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International Variation in Asthma and Bronchiolitis Guidelines Guideline recommendations for the same clinical condition may vary. The purpose of this study was to determine the degree of agreement among comparable asthma and bronchiolitis treatment recommendations from guidelines.National and international guidelines were searched by using guideline databases (eg, National Guidelines Clearinghouse: December 16-17, 2014, and January 9, 2015). Guideline recommendations were categorized as (1 (...) ) recommend, (2) optionally recommend, (3) abstain from recommending, (4) recommend against a treatment, and (5) not addressed by the guideline. The degree of agreement between recommendations was evaluated by using an unweighted and weighted κ score. Pairwise comparisons of the guidelines were evaluated similarly.There were 7 guidelines for asthma and 4 guidelines for bronchiolitis. For asthma, there were 166 recommendation topics, with 69 recommendation topics given in ≥2 guidelines. For bronchiolitis
Effectiveness and Safety of Bronchial Thermoplasty in Management of Asthma Comparative Effectiveness Review Number 202 Effectiveness and Safety of Bronchial Thermoplasty in Management of Asthma eComparative Effectiveness Review Number 202 Effectiveness and Safety of Bronchial Thermoplasty 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 (...) and safety of bronchial thermoplasty (BT), a procedure that uses heat to remove muscle tissue from the airways of adults with moderate to severe asthma. BT is usually given as three treatments 3 weeks apart. Key Messages • BT along with standard medical management, compared to medical management alone, may improve asthma control and quality of life, but evidence is insufficient to determine impact on asthma exacerbations. • BT along with standard medical management, compared to a similar procedure
Exemplar clinical pathways for a stratified approach to severe asthma The Academy of Medical Sciences 4 ? ? ? ? ? ? ? The Academy of Medical Sciences 5 The Academy of Medical Sciences 6 The Academy of Medical Sciences 7 Introduction to a stratified approach ? ? ? ? The Academy of Medical Sciences 8 The Academy of Medical Sciences 9 ? ? ? The Academy of Medical Sciences 10 The Academy of Medical Sciences 11 The Academy of Medical Sciences 12 The Academy of Medical Sciences 13 Adopting
Nebulized Hypertonic Saline for Asthma in Adults and Children: Clinical Effectiveness Nebulized Hypertonic Saline for Asthma in Adults and Children: Clinical Effectiveness | CADTH.ca Find the information you need Nebulized Hypertonic Saline for Asthma in Adults and Children: Clinical Effectiveness Nebulized Hypertonic Saline for Asthma in Adults and Children: Clinical Effectiveness Published on: October 31, 2017 Project Number: RA0937-000 Product Line: Research Type: Devices and Systems Report
Why and how to step down chronic asthma drugs. Asthma is a common chronic airways disease. The goal of asthma management is to control symptoms while minimizing the side effects of treatment. Following a period of stable asthma, clinicians should consider stepping down treatment. This approach is recommended by current guidelines. Step-down has been studied for several types of asthma drug regimens, and certain approaches may have lower risk than others. Systematic reviews of multiple trials (...) trials support an increased risk of asthma exacerbation for patients who completely stop taking inhaled corticosteroid or long acting bronchodilator. Strategies to implement step-down in practice include the use of risk prediction as well as tools to support shared decision making and communication about risk between clinicians and patients.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights
after rhinoviral infection exclusively in bronchial epithelial cells from asthmatics. In a translational mouse model of asthma exacerbation effects of caspase-1 on airway inflammation and Th2-upstream cytokines were explored. Caspase-1 deficient mice exhibited no alterations of general lung inflammatory parameters, but showed markedly reduced eosinophilia. Furthermore, the Th2-upstream cytokines IL-33, TSLP and IL-25 were reduced at exacerbation in mice lacking caspase-1. Rhinovirus infection (...) Caspase-1 deficiency reduces eosinophilia and interleukin-33 in an asthma exacerbation model Rhinovirus infections are common triggers of asthma exacerbations. Viruses can activate the inflammasome, resulting in processing and activation of caspase-1. This recruitment triggers production of interleukin (IL)-1β and IL-18, which have been implicated in asthma. Elucidating the involvement of the inflammasome and its compartments, such as caspase-1, in asthma exacerbations is warranted. Gene
Shared decision-making for people with asthma. Asthma is a chronic inflammatory disease that affects the airways and is common in both adults and children. It is characterised by symptoms including wheeze, shortness of breath, chest tightness, and cough. People with asthma may be helped to manage their condition through shared decision-making (SDM). SDM involves at least two participants (the medical practitioner and the patient) and mutual sharing of information, including the patient's values (...) and preferences, to build consensus about favoured treatment that culminates in an agreed action. Effective self-management is particularly important for people with asthma, and SDM may improve clinical outcomes and quality of life by educating patients and empowering them to be actively involved in their own health.To assess benefits and potential harms of shared decision-making for adults and children with asthma.We searched the Cochrane Airways Trials Register, which contains studies identified in several
Selective citation in the literature on swimming in chlorinated water and childhood asthma: a network analysis Knowledge development depends on an unbiased representation of the available evidence. Selective citation may distort this representation. Recently, some controversy emerged regarding the possible impact of swimming on childhood asthma, raising the question about the role of selective citation in this field. Our objective was to assess the occurrence and determinants of selective (...) (OR 4.1, CI 2.1-8.0). Further, there was some evidence for citation bias: articles that confirmed the relation between swimming and asthma were cited more often (OR 1.8, CI 1.1-2.9), but this finding was not robust.There is clear evidence of selective citation in this research field, but the evidence for citation bias is not very strong.
