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Stewart K, Kuo CR, Chan R, Lipworth B. Evaluating an electronic device to monitor the type 2 high unified airway response to dupilumab. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00233-3. [PMID: 38643948 DOI: 10.1016/j.anai.2024.04.015] [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] [Received: 02/13/2024] [Revised: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Kirsten Stewart
- Scottish Centre for Respiratory Research, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland, United Kingdom
| | - Rory Chan
- Scottish Centre for Respiratory Research, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland, United Kingdom
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland, United Kingdom.
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Lipworth B, Kuo CR, Stewart K, Chan R. Should Airway Hyper-Responsiveness Be Included in the Definition of Clinical Remission With Biologic Therapy in Severe Asthma. J Allergy Clin Immunol Pract 2024; 12:904-907. [PMID: 38097177 DOI: 10.1016/j.jaip.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/06/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/31/2023]
Abstract
Airway hyper-responsiveness (AHR) is a tenet of the persistent asthma phenotype along with reversible airway obstruction and type 2 (T2) inflammation. Indirect acting challenges such as mannitol are more closely related to the underlying T2 inflammatory process as compared with direct challenges. In this review article, we summarise the current literature and explore the future role of mannitol AHR in clinical remission with biologics.
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Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, United Kingdom.
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Kirsten Stewart
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Rory Chan
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, United Kingdom
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Lipworth B, Kuo CR, Stewart K, Chan R. Budesonide/Formoterol or Budesonide/Albuterol as Anti-Inflammatory Reliever Therapy for Asthma. The Journal of Allergy and Clinical Immunology: In Practice 2024; 12:889-893. [PMID: 38346474 DOI: 10.1016/j.jaip.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/09/2024] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
Overuse of reliever as short-acting beta-agonist and associated underuse of controller as inhaled corticosteroid (ICS) administered via separate inhalers results in worse asthma outcomes. Such discordance can be obviated by combining both controller and reliever in the same inhaler. So-called anti-inflammatory reliever (AIR) therapy comprises the use of a single inhaler containing an ICS such as budesonide (BUD) in conjunction with a reliever as either albuterol (ALB) or formoterol (FORM), to be used on demand, with variable dosing driven by asthma symptoms in a flexible patient-centered regimen. Global guidelines now support the use of BUD-ALB as AIR therapy to reduce exacerbations, either on its own in mild asthma or in conjunction with fixed-dose maintenance ICS-long-acting beta-agonist in moderate to severe asthma. Using BUD-FORM on its own allows patients to seamlessly move in an intuitive flexible fashion between AIR and maintenance and reliever therapy, by stepping up and down the dosing escalator across a spectrum of asthma severities. Head-to-head clinical studies are indicated to compare BUD-FORM versus BUD-ALB as AIR in mild asthma, and also BUD-FORM as maintenance and reliever therapy versus BUD-ALB as AIR plus maintenance ICS-long-acting beta-agonist in moderate to severe asthma. Patients should be encouraged to make an informed decision in conjunction with their health care professional regarding the best therapeutic option tailored to their individual needs, which in turn is likely to result in long-term compliance and associated optimal asthma control.
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Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom.
