1
|
Bendien SA, de Kruif MD, Feitsma H, van Hoolwerff-Blikkendaal C, Huurne KKT, Kuiterman A, Baranova EV, Wittkamp A, Brons A, Poulissen M, van der Meer AN. Summary of the Dutch Multidisciplinary Practice Guideline on Asthma and Pregnancy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1751-1762. [PMID: 38513758 DOI: 10.1016/j.jaip.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
Asthma is the most common chronic respiratory disease in women of childbearing age and during pregnancy. This paper presents a summary of the Dutch multidisciplinary guideline on asthma and pregnancy. The aim of this guideline is to provide structured, where possible, evidence-based recommendations to optimize the management of asthma during pregnancy. The main topics covered in this guideline are preconception counseling, the safety of asthma medications during pregnancy and breastfeeding and risk assessment and monitoring of asthma during pregnancy. Because many caregivers are involved and a uniform approach is desirable, this guideline has been developed in collaboration with all relevant health care providers and patient representatives.
Collapse
Affiliation(s)
- Sarah A Bendien
- Department of Respiratory Medicine, Haga Teaching Hospital, The Hague, The Netherlands.
| | | | - Hanneke Feitsma
- Department of Gynaecology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Cathelijn van Hoolwerff-Blikkendaal
- Nederlands huisartsen genootschap (NHG), Utrecht, The Netherlands; Dutch Association of General Practitioners and COPD & Astma Huisartsen Advies Groep (CAHAG), Utrecht, The Netherlands; Dutch COPD & Asthma Advisory Board for Practitioners, Utrecht, The Netherlands
| | | | | | - Ekaterina V Baranova
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Arjan Wittkamp
- Department of Respiratory Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Annette Brons
- Lung Foundation Netherlands, Amersfoort, The Netherlands
| | - Marjo Poulissen
- Lung Foundation Netherlands, Amersfoort, The Netherlands, and Patient Organization astma Vereniging Nederland en Davos (VND), Reeuwijk, The Netherlands
| | | |
Collapse
|
2
|
Joshi E, Gibson PG, McDonald VM, Murphy VE. Treatable traits in asthma during pregnancy: a call for a shift towards a precision-based management approach. Eur Respir Rev 2023; 32:230105. [PMID: 38123232 PMCID: PMC10731471 DOI: 10.1183/16000617.0105-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/16/2023] [Indexed: 12/23/2023] Open
Abstract
Asthma is the most common chronic medical condition in pregnancy. Asthma exacerbations in pregnancy are unpredictable, and are associated with adverse maternal and fetal perinatal outcomes such as preterm birth and low birthweight. Goals of asthma management in pregnancy are to establish effective asthma control and prevent exacerbations. Optimising the management of asthma in pregnancy is an important goal of practice and future research.Treatable traits is a precision medicine paradigm proposed for the management of airways diseases, which holistically addresses the complexity and heterogeneity of airways disease. It is an individualised treatment approach that aims to improve outcomes. This makes treatable traits well suited for pregnant women with asthma, who have a high prevalence of obesity, mental health conditions, poor symptom perception and suboptimal asthma management skills including low treatment adherence. These traits are measurable and treatable. In this review, we explore current knowledge on the burden of asthma, maternal and perinatal consequences of asthma during pregnancy, the treatable traits paradigm, the prevalence of treatable traits in pregnant women with asthma, and consider how the treatable traits paradigm can be integrated into the management of asthma in pregnancy.
Collapse
Affiliation(s)
- Esha Joshi
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Peter G Gibson
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Vanessa M McDonald
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, Australia
| |
Collapse
|
3
|
Murphy VE, Gibson PG, Schatz M. Managing Asthma During Pregnancy and the Postpartum Period. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3585-3594. [PMID: 37482082 DOI: 10.1016/j.jaip.2023.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
Asthma is one of the most common chronic diseases in pregnancy and is associated with adverse perinatal outcomes. Asthma symptoms worsen in approximately 40% of women, and exacerbations requiring medical intervention occur in at least 20% of women. Factors associated with exacerbation and worsening asthma include multiparity, obesity, Black race, exacerbations before pregnancy, and poor asthma control. Exacerbations are associated with further increased risks for poor perinatal outcomes, including low birth weight, preterm birth, and small for gestational age (SGA) status, as well as an increase in the development of asthma in early childhood. Common medications used for asthma, including short-acting β-agonists and inhaled corticosteroids, are considered safe to use in pregnancy. Whereas guidelines generally suggest traditional step therapy for managing asthma in pregnancy, there are alternative models of care and management approaches that may be effective in pregnancy, but require more research. These include single-inhaler maintenance and reliever therapy, treatment adjustment with FeNO, treatable traits personalized medicine approaches, and telemedicine. Little is known about changes to asthma in the postpartum period. However, low adherence to medication and the potential effects of postpartum depression on asthma exacerbation risk warrant further research.
