Omalizumab effectiveness in patients with severe allergic asthma according to blood eosinophil count: the STELLAIR study

Juan Carlos Ivancevich Tuesday, 17 July 2018 12:37
Marc HumbertCamille TailléLaurence MalaVincent Le GrosJocelyne JustMathieu Molimard

Abstract

Omalizumab is a monoclonal anti-IgE antibody used to treat severe allergic asthma (SAA). The aim of the STELLAIR study was to determine the importance of pre-treatment blood eosinophil count as a predictive measure for response to omalizumab.

This retrospective real-life study was conducted in France between December 2015 and September 2016 using medical records of SAA omalizumab-treated patients. Response to omalizumab was assessed by three criteria: physician evaluation, reduction of ≥40% in annual exacerbation rate and a combination of both. Response rate was calculated according to blood eosinophil count measured in the year prior to omalizumab initiation.

872 SAA omalizumab-treated patients were included by 78 physicians (723 adults (age ≥18 years) and 149 minors (age 6–17 years)). Blood eosinophil count was ≥300 cells·µL−1 in 52.1% of adults and 73.8% of minors. By physician evaluation, 67.2% of adults and 77.2% of minors were responders and 71.1% adults and 78.5% minors had a ≥40% reduction in the exacerbation rate. In adults, the response rate for combined criteria was 58.4% (95% CI 53.2–63.4%) for blood eosinophils ≥300 cells·µL−1 (n=377) and 58.1% (95% CI 52.7–63.4%) for blood eosinophils <300 cells·µL−1 (n=346).

This study shows that a large proportion of patients with SAA have a blood eosinophil count ≥300 cells·µL−1, and suggests that omalizumab effectiveness is similar in “high” and “low” eosinophil subgroups.


Full Text (PDF)

Criteria for enhancing mucus transport: a systematic scoping review

Juan Carlos Ivancevich Monday, 09 July 2018 22:26
Review - Open Access
Alison Pieterse and Susan D. Hanekom

Abstract

Background

Uncertainty exists regarding the physiological basis of physiotherapy strategies to facilitate mucus clearance. The aim of this review was to describe the physiological factors and intrinsic conditions that facilitate airway mucus transport.

Method

A scoping review was performed. A systematic literature search of six databases was executed. Eligibility criteria were applied by two researchers to reach the aim of the review. Papers were identified independently by two reviewers on title, abstract and full-text level. Any discrepancies were discussed with a third reviewer.

Results

The search identified 35 papers published between 1975 and 2015. These differed significantly in terms of outcome measures, measurement techniques and methodologies and included animal studies, laboratory investigations, and the use of small human samples. Nine key factors influencing mucus transport were identified. These include: temperature and humidity, bronchial perfusion, ATP, forced expiratory technique and cough, generation of oscillation, ventilation patterns/airflow, epithelial differences, mucus properties and positioning.

Conclusion

This review provides a framework for factors/conditions influencing mucus transport. Existing physiotherapy strategies for augmentation of airway mucus clearance can now be evaluated against the framework and new modalities informed.

Download PDF

 

Asthma exacerbations in a subtropical area and the role of respiratory viruses: a cross-sectional study

Juan Carlos Ivancevich Thursday, 05 July 2018 00:09
Research article -  Open Access - Open Peer Review
 
Lusmaia Damaceno Camargo CostaEmail authorPaulo Augusto Moreira CamargosPaul L. P. BrandFabíola Souza FiaccadoriMenira Borges de Lima Dias e SouzaDivina das Dôres de Paula CardosoItalo de Araújo CastroRuth Minamisava and Paulo Sérgio Sucasas da Costa

Abstract

Background

Multiple factors are involved in asthma exacerbations, including environmental exposure and viral infections. We aimed to assess the association between severe asthma exacerbations, acute respiratory viral infections and other potential risk factors.

Methods

Asthmatic children aged 4–14 years were enrolled for a period of 12 months and divided into two groups: those with exacerbated asthma (group 1) and non-exacerbated asthma (group 2). Clinical data were obtained and nasopharyngeal samples were collected through nasopharyngeal aspirate or swab and analysed via indirect fluorescent immunoassays to detect influenza A and B viruses, parainfluenza 1–3, adenovirus and respiratory syncytial virus. Rhinovirus was detected via molecular assays. Potential risk factors for asthma exacerbation were identified in univariate and multivariate analyses.

Results

In 153 children (group 1: 92; group 2: 61), median age 7 and 8 years, respectively, the rate of virus detection was 87.7%. There was no difference between groups regarding the frequency of virus detection (p = 0.68); however, group 1 showed a lower frequency (19.2%) of inhaled corticosteroid use (91.4%, p < 0.01) and evidence of inadequate disease control. In the multivariate analysis, the occurrence of three or more visits to the emergency room in the past 12 months (IRR = 1.40; p = 0.04) and nonadherence to inhaled corticosteroid (IRR = 4.87; p < 0.01) were the only factors associated with exacerbation.

