Publications
314 results found
King GG, Chung LP, Usmani OS, et al., 2024, Improving asthma outcomes: Clinicians' perspectives on peripheral airways., J Allergy Clin Immunol Glob, Vol: 3
Disease of the peripheral (or small) airways is fundamental in asthma, being closely related to symptoms (or lack of control of them), airway hyperresponsiveness, spirometric abnormalities, risk of loss of control, or exacerbations and inflammation. Current technology now allows routine measurement of peripheral airway function. Having a working concept of peripheral airways disease in asthma is arguably very useful to clinicians and beneficial to patients because it allows a more comprehensive assessment of asthma severity (rather than just symptoms alone, which is the norm), tracking of progress or deterioration, and assessing response to treatment. Oscillometry is a sensitive way to monitor the peripheral airways, whereas multiple breath nitrogen washout parameters are excellent measures of future risk. In the longer term, physiologic measurements will be crucial in research to define causes and find new disease-modifying treatments.
Capstick TGD, Gudimetla S, Harris DS, et al., 2024, Demystifying Dry Powder Inhaler Resistance with Relevance to Optimal Patient Care., Clin Drug Investig, Vol: 44, Pages: 109-114
The selection of an inhaler device is a key component of respiratory disease management. However, there is a lack of clarity surrounding inhaler resistance and how it impacts inhaler selection. The most common inhaler types are dry powder inhalers (DPIs) that have internal resistance and pressurised metered dose inhalers (pMDIs) that use propellants to deliver the drug dose to the airways. Inhaler resistance varies across the DPIs available on the market, depending largely on the design geometry of the device but also partially on formulation parameters. Factors influencing inhaler choice include measures such as flow rate or pressure drop as well as inhaler technique and patient preference, both of which can lead to improved adherence and outcomes. For optimal disease outcomes, device selection should be individualised, inhaler technique optimised and patient preference considered. By addressing the common clinically relevant questions, this paper aims to demystify how DPI resistance should guide the selection of the right device for the right patient.
Papi A, Qasuri M, Chung E, et al., 2023, Fixed-dose combination fluticasone/formoterol for asthma treatment in a real-world setting: meta-analysis of exacerbation rates and asthma control, EUROPEAN CLINICAL RESPIRATORY JOURNAL, Vol: 10, ISSN: 2001-8525
Lavorini F, Usmani OS, Salvi S, et al., 2023, A narrative review on the Synchrobreathe™: A novel breath-actuated pressurised metered-dose inhaler for the treatment of obstructive airway diseases, Respiratory Medicine, Vol: 219, ISSN: 0954-6111
Pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs), are widely used to deliver drugs for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Incorrect use of inhalers is one of the main obstacles to achieving better clinical control. Indeed, with pMDIs, patients fail to synchronise actuation with inhalation due to a lack of coordination and with DPIs insufficient inspiratory effort compromises drug deposition in lungs. More than 50% of patients desire to switch their pMDIs and DPIs for a better device. This led to the development of pressurised breath-actuated inhalers (BAIs) with the aim of combining the beneficial features of pMDIs and DPIs and mitigating their problems. BAIs, e.g., Synchrobreathe™, are designed such that they are activated by a low inhalation effort and mechanically actuate the dose in synchrony to inspiration, thereby resolving the need to coordinate actuation with inspiration. BAIs have advantages, including ease of use, high lung deposition of medication, and greater patient preference. We discussed the design features, operating procedure, and clinical evidence of the Synchrobreathe™ device (Cipla Ltd, India), a BAI available with a wide range of drug combinations. Studies have shown that a higher number of patients (68.19%) used the Synchrobreathe™ without any error than the pMDI (56.21%), and that the vast majority of them (92%) found it easy to understand and use. The Synchrobreathe™ is an innovative, easy-to-use inhaler that may overcome many limitations associated with pMDIs and DPIs, thus potentially improving management of obstructive airway diseases and patients’ quality of life.
