Definition of Asthma 4/27/2016. Asthma Phenotypes, Immunology and Implications for Therapy. J R Hansbrough MD, Ph.D.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Definition of Asthma 4/27/2016. Asthma Phenotypes, Immunology and Implications for Therapy. J R Hansbrough MD, Ph.D."

Transcription

1 Asthma Phenotypes, Immunology and Implications for Therapy J R Hansbrough MD, Ph.D. Graves Gilbert Clinic Bowling Green, Kentucky Definition of Asthma A chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation. Inflammatory disease of the airway Reversibility of airway obstruction (with time and treatment) Waxing and waning symptoms 1

2 Asthma Prevalence, Morbidity and Mortality 22.2 Million People Are Currently Diagnosed With Asthma 13.6 Million Unscheduled Office Visits Annually 1.8 Million Emergency Room Visits Annually 0.5 Million Hospitalizations Annually Approximately 4000 Asthma- Related Deaths Approximately 11 People Die From Asthma Each Day in the US National Center for Health Statistics, CDC, 2005; Mainstay of Asthma Therapy Inhaled steroids are by far the most effective therapy for chronic therapy. Should be utilized for anyone with chronic symptoms (use of rescue inhaler 2 or more times a week or evidence of chronic airflow obstruction). Long acting beta agonists (LABA) in combination with inhaled steroids improve control. Cardiovascular side effects have been of some concern. Environmental Control Smoking history and exposure Pets, plants, basement, damp living spaces, carpet. Exposure to fumes or smoke (wood burning stoves) Known triggers to asthma symptoms Specific IgE sensitivity (RAST or ImmunoCAP prolifes) 2

3 Poor Patient Adherence 4/27/2016 Stepwise Approach for Managing Asthma Step 6: High-dose ICS + LABA + Oral Corticosteroids and Consider Omalizumab Step 5: High-dose ICS + LABA and Consider Omalizumab Step 4: Medium-dose ICS + LABA Step 3: Low-dose ICS + Long-acting Beta 2-agonists (LABA) or Medium-dose ICS Step 2: Low-dose Inhaled Corticosteroids (ICS) Step 1: Short-acting Beta 2-agonists Phenotypes of Asthma Extrinsic vs. Instrinsic Allergic vs. Non Allergic Thy-2 vs. Non Thy-2 IgE mediated Eosinophilia Bronchitis The more we know, the less we understand. Better characterization of asthma phenotypes, the more heterogeneous the disease appears Immunology of WBCs Monocytes Granulocytes---Polymorphonuclear leukocytes Neutrophils Eosinophils Basophils---Mast cells Lymphocytes T cells regulatory cells B cells---mature into immunoglobulin producing cells 3

4 Immunoglobulins Infection fighting proteins produced by matured B cells (Plasma Cells) IgA IgG IgM IgE---anti parasitic and allergy mediators Interleukins (IL) Interleukin are a group of cytokines (secreted proteins and signal molecules) that were first described as being expressed by white blood cells. The function of the immune system depends in a large part on interleukins. Produced by a large number of cell types Local response to injury, inflammation or infection Maturation and developed of different white cell types (Esp. T/B cells) Most recent data describes 36 human interleukins 4

5 Interleukins of interest in asthma IL-4---Stimulates B cell maturation to IgE producing plasma cells and production of eosinophils IL-5---Maturation, production and stabilization of eosinophils IL-13--Stimulates B cell maturation to IgE producing plasma cells and production of eosinophils THIS IS A SIMPLIFICATION!!!! As with all interleukins, they can have multiple and wide ranging effects Pathophysiology of asthma Th2 pathways---t cell subtype associated with classic allergic (IgE mediated) mechanisms IL-4 and IL-13 mediated pathways IL-5 Eosinophil maturation and survival Non Th2 pathways---less well defined. Explains may of the non-allergic mediated asthma Epithelial-extracellular matrix inflammation Response to infectious agents TGF-beta/Smad2 overexpression Airway remodeling Inflammatory Cascade B cell T cell IL-4, IL-13 lge production Mast cell Antigenpresenting cell Allergen Activated B cell (plasma cell) Allergen cross-linking Mediator release Airway wall IgE Fc RI Storms. Am J Respir Med. 2002:1:361. MacGlashan et al. J Immunol. 1997;158:1438. Safety and efficacy have not been established in other allergic conditions. 15 5

6 6

7 Humanized Monoclonal Antibodies Revolutionary advance in the use of antibodies as therapy Monoclonal antibodies produced in animals/non human cell cultures Genetic sequence for the binding sites is spliced out of non human source and inserted into a human gene for IgG production Identified by the mab ending. Omalizumab Biological Characteristics Humanized monoclonal antibody against IgE Binds circulating IgE regardless of specificity Forms small, biologically inert Xolair: IgE complexes Does not activate complement Murine CDRs (5% of molecule) IgG1 kappa human framework (95% of molecule) CDR = complementarity-determining region. Adapted from Boushey. J Allergy Clin Immunol. 2001;108:S77. Please refer to the full Prescribing Information, including Boxed WARNING and Medication Guide. 20 In this simplistic model of asthma, specific antagonism of selected mediators could be a very effective treatment for asthma Specific targets Specific Agents IL-4 IL-5 IL-13 IgE Dupilumab Mepolizumab Dupilumab Omalizumab* 7

8 Recent Classification of Asthma Phenotypes Early onset atopic with stable asthma Early onset atopic asthma with poor control Late onset female predominant asthma associated with obesity Late onset atopic asthma Late onset with mixed inflammation Am J Respir Crit Care Med Vol 181. pp , 2010 Theory: Response to treatment, especially treatment with biological modifiers can be predicted by clinical asthma phenotypes Omalizumab Anti IgE therapy IgE mediated asthma with significant allergy triggers Mepolizumab---Anti IL-5 therapy Asthma with eosinophilia Dupilumab---Anti IL-4 and Anti-13 Allergic asthma with eosinophilia In actual practice, patient selection and response to treatment is much more complicated 8

9 Lancet 2000; 356: Effects of an interleukin-5 blocking monoclonal antibody on eosinophils, airway hyper-responsiveness, and the late asthmatic response 9

