Novel treatments for asthma: Corticosteroids and other anti-inflammatory agents.pharmaindexing
Asthma management is a challenge due to the prevalence of disease in the world. Based on the immunological and inflammatory mechanisms of asthma, corticosteroids and anti-inflammatory participate greatly in the treatment plan. Due to different reasons, there is still an unmet need to develop new agents in this field. A lot of compounds with anti-inflammatory effect are investigated in both pre-clinical and clinical studies.
Novel treatments for asthma corticosteroids and other anti inflammatory agents.pharmaindexing
The document discusses novel treatments for asthma, focusing on corticosteroids and other anti-inflammatory agents. It notes that while inhaled corticosteroids are currently the gold standard for asthma treatment, some patients experience side effects or resistance to the drugs. Researchers are working to develop dissociated corticosteroids that separate anti-inflammatory and side effect mechanisms. Other promising anti-inflammatory treatments discussed include phosphodiesterase 4 inhibitors like roflumilast, which may provide additional treatment options but also have gastrointestinal side effects. Overall the review examines current asthma therapies and novel agents under investigation to improve treatment outcomes.
Antihistamines and-asthma-patients-2002Dr P Deepak
H1 antihistamines are not first-line treatment for asthma but should not be withheld when needed to treat other conditions like allergic rhinitis. While not a replacement for other asthma medications, H1 antihistamines have demonstrated bronchoprotective effects and modest bronchodilation. Their benefits in asthma appear to be dose-related. For mild intermittent asthma with allergic rhinitis, H1 antihistamines can improve asthma symptoms. In moderate persistent asthma, some H1 antihistamines show clinical benefits including steroid-sparing effects, but risks may outweigh benefits at high doses. H1 antihistamines are not expected to provide significant benefits for severe persistent asthma.
ASTHMA CHALLENGES FOR TRIPLE DRUG OUTCOMES BETTER OR NOTdranimesharya
The document discusses challenges in asthma management from both patient and physician perspectives. It notes that while guidelines recommend regular inhaled corticosteroid (ICS) use, many patients have poor adherence due to a variety of factors like a lack of symptoms, misconceptions about asthma medications, and steroid phobia. Both patients and physicians often have misaligned views of asthma control, with patients underestimating their level of control. Effective communication between physicians and patients is important to address misunderstandings and optimize treatment plans.
This document discusses the pharmacotherapy of bronchial asthma. It begins by defining asthma as a chronic inflammatory airway disorder characterized by variable airflow obstruction and airway hyperresponsiveness. It then discusses the risk factors, pathophysiology, clinical presentation, diagnosis, and therapeutic objectives of asthma. The mainstay of treatment involves reliever medications like short-acting beta-agonists for acute symptoms and controller medications like inhaled corticosteroids to control inflammation and reduce exacerbations. The document outlines the specific drug classes used for treatment, including beta-agonists, anticholinergics, corticosteroids, leukotriene modifiers, mast cell stabilizers, anti-IgE, and anti-IL5 monoclonal antibodies
This document discusses the pharmacology of drugs used to treat asthma. It begins by outlining the objectives of understanding medications for asthma, their mechanisms of action, and side effects. It then presents a clinical case of an 8-year-old boy diagnosed with asthma who is prescribed an albuterol inhaler. The document goes on to describe the pathophysiology of asthma and the different types. It focuses on the major drug classes used to treat asthma, including bronchodilators, methylxanthines, beta-adrenergic agonists, mast cell stabilizers, and corticosteroids. Their mechanisms of action and side effects are explained.
Treat to target in inflammatory diseases SMMI 2018SMMI2015
In conclusion, treat to target is a new paradigm that involves regular disease assessment, therapy adaptation, and consideration of patient factors. Integration into daily
Diagnosis and Outpatient Management of Chronic Obstructive Pulmonary Diseasehuynhtrung2511
The document provides an overview of the diagnosis and outpatient management of chronic obstructive pulmonary disease (COPD). It discusses the following key approaches: smoking cessation, vaccinations, bronchodilators, inhaled corticosteroids, long-term oxygen therapy, pulmonary rehabilitation, and treatments for persistent exacerbations. Specific recommendations are provided for each approach based on the latest clinical practice guidelines and evidence from research studies.
Novel treatments for asthma: Corticosteroids and other anti-inflammatory agents.pharmaindexing
Asthma management is a challenge due to the prevalence of disease in the world. Based on the immunological and inflammatory mechanisms of asthma, corticosteroids and anti-inflammatory participate greatly in the treatment plan. Due to different reasons, there is still an unmet need to develop new agents in this field. A lot of compounds with anti-inflammatory effect are investigated in both pre-clinical and clinical studies.
Novel treatments for asthma corticosteroids and other anti inflammatory agents.pharmaindexing
The document discusses novel treatments for asthma, focusing on corticosteroids and other anti-inflammatory agents. It notes that while inhaled corticosteroids are currently the gold standard for asthma treatment, some patients experience side effects or resistance to the drugs. Researchers are working to develop dissociated corticosteroids that separate anti-inflammatory and side effect mechanisms. Other promising anti-inflammatory treatments discussed include phosphodiesterase 4 inhibitors like roflumilast, which may provide additional treatment options but also have gastrointestinal side effects. Overall the review examines current asthma therapies and novel agents under investigation to improve treatment outcomes.
Antihistamines and-asthma-patients-2002Dr P Deepak
H1 antihistamines are not first-line treatment for asthma but should not be withheld when needed to treat other conditions like allergic rhinitis. While not a replacement for other asthma medications, H1 antihistamines have demonstrated bronchoprotective effects and modest bronchodilation. Their benefits in asthma appear to be dose-related. For mild intermittent asthma with allergic rhinitis, H1 antihistamines can improve asthma symptoms. In moderate persistent asthma, some H1 antihistamines show clinical benefits including steroid-sparing effects, but risks may outweigh benefits at high doses. H1 antihistamines are not expected to provide significant benefits for severe persistent asthma.
