Asthma Research Articles

Economic burden of short-acting beta-2 agonist (SABA) overuse among asthma patients in Türkiye: a cost analysis with respect to the updated GINA treatment recommendations.

This cost of illness study aimed to determine economic burden of short-acting β2-agonist (SABA) overuse in Türkiye from payer perspective with respect to the updated GINA 2022 treatment recommendations. A total of 3,034,879 asthma patients comprised the study population, via estimations extrapolated from the Türkiye arm of the global SABINA III study. The economic burden (costs related to the drug use and severe exacerbations) was compared in subgroups of overall (≥ 0 canisters/year) vs. GINA-recommended (0-2 canisters/year, hypothetical population) SABA use and in subgroups of appropriate use (0-2 canisters/year, real population) vs. overuse (≥ 3 canisters/year) of SABA with extrapolation of SABINA Türkiye data to the Türkiye asthma population. Recommended SABA use was predicted to prevent 127,505 of 157,512 severe exacerbations per year in mild asthma patients and 2,668,916 of 3,262,800 severe exacerbations per year in moderate-severe asthma patients. Annual cost burden of not applying recommended SABA use (overall [≥ 0 canisters/year] vs. GINA-recommended [0-2 canisters/year] SABA use) in mild asthma and moderate-severe asthma patients was calculated to be €20.43 million and €427.65 million in terms of severe exacerbations, and to be €829,352 and €7.20 million in terms of drug costs, respectively. The total annual economic burden arising from not applying recommended SABA use was estimated to be €456.11 million. Appropriate use (0-2 canisters/year) vs. overuse (≥ 3 canisters/year) of SABA was associated with decreased frequency of severe exacerbations per year in mild asthma (from 129,878 to 27,634) and moderate-severe asthma (from 2,834,611 to 428,189) patients. SABA overuse in mild and moderate-severe asthma patients was estimated to yield an additional annual cost of €16.38 million and €385.59 million, respectively in terms of severe exacerbations, and a total €11.30 million additional drug cost. The overall annual economic burden arising from SABA overuse was estimated to be €413.27 million. The estimated annual total economic burden arising from not applying recommended SABA use (€456.11 million) and SABA overuse (€413.27 million) with respect to the updated GINA 2022 treatment recommendations indicates the substantial cost burden of SABA overuse to the Turkish National Health System, corresponding up to 26% of the total direct cost of asthma reported in our country.

Prevalence of asthma in Catalonia (Spain): a retrospective, large-scale population-based study.

Asthma epidemiology reports an estimated global prevalence of about 4.3-8.6% in adults, with last differences among geographical regions. This study analyses a more significant population of asthma patients (473,737 individuals).To study the prevalence of medical diagnosis of asthma, overall and by age, gender, and disease severity, as well as comorbidities and type 2 biomarkers, and undergo medical treatments of a retrospective population-based asthma cohort from Catalonia (Spain). Individuals with a diagnosis of asthma established by medical records at different healthcare levels (primary, hospital, and emergency) from the Catalan Health System (CHS) were included. Socio-demographic characteristics, prevalence, overall and by age and gender, disease severity, comorbidities, and biomarkers of type-2 inflammation were evaluated, together with appropriate medical treatment. The overall diagnosed asthma prevalence in the population of Catalonia was 6.3%, where patients mainly had mild asthma (5.3%) and were significantly higher in females (6.8%) than males (5.7%). By age groups, asthma was more prevalent in boys and young men adults; however, being more prevalent in females above the age of 30y. The prevalence of severe asthma was 0.4%, 42.6% had uncontrolled asthma, and a high proportion (84.2%) were under systemic corticosteroid prescription. As expected, SABAs were the most prescribed drug (62.6%), followed by systemic corticosteroids (43.3%). More than half (53.8%) of patients showed type 2 inflammation. Asthma prevalence in Catalonia is similar to other areas studied in Spain, with a high prevalence in women and of T2 asthma.

