ASTHMA PHENOTYPES DIFFICULT TO TREAT: THE POSSIBILITY TO ACHIVE A CONTROL



Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Asthma is a widespread, phenotypically heterogeneous, chronic disease characterized by inflammation and airflow obstruction, bronchial hyperresponsiveness and recurrent symptoms of respiratory discomfort. On the one hand, the treatment of asthma is based on the determination of the severity and on the control of symptoms. On the other hand, it is based on the risk management of exacerbations. The control of asthma in most patients is achieved as a result of conventional treatment with inhaled corticosteroids or a combination of them with long-acting beta-2-agonists. However, a substantial proportion of patients with difficult asthma phenotypes (severe atopic asthma, asthma and obesity, smoker’s asthma, asthma in the elderly, asthma with fixed airflow obstruction) can be refractory to the conventional therapy. Additional therapy with the long-acting anticholinergic drug such as tiotropium can optimize the control in these patients. This article describes the complex phenotypes of asthma and the clinical cases of tiotropium efficacy in therapy of such patients.

Full Text

Restricted Access

About the authors

N M Nenasheva

Email: 1444031@gmail.com
Russian Medical Academy of Postgraduate Education Moscow

A S Belevskiy

Russian National Research Medical University named after N.I. Pirogov Moscow

R S Fassahov

Institute of fundamental medicine and biology of Kazan Federal University Russia

A V Emelyanov

North-Western State Medical University named after I.I. Mechnikov St. Petersburg, Russia

