Refractory flare-up of severe bronchial asthma controlled with mepolizumab due to Pneumocystis pneumonia: a case report.

BACKGROUND: Biologics dramatically improve symptoms of severe asthma; however, various exacerbating factors may induce flare-up. Pneumocystis spp. have not been reported as a cause of asthma exacerbation during biologic use, although patients with severe asthma have high levels of antibodies against Pneumocystis spp. CASE PRESENTATION: An 87-year-old female with severe asthma that was well-controlled with mepolizumab, who developed a steroid-resistant refractory flare-up. Chest computed tomography showed bilateral ground glass opacities, and results of polymerase chain reaction tests on induced sputum were positive for Pneumocystis DNA. Therefore, a diagnosis of Pneumocystis pneumonia was made. The clinical symptoms improved after treatment with sulfamethoxazole-trimethoprim. CONCLUSION: Clinicians should be aware of Pneumocystis pneumonia as a cause of refractory exacerbation of bronchial asthma during use of interleukin-5 inhibitors.

[Modern understanding of bronchial asthma with fixed airflow obstruction].

The review provides data on one of the phenotypes of severe bronchial asthma it is asthma with fixed airway obstruction. According to data published today, there is no single pathway for the formation of fixed airway obstruction in patients with severe asthma. Increasing knowledge of the pathophysiology of fixed airway obstruction, as well as identifying the most significant risk factors, is essential for the successful treatment of such patients. In addition, the development of fixed obstruction is associated with a worse and sometimes fatal prognosis. Expanding the existing views is also necessary to overcome the difficulties of differential diagnosis between bronchial asthma with fixed airway obstruction and bronchial asthma in combination with COPD. All this will optimize the approach to the management of patients with bronchial asthma to prevent the formation of fixed airway obstruction.

[Severe bronchial asthma patient care organization in various regions of the Russian Federation. From endotypes and phenotypes of bronchial asthma to personalized choice of therapy].

The meeting of the Expert board was held in Moscow on June 24, 2019, at which the following issues were considered: the applicability of a new terminology characterizing asthma endotypes and phenotypes in real clinical practice, the effect of phenotypes and biomarkers in patients with bronchial asthma on the choice of biological drug, as well as the optimal clinical profiles of patients for whom dupilumab is most effective, taking into account the data of the III phase clinical trials, regional features of medical care and changes in updated international clinical guidelines for the diagnosis and treatment of asthma. The Expert board included members of leading Russian scientific and educational medical institutions: S.N. Avdeev, corresponding member of the Russian Academy of Sciences, prof., MD; O.A. Volkova, Ph.D.; I.V. Demko, prof., MD; G.L. Ignatova, prof., MD; I.V. Leshchenko, prof., MD; Kanukova N.A.; Kudelya L.M., prof., MD; V.A. Nevzorova, prof., MD; N.G. Nedashkovskaya; O.P. Ukhanova, prof., MD; L.V. Shulzhenko, prof., MD; R.S. Fassakhov, prof., MD.

Polish Society of Allergology statement on the diagnosis and treatment of severe, difficult-to-control bronchial asthma.

Severe asthma requires at least high doses of inhaled corticosteroids (ICS) in combination with a long-acting ß-agonist (LABA) or systemic corticosteroids (SCS) for more than 50% of days/year to avoid loss of control, or remains uncontrolled despite the treatment described above. The diagnosis of severe asthma should be confirmed in a reference centre as it requires careful differential diagnosis and the exclusion of factors hindering the achievement of optimal control. Severe asthma represents a significant burden for the patient, their family and the healthcare system. This is due to the severity of the symptoms, drug costs, significant impairment of everyday functioning and life quality, and limitation in the professional work. In the case of ineffectiveness of the step 4 GINA treatment, the patient should be referred to a specialist centre to consider additional treatment, including anti-IgE receptor (omalizumab), anti-IL-5 receptor (mepolizumab), or an antibody directed against the α-subunit of receptor for IL-5 (benralizumab). In the case of severe asthma, intensification of therapy should first of all include biological therapy and not the use of SCS. Biological drugs are available in Poland as a part of the therapeutic programme for the treatment of severe asthma. In practice, the therapeutic programme may change with subsequent notices of the Ministry of Health and does not have to be consistent with the Summary of Product Characteristics for individual preparations. The current review presents the basic principles of differential diagnosis of severe asthma and the selection of the optimal biological therapy in Polish conditions.

