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Murphy KR, Chipps BE. Tiotropium in children and adolescents with asthma. Ann Allergy Asthma Immunol 2019; 124:267-276.e3. [PMID: 31805357 DOI: 10.1016/j.anai.2019.11.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Asthma is a major cause of morbidity in children, despite the availability of various treatments. In adults, tiotropium-a long-acting muscarinic antagonist-as add-on therapy to an inhaled corticosteroid with or without a long-acting β2-agonist provides clinical benefit with a safety profile similar to placebo. OBJECTIVE To review published evidence on the efficacy and safety of tiotropium as add-on a long-acting muscarinic antagonist therapy in children and adolescents with asthma that is uncontrolled despite use of an inhaled corticosteroid with or without additional controller medication(s). METHODS We searched PubMed from inception until June 12, 2018, for randomized controlled trials of children and adolescents aged 1 to 17 years treated with tiotropium and reporting a primary outcome of any pulmonary function test and a secondary outcome of adverse events. RESULTS Overall, 7 randomized controlled trials of 1902 preschool children (aged 1-5 years; n = 102), school-age children (aged 6-11 years; n = 905), and adolescents (aged 12-17 years; n = 895) with moderate to severe asthma were included in the analysis. Once-daily tiotropium (5, 2.5, or 1.25 μg) improved lung function parameters, including peak and trough forced expiratory volume in 1 second, vs placebo. Commonly reported adverse events across treatment groups included asthma worsening or exacerbations, decreased peak expiratory flow rate, nasopharyngitis, viral respiratory tract infection, and respiratory tract infection. CONCLUSION Once-daily tiotropium as add-on therapy is efficacious and safe in adolescents and children with moderate to severe asthma. These results support the expanded indication by regulatory authorities for add-on tiotropium in patients 6 years or older.
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Affiliation(s)
- Kevin R Murphy
- Boys Town National Research Hospital, Boys Town, Nebraska
| | - Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California.
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Corren J, Castro M, O'Riordan T, Hanania NA, Pavord ID, Quirce S, Chipps BE, Wenzel SE, Thangavelu K, Rice MS, Harel S, Jagerschmidt A, Khan AH, Kamat S, Maroni J, Rowe P, Lu Y, Amin N, Pirozzi G, Ruddy M, Graham NMH, Teper A. Dupilumab Efficacy in Patients with Uncontrolled, Moderate-to-Severe Allergic Asthma. J Allergy Clin Immunol Pract 2019; 8:516-526. [PMID: 31521831 DOI: 10.1016/j.jaip.2019.08.050] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/19/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dupilumab blocks the shared receptor component for IL-4 and IL-13, key drivers of type 2 inflammation, including IgE-mediated allergic inflammation in asthma. In the LIBERTY ASTHMA QUEST (NCT02414854) study, dupilumab reduced severe asthma exacerbations and improved forced expiratory volume in 1 second (FEV1) in patients with uncontrolled, moderate-to-severe asthma with greater efficacy observed in patients with elevated type 2 inflammatory biomarkers (blood eosinophils and fractional exhaled nitric oxide) at baseline. OBJECTIVE We assessed dupilumab's effect on key asthma outcomes in QUEST patients with/without evidence of allergic asthma (total serum IgE ≥30 IU/mL and ≥1 perennial aeroallergen-specific IgE ≥0.35 kU/L at baseline). METHODS Severe exacerbation rates and change from baseline in FEV1, asthma control, and markers of type 2 inflammation during the 52-week treatment period were assessed. RESULTS In the allergic asthma subgroup (n = 1083), dupilumab 200/300 mg every 2 weeks versus placebo reduced severe asthma exacerbation rates (-36.9%/-45.5%; both P < .01), improved FEV1 at week 12 (0.13 L/0.16 L; both P < .001; improvements were evident by the first evaluation at week 2) with greater efficacy observed in patients with elevated type 2 inflammatory biomarkers at baseline, and improved asthma control. Dupilumab treatment also resulted in rapid and sustained reductions in type 2 inflammatory biomarkers. Comparable results were observed in patients without evidence of allergic asthma (n = 819). CONCLUSION Dupilumab reduced severe exacerbation rates, improved FEV1 and asthma control, and suppressed type 2 inflammatory biomarkers in patients with uncontrolled, moderate-to-severe asthma with or without evidence of allergic asthma, highlighting the key role of IL-4 and IL-13 in airway inflammation.
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Affiliation(s)
- Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, Calif.
| | - Mario Castro
- Washington University School of Medicine, St. Louis, Mo
| | | | | | - Ian D Pavord
- Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Santiago Quirce
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
| | - Sally E Wenzel
- University of Pittsburgh Asthma Institute, Pittsburgh, Pa
| | | | | | - Sivan Harel
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | | | | | | | | | - Yufang Lu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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Maspero JF, Katelaris CH, Busse WW, Castro M, Corren J, Chipps BE, Peters AT, Pavord ID, Ford LB, Sher L, Rabe KF, Rice MS, Rowe P, Lu Y, Harel S, Jagerschmidt A, Khan AH, Kamat S, Pirozzi G, Amin N, Ruddy M, Graham NMH, Mannent LP, Teper A. Dupilumab Efficacy in Uncontrolled, Moderate-to-Severe Asthma with Self-Reported Chronic Rhinosinusitis. J Allergy Clin Immunol Pract 2019; 8:527-539.e9. [PMID: 31351189 DOI: 10.1016/j.jaip.2019.07.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for IL-4 and IL-13 signaling, key drivers of type 2 inflammation. In the phase 3 study (NCT02414854), add-on dupilumab 200 mg/300 mg every 2 weeks, versus placebo, significantly reduced severe asthma exacerbations and improved pre-bronchodilator forced expiratory volume in 1 second (FEV1) and quality-of-life measures in patients with uncontrolled, moderate-to-severe asthma, with greater efficacy observed in those with a high baseline type 2 phenotype. OBJECTIVE To assess the efficacy and safety of dupilumab in patients with uncontrolled, moderate-to-severe asthma with or without self-reported comorbid chronic rhinosinusitis (CRS or non-CRS). METHODS Comorbid CRS was self-reported by patients using an e-diary. Annualized severe exacerbation rates, changes from baseline in pre- and post-bronchodilator FEV1, patient-reported outcomes, type 2 biomarkers, and safety were assessed. RESULTS CRS was self-reported by 382 of 1902 (20.1%) patients. Dupilumab 200 mg/300 mg reduced annualized severe exacerbation rates by 63%/61%, respectively, in patients with CRS, and by 42%/40% in patients without CRS (all P < .001 vs placebo). Dupilumab also improved lung function and patient-reported asthma control and quality of life, and suppressed type 2 biomarkers versus placebo in both subgroups. Clinical responses were rapid, with near-maximal responses observed at the earliest measured time points and sustained at week 52. Improvements observed in the CRS subgroup were similar to or numerically greater than those in the non-CRS subgroup. CONCLUSION Dupilumab showed efficacy and was generally well tolerated in patients with uncontrolled, moderate-to-severe asthma with or without CRS.
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Affiliation(s)
| | - Constance H Katelaris
- Campbelltown Hospital, Campbelltown, NSW, Australia; Western Sydney University, Sydney, NSW, Australia
| | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Mario Castro
- Washington University School of Medicine, Saint Louis, Mo
| | | | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
| | - Anju T Peters
- Division of Allergy-Immunology and the Sinus and Allergy Center, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | | | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, Calif
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany; Christian-Albrechts-University of Kiel, Member of the German Center for Lung Research (DZL), Kiel, Germany
| | | | | | - Yufang Lu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - Sivan Harel
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | | | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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Barnes PJ, Szefler SJ, Reddel HK, Chipps BE. Symptoms and perception of airway obstruction in asthmatic patients: Clinical implications for use of reliever medications. J Allergy Clin Immunol 2019; 144:1180-1186. [PMID: 31330221 DOI: 10.1016/j.jaci.2019.06.040] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Asthma causes the unpleasant sensation of breathlessness (dyspnea) caused by airway obstruction. Patients with poor perception of airway obstruction are at risk of delay in seeking medical attention and undertreatment, which can lead to avoidable deaths. Conversely, those with heightened perception are at risk of overtreatment and iatrogenic adverse effects with reliever medications, anxiety, and unnecessary use of health care resources. OBJECTIVE We sought to review evidence about symptom misperception in asthmatic patients and how to identify and manage affected patients, particularly with regard to reliever medications. METHODS We conducted a systematic literature search for studies of perception of airway function in asthmatic patients. We searched the OVID (Medline and Medline [R] in process [PubMed]), Embase, and Adisearch/Odyssey databases, restricting our search to human studies published in English from 1990-2018, with no restrictions on age, sex, or racial origin. RESULTS We found that both underperception and overperception assessed during induced bronchoconstriction or bronchodilation or during changes in airway resistance were common across all age groups and that aging, disease severity, smoking, sex, ethnicity, psychologic factors, and medication are all associated with differences in perception. Importantly, airway inflammation was associated with impaired perception and a history of severe or near-fatal asthma. We also identified knowledge gaps, such as whether an individual patient's perception varies over time and the influence perception has on patients' use of reliever medication. CONCLUSION We found that abnormal perception of airway obstruction has important clinical implications for the management of patients with asthma.
