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Background: Asthma is a chronic airway disease, affecting over 300 million people worldwide. 5-10% of patients suffer from severe asthma and account for 50% of asthma-related financial burden. Availability of real-life data about the clinical course of severe asthma is insufficient., Objectives: The aims of this study were to characterize patients with severe asthma in Switzerland, enrolled in the Swiss Severe Asthma Registry (SSAR), and evaluate predictors for asthma control., Method: A descriptive characterisation of 278 patients was performed, who were prospectively enrolled in the registry until January 2022. Socio-demographic variables, comorbidities, diagnostic values, asthma treatment, and healthcare utilisation were evaluated. Groups of controlled and uncontrolled asthma according to the asthma control test were compared., Results: Forty-eight percent of patients were female and the mean age was 55.8 years (range 13-87). The mean body mass index (BMI) was 27.4 kg/m2 (±6). 10.8% of patients were current smokers. Allergic comorbidities occurred in 54.3% of patients, followed by chronic rhinosinusitis (46.4%) and nasal polyps (34.1%). According to the ACT score, 54.7% had well controlled, 16.2% partly controlled and 25.9% uncontrolled asthma. The most common inhalation therapy was combined inhaled corticosteroids/long-acting β2-agonists (78.8%). Biologics were administered to 81.7% of patients and 19.1% received oral steroids. The multivariable analysis indicated that treatment with biologics was positively associated with asthma control whereas higher BMI, oral steroids, exacerbations, and COPD were negative predictors for asthma control., Conclusion: Biologics are associated with improved control in severe asthma. Further studies are required to complete the picture of severe asthma in order to provide improved care for those patients., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Over 20 years ago, the concept of asthma control was created and appropriate measurement tools were developed and validated. Loss of asthma control can lead to an exacerbation. Years ago, the term "clinically significant asthma exacerbation" was introduced to define when a loss of control is severe enough to declare it an asthma exacerbation. This term is also used by health insurances to determine when an exacerbation is eligible for reimbursement of biologics in clinical practice, however, it sometimes becomes apparent that a clear separation between loss of "asthma control" and an exacerbation is not always possible. In this review, we attempt to justify why exacerbations in early allergic asthma and adult eosinophilic asthma can differ significantly and why this is important in clinical practice as well as when dealing with health insurers., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

For general practitioners there have been important novelties in the treatment of asthma due to recent modifications of the international guidelines from Global Initiative for Asthma (GINA). In Step 1, use of short-acting beta2-agonists (SABA) without concomitant inhaled corticosteroids (ICS) as controller is no longer recommended for lack of efficacy and safety reasons. Instead, low dose ICS-formoterol as needed is recommended. In Step 5, in patients with severe uncontrolled asthma GINA recommends targeted biologic therapies like interleukin antibodies. Asthma patients presenting simultaneously with symptoms of chronic obstructive pulmonary disease (COPD) should receive treatment containing ICS. Independent of the current corona pandemic, GINA recommendations stay in place., Competing Interests: Les auteurs ont perçu des honoraires pour la participation à des travaux de formation, de conseils ou de participation à des groupes d’experts: Pr Jörg Leuppi: AstraZeneca, Boehringer Ingelheim, GSK, Munidpharma, Novartis et Sanofi. Pr Pierre-Olivier Brideveaux: AstraZeneca, GSK, Novartis, Sanofi, Boehringer Ingelheim. Dr Christian Clarenbach: Roche, Novartis, Boehringer Ingelheim, GSK, AstraZeneca, Sanofi, Vifor, OM Pharma, CSL Behring, Grifols, Daiichi Sankyo and Mundipharma. Dr Florian Charbonnier: AstraZeneca, GSK, Novartis, Sanofi. Dr Pietro Gianella: AstraZeneca, GSK, Novartis, Sanofi. Dr Nikolay Pavlov: AstraZeneca, CSL Behring, GlaxoSmithKline, Novartis, Olympus, OM Pharma, Sanofi. Dr Claudia Steurer: AstraZeneca, GSK, Novartis, OM Pharma. Pr Christophe von Garnier: AstraZeneca, Boehringer Ingelheim, GSK, Mundipharma, Novartis, Pfizer, OM Pharma, PneumRx et Pulmonx, Sanofi. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article. AstraZeneca AG a soutenu la rédaction du manuscrit en mettant à disposition un rédacteur médical, sans influence exercée sur le contenu.