ASTHMA CHALLENGES FOR TRIPLE DRUG OUTCOMES BETTER OR NOTdranimesharya
The document discusses challenges in asthma management from both patient and physician perspectives. It notes that while guidelines recommend regular inhaled corticosteroid (ICS) use, many patients have poor adherence due to a variety of factors like a lack of symptoms, misconceptions about asthma medications, and steroid phobia. Both patients and physicians often have misaligned views of asthma control, with patients underestimating their level of control. Effective communication between physicians and patients is important to address misunderstandings and optimize treatment plans.
This document discusses the pharmacotherapy of bronchial asthma. It begins by defining asthma as a chronic inflammatory airway disorder characterized by variable airflow obstruction and airway hyperresponsiveness. It then discusses the risk factors, pathophysiology, clinical presentation, diagnosis, and therapeutic objectives of asthma. The mainstay of treatment involves reliever medications like short-acting beta-agonists for acute symptoms and controller medications like inhaled corticosteroids to control inflammation and reduce exacerbations. The document outlines the specific drug classes used for treatment, including beta-agonists, anticholinergics, corticosteroids, leukotriene modifiers, mast cell stabilizers, anti-IgE, and anti-IL5 monoclonal antibodies
This document discusses the pharmacology of drugs used to treat asthma. It begins by outlining the objectives of understanding medications for asthma, their mechanisms of action, and side effects. It then presents a clinical case of an 8-year-old boy diagnosed with asthma who is prescribed an albuterol inhaler. The document goes on to describe the pathophysiology of asthma and the different types. It focuses on the major drug classes used to treat asthma, including bronchodilators, methylxanthines, beta-adrenergic agonists, mast cell stabilizers, and corticosteroids. Their mechanisms of action and side effects are explained.
Treat to target in inflammatory diseases SMMI 2018SMMI2015
In conclusion, treat to target is a new paradigm that involves regular disease assessment, therapy adaptation, and consideration of patient factors. Integration into daily
Diagnosis and Outpatient Management of Chronic Obstructive Pulmonary Diseasehuynhtrung2511
The document provides an overview of the diagnosis and outpatient management of chronic obstructive pulmonary disease (COPD). It discusses the following key approaches: smoking cessation, vaccinations, bronchodilators, inhaled corticosteroids, long-term oxygen therapy, pulmonary rehabilitation, and treatments for persistent exacerbations. Specific recommendations are provided for each approach based on the latest clinical practice guidelines and evidence from research studies.
1) Combination DMARD therapy is superior to monotherapy in treating rheumatoid arthritis, with methotrexate as the cornerstone. Studies show combinations of traditional DMARDs can be as effective as combinations including biologics.
2) The COBRA trial demonstrated the benefits of initial intensive combination therapy including prednisolone, methotrexate, and sulfasalazine, followed by tapering medications. Benefits were seen even after medications were withdrawn.
3) Triple therapy with methotrexate, hydroxychloroquine and sulfasalazine is effective and durable for rheumatoid arthritis, shown in trials to be superior to double therapies and monotherapy.
The document provides guidelines for the treatment of Acute Respiratory Distress Syndrome (ARDS). It discusses factors that cause ARDS and the spectrum of lung injury. Treatment guidelines cover oxygenation, ventilation, positioning, fluid management, and other modalities. Oxygenation goals aim to optimize oxygen levels while minimizing pressure and volume. Ventilation aims for low tidal volumes and pressures. Prone positioning may reduce mortality but did not consistently improve outcomes in studies. Conservative fluid management improved some outcomes compared to liberal management with no increase in complications.
Format 2016: how to get asthma control: from PubMed to the tricks of the trade.Envicon Medical Srl
This document discusses strategies for achieving asthma control. It begins by establishing the importance of a partnership between healthcare providers and patients. Effective self-regulation is key, which involves patients observing their condition, making judgments, and reacting appropriately. Motivational interviewing can help patients progress through stages of change. Active listening from providers helps address patients' cognitive and emotional needs. Both verbal and nonverbal communication impact the relationship and treatment outcomes. Involving children in their care can improve satisfaction and adherence.
This document presents a consensus on the diagnosis, management, and treatment of severe uncontrolled asthma. It defines severe asthma as requiring high doses of inhaled corticosteroids (ICS), with or without oral corticosteroids (OCS), to achieve control of symptoms and prevent exacerbations. Control refers to the level of symptom reduction achieved with treatment, while severity is an intrinsic characteristic of the underlying disease. The document proposes diagnostic algorithms and definitions for severe asthma and its various levels of control. It also describes different phenotypes and potential treatments for severe uncontrolled asthma.
The primary aims of COPD drug research are to develop agents capable of either inhibiting COPD-mediating inflammatory cell recruitment and activation directly, or indirectly - by targeting inflammatory mediators and blocking them from interacting with inflammatory cells.
As neutrophilic inflammation is present in most COPD cases, so first attempts at developing biologics for COPD therapy have focused on targeting the mechanisms of T1 inflammation.
Attempts at safe and effective mAb-mediated CXCR2 inhibition and TNF-a inhibition have also been unsuccessful, with high incidence of adverse effects and no improvements in patient health found in clinical trials.
Thus, further attempts at COPD biologics have turned their attention to primarily treating COPD related eosinophilia.
Asthma Medications in Clinical Practice - Part 1Ashraf ElAdawy
Asthma is a chronic inflammatory disease of the airways that cannot be cured but can be controlled. While medications are available to manage asthma, over half of patients still have poor control of their symptoms. Asthma deaths are preventable but still occur due to inappropriate management such as overreliance on reliever medications instead of preventer medications. The goal of asthma treatment is to control the disease through the stepwise use of controller medications such as inhaled corticosteroids in combination with reliever medications as needed. Proper inhaler technique and medication adherence are important for achieving optimal asthma control.
