scholarly journals Omalizumab and modification of bronchial asthma natural course

2021 ◽  
pp. 17-25
Author(s):  
N. P. Kniajeskaia ◽  
E. H. Anaev ◽  
A. S. Belevskiy ◽  
A. A. Kameleva ◽  
E. V. Safoshkina ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Bronchial Asthma ◽  
Natural Course ◽  
Atopic Asthma ◽  
Patient Treatment ◽  
Molecular Heterogeneity ◽  
Level Of Evidence ◽  
Biologic Treatment ◽  
Systemic Steroids ◽  
Steroid Dependent

Clinical and molecular heterogeneity of bronchial asthma has been documented in recent years. The search for novel solutions to enhance efficient patient support related first of all to understanding of asthma heterogenic nature and allows to personalize each patient treatment. Biological therapy application can influence to achieve better control at greater extent for patients with severe uncontrolled asthma. Nowadays 5 biological drugs are registered on Russian Federation territory and implemented according to severe asthma phenotypes: anti-IgE, anti-IL-4,13 and anti-IL-5 class therapies. Omalizumab become the first target drug for uncontrolled allergic asthma patients (monoclonal antibody against IgE). This medication is prescribed for uncontrolled moderate and severe allergic (atopic) asthma in patients on basic asthma therapy according GINA step 4 and 5 (Level of evidence A). Clinical trials confidently reported that anti- IgE-therapy reduces the rate of asthma exacerbations, severity of disease in patients with chronic severe asthma on high doses of inhaled steroids or systemic steroids and allows to reduce or withdraw systemic steroids doses in case of steroid-dependent asthma. For the last years special attention led to and demonstrated omalizumab positive effect on airways remodeling and modification of bronchial asthma natural course in adults and children. Antiinflammatory effect of omalizumab is documented. Omalizumab significantly reduces eosinophilic infiltration of submucosal bronchi layer among patients with atopic asthma, sputum eosinophilia, which correlates with reduction of FeNO during biologic treatment, reduces mast cells infiltration of smooth muscle cells in bronchi. Omalizumab significantly reduces the thickness of the bronchial wall, increases the lumen of the bronchi (positive dynamics of CT-scan parameters), which is clinically manifested by increased of FEV1.

scholarly journals Arterial dysfunction and systemic inflammation in patients with bronchial asthma

2012 ◽  
Vol 9 (1) ◽  
pp. 42-49
Author(s):  
E A Sobko ◽  
A Y Kraposhina ◽  
O P Ischenko ◽  
I V Demko ◽  
A B Salmina ◽  
...  
Keyword(s):  
Asthma Control ◽  
Severe Asthma ◽  
Bronchial Asthma ◽  
Peripheral Blood ◽  
Vascular Wall ◽  
Control Group ◽  
External Respiration ◽  
Steroid Dependent ◽  
Healthy Donors ◽  
And Function

Background. The objective of this study was to estimate a vascular wall status of large arteries and function of endothelium in patients with different clinical forms of bronchial asthma throughout the disease progression. 220 patients with bronchial asthma have been examined, including 106 persons with moderate asthma ( 1 st group), 61 persons with severe asthma (2 nd group), and 53 persons with steroid-dependent asthma. Control group was formed from 40 healthy donors. Methods. We have assessed parameters of external respiration, arterial rigidity, and the levels of TNFα, IL-6, sCD31 (sPECAM-1), CRP in the peripheral blood at the time of exacerbation and 48 weeks later. Results. We found elevation of IL-6 and TNFα levels in all the tested groups in the period of exacerbation comparing to the control group (p

РАСПРОСТРАНЕННОСТЬ ФЕНОТИПОВ ТЯЖЕЛОЙ БРОНХИАЛЬНОЙ АСТМЫ НА СРЕДНЕМ УРАЛЕ

2019 ◽  
Author(s):  
E.K. Beltyukov ◽  
V.V. Naumova ◽  
V.Ch. Abdullaev ◽  
Y.A. Styazhkina ◽  
S.S. Vedenskaya
Keyword(s):  
Targeted Therapy ◽  
Severe Asthma ◽  
Bronchial Asthma ◽  
Cost Effective ◽  
Atopic Asthma ◽  
Practical Significance ◽  
Asthma Prevalence ◽  
Uncontrolled Asthma ◽  
Asthma Phenotype ◽  
Number Of Patients

