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1.
Brasília, D.F.; OPAS; 2020-10-01. (OPAS/BRA/NMH/MH/COVID-19/20-0011).
em Português | PAHO-IRIS | ID: phr2-52786

RESUMO

Aborda os riscos enfrentados pelas pessoas com asma no contexto do COVID-19 e os passos que podem tomar para reduzi-los. O documento faz parte de uma série de notas descritivas que tratam de diferentes doenças não transmissíveis em relação ao COVID-19 por meio de perguntas e respostas. Eles visam um público em geral e, em particular, pessoas com doenças não transmissíveis, com o objetivo de fornecer informações e mensagens claras sobre os riscos associados ao COVID-19 e a gestão da situação de saúde.


Assuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Controle de Infecções , Asma , Doenças Respiratórias
2.
Chron Respir Dis ; 17: 1479973120962800, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33000648

RESUMO

INTRODUCTION: The COVID pandemic has had a high psychological impact on healthy populations. Increased levels of perceived stress, depression, and insomnia are expected, especially in people with pre-existing medical conditions, such as asthma and chronic obstructive pulmonary disease (COPD), who seem to be particularly vulnerable. However, the difference in psychological distress frequency between asthma and COPD patients is unknown. OBJECTIVE: To compare the prevalence of depression, perceived stress related to COVID, post-traumatic stress, and insomnia in asthma and COPD patients at a pulmonology clinic in Santa Marta, Colombia. METHODS: A cross-sectional study was designed. The patients were contacted by telephone. An electronic link was sent to those who accepted. The questionnaire asked for perceived stress related to COVID-19, post-traumatic stress symptoms, depressive symptoms, and insomnia risk. RESULTS: 148 asthma patients and 144 COPD patients participated in, between 18 and 96 years. The prevalence of high COVID-19 perceived stress was 10.6% (n = 31); post-traumatic stress risk, 11.3% (n = 33); depression risk, 31.5% (n = 92); and insomnia risk, 57.7% (n = 169). No significant differences were found between asthma and COPD in indicators of psychological distress. CONCLUSIONS: Asthma and COPD patients present similar frequencies of depression risk, COVID-19 perceived stress, post-traumatic stress risk, and insomnia risk during the Colombian lockdown. It is essential to evaluate and manage psychological distress among asthma and COPD patients. It can reduce the risk of exacerbation and improve the quality of life.


Assuntos
Asma , Infecções por Coronavirus , Depressão , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono , Transtornos de Estresse Pós-Traumáticos , Asma/epidemiologia , Asma/psicologia , Betacoronavirus , Colômbia/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Autoavaliação Diagnóstica , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Angústia Psicológica , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Pesquisa Qualitativa , Autoimagem , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia
4.
Respir Res ; 21(1): 265, 2020 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-33050900

RESUMO

BACKGROUND: Patients with severe, uncontrolled asthma, particularly those with a non-eosinophilic phenotype, have a great unmet need for new treatments that act on a broad range of inflammatory pathways in the airway. Tezepelumab is a human monoclonal antibody that blocks the activity of thymic stromal lymphopoietin, an epithelial cytokine. In the PATHWAY phase 2b study (NCT02054130), tezepelumab reduced exacerbations by up to 71% in adults with severe, uncontrolled asthma, irrespective of baseline eosinophilic inflammatory status. This article reports the design and objectives of the phase 2 CASCADE study. METHODS: CASCADE is an ongoing exploratory, phase 2, randomized, double-blind, placebo-controlled, parallel-group study aiming to assess the anti-inflammatory effects of tezepelumab 210 mg administered subcutaneously every 4 weeks for 28 weeks in adults aged 18-75 years with uncontrolled, moderate-to-severe asthma. The primary endpoint is the change from baseline to week 28 in airway submucosal inflammatory cells (eosinophils, neutrophils, T cells and mast cells) from bronchoscopic biopsies. Epithelial molecular phenotyping, comprising the three-gene-mean technique, will be used to assess participants' type 2 (T2) status to enable evaluation of the anti-inflammatory effect of tezepelumab across the continuum of T2 activation. Other exploratory analyses include assessments of the impact of tezepelumab on airway remodelling, including reticular basement membrane thickening and airway epithelial integrity. At the onset of the COVID-19 pandemic, the protocol was amended to address the possibility that site visits would be limited. The amendment allowed for: at-home dosing of study drug by a healthcare professional, extension of the treatment period by up to 6 months so patients are able to attend an onsite visit to undergo the end-of-treatment bronchoscopy, and replacement of final follow-up visits with a virtual or telephone visit. DISCUSSION: CASCADE aims to determine the mechanisms by which tezepelumab improves clinical asthma outcomes by evaluating the effect of tezepelumab on airway inflammatory cells and remodelling in patients with moderate-to-severe, uncontrolled asthma. An important aspect of this study is the evaluation of the anti-inflammatory effect of tezepelumab across patients with differing levels of eosinophilic and T2 inflammation. TRIAL REGISTRATION: NCT03688074 (ClinicalTrials.gov). Registered 28 September 2018.


