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Sample records for review severe asthma

  1. Severe Asthma

    Science.gov (United States)

    Erzurum, Serpil C.; Bleecker, Eugene R.; Calhoun, William J.; Castro, Mario; Comhair, Suzy A. A.; Chung, Kian Fan; Curran-Everett, Douglas; Dweik, Raed A.; Fain, Sean B.; Fitzpatrick, Anne M.; Gaston, Benjamin M.; Israel, Elliot; Hastie, Annette; Hoffman, Eric A.; Holguin, Fernando; Levy, Bruce D.; Meyers, Deborah A.; Moore, Wendy C.; Peters, Stephen P.; Sorkness, Ronald L.; Teague, W. Gerald; Wenzel, Sally E.; Busse, William W.

    2012-01-01

    The National Heart, Lung, and Blood Institute Severe Asthma Research Program (SARP) has characterized over the past 10 years 1,644 patients with asthma, including 583 individuals with severe asthma. SARP collaboration has led to a rapid recruitment of subjects and efficient sharing of samples among participating sites to conduct independent mechanistic investigations of severe asthma. Enrolled SARP subjects underwent detailed clinical, physiologic, genomic, and radiological evaluations. In addition, SARP investigators developed safe procedures for bronchoscopy in participants with asthma, including those with severe disease. SARP studies revealed that severe asthma is a heterogeneous disease with varying molecular, biochemical, and cellular inflammatory features and unique structure–function abnormalities. Priorities for future studies include recruitment of a larger number of subjects with severe asthma, including children, to allow further characterization of anatomic, physiologic, biochemical, and genetic factors related to severe disease in a longitudinal assessment to identify factors that modulate the natural history of severe asthma and provide mechanistic rationale for management strategies. PMID:22095547

  2. A review of omalizumab for the management of severe asthma

    Directory of Open Access Journals (Sweden)

    Lin CH

    2016-07-01

    Full Text Available Ching-Hsiung Lin,1–3 Shih-Lung Cheng4,5 1Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, Republic of China; 2Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan, Republic of China; 3School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China; 4Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan, Republic of China; 5Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan County, Taiwan, Republic of China Abstract: Despite the expansion of the understanding in asthma pathophysiology and the continual advances in disease management, a small subgroup of patients remain partially controlled or refractory to standard treatments. Upon the identification of immunoglobulin E and other inflammatory mediators, investigations and developments of targeted agents have thrived. Omalizumab is a humanized monoclonal antibody that specifically targets the circulating immunoglobulin E, which in turn impedes and reduces subsequent releases of the proinflammatory mediators. In the past decade, omalizumab has been proven to be efficacious and well-tolerated in the treatment of moderate-to-severe asthma in both trials and real-life studies, most notably in reducing exacerbation rates and corticosteroid use. While growing evidence has demonstrated that omalizumab may be potentially beneficial in treating other allergic diseases, its indication remains confined to treating severe allergic asthma and chronic idiopathic urticaria. Future efforts may be focused on determining the optimal length of omalizumab treatment, seeking biomarkers that could better predict treatment response, as well as extending its indications. Keywords: severe asthma, IgE, omalizumab, exacerbation, chronic idiopathic urticarial, inhaled corticosteroid

  3. Allergy in severe asthma.

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    Del Giacco, S R; Bakirtas, A; Bel, E; Custovic, A; Diamant, Z; Hamelmann, E; Heffler, E; Kalayci, Ö; Saglani, S; Sergejeva, S; Seys, S; Simpson, A; Bjermer, L

    2017-02-01

    It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps 4-5 of GINA guidelines to prevent their asthma from becoming 'uncontrolled', or whose disease remains 'uncontrolled' despite this therapy. Epidemiological studies on emergency room visits and hospital admissions for asthma suggest the important role of allergy in asthma exacerbations. In addition, allergic asthma in childhood is often associated with severe asthma in adulthood. A strong association exists between asthma exacerbations and respiratory viral infections, and interaction between viruses and allergy further increases the risk of asthma exacerbations. Furthermore, fungal allergy has been shown to play an important role in severe asthma. Other contributing factors include smoking, pollution and work-related exposures. The 'Allergy and Asthma Severity' EAACI Task Force examined the current evidence and produced this position document on the role of allergy in severe asthma. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Allergy in severe asthma

