267 results found
Louis R, Satia I, Ojanguren I, et al., 2022, European Respiratory Society Guidelines for the Diagnosis of Asthma in Adults., Eur Respir J
Although asthma is very common affecting 5-10% of the population, the diagnosis of asthma in adults remains a challenge in the real world that results in both over- and under-diagnosis. A task force (TF) was set up by the European Respiratory Society to systematically review the literature on the diagnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendation for clinical practice.The TF defined eight PICO (Population, Index, Comparator, and Outcome) questions that were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, The TF utilised the outcomes to develop an evidenced-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences.The TF support the initial use of spirometry followed, and if airway obstruction is present, by bronchodilator reversibility testing. If initial spirometry fails to show obstruction, further tests should be performed in the following order: FeNO, PEF variability or in secondary care, bronchial challenge. We present the thresholds for each test that are compatible with a diagnosis of asthma in the presence of current symptoms.The TF reinforce the priority to undertake spirometry and recognise the value of measuring blood eosinophils and serum IgE to phenotype the patient. Measuring gas trapping by body plethysmography in patients with preserved FEV1/FVC ratio deserves further attention. The TF draw attention on the difficulty of making a correct diagnosis in patients already receiving inhaled corticosteroids, the comorbidities that may obscure the diagnosis, the importance of phenotyping, and the necessity to consider the patient experience in the diagnostic process.
Usmani OS, Baldi S, Warren S, et al., 2022, Lung Deposition of Inhaled Extrafine Beclomethasone Dipropionate/Formoterol Fumarate/Glycopyrronium Bromide in Healthy Volunteers and Asthma: The STORM Study, JOURNAL OF AEROSOL MEDICINE AND PULMONARY DRUG DELIVERY, ISSN: 1941-2711
James M, Madeira Teixeira Baptista A, Barnabas D, et al., 2022, Collaborative case-based learning with programmatic team-based assessment: a novel methodology for developing advanced skills in early-years medical students, BMC Medical Education, ISSN: 1472-6920
Ohar JA, Ferguson GT, Mahler DA, et al., 2022, Measuring Peak Inspiratory Flow in Patients with Chronic Obstructive Pulmonary Disease, INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, Vol: 17, Pages: 79-92, ISSN: 1178-2005
Kouri A, Dandurand RJ, Usmani OS, et al., 2021, Exploring the 175-year history of spirometry and the vital lessons it can teach us today, EUROPEAN RESPIRATORY REVIEW, Vol: 30, ISSN: 0905-9180
Rohatgi A, Meah S, Usmani OS, 2021, COPD PATIENTS' KNOWLEDGE, TRAINING AND ADHERENCE WITH INHALATION THERAPIES DURING COVID-19, Publisher: BMJ PUBLISHING GROUP, Pages: A120-A120, ISSN: 0040-6376
Ojanguren I, Satia I, Usmani OS, 2021, The Role of Viral Infections on Severe Asthma Exacerbations: Present and Future., Arch Bronconeumol
Usmani O, Roche N, Wahab E, et al., 2021, A scintigraphy study of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler in patients with moderate-to-very severe chronic obstructive pulmonary disease, Respiratory Research, Vol: 22, Pages: 1-12, ISSN: 1465-9921
BackgroundTriple therapy with inhaled corticosteroids/long-acting muscarinic antagonists/long-acting β2-agonists (ICS/LAMA/LABA) is recommended for patients with chronic obstructive pulmonary disease (COPD) with continued symptoms or exacerbations, despite treatment with LAMA/LABA or ICS/LABA. The pulmonary, extrathoracic, and regional lung deposition patterns of a radiolabeled ICS/LAMA/LABA triple fixed-dose combination budesonide/glycopyrrolate/formoterol fumarate (BGF 320/18/9.6 μg), delivered via a single Aerosphere metered dose inhaler (MDI) were previously assessed in healthy volunteers and showed good deposition to the central and peripheral airways (whole lung deposition: 37.7%). Here, we report the findings assessing BGF in patients with moderate-to-very severe COPD.MethodsThis phase I, single-dose, open-label gamma scintigraphy imaging study (NCT03906045) was conducted in patients with moderate-to-very severe COPD. Patients received two actuations of BGF MDI (160/9/4.8 μg per actuation) radiolabeled with technetium‑99‑pertechnetate, not exceeding 5 MBq per actuation. Immediately following each inhalation, patients performed a breath-hold of up to 10 s, then exhaled into an exhalation filter. Gamma scintigraphy imaging of the anterior and posterior views of the lungs and stomach, and a lateral head and neck view, were performed immediately after exhalation. The primary objective of the study was to assess the pulmonary deposition of BGF. Secondary objectives assessed the deposited dose of radiolabeled BGF in the oropharyngeal and stomach regions, on the actuator, and on the exhalation filter in addition to regional airway deposition patterns in the lungs.ResultsThe mean BGF emitted dose deposited in the lungs was 32.1% (standard deviation [SD] 15.6) in patients with moderate-to-very severe COPD, 35.2% (SD 12.8) in patients with moderate COPD, and 28.7% (SD 18.4) in patients with severe/very severe COPD. Overall, the mean normalized outer/inner ra