10 Biomarkers useful in directing asthma therapy Blood eosinophil--il-5 especially (IL-4 and Il-13) Periostin---IL-13 FeNO---IL-4, IL-5, IL-13 IgE---Allergic mediated, IgE blocking agents Biomarker based asthma therapy Agent Target Markers Omalizumab IgE IgE, FeNO, atopy?eosinophil Mepolizumab Il-5 Blood Eosinophilia Dupilumab IL-4/Il-13 FeNO, Periostin, Eosinophilia Biological Modifiers in Asthma Omalizumab 1 st Monoclonal antibody on market for asthma treatment Selective IgE Blocker 10

11 Overview of IgE-Mediated Inflammatory Cascade B cell T cell IL-4, IL-13 lge production Mast cell Antigenpresenting cell Allergen Activated B cell (plasma cell) Allergen cross-linking Mediator release Airway wall IgE Fc RI Storms. Am J Respir Med. 2002:1:361. MacGlashan et al. J Immunol. 1997;158:1438. Safety and efficacy have not been established in other allergic conditions. 31 Omalizumab Mechanism of Action (cont d) Omalizumab down-regulates high-affinity receptors Omalizumab inhibits mast-cell degranulation Omalizumab helps prevent Omalizumab exacerbations and limits the improve symptoms release of inflammatory mediators Mast cell Mediator release Airway wall Allergen crosslinking IgE Other drugs Storms Am J Respir Med. 2002:1:361. MacGlashan et al. J Immunol. 1997;158:1438. Please refer to the full Prescribing Information, including Boxed WARNING and Medication Guide. Safety and efficacy have not been established in other allergic conditions. 32 Omalizumab Mechanism of Action Omalizumab acts early in the allergic cascade to selectively target lge IgE Omalizumab Mast cell Omalizumab binds serum-free lge to inhibit mediators of inflammation Storms. Am J Respir Med. 2002:1:361. MacGlashan et al. J Immunol. 1997;158:1438. Safety and efficacy have not been Please refer to the full Prescribing Information, including Boxed WARNING and Medication Guide. established in other allergic conditions

12 Odds ratio 4/27/2016 Relationship Between Asthma and Serum IgE Level Asthma Risk Versus Total Serum IgE Concentration* Serum IgE level (IU/mL) The risk for allergic asthma starts with relatively low IgE levels. Data from several population-based studies indicate that the overall geometric mean levels of IgE in the general population range from 20 IU/mL to 40 IU/mL. 1 *Results of a random, stratified cluster sample of 2657 patients that investigated the association of selfreported asthma with serum IgE levels and skin-test reactivity to allergens. Adapted from Burrows et al. N Engl J Med. 1989;320: Dolan et al. In: IgE and Anti-IgE Therapy in Asthma and Allergic Disease Clinical Summary of Omalizumab Therapy Clinical studies-50% reduction in asthma flares and significant improvement in symptoms and quality of life. Clinical experience-outstanding drug for selected moderate to severe asthmatics. Cancer risk most likely a statistical abnomity. Anaphylaxis risk. (25 patients out of 39,510 patients treated) Duration of Therapy Of patients stopping drug after 5-7 years, 75% maintained asthma control Mepolizumab therapy in asthma (NEJM 2014) 12

13 Dupilumab in Persistant Asthma with Elevated Eosinophil Levels NEJM 368(26): Biological Modifiers in Asthma--Summary Omalizumab reduces exacerbations, improves symptom control, reduces glucocorticoid and β2-agonist usage, improves patient quality of life, together with significant improvements in lung function and has a favorable risk benefit profile. Mepolizumab is efficacious in patients with specific phenotypes of severe asthma characterized by persistent, glucocorticosteroid-resistant eosinophilia. Dual inhibition of IL-4 and IL-13 with dupilumab represents a very promising avenue for biologic-based asthma therapy, but further largescale clinical trials on patients with day-to-day asthma are required to fully validate such an approach. Airway Smooth Muscle Normal Airway Asthmatic Attack Airway 13

14 Bronchial Thermoplasty Rationale Reduces Excessive Airway Smooth Muscle (ASM) Reduced Ability for Bronchoconstriction Reduced Asthma Symptoms and Exacerbations Improved Asthma Control and Quality of Life Bronchial Thermoplasty If airway smooth muscle is reduced, airway bronchoconstriction can be reduced, and therefore asthma symptoms and quality of life will potentially improve. Bronchial Thermoplasty with the Alair System reduces airway smooth muscle through controlled thermal treatment to the airway wall. The Alair System The Alair Catheter is a flexible tube with an expandable wire array at the tip. The Alair Radiofrequency Controller supplies energy via the Alair Catheter to heat the airway wall. Censored MCBG 14

15 Reduced Airway Smooth Muscle 3 Years Post-Treatment (Canine Model) Ciliated Epithelium ASM Reduced ASM Ciliated Epithelium Parenchyma Parenchyma UNTREATED TREATED Masson s Trichrome stain Treatment Method All visible and accessible airways (3-10mm) distal to mainstem bronchi are treated Series of contiguous activations 3 treatment sessions Danek et al. J Appl Physiol. 2004; 97:

16 Bronchoscopic View of Local Methacholine Challenge Cox et al. Eur Respir Journal. 2004; 24: Treated airway on left Treatment Effects of Bronchial Thermoplasty Reduces, but does not eliminate ASM. No clinical evidence of airway structure based on FEV 1 values in human studies. No clinical evidence of long-term (5 yr) bronchiectasis, decreased pulmonary function, or pneumonia based on CT scans. Miller et al. CHEST. 2005; 127(6): Cox et al. AJRCCM. 2006; 173(9): Preclinical histology in canine model showed a reduction in ASM, persistent out to 3 years. Danek et al. J Appl Physiol. 2004; 97: Summary Asthma is a complex disease. Newer therapies will be directed based on both clinical phenotypes and biomarkers. Biological modifiers have and should continue to have dramatic effects on the control of severe asthma. Bronchial Thermoplasty represents a promising, new, and novel treatment for asthma. 16

9/16/2014. Anti-Immunoglobulin E (IgE) Omalizumab (Xolair ) Dosing Guidance

9/16/2014. Anti-Immunoglobulin E (IgE) Omalizumab (Xolair ) Dosing Guidance Disclosure Statement of Financial Interest New Therapies for Asthma Including Omalizumab and Anti-Cytokine Therapies Marsha Dangler, PharmD, BCACP Clinical Pharmacy Specialist James H. Quillen VA Medical

