Indirect comparison of bronchial thermoplasty versus omalizumab for uncontrolled severe asthma

Objective: Bronchial thermoplasty (BT) as an add-on therapy for uncontrolled severe asthma is an alternative to biologic therapies like omalizumab (OM). We conducted an indirect treatment comparison (ITC) to appraise comparative effectiveness of BT and OM. Methods: A systematic literature review identified relevant randomized controlled trials. The ITC followed accepted methodology. Results: The ITC comprised a sham-controlled trial of BT (AIR2) and two placebo-controlled trials of OM (INNOVATE; EXTRA). Comparing the BT post-treatment period to ongoing treatment with OM, showed no significant differences in the rate ratios (RRs) for severe exacerbations (RR of BT versus OM = 0.91 [95% CI: 0.64, 1.30]; p = 0.62) or hospitalizations (RR = 0.57 [95% CI: 0.17, 1.86]; p = 0.53); emergency department visits were significantly reduced by 75% with BT (RR = 0.25 [95% CI: 0.07, 0.91]; p = 0.04); the proportions of patients with clinically meaningful response on the asthma quality-of-life questionnaire were comparable (RR = 1.06 [95% CI: 0.86, 1.34]; p = 0.59). The RR for exacerbations statistically favours OM over the total study period in AIR2 (RR = 1.50 [95% CI: 1.11, 2.02]; p = 0.009) likely reflecting a transient increase in events during the BT peri-treatment period. Conclusions: The ITC should be interpreted cautiously considering the differences between patient populations in the included trials. However, based on the analysis, BT compares well with a potentially more costly pharmacotherapy for asthma. Clinicians evaluating the relative merits of using these treatments should consider the totality of evidence and patient preferences to make an informed decision.     

Vitamin D deficiency and level of asthma control in women from North of Jordan: a case–control study

Introduction: Reduced vitamin-D levels in patients with asthma have been associated with impaired lung function, increased airway hyper-responsiveness, and reduced glucocorticoid responsiveness. Nationwide studies revealed a considerable prevalence of vitamin-D deficiency (VDD) in Jordanian women. Objective: A case–control study was conducted to determine the relationship between serum vitamin A and D levels and asthma among women in North of Jordan. Methods: Sixty-eight asthmatics, age range between 14 and 65 years and 77 healthy women, age range between 19 and 51 years, were enrolled. Asthma severity was classified using Global Initiative for Asthma (GINA) guidelines and Asthma Control Test (ACT) questionnaire. Serum vitamin-A and 25-hydroxyvitamin-D (25(OH)D3) levels were measured using high-performance liquid chromatography (HPLC) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods, respectively. Results: The prevalence of VDD (<15?ng/ml) was higher but not statistically significant for women with asthma compared with controls (95.6% vs. 87.0%; p?=?0.070). The severity of VDD correlated with the number of asthma medications (p?=?0.020). 25(OH)-D3 serum levels directly correlated with asthma control level using ACT score (p?=?0.012) and GINA classification (p?=?0.046). After adjusting for age, the odds of having VDD for asthmatic women were 35.9 times higher than that for women with no asthma. There was no difference in serum vitamin-A level between healthy and asthmatic women (p?=?0.214) and none had vitamin-A deficiency (<200?µg/dl). Conclusions: VDD is prevalent in women with asthma in northern Jordan. The severity of VDD correlated with poor asthma control and a need for more medications to control asthma. There was no association between vitamin-A and asthma.     

Le GINA 2006 et l’asthme : quoi de neuf en thérapeutique par rapport aux éditions antérieures ?

The 2006 revision of Global Initiative for Asthma (GINA) included several modifications which concern both adults and children. GINA was established in 1995 and its principal objectives were described then in the NHBLI/WHO Report, Global Strategy for Asthma Management and Prevention. This widely distributed report was revised in 2002 and then again in 2006. GINA 2006 is a document written in a simple fashion, mainly adapted for primary care physicians. It insists on the control of asthma in both children and adults, because that asthma symptoms and their consequences (trouble sleeping, limitation of daily living activities, reduction of respiratory function, use of rescue medications) can be controlled by appropriate treatment. In 2006, GINA proposed to abandon the notion of severity in favour of the concept of control, a concept already adopted in France in 2004 by the Haute Autorité de santé (HAS) in its recommendations on the management of asthmatic patients, both adults and adolescents. Control is defined by the presence or absence of asthma, defined essentially by clinical criteria that take into account the patient's activities over the several weeks (from one week to three months) before the consultation. Control includes three stages: for GINA, the three stages are “controlled”, “partially controlled” and “uncontrolled”, whereas for the Agence nationale d’accréditation et d’évaluation en santé (Anaes) they are “optimal”, acceptable” and “unacceptable”, which mean more-or-less the same thing. This concept is easier for primary care physicians to use. The therapeutic consequences of the GINA revisions will be considered in the present review.     