    NARCIS (Netherlands)

    Del Giacco, Stefano R.; Bakirtas, A.; Bel, E.; Custovic, A.; Diamant, Z.; Hamelmann, E.; Heffler, E.; Kalayci, O.; Saglani, S.; Sergejeva, S.; Seys, S.; Simpson, A.; Bjermer, Leif

    It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps

  5. Severe Asthma in Children.

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    Chipps, Bradley E; Parikh, Neil G; Maharaj, Sheena K

    2017-04-01

    The aim of this study is to characterize, diagnose, evaluate, and treat severe childhood asthma. Understanding the occurrence of the physiologic and clinical presentations of childhood severe asthma, the treatment and response may be predicted by biomarkers, but the patient's response is highly variable. The onset of severe asthma occurs early and is primarily predicted by severity of viral infection and coexistence of the atopic state.

  6. Severe bronchial asthma in children: a review of novel biomarkers used as predictors of the disease

    Directory of Open Access Journals (Sweden)

    Uwaezuoke SN

    2018-01-01

    Full Text Available Samuel N Uwaezuoke, Adaeze C Ayuk, Joy N Eze Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria Abstract: Severe asthma or therapy-resistant asthma in children is a heterogeneous disease that affects all age-groups. Given its heterogeneity, precision in diagnosis and treatment has become imperative, in order to achieve better outcomes. If one is thus able to identify specific patient phenotypes and endotypes using the appropriate biomarkers, it will assist in providing the patient with more personalized and appropriate treatment. However, there appears to be a huge diagnostic gap in severe asthma, as there is no single test yet that accurately determines disease phenotype. In this paper, we review the published literature on some of these biomarkers and their possible role in bridging this diagnostic gap. We also highlight the cellular and molecular mechanisms involved in severe asthma, in order to show the basis for the novel biomarkers. Some markers useful for monitoring therapy and assessing airway remodeling in the disease are also discussed. A review of the literature was conducted with PubMed to gather baseline data on the subject. The literature search extended to articles published within the last 40 years. Although biomarkers specific to different severe asthma phenotypes have been identified, progress in their utility remains slow, because of several disease mechanisms, the variation of biomarkers at different levels of inflammation, changes in relying on one test over time (eg, from sputum eosinophilia to blood eosinophilia, and the degree of invasive tests required to collect biomarkers, which limits their applicability in clinical settings. In conclusion, several biomarkers remain useful in recognizing various asthma phenotypes. However, due to disease heterogeneity, identification and utilization of ideal and defined biomarkers in severe asthma are still inconclusive. The development of novel

  7. Guidelines for severe uncontrolled asthma.

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    Cisneros Serrano, Carolina; Melero Moreno, Carlos; Almonacid Sánchez, Carlos; Perpiñá Tordera, Miguel; Picado Valles, César; Martínez Moragón, Eva; Pérez de Llano, Luis; Soto Campos, José Gregorio; Urrutia Landa, Isabel; García Hernández, Gloria

    2015-05-01

    Since the publication, 9 years ago, of the latest SEPAR (Spanish Society of Pulmonology and Thoracic Surgery) Guidelines on Difficult-to-Control Asthma (DCA), much progress has been made in the understanding of asthmatic disease. These new data need to be reviewed, analyzed and incorporated into the guidelines according to their level of evidence and recommendation. Recently, consensus documents and clinical practice guidelines (CPG) addressing this issue have been published. In these guidelines, specific mention will be made of what the previous DCA guidelines defined as "true difficult-to-control asthma". This is asthma that remains uncontrolled after diagnosis and a systematic evaluation to rule out factors unrelated to the disease itself that lead to poor control ("false difficult-to-control asthma"), and despite an appropriate treatment strategy (Spanish Guidelines for the Management of Asthma [GEMA] steps 5 and 6): severe uncontrolled asthma. In this respect, the guidelines propose a revised definition, an attempt to classify the various manifestations of this type of asthma, a proposal for a stepwise diagnostic procedure, and phenotype-targeted treatment. A specific section has also been included on DCA in childhood, aimed at assisting healthcare professionals to improve the care of these patients. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  8. Co-morbidities in severe asthma

