DRRANJITSINGH 58f4a983e229e60a187a8889 False 110 1
background image not found

Patients with persistent exacerbations despite treatment with triple therapy (LABA plus LAMA plus ICS) and with a history of smoking may be candidates for additional treatment with a macrolide.The macrolide azithromycin has been shown to be effective in these patients in decreasing the frequency of exacerbations and improving quality of life, although hearing impairment was observed in a small percentage of patients treated with azithromycin. Because the treatment effect of azithromycin was not seen in current smokers, its use is restricted to ex-smokers.

Patients with high eosinophilic levels have a good response to biologics. Nasal polyps are associated with allergic asthma. In these patients, anti-immunoglobulin (Ig) E and anti-interleukin (IL)-5 have proven efficacy. In the Global Initiative for Asthma (GINA) guidelines, the severity of symptoms is one of the major criteria in choosing a treatment. ICS are prescribed at the initial steps of asthma management, but analysis of comorbidities helps to adapt the treatment

Current treatment recommendations for adults and children beyond corticosteroids and their combinations, including clinical data on the use of anti-immunoglobulin E (IgE) therapy for severe allergic asthma

Practical Recommendations for COPD: Evidence-Based Care The treatment of patients with chronic obstructive pulmonary disease (COPD) depends on symptoms and history of exacerbation. These elements define the treatment strategies within the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines' ABCD assessment tool • Although not taken into account in the ABCD tool, spirometry remains important for the diagnosis and assessment of airflow limitation. Bronchodilators are first-line treatment, either as a single or dual bronchodilator treatment. • The recently available combination of a long-acting beta agonist (LABA) and a long-acting muscarinic receptor antagonist (LAMA) into a single inhaler has demonstrated improvement in lung function, either in combination or with monotherapy. In the SPARK study evaluating indacaterol/glycopyrrolate vs glycopyrronium and tiotropium (LABA/LAMA vs LAMA alone) for the prevention of exacerbation in patients with COPD, the combination therapy was superior to a single bronchodilator as measured by the reduction of exacerbations. • LABA/LAMA was also shown to be superior in the ILLUMINATE study, which compared the patient-reported outcomes and the transition dyspnea index (TDI) for patients on LABA/LAMA with patients on LABA/ICS (inhaled corticosteroid). Data from multiple studies show that ICS-containing regimens can also effectively reduce exacerbation rates. Data from post-hoc analyses of clinical trials suggest that patients with high levels of blood eosinophils may respond better to ICS therapy, whereas patients with very low levels of eosinophils may not respond. ICS therapy is associated with serious side effects, such as pneumonia. In the WISDOM trial, patients who discontinued ICS experienced approximately 40 mL in forced expiratory volume over 1 second (FEV1), indicating that ICS should be withdrawn very carefully in some patients. As exacerbations are more frequent and often more severe in winter months, it is recommended to not withdraw steroids during that period Current evidence suggests that the combination of LABA/LAMA with ICS into a single inhaler will improve lung function, exacerbations, and symptoms Other treatment options besides triple therapy exist for patients who still experience exacerbations after LABA/LAMA treatment. • Roflumilast may be considered in patients with chronic bronchitis. • The use of long-term macrolides is possible in a particular profile subset of patients who have frequent exacerbations with bronchiectasis, bronchial colonization, and frequent bacterial infections.

AR Advance Respiratory Hub Jamshedpur


Abnormalities predisposing to obstructive sleep-disordered breathing (SDB) in childhood 1. Adenotonsillar hypertrophy, allergic rhinitis 2. Obesity 3. Craniofacial abnormalities in non-syndromic children: retrusive chin, steep mandibular plane, class II malocclusion 4. Maxillary hypoplasia in craniosynostosis syndromes 5. Mandibular hypoplasia without or with cleft palate 6. Neuromuscular disorders 7. Complex conditions: achondroplasia, Chiari malformation, Down syndrome, mucopolysaccharidoses, Prader–Willi syndrome

Paediatric severe asthma Children with severe pre-school wheeze or severe asthma are usually atopic and have an impaired quality of life.

Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trial

Associations of sleep duration and disturbances with hypertension in metropolitan cities of Delhi, Chennai and Karachi in South Asia: cross-sectional analysis of the CARRS study. Self-reported snoring and insomnia were associated with hypertension in South Asia.