geoffrey modest medical blogs

  A  new systematic review/meta-analysis found that triple inhaler therapy significantly decreased severe asthma exacerbations in those with moderate to severe asthma (see  asthma triple vs dual therapy jama2021  in dropbox, or d oi :10.1001/jama.2021.7872 )     Details:   -- systematic review/meta-analysis of 20 RCTs in children and adults with persistent uncontrolled asthma, comparing triple therapy of inhaled corticosteroid (ICS), long-acting beta-agonist (LABA), and long-acting muscarinic antagonist (LAMA) versus ICS/LABA as dual therapy. Databases used from November 2017 to December 2020, without language restriction   -- 11,864 children (including 1870 children aged 6 to 18 in three trials) and adults were included: mean age 52 , 58% female --variability between studies:      -- two studies had patients with asthma/COPD overlap syndrome      -- seven had a crossover study design  ...

A recent article found the majority of patients with mild persistent asthma have a low sputum eosinophil level, with pretty much equal clinical responses to both mometasone (inhaled steroid) vs tiotropium (a long-acting muscarinic antagonist), see asthma mild no benefit steroids or tiotrop nejm2019 in  dropbox, or DOI: 10.1056/NEJMoa1814917 Details: --295 patients with mild persistent asthma were randomized to mometasone, tiotropium, or placebo -- the patients were categorized according to sputum eosinophil level, determined by 2 induced sputums, as being <2% vs > 2% -- median age 31, 40% male (more so with high eos count), mean age of diagnosis of asthma 8, duration of asthma 20 years, one or more episodes requiring emergency visits 24%, one or more courses of systemic steroids in the prior year 19%, BMI 28, FEV1 90% of predicted, FEV1/FVC 0.76, percent change to bronchodilators 11% (12.7% if high eosinophil level, 9.6% low), median score on ...

a recently released report, presented at the American Thoracic Society, found that patients with COPD benefited more from the combination of a long-acting  b -agonist (LABA) plus a long-acting anti-muscarinic (LAMA), as opposed to a LABA plus inhaled steroid (see  copd  LAMA LABA better than LABA steroid nejm2016  indropbox , or DOI: 10.1056/NEJMoa1516385). details of the FLAME trial (drug company sponsored trial), a double-blind, double-dummy, parallel-group, non-inferiority trial: --3354 patients with COPD, from 356 centers in 43 countries. Inclusion criteria: >40  yo , grade 2 or greater in modified MRC dyspnea scale (patient describing shortness of breath as "I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level"), post-bronchodilator FEV 1  25-60% of predicted value with FEV 1 /FVC <70%, and documen...