Biddiscombe MF, Usmani OS, 2021, Delivery and adherence with inhaled therapy in asthma, MINERVA MEDICA, Vol: 112, Pages: 564-572, ISSN: 0026-4806
Leving M, Wouters H, de la Hoz A, et al., 2021, Impact of PIF, Inhalation Technique and Medication Adherence on Health Status and Exacerbations in COPD: Protocol of a Real-World Observational Study (PIFotal COPD Study), PULMONARY THERAPY, Vol: 7, Pages: 591-606, ISSN: 2364-1754
Baldi S, Usmani O, Warren S, et al., 2021, Lung deposition and distribution of inhaled extra fine beclomethasone dipropionate / formoterol fumarate /glycopyrronium bromide (BDP/FF/GB) in subjects with and without airflow obstruction, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Kocks J, Wouters H, Bosnic-Anticevich S, et al., 2021, Late Breaking Abstract - Factors associated with health-status of COPD patients on Dry Powder Inhaler (DPI) maintenance therapy, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Garner JL, Biddiscombe MF, Meah S, et al., 2021, Endobronchial valve lung volume reduction and small airways function, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Usmani OS, Dhand R, Lavorini F, et al., 2021, Why We Should Target Small Airways Disease in Our Management of Chronic Obstructive Pulmonary Disease, MAYO CLINIC PROCEEDINGS, Vol: 96, Pages: 2448-2463, ISSN: 0025-6196
Biddiscombe M, Matthews J, Wright M, et al., 2021, NO EVIDENCE THAT ELECTROSTATIC CHARGE NEAR HIGH VOLTAGE POWER LINES INCREASES THE DEPOSITION OF INHALED ULTRAFINE ENVIRONMENTAL PARTICLES IN HUMAN LUNGS, Publisher: MARY ANN LIEBERT, INC, Pages: A3-A4, ISSN: 1941-2711
van Boven JFM, Dierick BJH, Usmani OS, 2021, When biology meets behaviour: can medication adherence mask the contribution of pharmacogenetic effects in asthma?, EUROPEAN RESPIRATORY JOURNAL, Vol: 58, ISSN: 0903-1936
Usmani OS, Hickey AJ, Guranlioglu D, et al., 2021, The impact of inhaler device regimen in patients with asthma or COPD, Journal of Allergy and Clinical Immunology: In Practice, Vol: 9, Pages: 3033-3040.e1, ISSN: 2213-2198
Many inhaler devices with varying handling requirements for optimal use are available for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Patients may be prescribed different device types for reliever and maintenance medications, which may lead to confusion and suboptimal device use. We aimed to understand whether simplifying inhaler regimens by employing a single device type in patients who use multiple devices or prescribing a device with which a patient was already experienced could improve clinical and economic outcomes in asthma and COPD management. A targeted literature search was performed and additional articles were identified through hand searching citations within screened publications. A total of 114 articles were included in the final review. Findings suggest that simplifying inhaler regimens by applying the same type of inhaler for concomitant inhaled medications over time minimizes device misuse, leading to improved clinical outcomes and reduced health care use in patients with asthma or COPD. Physicians should consider a patient's suitability for a device and training needs when prescribing an inhaled medication and before changing the medication type or dose, especially when suboptimal treatment outcomes are observed. Further research is required to determine whether consistent use of the same device type is associated with better treatment adherence and persistence in patients with asthma or COPD. Nevertheless, this literature review identified clinical benefits and reduced health care use with simplified inhaler regimens.
Lavorini F, Usmani OS, Dhand R, 2021, Aerosol delivery systems for treating obstructive airway diseases during the SARS-CoV-2 pandemic, INTERNAL AND EMERGENCY MEDICINE, Vol: 16, Pages: 2035-2039, ISSN: 1828-0447
Spencer S, Hamer O, Berger E, et al., 2021, Interventions to improve inhaler technique for adults with chronic obstructive pulmonary disease, Cochrane Database of Systematic Reviews, Vol: 2021, ISSN: 1465-1858
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To evaluate the impact of interventions to improve inhaler technique on performance and clinical outcomes in people with COPD.
