New TLD Indication: Asthma RELIEF-1 Study. Nick ten Hacken, MD Study Co-Principal Investigator

Size: px
Start display at page:

Download "New TLD Indication: Asthma RELIEF-1 Study. Nick ten Hacken, MD Study Co-Principal Investigator"

Transcription

1 New TLD Indication: Asthma RELIEF-1 Study Nick ten Hacken, MD Study Co-Principal Investigator

2 The Burden of Asthma WW Adult Asthma Prevalence Million Mild/Intermittent Million (70%) Moderate 39.2 Million (17%) Severe less refractory 17.9 Million (8%) Severe Refractory 11.5 Million (5%) Asthma control is suboptimal and prevalence is increasing worldwide 80% of costs are driven by 20% of asthma population WW 250,000 lives lost annually Sources: Global asthma prevalence in adults: world health survey. BMC Public Health 2012, 12:204; Global burden of asthma: GINA report. Allergy 2004: 59: ; Costs of asthma in the United States: J Allergy Clin Immunol 2011 Jan; 127(1):145-52; The Global Asthma Report 2011, ISAAC; Global Asthma Network 2014; AAAAI Asthma Statistics

3 Is TLD also Effective in Asthma? Targeted Anatomically to only the lung To a depth where the nerves are located Denervation Disrupt parasympathetic nerves to decrease release of acetylcholine Lung Decrease smooth muscle tone Decrease mucus production 3

4 Is TLD also Effective in Asthma? Asthma and COPD are look a likes (Dutch hypothesis) - Both have increased cholinergic tone - Suggestions of a cholinergic phenotype Surgical vagotomy improves airway obstruction in severe asthma Anticholinergic inhalers reduce airway obstruction and protect against a specific stimuli in asthma LAMA reduces inflammation and remodeling in animal studies. 4

5 Liccardi, Respir Med 2016; 117:

6 Growing Role of LAMAs in Asthma 6

7 Impact of LAMAs in severe Asthma Tiotropium on top of corticosteroids + LABA Tiotropium on top of corticosteroids + LABA Kerstjens, JACI 2011; 128:

8 Impact of LAMAs in Severe Asthma Tiotropium on top of corticosteroids + LABA (PEF) Rodrigo, Chest 2015; 147:

9 Impact of LAMAs on Severe Asthma Tiotropium on top of corticosteroids + LABA Kerstjens, NEJM 2012;367:

10 GINA Adds Tiotropium as Other Controller Option STEP 5 PREFERRED CONTROLLER CHOICE Other controller options RELIEVER STEP 1 STEP 2 Consider low dose ICS Low dose ICS Leukotriene receptor antagonists (LTRA) Low dose theophylline* As-needed short-acting beta 2 -agonist (SABA) STEP 3 Low dose ICS/LABA** Med/high dose ICS Low dose ICS+LTRA (or + theoph*) STEP 4 Med/high ICS/LABA Add tiotropium* High dose ICS + LTRA (or + theoph*) As-needed SABA or low dose ICS/formoterol # Refer for add-on treatment e.g. tiotropium,* omalizumab, mepolizumab* Add low dose OCS 10

11 RELIEF-1 CLINICAL TRIAL

12 A prospective, multicenter, single-arm study EvaLuating the safety and feasibility of Targeted Lung Denervation (TLD) for the treatment of severe asthma

13 First-in-Human Protocol Design Objec?ve Study Overview (NCT# ) Prospec3ve, mul3center, single-arm Evaluate safety & technical feasibility of TLD in severe uncontrolled asthma Primary Endpoint Major Secondary Endpoints Pa?ent number 30 Freedom from device related therapeu3c interven3ons AQLQ & ACQ Adverse events/exacerba3ons Peak Expiratory Flow Methacholine Challenge Medica3on u3liza3on Inflammatory markers (brush, wash & biopsy) Follow-up 3 years 3 month airway inspec3on/marker collec3on 1 year CT Principal Inves?gators Pallav Shah, UK Nick ten Hacken, NL 13

14 Trial Locations Site Hospital Site Principal Investigator Heidelberg, DE Thoraxklinik Heidelberg Felix Herth Grenoble, FR CHU de Grenoble Christophe Pison Groningen, NL University Medical Centre Groningen Nick ten Hacken Amsterdam, NL Academisch Medisch Centrum (AMC) Peter Bonta London, UK Royal Brompton & Harefield NHS Trust Pallav Shah Glasgow, UK Queen Elizabeth University Hospital Steve Bicknell Nottingham, UK NUH Nottingham City Hospital Dominick Shaw Southampton, UK Southampton General Hospital Paddy Dennison 14

15 Study Criteria Major Inclusion! 21 to 65 years old! Diagnosis of severe asthma as defined by GINA and taking meds! Post-BD FEV 1 60% on stable 4 week medication run-in! At lease 2 days of asthma symptoms during run-in! Non-smoker for at least 6 months Major Exclusion x Intensive care for asthma in last 2 years x 3 respiratory infections or asthma hospitalizations in last year x Steroid burst or change in maintenance medications in last 6 weeks x Prior lung or chest procedure x Other chronic disorder with asthma-like symptoms 15

16 Projected Study Timeline 2017 Enrollment Start 2018 Enrollment Complete Early safety analysis Inflammatory marker assessment 2019 Longer term safety analysis 16

17 Thank you

Global Initiative for Asthma (GINA) What s new in GINA 2017?

