Asthma: diagnosis, monitoring and chronic asthma management

Juan Carlos Ivancevich Thursday, 30 November 2017 11:45

National Institute for Health and Care Excellence (NICE)

Guidance
Tools and resources
Information for the public
Evidence
History

Guidance

This guideline covers diagnosing, monitoring and managing asthma in adults, young people and children. It aims to improve the accuracy of diagnosis, help people to control their asthma and reduce the risk of asthma attacks. It does not cover managing severe asthma or acute asthma attacks. The investment and training required to implement the guideline will take time. In the meantime, primary care services should implement what they can of the recommendations, using currently available approaches to diagnosis until the infrastructure for objective testing is in place.

Recommendations

This guideline includes recommendations on:

Who is it for?

  • GPs and practice nurses
  • Healthcare professionals in secondary care and tertiary asthma services
  • Commissioners and providers
  • People with suspected or diagnosed asthma, their families and carers

Implementation statement

We recognise that implementing the new approach to diagnosis in this guideline will need a big change in practice. See putting this guideline into practice.

Guideline development process

How we develop NICE guidelines

Next review: November 2019

Endobronchial thermoplasty for asthma

Juan Carlos Ivancevich Wednesday, 29 November 2017 12:41

Felix Zamora1, Roy Cho1, Madhuri Rao2, Heidi Gibson3, H. Erhan Dincer1

1Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, 2Division of Foregut and Thoracic Surgery, 3Cardiopulmonary Services, University of Minnesota, Minneapolis, MN, USA . Correspondence to: Felix Zamora, MD. Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, 420 Delaware St. SE, MMC 276, Minneapolis, MN 55455, USA. Email: This email address is being protected from spambots. You need JavaScript enabled to view it. .


Abstract: Asthma is an incurable chronic disease affecting approximately 24 million people in the United States. The hallmark features of asthma are reversible airflow obstruction, airway hyperresponsiveness, airway inflammation, bronchoconstriction, and excessive mucus secretion. Clinical symptoms include episodic or persistent breathlessness, wheezing, cough, or chest tightness/pressure. Forty-five percent of asthmatics continue to have yearly exacerbations and the disease is responsible for approximately 3,600 annual deaths. Pharmacologic advancements have continued to grow as the individual phenotypes of asthma are better delineated but there continues to be small population of asthmatics that are less responsive to pharmacologic therapy. Bronchial thermoplasty (BT) is an innovative procedure targeted primarily at decreasing airway smooth muscle (ASM) which is considered by some to be a vestigial organ. Decreasing the ASM bulk decreases hyperresponsiveness and bronchoconstriction leading to decreased exacerbations, decreased cost on the healthcare system, and improvement in patient quality of life.

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Detection of pathogens by real-time PCR in adult patients with acute exacerbation of bronchial asthma

Super User Thursday, 23 November 2017 11:39
 
Yutaka Yoshi, Kenichiro ShimizuMiyuki MorozumiNaoko ChibaKimiko UbukataHironori UrugaShigeo HanadaHiroshi WakuiShunsuke MinagawaHiromichi HaraTakanori NumataKeisuke SaitoJun ArayaKatsutoshi NakayamaKazuma Kishi and Kazuyoshi Kuwano

Abstract

Background

Respiratory tract infection is a major cause of acute exacerbation of bronchial asthma (AEBA). Although recent findings suggest that common bacteria are causally associated with AEBA, a comprehensive epidemiologic analysis of infectious pathogens including common/atypical bacteria and viruses in AEBA has not been performed. Accordingly, we attempted to detect pathogens during AEBA by using real-time polymerase chain reaction (PCR) in comparison to conventional methods.

Methods

We prospectively enroled adult patients with AEBA from August 2012 to March 2014. Infectious pathogens collected in nasopharyngeal swab and sputum samples were examined in each patient by conventional methods and real-time PCR, which can detect 6 bacterial and 11 viral pathogens. The causal association of these pathogens with AEBA severity and their frequency of monthly distribution were also examined.