Evaluation of cardiac biomarkers in children with acute severe bronchial Asthma-A prospective study from tertiary care center in northern India.

OBJECTIVES: During the attacks of acute severe bronchial asthma there are marked cardiopulmonary changes leading to hypoxia. The study aims to find the incidence of myocardial dysfunction in patients of acute severe bronchial asthma based on cardiac enzyme levels at admission and see whether the myocardial damage is transient or persistent even after stabilization of the patient based on enzyme levels at discharge. MATERIALS AND METHODS: This prospective, case control study was done at Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University between October 2016 to May 2018. Sixty pediatric patients of acute severe bronchial asthma were taken as cases and 15 age and sex matched children served as controls. Blood samples were collected in Ethylene diamine tetra acetic acid vials before the start of treatment, for measurement of cardiac biomarkers Troponin I (TnI), Brain natriuretic peptide (BNP) and Creatine Kinase-muscle/brain (CK-MB) and repeat samples were taken before discharge. RESULTS: Fifty percent of the cases had abnormal TnI levels, 15% had abnormal CK-MB levels and 8.3% had abnormal BNP levels at admission. At discharge, only 1 (1.7%) case had abnormal levels of CK-MB, whereas the levels of TnI and BNP normalized in all. The level of cardiac biomarkers were significantly raised at admission when compared to discharge values (p value < 0.001). CONCLUSIONS: The raised cardiac biomarkers suggest myocardial stress during acute exacerbation of bronchial asthma. Though, the present study showed that the changes are of transient nature, larger follow up studies are required to document any permanent damage to myocardium.

Clinical Observation of Tiotropium Bromide Combined with Budesonide Formoterol in the Treatment of Severe Bronchial Asthma in Adults / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of tiotropium bromide combined with budesonide formoterol in the treatment of severe bronchial asthma in adults. METHODS:A total of 110 adult patients with severe bronchial asthma were selected from our hospital during Mar. 2013-Mar. 2016 were divided into control group and observation group according to random number table,with 55 cases in each group. Control group was given Budesonide formoterol powder for inhalation,2 inhalations each time,bid;observation group was additionally given Tiotropium bromide powder for inhalation 18 μg,qd,on the basis of con-trol group. Both groups were treated for 6 months. Clinical efficacies as well as ACT scores,respiration function indexes and the times of acute attack of asthma before and after treatment,the occurrence of ADR were compared between 2 groups. RESULTS:The efficiency rate and total response rate of observation group were 54.55% and 96.36%,which were significantly higher than 32.73%,78.18% in control group,with statistical significance(P0.05). After treatment,ACT scores of 2 groups were significantly higher than before treatment;FEV1,FEV1/FVC and PEF were significantly greater than be-fore treatment,PEFR was significantly lower than before treatment;and the indexes in observation group was significantly better than control group,with statistical significance(P0.05). CONCLUSIONS:Tiotropium bromide combined with budesonide formoter-ol in the treatment of severe bronchial asthma in adults can effectively relieve the severity of disease,improve respiration function, reduce the times of acute attack of asthma,and have good therapeutic efficacy and safety.