Global Initiative for Asthma (GINA) What s new in GINA 2017? Global Initiative for Asthma (GINA) GINA Global Strategy for Asthma Management and Prevention Asthma-COPD overlap The word syndrome has been removed from the previous term asthma-copd overlap syndrome

More information

Global Initiative for Asthma (GINA) What s new in GINA 2015?

Global Initiative for Asthma (GINA) What s new in GINA 2015? Global Initiative for Asthma (GINA) What s new in GINA 2015? GINA Global Strategy for Asthma Management and Prevention What s new in GINA 2015 (1) Add-on tiotropium by soft-mist inhaler is a new other

More information

Improving Outcomes in the Management & Treatment of Asthma. April 21, Spring Managed Care Forum

Improving Outcomes in the Management & Treatment of Asthma. April 21, Spring Managed Care Forum Improving Outcomes in the Management & Treatment of Asthma April 21, 2016 2016 Spring Managed Care Forum David M. Mannino, M.D. Professor Department of Preventive Medicine and Environmental Health University

More information

Global Initiative for Asthma (GINA) What s new in GINA 2016?

Global Initiative for Asthma (GINA) What s new in GINA 2016? Global Initiative for Asthma (GINA) What s new in GINA 2016? GINA Global Strategy for Asthma Management and Prevention GINA: A Brief History Established in 1993 Collaboration between NHLBI and WHO Multiple

More information

Who can get most benefit

Who can get most benefit Who can get most benefit from tiotropium in asthma? Y-M. Oh Asan Medical Center Univ. of Ulsan College of Medicine Seoul, Korea Tiotripium for Asthma 1 New in GINA 2015 Add-on tiotropium by soft-mist inhaler

More information

Biologics in asthma Are we turning the corner? Roland Buhl Pulmonary Department Mainz University Hospital

Biologics in asthma Are we turning the corner? Roland Buhl Pulmonary Department Mainz University Hospital Biologics in asthma Are we turning the corner? Roland Buhl Pulmonary Department Mainz University Hospital Biologics in asthma - are we turning the corner? Allergic asthma anti - IgE Allergic airway inflammation

More information

Traiter l asthme sévère par le phénotype. Dr. Alain Michils CUB-Hôpital Erasme

Traiter l asthme sévère par le phénotype. Dr. Alain Michils CUB-Hôpital Erasme Traiter l asthme sévère par le phénotype Dr. Alain Michils CUB-Hôpital Erasme Darwin 25 mars 2017 Step 5 treatment (GINA 2016) STEP 5 STEP 4 PREFERRED CONTROLLER CHOICE STEP 1 STEP 2 Low dose ICS STEP

More information

Biologic Agents in the treatment of Severe Asthma

Biologic Agents in the treatment of Severe Asthma Biologic Agents in the treatment of Severe Asthma Daniel L Maxwell, D.O., FACOI, FAASM Clinical Assistant Professor of Medicine Michigan State University College of Osteopathic Medicine College of Human

More information

Asma e BPCO: le strategie terapeutiche

Asma e BPCO: le strategie terapeutiche Asma e BPCO: le strategie terapeutiche Dott. Marco Contoli ctm@unife.it Sezione di Medicina Interna e Cardio-Respiratoria Dipartimento di Scienze Mediche Università di Ferrara COPD Definition Chronic Obstructive

More information

Severe Asthma & Exacerbations: Dawn of a New Era?

Severe Asthma & Exacerbations: Dawn of a New Era? Severe Asthma & Exacerbations: Dawn of a New Era? Christophe von Garnier Department of Pulmonary Medicine Syndromes, Phenotypes & Endotypes Asthma Syndrome Variable symptoms, expiratory airflow limitation,

More information

Difficult Asthma Assessment: A systematic approach

Difficult Asthma Assessment: A systematic approach Difficult Asthma Assessment: A systematic approach Dr Naghmeh Radhakrishna Respiratory, Sleep & Allergy Physician Allergy, Asthma & Clinical Immunology Service The Alfred Hospital Melbourne, Australia

More information

Asthma Therapy 2017 JOSHUA S. JACOBS, M.D.

Asthma Therapy 2017 JOSHUA S. JACOBS, M.D. Asthma Therapy 2017 JOSHUA S. JACOBS, M.D. BACKGROUND-PREVALENCE Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals Prevalence is increasing

More information

PFT s / 2017 Pulmonary Update. Eric S. Papierniak, DO University of Florida NF/SG VHA

PFT s / 2017 Pulmonary Update. Eric S. Papierniak, DO University of Florida NF/SG VHA PFT s / 2017 Pulmonary Update Eric S. Papierniak, DO University of Florida NF/SG VHA Outline Overview of pulmonary function testing Uses/indications/limitations Technical aspects Basics of interpretation

More information

GINA. At-A-Glance Asthma Management Reference. for adults, adolescents and children 6 11 years. Updated 2017

GINA. At-A-Glance Asthma Management Reference. for adults, adolescents and children 6 11 years. Updated 2017 GINA At-A-Glance Asthma Management Reference for adults, adolescents and children 6 11 years Updated 2017 This resource should be used in conjunction with the Global Strategy for Asthma Management and

More information

Do We Need Biologics in Pediatric Asthma Management?

