Uncontrolled asthma symptoms amongst severe asthma patients: impact of comorbidities and prediction of exacerbation risk. Findings from the Singapore General Hospital Severe Asthma Phenotype Study

2018 ◽  
Author(s):  
Li Leng  Tan
Keyword(s):  
General Hospital ◽  
Severe Asthma ◽  
Uncontrolled Asthma ◽  
Asthma Phenotype ◽  
Asthma Symptoms ◽  
Singapore General Hospital ◽  
Asthma Patients ◽  
Exacerbation Risk

scholarly journals Fixed airways obstruction among patients with severe asthma: findings from the Singapore General Hospital-Severe Asthma Phenotype Study

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Anthony Chau Ang Yii ◽  
Gan Liang Tan ◽  
Keng Leong Tan ◽  
Therese Sophie Lapperre ◽  
Mariko Siyue Koh
Keyword(s):  
General Hospital ◽  
Severe Asthma ◽  
Asthma Phenotype ◽  
Airways Obstruction ◽  
Singapore General Hospital

ВАРИАБЕЛЬНОСТЬ ОТВЕТА НА СТАНДАРТНУЮ ФАРМАКОТЕРАПИЮ У ПАЦИЕНТОВ С БРОНХИАЛЬНОЙ АСТМОЙ

2019 ◽  
pp. 20-24
Author(s):  
K.S. Pavlova ◽  
D.S. Mdinaradze ◽  
O.M. Kurbacheva
Keyword(s):  
Severe Asthma ◽  
Ipratropium Bromide ◽  
Tiotropium Bromide ◽  
Bronchial Obstruction ◽  
Asthma Phenotype ◽  
Basic Therapy ◽  
Asthma Symptoms ◽  
Asthma Patients ◽  
High Doses ◽  
Basic Treatment

Актуальность. Основанием для проведения данного исследования послужило наличие группы пациентов с бронхиальной астмой (БА), которые предпочитают для купирования приступов удушья использовать короткодействующие антихолинергические препараты (КДХП). Цель. Изучение возможной низкой эффективности длительно действующих Р2агонистов (ДДБА) у пациентов с БА, не имеющих достаточного ответа на КДБА, а также вероятности уменьшения бронхиальной обструкции с помощью длительно действующих антихолинергических препаратов (ДДХП) у этих пациентов. Материалы и методы. В исследовании приняли участие 12 взрослых некурящих пациентов с БА средней степени тяжести (IIIIV ступень по GINA), получавшие в качестве базисной терапии ИГКС в средних или высоких дозах в сочетании с ДДБА, при этом характеризовались отсутствием или неполным контролем над симптомами БА. В первую (n7) группу были определены пациенты с клинически и инструментально подтвержденной эффективностью сальбутамола, которые в то же время имели хороший ответ на ипратропия бромид (КДБАКДХП). Во вторую группу (n5) вошли пациенты с низким ответом на сальбутамол и положительным тестом с ипратропия бромидом (КДБАКДХП). Пациентам проводили серию исследований функции внешнего дыхания (ФВД) до и через 5, 10, 15, 30, 60, 120 и 240 мин после ингаляции бронхолитического средства (салметерола 50 мкг, формотерола 12 мкг и тиотропия бромида 18 мкг). Результаты. Было показано, что пациенты с БА и фенотипом КДБАКДХП имеют низкий ответ на ДДБА: максимальный прирост ОФВгпосле ингаляции сальметерола составил 7,641,67 и 156,0116,03 мл, а после формотерола 9,435,84, 166,71103,14 мл (в сравнении с группой КДБАКДХП, где ответ на сальметерол составил 20,812,42 и 551,4393,94 мл, а на формотерол 30,216,75 и 718,57140,78 мл), и хороший ответ на ДДХП (13,735,78 и 250,0361,61). Заключение. Результаты исследования дают основание к выделению отдельного фенотипа БА с низкой обратимостью бронхиальной обструкции в ответ на КДБА и достаточной обратимостью в ответ на КДХП (КДБАКДХП). Этой группе пациентов в качестве базисной терапии следует рассматривать сочетание ИГКСДДБА и ДДХП (тиотропия бромида).Background. The aim of this study was to analyse the group of patients with asthma, who prefer to use shortacting anticholinergics (SAMA) for relief of asthma attacks. At the same time, these patients are prescribed inhaled glucocorticosteroids (ICS) in combination with longacting P2agonists (LABA) as a basic therapy according to the standards. Tha aim. To study the cause of low efficacy of LABA in patients with asthma who do not have a sufficient response to SABA, as well as the probability of reducing of bronchial obstruction with LAMA. Materials and methods. 12 nonsmoking adults with moderate to severe asthma (IIIIV stage of GINA), receiving medium or high doses of ICS in combination with LABA as a basic therapy without adequate control over asthma symptoms were included in the study. First group of patients showed the efficacy of salbutamol (FEV1reversibility was more than 12 and more than 200 ml after 400 g of salbutamol) and ipratropium bromide (SABASAMA). Second group included patients with low response to salbutamol and positive test (FEVtreversibility) with ipratropium bromide (SABASAMA). Spirometry was performed at baseline point and in 5, 10, 15, 30, 60, 120 and 240 min after inhalation of bronchodilator (salmeterol 50 g, formoterol 12 g and tiotropium bromide 18 g in the different days). Results. It was shown that SABASAMA phenotype asthma patients demonstrated low response to LABA: FEV1increased up to 7.641.67, 156.016.0 ml after salmeterol inhalation and up to 9.45.8, 166.7103.1 ml after formoterol inhalation (compared with a group of SABASAMA, where the response to salmeterol was 20.812.42, 551.4393.94 ml and the response to formoterol was 30.216.75, 718.57140.78 ml, p0.05), and a good response to LAMA (13.75.8 and 250.061.6). Conclusion. The results of the study allowed to define asthma phenotype with low bronchial obstruction reversibility to SABA and sufficient reversibility to SAMA (SABASAMA). This group of asthma patients need the basic treatment with the combination of ICS and LABA and LAMA (tiotropium bromide).

