Role Of Ics Alone Or In Combination In Different Asthma Phenotypes
The understanding of the biology and pathophysiology of asthma has progressed, with the identification of a number of distinct phenotypes . However, current international guidelines recommend initiating ICS treatment to almost all patients . ICSs work through both positive gene regulation and gene repression, with the result of this dual action being potent anti-inflammatory action in the airways .
The improvement with ICS in some clinical parameters, such as spirometry, is variable . As a result, different biomarkers, alone or in combination, are being used to increase the predictability of ICS response . For example, sputum eosinophil levels have been shown to predict response to ICS and to predict exacerbation risk on ICS withdrawal . In a separate study, titration of ICS treatment according to sputum eosinophil counts resulted in significantly fewer severe exacerbations compared with guideline-driven treatment . However, the analysis of induced sputum is still not widely available for routine use. Furthermore, by using multiple markers of inflammation , incremental ICS dosing in persistent asthma is associated with a plateau in symptoms and lung function, but with progressive improvement in inflammatory outcomes and AHR . Unfortunately, the use of either biomarker-based or symptom-based adjustment of ICS is not superior to physician assessment-based adjustment of ICS in terms of time to treatment failure .
Prevention Of Irreversible Airway Changes In Asthma
Some patients with asthma develop an element of irreversible airflow obstruction, but the pathophysiological basis of these changes is not yet understood. It is likely that they are the result of chronic airway inflammation and that they may be prevented by treatment with ICS. There is some evidence that the annual decline in lung function may be slowed by the introduction of ICS and this is supported by a five year study of low dose budesonide in patients with mild asthma . Increasing evidence also suggests that delay in starting ICS may result in less overall improvement in lung function in both adults and children . These studies suggest that introduction of ICS at the time of diagnosis is likely to have the greatest impact . So far there is no evidence that early use of ICS is curative and even when ICS are introduced at the time of diagnosis, symptoms and lung function revert to pretreatment levels when corticosteroids are withdrawn .
What Does Ics Mean In Medical
This page is about the meanings of the acronym/abbreviation/shorthand ICS in the field in general and in the Medical terminology in particular.
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What does ICS mean?
- What does ICS stand for? — Explore the various meanings for the ICS acronym on the Abbreviations.com website.
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Influence Of Disease Duration On Ics Efficacy In The Regular Group
We divided the regular group into 2 subgroups, based on disease duration: 2 years , or <2 years . After 1 year, both groups exhibited increased FEV1% predicted. However, the mean FEV1% predicted decreased by 7.4% in patients with a long duration until ICS treatment commencement and by 3.6% in the group with a duration of <2 years . FEV1 decreased over 15 years by 43.7 ml/year in the long-duration group and by 26.3 ml/year in the short-duration group .
When Are Labas Used For Asthma
New updates to asthma guidelines were published in 2020. These updates are known as the 2020 Asthma Guideline Update From the National Asthma Education and Prevention Program. These guidelines help doctors decide which drugs are right for asthma.3
The guidelines recommend major changes to the way doctors use LABAs treat asthma. They also make asthma treatment much simpler for most people with the condition. Now, in general:3
- Most people with asthma can be prescribed just 1 inhaler an ICS-LABA combination product. This should be used as both a maintenance and rescue inhaler.
- Most people, even those with mild asthma, should start with an ICS-LABA combination. Before, doctors recommended people start with an ICS alone.
- For people with mild intermittent asthma, an ICS-LABA should include low-dose ICS and be used as needed for symptoms. When asthma symptoms are under control, people can go without any inhalers. The ICS-LABA replaces albuterol as a rescue inhaler.
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Impact Of Ics On Long
In the majority of individuals with asthma, treatment with ICS improves symptoms and lung function, reduces the frequency of exacerbations, and reduces airway inflammation . In addition, the very earliest studies of the efficacy of ICSs in asthma demonstrated their ability to reduce or eliminate the need for OCSs as a maintenance treatment . Furthermore, registry studies have shown that even low doses of ICS reduce the risk of severe asthma exacerbations and death from asthma . The ability of ICS to reduce the risk of severe exacerbations can even be seen when ICSs and rapid-onset inhaled 2-agonists, delivered from the same inhaler, are only used as a reliever treatment .
Observational, nonrandomised studies of both children and adults followed in asthma clinics , and studies of adults with asthma from the general population , have suggested that ICS treatment may have beneficial effects on the course of lung function. However, this has been very difficult to prove in an RCT, since in excess of 3years of observation are needed to draw conclusions about long-term changes in FEV1, due to the combination of considerable measurement error and a very modest age-related annual FEV1 decline . In addition, randomisation of individuals with even mild asthma to placebo maintenance therapy may result in substantial withdrawal during such a study due to inadequately controlled symptoms and the occurrence of exacerbations.
