Management of asthma in adults

Balter, Meyer; Bell, Alan; Kaplan, Alan; Kim, Harold; McIvor, R. Andrew

doi:10.1503/cmaj.080007

Cited by 14 publications

(6 citation statements)

References 61 publications

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“…This compound has demonstrated efficacy in this patient population in a number of clinical studies [ 4 - 14 ], and its use for severe allergic asthma has been endorsed by several Canadian and International consensus bodies [ 2 , 3 , 15 - 18 ]. According to the 2010 Canadian Thoracic Society's Asthma Management Continuum, omalizumab can be used for "patients with difficult-to-control asthma confirmed with objective measures, who have documented allergies to a perennial aeroallergen, a serum IgE level of 30 IU/mL to 700 IU/mL and whose asthma symptoms remain uncontrolled despite adherence to high-dose inhaled corticosteroids plus at least one additional controller therapy [ 16 ]."…”

Section: Introductionmentioning

confidence: 99%

Omalizumab: Practical considerations regarding the risk of anaphylaxis

Kim

Leigh

Becker

2010

All Asth Clin Immun

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Omalizumab has demonstrated efficacy among patients with moderate to severe persistent allergic asthma, whose symptoms are inadequately controlled with other controller agents. This therapy is generally well tolerated, but there are some safety considerations, the most important of which is the rare, but potentially life-threatening, occurrence of omalizumab-associated anaphylaxis.In Canada, data from the manufacturer of omalizumab indicate that the frequency of anaphylaxis attributed to Xolair in post-marketing use is approximately 0.2%. Other researchers, including the American Omalizumab Joint Task Force (OJTF), have suggested a lower overall frequency of 0.09%.This paper provides a summary of the epidemiologic research carried out to date and presents a concise, practical set of recommendations for the prevention, monitoring and management of omalizumab-associated anaphylaxis. Prevention tips include advice on patient education measures, concomitant medications and optimal administration. For the first three injections, the recommendation is to monitor in clinic for two hours after the omalizumab injection; for subsequent injections, the monitoring period should be 30 minutes or an appropriate time agreed upon by the individual patient and healthcare professional.In the event that a patient does experience omalizumab-associated anaphylaxis, the paper provides recommendations for handling the situation in-clinic and recommendations on how to counsel patients to recognize the potential signs and symptoms in the community and react appropriately.

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Section: Introductionmentioning

confidence: 99%

Omalizumab: Practical considerations regarding the risk of anaphylaxis

Kim

Leigh

Becker

2010

All Asth Clin Immun

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“…Leukotrienes act as lipid mediators and are produced by cells of inflammation, such as mast cells and basophils, during the early phase of inflammatory response. Eosinophils and macrophages are responsible for the production of leukotrienes in the late phase of inflammation [7]. C4, D4, and E4 are cysteinyl leukotrienes that play a role in the development of allergic reactions in the upper and lower airways.…”

Section: Discussionmentioning

confidence: 99%

Effect of Montelukast on the Symptom Severity Score of Allergic Rhinitis

Rajput¹,

Arain²,

Rajput³

et al. 2020

Cureus

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Introduction Rhinitis is a common respiratory disorder that can be broadly defined as an inflammation of nasal mucosa. Allergic rhinitis is the most common form of chronic rhinitis characterized by one or more symptoms including sneezing, nasal itching, nasal congestion, postnasal drip, and rhinorrhea. Montelukast is an antagonist to the leukotriene receptor. It is non-sedating, dosed once daily, and has a safety profile similar in adults and children, with approval down to six months of age. The purpose of the study was to see the improvement in the severity of symptoms of the patients with allergic rhinitis treated with montelukast. Methods The symptom severity score for allergic rhinitis was calculated by asking the patient to evaluate the severity of individual symptoms (sneezing, nasal congestion, rhinorrhea, and postnasal drip) against the 4-point scoring scale over the last 24 hours. After explaining the scoring system to the patient, a proforma was filled before starting the treatment. A dose of 10 mg of montelukast once daily was prescribed. On the follow-up visit after four weeks of therapy, compliance was ensured and then the symptom severity score was recorded again on the proforma. The total nasal symptom severity score (TNSSS) was calculated as a sum of all four nasal symptoms. Pre-and post-treatment mean of TNSSS was compared using a t-test. P-value of less than 0.05 was considered significant. Results A total of 140 patients were included in the study. The mean age was 30 years. The minimum age was 15 years and the maximum age was 45 years. There were 93 males and 47 females. The difference between pre-and post-mean values of TNSSS was 5.82. Both pre-and post-mean of TNSSS were compared using the t-test, and P-value was significant, i.e., <0.005. Conclusions The common symptoms of allergic rhinitis evaluated in the study showed improvement in response to the treatment with montelukast. The improvement in symptom severity score was maximum in sneezing and least in rhinorrhea. In light of recent developments on neuropsychiatric adverse effects and FDA warnings, caution needs to be exercised to reserve the

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“…182 For some patients, the provision of an action plan based on use of a peak flow meter and asthma education can significantly reduce the risk of relapse, 183 but for most patients, action plans based on selfmonitoring of symptoms seem to be just as efficacious as plans based on peak flow. 184 Many examples of asthma action plans are available (see, for example, www.asthmaguidelines.com or www.lung.ca, or the sample action plan presented as an appendix to an earlier article in this series 185 ). Reassessment and re-evaluation are crucial elements in achieving and maintaining control of asthma.…”

Section: Action Plansmentioning

confidence: 99%