Collapse
Affiliation(s)
- Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
| | - Peter G Gibson
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
| |
Collapse
|
4
|
Wang J, Wang P, Shao Y, He D. Advancing Treatment Strategies: A Comprehensive Review of Drug Delivery Innovations for Chronic Inflammatory Respiratory Diseases. Pharmaceutics 2023; 15:2151. [PMID: 37631365 PMCID: PMC10458134 DOI: 10.3390/pharmaceutics15082151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic inflammatory respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis, present ongoing challenges in terms of effective treatment and management. These diseases are characterized by persistent inflammation in the airways, leading to structural changes and compromised lung function. There are several treatments available for them, such as bronchodilators, immunomodulators, and oxygen therapy. However, there are still some shortcomings in the effectiveness and side effects of drugs. To achieve optimal therapeutic outcomes while minimizing systemic side effects, targeted therapies and precise drug delivery systems are crucial to the management of these diseases. This comprehensive review focuses on the role of drug delivery systems in chronic inflammatory respiratory diseases, particularly nanoparticle-based drug delivery systems, inhaled corticosteroids (ICSs), novel biologicals, gene therapy, and personalized medicine. By examining the latest advancements and strategies in these areas, we aim to provide a thorough understanding of the current landscape and future prospects for improving treatment outcomes in these challenging conditions.
Collapse
Affiliation(s)
- Junming Wang
- Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China; (J.W.); (P.W.); (Y.S.)
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai 201508, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai 201508, China
| | - Pengfei Wang
- Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China; (J.W.); (P.W.); (Y.S.)
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai 201508, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai 201508, China
| | - Yiru Shao
- Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China; (J.W.); (P.W.); (Y.S.)
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai 201508, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai 201508, China
| | - Daikun He
- Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China; (J.W.); (P.W.); (Y.S.)
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai 201508, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai 201508, China
- Department of General Practice, Jinshan Hospital, Fudan University, Shanghai 201508, China
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| |
Collapse
|
5
|
Murphy VE, Jensen ME, Holliday EG, Giles WB, Barrett HL, Callaway LK, Bisits A, Peek MJ, Seeho SK, Abbott A, Robijn AL, Colditz PB, Searles A, Attia J, McCaffery K, Hensley MJ, Mattes J, Gibson PG. Effect of asthma management with exhaled nitric oxide versus usual care on perinatal outcomes. Eur Respir J 2022; 60:13993003.00298-2022. [PMID: 35777773 PMCID: PMC9669403 DOI: 10.1183/13993003.00298-2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/10/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Asthma exacerbations in pregnancy are associated with adverse perinatal outcomes. We aimed to determine whether fractional exhaled nitric oxide (F ENO)-based asthma management improves perinatal outcomes compared to usual care. METHODS The Breathing for Life Trial was a multicentre, parallel-group, randomised controlled trial conducted in six hospital antenatal clinics, which compared asthma management guided by F ENO (adjustment of asthma treatment according to exhaled nitric oxide and symptoms each 6-12 weeks) to usual care (no treatment adjustment as part of the trial). The primary outcome was a composite of adverse perinatal events (preterm birth, small for gestational age (SGA), perinatal mortality or neonatal hospitalisation) assessed using hospital records. Secondary outcomes included maternal asthma exacerbations. Concealed random allocation, stratified by study site and self-reported smoking status was used, with blinded outcome assessment and statistical analysis (intention to treat). RESULTS Pregnant women with current asthma were recruited; 599 to the control group (608 infants) and 601 to the intervention (615 infants). There were no significant group differences for the primary composite perinatal outcome (152 (25.6%) out of 594 control, 177 (29.4%) out of 603 intervention; OR 1.21, 95% CI 0.94-1.56; p=0.15), preterm birth (OR 1.14, 95% CI 0.78-1.68), SGA (OR 1.06, 95% CI 0.78-1.68), perinatal mortality (OR 3.62, 95% CI 0.80-16.5), neonatal hospitalisation (OR 1.24, 95% CI 0.89-1.72) or maternal asthma exacerbations requiring hospital admission or emergency department presentation (OR 1.19, 95% CI 0.69-2.05). CONCLUSION F ENO-guided asthma pharmacotherapy delivered by a nurse or midwife in the antenatal clinic setting did not improve perinatal outcomes.