Do We Need Biologics in Pediatric Asthma Management? Do We Need Biologics in Pediatric Asthma Management? Ting Fan LEUNG, MBChB, MD, FRCPCH, FAAAAI Professor and Chairman Department of Paediatrics The Chinese University of Hong Kong Asthma and Allergy by

More information

#1 cause of school absenteeism in children 13 million missed days annually

#1 cause of school absenteeism in children 13 million missed days annually Asthma Update 2013 Jennifer W. McCallister, MD, FACP, FCCP Associate Professor Pulmonary & Critical Care Medicine The Ohio State University Wexner Medical Center Disclosures None 2 Objectives Review burden

More information

Learning the Asthma Guidelines by Case Studies

Learning the Asthma Guidelines by Case Studies Learning the Asthma Guidelines by Case Studies Timothy Craig, DO Professor of Medicine and Pediatrics Distinguished Educator Penn State University Hershey Medical Center Objectives 1. Learn the Asthma

More information

The Acute & Maintenance Treatment of Asthma via Aerosolized Medications

The Acute & Maintenance Treatment of Asthma via Aerosolized Medications The Acute & Maintenance Treatment of Asthma via Aerosolized Medications Douglas S. Gardenhire, EdD, RRT-NPS, FAARC Associate Professor and Chairman Department of Respiratory Therapy Objectives Define Asthma.

More information

CHALLENGES OF REAL LIFE ASTHMA MANAGEMENT. Dr Chris Lewis Respiratory Physician and Director of Prevocational Training Auckland District Health Board

CHALLENGES OF REAL LIFE ASTHMA MANAGEMENT. Dr Chris Lewis Respiratory Physician and Director of Prevocational Training Auckland District Health Board CHALLENGES OF REAL LIFE ASTHMA MANAGEMENT Dr Chris Lewis Respiratory Physician and Director of Prevocational Training Auckland District Health Board CONFLICT OF INTEREST Employee of Auckland District Health

More information

Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing

Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School

More information

Changing Epidemiology: Quick Facts 9/28/2018. During the year New Treatment Options for COPD: Phenotypes, Endotypes or Treatable Traits?

Changing Epidemiology: Quick Facts 9/28/2018. During the year New Treatment Options for COPD: Phenotypes, Endotypes or Treatable Traits? New Treatment Options for COPD: Phenotypes, Endotypes or Treatable Traits? Conflict of Interest Statement 2018 Speakers Bureau Astra Zeneca Boehringer Ingelheim Genentech Sunovion Ron Balkissoon MD DIH

More information

Long Term Care Formulary RS -29

Long Term Care Formulary RS -29 RESTRICTED USE Asthma/COPD Management 1 of 6 PROTOCOL: Asthma Glossary of Medication Acronyms: SABA: short-acting beta agonist (e.g. salbutamol) SABD: short-acting bronchodilator (e.g. ipratropium or SABA)

More information

Amanda Hess, MMS, PA-C President-Elect, AAPA-AAI Arizona Asthma and Allergy Institute Scottsdale, AZ

Amanda Hess, MMS, PA-C President-Elect, AAPA-AAI Arizona Asthma and Allergy Institute Scottsdale, AZ Amanda Hess, MMS, PA-C President-Elect, AAPA-AAI Arizona Asthma and Allergy Institute Scottsdale, AZ Financial Disclosures Advanced Practiced Advisory Board for Circassia Learning Objectives 1. Briefly

More information

Asthma Update A/Prof. John Abisheganaden. Senior Consultant, Dept Of Respiratory & Crit Care Medicine Tan Tock Seng Hospital

Asthma Update A/Prof. John Abisheganaden. Senior Consultant, Dept Of Respiratory & Crit Care Medicine Tan Tock Seng Hospital Asthma Update - 2013 A/Prof. John Abisheganaden Senior Consultant, Dept Of Respiratory & Crit Care Medicine Tan Tock Seng Hospital Asthma A complex syndrome Multifaceted disease Heterogeneous Genetic and

More information

Searching for Targets to Control Asthma

Searching for Targets to Control Asthma Searching for Targets to Control Asthma Timothy Craig Distinguished Educator Professor Medicine and Pediatrics Penn State University Hershey, PA, USA Inflammation and Remodeling in Asthma The most important

More information

Breakfast Session Prof Neil Barnes Professor of Respiratory Medicine London Chest Hospital & The Royal London Hospital United Kingdom

Breakfast Session Prof Neil Barnes Professor of Respiratory Medicine London Chest Hospital & The Royal London Hospital United Kingdom Breakfast Session Prof Neil Barnes Professor of Respiratory Medicine London Chest Hospital & The Royal London Hospital United Kingdom 2 BEYOND SYMPTOMS ADDRESSING FUTURE RISK IN ASTHMA South GP CME 2013,

More information

Endobronchial Thermoplasty

Endobronchial Thermoplasty Endobronchial Thermoplasty Michigan Society for Respiratory Care Monday, October 5, 2015 Cynthia Ray, MD, FCCP Senior Staff Physician Interventional Pulmonology Pulmonary and Critical Care Medicine Henry

More information

Endobronchial Thermoplasty

Endobronchial Thermoplasty Endobronchial Thermoplasty Asthma Education Day Thursday, October 30, 2014 Cynthia Ray, MD, FCCP Senior Staff Physician Interventional Pulmonology Pulmonary and Critical Care Medicine Henry Ford Hospital

More information

RESPIRATORY CARE IN GENERAL PRACTICE

RESPIRATORY CARE IN GENERAL PRACTICE RESPIRATORY CARE IN GENERAL PRACTICE Definitions of Asthma and COPD Asthma is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Xolair (omalizumab) Page 1 of 15 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Xolair (omalizumab) Prime Therapeutics will review Prior Authorization requests.

