Inhaled Corticosteroids in Lung Diseases

Raissy, Hengameh H.; Kelly, H. William; Harkins, Michelle; Szefler, Stanley J.

doi:10.1164/rccm.201210-1853pp

Cited by 108 publications

(104 citation statements)

References 76 publications

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“…Of note, ICS may cause some of the same systemic side effects as oral corticosteroids, particularly adrenal suppression in susceptible individuals with asthma. 22 Limited studies suggest that the risk of systemic side effects increases dramatically when high-dose ICS are used and that children and adolescents are particularly vulnerable to effects on linear growth, bone mineral density and adrenal function. 23 For this reason, the prescribing of long-term high-dose ICS for children and adults should be limited to specialists.…”

Section: Corticosteroid-dependent Asthmamentioning

confidence: 99%

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

FitzGerald

Lemière

Lougheed

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: While severe asthma affects approximately 5% of all individuals with asthma, this small minority of individuals accounts for a large proportion of the asthma-related costs. Greater understanding of the pathophysiology of asthma combined with the emergence of novel biologic therapies for severe asthma supported the need for a thorough review of the diagnosis, investigation, phenotyping, and management of severe asthma. OBJECTIVES: We aimed to propose a practical approach to distinguish uncontrolled asthma due to inadequate asthma management from severe asthma despite optimal asthma management. Moreover, based on emerging scientific evidence, we sought to provide guidance for characterizing individuals with severe asthma and considering a phenotype-specific management. We also aimed to review other novel new potential therapeutic approaches. METHODS: We systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert opinion, were agreed upon by unanimous consensus. MAIN RESULTS: We defined severe asthma and outlined its significant impact from the societal and patient perspectives. We outlined a practical approach to distinguish severe from uncontrolled but not severe asthma, based on stepwise investigation and management of potential reasons for uncontrolled asthma. After reviewing the current evidence we concluded that: 1) Several biomarkers (e.g. sputum or blood eosinophil count, total IgE, or FeNO) can help identify potential responders to new therapeutic options; 2) Tiotropium may be considered as an add-on therapy for individuals 12 years of age and over with severe asthma uncontrolled despite combination ICS/LABA therapy; 3) The chronic use of macrolides may decrease asthma exacerbations in individuals 18 years of age and over with severe asthma independent of their inflammatory profile; 4) Children aged 6 years and older and adults who are sensitized to at least one relevant perennial allergen and who remain poorly controlled asthmatics despite high dose ICS and a second controller can benefit from the addition of anti-IgE therapy to reduce asthma exacerbations; due to the known risk of side effects associated with high-dose ICS in children, omalizumab should also be considered in children and adolescents who repeatedly exacerbate or have poor control when therapy is stepped down from high-dose to moderate-dose ICS and at least one other controller; 5) Anti-IL5 therapies may be considered for adults 18 years of age and over with severe eosinophilic asthma who experience recurrent asthma exacerbations in spite of high doses of ICS in addition to at least one other controller; and 6) Although bronchial thermoplasty has shown a decrease in asthma exacerbations in one study, its role in the treatment of severe asthma remains uncertain. CONCLUSIONS: After reviewing existing and emerging therapies for severe asthma, we developed ke...

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Section: Corticosteroid-dependent Asthmamentioning

confidence: 99%

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

FitzGerald

Lemière

Lougheed

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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“…Local side effects of ICS include oral thrush and dysphonia. Patients are at greater risk of ICS side-effects with higher doses or more potent formulations, 95,96 and, for local side-effects, with incorrect inhaler technique.…”

Section: Medication Side-effectsmentioning

confidence: 99%

“…For more detailed discussion see Raissy et al 95 In clinical practice, the choice of medication, device and dose should be based on assessment of symptom control, risk factors, patient preference, and practical issues (cost, ability to use the device, and adherence) (Box 3-3, p27). It is important to monitor the response to treatment and any side-effects, and to adjust the dose accordingly (Box 3-5, p31).…”

Section: Stepwise Approach For Adjusting Asthma Treatment In Adults mentioning

confidence: 99%

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

Kumbhare

Strange

2018

Southern Medical Journal

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“…15,16 Treatment with ICS is associated with an improvement in symptoms and lung function 17 and a reduction in exacerbations 17,18 and risk of death.…”

Section: Future Directionsmentioning

confidence: 99%

A review of standard pharmacological therapy for adult asthma – Steps 1 to 5

Patel

Shaw

2015

Chron Respir Dis

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The aim of pharmacological therapy for asthma is to improve symptoms and lung function and minimize the risk of asthma attacks. The intensity of treatment is based on the level of asthma control and the potential risk of future deterioration. In the British asthma guidelines, treatments are divided into steps 1 to 5, with each step signifying a need for an increase in therapy in response to symptoms or to prevent exacerbations. Treatments comprise of inhaled or systemic medications. Inhaled therapy includes short-acting and long-acting medication to improve symptoms and inhaled corticosteroids that reduce airway inflammation. Systemic treatments include medications that act on specific biological pathways, such as the leukotriene or immunoglobulin E pathways, or systemic corticosteroids. In choosing a particular therapy, treatment benefits are balanced by the potential risks of medication-related adverse effects. This review will provide a practical guide to the key pharmacological therapies for adult asthma at steps 1 to 5 based on British guidelines and consider future options for new treatments.

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Inhaled Corticosteroids in Lung Diseases

Cited by 108 publications

References 76 publications

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

A review of standard pharmacological therapy for adult asthma – Steps 1 to 5

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