High dose, fast delivery magnesium sulphate in a 3-year-old acute severe asthmatic

Australasian Medical Journal (Online); Floreat Vol. 10, Iss. 9,  (2017): 826-828

Case details A three and a half year-old 14.3kg female atopic asthmatic with seven previous hospital admissions since the age of 2% yrs. for acute asthma provoked by upper respiratory tract infection was admitted to the paediatric ward with another infection. Norflurane is the propellant HFA134a in pressurised metered dose inhalers.2 The usually suggested adult IV MgSO4 doses in asthma of 1.2 to 2g over 20 minutes3 (children 25-75mg.kg-1 over 20 min) will not reach serum levels high enough to relax smooth muscle; an indication of relaxation of skin vessels is "flushing" and a feeling of warmth. Conclusion Alternatives to reverse bronchospasm are intramuscular adrenaline (epinephrine) which is first line therapy of ambulance para-medical staff for respiratory compromise in acute asthma.14 Suggested in the National Review of Asthma Deaths (NRAD) after a first episode of lifethreatening asthma is the prescription of auto adrenaline injectors (AAI) to those at risk of further attacks.15,16 There is case report evidence from the Netherlands of the successful use of IV enoximone 1 to 2mg.kg-1 bolus as a fast acting and safe bronchodilator in moribund and ventilated asthma patients.17 Enoximone is a selective phosphodiesterase inhibitor used in cardiology for vascular smooth muscle dilatation.

UHCW Research: Elton, John R and Mclachlan, Karen

Vitamin D may prevent asthma worsening for some

"Vitamin D supplements protect against severe asthma attacks," The Daily Telegraph reports.

The headline was prompted by a review that pooled data from seven trials comparing taking vitamin D supplements with a placebo in people with asthma.

The researchers wanted to see whether vitamin D reduced the risk of severe asthma episodes that needed hospitalisation or treatment with oral steroids, referred to as "asthma exacerbations".

Overall, the researchers found vitamin D supplements reduced the risk of asthma exacerbations by 26%. Further analysis found the protective effect was only seen in people who were vitamin D deficient to start with.

But the main limitation of this evidence is the small number of exacerbations that occurred. For example, in two trials there were no asthma exacerbations, in another only a single event.

Reslizumab for treating severe eosinophilic asthma

Evidence-based recommendations on reslizumab (Cinqaero) for treating severe eosinophilic asthma in adults.

Thora-3Di for assessing asthma in children [MIB122]

New NICE Advice Medtech innovation briefing

The technology described in this briefing is Thora‑3Di for assessing respiratory function in children with asthma.

The innovative aspects are that the measurements are taken non-invasively without the need for special breathing manoeuvres, and provide information on right-versus-left lung function.

Asthma action plans for HCPs working with non-English speakers

Asthma UK has responded to requests for non-English asthma action plans from healthcare professionals, pointing to the need for more health information in translation to help patients from ethnic minority populations to manage their asthma more effectively.

‘Vaginal seeding’ birth trend could do more harm than good, say experts

The potential benefits of vaginal seeding do not outweigh the risks, according to a group of doctors who reviewed the available evidence published in BJOG: An International Journal of Obstetrics and Gynaecology.

Vaginal seeding is the practice of exposing babies born by caesarean section to their mother’s vaginal fluids in order to expose them to bacteria that may help to build their immunity against some chronic conditions, such as asthma and allergies. This involves taking a swab of vaginal fluid and applying it to the baby’s eyes, face and skin after birth.

Severe asthma report - the unmet need and the global challenge

Asthma UK has published Severe asthma: the unmet need and the global challenge. This publication examines the need to improve the prospects for people with severe asthma. The report sets out the challenges of treating this complex condition and the opportunity for the scientific community to come together to make new treatments available more quickly.

Latest Pharmacological Technology Briefings - March 2017

NIHR Horizon Scanning Research and Intelligence Centre's latest batch of briefings on pharmacological technologies in development is now available:

• SQ HDM SLIT-tablet for house dust mite allergic asthma
• Pembrolizumab (Keytruda) for locally advanced or metastatic urothelial carcinoma in adults who are not eligible for cisplatin-containing chemotherapy – first line
• Pembrolizumab (Keytruda) for endometrial carcinoma – second line
• Ipilimumab (Yervoy) for unresectable malignant melanoma in paediatric patients
•  Inotersen (Ionis TTRRx) for hereditary transthyretin amyloidosis with polyneuropathy (hATTR-PN) – first line
• Galcanezumab for prevention of chronic cluster headache 
• Dupilumab for persistent asthma – add on therapy 
• DNX-2401 for recurrent glioblastoma – in combination with pembrolizumab 
• Cefiderocol for severe gram-negative infections 
• Cannabidiol (Epidiolex) for Dravet syndrome – second and subsequent line 
• Cabozantinib (Cabometyx) for advanced or metastatic renal cell carcinoma – first line 
• Atezolizumab (Tecentriq) with gemcitabine and carboplatin for advanced bladder cancer 
• Atezolizumab (Tecentriq) in combination with carboplatin and paclitaxel, alone or in combination with bevacizumab, in patients with metastatic non-squamous non-small cell lung cancer – first line 
• ATA129 for Epstein-Barr virus-associated post-transplant lymphoproliferative disorder

The Health Foundation has selected eight projects for its new Evidence into Practice programme

The Evidence into Practice programme will enable the selected research teams to use their innovative and creative ideas and translate their findings from completed studies in improvement research, or more broadly in health services research, into actionable practical tools for practitioners in health services or health policy.

