2018 GINA Severe Asthma Pocket Guide: Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients

GINA has added an important addition to the resources that we offer to assist practitioners treating patients with asthma. A new Pocket Guide, “Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients” is now available on the GINA website, www.ginasthma.org. Embracing the issue of severe asthma was a critical goal for the GINA Board of Directors and Science Committee, as their mission remains focused on maximizing benefit for patients with asthma whilst minimizing healthcare provider burden.

Prof. Helen Reddel, Chair of the GINA Science Committee and a research leader at the Woolcock Institute of Medical Research in Sydney, Australia, stated “Difficult-to-treat and severe asthma are high priority issues because of the physical, emotional and financial burden for patients and their families, and the impact on primary and specialist healthcare systems. Clinicians in both low and high income countries need practical advice about how to assess and treat patients for whom conventional asthma therapies don’t seem to be working, and about how treatment strategies, including biologic therapies if available, can be implemented into patient care.”
The need for a practical resource addressing severe asthma was made apparent to the GINA Science Committee and Board of Directors from responses to a survey of members of the GINA Assembly, which is a group of physician volunteers around the world who actively disseminate GINA strategy in their respective countries. Two particular needs identified were (1) at what point should a patient be referred to a specialist, and (2) guidance for biologic therapies.

THE GOALS OF THE POCKET GUIDE ARE STATED ON PAGE 4:

The goal of this Pocket Guide is to provide a practical summary for health professionals about how to identify, assess and manage difficult-to-treat and severe asthma in adolescents and adults. It is intended for use by general practitioners (GPs, primary care physicians), pulmonary specialists and other health professionals involved in the management of people with asthma.

The recommendations in this Pocket Guide were based on evidence where good quality systematic reviews or randomized controlled trials or, lacking these, robust observational data, were available, and on consensus by expert clinicians and researchers, where not. Development of the Pocket Guide and decision tree included extensive collaboration with experts in human-centered design to enhance the utility of these resources for end-users. This means translating existing high level lowcharts and text-based information to a more detailed visual format, and applying information architecture and diagramming principles.

2019 COPD GOLD Guidelines launched on World COPD Day

World COPD Day is organized by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in collaboration with health care professionals and COPD patient groups throughout the world.
Its aim is to raise awareness about chronic obstructive pulmonary disease (COPD) and improve COPD care throughout the world.
Please join us in showing your support online using #WorldCOPDDay and #COPDDay to shed light on critical issues surrounding COPD and lung health. 

2019 GOLD Reports are available now on official website: 

https://goldcopd.org/gold-reports/

Chronic Obstructive Pulmonary Disease and Stroke (Free full text from Journal of COPD 2018)

Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the world and its incidence and prevalence is on the rise. It is evident that COPD is linked to cardiovascular disease. In the last years, several studies demonstrated that COPD may also be a risk factor for stroke, another major cause of death worldwide. 

Taking in consideration that COPD has multiple comorbidities it is hard to say whether COPD is an independent risk factor for stroke or it is due to confounding effect. This review is aimed to discuss current data on COPD and stroke, potential links, therapy, and prevention. Current data suggest that COPD may increase the risk of hemorrhagic stroke. The incidence of other stroke subtypes may also be increased in COPD or may be due to confounding effect. However, COPD patients who have stroke are at risk for pulmonary and extrapulmonary complications. We conclude that more studies are needed to further clarify the links between COPD and stroke. The management of COPD as well as the use of prevention therapy is essential to decrease the risk for stroke and should be at special attention in pulmonary medicine and neurology.

First 50 free online copies:

https://www.tandfonline.com/eprint/pRdiFwmv3BetmbMjk7zQ/full

2018 Update of Asthma Guidelines launched on World Asthma Day 2018

Today marks the 20th annual #WorldAsthmaDay!

The 2018 update of the Global Strategy for Asthma Management and Prevention incorporates new scientific information about asthma based on a review of recent scientific literature by an international panel of experts on the GINA Science Committee. This comprehensive and practical resource about one of the most common chronic lung diseases worldwide contains extensive citations from the scientific literature and forms the basis for other GINA documents and programs.

Evidence-Based Inhaler Therapy for COPD in 2018

See the winner of the 2018 Best of ATS Video Lecture Series: Penn PET Project: Evidence-Based Inhaler Therapy for #COPD

Triple versus Dual Inhaler Therapy in Patients with COPD - IMPACT Trial can change COPD Guidelines in 2019

The Informing the Pathway of COPD Treatment (IMPACT) trial, now reported in the The New England Journal of Medicine, aims to fill this gap with a report on the effectiveness of LAMA–LABA–inhaled glucocorticoid treatment, contained in a single inhaler, in COPD.

Background

The benefits of triple therapy for chronic obstructive pulmonary disease (COPD) with an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β₂-agonist (LABA), as compared with dual therapy (either inhaled glucocorticoid–LABA or LAMA–LABA), are uncertain.