Results

Among the 64 enroled patients, infectious pathogens were detected in 49 patients (76.6%) using real-time PCR and in 14 patients (21.9%) using conventional methods (p < 0.001). Real-time PCR detected bacteria in 29 patients (45.3%) and respiratory viruses in 28 patients (43.8%). Haemophilus influenzae was the most frequently detected microorganism (26.6%), followed by rhinovirus (15.6%). Influenza virus was the significant pathogen associated with severe AEBA. Moreover, AEBA occurred most frequently during November to January.

Conclusions

Real-time PCR was more useful than conventional methods to detect infectious pathogens in patients with AEBA. Accurate detection of pathogens with real-time PCR may enable the selection of appropriate anti-bacterial/viral agents as a part of the treatment for AEBA.

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Physician perspectives on the burden and management of asthma in six countries: The Global Asthma Physician Survey (GAPS)

Juan Carlos Ivancevich Wednesday, 29 November 2017 12:30
Kenneth R. ChapmanDavid Hinds, Peter Piazza,Chantal Raherison,Michael Gibbs,Timm Greulich,Kenneth Gaalswyk,Jiangtao Lin,Mitsuru Adachi and Kourtney J. Davis

Abstract

Background

Despite recognition of asthma as a growing global issue and development of global guidelines, asthma treatment practices vary between countries. Several studies have reported patients’ perspectives on asthma control. This study presents physicians’ perspectives and strategies for asthma management.

Methods

Physicians seeing ≥4 adult patients with asthma per month in Australia, Canada, China, France, Germany, and Japan were surveyed (N=1809; ≈300 per country). A standardised questionnaire was developed for this study and administered by telephone, online or face-to-face. Statistics were weighted to account for the sampling scheme.

Results

Physicians estimated that 71% of their adult patients received maintenance medication, with adherence monitored by 76–97% of physicians. Perceived major barriers to patient adherence included: patients taking treatment as needed; acceptance of symptoms; and patients not perceiving treatment benefits. Written action plans (37%) and technology (15%) were seldom employed by physicians to aid patients’ asthma management. Physicians rarely (10%) used validated patient-reported questionnaires to monitor asthma control, instead monitoring selected symptoms, exacerbations, and/or lung function measurements. Awareness of single maintenance and reliever therapy (SMART/MART) varied among countries (56–100%); although most physicians (72%) had prescribed SMART/MART, the majority (91%) co-prescribed a short-acting bronchodilator at least some of the time.

Conclusions

These results show that physicians generally do not employ standardised tools to monitor asthma control or to manage its treatment and that despite high awareness of SMART/MART, the strategy appears to be commonly misapplied. Better education for patients and physicians is required to improve asthma management and resulting patient outcomes.

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Asthma biomarkers in the age of biologics

Juan Carlos Ivancevich Saturday, 18 November 2017 10:37

Allergy, Asthma & Clinical Immunology

Harold Kim, Anne K. Ellis, David Fischer, Mary Noseworthy, Ron Olivenstein, Kenneth R. Chapman and Jason Lee

Allergy, Asthma & Clinical Immunology 2017, 13:48 | Published on: 17 November 2017

Abstract

The heterogeneous nature of asthma has been understood for decades, but the precise categorization of asthma has taken on new clinical importance in the era of specific biologic therapy. The simple categories of allergic and non-allergic asthma have given way to more precise phenotypes that hint at underlying biologic mechanisms of variable airflow limitation and airways inflammation. Understanding these mechanisms is of particular importance for the approximately 10% of patients with severe asthma. Biomarkers that aid in phenotyping allow physicians to “personalize” treatment with targeted biologic agents. Unfortunately, testing for these biomarkers is not routine in patients whose asthma is refractory to standard therapy. Scientific advances in the recognition of sensitive and specific biomarkers are steadily outpacing the clinical availability of reliable and non-invasive assessment methods designed for the prompt and specific diagnosis, classification, treatment, and monitoring of severe asthma patients. This article provides a practical overview of current biomarkers and testing methods for prompt, effective management of patients with severe asthma that is refractory to standard therapy.

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Editor: Juan C. Ivancevich, MD

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