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Asthma
\"Describes what it is like to live with asthma, what its symptoms are, and how it is treated\"-- Provided by publisher.
Book
P66 Improving asthma outcomes in Lancashire and South Cumbria (L&SC) through SABA reduction and MART implementation with SENTINEL Plus
IntroductionThere has been a concern nationally regarding the over-reliance on SABA -only reliever among asthma patients which can lead to poor asthma control, increased risk of exacerbations, and potential long-term consequences including avoidable excess carbon footprint.Strategy for changeL&SC ICB joint working with AstraZeneca using SENTINEL Plus, a quality improvement programme that aims to improve asthma management in patients, identifying and addressing Short-acting Beta-2 Agonist (SABA) over-use and implementing Maintenance and Reliever Therapy (MART).MethodsFrom October 2023 to September 2024, Interface Pharmacy Services analysed routinely collected NHS data to form a baseline and conducted asthma reviews aligned with SENTINEL Plus in 20 practices where 14,590 asthma patients are registered. Clinicians were provided with educational sessions on asthma management to adopt sustainable implementation of the national guidance. Changes in prescribing practice were reported using descriptive statistics.Results1,048 patient reviews were undertaken.598 (57.1%) patients had their short acting bronchodilator SABA-only or short acting muscarinic antagonist (SAMA) stopped753 (71.9%) patients commenced on MART932 (88.9%) reviewed patients received advice on worsening asthma control and provision of a personalised asthma action plan89 patients out of 170 (52.3%) patients who smoke expressed wanting to stop smoking and were signposted/referred for smoking cessation service.1,039 (99%) patients had their inhaler checkedConclusionThe Lancashire and South Cumbria ICB joint working approach created a collaborative framework to encourage an interdisciplinary approach and foster partnerships across multiple stakeholders in the ICB.This resulted in a reduction in SABA-only prescribing, and an increase in MART. Implementing guideline recommended therapy is critical to improve outcomes and to support decarbonising healthcare delivery.ReferencesCrowther L, Pearson M, Cummings H, Crooks MG. Towards codesign in respiratory care: development of an implementation-ready intervention to improve guideline-adherent adult asthma care across primary and secondary care settings. BMJ Open Respiratory Research 2022 Feb 1;9(1):e001155.Wilkinson AJK, Maslova E, Janson C, Radhakrishnan V, Quint JK, Budgen N, Tran TN, Xu Y, Menzies-Gow A, Bell JP. Greenhouse gas emissions associated with suboptimal asthma care in the UK. Thorax 2024 Feb 27;79(5):412–21
Journal Article
Handy health guide to asthma
\"An overview of asthma for children in grades 5 and up. Find out what asthma is, what causes it, how it is diagnosed, and some treatment options\"-- Provided by publisher.
Book
P297 Budesonide/glycopyrronium/formoterol fumarate dihydrate triple therapy for inadequately-controlled asthma: KALOS and LOGOS study results
A long-acting muscarinic antagonist (LAMA) may be added to medium-/high-dose inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) therapy in patients with uncontrolled asthma. KALOS and LOGOS, two Phase 3, double-blind, double-dummy randomised studies, compared fixed-dose triple combination budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) with budesonide/formoterol fumarate dihydrate via metered-dose inhaler (MDI; BFF) and via pressurised MDI ([Symbicort®] BUD/FORM).Participants (≥12 y) with inadequately-controlled asthma despite ICS/LABA use were randomised (pooled N=4311) to BGF 320/28.8/10 µg, BGF 320/14.4/10 µg, BFF 320/10 µg or BUD/FORM 320/9 µg (BID) for 24 to 52 weeks. Key lung function endpoints included change from baseline in morning pre-dose trough FEV1 and FEV1 AUC0–3 over 24 weeks; Day 1 onset of action was also assessed. Pooled analyses across studies assessed severe exacerbation rate. Safety measures included AE monitoring.BGF 320/28.8/10 µg improved lung function endpoints in each study, and in the pooled analysis BGF 320/28.8/10 µg reduced severe exacerbation rate vs combined ICS/LABA comparator arms (BFF+BUD/FORM; see table 1 for European regulatory approach). AE frequency was comparable across treatments in each study.BGF 320/28.8/10 μg is superior to dual ICS/LABA in adults and adolescents with asthma inadequately-controlled by ICS/LABA.Abstract P297 Table 1Summary of primary and secondary efficacy endpoint results (European regulatory approach)
Journal Article
P195 Phenotypic characteristics associated with frequent asthma exacerbations on tezepelumab
IntroductionTezepelumab is an anti-TSLP biologic therapy with broad anti-inflammatory effects. Clinical trials have been demonstrated its ability to significantly reduce asthma exacerbations (AE) and allow clinical remission (CR) in some patients with uncontrolled, severe asthma (SA). However, a proportion of patients do not adequately respond and continue to exacerbate on tezepelumab. The clinical characteristics of these ‘non-responders’ is poorly understood.MethodsThe clinical response of individuals with SA established on treatment with tezepelumab at our regional severe asthma centre was analysed. The baseline characteristics of patients who achieved CR (defined as no AE, no maintenance OCS, ACQ6<1.5 and stable FEV1) was compared with non-responders (NR) defined as ≥2 exacerbations in the first year of tezepelumab.ResultsOut of a total cohort of 218 patients, 103 patients had either achieved CR (n=54, 25%) or fulfilled criteria for NR (n=49, 22%) and were compared. Baseline clinical characteristics associated with NR vs CR included lower FeNO (35ppb vs 66ppb, p<0.001), higher baseline ACQ6 (2.90 vs 1.95, p<0.001), maintenance OCS requirement (p=0.03), higher baseline AE rate (3.6 vs 2.3, p=0.009), child-onset asthma (p=0.01) and the absence of comorbid nasal polyposis (p=0.006). The reduction in FeNO from baseline to treatment was significantly greater in patients achieving CR compared to NR, with median (IQR) changes of -43 ppb (-70 to -13) versus -4 ppb (-25 to 3), respectively (p<0.0001).ConclusionOver 20% of individuals with SA continue to exacerbate frequently despite tezepelumab. Reduced efficacy in patients with lower baseline FeNO, child-onset asthma and the absence of nasal polyposis all point to an increased likelihood of non-T2 related exacerbation events in these patients.
