New approach to intermittent and mild asthma therapy: evolution or revolution in the GINA guidelines?

Kupryś‐Lipińska, Izabela; Kołacińska-Flont, Marta; Kuna, Piotr

doi:10.1186/s13601-020-00316-z

Cited by 16 publications

(20 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…35 In terms of asthma, present evidence is less conflicted, with large studies showing mortality reductions in both mild-to-moderate and severe asthma. [36][37][38] In the present study, the increased risk of mortality with high-dose ICS use was independent of concurrent asthma and/or COPD. Data on mortality and ICS use in BE is sparse and the 2018 Cochrane review by Kapur et al does not report mortality as an outcome.…”

Section: Inhaled Corticosteroids and Mortalitysupporting

confidence: 50%

Inhaled Corticosteroid Therapy in Bronchiectasis is Associated with All-Cause Mortality: A Prospective Cohort Study

Håkansson¹,

Fjællegaard²,

Browatzki³

et al. 2021

COPD

View full text Add to dashboard Cite

Background and Objective: Prescribing inhaled corticosteroids (ICS) for bronchiectasis (BE) in the absence of obstructive lung disease is controversial. Studies investigating ICS therapy and impact on morbidity and mortality in BE are sparse. Methods: This study comprises all patients with BE managed at respiratory outpatient clinics at two university hospitals in the Capital Region of Denmark 2014-2015. Baseline data were obtained from patient medical records, and patients were followed until April 2020. Results: Out of 264 patients, 122 (46%) were prescribed ICS with no demographic differences between users/non-users of ICS. Among patients prescribed ICS, 21% did not have a concomitant diagnosis of asthma or COPD. Patients prescribed ICS had lower lung function (median FEV 1 65.2 vs 80.9%pred, p<0.001) and a higher symptom burden in terms of cough (p 0.028), sputum production (p <0.001) and dyspnea (p <0.001). Pseudomonaspositive sputum cultures were more common in ICS-treated patients (6.5 vs 20%, p 0.010), as were previous severe exacerbations (41% vs 21%, p <0.001). In terms of mortality, highdose ICS use was associated with increased mortality in multivariable Cox regression adjusted for age, sex, FEV 1 and concomitant asthma/COPD .0], p 0.003). Conclusion:In this cohort, close to one out of five patients with BE were prescribed ICS despite having no concomitant diagnosis of asthma or COPD. Overall, ICS treatment was associated with higher morbidity and mortality, though causation is difficult to establish.

show abstract

Section: Inhaled Corticosteroids and Mortalitysupporting

confidence: 50%

Inhaled Corticosteroid Therapy in Bronchiectasis is Associated with All-Cause Mortality: A Prospective Cohort Study

Håkansson¹,

Fjællegaard²,

Browatzki³

et al. 2021

COPD

View full text Add to dashboard Cite

show abstract

“…Another key reason for the introduction of as-needed ICS-FOR recommendations was an acceptance that patients with asthma frequently have poor adherence to ICS-based maintenance therapy and, subsequently, an over-reliance on SABA for symptom relief [9,69].…”

Section: Review Of Literature Comparing Ics-for Versus Saba As Reliev...mentioning

confidence: 99%

The Changing Asthma Management Landscape and Need for Appropriate SABA Prescription

Domingo

Singh

2023

Adv Ther

View full text Add to dashboard Cite

Short-acting b 2 agonists (SABAs) have been a mainstay of asthma treatment since the 1950s, and have been mainly recommended as-needed for symptom relief alongside daily inhaled corticosteroid (ICS)-based maintenance treatment for the past 30 years. However, patient adherence to regular ICS-based anti-inflammatory maintenance therapy is frequently poor, leading to SABA overuse for symptom relief and associated poor outcomes. At present, there is a lack of consensus between treatment guidelines on how SABA should be used, and as-needed ICS-formoterol is suggested by some as an alternative reliever therapy. Here, we examine the pharmacology and current use of inhaled SABAs, identify that regular dosing of ICS can encourage appropriate SABA use, and appraise the evidence used to support the changing reliever treatment recommendations. We conclude that SABA continues to play an important role in the asthma management landscape, and give our views on how it should be used in patients with mild-moderate asthma, to complement regular ICS-based maintenance treatment.

show abstract

“…It is important to note that any association between corticosteroid use in asthma and HZ risk may be complicated by correlations between corticosteroid use and more severe asthma. In contrast to current recommendations [ 34 ], ICS was previously not recommended as a first-line therapy for mild asthma and was reserved for more severe asthma [ 39 ]. Therefore, corticosteroid use in the studies described above likely correlated with more severe asthma.…”

Section: Risk Factors For Hz In Patients With Asthmamentioning

confidence: 99%

Risk factors for herpes zoster: should people with asthma or COPD be vaccinated?

et al. 2023

View full text Add to dashboard Cite

Without vaccination, an estimated 1 in 3 individuals will develop herpes zoster (HZ) in their lifetime. Increased risk of HZ is attributed to impaired cell-mediated immunity, as observed in age-related immunosenescence or in individuals immunocompromised due to disease or immunosuppressive treatments. Most vaccination guidelines recommend HZ vaccination in all adults ≥ 50 years of age, although Shingrix® was recently approved by the U.S. Food and Drug Administration for use in individuals aged ≥ 18 years who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy, followed by approval by the European Medicines Agency for use in immunocompromised individuals aged ≥ 18 years. Chronic respiratory diseases are also risk factors for HZ. A new meta-analysis reported 24% and 41% increased risks of HZ in those with asthma and chronic obstructive pulmonary disorder (COPD), respectively, compared with healthy controls. Asthma and COPD increase a person’s risk of HZ and associated complications at any age and may be further elevated in those receiving inhaled corticosteroids. Despite the increased risks, there is evidence that HZ vaccination uptake in those aged ≥ 50 years with COPD may be lower compared with the age-matched general population, potentially indicating a lack of awareness of HZ risk factors among clinicians and patients. The 2022 Global Initiative for Chronic Lung Disease report recognizes that Centers for Disease Control and Prevention recommended to vaccinate those aged ≥ 50 years against HZ, although health systems should consider the inclusion of all adults with asthma or COPD into their HZ vaccination programs. Further research into HZ vaccine efficacy/effectiveness and safety in younger populations is needed to inform vaccination guidelines. Graphical Abstract

show abstract

New approach to intermittent and mild asthma therapy: evolution or revolution in the GINA guidelines?

Cited by 16 publications

References 52 publications

Inhaled Corticosteroid Therapy in Bronchiectasis is Associated with All-Cause Mortality: A Prospective Cohort Study

Inhaled Corticosteroid Therapy in Bronchiectasis is Associated with All-Cause Mortality: A Prospective Cohort Study

The Changing Asthma Management Landscape and Need for Appropriate SABA Prescription

Risk factors for herpes zoster: should people with asthma or COPD be vaccinated?

Contact Info

Product

Resources

About