19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 3
SP-11-Treating mild asthma: a paradigm shift
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query_builder 16:30 - 17:50 | Event time (GMT+2)
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SP-11-Treating mild asthma: a paradigm shift
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Management of mild asthma has for a long time been unsatisfactory and the treatment of mild asthma has not been tested in clinical trials. The use/overuse of short-acting beta-2 agonist (SABA) alone in patients treated as mild asthmatics has become a concern and the association with severe adverse events has become clear. Access adherence with regular inhaled corticosteroid (ICS) treatment is a major issue in this population. The rationale efficacy of treatment with as needed ICS and rapid acting bronchodilator will be discussed in this session.

Learning Objectives:

Review concerns associated with the use of rescue SABA in the absence of maintenance treatment.

Discuss the merits of as-needed ICS treatment strategies in mild asthma in adults and children.

16:30 - 16:35: Introduction

16:35 - 16:47: GINA 2019: a fundamental change in asthma managementNew recommendations about the treatment of mild asthma, published by the Global Initiative for Asthma (GINA) in early 2019, have been described as the most fundamental change in asthma management in 30 years. These recommendations represented the culmination of a decade-long campaign by GINA to develop new strategies for mild asthma with the aim of reducing asthma morbidity and mortality, particularly in low-resource countries. They were prompted by concerns about the risks and consequences of treating mild asthma with short-acting beta2-agonists alone. This presentation will describe the background to the changes, the evidence obtained from large, new clinical trials and observational studies which provided the basis for the new GINA recommendations, the issues and priorities that were taken into account, and the global challenges and evidence gaps that remain.
Helen Reddel

16:47 - 16:59: As-needed use of ICS and SABA in separate inhalers? Applicability to childrenOne of the more frequent issues in difficult asthma in children is adherence. Using inhalers only when they are needed could be a good way to improve adherence and control. This presentation would update the evidence on the efficacy of treating asthma in children using as needed combination of short-acting beta-2 agonists and corticosteroids combined in the same inhaler, as compared to the standard approach in GINA guidelines. If this is approach is safe and effective in children, as well as being more affordable, it should be seriously considered.

Luis Garcia-Marcos

16:59 - 17:11: Combination inhaler (ICS/ formoterol) applicability to children: a low- resource setting perspective.Asthma in children is increasing in prevalence in children in low- and middle-income countries. Risk factors for this increase and poor asthma control in this population are poorly studied. One of the critical gaps in asthma treatment is access to affordable and safe medication delivered via an appropriate delivery system. The current Global Initiative for Asthma recommendations encourage the use of combination therapy to improve asthma control, but this may not be possible in settings where there is poor access to spacer delivery systems and unaffordability of drugs. Motivation for one drug device to manage asthma is an attractive option in this setting where there is an overuse of short-acting beta-agonist, together with interventions and advocacy, to improve access to asthma treatment and this may be a solution to this issue in low-income settings.
Refiloe Masekela

17:11 - 17:23: Obtaining optimal control of asthma in resource-limited settings: theory and practiceThe management of asthma requires medicines relaxing airway smooth muscles and reducing airway inflammation. Rapid-acting b2 agonist does not effectively address the underlying problem of airway inflammation. Excess use of inhaled bronchodilators alone for symptom relief may result in a delay in seeking health care. Inhaled corticosteroid (ICS) is critical in the treatment of airway inflammation but is underused. A substantial proportion of patients with persistent asthma in resource-limited settings have no access to affordable ICS for long-term treatment. Studies have shown that the use of both ICS and rapid-acting b-agonist as needed for symptom relief might be a better option.
Chen-Yuan Chiang

17:23 - 17:50: Q&A session

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Channel 6
OA-24-TB and diabetes
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query_builder 11:00 - 12:20 | Event time (GMT+2)
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OA-24-TB and diabetes
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-24-647-23-High proportion of transient hyperglycemia at TB diagnosis among people living with, and without, HIV in South Africa In a prospective cohort study of culture-confirmed, drug-susceptible tuberculosis (TB) patients in South Africa, we evaluated hyperglycemia before, and after, TB treatment. We assessed whether HIV status was associated with differences in resolution of hyperglycemia after completion of TB treatment.

Yuri van der Heijden

11:13 - 11:21: OA-24-650-23-Optimising diagnosis of diabetes mellitus among TB patients: preliminary findings from a multicentre study in Tanzania Active tuberculosis (TB) has a three-fold increase in populations with diabetes mellitus (DM) with overlapping clinical presentations to compromise clinical outcomes.  A study was conducted to implement an algorithm for DM screening in TB patients for early intervention of DM related complications. 

Kenneth Byashalira

11:21 - 11:29: OA-24-652-23-Prevalence of diabetes mellitus among people tested for TB in urban Uganda The increase in type 2 diabetes mellitus in sub-Saharan Africa where tuberculosis (TB) is also endemic has raised interest in diabetes as a risk factor for TB. We estimated the prevalence of diabetes using hemoglobin A1c among people tested for TB in urban Uganda.

Kamoga Caleb Erisa

11:29 - 11:37: OA-24-653-23-Screening hospitalised patients with diabetes mellitus for TB in rural South Africa This study describes the yield of systematic tuberculosis (TB) screening in hospitalised diabetic patients in two hospitals in rural South Africa where the burden of both diseases is high. The yield in different study sub-groups is described and the incremental yield of different diagnostic methods is shown.

Abera Balcha Bulti

11:37 - 11:45: OA-24-654-23-Performance of random plasma glucose compared to glycated hemoglobin in screening for diabetes in Filipino persons with TB This research assessed the performance of the use of random plasma glucose (RPG) and two-step RPG/HbA1c ≥6.5% to screen diabetic patients (HbA1c ≥6.5%) with tuberculosis in the Philippines. The sensitivity/specificity of RPG 200mg/dL was 38%/100%. Using two-step RPG≥110mg/dL as a first screen, then HbA1c≥6.5%, would have missed 25/100 diabetic cases.

Shuichi Jack Suzuki

11:45 - 12:20: Q&A


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