Jon-Emile S. Kenny MD [@heart_lung] “It is a narrow mind which cannot look at a subject from various points of view.” -George Eliot Background On background reading for the recent entry on ‘Asthmatic Mechanics,’ I happened across a delightful case report submitted as a letter to the editor of the New England Journal of Medicine in [… read more]
Jon-Emile S. Kenny MD [@heart_lung] Recently, Josh Farkas and Scott Weingart gave a series of engrossing posts and podcasts on asthma. I especially liked their deliberations on mechanical ventilation which inspired me – no pun intended – to create a vodcast of my own and, like a novice troubleshooting a ventilator alarm, poke and prod at [… read more]
Inhaled corticosteroids have been the mainstay of treatment for persistent asthma for decades. A new trial suggests that for the ~50% of asthma patients with low sputum eosinophils, inhaled steroids are no better than placebo, and neither was tiotropium. Treatment with the inhaled glucocorticoid mometasone or the long-acting muscarinic antagonist tiotropium resulted in similar outcomes [… read more]
In their first major update in 30 years, newly published asthma guidelines recommend significant changes to the way physicians treat millions of patients diagnosed with asthma. The Global Initiative for Asthma (GINA) now advises that, in general: Most people with asthma can now be prescribed just one inhaler: an inhaled corticosteroid-and-long-acting beta agonist (ICS-LABA) combination [… read more]
by Salynn Boyles, Contributing Writer, MedPage Today Treatment with antibiotics during hospitalization for asthma exacerbation was associated with longer hospital stays and higher hospital costs in a retrospective cohort study of nearly 20,000 adult patients. Mihaela Stefan, MD, PhD, of the University of Massachusetts Medical School in Springfield, and colleagues, found that despite guidelines recommending against routine [… read more]
The U.S. FDA approved the first generic version of blockbuster drug Advair (fluticasone/salmeterol) for asthma maintenance treatment in patients aged 4 and up, and also for maintenance treatment and prevention of exacerbations in chronic obstructive pulmonary disease (COPD). Mylan will make the generic alternative to fluticasone/salmeterol, which will be called Wixela Inhub and come in [… read more]
by John Gever, Managing Editor, MedPage Today WASHINGTON — Primatene Mist, the over-the-counter epinephrine inhaler for quick asthma relief, can go back on the market in a reformulated version, the FDA said. Now using a hydrofluoroalkane (HFA) propellant in place of the banned chlorofluorocarbon (CFC) used in the original Primatene product (and most other asthma inhalers), the new [… read more]
by Salynn Boyles, Contributing Writer, MedPage Today SEATTLE — Add-on treatment with the biologic therapy dupilumab (Dupixent) was associated with reduced severe exacerbations and improved lung function in patients with allergic asthma in a post-hoc analysis of phase III data from the Liberty Asthma Quest study reported here. The analysis compared outcomes in patients with allergic disease versus those [… read more]
The US Food and Drug Administration (FDA) approved dupilumab (Dupixent, Sanofi/Regeneron) as “add-on maintenance therapy in patients with moderate-to-severe asthma aged 12 years and older with an eosinophilic phenotype or with oral corticosteroid-dependent asthma,” according to the manufacturer’s news release. In randomized trials, asthmatic patients with higher blood eosinophil counts (≥ 150 cells/µL) failing corticosteroid [… read more]
In Europe, patients with asthma have long been advised to take more puffs of their combination inhaled corticosteroid-long-acting beta-agonist (ICS-LABA) inhaler during periods of increased asthma symptoms. In the U.S., patients are instead advised to use albuterol as their rescue inhaler, and stick firmly to the usual maintenance dose of ICS-LABA regardless of symptom severity. [… read more]
When patients with asthma feel their symptoms worsening and fear a full-blown exacerbation is imminent, what should they do? Doctors and researchers have never found a good answer to this question for most patients. The options are, generally: 1) continue current controller inhalers and observing; 2) increase the dose of inhaled steroid inhalers; or 3) [… read more]
By Salynn Boyles, Contributing Writer, MedPageToday Self-taught breath retraining proved to be an effective, readily available and cost efficient strategy for improving quality of life among patients with asthma in a randomized trial. The training involved video instruction designed to teach patients breathing exercises such as diaphragmatic breathing, nasal breathing, slow breathing, controlled breath holds, and relaxation [… read more]
by Salynn Boyles Contributing Writer, MedPage Today The FDA has approved AstraZeneca’s biologic drug benralizumab (Fasenra) for the add-on maintenance treatment of patients age 12 years and over with severe asthma with an eosinophilic phenotype, the drugmaker announced. Approval was based on pivotal trials showing up to a 51% reduction in the annual asthma exacerbation [… read more]
Multiple randomized trials have suggested that vitamin D supplementation might improve asthma control and reduce severity of asthma attacks. A new meta-analysis bolsters that hypothesis, and may encourage more physicians and people with asthma to consider vitamin D supplements for low vitamin D levels. In a study in Lancet Respiratory Medicine, authors analyzed the experience [… read more]
by Salynn Boyles, Contributing Writer, MedPage Today Asthma costs the U.S. economy more than $80 billion a year in medical expenditures, missed school and work days, and deaths, according to CDC researchers. The condition is responsible for 8.7 million lost workdays and 5.2 million lost school-days annually, at an estimated cost of around $3 billion, reported Tursynbek [… read more]
Combination inhalers for asthma and COPD containing long-acting beta agonists (LABA) drugs along with inhaled corticosteroids can lose their black-box warnings about their previously-theorized risk of asthma-related death, the FDA announced. The original boxed warning came in 2011 in the wake of a small number of asthma-related deaths among patients taking LABA monotherapy (without inhaled [… read more]
The FDA has expanded the indication for tiotropium (Spiriva Respimat) to include children age 6 and older, based on efficacy data similar to that in adults. Tiotropium (Spiriva Respimat) was approved by FDA in 2015 for adults with asthma after clinical trials showed benefit of Spiriva as an add-on therapy to patients with persistent asthma [… read more]
GlaxoSmithKline is voluntarily recalling more than 590,000 albuterol inhalers (brand name Ventolin), citing a defect that may cause the inhalers to deliver fewer doses of the medicine than prescribed, the British drugmaker announced. Patients complained about a bulging of the outside wrapper of Ventolin’s packaging; a leak of the medicine’s propellant is suspected to be [… read more]
Can fish oil supplements taken during pregnancy prevent asthma in children? According to a randomized trial in the New England Journal of Medicine, yes. Children of 736 pregnant women who took supplements containing given n-3 long-chain polyunsaturated fatty acid during their third trimester had a 31% relative reduction in risk of developing asthma or persistent [… read more]
Anyone caring for patients in a clinic setting knows that asthma can easily be overdiagnosed. Asthma lacks a gold standard test for diagnosis, can produce vague symptoms, and inexpensive, low risk treatments are available (inhaled corticosteroids and albuterol). The result is many dyspneic or coughing patients are given an asthma diagnosis that is provisional or tentative — whether [… read more]
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