The challenge of asthma control grading in clinical practice

Asthma is a chronic disease for which control is considered the management goal. However, the different methods to measure asthma control, including the Global Initiative for Asthma (GINA) criteria and Asthma Control Test (ACT), can produce conflicting results. This nationwide pediatric study compared both methods in 465 enrolled children (322 males, mean age 11.2 years). Lung function and symptom perception were also evaluated. The results showed fair concordance (k = 0.253) between GINA grading and childhood-ACT (C-ACT). Multivariate analysis revealed an association between the parents' perception of asthma and uncontrolled asthma (odds ratio [OR] = 1.52).These findings highlight the persisting puzzle of asthma control grading in primary care, which could confuse doctors. Therefore, asthma control assessment deserves adequate attention and requires substantial expertise in clinical practice.     

The beneficial role of FeNO in association with GINA guidelines for titration of inhaled corticosteroids in adult asthma: A randomized study

PurposeThis study aimed to demonstrate the role of fractional concentration of exhaled nitric oxide (FeNO) in association with Global Initiative for Asthma (GINA) guidelines for treatment of adult patients with asthma.MethodsIt was a prospective and randomized study. The symptomatic asthmatic patients were randomly divided into two groups: GINA group (followed GINA guidelines; N = 86) or GINA + FeNO group (followed GINA guidelines + FeNO for titration of inhaled corticosteroids - ICS; N = 90). They were followed-up for 9 months.ResultsIn GINA group, 37.2% patients had no treatment and 62.8% patients discontinued treatment vs. 40.0% and 60.0% in GINA + FeNO, respectively. After 3, 6 and 9 months of treatment, the percentage of mild, moderate and severe asthma showed no significant difference between the two groups. At 9th month, Δ moderate asthma (reduction) in GINA + FeNO group was significantly higher than in the GINA group (−22.0% vs. −11.6%; P = 0.018). The improvement of asthma control test (ACT) score was not different between the groups at 9th month (12 ± 6 vs. 10 ± 5; P > 0.05); the level of FeNO reduction in GINA + FeNO group was significantly higher than that in GINA group (−42 ± 11 vs. −35 ± 9; P = 0.022). The daily dose of ICS in GINA + FeNO group was significantly lower than that in GINA group (397 ± 171 vs. 482 ± 240 mcg and 375 ± 203 vs. 424 ± 221 mcg; respectively) at the end of 6 and 9 months.ConclusionThe use of FeNO in association with GINA guidelines has a beneficial role for accurate daily dose of ICS in adult patients with asthma.     

Efficacy and safety of mepolizumab in Japanese patients with severe eosinophilic asthma

Background

The MENSA trial assessed the efficacy and safety of mepolizumab in patients with severe eosinophilic asthma. This report describes the efficacy and safety of mepolizumab in Japanese patients from MENSA.

GINA吸入治疗方案与其他疗法治疗儿童哮喘的成本-效果分析

目的研究哮喘治疗的GINA吸入治疗方案与其他疗法的成本-效果分析(CEA)。方法随机病例对照研究,用10 cm线性可视性模拟分数图判定疗效。结果吸入疗法组单次药费(180.6±110.5)元,而其他疗法组为(102.8±53.2)元,吸入疗法组药费显著高于其他疗法组(P<0.01);1 a随访结果表明,吸入疗法组药费(2 608±1 630)元,而其他疗法组需(3 054±2 103)元,显著高于吸入疗法组(P<0.01);吸入疗法组满意分数为(86.8±13.1)%,而其他疗法组仅(53.1±19.7)%(P<0.01),其得到的CEA比分别为30.04和57.51,用吸入治疗后儿童上学缺课情况显著下降(86±15)与(328±94)人天(P均<0.01)。结论吸入治疗较其他抗喘治疗能产生较好的治疗效果,其花费也低于其他疗法组。