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Point-of-Care™ 201

Coming up for Air to Manage Patients With Severe Asthma

Clinical Practice Guidelines

Efficacy and safety of treatment with biologicals (benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab) for severe eosinophilic asthma. A systematic review for the EAACI Guidelines – recommendations on the use of biologicals in severe asthma.

Agache I, et al. Allergy. 2020;75(5):1023-1042.

Healthcare Improvement Scotland.

Scottish Intercollegiate Guidelines Network. Evidence-based clinical guidelines, 2019.

Difficult-to-treat & severe asthma in adolescent and adult patients.

Global Initiative for Asthma, 2019.

Global Strategy for Asthma Management and Prevention.

Global Initiative for Asthma, 2020.

Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline.

Holguin F, et al. Eur Respir J. 2020;55(1). pii: 1900588.

Clinical Practice Tools

Asthma Control Test (ACT)

This 5-question test evaluates asthma control over the past 4 weeks on a 5-point Likert scale. A score of <20 on the ACT suggests asthma that is uncontrolled.
Nathan RA, et al. J Allergy Clin Immunol. 2004;113(1):59-65.

Asthma Control Questionnaire (ACQ)

This 7-question assessment tool measures asthma control over the past 7 days. Six questions are self-administered by the patient, and 1 question requires a clinician’s input. Scores range from 1 (totally controlled) to 6 (severely uncontrolled).
Juniper EF, et al. Eur Respir J. 1999;14(4):902-907.

Royal College of Physicians, 3 Questions for Asthma (RCP-3Qs)

A 3-question health outcome indicator developed to assess asthma morbidity. A score of 0 indicates no symptoms, while a score of 3 is indicative of daily symptoms.
Hoskins G, et al. BMC Fam Pract. 2011;12:105.

Suggested Readings

Understanding asthma phenotypes, endotypes, and mechanisms of disease.

Kuruvilla ME, et al. Clin Rev Allergy Immunol. 2019;56(2): 219-233.

Tezepelumab in adults with uncontrolled asthma.

Corren J, et al. N Engl J Med. 2017;377(10):936-946. (Erratum: N Engl J Med. 2019;380(21):2082.)

Mepolizumab treatment in patients with severe eosinophilic asthma.

Ortega HG, et al. N Engl J Med. 2014;371(13):1198-1207.

Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials.

Castro M, et al. Lancet Respir Med. 2015;3(5):355-366.

Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial.

Bleecker ER, et al. Lancet. 2016;388(10056):2115-2127.

Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial.

FitzGerald JM, et al. Lancet. 2016;388(10056):2128-2141.

Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma.

Castro M, et al. N Engl J Med. 2018;378(26):2486-2496.

The effect of treatment with omalizumab, an anti-IgE antibody, on asthma exacerbations and emergency medical visits in patients with severe persistent asthma.

Bousquet J, et al. Allergy. 2005;60(3):302-308.

Co-morbidities in severe asthma: clinical impact and management.

Porsbjerg C, Menzies-Gow A. Respirology. 2017;22(4):651-661.

Revisiting type 2-high and type 2-low airway inflammation in asthma: current knowledge and therapeutic implications.

Robinson D, et al. Clin Exp Allergy. 2017;47(2):161-175.

Oral corticosteroid exposure and adverse effects in asthmatic patients.

Sullivan PW, et al. J Allergy Clin Immunol. 2018;141(1):110-116.e7.

Patient Resources

American Thoracic Society (ATS)

The mission of the ATS is to improve health worldwide by advancing research, clinical care, and public health in respiratory disease, critical illness, and sleep disorders.

Chest Foundation

The CHEST Foundation creates trusted patient education resources and disease awareness campaigns that empower patients to engage in better managing their health.

European Lung Foundation

Founded by the European Respiratory Society in 2000, the European Lung Foundation (ELF) aims to bring patients and the public together with respiratory health professionals to positively impact lung health.

Global Initiative for Asthma (GINA)

Launched in 1993 as a collaborative effort from the National Heart, Lung, and Blood Institute, National Institutes of Health, USA, and the World Health Organization, GINA provides programs and strategies for asthma care that are shaped by leading asthma experts around the world.

National Asthma Council Australia

The National Asthma Council Australia aims to build the capabilities for people to breathe well and facilitates best-practice health care for people with asthma and allergies.

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Coming up for Air to Manage Patients With Severe Asthma

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1 0.003905 0.003905 0.003905 0.003905
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1 0.003903 0.003903 0.003903 0.003903
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2491956
1 0.003790 0.003790 0.003790 0.003790
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
1 0.001728 0.001728 0.001728 0.001728
SHOW COLUMNS FROM `resources`
1 0.001516 0.001516 0.001516 0.001516
SHOW COLUMNS FROM `users`
1 0.001316 0.001316 0.001316 0.001316
SHOW COLUMNS FROM `activities`
1 0.001288 0.001288 0.001288 0.001288
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
2 0.001217 0.000608 0.000373 0.000844
SHOW COLUMNS FROM `resource_videos`
1 0.001100 0.001100 0.001100 0.001100
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
2 0.000956 0.000478 0.000471 0.000485
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
2 0.000943 0.000471 0.000285 0.000658
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
1 0.000474 0.000474 0.000474 0.000474
SELECT * FROM `resources` `t` WHERE `t`.`id`=163 LIMIT 1
1 0.000474 0.000474 0.000474 0.000474
SHOW CREATE TABLE `resources`
1 0.000344 0.000344 0.000344 0.000344
SHOW CREATE TABLE `activities`
1 0.000322 0.000322 0.000322 0.000322
SHOW CREATE TABLE `resource_videos`
1 0.000321 0.000321 0.000321 0.000321
SHOW CREATE TABLE `users`
1 0.000315 0.000315 0.000315 0.000315
# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000844
1
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
0.000658
2
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000373
3
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
0.000285
4
SHOW COLUMNS FROM `resources`
0.001516
5
SHOW CREATE TABLE `resources`
0.000344
6
SELECT * FROM `resources` `t` WHERE `t`.`id`=163 LIMIT 1
0.000474
7
SHOW COLUMNS FROM `resource_videos`
0.001100
8
SHOW CREATE TABLE `resource_videos`
0.000321
9
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
0.000474
10
SHOW COLUMNS FROM `activities`
0.001288
11
SHOW CREATE TABLE `activities`
0.000322
12
SHOW COLUMNS FROM `users`
0.001316
13
SHOW CREATE TABLE `users`
0.000315
14
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000485
15
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.003905
16
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000471
17
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2491956
0.003790
18
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
0.001728
19
SELECT r.id, COUNT(r.id) relevance FROM resources r join `resource_topics` rtj on rtj.`resource_id`=r.id WHERE rtj.`topic_id` in (SELECT topic_id from `resource_topics` rt where rt.`resource_id`=:rid AND rt.topic_id>0) AND r.id <> :rid AND r.status = 'active' Group by r.id order by relevance DESC, r.`createDate` DESC
0.003903
20
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (172, 144, 137, 136, 126, 116, 90, 62, 54, 53, 47, 34, 32, 180, 181, 171, 169, 168, 164, 154, 153, 151, 149, 147, 145, 143, 142, 141, 140, 139, 138, 132, 122, 117, 114, 107, 104, 96, 92, 91, 79, 69, 68, 63, 58, 57, 56, 55, 52, 51, 50, 48, 42, 41, 40, 38, 36, 35, 31, 28, 23)
0.006154
Log Messages
Message (details) Level Category Time