Collapse
Affiliation(s)
- Vanessa E. Murphy
- Priority Research Centre Grow Up Well, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia,School of Medicine and Public Health, Faculty of Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia,Corresponding author: Vanessa E. Murphy ()
| | - Megan E. Jensen
- Priority Research Centre Grow Up Well, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia,School of Medicine and Public Health, Faculty of Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia
| | - Elizabeth G. Holliday
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia
| | - Warwick B. Giles
- Specialty of Obstetrics, Gynaecology and Neonatology, Sydney Medical School Northern, University of Sydney, Sydney, Australia
| | - Helen L. Barrett
- Queensland Diabetes and Endocrine Centre, Mater Health Services, South Brisbane, Australia,Mater Research Institute – The University of Queensland, St Lucia, Australia
| | - Leonie K. Callaway
- School of Medicine, University of Queensland, Brisbane, Australia,Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Andrew Bisits
- Birthing Unit, Royal Hospital for Women Randwick, Randwick, Australia
| | - Michael J. Peek
- Australian National University Medical School, The Australian National University, Canberra, Australia,Department of Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra, Australia
| | - Sean K. Seeho
- Specialty of Obstetrics, Gynaecology and Neonatology, Sydney Medical School Northern, University of Sydney, Sydney, Australia
| | | | - Annelies L. Robijn
- Priority Research Centre Grow Up Well, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia
| | - Paul B. Colditz
- Perinatal Research Centre, UQCCR, University of Queensland, Brisbane, Australia
| | | | - John Attia
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia
| | | | - Michael J. Hensley
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Joerg Mattes
- Priority Research Centre Grow Up Well, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia,Paediatric Respiratory and Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Peter G. Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| |
Collapse
|
6
|
Sodhi A, Pisani M, Glassberg MK, Bourjeily G, D'Ambrosio C. Sex and Gender in Lung Disease and Sleep Disorders: A State-of-the-Art Review. Chest 2022; 162:647-658. [PMID: 35300976 PMCID: PMC9808608 DOI: 10.1016/j.chest.2022.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 01/13/2023] Open
Abstract
The terms sex and gender often are used interchangeably, but have specific meaning when it comes to their effects on lung disease. Ample evidence is now available that sex and gender affect the incidence, susceptibility, presentation, diagnosis, and severity of many lung diseases. Some conditions are more prevalent in women, such as asthma. Other conditions are seen almost exclusively in women, like lymphangioleiomyomatosis. Some life stages-such as pregnancy-are unique to women and can affect the onset and course of lung disease. Clinical presentation may differ as well, such as higher number of exacerbations experienced by women with COPD and greater cardiovascular morbidity in women with sleep-disordered breathing. In addition, response to therapy and medication safety may also differ by sex, and yet, pharmacogenomic factors often are not addressed adequately in clinical trials. Various aspects of lung and sleep biology and pathobiology are impacted by female sex and female reproductive transitions. Differential gene expression or organ development can be impacted by these biological differences. Understanding these differences is the first step in moving toward precision medicine for women. This article is a state-of-the-art review of specific effects of sex and gender focused on epidemiology, disease presentation, risk factors, and management of lung diseases. Pathobiological mechanisms explaining sex differences in these diseases are beyond the scope of this article. We review the literature and focus on recent guidelines about using sex and gender in research. We also review sex and gender differences in lung diseases.
