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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This study aimed to determine the impact of coexisting COPD on long-term mortality in patients with CS-dependent asthma. METHODS: A retrospective cohort of patients with CS-dependent asthma aged 40 years or older was established using records from the Korean National Health Insurance Service database for 2005 to 2015. We classified the subjects into 2 groups according to the presence of COPD and evaluated the hazard ratio (HR) for all-cause mortality in patients with COPD relative to those without COPD. RESULTS: Of 8,021 patients with CS-dependent asthma, 3,121 (38.9%) had COPD. All-cause mortality was significantl...
Source: Allergy, Asthma and Immunology Research - Category: Allergy & Immunology Tags: Allergy Asthma Immunol Res Source Type: research
CONCLUSION: In this real-world sample of U.S., subspecialist-treated patients with SA not controlled by HD ICS+, mSCS use was infrequent and biologic use was common, with similar prevalence of anti-IgE and anti-IL-5/IL-5Rα biologics. Treatment differences associated with patient and site characteristics should be investigated to ensure equitable access to biologics and minimize mSCS use. PMID: 32304877 [PubMed - as supplied by publisher]
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Ann Allergy Asthma Immunol Source Type: research
CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making. PMID: 32141261 [PubMed]
Source: Allergy, Asthma and Immunology Research - Category: Allergy & Immunology Tags: Allergy Asthma Immunol Res Source Type: research
Studies have demonstrated association of inhaled corticosteroids (ICS) with risk of pneumonia in chronic obstructive pulmonary disease patients. Risk in asthmatic children on ICS remains unclear. Our aim was to determine the association of ICS use with pneumonia risk in asthmatic children.
Source: Journal of Allergy and Clinical Immunology - Category: Allergy & Immunology Authors: Source Type: research
This study addresses the unmet need for a safe, non-steroidal asthma and COPD treatment by targeting GABAA receptors (GABAAR) in the lung. First-in-class drug candidate MIDD0301 is expected to be more effective than current inhaled and oral treatments and overcome adverse effects and resistance of commonly used corticosteroids.
Source: Journal of Allergy and Clinical Immunology - Category: Allergy & Immunology Authors: Source Type: research
Publication date: Available online 15 January 2020Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Yong Suk Jo, Yong Il Hwang, Kwang Ha Yoo, Tae-Hyung Kim, Myung Goo Lee, Sang Haak Lee, Kyeong-Cheol Shin, Kwang Ho In, Hyoung Kyu Yoon, Chin Kook Rhee, Korean Asthma Research Group &KOCOSS cohortBackgroundFew reports have investigated the efficacy of using inhaled corticosteroid (ICS)-containing inhalers to treat patients with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO).ObjectiveTo investigate the effect of ICS treatment on patients with ACO using 5 sets of diagnostic cri...
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
Publication date: Available online 15 January 2020Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Yong Suk Jo, Yong Il Hwang, Kwang Ha Yoo, Tae-Hyung Kim, Myung Goo Lee, Sang Haak Lee, Kyeong-Cheol Shin, Kwang Ho In, Hyoung Kyu Yoon, Chin Kook Rhee, Korean Asthma Research Group &KOCOSS cohortAbstractBackgroundFew reports have investigated the efficacy of using inhaled corticosteroid (ICS)-containing inhalers to treat patients with asthma–chronic obstructive pulmonary disease (COPD) overlap (ACO).ObjectiveTo investigate the effect of ICS treatment on patients with ACO using five sets ...
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
Inhaled corticosteroids (ICSs) are frequently prescribed medications for patients with the inflammatory airway diseases asthma and chronic obstructive pulmonary disease (COPD). The broad anti-inflammatory effects of these medications provide a range of beneficial effects on symptoms, exacerbation frequency, and lung function. In asthma, current Global Initiative for Asthma guidance states that all patients (regardless of severity) should be prescribed ICSs, with “as required” combined ICS/β2-agonist therapy recommended for those with mild intermittent disease (avoiding β2-agonist therapy alone) and ma...
Source: Journal of Allergy and Clinical Immunology - Category: Allergy & Immunology Authors: Tags: Paradigms and perspectives Source Type: research
Source: Journal of Allergy and Clinical Immunology - Category: Allergy & Immunology Authors: Source Type: research
Purpose of review Asthma/chronic obstructive pulmonary disease overlap (ACO) continues to be a poorly understood condition. This review discusses newly proposed criteria and potential biomarkers in ACO, to aid in diagnosis and research studies, and prudent therapeutic approaches. Recent findings A global expert panel proposed an operational definition consisting of major and minor criteria as a step toward defining ACO. Serum periostin and YKL-40 may serve as biomarkers for ACO. Clinically, a reasonable therapeutic approach to ACO is the early addition of a long-acting β-agonist (LABA) and/or a long-acting muscar...
Source: Current Opinion in Allergy and Clinical Immunology - Category: Allergy & Immunology Tags: MECHANISMS OF ALLERGY AND ADULT ASTHMA: Edited by J. Andrew Grant and Enrico Heffler Source Type: research
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