Assuntos
Antiasmáticos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Asma/tratamento farmacológico , Adolescente , Adulto , Idoso , Antiasmáticos/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Asma/diagnóstico , Asma/imunologia , Ensaios Clínicos Fase II como Assunto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
5.
Rev Assoc Med Bras (1992) ; 66(9): 1270-1276, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027457

RESUMO

OBJECTIVES: To evaluate the treatment of wheezing and exacerbation of asthma in a pediatric emergency unit (ED), comparing it to that recommended by the guidelines for this purpose. METHODS: Descriptive cross-sectional study through medical records survey of children and adolescents (0-15 years of age) who received medication for wheezing or asthma exacerbation from January to April 2015 in the ED. The selected treatment was compared to that recommended by the guidelines, being analyzed the variables related to the medication (number and dose of short-acting ß2 agonist, associated or not with anticholinergic, oral or parenteral corticosteroid) and the length of stay in ED (≤1 h, ≥8 h and hospital admission). RESULTS: One-thousand eleven patients were selected with 56.7% between 3 and 15 years and 56% male. Although the selected drugs were in accordance with what was recommended, errors were observed in relation to dose, drug of choice, and method and time of use with the most frequent finding being incorrect dose (short-acting ß2 agonist: 66% and ipratropium bromide: 95.2%). CONCLUSION: The level of use of the measures recommended by the guidelines was low but compatible with other studies, leading to an increased risk of treatment failure and higher costs. Despite wide dissemination, the established concepts have not been sufficiently incorporated into clinical practice, suggesting the need for more effective educational actions for this process to occur.


Assuntos
Asma , Sons Respiratórios , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Ipratrópio , Masculino
6.
Rev Med Liege ; 75(10): 682-685, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-33030846

RESUMO

We conducted a prospective observational study to evaluate the efficacy of yoga in poorly controlled severe asthmatic patients treated with maximal inhaled therapy and biologics. The objective of yoga was to improve breathing consciousness, exercising controlled ventilation with and without retention, abdominal breathing observation, improvement of inspiratory and expiratory muscles, opening of the chest, diaphragm exercises and relaxation. We measured exhaled nitric oxide, forced expiratory volume in one second, forced vital capacity, asthma control and quality of life questionnaires, anxiety and depression questionnaires before and after the tenth yoga course (performed twice a week). Half of the patients who were invited to participate to the study declined due to organization problems. Two patients were excluded due to bronchitis and arthralgia respectively. The analysis of the data from 12 participants revealed significant improvement in asthma control and asthma quality of life questionnaires and a reduction of anxiety.The regular practice of yoga in severe asthmatics insufficiently controlled despite maximal inhaled treatment and biotherapy seems to be an interesting complementary option to improve asthma control. Our results must be confirmed in larger randomized controlled trials.