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Affiliation(s)
- Peter J Barnes
- National Heart & Lung Institute, Imperial College, London, United Kingdom.
| | - Stanley J Szefler
- Paediatric Asthma Research Program and the Breathing Institute, Children's Hospital Colorado, and the Department of Pediatrics, University Colorado School of Medicine, Aurora, Colo
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
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Albers F, Liu MC, Chipps BE, Chapman KR, Muñoz X, Bergna M, Devouassoux G, Azmi J, Price R, Galkin D. Therapeutic switch from omalizumab to mepolizumab in patients with uncontrolled severe eosinophilic asthma: treatment effect by prior omalizumab treatment duration. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chipps BE, Calhoun WJ, Iqbal A, Holweg C, Haselkorn T, Yang M, Corren J. Stability of eosinophil classifications using common cut-points over time. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ciaccio CE, Chipps BE, Rosén K, Haselkorn T, Zigmont E, Casale TB. Preferences in Terminology Used to Describe Oral Immunotherapy Varies Based on Physician Utilization. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chipps BE, Ciaccio CE, Rosén K, Haselkorn T, Zigmont E, Casale TB. Real-world attitudes among allergists/immunologists regarding oral immunotherapy and preferred terminology. The Journal of Allergy and Clinical Immunology: In Practice 2019; 7:721-723.e9. [DOI: 10.1016/j.jaip.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/17/2022]
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Bousquet J, Maspero JF, Chipps BE, Corren J, FitzGerald JM, Chen Z, Lu Y, Rowe P, Staudinger H, Ruddy M, Graham NM, Kamat S, Amin N, Teper A, Khan A. Dupilumab Consistently Improves Rhinoconjunctivitis-Specific Health-Related Quality of Life in Patients With Uncontrolled, Moderate-to-Severe Asthma and Comorbid Allergic Rhinitis: Results from the Phase 3 LIBERTY ASTHMA QUEST Study. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Maspero JF, Corren J, Ford LB, Sher L, Chipps BE, Peters AT, Rice M, Rowe P, Lu Y, Harel S, Staudinger H, Amin N, Ruddy M, Graham NM, Teper A. Dupilumab Suppresses Type 2 Biomarkers in Asthma Patients With and Without Comorbid Chronic Rhinosinusitis With or Without Nasal Polyposis (CRS/NP): Post Hoc Analysis of LIBERTY ASTHMA QUEST. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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61
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Casale TB, Luskin AT, Busse W, Zeiger RS, Trzaskoma B, Yang M, Griffin NM, Chipps BE. Omalizumab Effectiveness by Biomarker Status in Patients with Asthma: Evidence From PROSPERO, A Prospective Real-World Study. The Journal of Allergy and Clinical Immunology: In Practice 2019; 7:156-164.e1. [DOI: 10.1016/j.jaip.2018.04.043] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/05/2018] [Accepted: 04/30/2018] [Indexed: 12/17/2022]
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Hanania NA, Chipps BE, Griffin NM, Yoo B, Iqbal A, Casale TB. Omalizumab effectiveness in asthma-COPD overlap: Post hoc analysis of PROSPERO. J Allergy Clin Immunol 2018; 143:1629-1633.e2. [PMID: 30576755 DOI: 10.1016/j.jaci.2018.11.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/09/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Nicola A Hanania
- Airways Clinical Research Center, Baylor College of Medicine, Houston, Tex
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
| | | | - Bongin Yoo
- Genentech, Inc, South San Francisco, Calif
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Casale TB, Haselkorn T, Ciaccio CE, Sriaroon P, Chipps BE. Harmonization of Terminology for Tolerated and Reactive Dose in Food Allergy Immunotherapy. J Allergy Clin Immunol Pract 2018; 7:389-392. [PMID: 30557719 DOI: 10.1016/j.jaip.2018.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/17/2022]
Abstract
Currently, there is no Food and Drug Administration-approved therapy for food allergy. Several new potential treatments are under investigation, including food allergen immunotherapy via various routes of administration, such as oral immunotherapy, epicutaneous immunotherapy, subcutaneous immunotherapy, and sublingual immunotherapy. The double-blind, placebo-controlled food challenge (DBPCFC) has traditionally been used for diagnostic purposes, but extrapolation of the specific terminology used in food allergy diagnosis to interpretation of efficacy in clinical trials is incongruent and difficult to apply. There is a need for standardization of the terminology used in food allergy clinical trials, because inconsistencies can lead to potential misinterpretation of end points. The reactive dose, previously referred to as the eliciting dose, is defined as the dose given that induces the onset of unequivocal allergic symptoms, or the dose that stops the challenge based on physician discretion. Conversely, the single highest tolerated dose is defined as the highest dose given during a food challenge that elicits either no symptoms or symptoms that do not meet stopping criteria per the study protocol. The evolving field of food allergy provides a novel opportunity to define those end points that are most meaningful for patients, which is fundamental for successful implementation, education, and safety.
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Affiliation(s)
- Thomas B Casale
- Division of Allergy and Immunology, University of South Florida, Tampa, Fla.
| | | | | | - Panida Sriaroon
- Division of Allergy and Immunology, University of South Florida, Tampa, Fla
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Chipps BE, Bacharier LB, Murphy KR, Lang D, Farrar JR, Rank M, Oppenheimer J, Zeiger RS. The Asthma Controller Step-down Yardstick. Ann Allergy Asthma Immunol 2018; 122:241-262.e4. [PMID: 30550809 DOI: 10.1016/j.anai.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 12/11/2022]
Abstract
Asthma guidelines recommend a control-based approach to disease management in which the assessment of impairment and risk is linked to step-based therapy. Using this model, controller treatment is adjusted-upward or downward-according to a patient's level of asthma control over time. Strategies for stepping up controller therapy are well described, and the adult and pediatric Asthma Yardsticks provide operational recommendations based on patient profiles. Strategies for stepping down controller treatment are less clear, although stepping down to the minimum effective therapy is important and should be considered when a patient's asthma has been well controlled for an adequate period as defined by risk and impairment. This Yardstick presents recommendations for when and how to step down asthma controller therapy according to guideline-defined control levels. The objective is to provide clinicians who treat patients with asthma with a practical and clinically relevant framework for implementing a step-down in controller therapy.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California.
| | - Leonard B Bacharier
- Washington University School of Medicine and St. Louis Children's Hospital, Division of Allergy, Immunology and Pulmonary Medicine, Saint Louis, Missouri
| | - Kevin R Murphy
- Boys Town National Research Hospital, Boys Town, Nebraska
| | - David Lang
- Division of Allergy and Clinical Immunology, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Matthew Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona
| | | | - Robert S Zeiger
- Kaiser Permanente Southern California Region, Department of Allergy and Research and Evaluation, San Diego and Pasadena, California
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Guilbert T, Zeiger RS, Haselkorn T, Iqbal A, Alvarez C, Mink DR, Chipps BE, Szefler SJ. Racial Disparities in Asthma-Related Health Outcomes in Children with Severe/Difficult-to-Treat Asthma. J Allergy Clin Immunol Pract 2018; 7:568-577. [PMID: 30172020 DOI: 10.1016/j.jaip.2018.07.050] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/22/2018] [Accepted: 07/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There are limited data that examine differences in asthma etiology between black and white children with severe or difficult-to-treat asthma. OBJECTIVE To describe demographic, clinical, and asthma-related outcomes in black and white children and examine whether differences in outcomes are explained by confounding factors in sequential multivariable models. METHODS Black (n = 86) and white (n = 262) children aged 6-11 years from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens 3-year observational study were analyzed. Baseline demographics and clinical characteristics were described for both cohorts, and outcomes at month 12 were analyzed using statistical models, sequentially adjusting for potential confounders. RESULTS Black children were more likely to be male (79.1% vs 66.4%; P < .05), obese (12.8% vs 1.5%; P < .001), and from a lower income stratum (USD43,400 vs 55,770; P < .001) than white children. Black children had higher geometric mean IgE levels (434.8 vs 136.8 IU/mL; P < .001), were more likely to have very poorly controlled asthma (72.1% vs 53.4%), use long-term systemic corticosteroids (30.2% vs 9.2%; P < .001), have poorer quality of life (5.5 vs 6.1; P < .001), and have an emergency department visit (27.4% vs 7.7%, P < .001) in the 3 months before month 12. Differences in asthma control and the severity of exacerbations persisted even after accounting for all confounding factors. CONCLUSIONS Among children with severe or difficult-to-treat asthma, asthma burden is greater in black than white children particularly related to several clinical and patient-reported outcome measures that are not explained by differences in background or clinical characteristics.
