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Printable Handouts
Navigable Slide Index
- Introduction
- Aims of the presentation
- Asthma: the basics
- A study in futility
- Daily FeNO monitoring
- Monitoring asthma using FeNO
- What is problematic severe asthma
- New terminology and definitions
- Definitions (1)
- Exacerbations vs. baseline control
- Wrong diagnosis and co-morbidity
- Difficult vs. Severe, therapy-resistant asthma
- The professor or the nurse
- Utility of nurse led home visits
- The big five: adherence
- Responsibility of parents
- The big four: allergens
- Dust-mite control measures of no use
- Cochrane review: problems
- Effect of pillow and mattress encasing
- Subclinical allergen exposure
- The big four: cigarettes
- The big four: psychology
- Nurse led home visits: outcomes
- Effect of allergen avoidance
- Baseline results: DA vs. STRA
- DA reduce ICS dose over time
- DA still have fewer exacerbation currently
- Improved spirometry in DA and STRA
- Severe asthma in children - invasive investigation
- ENFUMOSA
- STRA: demographics
- The investigation protocol
- Discordant phenotypes
- Histology is very variable
- Results- Eosinophilia
- Paediatric STRA eosinophilic, not neutrophilic
- Absence of TH2 cytokines
- SARP: molecular profiling
- Eosinophilia is not the same as TH2 cytokines
- Airway remodelling
- STRA in children: very different from adult asthma
- Persistent airflow limitation
- Corticosteroid response
- Proposed criteria for corticosteroid response
- Other criteria: clinical and inflammatory response
- Stability of inflammatory phenotypes
- Inflammatory phenotypes: severe asthma
- Common non-eosinophilic phenotypes
- Where from here: treatment
- Omalizumab and allergen exposure
- To get rid of asthma exacerbations
- Viruses and asthma
- Thunderstorm asthma
- Exacerbating phenotype
- TENOR study: what predicted exacerbations?
- Other demographic and clinical features
- Predictors of exacerbation: allergy
- Lessons from TENOR
- The exacerbating child: what actions to take?
- Control eosinophilia, reduce risk of exacerbations
- Monitoring children with severe asthma
- Severe asthma in children - the way forward
- Get basics right before going beyond guidelines
- The future
- We have a long way to go
Topics Covered
- Severe asthma
- Getting the basics right
- Rarity of genuine severe therapy resistant asthma
- Differences between childhood and adult asthma
- Protocol driven investigations to determine nature of any inflammation
- Phenotype discordance
- Steroid responsiveness
- Presence of fixed airflow obstruction
- Exacerbating phenotype particularly difficult to treat
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Bush, A. (2015, September 30). Asthma phenotypes in children [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved October 16, 2024, from https://doi.org/10.69645/DUIX6383.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Andrew Bush has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
A selection of talks on Immunology
Transcript
Please wait while the transcript is being prepared...
0:00
ANDREW BUSH: Thank you for
listening to this online lecture.
My name's Andrew Bush.
I'm professor of Pediatrics
at Imperial College.
0:09
The aim of my presentation is to
discuss the approach to the child
with 'nightmare asthma',
to demonstrate a protocol
for the assessment of
problematic, 'severe asthma',
and review the potential
phenotype-driven treatment options
that we have available to us.
0:27
The basics of asthma are
very straightforward.
Most children with asthma
are very easily treated.
Most respond to modest doses
of inhaled corticosteroids,
and neither need, nor get no
benefit from higher doses,
and high dose inhaled
corticosteroids may be harmful.
So the question faced with a
child with nightmare asthma is,
what makes this child's asthma
different from the run of the mill
asthma and makes it
difficult to treat?
0:56
We can get a clue from this
study from North America,
which was a study in futility.
The aim of this study was to
assess whether azithromycin
or a leukotriene receptor antagonist
was a better add-on therapy
for children who were
still symptomatic,
despite inhaled corticosteroids and
inhaled long-acting bronchodilator.
292 children were assessed
for eligibility, but only 55
could be randomized.
The others were excluded
due to nonadherence
or they did not have asthma,
and this underscores the fact
that many children with so-called
"difficult asthma," in fact,
do not have any such thing.
1:39
This study, looking at daily
monitoring of exhaled nitric oxide
was an excellently conducted
piece of work in over 150 children.
It was a 30-week study, there
were on a reasonable dose
of inhaled corticosteroids,
and they were randomized
to either a telemonitoring
of exhaled nitric oxide
and a detailed management
program of inhaled corticosteroids,
with regular and detailed
titration of the dose,
or the standard symptom-based
steroid management protocol.
They were telephoned
every three weeks,
the end-point was symptom
free days, and the results
showed that the time to
exacerbation and symptom
free days were exactly the
same in the two groups.
In other words,
standard care was just
as good as sophisticated
monitoring of airway inflammation.