Each research team will receive £50,000 for the development of tools and resources to support the implementation of findings into practice. Each project will be funded for 15 months.

The eight projects are:

1. A short animated film and other visual resources to support recognition and response to eating disorders in the perinatal period
Organisation: King’s College London, Institute of Psychiatry, Psychology and Neuroscience

2. A hand-drawn animation exploring accelerating systems thinking in health care incident investigation
Loughborough University

3. On-line tools for GPs to help support new migrants in primary care
University of Sheffield

4. Online resource pack with infographics, videos and downloadable materials on REasonable adjustments to MAINstream diabetes and obesity care for adults with a learning disability (REMAIN)
Leeds Institute of Health Sciences, University of Leeds

5. Online platform dedicated to innovation in breathlessness management (E-Breathe)
King’s College London. Cicely Saunders Institute,

​6. A year in an hour: Quality Improvement through Interactive Simulations (QIIS)
Chelsea and Westminster Hospital

​7. Short videos outlining key messages for better tracheostomy care
University Hospital South Manchester

​8. In Control: a 40 minute theatre piece and workshop to challenge, empower and provoke conversations amongst adolescents with asthma and their peers
Barts and The London School of Medicine and Dentistry, Queen Mary, University of London

Mepolizumab for treating severe refractory eosinophilic asthma

New Technology Appraisal guidance on using mepolizumab (Nucala) for treating severe refractory eosinophilic asthma in adults.

Physio makes respiratory MISSION possible

Called MISSION abc (which stands for modern innovative solutions improving outcomes in asthma, breathlessness and chronic obstructive pulmonary disease), the project has won two Healthcare News Journal awards, a patient safety award, and received local recognition.

Instead of waiting for at-risk patients to present at A&E or require unplanned care, the project identifies patients who are likely to benefit from a respiratory assessment via GP registers.

The nitric oxide breath test offers little benefit when monitoring asthma

Using exhaled nitric oxide levels to guide the dose of asthma medication at regular clinic visits may reduce flare-ups but does not improve overall symptoms or quality of life. In this review hospitalisations and the total inhaled steroid doses were unaffected by the intervention.

From the NIHR Dissemination Centre

Asthma: vitamin D has a beneficial effect on the risk of exacerbations

New Medicines Evidence Commentary from NICE:

A Cochrane review found that vitamin D supplementation had a beneficial effect on the risk of asthma exacerbations requiring treatment with systemic corticosteroids or those resulting in hospital admission or an emergency department visit. However, caution is needed when interpreting these findings and, in particular, when generalising them to people with recurrent severe asthma exacerbations or children. It is also unclear from the review how any potential beneficial effects relate to either baseline vitamin D levels or the dose of vitamin D given. Public Health England made general recommendations about vitamin D intake to protect bone and muscle health in July 2016. However, further research is required before any recommendations relating specifically to vitamin D intake for asthma can be made.

Smartinhaler for asthma

New MedTech innovation Briefing from NICE:

The Smartinhaler technology platform consists of a group of sensor devices and software. The sensors are contained in a small plastic case that clips around an asthma inhaler to detect and record inhaler activation. Audiovisual alerts on the sensor device remind patients if any medication is missed, and data on inhaler use can be shared with clinicians via the software.

Annual Asthma Survey: 2016 report

This is the 4th edition of the Annual Asthma Survey. This report finds that two thirds of people are still not receiving the basic care they need to manage their asthma, with wide variations in the level of care reported between different parts of the UK. It also found that seven out of ten people with asthma who end up in hospital are not given a follow-up appointment with a GP or nurse.

New NICE guideline to help people take control of their asthma could save the NHS millions

NICE has issued draft guidance setting out what medicines adults, young people and children with asthma should take to control symptoms and reduce asthma attacks.

In this draft guidance, now out for public consultation, NICE says that people should get a 7 pence a day tablet earlier than current practice. It estimates that every 10,000 people who take up the new recommendation could save £3 million a year.

Antibiotics are probably of no benefit for acute asthma attack

The antibiotic azithromycin does not appear to reduce symptoms or change other outcomes in adults seeking emergency care for an acute asthma attack. However people not already taking antibiotics were hard to find.

From the NIHR Dissemination Centre

Vitamin D supplements can reduce risk of asthma attacks

People with mild to moderate asthma experience fewer severe asthma attacks if they take vitamin D supplements.

This review found that the average number of asthma attacks was equivalent to about one every four years in those taking vitamin D, compared to nearly one every two years in those taking a placebo. Half as many people attended hospital for asthma treatment each year when taking vitamin D (3%) compared with those not taking vitamin D (6%). These reductions were clinically and statistically significant.

From the NIHR Dissemination Centre

NICE recommends first-of-its kind asthma treatment mepolizumab

Adults with severe asthma will soon have access to new drug mepolizumab, also known as Nucala, after NICE recommends it for NHS use. 

Mepolizumab is a new type of medicine that targets a specific cause of asthma for the first time. In draft guidance NICE says that adults with severe symptoms should have access to mepolizumab. This includes adults who suffer many asthma attacks or those taking regular oral steroids.

Intermittent inhaled steroids reduce asthma attacks in wheezing preschool children

Regular daily steroid inhalers reduce the number of severe asthma exacerbations requiring soluble tablets or injections in wheezing preschool children by about a third.

From the NIHR Dissemination Centre