Assuntos
Asma , Produtos Biológicos , Ioga , Asma/tratamento farmacológico , Volume Expiratório Forçado , Humanos , Qualidade de Vida
7.
Artigo em Chinês | MEDLINE | ID: mdl-33040502

RESUMO

Objective:To observe the secondary prevention efficacy of subcutaneous immunotherapy in children with allergic rhinitis(AR) and cough variant asthma(CVA) and to analyze its effect on the levels of serum sIgG4, IL-27 and IL-33. Method:The clinical data of 112 children aged 5-12 years with AR and CVA were retrospectively analyzed and divided into control group(52 cases) and SCIT group(60 cases). The patients were followed up for 3 years. The control group was received symptomatic treatment only, and the SCIT group was received SCIT on the basis of the control group. The numbers of cases of the two groups of children who produced new allergens and developed CA were analyze during the 3-year treatment. Changes in serum sIgG4, IL-27, IL-33 levels, TNSS, DCSS, NCSS, TRMS, TCMS, VAS score, and FEV1% before and after treatment were analyzed. Result:During the treatment, 4 patients(6.67%) in the SCIT group produced the new allergen, and 20 patients(38.46%) in the control group(χ²=16.73, P<0.05). There were only 3 cases(5.00%) in the SCIT group, which developed into CA, while 15 cases(28.85%) in the control group. The difference between the groups was statistically significant(χ²=11.74, P<0.05). Compared with baseline, serum levels of sIgG4 and IL-27 in both groups were significantly increased after 3 years of treatment(P<0.05), while serum levels of IL-33 were significantly decreased(P<0.05). After 3 years of treatment, serum levels of sIgG4 and IL-27 in the SCIT group were significantly higher than those in the control group, and serum levels of IL-33 were significantly lower than those in the control group(P<0.05). Compared with baseline, TNSS, DCSS, NCSS, TRMS, TCMS, VAS, and FEV1% in both groups were significantly improved at 1, 2, and 3 years of treatment(P<0.05). There was no significant difference in TNSS, DCSS, NCSS, TRMS, TCMS, VAS and FEV1% between the two groups at baseline(P>0.05), while after 1, 2 and 3 years of treatment the above indicators in the SCIT group were significantly better than those in the control group(P<0.05). Conclusion:SCIT treatment can prevent AR with CVA patients from producing new allergens and developing into CA, and improve serum sIgG4 and IL-27 and IL-33 levels.


Assuntos
Asma , Interleucina-27 , Rinite Alérgica , Asma/terapia , Criança , Pré-Escolar , Tosse , Humanos , Imunoterapia , Injeções Subcutâneas , Interleucina-33 , Estudos Retrospectivos , Rinite Alérgica/terapia , Prevenção Secundária
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4491-4497, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018992

RESUMO

Spirometry test, a measure of the patient's lung function, is the gold standard for diagnosis and monitoring of chronic pulmonary diseases. Spirometry is currently being done in hospital settings by having the patients blow the air out of their lungs forcefully and into the spirometer's tubes under the supervision and constant guidance of clinicians. This test is expensive, cumbersome and not easily applicable to every-day monitoring of these patients. The lung mechanism when performing a cough is very similar to when spirometry test is done. That includes a big inhalation, air compression and forceful exhalation. Therefore, it is reasonable to assume that obstruction of lung airways should have a similar effect on both cough features and spirometry measures. This paper explores the estimation of lung obstruction using cough acoustic features. A total number of 3695 coughs were collected from patients from 4 different conditions and 4 different severity categories along with their lung function measures in a clinical setting using a smartphone's microphone and a hospital-grade spirometry lab. After feature-set optimization and model hyperparameter tuning, the lung obstruction was estimated with MAE (Mean Absolute Error) of 8% for COPD and 9% for asthma populations. In addition to lung obstruction estimation, we were able to classify patients' disease state with 91% accuracy and patients' severity within each disease state with 95% accuracy.Clinical Relevance- This enables effort-independent estimation of lung function spirometry parameters which could potentially lead to passive monitoring of pulmonary patients.


Assuntos
Asma , Tosse , Acústica , Asma/diagnóstico , Tosse/diagnóstico , Humanos , Pulmão , Espirometria
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5531-5536, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019232

RESUMO

The estimation of inhalation flow rate (IFR) using acoustic devices has recently received attention. While existing work often assumes that the microphone is placed at a fixed distance from the acoustic device, this assumption does not hold in real settings. This leads to poor estimation of the IFR since the received acoustic energy varies significantly with the distance. Despite the fact that the acoustic source is passive and only one microphone is used, we show in this paper that the distance can be estimated by exploiting the inhaler actuation sound, generated when releasing the medication. Indeed, this sound is used as a reference acoustic signal which is leveraged to estimate the distance in real settings. The resulting IFR estimation is shown to be highly accurate (R2 = 80.3%).


