BACKGROUND Tumour necrosis factor alpha (TNFalpha) is a major therapeutic target in a range of chronic inflammatory disorders characterised by a Th1 type immune response in which TNFalpha is generated in excess. By contrast, asthma is regarded as a Th2 type disorder, especially when associated with atopy. However, as asthma becomes more severe and chronic, it adopts additional characteristics i...

Background: Tumour necrosis factor a (TNFa) is a major therapeutic target in a range of chronic inflammatory disorders characterised by a Th1 type immune response in which TNFa is generated in excess. By contrast, asthma is regarded as a Th2 type disorder, especially when associated with atopy. However, as asthma becomes more severe and chronic, it adopts additional characteristics including co...

Background. The control of severe bronchial asthma, such as corticosteroid-resistant asthma, is difficult. It is also possible that immunosuppressive agents would be effective for bronchial asthma. Case Summary. A 55-year-old Japanese female presented with severe bronchial asthma controlled with tacrolimus. She had been diagnosed with bronchial asthma during childhood. Her asthma worsened, and ...

Asthma is a common chronic airways disease. The goal of asthma management is to control symptoms while minimizing the side effects of treatment. Following a period of stable asthma, clinicians should consider stepping down treatment. This approach is recommended by current guidelines. Step-down has been studied for several types of asthma drug regimens, and certain approaches may have lower ris...

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Many patients with severe asthma driven by type 2 inflammation require long-term treatment systemic corticosteroids. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for IL-4/13, key and central drivers of inflammation. Dupilumab is approved in US as an add-on moderate-to-severe aged ≥12 ye...

Practice Pointers Asthma affects 8.2% of the U.S. population, and disproportionately affects those who are poor and black. Despite effective therapies, 3,404 U.S. deaths were attributed to asthma in 2010.1 Two types of inhaled pharmacologic agents are used for asthma control: inhaled corticosteroids and LABAs. Concerns about the safety of LABAs have risen with reports of increased hospital admi...

BACKGROUND Parental smoking is known to worsen asthma symptoms in children and to make them refractory to asthma treatment, but the molecular mechanism is unclear. Oxidative stress from tobacco smoke has been reported to impair histone deacetylase-2 (HDAC2) via phosphoinositide-3-kinase (PI3K)/Akt activation and, thus, to reduce corticosteroid sensitivity. The aim of this study was to investiga...

BACKGROUND Asthma guidelines advocate maintaining asthma control while minimizing corticosteroid exposure. OBJECTIVE To assess the reduction in corticosteroid burden during long-term treatment and the corresponding impact of this reduction on asthma control, lung function, and inflammation in patients with moderate to severe allergic asthma. METHODS We conducted a pooled analysis (N = 1,071...

OBJECTIVE To describe a series of eight patients with long-term asthma and pulmonary function consistent with "end-stage," irreversible obstruction. DESIGN Retrospective descriptive analysis of patients with severe asthma. SETTING A university-based allergy-immunology service with a large population of corticosteroid-dependent patients with asthma. PATIENTS Eight patients with long-standi...

BACKGROUND Long term administration of oral corticosteroids in patients with asthma may be associated with serious side effects. Non-steroidal anti-inflammatory drugs, including gold salts, have been shown to reduce the need for systemic corticosteroid treatment in uncontrolled studies. The effect of oral gold (auranofin) on asthma symptoms, lung function, and the need for oral prednisone treat...