Download PDF
Semin Respir Crit Care Med 2022; 43(05): 595-612
DOI: 10.1055/s-0042-1745747
Review Article

Understanding the Updates in the Asthma Guidelines

Deborah L. Lee
1   Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
,
Alan P. Baptist
1   Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Asthma is a chronic inflammatory lung disease that affects millions of Americans, with variable symptoms of bronchospasm and obstruction among individuals over time. The National Heart, Lung, and Blood Institute (NHLBI) published the 2020 Focused Updates to the Asthma Management Guidelines based on the latest research since the 2007 Expert Panel Report-3 (EPR-3). The following article reviews the 21 new recommendations on the six core topics in asthma: use of intermittent inhaled corticosteroids, long-acting muscarinic antagonist therapy, use of the fractional exhaled nitric oxide test in asthma diagnosis and monitoring, indoor allergen mitigation, immunotherapy, and bronchial thermoplasty. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate recommendations as strong or conditional based on the evidence. The recommendations were based on systematic reviews of the literature and focused on patient-centered critical outcomes of asthma exacerbations, asthma control, and asthma-related quality of life. Understanding the recommendations with consideration of individual values through shared decision-making may improve asthma outcomes.

Keywords

asthma - NHLBI - guidelines - GRADE - NIH


Publication History

Article published online:
21 June 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 National Center for Health Statistics. Percentage of ever having asthma for adults aged 18 and over, United States, 2019. National Health Interview Survey. 2019.. Accessed September 12, 2021 at: https://www.cdc.gov/NHISDataQueryTool/SHS_2019_ADULT3/index.html
    PubMedGoogle Scholar
  • 2 National Center for Health Statistics. Percentage of ever having asthma for children under age 18 years, United States, 2019. National Health Interview Survey 2019. . Accessed September 21, 2021 at: https://www.cdc.gov/NHISDataQueryTool/SHS_2019_CHILD3/index.html
    PubMedGoogle Scholar
  • 3 National Center for Health Statistics. Health, United States, 2019: Table ##. Hyattsville, MD. 2021. Accessed September 21, 2021 at: https://www.cdc.gov/nchs/hus/contents2019.htm 2019
    PubMedGoogle Scholar
  • 4 National Hospital Ambulatory Medical Care Survey: 2018 emergency department summary tables.. 2018 . Accessed October 7, 2021 at: https://www.cdc.gov/nchs/data/nhamcs/web_tables/2018_ed_web_tables-508.pdf
    PubMed
  • 5 Most recent asthma data.. 2021 . Accessed January 16, 2021 at: http://www.cdc.gov/asthma/national-surveillance-data/default.htm
    PubMed
  • 6 Leas BF, D'Anci KE, Apter AJ, Bryant-Stephens T, Schoelles K, Umscheid CA. AHRQ Comparative Effectiveness Reviews. Effectiveness of Indoor Allergen Reduction in Management of Asthma.. Rockville, MD: Agency for Healthcare Research and Quality (US); 2018
    Google Scholar
  • 7 Lin SY, Azar A, Suarez-Cuervo C. et al. AHRQ Comparative Effectiveness Reviews. The Role of Immunotherapy in the Treatment of Asthma.. Rockville, MD: Agency for Healthcare Research and Quality (US); 2018
    Google Scholar
  • 8 Wang Z, Pianosi P, Keogh K. et al. AHRQ Comparative Effectiveness Reviews. The Clinical Utility of Fractional Exhaled Nitric Oxide (FENO) in Asthma Management.. Rockville, MD: Agency for Healthcare Research and Quality (US); 2017
    Google Scholar
  • 9 Sobieraj DM, Baker WL, Weeda ER. et al. AHRQ Comparative Effectiveness Reviews. Intermittent Inhaled Corticosteroids and Long-Acting Muscarinic Antagonists for Asthma.. Rockville, MD: Agency for Healthcare Research and Quality (US); 2018
    Google Scholar
  • 10 Cloutier MM, Baptist AP, Blake KV. et al; Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC). 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol 2020; 146 (06) 1217-1270
    Google Scholar
  • 11 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 2011; 64 (04) 395-400
    CrossrefPubMedGoogle Scholar
