Stratification of patients with severe asthma

Juan Carlos Ivancevich Monday, 06 April 2015 02:01
Targeting interleukin 5 for eosinophilic asthma – discussion with Jean Bousquet and Richard Lane
Increased eosinophil counts have been recognised to be linked to asthma severity and are a risk factor for asthma exacerbations. Therefore, decreasing eosinophil count by targeting the interleukin-5-mediated signalling pathway could help to reduce airway inflammation and improve asthma treatment control. In The Lancet Respiratory Medicine, Mario Castro and colleagues1 report data from two large, randomised, placebo-controlled trials, in which reslizumab, a neutralising monoclonal antibody for interleukin 5, was safe and effective in patients with severe eosinophilic asthma.
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Lung function changes from childhood to adolescence: a seven-year follow-up study

Juan Carlos Ivancevich Saturday, 04 April 2015 11:30
Open Access
Research article
Pavilio PiccioniRoberta TassinariAurelia CarossoCarlo CarenaMassimiliano Bugiani and Roberto Bono
Abstract (provisional) 
Background As part of an investigation into the respiratory health in children conducted in Torino, northwestern Italy, our aim was to assess development in lung function from childhood to adolescence, and to assess changes or persistence of asthma symptoms on the change of lung function parameters. Furthermore, the observed lung function data were compared with the Global Lung Function Initiative (GLI) reference values.

Methods We conducted a longitudinal study, which lasted 7 years, composed by first survey of 4–5 year-old children in 2003 and a follow-up in 2010. Both surveys consisted in collecting information on health by standardized SIDRIA questionnaire and spirometry testing with FVC, FEV1, FEV1/FVC% and FEF25–75 measurements. Results 242 subjects successfully completed both surveys. In terms of asthma symptoms (AS = asthma attacks or wheezing in the previous 12 months), 191/242 were asymptomatic, 13 reported AS only in the first survey (early transient), 23 had AS only in the second survey (late onset), and 15 had AS in both surveys (persistent). Comparing the lung function parameters observed with the predicted by GLI only small differences were detected, except for FVC and FEF25–75, for which more than 5% of subjects had Z-score values beyond the Z-score normal limits. Furthermore, as well as did not significantly affect developmental changes in FVC and FEV1, the decrease in FEV1/FVC ratio was significantly higher in subjects with AS at the time of follow-up (late onset and persistent phenotypes) while the increase in FEF25–75 was significantly smaller in subjects with persistent AS (p - 0.05).

Conclusions The GLI equations are valid in evaluating lung function during development, at least in terms of lung volume measurements. Findings also suggest that the FEF25–75 may be a useful tool for clinical and epidemiological studies of childhood asthma.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Why aren’t we doing better in asthma: time for personalised medicine?

Juan Carlos Ivancevich Thursday, 26 March 2015 13:14

NPJ PRIMARY CARE RESPIRATORY MEDICINE | PERSPECTIVE OPEN npj Primary Care Respiratory Medicine 25, Article number: 15004 (2015)  doi:10.1038/npjpcrm.2015.4

Mike Thomas 

Abstract After decades of improvement, asthma outcomes have stalled. Mortality, hospitalisations, exacerbations and symptom control remain sub-optimal. In controlled trials, most patients gain high levels of control, but in ‘real-life’ routine clinical practice most patients do not. Avoidable factors are found in most asthma deaths and hospital admissions. This perspective paper considers and contextualises the factors underlying poor asthma outcomes, and it suggests approaches that could improve the situation. Factors discussed include severe, therapy-resistant disease and the role of new and upcoming pharmacological therapies in improving outcomes. These are likely to be beneficial when targeted on patients with severe disease and discrete phenotypic characteristics, identified through biomarkers. However, for the majority of patients treated in the community, they are unlikely to be used widely, and better use of current therapy classes will be more important. Non-adherence with regular inhaled corticosteroid treatment and over-use of rescue bronchodilators are common, and many patients have poor inhaler technique. Self-management is frequently poor, particularly in those with psychosocial disadvantages and co-morbidities. Communication between clinicians and patients is sometimes poor, with failure to detect avoidable poor control and non-adherence, and failure to provide the necessary information and education to support efficient self-management. Strategies for improving monitoring and clinician–patient interactions to allow personalised treatment are considered. These strategies have the potential to allow individual patient needs to be recognised and efficient targeting of the variety of effective pharmacological and non-pharmacological interventions that we possess, which has the potential to improve both individual and population outcomes.

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Eosinophilia in asthma: the easy way is not always the best

Juan Carlos Ivancevich Monday, 30 March 2015 13:13
According to the latest version of the Global Initiative for Asthma strategy document,1 asthma is a heterogeneous disease with clinical manifestations sustained by different molecular mechanisms; in particular, these manifestations could be (but are not invariably) associated with chronic airway inflammation. Indeed, part of the heterogeneity of asthma might be due to different intensities or patterns of airway inflammation (eg, eosinophilic vs neutrophilic).
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Bronchial thermoplasty for severe asthma - Nice Guideline

Juan Carlos Ivancevich Saturday, 21 March 2015 23:12

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Bronchial thermoplasty for severe asthma.

NICE interventional procedure guidance [IPG419] Published date: January 2012 

  • Description

    Treating severe asthma using radiofrequency (heat) energy.

    Asthma is a condition that causes the airways to become narrower; the lining of the airways also becomes inflamed and starts to swell. Bronchial thermoplasty involves applying thermal energy to the airway wall. The aim is to reduce the amount of excessive muscle in the airway, and limit its ability to contract and narrow the airway, in patients with severe asthma.

OPCS4.6 Code(s)

E48.8 Other specified therapeutic fibreoptic endoscopic operations on lower respiratory tract

  • Y11.4 Radiofrequency controlled thermal destruction of organ NOC
  • In addition one of the following site codes is assigned:
  • Z24.5 Bronchus
  • Z24.6 Lung
  • Z24.8 Specified respiratory tract NEC

In addition an ICD-10 code from category J45.- Asthma is assigned.

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