Conclusion

Our results suggest an association between asthma exacerbations, poor disease control and nonadherence to asthma medication, suggesting that viruses may not be the only culprits for asthma exacerbations in this population.

Download PDF

 

XII AIST 2018 Conference: “The thousand faces of cough: clinical and therapeutic updates”

Juan Carlos Ivancevich Thursday, 05 July 2018 13:00

Meeting report - Open Access

Multidisciplinary Respiratory Medicine

Alessandro Zanasi, Antonio M. Morselli-Labate, Massimiliano Mazzolini, Marianna Mastroroberto, Roberto W. Dal Negro, Ivan Poliacek, Alyn H. Morice, Sara Maio, Giovanni Viegi, Jamie Koufman, Francesco Torresan, Alexandros Ioannou, Daniele Mandolesi, Elisa Liverani, Amedeo Montale, Franco Bazzoli, Fabio Baldi, Maurizio Zompatori, Giovanni A. Fontana, Ahmad Kantar, Peter Dicpinigaitis, Clive Page, Surinder S. Birring and Francesco Tursi

Multidisciplinary Respiratory Medicine 2018 13:17

Abstract

This paper summarizes the presentations submitted for publication of the 12th AIST National Congress (Associazione Italiana Studio Tosse/Italian Association for Cough Study) entitled “The thousand facets of cough. A clinical and therapeutic update”, which occurred last February 2nd-3rd, 2018 in Bologna (Italy). It summarizes the contributions from leading experts of the sector, who, as in the previous editions, also this year have analyzed a problem too often underestimated which still has many dark sides as regards both the diagnosis and the therapy of cough. The Scientific Committee has chosen topics that had less space in previous editions and these are topical subjects representing a concrete opportunity for learning and comparison of opinions, as well as indispensable elements for the correct management of the symptoms.

Hereby we report the abstracts of the works submitted for publication in this Meeting report.

The main topics have covered Cough relationship with nerve vagus, ATP, air pollution, GERD, imaging, COPD, pediatric and therapy. Of particular interest it is the preliminary data on cough hydration ratio that shows a highly significant correlation between dehydration and cough.

 Download PDF

 

Type 2 immunity in asthma

Juan Carlos Ivancevich Thursday, 28 June 2018 00:08
 
Marco Caminati, Duy Le Pham, Diego Bagnasco and Giorgio Walter Canonica
 
World Allergy Organization Journal 2018 11:13

https://doi.org/10.1186/s40413-018-0192-5

Abstract

Type 2-immunity represents the typical adaptive response to allergen exposure in atopic individuals. It mainly involves Th2 cells and immunoglobulin E, as the main orchestrators of type 2-inflammation. Recently, it has been highlighted that allergens may be responsible for a Th2 response beside specific IgE activation and that a number of other environmental stimuli, such as viruses and pollutants, can trigger the same pattern of inflammation beyond atopy. Emerging data sustain a substantial role of the so-called epithelial dysfunction in asthma pathogenesis, both from anatomic and functional point of view. Furthermore an increasing amount of evidence demonstrates the relevance of innate immunity in polarizing a Th2 impaired response in asthmatic patients. Under this perspective, the complex cross-talking between airway epithelium, innate and adaptive immunity is emerging as a major determinant of type 2-inflammation beyond allergens.

This review will include an update on the relevance of dysregulation of innate and adaptive type 2-immunity in asthma pathogenesis, particularly severe asthma, and on the role of the allergens that are associated with severe asthma. Type 2-immunity also will be reviewed in the light of the current and upcoming targeted treatments for severe asthma.

Download PDF

Interasma on Twitter

Interasma RT @worldallergy: WISC 2018 - Florence Dec. 6-9 Registration online will be closed on November 20th. After this date, registration will on…
18hreplyretweetfavorite
Interasma RT @worldallergy: Top 10 Scientific Articles in the field of psychosocial aspects of allergy published in 2017 (or 2016 as noted). https://…
18hreplyretweetfavorite
Interasma RT @Aller_MD: “#Asthma biologic prices ‘far out of alignment’ with benefit, says ICER” https://t.co/rIKq8LypH9 https://t.co/t8vGuROsUw
18hreplyretweetfavorite
Interasma RT @Aller_MD: “Risk Factors ID'd for Persistent Atopic Dermatitis in Kids Could help clinicians personalize disease prediction” https://t.c…
18hreplyretweetfavorite
Interasma RT @RhinologyO: “The otolaryngologists’ non-surgical training needs to extend beyond the limits of ENT” http…
20hreplyretweetfavorite

Editor: Juan C. Ivancevich, MD

Copyright © Interasma 2003-2017  •  Terms of Use  •  Privacy Policy  •  Contact Us  •  Sitemap

Powered by FREI SA

InterAsma