Adrenal function recovery after durable oral corticosteroid sparing with benralizumab in the PONENTE study

Background Oral corticosteroid (OCS) dependence among patients with severe eosinophilic asthma can cause adverse outcomes, including adrenal insufficiency. PONENTE's OCS reduction phase showed that, following benralizumab initiation, 91.5% of patients eliminated corticosteroids or achieved a final dosage ≤5 mg·day-1 (median (range) 0.0 (0.0-40.0) mg). Methods The maintenance phase assessed the durability of corticosteroid reduction and further adrenal function recovery. For ~6 months, patients continued benralizumab 30 mg every 8 weeks without corticosteroids or with the final dosage achieved during the reduction phase. Investigators could prescribe corticosteroids for asthma exacerbations or increase daily dosages for asthma control deteriorations. Outcomes included changes in daily OCS dosage, Asthma Control Questionnaire (ACQ)-6 and St George's Respiratory Questionnaire (SGRQ), as well as adrenal status, asthma exacerbations and adverse events. Results 598 patients entered PONENTE; 563 (94.1%) completed the reduction phase and entered the maintenance phase. From the end of reduction to the end of maintenance, the median (range) OCS dosage was unchanged (0.0 (0.0-40.0) mg), 3.2% (n=18/563) of patients experienced daily dosage increases, the mean ACQ-6 score decreased from 1.26 to 1.18 and 84.5% (n=476/563) of patients were exacerbation free. The mean SGRQ improvement (-19.65 points) from baseline to the end of maintenance indicated substantial quality-of-life improvements. Of patients entering the maintenance phase with adrenal insufficiency, 32.4% (n=104/321) demonstrated an improvement in adrenal function. Adverse events were consistent with previous reports. Conclusions Most patients successfully maintained maximal OCS reduction while achieving improved asthma control with few exacerbations and maintaining or recovering adrenal function

Main eddy vertical structures observed in the four major Eastern Boundary Upwelling Systems

In the four major Eastern Boundary Upwelling Systems (EBUS), mesoscale eddies are known to modulate the biological productivity and transport near-coastal seawater properties toward the offshore ocean, however little is known about their main characteristics and vertical structure. This study combines 10 years of satellite-altimetry data and Argo float profiles of temperature and salinity, and our main goals are (i) to describe the main surface characteristics of long-lived eddies formed in each EBUS and their evolution, and (ii) to depict the main vertical structure of the eddy-types that coexist in these regions. A clustering analysis of the Argo profiles surfacing within the long-lived eddies of each EBUS allows us to determine the proportion of surface and subsurface-intensified eddies in each region, and to describe their vertical structure in terms of temperature, salinity and dynamic height anomalies. In the Peru-Chile Upwelling System, 55% of the sampled anticyclonic eddies (AEs) have subsurface-intensified maximum temperature and salinity anomalies below the seasonal pycnocline, whereas 88% of the cyclonic eddies (CEs) are surface-intensified. In the California Upwelling System, only 30% of the AEs are subsurface-intensified and all of the CEs show maximum anomalies above the pycnocline. In the Canary Upwelling System, approximate to 40% of the AEs and approximate to 60% of the CEs are subsurface-intensified with maximum anomalies extending down to 800 m depth. Finally, the Benguela Upwelling System tends to generate approximate to 40-50% of weak surface-intensified eddies and approximate to 50-60% of much stronger subsurface-intensified eddies with a clear geographical distribution. The mechanisms involved in the observed eddy vertical shapes are discussed

What can we learn from observed temperature and salinity isopycnal anomalies at eddy generation sites? Application in the Tropical Atlantic Ocean

International audienceAt their generation site, 50% of observed eddies have non-significant isopycnal temperature/salinity (θ/S) anomalies in the TAO. On density-coordinates, both CEs and AEs can exhibit significant positive, negative or non-significant isopycnal θ/S anomalies. We discuss the relationship between isopycnal θ/S and PV anomalies and how they can inform us on their generation mechanisms

An index to distinguish surface and subsurface intensified vortices from surface observations

In this study, we first show that it is difficult to reconstruct the vertical structure of vortices using only surface observations. In particular we show that the recent SQG and ISQG methods systematically lead to surface intensified vortices and those subsurface intensified vortices are thus not correctly modelled. We then investigate the possibility to distinguish between surface and subsurface intensified eddies from surface data only, using the sea surface height and the sea surface temperature available from satellite observations. A simple index, based on the ratio of the sea surface temperature anomaly and the sea level anomaly, is proposed. While the index is expected to give perfect results for isolated vortices, we show that in a complex environment, errors can be expected, in particular when strong currents exist in the vicinity of the vortex. The validity of the index is then analysed using results from a realistic regional circulation model of the Peru-Chile upwelling system, where both surface and subsurface eddies coexist. We find that errors are mostly associated with double core eddies (aligned surface and subsurface cores) and that the index can be useful to determine the nature of mesoscale eddies (surface or subsurface- intensified) from surface (satellite) observations. The errors however reach 24% and some possible improvements of the index calculations are discussed

Évaluation multicentrique et randomisée de l’impact des conseillers en environnement intérieur sur le contrôle de l’asthme : l’étude ECENVIR

International audienceIntroduction (contexte de la recherche)L’exposition répétée des patients asthmatiques aux allergènes intradomiciliaires contribue aux exacerbations de l’asthme. Plusieurs stratégies d’intervention sont proposées, parmi lesquelles, la visite domiciliaire de conseillers en environnement intérieur (CEI). Les CEI établissent un état des lieu au domicile du patient et proposent des mesures de remédiation afin d’améliorer les fonctions respiratoires. Plusieurs études monocentriques ont montré l’intérêt d’une telle démarche.ObjectifL’étude ECENVIR est un essai clinique, multicentrique, prospectif et randomisé qui vise à évaluer l’impact des CEI sur le niveau de contrôle de l’asthme.MéthodesAu total, 104 patients ont été inclus dont 85 patients ont été suivis médicalement et randomisés dans 2 groupes : le Groupe Intervention (GI) a bénéficié d’une visite de CEI avec prélèvements pour mesures d’allergènes et conseils à l’inclusion et après 12 mois de suivi ; et le groupe témoin (GT) a bénéficié d’une même visite de contrôle uniquement à M12.RésultatsLe critère de jugement principal a été analysé chez 71/85 patients : 34 dans le GI et 37 dans le GT. A M12, une amélioration du contrôle de l’asthme était notée dans le GI avec une diminution du nombre d’asthme sévère et une augmentation d’asthme intermittent (p = 0,05) comparativement au GT (p = 0,24). En comparaison intergroupe, 50 % (17/34) des patients du GI ont montré une amélioration clinique comparativement au GT (p = 0,43). Bien que non statistiquement significative probablement dû à un manque de puissance, les patients du GI avaient 1,5 fois plus de chance de s’améliorer cliniquement en analyse multivariée (OR 1,47 CI95 % [0,57–3,75]. Les analyses secondaires montrent que : (i) dans la population des asthmes sévères, 12/16 patients (75 %) du GI se sont améliorés contre 7/16 du GT(44 %)(p = 0,06) ; (ii) la consommation des corticoïdes oraux et le taux d’hospitalisation sont significativement diminués dans le groupe ayant bénéficié de conseils (p = 0,029 et p = 0,042, respectivement).ConclusionsL’intervention des CEI est bénéfique cliniquement sur le niveau du contrôle de l’asthme et permet sur le plan économique une diminution de la consommation de soins, en cours d’investigation via les données d’Assurance maladie