More information

Asthma (With a little SCID to start) Disclosures Outline Starting with the Immune System The Innate Immune System The Adaptive Immune System

Asthma (With a little SCID to start) Disclosures Outline Starting with the Immune System The Innate Immune System The Adaptive Immune System 1 2 3 4 5 6 7 8 9 Asthma (With a little SCID to start) Lauren Smith, MD CHKD Pediatric Allergy/Immunology Disclosures None Will be discussing some medications that are not yet FDA approved Outline SCID

More information

Progress in Treating Disease: The Case of Asthma

Progress in Treating Disease: The Case of Asthma 13TH EUROPEAN HEALTH FORUM CHRONIC RESPIRATORY DISEASES: A NEGLECTED EPIDEMICS GASTEIN 7 OCTOBER 2010 Progress in Treating Disease: The Case of Asthma Leonardo M. Fabbri Clinica di Malattie dell Apparato

More information

Background information

Background information Background information Asthma Asthma is a complex disease affecting the lungs that can be managed but cannot be cured. 1 Asthma can be controlled well in most people most of the time, although some people

More information

Objectives. Internal Medicine Board Review Asthma. Emily DiMango, MD. Asthma Is Prevalent: Significant Morbidity and Mortality

Objectives. Internal Medicine Board Review Asthma. Emily DiMango, MD. Asthma Is Prevalent: Significant Morbidity and Mortality Internal Medicine Board Review Asthma Emily DiMango, MD Director John Edsall/John Wood Asthma Center Columbia University Medical Center Objectives Review asthma epidemiology Asthma pathophysiology/definition

More information

A Paradigm Shift in Treating Asthma: Bronchial Thermoplasty

A Paradigm Shift in Treating Asthma: Bronchial Thermoplasty A Paradigm Shift in Treating Asthma: Bronchial Thermoplasty Brandy Alfred, MBA, CMR CAE June 7, 2013 Disclosure Successful completion: Participants must attend the entire program, including any resulting

More information

Reslizumab for treating asthma with elevated blood eosinophils inadequately controlled by inhaled corticosteroids [ID872]

Reslizumab for treating asthma with elevated blood eosinophils inadequately controlled by inhaled corticosteroids [ID872] For public handouts Reslizumab for treating asthma with elevated blood eosinophils inadequately controlled by inhaled corticosteroids [ID872] 1 st Appraisal Committee meeting Clinical Effectiveness and

More information

Asthma. These changes cause bronchial hyperresponsiveness and airflow limitation Affects over 300 million people worldwide

Asthma. These changes cause bronchial hyperresponsiveness and airflow limitation Affects over 300 million people worldwide Michael A. Venditto DO, FACOI, FCCP Professor and Chairman Division of Pulmonary and Critical Care Medicine Philadelphia College of Osteopathic Medicine Philadelphia, Pennsylvania Asthma Chronic disease

More information

Mepolizumab (Nucala ) for Treatment of Severe Asthma with Eosinophilic Inflammation: Effectiveness, Value, and Value-Based Price Benchmarks

Mepolizumab (Nucala ) for Treatment of Severe Asthma with Eosinophilic Inflammation: Effectiveness, Value, and Value-Based Price Benchmarks Mepolizumab (Nucala ) for Treatment of Severe Asthma with Eosinophilic Inflammation: Effectiveness, Value, and Value-Based Price Benchmarks Final Background and Scope November 18, 2015 Background: The

More information

Bronchial thermoplasty for severe asthma

Bronchial thermoplasty for severe asthma Severe Refractory Asthma Meeting, Leuven, Belgium 20 th February 2014 Bronchial thermoplasty for severe asthma Professor Neil C Thomson Institute of Infection, Immunity & Inflammation University of Glasgow

More information

New Biologic Therapies For Severe Asthma. Jonathan Corren, M.D. Department of Medicine David Geffen School of Medicine at UCLA

New Biologic Therapies For Severe Asthma. Jonathan Corren, M.D. Department of Medicine David Geffen School of Medicine at UCLA New Biologic Therapies For Severe Asthma Jonathan Corren, M.D. Department of Medicine David Geffen School of Medicine at UCLA Disclosures for Jonathan Corren, MD For the 12 months preceding this CME activity,

More information

MEDICAL POLICY STATEMENT

MEDICAL POLICY STATEMENT MEDICAL POLICY STATEMENT Original Effective Date Next Annual Review Date Last Review / Revision Date 06/15/2011 02/15/2017 03/09/2016 Policy Name Policy Number Xolair/Nucala SRx-0013 Policy Type Medical

More information

Pharmacy Management Drug Policy

Pharmacy Management Drug Policy PAGE: Page 1 of 5 DESCRIPTION: Asthma is a heterogeneous syndrome that might be better described as a constellation of phenotypes, each with distinct cellular and molecular mechanisms, rather than as a

More information

How to use FENO-guided asthma control in routine clinical practice

How to use FENO-guided asthma control in routine clinical practice How to use FENO-guided asthma control in routine clinical practice Asthma is a chronic inflammatory disease of the airways. This has implications for the diagnosis, management and potential prevention

More information

understanding the professional guidelines

understanding the professional guidelines SEVERE ASTHMA understanding the professional guidelines This guide includes information on what the European Respiratory Society (ERS) and the American Thoracic Society (ATS) have said about severe asthma.

More information

NIH Asthma Guidelines. Versus. Asthma: Cost Beyond Non-Compliance

NIH Asthma Guidelines. Versus. Asthma: Cost Beyond Non-Compliance Asthma: Cost Beyond Non-Compliance WILLIAM CRAWFORD, MD OCTOBER 24, 2014 Outpatient Management of Asthma NIH Asthma Guidelines-Based Care Stepping Up Controller Therapy Newer Treatments for Severe Asthma

More information

بسم اهلل الرحمن الرحيم

بسم اهلل الرحمن الرحيم بسم اهلل الرحمن الرحيم College of medicine 432 ASTHMA Done By Mohammed Abdullah Alghammass *please make sure you read the objectives from the reading material file Asthma: Asthma is a chronic inflammatory

More information

Lessons Learned from the Severe Asthma Program

Lessons Learned from the Severe Asthma Program Lessons Learned from the Severe Asthma Program March 20, 2015 Jonathan Gaffin, MD, MMSc Division of Respiratory Diseases Boston Children s Hospital Sachin Baxi, MD Division of Allergy & Immunology Boston

More information

Severe asthma Definition, epidemiology and risk factors. Mina Gaga Athens Chest Hospital

Severe asthma Definition, epidemiology and risk factors. Mina Gaga Athens Chest Hospital Severe asthma Definition, epidemiology and risk factors Mina Gaga Athens Chest Hospital Difficult asthma Defined as asthma, poorly controlled in terms of chronic symptoms, with episodic exacerbations,

More information

LECTURE 4 IMMEDIATE HYPERSENSITIVITY: ALLERGY

LECTURE 4 IMMEDIATE HYPERSENSITIVITY: ALLERGY LECTURE 4 IMMEDIATE HYPERSENSITIVITY: ALLERGY Allergies represent TYPE I reactions according to the Gell and Coombs classification. Most are caused by IgE ANTIBODIES which are capable of binding to Fc-

More information

Update in ASTHMA: Clearing the Air What Works and What Doesn t? Blair Brooks MD Dartmouth Hitchcock Medical Center COOP Meeting Pre Workshop 2/04/05

Update in ASTHMA: Clearing the Air What Works and What Doesn t? Blair Brooks MD Dartmouth Hitchcock Medical Center COOP Meeting Pre Workshop 2/04/05 Update in ASTHMA: Clearing the Air What Works and What Doesn t? Blair Brooks MD Dartmouth Hitchcock Medical Center COOP Meeting Pre Workshop 2/04/05 Knowing is not enough: we must apply. Willing is not

More information

New treatment approaches for airway diseases Ian Pavord

New treatment approaches for airway diseases Ian Pavord New treatment approaches for airway diseases Ian Pavord Professor of Respiratory Medicine University of Oxford Honorary Consultant Physician University of Oxford Hospitals NHS Trust Rosenthal. Thorax 2015;70:112

More information

Phenotype of Severe Asthma: Pediatric Perspectives

Phenotype of Severe Asthma: Pediatric Perspectives Severe Asthma Symposium Phenotype of Severe Asthma: Pediatric Perspectives Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea Young Yoo Asthma is a chronic, persistent disorder

More information

Monoclonal Antibodies in Asthma Therapy. Yehia El-Gamal MD, PhD

Monoclonal Antibodies in Asthma Therapy. Yehia El-Gamal MD, PhD Monoclonal Antibodies in Asthma Therapy Yehia El-Gamal MD, PhD Conflict of Interest Nothing to disclose Objectives Following this presentation, the audience should be able to: Recognize some important

More information

Module 1. Pathophysiology and Clinical Features of Asthma. Scott K. Stolte, Pharm.D.

Module 1. Pathophysiology and Clinical Features of Asthma. Scott K. Stolte, Pharm.D. Module 1 Pathophysiology and Clinical Features of Asthma Scott K. Stolte, Pharm.D. Pre-Assessment Exercise 1 Question #1 How many people in the US have asthma? a. 5 million b. 10 million c. 15 million

More information

Clinical Practice Guideline for the Management of Asthma in Children and Adults

Clinical Practice Guideline for the Management of Asthma in Children and Adults Clinical Practice Guideline for the Management of Asthma in Children and Adults Assessment: A critical aspect of the diagnosis and management of asthma is the precise and periodic measurement of lung function

More information

Key Components in Treating Asthma in Adults and Children Older than 5 Years: Diagnosis, Treatment and Referral

Key Components in Treating Asthma in Adults and Children Older than 5 Years: Diagnosis, Treatment and Referral Key Components in Treating Asthma in Adults and Children Older than 5 Years: Diagnosis, Treatment and Referral Initial Asthma Assessment Critical to accurately diagnose asthma by: Identifying the presence

More information

The Immune System and its Diseases. Part 2. Outline 2/18/2011. Jonathan Fox

The Immune System and its Diseases. Part 2. Outline 2/18/2011. Jonathan Fox The Immune System and its Diseases. Part 2. Jonathan Fox jfox7@uwyo.edu Outline Self and non self Introduction to hypersensitivity and autoimmune diseases Type I hypersensitivity i i mechanism of disease

More information

Pre-Operative Services Teaching Rounds 2 Jan 2011

Pre-Operative Services Teaching Rounds 2 Jan 2011 Pre-Operative Services Teaching Rounds 2 Jan 2011 Deborah Richman MBChB FFA(SA) Director Pre-Operative Services Department of Anesthesia Stony Brook University Medical Center, NY drichman@notes.cc.sunysb.edu

More information

SEVERE ASTHMA: CAN PHENOTYPING HELP WITH UNDERSTANDING AND TREATMENT? SALLY WENZEL, MD 1

SEVERE ASTHMA: CAN PHENOTYPING HELP WITH UNDERSTANDING AND TREATMENT? SALLY WENZEL, MD 1 AND TREATMENT? SALLY WENZEL, MD 1 So good day everyone, my presentation for today is Severe Asthma: Can Phenotyping Help with Understanding and Treatment? So severe asthma actually should be considered

More information

Compare the physiologic responses of the respiratory system to emphysema, chronic bronchitis, and asthma

Compare the physiologic responses of the respiratory system to emphysema, chronic bronchitis, and asthma Chapter 31 Drugs Used to Treat Lower Respiratory Disease Learning Objectives Describe the physiology of respirations Compare the physiologic responses of the respiratory system to emphysema, chronic bronchitis,

More information

COPD and Asthma Differential Diagnosis

COPD and Asthma Differential Diagnosis COPD and Asthma Differential Diagnosis Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in America. Learning Objectives Use tools to effectively diagnose chronic obstructive

More information

On completion of this chapter you should be able to: discuss the stepwise approach to the pharmacological management of asthma in children

On completion of this chapter you should be able to: discuss the stepwise approach to the pharmacological management of asthma in children 7 Asthma Asthma is a common disease in children and its incidence has been increasing in recent years. Between 10-15% of children have been diagnosed with asthma. It is therefore a condition that pharmacists

More information

Therapeutic phenotypes of severe asthma new treatments Ian Pavord

Therapeutic phenotypes of severe asthma new treatments Ian Pavord Therapeutic phenotypes of severe asthma new treatments Ian Pavord Professor of Respiratory Medicine University of Oxford Why individualised treatment in severe asthma? Disease is complex and difficult

More information

Update in ASTHMA and COPD: Clearing the Air What Works and What Doesn t?