    DEFF Research Database (Denmark)

    Porsbjerg, Celeste; Menzies-Gow, Andrew

    2017-01-01

    Patients with severe asthma represent a minority of the total asthma population, but carry a majority of the morbidity and healthcare costs. Achieving better asthma control in this group of patients is therefore of key importance. Systematic assessment of patients with possible severe asthma...... to identify treatment barriers and triggers of asthma symptoms, including co-morbidities, improves asthma control and reduces healthcare costs and is recommended by international guidelines on management of severe asthma. This review provides the clinician with an overview of the prevalence and clinical...... impact of the most common co-morbidities in severe asthma, including chronic rhinosinusitis, nasal polyposis, allergic rhinitis, dysfunctional breathing, vocal cord dysfunction, anxiety and depression, obesity, obstructive sleep apnoea syndrome (OSAS), gastroesophageal reflux disease (GERD...

  9. Phenotype-Driven Therapeutics in Severe Asthma.

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    Opina, Maria Theresa D; Moore, Wendy C

    2017-02-01

    Inhaled corticosteroids are the mainstay of asthma treatment using a step-up approach with incremental dosing and additional controller medications in order to achieve symptom control and prevent exacerbations. While most patients respond well to this treatment approach, some patients remain refractory despite high doses of inhaled corticosteroids and a long-acting β-agonist. The problem lies in the heterogeneity of severe asthma, which is further supported by the emergence of severe asthma phenotypes. This heterogeneity contributes to the variability in treatment response. Randomized controlled trials involving add-on therapies in poorly controlled asthma have challenged the idea of a "one size fits all" approach targeting specific phenotypes in their subject selection. This review discusses severe asthma phenotypes from unbiased clustering approaches and the most recent scientific evidence on novel treatments to provide a guide in personalizing severe asthma treatment.

  10. Vitamin D deficiency and severe asthma.

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    Poon, Audrey H; Mahboub, Bassam; Hamid, Qutayba

    2013-11-01

    Vitamin D has received tremendous amount of attention recently due to the ever-increasing reports of association between vitamin D deficiency and a wide range of conditions, from cancer to fertility to longevity. The fascination of disease association with vitamin D deficiency comes from the relatively easy solution to overcome such a risk factor, that is, either by increase in sun exposure and/or diet supplementation. Many reviews have been written on a protective role of vitamin D in asthma and related morbidities; here, we will summarize the epidemiological evidence supporting a role of vitamin D against hallmark features of severe asthma, such as airway remodeling and asthma exacerbations. Furthermore, we discuss data from in vitro and in vivo studies which provide insights on the potential mechanisms of how vitamin D may protect against severe asthma pathogenesis and how vitamin D deficiency may lead to the development of severe asthma. Approximately 5-15% of asthmatic individuals suffer from the more severe forms of disease in spite of aggressive therapies and they are more likely to have irreversible airflow obstruction associated with airway remodeling. At present drugs commonly used to control asthma symptoms, such as corticosteroids, do not significantly reverse or reduce remodeling in the airways. Hence, if vitamin D plays a protective role against the development of severe asthma, then the most effective therapy may simply be a healthy dose of sunshine. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Mepolizumab for Treating Severe Eosinophilic Asthma: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

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    Bermejo, Iñigo; Stevenson, Matt; Cooper, Katy; Harnan, Sue; Hamilton, Jean; Clowes, Mark; Carroll, Christopher; Harrison, Tim; Saha, Shironjit