Early detection and management of congenital pulmonary airway malformation in a newborn with stable clinical course

Introduction: Congenital pulmonary airway malformation (CPAM) is a rare developmental lung anomaly characterized by cystic lung lesions, constituting about 25% of congenital pulmonary anomalies. It typically occurs sporadically and is not significantly associated with race, age, or other maternal factors. The prenatal course of CPAM can vary based on factors such as lesion size, mediastinal shift, and associated anomalies. While the overall prognosis is generally favorable in the absence of severe complications like hydrops fetalis, which can adversely affect outcomes, management strategies include corticosteroids, thoracoamniotic shunt (TAS), and, in severe cases, open fetal surgery or the EXIT procedure. Postnatal surgical excision usually offers a curative outcome with an excellent prognosis. Without surgical intervention, there are risks of recurrent infections and, rarely, malignant transformation. Effective prenatal detection significantly impacts clinical decision-making and neonatal outcomes, and the necessity and timing of surgery for asymptomatic infants remain subjects of ongoing debate, underscoring the need for personalized, multidisciplinary care. Case Report: A female infant, delivered at 38 weeks via Cesarean section, was diagnosed with CPAM following routine prenatal ultrasound. Presence of extensive cystic regions in the right lung confirmed the diagnosis and a CPAM volume ratio (CVR) of 0.37 indicated a low risk of severe complications. The pregnancy was largely uneventful, with maternal chronic hypertension managed by Nifedipine and mild intermittent asthma. Postnatal chest radiography corroborated the CPAM diagnosis, while an abdominal ultrasound investigated intrahepatic calcifications. Maternal screening for cytomegalovirus and toxoplasmosis yielded negative results, and postnatally, the infant also tested negative for both infections. The neonate, though asymptomatic and stable, required close monitoring in the neonatal intensive care unit to prevent potential respiratory compromise. Conclusion: Advances in prenatal imaging have greatly improved the early detection and management of CPAM, allowing for targeted neonatal care and strategic planning. This case highlights the importance of a multidisciplinary approach involving obstetricians, maternal-fetal medicine specialists, neonatologists, and pediatric thoracic surgeons in the effective management of CPAM. Early identification and diligent postnatal monitoring are essential for ensuring optimal outcomes and minimizing the risk of complications. The coordinated care and strategic decision-making exemplified in this case underscore the potential for enhanced neonatal health and long-term well-being through comprehensive management of congenital anomalies.

Phenotypes of occupational bronchial asthma from the standpoint of immunopathogenesis

IIntroduction. Currently, occupational bronchial asthma is considered as a phe notypically and genetically heterogeneous disease. The assessment of clinical data, func tional features, and immunopathogenesis opens up new opportunities in assessing the development, predicting the characteristics of the course, and working out a personalized approach to pharmacotherapy of occupational asthma, as well as in developing an individ ual strategy for its prevention. The purpose of the study was to determine clinical and immunological markers of the risk of developing occupational asthma under conditions of exposure to sensitizing substances in various phenotypes of this disease. Materials and methods. The study included 170 patients with various OA phenotypes and 50 participants in the control group. The pulmonary function test was carried out on the CareFusion MicroLab Desktop Spirometer (Great Britain). The levels of IL-17, TNF-α, vas cular endothelial growth factor (VEGF), MCP-1, IFN-γ, and total IgE in blood serum were determined by solid-phase enzyme immunoassay using kits and reagents (OOO «Protein contour», «Vector-Best», «Diatex-E», «DIA-plus», «Pharmacia diagnostika»). Results. For the first time, the features of clinical and immunological manifestations in allergic and non-allergic OA phenotypes, as well as phenotypes of OA combination with occupational chronic obstructive pulmonary disease and metabolic syndrome were es tablished; the features of formation, immunopathogenesis, and prognosis in various phe notypes of occupational bronchial asthma were revealed. This allows recommending the determination of these immunological parameters during in-depth periodic medical exam inations of workers under conditions of exposure to sensitizing and irritating substances for differential diagnosis of various phenotypes of occupational bronchial asthma in a specialized inpatient examination. Limitations of the study. The study has regional (Samara region) and professional (in terms of detailing the working conditions in the studied comparison groups) limitations. Conclusion. The identified clinical, immunological, and genotypic features in various OA phenotypes and the established profiles of OA genotypes can optimize the approach to early diagnosis, prognosis, prevention, and pharmacotherapy of this disease, as well as expand the list of immunological study indicators used during preliminary and periodic medical examinations, in-depth examination of patients with occupational bronchial asth ma in occupational disease clinics and occupational pathology centers, and the application of new reliable criteria for predicting the course of the disease.