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
| | - Kirsten Stewart
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
| | - Rory Chan
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
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Lipworth BJ, Stewart K, Kuo CR, Chan R. Could Corticosteroid/Antihistamine Combination Nasal Sprays Be Used as Anti-Inflammatory Reliever Therapy for Allergic Rhinitis? J Allergy Clin Immunol Pract 2024:S2213-2198(24)00076-X. [PMID: 38281585 DOI: 10.1016/j.jaip.2024.01.024] [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] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Brian J Lipworth
- Scottish Centre for Respiratory Research and Rhinology Mega-Clinic, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
| | - Kirsten Stewart
- Scottish Centre for Respiratory Research and Rhinology Mega-Clinic, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research and Rhinology Mega-Clinic, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Rory Chan
- Scottish Centre for Respiratory Research and Rhinology Mega-Clinic, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
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Lipworth B, Stewart K, RuiWen Kuo C, Chan R. The eosinophil paradox in type 2 high severe eosinophilic unified airways disease. J Allergy Clin Immunol Pract 2024; 12:265. [PMID: 38185497 DOI: 10.1016/j.jaip.2023.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
| | - Kirsten Stewart
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
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Chan R, RuiWen Kuo C, Jabbal S, Lipworth BJ. Eosinophil depletion with benralizumab is associated with attenuated mannitol airway hyperresponsiveness in severe uncontrolled eosinophilic asthma. J Allergy Clin Immunol 2023; 151:700-705.e10. [PMID: 36400178 DOI: 10.1016/j.jaci.2022.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Airway hyperresponsiveness (AHR) and eosinophilia are hallmarks of persistent asthma. OBJECTIVE We investigated whether eosinophil depletion with benralizumab might attenuate indirect mannitol AHR in severe uncontrolled asthma using a pragmatic open-label design. METHODS After a 4-week run-in period with provision of usual inhaled corticosteroids and/or long-acting β-agonist (baseline), adults with mannitol-responsive uncontrolled severe eosinophilic asthma received 3 doses of open-label benralizumab 30 mg every 4 weeks, followed by 16 weeks' washout after the last dose. The primary outcome was doubling difference (DD) in provocative dose of mannitol required to decrease FEV1 by 10% (PD10) at the end point after 12 weeks, powered at 90% with 18 patients required to detect 1 DD. Secondary outcomes included measures assessed by the asthma control questionnaire and mini-asthma quality of life questionnaire. RESULTS Twenty-one patients completed 12 weeks' benralizumab therapy at the end point at week 12. Mean (SEM) age was 53 (4) years, and FEV1 80.2% (4.1%) inhaled corticosteroid dose was 1895 (59) μg, with 12 receiving long-acting muscarinic antagonist and 13 leukotriene receptor antagonists. Improvement in AHR was significant by 8 weeks, with a mean 2.1 DD (95% confidence interval 1.0, 3.3; P < .01) change in PD10 at week 12, while mean changes in asthma control questionnaire and mini-asthma quality of life questionnaire were significant by week 2 and sustained over 12 weeks, both exceeding the minimal important difference. Peripheral blood eosinophils were depleted by 2 weeks (439 to 6 cells/μL). No significant improvement occurred in lung function after 12 weeks. Domiciliary peak flow and symptoms also improved with benralizumab. CONCLUSION Eosinophil depletion results in clinically meaningful attenuated AHR in severe uncontrolled asthma patients.
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Affiliation(s)
- Rory Chan
- From the Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
| | - Chris RuiWen Kuo
- From the Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
| | - Sunny Jabbal
- From the Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
| | - Brian J Lipworth
- From the Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom.
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Melville P, Mohammed F, RuiWen Kuo C, Bradley J, Preston G, Dempsey OJ. Nodules, nodes and non-functioning macrophages: A risk with ibrutinib therapy. J R Coll Physicians Edinb 2022; 52:46-47. [DOI: 10.1177/14782715221088973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the case of a 70-year-old never smoker with chronic lymphocytic leukaemia, treated with single agent ibrutinib therapy. Chest imaging noted nodular change and mediastinal lymphadenopathy, which showed avid uptake on positron emission tomography and guided subsequent biopsies (bronchoscopy using endobronchial ultrasound, mediastinoscopy). Despite negative aspergillus blood immunology tests, he was found to have invasive aspergillosis, which is a known risk with ibrutinib therapy. He has since been successfully treated with antifungal therapy.
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Affiliation(s)
- Peter Melville
- Department of Respiratory Medicine, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Farheena Mohammed
- Department of Respiratory Medicine, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Chris RuiWen Kuo
- Department of Respiratory Medicine, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Jack Bradley
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Gavin Preston
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Owen J Dempsey
- Department of Respiratory Medicine, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
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Lipworth B, Chan R, Kuo CR. Criteria for Airway Oscillometry Reversibility in Asthma. Chest 2021; 158:1282-1283. [PMID: 32892863 DOI: 10.1016/j.chest.2020.03.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/07/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland.