  • 12 Durham AL, Caramori G, Chung KF, Adcock IM. Targeted anti-inflammatory therapeutics in asthma and chronic obstructive lung disease. Transl Res 2016; 167 (01) 192-203
    CrossrefPubMedGoogle Scholar
  • 13 Reddel HK, Busse WW, Pedersen S. et al. Should recommendations about starting inhaled corticosteroid treatment for mild asthma be based on symptom frequency: a post-hoc efficacy analysis of the START study. Lancet 2017; 389 (10065): 157-166
    Google Scholar
  • 14 National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol 2007; 120 (Suppl. 05) S94-S138
    CrossrefPubMedGoogle Scholar
  • 15 Bacharier LB, Phillips BR, Zeiger RS. et al; CARE Network. Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with moderate-to-severe intermittent wheezing. J Allergy Clin Immunol 2008; 122 (06) 1127-1135 .e8
    CrossrefPubMedGoogle Scholar
  • 16 Ducharme FM, Lemire C, Noya FJ. et al. Preemptive use of high-dose fluticasone for virus-induced wheezing in young children. N Engl J Med 2009; 360 (04) 339-353
    CrossrefPubMedGoogle Scholar
  • 17 Svedmyr J, Nyberg E, Thunqvist P, Asbrink-Nilsson E, Hedlin G. Prophylactic intermittent treatment with inhaled corticosteroids of asthma exacerbations due to airway infections in toddlers. Acta Paediatr 1999; 88 (01) 42-47
    CrossrefPubMedGoogle Scholar
  • 18 Boushey HA, Sorkness CA, King TS. et al; National Heart, Lung, and Blood Institute's Asthma Clinical Research Network. Daily versus as-needed corticosteroids for mild persistent asthma. N Engl J Med 2005; 352 (15) 1519-1528
    CrossrefPubMedGoogle Scholar
  • 19 Calhoun WJ, Ameredes BT, King TS. et al; Asthma Clinical Research Network of the National Heart, Lung, and Blood Institute. Comparison of physician-, biomarker-, and symptom-based strategies for adjustment of inhaled corticosteroid therapy in adults with asthma: the BASALT randomized controlled trial. JAMA 2012; 308 (10) 987-997
    CrossrefPubMedGoogle Scholar
  • 20 Papi A, Canonica GW, Maestrelli P. et al; BEST Study Group. Rescue use of beclomethasone and albuterol in a single inhaler for mild asthma. N Engl J Med 2007; 356 (20) 2040-2052
    Google Scholar
  • 21 Martinez FD, Chinchilli VM, Morgan WJ. et al. Use of beclomethasone dipropionate as rescue treatment for children with mild persistent asthma (TREXA): a randomised, double-blind, placebo-controlled trial. Lancet 2011; 377 (9766): 650-657
    Google Scholar
  • 22 Turpeinen M, Nikander K, Pelkonen AS. et al. Daily versus as-needed inhaled corticosteroid for mild persistent asthma (the Helsinki early intervention childhood asthma study). Arch Dis Child 2008; 93 (08) 654-659
    CrossrefPubMedGoogle Scholar
  • 23 Camargos P, Affonso A, Calazans G. et al. On-demand intermittent beclomethasone is effective for mild asthma in Brazil. Clin Transl Allergy 2018; 8: 7
    CrossrefPubMedGoogle Scholar
  • 24 Jackson DJ, Bacharier LB, Mauger DT. et al; National Heart, Lung, and Blood Institute AsthmaNet. Quintupling inhaled glucocorticoids to prevent childhood asthma exacerbations. N Engl J Med 2018; 378 (10) 891-901
    CrossrefPubMedGoogle Scholar
  • 25 Harrison TW, Oborne J, Newton S, Tattersfield AE. Doubling the dose of inhaled corticosteroid to prevent asthma exacerbations: randomised controlled trial. Lancet 2004; 363 (9405): 271-275
    CrossrefPubMedGoogle Scholar
  • 26 Lahdensuo A, Haahtela T, Herrala J. et al. Randomised comparison of guided self management and traditional treatment of asthma over one year. BMJ 1996; 312 (7033): 748-752
    CrossrefPubMedGoogle Scholar
  • 27 Oborne J, Mortimer K, Hubbard RB, Tattersfield AE, Harrison TW. Quadrupling the dose of inhaled corticosteroid to prevent asthma exacerbations: a randomized, double-blind, placebo-controlled, parallel-group clinical trial. Am J Respir Crit Care Med 2009; 180 (07) 598-602
    CrossrefPubMedGoogle Scholar
  • 28 McKeever T, Mortimer K, Wilson A. et al. Quadrupling inhaled glucocorticoid dose to abort asthma exacerbations. N Engl J Med 2018; 378 (10) 902-910
    CrossrefPubMedGoogle Scholar