References

  1. Global Initiative for asthma - NHLBI/WHO Workshop Report. National Heart Lung Blood Institute, updated 2016// www.ginasthma.org.
  2. Chuchalin A.G., Khaltaev N., Аntonov N. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. International Journal of COPD. 2014, v. 9, p. 963-974.
  3. Национальная программа «Бронхиальная астма у детей. Стратегия лечения и профилактика» , IV издание. Издательский дом «Атмосфера». М., 2012, 182 с.
  4. Федеральные клинические рекомендации по диагностике и лечению бронхиальной астмы 2016 // wwwipulmonology.ru.
  5. Rackemann F.M. A clinical classification of asthma. Am. J. Med. Sci. 1921, v. 12, p. 802-803.
  6. Johansson S.G., Hourihane J.O., Bousquet J. et al. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy. 2001, v. 56, p. 813-824.
  7. Pearce N., Pekkanen J., Beasley R. How much asthma is really attributable to atopy? Thorax. 1999, v. 54, p. 268-272.
  8. Чучалин А.Г., Черняк Б.А., Буйнова С.Н., Тяренкова С.В. Распространенность и клинико-аллергологическая характеристика бронхиальной астмы в Восточной Сибири. Пульмонология. 1999, № 1, c. 42-49.
  9. Емельянов А.В., Федосеев Г.Б., Сергеева Г.Р. и соавт. Распространенность бронхиальной астмы и аллергического ринита среди взрослого населения Санкт-Петербурга. Аллергология. 2002, № 2, c. 10-15.
  10. Ненашева Н.М. Клинические фенотипы атопической бронхиальной астмы: диагностика и лечение. Palmarium Academic Publishing. 2012, 319 c.
  11. Boulet L.P., Turcotte H., Laprise C. et al. Comparative degree and type of sensitization to common indoor and outdoor allergens in subjects with allergic rhinitis and/or asthma. Clin. Exp. Allergy. 1997, v. 27, p. 52-59.
  12. Суровенко Т.Н., Железнова Л.В. Акарофауна жилья и ее роль в развитии аллергического воспаления дыхательных путей. Аллергология. 2003, № 1, c. 11-15.
  13. Zureik M., Neukirch C., Leynaert B. et al. Sensitization to airborne moulds and severity of asthma: cross sectional study from European Community respiratory health survey. BMJ. 2002, v. 325, p. 411-419.
  14. Sears M.R., Greene J.M., Willan A.R. et al. A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. N. Engl. J. Med. 2003, v. 349, p. 1414-1422.
  15. Ненашева Н.М., Буриев Б.Б. Особенности атопической бронхиальной астмы у взрослых. Рос. Аллергол. Журн. 2009, № 4, c. 12-17.
  16. Moore W., Meyers D., Wenzel S. et al. Identification of Asthma Phenotypes Using Cluster Analysis in the Severe Asthma Research Program. Am. J. Respir. Crit. Care Med. 2010, v. 181, p. 315-323.
  17. Peters S.P., Kunselman S.J., Icitovic N. et al. Tiotropium bromide step-up therapy for adults with uncontrolled asthma. N. Engl. J. Med. 2010, v. 363, p. 1715-1726.
  18. Kerstjens H.A., Disse B., Schröder-Babo W. et al. Tiotropium improves lung function in patients with severe uncontrolled asthma: A randomized controlled trial. J. Allergy Clin. Immunol. 2011, v. 128, p. 308-314.
  19. Kerstjens H.A., Engel M., Dahl R. et al. Tiotropium in asthma poorly controlled with standard combination therapy. N. Engl. J. Med. 2012, v. 367, p. 1198-1207.
  20. FitzGerald M., Moroni-Zentgraf P., Engel M. et al. Once-daily tiotropium Respimat® add-on therapy improves symptom control across severtiies of symptomatic asthma, independent of allergic status. Poster 64426 presented at the ATS Conference, 2015, Denver, USA.
  21. King J., Hanania A. Asthma in the elderly: current knowledge and future directions Current Opinion in Pulmonary Medicine. 2010, v. 16, p. 55-59.
  22. Zein J., Dweik R., Comhair S. et al. Asthma Is More Severe in Older Adults. PLOS ONE 2015| doi: 10.1371/journal. pone.0133490.
  23. Tsai C., Lee W., Hanania N., Camargo C. Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008. J. Allergy Clin. Immunol. 2012, v. 129, p. 1252-1258.
  24. Reed C.E. Asthma in the elderly: diagnosis and management. Current Opinion in Pulmonary Medicine. 2010, v. 16, p. 55-59.
  25. King M.J., Lockey R.F. Allergen prick-puncture skin testing in the elderly. Drugs Aging. 2003, v. 20, p. 1011-1017.
  26. Busse P.J., Lurslurchachai L., Sampson H.A. et al. Perennial allergen-specific immunoglobulin E levels among inner-city elderly asthmatics. J. Asthma. 2010, v. 47, p. 781-785.
  27. Santulli G., Laccarino G. Pinpointing beta adrenergic receptor in ageing pathophysiology: victim or executioner? Evidence from crime scenes. Immunity & Ageing. 2013, v. 10, p. 10-16.
  28. Connolly M.J., Crowley J.J., Charan N.B. et al. Impaired bronchodilator response to albuterol in healthy elderly men and women. Chest. 1995, v. 108, p. 401-406.
  29. Ullah M.I., Newman G.B., Saunders K.B. Influence of age on response to ipratropium and salbutamol in asthma. Thorax. 1981, v. 36, p. 523-529.
  30. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19,2 million participants. The Global BMI Mortality Collaboration. Lancet. 2016, 3886, p. 776-786.
  31. Patterson R.E., Frank L.L., Kristal A.R., White E. A comprehensive examination of health conditions associated with obesity in older adults. Am. J. Prev. Med. 2004, v. 27, p. 385-390.
  32. Camargo C.A., Weiss S.T., Zhang S. et al. Prospective study of Body Mass Index, weight change and risk of adult-onset of asthma in women. Arch. Internal. Med. 1999, v. 159, p. 2582-2588.
  33. Beuther D.A., Sutherland E.R. Overweight, obesity, and incident asthma. A meta-analysis of prospective epidemiologic studies. Am. J. Respir. Crit. Care Med. 2007, v. 175, p. 661-666.
  34. Aarniala B.S., Poussa T., Kvarnström J. et al. Immediate and long term effects of weight reduction in obese people with asthma: randomized controlled study BMJ. 2000, v. 320, p. 827-832.
  35. Hasegawa K., Tsugawa Y., Lopez B.L. et al. Body mass index and risk of hospitalization among adults presenting with asthma exacerbation to the emergency department. Ann. Am. Thorac. Soc. 2014, v. 11, p. 1439-1444.
  36. Hotamisligil G.S. Inflammation and Metabolic Disorders. Nature. 2006, v. 444, p. 860-867.
  37. Leiria L.O., Martins M.A., Saad M.J. Obesity and asthma: beyond T(H)2 inflammation. Metabolism. 2015, v. 64, p. 172-181.
  38. Peters G.M., Swern A., Bird S.S. et al. Influence of body mass index on the response to asthma controller agents. Eur. Respir. J. 2006, v. 27, p. 495-503.
  39. Boulet L.P., Franssen E. Influence of obesity on response to fluticasone with or without salmeterol in moderate asthma. Respir. Med. 2007, v. 101, p. 2240-2247.
  40. Sutherland R.E., Goleva E., Strand M. et al. Body mass and glucocorticoid response in asthma. Am. J. Respir. Crit. Care Med. 2008, v. 178, p. 682-687.
  41. Arteaga-Solis, Zee T., Emala C.W et al. Leptin Regulation of Parasympathetic Signaling as a Cause of Extreme Body Weight-Associated Asthma Cell Metab. 2013, v. 17, p. 35-48.
  42. Contoli M., Baraldo S., Marku B. et al. Fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease: 5-year follow-up. J. Allergy Clin. Immunol. 2010, v. 125, p. 830-837.
  43. Lee T.L., Lee Y.S., Bae Y.J. et al. Smoking, longer disease duration and absence of rhinosinusitis are related to fixed airway obstruction in Koreans with severe asthma: findings from the COREA study. Respiratory Research. 2011, v. 12, p. 1-13.
  44. Lee J.H., Haselkorn T., Borish L. et al. Risk factors associated with persistent airflow limitation in severe or difficult- to-treat asthma: insights from the TENOR study. Chest. 2007, v. 132, p. 1882-1889.
  45. Ulrik C.S., Backer V. Nonreversible airflow obstruction in life-long nonsmokers with moderate to severe asthma. Eur. Respir. J. 1999, v 14, p. 892-896.
  46. Mannino D.M., Gagnon R.C., Petty T.L., Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. Arch. Intern. Med. 2000, v. 160, p. 1683-1689.
  47. Ten Brinke A., Zwinderman A.H., Sterk P.J. et al. Factors associated with persistent airflow limitation in severe asthma. Am. J. Respir. Crit. Care Med. 2001, v. 164, p. 744-748.
  48. Boulet L.P. Irreversible airway obstruction in asthma. Curr. Allergy Asthma Rep. 2009, v. 9, p. 168-173.
  49. Wise R.A., Anzueto A., Cotton D. et al. Tiotropium Respimat Inhaler and the Risk of Death in COPD. N. Engl. J. Med. 2013, v. 369, p. 0490-0050.
  50. Чучалин А.Г., Авдеев С.Н., Айсанов З.Р. и соавт. Согласованные рекомендации по применению антихолинергического препарата длительного действия тиотропия в терапии бронхиальной астмы. Практическая пульмонология. 2015, № 1, с. 56-61.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright © Pharmarus Print Media, 2016



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies