scholarly journals Budesonide/formoterol Turbuhaler® as needed in mild asthma: results of SYGMA-1 and SYGMA-2 trials (SYmbicort® Given as needed in Mild Asthma)

2019 ◽  
Vol 29 (4) ◽  
pp. 419-427
Author(s):  
S. N. Avdeev ◽  
Z. R. Aisanov ◽  
A. S. Belevskiy ◽  
A. V. Emelyanov ◽  
N. P. Knyazheskaya ◽  
...  
Keyword(s):  
Airway Inflammation ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Chronic Inflammatory Disease ◽  
Mild Asthma ◽  
Exacerbation Rate ◽  
Regular Treatment ◽  
High Dependency ◽  
Anti Inflammatory ◽  
Chronic Airway

According to the modern concepts, asthma is a heterogeneous disease characterized by chronic airway inflammation and respiratory symptoms, which vary in time and intensity and manifest together with variable obstruction of the airways. Asthma is responsible for the deterioration of health status and quality of life in approximately 339 million of adult patients and children worldwide. Despite the fact that asthma is a chronic inflammatory disease, patients with asthma generally inadequately receive anti-inflammatory therapy in real clinical practice and rely on short-acting beta2-agonists (SABA) too much; this can “mimic” worsening of asthma symptoms. SABA monotherapy “on demand” does not affect chronic airway inflammation, underlying asthma occurrence and progression. As a result, such patients still have the risk of asthma exacerbation and disease progression. Therefore, the need of a new therapeutic strategy for patients with milder asthma (steps 1 and 2), which would provide anti-inflammatory treatment considering the low adherence to the regular maintenance therapy and high dependency on SABA, is obvious. Such approach has become available after the SYGMA (SYmbicort® Given as needed in Mild Asthma) trial was completed. According to the results of this trial, budesonide/formoterol 160/4.5 µg/dose as needed was superior to as needed SABA in better asthma control and decrease in severe asthma exacerbation rate by 64% (p < 0.001). Results of SYGMA 1 and 2 trials also demonstrated that budesonide/formoterol 160/4.5 µg/dose as needed was noninferior compared to regular treatment with budesonide in preventing severe asthma exacerbations while the cumulative dose of budesonide was reduced by ≥75%. 

Lessons learned from clinical trials of asthma

2019 ◽  
Vol 40 (6) ◽  
pp. 410-413
Author(s):  
Paul A. Greenberger
Keyword(s):  
Asthma Control ◽  
Severe Asthma ◽  
Immunoglobulin E ◽  
Environmental Control ◽  
Mild Asthma ◽  
Inhaled Corticosteroid ◽  
Biologic Therapies ◽  
Asthma Control Questionnaire ◽  
Exacerbation Rate ◽  
Sputum Eosinophilia

Exacerbations of persistent or intermittent asthma should be anticipated by physicians and health-care professionals. Patients who are likely to experience an exacerbation often have a history of an exacerbation in the previous year, and the absolute eosinophil count in peripheral blood is ≥ 400/μL. Similarly, expectorated or induced sputum eosinophilia of ≥2% is associated with exacerbations. These phenotypic findings have led to effective biologic therapies, which target eosinophils or immunoglobulin E or the T-helper type 2 phenotype, especially in children, adolescents, and adults with frequent exacerbations. In children, a reduced forced expiratory volume in the first second of expiration (FEV1) to forced vital capacity ratio can be associated with future exacerbations, although the FEV1 may be in the normal range, even with children who have persistent severe asthma. Asthma control questionnaires did not differentiate between children with or children without a future exacerbation. Alternatively, in adults, the lower baseline FEV1 (2.3 L [74% predicted] versus 2.5 L [78% predicted]) identified patients more likely to have a future exacerbation compared with patients who were not having an exacerbation. After correcting for FEV1, the asthma control questionnaire data were associated with exacerbations. In adolescents (ages ≥ 12 years) and adults with persistent mild asthma, most (73%) did not have sputum eosinophilia, and some of these patients responded well to the anticholinergic, tiotropium, which would argue differently from administration of an inhaled corticosteroid as first-line controller therapy. In a three-track study of patients with persistent mild asthma, as-needed budesonide-formoterol and scheduled budesonide were associated with approximately one-half of the annual exacerbation rate of as-needed albuterol. In patients with persistent moderate-to-severe asthma, tiotropium added to controller therapy caused an increase in FEV1 without improving the asthma control questionnaire findings. There were two studies that explored whether either quadrupling or quintupling the inhaled corticosteroid at the first sign of loss of control of asthma would provide meaningful reductions of severe exacerbations of asthma, but the findings did not support this strategy. Both biologic therapies and environmental control (dust mite impermeable encasings) have resulted in reductions of exacerbations in patients with persistent moderate and severe asthma.