in differentiating between obstructed asthmatic breathing and normal function. T able 2 summarises the clinical evidence as well as its strengths and limitations. Overall assessment of the evidence The published evidence for Thora-3Di is based on small studies mostly published as abstracts. These are generally relevant to the NHS pathway but are descriptive, comparing a variety of respiratory parameters measured using Thora-3Di with conventional spirometry in healthy volunteers and patients with asthma, both (...) Thora-3Di for assessing asthma in children Thor Thora-3Di for assessing asthma in children a-3Di for assessing asthma in children Medtech innovation briefing Published: 2 October 2017 nice.org.uk/guidance/mib122 pathways Summary Summary The technology technology described in this briefing is Thora-3Di for assessing respiratory function in children with asthma. The inno innovativ vative aspects e aspects are that the measurements are taken non-invasively without the need for special breathing
Early Probiotic Supplementation for Eczema and Asthma Prevention: A Randomized Controlled Trial To determine if probiotic administration during the first 6 months of life decreases childhood asthma and eczema.We conducted a randomized, double-blind controlled trial of Lactobacillus rhamnosus GG (LGG) supplementation on the cumulative incidence of eczema (primary end point) and asthma and rhinitis (secondary end points) in high-risk infants. For the first 6 months of life, intervention infants (...) cumulative incidence of eczema was 30.9% (95% confidence interval [CI], 21.4%-40.4%) in the control arm and 28.7% (95% CI, 19.4%-38.0%) in the LGG arm, for a hazard ratio of 0.95 (95% CI, 0.59-1.53) (log-rank P = .83). At 5 years of age, the cumulative incidence of asthma was 17.4% (95% CI, 7.6%-27.1%) in the control arm and 9.7% (95% CI, 2.7%-16.6%) in the LGG arm, for a hazard ratio of 0.88 (95% CI, 0.41-1.87) (log-rank P = .25).For high-risk infants, early LGG supplementation for the first 6 months
A Roadmap for Optimizing Asthma Care Management via Computational Approaches Asthma affects 9% of Americans and incurs US $56 billion in cost, 439,000 hospitalizations, and 1.8 million emergency room visits annually. A small fraction of asthma patients with high vulnerabilities, severe disease, or great barriers to care consume most health care costs and resources. An effective approach is urgently needed to identify high-risk patients and intervene to improve outcomes and to reduce costs
Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets. Asthma-COPD overlap syndrome (ACOS) or asthma-COPD overlap captures the subset of patients with airways disease who have features of both asthma and chronic obstructive pulmonary disease (COPD). Although definitions of ACOS vary, it is generally thought to encompass persistent airflow limitation in a patient older than 40 years of age with either a history of asthma or large bronchodilator reversibility (...) . ACOS affects about a quarter of patients with COPD and almost a third of patients who previously had asthma. Compared with their counterparts with asthma or COPD alone, patients with ACOS have significantly worse respiratory symptoms, poorer quality of life, and increased risk of exacerbations and hospital admissions. Whether this condition emerges after gradual shifts in airway remodelling and inflammation in a patient with COPD, as the result of noxious exposures in a patient with asthma, or even
Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open-label, parallel group, randomised controlled trial. Evidence for management of asthma comes from closely monitored efficacy trials done in highly selected patient groups. There is a need for randomised trials that are closer to usual clinical practice.We did an open-label, randomised, controlled, two-arm effectiveness trial at 74 general practice clinics in Salford and South Manchester, UK (...) . Patients aged 18 years or older with a general practitioner's diagnosis of symptomatic asthma and on maintenance inhaler therapy were randomly assigned to initiate treatment with a once-daily inhaled combination of either 100 μg or 200 μg fluticasone furoate with 25 μg vilanterol or optimised usual care and followed up for 12 months. The primary endpoint was the percentage of patients who achieved an asthma control test (ACT) score of 20 or greater or an increase in ACT score from baseline of 3
