A Pragmatic Trial of Symptom-Based Inhaled Corticosteroid Use in African-American Children with Mild Asthma

Publication date: Available online 30 July 2019Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Kaharu Sumino, Leonard B. Bacharier, Juanita Taylor, Kelley Chadwick-Mansker, Vanessa Curtis, Alison Nash, Shawni Jackson-Triggs, Joseph Moen, Kenneth B. Schechtman, Jane Garbutt, Mario CastroBackgroundSymptom-based adjustment (SBA) of inhaled corticosteroids may be an alternative patient-centered approach in which day-to-day inhaled corticosteroid use is adjusted by symptoms and short-acting β-agonist need.ObjectiveTo evaluate the effectiveness of SBA in the primary care setting.MethodsWe conducted a randomized, open-label, pragmatic equivalence trial in African-American children (6-17 years old) with mild asthma managed by 12 primary care providers (PCPs). A total of 206 participants were randomized to SBA (as-needed beclomethasone 80 μg with rescue short-acting β-agonist) or provider-based guideline-directed adjustment (PBA): maintenance beclomethasone 80 μg/d (6-11 years old), 160 μg/d (12-17 years old), with subsequent guideline-based dose adjustment by PCPs. PCPs implemented both treatment assignments, with outcomes measured by blinded staff. All participants received symptom recognition and albuterol use education from peer educators. Primary outcome was change in asthma control (measured by Asthma Control Test [ACT]/childhood ACT [cACT]) over 12 months.ResultsParticipants had adequately controlled asthma (mean ACT or cACT scor...
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research

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Publication date: Available online 23 January 2020Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Cindy L.J. Weinstein, Nicholas Ryan, Xiaoli Zhang, Tulin Shekar, Davis Gates, Stephen J. Lane, Ioana Agache, Robert A. Nathan, SPIRO InvestigatorsAbstractBackgroundDue to historical safety concerns with use of long-acting beta agonists in asthma, step-down from inhaled corticosteroid/long-acting beta agonist (ICS/LABA) combination therapy to ICS monotherapy is recommended once asthma control is achieved.ObjectiveTo evaluate the benefit/risk question about whether asthma patients who achieve diseas...
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
Abstract BACKGROUND: The long-term clinical course of asthma in patients with Eosinophilic Granulomatosis with Polyangiitis (EGPA) remains unclear. We aimed to characterize long-term asthma in EGPA and to identify baseline predictors of long-term asthma severity. METHODS: Retrospective cohort study of patients who fulfilled standardized criteria for EGPA that were followed in a single referral center between 1990-2017. Baseline and 3 (±1) years of follow-up clinical, laboratory and pulmonary function data were analyzed. RESULTS: Eighty-nine patients with EGPA, and a documented asthma assessment at...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
We examined which patients respond to systematic assessment and whether oral corticosteroid burden can be decreased independent of monoclonal biologic use.MethodsSpecialist-referred patients are assessed systematically for difficult asthma at our centre. We undertook a responder analysis for improvements in the domains of symptom control, quality of life, exacerbations and airflow obstruction, assessed six months after initial assessment. Multivariate analyses were performed for each domain to identify predictors of response. Changes in oral corticosteroid burden were also measured, stratified by monoclonal biologics comme...
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
Source: Journal of Allergy and Clinical Immunology - Category: Allergy & Immunology Authors: Source Type: research
Little is known about the characteristics and treatments of patients with severe asthma across Europe, but both are likely to vary. This is the first study in the European Respiratory Society Severe Heterogeneous Asthma Research collaboration, Patient-centred (SHARP) Clinical Research Collaboration and it is designed to explore these variations. Therefore, we aimed to compare characteristics of patients in European severe asthma registries and treatments before starting biologicals. This was a cross-sectional retrospective analysis of aggregated data from 11 national severe asthma registries that joined SHARP with establis...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Asthma and allergy Original Articles: Asthma Source Type: research
CONCLUSION: Recruitment was feasible within the allocated period. Adherence to PARTICS was incomplete, questionnaire completion was suboptimal, and common rescue inhaler nomenclature usage was limited. We have modified the full study protocol to attempt to improve adherence to PARTICS and minimize barriers to study procedures. PMID: 31923550 [PubMed - as supplied by publisher]
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Ann Allergy Asthma Immunol Source Type: research
Underuse of guideline-recommended inhaled corticosteroids (ICS) controller therapy is a risk factor for greater asthma burden. ICS concomitantly-used with rescue inhalers [Patient-Activated Reliever-Triggered ICS( ‘PARTICS’)] reduced asthma exacerbations in efficacy trials, but whether PARTICS is effective in pragmatic trials is unknown.
Source: Annals of Allergy, Asthma and 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
Purpose of review Severe asthma is a serious disease affecting about 5–10% of asthmatic patients. Often patients with this kind of asthma requires periodical courses or daily intake of oral corticosteroids, to control symptoms. In the last few years several biological drugs have been developed with the aim to decrease exacerbations and reduce or suspend intake of systemic steroids in severe asthmatic patients. Clinical trials demonstrated the efficacy and the safety of biological antibodies in asthma, but it is already known that randomized controlled trials alone are not sufficient to provide complete information ...
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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