Update in ASTHMA and COPD: Clearing the Air What Works and What Doesn t? Update in ASTHMA and COPD: Clearing the Air What Works and What Doesn t? Blair Brooks MD Dartmouth Hitchcock Medical Center Community Faculty Development Symposium 11/05/04 Knowing is not enough: we must

More information

Autoimmunity and immunemediated. FOCiS. Lecture outline

Autoimmunity and immunemediated. FOCiS. Lecture outline 1 Autoimmunity and immunemediated inflammatory diseases Abul K. Abbas, MD UCSF FOCiS 2 Lecture outline Pathogenesis of autoimmunity: why selftolerance fails Genetics of autoimmune diseases Therapeutic

More information

Prevention of Acute COPD exacerbations

Prevention of Acute COPD exacerbations December 3, 2015 Prevention of Acute COPD exacerbations George Pyrgos MD 1 Disclosures No funding received for this presentation I have previously conducted clinical trials with Boehringer Ingelheim. Principal

More information

Asthma Diagnosis and Management

Asthma Diagnosis and Management Asthma Diagnosis and Management Asthma is a condition characterized by narrowing and inflammation of the airways. This inflammation causes the airways to be very sensitive and react to a variety of stimuli

More information

Rhinosinusitis and asthma: the missing link

Rhinosinusitis and asthma: the missing link Rhinosinusitis and asthma: the missing link Curr Opin Pulm Med. 2009 January ; 15(1): 19 24. Anne E. Dixon, MD. Vermont Lung Center at the University of Vermont Ri 王怡人 X Epidemiology 梁 risk factor Allergic

More information

The Immune System: A Tutorial

The Immune System: A Tutorial The Immune System: A Tutorial Modeling and Simulation of Biological Systems 21-366B Shlomo Ta asan Images taken from http://rex.nci.nih.gov/behindthenews/uis/uisframe.htm http://copewithcytokines.de/ The

More information

Before prescribing montelukast sodium, please read the accompanying Prescribing Information.

Before prescribing montelukast sodium, please read the accompanying Prescribing Information. Merck & Co., Inc. U.S. Human Health P.O. Box 1000 North Wales, PA 19454-1099 Dear Health Care Professional: Thank you for your interest in the enclosed attachment, Stepwise Approach for Managing, excerpted

More information

Treating by phenotype

Treating by phenotype Treating by phenotype Module 3 Zinc Code: NOCL/NLA/0009/16 Date of Preparation: April 2016 1 2 3 4 5 6 Learning objectives Severe asthma phenotypes Identifying phenotypes Phenotyping in the clinic Biomarkers

More information

Rheumatoid arthritis: an overview. Christine Pham MD

Rheumatoid arthritis: an overview. Christine Pham MD Rheumatoid arthritis: an overview Christine Pham MD RA prevalence Chronic inflammatory disease affecting approximately 0.5 1% of the general population Prevalence is higher in North America (approaching

More information

ONCE-DAILY TIOTROPIUM RESPIMAT ADD-ON TO ICS ± LABA IMPROVES CONTROL ACROSS ASTHMA SEVERITIES

ONCE-DAILY TIOTROPIUM RESPIMAT ADD-ON TO ICS ± LABA IMPROVES CONTROL ACROSS ASTHMA SEVERITIES SPIRIVA Respimat is approved for use in asthma in the EU, Japan, the USA and many other countries. The label varies by country. Please refer to the local product information ONCE-DAILY TIOTROPIUM RESPIMAT

More information

Basics of Immunology

Basics of Immunology Basics of Immunology 2 Basics of Immunology What is the immune system? Biological mechanism for identifying and destroying pathogens within a larger organism. Pathogens: agents that cause disease Bacteria,

More information

Pharmacology of the Respiratory Tract: COPD and Steroids

Pharmacology of the Respiratory Tract: COPD and Steroids Pharmacology of the Respiratory Tract: COPD and Steroids Dr. Tillie-Louise Hackett Department of Anesthesiology, Pharmacology and Therapeutics University of British Columbia Associate Head, Centre of Heart

More information

4/12/2010 Update in the management of Asthma and COPD M. Shafick Gareeboo Consultant Chest Physician Consultant Chest 1

4/12/2010 Update in the management of Asthma and COPD M. Shafick Gareeboo Consultant Chest Physician Consultant Chest 1 Update in the management of Asthma and COPD M. Shafick Gareeboo Consultant Chest Physician 1 Content Current guidelines in asthma management Current guidelines in COPD management New treatment for COPD

More information

Respiratory Reviews in Asthma 2013. Tae-Hyung Kim, M.D. Hanyang University College of Medicine

Respiratory Reviews in Asthma 2013. Tae-Hyung Kim, M.D. Hanyang University College of Medicine Respiratory Reviews in Asthma 2013 Tae-Hyung Kim, M.D. Hanyang University College of Medicine Contents New treatment options Effect of treatment adjustment Useful diagnostic markers in asthma Scoring systems

More information

Pharmacology of the Respiratory Tract: COPD and Steroids

Pharmacology of the Respiratory Tract: COPD and Steroids Pharmacology of the Respiratory Tract: COPD and Steroids Dr. Tillie-Louise Hackett Department of Anesthesiology, Pharmacology and Therapeutics University of British Columbia Associate Head, Centre of Heart

More information

Dr GH Kaye-Eddie Helen Joseph Hospital Pulmonology

Dr GH Kaye-Eddie Helen Joseph Hospital Pulmonology Dr GH Kaye-Eddie Helen Joseph Hospital Pulmonology Introduction Definitions Impact of Exacerbations Assessment of COPD Management of COPD Management of Acute Exacerbations Prevention of Exacerbations COPD

More information

DRUG UTILISATION STUDY IN BRONCHIAL ASTHMA IN A TERTIARY CARE HOSPITAL

DRUG UTILISATION STUDY IN BRONCHIAL ASTHMA IN A TERTIARY CARE HOSPITAL International Journal of Pharmaceutical Applications ISSN 0976-2639, Online ISSN 2278 6023 Vol 3, Issue 2, 2012, pp 297-305 http://www.bipublication.com DRUG UTILISATION STUDY IN BRONCHIAL ASTHMA IN A

More information

FOOD ALLERGY: WHEN ARE SKIN PRICK TESTS AND EPIPENS INDICATED? Dr Imogen Norton Consultant Paediatrician Northampton General Hospital

FOOD ALLERGY: WHEN ARE SKIN PRICK TESTS AND EPIPENS INDICATED? Dr Imogen Norton Consultant Paediatrician Northampton General Hospital FOOD ALLERGY: WHEN ARE SKIN PRICK TESTS AND EPIPENS INDICATED? Dr Imogen Norton Consultant Paediatrician Northampton General Hospital September 2012 OVERVIEW OF FOOD ALLERGY Definition Background Types

More information

Treatment of Asthma. Talk to your doctor about the various medications available to treat asthma.