Management of severe asthma an update 2014avicena1
This document discusses the management of severe asthma. It begins by defining several phenotypes of severe asthma, including refractory asthma and steroid-dependent asthma. It then reviews the diagnostic criteria for severe asthma established by the American Thoracic Society and European Respiratory Society, which requires one or more major criteria and two or more minor criteria. The document further discusses approaches to diagnosing and treating severe asthma, including evaluating for alternative diagnoses, assessing treatment compliance and triggers, addressing comorbidities, and considering immunotherapy options. It emphasizes the importance of phenotyping and endotyping asthma to enable personalized treatment approaches.
Medication use in chronic lung disease Shira Persona
This document discusses medication use in chronic lung diseases like COPD. It outlines different classes of bronchodilators and anti-inflammatory drugs used to treat chronic lung diseases, including beta agonists, antimuscarinics, methylxanthines, inhaled corticosteroids, oral glucocorticoids, PDE-4 inhibitors, antibiotics, and mucolytics. It provides details on recommended dosing and side effects of these medications. The document also discusses the roles of supplemental treatments like vaccines, alpha-1 antitrypsin augmentation therapy, and antitussives in chronic lung disease management.
This document discusses pulmonary pharmacology, focusing on asthma treatment. It begins by outlining the pathophysiology of asthma, involving mast cell activation and inflammation. It then classifies different types of asthma drugs, including bronchodilators like beta-2 agonists, methylxanthines, and muscarinic antagonists. It also discusses corticosteroids' mechanism of reducing inflammation. The document provides details on drug classes, specific medications, dosages, and side effects for treating both acute and chronic asthma, as well as other respiratory conditions like cough.
1. This document presents the case study of an 83-year-old female former smoker who was hospitalized for her third time with an exacerbation of COPD. She presented with worsening cough, shortness of breath, fever, loss of appetite and vomiting.
2. Her medical history includes hypertension, gout, dyslipidemia, and lumbosacral spondylosis. She has a history of COPD since 2016 and two previous admissions in 2018 for hypertensive urgency and a stomach ulcer.
3. Her impression upon arrival was a non-infective acute exacerbation of COPD and hyponatremia secondary to poor oral intake from her thiazide medication.
Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition caused by infection, injury or other insults that leads to hypoxemia. It is characterized by diffuse alveolar damage and impaired gas exchange. ARDS has a mortality rate ranging from 27-45% depending on severity. Treatment involves lung-protective ventilation with low tidal volumes, conservative fluid management, prone positioning in severe cases, paralysis and consideration of steroids in refractory cases. Refractory ARDS may be treated with extracorporeal membrane oxygenation.
Chronic Obstructive Pulmonary Disease basis of drugs used in treatment and Describe the factors which affect the quality of life of individuals suffering from COPD
This document discusses the optimal management of severe or refractory asthma. It defines refractory asthma based on medication requirements, symptoms, exacerbations, and airflow limitation. The pathology of refractory asthma involves persistent airway inflammation often with neutrophils and structural changes like increased smooth muscle mass. Treatment involves confirming the diagnosis, treating exacerbating factors, and optimizing standard pharmacotherapy with inhaled corticosteroids and additional controllers. For uncontrolled cases, alternative options like macrolide antibiotics, antifungals, omalizumab, and bronchial thermoplasty may be considered.
This document outlines learning objectives for a lecture on treating asthma and COPD. The objectives cover indications, mechanisms of action, adverse effects and contraindications of drugs used to treat respiratory diseases. Major classes of drugs are listed, including beta-agonists, corticosteroids, anticholinergics, and leukotriene modifiers. The objectives also describe pharmacokinetics, drug interactions, and toxicities of these medications.
This document discusses a study on the use of intravenous magnesium sulfate for treating acute severe asthma. The authors disagree with a conclusion from the study that IV magnesium should be added to conventional treatment. They argue that the standard therapy used in the study, nebulized beta-agonists and corticosteroids, was limited since combining an anticholinergic like ipratropium bromide is now the recommended treatment. The authors conducted their own study combining high doses of salbutamol and ipratropium bromide, which showed greater lung function improvements compared to the magnesium study. In conclusion, while magnesium may help those with very severe asthma, future studies should combine it with the evidence-based treatment of beta-
Week 2 Discussion-2nd reply
Jessica Alper
Chief complaint
The chief complaint that this fifteen-year-old patient is complaining of is shortness of breath and nonproductive nocturnal cough.
Primary and differential diagnoses
The patient states that she typically only feels the stated symptoms after working out, but lately she has consistently felt that way. She denies symptoms related to upper respiratory system, gastrointestinal, or urinary. The objective findings reveal vital signs that are within normal limits and the patient is in no signs of respiratory distress. Assessment of head, eyes, ears, nose, and throat are not impressive, and the inspection of the anterior and posterior chest show no abnormalities. While auscultating the patient’s chest, decreased air movement and high-pitched whistling on expiration was observed. The lungs were also noted to be resonant upon percussion.
The primary diagnosis for this patient is severe persistent asthma. Asthma is defined as complex and it typically involves airway inflammation, intermittent airflow obstruction, as well as bronchial hyperresponsiveness. Symptoms usually involve wheezing, coughing, shortness of breath, as well as chest tightness and pain (Morris, 2022). The patient is feeling these same symptoms daily, multiple times a day, and throughout the night, with a nocturnal nonproductive cough, therefore this is the final diagnosis for this patient.
The first differential diagnosis is viral bronchiolitis, which is defined as “an acute inflammatory injury of the bronchioles that is usually caused by a viral infection” (Maraqa, 2021). Congestive heart failure is another differential diagnosis as well as chronic sinusitis. Congestive heart failure is a condition that causes pulmonary vessels and interstitial pulmonary edema, reducing the compliance of the lungs, therefore leading to a feeling of dyspnea and wheezing (Morris, 2022). Acute sinusitis is an “inflammatory process involving the paranasal sinus” (Brook, 2022), and it may be associated with allergies. It can lead to unproductive cough as well as exacerbation of asthma.
