ASTHMA

RESPIRATORY

Dose a Pediatric indication give you a confidence to prescribe Dupixent?

KOL expert on Dupixent safety for Pediatric Asthma.

How does Dupixent help reduce asthma exacerbations across multiple phenotype.

Dupixent Asthma KOL Expert Series Video - Exacerbations.

<h2 style="text-align: center;">In pediatric asthma patients, FeNO can be a useful marker to:</h2>

<h2 style="text-align: center;">FeNO is the only noninvasive point-of-care test to rapidly assess&nbsp;type 2 inflammation&nbsp;13,14</h2>
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 <tbody>
 <tr>
 <td style="text-align: center; background-color: rgb(21, 144, 165);">
 <h3>FeNO is produced in the asthmatic airway as a result of elevated key and central type 2 cytokines IL-13 and IL-44,5,15-17</h3></td>
 </tr>
 </tbody>
</table>

ERS, European Respiratory Society;&nbsp;FeNO, fractional exhaled nitric oxide;&nbsp;GINA, Global Initiative for Asthma;&nbsp;IL, interleukin;&nbsp;iNOS, inducible nitric oxide synthase;&nbsp;ppb, parts per billion.&nbsp;1.&nbsp;Smith AD, et al.&nbsp;Am J Respir Crit Care Med.&nbsp;2005;172(4):453-459.&nbsp;2.&nbsp;Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Accessed January 18, 2024. https://ginasthma.org/2023-gina-main-report/.&nbsp;3.&nbsp;Peters MC, et al.&nbsp;Curr Allergy Asthma Rep. 2016;16(10):71.&nbsp;4.&nbsp;Katial RK, et al.&nbsp;J Allergy Clin Immunol Pract.&nbsp;2017;5(2S):S1-S14.&nbsp;5.&nbsp;Parulekar AD, et al.&nbsp;Curr Opin Pulm Med.&nbsp;2016;22(1):59-68.&nbsp;6.&nbsp;Gaillard EA, et al. European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years.&nbsp;Eur Respir J.&nbsp;2021;58(5):2004173.&nbsp;7.&nbsp;Ferraro VA, et al.&nbsp;J Clin Med.&nbsp;2019;8(11):1783.&nbsp;8.&nbsp;White MP, et al.&nbsp;J Asthma Allergy. 2020;13:11-22.&nbsp;9.&nbsp;Kim JK, et al.&nbsp;Respirology.&nbsp;2017;22(3):466-472.&nbsp;10. Diamant N, et al.&nbsp;Pediatr Pulmonol.&nbsp;2021;56(6):1449-1454.&nbsp;11. Di Cara G, et al.&nbsp;Pediatr Allergy Immunol.&nbsp;2015;26(1):85-87.&nbsp;12. di Palmo E, et al.&nbsp;Int J Mol Sci. 2021;22(9):4651.&nbsp;13.&nbsp;Kuo CR, et al.&nbsp;Respir Med.&nbsp;2019;155:54-57.&nbsp;14. Bjermer L, et al.&nbsp;Respir Med.&nbsp;2014;108(6):830-841.&nbsp;15. Prado CM, et al.&nbsp;ISRN Allergy. 2011:832560.&nbsp;16. Alving K, Malinovschi A. Basic aspects of exhaled nitric oxide. In: Horvath, de Jongste JC, eds. Exhaled Biomarkers. European Respiratory Society; 2010:1-33. European Respiratory Monograph No. 49.&nbsp;17.&nbsp;Munakata M.&nbsp;Allergol Int. 2012;61(3):365-372.

FeNO Is a Clinically Useful Biomarker of Type 2 Inflammation in Pediatric Patients With Asthma

RESPIRATORY-SYNCYTIAL-VIRUS

VACCINES

Implementing Beyfortus successfully (US)

<h3>Implementing Beyfortus successfully: practical insights from the US</h3>
Dr Jason Terk, Senior Consultant - Vice-Chair for Primary Care, Cook Children’s Physician Network, Texas, USA.

Implementing Beyfortus successfully (ES)

<h3>Implementing Beyfortus successfully: practical insights from Spain</h3>
Dr. Laura Castells Viella, Head of Pediatrics at Hospital Quironsalud del Vallès, Barcelona, Spain

Implementing Beyfortus successfully

<h3>Implementing Beyfortus successfully: Practical insights from Spain</h3>
Dr Laura Castells Vilella 
 Head of Pediatrics at Hospital Quironsalud del Vallès, Barcelona, Spain ECCMID congress, April 2024

Implementing Beyfortus successfully (FR)

<h3>Implementing Beyfortus successfully: practical insights from France</h3>
Dr Fabienne Cahn-Sellem, Office Pediatrician, member of AFPA (French Association of Ambulatory Pediatrics) and GPIP (Pediatric Infectious Pathologies Group), Paris, France