The Role of Aspergillus Antibody Detection in Allergic Bronchopulmonary Aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is an allergic lung disorder characterized by an exaggerated immune response to fungal allergens, particularly from Aspergillus fumigatus. ABPA leads to excessive mucus production and impaired mucociliary clearance. When A. fumigatus conidia are inhaled, they germinate, release exoproteases and other substances that further impede mucociliary clearance, and activate the immune response. The immune response is known by an exaggerated Th2 response to Aspergillus antigens, leading to production of IgE antibodies, eosinophilic infiltration of the lungs, and the formation of immune complexes. These immune complexes can deposit in the lung tissue, leading to airway inflammation, bronchiectasis, and fibrosis. This disease mainly occurs in individuals diagnosed with bronchial asthma and cystic fibrosis. Increased levels of A. fumigatus total IgE and specific IgE, IgG, and IgA antibodies, play a role in diagnosing patients with ABPA.

Genetic Predisposition of Language Disorders Among Different Independent Factors in Bronchial Asthma

Genetic Predisposition of Language Disorders Among Different Independent Factors in Bronchial Asthma

Asthmatic status in pediatric practice in patients with mild bronchial asthma

The main principle of the treatment of bronchial asthma is rational basic therapy, with priority appointment of inhaled glucocorticosteroids. The basis of the effectiveness of treatment is determined by the correct choice of the form of drug delivery, training the patient in inhalation skills and constant monitoring of the correct use of the inhaler. The article demonstrates the clinical observation of the formation of asthmatic status in a child with mild bronchial asthma. The deterioration of the condition and severe exacerbation was caused by insufficient intake of basic therapy funds into the respiratory tract due to improper inhalation techniques due to the patient's lack of skills in using an inhaler. At the same time, the patient was not trained and the necessary control over the correctness of the inhalation technique was not carried out at the outpatient stage.

Comorbid associations and risk factors for uncontrolled bronchial asthma in adolescents

Improving the effectiveness of bronchial asthma (BA) treatment in adolescents through early diagnosis and correction of associated pathological conditions, including psychoemotional spectrum disorders, is a pressing issue in modern medicine. Objective. To study disorders of the psychoemotional status in adolescents with uncontrolled BA. Material and methods. Psychoemotional disorders associated with BA have been described, assesses their significance as risk factors for uncontrolled and partially controlled asthma in 212 adolescents aged 12–18 years – patients of the pulmonary allergology center. Using the R. Goodman questionnaire (Strengths and Difficulties Questionnaire, SDQ) we investigated the presence and severity of emotional disorders, determined the values of the total score of the scales and the correlation relationships of the analyzed indicators. Results. The results of our own study revealed higher values of the total score of the scale of the questionnaire "Emotional symptoms" in adolescents with uncontrolled asthma, both boys and girls; the absence of deviations from the norm of the studied characteristics in the overwhelming majority of those examined, regardless of the controllability of asthma, gender and age of adolescents and a more significant contribution of borderline and deviating from the norm indicators in the partially controlled and uncontrolled course of asthma. Conclusion. The authors conclude that the approach to the treatment of uncontrolled asthma should be comprehensive, including mandatory diagnostics and correction of asthma-associated diseases and existing socio-psychological problems in adolescents.

Sub-Optimal Compliance to Long-Term Inhalation Strategies and Poorer Health Care Outcomes Associated with Extended Tattoos in Adolescents with Mild-to-Moderate Bronchial Asthma.