2017LancetControlled trial quality: predicted high
Tezepelumab in Adults with Uncontrolled Asthma. In some patients with moderate-to-severe asthma, particularly those with noneosinophilic inflammation, the disease remains uncontrolled. This trial evaluated the efficacy and safety of tezepelumab (AMG 157/MEDI9929), a human monoclonal antibody specific for the epithelial-cell-derived cytokine thymic stromal lymphopoietin (TSLP), in patients whose asthma remained uncontrolled despite treatment with long-acting beta-agonists and medium-to-high (...) doses of inhaled glucocorticoids.In this phase 2, randomized, double-blind, placebo-controlled trial, we compared subcutaneous tezepelumab at three dose levels with placebo over a 52-week treatment period. The primary end point was the annualized rate of asthma exacerbations (events per patient-year) at week 52.The use of tezepelumab at a dose of 70 mg every 4 weeks (low dose; 145 patients), 210 mg every 4 weeks (medium dose; 145 patients), or 280 mg every 2 weeks (high dose; 146 patients) resulted
Rapid vs Maintenance Vitamin D Supplementation in Deficient Children With Asthma to Prevent Exacerbations Whether vitamin D reduces clinically important exacerbations of childhood asthma remains uncertain. We compared rapid to maintenance vitamin D repletion analyzed by baseline vitamin D level.Children presenting to the ED with moderate-to-severe asthma exacerbations and vitamin D levels ≤ 25 ng/mL underwent masked randomization, and then open dosing to either IM+oral (the latter daily (...) ) therapy or daily oral-only therapy, and were followed for 12 months. The primary outcome was patient-initiated unplanned visits for asthma exacerbations, examined two ways: cumulative proportions with an exacerbation, and average exacerbation frequency. As this was a nutrient study, we analyzed treatment groups by quartile of baseline vitamin D level, collecting repeat levels and clinical observations at 3, 6, 9, and 12 months after enrollment.One hundred and sixteen patients in the IM+oral cohort vs
of this assessment has been made for the HTA database. Citation Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen. Reslizumab (Asthma): addendum zum auftrag A17-02; auftrag A17-22. [Reslizumab (asthma) - addendum to Commission A17-02] Cologne: Institut fuer Qualitaet und Wirtschaftlichkeit im Gesundheitswesen (IQWiG). IQWiG-Berichte 516. 2017 Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Anti-Asthmatic Agents; Antibodies, Monoclonal, Humanized; Asthma; Humans (...) [Reslizumab (asthma) - addendum to Commission A17-02] Reslizumab (Asthma): addendum zum auftrag A17-02; auftrag A17-22 [Reslizumab (asthma) - addendum to Commission A17-02] Reslizumab (Asthma): addendum zum auftrag A17-02; auftrag A17-22 [Reslizumab (asthma) - addendum to Commission A17-02] Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality
Acarizax - house dust mite allergic rhinitis and allergic asthma Acarizax® × Insert searchphrase to search the website Insert searchphrase to search the website > > > Acarizax® Conclusion It is IRF's overall assessment that Acarizax may be considered a relevant add-on therapy in house dust mite allergic rhinitis and allergic asthma in adults when symptomatic treatment is not adequate. Immunotherapy is a long-term treatment form, requiring high patient motivation, and after treatment
Stratification of eosinophilic asthma patients treated with reslizumab and GINA Step 4 or 5 therapy Reslizumab, an anti-interleukin-5 monoclonal antibody, significantly reduces exacerbation frequency and improves lung function, asthma control and quality of life in adults with severe eosinophilic asthma, as demonstrated in Phase III studies. This secondary analysis assessed reslizumab's efficacy in patients receiving baseline treatment per Global Initiative for Asthma (GINA) Step 4 and Step 5 (...) guidelines. Pooled data from duplicate, Phase III, reslizumab versus placebo studies in patients with severe eosinophilic asthma (blood eosinophils ≥400 cells·µL-1) were stratified by baseline therapy. Efficacy assessments were exacerbation rates and changes from baseline forced expiratory volume in 1 s (FEV1) and patient-reported outcomes. Of 953 patients, 69% (n=657) and 11% (n=106) were receiving Step 4 and Step 5 therapy, respectively. Compared with placebo, reslizumab reduced exacerbation rates