scholarly journals Autophagy Modulators From Chinese Herbal Medicines: Mechanisms and Therapeutic Potentials for Asthma

2021 ◽  
Vol 12 ◽  
Author(s):  
Yun Zhang ◽  
Xing Wang ◽  
He Zhang ◽  
Hongmei Tang ◽  
Hang Hu ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Treatment Options ◽  
Herbal Medicines ◽  
Allergic Inflammation ◽  
Gain Control ◽  
Airway Hyperreactivity ◽  
Therapeutic Interventions ◽  
Chinese Herbal ◽  
Increased Risk ◽  
Long Acting

Asthma has become a global health issue, suffering more than 300 million people in the world, which is a heterogeneous disease, usually characterized by chronic airway inflammation and airway hyperreactivity. Combination of inhaled corticosteroids (ICS) and long acting β-agonists (LABA) can relieve asthma symptoms and reduce the frequency of exacerbations, especially for patients with refractory asthma, but there are limited treatment options for people who do not gain control on combination ICS/LABA. The increase in ICS dose generally provides little additional benefit, and there is an increased risk of side effects. Therefore, therapeutic interventions integrating the use of different agents that focus on different targets are needed to overcome this set of diseases. Some findings suggest autophagy is closely correlated with the severity of asthma through eosinophilic inflammation, and its modulation may provide novel therapeutic approaches for severe allergic asthma. The chinese herbal medicine (CHM) have been demonstrated clinically as potent therapeutic interventions for asthma. Moreover some reports have found that the bioactive components isolated from CHM could modulate autophagy, and exhibit potent Anti-inflammatory activity. These findings have implied the potential for CHMs in asthma or allergic inflammation therapy via the modulation of autophagy. In this review, we discuss the basic pathomechanisms underpinning asthma, and the potential role of CHMs in treating asthma with modulating autophagy.

scholarly journals Safety of tiotropium in patients with asthma

2019 ◽  
Vol 13 ◽  
pp. 175346661882401 ◽  
Author(s):  
Daniel Dusser ◽  
Francine M. Ducharme
Keyword(s):  
Large Scale ◽  
Inhaled Corticosteroids ◽  
Treatment Options ◽  
Tolerability Profile ◽  
Anticholinergic Drugs ◽  
Upper Respiratory Tract ◽  
Number Of Patients ◽  
Long Acting ◽  
Clinical Trial Program ◽  
Tract Infections

Given the high proportion of patients with asthma who remain uncontrolled despite controller treatment, there remains a need for the development of more effective treatment options with a proven safety and tolerability profile. Recently, asthma guidelines have evolved to incorporate new therapies, including long-acting muscarinic antagonists (LAMAs) and biologics. Here we focus on the safety profile of tiotropium, a LAMA, using data from the large-scale UniTinA-asthma® clinical trial program, which investigated the use of tiotropium in over 6000 patients with asthma who remained symptomatic despite receiving inhaled corticosteroids maintenance therapy, with or without other adjunct therapies. The large number of patients included allows robust analysis of safety and tolerability. Overall, a similar incidence of patients reporting any adverse event (AE) was observed in the tiotropium (5 µg and 2.5 µg) and placebo groups. Asthma worsening, decreased peak expiratory flow, and upper respiratory tract infections were the most frequently reported AEs. Serious AEs (SAEs) and investigator-defined drug-related AEs were infrequently reported across all treatment groups, including the placebo group, and there were no deaths in any study. Reports of side effects typically associated with anticholinergic drugs, such as dry mouth and urinary retention, were either infrequent or not reported in children, adolescents or adults. The similar proportions of tiotropium- versus placebo-treated patients reporting AEs and SAEs in African-American and Japanese populations, as well as in elderly patients, contribute to the accumulating evidence of the safety and tolerability of tiotropium across broad ethnic and age populations.

scholarly journals The Potential of Chinese Herbal Medicines in the Treatment of Cervical Cancer