Collapse
Affiliation(s)
- Amik Sodhi
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Margaret Pisani
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Marilyn K Glassberg
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AR
| | - Ghada Bourjeily
- Division of Pulmonary, Critical Care and Sleep Medicine, Brown University, Providence, RI
| | - Carolyn D'Ambrosio
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
| |
Collapse
|
7
|
Robijn AL, Bokern MP, Jensen ME, Barker D, Baines KJ, Murphy VE. Risk factors for asthma exacerbations during pregnancy: a systematic review and meta-analysis. Eur Respir Rev 2022; 31:31/164/220039. [PMID: 35705210 DOI: 10.1183/16000617.0039-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/07/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Conflicting literature exists regarding the risk factors for exacerbations among pregnant women with asthma. This systematic review and meta-analysis aimed to determine risk factors for asthma exacerbations during pregnancy. METHODS Electronic databases were searched for the following terms: (asthma or wheeze) and (pregnan* or perinat* or obstet*) and (exacerb* or flare up or morbidit* or attack*).All studies published between 2000 and 24 August 2021 were considered for inclusion if they reported at least one potential risk factor of asthma exacerbations in pregnant women with asthma. Of the 3337 references considered, 35 publications involving 429 583 pregnant women with asthma were included. Meta-analyses were conducted to determine mean difference in risk factor between exacerbation groups, or the relative risks of exacerbation with certain risk factors. Good study quality was found through the Newcastle-Ottawa Scale (median score 8, interquartile range 7-9). RESULTS Increased maternal age (mean difference 0.62, 95% CI 0.11-1.13), obesity (relative risk 1.25, 95% CI 1.15-1.37), smoking (relative risk 1.35, 95% CI 1.04-1.75), black ethnicity (relative risk 1.62, 95% CI 1.52-1.73), multiparity (relative risk 1.31, 95% CI 1.01-1.68), depression/anxiety (relative risk 1.42, 95% CI 1.27-1.59), moderate-severe asthma (relative risk 3.44, 95% CI 2.03-5.83, versus mild) and severe asthma (relative risk 2.70, 95% CI 1.85-3.95, versus mild-moderate) were associated with an increased risk of asthma exacerbations during pregnancy. CONCLUSIONS Future interventions aimed at reducing exacerbations in pregnancy could address the modifiable factors, such as smoking and depression/anxiety, and introduce more regular monitoring for those with nonmodifiable risk factors such as obesity and more severe asthma.
Collapse
Affiliation(s)
- Annelies L Robijn
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Priority Research Centre for Healthy Lungs, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Marleen P Bokern
- Dept of Pharmaco-Therapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
| | - Megan E Jensen
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Priority Research Centre for Healthy Lungs, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Katherine J Baines
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Priority Research Centre for Healthy Lungs, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Vanessa E Murphy
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Priority Research Centre for Healthy Lungs, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
8
|
Jenkins CR, Boulet LP, Lavoie KL, Raherison-Semjen C, Singh D. Personalized Treatment of Asthma: The Importance of Sex and Gender Differences. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:963-971.e3. [PMID: 35150902 DOI: 10.1016/j.jaip.2022.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/18/2022] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
An individual's sex (nominally male or female, based on biological attributes) and gender (a complex term referring to socially constructed roles, behaviors, and expressions of identity) influence the clinical course of asthma in several ways. The physiologic development of the lungs and effects of sex hormones may explain why more boys than girls have asthma, and after puberty, more women than men have asthma. Female sex hormones have an impact throughout the life span and are associated with poor asthma control. Gender may influence exposure to asthma triggers, and sex and gender can influence the prevalence of comorbidities and interactions with health care professionals. Despite widely reported sex- and gender-based differences in asthma and asthma management, these issues frequently are not considered by health care professionals. There is also inconsistency regarding the use of "sex" and "gender" in scientific discourse; research is needed to define sex- and gender-based differences better and how they might interact to influence asthma outcomes. This review outlines the impact an individual's sex and gender can have on the pathogenesis, clinical course, diagnosis, treatment, and management of asthma.
