SMART and as-needed therapies in mild-to-severe asthma: a network meta-analysis
To date, there are no network meta-analyses comparing the impact of as-needed treatments in asthma, including the single maintenance and reliever therapy (known as "SMART" or "MART"; for simplicity, SMART will be used hereafter) and the use of inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination exclusively on an as-needed basis. Therefore, we performed a systematic review and network meta-analysis concerning the efficacy and safety of SMART and as-needed therapies in asthma. Data from 32 096 asthmatic patients were extracted from 21 studies, lasting from 6 to 12 months. In adult mild-to-moderate asthmatic patients low-dose SMART and as-needed low-dose ICS/LABA combination were significantly (relative effect
Publication date: Available online 8 October 2020Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Annelies L. Robijn, Daniel Barker, Peter G. Gibson, Warwick B. Giles, Vicki L. Clifton, Joerg Mattes, Michael J. Peek, Helen L. Barrett, Sean K. Seeho, Leonie K. Callaway, Alistair Abbott, John Attia, Peter A. Wark, Megan E. Jensen, Vanessa E. Murphy
Conclusion A significant number of patients who meet currently approved indications for anti-IL5 mAbs show suboptimal response to them in real-life clinical practice, particularly if they are on high doses of prednisone. Monitoring blood eosinophil count is not helpful to identify these patients. The concern of worsening of symptoms associated with immune-complex mediated complement activation in a small proportion of these patients highlights the relevance of recognising airway autoimmune phenomena and this requires further evaluation.
Conclusions The timing of ICS dose when self-titrated to β2-agonist use is more important than total ICS dose in reducing severe exacerbation risk in mild asthma, when associated with greater overall use of as-needed β2-agonist.
AbstractThe coronavirus disease (COVID-19) is caused by Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and presents with respiratory symptoms which can be life threatening in severe cases. At the start of the pandemic, allergy, asthma, and chronic obstructive pulmonary disease (COPD) were considered as risk factors for COVID-19 as they tend to exacerbate during respiratory viral infections. Recent literature has not shown that airway allergic diseases is a high-risk factor or that it increases the severity of COVID-19. This is due to a decrease in Angiotensin-converting enzyme 2 (ACE2) gene expression in the ...
In order to promote precision medicine, Kolmert et al (Am J Respir Crit Care Med. 2020 Jul 15. https://doi.org/10.1164/rccm.201909-1869oc) characterized expression of urinary lipid mediators in patients with type 2 asthma. Levels of multiple types of eicosanoids, including leukotriene E4 (LTE4) and prostaglandin D2, positively correlated with severity of asthma and type 2 inflammation. Notably, eicosanoid levels were independent of oral corticosteroid treatment status but were decreased in subjects on anti-IgE therapy.
ConclusionsIn some severe allergic asthma patients with persistently high eosinophil counts in peripheral blood and who are considered non- or mild responders to anti-IgE and anti-IL5 administered individually, a combination of the two antibodies covering the entire T2 spectrum may be effective.
Abstract Anaphylaxis is a life-threatening systemic reaction, normally occurring within one to two hours of exposure to an allergen. The incidence of anaphylaxis in the United States is 2.1 per 1,000 person-years. Most anaphylactic reactions occur outside the hospital setting. Urticaria, difficulty breathing, and mucosal swelling are the most common symptoms of anaphylaxis. The most common triggers are medications, stinging insect venoms, and foods; however, unidentified triggers occur in up to one-fifth of cases. Coexisting asthma, mast cell disorders, older age, underlying cardiovascular disease, peanut and tree...
AbstractPurpose of ReviewIntranasal corticosteroid sprays have been available as over-the-counter (OTC) medications since 2013. As such, clinicians need to be up-to-date with the risks and the safety of INS, as patients may have concerns and detailed questions. The following is a review of the recent medical literature regarding the safety profile, adverse reactions, and special populations using INS.Recent FindingsThe latest research on intranasal steroid sprays (INS) continue to confirm that INS rarely have significant local side effects, such as severe and persistent epistaxis. Recent studies looking at systemic side ef...
A new study failed to find an increased risk of psychiatric adverse events in asthma patients taking montelukast compared with patients who use inhaled corticosteroids.Reuters Health Information