Treatment plan
The goal of asthma is to control it as best as possible. An ideal goal for a 15-year-old child is to have less than 2 days per week in which the patient will have an attack, along with less than twice per month of nightly awakenings. According to the symptoms, this patient should follow step 4 or step 5 of the guidelines. Step 4 would include a medium-dose inhaled corticosteroids, as well as long-acting beta agonist. If the patient did not respond to this treatment, an alternative plan including a medium-dose inhaled corticosteroid and a leukotriene receptor antagonist or Theophylline may be used. If both these treatments fail, then the patient should be moved to step 5 of treatment, which includes a high-dose inhaled corticosteroid and a long-acting beta agonist would be prescribed (Managing Asthma, 2022). It is also important to orde ...
This document discusses treatment options for treatment-resistant depression (TRD). It defines TRD as major depression that does not resolve with adequate antidepressant treatment. Approximately 15-20% of depressed patients will have TRD. Treatment options discussed include optimization or augmentation of antidepressants, switching antidepressants, electroconvulsive therapy, transcranial magnetic stimulation, and vagus nerve stimulation. Future treatment options discussed are novel agents like S-adenosylmethionine and devices like deep brain stimulation. TRD poses substantial economic and disability burdens.
Role of Allergen Immunotherapy in Allergic Asthma | Jindal Chest Clinic Chand...Jindal Chest Clinic
Allergen immunotherapy (AIT) is a cost-effective, disease-modifying treatment for allergic diseases like asthma, offering both protective properties and disease-modifying effects against the allergic march. This presentation gives an overview on the topic "Role of Allergen Immunotherapy in Allergic Asthma ". For more information, please contact us: 9779030507.
Applications of NMR in Protein Structure Prediction.pptxAnagha R Anil
This presentation explores the pivotal role of Nuclear Magnetic Resonance (NMR) spectroscopy in predicting protein structures. It delves into the methodologies, advancements, and applications of NMR in determining the three-dimensional configurations of proteins, which is crucial for understanding their function and interactions.
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Similar to Asthma Severe DMAAD Thai thoracic 67 PDF
1) Combination DMARD therapy is superior to monotherapy in treating rheumatoid arthritis, with methotrexate as the cornerstone. Studies show combinations of traditional DMARDs can be as effective as combinations including biologics.
2) The COBRA trial demonstrated the benefits of initial intensive combination therapy including prednisolone, methotrexate, and sulfasalazine, followed by tapering medications. Benefits were seen even after medications were withdrawn.
3) Triple therapy with methotrexate, hydroxychloroquine and sulfasalazine is effective and durable for rheumatoid arthritis, shown in trials to be superior to double therapies and monotherapy.
The document provides guidelines for the treatment of Acute Respiratory Distress Syndrome (ARDS). It discusses factors that cause ARDS and the spectrum of lung injury. Treatment guidelines cover oxygenation, ventilation, positioning, fluid management, and other modalities. Oxygenation goals aim to optimize oxygen levels while minimizing pressure and volume. Ventilation aims for low tidal volumes and pressures. Prone positioning may reduce mortality but did not consistently improve outcomes in studies. Conservative fluid management improved some outcomes compared to liberal management with no increase in complications.
Format 2016: how to get asthma control: from PubMed to the tricks of the trade.Envicon Medical Srl
This document discusses strategies for achieving asthma control. It begins by establishing the importance of a partnership between healthcare providers and patients. Effective self-regulation is key, which involves patients observing their condition, making judgments, and reacting appropriately. Motivational interviewing can help patients progress through stages of change. Active listening from providers helps address patients' cognitive and emotional needs. Both verbal and nonverbal communication impact the relationship and treatment outcomes. Involving children in their care can improve satisfaction and adherence.
This document presents a consensus on the diagnosis, management, and treatment of severe uncontrolled asthma. It defines severe asthma as requiring high doses of inhaled corticosteroids (ICS), with or without oral corticosteroids (OCS), to achieve control of symptoms and prevent exacerbations. Control refers to the level of symptom reduction achieved with treatment, while severity is an intrinsic characteristic of the underlying disease. The document proposes diagnostic algorithms and definitions for severe asthma and its various levels of control. It also describes different phenotypes and potential treatments for severe uncontrolled asthma.
The primary aims of COPD drug research are to develop agents capable of either inhibiting COPD-mediating inflammatory cell recruitment and activation directly, or indirectly - by targeting inflammatory mediators and blocking them from interacting with inflammatory cells.
As neutrophilic inflammation is present in most COPD cases, so first attempts at developing biologics for COPD therapy have focused on targeting the mechanisms of T1 inflammation.
Attempts at safe and effective mAb-mediated CXCR2 inhibition and TNF-a inhibition have also been unsuccessful, with high incidence of adverse effects and no improvements in patient health found in clinical trials.
Thus, further attempts at COPD biologics have turned their attention to primarily treating COPD related eosinophilia.
Asthma Medications in Clinical Practice - Part 1Ashraf ElAdawy
Asthma is a chronic inflammatory disease of the airways that cannot be cured but can be controlled. While medications are available to manage asthma, over half of patients still have poor control of their symptoms. Asthma deaths are preventable but still occur due to inappropriate management such as overreliance on reliever medications instead of preventer medications. The goal of asthma treatment is to control the disease through the stepwise use of controller medications such as inhaled corticosteroids in combination with reliever medications as needed. Proper inhaler technique and medication adherence are important for achieving optimal asthma control.
Management of severe asthma an update 2014avicena1
This document discusses the management of severe asthma. It begins by defining several phenotypes of severe asthma, including refractory asthma and steroid-dependent asthma. It then reviews the diagnostic criteria for severe asthma established by the American Thoracic Society and European Respiratory Society, which requires one or more major criteria and two or more minor criteria. The document further discusses approaches to diagnosing and treating severe asthma, including evaluating for alternative diagnoses, assessing treatment compliance and triggers, addressing comorbidities, and considering immunotherapy options. It emphasizes the importance of phenotyping and endotyping asthma to enable personalized treatment approaches.