Treatment of Asthma. Talk to your doctor about the various medications available to treat asthma. Please call 911 if you think you have a medical emergency. Treatment of Asthma The goals of asthma therapy are to prevent your child from having chronic and troublesome symptoms, to maintain your child's

More information

Asthma in Older Adults: overcoming the challenges of diagnosis and management

Asthma in Older Adults: overcoming the challenges of diagnosis and management Asthma in Older Adults: overcoming the challenges of diagnosis and management Jennifer Gonzalez McComb, MD, MPH, FACP Section Chief, Pulmonary and Critical Care Medicine UPMC Shadyside Hospital April 9,

More information

Immune system Disorders. Chapter 19

Immune system Disorders. Chapter 19 Immune system Disorders Chapter 19 I. Hypersensitivity Definition Once sensitized with an antigen (allergen) the immune system responds to a subsequent exposure by reacting with it in a way that damages

More information

Selective IgA deficiency (slgad) hello@piduk.org 0800 987 8986 www.piduk.org

Selective IgA deficiency (slgad) hello@piduk.org 0800 987 8986 www.piduk.org Selective IgA deficiency (slgad) hello@piduk.org 0800 987 8986 www.piduk.org About this booklet This booklet provides information on selective IgA deficiency (sigad). It has been produced by the PID UK

More information

An Overview of Asthma - Diagnosis and Treatment

An Overview of Asthma - Diagnosis and Treatment An Overview of Asthma - Diagnosis and Treatment Asthma is a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness,

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

11/20/2011. Outline. Immune System Function. Terminology. Two Types of Immune Defense. Innate Immunity = Non Specific

11/20/2011. Outline. Immune System Function. Terminology. Two Types of Immune Defense. Innate Immunity = Non Specific Chapter 43 Immune System Outline I. Nonspecific Defenses A. Barrier B. Protective proteins C. Phagocytes D. Natural killer cells E. Inflammatory reaction II. Specific Defenses A. B cells Antibody mediated

More information

Hypersensitivity. TYPE I Hypersensitivity Classic allergy. Allergens. Characteristics of allergens. Allergens. Mediated by IgE attached to Mast cells.

Hypersensitivity. TYPE I Hypersensitivity Classic allergy. Allergens. Characteristics of allergens. Allergens. Mediated by IgE attached to Mast cells. Gel and Coombs classification of hypersensitivities. Hypersensitivity Robert Beatty Type I Type II Type III Type IV MCB150 IgE Mediated IgG/IgM Mediated IgG Mediated T cell Classic Allergy rbc lysis Immune

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of bronchial thermoplasty for severe asthma Treating severe asthma using radiofrequency

More information

Ambulatory Asthma Management

Ambulatory Asthma Management Ambulatory Asthma Management Summary of Recommendations Algorithm Patient presents with symptoms of asthma Establish diagnosis and determine level of severity by H and P and spirometry. (A) Consider alternative

More information

ANIMALS FORM & FUNCTION BODY DEFENSES NONSPECIFIC DEFENSES PHYSICAL BARRIERS PHAGOCYTES. Animals Form & Function Activity #4 page 1

ANIMALS FORM & FUNCTION BODY DEFENSES NONSPECIFIC DEFENSES PHYSICAL BARRIERS PHAGOCYTES. Animals Form & Function Activity #4 page 1 AP BIOLOGY ANIMALS FORM & FUNCTION ACTIVITY #4 NAME DATE HOUR BODY DEFENSES NONSPECIFIC DEFENSES PHYSICAL BARRIERS PHAGOCYTES Animals Form & Function Activity #4 page 1 INFLAMMATORY RESPONSE ANTIMICROBIAL

More information

Caribbean Asthma Guidelines. UWI/BAMP CME meeting November 2015

Caribbean Asthma Guidelines. UWI/BAMP CME meeting November 2015 Caribbean Asthma Guidelines UWI/BAMP CME meeting November 2015 Dr. M.E. Howitt 1 Why do we need Caribbean Asthma Guidelines? 2 Asthma in the Caribbean- concerns Concerns: High Prevalence Morbidity Economic

More information

Influenza (Flu) Influenza is a viral infection that may affect both the upper and lower respiratory tracts. There are three types of flu virus:

Influenza (Flu) Influenza is a viral infection that may affect both the upper and lower respiratory tracts. There are three types of flu virus: Respiratory Disorders Bio 375 Pathophysiology General Manifestations of Respiratory Disease Sneezing is a reflex response to irritation in the upper respiratory tract and is associated with inflammation

More information

specific B cells Humoral immunity lymphocytes antibodies B cells bone marrow Cell-mediated immunity: T cells antibodies proteins

specific B cells Humoral immunity lymphocytes antibodies B cells bone marrow Cell-mediated immunity: T cells antibodies proteins Adaptive Immunity Chapter 17: Adaptive (specific) Immunity Bio 139 Dr. Amy Rogers Host defenses that are specific to a particular infectious agent Can be innate or genetic for humans as a group: most microbes

More information

Faculty. EPR3: A Pediatric Asthma Diagnosis and Management Update. Outline. Definition of AR. Objective Findings. Allergy?

