Latest news with #GEMA
Medscape
14-05-2025
- Health
- Medscape
Can Chronic Asthma Be Reversed? Experts Reopen the Debate
A new clinical horizon is emerging in asthma management, with the possibility of achieving sustained reversal of the disease and even remission. This involves altering and reversing the progression of diseases that are traditionally considered chronic. This possibility has led to significant therapeutic advances and sparked a clinical debate: Should sustained reversibility be considered a therapeutic goal in its own right or merely as an indirect marker of effective disease control? Reversibility in asthma, understood as the ability to recover pulmonary function and maintain the absence of symptoms, has historically been an elusive goal. Recent research suggests that this challenge may be closer to resolution due to advances in biological therapies and a deeper understanding of the inflammatory phenotypes of asthma. While reversibility remains a central marker in the diagnosis and monitoring of asthma, the scientific community emphasizes that not all patients with asthma experience complete reversibility. The persistence of obstruction may be attributed to structural remodeling of the airways. Clinical Remission Clinical remission is defined as the absence of symptoms and exacerbations for at least 12 months, even without medication. Complete remission is defined as the normalization of pulmonary function and disappearance of bronchial hyper-responsiveness and airway inflammation. However, patients in clinical remission who continue to show elevated inflammatory biomarker levels may still be at risk for future functional decline. Although increasingly achievable in patients treated with biologics, complete remission is still limited by the persistence of certain pathophysiological processes. Airway remodeling in asthma, once it occurs, is difficult to reverse. Achieving complete and sustained disease control is considered the most ambitious goal, while reversibility is a more practical indicator of therapeutic response. Guidelines such as the Global Initiative for Asthma (GINA) and Spanish Guide for Asthma Management (GEMA), recognize the prognostic value of sustained bronchodilator reversibility and its ability to help predict exacerbations but caution against using it alone. Therefore, we recommend incorporating it into a comprehensive assessment that includes symptoms, pulmonary function, rescue medication use, and quality of life. Inflammatory Phenotypes This integrated approach is particularly relevant when considering the dynamic variability of inflammatory phenotypes in asthma. The Spanish MEGA (Mechanism underlying the genesis and evolution of asthma) project analyzed the stability of inflammatory biomarkers and asthma phenotypes. The results confirmed the instability of these phenotypes; although they remained stable during the first year, their instability increased thereafter. The study, led by the Spanish national research consortium CIBERES (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), showed that while 88% of patients initially presented a high T2 phenotype, only 61.3% maintained this classification after 2 years. Similarly, 53.3% of patients had eosinophilic sputum at baseline, but only 37.5% maintained this at 24 months. These findings highlight the need for aggressive therapeutic adjustments. Moreover, the correlations between different inflammatory phenotypes were moderate in the first 2 years but significantly decreased in the third year. Other biomarkers, such as fractional exhaled nitric oxide, total immunoglobulin E, and lung function, did not show significant variations during the study period. These results highlight the fluctuating nature of this disease and the necessity to adapt the therapeutic strategy to each patient's changing inflammatory profile. Mechanical Damage Another recent international study conducted by King's College London, London, England, identified a new pathophysiological mechanism in asthma that should be considered in clinical management. Published in Science , the study revealed that pathological crowding of a broncho constrictive attack causes so much epithelial cell extrusion that it damages the airways, resulting in inflammation and mucous secretion. This previously overlooked process perpetuates the characteristic inflammatory cycle of asthma, as repeated damage to the epithelium promotes chronic inflammation. It also results in scarring and permanent narrowing of the airways, contributing to the progression and severity of the disease. Researchers, including Elena Ortiz-Zapater, PhD, from the University of Valencia, Valencia, Spain, have demonstrated that traditional treatments do not prevent this damage. In contrast, gadolinium, a cell extrusion inhibitor, counteracts mechanical damage and significantly reduces the inflammatory response. Although this breakthrough has only been demonstrated in animal models, it opens new avenues for therapies that not only alleviate asthma symptoms but also prevent structural damage in the airways, offering hope for more durable remission. Biological Therapies Focusing on treatments, biological therapies have marked a turning point in the treatment of severe asthma and type 2 inflammatory phenotypes. This allows many patients to achieve a sustained clinical remission. Some biologics target different inflammatory pathways, demonstrating improvements in baseline pulmonary function and reducing persistent obstruction. Thus, they facilitate more sustained reversibility and even remission in selected subgroups of patients. Targeted drugs, such as omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab, have shown remarkable efficacy. Sustained improvements in pulmonary function, reduced exacerbations, and decreased systemic corticosteroid use have been observed. Recent registries and multicenter studies have shown an increasing number of patients treated with biologics who meet the partial or clinical remission criteria. For instance, the PrecISE trial is evaluating how therapies targeting specific biomarkers such as interleukin (IL)-4/IL-13 and thymic stromal lymphopoietin can induce sustained reversibility in cases of refractory severe asthma. In parallel, new molecules, such as amlitelimab, currently in phase 2 trials, demonstrate prolonged effects, even in phenotypes with mixed inflammation. These agents employ innovative mechanisms, such as targeting the OX40 pathway and using less frequent dosing, which could also facilitate adherence and sustainability of remission. The latest updates from GINA and GEMA have formally incorporated remission as a treatment goal for patients with severe asthma, particularly