Usmani OS, Han MK, Kaminsky DA, et al., 2021, Seven Pillars of Small Airways Disease in Asthma and COPD Supporting Opportunities for Novel Therapies, CHEST, Vol: 160, Pages: 114-134, ISSN: 0012-3692
Usmani OS, Mignot B, Kendall I, et al., 2021, Predicting lung deposition of extrafine inhaled corticosteroid-containing fixed combinations in patients with chronic obstructive pulmonary disease using functional respiratory imaging: AnIn SilicoStudy, Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol: 3, Pages: 204-211, ISSN: 0894-2684
Background: Functional respiratory imaging (FRI) is a computational fluid dynamics-based technique using three-dimensional models of human lungs and formulation profiles to simulate aerosol deposition.Methods: FRI was used to evaluate lung deposition of extrafine beclomethasone dipropionate (BDP)/formoterol fumarate (FF)/glycopyrronium bromide (GB) and extrafine BDP/FF delivered through pressurized metered dose inhalers and to compare results with reference gamma scintigraphy data. FRI combined high-resolution computed tomography scans of 20 patients with moderate-to-severe chronic obstructive pulmonary disease (mean forced expiratory volume in 1 second 42% predicted) with in silico computational flow simulations, and incorporated drug delivery parameters to calculate aerosol airway deposition. Inhalation was simulated using profiles obtained from real-life measurements.Results: Total lung deposition (proportion deposited in intrathoracic region) was similarly high for both products, with mean ± standard deviation (SD) values of 31.0% ± 5.7% and 28.1% ± 5.2% (relative to nominal dose) for BDP/FF/GB and BDP/FF, respectively. Pairwise comparison of the deposition of BDP and FF gave a mean intrathoracic BDP/FF/GB:BDP/FF deposition ratio of 1.10 (p = 0.0405). Mean intrathoracic, central and peripheral deposition ratios for BDP were 1.09 (95% confidence interval [CI]: 1.05–1.14), 0.92 (95% CI: 0.89–0.96), and 1.20 (95% CI: 1.15–1.26), respectively, and for FF were 1.11 (95% CI: 1.07–1.15), 0.94 (95% CI: 0.91–0.98), and 1.21 (95% CI: 1.15–1.27), within the bioequivalence range (0.80–1.25) for intrathoracic and central regions, and slightly exceeding the upper boundary in the peripheral region. Mean ± SD central:peripheral deposition (C:P) was 0.48 ± 0.13 for BDP/FF/GB and 0.62 ± 0.17 for BDP/F
Kocks JWH, Andringa HJH, van Heijst E, et al., 2021, Aeroallergen sensitization for detecting asthma in primary care: A diagnostic test accuracy study, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 1080-1084, ISSN: 0954-7894
Bousquet J, Jutel M, Akdis CA, et al., 2021, ARIA-EAACI statement on asthma and COVID-19 (June 2, 2020), Allergy, Vol: 76, Pages: 689-697, ISSN: 0105-4538
Garner J, Biddiscombe MF, Meah S, et al., 2021, Endobronchial valve lung volume reduction and small airways function., American Journal of Respiratory and Critical Care Medicine, Vol: 203, Pages: 1576-1579, ISSN: 1073-449X
Almeshari M, Alobaidi NY, Sapey E, et al., 2021, SMALL AIRWAYS RESPONSE TO BRONCHODILATOR IN ASTHMA AND COPD: A SYSTEMATIC REVIEW, Publisher: BMJ PUBLISHING GROUP, Pages: A129-A129, ISSN: 0040-6376
Haughney J, Lee AJ, McKnight E, et al., 2021, Peak inspiratory flow measured at different inhaler resistances in patients with asthma, Journal of Allergy and Clinical Immunology: In Practice, Vol: 9, Pages: 890-896, ISSN: 2213-2198
BACKGROUND: Patients' peak inspiratory flow rate (PIFR) may help clinicians select an inhaler device. OBJECTIVE: To determine the proportion of patients with asthma who could generate correct PIFRs at different inhaler resistance settings. METHODS: During a UK asthma review service, patients' PIFR was checked at resistance settings matching their current preventer inhaler device, at R5 (high resistance dry powder inhaler (DPI)) and at R0 (low resistance, pressurised metered dose inhaler (pMDI)). Correct PIFR ('pass') was defined for R5 as 30-90 L/min and for R0 as 20-60 L/min. A logistic regression model examined the independent predictors of incorrect PIFR ('fail') at R5 and R0. Asthma severity was assessed retrospectively from treatment level. RESULTS: A total of 994 adults (female 64.3%) were included, of whom 90.4% currently used a preventer inhaler (71.5% pMDI). PIFR pass rates were: 93.7% at R5 compared with 70.5% at R0 (p<0.0001). All patients failing the R0 PIFR breathed in too fast (>60 L/min), and 20% of patients currently using pMDI failed for this reason. Independent risk factors for failing R5 were: female gender, older age group and current preventer pMDI; and for failing R0 included: male gender, younger age group, current preventer DPI and mild versus severe asthma. CONCLUSIONS: This study demonstrates that most patients with asthma can achieve adequate inspiratory flow to activate high resistance DPIs, whereas approximately a third of patients breathe in too fast to achieve recommended inspiratory flows for correct pMDI use, including one fifth of patients who currently use a pMDI preventer.
