Step-up and step-down approaches in the treatment of asthma

Cazzola, Mario; Matera, Maria Gabriella; Rogliani, Paola; Calzetta, Luigino; Ora, Josuel

doi:10.1080/17476348.2021.1935245

Cited by 9 publications

(3 citation statements)

References 74 publications

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“…Asthma is currently recognized as a collection of distinct clinical and pathophysiological syndromes that may overlap [ 34 ]. Nonetheless, both NHLBI/NAEPP and GINA suggest a treatment strategy for asthma that ignores the underlying disease processes and instead focuses on so-called “severity phenotypes” based on lung function, symptoms, and quality of life that allows a “one-size-fits-all” approach [ 35 ]. However, escalation to phenotype-specific personalized biological therapies should be understood with the first, albeit limited, attempt at personalized therapy in asthma [ 36 ].…”

Section: Use Of Lamas Considering Treatable Traitsmentioning

confidence: 99%

Might It Be Appropriate to Anticipate the Use of Long-Acting Muscarinic Antagonists in Asthma?

Cazzola

Rogliani

Matera

2023

Drugs

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A growing number of clinical trials are documenting that adding a long-acting muscarinic antagonist (LAMA) to established asthma treatment with an inhaled corticosteroid (ICS) and a long-acting β 2 -agonist (LABA) is a treatment option that improves the health of patients with uncontrolled severe asthma even when therapy is optimized. These favorable results are the reason why the leading guidelines recommend triple therapy with ICS + LABA + LAMA in patients with asthma uncontrolled by medium- to high-dose ICS-LABA. However, we suggest adding LAMAs to ICS-LABAs at an earlier clinical stage. Such action could positively influence airflow limitation, exacerbations, and eosinophilic inflammation, conditions that are associated with acetylcholine (ACh) activity. It could also interrupt the vicious cycle related to a continuous release of ACh leading to the progressive expansion of neuronal plasticity resulting in small airway dysfunction. The utility of an earlier use of triple therapy in asthma should, in any case, be confirmed by statistically powered trials.

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Section: Use Of Lamas Considering Treatable Traitsmentioning

confidence: 99%

Might It Be Appropriate to Anticipate the Use of Long-Acting Muscarinic Antagonists in Asthma?

Cazzola

Rogliani

Matera

2023

Drugs

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“…The guidelines also stress the importance of educating parents of children as primary caregivers and core decision-makers on how to effectively collaborate with healthcare professionals for the formulation of appropriate asthma management plans for children. However, research has found that these guideline recommendations are not consistently followed, with fewer than half of families receiving any training related to their child's asthma recovery plan 10,11 . Therefore, gaining a deeper understanding of how decision-making occurs between healthcare providers and parents during the process of pediatric asthma plan formulation, especially for parents of children experiencing acute attacks and severe asthma, is crucial.…”

Section: Introductionmentioning

confidence: 99%

Factors contributing to decision-making dilemmas faced by parents of children with severe asthma in PICU during the development of discharge care plans: a phenomenological study

Fan,

Yi,

Qiu

et al. 2023

Preprint

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Purpose: This study aims to explore the complex decision-making dilemma and challenges confronted by parents of children suffering from severe asthma within the Pediatric Intensive Care Unit (PICU) when participating in the development of their children's discharge care plans. Methods: Employing a phenomenological approach, 18 parents, purposively selected, were subjected to in-depth semi-structured interviews between October 2022 and February 2023. The transcripts of these interviews were transcribed into textual data, which was then subjected to Colaizzi's seven-step analysis for meticulous coding and comprehensive thematic elucidation. Results: The comprehensive analysis of the factors contributing to the intricate decision-making dilemmas faced by parents of children with severe asthma during the process of crafting discharge care plans in the PICU revealed five themes and eight sub-themes: 1) Complexity of asthma-related information; 2) Insufficient provision of comprehensive decision-making support; 3) Encountering negative emotions and wavering parental confidence; 4) Navigating realistic constraints impacting both parents and healthcare providers; 5) Balancing the advantages and disadvantages of various plans. Conclusion: Parents of children with severe asthma in the PICU encounter intricate and multifaceted decision-making dilemmas while engaging in the formulation of discharge care plans. These complexities significantly dampen their decision-making enthusiasm and introduce potential risks to the children's prognosis and recovery. In the future, it is imperative to leverage the guidance provided by healthcare professionals (HCPs) in the decision-making process, develop tailored decision support tools specifically designed for the formulation of discharge care plans for children with severe asthma in the PICU.

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“…However, research has found that these guideline recommendations are not consistently followed, with fewer than half of families receiving any training related to their child’s asthma recovery plan. 10 , 11 Therefore, gaining a deeper understanding of how decision-making occurs between HCPs and parents during the process of pediatric asthma plan formulation, especially for parents of children experiencing acute attacks and severe asthma, is crucial.…”

Section: Introductionmentioning

confidence: 99%

Factors Involved in Decision-Making Dilemmas Faced by Parents of Children with Severe Asthma in PICU During the Development of Discharge Care Plans: A Phenomenological Study

Fan,

Yi,

Qiu

et al. 2023

JAA

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Purpose This study aims to explore the complicated decision-making dilemma and challenges confronted by parents of children suffering from severe asthma within the Pediatric Intensive Care Unit (PICU) when participating in the development of their children’s discharge care plans. Patients and Methods Employing a phenomenological methodology, a purposive sampling was performed to engage with 17 parents who participated in in-depth and semi-structured interviews between October 2022 and February 2023. The transcripts of these interviews were transcribed into textual data, which was then subjected to Colaizzi’s seven-step analysis for meticulous coding and comprehensive thematic elucidation. Results The comprehensive analysis of the factors involved in the intricate decision-making dilemmas faced by parents of children with severe asthma during the process of crafting discharge care plans in the PICU revealed five themes and eight sub-themes: 1) Complexity of asthma-related information; 2) Insufficient provision of comprehensive decision-making support; 3) Encountering negative emotions and wavering confidence; 4) Navigating realistic constraints impacting both parents and HCPs; 5) Balancing the advantages and disadvantages of various plans. Conclusion Parents of children with severe asthma in the PICU encounter intricate and multifaceted decision-making dilemmas while engaging in the formulation of discharge care plans. These complexities significantly dampen their decision-making enthusiasm and introduce potential risks to the children’s prognosis and recovery. In the future, it is imperative to leverage the guidance provided by healthcare professionals (HCPs) in the decision-making process, develop tailored decision support tools specifically designed for the formulation of discharge care plans for children with severe asthma in the PICU.

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Step-up and step-down approaches in the treatment of asthma

Cited by 9 publications

References 74 publications

Might It Be Appropriate to Anticipate the Use of Long-Acting Muscarinic Antagonists in Asthma?

Might It Be Appropriate to Anticipate the Use of Long-Acting Muscarinic Antagonists in Asthma?

Factors contributing to decision-making dilemmas faced by parents of children with severe asthma in PICU during the development of discharge care plans: a phenomenological study

Factors Involved in Decision-Making Dilemmas Faced by Parents of Children with Severe Asthma in PICU During the Development of Discharge Care Plans: A Phenomenological Study

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