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The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on asthma or other clinical topics then use Trip today.
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Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations. Asthma exacerbations occur frequently despite the regular use of asthma-controller therapies, such as inhaled glucocorticoids. Clinicians commonly increase the doses of inhaled glucocorticoids at early signs of loss of asthma control. However, data on the safety and efficacy of this strategy in children are limited.We studied 254 children, 5 to 11 years of age, who had mild-to-moderate persistent asthma and had had (...) at least one asthma exacerbation treated with systemic glucocorticoids in the previous year. Children were treated for 48 weeks with maintenance low-dose inhaled glucocorticoids (fluticasone propionate at a dose of 44 μg per inhalation, two inhalations twice daily) and were randomly assigned to either continue the same dose (low-dose group) or use a quintupled dose (high-dose group; fluticasone at a dose of 220 μg per inhalation, two inhalations twice daily) for 7 days at the early signs of loss
Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations. Asthma exacerbations are frightening for patients and are occasionally fatal. We tested the concept that a plan for patients to manage their asthma (self-management plan), which included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate, would reduce the incidence of severe asthma exacerbations among adults and adolescents with asthma.We conducted a pragmatic, unblinded (...) , randomized trial involving adults and adolescents with asthma who were receiving inhaled glucocorticoids, with or without add-on therapy, and who had had at least one exacerbation in the previous 12 months. We compared a self-management plan that included an increase in the dose of inhaled glucocorticoids by a factor of 4 (quadrupling group) with the same plan without such an increase (non-quadrupling group), over a period of 12 months. The primary outcome was the time to a first severe asthma
Effectiveness of Indoor Allergen Reduction in Management of Asthma Comparative Effectiveness Review Number 201 Effectiveness of Indoor Allergen Reduction in Management of Asthma e12 Comparative Effectiveness Review Number 201 Effectiveness of Indoor Allergen Reduction in Management of Asthma Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-00005-I Prepared by: ECRI (...) Institute–Penn Medicine Evidence-based Practice Center Plymouth Meeting, PA Investigators: Brian F. Leas, M.S., M.A., and Kristen E. D’Anci, Ph.D.* Andrea J. Apter, M.D., M.Sc. Tyra Bryant-Stephens, M.D. Karen Schoelles, M.D., S.M. Craig A. Umscheid, M.D., M.S.C.E. *Mr. Leas and Dr. D’Anci contributed equally to this report. AHRQ Publication No. 18-EHC002-EF February 2018 ii Key Messages Purpose of Review To evaluate the effectiveness of indoor allergen reduction interventions on asthma outcomes. Key
, or asthma symptoms. However treatment with both daily and twice daily dosing was associated with a small improvement in the forced expiratory volume in 1 minute (FEV1) (mean difference, +0.09 L, P = .0039 and +0.12L, P < .0001 respectively). Again the clinical significance of these results are unclear due to the small treatment effect. The above studies only included asthmatics with symptomatic GERD. Up until this point a large randomized controlled trial (RCT) of patients with poorly controlled asthma (...) and no symptoms of GERD had never been performed. In addition these studies did not incorporate objective confirmation of acid reflux, usually measured using the gold standard 24-hour esophageal pH monitoring. However, it should be noted that this method has notoriously poor correlation with symptoms, with 1 study finding that only 51% of asthmatics endorsing symptomatic GERD had abnormal acid reflux on pH monitoring. 6 18 randomized 412 subjects with poorly controlled asthma despite ICS and no reported
Budesonide/formoterol maintenance and reliever therapy in adolescent patients with asthmaAsthma control is often suboptimal in adolescents, but few studies have evaluated asthma treatments in this population.This post hoc analysis assessed the efficacy and safety of budesonide/formoterol (BUD/FORM) maintenance and reliever therapy (MART) for treatment of persistent asthma in adolescent (age 12-17 years) subgroups within six randomised, double-blind trials. The primary end-point was time (...) to first severe exacerbation. Secondary end-points included number of severe exacerbations, asthma-related symptoms, night-time awakenings, morning peak expiratory flow, forced expiratory volume in 1 s, as-needed medication use and five-item asthma control questionnaire scores.In adolescents (n=1847), BUD/FORM MART was similar to or more effective than comparators across each of the studies in reducing the risk of a first severe exacerbation (hazard ratios (HR) BUD/FORM MART versus comparators 0.15
Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial Poor adherence to recommended preventive asthma medications is common, leading to preventable morbidity. We developed the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) program to build on school-based supervised therapy programs by incorporating telemedicine at school to overcome barriers to preventive asthma care.To evaluate the effect of the SB (...) -TEAM program on asthma morbidity among urban children with persistent asthma.In this randomized clinical trial, children with persistent asthma aged 3 to 10 years in the Rochester City School District in Rochester, New York, were stratified by preventive medication use at baseline and randomly assigned to the SB-TEAM program or enhanced usual care for 1 school year. Participants were enrolled at the beginning of the school year (2012-2016), and outcomes were assessed through the end of the school
Randomized Trial of Dexamethasone Versus Prednisone for Children with Acute Asthma Exacerbations To determine whether 2 doses of dexamethasone is as effective as 5 days of prednisolone/prednisone therapy in improving symptoms and quality of life of children with asthma exacerbations admitted to the emergency department (ED).We conducted a randomized, noninferiority trial including patients aged 1-14 years who presented to the ED with acute asthma to compare the efficacy of 2 doses (...) of dexamethasone (0.6 mg/kg/dose, experimental treatment) vs a 5-day course of prednisolone/prednisone (1.5 mg/kg/d, followed by 1 mg/kg/d on days 2-5, conventional treatment). Two follow-up telephone interviews were completed at 7 and 15 days. The primary outcome measures were the percentage of patients with asthma symptoms and quality of life at day 7. Secondary outcomes were unscheduled returns, admissions, adherence, and vomiting.During the study period, 710 children who met the inclusion criteria were
Acute Severe Asthma Printed copies of this document may not be up to date, obtain the most recent version from www.cats.nhs.uk . Children’s Acute Transport Service provides paediatric intensive care retrieval funded and accountable to the North Thames Paediatric Intensive Care Commissioning Group through Great Ormond Street NHS Trust. Cats_Acute Severe Asthma_2013 Page 1 of 5 Children’s Acute Transport Service Clinical Guidelines Acute Severe Asthma Document Control Information Author E Randle (...) Threatening Cant complete sentences in one breath or too breathless to feed Silent Chest, Cyanosis Pulse >120 if >5years >130 if 2-5 years Hypotension Respiratory Rate >30 if >5 years >50 if 2-5 years Poor respiratory effort Exhaustion Confusion or Coma PEFR* 12 years). Theophylline levels should be sent 4-6 hours after starting aminophylline, target 10-20mg/litre. 2.6 IV Magnesium Sulphate Magnesium sulphate may be useful as an adjunct in acute severe asthma. 40-50 mg/kg should be given by slow infusion
Nucala - mepolizumab - Asthma, severe eosinophilic mepolizumab | CADTH.ca Find the information you need mepolizumab mepolizumab Last Updated: April 23, 2019 Result type: Reports Project Number: SF0593-000 Product Line: Generic Name: mepolizumab Brand Name: Nucala Manufacturer: GlaxoSmithKline Inc. Indications: Asthma, severe eosinophilic Manufacturer Requested Reimbursement Criteria 1 : Not applicable. Submission Type: Request For Advice Project Status: Complete Biosimilar: No Companion (...) Asthma Canada and The Ontario Lung Association Patient input summary sent for review to patient input groups December 17, 2018 Patient group comments on input summary closed December 20, 2018 Clarification: - Patient input summary feedback received Request for Advice received October 24, 2018 Manufacturer informed of request for advice October 24, 2018 Manufacturer information or comments due November 07, 2018 Request for Advice initiated October 29, 2018 Draft CDR Request for Advice report sent
