scholarly journals Severe Asthma, Telemedicine, Self-Administered Therapy: Listening First to the Patient

2021 ◽  
Author(s):  
Gabriella Guarnieri ◽  
Marco Caminati ◽  
Alessia Achille ◽  
Rachele Vaia ◽  
Fulvia Chieco Bianchi ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Ad Hoc ◽  
Standard Of Care ◽  
Healthcare Personnel ◽  
Self Administration ◽  
Asthmatic Patients ◽  
Increased Risk ◽  
Asthma Patients ◽  
E Mail

Severe asthma patients are at increased risk of major exacerbations and they need to be monitored regularly. The COVID-19 pandemic has impressively impacted on the health care resources. The telemedicine approach applied to the follow-up of asthmatic patients has been proved to be effective in monitoring their disease and adherence to the therapy. The aim of our study was to investigate the satisfaction of severe asthma patients, before the activation of a telemedicine management complemented by a standard of care. An ad hoc questionnaire was developed and sent by e-mail to 180 severe asthma patients. Most of subjects (82%) were confident with the idea of doing self-measurements and self-managing their disease; 77% of subjects favoured to carry out virtual visit and telemedicine. 93% of patients considered easy the self-injection therapy. 94% of subjects felt safe and 93% were not worried while self-administering. Only mild adverse events were reported in 22% subjects after self-administration. Our results showed an agreement between what is considered necessary and practicable by healthcare personnel and what is perceived by the severe asthma patients, in terms of treatment and monitoring of the disease with Telehealth. Biologics have a safety profile and can be easily self-administred at home

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 Lung function decline in asthma patients with elevated bronchial CD8, CD4 and CD3 cells

2016 ◽  
Vol 48 (2) ◽  
pp. 393-402 ◽  
Author(s):  
Irene den Otter ◽  
Luuk N.A. Willems ◽  
Annemarie van Schadewijk ◽  
Simone van Wijngaarden ◽  
Kirsten Janssen ◽  
...  
Keyword(s):  
Lung Function ◽  
Granzyme B ◽  
Eosinophil Cationic Protein ◽  
Risk Groups ◽  
Forced Expiratory Volume ◽  
Lung Function Decline ◽  
Cationic Protein ◽  
Asthmatic Patients ◽  
Asthma Patients

Which inflammatory markers in the bronchial mucosa of asthma patients are associated with decline of lung function during 14 years of prospective follow-up?To address this question, 19 mild-to-moderate, atopic asthmatic patients underwent spirometry and bronchoscopy at baseline and after 14 years of follow-up (t=14). Baseline bronchial biopsies were analysed for reticular layer thickness, eosinophil cationic protein (EG2), mast cell tryptase (AA1), CD3, CD4 and CD8. Follow-up biopsies were stained for EG2, AA1, neutrophil elastase, CD3, CD4, CD8, CD20, granzyme B, CD68, DC-SIGN, Ki67 and mucins.Decline in forced expiratory volume in 1 s (FEV1) % predicted was highest in patients with high CD8 (p=0.01, both pre- and post-bronchodilator) or high CD4 counts at baseline (p=0.04 pre-bronchodilator, p=0.03 post-bronchodilator). Patients with high CD8, CD3 or granzyme B counts at t=14 also exhibited faster decline in FEV1 (p=0.00 CD8 pre-bronchodilator, p=0.04 CD8 post-bronchodilator, p=0.01 granzyme B pre-bronchodilator, and p<0.01 CD3 pre-bronchodilator).Long-term lung function decline in asthma is associated with elevation of bronchial CD8 and CD4 at baseline, and CD8, CD3 and granzyme B at follow-up. This suggests that high-risk groups can be identified on the basis of inflammatory phenotypes.

scholarly journals Asthma severity as a contributing factor to cancer incidence: A cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250430
Author(s):  
Laila Salameh ◽  
Bassam Mahboub ◽  
Amar Khamis ◽  
Mouza Alsharhan ◽  
Syed Hammad Tirmazy ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Incidence ◽  
Asthma Severity ◽  
Asthmatic Patients ◽  
Increased Risk ◽  
Different Types ◽  
Asthma Patients ◽  
Main Factors ◽  
Population Source