  • 29 O'Byrne PM, Bisgaard H, Godard PP. et al. Budesonide/formoterol combination therapy as both maintenance and reliever medication in asthma. Am J Respir Crit Care Med 2005; 171 (02) 129-136
    CrossrefPubMedGoogle Scholar
  • 30 Rabe KF, Pizzichini E, Ställberg B. et al. Budesonide/formoterol in a single inhaler for maintenance and relief in mild-to-moderate asthma: a randomized, double-blind trial. Chest 2006; 129 (02) 246-256
    CrossrefPubMedGoogle Scholar
  • 31 Scicchitano R, Aalbers R, Ukena D. et al. Efficacy and safety of budesonide/formoterol single inhaler therapy versus a higher dose of budesonide in moderate to severe asthma. Curr Med Res Opin 2004; 20 (09) 1403-1418
    CrossrefPubMedGoogle Scholar
  • 32 Bisgaard H, Le Roux P, Bjåmer D, Dymek A, Vermeulen JH, Hultquist C. Budesonide/formoterol maintenance plus reliever therapy: a new strategy in pediatric asthma. Chest 2006; 130 (06) 1733-1743
    CrossrefPubMedGoogle Scholar
  • 33 Atienza T, Aquino T, Fernández M. et al. Budesonide/formoterol maintenance and reliever therapy via Turbuhaler versus fixed-dose budesonide/formoterol plus terbutaline in patients with asthma: phase III study results. Respirology 2013; 18 (02) 354-363
    CrossrefPubMedGoogle Scholar
  • 34 Papi A, Corradi M, Pigeon-Francisco C. et al. Beclometasone-formoterol as maintenance and reliever treatment in patients with asthma: a double-blind, randomised controlled trial. Lancet Respir Med 2013; 1 (01) 23-31
    Google Scholar
  • 35 Rabe KF, Atienza T, Magyar P, Larsson P, Jorup C, Lalloo UG. Effect of budesonide in combination with formoterol for reliever therapy in asthma exacerbations: a randomised controlled, double-blind study. Lancet 2006; 368 (9537): 744-753
    CrossrefPubMedGoogle Scholar
  • 36 Patel M, Pilcher J, Pritchard A. et al; SMART Study Group. Efficacy and safety of maintenance and reliever combination budesonide-formoterol inhaler in patients with asthma at risk of severe exacerbations: a randomised controlled trial. Lancet Respir Med 2013; 1 (01) 32-42
    Google Scholar
  • 37 Vogelmeier C, D'Urzo A, Pauwels R. et al. Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option?. Eur Respir J 2005; 26 (05) 819-828
    CrossrefPubMedGoogle Scholar
  • 38 Bousquet J, Boulet LP, Peters MJ. et al. Budesonide/formoterol for maintenance and relief in uncontrolled asthma vs. high-dose salmeterol/fluticasone. Respir Med 2007; 101 (12) 2437-2446
    CrossrefPubMedGoogle Scholar
  • 39 Kuna P, Peters MJ, Manjra AI. et al. Effect of budesonide/formoterol maintenance and reliever therapy on asthma exacerbations. Int J Clin Pract 2007; 61 (05) 725-736
    CrossrefPubMedGoogle Scholar
  • 40 Louis R, Joos G, Michils A, Vandenhoven G. A comparison of budesonide/formoterol maintenance and reliever therapy vs. conventional best practice in asthma management. Int J Clin Pract 2009; 63 (10) 1479-1488
    CrossrefPubMedGoogle Scholar
  • 41 Quirce S, Barcina C, Plaza V. et al. A comparison of budesonide/formoterol maintenance and reliever therapy versus conventional best practice in asthma management in Spain. J Asthma 2011; 48 (08) 839-847
    CrossrefPubMedGoogle Scholar
  • 42 Riemersma RA, Postma D, van der Molen T. Budesonide/formoterol maintenance and reliever therapy in primary care asthma management: effects on bronchial hyperresponsiveness and asthma control. Prim Care Respir J 2012; 21 (01) 50-56
    CrossrefPubMedGoogle Scholar
  • 43 Sears MR, Boulet LP, Laviolette M. et al. Budesonide/formoterol maintenance and reliever therapy: impact on airway inflammation in asthma. Eur Respir J 2008; 31 (05) 982-989
    CrossrefPubMedGoogle Scholar
  • 44 Wechsler ME, Yawn BP, Fuhlbrigge AL. et al; BELT Investigators. Anticholinergic vs long-acting β-agonist in combination with inhaled corticosteroids in black adults with asthma: the BELT randomized clinical trial. JAMA 2015; 314 (16) 1720-1730
    CrossrefPubMedGoogle Scholar
  • 45 Peters SP, Kunselman SJ, Icitovic N. et al; National Heart, Lung, and Blood Institute Asthma Clinical Research Network. Tiotropium bromide step-up therapy for adults with uncontrolled asthma. N Engl J Med 2010; 363 (18) 1715-1726
    Google Scholar