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Affiliation(s)
- Theresa Guilbert
- Division of Pulmonology Medicine, Cincinnati Children's Hospital & Medical Center, Cincinnati, Ohio.
| | - Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif
| | | | - Ahmar Iqbal
- US Medical Affairs, Genentech, Inc., South San Francisco, Calif
| | | | | | | | - Stanley J Szefler
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
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Affiliation(s)
- Bradley E Chipps
- American College of Allergy, Asthma & Immunology, Capital Allergy & Respiratory Disease Center, 5609 J Street, Suite C, Sacramento, CA 95819, USA.
| | - Stephen P Peters
- Section on Pulmonary, Critical Care, Allergy & Immunologic Diseases, Internal Medicine, Pediatrics and Translational Science, Center for Genomics and Personalized Medicine Research, Respiratory Service Line, Wake Forest Baptist Health, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Luthe SK, Goto T, Chipps BE, Pallin DJ, Stoyanov S, Camargo CA, Hasegawa K. Dose counting and use of short-acting beta-agonist inhalers in emergency department patients with asthma exacerbation. Ann Allergy Asthma Immunol 2018; 121:256-257.e1. [PMID: 29803712 DOI: 10.1016/j.anai.2018.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/22/2018] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Sarah Kyuragi Luthe
- Department of Emergency Medicine Massachusetts General Hospital Boston, Massachusetts; Department of Anesthesiology and Critical Care Medicine Asahikawa Medical University Hokkaido, Japan.
| | - Tadahiro Goto
- Department of Emergency Medicine Massachusetts General Hospital Boston, Massachusetts
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center Sacramento,California
| | - Daniel J Pallin
- Department of Emergency Medicine Brigham and Women's Hospital Boston, Massachusetts
| | | | - Carlos A Camargo
- Department of Emergency Medicine Massachusetts General Hospital Boston, Massachusetts
| | - Kohei Hasegawa
- Department of Emergency Medicine Massachusetts General Hospital Boston, Massachusetts
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Chipps BE, Bacharier LB, Farrar JR, Jackson DJ, Murphy KR, Phipatanakul W, Szefler SJ, Teague WG, Zeiger RS. The pediatric asthma yardstick: Practical recommendations for a sustained step-up in asthma therapy for children with inadequately controlled asthma. Ann Allergy Asthma Immunol 2018; 120:559-579.e11. [PMID: 29653238 DOI: 10.1016/j.anai.2018.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 03/31/2018] [Accepted: 04/03/2018] [Indexed: 12/29/2022]
Abstract
Current asthma guidelines recommend a control-based approach to management involving assessment of impairment and risk followed by implementation of treatment strategies individualized according to the patient's needs and preferences. However, for children with asthma, achieving control can be elusive. Although tools are available to help children (and families) track and manage day-to-day symptoms, when and how to implement a longer-term step-up in care is less clear. Furthermore, treatment is challenged by the 3 age groups of childhood-adolescence (12-18 years old), school age (6-11 years old), and young children (≤5 years old)-and what works for 1 age group might not be the best approach for another. The Pediatric Asthma Yardstick provides an in-depth assessment of when and how to step-up therapy for the child with not well or poorly controlled asthma. Development of this tool follows others in the Yardstick series, presenting patient profiles and step-up strategies based on current guidance documents, but modified according to newer data and the authors' combined clinical experience. The objective is to provide clinicians who treat children with asthma practical and clinically relevant recommendations for each step-up and each intervention, with the intent of helping practitioners better treat their pediatric patients with asthma, particularly those who do not always respond to recommended therapies.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California.
| | - Leonard B Bacharier
- Division of Allergy, Immunology and Pulmonary Medicine, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri
| | | | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kevin R Murphy
- Boys Town National Research Hospital, Boys Town, Nebraska
| | - Wanda Phipatanakul
- Allergy, Asthma, Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stanley J Szefler
- Breathing Institute, Children's Hospital of Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - W Gerald Teague
- Division of Pediatric Respiratory Medicine and Allergy, University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Robert S Zeiger
- Department of Allergy and Research and Evaluation, Kaiser Permanente Southern California Region, San Diego and Pasadena, California
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Dinakar C, Fineman SM, Chipps BE, Khan DA, Tilles SA. Recent advances in our understanding of the environment's role in allergy. Ann Allergy Asthma Immunol 2018; 120:465-467. [PMID: 29577979 DOI: 10.1016/j.anai.2018.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Chitra Dinakar
- AllergyWatch, Sacramento, California; Medicine, Pulmonary & Critical Care Medicine, Stanford University, Stanford, California; Asthma and Immunodeficiency, Stanford Health Care, Stanford, California
| | - Stanley M Fineman
- AllergyWatch, Sacramento, California; Atlanta Allergy & Asthma, Marietta, Georgia
| | - Bradley E Chipps
- AllergyWatch, Sacramento, California; American College of Allergy, Asthma & Immunology, Arlington Heights, Illinois; Capital Allergy & Respiratory Disease Center, Sacramento, California
| | - David A Khan
- AllergyWatch, Sacramento, California; Division of Allergy & Immmunology, University of Texas Southwestern Medical School, Dallas, Texas
| | - Stephen A Tilles
- AllergyWatch, Sacramento, California; Northwest Asthma & Allergy Center, Redmond, Washington.
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70
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Chipps BE, Newbold P, Hirsch I, Trudo F, Goldman M. Efficacy of Benralizumab for Patients with Severe, Uncontrolled Atopic Asthma by Serum Immunoglobulin E Concentrations. Pneumologie 2018. [DOI: 10.1055/s-0037-1619154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- BE Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, CA, USA
| | - P Newbold
- Medimmune LLC, Gaithersburg, MD, USA
| | - I Hirsch
- Astrazeneca, Gaithersburg, MD, USA
| | - F Trudo
- Astrazeneca, Gaithersburg, MD, USA
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71
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Luskin AT, Chipps BE, Casale TB, Griffin NM. Baseline asthma burden, comorbidities, and biomarkers in omalizumab-treated patients in PROSPERO. Ann Allergy Asthma Immunol 2018; 120:549-550. [PMID: 29421314 DOI: 10.1016/j.anai.2018.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | - Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California
| | - Thomas B Casale
- Morsani College of Medicine, University of South Florida, Tampa, Florida
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72
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Casale TB, Gonzalez-Reyes EG, Yang M, Trzaskoma BL, Griffin NM, Chipps BE. Impact of Baseline IgE levels on Exacerbations and Asthma Symptom Control After Omalizumab Initiation. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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73
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Galkin D, Liu MC, Chipps BE, Chapman KR, Muñoz X, Angel Bergna M, Azmi J, Mouneimne D, Joksaite S, Albers FC. Efficacy and Safety of Mepolizumab in Uncontrolled Patients with Severe Eosinophilic Asthma Following a Switch from Omalizumab (OSMO Study): Exacerbation and Safety Outcomes. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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74
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Chipps BE, Newbold P, Hirsch I, Trudo F, Goldman M. Benralizumab efficacy by atopy status and serum immunoglobulin E for patients with severe, uncontrolled asthma. Ann Allergy Asthma Immunol 2018; 120:504-511.e4. [PMID: 29409951 DOI: 10.1016/j.anai.2018.01.030] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/09/2018] [Accepted: 01/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with severe asthma can have eosinophilic inflammation and/or allergen sensitization. Benralizumab is an anti-eosinophilic monoclonal antibody indicated for add-on maintenance treatment of patients with severe asthma aged 12 years and older, and with an eosinophilic phenotype. OBJECTIVE To investigate the efficacy of benralizumab by atopic status and serum immunoglobulin E (IgE) concentrations. METHODS We analyzed pooled results from the SIROCCO (NCT01928771) and CALIMA (NCT01914757) phase III studies. Patients 12 to 75 years old with severe, uncontrolled asthma on high-dosage inhaled corticosteroids plus long-acting β2-agonists received 30 mg of subcutaneous benralizumab every 4 weeks or every 8 weeks (first 3 doses every 4 weeks) or placebo every 4 weeks. The analysis stratified patients who did and did not meet similar omalizumab-qualifying criteria of atopy and serum IgE levels 30 to 700 kU/L. Patients also categorized as having high serum IgE (≥150 kU/L) or low serum IgE (<150 kU/L) and as having atopy or no atopy. Efficacy outcomes were for all patients and by blood eosinophil counts and included annual exacerbation rate ratio and pre-bronchodilator forced expiratory volume in 1 second change at treatment end vs placebo. RESULTS Benralizumab every 8 weeks decreased exacerbations by 46% (95% confidence interval 26-61, P = .0002) and increased forced expiratory volume in 1 second by 0.125 L (95% confidence interval 0.018-0.232, P = .0218) vs placebo for patients with at least 300 eosinophils/μL who met the atopy and IgE criteria. For patients with eosinophilia and high or low IgE, treatment with benralizumab every 8 weeks resulted in 42% and 43% decreases in exacerbation rate (P ≤ .0004) and 0.123- and 0.138-L increases in forced expiratory volume in 1 second (P ≤ .0041) vs placebo, respectively. CONCLUSION Benralizumab treatment decreased exacerbations and improved lung function for patients with severe, uncontrolled eosinophilic asthma regardless of serum IgE concentrations and atopy status.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California.
