Profile of difficult to treat asthma patients referred for systematic assessment

Radhakrishna, Naghmeh; Tay, Tunn Ren; Hore‐Lacy, Fiona; Hoy, Ryan; Dabscheck, Eli; Hew, Mark

doi:10.1016/j.rmed.2016.06.012

Cited by 49 publications

(53 citation statements)

References 19 publications

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“…Psychological dysfunction was most frequently assessed (69.2% of Group 1), followed by sinusitis (nine studies) and gastro‐oesophageal reflux disease (GORD) (six studies) …”

Section: Resultsmentioning

confidence: 99%

Multidimensional assessment of severe asthma: A systematic review and meta‐analysis

et al. 2017

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The management of severe asthma is complex. Multidimensional assessment (MDA) of specific traits has been proposed as an effective strategy to manage severe asthma, although it is supported by few prospective studies. We aimed to systematically review the literature published on MDA in severe asthma, to identify the traits included in MDA and to determine the effect of MDA on asthma-related outcomes. We identified 26 studies and classified these based on study type (cohort/cross-sectional studies; experimental/outcome studies; and severe asthma disease registries). Study type determined the comprehensiveness of the assessment. Assessed traits were classified into three domains (airways, co-morbidities and risk factors). The airway domain had the largest number of traits assessed (mean AE SD = 4.2 AE 1.7) compared with co-morbidities (3.6 AE 2.2) and risk factors (3.9 AE 2.1). Bronchodilator reversibility and airflow limitation were assessed in 92% of studies, whereas airway inflammation was only assessed in 50%. Commonly assessed co-morbidities were psychological dysfunction, sinusitis (both 73%) and gastro-oesophageal reflux disease (GORD; 69%). Atopic and smoking statuses were the most commonly assessed risk factors (85% and 86%, respectively). There were six outcome studies, of which five concluded that MDA is effective at improving asthma-related outcomes. Among these studies, significantly more traits were assessed than treated. MDA studies have assessed a variety of different traits and have shown evidence of improved outcomes. This promising model of care requires more research to inform which traits should be assessed, which traits should be treated and what effect MDA has on patient outcomes.

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“…Psychological dysfunction was most frequently assessed (69.2% of Group 1), followed by sinusitis (nine studies) and gastro‐oesophageal reflux disease (GORD) (six studies) …”

Section: Resultsmentioning

confidence: 99%

Multidimensional assessment of severe asthma: A systematic review and meta‐analysis

et al. 2017

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“…Management of co-morbidities is important, as they may contribute to the severity of asthma [131]. In general, there is a relative paucity of data on the effect of co-morbidities in asthma .…”

Section: Management Of Severe Asthmamentioning

confidence: 99%

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Porsbjerg

Ulrik

Skjold

et al. 2018

European Clinical Respiratory Journal

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Although a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma (‘difficult asthma’) should undergo systematic assessment, in order to differentiate between true severe asthma, and ‘difficult-to-treat’ patients, in whom poor control is related to factors such as poor adherence or co-morbidities. The Nordic Consensus Statement on severe asthma was developed by the Nordic Severe Asthma Network, consisting of members from Norway, Sweden, Finland, Denmark, Iceland and Estonia, including representatives from the respective national respiratory scientific societies with the aim to provide an overview and recommendations regarding the diagnosis, systematic assessment and management of severe asthma. Furthermore, the Consensus Statement proposes recommendations for the organization of severe asthma management in primary, secondary, and tertiary care.

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“…We truly hope that further research will help to obtain more precise data because asthma is associated with enormous socioeconomic costs [1]. The most costly treatment -multi-drug regime -concerns severe asthma, especially so-called difficult-totreat asthma [2,[17][18][19]. It seems that application of a single therapeutic means (e.g.…”

Section: Discussionmentioning

confidence: 99%

Assessment of concentrations of interleukin-25 in bronchial asthma – preliminary studies

Czarny-Działak¹,

Słuszniak²

2016

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Introduction: Studies have demonstrated an important role of cytokines in the development of asthma, in particular the balance between them disturbed in favour of pro-inflammatory cytokines. belongs to the family of cytokines from IL-17. Its role in the pathogenesis of allergic diseases of the respiratory tract is not entirely clear. The study took into account the fact that the role can be very important due to the dual mechanism of action as an anti-inflammatory and inflammatory stimulant. Aim of the research: To assess whether the concentration of IL-25 depends on the the severity of the course of asthma. Material and methods: The study involved 80 people: 20 volunteers and 60 patients with asthma -20 people with mild persistent asthma, 20 with moderate, and with 20 severe. All patients were maintained on a course of asthma control. From each patient, blood was drawn to assess IL-25 ELISA test; all patients also had spirometry performed (in the framework of visits to the clinic). Results: In none of the cases of the people from the examined group there was an increased level of IL-25. However, some subjects (17) had higher levels of this interleukin than other people -among these were four volunteers and 13 patients with asthma. Conclusions: In the future patients should be checked during exacerbations of asthma and have the response time tried to be extended to maximum so that we can measure lower concentrations, which within a standard procedure could has not been varied (found below the lowest standard).

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Profile of difficult to treat asthma patients referred for systematic assessment

Cited by 49 publications

References 19 publications

Multidimensional assessment of severe asthma: A systematic review and meta‐analysis

Multidimensional assessment of severe asthma: A systematic review and meta‐analysis

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Assessment of concentrations of interleukin-25 in bronchial asthma – preliminary studies

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