The Role Of Inhaled Corticosteroids In Asthma Treatment: A Health Economic Perspective
Dennis L. Spangler, MDSupplements and Featured Publications
Asthma affects approximately 23 million Americans, including almost 7 million children ,1,2 and it is estimated that by 2025 that number will grow by more than 100 million worldwide.3 Asthma is responsible for almost 15 million physician office and hospital visits, and nearly 2 million visits to emergency departments, every year.4 In addition, results from the survey Asthma in America indicate that the United States is not meeting asthma goals set forth by the National Heart, Lung, and Blood Institute, which consist of no sleep disruption, no missed school or work, no need for emergency department visits/hospitalizations, maintenance of normal activity levels, and normal or near-normal lung function.5 This lack of control has contributed to the annual economic costs associated with asthma, which have been estimated to be as high as $56 billion.6
Asthma Treatment: ICS Monotherapy as the Gold Standard
The National Asthma Education and Prevention Program Expert Panel Report -3 Guidelines recommend a stepwise approach to asthma treatment:
Comparison of Current Agents and Differences Between ICS Therapies
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Copd Alone And Copd Patients With A Concomitant Asthma Diagnosis
Baseline characteristics of the two groups, i.e., COPD alone and COPD with concomitant asthma, are outlined in Table 2. A statistically significant difference was found in mean MRC for COPD alone and for COPD patients with concomitant asthma . The mean number of pack years for COPD alone patients and for COPD patients with concomitant asthma, respectively, was 36 and 26 . COPD patients with concomitant asthma had higher blood-eosinophil count than patients with COPD alone . Further details are given in Table 2.
Table 2 Baseline Characteristics of Enrolled Patients with Chronic Obstructive Pulmonary Disease Managed in Primary Care and Currently Prescribed Inhaled Corticosteroids Divided by Whether Patients Have a Concomitant Diagnosis of Asthma or COPD Alone
The distribution of severity of airflow limitation, based on the GOLD classification, among patients with COPD alone and COPD with concomitant asthma is presented in Figure 2, revealing a significant difference between the two groups . The distribution of the most common comorbidities and levels of blood eosinophils, respectively, in patients with COPD alone and COPD with concomitant asthma are presented in Figure 3 and Table 3.
Table 3 Blood Eosinophil Distribution in Patients with Information on Blood Eosinophils . Chronic Obstructive Pulmonary Disease Alone Compared to COPD with a Concomitant Diagnosis of Asthma Low Blood Eosinophils , Intermediate Blood Eosinophils and High Blood Eosinophils
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Natural History Of Asthma
Describing the natural history of asthma poses the same challenges as defining asthma. This is due to the heterogeneity of the airway diseases unified under the asthma label . Thus, the natural history may follow different paths of disease progression, including lung function decline, remission, reoccurrence, morbidity and mortality.
Inhaled Corticosteroids As Asthma Treatment Options
Inhaled corticosteroids , also known as inhaled steroids, are the most potent anti-inflammatory controller medications available today for asthma control and are used to decrease the frequency and severity of asthma symptoms. They are the current mainstay of treatment once a person with asthma needs a higher level of care than a rescue inhaler;.
Inhaled corticosteroids help prevent chronic asthma symptoms such as:
You and your physician may want to consider inhaled corticosteroids if any of the following apply:
- You use rescue -agonist treatments, such as albuterol, more than two days per week.
- You have asthma symptoms more than twice weekly.
- You meet certain criteria on spirometry.
- Your asthma interferes with your daily activities.
- You have needed;oral steroids;two;or more times in the last year.
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Inhaled Medication Delivery Devices
Inhaled asthma medications come in a variety forms including pressurized metered-dose inhalers and dry powder inhalers . Not all medications are available in the same delivery devices. Also, some devices have dose counters included and others, such as pMDIs, do not. The most important factor in selecting a medication delivery device is to ensure that the patient uses it properly.
In children, it is recommended that pMDIs always be used with a spacer device since they are as effective as nebulizers; a pMDI with spacer is also preferred over nebulizers . A spacer with face mask is recommended for children 24;years of age, while a spacer with mouthpiece is recommended for children 46;years of age. To transition to a spacer with mouthpiece, children must be able to form a seal around the mouthpiece and breathe through their mouths. For children 6;years of age or over, a pMDI plus spacer with mouthpiece or DPI is recommended. Since children must have sufficient inspiratory force to use a DPI, these devices are generally not recommended for children under 6;years of age.
Changing Concepts In Asthma Diagnosis Severity Assessment And Treatment And Their Effects On Asthma Progression And Mortality
The first guidelines on asthma diagnosis and management were published in the late 1980s . The development of these documents was stimulated by an increase in asthma-related mortality in several countries , and a marked increase in asthma prevalence in many countries in the 1970s and 1980s . These were consensus statements, rather than formal evidence-based clinical practice guidelines, but all identified the need to establish the diagnosis of asthma using objective criteria to document variable lung function, which has not changed over time, and recommended treatment options based on the perceived severity of the disease. The objectives of treatment were to improve symptom control and lung function. The importance of airway inflammation in asthma pathogenesis had already been identified , but the early documents did not emphasise the benefits of anti-inflammatory treatments, and as a result medications that rapidly improved symptoms and lung function, particularly inhaled 2-agonists, were the focus of treatment, especially for patients with mild-to-moderate asthma.