  • 46 Lee LA, Yang S, Kerwin E, Trivedi R, Edwards LD, Pascoe S. The effect of fluticasone furoate/umeclidinium in adult patients with asthma: a randomized, dose-ranging study. Respir Med 2015; 109 (01) 54-62
    CrossrefPubMedGoogle Scholar
  • 47 Bateman ED, Kornmann O, Schmidt P, Pivovarova A, Engel M, Fabbri LM. Tiotropium is noninferior to salmeterol in maintaining improved lung function in B16-Arg/Arg patients with asthma. J Allergy Clin Immunol 2011; 128 (02) 315-322
    CrossrefPubMedGoogle Scholar
  • 48 Kerstjens HA, Casale TB, Bleecker ER. et al. Tiotropium or salmeterol as add-on therapy to inhaled corticosteroids for patients with moderate symptomatic asthma: two replicate, double-blind, placebo-controlled, parallel-group, active-comparator, randomised trials. Lancet Respir Med 2015; 3 (05) 367-376
    CrossrefPubMedGoogle Scholar
  • 49 Rajanandh MG, Nageswari AD, Ilango K. Pulmonary function assessment in mild to moderate persistent asthma patients receiving montelukast, doxofylline, and tiotropium with budesonide: a randomized controlled study. Clin Ther 2014; 36 (04) 526-533
    CrossrefPubMedGoogle Scholar
  • 50 Rajanandh MG, Nageswari AD, Ilango K. Assessment of montelukast, doxofylline, and tiotropium with budesonide for the treatment of asthma: which is the best among the second-line treatment? A randomized trial. Clin Ther 2015; 37 (02) 418-426
    CrossrefPubMedGoogle Scholar
  • 51 Hamelmann E, Bateman ED, Vogelberg C. et al. Tiotropium add-on therapy in adolescents with moderate asthma: a 1-year randomized controlled trial. J Allergy Clin Immunol 2016; 138 (02) 441-450 .e8
    Google Scholar
  • 52 Paggiaro P, Halpin DM, Buhl R. et al. The effect of tiotropium in symptomatic asthma despite low- to medium-dose inhaled corticosteroids: a randomized controlled trial. J Allergy Clin Immunol Pract 2016; 4 (01) 104-13 .e2
    CrossrefPubMedGoogle Scholar
  • 53 Dweik RA, Boggs PB, Erzurum SC. et al; American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med 2011; 184 (05) 602-615
    Google Scholar
  • 54 Szefler SJ, Mitchell H, Sorkness CA. et al. Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial. Lancet 2008; 372 (9643): 1065-1072
    CrossrefPubMedGoogle Scholar
  • 55 de Jongste JC, Carraro S, Hop WC, Baraldi E. CHARISM Study Group. Daily telemonitoring of exhaled nitric oxide and symptoms in the treatment of childhood asthma. Am J Respir Crit Care Med 2009; 179 (02) 93-97
    CrossrefPubMedGoogle Scholar
  • 56 Fritsch M, Uxa S, Horak Jr F. et al. Exhaled nitric oxide in the management of childhood asthma: a prospective 6-months study. Pediatr Pulmonol 2006; 41 (09) 855-862
    CrossrefPubMedGoogle Scholar
  • 57 Peirsman EJ, Carvelli TJ, Hage PY. et al. Exhaled nitric oxide in childhood allergic asthma management: a randomised controlled trial. Pediatr Pulmonol 2014; 49 (07) 624-631
    CrossrefPubMedGoogle Scholar
  • 58 Petsky HL, Li AM, Au CT, Kynaston JA, Turner C, Chang AB. Management based on exhaled nitric oxide levels adjusted for atopy reduces asthma exacerbations in children: a dual centre randomized controlled trial. Pediatr Pulmonol 2015; 50 (06) 535-543
    CrossrefPubMedGoogle Scholar
  • 59 Pijnenburg MW, Bakker EM, Hop WC, De Jongste JC. Titrating steroids on exhaled nitric oxide in children with asthma: a randomized controlled trial. Am J Respir Crit Care Med 2005; 172 (07) 831-836
    CrossrefPubMedGoogle Scholar
  • 60 Pike K, Selby A, Price S. et al. Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial. Clin Respir J 2013; 7 (02) 204-213
    CrossrefPubMedGoogle Scholar
  • 61 Voorend-van Bergen S, Vaessen-Verberne AA, Brackel HJ. et al. Monitoring strategies in children with asthma: a randomised controlled trial. Thorax 2015; 70 (06) 543-550
    CrossrefPubMedGoogle Scholar
  • 62 Verini M, Consilvio NP, Di Pillo S. et al. FeNO as a marker of airways inflammation: the possible implications in childhood asthma management. J Allergy (Cairo) 2010; 2010: 691425
    PubMedGoogle Scholar
  • 63 Zeiger RS, Szefler SJ, Phillips BR. et al; Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute. Response profiles to fluticasone and montelukast in mild-to-moderate persistent childhood asthma. J Allergy Clin Immunol 2006; 117 (01) 45-52