Medication use in chronic lung disease Shira Persona
This document discusses medication use in chronic lung diseases like COPD. It outlines different classes of bronchodilators and anti-inflammatory drugs used to treat chronic lung diseases, including beta agonists, antimuscarinics, methylxanthines, inhaled corticosteroids, oral glucocorticoids, PDE-4 inhibitors, antibiotics, and mucolytics. It provides details on recommended dosing and side effects of these medications. The document also discusses the roles of supplemental treatments like vaccines, alpha-1 antitrypsin augmentation therapy, and antitussives in chronic lung disease management.
This document discusses pulmonary pharmacology, focusing on asthma treatment. It begins by outlining the pathophysiology of asthma, involving mast cell activation and inflammation. It then classifies different types of asthma drugs, including bronchodilators like beta-2 agonists, methylxanthines, and muscarinic antagonists. It also discusses corticosteroids' mechanism of reducing inflammation. The document provides details on drug classes, specific medications, dosages, and side effects for treating both acute and chronic asthma, as well as other respiratory conditions like cough.
1. This document presents the case study of an 83-year-old female former smoker who was hospitalized for her third time with an exacerbation of COPD. She presented with worsening cough, shortness of breath, fever, loss of appetite and vomiting.
2. Her medical history includes hypertension, gout, dyslipidemia, and lumbosacral spondylosis. She has a history of COPD since 2016 and two previous admissions in 2018 for hypertensive urgency and a stomach ulcer.
3. Her impression upon arrival was a non-infective acute exacerbation of COPD and hyponatremia secondary to poor oral intake from her thiazide medication.
Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition caused by infection, injury or other insults that leads to hypoxemia. It is characterized by diffuse alveolar damage and impaired gas exchange. ARDS has a mortality rate ranging from 27-45% depending on severity. Treatment involves lung-protective ventilation with low tidal volumes, conservative fluid management, prone positioning in severe cases, paralysis and consideration of steroids in refractory cases. Refractory ARDS may be treated with extracorporeal membrane oxygenation.
Chronic Obstructive Pulmonary Disease basis of drugs used in treatment and Describe the factors which affect the quality of life of individuals suffering from COPD
This document discusses the optimal management of severe or refractory asthma. It defines refractory asthma based on medication requirements, symptoms, exacerbations, and airflow limitation. The pathology of refractory asthma involves persistent airway inflammation often with neutrophils and structural changes like increased smooth muscle mass. Treatment involves confirming the diagnosis, treating exacerbating factors, and optimizing standard pharmacotherapy with inhaled corticosteroids and additional controllers. For uncontrolled cases, alternative options like macrolide antibiotics, antifungals, omalizumab, and bronchial thermoplasty may be considered.
This document outlines learning objectives for a lecture on treating asthma and COPD. The objectives cover indications, mechanisms of action, adverse effects and contraindications of drugs used to treat respiratory diseases. Major classes of drugs are listed, including beta-agonists, corticosteroids, anticholinergics, and leukotriene modifiers. The objectives also describe pharmacokinetics, drug interactions, and toxicities of these medications.
This document discusses a study on the use of intravenous magnesium sulfate for treating acute severe asthma. The authors disagree with a conclusion from the study that IV magnesium should be added to conventional treatment. They argue that the standard therapy used in the study, nebulized beta-agonists and corticosteroids, was limited since combining an anticholinergic like ipratropium bromide is now the recommended treatment. The authors conducted their own study combining high doses of salbutamol and ipratropium bromide, which showed greater lung function improvements compared to the magnesium study. In conclusion, while magnesium may help those with very severe asthma, future studies should combine it with the evidence-based treatment of beta-
Week 2 Discussion-2nd reply
Jessica Alper
Chief complaint
The chief complaint that this fifteen-year-old patient is complaining of is shortness of breath and nonproductive nocturnal cough.
Primary and differential diagnoses
The patient states that she typically only feels the stated symptoms after working out, but lately she has consistently felt that way. She denies symptoms related to upper respiratory system, gastrointestinal, or urinary. The objective findings reveal vital signs that are within normal limits and the patient is in no signs of respiratory distress. Assessment of head, eyes, ears, nose, and throat are not impressive, and the inspection of the anterior and posterior chest show no abnormalities. While auscultating the patient’s chest, decreased air movement and high-pitched whistling on expiration was observed. The lungs were also noted to be resonant upon percussion.
The primary diagnosis for this patient is severe persistent asthma. Asthma is defined as complex and it typically involves airway inflammation, intermittent airflow obstruction, as well as bronchial hyperresponsiveness. Symptoms usually involve wheezing, coughing, shortness of breath, as well as chest tightness and pain (Morris, 2022). The patient is feeling these same symptoms daily, multiple times a day, and throughout the night, with a nocturnal nonproductive cough, therefore this is the final diagnosis for this patient.
The first differential diagnosis is viral bronchiolitis, which is defined as “an acute inflammatory injury of the bronchioles that is usually caused by a viral infection” (Maraqa, 2021). Congestive heart failure is another differential diagnosis as well as chronic sinusitis. Congestive heart failure is a condition that causes pulmonary vessels and interstitial pulmonary edema, reducing the compliance of the lungs, therefore leading to a feeling of dyspnea and wheezing (Morris, 2022). Acute sinusitis is an “inflammatory process involving the paranasal sinus” (Brook, 2022), and it may be associated with allergies. It can lead to unproductive cough as well as exacerbation of asthma.
Treatment plan
The goal of asthma is to control it as best as possible. An ideal goal for a 15-year-old child is to have less than 2 days per week in which the patient will have an attack, along with less than twice per month of nightly awakenings. According to the symptoms, this patient should follow step 4 or step 5 of the guidelines. Step 4 would include a medium-dose inhaled corticosteroids, as well as long-acting beta agonist. If the patient did not respond to this treatment, an alternative plan including a medium-dose inhaled corticosteroid and a leukotriene receptor antagonist or Theophylline may be used. If both these treatments fail, then the patient should be moved to step 5 of treatment, which includes a high-dose inhaled corticosteroid and a long-acting beta agonist would be prescribed (Managing Asthma, 2022). It is also important to orde ...