Faculty. EPR3: A Pediatric Asthma Diagnosis and Management Update. Outline. Definition of AR. Objective Findings. Allergy? EPR3: A Pediatric Asthma Diagnosis and Management Update Produced by the Alabama Department of Public Health Video Communications and Distance Learning Division Faculty Mary Dell Railey, M.D. Pediatric

More information

SEVERE ASTHMA 2015 2/23/2015 RICK BLEVINS, MD SEVERE ASTHMA: WHAT IS IT? No financial disclosures. Asthma Severe Asthma Bronchial Thermoplasty

SEVERE ASTHMA 2015 2/23/2015 RICK BLEVINS, MD SEVERE ASTHMA: WHAT IS IT? No financial disclosures. Asthma Severe Asthma Bronchial Thermoplasty SEVERE ASTHMA 2015 Big Sky Pulmonary Conference Fairmont Hot Springs Resort 27 February 2015 Rick Blevins, MD 1 AND THE ROLE OF BRONCHIAL THERMOPLASTY RICK BLEVINS, MD No financial disclosures Asthma Severe

More information

Immunology in pathology (immunopathology) Patology. immunology in pathology. immunologic response. lecture 3

Immunology in pathology (immunopathology) Patology. immunology in pathology. immunologic response. lecture 3 Patology Immunology in pathology (immunopathology) lecture 3 prof. dr hab. n. med. Andrzej Marszałek immunology in pathology Diseases with immunologic mechanism of tissue injury. Hypersensitivity reactions:

More information

IgG4-RELATED LUNG DISEASE. Erik Baltaxe Institute of Pulmonary Diseases Chaim Sheba Medical Center

IgG4-RELATED LUNG DISEASE. Erik Baltaxe Institute of Pulmonary Diseases Chaim Sheba Medical Center IgG4-RELATED LUNG DISEASE Erik Baltaxe Institute of Pulmonary Diseases Chaim Sheba Medical Center Case Presentations Case Age / Sex Initial Presentation Associated Conditions 1 44 / F Cough, shortness

More information

SmPC SYMBICORT pressurised inhalation, suspension Approved indications and posology given in Section 4. CLINICAL PARTICULARS

SmPC SYMBICORT pressurised inhalation, suspension Approved indications and posology given in Section 4. CLINICAL PARTICULARS Table VI-14 Risk miminisation by safety concern: off-label use of SYMBICORT pressurised inhalation, suspension for the treatment of asthma, in children, adolescents, or adults Safety concern Routine risk

More information

Children are at greater risk of developing asthma than adults; over 2.5 million children under age 18 suffer from allergic asthma.

Children are at greater risk of developing asthma than adults; over 2.5 million children under age 18 suffer from allergic asthma. Children are at greater risk of developing asthma than adults; over 2.5 million children under age 18 suffer from allergic asthma. Asthma What Is Asthma? Asthma is a chronic (long-term) lung disease that

More information

Types of Hypersensitivity. Type I: Allergic Reactions. more on Allergic Reactions

Types of Hypersensitivity. Type I: Allergic Reactions. more on Allergic Reactions Chapter 19: Disorders of the Immune System 1. Hypersensitivity 2. Autoimmunity 3. Transplant Rejection 1. Hypersensitivity What is Hypersensitivity? Hypersensitivity is an immunological state in which

More information

A New Procedure for Severe Asthma

A New Procedure for Severe Asthma A New Procedure for Severe Asthma This brochure describes a new procedure for treating severe asthma in adults. Contents About Severe Asthma 2 Why do doctors do this treatment? 2 What is the Alair System?

More information

Modified Soluble CD23 for the Treatment of IgE- Mediated Diseases

Modified Soluble CD23 for the Treatment of IgE- Mediated Diseases Modified Soluble CD23 for the Treatment of IgE- Mediated Diseases Boston University Office of Technology Development April Effort Director Business Development, Life Sciences Phone: 617-358-3045 Email:

More information

THE ROLE OF DIETARY FATTY ACIDS IN ASTHMA

THE ROLE OF DIETARY FATTY ACIDS IN ASTHMA THE ROLE OF DIETARY FATTY ACIDS IN ASTHMA A/Professor Lisa Wood Centre for Asthma and Respiratory Disease University of Newcastle and Hunter Medical Research Institute NSW Australia email: lisa.wood@newcastle.edu.au

More information

Understanding the Risks and Benefits of Stepping Down Asthma MedicaDons

Understanding the Risks and Benefits of Stepping Down Asthma MedicaDons Understanding the Risks and Benefits of Stepping Down Asthma MedicaDons 4813 Workshop: Stepping Down Asthma MedicaDons: Benefits and Risks Monday March 3, 2014 4:45 pm to 6:00 pm AAAAI 2014 John B. Hagan,

More information

Changes in blood eosinophilia during omalizumab therapy as a predictor of asthma exacerbation

Changes in blood eosinophilia during omalizumab therapy as a predictor of asthma exacerbation Original paper Changes in blood eosinophilia during omalizumab therapy as a predictor of asthma exacerbation Roman Skiepko 1, Ziemowit Ziętkowski 1, Mateusz Łukaszyk 1, Wojciech Budny 1, Urszula Skiepko

More information

BIOS E-162 Human Pathophysiology I Problem Set 2 Due Nov.23, 2009

BIOS E-162 Human Pathophysiology I Problem Set 2 Due Nov.23, 2009 BIOS E-162 Human Pathophysiology I Problem Set 2 Due Nov.23, 2009 Note that the last question is for grad students only. Undergrads and Grads: Answer all parts. 1. Marie has just been hired for a job in

More information

Biologic Treatments for Rheumatoid Arthritis

Biologic Treatments for Rheumatoid Arthritis Biologic Treatments Rheumatoid Arthritis (also known as cytokine inhibitors, TNF inhibitors, IL 1 inhibitor, or Biologic Response Modifiers) Description Biologics are new class of drugs that have been

More information

ASTHMA IN INFANTS AND YOUNG CHILDREN

ASTHMA IN INFANTS AND YOUNG CHILDREN ASTHMA IN INFANTS AND YOUNG CHILDREN What is Asthma? Asthma is a chronic inflammatory disease of the airways. Symptoms of asthma are variable. That means that they can be mild to severe, intermittent to

More information

Drug: mepolizumab (Nucala) Class: Interleukin-5 Receptor Antagonist Line of Business: Non-Medicare Effective Date: February 17, 2016.

Drug: mepolizumab (Nucala) Class: Interleukin-5 Receptor Antagonist Line of Business: Non-Medicare Effective Date: February 17, 2016. This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutics

More information

EMPHYSEMA THERAPY. Information brochure for valve therapy in the treatment of emphysema.