Обоснование. Тяжелая БА является гетерогенным и экономически затратным заболеванием, что требует персонифицированного подхода к лечению с включением таргетной терапии, предполагающей фенотипирование астмы. Цель. Определение динамики распространенности бронхиальной астмы (БА) на Среднем Урале, в том числе тяжелой БА, и проведение фенотипирования пациентов с тяжелой БА для определения потребности в таргетной терапии. Материалы и методы. Популяционные исследования распространенности БА проводились на Среднем Урале с 2000 по 2012 г. с использованием стандартного вопросника ECRHS создавались регистры больных БА. В 2018 г. в г. Екатеринбурге проведен анализ амбулаторных карт пациентов с БА (n216). Фенотипирование БА проводилось врачом аллергологом-иммунологом. Результаты. На Среднем Урале за 17 лет число больных БА увеличилось в 2,7 раза. В популяции превалируют больные с легким течением астмы в 70,8-81 случаев преобладает атопический фенотип вне зависимости от категории населения. В структуре зарегистрированных по обращаемости больных астмой тяжелая неконтролируемая БА составляет 10,2. Каждый второй пациент с тяжелой неконтролируемой астмой имеет атопический фенотип, что составляет 5 от числа всех случаев БА каждый четвертый больной из данной группы имеет эозинофильной фенотип, что составляет 2,3 от числа всех случаев (n216). Заключение. Фенотипирование БА имеет важное прикладное значение для планирования эффективной таргетной терапии в популяции больных тяжелой неконтролируемой астмой.Topicality. Severe asthma is a heterogeneous and cost-effective disease that requires a personalized treatment approach with inclusion of targeted therapy involving the phenotyping of asthma. Objective. Determine the dynamics of asthma prevalence in the Middle Ural, including severe asthma, and phenotype patients with severe asthma for the selection of targeted therapy. Materials and methods. Population studies of bronchial asthma prevalence were conducted in the Middle Ural from 2000 to 2012 using the standard ECRHS questionnaire. Also registers of patients with asthma were created. An analysis of outpatient records of patients with asthma was conducted in Ekaterinburg in 2018. The phenotyping of bronchial asthma was carried out by an allergist-immunologist. Results. The number of patients with bronchial asthma increased by 2.7 times over 17 years in the Middle Ural. Patients with mild asthma prevail in the population. The atopic asthma phenotype predominates in 70.8-81 of cases regardless of the population category. Severe uncontrolled bronchial asthma occurs in 10.2 of cases among all patients seeking medical care. Every second patient with severe uncontrolled asthma has an atopic phenotype, which is 5 of the total number of analyzed patients with bronchial asthma. Every fourth patient with severe uncontrolled bronchial asthma has an eosinophilic phenotype, which is 2.3 of all analyzed patients with bronchial asthma (n216). Conclusion. Phenotyping of asthma has important practical significance for planning effective targeted therapy in a population of patients with severe uncontrolled asthma.

scholarly journals The characteristics of serum circulating immune complexes of patients with atopic asthma with different severity degree

2013 ◽  
Vol 94 (5) ◽  
pp. 744-748 ◽  
Author(s):  
Y V Skibo ◽  
N S Kurmaeva ◽  
V N Tsibulkina ◽  
I G Mustafin ◽  
Z I Abramova
Keyword(s):  
Severe Asthma ◽  
Bronchial Asthma ◽  
Immune Complexes ◽  
Wave Length ◽  
Molecular Complexes ◽  
Electrophoretic Analysis ◽  
Circulating Immune Complexes ◽  
Atopic Asthma ◽  
Control Group ◽  
Serum Samples

Aim. To evaluate the serum level of pathogenic circulating immune complexes in patients with mild and severe atopic bronchial asthma. Methods. Serum samples of patients with atopic asthma of mild persistent (30 patients) and severe persistent (20 patients) forms were analyzed. The control group consisted of 15 healthy volunteers. To detect the giant, large, medium and small-sized serum immune complexes, 3, 3.5, 4 and 7% polyethyleneglycol-6000 solutions were used. For quantitative evaluation of the immune complexes we measured the ultraviolet optical density at 280 nm wave length. To separate the immune complexes from immunoglobulin, Protein-G-Sepharose was used. Determination of the protein composition of circulating immune complexes was performed by electrophoresis in 8% polyacrylamide gel. Results. The concentration of immune complexes was increased in patients with bronchial asthma compared to healthy donors. Small and medium-sized immune complexes were prevailing, their concentrations correlated with the severity of asthma. Large, medium and small-sized immune complexes participated in immunopathological reactions in patients with both mild and severe asthma, with immune complexes pathogenicity coefficient significantly increased depending on the severity of the disease. Electrophoretic analysis of circulating immune complexes has shown the presence of proteins with molecular weight of 60 kDa in the complexes of all sizes. In the severe asthma group, an antigen fraction with a molecular mass of 36 kDa within the small-sized molecular complexes was revealed. Conclusion. The observed increase of small and medium-sized circulating immune complexes serum levels in patients with bronchial asthma may be an indicator of of these patients predisposal to autoimmune reactions development.