    2017-09-20

    As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the company (GlaxoSmithKline) that manufactures mepolizumab (Nucala®) to submit evidence on the clinical and cost effectiveness of mepolizumab for the treatment of severe eosinophilic asthma. The School of Health and Related Research Technology Appraisal Group (ScHARR-TAG) at the University of Sheffield was commissioned to act as the independent evidence review group (ERG). The ERG produced a review of the evidence for the clinical and cost effectiveness of mepolizumab as add-on to standard of care (SoC) compared with SoC and omalizumab, based upon the company's submission to NICE. The clinical-effectiveness evidence in the company's submission was based predominantly on three randomised controlled trials (DREAM, MENSA and SIRIUS) comparing add-on mepolizumab with placebo plus SoC. The relevant population was defined in terms of degree of asthma severity (four or more exacerbations in the previous year and/or dependency on maintenance oral corticosteroids [mOCS]) and degree of eosinophilia (a blood eosinophil count of ≥ 300 cells/µl in the previous year) based on post hoc subgroup analyses of the pivotal trials. Other subpopulations were considered throughout the appraisal, defined by different eosinophil measurements, number of exacerbations and dependency (or lack thereof) on mOCS. Statistically significant reductions in clinically significant exacerbations were observed in patients receiving mepolizumab compared with SoC meta-analysed across MENSA and DREAM in the modified intention-to-treat (ITT) population (rate ratio [RR] 0.51; 95% confidence interval [CI] 0.42-0.62) as well as in the relevant population (RR 0.47; 95% CI 0.36-0.62). In terms of quality of life, differences on the St. George's Respiratory Questionnaire in MENSA for add-on subcutaneous mepolizumab 100 mg vs. placebo were 7 and 7.5 units in the modified ITT and

  12. Genetics of Asthma Susceptibility and Severity

    NARCIS (Netherlands)

    Slager, Rebecca E.; Hawkins, Gregory A.; Li, Xingnan; Postma, Dirkje S.; Meyers, Deborah A.; Bleecker, Eugene R.

    This article summarizes major findings in genome-wide studies of asthma susceptibility and severity. Two large meta-analyses identified four chromosomal regions which were consistently associated with development of asthma. Genes that are associated with asthma subphenotypes such as lung function,

  13. Co-morbidities in severe asthma: Clinical impact and management.

    Science.gov (United States)

    Porsbjerg, Celeste; Menzies-Gow, Andrew

    2017-05-01

    Patients with severe asthma represent a minority of the total asthma population, but carry a majority of the morbidity and healthcare costs. Achieving better asthma control in this group of patients is therefore of key importance. Systematic assessment of patients with possible severe asthma to identify treatment barriers and triggers of asthma symptoms, including co-morbidities, improves asthma control and reduces healthcare costs and is recommended by international guidelines on management of severe asthma. This review provides the clinician with an overview of the prevalence and clinical impact of the most common co-morbidities in severe asthma, including chronic rhinosinusitis, nasal polyposis, allergic rhinitis, dysfunctional breathing, vocal cord dysfunction, anxiety and depression, obesity, obstructive sleep apnoea syndrome (OSAS), gastroesophageal reflux disease (GERD), bronchiectasis, allergic bronchopulmonary aspergillosis (ABPA) and eosinophilic granulomatous with polyangiitis (EGPA). Furthermore, the review offers a summary of recommended diagnostic and management approaches for each co-morbidity. Finally, the review links co-morbid conditions to specific phenotypes of severe asthma, in order to guide the clinician on which co-morbidities to look for in specific patients. © 2017 Asian Pacific Society of Respirology.

  14. Insights into disease severity in adult asthma

    NARCIS (Netherlands)

    Amelink, M.

    2014-01-01

    In this thesis we investigated and associated several new insights into disease severity in adult asthma. First we identified several clusters of adult-onset asthma and in addition to this we showed that severe disease is mostly associated with persistent eosinophilia and ENT disease. Also we showed

  15. Psychopathology in difficult asthma : Review

    NARCIS (Netherlands)

    Prins, L.C.J.; van Son, M.A.C.; van Keimpema, A.R.J.; van Ranst, D.; Antonissen-Pommer, A.M.; Meijer, J.W.G.; Pop, V.J.M.