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.

ВАРИАБЕЛЬНОСТЬ ОТВЕТА НА СТАНДАРТНУЮ ФАРМАКОТЕРАПИЮ У ПАЦИЕНТОВ С БРОНХИАЛЬНОЙ АСТМОЙ

2019 ◽  
Author(s):  
K.S. Pavlova ◽  
D.S. Mdinaradze ◽  
O.M. Kurbacheva
Keyword(s):  
Ipratropium Bromide ◽  
Tiotropium Bromide ◽  
Bronchial Obstruction ◽  
Asthma Phenotype ◽  
Basic Therapy ◽  
Asthma Symptoms ◽  
Asthma Patients ◽  
High Doses ◽  
Long Acting ◽  
Basic Treatment

Актуальность. Основанием для проведения данного исследования послужило наличие группы пациентов с бронхиальной астмой (БА), которые предпочитают для купирования приступов удушья использовать короткодействующие антихолинергические препараты (КДХП). Цель. Изучение возможной низкой эффективности длительно действующих Р2-агонистов (ДДБА) у пациентов с БА, не имеющих достаточного ответа на КДБА, а также вероятности уменьшения бронхиальной обструкции с помощью длительно действующих антихолинергических препаратов (ДДХП) у этих пациентов. Материалы и методы. В исследовании приняли участие 12 взрослых некурящих пациентов с БА средней степени тяжести (III-IV ступень по GINA), получавшие в качестве базисной терапии ИГКС в средних или высоких дозах в сочетании с ДДБА, при этом характеризовались отсутствием или неполным контролем над симптомами БА. В первую (n7) группу были определены пациенты с клинически и инструментально подтвержденной эффективностью сальбутамола, которые в то же время имели хороший ответ на ипратропия бромид (КДБАКДХП). Во вторую группу (n5) вошли пациенты с низким ответом на саль-бутамол и положительным тестом с ипратропия бромидом (КДБА-КДХП). Пациентам проводили серию исследований функции внешнего дыхания (ФВД) до и через 5, 10, 15, 30, 60, 120 и 240 мин после ингаляции бронхолитического средства (салметерола 50 мкг, формотерола 12 мкг и тиотропия бромида 18 мкг). Результаты. Было показано, что пациенты с БА и фенотипом КДБА-КДХП имеют низкий ответ на ДДБА: максимальный прирост ОФВгпосле ингаляции сальметерола составил 7,641,67 и 156,0116,03 мл, а после формотерола 9,435,84, 166,71103,14 мл (в сравнении с группой КДБАКДХП, где ответ на сальметерол составил 20,812,42 и 551,4393,94 мл, а на формотерол 30,216,75 и 718,57140,78 мл), и хороший ответ на ДДХП (13,735,78 и 250,0361,61). Заключение. Результаты исследования дают основание к выделению отдельного фенотипа БА с низкой обратимостью бронхиальной обструкции в ответ на КДБА и достаточной обратимостью в ответ на КДХП (КДБА-КДХП). Этой группе пациентов в качестве базисной терапии следует рассматривать сочетание ИГКСДДБА и ДДХП (тиотропия бромида).Background. The aim of this study was to analyse the group of patients with asthma, who prefer to use short-acting anticholinergics (SAMA) for relief of asthma attacks. At the same time, these patients are prescribed inhaled glucocorticosteroids (ICS) in combination with long-acting P2-agonists (LABA) as a basic therapy according to the standards. Tha aim. To study the cause of low efficacy of LABA in patients with asthma who do not have a sufficient response to SABA, as well as the probability of reducing of bronchial obstruction with LAMA. Materials and methods. 