scholarly journals Tiotropium: a new therapeutic option in asthma

2013 ◽  
Vol 79 (3-4) ◽  
Author(s):  
F. Novelli ◽  
F. Costa ◽  
M. Latorre ◽  
L. Malagrinò ◽  
A. Celi ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Therapeutic Option ◽  
Bronchial Hyperresponsiveness ◽  
Asthma Management ◽  
Similar Efficacy ◽  
Current Therapy ◽  
Anticholinergic Drugs ◽  
Asthmatic Patients ◽  
Severe Asthmatic ◽  
Medium Dose

Tiotropium: a new therapeutic option in asthma. F. Novelli, F. Costa, M. Latorre, L. Malagrinò, A. Celi, B. Vagaggini, P. Paggiaro. Although bronchial hyperresponsiveness to cholinergic agents is a main feature of asthma, the role of anticholinergic drugs in chronic asthma management has been largely underestimated. Several single-dose studies comparing acute bronchodilation induced by ipratropium bromide with salbutamol have shown that salbutamol is more effective than ipratropium in treating asthma. Recently, tiotropium has been studied in asthma, when added to low-medium dose inhaled corticosteroids (ICS) in unselected moderate asthmatics or in patients with uncontrolled asthma, or with COPD and history of asthma. Later, studies on patients with Arg/Arg beta2-receptor polymorphism demonstrated a similar efficacy of tiotropium in comparison with salmeterol, when both were added to ICS. More recently, pivotal long-term studies have been performed on severe asthmatics uncontrolled under ICS/LABA combination, showing the efficacy of tiotropium in improving lung function and in increasing the time until the first severe asthma exacerbation. These data support the use of tiotropium on top of ICS/LABA combination in moderate-severe asthmatic patients. New studies are going to be published on the use of tiotropium in mild and moderate asthmatics, when added to low or medium dose ICS, in comparison with ICS alone or with ICS/LABA combination. These data might extend the indication for using tiotropium in asthma. Therefore, tiotropium represents now a valid therapeutic option, in addition to the current therapy available for severe asthmatics, and in alternative to LABA in selected asthma populations. The specific asthma phenotype which may be appropriate for tiotropium treatment should still be defined.

scholarly journals FASE-CPHG study: a panoramic snapshot of difficult-to-treat, severe asthma in French nonacademic hospitals

2019 ◽  
Vol 5 (4) ◽  
pp. 00069-2019 ◽  
Author(s):  
Laurent Portel ◽  
Eric Parrat ◽  
Cécilia Nocent-Ejnaini ◽  
Gilles Mangiapan ◽  
Anne Prud'homme ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Eosinophil Count ◽  
Inhaled Corticosteroids ◽  
Total Serum ◽  
Blood Eosinophil ◽  
Anticholinergic Drugs ◽  
Real World Data ◽  
Asthmatic Patients ◽  
Severe Asthmatic ◽  
The Mean

BackgroundReal-world data describing management of patients with severe asthma are limited. To address this issue, we conducted FASE-CPHG (France Asthme Sevère – Collège des Pneumologues des Hôpitaux Généraux), a descriptive, multicentric, and observational cross-sectional study.MethodsFrench pulmonologists from nonacademic hospitals completed questionnaires on patient characteristics and ongoing asthma treatment for severe asthmatic patients observed during the inclusion period. In addition, we collected data from patients via self-assessment questionnaires.Findings104 physicians recruited 1502 patients within 1 year. The mean age of the 1465 patients analysed was 54.4±16.1 years. Severe asthmatic patients were more frequently female (63%), with a history of atopy (65%). Most patients remained poorly controlled or uncontrolled, with an important difference between physicians' opinion and the Global Initiative for Asthma criteria (63% versus 96%). The most common comorbidities included ear, nose and throat diseases (59% of cases); anxiety (40%); and gastro-oesophageal reflux disease (39%). Allergic sensitisation tests and/or blood eosinophil count evaluation, and spirometry were performed in 92% and 98% of patients, respectively. The mean eosinophil count and total serum IgE were 437 cells·mm−3 and 546 UI·L−1, respectively. In addition to high doses of inhaled corticosteroids plus long-acting β2-agonists, patients were receiving leukotriene receptor antagonists (52%), anticholinergic drugs (34%), anti IgE (27%) and oral corticosteroids (17%); 65% adhered to their treatment.InterpretationThis study provides insight into the characteristics and management of severe asthma in France and may help improve knowledge on this pathology, which represents a high burden to healthcare.