2019 ◽  
Vol 18 ◽  
pp. 153473541986169 ◽  
Author(s):  
Yi-Hsuan Hsiao ◽  
Chiao-Wen Lin ◽  
Po-Hui Wang ◽  
Min-Chien Hsin ◽  
Shun-Fa Yang
Keyword(s):  
Cervical Cancer ◽  
Treatment Options ◽  
Herbal Medicines ◽  
Antitumor Effects ◽  
Clinical Safety ◽  
Chinese Herbal Medicines ◽  
Chinese Herbal ◽  
Global Health Issue ◽  
Underlying Mechanisms

Cervical cancer is a global health issue and places a considerable economic and medical burden on society. Thus, a concerted effort to improve the treatment of cervical cancer is warranted. Although several treatment options are currently available for treating patients with cervical cancer, such as chemoradiation and neoadjuvant or adjuvant chemotherapy, more aggressive systemic therapies and newer therapeutic agents are under investigation. Medicinal herbs have long been used to treat diseases. In this review, we summarize studies analyzing the antitumor effects and underlying mechanisms of Chinese herbal medicines, including the effects of crude extracts and compounds in vitro or in animal models for inducing apoptosis and inhibiting invasion or metastasis. Chinese herbal medicines with therapeutic targeting, such as those that interfere with tumor growth and progression in cervical cancer, have been widely investigated. To apply Chinese herbal medicine in the treatment of cervical cancer, adequate clinical studies are required to confirm its clinical safety and efficiency. Further investigations focused on the purification, pharmacokinetics, and identification of compounds from Chinese herbal medicines in cervical cancer treatment are necessary to achieve the aforementioned treatment goals.

scholarly journals Inhaled corticosteroid use and risk COVID-19 related death among 966,461 patients with COPD or asthma: an OpenSAFELY analysis

2020 ◽  
Author(s):  
◽  
Anna Schultze ◽  
Alex J Walker ◽  
Brian MacKenna ◽  
Caroline E Morton ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Beta Agonist ◽  
High Dose ◽  
Unmeasured Confounder ◽  
Risk Of Death ◽  
Increased Risk ◽  
Analyse Data ◽  
Long Acting ◽  
The Uk ◽  
Primary Care Practices

AbstractBackgroundEarly descriptions of the coronavirus outbreak showed a lower prevalence of asthma and COPD than was expected for people diagnosed with COVID-19, leading to speculation that inhaled corticosteroids (ICS) may protect against infection with SARS-CoV-2, and development of serious sequelae. We evaluated the association between ICS and COVID-19 related death using linked electronic health records in the UK.MethodsWe conducted cohort studies on two groups of people (COPD and asthma) using the OpenSAFELY platform to analyse data from primary care practices linked to national death registrations. People receiving an ICS were compared to those receiving alternative respiratory medications. Our primary outcome was COVID-19 related death.FindingsWe identified 148,588 people with COPD and 817,973 people with asthma receiving relevant respiratory medications in the four months prior to 01 March 2020. People with COPD receiving ICS were at a greater risk of COVID-19 related death compared to those receiving a long-acting beta agonist (LABA) and a long-acting muscarinic antagonist (LAMA) (adjusted HR = 1.38, 95% CI = 1.08 – 1.75). People with asthma receiving high dose ICS were at an increased risk of death compared to those receiving a short-acting beta agonist (SABA) only (adjusted HR = 1.52, 95%CI = 1.08 – 2.14); the adjusted HR for those receiving low-medium dose ICS was 1.10 (95% CI = 0.82 – 1.49). Quantitative bias analyses indicated that an unmeasured confounder of only moderate strength of association with exposure and outcome could explain the observed associations in both populations.InterpretationThese results do not support a major role of ICS in protecting against COVID-19 related deaths. Observed increased risks of COVID-19 related death among people with COPD and asthma receiving ICS can be plausibly explained by unmeasured confounding due to disease severity.FundingThis work was supported by the Medical Research Council MR/V015737/1.