Background A putative link between asthma and asthma severity with the occurrence of cancer has been suggested but has not been fully investigated. The objective of this study is to assess the incidence of all types of cancer in a cohort of asthmatic patients. Methods and findings A single center cohort retrospective study was conducted to investigate the role of asthma as a potential risk factor for various cancers. Participants were followed for a period of 9 years from 01/01/2010 to 30/12/2018 and cancer incidence and its determinants were collected in asthmatic patients and controls from the same population source but without any respiratory disease. Overall, 2,027 asthma patients and 1,637 controls were followed up for an average of 9 years. The statistical analysis showed that 2% of asthma patients were diagnosed with various cancers, resulting in an incidence rate of cancer of 383.02 per 100,000 persons per year which is significantly higher than the 139.01 per 100,000 persons per year observed in matched controls (p-value < 0.001). The top four cancers reported among asthmatics were breast, colon, lung and prostate cancer. Lung cancer in asthmatics had the longest diagnosis period with a mean of 36.6 years compared to the shortest with prostate cancer with 16.5 years. Conclusions This study shows that asthma patients are at increased risk of different types of cancers with asthma severity and goiter as the main factors that may increase the risk of developing cancers among asthmatic patients.

scholarly journals Typical Antipsychotics Increase Risk of Severe Exacerbation in Asthma Patients– A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Chin-Wei Kuo ◽  
Szu-Chun Yang ◽  
Yu-Fen Shih ◽  
Xin-Min Liao ◽  
Sheng-Hsiang Lin
Keyword(s):  
Severe Asthma ◽  
Asthma Exacerbation ◽  
High Dose ◽  
Severe Exacerbation ◽  
Severe Asthma Exacerbation ◽  
Increased Risk ◽  
Asthma Patients ◽  
Ed Visits ◽  
Dose Dependent ◽  
Typical Antipsychotics

Abstract Background:Severe asthma exacerbation reduces patients’ life quality, results in visits to the emergency department (ED) and hospitalization, and incurs additional medical costs. Antipsychotics block receptors with bronchodilation function; however, the effects of antipsychotics use on severe asthma exacerbation are unknown. This study aimed to investigate the effects of antipsychotics on asthma-related ED visits and hospitalizations.Methods:This study used a case-crossover design. Using the 2003-2017 Taiwan National Health Insurance Reimbursement Database, we established a cohort of 18,657 adults with severe asthma exacerbation leading to ED visits or hospitalization. Univariate and multivariate conditional logistic regressions were conducted to explore the association of antipsychotics use with severe asthma exacerbation. Subgroup analyses of different classes, doses, receptor functions of antipsychotics and schizophrenia were also performed.Results:Antipsychotics use was associated with a higher risk of severe asthma exacerbation (adjusted odds ratio (OR): 1.27; 95% confidence interval (CI): 1.05-1.54; P = 0.013) compared with no use of antipsychotics. Use of typical antipsychotics increased the risk of severe asthma exacerbation (adjusted OR: 1.40, 95% CI: 1.10-1.79, P = 0.007), whereas use of atypical antipsychotics did not. There was a dose-dependent effect of antipsychotics (test for trend: P =0.025). Antipsychotics that block the M2 muscarinic or D2 dopaminergic receptor were associated with an increased risk of severe asthma exacerbation (adjusted OR: 1.39, 95% CI: 1.10-1.76, P = 0.007 and adjusted OR: 1.33, 95% CI: 1.08-1.63, P = 0.008, respectively).Conclusions: Use of typical antipsychotics is associated with a dose-dependent increased risk of severe asthma exacerbation. Physicians should thus weight the risk and benefit of prescribing high-dose typical antipsychotics for asthma patients.

scholarly journals Small RNA Species and microRNA Profiles are Altered in Severe Asthma Nanovesicles from Broncho Alveolar Lavage and Associate with Impaired Lung Function and Inflammation