Collapse
Affiliation(s)
| | | | - Kim L Lavoie
- Department of Psychology, University of Québec at Montreal and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Chantal Raherison-Semjen
- Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France; INSERM U1219, EpiCene Team, University of Bordeaux, Bordeaux, France
| | - Dave Singh
- University of Manchester, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
9
|
Using FeNO Measurement in Clinical Asthma Management. Chest 2021; 161:906-917. [PMID: 34673021 DOI: 10.1016/j.chest.2021.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/30/2021] [Accepted: 10/10/2021] [Indexed: 11/24/2022] Open
Abstract
Asthma is a common and heterogeneous disease, characterised by lower airway inflammation and airflow limitation. Critical factors in asthma management include establishing an accurate diagnosis and ensuring appropriate selection and dosage of anti-inflammatory therapies. The majority of asthma patients exhibit type 2 (T2) inflammation, with increased interleukin (IL)-4, IL-5, and IL-13 signalling, often with associated eosinophilia. Identifying lower airway eosinophilia with sputum induction improves asthma outcomes, but is time consuming and costly. Increased T2-inflammation leads to upregulation of nitric oxide (NO) release into the airway, with increasing fractional exhaled NO (FeNO) reflecting greater T2-inflammation. FeNO can be easily and quickly measured in the clinic, offering a point of care surrogate measure of the degree of lower airway inflammation. FeNO testing can be used to help confirm an asthma diagnosis, to guide inhaled corticosteroid therapy, to assess adherence to treatment, and to aid selection of appropriate biologic therapy. However, FeNO levels may also be influenced by a variety of intrinsic and extrinsic factors other than asthma, including nasal polyposis and cigarette smoking, and must be interpreted in the broader clinical context rather than viewed in isolation. This review discusses the clinical application of FeNO measurement in asthma care, from diagnosis to treatment selection, and describes its place in current international expert guidelines.
Collapse
|
10
|
Couillard S, Connolly C, Borg C, Pavord I. Asthma in pregnancy: An update. Obstet Med 2021; 14:135-144. [PMID: 34646341 PMCID: PMC8504309 DOI: 10.1177/1753495x20965072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/16/2020] [Indexed: 01/13/2023] Open
Abstract
AIM To update obstetric care providers about asthma management. SUMMARY Asthma is the most frequent comorbid chronic illness in pregnancy. Convincing evidence shows that uncontrolled asthma magnifies the risk of maternal, fetal and neonate complications. Unfortunately, one in four women take no inhaler during pregnancy, and it is likely that decreased adherence, rather than changes in pathology, explains uncontrolled maternal asthma. Patient surveys reveal a need for information and reassurance. Although some molecules are preferred in pregnancy, there is currently no basis to withhold any asthma medication - old or new. Biomarkers such as blood eosinophils and fractional exhaled nitric oxide are an effective way to assess the risk of asthma attacks and the likelihood of responding to inhaled steroids. Furthermore, practice-changing trials in mild asthma show that switching reliever-only regimens to as-needed 'controller-and-reliever' therapy is effective. We suggest that applying these changes can alleviate women's concerns and improve outcomes.
Collapse
Affiliation(s)
- Simon Couillard
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Clare Connolly
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine Borg
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
11
|
Vieira AC, Pité H, Morais-Almeida M. Asthma and pregnancy in the 2020 decade: still a matter of concern. J Matern Fetal Neonatal Med 2021; 35:6498-6504. [PMID: 33926358 DOI: 10.1080/14767058.2021.1916462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Asthma is a fairly common health problem for pregnant women and a potentially serious medical condition that may complicate pregnancy. Most complications are related to lack of disease control, which can adversely affect both maternal quality of life and perinatal outcomes. In this article, we review recent literature concerning asthma in pregnancy, describing the course of the disease and associated complications. Furthermore, we review and discuss asthma monitoring and management during pregnancy, labor and post-partum. The course of asthma symptoms during pregnancy is unpredictable but exacerbations are more common during the second trimester. The causes are multifactorial and asthma phenotype may have a role. It has been proposed that combined use of CARAT (Control of Allergic Rhinitis and Asthma Test) and lung function tests can be used to monitor and adjust therapy during pregnancy in patients with asthma. As a complement, an approach that considers airway inflammation assessment using fractional exhaled nitric oxide (FeNO), a noninvasive marker of inflammation, may improve asthma control during pregnancy. It is important to consider a few but relevant differences in asthma management and treatment regarding pregnancy and the peri-partum period to safely achieve optimal management of asthma during all these phases for both mother and offsprings.
Collapse
Affiliation(s)
- Ana Cláudia Vieira
- Pulmonology Department, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Helena Pité
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital, Lisbon, Portugal.,CEDOC, Chronic Diseases Research Center, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital, Lisbon, Portugal
| |
Collapse
|
12
|
Brightling CE. Asthma exacerbations during pregnancy: A need for precision medicine. Respirology 2019; 25:670-671. [PMID: 31840898 DOI: 10.1111/resp.13761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Christopher E Brightling
- Institute for Lung Health, Department of Respiratory and Microbial Sciences, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| |
Collapse
|