    CrossrefPubMedGoogle Scholar
  • 64 Visitsunthorn N, Mahawichit N, Maneechotesuwan K. Association between levels of fractional exhaled nitric oxide and asthma exacerbations in Thai children. Respirology 2017; 22 (01) 71-77
    CrossrefPubMedGoogle Scholar
  • 65 van Vliet D, Alonso A, Rijkers G. et al. Prediction of asthma exacerbations in children by innovative exhaled inflammatory markers: results of a longitudinal study. PLoS One 2015; 10 (03) e0119434
    CrossrefPubMedGoogle Scholar
  • 66 McCormack MC, Aloe C, Curtin-Brosnan J, Diette GB, Breysse PN, Matsui EC. Guideline-recommended fractional exhaled nitric oxide is a poor predictor of health-care use among inner-city children and adolescents receiving usual asthma care. Chest 2013; 144 (03) 923-929
    CrossrefPubMedGoogle Scholar
  • 67 Raj D, Lodha R, Mukherjee A, Sethi T, Agrawal A, Kabra SK. Fractional exhaled nitric oxide in children with acute exacerbation of asthma. Indian Pediatr 2014; 51 (02) 105-111
    CrossrefPubMedGoogle Scholar
  • 68 Salmeron S, Liard R, Elkharrat D, Muir J, Neukirch F, Ellrodt A. Asthma severity and adequacy of management in accident and emergency departments in France: a prospective study. Lancet 2001; 358 (9282): 629-635
    CrossrefPubMedGoogle Scholar
  • 69 Gill M, Walker S, Khan A. et al. Exhaled nitric oxide levels during acute asthma exacerbation. Acad Emerg Med 2005; 12 (07) 579-586
    CrossrefPubMedGoogle Scholar
  • 70 Ko FW, Hui DS, Leung TF. et al. Evaluation of the asthma control test: a reliable determinant of disease stability and a predictor of future exacerbations. Respirology 2012; 17 (02) 370-378
    CrossrefPubMedGoogle Scholar
  • 71 Zeiger RS, Schatz M, Zhang F. et al. Association of exhaled nitric oxide to asthma burden in asthmatics on inhaled corticosteroids. J Asthma 2011; 48 (01) 8-17
    CrossrefPubMedGoogle Scholar
  • 72 Balinotti JE, Colom A, Kofman C, Teper A. Association between the Asthma Predictive Index and levels of exhaled nitric oxide in infants and toddlers with recurrent wheezing. Arch Argent Pediatr 2013; 111 (03) 191-195
    CrossrefPubMedGoogle Scholar
  • 73 Bloemen K, Van Den Heuvel R, Govarts E. et al. A new approach to study exhaled proteins as potential biomarkers for asthma. Clin Exp Allergy 2011; 41 (03) 346-356
    CrossrefPubMedGoogle Scholar
  • 74 Castro-Rodríguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med 2000; 162 (4 Pt 1): 1403-1406
    CrossrefPubMedGoogle Scholar
  • 75 Caudri D, Wijga AH, Hoekstra MO. et al. Prediction of asthma in symptomatic preschool children using exhaled nitric oxide, Rint and specific IgE. Thorax 2010; 65 (09) 801-807
    CrossrefPubMedGoogle Scholar
  • 76 Chang D, Yao W, Tiller CJ. et al. Exhaled nitric oxide during infancy as a risk factor for asthma and airway hyperreactivity. Eur Respir J 2015; 45 (01) 98-106
    CrossrefPubMedGoogle Scholar
  • 77 Elliott M, Heltshe SL, Stamey DC, Cochrane ES, Redding GJ, Debley JS. Exhaled nitric oxide predicts persistence of wheezing, exacerbations, and decline in lung function in wheezy infants and toddlers. Clin Exp Allergy 2013; 43 (12) 1351-1361
    CrossrefPubMedGoogle Scholar
  • 78 Klaassen EM, van de Kant KD, Jöbsis Q. et al. Symptoms, but not a biomarker response to inhaled corticosteroids, predict asthma in preschool children with recurrent wheeze. Mediators Inflamm 2012; 2012: 162571
    CrossrefPubMedGoogle Scholar
  • 79 Prado CM, Martins MA, Tibério IF. Nitric oxide in asthma physiopathology. ISRN Allergy 2011; 2011: 832560
    CrossrefPubMedGoogle Scholar
  • 80 Singer F, Luchsinger I, Inci D. et al. Exhaled nitric oxide in symptomatic children at preschool age predicts later asthma. Allergy 2013; 68 (04) 531-538
    CrossrefPubMedGoogle Scholar
  • 81 van Wonderen KE, van der Mark LB, Mohrs J. et al. Prediction and treatment of asthma in preschool children at risk: study design and baseline data of a prospective cohort study in general practice (ARCADE). BMC Pulm Med 2009; 9: 13
    CrossrefPubMedGoogle Scholar