Assuntos
Acústica , Asma , Asma/tratamento farmacológico , Humanos , Nebulizadores e Vaporizadores , Taxa Respiratória , Som
12.
Med Hypotheses ; 143: 110110, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33017904

RESUMO

Current formulations and dose regimens of hydroxychloroquine (HCQ) put patients at risk of harm. An analysis of clinical trials registered on ClinicalTrials.gov revealed that this may continue as many studies combine HCQ with agents that prolong the QT interval. Further, almost all of the trials registered do not consider dosage adjustment in the elderly, a patient population most likely to require HCQ treatment. Here we describe an inhaled formulation of HCQ which has passed safety studies in clinical trials for the treatment of asthma and discuss how this approach may reduce side-effects and improve efficacy. As this simple formulation progressed to phase II studies, safety data can be used to immediately enable phase II trials in COVID-19.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Hidroxicloroquina/administração & dosagem , Pulmão/efeitos dos fármacos , Pneumonia Viral/tratamento farmacológico , Administração por Inalação , Adolescente , Adulto , Idoso , Asma/tratamento farmacológico , Betacoronavirus , Ensaios Clínicos Fase I como Assunto , Ensaios Clínicos Fase II como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Segurança do Paciente , Resultado do Tratamento , Adulto Jovem
13.
Medicine (Baltimore) ; 99(41): e22519, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031292

RESUMO

BACKGOUN: Asthma and dry eye disease are common clinical diseases. Studies have shown that asthma is related to dry eye, but there is no high-quality evidence-based medical evidence. METHOD: This protocol and final study will be conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 statement. We will search PubMed, EMBASE, ISI Web of Science, China National Knowledge Infrastructure for all relevant literature published from their inception up to August 1, 2020. Literature search, data extraction, and quality assessment will be carried out independently by two researchers, and a third researcher will resolve differences when necessary. The association between dry eye disease and asthma will indicate as odds ratio with 95% confidence interval and statistically analyzed using RevMan 5.3 software. If the studies included have high heterogeneity, we will conduct sensitivity analysis and subgroup analysis. RESULTS: The protocol is intended to guide a meta-analysis aimed at identifying and quantifying the association between asthma and dry eye disease.


Assuntos
Asma/epidemiologia , Síndromes do Olho Seco/epidemiologia , Humanos , Metanálise como Assunto , Razão de Chances , Projetos de Pesquisa , Fatores de Risco , Revisões Sistemáticas como Assunto
14.
Tidsskr Nor Laegeforen ; 140(13)2020 09 29.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-32998491

RESUMO

BACKGROUND: Cardiovascular diseases, cancer, type-2 diabetes and chronic obstructive pulmonary disease (COPD) were initially noted as the most common diseases among individuals who were hospitalised for COVID-19. However, the evidence base is weak. The objective of this study is to describe how selected diseases were distributed among adults with confirmed COVID-19 (COVID-19 positive tests) and among those hospitalised for COVID-19 compared to the general population. MATERIAL AND METHOD: We used data from the Norwegian Patient Registry, the Norwegian Registry for Primary Health Care and the Norwegian Surveillance System for Communicable Diseases for adults from the age of 20 and older for the period 1 March 2020-13 May 2020. RESULTS: Of all those who tested positive for COVID-19, 7 632 (94 %) were aged 20 years or older, and 1 025 (13.4 %) of these had been hospitalised. Among those hospitalised with COVID-19, there was a higher proportion of individuals with cardiovascular diseases (18.3 % versus 15.6 %), cancer (6.9 % versus 5.4 %), type-2 diabetes (8.6 % versus 5.2 %) and COPD (3.8 % versus 2.7 %) than in the general population as a whole after adjusting for age. The proportion of hospitalised patients with asthma, other chronic respiratory disease, cardiovascular disease, ongoing cancer treatment, complications related to hypertension, obesity and overweight, neurological disorders and cardiac and renal failure was also higher than in the general population. There were few differences between persons who had tested positive for COVID-19 and the general population in terms of underlying conditions. INTERPRETATION: Among those hospitalised for COVID-19, there was a higher proportion of patients with underlying illnesses than in the general population. This may indicate that these patients tend to have a more severe course of disease or that they are more likely to be hospitalised compared to healthy individuals. The results must be interpreted with caution, since the sample of COVID-19 individuals is non-random.


