Bringing asthma care into the twenty-first century

Larsson, Kjell; Kankaanranta, Hannu; Janson, Christer; Lehtimäki, Lauri; Ställberg, Björn; Løkke, Anders; Høines, Kristian Jong; Roslind, Klaus; Ulrik, Charlotte Suppli

doi:10.1038/s41533-020-0182-2

Cited by 38 publications

(26 citation statements)

References 101 publications

(168 reference statements)

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“…It has been demonstrated that the recognition of various stimuli and the associated inflammatory responses are important in the development and exacerbation of asthma (6,7). Corticosteroids, b2 agonists and leukotriene receptor antagonists are commonly used in the treatment of asthma (8). Side effects, including respiratory tract infections and decreased bone density, often occur with the use of inhaled corticosteroids, which are primary medications in all steps of asthma therapy (9,10).…”

Section: Introductionmentioning

confidence: 99%

Inhibition of the Inflammasome Activity of NLRP3 Attenuates HDM-Induced Allergic Asthma

et al. 2021

Front. Immunol.

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Inhaled allergens promote inflammatory response, tissue damage, and airway hyperresponsiveness in the lungs, leading to allergic asthma. NLRP3, as an immune sensor of infections and cellular stress, is associated with the development and exacerbation of asthma. However, the mechanism by which NLRP3 affects asthma requires further investigation. Here, we showed that inhaled house dust mite (HDM) promotes NLRP3 inflammasome activation in the lungs and specifically induces the maturation of caspase-1 and IL-1β in alveolar macrophages (AMs). Using Nlrp3-mutant mice, we found that NLRP3 promotes the inflammatory response and pathogenesis in HDM-induced allergic asthma in an inflammasome-dependent manner. Treatment with RRx-001, an NLRP3 inhibitor, significantly reduced inflammatory cell infiltration and mucus secretion in the airway. Our results showed that NLRP3 in myeloid cells promoted the development and progression of allergic asthma in an inflammasome-dependent manner. Small molecules targeting the NLRP3 inflammasome may provide new treatment options for this disease.

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Section: Introductionmentioning

confidence: 99%

Inhibition of the Inflammasome Activity of NLRP3 Attenuates HDM-Induced Allergic Asthma

et al. 2021

Front. Immunol.

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“…12 The second parameter is improving education of both providers and patients. This may be accomplished by a variety of strategies 19 including participating in global efforts such as GINA. [6][7][8][9] And finally, there is a need to increase the availability of assessment tools.…”

Section: Recommendationsmentioning

confidence: 99%

The Care of Asthma Patients in Communities with Limited Resources

Dubaybo

2021

RRTM

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Asthma care has undergone significant changes over the past several years. Our understanding of the pathophysiology, risk factors, diagnosis, treatment, follow-up and prognosis has changed as more investigations shed new light on all of these aspects. This complexity has resulted in global guidelines aimed at improving the management of asthma patients. Among the multitude of guidelines, those published by the Global Initiative for Asthma (GINA) have achieved widespread and global acceptance. These guidelines cover the spectrum of factors that impact asthma care and include specific recommendations that treating physicians should follow to provide optimal patient care. In this review of asthma care in adult patients, we will outline some of the recommendations issued by GINA and discuss the challenges and limitations to the implementation of these guidelines in communities with limited resources. We will also propose recommendations to overcome these limitations in adult patients.

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“…Referral to a specialist is appropriate when a primary care patient’s long-term condition worsens suddenly, or when a patient fails to respond to the standard GINA step care management (Fig. 1 ) or has poor asthma control despite showing good adherence and the correct inhalation technique [ 22 ].…”

Section: Analysis Of An Exacerbationmentioning

confidence: 99%

The Myth of Mild: Severe Exacerbations in Mild Asthma: An Underappreciated, but Preventable Problem

Kaplan

2021

Adv Ther

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Asthma is a common, chronic inflammatory airway disease, characterised by unpredictable episodes of worsening symptoms, or exacerbations. Causes of asthma exacerbations include viral infections, exposure to allergen and air pollution, all of which increase the underlying inflammation that typifies asthma. Most (50-75%) patients are classed as having mild asthma, with symptoms that can be readily controlled with available inhaled medications. Paradoxically, for the past 30 years, the first treatment recommended in asthma management guidelines was short-acting b 2 -agonists (SABA), which not only have no anti-inflammatory properties but may, in fact, worsen inflammation. The Global Initiative for Asthma (GINA) 2019/2020 broke with this paradox by stating clearly that SABA should no longer be used alone as a reliever, for safety reasons. Instead, GINA now recommends an anti-inflammatory rescue/reliever approach for adult and adolescent patients, based on the combination of an inhaled corticosteroid with a rapid onset b 2 -agonist such as formoterol. This commentary highlights the fact that even patients with well-controlled mild asthma are at risk of severe, potentially life-threatening exacerbations, similar to those in patients with moderate or severe asthma, and therefore 'mild asthma', is a misnomer. The commentary describes the case history of a patient with mild asthma to illustrate how increasing use of SABA alone can worsen and prolong exacerbations when they occur. The author goes on to describe how the management of this patient's exacerbation could have been improved, and provides up-todate advice on broader aspects of the management of mild asthma and exacerbations, supported by the recent changes to the GINA recommendations.

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Bringing asthma care into the twenty-first century

Cited by 38 publications

References 101 publications

Inhibition of the Inflammasome Activity of NLRP3 Attenuates HDM-Induced Allergic Asthma

Inhibition of the Inflammasome Activity of NLRP3 Attenuates HDM-Induced Allergic Asthma

The Care of Asthma Patients in Communities with Limited Resources

The Myth of Mild: Severe Exacerbations in Mild Asthma: An Underappreciated, but Preventable Problem

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