scholarly journals Identifying and rectifying prescriptions of long-acting antimuscarinic and beta-agonist inhalers without inhaled corticosteroids to asthma patients: an audit from a UK general practice surgery

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703553
Author(s):  
Toni Robinson ◽  
John Edwards ◽  
Elizabeth Cottrell
Keyword(s):  
Inhaled Corticosteroids ◽  
Beta Agonist ◽  
National Review ◽  
Risk Of Death ◽  
Increased Risk ◽  
Electronic Alerts ◽  
Asthma Patients ◽  
Receive Treatment ◽  
Long Acting ◽  
The Uk

BackgroundIn the UK 5.4 million people receive treatment for asthma. Patients diagnosed with asthma should not be prescribed a long-acting muscarinic antagonist (LAMA), or a long-acting beta 2 agonist (LABA) without co-prescription of an inhaled corticosteroid (ICS), due to the increased risk of death.AimTo identify patients with asthma (+/− COPD), who have a current prescription for a LABA/LAMA without an ICS.MethodAudit criteria were derived from guidelines relevant to the Asthma UK national review, with standards of 100%. An electronic medical record search identified patients prescribed a LABA/LAMA without an ICS. Patients without a coded diagnosis and those with a diagnosis of asthma (+/− COPD) were identified for action.ResultsFifty-four patients from the practice population (n = 11 293) were prescribed a LABA/LAMA without an ICS. Of these, 7% (n = 4) did not have a relevant coded diagnosis. Of the remaining 50 patients, 16% (n = 8) had a diagnosis of asthma (+/− COPD). Re-audit results found 3% (n = 2) of patients did not have a relevant coded diagnosis. Patients with an asthma (+/−COPD) diagnosis on a LABA/LAMA without an ICS decreased to 11% (n = 7).ConclusionSuboptimal coding and potentially risky prescriptions were identified. Interventions were to ensure patients have a coded diagnosis, review LABA/LAMA without ICS prescriptions, discuss audit results with practice prescribers, and to activate electronic alerts to prompt safe prescriptions. Following re-audit, the patients with asthma (+/− COPD) still on a LABA/LAMA have been offered appointments to clarify their asthma diagnosis or to explain the risks associated with LABA/LAMA prescription without an ICS.

scholarly journals Managing Severe Asthma: A Role for the Long-Acting Muscarinic Antagonist Tiotropium

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Eckard Hamelmann
Keyword(s):  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Gain Control ◽  
Clinical Trial Data ◽  
Cost Effective ◽  
Phase Iii ◽  
Muscarinic Antagonist ◽  
Phase Iii Clinical Trials ◽  
Cost Effective Treatment ◽  
Long Acting

Severe asthma is associated with substantial morbidity and mortality. Therapies must be maximized to gain control of a patient’s severe asthma; however, avoiding overtreatment is also important. The mainstays of asthma maintenance treatment are inhaled corticosteroids (ICS) and long-acting β2-agonsits (LABAs), with the option of supplementary add-on treatments. New add-on treatments for severe asthma have emerged over the past two decades, including personalized biological therapies that are guided by a patient’s asthma phenotype. In addition, the long-acting muscarinic antagonist tiotropium has been recommended as an add-on treatment for severe asthma. Phase III clinical trials have shown tiotropium in combination with ICS/LABA to be efficacious in patients with severe asthma. Further analyses of clinical trial data have indicated that there is no benefit in stratifying patients by phenotype to predict tiotropium efficacy. Furthermore, health economic studies suggest tiotropium to be a cost-effective treatment in patients with severe asthma. This review will present the evidence surrounding the role of tiotropium in severe asthma and will discuss the use of tiotropium add-on therapy before personalized medicine strategies in the stepwise process of gaining asthma control.

