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.

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.

scholarly journals ASMANEX TWISTHALER - THE DRUG OF CHOICE AMONG INHALED CORTICOSTEROIDS

2013 ◽  
Vol 10 (6) ◽  
pp. 51-57
Author(s):  
T V Latysheva ◽  
E A Latysheva ◽  
O V Shubina
Keyword(s):  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Control Methods ◽  
Efficacy And Safety ◽  
Prior Therapy ◽  
Asthma Symptoms ◽  
Drug Of Choice ◽  
Systemic Corticosteroids ◽  
Before And After ◽  
Baseline Therapy

Goals. To reveal the clinical efficacy and safety of Asmanex in patients with moderate and severe bronchial asthma (BA), treated with inhaled and/or systemic glucocorticosteroids (GCS), depending on the severity and level of control. Methods. 40 patients (age 18 to 65 years) were treated with Asmanex with equivalent to prior therapy with inhaled corticosteroids (ICS) doses or in combination with systemic corticosteroids prior therapy (without increasing the dose of systemic corticosteroids) for 3 months. Efficacy was assessed before and after the treatment on a background of Asmanex treatment by the need of additional using of agonists of β 2-adrenoreceptors, severity of daytime and nighttime asthma symptoms, dynamics of spirometry parameters. The efficacy of Asmanex was compared with the original baseline therapy of other inhaled corticosteroids at equivalent doses using the new delivery system.

scholarly journals Uncontrolled asthma: what is behind it?

2018 ◽  
Vol 96 (6) ◽  
pp. 485-490
Author(s):  
Y. G. Belotserkovskaya ◽  
A. G. Romanovskikh ◽  
I. P. Smirnov ◽  
E. A. Sturt
Keyword(s):  
Inhaled Corticosteroids ◽  
Clinical Symptoms ◽  
Late Onset ◽  
Atopic Asthma ◽  
Uncontrolled Asthma ◽  
Trigger Factors ◽  
Eosinophilic Asthma ◽  
Systemic Corticosteroids ◽  
Long Acting ◽  
Inhalation Techniques

Authors describe the clinical features and causes of severe uncontrolled asthma. Algorithm of evaluation of the patient with persisting clinical symptoms receiving treatment with the highest doses of inhaled corticosteroids in combination with long-acting β­-agonists and/or systemic corticosteroids, should include: a preliminary exclusion of an alternative diagnosis, eliminating the influence of concomitant diseases, preventing exposure to trigger factors, achieving high adherence to prescribed treatment, improving the inhalation techniques. Further steps on the path of regaining control should be aimed at determining phenotype of asthma. Difficulties in achieving control can be expected in patients with severe atopic asthma, late-onset persistent eosinophilic asthma, obesity-related severe nonatopic asthma, neutrophilic asthma.

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 Recent Advances in Asthma Management

2018 ◽  
Vol 4 (1) ◽  
pp. 15
Author(s):  
Peter J Barnes ◽  
Keyword(s):  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Asthma Management ◽  
European Respiratory Society ◽  
Systemic Corticosteroids ◽  
Expert Interview ◽  
Asthma Patients ◽  
Global Initiative ◽  
High Doses ◽  
Gina Guidelines

The treatment of asthma has improved greatly during the last two decades, and deaths from the disease have decreased.1 Despite these advances, many asthma patients fail to achieve optimal asthma control as defined by international guidelines.2,3 Severe asthma is associated with high risk of exacerbations and death.4 Definitions of severe asthma vary but, according to European Respiratory Society (ERS)/American Thoracic Society (ATS) and Global Initiative for Asthma (GINA) guidelines, severe asthma is asthma that requires treatment with high doses of inhaled corticosteroids plus a second controller, and/or systemic corticosteroids, to prevent it from becoming uncontrolled, or remains uncontrolled despite this therapy.2,5 In an expert interview, Professor Barnes discusses the latest advances in the management of both mild and severe asthma.

