scholarly journals Evaluation of controller medication efficiency in patients with moderate and severe uncontrolled asthma

2009 ◽  
Vol 8 (1) ◽  
pp. 71-76
Author(s):  
P. A. Selivanova
Keyword(s):  
Fluticasone Propionate ◽  
Severe Asthma ◽  
Combined Therapy ◽  
Prospective Trial ◽  
Severe Phenotype ◽  
Uncontrolled Asthma ◽  
Moderate Asthma ◽  
Controller Medication ◽  
Oral Steroids ◽  
Control Criteria

Evaluation of efficiency of controller medication (combination of fluticasone propionate and Salmeterol) in 40 patients (age from 18 to 65 years) with moderate (n = 15) and severe (phenotype brittle n = 10, asthma with fixed obstruction n = 15) uncontrolled asthma was evaluated in open prospective trial. It was observed, that all patients with moderate asthma achieved control criteria (GINA, 2006) to 12th week of treatment with combination of fluticasone propionate and Salmeterol. Improvement of clinical-functional indexes was observed in patients with severe asthma to 24th week of therapy. 5 patients with brittle asthma achieved controlled and partly controlled asthma to 24th week therapy. Controlled asthma was not reach through the patients with fixed obstruction asthma, whereas increase of clinical-functional parameters was observed, usage of inhaled combined therapy allowed us to reduce oral steroids dose in 4 patients of this group.

scholarly journals Efficacy of antiinflammatory therapy in patients with severe asthma and cold air-provoked bronchial hyperresponsiveness

2018 ◽  
Vol 28 (5) ◽  
pp. 576-583 ◽  
Author(s):  
A. B. Pirogov ◽  
A. G. Prikhod’ko ◽  
D. A. Gassan ◽  
T. A. Mal’tseva ◽  
V. P. Kolosov ◽  
...  
Keyword(s):  
Fluticasone Propionate ◽  
Asthma Control ◽  
Severe Asthma ◽  
Combined Therapy ◽  
Bronchial Hyperresponsiveness ◽  
Sputum Eosinophil ◽  
Partial Control ◽  
Cold Air ◽  
Antiinflammatory Therapy ◽  
Neutrophil Number

The aim of this study was to assess effects of antiinflammatory therapy with leukotriene receptor antagonists (LTA) and/or combination of an inhaled corticosteroid (ICS) and a long-acting β2-agonist (LABA) on the clinical course and airway inflammatory patterns in patients with severe asthma and cold air-provoked bronchial hyperresponsiveness. Methods. Asthma symptoms, lung function, and spontaneous sputum cytology were assessed at baseline and after 24 weeks of the therapy. Subgroup analysis was performed for patients with sputum eosinophils < 61% and sputum neutrophils < 61%. Eosinophilic patients were treated with fluticasone propionate/salmeterol, neutrophilic patients with treated with fluticasone propionate/salmeterol plus montelukast during 24 weeks. The control of the disease was assessed using Asthma Control Test (ACT). Results. After 24-wk treatment, eosinophilic patients improves asthma control from 10.9 ± 0.5 to 19.6 ± 1.3 according to ACT questionnaire (р < 0.001), FEV1 improved from 45.9 ± 3.7% pred. to 79.2 ± 2.2% pred. (р < 0.001). Sputum eosinophil number decreased from 27.9 ± 2.1% to 7.1 ± 1.9% (р < 0.001); sputum neutrophil number decreased from 21.1 ± 2.1% to 8.7 ± 2.3% (р < 0.001). In neutrophilic patients, ACT score improved from 8.9 ± 0.6 to 15.9 ± 1.2 (р < 0.001), FEV1 improved from 42.9 ± 2.6% pred. to 72.3 ± 2.5% pred. (р < 0.001). Sputum neutrophil number decreased from 76.8 ± 3.7 to 52.2 ± 4.3 % (р < 0.001); Sputum eosinophil number decreased from 8.1 ± 0.7% to 6.2 ± 0.4% (р < 0.05). After 24 weeks of the treatment, partial control of asthma (ACT 20 -24) was achieved in 63% and 29% of patients in eosinophilic and neutrophilic groups, respectively (χ2 = 1.81; р > 0.05) after treatment. Conclusion. Adding montelukast to the combined therapy with fluticasone propionate/salmeterol in patients with severe asthma, cold air-provoked bronchial hyperresponsiveness and increased sputum neutrophils did not resulted in better control of the disease. The analysis of airway inflammatory pattern could be used as an additional marker to predict treatment efficiency.

