Polish Society of Allergology statement on the diagnosis and treatment of severe, difficult-to-control bronchial asthma (original) (raw)
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Pneumonologia i Alergologia Polska, 2015
The main objective of asthma treatment is to control symptoms of the disease; however, despite the availability of guidelines and many groups of medications, the degree of control of this condition is insufficient. In difficult-to-treat asthma, the optimal control cannot be achieved due to reasons independent of the disease. Factors worsening asthma control include: inadequate treatment plan (low therapy adherence and compliance), inappropriate inhalation technique, insufficient symptom control using the available classes of medications, incomplete response to treatment (non-responders, steroid-resistance), incorrect diagnosis of asthma or comorbidities, and environmental factors. In order to achieve the optimal asthma control, it is recommended to: take therapeutic decisions with the patient, assess the probability of non-compliance, perform detailed diagnostics and initiate treatment of concomitant diseases, carry out differential diagnosis of conditions mimicking asthma, educate the patient as to the inhalation technique and check it, eliminate unfavourable environmental factors, and modify current treatment. New treatment options for patients with asthma include: ultra-long-acting beta2-agonists, long-acting muscarine receptor antagonists (LAMA), monoclonal antibodies, and non-pharmacological interventions. The only LAMA approved for treatment of asthma is tiotropium bromide. The analyses performed demonstrated a high efficacy of tiotropium in terms of improved lung function parameters and prolonged time to the first asthma exacerbation. It is recommended as an add-on therapy at asthma treatment steps 4 and 5 according to GINA (Global Initiative for Asthma) 2014. The optimal asthma control is important from the medical as well as the economical point of view.
Diagnosis and Management of Asthma: A Review
Asthma is a common chronic disease characterized by respiratory symptoms such as wheezing, coughing, chest tightness, and shortness of breath. These symptoms are usually associated with airflow limitation due to inflammation and airway constriction. Asthma is a significant global health issue, impacting millions of people and causing considerable morbidity.It is known for its heterogeneity and its pathophysiology involves a complex interplay of genetic, environmental factors, leading to inflammation, airway hyperresponsiveness and airway remodeling. Grasping the severity of asthma is crucial for tailoring treatment strategies effectively. Treatment of asthma aims to achieve symptom control , improve ling function and prevent its worsening. The pharmacologic treatment of asthma typically involves a stepwise approach based on severity and frequency of symptoms. For intermittent asthma , short-acting beta agonists (SABAs) are commonly used for quick relief of symptoms and for persevere asthma , inhaled corticosteroids (ICS) are main stay of treatment to reduce airway inflammation and prevent axacerbations. In more severe cases or when ICS alone are not sufficient ,a combination therapy of ICS with long-acting beta agonists (LABAs) is recommended to provide both anti-inflammatory and broncodilator effects.
Therapeutic interventions in severe asthma
The World Allergy Organization journal, 2016
The present paper addresses severe asthma which is limited to 5-10% of the overall population of asthmatics. However, it accounts for 50% or more of socials costs of the disease, as it is responsible for hospitalizations and Emergency Department accesses as well as expensive treatments. The recent identification of different endotypes of asthma, based on the inflammatory pattern, has led to the development of tailored treatments that target different inflammatory mediators. These are major achievements in the perspective of Precision Medicine: a leading approach to the modern treatment strategy. Omalizumab, an anti-IgE antibody, has been the only biologic treatment available on the market for severe asthma during the last decade. It prevents the linkage of the IgE and the receptors, thereby inhibiting mast cell degranulation. In clinical practice omalizumab significantly reduced the asthma exacerbations as well as the concomitant use of oral glucocorticoids. In the "Th2-high as...
Severe Asthma and Biological Therapy: When, Which, and for Whom
Pulmonary therapy, 2019
Asthma is a heterogeneous chronic inflammatory disease of the airways that affects approximately 300 million people worldwide. About 5-10% of all asthmatics suffer from severe or uncontrolled asthma, associated with increased mortality and hospitalization, reduced quality of life, and increased health care costs. In recent years, new treatments have become available, and different asthma phenotypes characterized by specific biomarkers have been identified. Biological drugs are currently indicated for patients with severe asthma that is not controlled with recommended treatments. They are mostly directed against inflammatory molecules of the type 2 inflammatory pathway and are effective at reducing exacerbations, maintaining control over asthma symptoms, and reducing systemic steroid use, which is associated with well-known adverse events. Although biological drugs for severe asthma have had a major impact on the management of the disease, there is still a need for head-to-head comparison studies of biologics and to identify new biomarkers for asthma diagnosis, prognosis, and response to treatment. Identifying novel biomarkers could facilitate the development of therapeutic strategies that are precisely tailored to each patient's requirements.