This document discusses treatment options for treatment-resistant depression (TRD). It defines TRD as major depression that does not resolve with adequate antidepressant treatment. Approximately 15-20% of depressed patients will have TRD. Treatment options discussed include optimization or augmentation of antidepressants, switching antidepressants, electroconvulsive therapy, transcranial magnetic stimulation, and vagus nerve stimulation. Future treatment options discussed are novel agents like S-adenosylmethionine and devices like deep brain stimulation. TRD poses substantial economic and disability burdens.
Role of Allergen Immunotherapy in Allergic Asthma | Jindal Chest Clinic Chand...Jindal Chest Clinic
Allergen immunotherapy (AIT) is a cost-effective, disease-modifying treatment for allergic diseases like asthma, offering both protective properties and disease-modifying effects against the allergic march. This presentation gives an overview on the topic "Role of Allergen Immunotherapy in Allergic Asthma ". For more information, please contact us: 9779030507.
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Applications of NMR in Protein Structure Prediction.pptxAnagha R Anil
This presentation explores the pivotal role of Nuclear Magnetic Resonance (NMR) spectroscopy in predicting protein structures. It delves into the methodologies, advancements, and applications of NMR in determining the three-dimensional configurations of proteins, which is crucial for understanding their function and interactions.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Allopurinol, a uric acid synthesis inhibitor acts by inhibiting Xanthine oxidase competitively as well as non- competitively, Whereas Oxypurinol is a non-competitive inhibitor of xanthine oxidase.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
Home
Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
1. Siwasak Juthong. M.D.
Respiratory and Respiratory Critical Care Unit, Division of Internal Medicine,
Faculty of Medicine, Prince of Songkla University, Songkhla
Time to Thinking of the Disease-Modifying
Anti-Asthma Drugs for Treatment of Severe Asthma
4. Lommatzsch M. et al. Lancet 2022; 399: 1664–68
Comparison of asthma treatment concepts in the 20th and 21st centuries
20th century 21st century
Maintenance or intermittent treatment
Systemic corticosteroids
Short-acting beta-2-agonist monotherapies or cromones
Ephedrine or methyxanthines
Biologics
Allergen Immunotherapy
Inhaled corticosteroids or leukotriene receptor antagonists
Reliever (as needed)
Early 20th century
Scopolamine or epinephrine Inhaled corticosteroids and formoterol
Short-acting beta-2 agonist monotherspies
Rescue medications
Side-effects
Short-term benefits:
Acute relief of symptoms Treatment concept and aim
Treatment with
Application to patients?
Patient perspectives
Long-tern benefits:
Disease modification
Remission
Major adverse effects Collateral efficiency
One size fits all Individual treatment
Anxiety
Recurrence symptoms
Safety
No symptoms
Preventive medications
5. Asthma guidelines should include a definition for remission as a treatment goal
GOALs for the treatment of asthma
Asthma treatment
Symptoms Future Risks
Dyspnea
Exercise limitation
Nocturnal symptom
Exacerbation
Lung function tests
Mortality
Disease modification and asthma remission as therapeutic goals
6. Focus on targeting type 2 inflammation (eg, ICS-containing inhalation, biologics,
allergen immunotherapy) are highly effective in reducing asthma exacerbations
and improving asthma control with few adverse effects by preventing
symptoms as well as by reducing future risks
Asthma treatments recommended by GINA
GINA 2023
7. Lommatzsch M, et al. Disease-modifying anti- asthmatic drugs. Lancet 2022; 399: 1664–68.
Definitions of asthma remission independent of the current treatment
status and combined with a long-term view of the partial or complete
remission of signs and symptoms (ie, for at least 12 months) unlike the shorter
periods considered in the concept of asthma control
With the advent of effective biologics for the treatment of severe asthma
and a growing number of symptom-free patients on treatment in real life,
this perspective has changed
The new era of asthma treatment goals
8. The management of asthma has changed fundamentally for the past 20 years
DMAADs = ICS-containing inhalations, leukotriene receptor antagonists,
biologics, and allergen immunotherapy
Disease-modifying anti-asthmatic drugs
Precise assessment and phenotyping are now required to establish
individually targeted treatment with disease-modifying anti-asthmatic drugs
(DMAADs)
Lommatzsch M. et al. Lancet Respir Med 2023; 11: 573–76
9. Disease modification and asthma remission as therapeutic goals
The development and approval of DMAADs has fundamentally changed the
asthma therapy concept from symptom control to symptom prevention
The concept new asthma treatment goal of asthma remission:
- long- term absence of symptoms (good asthma control)
- absence of exacerbations
- stable lung function
- no use of systemic steroids
Marek Lommatzsch. Allergologie select, Vol. 8/2024 (1-5)
10. Marek Lommatzsch. Allergologie select, Vol. 8/2024 (1-5)
A treat- to-target approach
Used as in rheumatoid arthritis or chronic inflammatory bowel disease
The goal is to achieve asthma remission, through individually tailored
treatment with highly effective drugs with minimal side effects
Requires precise phenotyping, including detailed history taking, pulmonary
function, allergological diagnostics, and measurement of type 2 biomarkers
11. .
Changes in asthma therapy: symptom prevention as a goal
This paradigm shift was made possible by modern ICS (either ICS, ICS/LABA,
ICS?LABA/LAMA), biologics and modern allergen immunotherapies (AIT)
Analogous to disease-modifying antirheumatic drugs (DMARDs) in
rheumatology)
DMAADs are not only highly effective, but also have few side effects
12. Asthma remission as a new treatment goal
The remission concepts are based on the remission can also occur during
anti-inflammatory therapy (remission on treatment)
Previously, the concept of asthma remission was limited to spontaneous
remission (especially in pediatrics) or remission after treatment (especially in
allergology, after allergen immunotherapy)
13. 1. Upham JW, James AL. Remission of asthma: The next therapeutic frontier? Pharmacol Ther. 2011; 130: 38-45.
2.. Brusselle GG, Koppelman GH. Biologic Therapies for Severe Asthma. N Engl J Med. 2022; 386: 157- 171.