Patients' compliance to inhalation therapy is usually sub-optimal in young asthmatics. Adolescents poorly compliant to regular anti-asthma treatments and those with tattoos (and the associated attitude) can share some personality traits and maladaptive behaviors. This relationship has not been investigated. To assess if "extended" tattoos can predict long-term compliance to regular therapy of adolescents with mild-to-moderate asthma. A 12-month retrospective observational investigation was conducted on non-smoker asthmatic adolescents of both genders. Patients assuming <70% of prescribed vilanterol/fluticasone furoate o.d. were defined as "non-compliant". Tattoo surfaces were defined as "mild" or "extended" if they were < or ≥400 cm2, respectively. The relationship between tattoos and compliance on the evolution of resources consumption at 6 and 12 months was assessed by generalized estimating equation (GEE) models at the first and second semester of the treatment period. It was found that 13.2% of compliant adolescents had mild tattoos, while 47.2% of non-compliant adolescents had mild-to-extended tattoos (odds ratio (OR) 6.91, 95% CI 2.49 to 19.17, p < 0.001). The mean annual adherence to treatment was 57.8% ± 10.1 SD expected doses in non-compliant subjects with "mild tattoos" (54.8 cm2 ± 36.9 SD), but 38.6% ± 11.4 SD expected doses in those with "extended tattoos" (568.4 cm2 ± 111.6 SD, p < 0.001). Total cost proved to be a linear trend from the lowest values of compliant patients with no/mild tattoos (EUR 65.22 at 6 months and EUR 33.63 at 12 months) to the highest values of non-compliant adolescents with extended tattoos (EUR 330.75 at 6 months and EUR 297.34 at 12 months). Tattoo extension might be used as a reliable predictor of poor compliance and higher health care costs in adolescents with mild-to-moderate asthma. Patients characterized by poor compliance to a long-term therapeutic strategy and tattooing attitude likely share some aspects of their personality profile.

A clinical study on the relationship between chronic rhinosinusitis and bronchial asthma.

To investigate the correlation between chronic rhinosinusitis (CRS) and bronchial asthma, focusing on the CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP), as well as their impact on lung function. A total of 141 patients diagnosed with chronic nasal-sinus inflammation were included in this study. Clinical data, including medical histories, nasal endoscopy scores, CT scores, symptom scores, and quality of life assessments, were collected. Among the patients with CRSsNP, 23.8% had concomitant bronchial asthma. The incidence of asthma was significantly associated with the severity of sinus involvement in CRSsNP patients (p = 0.049). Pulmonary function impairment was correlated with the severity of sinus inflammation in CRSsNP patients (p = 0.019). Quality of life was significantly affected in patients with concomitant asthma and CRSsNP or CRSwNP. Chronic rhinosinusitis, both with and without nasal polyps, is closely correlated with bronchial asthma. Pulmonary function impairment is associated with the extent of inflammatory lesions in CRSsNP. Although CRSwNP does not significantly affect pulmonary function, the treatment of sinus diseases can contribute to the control of asthma.

A case of Iatrogenic Pseudo Aneurysm of Femoral Artery

A 55-year-old woman was admitted hospital in-patient unit withfever and breathlessness for 5 days. Pertinent medical history included chronic kidney disease (CKD), poorly controlled Diabetes with retinopathy, Hypertension and Bronchial asthma. After admission patient was found to be severely anaemic and her stool was black and tarry. Blood transfusion was required for correction of anaemia. Endoscopy of upper GIT was planned after stabilization. RT PCR for COVID-19 was positive. After couple of days she became desaturated in spite of high level of oxygen delivery and was shifted to ICU. Bangladesh Crit Care J September 2024; 12 (2): 179-180

PGRN Inhibits Early B-cell Activation and IgE Production Through the IFITM3-STAT1 Signaling Pathway in Asthma.

