Asthma Association

Background: Hereditary angioedema (HAE) is a rare, potentially fatal genetic disorder characterized by unpredictable attacks of bodily swelling that substantially impair patients' quality of life (QoL). Lanadelumab is approved for long-term prophylaxis (LTP) in patients with HAE; however, there are limited real-world data that compare lanadelumab with other treatments to guide patient care. Objective: The objective was to describe real-world QoL and related outcomes of patients with HAE who received lanadelumab versus other LTP. Methods: Data were drawn from a real-world, cross-sectional survey of physicians and their consulting patients with HAE in the United States from January 2023 to January 2024. Physician-reported attack and disease severity, pain, fatigue, QoL, and patient-reported outcomes were compared among patients receiving lanadelumab or other LTP. Results: Physicians reported data on 86 patients treated with lanadelumab and 84 treated with other LTP. A statistically significantly higher proportion of patients receiving lanadelumab had no chronic pain (58.1%) and no chronic fatigue (51.2%) at the time of the survey than those receiving other LTP (38.1% [p = 0.0023] and 34.9% [p = 0.0037], respectively). More patients receiving lanadelumab had "very good" physician-reported QoL and less patient-reported QoL impairment at the time of the survey compared with those receiving other LTP (p = 0.0102). A higher proportion of patients receiving lanadelumab compared with other LTP reported complete satisfaction overall with their treatment (30.2% versus 17.9%, respectively; p = 0.0144) and complete satisfaction with the efficacy of their treatment (44.2% versus 11.9%, respectively; p < 0.0001). Conclusion: In this real-world study, physicians reported a higher proportion of patients receiving lanadelumab had no chronic pain or fatigue compared with those receiving other LTP. Both physicians and patients reported higher QoL in those receiving lanadelumab. Continued real-world research in patients with HAE to further assess the effect of lanadelumab on QoL will help guide patient care.

<bold>Background:</bold> Oral steroids are still regularly used for treatment of patients with severe asthma. Still there is scarce data on the differences between severe asthma patients on OCS long term therapy compared to patients without regular OCS treatment. <bold>Methods:</bold> Data from 3134 patients with severe asthma from the German Asthma Net's registry were evaluated and 977 patients with long term OCS therapy (OCS group) and 2157 patients without OCS (nonOCS) were compared. <bold>Results:</bold> There were no significant differences in BMI, asthma duration, or smoking habits between the two groups. Patients in the OCS group received a median dose of 10 mg prednisolone and were more symptomatic and experienced significantly more exacerbations compared to nonOCS patients. Asthma control was poorer in the OCS group compared to nonOCS. In addition, OCS group patients had lower median FEV₁, Tiffeneau index, and higher residual volume compared to nonOCS. Prevalence of chronic sinusitis was higher in OCS group (52% vs. 41%, p<0.0001). In addition, OCS group patients exhibited higher FeNO levels (55 ppb vs. 46 ppb, p=0.0009), whereas eosinophil counts were not different and IgE levels tended to be lower. nonOCS patients were more likely to have allergic asthma compared to OCS group patients. OCS group patients received higher doses of ICS (BDP 1400 µg vs. 1000 µg, p<0.0001). Treatment with biologic was equally common in both groups. <bold>Conclusion:</bold> There are differences between OCS group and nonOCS. OCS group patients exhibit more severe disease characteristics and poorer asthma control. These findings highlight the need for optimized treatment strategies in this group.