| | - Rory Chan
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
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Lipworth B, Chan R, RuiWen Kuo C. Optimal asthma control in African American children with asthma. J Allergy Clin Immunol Pract 2021; 8:2121. [PMID: 32499041 DOI: 10.1016/j.jaip.2020.01.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom.
| | - Rory Chan
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
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Lipworth B, RuiWen Kuo C, Jabbal S, Chan R. Inhaled triple therapy and airway hyperresponsiveness in persistent asthma. Ann Allergy Asthma Immunol 2021; 126:597-598. [PMID: 33548471 DOI: 10.1016/j.anai.2021.01.032] [Citation(s) in RCA: 1] [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: 10/21/2020] [Revised: 12/11/2020] [Accepted: 01/25/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital, University of Dundee, Scotland, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital, University of Dundee, Scotland, United Kingdom
| | - Sunny Jabbal
- Scottish Centre for Respiratory Research, Ninewells Hospital, University of Dundee, Scotland, United Kingdom
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital, University of Dundee, Scotland, United Kingdom
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Chan R, RuiWen Kuo C, Lipworth B. Real-life small airway outcomes in severe asthma patients receiving biologic therapies. J Allergy Clin Immunol Pract 2021; 9:2907-2909. [PMID: 33545398 DOI: 10.1016/j.jaip.2021.01.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Rory Chan
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, United Kingdom
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, United Kingdom.
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Lipworth B, Chan R, Kuo CR. Don't Forget about Facilitatory Effects of Corticosteroids on β 2-Adrenoceptors in Acute Asthma. Am J Respir Crit Care Med 2021; 202:1743. [PMID: 32970458 PMCID: PMC7737594 DOI: 10.1164/rccm.202007-2837le] [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: 11/21/2022] Open
Affiliation(s)
| | - Rory Chan
- University of Dundee Scotland, United Kingdom
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13
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Lipworth B, Chan R, Kuo CR. Omalizumab or dupilumab for chronic rhinosinusitis with nasal polyposis. J Allergy Clin Immunol 2020; 147:413. [PMID: 33160644 DOI: 10.1016/j.jaci.2020.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Brian Lipworth
- Tayside Rhinology Mega-Clinic, Ninewells Hospital and Medical School, Scottish Centre for Respiratory Research, University of Dundee, Dundee, United Kingdom.
| | - Rory Chan
- Tayside Rhinology Mega-Clinic, Ninewells Hospital and Medical School, Scottish Centre for Respiratory Research, University of Dundee, Dundee, United Kingdom
| | - Chris RuiWen Kuo
- Tayside Rhinology Mega-Clinic, Ninewells Hospital and Medical School, Scottish Centre for Respiratory Research, University of Dundee, Dundee, United Kingdom
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Lipworth B, Chan R, Kuo CR. Use of inhaled corticosteroids in asthma and coronavirus disease 2019: Keep calm and carry on. Ann Allergy Asthma Immunol 2020; 125:503-504. [PMID: 32585180 PMCID: PMC7329280 DOI: 10.1016/j.anai.2020.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, United Kingdom.
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, United Kingdom
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Affiliation(s)
| | | | | | - Rory Chan
- University of DundeeDundee, United
Kingdomand
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Lipworth B, Chan R, Kuo CR. Systemic effects of fluticasone on blood eosinophils in bronchiectasis. Eur Respir J 2020; 56:56/3/2002005. [PMID: 32883758 DOI: 10.1183/13993003.02005-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School Dundee, Dundee, Scotland UK
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School Dundee, Dundee, Scotland UK
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School Dundee, Dundee, Scotland UK
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Affiliation(s)
- Brian J Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Dundee, Scotland, UK
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18
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Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hopsital and Medical School, University of Dundee, Dundee, United Kingdom.