Anti-inflammatory modulation of chronic airway inflammation in the murine house dust mite model

2008 ◽  
Vol 21 (4) ◽  
pp. 637-647 ◽  
Author(s):  
Kristina Ulrich ◽  
Jennifer S. Hincks ◽  
Roddy Walsh ◽  
E.M. Caroline Wetterstrand ◽  
Mark D. Fidock ◽  
...  
Keyword(s):  
Airway Inflammation ◽  
House Dust ◽  
House Dust Mite ◽  
Dust Mite ◽  
Anti Inflammatory ◽  
Inflammatory Modulation ◽  
Chronic Airway

Relationship between Benralizumab Exposure and Asthma Exacerbation Rate for Patients with Severe Asthma

Pneumologie ◽  
2018 ◽  
Vol 72 (S 01) ◽  
pp. S15-S15
Author(s):  
L Roskos ◽  
B Wang ◽  
YL Chia ◽  
B Yu ◽  
P Barker ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Exacerbation Rate

scholarly journals Risk factors associated with severe asthma exacerbations in children attending Alexandria University Children’s Hospital, Egypt

2018 ◽  
Vol 5 (12) ◽  
pp. 5019
Author(s):  
Ihab H. El Sawy ◽  
Reham M. Wagdy ◽  
Afaf G. Ibrahim ◽  
Suzy W. Ibrahim
Keyword(s):  
Risk Factors ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Mild Asthma ◽  
Factors Associated ◽  
Children's Hospital ◽  
Asthma Exacerbations ◽  
Severe Asthma Exacerbation ◽  
Children’S Hospital ◽  
History Of

Background: Severe asthma exacerbation is one of the common pediatric medical emergencies that necessitates hospital visits. The study aimed to identify risk factors associated with pediatric severe asthma exacerbations that might have the potential to guide the parents for early medical consultations and physicians at primary health care centers for proper management.Methods: A case-control study was conducted on over 100 asthmatic children below 12 years attending the Emergency Department of Alexandria University Children’s Hospital in acute exacerbation. Based on a modified pulmonary index score, the patients were allocated into 2 groups; study group (50 patients with severe asthma exacerbation) and control group (50 patients with mild asthma exacerbations). Demographic data, history of illness, alarming clinical signs, medications, and outcome of all participants were recorded.Results: Severe asthma exacerbations were more encountered among males, older age, and with a longer duration of asthma (X±SD=28.4±15.9 months) with significant differences when compared to controls. Comparing the studied groups revealed higher risk for severe asthma exacerbations mainly with; history of sudden onset of severe respiratory distress (Odds ratio “OR”=30.13, 95% CI, 13.78-66.69) and chronic steroid-dependent asthma (OR=14.46, 95% CI, 3.97-52.65). Cyanosis, lethargy, and inability to talk were alarming signs in patients with severe asthma exacerbation when compared to those with mild asthma exacerbation (p<0.05).Conclusions: Severe asthma exacerbation in children is still associated with many risk factors that may alert the patients’ caregivers and physicians prospectively for early proper management. 

DUPILUMAB REDUCES SEVERE ASTHMA EXACERBATION RATE AND IMPROVES LUNG FUNCTION REGARDLESS OF AGE AT ONSET OF ASTHMA: THE LIBERTY ASTHMA QUEST STUDY

CHEST Journal ◽  
2019 ◽  
Vol 156 (4) ◽  
pp. A936-A939 ◽  
Author(s):  
Mario Castro ◽  
Nicola Hanania ◽  
Santiago Quirce ◽  
Lawrence Sher ◽  
Jorge Maspero ◽  
...  
Keyword(s):  
Lung Function ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Age At Onset ◽  
Exacerbation Rate ◽  
Severe Asthma Exacerbation

scholarly journals Risk factors of asthma exacerbation based on asthma severity: a nationwide population-based observational study in South Korea