    2015-01-01

    Objective: Within the asthma population, difficult asthma (DA) is a severe condition in which patients present with frequent exacerbations, hospitalizations and emergency room visits. The identification and treatment of psychopathology is included in the management of DA. Psychopathology is supposed

  16. Role of T2 inflammation biomarkers in severe asthma

    NARCIS (Netherlands)

    Parulekar, Amit D.; Diamant, Zuzana; Hanania, Nicola A.

    Purpose of reviewSevere asthma is a heterogeneous syndrome. Classification of asthma into phenotypes and endotypes can improve understanding and treatment of the disease. Identification and utilization of biomarkers, particularly those linked to T2 inflammation, can help group patients into

  17. Asthma control questionnaires in the management of asthma in children: A review.

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    Voorend-van Bergen, S; Vaessen-Verberne, A A; de Jongste, J C; Pijnenburg, M W

    2015-02-01

    Several self-administered questionnaires have been developed to assess childhood asthma control in a simple and standardized way. This review discusses the most commonly used questionnaires and explores their usefulness in asthma management in children. We conclude that the use of asthma control questionnaires in daily practice and in research contributes to the standardized evaluation of children with asthma and helps to track asthma symptoms, but validation studies in a wider range of settings are needed. © 2014 Wiley Periodicals, Inc.

  18. [Obesity and the severity of asthma crisis].

    Science.gov (United States)

    Boussoffara, L; Boudawara, N; Touil, I; El Fahem, N; Sakka, M; Knani, J

    2014-09-01

    Obesity is associated with inflammatory processes, which could influence the airway inflammation that is found in patients with asthma. Obesity may thus have a role in the development of asthma. However, the role of obesity in the severity of acute asthma has not been well described. We performed a retrospective study, which included 77 patients hospitalized for acute asthma. Two groups of patients were formed according to their body mass index (BMI): group 1 consisting of 59 patients with a BMI inferior to 30 kg/m(2) and group 2 consisting of 18 patients with a BMI superior or equal to 30 kg/m(2). These two groups were compared according to demographic factors, clinical features and the spirometric severity of asthma. The mean age was 43 ± 17.4 years with a sex-ratio 0.57 (28 men/49 women). Thirty-one percent of these patients had a severe asthma attack requiring hospitalization in intensive care in four patients with the use of mechanical ventilation in two patients. The comparison between obese and non-obese patients did not show a significant difference in the severity of asthma. Although a contribution of obesity to the manifestation and severity of asthma is commonly recognized, the present data to not confirm the impact of obesity on the severity of acute attacks. Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  19. Assessment of problematic severe asthma in children

    DEFF Research Database (Denmark)

    Carlsen, K. C. L.; Hedlin, G.; Bush, A.

    2011-01-01

    Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi-disciplinary assessm......Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi...... in our current knowledge in all these steps are highlighted, and recommendations for current clinical practice and future research are made. The lack of good data and the heterogeneity of problematic severe asthma still limit our ability to optimise the management on an individual basis in this small...

  20. The role of airway hyperresponsiveness measured by methacholine challenge test in defining asthma severity in asthma-obesity syndrome.

    Science.gov (United States)

