severe asthma: a 14-year population-based study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mohsen Sadatsafavi ◽  
Amir Khakban ◽  
Hamid Tavakoli ◽  
Solmaz Ehteshami-Afshar ◽  
Larry D. Lynd ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Poisson Regression ◽  
Population Based ◽  
Population Based Study ◽  
Factors Associated ◽  
Asthma Patients ◽  
Oral Corticosteroids ◽  
Administrative Health Databases ◽  
Time Since Diagnosis

Abstract Background Oral corticosteroids are important components of pharmacotherapy in severe asthma. Our objective was to describe the extent, trends, and factors associated with exposure to oral corticosteroids (OCS) in a severe asthma cohort. Methods We used administrative health databases of British Columbia, Canada (2000–2014) and validated algorithms to retrospectively create a cohort of severe asthma patients. Exposure to OCS within each year of follow-up was measured in two ways: maintenance use as receiving on average ≥ 2.5 mg/day (prednisone-equivalent) OCS, and episodic use as the number of distinct episodes of OCS exposure for up to 14 days. Trends and factors associated with exposure on three time axes (calendar year, age, and time since diagnosis) were evaluated using Poisson regression. Results 21,144 patients (55.4% female; mean entry age 28.7) contributed 40,803 follow-up years, in 8.2% of which OCS was used as maintenance therapy. Maintenance OCS use declined by 3.8%/calendar year (p < 0.001). The average number of episodes of OCS use was 0.89/year, which increased by 1.1%/calendar year (p < 0.001). Trends remained significant for both exposure types in adjusted analyses. Both maintenance and episodic use increased by age and time since diagnosis. Conclusions This population-based study documented a secular downward trend in maintenance OCS use in a period before widespread use of biologics. This might have been responsible for a higher rate of exacerbations that required episodic OCS therapy. Such trends in OCS use might be due to changes in the epidemiology of severe asthma, or changes in patient and provider preferences over time.

scholarly journals Systems Approaches to Treatment Response to Imatinib in Severe Asthma: A Pilot Study

2021 ◽  
Vol 11 (4) ◽  
pp. 240
Author(s):  
Seung Han Baek ◽  
Dinah Foer ◽  
Katherine N. Cahill ◽  
Elliot Israel ◽  
Enrico Maiorino ◽  
...  
Keyword(s):  
Gene Expression ◽  
Clinical Trial ◽  
Systems Biology ◽  
Pilot Study ◽  
Severe Asthma ◽  
Treated Patient ◽  
Expression Patterns ◽  
Airflow Limitation ◽  
Response To Treatment ◽  
Imatinib Treatment

There is an acute need for advances in pharmacologic therapies and a better understanding of novel drug targets for severe asthma. Imatinib, a tyrosine kinase inhibitor, has been shown to improve forced expiratory volume in 1 s (FEV1) in a clinical trial of patients with severe asthma. In a pilot study, we applied systems biology approaches to epithelium gene expression from these clinical trial patients treated with imatinib to better understand lung function response with imatinib treatment. Bronchial brushings from ten imatinib-treated patient samples and 14 placebo-treated patient samples were analyzed. We used personalized perturbation profiles (PEEPs) to characterize gene expression patterns at the individual patient level. We found that strong responders—patients with greater than 20% increase in FEV1—uniquely shared multiple downregulated mitochondrial-related pathways. In comparison, weak responders (5–10% FEV1 increase), and non-responders to imatinib shared none of these pathways. The use of PEEP highlights its potential for application as a systems biology tool to develop individual-level approaches to predicting disease phenotypes and response to treatment in populations needing innovative therapies. These results support a role for mitochondrial pathways in airflow limitation in severe asthma and as potential therapeutic targets in larger clinical trials.

scholarly journals Impact on hospitalization rates as a result of the implementation of a care programme for severe asthma patients in Espirito Santo, Brazil

2015 ◽  
Vol 8 ◽  
pp. A224
Author(s):  
Lyvia Barbosa Alves ◽  
Maria José Sartório ◽  
Faradiba Serpa ◽  
Rayane Fontoura Koch ◽  
Braga Neto ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Care Programme ◽  
Espírito Santo ◽  
Hospitalization Rates ◽  
Asthma Patients ◽  
Espirito Santo

scholarly journals Pharmacological Rationale for Targeting IL-17 in Asthma

2021 ◽  
Vol 2 ◽  
Author(s):  
Siti Farah Rahmawati ◽  
Maurice te Velde ◽  
Huib A. M. Kerstjens ◽  
Alexander S. S. Dömling ◽  
Matthew Robert Groves ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Current Knowledge ◽  
Experimental Models ◽  
Airflow Limitation ◽  
Interleukin 17 ◽  
Asthma Phenotype ◽  
T Helper 2 ◽  
Bronchial Biopsies

Asthma is a respiratory disease that currently affects around 300 million people worldwide and is defined by coughing, shortness of breath, wheezing, mucus overproduction, chest tightness, and expiratory airflow limitation. Increased levels of interleukin 17 (IL-17) have been observed in sputum, nasal and bronchial biopsies, and serum of patients with asthma compared to healthy controls. Patients with higher levels of IL-17 have a more severe asthma phenotype. Biologics are available for T helper 2 (Th2)-high asthmatics, but the Th17-high subpopulation has a relatively low response to these treatments, rendering it a rather severe asthma phenotype to treat. Several experimental models suggest that targeting the IL-17 pathway may be beneficial in asthma. Moreover, as increased activation of the Th17/IL-17 axis is correlated with reduced inhaled corticosteroids (ICS) sensitivity, targeting the IL-17 pathway might reverse ICS unresponsiveness. In this review, we present and discuss the current knowledge on the role of IL-17 in asthma and its interaction with the Th2 pathway, focusing on the rationale for therapeutic targeting of the IL-17 pathway.