Sousa-Pinto B, Louis R, Anto JM, et al., 2023, Adherence to inhaled corticosteroids and long-acting β2-agonists in asthma: A MASK-air study., Pulmonology
INTRODUCTION: Adherence to controller medication is a major problem in asthma management, being difficult to assess and tackle. mHealth apps can be used to assess adherence. We aimed to assess the adherence to inhaled corticosteroids+long-acting β2-agonists (ICS+LABA) in users of the MASK-air® app, comparing the adherence to ICS+formoterol (ICS+F) with that to ICS+other LABA. MATERIALS AND METHODS: We analysed complete weeks of MASK-air® data (2015-2022; 27 countries) from patients with self-reported asthma and ICS+LABA use. We compared patients reporting ICS+F versus ICS+other LABA on adherence levels, symptoms and symptom-medication scores. We built regression models to assess whether adherence to ICS+LABA was associated with asthma control or short-acting beta-agonist (SABA) use. Sensitivity analyses were performed considering the weeks with no more than one missing day. RESULTS: In 2598 ICS+LABA users, 621 (23.9%) reported 4824 complete weeks and 866 (33.3%) reported weeks with at most one missing day. Higher adherence (use of medication ≥80% of weekly days) was observed for ICS+other LABA (75.1%) when compared to ICS+F (59.3%), despite both groups displaying similar asthma control and work productivity. The ICS+other LABA group was associated with more days of SABA use than the ICS+F group (median=71.4% versus 57.1% days). Each additional weekly day of ICS+F use was associated with a 4.1% less risk in weekly SABA use (95%CI=-6.5;-1.6%;p=0.001). For ICS+other LABA, the percentage was 8.2 (95%CI=-11.6;-5.0%;p<0.001). CONCLUSIONS: In asthma patients adherent to the MASK-air app, adherence to ICS+LABA was high. ICS+F users reported lower adherence but also a lower SABA use and a similar level of control.
Usmani OSS, Levy MLL, 2023, Effective respiratory management of asthma and COPD and the environmental impacts of inhalers, NPJ PRIMARY CARE RESPIRATORY MEDICINE, Vol: 33
Bousquet J, Shamji MH, Anto JM, et al., 2023, Patient-centered digital biomarkers for allergic respiratory diseases and asthma: The ARIA-EAACI approach - ARIA-EAACI Task Force Report, ALLERGY, Vol: 78, Pages: 1758-1776, ISSN: 0105-4538
Wang R, Usmani OS, Chung KF, et al., 2023, Domiciliary Fractional Exhaled Nitric Oxide and Spirometry in Monitoring Asthma Control and Exacerbations, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, Vol: 11, Pages: 1787-+, ISSN: 2213-2198
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- Citations: 2
Beech A, Portacci A, Herrero-Cortina B, et al., 2023, ERS International Congress 2022: highlights from the Airway Diseases Assembly, ERJ OPEN RESEARCH, Vol: 9
Bell JP, Rignall A, Khezrian M, et al., 2023, Potential Impact of the European Union F-gas Regulation on Patients With Asthma and Chronic Lower Respiratory Diseases, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Bell JP, Ringall A, Khezrian M, et al., 2023, An Assessment of Pressurized Metered-dose Inhaler Use in Countries in Europe and the Rest of the World, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Marshall J, Li G, De Backer J, et al., 2023, Small Airways Deposition of Two Fixed-dose Triple Therapy Combinations Assessed With Functional Respiratory Imaging (FRI), International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Toumpanakis D, Usmani OS, 2023, Small airways disease in patients with alpha-1 antitrypsin deficiency, RESPIRATORY MEDICINE, Vol: 211, ISSN: 0954-6111
Sousa-Pinto B, Jacome C, Pereira AM, et al., 2023, Development and validation of an electronic daily control score for asthma (e-DASTHMA): a real-world direct patient data study, LANCET DIGITAL HEALTH, Vol: 5, Pages: E227-E238
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- Citations: 2
Usmani OS, Lavorini F, 2023, Principles of Inhaled Therapy, Inhaled Delivery Systems for the Treatment of Asthma and COPD, Pages: 1-11, ISBN: 9781032215747
Delivering drugs using the inhalation route to the lungs is the foundation of the everyday clinical management of patients with airway diseases. The inhaled route, as opposed to systemic drug administration, allows key therapeutic benefits. Targeting the drugs to the site of action in the lungs achieves a quicker onset of action, a reduction in the dose of drug used, and an improved therapeutic ratio (efficacy to adverse event ratio). The global pandemic has seen a seismic need for us to understand aerosol science, for example, infectious aerosols and therapeutic aerosols. In this chapter we discuss the physiochemical factors that control the transport, delivery, and deposition of inhaled drug within the lungs.
