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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
Developing and Emerging Clinical Asthma Phenotypes
For more than a century, clinicians have attempted to subdivide asthma into different phenotypes based on triggers that cause asthma attacks, the course of the disease, or the prognosis. The first phenotypes that were described included allergic asthma, intrinsic or nonallergic asthma, infectious asthma, and aspirin-exacerbated asthma. These phenotypes are being reviewed elsewhere in this issue of the journal. The present article focuses on developing and emerging clinical asthma phenotypes. First, asthma phenotypes that are associated with environmental exposures (occupational agents, cigarette smoke, air pollution, cold dry air); second, asthma phenotypes that are associated with specific symptoms or clinical characteristics (cough, obesity, adult onset of disease); and third, asthma phenotypes that are based on biomarkers. This latter approach is the most promising because it attempts to identify asthma phenotypes with different underlying mechanisms so that therapies can be better targeted toward disease-specific features and disease outcomes can be improved.
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
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
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
S139 Efficacy of tezepelumab in patients with low and high bronchodilator reversibility in PATHWAY
Introduction and ObjectivesIn the phase 2b PATHWAY study (NCT02054130), tezepelumab reduced annualized asthma exacerbation rates (AAER) by up to 71% versus placebo in adults with severe, uncontrolled asthma. We evaluated the effect of tezepelumab on exacerbations in patients from PATHWAY with low and high bronchodilator reversibility.MethodsAdults with severe, uncontrolled asthma were randomized to receive tezepelumab (70 mg every 4 weeks [Q4W], 210 mg Q4W or 280 mg every 2 weeks) or placebo for 52 weeks. AAER and the rate of exacerbations resulting in hospitalization or emergency room (ER) visits were estimated for patients with low (<20%) and high (≥20%) forced expiratory volume in 1 second (FEV1) reversibility at baseline.ResultsOf 550 randomized patients, 299 and 251 had low and high FEV1 reversibility, respectively. Tezepelumab 210 mg (phase 3 dose) reduced AAER over 52 weeks by 70% (95% confidence interval [CI]: 41, 85) and 72% (95% CI: 32, 88) versus placebo in patients with low and high FEV1 reversibility, respectively. For pooled tezepelumab doses, AAER was reduced by 69% (95% CI: 50, 81) and 60% (95% CI: 26, 78) in the low and high groups, respectively. Data were similar for 70 and 280 mg. Exacerbations resulting in hospitalizations or ER visits were reduced by 85% (95% CI: 21, 97) and 78% (95% CI: −32, 96) versus placebo in patients with low and high FEV1 reversibility, respectively, for tezepelumab 210 mg, and by 84% (95% CI: 51, 94) and 64% (95% CI: −18, 89) in the pooled tezepelumab group, respectively.ConclusionsTezepelumab treatment reduced AAER irrespective of baseline bronchodilator reversibility, further supporting its potential benefits in a broad population of patients with severe asthma.
Journal Article