Novelties in the Treatment of Asthma Abstract. For general practitioners there have been important novelties in the treatment of asthma due to recent modifications of the international guidelines from Global Initiative for Asthma (GINA). Step 1 no longer recommends the use of short-acting β2-agonists (SABA) without concomitant inhaled corticosteroids (ICS) as a controller because of the lack of efficacy and for safety reasons. Instead, low dose ICS-formoterol as needed is recommended. GINA step 5 recommends targeted biologic therapies like interleukin antibodies in patients with severe uncontrolled asthma. Asthma patients presenting simultaneously with symptoms of chronic obstructive pulmonary disease (COPD) should receive treatment containing ICS. Independent of the current corona pandemic, GINA recommendations stay in place. Recent data on prescriptions of SABA and oral corticosteroids (OCS) in Switzerland indicate that they still play an important role in asthma management and that GINA recommendations have not yet been sufficiently implemented into practice.

Type-2 Asthma: Leaving Behind the Perspective of the Seventies Abstract. The diagnosis 'bronchial asthma' spans different phenotypes of this disease like an umbrella. The differentiation of these phenotypes and their overlaps is becoming increasingly important, as the phenotype-specific treatment approaches of today are not effective with every form of asthma. These approaches include the strategy of allergen avoidance, allergen immunotherapy and, most importantly, the newly available biologics for asthma. Treatable disease patterns, so-called 'treatable traits', require targeted diagnostics. The knowledge necessary to identify these traits still needs to be established in practice.

Physical and Clinical Aspects of Inhalation Therapy for Asthma and COPD Abstract. Inhalations form the basis of the medicinal treatment of respiratory diseases. In recent years, therapy has become more complex for patients, but also for medical professionals, as new systems have come onto the market. The knowledge required for this shall be conveyed in this article.

The data situation for the use of ICS in asthma is clear. In the case of COPD, on the other hand, where in recent years the pendulum has moved away from ICS towards a dual therapy based on LABA / LAMA, the discussion is open again thanks to new work. However, it would certainly be wrong to recommend ICS as a meaningful therapy for all COPD patients at this point in time, since therapy with ICS is associated with side effects, in particular an increase in the risk of developing pneumonia or osteoporosis. However, there is no doubt that patients with asthma COPD overlap require ICS therapy.

Benralizumab: Targeting the IL-5 Receptor in Severe Eosinophilic Asthma Abstract. For patients with difficult-to-control, severe bronchial asthma, highly effective, targeted treatment options are available in addition to inhaled medication. In the presence of eosinophilia, inhibition of the interleukin-5 (IL‑5) axis with specific monoclonal antibodies promises to be an effective alternative to continuous systemic steroid therapy with few side effects. This review summarizes the data on benralizumab, a specific antibody against the IL-5 receptor alpha preventing receptor stimulation by IL-5 and activating a NK-cell mediated cytotoxic reaction with apoptosis of eosinophils. The s.c.-application of benralizumab leads within days to a virtually complete depletion of blood eosinophils with consecutive improvement in lung function and stabilization of asthma. For selected severe asthmatics, this is a promising therapy option.