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020825 ◽  
Author(s):  
Hye-Rim Kang ◽  
Hyun Jin Song ◽  
Jin Hyun Nam ◽  
Sung-Hyun Hong ◽  
So-Young Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Asthma Severity ◽  
Population Based ◽  
Mild Asthma ◽  
High Dose ◽  
Moderate Asthma ◽  
History Of

ObjectivesAsthma exacerbation, associated with many risks factors, can reflect management failure. However, little is known about how risk factors are associated with exacerbation, according to asthma severity. We aimed to investigate differences in risk factors in patients with different asthma severity and evaluate whether risk factors differed between frequent exacerbators and patients with single exacerbation.DesignNationwide population-based observational study.SettingKorean National Sample Cohort database.ParticipantsWe included 22 130 adults with asthma diagnoses more than twice (ICD-10 (International Classification of Diseases, Tenth revision) codes J45 and J46) and one prescription for asthma medication from 2010 to 2011.Outcome measuresAsthma exacerbation was defined as having a corticosteroid (CS) burst characterised by a prescription of high-dose oral CS for ≥3 days or one systemic CS injection, hospitalisation or emergency department visit.ResultsAmong severities, history of CS bursts was significantly associated with exacerbation. In mild and moderate asthma, exacerbation was significantly associated with age ≥45 years, being female, gastro-oesophageal reflux disease and chronic rhinitis. High medication possession ratio (MPR≥50%), compared with low MPR (<20%) showed adjusted ORs of 0.828 (95% CI 0.707 to 0.971) and 0.362 (0.185 to 0.708) in moderate and severe asthma, respectively. In severe asthma, compared with mild asthma, only allergic rhinitis and history of hospitalisation were strongly associated with exacerbation. When comparing frequent exacerbators to patients with single exacerbation, age ≥45 years, atopic dermatitis, anxiety and history of CS burst were significant risk factors in mild and moderate asthma, whereas no risk factors were significant in severe asthma.ConclusionsDifferent associations between risk factors and asthma exacerbations based on asthma severity suggest that patients with mild asthma require greater attention to their age and comorbidities, whereas those with severe asthma require greater attention to hospitalisation history and drug adherence.

Relationship between benralizumab exposure and asthma exacerbation rate for patients with severe asthma

2017 ◽  
Author(s):  
Bing Wang ◽  
Yen Lin Chia ◽  
Binbing Yu ◽  
Peter Barker ◽  
Mitch Goldman ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Exacerbation Rate

Assessment of biochemical determinants in Multiple Sclerosis patients following the oral administration of β-D-Mannuronic acid [M2000]

2020 ◽  
Vol 17 ◽  
Author(s):  
Mohamad Reza Nikouei Moghaddam ◽  
Monireh Movahedi ◽  
Maryam Bananej ◽  
Soheil Najafi ◽  
Nahid Beladi Moghadam ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Uric Acid ◽  
Vitamin D3 ◽  
Chronic Inflammatory Disease ◽  
Toxic Effects ◽  
Control Group ◽  
Therapeutic Effects ◽  
Mannuronic Acid ◽  
Anti Inflammatory ◽  
Multiple Sclerosis Patients

Background: Multiple sclerosis is an autoimmune chronic inflammatory disease of the central nervous system that can lead to some serious disabilities. Despite using various immunomodulatory and anti-inflammatory drugs that have therapeutic effects, they cannot reduce its progression completely, and have some unwanted side effects too. The immunomodulatory and anti-inflammatory effects of the β-D-Mannuronic acid [M2000] have been proven in several surveys, and the present research was designed to determine its toxicity and therapeutic effects in MS patients. Methods: This study was performed on 15 MS patients who took 25 mg/kg/day the oral form of the β-D-Mannuronic acid for six months, and 15 healthy people as a control group. Serum levels of Urea, Creatinine, GGT, Vitamin D3, Uric acid, and Anti-Phospholipids were compared to evaluate the therapeutic and possible toxic effects of this drug after this period. Results: Non- toxic effects through the study of Urea, Creatinine, GGT, and non-significant changes in Uric acid and AntiPhospholipids levels, besides a significant rise in Vitamin, D3 levels in the M2000 treated cases were found. Conclusions: Our results suggested that β-D-Mannuronic acid is a safe drug and has no toxicity when administered orally and also has some therapeutic effects in MS patients.

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