Incidence and Risk of Adverse Perioperative Events among Surgical Patients Taking Traditional Chinese Herbal Medicines

2006 ◽  
Vol 105 (3) ◽  
pp. 454-461 ◽  
Author(s):  
Anna Lee ◽  
Po Tong Chui ◽  
Cindy S. T. Aun ◽  
Angel S. C. Lau ◽  
Tony Gin
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Case Reports ◽  
Herbal Medicines ◽  
Adjusted Relative Risk ◽  
Preoperative Period ◽  
Chinese Herbal Medicines ◽  
Chinese Herbal ◽  
Increased Risk ◽  
Traditional Chinese Herbal Medicines

Background The use of traditional Chinese herbal medicines (TCHMs) among the presurgical population is widespread, but their impact on perioperative patient care is unclear. The authors estimated the incidence and risk of TCHM-related perioperative events. Methods In a Hong Kong cohort study, 601 patients undergoing major elective surgery were asked about their Western medicine and TCHM use in the 2 weeks before surgery. Unanticipated perioperative events were noted by attending anesthesiologists, blinded to patients' use of specific TCHMs. Modified Poisson regression models were used to obtain the relative risk of combined endpoints of perioperative events associated with TCHM use. Results Of the 601 patients, 483 patients (80%) took self-prescribed TCHM, and 47 (8%) took TCHM by prescription (with or without self-prescribed TCHM) in the 2 weeks before surgery. The crude incidences of any combined endpoints of preoperative, intraoperative, and postoperative events were 23% (95% confidence interval, 19-26%), 74% (95% confidence interval, 71-78%), and 63% (95% confidence interval, 59-66%), respectively. Compared with nonusers, patients who took TCHM by prescription were more likely to have a preoperative event (adjusted relative risk, 2.21; 95% confidence interval, 1.14-4.29). The authors present four case reports to highlight the effect of TCHM by prescription on prolonged activated partial thromboplastin time and hypokalemia in the preoperative period. In contrast, there was no significant association between the use of any type of TCHM and the occurrence of either intraoperative or postoperative events. Conclusions The use of TCHM by prescription near the time of surgery should be discouraged because of the increased risk of adverse events in the preoperative period.

Potentially (near) fatal asthma

2019 ◽  
Vol 40 (6) ◽  
pp. 403-405 ◽  
Author(s):  
Paul A. Greenberger
Keyword(s):  
Severe Asthma ◽  
Health Care Professionals ◽  
Rescue Therapy ◽  
Respiratory Acidosis ◽  
Acute Severe Asthma ◽  
Increased Risk ◽  
High Risk Type ◽  
Fatal Asthma ◽  
Long Acting ◽  
Near Fatal Asthma

Potentially (near) fatal asthma (PFA) defines a subset of patients with asthma who are at increased risk for death from their disease. The diagnosis of PFA should motivate treating physicians, health professionals, and patients to be more aggressive in the monitoring, treatment, and control of this high-risk type of asthma. A diagnosis of PFA is made when any one of the following are present: (1) a history of endotracheal intubation from asthma, (2) acute respiratory acidosis (pH < 7.35) or respiratory failure from acute severe asthma, (3) two or more episodes of acute pneumothorax or pneumomediastinum from asthma, (4) two or more episodes of acute severe asthma, despite the use of long-term oral corticosteroids and other antiasthma medications. There are two predominant phenotypes of near-fatal exacerbations: “subacute” exacerbation and “hyperacute” exacerbation. The best way to “treat” acute severe asthma is 3‐7 days before it occurs (i.e., at the onset of symptoms or change in respiratory function) and to optimize control of asthma by decreasing the number of symptomatic days and the days and/or nights that require rescue therapy and increasing baseline respiratory status in “poor perceivers.” PFA is treated with a multifaceted approach; physicians and health-care professionals should appreciate limitations of pharmacotherapy, including combination inhaled corticosteroid‐long-acting β-agonist products as well as addressing nonadherence, psychiatric, and socioeconomic issues that complicate care.

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