Almeshari MA, Alobadidi NY, Sapey E, et al., 2021, Small Airways Response to Bronchodilators in Adults with Asthma or COPD: A Systematic Review, INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, Vol: 16, Pages: 3065-3082, ISSN: 1178-2005
Soni S, Garner J, O'Dea K, et al., 2021, Intra-alveolar neutrophil-derived microvesicles are associated with disease severity in COPD, American Journal of Physiology: Lung Cellular and Molecular Physiology, Vol: 320, Pages: L73-L83, ISSN: 1040-0605
Despite advances in the pathophysiology of Chronic Obstructive Pulmonary Disease (COPD), there is a distinct lack of biochemical markers to aid clinical management. Microvesicles (MVs) have been implicated in the pathophysiology of inflammatory diseases including COPD but their association to COPD disease severity remains unknown. We analysed different MV populations in plasma and bronchoalveolar lavage fluid (BALF) taken from sixty-two patients with mild to very severe COPD (51% male; mean age: 65.9 years). These patients underwent comprehensive clinical evaluation (symptom scores, lung function, exercise testing) and the capacity of MVs to be clinical markers of disease severity was assessed. We successfully identified various MV subtype populations within BALF (leukocyte, PMN (polymorphonuclear leukocyte i.e. neutrophil), monocyte, epithelial and platelet MVs) and plasma (leukocyte, PMN, monocyte and endothelial MVs), and compared each MV population to disease severity. BALF neutrophil MVs were the only population to significantly correlate with the clinical evaluation scores including FEV1, mMRC dyspnoea score, 6-minute walk test, hyperinflation and gas transfer. BALF neutrophil MVs, but not neutrophil cell numbers, also strongly correlated with BODE index. We have undertaken, for the first time, a comprehensive evaluation of MV profiles within BALF/plasma of COPD patients. We demonstrate that BALF levels of neutrophil-derived MVs are unique in correlating with a number of key functional and clinically-relevant disease severity indices. Our results show the potential of BALF neutrophil MVs for a COPD biomarker that tightly links a key pathophysiological mechanism of COPD (intra-alveolar neutrophil activation) with clinical severity/outcome.
Pleasants RA, Tilley SL, Hickey AJ, et al., 2021, User-life of ICS/LABA inhaler devices should be considered when prescribed as relievers, EUROPEAN RESPIRATORY JOURNAL, Vol: 57, ISSN: 0903-1936
Dreher M, Price D, Gardev A, et al., 2021, Patient perceptions of the re-usable Respimatt(R) Soft Mist (TM) inhaler in current users and those switching to the device: A real-world, non-interventional COPD study, Chronic Respiratory Disease, Vol: 18, Pages: 1-10, ISSN: 1479-9723
The Respimat® Soft Mist™ inhaler (SMI) has recently been improved, with a re-usable device replacing the disposable version. Certain countries are currently phasing out the disposable inhaler. This study aimed to assess patient satisfaction with and preference for the re-usable device. This 4–6-week, multicentre, open-label, prospective, real-world, non-interventional study was conducted across six European countries. Patients with chronic obstructive pulmonary disease were enrolled between October and December 2019, in three cohorts: (1) currently using the re-usable Respimat SMI; (2) switched from disposable Respimat SMI at study entry; and (3) naïve to any Respimat SMI. Patients were assessed using the Patient Satisfaction and Preference Questionnaire (PASAPQ) and Ease of Handling Questionnaire. In total, 262 patients were enrolled. At follow-up, the mean PASAPQ score was 83.3/100 overall, with similar results across all three patient cohorts. Most patients were ‘satisfied’ or ‘very satisfied’ with the re-usable device. The overall score for willingness to continue using the device was 87.8/100. In total, 13 adverse events were recorded, none of which was classified as serious. This study provides real-world evidence for practitioners to start patients on Respimat re-usable, irrespective of a patient’s prior experience with this inhaler.
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