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hopsital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hopsital and Medical School, University of Dundee, Dundee, United Kingdom
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Lipworth B, Chan R, Kuo CR. Diagnosing adrenal insufficiency using ACTH stimulation test. Eur Respir J 2020; 56:56/2/2001478. [PMID: 32763962 DOI: 10.1183/13993003.01478-2020] [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: 04/29/2020] [Accepted: 05/19/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee Scotland, UK
| | - Rory Chan
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee Scotland, UK
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee Scotland, UK
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Kuo CR, Chan R, Lipworth B. Impulse oscillometry bronchodilator response and asthma control. J Allergy Clin Immunol Pract 2020; 8:3610-3612. [PMID: 32745702 DOI: 10.1016/j.jaip.2020.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
| | - Rory Chan
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom.
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21
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Lipworth B, Chan R, RuiWen Kuo C. How bad is the SAD phenotype in relation to asthma control. J Allergy Clin Immunol Pract 2020; 8:427. [PMID: 31950911 DOI: 10.1016/j.jaip.2019.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom.
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom
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22
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Jabbal S, Kuo CR, Lipworth B. Randomized controlled trial of triple versus dual inhaler therapy on small airways in smoking asthmatics. Clin Exp Allergy 2020; 50:1140-1147. [PMID: 33180376 DOI: 10.1111/cea.13702] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Smoking worsens underlying asthma inflammation and also induces resistance to inhaled corticosteroids (ICS). Small airways dysfunction measured by impulse oscillometry (IOS) is associated with worse control. OBJECTIVES We investigated the effects on small airways of adding long-acting beta-agonist (LABA) alone or with long-acting muscarinic antagonist (LAMA) to ICS in asthmatic smokers. METHODS Sixteen current smokers were enrolled: mean age 44 year, FEV1 84%, FEF25-75 47%, R5 158%, ACQ 1.69, 20 pack year . Patients were converted to a reference ICS as HFA-BDP during initial run-in at median dose of 800 µg/day. Open label olodaterol 5 µg od (OLO) or olodaterol 5 µg/tiotropium 5 µg od (OLO/TIO) was added to HFA-BDP for median duration of 3 weeks in a randomized cross over design, including run-in and washout periods on HFA-BDP. IOS and spirometry were measured after each treatment (BDP/OLO/TIO or BDP/OLO) and at baseline after run-in and washout (BDP). RESULTS After chronic dosing, IOS outcomes at trough except for R20 were all significantly improved with OLO/TIO compared to OLO. For the primary end-point of total airway resistance (as R5), the mean difference (95%CI) at trough was 0.06 (0.015-0.10) kPa/l/s, peripheral airways resistance (as R5-R20) 0.03 (0.003-0.06) kPa/l/s, peripheral lung reactance area (as AX) 0.38 (0.08-0.68) kPa/l and resonant frequency (as RF) 2.28 (0.45-4.12) Hz. FEF25-75 at trough was also better with OLO/TIO vs TIO: 0.93 (0.86 - 0.95) l/s while FEV1 was not different. CONCLUSIONS ICS/LABA/LAMA was superior to ICS/LABA on trough small airway outcomes in asthma patients who smoke.
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Affiliation(s)
- Sunny Jabbal
- Scottish Centre for Respiratory Research, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland
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Lipworth B, Chan R, Kuo CR. Dupilumab for nasal polyposis. Lancet 2020; 396:233. [PMID: 32711789 DOI: 10.1016/s0140-6736(20)30562-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/05/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research and Dundee Rhinology Mega-Clinic, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
| | - Rory Chan
- Scottish Centre for Respiratory Research and Dundee Rhinology Mega-Clinic, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research and Dundee Rhinology Mega-Clinic, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
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Chan R, RuiWen Kuo C, Lipworth B. Pragmatic Clinical Perspective on Biologics for Severe Refractory Type 2 Asthma. J Allergy Clin Immunol Pract 2020; 8:3363-3370. [PMID: 32673880 DOI: 10.1016/j.jaip.2020.06.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/07/2020] [Accepted: 06/28/2020] [Indexed: 12/18/2022]
Abstract
Patients with severe refractory asthma present a challenging clinical conundrum for practicing clinicians. Biologics that target key mediators in the type 2 inflammation cascade, including IL-4, IL-5, IL-13, and IgE, can be effective strategies for these patients. However, with various biologics available, choosing the optimal one for a particular patient becomes a nuanced decision. We propose a pragmatic algorithm that identifies the optimal biologic class for patients who have specific type 2 disease endotypes. Patients with eosinophilic endotypes fare well with anti-IL-5(rα) medications, comprising mepolizumab, benralizumab, and reslizumab because they have been shown to reduce exacerbations in severe eosinophilic asthma by approximately 50%. In patients with fractional exhaled nitric oxide-high endotypes, anti-IL-4rα such as dupilumab is deemed to be most effective and has demonstrated a 47% reduction in asthma exacerbations. For patients with severe uncontrolled allergic asthma, anti-IgE (omalizumab) is effective and has been shown to confer a 25% reduction in asthma exacerbations. Type 2 comorbidities including chronic rhinosinusitis with nasal polyps, atopic dermatitis, chronic idiopathic urticaria, and eosinophilic esophagitis are important to bear in mind before the prescription of biologics. Further head-to-head studies are indicated to compare biologics in patients with mixed endotypes according to peripheral blood eosinophils, fractional exhaled nitric oxide, and allergic status. The evidence strongly supports endotype-driven prescribing of biologics to achieve clinically relevant outcomes in severe refractory asthma and related comorbidities.