in the context of biological therapies. A major challenge remains the achievement of complete and sustained remission without chronic treatment, guided by biomarkers, new drugs, and more personalized clinical follow-ups. Short-Acting Beta-2 Agonists (SABAs) Alongside pharmacological advances and strategies for remission, the SABINA study highlights a critical aspect of asthma management. It addresses the inappropriate use of SABAs and their effect on disease control. With over a million patients from 40 countries, including Spain, this is the largest real-world observational analysis of this therapeutic class. The findings showed that approximately 28%-30% of patients with asthma in the country used three or more SABA inhalers annually. This is associated with a higher risk for exacerbations, poor symptom control, and increased mortality. In contrast, 13%-15% of patients use fewer than four inhalers of inhaled corticosteroids annually, which compromises the control of the underlying inflammation. SABAs provide immediate and temporary relief, which may contribute to a cycle of suboptimal control and symptom recurrence. Consequently, the GINA and GEMA guidelines discourage the use of SABA as monotherapy. These guidelines recommend combining inhaled corticosteroids with formoterol (a long-acting beta-2 agonist) as both maintenance and reliever therapy. This combination ensures improved disease management through prevention and continuous anti-inflammatory treatment, which is essential for sustained functional reversibility and clinical remission. Diagnostic Techniques Recent updates in diagnostic techniques have improved the ability to assess asthma reversibility and remission, particularly in patients with nearly normal baseline lung function. The joint guidelines from the European Respiratory Society and the American Thoracic Society recommend that a significant bronchodilator response is an increase of more than 10% in forced expiratory volume in 1 second or forced vital capacity. This adjustment improves the diagnostic sensitivity in patients with asthma, helping to identify cases that might have been previously overlooked and allowing earlier intervention. Additionally, serial spirometry has become a key tool for confirming sustained reversibility, particularly when the initial response to bronchodilators is unclear. This practice of monitoring pulmonary function over time helps assess the effectiveness of treatment and the potential for achieving remission. The integration of these updated diagnostic techniques into clinical practice improves diagnostic accuracy and regulates more personalized therapeutic strategies, increasing the chances of achieving sustained reversibility and, in some cases, complete remission of asthma. In conclusion, the updated assessment of asthma reversibility and remission integrates functional testing, including spirometry, peak expiratory flow, and bronchial provocation testing, inflammatory biomarkers such as fractional exhaled nitric oxide and blood eosinophil counts, and structured clinical follow-up, enabling a more accurate and personalized evaluation of disease status and progression.
Hamilton Spectator
29-04-2025
- Politics
- Hamilton Spectator
As Gov. Brian Kemp signs Georgia school safety law, supporters look to implementing it
ATLANTA (AP) — Georgia Gov. Brian Kemp on Monday signed a law that supporters hope will prevent future school shootings like the one that killed two students and two teachers on Sept. 4 at Apalachee High School northeast of Atlanta. Richard Aspinwall, the father of the Ricky Aspinwall, one of the teachers who was killed, called Monday 'a great day for advancing safety.' 'I don't want anyone else to have to go through this,' Aspinwall told reporters. You see it happening all over the country. It's got to stop. Some way or another, it's got to stop.' But like with most new laws, putting the words into practice will be key. 'Everybody's got to work together,' Rep. Holt Persinger, the Winder Republican who represents Apalachee High School and sponsored the bill, said after the signing ceremony. He said that included not only schools and local law enforcement agencies, but Georgia's child welfare, mental health and emergency management agencies. House Bill 268 was driven in part by the belief among many that the Barrow County school system didn't have a full picture of the warning signs displayed by the 14-year-old accused in the fatal shootings. School officials never became aware that a sheriff's deputy in Jackson County had interviewed Colt Gray in May 2023 after the FBI passed along a tip that Gray might have posted a shooting threat online. The new law requires police agencies to report to schools when officers learn that a child has threatened death or injury to someone at a school. It also mandates quicker transfers of records when a student enters a new school, creates at least one new position to help coordinate mental health treatment for students in each of Georgia's 180 school districts and sets up an anonymous reporting system statewide. Public schools will have to provide wearable panic buttons to employees and would be required to submit electronic maps of their campuses to local, state and federal agencies once a year. The law also makes adult prosecution the default when children aged 13 to 16 are charged with terroristic acts at school, any aggravated assault with a gun, or attempted murder. The measure, though, required only a reduced version of a student-tracking database that was once a centerpiece of the bill, after opponents raised fears that it could become a permanent blacklist of students. Instead, the Georgia Emergency Management and Homeland Security Agency was directed to create a database of students who an investigation has found threatened violence or committed violence at schools. The law directs GEMA to make rules about when names would be included and how someone could petition to be removed. But lawmakers didn't specifically appropriate any money to GEMA for what they called an 'emergency alert system.' Barrow County Sheriff Jud Smith called the measure a 'good start line,' but agreed cooperation would be key moving forward. 'You're not always going to get the job done unless you communicate,' Smith said. 'And you've got to understand what lanes they're in. Law enforcement has a lane, education has a lane, and then you have the taxpayers who have a lane.' Getting the law passed was emotional for many, including Persinger, who cried on the day it got final approval, and for the Aspinwall family 'It is part of the healing, but you never really heal,' Aspinwall said. 'You always have your memories. It always hurts.'
