Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
247,150
result(s) for
"ASTHMA"
Sort by:
Asthma
\"Describes what it is like to live with asthma, what its symptoms are, and how it is treated\"-- Provided by publisher.
Book
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
T-helper Type 2-driven Inflammation Defines Major Subphenotypes of Asthma
T-helper type 2 (Th2) inflammation, mediated by IL-4, IL-5, and IL-13, is considered the central molecular mechanism underlying asthma, and Th2 cytokines are emerging therapeutic targets. However, clinical studies increasingly suggest that asthma is heterogeneous.
To determine whether this clinical heterogeneity reflects heterogeneity in underlying molecular mechanisms related to Th2 inflammation.
Using microarray and polymerase chain reaction analyses of airway epithelial brushings from 42 patients with mild-to-moderate asthma and 28 healthy control subjects, we classified subjects with asthma based on high or low expression of IL-13-inducible genes. We then validated this classification and investigated its clinical implications through analyses of cytokine expression in bronchial biopsies, markers of inflammation and remodeling, responsiveness to inhaled corticosteroids, and reproducibility on repeat examination.
Gene expression analyses identified two evenly sized and distinct subgroups, \"Th2-high\" and \"Th2-low\" asthma (the latter indistinguishable from control subjects). These subgroups differed significantly in expression of IL-5 and IL-13 in bronchial biopsies and in airway hyperresponsiveness, serum IgE, blood and airway eosinophilia, subepithelial fibrosis, and airway mucin gene expression (all P < 0.03). The lung function improvements expected with inhaled corticosteroids were restricted to Th2-high asthma, and Th2 markers were reproducible on repeat evaluation.
Asthma can be divided into at least two distinct molecular phenotypes defined by degree of Th2 inflammation. Th2 cytokines are likely to be a relevant therapeutic target in only a subset of patients with asthma. Furthermore, current models do not adequately explain non-Th2-driven asthma, which represents a significant proportion of patients and responds poorly to current therapies.
Journal Article
P69 Peak flow variability in asthma diagnosis – which is the best threshold to use in practice?
IntroductionAlthough peak flow variability (PEFv) is one of the diagnostic tests in the NICE guidance for asthma (NG80), instructions on how to calculate PEFv are brief; PEFv can be expressed as amplitude% mean (A%M) or amplitude% highest (A%H, a simpler calculation). A positive test can be recorded if the average daily amplitude ≥20% (A%M20, advised in NG80), ≥15% (A%M15) or ≥10% (A%M10). We investigated the effect of changing the way a positive PEFv test is defined on the classification of adults and children with symptoms in keeping with asthma.MethodsAdults and children with symptoms in keeping with asthma were referred by primary care for a thorough evaluation. Participants were asked to record PEF at least twice per day for two weeks with an electronic PEF meter. Participants completed a detailed panel of lung function tests and were treated with ICS for 8 weeks. All tests and response to treatment were evaluated by a panel of consultant respiratory physicians and participants were diagnosed with asthma or not asthma (or insufficient evidence). We calculated sensitivity and specificity of different PEFv thresholds in diagnosing asthmaResultsOf the 117 symptomatic participants recruited into the study, 91 (50 adults) completed PEF measurements for ≥4 days (median 10 days [IQR 8–12 days]). A significant correlation (R=0.927) was found between PEFv for patients who collected ≥10 days PEF and their first 5 days of PEF data. Of 47 adults with sufficient data, 31 were diagnosed with asthma. Of 31 children with sufficient data, 23 had asthma. Sensitivity and specificity of different thresholds of PEFv are shown in table 1. Only 3 adults with asthma had PEFv A%M20, indicating this threshold is too high. Expressing results as A%M or A%H made little difference in sensitivity or specificity, as did using the first 5 days of data rather than all data collected.Abstract P69 Table 1Sensitivity = TP/(TP+FN) Specificity = TN/(TN+FP) Sensitivity All available readings Specificity All available readings Sensitivity using 1st 5 days only Specificity using 1st 5 days only Adults A%M20 9.7% 100% 12.9% 100% Adults A%H20 6.4% 100% 3.2% 100% Adults A%M15 16.1% 100% 22.6% 100% Adults A%H15 16.1% 100% 19.4% 100% Adults A%M10 54.8% 75% 45.2% 81.3% Adults A%H10 54.8% 81.3% 41.9% 93.4% Children A%M20 43.4% 100% 34.8% 100% Children A%H20 17.4% 100% 30.4% 100% Children A%M15 56.5% 87.5% 60.7% 87.5% Children A%H15 47.8% 87.5% 52.2% 100% Children A%M10 78.2% 87.5% 82.6% 87.5% Children A%H10 73.9% 87.5% 69.6% 87.5% ConclusionPEFv could be calculated as A%H10 for 5 days as part of the NICE CG80 diagnostic algorithm, as this is simpler to collect and to calculate, is more sensitive, and has little loss in specificity compared to A%M20 for 2 weeks.
Journal Article
Mepolizumab Treatment in Patients with Severe Eosinophilic Asthma
In patients with asthma who had elevated blood eosinophil levels and marginal asthma control despite treatment with high-dose inhaled or oral glucocorticoids, asthma exacerbations were reduced in those receiving a monoclonal antibody that binds to and inactivates interleukin-5.
Severe asthma affects less than 10% of patients with asthma and is associated with substantial morbidity and mortality and a large fraction of the health care costs among patients with asthma.
1
–
3
Despite available care, recurrent asthma exacerbations are a major issue in a subgroup of patients with eosinophilic airway inflammation.
4
–
6
Mepolizumab, a humanized monoclonal antibody against interleukin-5, selectively inhibits eosinophilic inflammation
7
,
8
and reduces the number of eosinophils in both sputum and blood, resulting in a reduction in exacerbations and in the need for treatment with systemic glucocorticoids.
7
–
12
In the Dose Ranging Efficacy and Safety with Mepolizumab . . .
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
Association between socioeconomic deprivation, ethnicity and health outcomes in preschool children with recurrent wheeze in England: a retrospective cohort study
BackgroundPreschool-aged children have among the highest burden of acute wheeze. We investigated differences in healthcare use, treatment and outcomes for recurrent wheeze/asthma in preschoolers from different ethno-socioeconomic backgrounds.MethodsRetrospective cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics in England. We reported number of acute presentations and hospitalisations stratified by index of multiple deprivation (IMD) and ethnicity; and factors associated with treatment non-escalation, and hospitalisation rates using multivariable logistic and Poisson regression models.Results194 291 preschool children were included. In children not trialled on asthma preventer medications, children from the most deprived IMD quintile (adjusted OR 1.67; 95% CI 1.53 to 1.83) and South Asian (1.77; 1.64 to 1.91) children were more likely to have high reliever usage and where specialist referral had not occurred, the odds of referral being indicated was higher in the most deprived quintile (1.39; 1.28 to 1.52) and South Asian (1.86; 1.72 to 2.01) children compared with the least deprived quintile and white children, respectively.Hospitalisation rates for wheeze/asthma were significantly higher in children from the most deprived quintile (adjusted IRR 1.20; 95% CI 1.13 to 1.27) compared with the least, and in South Asian (1.57; 1.44 to 1.70) and black (1.32; 1.22 to 1.42) compared with white children.ConclusionsWe identified inequalities in wheeze/asthma treatment and morbidity in preschool children from more deprived, and non-white backgrounds. A multifaceted approach to tackle health inequality at both the national and local levels, which includes a more integrated and standardised approach to treatment, is needed to improve health outcomes in children with preschool wheeze/asthma.
Journal Article