CLINICAL AND SPIROGRAPHIC FEATURES OF BRONCHIAL ASTHMA IN SCHOOLCHILDREN DEPENDING ON THE DIFFERENT REGIMENS OF BASIC ANTI-INFLAMMATORY THERAPY

2020 ◽  
Vol 73 (1) ◽  
Author(s):  
Olena Koloskova ◽  
Tetiana Bilous ◽  
Galyna Bilyk ◽  
Kristina Buryniuk-Glovyak ◽  
Olena Korotun ◽  
...  
Keyword(s):  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Persistent Asthma ◽  
High Specificity ◽  
Clinical Feature ◽  
Clinical Group ◽  
Comparison Groups ◽  
Anti Inflammatory ◽  
High Doses ◽  
Persistent Bronchial Asthma

The aim: To study the clinical and spirographic features persistence of the bronchial asthma in schoolchildren against the background of the alternative daily doses of inhaled corticosteroids to increase the effectiveness of anti-inflammatory therapy for this disease. Materials and methods: A complete comprehensive clinical-paraclinical examination of 65 schoolchildren with persistent asthma was conducted. According to the average daily dose of inhaled corticosteroids (ICS) the patients were divided into two clinical groups. The first (I) group consisted of 46 children who received ICS in the regimen of low-to-medium equipotent doses (253.95±9.98 μg per day), and the second (II) comparison group was formed of 19 patients who controlled the pBA using high doses of ICS (494.74±5.56 μg per day). Results: The patients of the І clinical group compared to patients of the ІІ group have a higher risk of the mild bronchial obstructive syndrome during asthma attacks. In assessing the level of control of persistent bronchial asthma using the CIA-scale, it was found that in II group cases of the controlled course of the disease were observed almost two times less than in children of the I group of comparison. In conducting spirography in children of comparison groups, it was shown that the ratio of indices of bronchospasm (FEV1/ FVC) was worse in patients receiving high doses of ICS. Conclusions: So, сharacteristic clinical feature of asthma controlled by high doses of ICS is more severe nature of bronchial obstructive syndrome during the period of exacerbation (OR=1.9-3.0). In the management of persistent bronchial asthma, the Gensler index which has high specificity (94.4%) and accuracy (92.2%) should be used for disease control verification.

scholarly journals In an Adult Horse With Severe Asthma (Previously Recurrent Airway Obstruction) Does Using Inhaled Corticosteroids Result in an Equal Improvement in Clinical Signs When Compared to Systemic Corticosteroids?

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Natasha A Jocelyn
Keyword(s):  
Open Access ◽  
Airway Obstruction ◽  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Clinical Signs ◽  
The Body ◽  
Recurrent Airway Obstruction ◽  
Bottom Line ◽  
Systemic Corticosteroids ◽  
Equine Asthma

<strong>PICO question</strong><br /><p>In an adult horse with severe asthma (previously recurrent airway obstruction (RAO)) does using inhaled corticosteroids result in an equal improvement in clinical signs when compared to systemic corticosteroids?</p><strong>Clinical bottom line</strong><br /><p>The level of confidence in the outcomes from the body of evidence in the 4 papers identified is high. This suggests inhaled corticosteroids (fluticasone and beclomethasone) when used at an appropriate dose can have equivalent effects on severe equine asthma as systemic intravenous dexamethasone. Inhaled corticosteroids can take longer to have the desired effects. </p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />

Inhaled Budesonide vis-à-vis Inhaled Mometasone in Chinese Children with Mild Persistent Asthma: A Single-Center, Retrospective Study

Pharmacology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Pei Gao ◽  
Ying Ding ◽  
Bingru Yin ◽  
Haoxiang Gu
Keyword(s):  
Retrospective Study ◽  
Asthma Exacerbation ◽  
Inhaled Corticosteroids ◽  
Persistent Asthma ◽  
Forced Expiratory Volume ◽  
Single Center ◽  
Level Of Evidence ◽  
Asthmatic Children ◽  
Technical Efficacy ◽  
Mild Persistent Asthma