More information

HCT Medical Policy. Bronchial Thermoplasty. Policy # HCT113 Current Effective Date: 05/24/2016. Policy Statement. Overview

HCT Medical Policy. Bronchial Thermoplasty. Policy # HCT113 Current Effective Date: 05/24/2016. Policy Statement. Overview HCT Medical Policy Bronchial Thermoplasty Policy # HCT113 Current Effective Date: 05/24/2016 Medical Policies are developed by HealthyCT to assist in administering plan benefits and constitute neither

More information

Methacholine versus Mannitol Challenge in the Evaluation of Asthma Clinical applications of methacholine and mannitol challenges

Methacholine versus Mannitol Challenge in the Evaluation of Asthma Clinical applications of methacholine and mannitol challenges Methacholine versus Mannitol Challenge in the Evaluation of Asthma Clinical applications of methacholine and mannitol challenges AAAAI San Antonio Tx February 2013 Catherine Lemière MD, MSc Hôpital du

More information

INHALATION DRUG DELIVERY DEVICES: BRONCHODILATORS NATTAWAT NATPHOBSUK, MD

INHALATION DRUG DELIVERY DEVICES: BRONCHODILATORS NATTAWAT NATPHOBSUK, MD INHALATION DRUG DELIVERY DEVICES: BRONCHODILATORS NATTAWAT NATPHOBSUK, MD BACKGROUND SHORT-ACTING 2 -AGONISTS SHORT-ACTING 2 -AGONISTS (SABAS) USED EXTENSIVELY IN THE MANAGEMENT OF PULMONARY DISEASES SINCE

More information

COPD and Asthma Update. April 29 th, 2017 Rachel M Taliercio, DO Staff, Respiratory Institute

COPD and Asthma Update. April 29 th, 2017 Rachel M Taliercio, DO Staff, Respiratory Institute COPD and Asthma Update April 29 th, 2017 Rachel M Taliercio, DO Staff, Respiratory Institute What we ll be talking about COPD: diagnosis, management of stable COPD, COPD exacerbations Asthma: diagnosis,

More information

Treatment Responses. Ronald Dahl, Aarhus University Hospital, Denmark

Treatment Responses. Ronald Dahl, Aarhus University Hospital, Denmark Asthma and COPD: Are They a Spectrum Treatment Responses Ronald Dahl, Aarhus University Hospital, Denmark Pharmacological Treatments Bronchodilators Inhaled short-acting β -Agonist (rescue) Inhaled short-acting

More information

Bronchial Thermoplasty For Severe Persistent Asthma

Bronchial Thermoplasty For Severe Persistent Asthma Bronchial Thermoplasty For Severe Persistent Asthma Faisal Khan MD Center For Respiratory and Sleep Medicine Indiana Internal Medicine Consultants Franciscan Saint Francis hospital Agenda Burden of Severe

More information

LINEE GUIDA DELL ASMA: UP TO DATE

LINEE GUIDA DELL ASMA: UP TO DATE LINEE GUIDA DELL ASMA: UP TO DATE Azienda Ospedaliera Pisana Università degli Studi di Pisa Pierluigi Paggiaro GINA International Executive Committee, Chairman GINA ITaly Cardio-Thoracic and Vascular Department,

More information

Brooke L. Gildon, Pharm.D., BCPS, BCPPS, AE C

Brooke L. Gildon, Pharm.D., BCPS, BCPPS, AE C Brooke L. Gildon, Pharm.D., BCPS, BCPPS, AE C Associate Professor of Pharmacy Practice Southwestern Oklahoma State University College of Pharmacy Oklahoma Society of Health System Pharmacists Annual Meeting

More information

Putting NICE guidance into practice. Resource impact report: Asthma: diagnosis, monitoring and chronic asthma management (NG80)

Putting NICE guidance into practice. Resource impact report: Asthma: diagnosis, monitoring and chronic asthma management (NG80) Putting NICE guidance into practice Resource impact report: Asthma: diagnosis, monitoring and chronic asthma management (NG80) Published: November 2017 Summary This report focuses on the recommendations

More information

Phenotypes of asthma; implications for treatment. Medical Grand Rounds Feb 2018 Jim Martin MD DSc

Phenotypes of asthma; implications for treatment. Medical Grand Rounds Feb 2018 Jim Martin MD DSc Phenotypes of asthma; implications for treatment Medical Grand Rounds Feb 2018 Jim Martin MD DSc No conflicts to declare Objectives To understand the varied clinical forms of asthma To understand the pathobiologic

More information

12/18/2017. Disclosures. Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing

12/18/2017. Disclosures. Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School

More information

Optum Research Database Proportion of asthma patients with prescription fills for rescue and controller medications by year,

Optum Research Database Proportion of asthma patients with prescription fills for rescue and controller medications by year, ASTHMA CHART 1 Optum Research Database Proportion of asthma patients with prescription fills for rescue and controller medications by year, 215-216 7 6 5 4 3 2 1 1 Controller medication 1 Rescue medication

More information

Getting Asthma treatment right. Dr David Cremonesini Specialist Pediatrician American Hospital

Getting Asthma treatment right. Dr David Cremonesini Specialist Pediatrician American Hospital Getting Asthma treatment right Dr David Cremonesini Specialist Pediatrician American Hospital cdavid@ahdubai.com } Consultant Paediatrician from UK of 5.5 years } Speciality in Allergy / Asthma (PG Certificate)

More information

THE PROMISE OF NEW AND NOVEL DRUGS. Pyng Lee Respiratory & Critical Care Medicine National University Hospital