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75
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Chipps BE, McDonald M, Garin M. Baseline Characteristics Associated with Quartiles of Reslizumab Effect: Pooled Analysis Of Two Phase 3 Studies. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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76
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Bleecker ER, Szefler SJ, Zeiger RS, Foreman A, Haselkorn T, Neiman E, Kianifard F, Paknis B, Ortiz B, Chipps BE. An Analysis of Type 2 Biomarkers in TENOR II. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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77
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Hanania NA, Rosén K, Griffin NM, Trzaskoma BL, Haselkorn T, Chipps BE, Casale TB. Response to Omalizumab Observed Over Wide Range of Blood Eosinophil Levels. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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78
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Traina G, Valluzzi RL, Fierro V, Riccardi C, Artesani MC, De Vuono A, Fiocchi A, Martelli AG, Ríos LA, Alcocer CR, Navarrete E, Del Rio Navarro BE, Gonzalez V, Velasco B, Perez Aviles HJ, Fernandez RJ, Pozo FC, Farhan AJ, Arshad H, Hussain A, Sharikadze O, Okhotnikova O, Alcover J, Rodriguez D, Pineda F, Dalal I, Weinbrand-Goichberg J, Benor S, Rottem M, Kivity S, Sato S, Yanagida N, Ebisawa M, Umanets T, Pineda F, Antipkin Y, Barzylovich V, Lapshyn V, Umanets T, Umanets M, Yuriev S, Pineda F, Rodriguez D, Alcover J, Bekir S, Pincock T, Vieira Hernandez A, Capriles Hulett A, Sánchez Borges M, Fabiano F, Albarran C, Goyal R, Gupta S, Gaurav G, Luskin AT, Griffin NM, Wagelie-Steffen A, Trzaskoma BL, Limb SL, Busse WW, Zeiger RS, Gonzalez-Reyes E, Casale TB, Chipps BE, Sugizaki C, Goto F, Sato S, Yanagida N, Ebisawa M, Yamaide A, Mitsunaga K, Tomiita M, Hoshioka A, Shimojo N, Pop LL, Ciucǎ IM, Tǎmaş L, Lazarescu M, Pienar C, Yamaide F, Fikri B, Sato H, Shimojo N, Okishima N, Kobayashi M, Takai M, Nishigata K, Yoda R, Oana YT, Kajiwara C, Shimodaira M, Suzuki T, Iizawa H, Kamijo K, Karmakar B, Bhattacharya SG, Blohlávková S, Kopelentová E, Víšek P, Štádler J, Šetinová I, Novobílská J, Lundelin K, Salminen S, Isolauri E, Pitt T, Flanders T, Peñalver M, Martínez P, Lluch M, Malet A, Nam YH, Jin HJ, Lee SK, Kulalert P, Sritipsukho P, Pathumanond J, Baynova K, Labella M, De Aramburu T, Prados M, Haanpää L, Aarnio J, Nermes M, Af Ursin P, Kaljonen A, Isolauri E, Bala N, Bhagwat K, Hindley J, Chapman M, Baalasubramanian S, Besednjak-Kocijančič L, SenGupta K, Bhattacharya SG, Chipps BE, Antonova E, Kong AM, Iqbal A, Teague WG, Chipps BE, Antonova E, Trzaskoma B, Ortiz B, Paknis B, Iqbal A, Rosen K, Szefler S, Alblooshi A, Al-Hammadi S, Vega A, Gutiérrez-Rivas R, Alonso AM, Beitia JM, Belén Mateo M, Cárdenas R, García-Domínguez JJ, Pitchon Dos Reis R, Gonçalves Alvim C, Andrade C, Reis A, Ribeiro H, Panaitescu Bunu C, Marusciac L, Paralescu S, Tamas P, Panitescu Bunu C, Marusciac L, Paralescu S, Tamas P, Martí Guadaño E, Escobar Bolaños C, Martí José N, Pau Casanovas P, Biarnés Rib G, Castells M, de Vicente Jiménez T, Mennini M, Riccardi C, De Angelis P, Rea F, Malamisura M, Tambucci R, Fiocchi A, Dall'Oglio L, Mennini M, Del Chierico F, Napolitano T, Reddel S, Vernocchi P, D'Ambrosio A, Putignani L, Artesani MC, Dahdah L, Fierro V, Banzato C, Echeverría Zudaire LA, Plaza AM, Bosque García M, Íbero M, Mazzina O, Fierro V, Marzano V, Riccardi C, Mazzina O, Dahdah L, Mennini M, Artesani MC, Mazzina O, Pecora V, Koch P, Valluzzi RL, Fierro V, Fiocchi A, Pecora V, Valentini D, Mennini M, Dahdah L, Mazzina O, Santamaria F, Valluzzi R, Mukherjee A, Kandhare A, Bodhankar S. Proceedings of the 2017 WAO Symposium on Hot Topics in Allergy: Pediatric & Regulatory Aspects: Rome, Italy/Vatican City. 27-29 April 2017. World Allergy Organ J 2017; 10:39. [PMID: 29444193 PMCID: PMC5773904 DOI: 10.1186/s40413-017-0170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Giovanni Traina
- U.O.C Pediatria, Ospedale G. Salvini, Garbagnate Milanese, Milan, Italy
| | - Rocco Luigi Valluzzi
- 2Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Vincenzo Fierro
- 2Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Carla Riccardi
- 2Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Maria Cristina Artesani
- 2Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Andrea De Vuono
- Ufficio Statistica, Ospedale G. Salvini, Garbagnate Milanese, Milan, Italy
| | - Alessandro Fiocchi
- 2Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Italy
| | | | - Luis Alberto Ríos
- 4Pediatric Allergy and Clinical Immunology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Christian R Alcocer
- 4Pediatric Allergy and Clinical Immunology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Elsy Navarrete
- 4Pediatric Allergy and Clinical Immunology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Victor Gonzalez
- 4Pediatric Allergy and Clinical Immunology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Berenice Velasco
- 4Pediatric Allergy and Clinical Immunology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Herberth J Perez Aviles
- 4Pediatric Allergy and Clinical Immunology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Roberto Jose Fernandez
- 4Pediatric Allergy and Clinical Immunology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - F Cesar Pozo
- 4Pediatric Allergy and Clinical Immunology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Hasan Arshad
- 6Faculty of Medicine, Southampton University, Southampton, UK
| | | | - Olena Sharikadze
- 8Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Olena Okhotnikova
- 8Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | | | | | | | - Ilan Dalal
- 10Pediatric Allergy Unit, E. Wolfson Medical Center, Pediatric Department, E. Wolfson Medical Center, Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shira Benor
- 12Allergy and Clinical Immunology Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Menachem Rottem
- 13Allergy Asthma and Immunology Unit, Emek Medical Center, Afula, Israel
| | - Shmuel Kivity
- 12Allergy and Clinical Immunology Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sakura Sato
- 14Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Noriyuki Yanagida
- 15Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan
| | - Motohiro Ebisawa
- 14Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Tetiana Umanets
- Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | | | - Youriy Antipkin
- Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | | | | | - Tetiana Umanets
- Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | | | - Sergey Yuriev
- Ukrainian School of Molecular Allergy and Immunology, Kyiv, Ukraine
| | | | | | | | - Suzan Bekir
- Collective.care Allergy Clinic, Sydney, Australia.,Australian Allergy Centre, Sydney, Australia
| | - Tobias Pincock
- Collective.care Allergy Clinic, Sydney, Australia.,Australian Allergy Centre, Sydney, Australia
| | | | | | - Mario Sánchez Borges
- 26Departamento de Pediatria, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | | | - Carlos Albarran
- 25Departamento de Alergologia, Hospital de San Juan De Dios, Caracas, Venezuela
| | - Rohit Goyal
- 28Max Super Speciality Hospital, Bathinda, India
| | | | - Garg Gaurav
- 30Deen Dayal Upadhyay Hospital, New Delhi, India
| | | | | | | | | | | | - William W Busse
- 34University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Robert S Zeiger
- 35Deptartment of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego, CA USA
| | - Erika Gonzalez-Reyes
- 36The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX USA
| | - Thomas B Casale
- 37Division of Allergy and Immunology, University of South Florida, Tampa, FL USA
| | - Bradley E Chipps
- 38Capital Allergy and Respiratory Disease Center, Sacramento, CA USA
| | - Chizuko Sugizaki
- 39Clinical Research Center, Sagamihara National Hospital, Sagamihara, Japan
| | - Fumiko Goto
- 39Clinical Research Center, Sagamihara National Hospital, Sagamihara, Japan
| | - Sakura Sato
- 39Clinical Research Center, Sagamihara National Hospital, Sagamihara, Japan
| | - Noriyuki Yanagida
- 39Clinical Research Center, Sagamihara National Hospital, Sagamihara, Japan
| | - Motohiro Ebisawa
- 39Clinical Research Center, Sagamihara National Hospital, Sagamihara, Japan
| | - Akiko Yamaide
- 40Department of Allergy and Rheumatology, Chiba Children's Hospital, Chiba, Japan
| | - Kanako Mitsunaga
- 40Department of Allergy and Rheumatology, Chiba Children's Hospital, Chiba, Japan
| | - Minako Tomiita
- 40Department of Allergy and Rheumatology, Chiba Children's Hospital, Chiba, Japan
| | - Akira Hoshioka
- 40Department of Allergy and Rheumatology, Chiba Children's Hospital, Chiba, Japan
| | - Naoki Shimojo
- 41Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Liviu L Pop
- 42Department of Pediatrics II, Victor Babeş University of Medicine and Pharmacy Timisora, Timisoara, Romania.,National Cystic Fibrosis Center, Timisoara, Romania
| | - Ioana-Mihaela Ciucǎ
- 42Department of Pediatrics II, Victor Babeş University of Medicine and Pharmacy Timisora, Timisoara, Romania.,National Cystic Fibrosis Center, Timisoara, Romania
| | - Liviu Tǎmaş
- 43Department of Biochemistry, Victor Babeş University of Medicine and Pharmacy Timisora, Timisoara, Romania
| | | | - Corina Pienar
- 42Department of Pediatrics II, Victor Babeş University of Medicine and Pharmacy Timisora, Timisoara, Romania
| | - Fumiya Yamaide
- 45Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Bahrul Fikri
- 45Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hironori Sato
- 45Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoki Shimojo
- 45Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoko Okishima
- 46Department of Health and Nutritional Science, Matsumoto University, Matsumoto, Japan
| | - Miyabi Kobayashi
- 46Department of Health and Nutritional Science, Matsumoto University, Matsumoto, Japan
| | - Mizuki Takai
- 46Department of Health and Nutritional Science, Matsumoto University, Matsumoto, Japan
| | - Kotarou Nishigata
- 46Department of Health and Nutritional Science, Matsumoto University, Matsumoto, Japan
| | - Ryou Yoda
- 46Department of Health and Nutritional Science, Matsumoto University, Matsumoto, Japan
| | - Yu-Ta Oana
- 46Department of Health and Nutritional Science, Matsumoto University, Matsumoto, Japan
| | - Chifu Kajiwara
- 46Department of Health and Nutritional Science, Matsumoto University, Matsumoto, Japan
| | - Moe Shimodaira
- 46Department of Health and Nutritional Science, Matsumoto University, Matsumoto, Japan
| | - Tomoka Suzuki
- 46Department of Health and Nutritional Science, Matsumoto University, Matsumoto, Japan
| | - Hiromi Iizawa
- 47Health Support Station, Matsumoto University, Matsumoto, Japan
| | | | | | | | - Simona Blohlávková
- Immuno-flow, s.r.o., Prague, Czech Republic.,52Medical Faculty, Charles University, Pilsen, Czech Republic
| | - Eliška Kopelentová
- Allergology Department, Kolín Hospital, Kolín, Czech Republic.,54Allergology and Immunology Department, Faculty Hospital Motol, Prague, Czech Republic
| | - Petr Víšek