A study on symptom improvement and efϑicacy of formoterol plus budesonide in the asthma management in northern parts of Tamil Nadu

2021 ◽  
Vol 12 (1) ◽  
pp. 742-748
Author(s):  
Mani Dhandayuthapani ◽  
Murugesh Shivashankar ◽  
Uma K
Keyword(s):  
Tamil Nadu ◽  
Asthma Management ◽  
Symptom Improvement ◽  
Asthmatic Patients ◽  
Severe Asthmatic ◽  
Number Of Patients ◽  
One Year ◽  
Experienced Symptom

The purpose is to study the asthma symptom improvement and efficacy of formoterol (LABA) and Budesonide (ICS) combination in the asthma management in northern districts of Tamilnadu. It is a multicentric, non-comparative, questionnaire and random sampling study was conducted in 145 mild to severe asthmatic patients. They were in Formoterol plus budesonide combination inhalation drugs available in DPI and pMDI. Among the 145 asthmatic patients, 45 patients, 6 patients and 94 patients were in DPI, nebuliser and pMDI devices respectively. During drug initiation, The Asthmatics were in mild (27%), Moderate (57%) and Severe (16%) stages. After one year of follow-up, the number of patients in the mild is 84%, moderate 14% and severe 2%. Among 45 DPI Asthmatic patients, 29 patients, 15 patients and 1 patient have reported the handling the devices as easy, medium and hard respectively. On the other hand, 94 pMDI asthmatic patients, 38 patients, 48 patients and 8 patients have reported the handling of devices as easy, medium and hard respectively. The treatment resulted in 77 patients as good, 65 as satisfactory and 3 as same. After one year, all the 145 asthmatic patients adhered with the treatment and experienced symptom improvement with 53% patients as good, 45% patients as satisfactory and 2% patients as same. The treatment of formoterol and budesonide combination in the northern districts of Tamilnadu have effectively controlled the asthmatic symptoms and improved the quality of life in asthmatics. Moreover, the patient's adherence to the treatment is good in the northern parts of Tamilnadu.

scholarly journals Effects of single-dose zileuton on bronchial hyperresponsiveness in asthmatic patients treated with inhaled corticosteroids

1997 ◽  
Vol 10 (12) ◽  
pp. 2749-2753 ◽  
Author(s):  
P.N.R. Dekhuijzen ◽  
G.P. Bootsma ◽  
P.L.M.L. Wielders ◽  
L.R.M. van den Berg ◽  
J. Festen ◽  
...  
Keyword(s):  
Single Dose ◽  
Inhaled Corticosteroids ◽  
Bronchial Hyperresponsiveness ◽  
Asthmatic Patients

scholarly journals Inhaled Formoterol-Fluticasone Single Inhaler Therapy in Asthma: Real-World Efficacy, Budget Impact, and Potential to Improve Adherence

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
V. Rajesh ◽  
Jolsana Augustine ◽  
R. Divya ◽  
Melcy Cleetus
Keyword(s):  
Real World ◽  
Disease Burden ◽  
Budget Impact ◽  
Inhaled Corticosteroids ◽  
Therapeutic Option ◽  
Asthma Management ◽  
First Line ◽  
Advantageous Position ◽  
Long Acting ◽  
Practical Recommendations

Asthma is the commonest chronic disease affecting airways in humans and has an increasing global disease burden. Inhaled corticosteroids (ICS) are the first-line therapeutic option for asthma, and addition of a long-acting beta 2-agonist (LABA) has been shown to improve asthma control. A combination of the two agents in a single inhaler is beneficial with regard to ease of administration and patient compliance. Various ICS-LABA formulations are available across various countries in the world, one among them being formoterol-fluticasone. Both formoterol and fluticasone have pharmacologic peculiarities which places the combination in a uniquely advantageous position when it comes to asthma therapy. The present review focuses on some of the, hitherto, less explored aspects of this combination inhaler such as real-world efficacy, impact on budget allocation, results of switch-over therapy, and potential to improve adherence to asthma treatment. It also provides practical recommendations on positioning it in real-world asthma management.