АНТИ-IGE ТЕРАПИЯ ТЯЖЕЛОЙ АТОПИЧЕСКОЙ БРОНХИАЛЬНОЙ АСТМЫ

2019 ◽  
Author(s):  
N.P. Knyazheskaya ◽  
A.S. Belevskiy ◽  
E.V. Safoshkina
Keyword(s):  
Inhaled Corticosteroids ◽  
Positive Impact ◽  
Atopic Asthma ◽  
Level Of Evidence ◽  
Systemic Corticosteroids ◽  
Steroid Dependent ◽  
Stage 4 ◽  
High Doses ◽  
Baseline Therapy ◽  
Inflammatory Effect

Первым таргетным (целевым) препаратом, который применяется у пациентов с неконтролируемой среднетяжелой и тяжелой бронхиальной астмой (БА), стал анти-IgE препарат омализумаб (Ксолар). Этот препарат назначается пациентам со среднетяжелой и тяжелой атопической БА, которая не контролируется базисной терапией, соответствующей ступени 4 (уровень доказательности А). Клинические исследования убедительно продемонстрировали, что у пациентов с тяжелой астмой, требующих терапии высокими дозами ингаляционных кортикостероидов или пероральными глюкокортикостероидами, лечение препаратом Ксолар снижает частоту обострений БА, уменьшает степень тяжести астмы и позволяет при стероидозависимой БА отменять или значительно снижать дозы системных кортикостероидов. Кроме того, доказан противовоспалительный эффект препарата. Исследования последних лет приводят все больше данных о положительном влиянии омализумаба на ремоделирование дыхательных путей.The first targeted drug that is used for patients with uncontrolled moderate and severe atopic asthma (BA) was anti-IgE drug omalizumab (Xolar). This drug is prescribed to patients with moderate to severe atopic BA, which is not controlled by baseline therapy corresponding to stage 4 (level of evidence A). Clinical studies have convincingly demonstrated that in patients with severe asthma requiring treatment with high doses of inhaled corticosteroids or oral glucocorticosteroids, treatment with Xolar reduces the frequency of exacerbations of BA, reduces the severity of asthma and allows for steroid-dependent BA to cancel or significantly reduce the dose of systemic corticosteroids. In addition, the anti-inflammatory effect of the drug has been proven. Studies in recent years provide more and more data on the positive impact of omalizumab on the remodeling of the respiratory tract.

РАСПРОСТРАНЕННОСТЬ ФЕНОТИПОВ ТЯЖЕЛОЙ БРОНХИАЛЬНОЙ АСТМЫ НА СРЕДНЕМ УРАЛЕ

2019 ◽  
pp. 67-74
Author(s):  
E.K. Beltyukov ◽  
V.V. Naumova ◽  
V.Ch. Abdullaev ◽  
Y.A. Styazhkina ◽  
S.S. Vedenskaya
Keyword(s):  
Targeted Therapy ◽  
Severe Asthma ◽  
Bronchial Asthma ◽  
Atopic Asthma ◽  
Practical Significance ◽  
Asthma Prevalence ◽  
Uncontrolled Asthma ◽  
Asthma Phenotype ◽  
Number Of Patients ◽  
Selection Of

