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New therapies and management strategies in the treatment of asthma: patient-focused developments.

Agbetile J, Green R - J Asthma Allergy (2010)

Bottom Line: It is increasingly recognized that large proportions of patients with asthma remain poorly controlled with daily symptoms, limitation in activities, or severe exacerbations despite traditional treatment with inhaled corticosteroids and other agents.This suggests that there is considerable scope for the refinement of traditional guidelines on the use of inhaled therapies in asthma and also a need for the development of novel therapeutic agents, particularly for the treatment of severe asthma.Secondly, we will review new strategies to better use the existing therapies such as inhaled corticosteroids and long-acting β(2)-agonists that remain the mainstay of treatment for most patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine and Thoracic Surgery, Institute for Lung Health, Glenfield Hospital, Leicester, UK.

ABSTRACT
It is increasingly recognized that large proportions of patients with asthma remain poorly controlled with daily symptoms, limitation in activities, or severe exacerbations despite traditional treatment with inhaled corticosteroids and other agents. This suggests that there is considerable scope for the refinement of traditional guidelines on the use of inhaled therapies in asthma and also a need for the development of novel therapeutic agents, particularly for the treatment of severe asthma. This review aims to discuss a range of emerging treatment approaches in asthma. Firstly, we will set the scene by highlighting the importance of achieving good asthma control in a patient-focused manner and discussing recent work that has furthered our understanding of asthma phenotypes and paved the way for patient-specific treatments. Secondly, we will review new strategies to better use the existing therapies such as inhaled corticosteroids and long-acting β(2)-agonists that remain the mainstay of treatment for most patients. Finally, we will review the novel therapies that are becoming available, both pharmacological and interventional, and discuss their likely place in the management of this complex disease.

No MeSH data available.


Related in: MedlinePlus

Cumulative asthma exacerbations in the BTS management group and the sputum management group.Copyright © 2010, Elsevier Limited. Reproduced with permission from Green RH, Brightling Ce, McKenna S, et al. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet. 2002;360(9347):1715–1721.
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Related In: Results  -  Collection


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f2-jaa-4-001: Cumulative asthma exacerbations in the BTS management group and the sputum management group.Copyright © 2010, Elsevier Limited. Reproduced with permission from Green RH, Brightling Ce, McKenna S, et al. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet. 2002;360(9347):1715–1721.

Mentions: We randomized 74 attending outpatients with moderate to severe asthma into treatments based on standard guidelines (BTS) or to a management strategy directed at maintaining the sputum eosinophil count at or below 3% using anti-inflammatory therapy, both inhaled and oral. If the sputum eosinophil count was <1%, irrespective of asthma control, anti-inflammatory treatment was reduced. If the eosinophil count was 1%–3%, no changes to anti-inflammatory treatment were made, and if the eosinophil count was >3%, anti-inflammatory treatment was increased. Bronchodilator treatment was modified according to individual patients’ symptoms, rescue β2-agonists use, and peak expiratory flow readings compared with baseline using the same measures as in the standard management group (Figure 2). There were significantly fewer severe exacerbations in the sputum management group in contrast to the BTS management group (35 versus 109 total exacerbations, respectively, P = 0.01) and fewer rescue courses of oral corticosteroids (24 versus 73, P = 0.008). Additionally, we demonstrated a significant reduction in the inhaled corticosteroid dose in those managed by sputum guidelines compared with baseline, in contrast to an increase in dose in the BTS group. This demonstrated that the sputum management strategy allowed appropriate targeting of anti-inflammatory treatment where it was most needed and an avoidance of inappropriately high doses in patients who were unlikely to benefit. Accepting that widespread inflammometry using induced sputum is not available, this tailored approach offers significant proven benefits to patients with severe asthma, particularly in avoiding harmful unwarranted treatment.


New therapies and management strategies in the treatment of asthma: patient-focused developments.

Agbetile J, Green R - J Asthma Allergy (2010)

Cumulative asthma exacerbations in the BTS management group and the sputum management group.Copyright © 2010, Elsevier Limited. Reproduced with permission from Green RH, Brightling Ce, McKenna S, et al. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet. 2002;360(9347):1715–1721.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108304&req=5

f2-jaa-4-001: Cumulative asthma exacerbations in the BTS management group and the sputum management group.Copyright © 2010, Elsevier Limited. Reproduced with permission from Green RH, Brightling Ce, McKenna S, et al. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet. 2002;360(9347):1715–1721.
Mentions: We randomized 74 attending outpatients with moderate to severe asthma into treatments based on standard guidelines (BTS) or to a management strategy directed at maintaining the sputum eosinophil count at or below 3% using anti-inflammatory therapy, both inhaled and oral. If the sputum eosinophil count was <1%, irrespective of asthma control, anti-inflammatory treatment was reduced. If the eosinophil count was 1%–3%, no changes to anti-inflammatory treatment were made, and if the eosinophil count was >3%, anti-inflammatory treatment was increased. Bronchodilator treatment was modified according to individual patients’ symptoms, rescue β2-agonists use, and peak expiratory flow readings compared with baseline using the same measures as in the standard management group (Figure 2). There were significantly fewer severe exacerbations in the sputum management group in contrast to the BTS management group (35 versus 109 total exacerbations, respectively, P = 0.01) and fewer rescue courses of oral corticosteroids (24 versus 73, P = 0.008). Additionally, we demonstrated a significant reduction in the inhaled corticosteroid dose in those managed by sputum guidelines compared with baseline, in contrast to an increase in dose in the BTS group. This demonstrated that the sputum management strategy allowed appropriate targeting of anti-inflammatory treatment where it was most needed and an avoidance of inappropriately high doses in patients who were unlikely to benefit. Accepting that widespread inflammometry using induced sputum is not available, this tailored approach offers significant proven benefits to patients with severe asthma, particularly in avoiding harmful unwarranted treatment.

Bottom Line: It is increasingly recognized that large proportions of patients with asthma remain poorly controlled with daily symptoms, limitation in activities, or severe exacerbations despite traditional treatment with inhaled corticosteroids and other agents.This suggests that there is considerable scope for the refinement of traditional guidelines on the use of inhaled therapies in asthma and also a need for the development of novel therapeutic agents, particularly for the treatment of severe asthma.Secondly, we will review new strategies to better use the existing therapies such as inhaled corticosteroids and long-acting β(2)-agonists that remain the mainstay of treatment for most patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine and Thoracic Surgery, Institute for Lung Health, Glenfield Hospital, Leicester, UK.

ABSTRACT
It is increasingly recognized that large proportions of patients with asthma remain poorly controlled with daily symptoms, limitation in activities, or severe exacerbations despite traditional treatment with inhaled corticosteroids and other agents. This suggests that there is considerable scope for the refinement of traditional guidelines on the use of inhaled therapies in asthma and also a need for the development of novel therapeutic agents, particularly for the treatment of severe asthma. This review aims to discuss a range of emerging treatment approaches in asthma. Firstly, we will set the scene by highlighting the importance of achieving good asthma control in a patient-focused manner and discussing recent work that has furthered our understanding of asthma phenotypes and paved the way for patient-specific treatments. Secondly, we will review new strategies to better use the existing therapies such as inhaled corticosteroids and long-acting β(2)-agonists that remain the mainstay of treatment for most patients. Finally, we will review the novel therapies that are becoming available, both pharmacological and interventional, and discuss their likely place in the management of this complex disease.

No MeSH data available.


Related in: MedlinePlus