SMART and as-needed therapies in mild-to-severe asthma: a network meta-analysis

2020 ◽  
Vol 56 (3) ◽  
pp. 2000625 ◽  
Author(s):  
Paola Rogliani ◽  
Beatrice Ludovica Ritondo ◽  
Josuel Ora ◽  
Mario Cazzola ◽  
Luigino Calzetta
Keyword(s):  
Severe Asthma ◽  
Treatment Option ◽  
Low Dose ◽  
Therapeutic Option ◽  
Meta Analysis ◽  
Specific Treatment ◽  
High Dose ◽  
Asthmatic Patients ◽  
The Impact ◽  
Medium Dose

To date, there are no network meta-analyses comparing the impact of as-needed treatments in asthma, including the single maintenance and reliever therapy (known as “SMART” or “MART”; for simplicity, SMART will be used hereafter) and the use of inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination exclusively on an as-needed basis. Therefore, we performed a systematic review and network meta-analysis concerning the efficacy and safety of SMART and as-needed therapies in asthma. Data from 32 096 asthmatic patients were extracted from 21 studies, lasting from 6 to 12 months. In adult mild-to-moderate asthmatic patients low-dose SMART and as-needed low-dose ICS/LABA combination were significantly (relative effect <0.78; p<0.05) more effective than the other as-needed therapies in reducing the risk of exacerbation, and both were ranked as the first treatment option reaching the first quartile of the surface under the cumulative ranking curve analysis (SUCRA). In adult moderate-to-severe asthmatic patients, low-dose to medium-dose SMART and high-dose ICS/LABA+as-needed short-acting β2-agonist were equally effective in reducing the risk of severe asthma exacerbation (p>0.05), although only low- to medium-dose SMART was ranked as the first treatment option (first SUCRA quartile). Overall, these treatments were well tolerated, and effective also on lung function and disease control. This study supports SMART and as-needed therapies as a suitable therapeutic option for asthma, by providing the most effective positioning of each specific treatment according to the disease severity.

scholarly journals Chlamydia pneumoniae Influence on Cytokine Production in Steroid-Resistant and Steroid-Sensitive Asthmatics

Pathogens ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 112
Author(s):  
Dóra Paróczai ◽  
Tímea Mosolygó ◽  
Dávid Kókai ◽  
Valéria Endrész ◽  
Dezső P. Virok ◽  
...  
Keyword(s):  
Chlamydia Pneumoniae ◽  
Mononuclear Cells ◽  
Cytokine Production ◽  
Inhaled Corticosteroids ◽  
Asthma Management ◽  
Peripheral Blood Mononuclear ◽  
Steroid Resistant ◽  
Asthmatic Patients ◽  
Tnf Α ◽  
Steroid Sensitive

Medications for asthma management consisting of inhaled corticosteroids act by controlling symptoms. However, some patients do not respond to steroid treatment due to immunological factors at the cytokine level. Chlamydia pneumoniae (C. pneumoniae) infection is strongly implicated in asthma pathogenesis, causing altered immune responses. We investigated the association of C. pneumoniae serostatus with the production of certain cytokines by peripheral blood mononuclear cells (PBMCs) of steroid-resistant and -sensitive asthmatic patients. Our most important findings are the following: In the case of C. pneumoniae seropositive patients we detected pronounced spontaneous interleukin (IL)-10 secretion and, in the case of steroid-resistant patients, IL-10 secretion was at a significantly higher level as compared with in-sensitive patients (p < 0.01). Furthermore, steroid-resistant seropositive patients produced a significantly higher level of IL-10 spontaneously and under antigen stimulation as compared with steroid-resistant seronegative individuals (p < 0.05). Concerning spontaneous TNF-α secretion by C. pneumoniae seropositive asthmatics, we observed that steroid-resistant patients produced significantly more of this cytokine than steroid-sensitive patients. In the steroid-resistant patients’ sera, a remarkably high MMP-9 concentration was associated with C. pneumoniae seronegativity. Our study revealed that the differences in the cytokine production in steroid-sensitive and -resistant asthmatic patients can be influenced by their C. pneumoniae serostatus.

scholarly journals Asthma Clinics in Primary Healthcare Centres in Oman: Do they make a difference?