Assuntos
Comorbidade , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Adulto , Asma , Betacoronavirus , Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Hospitalização , Humanos , Neoplasias , Noruega/epidemiologia , Pandemias , Doença Pulmonar Obstrutiva Crônica , Adulto Jovem
15.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32917845

RESUMO

OBJECTIVES: To explore and define contemporary trends in the use of invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV) in the treatment of children with asthma. METHODS: We performed a serial cross-sectional analysis using data from the Pediatric Health Information System. We examined 2014-2018 admission abstracts from patients aged 2 to 17 years who were admitted to member hospitals with a primary diagnosis of asthma. We report temporal trends in IMV use, NIV use, ICU admission, length of stay, and mortality. RESULTS: Over the study period, 48 hospitals reported 95 204 admissions with a primary diagnosis of asthma. Overall, IMV use remained stable at 0.6% between 2014 and 2018 (interquartile range [IQR]: 0.3%-1.1% and 0.2%-1.3%, respectively), whereas NIV use increased from 1.5% (IQR: 0.3%-3.2%) to 2.1% (IQR: 0.3%-5.6%). There was considerable practice variation among centers, with NIV rates more than doubling within the highest quartile of users (from 4.8% [IQR: 2.8%-7.5%] to 13.2% [IQR: 7.4%-15.2%]; P < .02). ICU admission was more common among centers with high NIV use, but centers with high NIV use did not differ from lower-use centers in mortality, IMV use, or overall average length of stay. CONCLUSIONS: The use of IMV is at historic lows, and NIV has replaced it as the primary mechanical support mode for asthma. However, there is considerable variability in NIV use. Increased NIV use was not associated with a change in IMV rates, which remained stable. Higher NIV use was associated with increased ICU admissions. NIV's precise contribution to the cost and quality of care remains to be determined.


Assuntos
Asma/terapia , Ventilação não Invasiva/tendências , Respiração Artificial/tendências , Adolescente , Asma/mortalidade , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/tendências , Tempo de Internação/tendências , Masculino , Fatores de Tempo
16.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32934151

RESUMO

OBJECTIVES: Although the airway microbiota is a highly dynamic ecology, the role of longitudinal changes in airway microbiota during early childhood in asthma development is unclear. We aimed to investigate the association of longitudinal changes in early nasal microbiota with the risk of developing asthma. METHODS: In this prospective, population-based birth cohort study, we followed children from birth to age 7 years. The nasal microbiota was tested by using 16S ribosomal RNA gene sequencing at ages 2, 13, and 24 months. We applied an unsupervised machine learning approach to identify longitudinal nasal microbiota profiles during age 2 to 13 months (the primary exposure) and during age 2 to 24 months (the secondary exposure) and examined the association of these profiles with the risk of physician-diagnosed asthma at age 7 years. RESULTS: Of the analytic cohort of 704 children, 57 (8%) later developed asthma. We identified 4 distinct longitudinal nasal microbiota profiles during age 2 to 13 months. In the multivariable analysis, compared with the persistent Moraxella dominance profile during age 2 to 13 months, the persistent Moraxella sparsity profile was associated with a significantly higher risk of asthma (adjusted odds ratio, 2.74; 95% confidence interval, 1.20-6.27). Similar associations were observed between the longitudinal changes in nasal microbiota during age 2 to 24 months and risk of asthma. CONCLUSIONS: Children with an altered longitudinal pattern in the nasal microbiota during early childhood had a high risk of developing asthma. Our data guide the development of primary prevention strategies (eg, early identification of children at high risk and modification of microbiota) for childhood asthma. These observations present a new avenue for risk modification for asthma (eg, microbiota modification).