- Allergology and Immunology Department, Litomyšl, Czech Republic
| | | | | | | | - Krisa Lundelin
- 58Department of Paediatrics, Turku University Hospital, Turku, Finland
| | - Seppo Salminen
- 58Department of Paediatrics, Turku University Hospital, Turku, Finland.,59Functional Foods Forum, University of Turku, Turku, Finland
| | - Erika Isolauri
- 58Department of Paediatrics, Turku University Hospital, Turku, Finland
| | - Tracy Pitt
- Department of Paediatrics, Humber River Hospital, Toronto, ON Canada.,61Deptartment of Paediatrics, Queen's University, Kingston, ON Canada
| | | | | | - Patricia Martínez
- Allergy and Clinical Immunology Service, Hospital de Nens de Barcelona, Barcelona, Spain
| | - Magdalena Lluch
- Allergy and Clinical Immunology Service, Hospital de Nens de Barcelona, Barcelona, Spain
| | - Alfonso Malet
- Allergy and Clinical Immunology Service, Hospital de Nens de Barcelona, Barcelona, Spain
| | - Young-Hee Nam
- 65Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Hyun Jung Jin
- 66Department of Internal Medicine, Yeungnam University Medical School, Daegu, Korea
| | - Soo-Keol Lee
- 65Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Prapasri Kulalert
- 67Division of Clinical Epidemiology, and Division of Allergy and Immunology, Deptartment of Pediatrics, Faculty of Medicine, Thammasat University (Rungsit Campus), Pathum Thani, Thailand.,68Thammasat University Center of Excellence of Asthma, Allergy and Immunology, Thammasat University Hospital, Pathum Thani, Thailand
| | - Paskorn Sritipsukho
- 69Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Thammasat University (Rungsit Campus), Pathum Thani, Thailand.,70Center of Excellence in Applied Epidemiology, Thammasat University (Rungsit campus), Pathum Thani, Thailand
| | - Jayanton Pathumanond
- 71Division of Clinical Epidemiology, Faculty of Medicine, Thammasat University (Rungsit Campus), Pathum Thani, Thailand
| | - Krasimira Baynova
- 72Allergy Unit, University Hospital Virgen del Rocío, Seville, Spain
| | - Marina Labella
- 72Allergy Unit, University Hospital Virgen del Rocío, Seville, Spain
| | | | - Manuel Prados
- 72Allergy Unit, University Hospital Virgen del Rocío, Seville, Spain
| | - Leena Haanpää
- 73Child and Youth Research Institute, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Jasmin Aarnio
- 75Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Merja Nermes
- 74Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Piia Af Ursin
- 73Child and Youth Research Institute, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Anne Kaljonen
- 75Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Erika Isolauri
- 74Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Nandana Bala
- 77Rainbow Children's Hospital, Bangalore, India.,79Indoor Biotechnologies Inc, Charlottesville, VA USA
| | | | | | | | | | | | - Koyel SenGupta
- 81Division of Plant Biology, Bose Institute, Kolkata, India
| | | | - Bradley E Chipps
- 82Capital Allergy and Respiratory Disease Center, Sacramento, CA USA
| | | | - Amanda M Kong
- Truven Health Analytics, an IBM Company, Cambridge, MA USA
| | - Ahmar Iqbal
- 83Genentech, Inc., South San Francisco, CA USA
| | - W Gerald Teague
- 85Child Health Research Center, University of Virginia School of Medicine, Charlottesville, VA USA
| | - Bradley E Chipps
- 86Capital Allergy and Respiratory Disease Center, Sacramento, CA USA
| | | | | | - Benjamin Ortiz
- 88Novartis Pharmaceuticals Corporation, East Hanover, NJ USA
| | - Brandee Paknis
- 88Novartis Pharmaceuticals Corporation, East Hanover, NJ USA
| | - Amar Iqbal
- 87Genentech, Inc., South San Francisco, CA USA
| | - Karin Rosen
- 87Genentech, Inc., South San Francisco, CA USA
| | - Stanley Szefler
- 89Pediatric Asthma Research Program, Children's Hospital and University of Colorado School of Medicine, Colorado, Aurora, CO USA
| | - Afaf Alblooshi
- 90Deptartment of Pediatrics, UAE University, Al-Ain, United Arab Emirates
| | | | - Arantza Vega
- 91Allergy Service, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Ana Maria Alonso
- 91Allergy Service, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Juan Maria Beitia
- 91Allergy Service, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Maria Belén Mateo
- 91Allergy Service, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Remedios Cárdenas
- 91Allergy Service, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Raquel Pitchon Dos Reis
- 93Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil.,94Allergy Department, Mater Dei Hospital, Belo Horizonte, Brazil
| | | | - Claudia Andrade
- 93Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Adriana Reis
- 93Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Henrique Ribeiro
- 93Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Laura Marusciac
- OncoGen Research Center, Emergency Clinical County Hospital, Timisoara, Romania
| | - Sorin Paralescu
- 95Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Paul Tamas
- OncoGen Research Center, Emergency Clinical County Hospital, Timisoara, Romania
| | | | - Laura Marusciac
- OncoGen Research Center, Emergency Clinical County Hospital, Timisoara, Romania
| | - Sorin Paralescu
- 97Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Paul Tamas
- OncoGen Research Center, Emergency Clinical County Hospital, Timisoara, Romania
| | | | | | | | | | | | - Mariana Castells
- 101Desensitization Unit, Brigham and Women's Hospital, Boston, MA USA
| | | | - Maurizio Mennini
- 103Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Carla Riccardi
- 103Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Papola De Angelis
- 104Digestive Surgery and Endoscopy Unit, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Francesca Rea
- 104Digestive Surgery and Endoscopy Unit, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Monica Malamisura
- 104Digestive Surgery and Endoscopy Unit, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Renato Tambucci
- 104Digestive Surgery and Endoscopy Unit, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Alessandro Fiocchi
- 103Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Luigi Dall'Oglio
- 104Digestive Surgery and Endoscopy Unit, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Maurizio Mennini
- 105Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | | | - Tania Napolitano
- 105Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Silvia Reddel
- 106Human Microbiome Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Pamela Vernocchi
- 106Human Microbiome Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Angelo D'Ambrosio
- 106Human Microbiome Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Lorenza Putignani
- 106Human Microbiome Unit, Bambino Gesù Children Hospital, Rome, Italy
| | | | - Lamia Dahdah
- 107Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Vincenzo Fierro
- 107Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Claudia Banzato
- 108Department of Life and Reproduction Sciences, Section of Pediatrics, University of Verona, Verona, Italy
| | | | - Ana María Plaza
- 110Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Montserrat Bosque García
- 111Division of Pneumology, Hospital Parc Taulí, Autonomous University of Barcelona, Barcelona, Spain
| | - Marcel Íbero
- 112Allergy Unit, Hospital de Terrassa, Barcelona, Spain
| | - Oscar Mazzina
- 107Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Vincenzo Fierro
- 113Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Valeria Marzano
- 114Human Microbiome Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Carla Riccardi
- 113Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Oscar Mazzina
- 113Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Lamia Dahdah
- 113Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Maurizio Mennini
- 115Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Maria Cristina Artesani
- 115Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Oscar Mazzina
- 115Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Valeria Pecora
- 115Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Pierluigi Koch
- 115Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Rocco Luigi Valluzzi
- 115Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Vincenzo Fierro
- 115Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Alessandro Fiocchi
- 115Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Valentina Pecora
- 116Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Diletta Valentini
- 117Division of Infectious disease, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Maurizio Mennini
- 116Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Lamia Dahdah
- 116Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Oscar Mazzina
- 116Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Francesca Santamaria
- 116Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Rocco Valluzzi
- 116Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Anwesha Mukherjee
- Department of Pharmacology, Poona College of Pharmacy, Bharati Videyapeeth Deemed University, Pune, India
| | - Amit Kandhare
- Department of Pharmacology, Poona College of Pharmacy, Bharati Videyapeeth Deemed University, Pune, India
| | - Subhash Bodhankar
- Department of Pharmacology, Poona College of Pharmacy, Bharati Videyapeeth Deemed University, Pune, India
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Chipps BE, Lanier B, Milgrom H, Deschildre A, Hedlin G, Szefler SJ, Kattan M, Kianifard F, Ortiz B, Haselkorn T, Iqbal A, Rosén K, Trzaskoma B, Busse WW. Omalizumab in children with uncontrolled allergic asthma: Review of clinical trial and real-world experience. J Allergy Clin Immunol 2017; 139:1431-1444. [PMID: 28477722 DOI: 10.1016/j.jaci.2017.03.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/27/2017] [Accepted: 03/08/2017] [Indexed: 02/04/2023]
Abstract
Asthma is one of the most common chronic diseases of childhood. Allergen sensitization and high frequencies of comorbid allergic diseases are characteristic of severe asthma in children. Omalizumab, an anti-IgE mAb, is the first targeted biologic therapeutic approved for the treatment of moderate-to-severe persistent allergic asthma (AA) that remains uncontrolled despite high-dose inhaled corticosteroids plus other controller medications. Since its initial licensing for use in adults and adolescents 12 years of age and older, the clinical efficacy, safety, and tolerability of omalizumab have been demonstrated in several published clinical trials in children aged 6 to less than 12 years with moderate-to-severe AA. These studies supported the approval of the pediatric indication (use in children aged ≥6 years) by the European Medicines Agency in 2009 and the US Food and Drug Administration in 2016. After this most recent change in licensing, we review the outcomes from clinical trials in children with persistent AA receiving omalizumab therapy and observational studies from the past 7 years of clinical experience in Europe. Data sources were identified by using PubMed in 2016. Guidelines and management recommendations and materials from the recent US Food and Drug Administration's Pediatric Advisory Committee meeting are also reviewed.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif.