scholarly journals Ventilation heterogeneity in children with severe asthma

2021 ◽  
Author(s):  
Amy G. Nuttall ◽  
Caroline S. Beardsmore ◽  
Erol A. Gaillard
Keyword(s):  
Severe Asthma ◽  
Airway Disease ◽  
Asthma Severity ◽  
Small Airway ◽  
Cross Sectional ◽  
Lung Clearance ◽  
Moderate Asthma ◽  
Lung Clearance Index ◽  
Children With Asthma ◽  
Ventilation Heterogeneity

AbstractSmall airway disease, characterised by ventilation heterogeneity (VH), is present in a subgroup of patients with asthma. Ventilation heterogeneity can be measured using multiple breath washout testing. Few studies have been reported in children. We studied the relationship between VH, asthma severity, and spirometry in a cross-sectional observational cohort study involving children with stable mild-moderate and severe asthma by GINA classification and a group of healthy controls. Thirty-seven participants aged 5–16 years completed multiple breath nitrogen washout (MBNW) testing (seven controls, seven mild-moderate asthma, 23 severe asthma). The lung clearance index (LCI) was normal in control and mild-moderate asthmatics. LCI was abnormal in 5/23 (21%) of severe asthmatics. The LCI negatively correlated with FEV1z-score.Conclusion: VH is present in asthmatic children and appears to be more common in severe asthma. The LCI was significantly higher in the cohort of children with severe asthma, despite no difference in FEV1 between the groups. This supports previous evidence that LCI is a more sensitive marker of airway disease than FEV1. MBNW shows potential as a useful tool to assess children with severe asthma and may help inform clinical decisions. What is Known:• Increased ventilation heterogeneity is present in some children with asthma• Spirometry is not sensitive enough to detect small airway involvement in asthma What is New• Lung clearance index is abnormal in a significant subgroup of children with severe asthma but rarely in children with mild-moderate asthma• Our data suggests that LCI monitoring should be considered in children with severe asthma

scholarly journals Nebulized fluticasone propionate, a viable alternative to systemic route in the management of childhood moderate asthma attack: A double-blind, double-dummy study

2015 ◽  
Vol 109 (9) ◽  
pp. 1120-1125 ◽  
Author(s):  
Beyza Poplata Demirca ◽  
Hasret Cagan ◽  
Ayca Kiykim ◽  
Ulku Arig ◽  
Medeni Arpa ◽  
...  
Keyword(s):  
Fluticasone Propionate ◽  
Viable Alternative ◽  
Double Blind ◽  
Moderate Asthma ◽  
Asthma Attack

Identification of asthma phenotypes based on extrapulmonary treatable traits

2020 ◽  
pp. 2000240 ◽  
Author(s):  
Patricia Duarte Freitas ◽  
Rafaella França Xavier ◽  
Vanessa Marie McDonald ◽  
Peter Gerard Gibson ◽  
Laura Cordova-Rivera ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cluster Analysis ◽  
Health Status ◽  
Asthma Control ◽  
Severe Asthma ◽  
Sedentary Time ◽  
Depression Symptoms ◽  
Uncontrolled Asthma ◽  
Asthma Phenotypes ◽  
Physically Inactive

BackgroundAsthma is a heterogeneous and complex disease, and the description of asthma phenotypes based on extrapulmonary treatable traits has not been previously reported.Objectiveto identify and characterise clusters based on clinical, functional, anthropometrical, and psychological characteristics in participants with moderate-to-severe asthma.MethodsThis is a cross-sectional multicentre study involving centres from Brazil and Australia. Participants (N=296) with moderate-to-severe asthma were consecutively recruited. Physical activity and sedentary time, clinical asthma control, anthropometric data, pulmonary function, psychological, and health-status were evaluated. Participants were classified by hierarchical cluster analysis and the clusters compared using ANOVA, Kruskal-Wallis, and Chi-square tests. Multiple logistic and linear regression models were performed to evaluate the association between variables.ResultsWe identified four clusters: (1)controlled asthma who were physically active, (2)uncontrolled asthma who were physically inactive and more sedentary, (3)uncontrolled asthma with low physical activity, who were also obese and experienced anxiety and/or depression symptoms (4)very uncontrolled asthma, who were physically inactive, more sedentary, obese and experienced anxiety and/or depression symptoms. Higher levels of sedentary time, female sex, and anxiety symptoms were associated with increased odds of exacerbation risk while being more active showed a protective factor for hospitalisation. Asthma control was associated with sex, the occurrence of exacerbation, physical activity, and health-status.ConclusionTraits such as physical inactivity, obesity, and symptoms of anxiety and/or depression were associated with worse asthma outcomes, and closely and inextricably with asthma control. This cluster analysis supports the importance of assessing extrapulmonary traits to improve personalised management and outcomes for people with moderate and severe asthma.

scholarly journals Novel Comprehensive Bioinformatics Approaches to Determine the Molecular Genetic Susceptibility Profile of Moderate and Severe Asthma