San Francisco Chronicle
28-04-2025
- Politics
- San Francisco Chronicle
As Gov. Brian Kemp signs Georgia school safety law, supporters look to implementing it
ATLANTA (AP) — Georgia Gov. Brian Kemp on Monday signed a law that supporters hope will prevent future school shootings like the one that killed two students and two teachers on Sept. 4 at Apalachee High School northeast of Atlanta. Richard Aspinwall, the father of the Ricky Aspinwall, one of the teachers who was killed, called Monday 'a great day for advancing safety.' 'I don't want anyone else to have to go through this,' Aspinwall told reporters. You see it happening all over the country. It's got to stop. Some way or another, it's got to stop." But like with most new laws, putting the words into practice will be key. 'Everybody's got to work together,' Rep. Holt Persinger, the Winder Republican who represents Apalachee High School and sponsored the bill, said after the signing ceremony. He said that included not only schools and local law enforcement agencies, but Georgia's child welfare, mental health and emergency management agencies. House Bill 268 was driven in part by the belief among many that the Barrow County school system didn't have a full picture of the warning signs displayed by the 14-year-old accused in the fatal shootings. School officials never became aware that a sheriff's deputy in Jackson County had interviewed Colt Gray in May 2023 after the FBI passed along a tip that Gray might have posted a shooting threat online. The new law requires police agencies to report to schools when officers learn that a child has threatened death or injury to someone at a school. It also mandates quicker transfers of records when a student enters a new school, creates at least one new position to help coordinate mental health treatment for students in each of Georgia's 180 school districts and sets up an anonymous reporting system statewide. Public schools will have to provide wearable panic buttons to employees and would be required to submit electronic maps of their campuses to local, state and federal agencies once a year. The law also makes adult prosecution the default when children aged 13 to 16 are charged with terroristic acts at school, any aggravated assault with a gun, or attempted murder. The measure, though, required only a reduced version of a student-tracking database that was once a centerpiece of the bill, after opponents raised fears that it could become a permanent blacklist of students. Instead, the Georgia Emergency Management and Homeland Security Agency was directed to create a database of students who an investigation has found threatened violence or committed violence at schools. The law directs GEMA to make rules about when names would be included and how someone could petition to be removed. But lawmakers didn't specifically appropriate any money to GEMA for what they called an 'emergency alert system.' Barrow County Sheriff Jud Smith called the measure a 'good start line,' but agreed cooperation would be key moving forward. 'You're not always going to get the job done unless you communicate," Smith said. "And you've got to understand what lanes they're in. Law enforcement has a lane, education has a lane, and then you have the taxpayers who have a lane.' 'It is part of the healing, but you never really heal," Aspinwall said. "You always have your memories. It always hurts.'