Journal Article
P260 Bronchial hyperresponsiveness in asthma: the use of direct and indirect challenge testing at diagnosis
BackgroundBronchial challenge agents induce bronchoconstriction through distinct pathways, hence varying in sensitivity and specificity across patient cohorts. The BTS/NICE/SIGN 2024 asthma guidance recommends bronchial challenge testing (BCT) for diagnosis, but without specifying challenge agents. In contrast, ERS 2022 recommends a sequential approach: direct challenge followed by indirect if negative. We aim to establish the test concordance between methacholine and mannitol challenges (BCTMch and BCTMann) and identify predictors of response to each in both adults and children. We will also assess the added value of sequential testing in adults.MethodsSymptomatic and untreated children and adults with GP-suspected asthma were recruited into the RADicA study. Clinical history, examination and objective tests including fractional exhaled nitric oxide (FeNO), blood eosinophil counts (BEC), spirometry, bronchodilator reversibility (BDR), skin prick testing (SPT) and both direct BCTMch and BCTMann were performed (on separate days prior to inhaled corticosteroid treatment).ResultsOf 95 participants (median [IQR] age: 26.0 [13.2–39.1] years, 41.1% male) who completed both BCTMch and BCTMann, 35.8% had a positive BCTMann (PD15<635 mg), and 33.7% a positive BCTMch (PD20<0.2 mg), with an overall agreement of 78.9% between the two tests: nine individuals had positive BCTMch but negative BCTMann, compared to 11 BCTMann positive and BCTMch negative. Self-reported exercise-induced symptoms were not associated with either BCTMann or BCTMch outcomes. SPT, FeNO, BEC and BDR were associated with both positive BCTMann and BCTMch (table 1). In adults, following BTS/NICE/SIGN (2024) diagnostic pathway, 57–76% require BCT, of which 14–24% had positive BCTMann and 11–30% for BCTMch. Following ERS (2022) diagnostic pathway, 43–71% patients require BCTMch, 79–89% had a negative result, requiring further BCTMann; of these only 12–16% subsequently tested positive.Abstract P260 Table 1Univariate logistic regression for predicting positive BCTMann and BCTMch in both adults and childrenConclusionBCT is required in over half of cases using current UK and European diagnostic pathways; sequential testing advised by ERS, yields few additional diagnoses. We found no differential predictors of bronchial hyperresponsiveness between mannitol and methacholine. Given their moderate agreement, high cost and limited accessibility, identifying better predictors may help guide more efficient selection of challenge agents. This also highlight the urgent need for more accessible and efficient diagnostic tools.
Journal Article
Mighty Monty
Monty, a quiet first-grader, continues to come into his own--playing the part of a tree in a miscued school play, sharing his enthusiasm for ants at an outdoor birthday party, and even signing up for karate class despite his asthma.
Book
P205 Real world outcomes of Tezepelumab in obese and non-obese severe asthmatics
IntroductionObese patients with severe asthma have a distinct clinical phenotype. These patients are more likely to have low T2 biomarkers (T2low) so are less likely to meet criteria to be treated with most biologics. Use of Tezepelumab does not require raised eosinophils or FeNO so it may be able to reach this population. Here we present real world outcomes for patients treated with Tezepelumab comparing obese and non obese groups.MethodsData from our service registry were used to study asthma outcomes from Tezepelumab comparing the obese (BMI≥30 kg/m2 ) and the non obese population.ResultsA total of 142 patients were analysed (60% were obese). The cohort median BMI was 31.0 (27.2–37.2). At baseline, obese patients had non-significant trend of higher exacerbation frequency (5 vs 4.5 p=0.371), median ACQ (3.83 vs 3.5 p= 0.16) and mOCS use (8.4% vs 19.7% n=40 p =0.124) compared to non obese. 31.2% of patients had been treated with another biologic previously. Overall, 34.5% of patients were T2low.Outcomes for patients who completed 12 month trials are described in table 1.Trials were discontinued for adverse effects in 9.2% (n= 13/142 including rash and joint pains. 2.8% (n=4/142) of patients felt no improvement in their symptoms and so trials were discontinued early at their request. A further 2.1% (n=3) of patients did not attend (DNA) multiple appointments and so were unable to complete trials. There were no significant differences in the responses of obese and non obese in this regard.Abstract P205 Table 1Outcomes for patients who completed 12 month trialsConclusionTezepelumab improves asthma outcomes for both obese and non obese patients. However, obese patients still have significantly higher exacerbation frequency. Symptoms remain uncontrolled in the obese group though this did not reach statistical significance. However, this may be affected by the number of patients who did not complete a 12-month trial because of adverse effects or non improvement in symptoms. There is a need for other management options in obesity related severe asthma.
Journal Article