  • 82 Carswell F, Birmingham K, Oliver J, Crewes A, Weeks J. The respiratory effects of reduction of mite allergen in the bedrooms of asthmatic children—a double-blind controlled trial. Clin Exp Allergy 1996; 26 (04) 386-396
    CrossrefPubMedGoogle Scholar
  • 83 Cloosterman SG, Schermer TR, Bijl-Hofland ID. et al. Effects of house dust mite avoidance measures on Der p 1 concentrations and clinical condition of mild adult house dust mite-allergic asthmatic patients, using no inhaled steroids. Clin Exp Allergy 1999; 29 (10) 1336-1346
    CrossrefPubMedGoogle Scholar
  • 84 El-Ghitany EM, Abd El-Salam MM. Environmental intervention for house dust mite control in childhood bronchial asthma. Environ Health Prev Med 2012; 17 (05) 377-384
    CrossrefPubMedGoogle Scholar
  • 85 Marks GB, Tovey ER, Green W, Shearer M, Salome CM, Woolcock AJ. House dust mite allergen avoidance: a randomized controlled trial of surface chemical treatment and encasement of bedding. Clin Exp Allergy 1994; 24 (11) 1078-1083
    CrossrefPubMedGoogle Scholar
  • 86 Shapiro GG, Wighton TG, Chinn T. et al. House dust mite avoidance for children with asthma in homes of low-income families. J Allergy Clin Immunol 1999; 103 (06) 1069-1074
    CrossrefPubMedGoogle Scholar
  • 87 DiMango E, Serebrisky D, Narula S. et al. Individualized household allergen intervention lowers allergen level but not asthma medication use: a randomized controlled trial. J Allergy Clin Immunol Pract 2016; 4 (04) 671-679 .e4
    CrossrefPubMedGoogle Scholar
  • 88 Krieger J, Takaro TK, Song L, Beaudet N, Edwards K. A randomized controlled trial of asthma self-management support comparing clinic-based nurses and in-home community health workers: the Seattle-King County Healthy Homes II Project. Arch Pediatr Adolesc Med 2009; 163 (02) 141-149
    CrossrefPubMedGoogle Scholar
  • 89 Krieger JW, Takaro TK, Song L, Weaver M. The Seattle-King County Healthy Homes Project: a randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. Am J Public Health 2005; 95 (04) 652-659
    CrossrefPubMedGoogle Scholar
  • 90 Warner JA, Frederick JM, Bryant TN. et al. Mechanical ventilation and high-efficiency vacuum cleaning: a combined strategy of mite and mite allergen reduction in the control of mite-sensitive asthma. J Allergy Clin Immunol 2000; 105 (1 Pt 1): 75-82
    CrossrefPubMedGoogle Scholar
  • 91 Morgan WJ, Crain EF, Gruchalla RS. et al; Inner-City Asthma Study Group. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med 2004; 351 (11) 1068-1080
    CrossrefPubMedGoogle Scholar
  • 92 Parker EA, Israel BA, Robins TG. et al. Evaluation of community action against asthma: a community health worker intervention to improve children's asthma-related health by reducing household environmental triggers for asthma. Health Educ Behav 2008; 35 (03) 376-395
    CrossrefPubMedGoogle Scholar
  • 93 Eggleston PA, Butz A, Rand C. et al. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial. Ann Allergy Asthma Immunol 2005; 95 (06) 518-524
    CrossrefPubMedGoogle Scholar
  • 94 Matsui EC, Perzanowski M, Peng RD. et al. Effect of an integrated pest management intervention on asthma symptoms among mouse-sensitized children and adolescents with asthma: a randomized clinical trial. JAMA 2017; 317 (10) 1027-1036
    CrossrefPubMedGoogle Scholar
  • 95 Evans III R, Gergen PJ, Mitchell H. et al. A randomized clinical trial to reduce asthma morbidity among inner-city children: results of the National Cooperative Inner-City Asthma Study. J Pediatr 1999; 135 (03) 332-338
    CrossrefPubMedGoogle Scholar
  • 96 Bryant-Stephens T, Kurian C, Guo R, Zhao H. Impact of a household environmental intervention delivered by lay health workers on asthma symptom control in urban, disadvantaged children with asthma. Am J Public Health 2009; 99 (Suppl. 03) S657-S665
    CrossrefPubMedGoogle Scholar
  • 97 Bryant-Stephens T, Li Y. Outcomes of a home-based environmental remediation for urban children with asthma. J Natl Med Assoc 2008; 100 (03) 306-316
    PubMedGoogle Scholar
  • 98 Burr ML, Matthews IP, Arthur RA. et al. Effects on patients with asthma of eradicating visible indoor mould: a randomised controlled trial. Thorax 2007; 62 (09) 767-772