Progranulin (PGRN) plays a critical role in bronchial asthma and the function of various immune cells. However, the mechanisms by which PGRN influences B-cell receptor (BCR) signaling and immunoglobulin E(IgE) production are not fully understood. The study aimed to elucidate the molecular mechanisms through which PGRN affects BCR signaling, B-cell differentiation, and IgE production. A PGRN knockout mouse model, along with techniques including flow cytometry, the creation of a bone marrow chimeric mouse model, total internal reflection fluorescence (TIRF), and Western blot (WB) analysis is employed, to investigate the link between PGRN and various aspects of B-cell biology. It is discovered that the absence of PGRN in mice alters peripheral B-cell subpopulations, promotes IgE class switching in a cell-intrinsic manner, and affects B-cell subpopulations. Additionally, PGRN modulates B-cell functions by regulating BCR signaling pathways, metabolic processes, and the actin cytoskeleton during early B-cell activation. Significantly, PGRN deficiency results in diminished production of NP-specific antibodies. Moreover, it is found that PGRN inhibits B-cell activation and IgE production through the PGRN-IFITM3-STAT1 signaling pathway. The findings provide new strategies for the targeted treatment of bronchial asthma, highlighting the crucial role of PGRN in B-cell signaling and IgE production.

Innate players in Th2 and non-Th2 asthma: emerging roles for the epithelial cell, mast cell, and monocyte/macrophage network.

Asthma is one of the most common chronic respiratory diseases and is characterized by airway inflammation, increased mucus production, and structural changes in the airways. Recently, there is increasing evidence that the disease is much more heterogeneous than expected, with several distinct asthma endotypes. Based on the specificity of T cells as the best-known driving force in airway inflammation, bronchial asthma is categorized into T helper cell 2 (Th2) and non-Th2 asthma. The most studied effector cells in Th2 asthma include T cells and eosinophils. In contrast to Th2 asthma, much less is known about the pathophysiology of non-Th2 asthma, which is often associated with treatment resistance. Besides T cells, the interaction of myeloid cells such as monocytes/macrophages and mast cells with the airway epithelium significantly contributes to the pathogenesis of asthma. However, the underlying molecular regulation and particularly the specific relevance of this cellular network in certain asthma endotypes remain to be understood. In this review, we summarize recent findings on the regulation of and complex interplay between epithelial cells and the "nonclassical" innate effector cells mast cells and monocytes/macrophages in Th2 and non-Th2 asthma with the ultimate goal of providing the rationale for future research into targeted therapy regimens.

Azithromycin induces liver injury in mice by targeting the AMPK/Nrf2 pathway

Background Azithromycin is an antibacterial and anti-inflammatory drug widely used for the treatment of various diseases, including those caused by atypical pathogens, bacterial or viral infections, chronic sinusitis, and bronchial asthma, particularly in pediatric patients. However, concerns have emerged regarding its hepatotoxicity and its precise mechanism of action remains unclear. Objective To investigate the molecular mechanisms responsible for azithromycin-induced acute liver injury to advance our understanding of the progression and pathogenesis of antibiotic-induced liver damage, and to improve prevention and treatment strategies. Materials and methods C57BL/6 mice, Nrf2-/- mice, and primary hepatocytes were used. Primary hepatocytes from mice were isolated using a two-step perfusion method and cultured in vitro via the ‘sandwich’ culture model. Results The exposure to azithromycin resulted in increased apoptosis and reactive oxygen species (ROS) levels. In mouse models, intraperitoneal administration of azithromycin at varying concentrations and time points substantially induced hepatic disarray, swelling, and dysfunction. Azithromycin markedly upregulated the mRNA and protein levels of phosphorylated adenosine-activated protein kinase (AMPK) while downregulating nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase 1 (HO-1), and NADPH: quinone oxidoreductase 1 (NQO-1). Moreover, HO-1 and NQO-1 protein levels remained largely unaffected in primary hepatocytes co-cultured with azithromycin in Nrf2-/- mice. Conclusions Our findings suggest that azithromycin-induced acute liver injury is mediated by suppression of Nrf2 activation and ROS production. This sheds light on the potential mechanisms involved in azithromycin-induced liver damage, underscoring the importance of exploring targeted interventions to mitigate the hepatotoxic effects.