Highly effective biologics for the treatment of severe asthma and the
increasing number of permanently symptom-free patients on this therapy
[2], these views have changed
The concept of asthma remission on treatment was previously rejected by
many respiratory physicians;
- not a disease modification (in contrast to all other specialties of internal medicine)
- forms of asthma (especially patients with severe asthma) could ever achieve this goal [1]
14. Lommatzsch M. et al. Lancet 2022; 399: 1664–68
Changing asthma treatment concepts: from symptom relief to symptom prevention
Treatment with DMAADs aims to prevent asthma symptoms and
exacerbations with minimal treatment-related side-effects, with the ultimate
goal of inducing and maintaining asthma remission
15. Lommatzsch M. et al. Lancet Respir Med 2023; 11: 573–76 Lommatzsch M. Lancet 2022; 399: 1664–68
Clinical definitions of asthma remission and disease-modifying anti-asthmatic drugs
These terms do not necessarily imply biological remission (absence of any airway pathology)
Proposed criteria for asthma remission
• Sustained absence of asthma symptoms
• Sustained absence of asthma exacerbations
• Stable lung function
• No need for systemic corticosteroids for the treatment of asthma
Proposed definition of disease-modifying anti-asthmatic drugs
• Any drug class that can potentially achieve the goal of asthma remission
16. Lommatzsch M. et al. Lancet Respir Med 2023; 11: 573–76
The new terminology (DMAAD) might even motivate physicians to
phenotype asthma and to treat asthma to target (analogous to the treatment aim in
rheumatoid arthritis or in IBD) with the currently available spectrum of treatment
options, and to motivate patients to adhere to treatment recommendations
18. Thomas D . Eur Respir J 2022; 60: 2102583
Asthma Remission
19. Beasley R, et al. Eur Respir J 2023; 62: 2301844
Outcomes in response to biologic treatments in severe asthma
20. Early attempts to define clinical remission include composite end points
Lugogo NL, et al. CHEST October 2023, 164: 831-834
Remission on biologics
Biological therapy can raise our ambition towards asthma remission
21. Jackson D.Lancet 2024; 403: 271–81
Clinical remission in the reduction group 54% at week 48 (ACQ-5 score <1·5)
22. Lommatzsch M. et al. Lancet Respir Med. 2024 Feb;12(2):96-99.
Criteria for clinical remission of asthma in national guidelines
In 2023, the concept of remission on treatment has gained support, national societies
have incorporated remission as a treatment goal in asthma guidelines
23. Treatment concepts in asthma
DMAAD=disease-modifying anti-asthmatic drug Lommatzsch M. et al. Lancet Respir Med. Feb, 2024 Feb;12(2):96-99.
Individual tailored treatment with DMAADs
Disease control
Phenotyping optional
Disease modification
Phenotyping essential
Severe asthma
High treatment burden
- Many drugs
- High doses
- Many adverse effects
Step-up treatment
Drug A
Drug A Drug A Drug A
Drug A Drug A
Drug B Drug B Drug B
Drug C Drug C
Drug D
Severe asthma
Lowtreatment burden
- Few drugs
- Lowest possible doses
- Minimal adverse effects
Standard treatment steps with standard drugs
Drug A
Drug B
Drug C
Drug C
Drug C
Drug D
Induction of remission Maintenance of remission
Identify and treat with
most effective DMAADs
Reduction to lowest possible
number and dose of DMAADs
Identification of the right DMAAD(s) for the right patient at the right time
24. Lommatzsch M. et al. Lancet Respir Med. 2024 Feb;12(2):96-99.
The new concept of disease modification does not warrant the simple
addition of one drug to another, but the identification of the right DMAAD(s)
for the right patient at the right time.
According to this new concept, phenotyping is an essential prerequisite to
establish individually effective treatment
Treatment concepts in asthma
25. Asthma therapy of the future will consist of 2 phases;
1) An initial phase of remission induction (higher doses, typically a
combination of several DMAADs) and
2) Second phase of remission maintenance (as few DMAADs as possible, in
the lowest possible dose)
The future of asthma therapy
26. Lommatzsch M. et al. Lancet Respir Med 2023; 11: 573–76
There is a need for easy-to-understand, concise guides for general practice
Propose a one-page practical guide for asthma management, titled A2BCD, with 4 components:
A: Dual assessment (A2) of asthma (ie, diagnosis and phenotype, plus asthma control and future risks);
B: Basic measures (B); (eg, education, self- management skills, regular physical activity, and avoidance of asthma triggers);
C: identification and treatment of Comorbidities (C) of asthma (eg, chronic rhinosinusitis, obesity, or sleep apnea);
D: phenotype-specific, individually targeted treatment with DMAADs (D)
27. Lommatzsch M. et al. Lancet Respir Med 2023; 11: 573–76
A2BCD guide for asthma management
28. Conclusion
“Disease-modifying anti-asthmatic drugs”, (ICS, ICS/LABA, ICS/LABA/LAMA),
biologics and modern allergen immunotherapies, has fundamentally
changed the asthma therapy concept from symptom control to symptom
prevention
The new asthma treatment goal of asthma remission: long- term
absence of symptoms (good asthma control), absence of exacerbations,
and stable lung function, without the use of systemic steroids for
asthma therapy
A treat- to-target approach is used. The goal is to achieve asthma
remission, through individually tailored treatment with highly effective
drugs with minimal side effects
30. The term remission is well defined in rheumatoid arthritis, Crohn’s disease,
ulcerative colitis, SLE or cancer
Remission in childhood asthma is a common (5% - 69%[1])
Remission in adults with asthma is a relatively new concept and gained attention
Might be possible to induce remission with asthma treatments
Concept of asthma remission
1. Carpaij OA,. A review on the pathophysiology of asthma remission. Pharmacol Ther 2019;201:8-24.
2. Lommatzsch M, et al. A2BCD: a concise guide for asthma management. Lancet Respir Med 2023; 11: 573–76
Asthma treatment concepts have changed, from short-term symptom control to
long-term symptom prevention, with the achievable goal of disease remission(2)
31. 1. Virchow JC, et al. Efficacy of a HDM sublingual AIT tablet in adults with allergic asthma: a randomized clinical trial. JAMA 2016; 315: 1715–25.