    CrossrefPubMedGoogle Scholar
  • 99 Williams SG, Brown CM, Falter KH. et al. Does a multifaceted environmental intervention alter the impact of asthma on inner-city children?. J Natl Med Assoc 2006; 98 (02) 249-260
    PubMedGoogle Scholar
  • 100 Rabito FA, Carlson JC, He H, Werthmann D, Schal C. A single intervention for cockroach control reduces cockroach exposure and asthma morbidity in children. J Allergy Clin Immunol 2017; 140 (02) 565-570
    CrossrefPubMedGoogle Scholar
  • 101 Levy JI, Brugge D, Peters JL, Clougherty JE, Saddler SS. A community-based participatory research study of multifaceted in-home environmental interventions for pediatric asthmatics in public housing. Soc Sci Med 2006; 63 (08) 2191-2203
    CrossrefPubMedGoogle Scholar
  • 102 Powell H, Murphy VE, Taylor DR. et al. Management of asthma in pregnancy guided by measurement of fraction of exhaled nitric oxide: a double-blind, randomised controlled trial. Lancet 2011; 378 (9795): 983-990
    Google Scholar
  • 103 Gallego MT, Iraola V, Himly M. et al. Depigmented and polymerised house dust mite allergoid: allergen content, induction of IgG4 and clinical response. Int Arch Allergy Immunol 2010; 153 (01) 61-69
    CrossrefPubMedGoogle Scholar
  • 104 García-Robaina JC, Sánchez I, de la Torre F, Fernández-Caldas E, Casanovas M. Successful management of mite-allergic asthma with modified extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae in a double-blind, placebo-controlled study. J Allergy Clin Immunol 2006; 118 (05) 1026-1032
    CrossrefPubMedGoogle Scholar
  • 105 Olsen OT, Larsen KR, Jacobsan L, Svendsen UG. A 1-year, placebo-controlled, double-blind house-dust-mite immunotherapy study in asthmatic adults. Allergy 1997; 52 (08) 853-859
    CrossrefPubMedGoogle Scholar
  • 106 Epstein TG, Liss GM, Berendts KM, Bernstein DI. AAAAI/ACAAI subcutaneous immunotherapy surveillance study (2013-2017): fatalities, infections, delayed reactions, and use of epinephrine autoinjectors. J Allergy Clin Immunol Pract 2019; 7 (06) 1996-2003 .e1
    CrossrefPubMedGoogle Scholar
  • 107 Lieberman P. The risk and management of anaphylaxis in the setting of immunotherapy. Am J Rhinol Allergy 2012; 26 (06) 469-474
    CrossrefPubMedGoogle Scholar
  • 108 Gómez Vera J, Flores Sandoval G, Orea Solano M, López Tiro J, Jiménez Saab N. [Safety and efficacy of specific sublingual immunotherapy in patients with asthma and allergy to Dermatophagoides pteronyssinus]. Rev Alerg Mex 2005; 52 (06) 231-236
    PubMedGoogle Scholar
  • 109 Virchow JC, Backer V, Kuna P. et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA 2016; 315 (16) 1715-1725
    Google Scholar
  • 110 de Blay F, Kuna P, Prieto L. et al. SQ HDM SLIT-tablet (ALK) in treatment of asthma–post hoc results from a randomised trial. Respir Med 2014; 108 (10) 1430-1437
    CrossrefPubMedGoogle Scholar
  • 111 Devillier P, Fadel R, de Beaumont O. House dust mite sublingual immunotherapy is safe in patients with mild-to-moderate, persistent asthma: a clinical trial. Allergy 2016; 71 (02) 249-257
    CrossrefPubMedGoogle Scholar
  • 112 Marogna M, Braidi C, Bruno ME. et al. The contribution of sublingual immunotherapy to the achievement of control in birch-related mild persistent asthma: a real-life randomised trial. Allergol Immunopathol (Madr) 2013; 41 (04) 216-224
    CrossrefPubMedGoogle Scholar
  • 113 Mosbech H, Canonica GW, Backer V. et al. SQ house dust mite sublingually administered immunotherapy tablet (ALK) improves allergic rhinitis in patients with house dust mite allergic asthma and rhinitis symptoms. Ann Allergy Asthma Immunol 2015; 114 (02) 134-140
    CrossrefPubMedGoogle Scholar
  • 114 Wang L, Yin J, Fadel R, Montagut A, de Beaumont O, Devillier P. House dust mite sublingual immunotherapy is safe and appears to be effective in moderate, persistent asthma. Allergy 2014; 69 (09) 1181-1188
    CrossrefPubMedGoogle Scholar
  • 115 Maloney J, Prenner BM, Bernstein DI. et al. Safety of house dust mite sublingual immunotherapy standardized quality tablet in children allergic to house dust mites. Ann Allergy Asthma Immunol 2016; 116 (01) 59-65