The Guardian
28-04-2025
- Politics
- The Guardian
Georgia governor signs school safety law after last year's fatal shooting
Georgia governor Brian Kemp on Monday signed a law that supporters hope will prevent future school shootings like the one that killed two students and two teachers on 4 September at the Apalachee high school north-east of Atlanta. Richard Aspinwall, the father of the Ricky Aspinwall, one of the teachers who was killed, called Monday 'a great day for advancing safety'. 'I don't want anyone else to have to go through this,' Aspinwall told reporters. You see it happening all over the country. It's got to stop. Some way or another, it's got to stop.' But like with most new laws, putting the words into practice will be key. 'Everybody's got to work together,' Holt Persinger, the Winder Republican state representative who serves Apalachee high school and sponsored the bill, said after the signing ceremony. He said that included not only schools and local law enforcement agencies, but Georgia's child welfare, mental health and emergency management agencies. House bill 268 was driven in part by the belief among many that the Barrow county school system didn't have a full picture of the warning signs displayed by the 14-year-old accused in the fatal shootings. School officials never became aware that a sheriff's deputy in Jackson county had interviewed Colt Gray in May 2023 after the FBI passed along a tip that Gray might have posted a shooting threat online. The new law requires police agencies to report to schools when officers learn that a child has threatened death or injury to someone at a school. It also mandates quicker transfers of records when a student enters a new school, creates at least one new position to help coordinate mental health treatment for students in each of Georgia's 180 school districts and sets up an anonymous reporting system statewide. Public schools will have to provide wearable panic buttons to employees and would be required to submit electronic maps of their campuses to local, state and federal agencies once a year. The law also makes adult prosecution the default when children aged 13 to 16 are charged with terroristic acts at school, any aggravated assault with a gun, or attempted murder. The measure, though, required only a reduced version of a student-tracking database that was once a centerpiece of the bill, after opponents raised fears that it could become a permanent blacklist of students. Instead, the Georgia Emergency Management and Homeland Security Agency (GEMA) was directed to create a database of students who an investigation has found threatened violence or committed violence at schools. The law directs GEMA to make rules about when names would be included and how someone could petition to be removed. But lawmakers didn't specifically appropriate any money to GEMA for what they called an 'emergency alert system'. Jud Smith, Barrow county's sheriff, called the measure a 'good start line' but agreed cooperation would be key moving forward. 'You're not always going to get the job done unless you communicate,' Smith said. 'And you've got to understand what lanes they're in. Law enforcement has a lane, education has a lane, and then you have the taxpayers who have a lane.' Getting the law passed was emotional for many, including Persinger, who cried on the day it got final approval, and for the Aspinwall family. 'It is part of the healing, but you never really heal,' Aspinwall said. 'You always have your memories. It always hurts.'
Yahoo
28-04-2025
- Politics
- Yahoo
As Gov. Brian Kemp signs Georgia school safety law, supporters look to implementing it
ATLANTA (AP) — Georgia Gov. Brian Kemp on Monday signed a law that supporters hope will prevent future school shootings like the one that killed two students and two teachers on Sept. 4 at the Apalachee High School northeast of Atlanta. Richard Aspinwall, the father of the Ricky Aspinwall, one of the teachers who was killed, called Monday 'a great day for advancing safety.' 'I don't want anyone else to have to go through this,' Aspinwall told reporters. You see it happening all over the country. It's got to stop. Some way or another, it's got to stop." But like with most new laws, putting the words into practice will be key. 'Everybody's got to work together,' Rep. Holt Persinger, the Winder Republican who represents Apalachee High School and sponsored the bill, said after the signing ceremony. He said that included not only schools and local law enforcement agencies, but Georgia's child welfare, mental health and emergency management agencies. House Bill 268 was driven in part by the belief among many that the Barrow County school system didn't have a full picture of the warning signs displayed by the 14-year-old accused in the fatal shootings. School officials never became aware that a sheriff's deputy in Jackson County had interviewed Colt Gray in May 2023 after the FBI passed along a tip that Gray might have posted a shooting threat online. The new law requires police agencies to report to schools when officers learn that a child has threatened death or injury to someone at a school. It also mandates quicker transfers of records when a student enters a new school, creates at least one new position to help coordinate mental health treatment for students in each of Georgia's 180 school districts and sets up an anonymous reporting system statewide. Public schools will have to provide wearable panic buttons to employees and would be required to submit electronic maps of their campuses to local, state and federal agencies once a year. The law also makes adult prosecution the default when children aged 13 to 16 are charged with terroristic acts at school, any aggravated assault with a gun, or attempted murder. The measure, though, required only a reduced version of a student-tracking database that was once a centerpiece of the bill, after opponents raised fears that it could become a permanent blacklist of students. Instead, the Georgia Emergency Management and Homeland Security Agency was directed to create a database of students who an investigation has found threatened violence or committed violence at schools. The law directs GEMA to make rules about when names would be included and how someone could petition to be removed. But lawmakers didn't specifically appropriate any money to GEMA for what they called an 'emergency alert system.' Barrow County Sheriff Jud Smith called the measure a 'good start line,' but agreed cooperation would be key moving forward. 'You're not always going to get the job done unless you communicate," Smith said. "And you've got to understand what lanes they're in. Law enforcement has a lane, education has a lane, and then you have the taxpayers who have a lane.' Getting the law passed was emotional for many, including Persinger, who cried on the day it got final approval, and for the Aspinwall family 'It is part of the healing, but you never really heal," Aspinwall said. "You always have your memories. It always hurts.'