2020 ◽  
Vol 21 (11) ◽  
pp. 4022
Author(s):  
Hatem Zayed
Keyword(s):  
Severe Asthma ◽  
Protein Interactions ◽  
Gene Networks ◽  
Molecular Genetic ◽  
Enrichment Analysis ◽  
Protein Protein Interactions ◽  
Bioinformatics Pipeline ◽  
Moderate Asthma ◽  
Asthma Phenotypes ◽  
Chronic Inflammatory Condition

Background: Asthma is a chronic inflammatory condition linked to hyperresponsiveness in the airways. There is currently no cure available for asthma, and therapy choices are limited. Asthma is the result of the interplay between genes and the environment. The exact molecular genetic mechanism of asthma remains elusive. Aims: The aim of this study is to provide a comprehensive, detailed molecular etiology profile for the molecular factors that regulate the severity of asthma and pathogenicity using integrative bioinformatics tools. Methods: The GSE43696 omnibus gene expression dataset, which contains 50 moderate cases, 38 severe cases, and 20 healthy controls, was used to investigate differentially expressed genes (DEGs), susceptible chromosomal loci, gene networks, pathways, gene ontologies, and protein–protein interactions (PPIs) using an intensive bioinformatics pipeline. Results: The PPI network analysis yielded DEGs that contribute to interactions that differ from moderate-to-severe asthma. The combined interaction scores resulted in higher interactions for the genes STAT3, AGO2, COL1A1, CLCN6, and KSR for moderate asthma and JAK2, INSR, ERBB2, NR3C1, and PTK6 for severe asthma. Enrichment analysis (EA) demonstrated differential enrichment between moderate and severe asthma phenotypes; the ion transport regulation pathway was significantly enhanced in severe asthma phenotypes compared to that in moderate asthma phenotypes and involved PER2, GCR, IRS-2, KCNK7, KCNK6, NOX1, and SCN7A. The most enriched common pathway in both moderate and severe asthma is the development of the glucocorticoid receptor (GR) signaling pathway followed by glucocorticoid-mediated inhibition of proinflammatory and proconstrictory signaling in the airway of smooth muscle cell pathways. Gene sets were shared between severe and moderate asthma at 16 chromosome locations, including 17p13.1, 16p11.2, 17q21.31, 1p36, and 19q13.2, while 60 and 48 chromosomal locations were unique for both moderate and severe asthma, respectively. Phylogenetic analysis for DEGs showed that several genes have been intersected in phases of asthma in the same cluster of genes. This could indicate that several asthma-associated genes have a common ancestor and could be linked to the same biological function or gene family, implying the importance of these genes in the pathogenesis of asthma. Conclusion: New genetic risk factors for the development of moderate-to-severe asthma were identified in this study, and these could provide a better understanding of the molecular pathology of asthma and might provide a platform for the treatment of asthma.

scholarly journals Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Carlo Mümmler ◽  
Bernd Kemmerich ◽  
Jürgen Behr ◽  
Nikolaus Kneidinger ◽  
Katrin Milger
Keyword(s):  
Lung Function ◽  
Severe Asthma ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Oral Steroid ◽  
Case Presentation ◽  
Oral Steroids ◽  
Treatment Responses ◽  
Oral Steroid Therapy ◽  
Switching Treatment ◽  
Severe Hypersensitivity Reaction

Abstract Background Allergic bronchopulmonary aspergillosis (ABPA) is a severe hypersensitivity reaction to aspergillus species colonizing the airways of patients with asthma or cystic fibrosis. Biologics including anti-IgE and anti-IL5 antibodies have strongly changed the treatment of severe asthmatics and have partly been reported to be effective in the treatment of ABPA. Recently, dupilumab, an anti-IL4-Rα antibody which inhibits signaling by the Th2-cytokines IL4 and IL13, has been approved for the treatment of severe asthma. Case presentation Here, we report the case of a 49-year-old woman with severe asthma and ABPA, who was uncontrolled despite maximum inhalative therapy, anti-IL5-Rα antibody and continuous oral steroid therapy. Moreover, trials of itraconazole as well as omalizumab showed insufficient efficacy. Lung function revealed peripheral obstruction. FeNO and IgE were increased, eosinophils were suppressed under treatment while marked increases had been documented previously. Switching to dupilumab led to a complete resolution of pulmonary symptoms, resolution of exacerbations and complete withdrawal of oral steroids. A drastic improvement in lung function was noted, with an increase in FEV1 of almost 1 l. FeNO was normalized and IgE strongly reduced. Conclusion Our case highlights that a patient may exhibit differential treatment responses to the currently available asthma biologics and suggests switching treatment if outcome is insufficient. A potential role for dupilumab in the treatment of ABPA warrants future studies.

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