2018 ◽  
Vol 18 (2) ◽  
pp. 137
Author(s):  
Abdulaziz Al-Mahrezi ◽  
Sawsan Baddar ◽  
Sheikha Al-Siyabi ◽  
Safaa Al-Kindi ◽  
Ibrahim Al-Zakwani ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Medical Records ◽  
Inhaled Corticosteroids ◽  
Positive Impact ◽  
Asthma Management ◽  
Signs And Symptoms ◽  
History Taking ◽  
Asthmatic Patients ◽  
Prescription Rates ◽  
History Of

Objectives: This study aimed to determine the effect of newly established asthma clinics (ACs) on asthma management at primary healthcare centres (PHCs) in Oman. Methods: This retrospective crosssectional study was conducted between June 2011 and May 2012 in seven PHCs in the Seeb wilayat of Muscat, Oman. All ≥6-year-old asthmatic patients visiting these PHCs during the study period were included. Electronic medical records were reviewed to determine which clinical assessment and management components had been documented. Results: A total of 452 asthmatic patients were included in the study. The mean age was 35 ± 21 years old (range: 6–95 years) and the majority (57%) were female. In total, 288 (64%) cases were managed at ACs and 164 (36%) were managed at general clinics (GCs). Significant differences were noted in the documentation of cases managed at ACs compared to those at GCs, including history-taking information regarding signs and symptoms (91% versus 19%; P <0.001), trigger factors (79% versus 16%; P <0.001) and a history of atopy (81% versus 17%; P <0.001), smoking (61% versus 7%; P <0.001), asthma exacerbations (73% versus 10%; P <0.001) or previous admissions (63% versus 10%; P <0.001). Furthermore, prescription rates of inhaled corticosteroids (72% versus 61%; P = 0.021) and short-acting β-agonists (93% versus 82%; P = 0.001) were significantly higher at ACs compared to GCs. Conclusion: Overall, the findings indicated that ACs have had a positive impact on asthma management at the studied PHCs.Keywords: Asthma; Disease Management; Patient Compliance; Medical History Taking; Medical Records; Documentation; Oman.

scholarly journals Precision Medicine in Targeted Therapies for Severe Asthma: Is There Any Place for “Omics” Technology?

2018 ◽  
Vol 2018 ◽  
pp. 1-15 ◽  
Author(s):  
Carla Galeone ◽  
Chiara Scelfo ◽  
Francesca Bertolini ◽  
Marco Caminati ◽  
Patrizia Ruggiero ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Current Knowledge ◽  
Asthma Management ◽  
Biological Therapies ◽  
Omics Technologies ◽  
Asthma Phenotypes ◽  
Asthmatic Patients ◽  
Severe Asthmatic ◽  
Appropriate Therapy ◽  
Personalized Approach

According to the current guidelines, severe asthma still represents a controversial topic in terms of definition and management. The introduction of novel biological therapies as a treatment option for severe asthmatic patients paved the way to a personalized approach, which aims at matching the appropriate therapy with the different asthma phenotypes. Traditional asthma phenotypes have been decomposing by an increasing number of asthma subclasses based on functional and physiopathological mechanisms. This is possible thanks to the development and application of different omics technologies. The new asthma classification patterns, particularly concerning severe asthma, include an increasing number of endotypes that have been identified using new omics technologies. The identification of endotypes provides new opportunities for the management of asthma symptoms, but this implies that biological therapies which target inflammatory mediators in the frame of specific patterns of inflammation should be developed. However, the pathway leading to a precision approach in asthma treatment is still at its beginning. The aim of this review is providing a synthetic overview of the current asthma management, with a particular focus on severe asthma, in the light of phenotype and endotype approach, and summarizing the current knowledge about “omics” science and their therapeutic relevance in the field of bronchial asthma.

Sign in / Sign up

Export Citation Format

Share Document