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Affiliation(s)
- Rory Chan
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom.
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Abstract
Broadly speaking, pharmacological treatments for COVID-19 can be divided into those acting on upstream pathways early on in the disease process via suppression of viral replication or by inhibiting cell entry, and those acting on downstream pathways later on via selective attenuation of the adaptive immune cytokine-mediated inflammatory response. The antiviral drug remdesivir has been shown to shorten duration of disease while interferon beta-1b may speed up viral clearance. The results with hydroxychloroquine have thus far been rather disappointing. Trials with selective cytokine blockers including anti-interleukin-1 (anti-IL-1) and anti-interleukin-6 (anti-IL-6), have shown some promise in more severe cases, with further confirmation being required from large-scale phase-3 randomised controlled trials. The likelihood is that combination therapy addressing both upstream and downstream pathways may be required to prevent progression of severe COVID-19 infection in susceptible older patients with comorbidities and we believe further studies are now warranted to specifically target such at-risk groups who are more prone to worse outcomes.
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Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK,
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
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Lipworth B, Chan R, Lipworth S, RuiWen Kuo C. Weathering the Cytokine Storm in Susceptible Patients with Severe SARS-CoV-2 Infection. J Allergy Clin Immunol Pract 2020; 8:1798-1801. [PMID: 32311489 PMCID: PMC7165083 DOI: 10.1016/j.jaip.2020.04.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/05/2020] [Accepted: 04/11/2020] [Indexed: 12/11/2022]
MESH Headings
- Administration, Inhalation
- Adrenal Cortex Hormones/adverse effects
- Age Factors
- Angiotensin-Converting Enzyme Inhibitors/therapeutic use
- Anti-Bacterial Agents/therapeutic use
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antiviral Agents/therapeutic use
- Azithromycin/therapeutic use
- Bromhexine/therapeutic use
- COVID-19
- Coronavirus Infections/complications
- Coronavirus Infections/drug therapy
- Coronavirus Infections/epidemiology
- Coronavirus Infections/immunology
- Cytokines/immunology
- Expectorants/therapeutic use
- Humans
- Hydroxychloroquine/therapeutic use
- Hypertension/epidemiology
- Inflammation
- Interferon beta-1a/immunology
- Interleukin-1/immunology
- Interleukin-12/immunology
- Interleukin-6/immunology
- Lymphohistiocytosis, Hemophagocytic/etiology
- Lymphohistiocytosis, Hemophagocytic/immunology
- Obesity/epidemiology
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/drug therapy
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/immunology
- Pulmonary Disease, Chronic Obstructive/drug therapy
- Pulmonary Disease, Chronic Obstructive/epidemiology
- Respiratory Distress Syndrome/etiology
- Respiratory Distress Syndrome/immunology
- Risk Factors
- Smoking/epidemiology
- Tumor Necrosis Factor-alpha/immunology
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Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom.