THE PROMISE OF NEW AND NOVEL DRUGS. Pyng Lee Respiratory & Critical Care Medicine National University Hospital THE PROMISE OF NEW AND NOVEL DRUGS Pyng Lee Respiratory & Critical Care Medicine National University Hospital Pyng_lee@nuhs.edu.sg Asthma Prevalence, Morbidity, Mortality 235 million suffer from asthma

More information

Greater Manchester Asthma Management Plan 2018 Inhaler therapy options for adult patients (18 and over) with asthma

Greater Manchester Asthma Management Plan 2018 Inhaler therapy options for adult patients (18 and over) with asthma Greater Manchester Asthma Management Plan 2018 Inhaler therapy options for adult patients (18 and over) with asthma Non-pharmacological options for ALL patients, consider at ALL stages Make sure diagnosis

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Xolair (omalizumab) Page 1 of 15 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Xolair (omalizumab) Prime Therapeutics will review Prior Authorization requests.

More information

Cynthia S. Kelly, M.D. Professor of Pediatrics Eastern Virginia Medical School Division Director Allergy Children s Hospital of The King s Daughters

Cynthia S. Kelly, M.D. Professor of Pediatrics Eastern Virginia Medical School Division Director Allergy Children s Hospital of The King s Daughters Cynthia S. Kelly, M.D. Professor of Pediatrics Eastern Virginia Medical School Division Director Allergy Children s Hospital of The King s Daughters Disclosures Speakers bureau of Novartis and Genentech

More information

Prof Neil Barnes. Respiratory and General Medicine London Chest Hospital and The Royal London Hospital

Prof Neil Barnes. Respiratory and General Medicine London Chest Hospital and The Royal London Hospital Prof Neil Barnes Respiratory and General Medicine London Chest Hospital and The Royal London Hospital ASTHMA: WHEN EVERYTHING FAILS WHAT DO YOU DO? South GP CME 2013, Dunedin Saturday 17 th August 2013

More information

DR REBECCA THOMAS CONSULTANT RESPIRATORY PHYSICIAN YORK DISTRICT HOSPITAL

DR REBECCA THOMAS CONSULTANT RESPIRATORY PHYSICIAN YORK DISTRICT HOSPITAL DR REBECCA THOMAS CONSULTANT RESPIRATORY PHYSICIAN YORK DISTRICT HOSPITAL Definition Guidelines contact complicated definitions Central to this is Presence of symptoms Variable airflow obstruction Diagnosis

More information

What s new in Asthma? Dr Alexandra Nanzer-Kelly Consultant Respiratory Physician Royal Brompton and Harefield Hospitals

What s new in Asthma? Dr Alexandra Nanzer-Kelly Consultant Respiratory Physician Royal Brompton and Harefield Hospitals What s new in Asthma? Dr Alexandra Nanzer-Kelly Consultant Respiratory Physician Royal Brompton and Harefield Hospitals Asthma is an inflammatory disease Relaxed smooth muscles Air trapped in alveoli Tightened

More information

BRONCHIAL THERMOPLASTY

BRONCHIAL THERMOPLASTY Review Article 155 BRONCHIAL THERMOPLASTY Prince James* and Richa Gupta* (Received on 4.5.2010; Accepted after revision on 5.9.2011) Summary: Even with the use of maximum pharmacological treatment, asthma

More information

aclidinium 322 micrograms inhalation powder (Eklira Genuair ) SMC No. (810/12) Almirall S.A.

aclidinium 322 micrograms inhalation powder (Eklira Genuair ) SMC No. (810/12) Almirall S.A. aclidinium 322 micrograms inhalation powder (Eklira Genuair ) SMC No. (810/12) Almirall S.A. 05 October 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and

More information

Asthma Upate 2018: What s New Since the 2007 Asthma Guidelines of NAEPP?

Asthma Upate 2018: What s New Since the 2007 Asthma Guidelines of NAEPP? 10:50-11:50am Asthma Update 2018: What s New Since the 2007 National Asthma Guidelines? SPEAKER Christopher H. Fanta, MD Disclosures The following relationships exist related to this presentation: Christopher

More information

WEBINAR. Difficult-to-treat and severe asthma: changing the paradigm

WEBINAR. Difficult-to-treat and severe asthma: changing the paradigm WEBINAR Difficult-to-treat and severe asthma: changing the paradigm A multidisciplinary discussion on new therapies, and how to identify and manage difficult-to-treat and severe asthma DIFFICULT-TO-TREAT

More information

CHRONIC OBSTRUCTIVE LUNG DISEASE (COPD), BRONCHIAL ASTHMA

CHRONIC OBSTRUCTIVE LUNG DISEASE (COPD), BRONCHIAL ASTHMA CHRONIC OBSTRUCTIVE LUNG DISEASE (COPD), BRONCHIAL ASTHMA GOLD GINA Chronic Obstructive Pulmonary Disease (COPD) COPD is currently the fourth leading cause of death in the world.1 COPD is projected to

More information

Meeting the Challenges of Asthma

Meeting the Challenges of Asthma Presenter Disclosure Information 11:05 11:45am Meeting the Challenge of Asthma SPEAKER Christopher Fanta, MD The following relationships exist related to this presentation: Christopher Fanta, MD: No financial

More information

Scottish Medicines Consortium

Scottish Medicines Consortium Scottish Medicines Consortium budesonide/formoterol 100/6, 200/6 turbohaler (Symbicort SMART ) No. (362/07) Astra Zeneca UK Limited 9 March 2007 (Issued May 2007) The Scottish Medicines Consortium (SMC)