2019 ◽  
Vol 5 (4) ◽  
pp. 51 ◽  
Author(s):  
Ana S. Francisco-Garcia ◽  
Eva M. Garrido-Martín ◽  
Hitasha Rupani ◽  
Laurie C. K. Lau ◽  
Rocio T. Martinez-Nunez ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Small Rna ◽  
Small Rna Sequencing ◽  
Filtration Method ◽  
Asthmatic Patients ◽  
Expression Of Genes ◽  
Severe Asthmatic ◽  
Asthma Patients ◽  
Impaired Lung Function ◽  
The Impact

MicroRNAs are known to regulate important pathways in asthma pathology including the IL-6 and IFN pathways. MicroRNAs have been found not only within cells but also within extracellular vesicles such as exosomes. In this study, we particularly focused on microRNA cargo of nanovesicles in bronchoalveolar lavage of severe asthmatic patients. We extracted nanovesicle RNA using a serial filtration method. RNA content was analyzed with small RNA sequencing and mapped to pathways affected using WebGestalt 2017 Software. We report that severe asthma patients have deficient loading of microRNAs into their airway luminal nanovesicles and an altered profile of small RNA nanovesicle content (i.e., ribosomal RNA and broken transcripts, etc.). This decrease in microRNA cargo is predicted to increase the expression of genes by promoting inflammation and remodeling. Consistently, a network of microRNAs was associated with decreased FEV1 and increased eosinophilic and neutrophilic inflammation in severe asthma. MicroRNAs in airway nanovesicles may, thus, be valid biomarkers to define abnormal biological disease processes in severe asthma and monitor the impact of interventional therapies.

scholarly journals Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme

2020 ◽  
Vol 55 (4) ◽  
pp. 1901872 ◽  
Author(s):  
Bright I. Nwaru ◽  
Magnus Ekström ◽  
Pål Hasvold ◽  
Fredrik Wiklund ◽  
Gunilla Telg ◽  
...  
Keyword(s):  
Cox Regression ◽  
Asthma Management ◽  
Baseline Period ◽  
Population Based ◽  
Short Acting ◽  
Adverse Health Outcomes ◽  
Increased Risk ◽  
Asthma Patients ◽  
Β2 Agonists

BackgroundOveruse of short-acting β2-agonists (SABA) may indicate poor asthma control and adverse health outcomes. Contemporary population-based data on use, risk factors and impact of SABA (over)use on asthma exacerbations and mortality are scarce, prompting initiation of the global SABINA (SABA use IN Asthma) programme.MethodsBy linking data from Swedish national registries, asthma patients aged 12–45 years with two or more collections of drugs for obstructive lung disease during 2006–2014 were included. SABA overuse was defined as collection of more than two SABA canisters in a 1-year baseline period following inclusion. SABA use was grouped into 3–5, 6–10 and ≥11 canisters per baseline-year. Cox regression was used to examine associations between SABA use and exacerbation (hospitalisations and/or oral corticosteroid claims) and mortality.ResultsThe analysis included 365 324 asthma patients (mean age 27.6 years; 55% female); average follow-up was 85.4 months. 30% overused SABA, with 21% collecting 3–5 canisters per year, 7% collecting 6–10 canisters per year and 2% collecting ≥11 canisters per year. Increasing number of collected SABA canisters was associated with increased risk of exacerbation, as follows. 3–5 canisters: hazard ratio (HR) 1.26 (95% CI 1.24–1.28); 6–10 canisters: 1.44 (1.41–1.46); and ≥11 canisters: 1.77 (1.72–1.83), compared to two or fewer canisters per year. Higher SABA use was associated with incrementally increased mortality risk (2564 deaths observed), as follows. 3–5 canisters: HR 1.26 (95% CI 1.14–1.39); 6–10 canisters 1.67 (1.49–1.87); and ≥11 canisters: 2.35 (2.02–2.72) compared to two or fewer canisters per year.ConclusionOne-third of asthma patients in Sweden collected three or more SABA canisters annually. SABA overuse was associated with increased risks of exacerbation and mortality. These findings emphasise that monitoring of SABA usage should be key in improving asthma management.