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom
| | - Samuel Lipworth
- Medical Microbiology, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom
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27
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Lipworth B, Kuo CR, Chan R. Making simple things complicated using anti-inflammatory reliever therapy. Eur Respir J 2020; 55:55/4/2000267. [PMID: 32354861 DOI: 10.1183/13993003.00267-2020] [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: 02/07/2020] [Accepted: 02/15/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Rory Chan
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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28
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Lipworth B, Chan R, Kuo CR. Sex Hormones and Asthma: Don't Forget Progesterone. Am J Respir Crit Care Med 2020; 201:392. [PMID: 31639319 PMCID: PMC6999105 DOI: 10.1164/rccm.201909-1801le] [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: 11/16/2022] Open
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory ResearchDundee, United Kingdom
| | - Rory Chan
- Scottish Centre for Respiratory ResearchDundee, United Kingdom
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29
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Lipworth B, Chan R, RuiWen Kuo C. Observational Data With Inhaled Corticosteroid/Long-Acting Beta-Agonist/Long-Acting Muscarinic Antagonist May Not Reflect Current Practice With Single Triple Inhalers. Chest 2020; 157:1045. [PMID: 32252915 DOI: 10.1016/j.chest.2019.12.029] [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] [Received: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland.
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland
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30
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Lipworth B, Kuo CR. Resistance Heterogeneity and Small Airway Asthma Phenotype. Am J Respir Crit Care Med 2020; 200:1441-1442. [PMID: 31339343 PMCID: PMC6884047 DOI: 10.1164/rccm.201905-1060le] [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: 11/16/2022] Open
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31
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Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Rory Chan
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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32
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Chan R, RuiWen Kuo C, Lipworth B. Disconnect between effects of mepolizumab on severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol Pract 2020; 8:1714-1716. [PMID: 31954194 DOI: 10.1016/j.jaip.2020.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Rory Chan
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, Scotland, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, Scotland, United Kingdom
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, Scotland, United Kingdom.
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33
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Kuo CR, Lipworth B. Airwave oscillometry and patient-reported outcomes in persistent asthma. Ann Allergy Asthma Immunol 2020; 124:289-290. [PMID: 31904425 DOI: 10.1016/j.anai.2019.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/07/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom.
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Kuo CR, Chan R, Lipworth B. Does unified allergic airway disease impact on lung function and type 2 biomarkers? Allergy Asthma Clin Immunol 2019; 15:75. [PMID: 31788008 PMCID: PMC6880485 DOI: 10.1186/s13223-019-0388-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
The concept of the unified allergic airway disease (UAD) recognises the association between allergic inflammation in the upper and lower airways. Patients with asthma and concomitant allergic rhinitis experience more asthma-related primary and secondary care visits. We therefore aimed to determine differences in asthma control (asthma control questionnaire ACQ-6), lung function (spirometry) and T2 biomarkers (FeNO and Eos) in relation to the presence of allergic rhinitis in patients with allergic asthma. Retrospectively, we evaluated a cohort of 60 consecutive patients with persistent asthma attending our research unit for screening into clinical trials. All included subjects were receiving inhaled corticosteroids (ICS) and had a positive skin prick test (SPT) to at least one common aeroallergen to fulfil the criterion of allergic asthma. Patients with UAD had a diagnosis of allergic asthma in addition to established concomitant allergic rhinitis. T2 biomarkers were significantly higher in patients with allergic rhinitis in contrast to those without. FEV1 % predicted and FEF25-75 % predicted were also significantly lower in patients with concomitant allergic rhinitis. However, there was no difference in ACQ-6 observed between groups. In summary, patients with allergic asthma, the presence of concomitant allergic rhinitis is associated with worse lung function and higher type 2 biomarkers.