More information

(Asthma) Diagnosis, monitoring and chronic asthma management

(Asthma) Diagnosis, monitoring and chronic asthma management Dubai Standards of Care 2018 (Asthma) Diagnosis, monitoring and chronic asthma management Preface Asthma is one of the most common problem dealt with in daily practice. In Dubai, the management of chronic

More information

Defining COPD. Georgina Grantham Community Respiratory Team Leader/ Respiratory Nurse Specialist

Defining COPD. Georgina Grantham Community Respiratory Team Leader/ Respiratory Nurse Specialist Defining COPD Georgina Grantham Community Respiratory Team Leader/ Respiratory Nurse Specialist Defining COPD Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease

More information

Doctor of Medicine. Alastair Stewart Dept. of Pharmacology 8 th Floor, Medical Building Rm. N802

Doctor of Medicine. Alastair Stewart Dept. of Pharmacology 8 th Floor, Medical Building Rm. N802 Doctor of Medicine Alastair Stewart Dept. of Pharmacology 8 th Floor, Medical Building Rm. N802 astew@unimelb.edu.au Drugs affecting airway structure and function 2 Objectives Understand and know the mechanism

More information

NG80. Asthma: diagnosis, monitoring and chronic asthma management (NG80)

NG80. Asthma: diagnosis, monitoring and chronic asthma management (NG80) Asthma: diagnosis, monitoring and chronic asthma management (NG80) NG80 NICE has checked the use of its content in this product and the sponsor has had no influence on the content of this booklet. NICE

More information

Clinical Implications of Asthma Phenotypes. Michael Schatz, MD, MS Department of Allergy

Clinical Implications of Asthma Phenotypes. Michael Schatz, MD, MS Department of Allergy Clinical Implications of Asthma Phenotypes Michael Schatz, MD, MS Department of Allergy Definition of Phenotype The observable properties of an organism that are produced by the interaction of the genotype

More information

Biologic Therapy in the Management of Asthma. Nabeel Farooqui, MD

Biologic Therapy in the Management of Asthma. Nabeel Farooqui, MD Biologic Therapy in the Management of Asthma Nabeel Farooqui, MD None Disclosures Objectives Define severe asthma phenotypes and endotypes Describe the role of biologics in asthma management Review pivotal

More information

Pulmonary and Critical Care Year in Review

Pulmonary and Critical Care Year in Review Pulmonary and Critical Care Year in Review Heath E Latham, MD Assistant Professor University of Kansas Dept of Internal Medicine Division of Pulmonary and Critical Care None Disclosure Lung Cancer Screening

More information

Cigna Drug and Biologic Coverage Policy

Cigna Drug and Biologic Coverage Policy Cigna Drug and Biologic Coverage Policy Subject Interleukin (IL)-5 Antagonists: Mepolizumab and Reslizumab Table of Contents Coverage Policy... 1 General Background... 3 Coding/Billing Information... 5

More information

COPD. Breathing Made Easier

COPD. Breathing Made Easier COPD Breathing Made Easier Catherine E. Cooke, PharmD, BCPS, PAHM Independent Consultant, PosiHleath Clinical Associate Professor, University of Maryland School of Pharmacy This program has been brought

More information

COPD: A Renewed Focus. Disclosures

COPD: A Renewed Focus. Disclosures COPD: A Renewed Focus Heath Latham, MD Assistant Professor Division of Pulmonary and Critical Care Medicine Disclosures No Business Interests No Consulting No Speakers Bureau No Off Label Use to Discuss

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Injectable Asthma Agents Page 1 of 18 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: See also: Injectable Asthma Agents Xolair (omalizumab) Prime Therapeutics will

More information

Asthma Update I have no professional or personal financial conflicts of interest to disclose.

Asthma Update I have no professional or personal financial conflicts of interest to disclose. Asthma Update 2018 Disclosures Jennifer W. McCallister, MD, FACP, FCCP Associate Professor Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical Center I have

More information

Asthma Update Jennifer W. McCallister, MD, FACP, FCCP

Asthma Update Jennifer W. McCallister, MD, FACP, FCCP Asthma Update 2018 Jennifer W. McCallister, MD, FACP, FCCP Associate Professor Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical Center Disclosures I have

More information

Treatment of Severe Asthma: Biologics to Bronchial Thermoplasty. Disclosures

Treatment of Severe Asthma: Biologics to Bronchial Thermoplasty. Disclosures Treatment of Severe Asthma: Biologics to Bronchial Thermoplasty Monica Kraft, M.D. Robert and Irene Flinn Professor of Medicine Chair, Department of Medicine Deputy Director, Asthma and Airway Disease

More information

Asthma training. Mike Levin Division of Asthma and Allergy Red Cross Hospital

Asthma training. Mike Levin Division of Asthma and Allergy Red Cross Hospital Asthma training Mike Levin Division of Asthma and Allergy Red Cross Hospital Introduction Physiology Diagnosis Severity Treatment Control Stage 3 of guidelines Acute asthma Drug delivery Conclusion Overview

More information

Lead team presentation: Roflumilast for treating chronic obstructive pulmonary disease [ID984]

Lead team presentation: Roflumilast for treating chronic obstructive pulmonary disease [ID984] Lead team presentation: Roflumilast for treating chronic obstructive pulmonary disease [ID984] 1 st Appraisal Committee meeting Background & Clinical Effectiveness John McMurray 11 th January 2016 For

More information

Step-down approach in chronic stable asthma: A comparison of reducing dose Inhaled Formoterol/ Budesonide with maintaining Inhaled Budesonide.