12 non-smoking adults with moderate to severe asthma (III-IV stage of GINA), receiving medium or high doses of ICS in combination with LABA as a basic therapy without adequate control over asthma symptoms were included in the study. First group of patients showed the efficacy of salbutamol (FEV1reversibility was more than 12 and more than 200 ml after 400 g of salbutamol) and ipratropium bromide (SABASAMA). Second group included patients with low response to salbutamol and positive test (FEVtreversibility) with ipratropium bromide (SABA-SAMA). Spirometry was performed at baseline point and in 5, 10, 15, 30, 60, 120 and 240 min after inhalation of bronchodilator (salmeterol 50 g, formoterol 12 g and tiotropium bromide 18 g in the different days). Results. It was shown that SABA-SAMA phenotype asthma patients demonstrated low response to LABA: FEV1increased up to 7.641.67, 156.016.0 ml after salmeterol inhalation and up to 9.45.8, 166.7103.1 ml after formoterol inhalation (compared with a group of SABASAMA, where the response to salmeterol was 20.812.42, 551.4393.94 ml and the response to formoterol was 30.216.75, 718.57140.78 ml, p0.05), and a good response to LAMA (13.75.8 and 250.061.6). Conclusion. The results of the study allowed to define asthma phenotype with low bronchial obstruction reversibility to SABA and sufficient reversibility to SAMA (SABA-SAMA). This group of asthma patients need the basic treatment with the combination of ICS and LABA and LAMA (tiotropium bromide).

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 A 1-day visit in a severe asthma centre: effect on asthma control, quality of life and healthcare use

2016 ◽  
Vol 48 (3) ◽  
pp. 726-733 ◽  
Author(s):  
Akke-Nynke van der Meer ◽  
Henk Pasma ◽  
Wilma Kempenaar-Okkema ◽  
Jo-Anneke Pelinck ◽  
Myrte Schutten ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Asthma Control ◽  
Severe Asthma ◽  
Life Questionnaire ◽  
Healthcare Use ◽  
Uncontrolled Asthma ◽  
Control Quality ◽  
Asthma Patients

Patients with uncontrolled asthma report ongoing symptoms, poor quality-of-life and extensive healthcare use (HCU) and might benefit from management by a specialised severe asthma team. It is unknown whether a one-time evaluation by asthma experts, without long-term supervision by a specialised team, provides favourable outcomes. We evaluated asthma control (Asthma Control Questionnaire; ACQ), quality-of-life (Asthma-related Quality of Life Questionnaire; AQLQ) and HCU before and 1 year after a 1-day visit programme in a severe asthma centre, including a multidisciplinary assessment resulting in a personalised management plan to be implemented by patients own pulmonologists.40 uncontrolled asthma patients completed questionnaires (ACQ, AQLQ, HCU) at baseline, and 6 and 12 months follow-up.ACQ improved from 2.6 (interquartile range 1.7–3.2) to 1.8 (1.2–3.2) (p=0.003) and AQLQ from 4.8 (4.0–5.2) to 5.3 (4.4–6.0) (p<0.001). We found a reduction in patients with ≥2 exacerbations (95% versus 17%; p<0.001), ≥1 emergency room visit (78% versus 37%; p<0.001) and ≥1 hospitalisation (47% versus 10%; p=0.001).Evaluation of uncontrolled asthma patients in a 1-day visit programme in a severe asthma centre resulted in significant improvements in asthma control, quality-of-life and healthcare use after 1 year. This 1-day visit approach seems beneficial for uncontrolled asthma patients and might reduce their dependence on expensive treatment modalities and long-term management in specialised centres.