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Affiliation(s)
- Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY Scotland, UK
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY Scotland, UK
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY Scotland, UK
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Abstract
A 43-year-old non-smoker was referred with a 3-month history of malaise, fatigue and breathlessness. Blood avian precipitins were strongly positive. Lung function testing confirmed a restrictive pattern with impaired gas transfer. A 'ground glass' mosaic pattern was seen on CT imaging, suggestive of hypersensitivity pneumonitis. Although he had no pet birds, on closer questioning he had recently acquired a duvet and pillows containing feathers. His symptoms, chest radiograph and lung function tests improved after removal of all feather bedding, and he was also started on oral corticosteroid therapy. Our case reinforces the importance of taking a meticulous exposure history and asking about domestic bedding in patients with unexplained breathlessness. Prompt recognition and cessation of antigen exposure may prevent the development of irreversible lung fibrosis.
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Affiliation(s)
| | | | | | - Owen Dempsey
- Respiratory Medicine, Aberdeen Royal Infirmary, Aberdeen, UK
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36
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Lipworth B, Chan R, Kuo CR. Anti-inflammatory reliever therapy for asthma. Ann Allergy Asthma Immunol 2019; 124:13-15. [PMID: 31610234 DOI: 10.1016/j.anai.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/17/2019] [Accepted: 10/04/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland.
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland
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37
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Lipworth B, Chan R, RuiWen Kuo C. Non-canonical β 2-receptor signaling. J Allergy Clin Immunol 2019; 144:1735. [PMID: 31564472 DOI: 10.1016/j.jaci.2019.08.017] [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: 07/29/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
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38
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Kuo CR, Jabbal S, Anderson W, Lipworth BJ. Pragmatic evaluation of inhaled corticosteroid particle size formulations on asthma control. Clin Exp Allergy 2019; 49:1321-1327. [PMID: 31264282 DOI: 10.1111/cea.13453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/07/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Extra-fine particle formulations of inhaled corticosteroid (ICS) are associated with improved lung delivery. OBJECTIVES A pragmatic study to assess patient-reported outcomes after switching from fine to extra-fine particle ICS in persistent asthma. METHODS Twenty-four patients (mean age 48 year, FEV1 84%, ACQ 1.67) received 4 weeks run-in with a constant dose of fine particle ICS (mean dose 710 µg), followed by switching to an equivalent dose of extra-fine particle hydrofluoroalkane beclomethasone dipropionate (mean dose 355µg). Asthma control questionnaire (ACQ), the primary outcome and mini asthma quality of life questionnaire (mAQLQ) were measured pre- and post-run-in (baseline) and after 4 weeks and 8 weeks of switching. RESULTS Comparing pre- vs post-run-in, there were no differences for ACQ: 1.67 vs 1.65 or AQLQ: 5.08 vs 5.34. There were mean (95%CI) improvements (P < 0.001) from baseline after 8 weeks for ACQ: -0.53 (-0.83, -0.23) and AQLQ: 0.69 (0.35, 1.04), which exceeded the minimal clinically important difference (MCID) of 0.5 for both. There were also differences (P < 0.05) in domiciliary symptoms and reliever use. There were no significant changes at 8 weeks in lung function, FeNO or blood eosinophils. CONCLUSIONS Pragmatic switching from fine to extra-fine particle ICS at half the dose was associated with clinically relevant improvements in asthma control and quality of life, but not lung function or type 2 biomarkers.
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Affiliation(s)
- Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Sunny Jabbal
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - William Anderson
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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39
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Lipworth B, RuiWen Kuo C. Bronchoprotective tolerance with inhaled corticosteroid/long-acting β-agonist treatment. J Allergy Clin Immunol 2019; 144:873. [PMID: 31300278 DOI: 10.1016/j.jaci.2019.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom.
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
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40
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Kuo CR, Spears M, Haughney J, Smith A, Miller J, Bradshaw T, Murray L, Williamson P, Lipworth B. Scottish consensus statement on the role of FeNO in adult asthma. Respir Med 2019; 155:54-57. [PMID: 31299469 DOI: 10.1016/j.rmed.2019.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/14/2019] [Accepted: 07/05/2019] [Indexed: 01/15/2023]
Abstract
Fractional exhaled nitric oxide (FeNO) is the only available point of care test to assess type-2 inflammation in asthma. In making a diagnosis of asthma, FeNO should be used together with blood eosinophils and spirometry, alongside a history. Raised FeNO in conjunction with blood eosinophilia are treatable traits of type 2 inflammation in asthma, which in turn may guide personalised management. A FeNO suppression test can be used to assess adherence and device use with ICS therapy. Furthermore FeNO may be used to provide feedback to patients in response to ICS, especially when spirometry is normal. FeNO may facilitate appropriate referral to secondary care for more definitive specialist investigations. In summary, FeNO is cost effective in the diagnosis and management of asthma and should be incorporated into primary and secondary care as part of routine clinical practice.