Atherosclerotic cardiovascular disease risk assessment: An American Society for Preventive Cardiology clinical practice statement.
The American Society for Preventive Cardiology (ASPC) offers guidance and tools to assess the risk of atherosclerotic cardiovascular disease (ASCVD), with the goal of enabling specialists to provide suitable treatments to prevent ASCVD events.
<h2>Key Takeaway</h2>
For primary prevention of ASCVD, the first step is to assess cardiovascular risk by determining the global risk score, after which the presence of the following factors can be used to further refine risk estimation:
<ul>
 <li>Traditional risk factors: Age, sex, diabetes, systolic blood pressure, antihypertensive treatment, total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol, and cigarette smoking</li>
 <li>Risk enhancing factors: Family history of premature ASCVD, sex-specific factors, high-risk ethnicities, primary hypercholesterolemia, metabolic syndrome, chronic inflammatory conditions, and chronic kidney disease</li>
 <li>Female-specific factors: Auto-immune disease, menarche, polycystic ovary syndrome, oral contraceptives, infertility, multiparity, adverse pregnancy outcomes, preeclampsia, gestational diabetes mellitus, early menopause, premature ovarian insufficiency, and vasomotor symptoms</li>
 <li>Inflammatory biomarkers: High sensitivity C-reactive protein (hs-CRP), lipoprotein-associated phospholipase A2, myeloperoxidase, myeloid-related protein 8/14, matrix metalloproteinases, lectin-like oxidized LDL receptor-1, and growth differentiation factor-15</li>
 <li>Other biomarkers: Persistently elevated triglycerides, elevated lipoprotein (a) (Lp[a]) or apolipoprotein B, and low ankle-brachial index (ABI)</li>
 <li>Racial / ethnic factors: Non-Hispanic Black, African American, Asian, etc.</li>
 <li>Social determinants of health: Psychological distress, delayed care due to lack of transport, shortage of food, unemployment, lack of health insurance, inability to pay medical bills, or downward social mobility</li>
 <li>Screening for subclinical atherosclerosis: 
 <ul>
 <li>Carotid intimal-media thickness or established plaque by carotid ultrasound</li>
 <li>Endothelial function by brachial artery reactivity, large vessel (aorta) or small vessel assessment of vascular health</li>
 <li>Provides the largest decrease in LDL-C with clinical benefits in observational studies.</li>
 <li>Enables early decision on introducing PCSK9 inhibitors.</li>
 </ul></li>
 <li>Nutritional factors, physical activity, and cardiorespiratory fitness levels play vital roles in ASCVD risk assessment and should also be considered.</li>
 <li>For secondary prevention, risk stratification (very high, high, moderate, or low), followed by immediate and intensive risk factor management are essential.</li>
</ul>
<h2>Why This Matters</h2>
<ul>
 <li>To reduce the risk of developing ASCVD, an accurate assessment of the risk is crucial to provide patients with appropriately targeted preventive therapies.</li>
 <li>Without doing a formal risk assessment, a clinician’s estimate can be inaccurate, which can underestimate the actual risk; hence, the use of global risk scores can be beneficial to improve the application of guideline-based therapies.</li>
 <li>Cardiovascular risk assessment forms the basis of preventive cardiology to determine the appropriateness or intensification of preventive therapy.</li>
</ul>
<h2>Clinical recommendations</h2>
<ul>
 <li>For primary prevention, global risk scoring provides a calculation of ASCVD risk from a set of standard office-based risk factors for a stipulated period. 
 <ul>
 <li>Clinicians can then determine the best ways to reduce the risk of developing ASCVD and discuss the same with the patient.</li>
 </ul></li>
 <li>The presence, number, and / or extent of risk enhancing factors as well as severity of inflammatory factors such as hs-CRP and laboratory measures such as Lp(a) levels can help to further refine treatment decision.</li>
 <li>In women, it is crucial to obtain a complete and thorough reproductive history from menarche to menopause, including premature menopause, preeclampsia, and autoimmune disease.</li>
 <li>Certain race / ethnic groups have a higher risk of developing ASCVD, which can help to further refine the use of preventive therapy.</li>
 <li>Social determinants of health may exert independent effects and should be part of the clinician-patient discussion to determine appropriate ways to lower risk.</li>
 <li>Among screening tests for subclinical ASCVD, CAC testing provides considerable improvement of risk reclassification over global risk scoring in most primary prevention groups, including diabetes. 
 <ul>
 <li>Additionally, it can be used to refine decisions on preventive therapy, including on the use of statin and aspirin.</li>
 </ul></li>
 <li>If CAC scoring is unavailable, carotid ultrasound imaging together with carotid plaque assessment may be beneficial for risk assessment.</li>
 <li>The use of ABI is valuable for assessment of peripheral artery disease and can improve risk reclassification beyond global risk scoring.</li>
 <li>In patients with pre-existing ASCVD, more aggressive treatment should be considered for those at the highest risk, based on the history of either multiple high-risk conditions and one major ASCVD event or multiple major events.</li>
 <li>Patients with recurrent ASCVD events within a short period of time represent an extreme risk for further events 
 <ul>
 <li>An even more aggressive risk factor management and intensive treatment should be considered</li>
 </ul></li>
 <li>Clinician-patient discussions on lifestyle management and on the benefits and risks of evidence-based pharmacologic therapies that are essential to lower the risk of developing ASCVD is central to preventive cardiology.</li>
</ul>