Fasenra - benralizumab - Asthma, severe eosinophilic benralizumab | CADTH.ca Find the information you need benralizumab benralizumab Last Updated: April 23, 2019 Result type: Reports Project Number: SF0592-000 Product Line: Generic Name: benralizumab Brand Name: Fasenra Manufacturer: AstraZeneca Canada Inc. Indications: Asthma, severe eosinophilic Manufacturer Requested Reimbursement Criteria 1 : Not applicable. Submission Type: Request For Advice Project Status: Complete Biosimilar (...) received from Asthma Canada and The Ontario Lung Association Patient input summary sent for review to patient input groups December 17, 2018 Patient group comments on input summary closed December 20, 2018 Clarification: - Patient input summary feedback received Request for Advice received October 24, 2018 Manufacturer informed of request for advice October 24, 2018 Manufacturer information or comments due November 07, 2018 Request for Advice initiated October 29, 2018 Draft CDR Request for Advice
Cinqair - reslizumab - Asthma, eosinophilic reslizumab | CADTH.ca Find the information you need reslizumab reslizumab Last Updated: April 23, 2019 Result type: Reports Project Number: SF0591-000 Product Line: Generic Name: reslizumab Brand Name: Cinqair Manufacturer: TEVA Canada Innovation Indications: Asthma, eosinophilic Manufacturer Requested Reimbursement Criteria 1 : Not applicable Submission Type: Request For Advice Project Status: Complete Biosimilar: No Date Recommendation Issued: March (...) 27, 2019 Recommendation Type: Reimburse with clinical criteria and/or conditions The requested reimbursement criteria are provided by the applicant and do not necessarily reflect the views of CADTH. Reimbursement criteria from CADTH will be documented in the final recommendation, if applicable. Key Milestones 1 Call for patient input posted October 24, 2018 Patient group input closed December 12, 2018 Clarification: - Patient input submission received from Asthma Canada and The Ontario Lung
The effect of self-care education on the quality of life in children with allergic asthma. Asthma is a condition where the airways become tiny and swollen producing extra mucus. This can cause breathing difficulty and wheezing, coughing, and shortness of breath. Self-care education affects the quality of life of children. This study examined the effect of self-care education on quality of life for children between 8 and 11 years with allergic asthma. This study was a randomized controlled trial (...) . Study sample included 70 children between 8 and 11 years with asthma allergy referred to Children's Hospital Clinic of Khorramabad, Lorestan Province in 2015; they were selected by possible non-consecutive sampling method. Children were divided by random sampling of blocks, and classified into two groups of 35 patients each in the experimental and control groups. Both groups were matched for age and sex of children's and parents' educational level and initial quality of life scores were analyzed
Prospective Open-Label Study of 48-Week Subcutaneous Administration of Mepolizumab in Japanese Patients with Severe Eosinophilic Asthma. The long-term efficacy and safety of mepolizumab in patients with severe eosinophilic asthma has been evaluated in large-scale double-blind placebo-controlled trials. However, a prospective open-label trial of long-term subcutaneous administration of mepolizumab has not been performed in Japanese patients with severe eosinophilic asthma.This study (...) was a prospective, 48-week, open-label trial in 32 Japanese patients with severe eosinophilic asthma who received subcutaneous mepolizumab 100 mg every 4 weeks. Nine patients required oral corticosteroids daily despite receiving high-dose inhaled corticosteroids. Six patients had aspirin-exacerbated respiratory disease.All patients took mepolizumab throughout the study period. No patients experienced adverse events during the treatment. None of the patients experienced asthma exacerbations during the trial
Occupational asthma Occupational asthma - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Occupational asthma Last reviewed: February 2019 Last updated: September 2018 Summary Should be suspected in all adult patients with asthma. An occupational history should be taken to identify work-related causes. Details of work exposures should be obtained from material safety data sheets and other material available (...) to the patient from their workplace. Objective evidence of asthma should be obtained from spirometry, a bronchodilator response, and/or a methacholine challenge. Tests should be performed when the patient is symptomatic and/or within days of having exposure to a suspected aetiological agent. If sensitiser-induced occupational asthma is suspected, additional testing of asthma should be done, preferably while the patient is still working. Whenever possible an immunological response to a suspected work