Comparison of exacerbation phenotypes among patients with severe asthma

2020 ◽  
Vol 41 (4) ◽  
pp. e67-e79
Author(s):  
Karina Ruth Soenjoyo ◽  
Nivedita Nadkarni ◽  
Mariko Siyue Koh
Keyword(s):  
Severe Asthma ◽  
Immunoglobulin E ◽  
Laboratory Data ◽  
Therapeutic Strategies ◽  
Demographic Differences ◽  
Asthma Exacerbations ◽  
Singapore General Hospital ◽  
Asthma Patients ◽  
Hospital Stays

Background: Exacerbation phenotypes among patients with severe asthma have been largely characterized during stable periods. Little is known about severe asthma patients during exacerbation periods. Objective: To compare persistently frequent exacerbators (PFE), non‐persistently frequent exacerbators (NPFE), and infrequent exacerbators (IFE) among patients with severe asthma during stable and exacerbation periods. Methods: Patients with severe asthma who were admitted for asthma exacerbations from 2011 to 2017 and on follow up at Singapore General Hospital were recruited and categorized as PFEs (two or more exacerbations per year over 2 consecutive years), NPFEs (two or more exacerbations in 1 year only), or IFEs (fewer than two exacerbations per year over 2 consecutive years). Demographic, clinical, and laboratory data were collected at baseline and during exacerbation periods. Results: The participants were categorized as the following: 20 PFEs, 36 NPFEs, and 57 IFEs, with no significant demographic differences. The participants as PFEs (versus NPFEs and IFEs) were characterized by having a higher prevalence of psychiatric disorders (25% versus 8% versus 5%; p = 0.046), more comorbidities (7 versus 4 versus 2; p < 0.001), and a higher steroid burden per year (1150 versus 456 versus 350 mg; p < 0.001). The participants who were PFEs (versus IFEs) had a higher total immunoglobulin E (IgE) level (625 versus 232 IU/mL; p = 0.046) and longer duration of admission stay (3 versus 2 days; p = 0.009). All three groups had higher blood neutrophil counts during exacerbation periods than during stable periods (p = 0.008 versus p < 0.001 versus p = 0.004). Conclusion: The participants categorized as PFEs were characterized by comorbidities, higher steroid burden, IgE levels, and longer hospital stays. Exacerbations in the participants with severe asthma, regardless of exacerbation phenotype, were characterized by neutrophilia. These findings provided insights into potential therapeutic strategies to reduce exacerbations in patients with severe asthma.

Breast cancer after treatment of Hodgkin disease: Clinical outcome of 38 cases in 27 patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11059-11059
Author(s):  
M. A. Alm El-Din ◽  
K. S. Hughes ◽  
S. I. Goldberg ◽  
R. A. Raad ◽  
A. G. Taghian
Keyword(s):  
General Population ◽  
Standard Of Care ◽  
Partial Breast Irradiation ◽  
Symptom Presentation ◽  
Breast Irradiation ◽  
Exact Test ◽  
Bilateral Disease ◽  
Increased Risk ◽  
Reasonable Approach