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Affiliation(s)
- Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, DD1 9SY, UK
| | - Mark Spears
- Respiratory Medicine, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
| | - John Haughney
- Clinical R&D, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Andrew Smith
- Department of Respiratory Medicine, University Hospital Wishaw, ML2 0DP, UK
| | - Joy Miller
- Respiratory Medicine Unit, Aberdeen Royal Infirmary, University of Aberdeen, AB25 2ZN, UK
| | - Tracey Bradshaw
- Respiratory Medicine Unit, Royal Infirmary of Edinburgh, EH16 4SA, UK
| | - Lorna Murray
- Department of Respiratory Medicine, Raigmore Hospital, Inverness, IV2 4AG, UK
| | | | - Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, DD1 9SY, UK.
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41
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Kuo CR, Lipworth B. Differences in asthma control and lung function in relation to allergic status. Eur Respir J 2019; 53:13993003.02102-2018. [PMID: 30880284 DOI: 10.1183/13993003.02102-2018] [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: 11/04/2018] [Accepted: 03/03/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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42
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Lipworth B, Kuo CR, Jabbal S. Inhaled triple therapy in chronic obstructive pulmonary disease. Lancet 2018; 392:1112-1113. [PMID: 30303075 DOI: 10.1016/s0140-6736(18)31795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/27/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland DD1 9SY, UK.
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland DD1 9SY, UK
| | - Sunny Jabbal
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland DD1 9SY, UK
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43
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Abstract
A single inhaler containing inhaled corticosteroid (ICS)/long-acting beta-agonist (LABA)/long-acting muscarinic antagonist (LAMA) is a more convenient way of delivering triple therapy in patients with COPD. Single triple therapy has been shown to be superior at reducing exacerbations and improving quality of life compared to LABA/LAMA, especially in patients with a prior history of frequent exacerbations and blood eosinophilia, who have ICS responsive disease. The corollary is that patients with infrequent exacerbations who are noneosinophilic may be safely de-escalated from triple therapy to LABA/LAMA without loss of control. Pointedly, there is a substantially increased risk of pneumonia associated with the triple therapy containing fluticasone furoate but not beclometasone dipropionate or budesonide. Since triple therapy is also better than ICS/LABA at reducing exacerbations and improving lung function, symptoms, and quality of life, this brings into question the rationale for using ICS/LABA. Hence, we propose a simplified pragmatic decision process based on symptoms, prior to exacerbation history, and blood eosinophils to select which patients should be given a single triple inhaler or LABA/LAMA. Differences in patient preference of inhaler device, formulations and drugs will also determine which triple inhaler prescribers elect to use.
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Affiliation(s)
- Brian Lipworth
- Division of Molecular & Clinical Medicine, Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK,
| | - Chris RuiWen Kuo
- Division of Molecular & Clinical Medicine, Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK,
| | - Sunny Jabbal
- Division of Molecular & Clinical Medicine, Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK,
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Kuo CR, Jabbal S, Lipworth B. Is small airways dysfunction related to asthma control and type 2 inflammation? Ann Allergy Asthma Immunol 2018; 121:631-632. [PMID: 30134181 DOI: 10.1016/j.anai.2018.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/19/2018] [Accepted: 08/13/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, UK
| | - Sunny Jabbal
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, UK
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, UK.
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45
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Lipworth B, Jabbal S, Kuo CR. Anti-interleukin 13 for asthma: stick or twist? Lancet Respir Med 2018; 6:e46-e47. [PMID: 30078617 DOI: 10.1016/s2213-2600(18)30275-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
| | - Sunny Jabbal
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
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