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 Immunobiology of Steroid-Unresponsive Severe Asthma

2021 ◽  
Vol 2 ◽  
Author(s):  
Courtney Lynn Marshall ◽  
Kosovare Hasani ◽  
Neeloffer Mookherjee
Keyword(s):  
Immune Responses ◽  
Airway Inflammation ◽  
Severe Asthma ◽  
Airflow Obstruction ◽  
Bronchial Hyperresponsiveness ◽  
Disease Process ◽  
Molecular Networks ◽  
Uncontrolled Asthma ◽  
Immune Mediators ◽  
Asthma Patients

Asthma is a heterogeneous respiratory disease characterized by airflow obstruction, bronchial hyperresponsiveness and airway inflammation. Approximately 10% of asthma patients suffer from uncontrolled severe asthma (SA). A major difference between patients with SA from those with mild-to-moderate asthma is the resistance to common glucocorticoid treatments. Thus, steroid-unresponsive uncontrolled asthma is a hallmark of SA. An impediment in the development of new therapies for SA is a limited understanding of the range of immune responses and molecular networks that can contribute to the disease process. Typically SA is thought to be characterized by a Th2-low and Th17-high immunophenotype, accompanied by neutrophilic airway inflammation. However, Th2-mediated eosinophilic inflammation, as well as mixed Th1/Th17-mediated inflammation, is also described in SA. Thus, existing studies indicate that the immunophenotype of SA is diverse. This review attempts to summarize the interplay of different immune mediators and related mechanisms that are associated with airway inflammation and the immunobiology of SA.

scholarly journals The response variability of the asthma patients to the standard pharmacotherapy

2019 ◽  
Vol 16 (2) ◽  
pp. 20-24
Author(s):  
K S Pavlova ◽  
D S Mdinaradze ◽  
O M Kurbacheva
Keyword(s):  
Severe Asthma ◽  
Ipratropium Bromide ◽  
Response Variability ◽  
Bronchial Obstruction ◽  
Short Acting ◽  
Basic Therapy ◽  
Asthma Symptoms ◽  
Asthma Patients ◽  
High Doses ◽  
Long Acting

Background. The aim of this study was to analyse the group of patients with asthma, who prefer to use short-acting anticholinergics (SAMA) for relief of asthma attacks. At the same time, these patients are prescribed inhaled glucocorticosteroids (ICS) in combination with long-acting P2-agonists (LABA) as a basic therapy according to the standards. Tha aim. To study the cause of low efficacy of LABA in patients with asthma who do not have a sufficient response to SABA, as well as the probability of reducing of bronchial obstruction with LAMA. Materials and methods. 12 non-smoking adults with moderate to severe asthma (III-IV stage of GINA), receiving medium or high doses of ICS in combination with LABA as a basic therapy without adequate control over asthma symptoms were included in the study. First group of patients showed the efficacy of salbutamol (FEV1 reversibility was more than 12% and more than 200 ml after 400 ^g of salbutamol) and ipratropium bromide (SABA+SAMA+). Second group included patients with low response to salbutamol and positive test (FEVt reversibility) with ipratropium bromide (SABA-SAMA+). Spirometry was performed at baseline point and in 5, 10, 15, 30, 60, 120 and 240 min after inhalation of bronchodilator (salmeterol 50 ^g, formoterol 12 ^g and tiotropium bromide 18 ^g in the different days). Results. It was shown that SABA-SAMA+ phenotype asthma patients demonstrated low response to LABA: FEV1 increased up to 7.64±1.67%, 156.0±16.0 ml after salmeterol inhalation and up to 9.4±5.8%, 166.7±103.1 ml after formoterol inhalation (compared with a group of SABA+SAMA+, where the response to salmeterol was 20.81±2.42%, 551.43±93.94 ml and the response to formoterol was 30.21±6.75%, 718.57±140.78 ml, p

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