| | - Bob Lanier
- Department of Pediatrics, University of North Texas, Fort Worth, Tex
| | | | - Antoine Deschildre
- Pneumologie Pédiatrique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Gunilla Hedlin
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Stanley J Szefler
- Department of Pediatrics, Breathing Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Meyer Kattan
- Pediatric Pulmonary Division, Columbia University Medical Center, New York, NY
| | | | | | | | | | | | | | - William W Busse
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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80
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Chipps BE, Haselkorn T, Rosén K, Mink DR, Trzaskoma BL, Luskin AT. Asthma Exacerbations and Triggers in Children in TENOR: Impact on Quality of Life. J Allergy Clin Immunol Pract 2017; 6:169-176.e2. [PMID: 28803186 DOI: 10.1016/j.jaip.2017.05.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/08/2017] [Accepted: 05/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data examining associations between asthma exacerbations, triggers, and asthma-related quality of life (QOL) in children with severe/difficult-to-treat asthma are unavailable. OBJECTIVE To evaluate real-world data on relationships between asthma exacerbations, triggers, and QOL in children using data from TENOR (The Epidemiology and Natural History of Asthma Outcomes and Treatment Regimens), a 3-year observational study of patients with severe/difficult-to-treat asthma, including those aged 6 to 12 years. METHODS QOL was examined using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and defined exacerbations hierarchically (descending order of severity): hospitalization, emergency department visit, steroid burst, no exacerbation, using the highest value from months 6 and 12. One-way ANOVA was used to test for differences in PAQLQ domain scores at month 12 across exacerbation severity, total number of asthma exacerbations, and number of baseline asthma triggers. Mantel-Haenszel chi-square test was used to test the association between the number of triggers and exacerbation hierarchy. RESULTS Greater severity of asthma exacerbations was associated with significantly (P < .001) lower mean PAQLQ domain scores, indicating poorer QOL. A higher number of asthma exacerbations was associated with significantly (P < .001) lower mean PAQLQ domain scores. PAQLQ scores were significantly lower with higher numbers of baseline triggers. Higher baseline number of asthma triggers was associated with greater severity (P = .05) and number of asthma exacerbations (P < .001). CONCLUSIONS A higher number of asthma triggers at baseline was associated with greater asthma severity and number of asthma exacerbations and lower QOL in children with severe/difficult-to-treat asthma.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif.
| | | | | | | | | | - Allan T Luskin
- HealthyAirways, LLC, Madison, Wis; University of Wisconsin, Madison, Wis
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81
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Chipps BE, Haselkorn T, Paknis B, Ortiz B, Bleecker ER, Kianifard F, Foreman AJ, Szefler SJ, Zeiger RS. More than a decade follow-up in patients with severe or difficult-to-treat asthma: The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) II. J Allergy Clin Immunol 2017; 141:1590-1597.e9. [PMID: 28797732 DOI: 10.1016/j.jaci.2017.07.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 07/10/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR I) study demonstrated high morbidity in patients with severe or difficult-to-treat asthma despite standard-of-care treatment. OBJECTIVE We sought to determine the long-term natural history of disease and outcomes in patients in TENOR I after more than a decade. METHODS TENOR I was a multicenter observational study (2001-2004) of 4756 patients with severe or difficult-to-treat asthma. TENOR II was a follow-up study of TENOR I patients using a single cross-sectional visit in 2013/2014. Overall, the sites participating in TENOR II originally enrolled 1230 patients in TENOR I. Clinical and patient-reported outcomes were assessed, including very poorly controlled asthma based on National Heart, Lung, and Blood Institute guidelines. RESULTS A total of 341 (27.7%) patients were enrolled in TENOR II and were representative of the TENOR I cohort. The most frequent comorbidities were rhinitis (84.0%), sinusitis (47.8%), and gastroesophageal reflux disease (46.3%). Mean percent predicted prebronchodilator and postbronchodilator FEV1 were 72.7% (SD, 21.4%) and 78.2% (SD, 20.7%), respectively. A total of 231 (72.9%) of 317 patients had positive test responses to 1 or more allergen-specific IgEs. The mean blood eosinophil count was 200/μL (SD, 144/μL). Eighty-eight (25.8%) patients experienced an asthma exacerbation in the prior 3 months requiring hospital attention, oral corticosteroids, or both. More than half (197/339 [58.1%]) had very poorly controlled asthma. Medication use suggested undertreatment. CONCLUSION TENOR II provides longitudinal data to characterize disease progression, heterogeneity, and severity in patients with severe or difficult-to-treat asthma. Findings show continued morbidity, including a high degree of comorbid conditions, allergic sensitization, exacerbations, and very poorly controlled asthma, including reduced lung function.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif.
| | | | | | | | - Eugene R Bleecker
- Center for Genomics & Personalized Medicine, Section of Pulmonary & Critical Care Medicine, Wake Forest University, Winston-Salem, NC
| | | | | | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital, Colorado, Aurora, Colo
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
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82
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Abstract
PURPOSE OF REVIEW The aim of this study is to characterize, diagnose, evaluate, and treat severe childhood asthma. RECENT FINDINGS Understanding the occurrence of the physiologic and clinical presentations of childhood severe asthma, the treatment and response may be predicted by biomarkers, but the patient's response is highly variable. The onset of severe asthma occurs early and is primarily predicted by severity of viral infection and coexistence of the atopic state.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, 5609 J Street, Suite C, Sacramento, CA, 95819, USA.
| | - Neil G Parikh
- Capital Allergy and Respiratory Disease Center, 5609 J Street, Suite C, Sacramento, CA, 95819, USA
| | - Sheena K Maharaj
- Capital Allergy and Respiratory Disease Center, 5609 J Street, Suite C, Sacramento, CA, 95819, USA
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83
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Chipps BE, Peters SP. Biologic Therapies of Immunologic Diseases. Immunol Allergy Clin North Am 2017. [DOI: 10.1016/s0889-8561(17)30020-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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84
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Gonzalez-Reyes EG, Luskin AT, Busse W, Casale TB, Chipps BE, Antonova E, Limb SL, Trzaskoma BL, Griffin NM, Zeiger RS. Clinically Significant Improvements in Asthma Patient-Reported Outcomes: Results from the Prospective Observational Study to Evaluate Predictors of Clinical Effectiveness in Response to Omalizumab (PROSPERO) Study. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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85
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Katial RK, Bensch GW, Busse WW, Chipps BE, Denson JL, Gerber AN, Jacobs JS, Kraft M, Martin RJ, Nair P, Wechsler ME. Changing Paradigms in the Treatment of Severe Asthma: The Role of Biologic Therapies. J Allergy Clin Immunol Pract 2017; 5:S1-S14. [PMID: 28143691 DOI: 10.1016/j.jaip.2016.11.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/21/2016] [Accepted: 11/23/2016] [Indexed: 11/30/2022]
Abstract
Cytokine antagonists are monoclonal antibodies that offer new treatment options for refractory asthma but will also increase complexity because they are effective only for patients with certain asthma subtypes that remain to be more clearly defined. The clinical and inflammatory heterogeneity within refractory asthma makes it difficult to manage the disease and to determine which, if any, biologic therapy is suitable for a specific patient. The purpose of this article is to provide a data-driven discussion to clarify the use of biologic therapies in patients with refractory asthma. We first discuss the epidemiology and pathophysiology of refractory asthma. We then interpret current evidence for biomarkers of eosinophilic or type 2-high asthma so that clinicians can determine potential treatments for patients based on knowledge of their effectiveness in specific asthma phenotypes. We then assess clinical data on the efficacy, safety, and mechanisms of action of approved and pipeline biologic therapies. We conclude by discussing the potential of phenotyping or endotyping refractory asthma and how biologic therapies can play a role in treating patients with refractory asthma.