Обоснование. Тяжелая БА является гетерогенным и экономически затратным заболеванием, что требует персонифицированного подхода к лечению с включением таргетной терапии, предполагающей фенотипирование астмы. Цель. Определение динамики распространенности бронхиальной астмы (БА) на Среднем Урале, в том числе тяжелой БА, и проведение фенотипирования пациентов с тяжелой БА для определения потребности в таргетной терапии. Материалы и методы. Популяционные исследования распространенности БА проводились на Среднем Урале с 2000 по 2012 г. с использованием стандартного вопросника ECRHS создавались регистры больных БА. В 2018 г. в г. Екатеринбурге проведен анализ амбулаторных карт пациентов с БА (n216). Фенотипирование БА проводилось врачом аллергологомиммунологом. Результаты. На Среднем Урале за 17 лет число больных БА увеличилось в 2,7 раза. В популяции превалируют больные с легким течением астмы в 70,881 случаев преобладает атопический фенотип вне зависимости от категории населения. В структуре зарегистрированных по обращаемости больных астмой тяжелая неконтролируемая БА составляет 10,2. Каждый второй пациент с тяжелой неконтролируемой астмой имеет атопический фенотип, что составляет 5 от числа всех случаев БА каждый четвертый больной из данной группы имеет эозинофильной фенотип, что составляет 2,3 от числа всех случаев (n216). Заключение. Фенотипирование БА имеет важное прикладное значение для планирования эффективной таргетной терапии в популяции больных тяжелой неконтролируемой астмой.Topicality. Severe asthma is a heterogeneous and costeffective disease that requires a personalized treatment approach with inclusion of targeted therapy involving the phenotyping of asthma. Objective. Determine the dynamics of asthma prevalence in the Middle Ural, including severe asthma, and phenotype patients with severe asthma for the selection of targeted therapy. Materials and methods. Population studies of bronchial asthma prevalence were conducted in the Middle Ural from 2000 to 2012 using the standard ECRHS questionnaire. Also registers of patients with asthma were created. An analysis of outpatient records of patients with asthma was conducted in Ekaterinburg in 2018. The phenotyping of bronchial asthma was carried out by an allergistimmunologist. Results. The number of patients with bronchial asthma increased by 2.7 times over 17 years in the Middle Ural. Patients with mild asthma prevail in the population. The atopic asthma phenotype predominates in 70.881 of cases regardless of the population category. Severe uncontrolled bronchial asthma occurs in 10.2 of cases among all patients seeking medical care. Every second patient with severe uncontrolled asthma has an atopic phenotype, which is 5 of the total number of analyzed patients with bronchial asthma. Every fourth patient with severe uncontrolled bronchial asthma has an eosinophilic phenotype, which is 2.3 of all analyzed patients with bronchial asthma (n216). Conclusion. Phenotyping of asthma has important practical significance for planning effective targeted therapy in a population of patients with severe uncontrolled asthma.

scholarly journals Prevalence of severe bronchial asthma phenotypes in the Middle Urals

2019 ◽  
Vol 16 (2) ◽  
pp. 67-74
Author(s):  
E K Beltyukov ◽  
V V Naumova ◽  
V Ch Abdullaev ◽  
Y A Styazhkina ◽  
S S Vedenskaya
Keyword(s):  
Targeted Therapy ◽  
Severe Asthma ◽  
Bronchial Asthma ◽  
Cost Effective ◽  
Atopic Asthma ◽  
Practical Significance ◽  
Asthma Prevalence ◽  
Middle Urals ◽  
Uncontrolled Asthma ◽  
Number Of Patients

Topicality. Severe asthma is a heterogeneous and cost-effective disease that requires a personalized treatment approach with inclusion of targeted therapy involving the phenotyping of asthma. Objective. Determine the dynamics of asthma prevalence in the Middle Ural, including severe asthma, and phenotype patients with severe asthma for the selection of targeted therapy. Materials and methods. Population studies of bronchial asthma prevalence were conducted in the Middle Ural from 2000 to 2012 using the standard ECRHS questionnaire. Also registers of patients with asthma were created. An analysis of outpatient records of patients with asthma was conducted in Ekaterinburg in 2018. The phenotyping of bronchial asthma was carried out by an allergist-immunologist. Results. The number of patients with bronchial asthma increased by 2.7 times over 17 years in the Middle Ural. Patients with mild asthma prevail in the population. The atopic asthma phenotype predominates in 70.8-81% of cases regardless of the population category. Severe uncontrolled bronchial asthma occurs in 10.2% of cases among all patients seeking medical care. Every second patient with severe uncontrolled asthma has an atopic phenotype, which is 5% of the total number of analyzed patients with bronchial asthma. Every fourth patient with severe uncontrolled bronchial asthma has an eosinophilic phenotype, which is 2.3% of all analyzed patients with bronchial asthma (n=216). Conclusion. Phenotyping of asthma has important practical significance for planning effective targeted therapy in a population of patients with severe uncontrolled asthma.

scholarly journals Anti-IgE therapy for severe atopic asthma

2019 ◽  
Vol 16 (1) ◽  
pp. 71-78
Author(s):  
N P Knyazheskaya ◽  
A S Belevskiy ◽  
E V Safoshkina
Keyword(s):  
Inhaled Corticosteroids ◽  
Positive Impact ◽  
Atopic Asthma ◽  
Level Of Evidence ◽  
Systemic Corticosteroids ◽  
Steroid Dependent ◽  
Stage 4 ◽  
High Doses ◽  
Baseline Therapy ◽  
Inflammatory Effect

The first targeted drug that is used for patients with uncontrolled moderate and severe atopic asthma (BA) was anti-IgE drug omalizumab (Xolar®). This drug is prescribed to patients with moderate to severe atopic BA, which is not controlled by baseline therapy corresponding to stage 4 (level of evidence A). Clinical studies have convincingly demonstrated that in patients with severe asthma requiring treatment with high doses of inhaled corticosteroids or oral glucocorticosteroids, treatment with Xolar® reduces the frequency of exacerbations of BA, reduces the severity of asthma and allows for steroid-dependent BA to cancel or significantly reduce the dose of systemic corticosteroids. In addition, the anti-inflammatory effect of the drug has been proven. Studies in recent years provide more and more data on the positive impact of omalizumab on the remodeling of the respiratory tract.