ABSTRACTBackgroundBotulinum neurotoxin A (BoNT‐A) is recommended for the treatment of cervical dystonia (CD), spasticity, and blepharospasm. Some patients treated with BoNT‐A have been reported to develop neutralizing antibodies (NAbs) against BoNT‐A, which may result in reduced efficacy and, in some cases, secondary treatment failure (STF). Our aim was to investigate the incidence of STF and NAb positivity after treatment with one of three commercially‐available BoNT‐A formulations.MethodsA systematic review and meta‐analysis of STF and/or NAb positivity after treatment with abobotulinumtoxinA, incobotulinumtoxinA, or onabotulinumtoxinA in patients with CD, spasticity, or blepharospasm was conducted using PubMed, Embase, and Google Scholar.ResultsTwenty‐nine unique studies reported in 29 publications assessed NAb positivity and were included. The meta‐analysis showed that the proportions of patients developing STF were significantly higher after treatment with abobotulinumtoxinA or onabotulinumtoxinA than with incobotulinumtoxinA for CD or spasticity. Depending on the antibody test used, the proportions of patients developing NAbs were also significantly higher after treatment with abobotulinumtoxinA or onabotulinumtoxinA than with incobotulinumtoxinA for CD or spasticity. When data for all indications were pooled, proportions of NAb‐positive patients were numerically higher with increasing mean doses of abobotulinumtoxinA or onabotulinumtoxinA. No patients treated exclusively with incobotulinumtoxinA were found to have developed immunogenic STF or persistent NAbs.ConclusionsThe risk of developing STF and NAbs appears to vary with indication and BoNT‐A formulation. When the efficacy and safety of formulations are comparable, incobotulinumtoxinA may be recommended to avoid developing STF and immunogenicity, particularly for patients requiring higher doses and repeated treatments.

SummaryBackground and ObjectivesSystemic treatment of pregnant/breastfeeding atopic dermatitis (AD) patients is challenging due to limited safety data. We explored treatment practices with systemic agents, including the guideline‐recommended cyclosporine as the first systemic choice as well as emerging therapies, in this vulnerable population.Patients and MethodsThe Global Allergy and Asthma Excellence Network (GA2LEN) ADCARE initiative collected data from physicians worldwide who treat pregnant women with AD. Physicians completed an electronic questionnaire on the use of systemic agents in pregnant/breastfeeding AD patients.Results103 physicians from 32 countries completed the survey, primarily dermatologists (n = 48) or allergologists (n = 43). Antihistamines were the systemic drug most often considered to be used during pregnancy/breastfeeding (n = 73/81, 90.1%), with fewer physicians considering the use of systemic agents for the first trimester compared to later stages of pregnancy. For acute flares, systemic corticosteroids (n = 34/80, 42.5%) were preferred, followed by biologics and antihistamines (each n = 15/80, 18.8%). Although the guideline‐recommended cyclosporine is sometimes considered for AD during pregnancy (n = 38/81, 46.9%), it was rarely considered as the preferred drug by physicians (n = 1/80, 1.25%).ConclusionsOur study shows a misalignment between guideline recommendations and prescription patterns and highlights an unmet need for knowing and using the existing recommendations.

Background: The profession of respiratory care has not seen an increase in minimum education requirements in over 40 years; however, the roles and responsibilities of providers have dramatically increased. Although degree advancement (DA) opportunities have increased exponentially to support respiratory therapists (RTs) pursue higher levels of education, the number of RTs who pursue a baccalaureate-level degree remain a small percentage of practitioners, indicating that barriers to advancement exist. The purpose of this study was to identify the perceptions and barriers to DA among active RTs. Method: This cross-sectional study utilized a web-based survey to glean descriptive and qualitative information related to the study questions. The survey was conducted using Qualtrics software and released via a social media platform with a specific audience of over 60,000 practicing RTs. Results: Responses from 785 RTs were included in the final analysis. Relevant findings identified variables such as age, time in the field, likelihood and rate of tuition reimbursement, and compensation post completion of DA all represented perceived barriers to DA. Qualitative analysis of open-ended questions revealed four predominant themes in the perception of DA in respiratory care. These themes included the perception of irrelevance, insurmountable alterations to lifestyle, cost of DA, and age in the context of benefits to DA. Conclusions: Findings support the need for institutions to encourage RTs who are concerned about the cost to return for DA. Other factors such as age and years of experience also play large roles in an individual's choice to return for DA. However, individuals who found financial barriers were more likely to signify a positive indication to return for DA; therefore, it is vital to provide a level of tuition reimbursement to minimize this barrier.