Effects of montelukast combined with budesonide on FEV1%, symptom score and adverse effects in moderate to severe bronchial asthma / 中国生化药物杂志

Objective To observe the effect of montelukast combined with budesonide on FEV1%, symptom score and adverse reaction in moderate to severe bronchial asthma patients. Methods 70 patients with moderate to severe bronchial asthma from April 2016 to April 2017 were randomly divided into single group and combined group. 35 patients in a single group were treated with budesonide, combined group 35 patients were treated with montelukast combined with budesonide, and the therapeutic effects were compared between the two groups after treatment. Results There were no differences in the scores of lung function and symptoms between two groups before treatment, and there was no significant difference in the incidence of adverse reactions between the two groups. After treatment, the lung function index, symptom score and total effective treatment of the combined group were obvious better than that of the single group (P<0.05). Conclusion Montelukast combined with budesonide in the treatment of moderate to severe bronchial asthma has good effect and high safety. It reduces the number of asthma attacks and improves the lung function of patients. It is worthy to be widely used and widely used in clinical practice.

Effects of montelukast combined with budesonide on FEV1%, symptom score and adverse effects in moderate to severe bronchial asthma / 中国生化药物杂志

Objective To observe the effect of montelukast combined with budesonide on FEV1%, symptom score and adverse reaction in moderate to severe bronchial asthma patients. Methods 70 patients with moderate to severe bronchial asthma from April 2016 to April 2017 were randomly divided into single group and combined group. 35 patients in a single group were treated with budesonide, combined group 35 patients were treated with montelukast combined with budesonide, and the therapeutic effects were compared between the two groups after treatment. Results There were no differences in the scores of lung function and symptoms between two groups before treatment, and there was no significant difference in the incidence of adverse reactions between the two groups. After treatment, the lung function index, symptom score and total effective treatment of the combined group were obvious better than that of the single group (P<0.05). Conclusion Montelukast combined with budesonide in the treatment of moderate to severe bronchial asthma has good effect and high safety. It reduces the number of asthma attacks and improves the lung function of patients. It is worthy to be widely used and widely used in clinical practice.

Clinical Observation of Aerosol Inhalation of Magnesium Sulfate Combined with Salbutamol Sulfate in the Treatment of Acute Attack of Severe Bronchial Asthma in Children / 中国药房

OBJECTIVE:To investigate the clinical efficacy and safety of aerosol inhalation of magnesium sulfate and salbuta-mol sulfate in the treatment of acute attack of severe bronchial asthma in children. METHODS:85 children with acute attack of se-vere bronchial asthma were divided into control group(45 cases)and intervention group(40 cases)in accordance to even and odd number of hospitalization time. Based on routine treatment of glucocorticoid intravenous injection,oxygen uptake,sedation and nu-tritional support,control group was given aerosol inhalation of salbutamol sulfate,0.6 ml each time,once every 20 min,for 1 h;intervention group was additionally given aerosol inhalation of magnesium sulfate,0.6 ml each time,once every 20 min,for 1 h, on the basis of control group. Therapeutic efficacy,improvement time of shortness of physical examination indexes (breath, wheeze,coughing),lung function indicators and ADR were observed in 2 groups,and discharge time was recorded in 2 groups. RESULTS:The total effective rate of clinical efficacy of intervention group was 95.00%after 1 h treatment,which was significant-ly higher than 77.78% in control group,with statistical significance (P0.05). CONCLUSIONS:On the basis of conventional treatment,the aerosol inhalation of magnesium sulfate and salbutamol sulfate shows good clinical efficacy and safety in the treatment of acute attack of severe bronchi-al asthma in children.