Safety of switching systemic steroids to budesonide modified-release capsules in steroid-dependent patients with inactive Crohn's disease

2001 ◽  
Vol 120 (5) ◽  
pp. A749-A749
Author(s):  
A CORTOT ◽  
J COLOMBEL ◽  
P RUTGEERTS ◽  
K LAURITSEN ◽  
H MALCHOW ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Modified Release ◽  
Systemic Steroids ◽  
Steroid Dependent

scholarly journals Severe eosinophilic bronchial asthma: new therapeutic options

2018 ◽  
pp. 44-52 ◽  
Author(s):  
N. M. Nenasheva
Keyword(s):  
Monoclonal Antibodies ◽  
Severe Asthma ◽  
Bronchial Asthma ◽  
Biological Agents ◽  
Therapeutic Options ◽  
Clinical Use ◽  
Eosinophilic Asthma ◽  
Interleukin 5 ◽  
Severe Eosinophilic Asthma

Eosinophilic asthma is a common phenotype of severe asthma, occurring in at least half of patients. In recent years, there have been significant changes in the approaches to the treatment of severe bronchial asthma and, above all, eosinophilic asthma. The article discusses the role of eosinophils in the pathogenesis of severe asthma, the detection of the phenotype of severe eosinophilic asthma, and modern approaches to targeting severe asthma with an eosinophilic phenotype using biological agents. A special emphasis is placed on preparations of monoclonal antibodies to interleukin-5, in particular, mepolizumab, recently approved for clinical use in our country.

scholarly journals Effects of the Airway Obstruction on the Skin Microcirculation in Patients with Bronchial Asthma

2016 ◽  
Vol 71 (3) ◽  
Author(s):  
Irina V. Tikhonova ◽  
N. I. Kosyakova ◽  
A. V. Tankanag ◽  
N. K. Chemeris
Keyword(s):  
Blood Flow ◽  
Airway Obstruction ◽  
Bronchial Asthma ◽  
Skin Blood Flow ◽  
Peripheral Blood ◽  
Atopic Asthma ◽  
Control Group ◽  
Bronchial Obstruction ◽  
Peripheral Blood Flow ◽  
Flow Parameters

Background: Pulmonary hemodynamic disorders depend on the inflammatory phases and severity of the obstructive syndrome. However, the effect of asthma bronchial obstruction on the state of peripheral hemodynamics remains insufficiently known. Aims: To study the effects of airway obstruction on skin blood flow parameters and its regulatory systems in patients with persistent atopic bronchial asthma in the remission state.Materials and methods: A comparative study of the skin peripheral blood flow in patients with bronchial asthma with severe airway obstruction (1st group) and without obstruction (2nd group) was conducted. 20 patients with confirmed diagnosis of atopic asthma of 50–74 years old participated in the study. All patients received basic therapy in a constant dosing of high doses of inhaled glucocorticosteroids/long-acting beta-2-agonists. The control group included 20 healthy volunteers without evidence of bronchial obstruction. The study lasted for 3 months. The forced expiratory volume in 1 s (FEV1) was used to evaluate the bronchial obstruction by spirometry technique. Skin blood perfusion changes were recorded by laser Doppler flowmetry at rest and in response to short-term local ischemia. Registered peripheral blood flow signals were examined using the amplitude temporal filtering in five frequency intervals to identify the functional features of the peripheral blood flow regulation systems. Results: Consistent two-fold decrease of the oscillation amplitudes was found in the neurogenic interval at rest (p=0.031), as well as in the myogenic (p=0.043; p=0.031) and endothelial intervals (p=0.037; p≤0.001) both at rest and during the postocclusive reactive hyperemia respectively in the 1st group of patients with bronchial obstruction (FEV1 80%) compared with the control group. No significant changes were revealed for skin blood flow parameters in the 2nd patient group (without obstruction, FEV1 80%) in comparison to control subjects.Conclusions: The presence of bronchial obstruction has a significant impact on the changes of the amplitudes of skin blood flow oscillations in patients with bronchial asthma in the myogenic, neurogenic and endothelial intervals.

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