Methods

In this randomized trial involving 10,355 patients with COPD, we compared 52 weeks of a once-daily combination of fluticasone furoate (an inhaled glucocorticoid) at a dose of 100 μg, umeclidinium (a LAMA) at a dose of 62.5 μg, and vilanterol (a LABA) at a dose of 25 μg (triple therapy) with fluticasone furoate–vilanterol (at doses of 100 μg and 25 μg, respectively) and umeclidinium–vilanterol (at doses of 62.5 μg and 25 μg, respectively). Each regimen was administered in a single Ellipta inhaler. The primary outcome was the annual rate of moderate or severe COPD exacerbations during treatment.

Results

The rate of moderate or severe exacerbations in the triple-therapy group was 0.91 per year, as compared with 1.07 per year in the fluticasone furoate–vilanterol group (rate ratio with triple therapy, 0.85; 95% confidence interval [CI], 0.80 to 0.90; 15% difference; P<0.001) and 1.21 per year in the umeclidinium–vilanterol group (rate ratio with triple therapy, 0.75; 95% CI, 0.70 to 0.81; 25% difference; P<0.001). The annual rate of severe exacerbations resulting in hospitalization in the triple-therapy group was 0.13, as compared with 0.19 in the umeclidinium–vilanterol group (rate ratio, 0.66; 95% CI, 0.56 to 0.78; 34% difference; P<0.001). There was a higher incidence of pneumonia in the inhaled-glucocorticoid groups than in the umeclidinium–vilanterol group, and the risk of clinician-diagnosed pneumonia was significantly higher with triple therapy than with umeclidinium–vilanterol, as assessed in a time-to-first-event analysis (hazard ratio, 1.53; 95% CI, 1.22 to 1.92; P<0.001).

Conclusions

Triple therapy with fluticasone furoate, umeclidinium, and vilanterol resulted in a lower rate of moderate or severe COPD exacerbations than fluticasone furoate–vilanterol or umeclidinium–vilanterol in this population. Triple therapy also resulted in a lower rate of hospitalization due to COPD than umeclidinium–vilanterol.

full text:

http://www.nejm.org/doi/full/10.1056/NEJMoa1713901

Higher cigarette prices would help millions avoid poor health and extreme poverty

According to a study published in the these days in BMJ, a significant increase in prices of cigarette would aid millions of people at the global level to avoid poor health and extreme poverty.
Objective To examine the impact of a 50% increase in market prices of cigarettes on health, poverty, and financial protection.

Design Compartmental model study.

Setting 13 middle income countries, totalling two billion men.

Participants 500 million male smokers.

Main outcome measures Life years gained, averted treatment costs, number of men avoiding catastrophic healthcare expenditures and poverty, and additional tax revenue by income group.

Results A 50% increase in cigarette prices would lead to about 450 million years of life gained across the 13 countries from smoking cessation, with half of these in China. Across all countries, men in the bottom income group (poorest 20% of the population) would gain 6.7 times more life years than men in the top income group (richest 20% of the population; 155 v 23 million). The average life years gained from cessation for each smoker in the bottom income group was 5.1 times that of the top group (1.46 v 0.23 years). Of the $157bn (£113bn; €127bn) in averted treatment costs, the bottom income group would avert 4.6 times more costs than the top income group ($46bn v $10bn). About 15.5 million men would avoid catastrophic health expenditures in a subset of seven countries without universal health coverage. As result, 8.8 million men, half of them in the bottom income group, would avoid falling below the World Bank definition of extreme poverty. These 8.8 million men constitute 2.4% of people living in extreme poverty in these countries. In contrast, the top income group would pay twice as much as the bottom income group of the $122bn additional tax collected. Overall, the bottom income group would get 31% of the life years saved and 29% each of the averted disease costs and averted catastrophic health expenditures, while paying only 10% of the additional taxes.

Conclusions Higher prices of cigarettes provide more health and financial gains to the poorest 20% than to the richest 20% of the population. Higher excise taxes support the targets of the sustainable development goals on non-communicable diseases and poverty, and provides financial protection against illness.

What is already known on this topic

• Higher excise taxes on tobacco are essential to reach the sustainable development goals to reduce mortality from non-communicable diseases by one third by 2030
• Low income groups are more responsive to price increases than high income groups
• There are few published studies of the distributional impact of higher tobacco taxes on health and financial outcomes

What this study adds

• Despite differences in socioeconomic class and health finance arrangements a 50% increase in tobacco prices strongly favours those in the bottom income group for life years saved, out-of-pocket expenses from tobacco attributable treatment costs averted, and avoidance of catastrophic health expenditures or poverty
• Higher tobacco excise taxes are a powerful but generally underused tool by most governments to reduce expenditures on treatment of diseases that are a major cause of income poverty
• In 13 middle income countries studied, around 450 million life years would be saved from higher excise taxes, contributing substantially to the target of the sustainable development goals of a one third reduction in mortality from non-communicable diseases at ages 30-69 by 2030

Full text