, intravenous bronchodilators, and intramuscular adrenaline (if anaphylaxis is present). Severe and life-threatening cases may require non-invasive ventilation or intubation, and the intensive care team should be involved as early as possible. In children not responding to standard asthmatic treatment, other differential diagnoses should be considered. On discharge from hospital, a clear asthma management plan and asthma education is essential to optimise asthma control and prevent future exacerbations (...) Acute asthma exacerbation in children Acute asthma exacerbation in children - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Acute asthma exacerbation in children Last reviewed: February 2019 Last updated: July 2018 Summary Asthma exacerbations present with acute or sub-acute onset of wheeze and respiratory distress, the symptoms and signs of which vary depending on the developmental and maturational age of the child
be considered when evaluating a child with suspected asthma, especially in very young children or when high doses of inhaled corticosteroids are required. Definition Asthma is a chronic respiratory disorder characterised by variable airway inflammation, airway obstruction, and airway hyper-responsiveness. These features interact to determine the clinical symptom pattern of the individual. While the majority of asthmatic children have an intermittent symptom phenotype, the minority have persistent symptoms (...) Asthma in children Asthma in children - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Asthma in children Last reviewed: February 2019 Last updated: July 2018 Summary As paediatric asthma differs from adult asthma, child-specific asthma guidelines should be used and adult and adolescent guidelines should not be extrapolated to younger age groups. The prevalence of childhood asthma appears to have plateaued in many
Acute asthma exacerbation in adults Acute asthma exacerbation in adults - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Acute asthma exacerbation in adults Last reviewed: February 2019 Last updated: June 2018 Summary Presents as an acute or subacute episode of progressive worsening of symptoms, such as shortness of breath, wheezing, cough, and chest tightness. Pulse rate, respiratory rate, subjective assessment (...) , mechanical ventilation. Pneumonia, pneumothorax, pneumomediastinum, and respiratory failure are complications. Definition An asthma exacerbation is an acute or subacute episode of progressive worsening of symptoms of asthma, including shortness of breath, wheezing, cough, and chest tightness. Exacerbations are marked by decreases from baseline in objective measures of pulmonary function, such as peak expiratory flow rate and FEV1. History and exam presence of risk factors cough wheezing shortness
, based on symptoms. Patients may need to monitor their peak expiratory flow daily and should be aware of the warning signs of a severe attack. Some patients may develop progressive, irreversible obstructive lung disease. Definition Asthma is a chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity. Many cellular components are involved in the asthmatic pathway, including mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial (...) Asthma in adults Asthma in adults - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Asthma in adults Last reviewed: February 2019 Last updated: June 2018 Summary Patients present with recurrent episodes of shortness of breath, chest tightness, wheezing, or coughing. Examination typically demonstrates an expiratory wheeze; however, in severe asthma there is poor air entry and the chest is silent. Treatment is step-wise
Association Between Inhaled Corticosteroid Use and Bone Fracture in Children With Asthma Daily use of inhaled corticosteroids is a widely recommended treatment for mild persistent asthma in children. There is concern that, similar to systemic corticosteroids, inhaled corticosteroids may have adverse effects on bone health.To determine whether there is an increased risk of bone fracture associated with inhaled corticosteroid use in children with asthma.In this population-based nested case (...) -control study, we used health administrative databases to identify a cohort of children aged 2 to 18 years with a physician diagnosis of asthma between April 1, 2003, and March 31, 2014, who were eligible for public drug coverage through the Ontario Drug Benefit Program (Ontario, Canada). We matched cases of first fracture after asthma diagnosis to fracture-free controls (ratio of 1 to 4) based on date of birth (within 1 year), sex, and age at asthma diagnosis (within 2 years). We used a 1-year