Circulatory collapse requiring mechanical circulatory support in a child with autoimmune adrenal insufficiency: a case report

BackgroundWe report a rare case of new onset autoimmune adrenal insufficiency in childhood, presenting with severe shock requiring mechanical circulatory support. In the current era of readily available imaging, laboratory and other diagnostic investigations, medical history and careful physical exam can often provide valuable diagnostic information for timely therapy.Case presentationA 7-year-old boy with a history of mild intermittent asthma, presented with severe cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO). Bronzing of his entire body was noted on physical exam. Stress dose hydrocortisone was given for suspected adrenal insufficiency. After weaning from ECMO and extensive rehabilitation, the patient recovered and was discharged home.ConclusionPrimary adrenal insufficiency (PAI) should be considered in the context of physical exam and laboratory findings, even in the presence of circulatory shock.

Impact of obesity on allergic respiratory diseases and on mental and cognitive performance

Summary Background Obesity and allergies are among the most common diseases of our civilization. Given the simultaneous rise in the prevalence of these diseases in recent years, a potential causal link between the two has been proposed. In particular, obese patients are at an increased risk of developing bronchial asthma, likely due to mechanical restrictions but also to metabolic changes that adversely affect immune function. Neuroscience studies have also shown that obesity can lead to impaired brain function and mental health. In the following review, we will take a closer look at our studies that focus on the influence of obesity on allergic diseases and cognitive performance. Results Both human studies and animal models (mice) have shown that obesity leads to increased allergic responses in the airways. Our studies in a mouse model of obesity confirm that an obese phenotype is associated with increased allergic sensitization and manifestation. These changes are associated with significant shifts in the composition of the gut microbial flora. The microbiome changes are further associated with allergic airway inflammation and an increased incidence of T helper 1 (Th1) type pulmonary macrophages. Interestingly, despite the changes in the microbiome, it is possible to effectively prevent allergy development by inducing oral tolerance. Furthermore, it was observed that obese mice show increased signs of anxiety and depression, as well as reduced cognitive performance. Conclusion Obesity is a complex metabolic disease that significantly impacts our body’s gut microbiome and immune system, resulting in an increased incidence of allergic asthma and neurological/psychological changes. Attention should be given to both the prophylactic and therapeutic measures to mitigate the impact of obesity, including oral tolerance for managing existing allergic diseases.

Short-term Clinical Outcomes of COVID-19 Patients Hospitalized with Chronic Obstructive Pulmonary Disease and Asthma in Three Tertiary Level Hospitals in Bangladesh

Background: Several comorbidities including chronic obstructive pulmonary disease (COPD) or bronchial asthma have been found associated with COVID-19 cases. But it remains unclear which of the comorbidities are associated with worse outcomes of the patients. Objectives: This study was carried out to determine the clinical outcomes of hospitalized COVID-19 patients with COPD or asthma. Methodology: This prospective study was carried out at Respiratory Medicine unit of Monno Medical College and Hospital, Manikganj, from April 2020 to December 2022. Admitted COVID-19 patients, suffering from COPD or bronchial asthma, were enrolled purposively upon fulfilling the inclusion and exclusion criteria. The patients were divided into two groups with associated comorbidities: Group A suffering from COPD and Group B suffering from Asthma. Data were collected from the patients on variables of interest using a semi-structured questionnaire. Results: Among the 144 enrolled patients, 96(66.67%) in group A were suffering from COPD and the other 48 (33.33%) in group B had bronchial asthma. In this study, 41(42.7%) patients in Group A exhibited &gt;25% lung field involvement in the high-resolution computed tomography (CT) chest imaging, compared to only 10(20.8%) in COVID-19 patients in Group B, and this difference in distribution was statistically significant (p=0.026). The COVID-19 patients in Group A were more severe to critically ill (45, 46.9%), compared to patients in Group B (12, 25.0%) with a p value of 0.011. Group A study subjects required intensive care unit (ICU) admission (49, 51.0%) more than the group B participants (16, 33.3%), which was also found statistically significant (p&lt;0.05). Nearly one-fifth (17, 17.7%) of the patients died among the Group A, compared to only 2(4.2%) mortality observed in Group B (p=0.024). The COVID-19 patients with COPD were found significantly associated with the risk of &gt;25% lung field involvement, severe to critical illness, ICU admission, invasive mechanical ventilation, and death (all p values &lt;0.05). Conclusion: The comorbidity of COPD was found to increase the risk of disease severity and adverse outcomes in COVID-19patients significantly. It also heightened the risk of lung field involvement, exceeding 25% more severe disease and increased mortality rates compared to individuals with bronchial asthma. Journal of Monno Medical College December, 2023; 9 (2):47-52

