Real-World Effectiveness of Reslizumab in Patients With Severe Eosinophilic Asthma - First Initiators and Switchers.

BACKGROUND: Reslizumab, a biologic targeting IL-5, has been shown to reduce asthma exacerbations and maintenance oral corticosteroid use in randomized controlled trials and pre-post studies in patients with severe eosinophilic asthma. However, real-world effectiveness data of reslizumab are scarce, and it is unknown whether reslizumab has added value after switching from another type 2 biologic. OBJECTIVE: To evaluate (1) the real-world effectiveness of reslizumab on severe asthma exacerbations, maintenance oral corticosteroid use, and overall treatment response, both in biologic-naive patients who initiated reslizumab and in those who switched from another type 2 biologic; and (2) physicians' experience with reslizumab treatment. METHODS: This observational real-world study evaluated data from 134 adults with severe eosinophilic asthma included in the Dutch severe asthma registry (RAPSODI), who initiated reslizumab treatment (4-weekly infusions, 0.3 mg/kg) before April 2020 and had follow-up data for 6 months and greater. Clinical asthma experts completed surveys on their experience with reslizumab treatment. RESULTS: Overall, reslizumab reduced the exacerbation rate (odds ratio [95% CI] = 0.10 [0.05-0.21]; P < .001), oral corticosteroid use (OR [95% CI], 0.2 [0.0-0.5]; P < .001), and maintenance dose (median [CI], 5.0 [0.0-10.0] to 0.0 [0.0-5.0]; P < .001), with comparable results in biologic-naive reslizumab initiators and switchers. The overall response to reslizumab was graded good or excellent in 59.2% of patients. The additive effectiveness of reslizumab after switching from another biologic was reflected in physicians' surveys. CONCLUSIONS: Real-world data show that reslizumab reduces severe asthma exacerbations and oral corticosteroid use in patients with severe eosinophilic asthma, both in biologic-naive reslizumab initiators and in those who switched from another type 2 biologic. This additional value of reslizumab was recognized by clinical asthma experts.

[Sudden dyspnoea and facial swelling during labour]. / Acute dyspneu en een opgezet gelaat tijdens partus.

A 25-year-old woman was in the hospital to give birth to her first child. During labour, she suddenly experienced dyspnoea and facial swelling. Palpation revealed crepitus around the face, neck and chest. A chest radiograph showed a continuous diaphragm sign with subcutaneous emphysema, consistent with a spontaneous pneumomediastinum (Hamman's syndrome).

Clinical evaluation of geriatric outpatients with suspected heart failure: value of symptoms, signs, and additional tests.

AIMS: Heart failure (HF) is common in geriatric patients. Clinicians face diagnostic challenges primarily due to comorbidity and limited access to echocardiography. The purpose of this study was to identify independent determinants of the presence of HF in geriatric outpatients and to determine the optimal diagnostic strategy. METHODS AND RESULTS: Geriatric outpatients [mean age 82 (±6) years, 30% men] with suspected HF underwent an extensive standardized diagnostic work-up. An expert consensus panel determined the presence of HF. Heart failure was present in 94 of 206 participants (46%). Male sex [odds ratio (OR) 2.0], age per 10 years (OR 1.6), nocturnal dyspnoea (OR 1.7), absence of wheezing (OR 2.1), loss of appetite (OR 1.7), and lower body mass index (BMI; OR 0.9) were independently associated with the presence of HF: the c-statistic of the model containing these items was 0.75. Of all additional tests, N-terminal pro-B-type natriuretic peptide (NT-proBNP) improved the diagnostic accuracy the most (OR ln NT-proBNP 2.8; c-statistic 0.92). A diagnostic rule, consisting of six clinical variables and NT-proBNP, showed good negative and positive predictive values. CONCLUSION: Half of geriatric patients suspected of HF actually have HF. Apart from age, gender, and nocturnal dyspnoea, absence of wheezing, loss of appetite, and lower BMI were independently associated with the presence of HF. Symptoms and signs in combination with NT-proBNP reliably identified the presence or absence of HF in the vast majority of patients. Additional diagnostic tests, in particular echocardiography, can be targeted at those in whom the presence of HF remains uncertain and to ascertain the cause of HF.

[Cystic fibrosis in a woman aged seventy]. / Cystische fibrose bij een vrouw van 70 jaar.

A seventy-year-old woman was admitted to hospital with a Staphylococcus aureus respiratory tract infection. She had a history of extensive bronchiectasis and allergic bronchopulmonary aspergillosis (ABPA). Cystic fibrosis (CF) was suspected and cystic fibrosis transmembrane conductance regulator (CFTR) gene analysis showed F508del and R117H-7T mutations. In these mutations there is residual activity in the chloride channel in the cell membrane coded by the CFTR gene. This results in a much milder disease pattern varying from no disease at all to isolated organ disease. This type of disease is known as non-classical cystic fibrosis. In our patient the diagnosis of cystic fibrosis was made exceptionally late in life.