Chronic rhinosinusitis with nasal polyps and allergic rhinitis as different multimorbid treatable traits in asthma.

Background: Respiratory multimorbidities are linked to asthma, such as allergic rhinitis (AR) with early allergic asthma and chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) with late nonallergic asthma.

Objective: Our aim was to investigate the association of asthma severity and control with specific upper airway phenotypes.

Method: Patients with asthma were prospectively recruited from 23 pulmonology and ear, nose, and throat clinics.

Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review.

Background: Inefficient inhaler technique (IT) compromises the optimal delivery of medication. However, the IT knowledge of health care professionals (HCPs) has received scant attention.

Objective: The objective of this study was to perform a systematic review of published reports assessing the IT proficiency of HCPs in using pressurized metered dose (pMDI) and dry powder (DPI) inhalers.

Anticholinergics for asthma: a long history.

Purpose Of Review: To provide a fast overview about the introduction and development of anticholinergic drugs in Western medicine to their current indications particularly in asthma.

Recent Findings: Although short-acting muscarinic antagonists have been positioned in the last 15 years for the treatment of adults and children with moderate-to-severe acute asthma in the emergency setting (reducing the risk of hospital admissions and improving lung function), a growing body of evidence has recently emerged that positions the long-acting muscarinic anticholinergic tiotropium bromide as add-on therapy to at least inhaled corticosteroids (ICS) maintenance therapy in adults, adolescents, and children with symptomatic asthma. Thus, the addition of tiotropium bromide to ICS alone or ICS and another controller was associated with significant improvements in spirometric measures and asthma control, and a significantly decrease in the rate of asthma exacerbations.

Efficacy and safety of tiotropium in school-age children with moderate-to-severe symptomatic asthma: A systematic review.

Background: Recently published data support the benefits and safety of the once-daily (OD) long-acting anticholinergic tiotropium bromide bronchodilator for the treatment of uncontrolled moderate-to-severe asthma in adults and adolescents. However, its role for the treatment of school-age asthmatics has not yet been clearly defined. The aim of this systematic review was to assess the efficacy and safety of tiotropium Respimat in children aged 6-11 years with moderate-to-severe symptomatic asthma.

LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis.

Background: Randomized controlled trials (RCTs) indicate that long-acting bronchodilator combinations, such as β-agonist (LABA)/muscarinic antagonist (LAMA), have favorable efficacy compared with commonly used COPD treatments. The objective of this analysis was to compare the efficacy and safety of LABA/LAMA with LAMA or LABA/inhaled corticosteroid (ICS) in adults with stable moderate-to-very-severe COPD.

Methods: This systematic review and meta-analysis (PubMed/MEDLINE, Embase, Cochrane Library and clinical trial/manufacturer databases) included RCTs comparing ≥12 weeks' LABA/LAMA treatment with LAMA and/or LABA/ICS (approved doses only).

A systematic review with meta-analysis of fluticasone furoate/vilanterol combination for the treatment of stable COPD.

Background: Current guidelines recommend the use of inhaled corticosteroids/long-acting beta2-agonists as first-line therapy for COPD patients at risk for acute exacerbations and/or severe airflow limitation. This systematic review assesses available evidence on the efficacy and safety of fluticasone furoate/vilanterol (FF/VI) combination versus each alone, for the treatment of patients with severe to very severe stable COPD.

Methods: Randomized, placebo-controlled trials of >8 weeks of duration were included.

Asthma-chronic obstructive pulmonary disease overlap syndrome: a controversial concept.

Purpose Of Review: To illustrate the scant evidence and the shortcomings of the concept of 'asthma-COPD overlap syndrome' (ACOS) in terms of clinical utility.

Recent Findings: Asthma and chronic obstructive pulmonary disease (COPD) are considered as two distinct and heterogeneous diseases. For many years, physicians have been aware that asthma and COPD can coexist in some patients.

Once-daily fluticasone furoate and vilanterol for adolescents and adults with symptomatic asthma: A systematic review with meta-analysis.

Background: Fluticasone furoate and vilanterol is a new inhaled corticosteroid (ICS) and long-acting β2-agonist (LABA) combination developed for once-daily administration via a dry powder inhaler.

Objective: To assess the efficacy and safety of fluticasone furoate-vilanterol in adolescents and adults with symptomatic asthma compared with ICS monotherapy or twice-daily ICS-LABA formulations.

Methods: Randomized, placebo-controlled trials with longer than 8 weeks of treatment duration were included.

Assessment of acute asthma severity in the ED: are heart and respiratory rates relevant?

Background: Assessment of acute asthma severity in the emergency department (ED) determines the appropriate initial therapy. The aim of this study was to evaluate the usefulness of heart and respiratory rates as determinants of severity of asthma exacerbations.

Methods: It was a pooled analysis of individual patient data from different controlled clinical trials performed over a 9-year period.

Tiotropium for the treatment of adolescents with moderate to severe symptomatic asthma: a systematic review with meta-analysis.

Background: The role of tiotropium for the treatment of adolescents with asthma has not yet been clearly defined.

Objective: To assess the efficacy and safety of inhaled tiotropium in adolescents with moderate to severe symptomatic asthma.