2. Reddel HK,et al. GINA 2021: executive summary and rationale for key changes. Eur Respir J 2022; 59: 2102730.
Disease modification and asthma remission as therapeutic goals
The first concept: allergen immunotherapy concept
MITRA study, first to show 1-year treatment with house dust mite (HDM)
sublingual immunotherapy tablet can reduce exacerbations in uncontrolled
asthma and HDM allergy, with an acceptable safety profile (1)
Led to GINA 2021 recommendation that HDM- sublingual immunotherapy
should be evaluated as an additional therapeutic option in the treatment
mild to moderate asthma (2)
32. 1. Pfaar O, et al. One hundred ten years of allergen immunotherapy: a broad look into the future. J Allergy Clin Immunol Pract 2021; 9: 1791–803.
2. Marogna M, et al. Long-lasting effects of sublingual immunotherapy according to its duration: a 15-year prospective study. J Allergy Clin Immunol 2010;
Disease modification and asthma remission as therapeutic goals
Allergen immunotherapy is currently postulated to be a disease modifier,
primarily because clinical benefits and immunological changes last beyond
the time of treatment (ie, the disease remains modified after treatment
discontinuation) (1,2)
33. Disease modification and asthma remission as therapeutic goals
The second concept: the rheumatoid arthritis concept
The European League Against Rheumatism defines a large group of modern
anti-inflammatory drugs against rheumatoid arthritis as disease modifiers or
disease-modifying anti-rheumatic drugs (DMARDs) (1)
1. Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020; 79: 685–99.
2. Felson DT, et al. American College of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann Rheum Dis 2011; 70: 404–13.
Linked to idea of rheumatoid arthritis remission, defined as a very low
disease activity (the patient must satisfy all of the following: tender joint count ≤1, swollen joint count ≤1, C-reactive
protein ≤1 mg/dl, and patient global assessment ≤1, on a 0–10 scale) during treatment with DMARDs (2)
34. Lommatzsch M. Lancet 2022; 399: 1664–68
Today, effective, safe, phenotype-specific immunomodulatory drugs aimed
at preventing symptoms and exacerbations by targeting the underlying
inflammatory cascade, with the advantage of improving control of co-
existing co-morbidities
Drugs do not only successfully modulate inflammation, but can improve the
function of structural cells, such as epithelial cells, smooth muscle cells,
fibroblasts, and nerves, and consequently reduce airway remodelling
35. ICS molecules,
ICS doses
ICS/LABA (LAMA)
fixed combination
inhaler
Application schemes
maintenance therapy
or inhalation on an as- needed basis
Inhaled Devices
Asthma
The choice of inhaled therapies has become more and more individualize
Lommatzsch M. Lancet 2022; 399: 1664–68
36. Type Criteria Assessments
Clinical remission No symptoms Sustained absence of significant asthma symptoms established
using a validated instrument (e.g. ACQ score ⩽1 or ACT score
⩾20); the use of relievers is not permitted during the remission
period
No exacerbations The use of systemic corticosteroids for exacerbation treatment
is not permitted during the remission period; hospitalisation or
emergency department visit or unscheduled doctor visit for
asthma exacerbation management are also not permitted
during the remission period
Optimisation of lung function Example: post-bronchodilator FEV1 ⩾80% predicted
Complete remission Clinical remission plus
normalisation of underlying
pathology
No evidence of current inflammation established using either blood
eosinophil count (<300 cells·μL−1), sputum eosinophil count (<3%) or
FENO (<40 ppb); other measures of underlying pathology may
include a negative bronchial hyperresponsiveness test (e.g.
histamine or methacholine provocation tests) or degree of
subepithelial fibrosis (subepithelial thickness)
Both clinical and complete remission can be achieved either on treatment or off treatment.
12 months or longer without symptoms Thomas D . Eur Respir J 2022; 60: 2102583
Types and measures of asthma remission
37. Type Criteria Assessments
Clinical remission No symptoms Sustained absence of significant asthma symptoms established
using a validated instrument (e.g. ACQ score ⩽1 or ACT score
⩾20); the use of relievers is not permitted during the remission
period
No exacerbations The use of systemic corticosteroids for exacerbation treatment
is not permitted during the remission period; hospitalisation or
emergency department visit or unscheduled doctor visit for
asthma exacerbation management are also not permitted
during the remission period
Optimisation of lung function Example: post-bronchodilator FEV1 ⩾80% predicted
Complete remission Clinical remission plus
normalisation of underlying
pathology
No evidence of current inflammation established using either blood
eosinophil count (<300 cells·μL−1), sputum eosinophil count (<3%) or
FENO (<40 ppb); other measures of underlying pathology may
include a negative bronchial hyperresponsiveness test (e.g.
histamine or methacholine provocation tests) or degree of
subepithelial fibrosis (subepithelial thickness)
Both clinical and complete remission can be achieved either on treatment or off treatment.
12 months or longer without symptoms Thomas D . Eur Respir J 2022; 60: 2102583
Types and measures of asthma remission
38. 3. Milger K, Suhling H, Skowasch D, Holtdirk A, Kneidinger N, Behr J, et al. Response to biologics and clinical remission in the adult GAN severe asthma registry
cohort. Allergy Clin Immunol Pract 2023;11:2701-12.
.
32.1% of those initiating biologics achieved remission
9.5% of patients not receiving biologics met remission criteria
The biologic super-response rate was 61.4% (without the lung function criterion),
superresponse rate = 34.8% not receiving biologics
39. The general concept of treatment recommendations is phenotype-specific,
anti-inflammatory DMAAD therapy, moving towards clever “fire prevention”
and away from constant “fire extinguishing”
41. Time to change the paradigm of treatment for
patients with severe asthma who have
frequent severe exacerbations, multiple OCS
bursts and severe symptom burden, to the
treatment goals from asthma control to
asthma remission by biologics