Reference

Atherosclerotic Cardiovascular Disease Risk Assessment

DYSLIPIDEMIA

CARDIOLOGY

<h2>Improve prognosis in patients with type 2 diabetes mellitus 
 Regulate low-density lipoprotein cholesterol level for those undergoing coronary revascularisation</h2>
<h3>Main takeaway</h3>
<ul>
 <li>Depending on the revascularisation strategy, LDL-C levels yield a differential influence on cardiovascular (CV) outcomes 
 <ul>
 <li>Compared to patients with 1-year LDL-C &lt;70 mg/dl, patients who had 1-year LDL-C ≥100 mg/dl showed a significant increase in long-term cardiovascular risk</li>
 <li>Patients randomised to coronary artery bypass grafting (CABG) group had lower rates of major adverse cardiac or cerebrovascular events (MACCE) versus the optimal medical therapy (OMT) alone group</li>
 </ul></li>
</ul>

<h3>Why this matters</h3>
<ul>
 <li>Guideline-directed management of patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) includes intensive lifestyle intervention along with aggressive secondary prevention (OMT) and an appropriate revascularisation strategy 
 <ul>
 <li>This analysis highlights the significance of LDL-C control in the first year post-procedure</li>
 </ul></li>
</ul>

<h3>Study design</h3>
<ul>
 <li>Pooled analysis: combined individual patient-level information from 3 federally funded trials (BARI 2D, COURAGE, and FREEDOM)</li>
 <li>4,050 patients with T2DM (mean age = 62.8 ± 8.8 years; female = 27.0%; median follow-up = 3.9 years [after the index 1-year assessment]) were categorised according to LDL-C levels at 1 year following randomisation 
 <ul>
 <li>Key inclusion criteria: all patients with CHD and T2DM from BARI-2D and FREEDOM trials and only patients with T2DM in the COURAGE trial</li>
 <li>Key exclusion criteria: patients with LDL-C &lt;20 mg/dl and triglycerides &gt;400 mg/dl both at baseline and 1 year</li>
 <li>Primary outcome: 4-year rate of the MACCE composite (all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke)</li>
 <li>Secondary outcomes: subsequent revascularisation</li>
 </ul></li>
</ul>

<h3>Key results</h3>
<ul>
 <li>Patients with 1-year LDL-C levels ≥100 mg/dl experienced higher 4-year cumulative risk of MACCE 
 <ul>
 <li>17.2% versus 13.3% (70 to &lt;100 mg/dl) versus 13.1% (&lt;70 mg/dl); p = 0.016</li>
 </ul></li>
 <li>Incidence of CV events following a coronary revascularisation procedure or OMT: 
 <ul>
 <li>When comparing CABG with PCI, CABG led to significantly lower rates of MACCE for those with 1-year LDL-C levels: 
 <ul>
 <li>Between 70 and &lt;100 mg/dl: HR: 0.49; 95% CI, 0.31 to 0.79; p = 0.003</li>
 <li>≥100 mg/dl: HR: 0.53; 95% CI, 0.30 to 0.91; p = 0.022</li>
 </ul></li>
 <li>When compared with both OMT and PCI patients, CABG correlated with lower rates of subsequent revascularisation in all 1-year LDL-C strata 
 <ul>
 <li>No difference in subsequent revascularisation rates were observed when comparing PCI with OMT in any of the 1-year LDL-C strata</li>
 </ul></li>
 </ul></li>
</ul>

<h3>Limitations</h3>
<ul>
 <li>There may be a possibility of additional confounders influencing the association between cardiovascular outcomes and both the choice of revascularisation procedure and the LDL-C control rate</li>
 <li>There is a lack of data for adherence to the prescribed therapy</li>
 <li>A systematic analysis was not pursued for lipid lowering therapy during the first year of follow-up</li>
 <li>There could be an occurrence of immortal time bias</li>
</ul>

Regulate LDL-C level for those undergoing coronary revascularization (Diabetic Patients)

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