Methods: Randomized, placebo-controlled trials were included in this systematic review.

Systematic review on the use of omalizumab for the treatment of asthmatic children and adolescents.

Background: There are less data on omalizumab treatment in pediatric asthma than in adult population. Thus, to establish the efficacy and safety of subcutaneous omalizumab as an add-on therapy, a systematic review of placebo-controlled studies was performed.

Methods: Primary outcome was the frequency of asthma exacerbations.

A Systematic Review of the Efficacy and Safety of a Fixed-Dose Combination of Umeclidinium and Vilanterol for the Treatment of COPD.

Background: COPD guidelines recommend the combined use of inhaled long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) if symptoms are not improved by a single agent. This systematic review tested the hypothesis that the bronchodilator effect of the LABA/LAMA combination, umeclidinium (UMEC)/vilanterol (VIL), would translate into better outcomes without incurring increased adverse events (AEs).

Methods: This was a systematic review of randomized, placebo-controlled or crossover trials (> 4 weeks) involving UMEC/VIL compared with its monocomponents, tiotropium, or fluticasone/salmeterol.

Assessment of the internal structure of GOLD 2011 system.

Background: Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 introduced a new multidimensional system (symptom/risk) for assessment chronic obstructive pulmonary disease (COPD). The aim of this study was to explore the construct validity of the GOLD 2011 classification strategy; specifically, we evaluated its internal structure in terms of reliability and exploratory factor analysis (EFA).

Methods: Reliability (Cronbach alpha coefficient), correlations between variables and two successive EFA were performed to assess the internal structure of GOLD 2011.

Advances in acute asthma.

Purpose Of Review: The purpose of this study is to highlight some of the recent findings related with the management of acute exacerbations in the context of the emergency department setting.

Recent Findings: β₂-agonist heliox-driven nebulization significantly increased by 17% [95% confidence interval (CI) 5.2-29.

What is the role of tiotropium in asthma?: a systematic review with meta-analysis.

Background: The role of tiotropium for the treatment of asthma has not yet been clearly defined. The aim of this systematic review was to assess the efficacy and safety of tiotropium in patients with asthma.

Methods: Randomized placebo-controlled trials were included.

Principal findings of systematic reviews for chronic treatment in childhood asthma.

Objective: To summarize the principal findings pertaining to most effective long-term pharmacologic treatment of childhood asthma.

Methods: Systematic reviews of randomized clinical trials (SRCTs) on pharmacologic chronic treatment in children (1-18 years) with persistent asthma were retrieved through MEDLINE, EMBASE, CINAHL, SCOPUS, and CDSR (up to January2014).

Results: One hundred eighty-three SRCTs were searched from databases.

Asthma in the elderly: what we know and what we have yet to know.

In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life.

Daily versus intermittent inhaled corticosteroid treatment for mild persistent asthma.

Purpose Of Review: Guidelines recommend the use of daily inhaled corticosteroids as preferred treatment for preschoolers, children, adolescents, and adults with recurrent wheezing and mild persistent asthma. However, intermittent or as-needed inhaled corticosteroids treatment in response to symptoms is an emerging strategy. This review is focused on the analysis (clinical efficacy and safety) of this approach in comparison with the current daily-based therapy.

Efficacy and safety of a fixed-dose combination of indacaterol and Glycopyrronium for the treatment of COPD: a systematic review.

Background: COPD guidelines recommend the combined use of inhaled, long-acting β2-agonists and long-acting muscarinic antagonists if symptoms are not improved by a single agent. This systematic review assessed the efficacy and safety of the fixed-dose combination of the long-acting β2-agonist indacaterol and long-acting muscarinic antagonist glycopyrronium (QVA149) compared with its monocomponents (glycopyrronium and indacaterol) and tiotropium for the treatment of moderate to severe COPD.

Methods: This was a systematic review of randomized, placebo-controlled or crossover trials (3-64 weeks).

Heliox-driven β2-agonists nebulization for children and adults with acute asthma: a systematic review with meta-analysis.

Background: The effect of heliox as a nebulizer β2-agonist driving gas in acute asthma remains controversial.

Objective: To perform a systematic review with a meta-analysis of randomized trials designed to evaluate the efficacy of heliox versus oxygen in driving β2-agonist nebulization in patients with acute asthma.

Methods: A search was conducted of all randomized controlled trials published before August 2013.

Daily vs. intermittent inhaled corticosteroids for recurrent wheezing and mild persistent asthma: a systematic review with meta-analysis.

Background: Intermittent ICS treatment with SABA in response to symptoms, is an emerging strategy for control of mild-to-moderate asthma, and recurrent wheezing. This systematic revue compares the efficacy of daily vs. intermittent ICS among preschoolers, children and adults with persistent wheezing and mild to moderate stable persistent asthma.

Quality assessment of asthma clinical practice guidelines: a systematic appraisal.

Background: The quality and potential impact of available clinical guidelines for asthma management have not been systematically evaluated. We, therefore, evaluated the quality of clinical practice guidelines (CPGs) for asthma.

Methods: We performed a systematic search of scientific literature published between 2000 and 2010 to identify and select CPGs related to asthma management.