CME: Severe Uncontrolled Asthma: Assessing Phenotypic-driven Approaches to Treatment

Juan Carlos Ivancevich Saturday, 29 December 2018 00:16

Released: December 18, 2018     Valid for credit through: December 17, 2019

 

Activity Overview

 

An increasing body of evidence continues to define the presence of severe asthma subtypes that do not respond to standard therapies. While there are still no widely accepted definitions of phenotypes in severe asthma, guidelines from the European Respiratory Society and American Thoracic Society suggest that there may be certain characteristics, such as eosinophilic airway inflammation, that may guide health care professionals to tailor a more individualized, targeted treatment approach. In this live satellite symposium, experts in the field will evaluate asthma phenotypes and their implications for the treatment of severe uncontrolled asthma, as well as assess pertinent clinical studies utilizing monoclonal antibodies that target key immunologic mediators in severe asthma. The program will also feature the Wheel of Knowledge, a gaming segment that will reinforce topics discussed in the preceding didactic presentations.

Estimated Time To Complete: 60 minutes

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Clinical Implications of Single Nucleotide Polymorphisms in Diagnosis of Asthma and its Subtypes

Juan Carlos Ivancevich Monday, 17 December 2018 22:49

   
Jong-Sook Park,1 Ji-Hye Son,2 Choon-Sik Park,1 and Hun Soo Chang2
 

For the past three decades, a large number of genetic studies have been performed to examine genetic variants associated with asthma and its subtypes in hopes of gaining better understanding of the mechanisms underlying disease pathology and to identify genetic biomarkers predictive of disease outcomes. Various methods have been used to achieve these objectives, including linkage analysis, candidate gene polymorphism analysis, and genome-wide association studies (GWAS); however, the degree to which genetic variants contribute to asthma pathogenesis has proven to be much less significant than originally expected. Subsequent application of GWAS to well-defined phenotypes, such as occupational asthma and non-steroidal anti-inflammatory drug exacerbated respiratory diseases, has overcome some of these limitations, although with only partial success. Recently, a combinatorial analysis of single nucleotide polymorphisms (SNPs) identified by GWAS has been used to develop sets of genetic markers able to more accurately stratify asthma subtypes. In this review, we discuss the implications of the identified SNPs in diagnosis of asthma and its subtypes and the progress being made in combinatorial analysis of genetic variants.

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The North-Western Italian experience with anti IL-5 therapy and comparison with regulatory trials.

Juan Carlos Ivancevich Friday, 07 December 2018 12:27
Original research. Open Access
Diego BagnascoManlio MilaneseGiovanni RollaCarlo LombardiCaterina BuccaEnrico HefflerGiorgio Walter Canonica and Giovanni Passalacqua Email author

Abstract

Background

The severe forms of asthma represent a major burden, because of severity of symptoms, costs and impact on everyday life. Recently, Mepolizumab (MEP) was approved and marketed for the treatment of hypereosinophilic severe asthma. This anti-IL-5 monoclonal antibody reduced exacerbation rates and oral corticosteroid (OCS) use in well selected patients. The aim of this study was to evaluate the characteristics of patients receiving MEP in a real-life setting. Thus, we describe a retrospective analysis of patients treated with MEP in six centres in North Western Italy, including those who participated in the main regulatory trials.

Methods

The baseline data, before prescription, from six North Western Italy severe asthma clinics, between June 1st 2017 and December 31st 2017, were evaluated. The collected real-life data were then compared with those of SIRUS, MENSA, DREAM and MUSCA trials.

Results

Sixty-five patients were included (45% female; mean age 56 years; age range 19–84). Main observed differences with regulatory trials could be observed in eosinophils blood count at baseline, where the mean of our real-life patients (653 cells/μL) was overall higher than the one of all trials (240 cells/μL, 296 cells/μL, 253 cells/μL; p <  0.0001). The incidence of polyposis was also significantly higher in our sample (72% vs. 24%, 49%, 10%, 19%; p <  0.0001). The daily average dose of OCS was lower in our real-life patients (9 mg), if compared with SIRIUS (13.7 mg), MENSA (13.2) and MUSCA (13), and similar to the data published in DREAM (10.8).

Conclusions

The comparison of real-life patients' characteristics with regulatory trials, displayed several apparent discrepancies. The demographic and clinical aspects were similar in all groups, whereas other features (eosinophil count, pulmonary function FEV1%) differed. These data, for the first time, could represent a basis for a more accurate prescription of the drug.

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Theory-Based Digital Interventions to Improve Asthma Self-Management Outcomes: Systematic Review

Juan Carlos Ivancevich Friday, 14 December 2018 12:59

Journal of Medical Internet Research Vol 20, No 12 (2018): December

Helen J Lycett1*, BSc, MSc Eva M Raebel1*, BSc, MSc, PhD Emilie K Wildman1*, BSc, MSc Jordi Guitart1*, PhD Thomas Kenny1*, BM, MSc-PH(HSM), MFPH, MBA Jon-Paul Sherlock2*, BEng, PhD Vanessa Cooper3*, BSc, MSc, PhD 

ABSTRACT

Background: Asthma is a chronic disease requiring effective self-management to control it and prevent mortality. The use of theory-informed digital interventions promoting asthma self-management is increasing. However, there is limited knowledge concerning how and to what extent psychological theory has been applied to the development of digital interventions, or how using theory impacts outcomes.

Objective: The study aimed to examine the use and application of theory in the development of digital interventions to enhance asthma self-management and to evaluate the effectiveness of theory-based interventions in improving adherence, self-management, and clinical outcomes.

Methods: Electronic databases (CENTRAL, MEDLINE, EMBASE, and PsycINFO) were searched systematically using predetermined terms. Additional studies were identified by scanning references within relevant studies. Two researchers screened titles and abstracts against predefined inclusion criteria; a third resolved discrepancies. Full-text review was undertaken for relevant studies. Those meeting inclusion criteria were assessed for risk of bias using the Cochrane Collaboration tool. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Study outcomes were classified as medication adherence, self-management, asthma control, clinical markers of health, quality of life, other quality of life outcomes, and health care utilization. Effectiveness was calculated as an average outcome score based on the study’s reported significance. The Theory Coding Scheme (TCS) was used to establish the extent to which each intervention had applied theory and which theoretical constructs or behavioral determinants were addressed. Associations between TCS scores and asthma outcomes were described within a narrative synthesis.

Results: Fourteen studies evaluating 14 different digital interventions were included in this review. The most commonly cited theories were Social Cognitive Theory, Health Belief Model, and Self-Efficacy Theory. A greater use of theory in the development of interventions was correlated with effective outcomes (r=.657; P=.01): only the 3 studies that met >60% of the different uses of theory assessed by the TCS were effective on all behavioral and clinical outcomes measured. None of the 11 studies that met ≤60% of the TCS criteria were fully effective; however, 3 interventions were partially effective (ie, the intervention had a significant impact on some, but not all, of the outcomes measured). Most studies lacked detail on the theoretical constructs and how they were applied to the development and application of the intervention.

Conclusions: These findings suggest that greater use of theory in the development and application of digital self-management interventions for asthma may increase their effectiveness. The application of theory alone may not be enough to yield a successful intervention, and other factors (eg, the context in which the intervention is used) should be considered. A systematic approach to the use of theory to guide the design, selection, and application of intervention techniques is needed.

J Med Internet Res 2018;20(12):e293

doi:10.2196/jmir.9666

Effectiveness of benralizumab for allergic and eosinophilic predominant asthma following negative initial results with omalizumab

Juan Carlos Ivancevich Monday, 03 December 2018 21:51

Abstract: A 64‐year‐old woman, who had presented with a 30‐year history of refractory asthma, and been treated with anti‐allergic drug therapy, inhaled corticosteroids, a long‐acting beta‐agonist, and a long‐acting muscarinic antagonist. She had been characterized as an allergic, eosinophilic asthmatic. Although omalizumab was tried initially, it was found to be insufficient. We began treatment with benralizumab. The asthma symptom control and sinusitis were improved immediately. Benralizumab was effective for overlapping patient population following negative initial results with omalizumab.

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Editor: Juan C. Ivancevich, MD

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