PRACTICAL CONSIDERATIONS FOR THE DIAGNOSIS AND MANAGEMENT OF ASTHMA PATIENTS.
Asthma is a chronic inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction and bronchospasm. Asthma is caused by a combination of genetic and environmental factors. There is no cure for asthma. Symptoms can be prevented by avoiding triggers such as allergens and irritants and by the use of inhaled corticosteroids. The primary goal of asthma treatment as: preventing chronic symptoms that interfere with daily living, such as coughing or shortness of breath during the night or after exercise. Maintaining lung function near the personal best measurement, preventing repeated asthma attacks. This review is aimed at providing a systemic analysis of the diagnosis and management of asthma, with a particular focus on the most relevant studied about 70 articles published over the last few years. The diagnosis of asthma includes the spirometer test, temperature controlled laminar airflow in severe asthma for exacerbation reduction (THE LASER TRIAL), artificial neural network, fractional exhaled nitric oxide (FeNO), skin prick test, etc. Asthma can be managed by pharmacological as well as non- pharmacological therapies. The non- pharmacological therapy includes acupuncture, acupoint herbal patching, and exercise. Pharmacologically asthma is managed with rescue inhalers to treat symptoms (salbutamol) and controller inhalers that prevent symptoms (steroids). Severe cases may require longer acting inhalers that keep the airways open (salmeterol, tiotropium) as well as inhalant steroids.
Special report Management of asthma: a consensus statement
In developing these international guidelines there were several unifying themes in the diagnosis and simple management of childhood asthma. For the purposes of the meeting, asthma was operationally defined as 'episodic wheeze and/or cough in a clinical setting where asthma is likely and other rarer conditions have been excluded'. In making a diagnosis of asthma, a full history is a prerequisite. Additional tests are only used to support clinical impression and to provide objective evidence for therapeutic recommendations. General features of a multidisciplinary approach include an appreciation of the importance of psychosocial factors, counselling, and education. Drugs should be prescribed in a rational sequence: ,62-stimulants for mild episodic wheeze; sodium cromoglycate for mild to moderate asthma; inhaled steroids for moderate to severe asthma; with xanthines, ipratropium bromide, and oral steroids having their place in more persistent and severe cases. Children and their parents should be reassured that if asthma is properly controlled there is no reason why the child should not lead a normal and physically active life. The management of asthma is rewarding and return to 'normal' lifestyle is nearly always possible with active participation in sporting activities.
The Clinical Complications of Asthma and its Pharmacotherapy
British Biomedical Bulletin, 2014
Asthma is a disease characterized by wide variations in pathogenesis that cause resistance to flow in intrapulmonary airways. The dramatic changes in the architecture of the airway walls are usually connected to allergic reaction or other forms of hyper sensitivity, causing marked spasms that lead to difficulty in breathing. It is possible to relieve or remove the symptoms in the majority of patients by adopting the clinical guidelines for pharmacotherapy of asthma which include inhaled corticosteroids, long and short acting beta agonists, muscarinic antagonists, leukotriene modifiers, xanthine drugs and some allergy medicines. The proper use of these agents can aid in reducing or reversing many symptoms of asthma. Certain methods of using medicines, for example the correct use of the inhaler for relief and maintenance therapy, are also associated with a significant reduction in symptoms. This can be achieved by a pharmacist’s intervention that can provide a detailed understanding of the current rational drug choices and proper medication use to the patient. Nowadays massive resources are being ploughed into research in a concerted effort to halt the progress of this illness that can strike in all ages.
BMC pulmonary medicine, 2016
A national program for the treatment of severe allergic (IgE-dependent) asthma with omalizumab (OMA) was implemented in Poland in 2013. This observational study evaluated the effectiveness of the Polish OMA program and monitored asthma control after treatment discontinuation. In the first year of the program, 53 patients (23 new/30 continuing treatment) received OMA in the Barlicki Hospital, Poland. Patients were evaluated at baseline and after 16 weeks of OMA treatment by spirometry, mean dose of inhaled corticosteroids (ICS) and oral corticosteroids (OCS), number of asthma exacerbations, the Asthma Control Questionnaire (ACQ), and the Asthma Quality of Life Questionnaire (AQLQ). OMA treatment responses were determined using the global effectiveness of treatment evaluation scale. Fourteen patients ceased OMA treatment following ≥36 months of therapy and entered follow up. All patients treated with OMA de novo for at least 16 weeks had a decrease in asthma exacerbations and showed a...