EMPHYSEMA THERAPY. Information brochure for valve therapy in the treatment of emphysema. EMPHYSEMA THERAPY Information brochure for valve therapy in the treatment of emphysema. PATIENTS WITH EMPHYSEMA With every breath, lungs deliver oxygen to the rest of the body to perform essential life

More information

Costs of drugs used for the treatment of asthma

Costs of drugs used for the treatment of asthma Costs of drugs used for asthma treatment 12 Costs of drugs used for the treatment of asthma in relation to disease severity Yoshiro Tanizaki, Fumihiro Mitsunobu, Yasuhiro Hosaki, Kozo Ashida, Masanori

More information

Co-morbitities of Asthma - Allergic Rhinitis, Rhinosinusitis, OME, OSA

Co-morbitities of Asthma - Allergic Rhinitis, Rhinosinusitis, OME, OSA Co-morbitities of Asthma - Allergic Rhinitis, Rhinosinusitis, OME, OSA Ruby Pawankar, MD, Ph.D Nippon Medical School, Tokyo, Japan rpawankar @gmail.com Introduction Asthma and allergic rhinitis (AR) are

More information

The Link Between Viruses and Asthma Catherine Kier, M.D.

The Link Between Viruses and Asthma Catherine Kier, M.D. The Link Between Viruses and Asthma Catherine Kier, M.D. Professor of Clinical Pediatrics Division Chief, Pediatric Pulmonary Director, Cystic Fibrosis Center No disclosures Objectives: At the end of this

More information

RSPT 2317 Non-steroidal anti-asthma agents

RSPT 2317 Non-steroidal anti-asthma agents RSPT 2317 Non-steroidal Anti-asthma Agents Mechanisms of Inflammation in Asthma Mechanisms of Inflammation in Asthma Asthma is a chronic inflammatory disorder of the airways It is divided into extrinsic

More information

GOVERNMENT OF INDIA AERONAUTICAL INFORMATION SERVICES DIRECTOR GENERAL OF CIVIL AVIATION OPPOSITE SAFDARJUNG AIRPORT NEW DELHI

GOVERNMENT OF INDIA AERONAUTICAL INFORMATION SERVICES DIRECTOR GENERAL OF CIVIL AVIATION OPPOSITE SAFDARJUNG AIRPORT NEW DELHI Telephone No. 2:4622495 Telegraphic Address: Commercial : AIRCIVIL NEW DELHI Aeronautical : VIDDYAYX E Mail: dri@dgca.nic.in Fax : 01124629221 GOVERNMENT OF INDIA AERONAUTICAL INFORMATION SERVICES DIRECTOR

More information

Sometimes it s COPD...Sometimes it s not

Sometimes it s COPD...Sometimes it s not Sometimes it s COPD...Sometimes it s not Talk Objectives Not everyone who wheezes or coughs has COPD 1. Give due diligence to COPD: update on this common disease with emphasis on diagnosis 2. Discuss other

More information

Special Conditions That May Have an Impact on Asthma

Special Conditions That May Have an Impact on Asthma Special Conditions That May Have an Impact on Asthma When asthma is not optimally controlled, there may be issues with compliance or adherence to the therapeutic program or issues with proper medication

More information

Asthma. Micah Long, MD

Asthma. Micah Long, MD Asthma Micah Long, MD Goals Define the two components of asthma. Describe the method of action and uses for: Steroids (inhaled and IV) Quick Beta Agonists (Nebs and MDIs) The "Others" Magnesium, Epi IM,

More information

Leukotriene receptor antagonists: Montelukast and zafirlukast

Leukotriene receptor antagonists: Montelukast and zafirlukast Bulletin 61 February 2014 2.0 Leukotriene receptor antagonists: Montelukast and zafirlukast Across the PrescQIPP membership (20.2 million patients, November 2013), annual spend for the leukotriene receptor

More information

Objectives COPD. Chronic Obstructive Pulmonary Disease (COPD) 4/19/2011

Objectives COPD. Chronic Obstructive Pulmonary Disease (COPD) 4/19/2011 Objectives Discuss assessment findings and treatment for: Chronic Obstructive Pulmonary Disease Bronchitis Emphysema Asthma Anaphylaxis Other respiratory issues Provide some definitions Chronic Obstructive

More information

written by Harvard Medical School COPD It Can Take Your Breath Away www.patientedu.org/copd

written by Harvard Medical School COPD It Can Take Your Breath Away www.patientedu.org/copd written by Harvard Medical School COPD It Can Take Your Breath Away www.patientedu.org/copd What Is COPD? COPD stands for chronic obstructive pulmonary disease. There are two major diseases included in

More information

Guidance. The Human Rights Act has been considered in the formation of this guidance statement.

Guidance. The Human Rights Act has been considered in the formation of this guidance statement. Bedfordshire and Hertfordshire Priorities Forum statement Number: 62 Subject: Temperature-controlled laminar airflow device for the treatment of chronic allergic asthma Date of decision: March 2014 Date

More information

The optimal management of patients with COPD

The optimal management of patients with COPD The optimal management of patients with COPD Part 1: The diagnosis 12 Chronic obstructive pulmonary disease (COPD) affects approximately one in seven New Zealanders aged over 40 years, 1 and is the fourth

More information

B Cells and Antibodies

B Cells and Antibodies B Cells and Antibodies Andrew Lichtman, MD PhD Brigham and Women's Hospital Harvard Medical School Lecture outline Functions of antibodies B cell activation; the role of helper T cells in antibody production

More information

HYPERSENSITIVITY REACTIONS TYPE III&IV

HYPERSENSITIVITY REACTIONS TYPE III&IV HYPERSENSITIVITY REACTIONS TYPE III&IV LEARNING OBJECTIVES By the end of the lecture student should be able to understand: What is type III Hypersensitivity reactions Different eg type III of hypersensitivity

More information

CADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION

CADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION CADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION MEPOLIZUMAB (Nucala GlaxoSmithKline Inc.) Indication: Severe eosinophilic asthma Recommendation: The CADTH Canadian Drug Expert Committee (CDEC)

More information

Immunology and immunotherapy in allergic disease

Immunology and immunotherapy in allergic disease Immunology and immunotherapy in allergic disease Jing Shen, MD Faculty Advisor: Matthew Ryan, MD The University of Texas Medical Branch Department of Otolaryngology Grand Rounds Presentation February 2005

More information