Step-down approach in chronic stable asthma: A comparison of reducing dose Inhaled Formoterol/ Budesonide with maintaining Inhaled Budesonide. Step-down approach in chronic stable asthma: A comparison of reducing dose Inhaled Formoterol/ Budesonide with maintaining Inhaled Budesonide. By: DR MOHD SHAMSUL AMRI Supervisor: Associate Professor Dr

More information

Bronchial asthma. MUDr. Mojmír Račanský Odd. Alergologie a klinické imunologie FNOL Ústav Imunologie LF UPOL

Bronchial asthma. MUDr. Mojmír Račanský Odd. Alergologie a klinické imunologie FNOL Ústav Imunologie LF UPOL Bronchial asthma MUDr. Mojmír Račanský Odd. Alergologie a klinické imunologie FNOL Ústav Imunologie LF UPOL DEFINITION ASTHMA BRONCHIALE = Asthma is a chronic inflammatory disorder of the airways in which

More information

The Pharmacist s Role in Managing Severe Asthma. This activity is supported by an educational grant from Genentech. Educational Objectives

The Pharmacist s Role in Managing Severe Asthma. This activity is supported by an educational grant from Genentech. Educational Objectives The Pharmacist s Role in Managing Severe Asthma Jennifer M. Malinowski, PharmD, RPh Assistant Dean, Academic Affairs Associate Professor, Pharmacy Practice Wilkes University School of Pharmacy Wilkes-Barre,

More information

Controversial Issues in the Management of Childhood Asthma: Insights from NIH Asthma Network Studies

Controversial Issues in the Management of Childhood Asthma: Insights from NIH Asthma Network Studies Controversial Issues in the Management of Childhood Asthma: Insights from NIH Asthma Network Studies Stanley J. Szefler, MD Helen Wohlberg and Herman Lambert Chair in Pharmacokinetics, Head, Pediatric

More information

The methodology behind GINA and EPR-3 medication recommendations: Stepwise treatment in asthma

The methodology behind GINA and EPR-3 medication recommendations: Stepwise treatment in asthma The methodology behind GINA and EPR-3 medication recommendations: Stepwise treatment in asthma Maureen George PhD RN AE-C FAAN Columbia University mg3656@cumc.columbia.edu Faculty Disclosures Maureen George

More information

Asthma and Its Many Unmet Needs: Directions for Novel Therapeutic Approaches

Asthma and Its Many Unmet Needs: Directions for Novel Therapeutic Approaches Asthma and Its Many Unmet Needs: Directions for Novel Therapeutic Approaches William W. Busse,, M.D. University of Wisconsin School of Medicine and Public Health Madison, WI, USA Disclosure Slide Employment

More information

Breathtaking science. Developing respiratory drugs to improve health and quality of life. H.C. Wainwright Global Life Sciences Conference April 2018

Breathtaking science. Developing respiratory drugs to improve health and quality of life. H.C. Wainwright Global Life Sciences Conference April 2018 Breathtaking science Developing respiratory drugs to improve health and quality of life H.C. Wainwright Global Life Sciences Conference April 2018 www.veronapharma.com Forward-Looking Statements This presentation

More information

The Journal Club: COPD Exacerbations

The Journal Club: COPD Exacerbations 252 The Journal Club: COPD Exacerbations Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation Journal Club The Journal Club: COPD Exacerbations Ron Balkissoon, MD, MSc, DIH, FRCPC 1 Abbreviations:

More information

Asthma Population Management: Identifying Persistent Asthma, Defining High Risk Asthma, and Measuring Quality of Asthma Care

Asthma Population Management: Identifying Persistent Asthma, Defining High Risk Asthma, and Measuring Quality of Asthma Care Asthma Population Management: Identifying Persistent Asthma, Defining High Risk Asthma, and Measuring Quality of Asthma Care Michael Schatz, MD, MS Allergy Department Kaiser Permanente, San Diego, CA Constructs

More information

Management of Severe Asthma Including Biologics and Bronchial Thermoplasty. Karen L. Gregory, DNP, APRN, CNS, RRT, AE-C, FAARC

Management of Severe Asthma Including Biologics and Bronchial Thermoplasty. Karen L. Gregory, DNP, APRN, CNS, RRT, AE-C, FAARC Management of Severe Asthma Including Biologics and Bronchial Thermoplasty Karen L. Gregory, DNP, APRN, CNS, RRT, AE-C, FAARC Disclosures ALK speaker Monaghan Medical Corporation speaker Novartis speaker

More information

SEVERE ASTHMA - EVIDENCE TABLES APPENDIX 1

SEVERE ASTHMA - EVIDENCE TABLES APPENDIX 1 Section 2: Biomarkers Biomarkers to predict response to biologic therapies and macrolides Summary of randomized controlled trials Cut-offs Cut-off selection Study Design N Drug Predictive ability to identify

More information

MANAGING ASTHMA. Nancy Davis, RRT, AE-C

MANAGING ASTHMA. Nancy Davis, RRT, AE-C MANAGING ASTHMA Nancy Davis, RRT, AE-C What is asthma? Asthma is a chronic respiratory disease characterized by episodes or attacks of inflammation and narrowing of small airways in response to asthma

More information

Disclosures. Learning Objective. Biological therapies. Biologics with action against 11/30/2011. Biologic Asthma Therapies and Individualized Medicine

Disclosures. Learning Objective. Biological therapies. Biologics with action against 11/30/2011. Biologic Asthma Therapies and Individualized Medicine Biologic Asthma Therapies and Individualized Medicine Mark S. Dykewicz, MD Director, Allergy & Immunology Fellowship Program Director Wake Forest University School of Medicine Winston-Salem, North Carolina

