Appropriate Selection of Corticosteroids in Treating Asthma and COPD

You're dispatched to the scene of a residential facility for a patient with difficulty breathing. You and your partner arrive to find an elderly male on his living room couch in clear respiratory distress as indicated by tripod positioning with accessory muscle use, pursed lip breathing, and paradoxical chest wall/abdominal movements (positive Hoover sign). Initial impression of your patient reveals he has difficulty speaking due to his increased respiratory effort and explains that recently he's unable to catch his breath. He says he recently ran out of his home DuoNeb (ipratropium bromide/albuterol sulfate) treatments. Further questioning reveals he's a chronic smoker and has a confirmed diagnosis of chronic obstructive pulmonary disease (COPD) and asthma, both of which are pharmacologically managed without home oxygen administration. When asked supplemental questions regarding allergies and current symptoms, the patient appears to be confused, which is consistent with his progressively declining mental status. Initial vitals are significant for elevated blood pressure (currently hypertensive with initial reading of 160/100 mmHg), tachycardia (pulse rate of 110), marked tachypnea (respiratory rate of 26) and an oxygen saturation of 88% on room air (without supplemental O2). Physical exam reveals wheezing/coarse rhonchi on auscultation with prolonged expiration, notable clubbing of extremities, barreled chest (concerning for hyperinflation), diffusely decreased breath sounds...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Patient Care Source Type: news

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ConclusionsPatients may adapt their ICS use to their current needs without this impacting later RDAC.
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
Publication date: Available online 18 September 2019Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Marcia Vervloet, Liset van Dijk, Peter Spreeuwenberg, David Price, Alison Chisholm, Eric Van Ganse, Hilary Pinnock, Cynthia S. Rand, Michelle N. Eakin, Tjard Schermer, Patrick C. Souverein, Alexandra L. Dima, Respiratory Effectiveness Group’s Adherence Working GroupAbstractBackgroundLow inhaled corticosteroids (ICS) adherence is associated with increased asthma burden. This relationship is likely bidirectional, and may vary across adherence stages (initiation, implementation, persistence)....
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
Asthma and chronic obstructive pulmonary disease (COPD) are markedly different airway diseases, but sometimes they overlap, with some asthmatic patients showing some features of COPD (fixed airway obstruction, mixed neutrophilic/eosinophilic airway inflammation, and relatively poor response to corticosteroids) and some patients with COPD having features of asthma (atopy, history of asthma, greater airway reversibility, increased blood and sputum eosinophil counts, and a clinical response to corticosteroids).
Source: Journal of Allergy and Clinical Immunology - Category: Allergy & Immunology Authors: Tags: Editorial Source Type: research
Publication date: May–June 2019Source: The Journal of Allergy and Clinical Immunology: In Practice, Volume 7, Issue 5Author(s): Richard H. Stanford, Carlyne Averell, Emily D. Parker, Cori Blauer-Peterson, Tyler K. Reinsch, Ami R. BuikemaBackgroundAlthough efficacy and safety of fluticasone furoate/vilanterol (FF/VI) and budesonide/formoterol (BUD/F) have been demonstrated in clinical studies, real-world comparisons of utilization have not been performed.ObjectiveTo compare similar patients with asthma initiating FF/VI or BUD/F on measures of adherence, persistence, and the asthma medication ratio (AMR).MethodsThis wa...
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
Mario Malerba1,2*, Valentina Foci1,2, Filippo Patrucco1,2, Patrizia Pochetti1,2, Matteo Nardin3, Corrado Pelaia4 and Alessandro Radaeli5 1Respiratory Medicine, Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy 2Respiratory Unit, Sant’Andrea Hospital, Vercelli, Italy 3Department of Medicine, Spedali Civili di Brescia, Brescia, Italy 4Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University “Magna Græcia” of Catanzaro, Catanzaro, Italy 5Department of Emergency, Spedali Civili di Brescia, Brescia, Italy Chronic obstructiv...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
This study evaluated the effects of dried ginger and LGWWJX decoction on cold asthma at the metabolomics level. It provides a reference for the research on the compatibility of Chinese Medicine. Introduction Ginger is a Chinese medicine (CM) used as a food and as a medicine, and is often used to treat cold syndrome through the property of warming. Dried ginger (Zingiberis Rhizoma, GanJiang, GJ) is processed from fresh ginger and is also commonly used in CM. It is used to treat cold asthma by “warming the stomach to dispel cold, warming the lung to resolve fluid,” and it has significant anti-inflammatory...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
This study was supported by grants from GSK and the UK Medical Research Council (U105178805). Conflict of Interest Statement AM has grant funding from GSK and AstraZeneca/MedImmune. MB, DJ, AP, DT, and AvO are employees of GSK. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Acknowledgments We are grateful to the Ares staff, genotyping facility, and flow cytometry core for their technical assistance. We thank Jen Walker for advice on the manuscript. Supplementary Material The Supplem...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
ConclusionWhile most PCPs and respiratory/allergy specialists can reach a working diagnosis of ACO, there remains uncertainty around which diagnostic features are most important and what constitutes optimal management. It is imperative that clinical studies including patients with ACO are initiated, allowing the generation of evidence ‐based management strategies.This article is protected by copyright. All rights reserved.
Source: The Clinical Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Article Source Type: research
Conclusion: GRNX effectively treated asthma and COPD patients with acute bacterial infection without severe adverse events. Further research with a larger study population is needed.Int Arch Allergy Immunol
Source: International Archives of Allergy and Immunology - Category: Allergy & Immunology Source Type: research
Publication date: Available online 10 January 2019Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Richard H. Stanford, Carlyne Averell, Emily D. Parker, Cori Blauer-Peterson, Tyler K. Reinsch, Ami R. BuikemaAbstractBackgroundWhile efficacy and safety of fluticasone furoate/vilanterol (FF/VI) and budesonide/formoterol (BUD/F) have been demonstrated in clinical studies, real-world comparisons of utilization has not been performed.ObjectiveCompare similar asthma patients initiating FF/VI or BUD/F on measures of adherence, persistence, and the asthma medication ratio (AMR).MethodsThis was a retros...
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
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