Risk factors of frequent exacerbations in difficult-to-treat asthma
ten A. Brinke,P. J. Sterk,Ad A.M. Masclee,Ph. Spinhoven,J.T. Schmidt,A. H. Zwinderman,K. F. Rabe,Elisabeth H. Bel +7 more
TLDR
The results show that recurrent exacerbations in asthma are associated with specific co-morbid factors that are easy to detect and that are treatable and Therapeutic interventions aimed at correcting these factors are likely to reduce morbidity and medical expenditure in patients with asthma.Abstract:
Recurrent exacerbations are a major cause of morbidity and medical expenditure in patients with asthma. Various exogenous and endogenous factors are thought to influence the level of asthma control, but systematical data on the involvement of these factors in the recurrence of asthma exacerbations are scarce. In this study, 13 clinical and environmental factors potentially associated with recurrent exacerbations were investigated in 136 patients with difficult-to-treat asthma. Patients with more than three severe exacerbations (n = 39) in the previous year were compared with those with only one exacerbation per year (n = 24). A systematic diagnostic protocol was used to assess 13 potential risk factors. Factors significantly associated with frequent exacerbations included: severe nasal sinus disease (adjusted odds ratio (OR) 3.7); gastro-oesophageal reflux (OR 4.9); recurrent respiratory infections (OR 6.9); psychological dysfunctioning (OR 10.8); and obstructive sleep apnoea (OR 3.4). Severe chronic sinus disease and psychological dysfunctioning were the only independently associated factors (adjusted OR 5.5 and 11.7, respectively). All patients with frequent exacerbations exhibited at least one of these five factors, whilst 52% showed three or more factors. In conclusion, the results show that recurrent exacerbations in asthma are associated with specific co-morbid factors that are easy to detect and that are treatable. Therapeutic interventions aimed at correcting these factors are likely to reduce morbidity and medical expenditure in these patients.read more
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International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma
Kian Fan Chung,Sally E. Wenzel,Jan Brozek,Andrew Bush,Mario Castro,Peter J. Sterk,Ian M. Adcock,Eric D. Bateman,Elisabeth H. Bel,Eugene R. Bleecker,Louis-Philippe Boulet,Christopher E. Brightling,Pascal Chanez,Sven-Erik Dahlén,Ratko Djukanovic,Urs Frey,Mina Gaga,Peter G. Gibson,Qutayba Hamid,Nizar N. Jajour,Thais Mauad,Ronald L. Sorkness,W. Gerald Teague +22 more
TL;DR: Recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults and coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy are provided.
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An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice.
Helen K. Reddel,D. Robin Taylor,Eric D. Bateman,Louis-Philippe Boulet,Homer A. Boushey,William W. Busse,Thomas B. Casale,Pascal Chanez,Paul L. Enright,Peter G. Gibson,Johan C. de Jongste,Huib A. M. Kerstjens,Stephen C. Lazarus,Mark L Levy,Paul M. O'Byrne,Martyn R Partridge,Ian D. Pavord,Malcolm R. Sears,Peter J. Sterk,Stuart W. Stoloff,Sean D. Sullivan,Stanley J. Szefler,Mike Thomas,Sally E. Wenzel +23 more
TL;DR: New definitions for asthma control, severity, and exacerbations are developed, based on current treatment principles and clinical and research relevance, to provide a basis for a multicomponent assessment of asthma by clinicians, researchers, and other relevant groups in the design, conduct, and evaluation of clinical trials, and in clinical practice.
Journal ArticleDOI
Endotyping asthma: new insights into key pathogenic mechanisms in a complex, heterogeneous disease
TL;DR: This approach is already suggesting entirely novel pathways to disease-eg, alternative macrophage specification, steroid refractory innate immunity, the interleukin-17-regulatory T-cell axis, epidermal growth factor receptor co-amplification, and Th2-mimicking but non-T-cell,interleukins 18 and 33 dependent processes that can offer unexpected therapeutic opportunities for specific patient endotypes.
Journal ArticleDOI
Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program
Wendy C. Moore,Eugene R. Bleecker,Douglas Curran-Everett,Serpil C. Erzurum,Bill T. Ameredes,Leonard B. Bacharier,William J. Calhoun,Mario Castro,Kian Fan Chung,Melissa P. Clark,Raed A. Dweik,Anne M. Fitzpatrick,Benjamin Gaston,Mark Hew,Iftikhar Hussain,Nizar N. Jarjour,Elliot Israel,Bruce D. Levy,James Murphy,Stephen P. Peters,W. Gerald Teague,Deborah A. Meyers,William W. Busse,Sally E. Wenzel,Sally E. Wenzel,Sally E. Wenzel +25 more
TL;DR: Severe asthma is characterized by abnormal lung function that is responsive to bronchodilators, a history of sinopulmonary infections, persistent symptoms, and increased health care utilization.
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