Clinical Observation of Salmeterol and Fluticasone Propionate in the Treatment of Moderate and Severe Bronchial Asthma / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of salmeterol and fluticasone propionate in the treatment of mod-erate and severe bronchial asthma. METHODS:98 patients with moderate and severe bronchial asthma were selected from our hospi-tal were included in the study and were randomly divided into control group(49 cases,3 cases withdrew from the test and 46 cases completed the test)and observation group(49 cases,2 cases withdrew from the test and 47 cases completed the test). Control group was given Budesonide aerosol preparation,1 dose,bid;observation group was given Salmeterol and fluticasone propionate inhala-tion,1 dose,bid. The treatment course lasted for 2 months. Clinical efficacy,lung function indexes,the time of clinical symptom disappearance,FEV1,PD20,ACT score,asthma attack times within half an year,EO%and ECP in serum and sputum,and the oc-currence of ADR were compared between 2 groups. RESULTS:After treatment,total effective rate of observation group was signifi-cantly higher than that of control group(95.73% vs. 76.09%);FVC,FEV1 and PEF and other indexes of 2 groups were increased significantly,and the observation group was significantly higher than the control group;the disappearance time of pulmonary rales, wheezing,dyspnea and cough in observation group were significantly shorter than in control group;PD20 and ACT score of 2 groups were significantly increased,ACT score of observation group was significantly higher than that of control group;EO% and ECP in serum and sputum of observation group were significantly lower than those of control group,there was statistical significance (P0.05). All ADRs disappeared after drug withdrawal. CONCLUSIONS:Therapeutic efficacy of salmeterol and fluticasone propio-nate is better than budesonide in the treatment of moderate and severe bronchial asthma,and can effectively improve lung function, shorten the time of clinical symptoms disapperance and reduce the level of inflammatory factor with and good safety.

Sensibilización a ácaros domésticos en niños asmáticos severos / Sensitization to domestic mites identified in severe asthmatic patients

Introducción: las enfermedades alérgicas y el asma incrementan su prevalencia en Cuba y a nivel mundial. Los ácaros del polvo se encuentran entre los alérgenos perennes más prevalentes en todo el mundo. Objetivo: determinar la sensibilización a 3 especies de ácaros domésticos en los niños asmáticos severos de la Escuela Especial Celia Sánchez Manduley, de Tarará, provincia La Habana. Métodos: se realizó un estudio descriptivo transversal en 91 alumnos, durante el curso escolar 2011-2012, y a toda la muestra se le realizaron pruebas cutáneas por punción (prick test), utilizando extractos Vallergen-BT (Blomia tropicalis), Vallergen-DS (Dermatophagoides siboney) y Vallergen-DP (Dermatophagoides pteronyssinus) confeccionados por el Centro de Biopreparados, en Cuba; además se determinó IgE sérica total. Resultados: la rinitis alérgica resultó la comorbilidad alérgica más frecuente. El total de los pacientes presentó reactividad cutánea positiva a los ácaros, así como IgE sérica total elevada. La sensibilización frente al D. pteronyssinus se reportó en el 93,4 por ciento de los pacientes. No existió diferencia estadísticamente significativa en el diámetro del habón. Existió correlación entre la positividad de la IgE sérica total y la sensibilización cutánea a los 3 ácaros del polvo estudiado. Conclusiones: existe una estrecha relación entre el asma bronquial y la sensibilización a ácaros, con predominio de la especie D. Pteronyssinus

Introduction: the prevalence of allergic diseases and asthma grows in Cuba and worldwide. Dust mites are one of the most prevailing perennial allergens throughout the world. Objective: to determine the sensitization to 3 domestic mite species of severe asmathic children from Celia Sanchez Manduley special school located in Tarara, Havana province. Methods: a cross-sectional descriptive study was carried out in 91 students during the 2011-2012 academic year. The whole sample was performed prick tests using Vallergen-BT (Blomia tropicalis), Vallergen-DS (Dermatophagoides siboney) and Vallergen-DP (Dermatophagoides pteronyssinus) extracts prepared by the National Center of Biopreparations and their total serum IgE were additionally estimated. Results: allergic rhinitis proved to be the most frequent comorbidity. All the patients showed positive skin reactivity to mites as well as increased total serum IgE. Sensitization to D. pteronyssinus was reported in 93.4 percent of patients. There was no statistically significant difference in the habon diameter, but total serum IgE positivity and skin sensitization to the three dust mites under study were correlated. Conclusions: there is close association between bronchial asthma and sensitization to mites, being D. Pteronyssinus predominant