Transportation noise leads to sleep disturbance and to psychological and physiological sustained stress reactions, which could impact respiratory health. However, epidemiologic evidence on associations of objective transportation noise exposure and also perceived noise annoyance with respiratory morbidity is limited. We investigated independent associations of transportation noise exposure and noise annoyance with prevalent respiratory symptoms and incident asthma in adults. Using 17,138 observations (from 7049 participants) from three SAPALDIA (Swiss Cohort Study on Lung and Heart Diseases in Adults) surveys, we assessed associations of transportation noise exposure and noise annoyance with prevalent respiratory symptoms, and with incident asthma (in 10,657 nested observations from 6377 participants). Annual day-evening-night transportation noise comprising road, railway and aircraft Lden (Transportation Lden) was calculated for the most exposed façade of participants' residence using Swiss noise models. Transportation noise annoyance was assessed using an 11-point scale, and participants reported respiratory symptoms and doctor-diagnosed asthma at each survey. We estimated associations with transportation Lden (as well as source-specific Lden) and noise annoyance, independent of air pollution and other potential confounders, using mutually-adjusted mixed logistic and Poisson models and applying random intercepts at the level of the participants. Prevalent respiratory symptoms ranged from 5% (nocturnal dyspnoea) to 23% (regular cough/phlegm). Transportation noise annoyance, but not Lden, was independently associated with respiratory symptoms and current asthma in all participants, with odds ratios (OR) and 95% confidence intervals (CI) ranging between 1.03 (95%CI: 1.01, 1.06) and 1.07 (95% CI: 1.04, 1.11) per 1-point difference in noise annoyance. Both noise annoyance and Lden showed independent associations with asthma symptoms among asthmatics, especially in those reporting adult-onset asthma [OR Lden : 1.90 (95% CI: 1.25, 2.89) per 10 dB; p-value of interaction (adult-onset vs. childhood-onset): 0.03; OR noise annoyance : 1.06 (95%CI: 0.97, 1.16) per 1-point difference; p-value of interaction: 0.06]. No associations were found with incident asthma. Transportation noise level and annoyance contributed to symptom exacerbation in adult asthma. This suggests both psychological and physiological noise reactions on the respiratory system, and could be relevant for asthma care. More studies are needed to better understand the effects of objective and perceived noise in asthma aetiology and overall respiratory health., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Respiratory diseases are associated with increased cardiovascular risk in adults, but little is known on the early impact on the vasculature in youth. The SAPALDIA Youth study, the offspring study of the Swiss Study on Air Pollution and Lung and Heart Disease In Adults (SAPALDIA), investigated the association between physician-diagnosed asthma status and common carotid artery intima media thickness (CIMT). Offspring underwent standardized clinical protocols and provided information on early life factors, health, and lifestyle. The association between per subject averages of CIMT and asthma was estimated using mixed linear regression analyses adjusting for main confounders, testing for interaction with gender and age. Of 257 offspring (mean age 15 years, 53% female), 11.5% reported doctor-diagnosed asthma (male 17%, female 7%). Mean CIMT was significantly different by gender (male 0.53 mm (± 0.045), female 0.50 mm (± 0.048); p < 0.001). Interaction was highly significant by gender (p = 0.001) with significantly increased CIMT in asthmatic vs. non-asthmatics boys (difference 0.023 mm, 95% CI 0.003; 0.043), as compared to girls., Conclusion: Our study suggests an increased risk for early vascular change in adolescent asthmatic boys. Whereas the small number of girls limits the interpretation, the result necessitates further research into sex-specific atherosclerotic burden related to respiratory health in adolescence. What is Known: • Evidence points to a significant impact of adult respiratory disease on cardiovascular health indicators as well as on endpoints. • Inflammation is a key pathway in vascular change across the life course. What is New: • We observe an adverse association between physician-diagnosed asthma and carotid intima media thickness in adolescent boys. • Albeit a limited number of asthmatic girls, we hypothesize the gender typical timing of asthma or a higher male cardiovascular vulnerability as possible explanations for the gender-specific results.

The Global Initiative for Asthma (GINA) is a network of individuals, organizations, and public health officials that was established to disseminate information about the care of patients with asthma and to improve asthma care. The GINA ("Global Strategy for Asthma Management and Prevention") report has been updated annually since 2002. Due to new knowledge and therapeutic development in the field, the Swiss Respiratory Society felt the need to provide a new document that is based on both the available literature and the recommendations of the 2016 GINA report. Key new features of the 2016 GINA report include a "new" definition of asthma, underscoring its heterogeneous nature, and the core elements of variable symptoms and variable expiratory airflow limitation; the importance of confirming the diagnosis of asthma in order to minimize both under- and overtreatment; practical tools for the assessment of symptom control and risk factors for adverse outcomes; a comprehensive approach to asthma management that acknowledges the foundational role of inhaled corticosteroid therapy, but also provides a framework for individualizing patient care; an emphasis on maximizing the benefit of available medications by addressing common problems such as incorrect inhaler technique and poor adherence; a continuum of care for worsening asthma, starting with early self-management and progressing to primary care or acute care management; and diagnosis of the asthma/chronic obstructive pulmonary disease overlap syndrome. This document is meant to advice the key stakeholders on the diagnosis and management of asthma and highlights the need to individualize the care of each and every asthmatic patient., (© 2018 S. Karger AG, Basel.)

