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Related Concept Videos

Asthma: Pathogenesis and Management01:20

Asthma: Pathogenesis and Management

Asthma is a chronic pulmonary condition involving inflammation of the airways, hyper-reactivity, and reversible obstruction of the airways. This condition can significantly impact a person's quality of life, making breathing difficult and leading to distressing symptoms.
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
Antiasthma Drugs: Leukotriene Modifiers01:19

Antiasthma Drugs: Leukotriene Modifiers

Leukotriene modifiers, or cysteinyl leukotriene receptor antagonists, are medications used to manage chronic asthma. These agents target specific inflammatory mediators produced during arachidonic acid metabolism, an essential process in generating inflammation in the body.
Leukotriene modifiers work through two distinct mechanisms:
Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids01:25

Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids

Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
COPD: Management Using Bronchodilators and Corticosteroids01:26

COPD: Management Using Bronchodilators and Corticosteroids

Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
Asthma-II: Pathophysiology and Classification01:26

Asthma-II: Pathophysiology and Classification

Asthma is a prevalent chronic respiratory condition marked by inflammation and hyperresponsiveness of the airways. Its pathophysiology involves complex interactions among inflammatory pathways, immune responses, and neural mechanisms.
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
Asthma III: Clinical Manifestations01:13

Asthma III: Clinical Manifestations

Asthma presents with a characteristic pattern of episodic respiratory symptoms that reflect underlying airway inflammation, bronchoconstriction, and mucus hypersecretion. Although severity varies among individuals, certain clinical manifestations are considered hallmarks of the disorder and often guide diagnosis and assessment.Respiratory SymptomsA persistent cough is one of the most common early features of asthma. It is frequently dry and tends to worsen at night or in the early morning,...

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Related Experiment Video

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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
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Real-World Biologic Use Patterns in Severe Asthma, 2015-2021: The CLEAR Study.

Trung N Tran1, Stephanie Chen1, Benjamin Emmanuel1

  • 1Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA.

Pragmatic and Observational Research
|March 24, 2025
PubMed
Summary

Switching or stopping biologic therapy for severe asthma is linked to worse outcomes. Continuing initial biologic treatment is associated with better clinical results and fewer exacerbations compared to changing or halting therapy.

Keywords:
ISARbiologicseffectivenessreal-worldsevere asthma

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Area of Science:

  • Pulmonology
  • Immunology
  • Pharmacology

Background:

  • Biologics targeting immunoglobulin E, interleukin (IL)-4/IL-13, or IL-5 pathways are used for severe asthma.
  • Suboptimal patient responses can lead to treatment modifications, necessitating real-world data analysis.

Purpose of the Study:

  • To assess real-world patterns of biologic use in severe asthma patients.
  • To evaluate the clinical outcomes associated with continuing, switching, or stopping biologic therapy.

Main Methods:

  • A multicenter, observational study (CLEAR) involving 1,859 adults from 23 countries in the International Severe Asthma Registry.
  • Patients were categorized based on their biologic treatment trajectory (continue, switch, stop) within 6 months of initiation.
  • Outcomes were assessed at 12 months using propensity score-weighted multivariable regression models.

Main Results:

  • 60.0% continued, 25.5% switched, and 14.5% stopped biologic therapy.
  • Switching or stopping was associated with higher annualized asthma exacerbation rates and uncontrolled asthma.
  • Patients who switched experienced increased oral corticosteroid use, hospitalizations, and emergency room visits compared to those who continued therapy.

Conclusions:

  • Switching or discontinuing biologic therapy in severe asthma is linked to poorer clinical outcomes.
  • Continuing initial biologic treatment appears to be associated with more favorable long-term results.