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Affiliation(s)
- Rohit K Katial
- Department of Medicine, Division of Allergy and Clinical Immunology, National Jewish Health, Denver, Colo.
| | - Greg W Bensch
- Allergy, Immunology and Asthma Medical Group, Stockton, Calif
| | - William W Busse
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
| | - Joshua L Denson
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colo; Division of Pulmonary Sciences and Critical Care Medicine, School of Medicine, University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colo
| | - Anthony N Gerber
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colo; Department of Biomedical Research, National Jewish Health, Denver, Colo
| | - Joshua S Jacobs
- Allergy and Asthma Clinical Research, Inc., Walnut Creek, Calif
| | - Monica Kraft
- Department of Medicine, Asthma and Airway Disease Research Center, University of Arizona Health Sciences, Tucson, Ariz
| | | | - Parameswaran Nair
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael E Wechsler
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colo
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86
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Abstract
Asthma affects an estimated 7 million children and causes significant health care and disease burden. The most recent iteration of the National Heart, Lung and Blood Institute asthma guidelines, the Expert Panel Report 3, emphasizes the assessment and monitoring of asthma control in the management of asthma. Asthma control refers to the degree to which the manifestations of asthma are minimized by therapeutic interventions and the goals of therapy are met. Although assessment of asthma severity is used to guide initiation of therapy, monitoring of asthma control helps determine whether therapy should be maintained or adjusted. The nuances of estimation of asthma control include understanding concepts of current impairment and future risk and incorporating their measurement into clinical practice. Impairment is assessed on the basis of frequency and intensity of symptoms, variations in lung function, and limitations of daily activities. "Risk" refers to the likelihood of exacerbations, progressive loss of lung function, or adverse effects from medications. Currently available ambulatory tools to measure asthma control range are subjective measures, such as patient-reported composite asthma control score instruments or objective measures of lung function, airway hyperreactivity, and biomarkers. Because asthma control exhibits short- and long-term variability, health care providers need to be vigilant regarding the fluctuations in the factors that can create discordance between subjective and objective assessment of asthma control. Familiarity with the properties, application, and relative value of these measures will enable health care providers to choose the optimal set of measures that will adhere to national standards of care and ensure delivery of high-quality care customized to their patients.
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87
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Ledford D, Busse W, Trzaskoma B, Omachi TA, Rosén K, Chipps BE, Luskin AT, Solari PG. A randomized multicenter study evaluating Xolair persistence of response after long-term therapy. J Allergy Clin Immunol 2016; 140:162-169.e2. [PMID: 27826098 DOI: 10.1016/j.jaci.2016.08.054] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/09/2016] [Accepted: 08/25/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few data are available to assist clinicians with decisions regarding long-term use of asthma therapies, including omalizumab. OBJECTIVE We sought to evaluate the benefit and persistence of response in subjects continuing or withdrawing from long-term omalizumab treatment. METHODS Evaluating the Xolair Persistency Of Response After Long-Term Therapy (XPORT) was a randomized, double-blind, placebo-controlled withdrawal study that included subjects with moderate-to-severe persistent asthma receiving long-term omalizumab. Subjects were randomized by using a hierarchical dynamic randomization scheme to continue their same dose of omalizumab or withdraw to placebo and were then followed every 4 weeks for 1 year. The primary outcome was any protocol-defined severe asthma exacerbation. The secondary outcome was time to first protocol-defined severe asthma exacerbation. Exploratory outcomes included changes in Asthma Control Questionnaire and Asthma Control Test scores. RESULTS Significantly more subjects in the omalizumab group (67%) had no protocol-defined exacerbation than in the placebo group (47.7%); an absolute difference of 19.3% (95% CI, 5.0%, 33.6%) represents a 40.1% relative difference. Time to first protocol-defined exacerbation analysis revealed a significantly different between-group exacerbation pattern that was consistent with the primary analysis. Subjects continuing omalizumab had significantly better asthma control (mean [SD] change from baseline to week 52: Asthma Control Test score, -1.16 [4.14] vs placebo, -2.88 [5.38], P = .0188; Asthma Control Questionnaire score, 0.22 [0.66] vs placebo, 0.63 [1.13], P = .0039). Discontinuation of omalizumab was associated with an increase in free IgE levels and an increase in basophil expression of the high-affinity IgE receptor. No safety concerns were noted. CONCLUSION Continuation of omalizumab after long-term treatment results in continued benefit, as evidenced by improved symptom control and reduced exacerbation risk.
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Affiliation(s)
- Dennis Ledford
- Morsani College of Medicine and James A. Haley VA Hospital, University of South Florida, Tampa, Fla.
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88
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Tran TN, Zeiger RS, Peters SP, Colice G, Newbold P, Goldman M, Chipps BE. Overlap of atopic, eosinophilic, and TH2-high asthma phenotypes in a general population with current asthma. Ann Allergy Asthma Immunol 2016; 116:37-42. [PMID: 26707771 DOI: 10.1016/j.anai.2015.10.027] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/21/2015] [Accepted: 10/26/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Atopic, eosinophilic, and TH2-high asthma phenotypes may overlap, but the extent is unknown. Understanding the overlap across these phenotypes may be useful in guiding asthma patient care. OBJECTIVE To examine the frequency and overlap of atopic, eosinophilic, and TH2-high asthma phenotypes. METHODS We analyzed 2005 to 2006 data from the National Health and Nutrition Examination Survey. Patients with asthma were identified based on the participant self-report. Eosinophilic asthma was defined as a blood eosinophil cutoff point of ≥150, 300, or 400/μL. Atopic asthma was defined as having an allergen-specific IgE level of ≥0.35 IU/mL for any of the 9 perennial allergens tested. TH2-high asthma was defined as a total serum IgE of ≥100 IU/mL and a blood eosinophil count of ≥140/μL. RESULTS The study included 269 children and 310 adults. Depending on the eosinophil cutoff used, 31% to 78% of children and 21% to 69% of adults with asthma were classified as having eosinophilic asthma. In addition, 63% of children and 61% of adults were classified as having atopic disease and 48% of children and 37% of adults as having TH2-high asthma. At a higher eosinophil cutoff point, a greater proportion of eosinophilic asthma can be classified as atopic or TH2 high, but a lower proportion of atopic or TH2-high asthma can be classified as eosinophilic. Approximately 70% or more of children and adults with asthma were 1 of these 3 phenotypes. CONCLUSION A considerable overlap among eosinophilic, atopic, and TH2-high asthma phenotypes exists in a general asthma population.
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Affiliation(s)
- Trung N Tran
- Global Medicine Development, AstraZeneca, Gaithersburg, Maryland.
| | - Robert S Zeiger
- Kaiser Permanente Southern California, San Diego, California
| | | | - Gene Colice
- Global Medicine Development, AstraZeneca, Gaithersburg, Maryland
| | - Paul Newbold
- Translational Medicine, MedImmune, Gaithersburg, Maryland
| | - Mitchell Goldman
- Global Medicine Development, AstraZeneca, Gaithersburg, Maryland
| | - Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California
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89
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Tashkin DP, Moore GE, Trudo F, DePietro M, Chipps BE. Assessment of Consistency of Fixed Airflow Obstruction Status during Budesonide/Formoterol Treatment and Its Effects on Treatment Outcomes in Patients with Asthma. J Allergy Clin Immunol Pract 2016; 4:705-12. [PMID: 27039236 DOI: 10.1016/j.jaip.2016.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/10/2016] [Accepted: 02/26/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The consistency of fixed airflow limitation status during treatment in patients with asthma is unknown. OBJECTIVE The objective of this study was to determine the consistency of fixed airflow obstruction (FAO) status during treatment and effects on treatment response. METHODS This post hoc analysis from a 12-week study (NCT00652002) assessed patients aged 12 years or more with moderate-to-severe asthma randomized to twice-daily budesonide/formoterol (BUD/FM) via pressurized metered-dose inhaler (pMDI) 320/9 μg, BUD pMDI 320 μg, FM 9 μg via dry-powder inhaler, or placebo. FAO status was assessed postbronchodilator at screening and after study drug administration at weeks 2, 6, and 12 via the forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio < lower limit of normal (LLN) (FAO+) or ≥ LLN (FAO-). Patients with persistent FAO- and FAO+ retained their screening FAO status at all visits. Patients with inconsistent FAO changed categories at least once during the study. Assessments included early withdrawal due to predefined worsening asthma events (PAEs), lung function, and symptoms. RESULTS Of 386 patients, 29% had persistent FAO+, 31% inconsistent FAO, and 40% persistent FAO-. PAEs were lowest in the FAO- group overall and with BUD/FM treatment in patients with FAO+ and inconsistent FAO. Baseline demographics and treatment responses of the inconsistent FAO group were most similar to the FAO+ group. The greatest improvements in asthma control days and use of rescue medications were seen with BUD/FM treatment, regardless of FAO status. CONCLUSIONS Approximately one third of patients with moderate-to-severe asthma in this study had inconsistent FAO, and their treatment responses were most similar to patients with FAO+. Regardless of FAO status, patients treated with BUD/FM experienced the most improved treatment responses and fewest withdrawals due to PAEs.