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Changes In Treatment And Symptom Steps In Each Group
Over 15 years, treatment steps 2, 3 and 4 in the regular group changed from 32 to 29, from 24 to 33 and from 44 to 38%, respectively. This finding indicated little change in the dose of ICS , although the types of ICS treatment varied .
Over 15 years, the distribution in the regular group of symptom steps 1, 2, 3 and 4 among the patients changed from 10, 25, 35 and 30 patients to 77, 17, 6 and 0 patients, respectively. This finding indicated that ICS treatment improved the patients’ overall severity significantly . However, over 15 years, the distribution in the irregular group of steps 1, 2, 3 and 4 among the patients was 0, 13, 36 and 51 patients, indicating a worsening of severity. The number of exacerbations in the regular group was 6.7 over 15 years, but the number of exacerbations in the irregular group was unknown.
Changes in treatment and symptom steps. Treatment steps in the regular treatment group changed from 32/24/44 to 29/33/38%, respectively, over 15 years, showing a proportional reduction at step 4. The symptom steps changed over 15 years, from 10/25/35/30 to 77/17/6/0, respectively, in the regular treatment group, showing that ICS had improved the overall severity significantly .
Characteristics Of Enrolled Patients With Copd
Of the COPD patients currently on ICS therapy included in the present study, 540 were classified by the GP as having concomitant asthma.
Slightly more female than male patients were recruited , whereas no difference was found in mean age between sexes . Further characteristics of the patients are given in Table 1.
Table 1 Characteristics of Enrolled Patients with Chronic Obstructive Pulmonary Disease Managed in Primary Care and Currently Prescribed Inhaled Corticosteroids According to Sex
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Ics Use In Copd Asthma Does Not Affect Covid
Regular use of inhaled corticosteroids for the treatment of chronic obstructive pulmonary disease or asthma does not appear to affect COVID-19-related mortality, an observational study from England showed.
ur findings do not provide any strong support for a protective effect from ICS use in these populations, as has been previously hypothesized might exist, the researchers pointed out. o evidence supports that patients should alter their ICS therapies during the ongoing pandemic.
Primary care electronic health records of patients with COPD or asthma were linked with death data from the Office for National Statistics. Eligibility criteria for patients with COPD was age35 years, current or former smoker, and prescribed ICS plus LABA or LABALAMA* within 4 months of the onset of follow-up . Eligibility criteria for patients with asthma was age18 years, diagnosed with asthma within 3 years of the index date, and treated with ICS or SABA* only within 4 months of the index date.
There were 429 and 529 COVID-19-related deaths in the COPD and asthma cohort, respectively.
Among patients with COPD, those prescribed ICS combinations had a higher risk of COVID-19-related mortality compared with those prescribed LABALAMA .
Among patients with asthma, COVID-19-related mortality risk was higher with high-dose ICS vs SABA only , a risk not noted among those prescribed low- or medium-dose ICS .
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Do Inhaled Corticosteroids Reduce Growth In Children With Persistent Asthma
Review question: We reviewed the evidence on whether inhaled corticosteroids could affect growth in children with persistent asthma, that is, a more severe asthma that requires regular use of medications for control of symptoms.
Background: Treatment guidelines for asthma recommend ICS as first-line therapy for children with persistent asthma. Although ICS treatment is generally considered safe in children, parents and physicians always remain concerned about the potential negative effect of ICS on growth.
Search date: We searched trials published until January 2014.
Study characteristics: We included in this review trials comparing daily use of corticosteroids, delivered by any type of inhalation device for at least three months, versus placebo or non-steroidal drugs in children up to 18 years of age with persistent asthma.
Key results: Twenty-five trials involving 8471 children with mild to moderate persistent asthma were included in this review. Eighty percent of these trials were conducted in more than two different centres and were called multi-centre studies; five were international multi-centre studies conducted in high-income and low-income countries across Africa, Asia-Pacifica, Europe and the Americas. Sixty-eight percent were financially supported by pharmaceutical companies.
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Adherence To Ics In Asthma: A Clinically Important Issue
Studies Investigating the Effects of Interventions Aimed at Improving Adherence to ICS in Adults With Asthma and the Effect on Asthma Outcomes
In 2012, Clark et al performed telephone interviews and reviewed medical records for 808 women with asthma and then repeated the data collection after 1 and 2 y of follow-up . All subjects were asked if they had an asthma management plan developed together with their doctor describing how to adjust their medication with changing symptoms; if they took their prescribed medication usually, sometimes, or rarely; and if they were prescribed oral steroids. At baseline, those with a negotiated treatment plan were prescribed more medication and had a higher level of education. At follow-up, the odds ratio of adhering to ICS usually or sometimes with a negotiated plan was 2.4 compared without such a plan. A total of 41 women with a treatment plan used oral steroids at baseline; at follow-up, 23 of these women were no longer on oral steroids. In comparison, 8 of 18 subjects without a treatment plan had stopped oral steroids at follow-up. However, there were no differences in the number of hospitalizations, emergency department visits, or unscheduled physician visits. Women with a negotiated treatment plan were estimated to have 17% more days and 31% more nights without symptoms than those without such a plan, which suggests a more direct approach to asthma treatment by physicians in more symptomatic patients.