More information

Evaluation of Asthma Management in Middle EAst North Africa Adult population

Evaluation of Asthma Management in Middle EAst North Africa Adult population STUDY REPORT SUMMARY Evaluation of Asthma Management in Middle EAst North Africa Adult population Descriptive study on the management of asthma in an asthmatic Middle East Africa adult population Background/Rationale:

More information

Treatment. Assessing the outcome of interventions Traditionally, the effects of interventions have been assessed by measuring changes in the FEV 1

Treatment. Assessing the outcome of interventions Traditionally, the effects of interventions have been assessed by measuring changes in the FEV 1 58 COPD 59 The treatment of COPD includes drug therapy, surgery, exercise and counselling/psychological support. When managing COPD patients, it is particularly important to evaluate the social and family

More information

Position within the Organisation

Position within the Organisation ASTHMA TREATMENT GUIDELINES Document Description Document Type Service Application Guidelines All healthcare professionals(hcps) caring for patients with asthma Version 4.0 Ratification date September

More information

Asthma: Chronic Management. Yung-Yang Liu, MD Attending physician, Chest Department Taipei Veterans General Hospital April 26, 2015

Asthma: Chronic Management. Yung-Yang Liu, MD Attending physician, Chest Department Taipei Veterans General Hospital April 26, 2015 Asthma: Chronic Management Yung-Yang Liu, MD Attending physician, Chest Department Taipei Veterans General Hospital April 26, 2015 Global Strategy for Asthma Management and Prevention Evidence-based Implementation

More information

COPD, Asthma, Or Something In Between? Sharon R. Rosenberg Assistant Professor of Medicine Northwestern University December 4, 2013

COPD, Asthma, Or Something In Between? Sharon R. Rosenberg Assistant Professor of Medicine Northwestern University December 4, 2013 COPD, Asthma, Or Something In Between? Sharon R. Rosenberg Assistant Professor of Medicine Northwestern University December 4, 2013 None Disclosures Definitions Asthma Asthma is a chronic inflammatory

More information

Current Approaches to Asthma & COPD

Current Approaches to Asthma & COPD 10/11/18 Current Approaches to Asthma & COPD Lekshmi Santhosh, M.D. Assistant Professor, Pulm/Critical Care & Hosp Med Primary Care Medicine: Principles & Practice 10.11.2018 Revisiting the Dutch Hypothesis:

More information

Treating the right patient with the right

Treating the right patient with the right Asthma Getting it Right. Diagnosis, phenotypes, guidelines Treating the right patient with the right treatment Rama Vancheeswaran, FRCP, MSc Immunology, PhD Royal Free Hospital NHS Trust (Barnet site)

More information

Update on Pulmonary Diseases. Jeffrey Lessar, MD

Update on Pulmonary Diseases. Jeffrey Lessar, MD Update on Pulmonary Diseases Jeffrey Lessar, MD 1 No disclosures to make No conflicts 2 Goals Update on key changes in Pulmonary Therapy 3 Spirometry Spirometry FEV1- forced expiratory Volume in 1 Sec

More information

What is COPD? COPD Pharmacotherapy. COPD Mortality Is Increasing

What is COPD? COPD Pharmacotherapy. COPD Mortality Is Increasing COPD Pharmacotherapy Chronic Bronchitis What is COPD? 75% 17.5% Emphysema Laura C. Feemster, MD, MS Assistant Professor University of Washington Division of Pulmonary & Critical Care April 23,2015 COPD

More information

Guideline for the Diagnosis and Management of COPD

Guideline for the Diagnosis and Management of COPD Guideline for the Diagnosis and Management of COPD Introduction Chronic obstructive pulmonary disease (COPD) is a respiratory disorder largely caused by smoking. It is characterized by progressive, partially

More information

Subject: Bronchial Thermoplasty

Subject: Bronchial Thermoplasty Subject: Bronchial Thermoplasty Guidance Number: MCG-171 Revision Date(s): Original Effective Date: 6/12/14 Medical Coverage Guidance Approval Date: 6/12/14 PREFACE This Medical Guidance is intended to

More information

Asthma Update Eric S. Papierniak, DO Malcom Randall VAMC Assistant Professor of Medicine UF Div. of Pulmonary, Critical Care, and Sleep Medicine

Asthma Update Eric S. Papierniak, DO Malcom Randall VAMC Assistant Professor of Medicine UF Div. of Pulmonary, Critical Care, and Sleep Medicine Asthma Update 2014 Eric S. Papierniak, DO Malcom Randall VAMC Assistant Professor of Medicine UF Div. of Pulmonary, Critical Care, and Sleep Medicine Goals/Objectives Review of 2014 GINA guidelines Significant

More information

Asthma in Day to Day Practice

Asthma in Day to Day Practice Asthma in Day to Day Practice VIJAY.K.VANAM Financial relationships: Disclosures Employed at Mercy Medical Center, Mason City. Nonfinancial relationships: I receive no financial gain from any pharmaceutical

More information

Asthma Pathophysiology and Treatment. John R. Holcomb, M.D.

Asthma Pathophysiology and Treatment. John R. Holcomb, M.D. Asthma Pathophysiology and Treatment John R. Holcomb, M.D. Objectives Definition of Asthma Epidemiology and risk factors of Asthma Pathophysiology of Asthma Diagnostics test of Asthma Management of Asthma

More information