Sensibilización a ácaros domésticos en niños asmáticos severos / Sensitization to domestic mites identified in severe asthmatic patients

Introducción: las enfermedades alérgicas y el asma incrementan su prevalencia en Cuba y a nivel mundial. Los ácaros del polvo se encuentran entre los alérgenos perennes más prevalentes en todo el mundo. Objetivo: determinar la sensibilización a 3 especies de ácaros domésticos en los niños asmáticos severos de la Escuela Especial Celia Sánchez Manduley, de Tarará, provincia La Habana. Métodos: se realizó un estudio descriptivo transversal en 91 alumnos, durante el curso escolar 2011-2012, y a toda la muestra se le realizaron pruebas cutáneas por punción (prick test), utilizando extractos Vallergen-BT (Blomia tropicalis), Vallergen-DS (Dermatophagoides siboney) y Vallergen-DP (Dermatophagoides pteronyssinus) confeccionados por el Centro de Biopreparados, en Cuba; además se determinó IgE sérica total. Resultados: la rinitis alérgica resultó la comorbilidad alérgica más frecuente. El total de los pacientes presentó reactividad cutánea positiva a los ácaros, así como IgE sérica total elevada. La sensibilización frente al D. pteronyssinus se reportó en el 93,4 por ciento de los pacientes. No existió diferencia estadísticamente significativa en el diámetro del habón. Existió correlación entre la positividad de la IgE sérica total y la sensibilización cutánea a los 3 ácaros del polvo estudiado. Conclusiones: existe una estrecha relación entre el asma bronquial y la sensibilización a ácaros, con predominio de la especie D. Pteronyssinus(AU)

Introduction: the prevalence of allergic diseases and asthma grows in Cuba and worldwide. Dust mites are one of the most prevailing perennial allergens throughout the world. Objective: to determine the sensitization to 3 domestic mite species of severe asmathic children from Celia Sanchez Manduley special school located in Tarara, Havana province. Methods: a cross-sectional descriptive study was carried out in 91 students during the 2011-2012 academic year. The whole sample was performed prick tests using Vallergen-BT (Blomia tropicalis), Vallergen-DS (Dermatophagoides siboney) and Vallergen-DP (Dermatophagoides pteronyssinus) extracts prepared by the National Center of Biopreparations and their total serum IgE were additionally estimated. Results: allergic rhinitis proved to be the most frequent comorbidity. All the patients showed positive skin reactivity to mites as well as increased total serum IgE. Sensitization to D. pteronyssinus was reported in 93.4 percent of patients. There was no statistically significant difference in the habon diameter, but total serum IgE positivity and skin sensitization to the three dust mites under study were correlated. Conclusions: there is close association between bronchial asthma and sensitization to mites, being D. Pteronyssinus predominant(AU)

Effects of Lidocaine on Respiratory Failure and the Airway Peak Pressure in Patients with Severe Asthma: A Clinical Research / 中国药房

OBJECTIVE: To observe the effect of lidocaine on respiratory failure and the airway peak pressure in patients with severe asthma. METHODS: The severe bronchial asthma patients treated with mechanical ventilation were randomly divided into treatment group and control group. The change in airway peak pressure, man-machine counteraction, and the correcting time of respiratory failure of the two groups were recorded. RESULTS: The average airway peak pressure was(41.18?10.66) cmH2O in the control group vs.(29.23?9.07) cmH2O in the treatment group; the incidence of man-machine counteraction was 100% for the control group vs. only 40% for the treatment group; the correcting time of respiratory failure was(6.42?1.73) h for the control group vs.(3.31?1.08) h for the treatment group. There were significant differences between the two groups in the above mentioned indexes(P

Mechanical ventilation in the treatment of acute severe bronchial asthma-analysis of 13 cases / 中国实用内科杂志

1∶2,inspiratory press