11059 Background: Many studies showed that women who are cured of HD have an increased risk of developing BC. Our purpose is to evaluate detection, pathology, management and prognosis of BC occurring after HD. Methods: Thirty-eight cases of BC in 27 survivors of HD were analyzed. All patients received supradiaphragmatic RT and 13 had also chemotherapy for HD. Results: The median age of the patients at diagnosis of HD was 25.5 years. The median interval to develop BC was 15.9 years. The median age at diagnosis of BC was 45.8 years. Ten women (37%) had bilateral disease; one of them had DCIS, 7 years before developing bilateral disease. Cancers were detected by mammography (59.4%), symptom presentation (24.3%), clinical examination (8%), and incidental during elective mastectomy (8%). Using Fisher’s Exact test, DCIS was more frequent (27%), where nodal involvement (29.6%), and ER positivity (81.5%) were paralleled that reported in general population. Thirty tumors (79%) were managed by mastectomy due to prior RT. Two women received RT following mastectomy. Eight tumors treated by lumpectomy, followed by RT in two women; one received whole breast RT, while the other received fractionated partial breast irradiation using 3D-conformal technique (50Gy/25 fractions) and she is doing well 1 1/2 years after RT. Adjuvant systemic therapy, given to 17 patients, was well tolerated. The median follow-up after BC was 61 months. Using Kaplan-Maier procedure, the 6-year actuarial relapse-free survival for node-negative BC after HD was 100%. Node positive patients had a significantly lower RFS of 58.3% ± 19% (P = 0.01). Conclusions: Compared to patients with primary BC, patients developing BC after HD are more likely to be younger, have bilateral disease and have more frequent DCIS. Other pathological features and prognosis are similar to that reported in general population. Patient awareness, breast examination and mammography should be part of the follow-up program for HD survivors. Mastectomy remains the standard of care in most of cases; however, lumpectomy followed by fractionated partial breast irradiation might be a reasonable approach to investigate for women who refuse mastectomy. No significant financial relationships to disclose.

Predictors of clinical metastases and survival among nonmetastatic prostate cancer (PC) patients (pts) treated with androgen-deprivation therapy (ADT) in Sweden.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16066-e16066
Author(s):  
Rohini Khorana Hernandez ◽  
Johan Mesterton ◽  
Jonas Banefelt ◽  
Jan Stålhammar ◽  
Patrik Sobocki ◽  
...  
Keyword(s):  
Disease Progression ◽  
Specific Antigen ◽  
Significant Risk ◽  
Standard Of Care ◽  
Primary Therapy ◽  
Time Varying ◽  
Real World Data ◽  
Hazard Ratios ◽  
Increased Risk

e16066 Background: ADT is the standard of care in Sweden for PC pts with signs of recurrence after primary therapy (tx). Studies of predictors of metastasis (mets) and survival have largely focused on pt characteristics at cancer diagnosis. Time-varying factors, such as prostate-specific antigen (PSA) levels, may have greater impact on a pt’s risk of disease progression. This study examines predictors of mets and survival among men with PC treated with ADT. Methods: Using electronic medical records from Swedish urology clinics linked to national registries (Cancer Registry, National Pt Registry, Cause of Death Registry), we identified men with PC and no evidence of mets treated with ≥6 months (mos) ADT (gonadotropin-releasing hormone agonists/antagonists or bilateral orchiectomy) between 2000-2010 with ≥2 PSA values. Men were followed from ADT index date to mets, death, or end of follow-up (12/31/2010). Multivariate competing risks regression analysis was used to estimate hazard ratios (HR) and 95% CIs; predictors and covariates of interest included PC diagnosis year (yr), age, comorbidities, anti-androgen tx, region, and time-varying characteristics (PSA absolute value, PSA doubling time [DT]). Results: Cohort was 446 men with mean follow-up of 3.3 yrs. Most mets were to the bone (7-yr cumulative incidence 25% for bone, 30% for any mets). Median survival was 6 yrs (5.9 mos after bone mets, 6.1 mos after any mets). Higher PSA and shorter PSA DT were strong predictors of all outcomes. In particular, PSA DT ≤ 6 mos was associated with increased risk of bone mets (13.9 [8.0 – 24.1]), any mets (7.9 [4.9 – 12.8]), mortality (5.7 [3.9 – 8.5]), and bone mets-free survival (6.9 [4.7–10.1]) when compared to PSA DT > 6 mos. HRs were adjusted for age, Charlson comorbidity index, anti-androgen tx, and region. Conclusions: PC pts treated with ADT are at significant risk of bone mets, any mets, and death. This study based on real-world data demonstrates the importance of PSA measured after ADT initiation in defining high risk of these outcomes, particularly PSA DT ≤6 mos. PC pts may benefit from new tx to prevent disease progression since survival is short after bone or other mets.

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