Choice of therapy for patients who do not achieve control over bronchial asthma on basic therapy with medium doses of inhaled glucocorticosteroids/long-acting β2-agonists. Resolution of the Expert Council

Recently, new drugs for the treatment of bronchial asthma (BA) have been registered in the Russian Federation: fixed triple combinations, which include inhaled corticosteroids (ICS), long-acting β2-agonists (LABA) and anticholinergics, high-dose combinations of beclomethasone dipropionate (BDP) and formoterol (FORM) in the form of an extrafine metered-dose aerosol, which allows prescribing 800 mcg of extrafine BDP and 24 mcg of FORM per day.The aim of publishing the resolution of the Expert Council “Choice of therapy for patients who do not achieve control over bronchial asthma on basic therapy with medium doses of inhaled corticosteroids/long-acting β2-agonists” was to compare possible ways of therapy optimization and propose criteria for choosing therapeutic alternatives based on the individual clinical and phenotypic characteristics.Conclusion. If a patient does not achieve asthma control (or had asthma exacerbations over the past year) with alternative therapy at step 4, it is advisable to switch to a maintenance and relief therapy (MART) regimen with fixed combination of inhaled corticosteroids/formoterol and with medium doses of ICS in the maintenance part of the regimen. In patients with poor control on alternative therapy with a medium dose of ICS, it is advisable to consider increasing the dose of ICS as part of an ICS/LABA combination or as part of a triple combination instead of switching to MART. Switching to a medium- or high-dose triple combination is especially useful for patients with fixed obstruction and when bronchial asthma is combined with chronic obstructive pulmonary disease. In patients who require high-dose therapy, it is advisable to consider prescribing high doses of ICS using an extrafine combination of BDP/FORM (400/12 mcg in the morning and evening). If MART with a medium dose of ICS does not prevent exacerbations, provide normal spirometry results and/or good control of symptoms, MART in combination with an anticholinergic drug should be used at step 5. If triple therapy or high doses of ICS/LABA are insufficiently effective, biological therapy should be considered.

Bronchial obstruction in patients during COVID-19 and as a manifestation of post-COVID syndrome

СOVID-19, the novel coronavirus infection, is a severe acute respiratory infection caused by a virus of the Coronaviridae family, with more than 45 species today. The first manifestations of respiratory disorders were identified back in 1965. As a rule, the main route of infection is airborne. Since the declaration of the pandemic of the novel coronavirus disease in 2019, the world continues to face not only its devastating impact on morbidity and mortality, but also global socioeconomic consequences, particularly respiratory complications. The most significant one is the development of bronchial obstruction in the post-COVID period. This article talks about COVID-19 and the post-Covid period in patients with chronic obstructive pulmonary disease and bronchial asthma, touches on the etiopathogenetic aspects of the development of bronchial obstruction, and discusses the diagnosis, treatment, and prevention of these conditions.

Efficacy and safety of benralizumab

The purpose of the review is to analyze Russian and foreign literature sources on the effectiveness and safety of benralizumab in the treatment of moderate and severe bronchial asthma. Benralizumab is a humanized monoclonal antibody directed against the interleukin-5 receptor (IL-5R) subunit. Binding of benralizumab with the alpha chain of IL-5R leads to inhibition of hetero-oligomerization of alpha and beta subunits, thus preventing signal transduction and consequent proliferation of eosinophils and basophils and the cascade of events following it. Benralizumab significantly reduces annual asthma exacerbation rates and is well tolerated by patients with severe uncontrolled asthma. The efficacy and long-term adverse reactions of benralizumab therapy have not been sufficiently studied and require more detailed analysis.