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Affiliation(s)
- Donald P Tashkin
- Department of Medicine, University of California, Los Angeles, Calif.
| | - Gary E Moore
- Moore Computing Services, Inc., Little Rock, Ark
| | - Frank Trudo
- AstraZeneca LP - Respiratory, Wilmington, Del
| | | | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
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90
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Wilhelm CP, Chipps BE. Bronchial thermoplasty: a review of the evidence. Ann Allergy Asthma Immunol 2015; 116:92-8. [PMID: 26654482 DOI: 10.1016/j.anai.2015.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/13/2015] [Accepted: 11/02/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Chelle Pope Wilhelm
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
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91
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Abstract
BACKGROUND Corticosteroids, delivered systemically and by inhalation, are widely used for the treatment of multiple acute respiratory illnesses in children. However, the level of evidence to support the utility of this therapy varies between these different acute respiratory illnesses. OBJECTIVE To summarize the evidence regarding the utility of corticosteroids in the management of common acute pediatric respiratory conditions and to highlights the controversies regarding their use. METHODS Literature search of manuscripts describing the evidence regarding the efficacy of corticosteroids (systemic and inhaled) in the management of: acute asthma exacerbation among school age children, acute episodic wheeze among preschool children, viral croup, and acute viral bronchiolitis. RESULTS Current evidence indicates that systemic corticosteroids provide benefits for the treatment of acute asthma exacerbations in school age children, mainly in the acute care setting. In addition, high dose inhaled corticosteroid therapy administered in the Emergency Department appears to have comparable effect for the prevention of asthma-related hospital admission as systemic corticosteroids in this age group. In contrast, most available studies have not shown benefit for systemic corticosteroids during acute wheezing episodes in preschool children. Systemic corticosteroids decrease symptoms and the rate of hospital admissions in patients with severe croup; however, corticosteroids have no role in the treatment of acute bronchiolitis and their use in this condition should be discouraged. CONCLUSION Corticosteroids treatment response varies between the acute respiratory illnesses presented in this review. Future research should aim to fill the current gaps-of-knowledge regarding the utility this intervention such as the identification of specific wheezing phenotypes among preschool children which might benefit from systemic corticosteroids as a treatment for acute viral wheeze.
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Affiliation(s)
- Avraham Beigelman
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, Missouri, USA
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92
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Chipps BE. The Bela Schick Lecture: if you don't know where you are going, you may end up somewhere else. Ann Allergy Asthma Immunol 2015; 114:440-2. [PMID: 25900018 DOI: 10.1016/j.anai.2015.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/17/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California.
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93
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Chipps BE, Haselkorn T, Miller DP, Mink DR, Omachi TA. Oral Corticosteroid Use and Health Outcomes in Patients with Severe or Difficult-to-Treat Asthma. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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94
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DePietro M, Tashkin DP, Chipps BE, Trudo F. Effects of Doubling the Highest Indicated Dose of Budesonide/Formoterol (BUD/FM) on Lung Function and Symptoms in Moderate-to-Severe Asthma with Fixed Airflow Obstruction (FAO). J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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95
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Tashkin DP, Trudo F, DePietro M, Chipps BE. Effect of Fixed Airflow Obstruction (FAO) Status on Lung Function, Asthma Control Days (ACD), and Asthma Symptom Score (AS) Responses to Budesonide/Formoterol (BUD/FM) Treatment in Patients with Moderate-to-Severe Asthma. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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96
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97
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Chipps BE, Anderson CT, Harder JM. Fractional exhaled nitric oxide of at least 100 ppb and implications for future asthma research. Ann Allergy Asthma Immunol 2014; 113:118-9. [PMID: 24950849 DOI: 10.1016/j.anai.2014.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/09/2014] [Accepted: 05/11/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California.
| | | | - Julia M Harder
- Capital Allergy & Respiratory Disease Center, Sacramento, California
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98
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Luskin AT, Chipps BE, Rasouliyan L, Miller DP, Haselkorn T, Dorenbaum A. Impact of asthma exacerbations and asthma triggers on asthma-related quality of life in patients with severe or difficult-to-treat asthma. J Allergy Clin Immunol Pract 2014; 2:544-52.e1-2. [PMID: 25213047 DOI: 10.1016/j.jaip.2014.02.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few data are available that evaluate the relationship among asthma exacerbations, asthma triggers, and asthma-related quality of life (QoL). OBJECTIVE To evaluate the impact of asthma exacerbations and asthma triggers on QoL. METHODS Patients with severe or difficult-to-treat asthma, ages ≥ 13 years (n = 2679) from the TENOR (The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens) 3-year observational study were included. Exacerbations were defined hierarchically in descending order of severity (hospitalization, emergency department [ED] visit, steroid burst, no exacerbation) by using data from months 6 and 12. The total number (frequency) of exacerbations was assessed. Asthma-related QoL was measured at month 12 by using the Mini-Asthma QoL Questionnaire (Mini-AQLQ); self-reported asthma triggers were collected at baseline and annually. We used 1-way ANOVA to test for differences in Mini-AQLQ domain scores across asthma exacerbation severity, the total number of asthma exacerbations, and the number of asthma triggers. RESULTS A significant decrease (P < .001) in Mini-AQLQ domain scores was seen with increasing severity of asthma exacerbation (no exacerbation, steroid burst, ED visit, and hospitalization); symptom (5.5, 4.8, 4.3, and 4.2), activity (5.8, 5.2, 4.6, and 4.4), emotional (5.6, 5.0, 4.4, and 4.2), exposure (5.0, 4.5, 4.0, and 3.9); and overall (5.5, 4.9, 4.3, and 4.1). Increasing exacerbation frequency and the number of baseline asthma triggers also were associated with significant decreases in Mini-AQLQ domain scores. An increasing number of asthma triggers were associated with an increase in severity and frequency of exacerbations. CONCLUSION Avoidance of asthma triggers may reduce exacerbation rates and improve asthma-related QoL in patients with severe or difficult-to-treat asthma. Interventional studies are warranted to further explore these outcomes.
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Affiliation(s)
- Allan T Luskin
- Department of Medicine, University of Wisconsin, Madison, Wis.
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
| | - Lawrence Rasouliyan
- Late Phase and Outcomes Research, ICON Clinical Research, San Francisco, Calif
| | - Dave P Miller
- Late Phase and Outcomes Research, ICON Clinical Research, San Francisco, Calif
| | | | - Alejandro Dorenbaum
- Department of Pediatric Immunology and Allergy, Stanford University School of Medicine, Stanford, Calif
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99
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Tashkin DP, Chipps BE, Trudo F, Zangrilli JG. Fixed airflow obstruction in asthma: a descriptive study of patient profiles and effect on treatment responses. J Asthma 2014; 51:603-9. [PMID: 24524222 PMCID: PMC4162502 DOI: 10.3109/02770903.2014.895012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The role of fixed airflow obstruction (FAO) in asthma is unclear. Objective: To assess the relationship between FAO and clinical features of asthma and the effect of FAO on treatment response. Methods: Post hoc descriptive analysis of data stratified by FAO category (screening post-albuterol FEV1/FVC <lower limit of normal [LLN] [FAO+] or ≥LLN [FAO−]) from two 12-week, randomized, placebo-controlled studies of budesonide/formoterol or the monocomponents in mild−moderate (study I; aged ≥6 years; NCT00651651; placebo run-in) or moderate−severe (study II; ≥12 years; NCT00652002; budesonide run-in) asthma patients. Results: At baseline, FAO+ versus FAO− patients were more likely male and had longer asthma duration and worse pulmonary function. During the treatment period, lung function and asthma control measures with placebo were generally worse in FAO+ versus FAO− patients. Budesonide was effective on most end points in both FAO+ and FAO− patients. In contrast to FAO− patients, FAO+ patients were unresponsive to formoterol monotherapy in both study populations. Consistently greater improvements in most end points (including worsening of asthma as predefined by specific lung function parameters or clinical symptoms) were observed moving from formoterol to budesonide to budesonide/formoterol in both FAO+ and FAO− patients, with generally greater than additive effects on lung function with budesonide/formoterol in FAO+ patients. Conclusions: FAO+ patients tended to be more impaired and at greater risk for an asthma event versus FAO− patients. While FAO+ patients were non-responsive to formoterol monotherapy, they retained responsiveness to budesonide and had the greatest lung function and control responses to budesonide/formoterol that were similar to or greater than responses of FAO− patients.
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Affiliation(s)
- Donald P Tashkin
- David Geffen School of Medicine at UCLA, Division of Pulmonary & Critical Care Medicine, University of California , Los Angeles, CA , USA
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100
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Tashkin DP, Chipps BE, Trudo F. Effects of Budesonide/Formoterol (BUD/FM) Deliverd By Pressurized Metered-Dose Inhaler (pMDI) on Symptoms In African Americans and Caucasians With Moderate and Severe Asthma With and Without Fixed Airway Obstruction (FAO). J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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