4 clinical phenotypes can be differentiated in asthma and COPD. Apart from routine treatment strategies, phenotyp-specific options in treatment are important to optimise therapy in these patients. Identification of phenotypes and re-evaluation of patients not responding to treatment in the practitioners practise belong in the hand of the pneumologist as well as treatment of severe asthma. Acute severe asthma attacks have become rare in Swiss hospitals. Despite this progress, asthma control in our patients can still be improved. In COPD, any effort of primary respectively secondary smoking prevention is important.

Asthma is not a homogenous disease but a bundle of different phenotypes producing common symptoms due to swelling of bronchial mucosa and constriction of the airway smooth muscle. Beyond the treatment with a combination of topical steroids and long-acting beta agonists, new therapeutic options arise with the knowledge of different phenotypes. One option, specifically in allergic asthma, is the long known allergen immunotherapy. To identify the individual phenotype a diagnostic work up is warranted when the asthma is diagnosed and whenever asthma control cannot be maintained.

According to the international guidelines of COPD (GOLD) and asthma (GINA) diagnosis and treatment of both diseases necessitate spirometry in the private practice as well as in hospital setting. However today, spirometry is not sufficiently used in Switzerland. This paper intends to give an easy overview how spirometry is performed and spirometric values can be interpreted.

In clinical practice, differentiation of COPD and asthma is difficult. A case report of an asthma patient with a drifter type of asthma imitating COPD is presented. In this context differences and similarities of both diseases are high-lighted. The definitions of asthma and COPD in international guidelines leave some space to misdiagnosing.

Background: Good asthma control is the main goal of long-term asthma treatment. According to the Global Initiative for Asthma (GINA) guidelines (www.ginasthma.com), medical professionals assess asthma control based on specific questions regarding asthma symptoms and by spirometry measuring forced expiratory volume in 1 second (FEV(1)). Patients trained in early self-detection of asthma exacerbations use a symptom-based questionnaire, such as the Asthma Control Test (ACT) [Nathan RA, Sorkness CA, Kosinski M, et al. Development of the Asthma Control Test. A survey for assessing asthma control. J Allergy Clin Immunol 2004; 113:59-64]. However, some patients may prefer harder indicators, like peak flow values, when considering how to act within their regular asthma self-management plan., Objectives: Monitoring of FEV(1) at home could be an even more valuable alternative to recording peak flow values. The inexpensive handheld pocket spirometer "Piko-1®" offers the opportunity to monitor and store consecutive FEV(1) values. This study assesses the accuracy of the Piko-1 device., Methods: Twenty volunteers tested 20 Piko-1 devices over five consecutive days. All results were compared to daily FEV(1) values, as measured by a calibrated reference spirometer., Results: Overall, the accuracy was acceptable, although Piko-1 tended to underestimate FEV(1) in the lower range. Moreover, there was no evidence of major heterogeneity between Piko-1 devices., Conclusion: The Piko-1 FEV(1) measurements are sufficiently accurate to start a clinical trial to compare the detection of asthma exacerbations with this device and based on asthma symptoms alone.

Asthma is characterized by a reversible bronchial obstruction. Some patients may present a restrictive lung function pattern. Most often, this is due to extrapulmonary causes such as obesity, scoliosis, etc. As in chronic obstructive pulmonary disease (COPD), a "pseudorestriction," a lowered forced vital capacity (FVC) due to dynamic hyperinflation with air trapping, may be seen. This article presents two patients suffering from asthma who had an considerable impairment of total lung capacity (TLC) and FVC when their asthma was poorly controlled, showing a complete reversibility of restriction when treated properly for the asthma.

Any anti-asthmatic therapy aims to control the disease activity. The amount of medication necessary to maintain asthma control over a longer period may vary. In the course of a long-term treatment, achievement of asthma control has regularly to be assessed. This case reports of a patient suffering from steroid dependent intrinsic asthma illustrates the different parameters being used to evaluate asthma control.

In clinical practice, gastrooesophageal reflux (GER) and bronchial asthma often coincide. In the case of sufficient asthma control, the asthma does not need to be taken into account when treatment of GER is being evaluated. In patients with symptomatic asthma despite adequate antiasthmatic treatment, a possible causal relationship between GER and the poor responsiveness to asthma therapy has to be considered. An algorithm to guide the diagnostic and therapeutic steps in such cases is presented.