    CrossrefPubMedGoogle Scholar
  • 116 Mösges R, Graute V, Christ H, Sieber HJ, Wahn U, Niggemann B. Safety of ultra-rush titration of sublingual immunotherapy in asthmatic children with tree-pollen allergy. Pediatr Allergy Immunol 2010; 21 (08) 1135-1138
    CrossrefPubMedGoogle Scholar
  • 117 Pham-Thi N, Scheinmann P, Fadel R, Combebias A, Andre C. Assessment of sublingual immunotherapy efficacy in children with house dust mite-induced allergic asthma optimally controlled by pharmacologic treatment and mite-avoidance measures. Pediatr Allergy Immunol 2007; 18 (01) 47-57
    CrossrefPubMedGoogle Scholar
  • 118 Shao J, Cui YX, Zheng YF. et al. Efficacy and safety of sublingual immunotherapy in children aged 3-13 years with allergic rhinitis. Am J Rhinol Allergy 2014; 28 (02) 131-139
    CrossrefPubMedGoogle Scholar
  • 119 Cox G, Thomson NC, Rubin AS. et al; AIR Trial Study Group. Asthma control during the year after bronchial thermoplasty. N Engl J Med 2007; 356 (13) 1327-1337
    CrossrefPubMedGoogle Scholar
  • 120 Pavord ID, Cox G, Thomson NC. et al; RISA Trial Study Group. Safety and efficacy of bronchial thermoplasty in symptomatic, severe asthma. Am J Respir Crit Care Med 2007; 176 (12) 1185-1191
    CrossrefPubMedGoogle Scholar
  • 121 Balu A, Ryan D, Niven R. Lung abscess as a complication of bronchial thermoplasty. J Asthma 2015; 52 (07) 740-742
    CrossrefPubMedGoogle Scholar
  • 122 Facciolongo N, Menzella F, Lusuardi M. et al. Recurrent lung atelectasis from fibrin plugs as a very early complication of bronchial thermoplasty: a case report. Multidiscip Respir Med 2015; 10 (01) 9
    CrossrefPubMedGoogle Scholar
  • 123 Nguyen DV, Murin S. Bronchial artery pseudoaneurysm with major hemorrhage after bronchial thermoplasty. Chest 2016; 149 (04) e95-e97
    CrossrefPubMedGoogle Scholar
  • 124 Cox G, Miller JD, McWilliams A, Fitzgerald JM, Lam S. Bronchial thermoplasty for asthma. Am J Respir Crit Care Med 2006; 173 (09) 965-969
    CrossrefPubMedGoogle Scholar
  • 125 Doeing DC, Husain AN, Naureckas ET, White SR, Hogarth DK. Bronchial thermoplasty failure in severe persistent asthma: a case report. J Asthma 2013; 50 (07) 799-801
    CrossrefPubMedGoogle Scholar
  • 126 Doeing DC, Mahajan AK, White SR, Naureckas ET, Krishnan JA, Hogarth DK. Safety and feasibility of bronchial thermoplasty in asthma patients with very severe fixed airflow obstruction: a case series. J Asthma 2013; 50 (02) 215-218
    CrossrefPubMedGoogle Scholar
  • 127 Funatsu A, Kobayashi K, Iikura M, Ishii S, Izumi S, Sugiyama H. A case of pulmonary cyst and pneumothorax after bronchial thermoplasty. Respirol Case Rep 2017; 6 (02) e00286
    CrossrefPubMedGoogle Scholar
  • 128 Han X, Zhang S, Zhao W. et al. A successful bronchial thermoplasty procedure in a “very severe” asthma patient with rare complications: a case report. J Asthma 2019; 56 (09) 1004-1007
    CrossrefPubMedGoogle Scholar
  • 129 Mahajan AK, Hogarth DK. Bronchial thermoplasty: therapeutic success in severe asthma associated with persistent airflow obstruction. J Asthma 2012; 49 (05) 527-529
    CrossrefPubMedGoogle Scholar
  • 130 Menzella F, Lusuardi M, Galeone C, Montanari G, Cavazza A, Facciolongo N. Heat-induced necrosis after bronchial thermoplasty: a new concern?. Allergy Asthma Clin Immunol 2018; 14: 25
    CrossrefPubMedGoogle Scholar
  • 131 Qiu M, Lai Z, Wei S. et al. Bronchiectasis after bronchial thermoplasty. J Thorac Dis 2018; 10 (10) E721-E726
    CrossrefPubMedGoogle Scholar
  • 132 Takeuchi A, Kanemitsu Y, Takakuwa O. et al. A suspected case of inflammatory bronchial polyp induced by bronchial thermoplasty but resolved spontaneously. J Thorac Dis 2018; 10 (09) E678-E681
    CrossrefPubMedGoogle Scholar
  • 133 Lieu TA, Au D, Krishnan JA. et al; Comparative Effectiveness Research in Lung Diseases Workshop Panel. Comparative effectiveness research in lung diseases and sleep disorders: recommendations from the National Heart, Lung, and Blood Institute workshop. Am J Respir Crit Care Med 2011; 184 (07) 848-856
    CrossrefPubMedGoogle Scholar