<b><i>Introduction:</i></b> A very limited option of inhaled corticosteroids (ICSs) is approved for pediatric use in China because in children the use of ICSs for long periods is associated with dose-dependent growth reduction. Due to the lack of consensus on which is the best ICS-based treatment option to manage mild persistent asthma in children, the present study was performed to evaluate the efficacy and safety of budesonide (BUD)-based therapy vis-à-vis mometasone-based therapy in children with mild persistent asthma. <b><i>Methods:</i></b> A single-center, retrospective study was conducted in asthmatic children aged between 6 and 11 years. BUD and mometasone furoate (MF) were administered as per the approved dosing regimen using pressurized metered-dose inhalers via oral inhalation route for a period of 12 weeks. The study outcome was assessed in terms of the forced expiratory volume in 1 s (FEV<sub>1</sub>), symptom scores, and nonoccurrence of side effects. <b><i>Results:</i></b> Among the 77 asthmatic children, 71 completed the study treatment and were used in carrying out the analysis. The improvement of spirometric parameters like FEV<sub>1</sub>, Tiffeneau-Pinelli index (FEV1/forced vital capacity [FVC]), and peak expiratory flow (PEF) values observed in the MF cohort was significantly greater than those of the BUD cohort (<i>p</i> &#x3c; 0.05 for all). An increase of approximately 12%/child was observed for FEV<sub>1</sub>/FVC ratios for the BUD cohort and MF cohorts. After the 12-week study, the PEF<sub>m</sub> and PEF<sub>e</sub> values increased to about 50 L/min/child for the BUD cohort and about 98 L/min/child for the MF cohort. During the study, no asthma exacerbation event was observed in the MF cohort, whereas 1 child in the BUD cohort had asthma exacerbation in week 4. The use of rescue medication during the study was required for 16.2 and 6% of children, respectively, for BUD and MF cohorts. Owing to low dosing frequency, MF could provide a better treatment approach than BUD due to improved patient compliance. <b><i>Conclusions:</i></b> Although both drugs showed improvement in the quality of life of asthmatic children with manageable treatment-emergent adverse effects, the improvement was augmented in MF-treated children. <b><i>Level of Evidence:</i></b> The level of evidence was III. <b><i>Technical Efficacy Stage:</i></b> The technical efficacy stage was 4.

scholarly journals Revision of ‘golden hour’ for hemodynamically unstable trauma patients: an analysis of nationwide hospital-based registry in Japan

2020 ◽  
Vol 5 (1) ◽  
pp. e000405
Author(s):  
Kazuhiro Okada ◽  
Hisashi Matsumoto ◽  
Nobuyuki Saito ◽  
Takanori Yagi ◽  
Mihye Lee
Keyword(s):  
Positive Impact ◽  
Additive Model ◽  
Data Bank ◽  
Shock Group ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Golden Hour ◽  
Impact On Survival ◽  
The Relationship ◽  
Time From Injury

BackgroundThe ‘golden hour’ is a well-known concept, suggesting that shortening time from injury to definitive care is critically important for better outcome of trauma patients. However, there was no established evidence to support it. We aimed to validate the association between time to definitive care and mortality in hemodynamically unstable patients for the current trauma care settings.MethodsThe data were collected from the Japan Trauma Data Bank between 2006 and 2015. The inclusion criteria were patients with systolic blood pressure (SBP) <90 mm Hg and heart rate (HR) >110 beats/min or SBP <70 mm Hg who underwent definitive care within 4 hours from the onset of injury and survived for more than 4 hours. The outcome measure was in-hospital mortality. We evaluated the relationship between time to definitive care and mortality using the generalized additive model (GAM). Subgroup analysis was also conducted using GAM after dividing the patients into the severe (SBP <70 mm Hg) and moderate (SBP ≥70 mm Hg and <90 mm Hg, and HR >110 beats/min) shock group.Results1169 patients were enrolled in this study. Of these, 386 (33.0%) died. Median time from injury to definitive care was 137 min. Only 61 patients (5.2%) received definitive care within 60 min. The GAM models demonstrated that mortality remained stable for the early phase, followed by a decrease over time. The severe shock group presented with a paradoxical decline of mortality with time, whereas the moderate shock group had a time-dependent increase in mortality.DiscussionWe did not observe the association of shorter time to definitive care with a decrease in mortality. However, this was likely an offset result of severe and moderate shock groups. The result indicated that early definitive care could have a positive impact on survival outcome of patients with moderate shock.Level of evidenceLevel Ⅳ, prognostic study,

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