Peak flow meters do not allow to perform lung function analysis in the private practice. However, they can be used for the diagnosis of reversible airway obstruction, to search for exacerbation factors in asthma, and to monitor drug therapy in chronic asthma. Peak flow measurements provide the means for self-assessment and self-management of asthma by the patients themselves allowing treatment to be optimized and guaranteeing a better quality of life. The plotting of daily pre- and post-bronchodilator peak flow values enables the patient to understand the pathophysiologic changes in his respiratory tract. Therapeutic implications are easily recognized and can be performed without delay by the patient himself on the basis of the so-called "traffic light system".

Aspirin desensitization is a valuable treatment for aspirin-sensitive sinusitis. We present a case where long-term desensitization failed. While undergoing desensitization, our patient had prolonged severe asthmatic reactions and therefore received high intravenous doses of prednisone. We hypothesize that high steroid doses administered at the time of desensitization may have raised the threshold of intolerance to a point where the administered aspirin doses were tolerated. Consequently, symptoms of intolerance subsided during the procedure. Subsequent tapering down of the daily prednisone dose caused a re-emergence of the symptoms of intolerance, apparently due to a decrease in the intolerance threshold.

Despite the introduction of new and potent antiasthmatic drugs, a minority of asthma patients, remains without response to therapy. Some of the patients with asthma refractory to therapy actually do not have asthma at all, but suffer from another syndrome mimicking asthma. Asthma may also exist in combination with a syndrome mimicking asthma (e.g. vocal cord dysfunction). Patients may then get treated with high doses of corticosteroids unnecessarily, because the symptoms due to vocal cord dysfunction are misinterpreted as being asthmatic. Sometimes asthma is complicated by an independent factor (e.g. gastroesophageal reflux), which does not respond to antiasthmatic drugs. In all cases of asthma being unresponsive to therapy, the diagnosis of asthma must be questioned, and other complicating factors need to be excluded. The patient's compliance should be encouraged, and correct handling of modern inhalation devices has to be monitored. Patients with refractory asthma should also undergo flexible bronchoscopy to exclude morphologic changes of the bronchial system and to obtain mucosal biopsies.

Up to 10% of all asthmatics are intolerant to aspirin reacting with bronchospasm after intake of this drug. The triad aspirin-intolerance, glucocorticoid-dependent intrinsic asthma and nasal polyps is common in these patients. The reaction to aspirin is not mediated by IgE. Cross-intolerance is observed with all non-steroidal antiinflammatory drugs inhibiting the enzyme cyclooxygenase. If intolerance to aspirin is suspected such drugs have to be strictly avoided. Paracetamol is the alternative in most instances. Only rarely an adaptive desensitization with acetylsalicylic acid is indicated. This method may help to overcome the intolerance. Non-acetylated salicylates occurring also in some foods, preservatives, and food dyes must not generally be avoided in aspirin-induced asthma.

In conditions associated with stimulation of cellular immunity and enhanced macrophage activity, for example, in viral infections, neopterin is elevated. Acute exacerbations of bronchial asthma--in particular in the case of intrinsic asthma--are frequently precipitated by viral infections of the upper airways. In both extrinsic and intrinsic asthma, neopterin is normal in the stable phases. In the exacerbation phase with signs of infection of the upper airways, however, neopterin in significantly elevated both in the serum and in the urine. In contrast, during and following positive inhalative provocation testing with histamine, allergens and aspirin, no increase in neopterin is to be observed.

Although treatment comprising a combination of methylprednisolone (MP) and troleandomycin (TAO) has been employed to treat cases of severe bronchial asthma requiring high doses of corticosteroids, for about 20 years, now, it has always been associated with major adverse reactions (1). A new protocol avoids these adverse effects by a rapid reduction in the dose of MP to alternating administrations and low TAO dosage (250 mg). Nineteen patients were treated using this protocol, 16 of whom for more than two months (maximum 21, minimum 4 months). Three patients were taken out of the study as early non-responders in the initial phase. Five patients must be considered to be late non-responders, or were discharged from the study on account of pathological liver parameters. In 8 patients who showed good tolerance, an appreciable reduction in the dose of steroids, with stabilisation of the asthma, was observed.

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)