Kole TM, Vanden Berghe E, Kraft M, et al., 2023, Predictors and associations of the persistent airflow limitation phenotype in asthma: a post-hoc analysis of the ATLANTIS study., The Lancet Respiratory Medicine, Vol: 11, Pages: 55-64, ISSN: 2213-2600
BACKGROUND: Persistent airflow limitation (PAL) occurs in a subset of patients with asthma. Previous studies on PAL in asthma have included relatively small populations, mostly restricted to severe asthma, or have no included longitudinal data. The aim of this post-hoc analysis was to investigate the determinants, clinical implications, and outcome of PAL in patients with asthma who were included in the ATLANTIS study. METHODS: In this post-hoc analysis of the ATLANTIS study, we assessed the prevalence, clinical characteristics, and implications of PAL across the full range of asthma severity. The study population included patients aged 18-65 years who had been diagnosed with asthma at least 6 months before inclusion. We defined PAL as a post-bronchodilator FEV1/forced vital capacity (FVC) of less than the lower limit of normal at recruitment. Asthma severity was defined according to the Global Initiative for Asthma. We used Mann-Whitney U test, t test, or χ2 test to analyse differences in baseline characteristics between patients with and without PAL. Logistic regression was used for multivariable analysis of the associations between PAL and baseline data. Cox regression was used to analyse risk of exacerbation in relation to PAL, and a linear mixed-effects model was used to analyse change in FEV1 over time in patients with versus patients without PAL. Results were validated in the U-BIOPRED cohort. FINDINGS: Between June 30, 2014 and March 3, 2017, 773 patients were enrolled in the ATLANTIS study of whom 760 (98%) had post-bronchodilator FEV1/FVC data available. Of the included patients with available data, mean age was 44 years (SD 13), 441 (58%) of 760 were women, 578 (76%) were never-smokers, and 248 (33%) had PAL. PAL was not only present in patients with severe asthma, but also in 21 (16%) of 133 patients with GINA step 1 and 24 (29%) of 83 patients with GINA step 2. PAL was independently associated with older age at baseline (46 years in PAL group vs 43
Leving MT, Bosnic-Anticevich S, van Cooten J, et al., 2022, Clinical recommendations for dry powder inhaler use in the management of COPD in primary care, NPJ PRIMARY CARE RESPIRATORY MEDICINE, Vol: 32
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- Citations: 1
Chakma MS, Usmani OS, 2022, Inhalers and the environment: Pollution, plastics and policy, PNEUMON, ISSN: 1105-848X
Bousquet J, Sousa-Pinto B, Anto JM, et al., 2022, Identification by cluster analysis of patients with asthma and nasal symptoms using the MASK-air® mHealth app, PULMONOLOGY, Vol: 29, Pages: 292-305, ISSN: 2531-0437
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- Citations: 4
Dickens AP, Halpin DMG, Carter V, et al., 2022, POOR ADHERENCE IN EXACERBATING COPD PATIENTS: MAGNITUDE AND RELATED FACTORS AT BASELINE IN THE MAGNIFY PRAGMATIC TRIAL, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A72-A73, ISSN: 0040-6376
Yorgancioglu A, Andersen ZJ, Hansen K, et al., 2022, Asthma, Climate Change and Planetary Health, INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, Vol: 26, Pages: 86-87, ISSN: 1027-3719
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- Citations: 1
Dickens AP, Halpin DMG, Carter V, et al., 2022, FACILITATORS TO RECRUITING COPD PATIENTS TO AN ADHERENCE INTERVENTION TRIAL, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A182-A182, ISSN: 0040-6376
Hutchinson A, Russell R, Cummings H, et al., 2022, PATIENT RECOGNITION OF, AND RESPONSE TO, ACUTE EXACERBATIONS OF COPD IS RELATED TO PREVIOUS EXPERIENCES OF HELP-SEEKING, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A156-A156, ISSN: 0040-6376
Wang R, Usmani OS, Chung KF, et al., 2022, DOMICILIARY FRACTIONAL EXHALED NITRIC OXIDE AND SPIROMETRY IN PREDICTING ASTHMA CONTROL AND EXACERBATIONS, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A73-A74, ISSN: 0040-6376
Usmani OS, Bosnic-Anticevich S, Dekhuijzen R, et al., 2022, Real-World Impact of Nonclinical Inhaler Regimen Switches on Asthma or COPD: A Systematic Review, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, Vol: 10, Pages: 2624-2637, ISSN: 2213-2198
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- Citations: 4
Deprato A, Ferrara G, Bhutani M, et al., 2022, Reference equations for oscillometry and their differences among populations: a systematic scoping review, EUROPEAN RESPIRATORY REVIEW, Vol: 31, ISSN: 0905-9180
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- Citations: 1
Crooks M, Russell R, Cummings H, et al., 2022, COPD patients' experiences and understanding of exacerbations: a qualitative study, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Ritchie A, Donaldson G, Usmani O, et al., 2022, The BLF Early COPD Consortium: Respiratory Oscillometry Detects Abnormalities before Lung Function Testing, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 1
Dickens A, Halpin D, Carter V, et al., 2022, Patient-reported barriers to accepting a technological adherence package in the MAGNIFY trial, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Leving M, Bosnic-Anticevich S, Van Cooten J, et al., 2022, Sufficient inspiratory effort for a Dry Powder Inhaler - do we have to measure it, or can we observe it? Post hoc analysis of the PIFotal study, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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