scholarly journals The efficacy of the combination of exhaled nitric oxide and blood eosinophil count in the diagnosis of asthma in China

2020 ◽  
Author(s):  
Jiang-hua Li ◽  
Rui Han ◽  
Yu-bo Wang ◽  
Min Cheng ◽  
Heng-yi Chen ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Exhaled Nitric Oxide ◽  
Airflow Limitation ◽  
Blood Eosinophil ◽  
Asthma Diagnosis ◽  
Diagnostic Efficacy ◽  
Asthma Patients ◽  
In Series

Abstract BackgroundTests to identify reversible airflow limitation are important in asthma diagnosis, but they are time-consuming and may be difficult for patients to cooperate. We aim to evaluate the predictive value of fractional exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) count in asthma diagnosis, and to distinguish patients who could avoid reversibility testing.MethodsWe screened 7463 suspected asthma cases between January 2014 and December 2019 in Chongqing, China, and identified 2349 patients with complete FeNO, B-Eos count, and spirometry data. Of these, 824 were diagnosed with asthma via a positive bronchial-provocation or bronchodilation test.ResultsWhen FeNO and B-Eos counts were used in combination, the area under the receiver operating characteristic curve (AUC) for diagnosing asthma increased (0.768 vs. 0.745 or 0.728; both P < 0.001). The odds ratio for having asthma increased progressively with a gradual increase in FeNO or B-Eos count (both P < 0.001). Further analysis of in-series combinations of different threshold values for these biomarkers indicated that moderately elevated biomarker levels (FeNO > 40 ppb and B-Eos > 300 cells/μl) support a diagnosis of asthma because diagnostic specificity was > 95% and the positive likelihood ratio (PLR) was > 10. This conclusion was verified when selecting the data from 2017 to 2019 as the verification cohort.ConclusionThe combination of FeNO and B-Eos count can improve diagnostic efficacy for asthma. Patients with moderately elevated biomarkers (FeNO > 40 ppb and B-Eos > 300 cells/μl) could be diagnosed with asthma.

scholarly journals Clinical equivalency of Beclasone Eco Easi Breathe and Flixotide via MDI in asthma patients

2007 ◽  
pp. 74-81
Author(s):  
A. A. Visel ◽  
V. N. Seliverstov ◽  
I. Yu. Visel ◽  
V. A. Sergeev ◽  
N. M. Rakhmatullina
Keyword(s):  
Severe Asthma ◽  
Comparative Trial ◽  
Similar Efficacy ◽  
Heart Beat ◽  
Inhaled Steroids ◽  
Russian Version ◽  
Asthma Patients ◽  
Heart Beat Rate ◽  
Physical Findings

It is well known that efficacy of asthma treatment depends on a choice of a basic medication as well as on a delivery system. The aim of this study was a comparison of clinical efficacy of equal doses of beclomethasone dipropionate (Beclasone Eco Easi Breathe) and fluticasone propionate (Flixotide) via MDI. The study was designed as a randomized open prospective comparative trial. Findings of 26 patients with moderate and severe asthma of > 18 yrs old were analyzed, such as medical history, physical findings, spirometric and bronchodilating test results, heart beat rate and blood pressure, quality of life (QoL) using Russian version of AQLQ questionnaire. After the run-in period the patients randomly received Beclasone Eco Easi Breathe 500 to 1000 μg daily or Flixotide at the same doses for 4 weeks followed the cross-over change of the drugs for the next 4 weeks. After 1 month of the treatment, significant improvements in airflow parameters, need in short-acting β2 -agonists and QoL have been reported. After changing the drugs these effects have been maintained with no further reliable improvement. Thus, the study demonstrated similar efficacy and safety of these inhaled steroids that could be considered as being clinically equal in treatment of moderate and severe asthma.

scholarly journals Features of pulmonary haemodynamics and endothelium function in children with asthma

2007 ◽  
pp. 56-59
Author(s):  
E. A. Starovoytova ◽  
S. N. Ivanov ◽  
L. M. Ogorodova
Keyword(s):  
Right Ventricle ◽  
Severe Asthma ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Control Group ◽  
Pulmonary Hemodynamics ◽  
Vasomotor Function ◽  
Ultrasound Evaluation ◽  
Endothelium Function ◽  
Asthma Patients

Asthma patients (n = 79, 7 to 17 years of age) were divided into 3 groups according to asthma severity: mild (n = 23), moderate (n = 24), and severe asthma (n = 32). Asthma was diagnosed according to GINA (2002). Echocardiography, ultrasound evaluation of endothelium vasomotor function and measurement of nitrite anion concentration in exhaled breathe condensate (EBC) were performed in the all patients. Right ventricle dilatation and increase in the total pulmonary vascular resistance were revealed only in patients with severe asthma compared to the control group. Increase in pulmonary artery systolic pressure was significantly higher in the severe asthma patients compared both to the control group and mild asthma patients. Increased right ventricle pressure was accompanied by endothelium dysfunction in 48.1 % (38 patients). High EBC nitrite anion concentration (12.11 ± 1.72 μmol/L) was revealed in asthmatic children compared to control group (3,34 ± 1,58 μmol/L). The results suggest that childhood asthma is associated with morphological and functional abnormalities of pulmonary hemodynamics and endothelium function depending on severity of the disease.

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