Assuntos
Asma/etiologia , Microbiota , Nariz/microbiologia , Aerococcaceae/isolamento & purificação , Fatores Etários , Asma/diagnóstico , Asma/microbiologia , Criança , Pré-Escolar , Feminino , Finlândia , Seguimentos , Perfilação da Expressão Gênica/métodos , Haemophilus/isolamento & purificação , Humanos , Incidência , Lactente , Recém-Nascido , Aprendizado de Máquina , Masculino , Microbiota/genética , Moraxella/isolamento & purificação , Análise Multivariada , Estudos Prospectivos , RNA Ribossômico 16S/genética , Infecções Respiratórias/complicações , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Risco , Streptococcus/isolamento & purificação
17.
Dtsch Arztebl Int ; 117(25): 434-444, 2020 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-32885783

RESUMO

BACKGROUND: Asthma is a chronic inflammatory airway disease that usually causes variable airway obstruction. It affects 5-10% of the German population. METHODS: This review is based on relevant publications retrieved by a selective search, as well as on national and international guidelines on the treatment of mild and moderate asthma in adults. RESULTS: The goal of treatment is to attain optimal asthma control with a minimal risk of exacerbations and mortality, loss of pulmonary function, and drug side effects. This can be achieved with a combination of pharmacotherapy and non-drug treatment including patient education, exercise, smoking cessation, and rehabilitation. Pharmacohterapy is based on inhaled corticosteroids (ICS) and bronchodilators. It is recommended that mild asthma should be treated only when needed, either with a fixed combination of ICS and formoterol or with short-acting bronchodilators. For moderate asthma, maintenance treatment is recommended, with an inhaled fixed combinations of ICS and long-acting beta-mimetics, possibly supplemented with longacting anticholinergic agents. Allergen immunotherapy, i.e., desensitization treatment, should be considered if the allergic component of asthma is well documented and the patient is not suffering from uncontrolled asthma. Asthma control should be monitored at regular intervals, and the treatment should be adapted accordingly. CONCLUSION: The treatment of asthma in adults should be individually tailored, with anti-inflammatory treatment as its main component.


Assuntos
Antiasmáticos , Asma , Administração por Inalação , Corticosteroides , Adulto , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Quimioterapia Combinada , Fumarato de Formoterol , Humanos
18.
Lancet Respir Med ; 8(10): 1032-1044, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32910897

RESUMO

Severe asthma in children is rare, accounting for only a small proportion of childhood asthma. After addressing modifiable factors such as adherence to treatment, comorbidities, and adverse exposures, children whose disease is not well controlled on high doses of medication form a heterogeneous group of severe asthma phenotypes. Over the past decade, considerable advances have been made in understanding the pathophysiology of severe therapy-resistant asthma in children. However, asthma attacks and hospital admissions are frequent and mortality is still unacceptably high. Strategies to modify the natural history of asthma, prevent severe exacerbations, and prevent lung function decline are needed. Mechanistic studies have led to the development of several biologics targeting type 2 inflammation. This growing pipeline has the potential to reduce the burden of severe asthma; however, detailed assessment and characterisation of each child with seemingly severe asthma is necessary so that the most effective and appropriate management strategy can be implemented. Risk stratification, remote monitoring, and the integration of multiple data sources could help to tailor management for the individual child with severe asthma.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Adolescente , Asma/complicações , Criança , Pré-Escolar , Progressão da Doença , Hospitalização , Humanos
20.
Lancet Respir Med ; 8(10): 1045-1056, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32910899

RESUMO

Asthma is an inflammatory airway disease that is estimated to affect 339 million people globally. The symptoms of about 5-10% of patients with asthma are not adequately controlled with current therapy, and little success has been achieved in developing drugs that target the underlying mechanisms of asthma rather than suppressing symptoms. Over the past 3 years, well powered genetic studies of asthma have increased the number of independent asthma-associated genetic loci to 128. In this Series paper, we describe the immense progress in asthma genetics over the past 13 years and link asthma genetic variants to possible drug targets. Further studies are needed to establish the functional significance of gene variants associated with asthma in subgroups of patients and to describe the biological networks within which they function. The genomics-guided discovery of plausible drug targets for asthma could pave the way for the repurposing of existing drugs for asthma and the development of new treatments.


Assuntos
Asma/genética , Asma/terapia , Terapia de Alvo Molecular , Descoberta de Drogas , Estudo de Associação Genômica Ampla , Humanos
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