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Severe Persistent Asthma (severe + persistent_asthma)
Selected AbstractsEvaluation of the Asthma Life Quality test for the screening and severity assessment of asthmaALLERGY, Issue 11 2004J. A. Fonseca Background:, Asthma Life Quality (ALQ) test, a 20-question questionnaire developed by the American College of Allergy, Asthma and Immunology, has been shown to be useful for asthma diagnosis. We aimed to determine the relation between ALQ scores and (a) diagnosis of asthma; (b) physician's classification of asthma severity according to National Institutes of Health/Global Initiative for Asthma (GINA). Methods:, Standard translation and cultural adaptation to Portuguese was performed. Patients self-administered the ALQ in the waiting room; the attending allergist classified them, blindly for the test. The scores of nonasthmatics were compared with those of asthma patients. Asthma patients were analyzed in two severity groups: intermittent and mild persistent asthma (IMPA), and moderate and severe persistent asthma (MSPA); sensitivity, specificity, positive and negative predictive values were calculated and receiver operating characteristic curve plotted. Logistic regression analysis models were computed. Results:, From 283 patients, 237 tests were analyzed. Non-asthmatic patients ALQ scores (mean ± SD) were 6 ± 4 and, for asthmatics, 10 ± 5 [mean difference 4.6 (95%CI 3.3,5.9)]. The odds of positive diagnosis increased 1.27 times (95%CI 1.17,1.38) for each one-unit increase in the test. For asthma severity ALQ scores were 9 ± 4 for IMPA, 15 ± 3 for MSPA [difference 6.0 (95%CI 4.8,7.1)]; with a sensitivity of 88% and specificity of 74% for a score of 12. The odds of MSPA increased 1.49 times (95%CI 1.28,1.74) per unit increase in ALQ. Conclusions:, ALQ can help both to identify patients with asthma and to differentiate those more likely to have moderate/severe asthma. These are relevant characteristics for the possible use of this simple, self-administered questionnaire in the assessment of asthma patients needing additional medical management. [source] Nitrites in induced sputum as a simple and cheap non-invasive marker of airway inflammation for asthmatic schoolchildrenPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 5 2008Arturo Recabarren To determine if there are differences in the nitric oxide metabolites (nitrites) in sputum of patients with persistent asthma and healthy schoolchildren, we performed a case-control study in a tertiary care hospital in Arequipa, Perú. Nitrites in induced sputum samples were measured using the Griess assay in 30 persistent asthmatics (mean age of 10.1 yr) and 30 controls (mean age of 11.9 yr). The mean ± s.d. of nitrites among asthmatics was significantly higher than the controls (16.30 ± 8.6 vs. 10.25 ± 4.68 nmol/ml, respectively, p = 0.001). Moreover, the nitrite level in the sputum in children with severe persistent asthma was higher than in the level found in the moderate and mild asthmatics (32.83 ± 9.48 vs. 18.10 ± 1.96 vs. 11.84 ± 4.73 nmol/ml, respectively, p < 0.01 for linear trend). This study showed for the first time in children that asthmatics have significantly higher levels of nitrites in induced sputum than healthy controls and that the level of nitrite correlates with the severity of the asthma. Nitrite levels in sputum, a simple and cheap, non-invasive method, may be a good alternative to measure the severity of inflammation in asthmatic children. [source] Unmet need in inadequately controlled asthmaRESPIROLOGY, Issue 2007Richard BEASLEY Abstract: Over the last 20 years in Australia, outcomes have improved for patients with asthma. With the advent of inhaled corticosteroids and long-acting beta agonists, and improvements in management including implementation of the guided self-management plan system of care, the mortality rate for asthma has fallen by almost half. However, despite huge improvements, there remains a small but significant cohort of patients with inadequately controlled severe persistent asthma. This group of patients consumes a substantial proportion of public health resources. Patients who have poorly controlled asthma, despite receiving ,optimal' treatment, are the ones most likely to benefit from new therapies such as those that target IgE. This presentation provides an overview of severe asthma in terms of prevalence and morbidity, mortality, economic costs and then considers a way forward in terms of identifying patients in greatest need of novel treatment such as omalizumab. [source] Efficacy and safety of inhaled ciclesonide compared with chlorofluorocarbon beclomethasone dipropionate in adults with moderate to severe persistent asthma,RESPIROLOGY, Issue 4 2007Mitsuru ADACHI Background and objective: Inhaled corticosteroids are recognized as first-line therapy in the management of asthma; however, their use may be limited by systemic and local side-effects. Ciclesonide, a novel pro-drug inhaled corticosteroid, is activated in the lungs and is expected to have less systemic and local side-effects. This study evaluated the efficacy and safety of ciclesonide in hydrofluoroalkane (HFA) compared with beclomethasone dipropionate (BDP) in a chlorofluorocarbon (CFC) formulation in adult patients with moderate to severe asthma. Methods: This was a multicentre, randomized, open-label, parallel-group comparative study. The patients were given 800 ,g/day of CFC-BDP in the four-week baseline period. After the baseline period, 319 patients were randomly allocated into three groups which, respectively, received HFA-ciclesonide 400 ,g/day (without a spacer), HFA-ciclesonide 800 ,g/day (without spacer) and CFC-BDP 800 ,g/day (with spacer) for the eight-week treatment period. The primary efficacy variable was morning PEF. Results: The morning PEF increased by 16.02 L/min in the 400 ,g HFA-ciclesonide group, 23.98 L/min in the 800 ,g HFA-ciclesonide group and 5.91 L/min in the 800 ,g CFC-BDP group. Better outcomes were achieved by the use of 800 ,g/day of HFA-ciclesonide compared with 800 ,g/day of CFC-BDP (P = 0.001). There was no difference in adverse events between the groups. Conclusion: In adult patients with moderate to severe asthma, 800 ,g/day of HFA-ciclesonide was significantly more effective than 800 ,g/day of CFC-BDP. Ciclesonide at doses of 400 ,g/day and 800 ,g/day was safe and well tolerated. [source] A need for circulating biomarkers of severe persistent asthma and its treatmentCLINICAL & EXPERIMENTAL ALLERGY, Issue 11 2006S. T. Holgate No abstract is available for this article. [source] Presentation of new GINA guidelines for paediatricsCLINICAL & EXPERIMENTAL ALLERGY, Issue 2000Von Mutius The Global Initiative on Asthma (GINA) has provided guidelines for the management of children with asthma. For a step-wise approach to therapy, asthma is divided into four categories based on severity of symptoms: intermittent, mild persistent, moderate persistent, and severe persistent asthma. Long-term preventive therapy is distinguished from quick relief therapy in each group. Although these guidelines are clear and simple there have been few studies on asthma therapy for infants. Moreover, the existence of different wheezing phenotypes with varying pathogenic mechanisms hampers the interpretation of these studies. Transient wheezers have stopped wheezing by the age of 3 years and there is no relationship to atopy or a family history of asthma. In contrast, persistent wheezers continue to wheeze from the first year of life throughout school-age and have a high risk of atopy. Although they have normal lung function at birth, persistent wheezers develop significant decrements in lung function by the age of 6 years. Whether these impairments are amenable to prevention by early initiation of anti-inflammatory therapy remains to be seen. At present, there are no disease markers to identify the different wheezing phenotypes in infancy, although eosinophil counts and measurements of eosinophil cationic protein in serum may prove to be helpful in distinguishing these conditions. [source] | ||||||||||