    Charron, Catherine B; Pakhalé, Smita

    2016-06-01

    Asthma is a complex disease defined by chronic inflammation of the airways. In research and clinical practice measures used for diagnosis, an assessment of control and severity of asthma are varied and there exists no gold standard. To date, several studies have explored the link between obesity and asthma although the exact mechanism is not yet fully understood. A study undertaken by our research group in 2015, on the effects of weight loss on asthma severity in obese asthmatics, demonstrated that an improvement in airway hyperresponsiveness could be achieved after significant weight reduction with a weight loss program. The objective of this article is to review the current literature for the primary and secondary outcomes studied to estimate the effects of weight loss on asthma severity in adults with obesity and asthma. A review of the most recent research conducted since 2014 demonstrates that effects of weight loss on asthma severity in adults with obesity and asthma has not been the focus of majority of the studies. Apart from our study published in 2015, very few studies used airway hyperresponsiveness as the primary or secondary outcome measure. The literature reveals that significant weight loss does, however, lead to improvement in asthma severity and control in adults with obesity and asthma. The current literature suggests that improvement in lung function requires moderate to significant (5-10%) weight loss in adults with obesity and asthma. However, with a few exceptions, the majority of these studies were small and used variable and questionable asthma severity outcome measures. There is an urgent need for standardization of diagnosis of asthma, study inclusion criteria, and outcome measures to assess asthma severity in research setting. Long-term effects of weight loss interventions on asthma severity and control, in adults with obesity and asthma, also remain unanswered.

  1. Violence and Asthma: A Review

    Directory of Open Access Journals (Sweden)

    Takeo Fujiwara

    2008-01-01

    Full Text Available Recent research shows that exposure to community violence is, directly and indirectly, associated with asthma. This article reviews the findings on the impact of violence on asthma, and the pathways for the association of violence and asthma are suggested: 1 exposure to violence is directly associated with asthma, mainly through dysregulation of sympathetic-adrenal-medullary (SAM and hypothalamic-pituitary-adrenal (HPA axis, 2 exposure to violence is associated with the change of susceptibility of outdoor air pollution on asthma, probably through the change of an immune response, and 3 behavioral change due to exposure to violence (e.g. keeping children indoors leads to more exposure to indoor pollutants. The suggested framework may be useful to develop health policy on asthma in high-violence communities.

  2. Children with problematic severe asthma: A biopsychosocial perspective

    NARCIS (Netherlands)

    Verkleij, M.

    2016-01-01

    This thesis focuses on problematic severe asthma in children and its treatment from a biopsychosocial perspective. Asthma is a chronic inflammatory disease of the airways. In children with problematic severe asthma, asthma is not under control despite optimal medical treatment. Asthma control is the

  3. Reducing asthma attacks in patients with severe asthma: The role of bronchial thermoplasty.

    Science.gov (United States)

    Dunn, Ryan; Wechsler, Michael E

    2015-01-01

    Asthma remains one of the most common diseases worldwide and results in significant societal health care costs and in morbidity and mortality to those afflicted. Despite currently available medications, 5-10% of patients with asthma have severe disease with debilitating symptoms and/or life-threatening exacerbations. Bronchial thermoplasty is a device-based therapy with proven efficacy in this subgroup of patients. Thus far, bronchial thermoplasty has been shown to reduce exacerbations and to improve important measures of asthma control. The purpose of this article is to review the pathophysiology of severe asthma, including the role of airway smooth muscle cells and the procedural aspects of bronchial thermoplasty, and to review the evidence behind this important therapy.

  4. Challenges in the management of severe allergic asthma in the elderly

    Directory of Open Access Journals (Sweden)

    Ozturk AB

    2016-03-01

    Full Text Available Ayse Bilge Ozturk,1 Sinem Iliaz21Department of Allergy and Immunology, 2Department of Pulmonary Medicine, Koç University Hospital, Istanbul, TurkeyAbstract: Little is known about the features of asthma and allergy in the elderly. A significant number of elderly patients with asthma have uncontrolled and severe asthma. This review aims to provide an analysis of the literature on the assessment and phenotype of severe allergic asthma in the elderly. Gaps and pitfalls in diagnostic and therapeutic approaches, as well as management of severe allergic asthma in the elderly, are also discussed.Keywords: allergy, asthma, elderly, severe, chronic obstructive pulmonary disease, atopy

  5. Novel monoclonal treatments in severe asthma

    DEFF Research Database (Denmark)

    Meteran, Howraman; Meteran, Hanieh; Porsbjerg, Celeste

    2017-01-01

    AIM: To provide a general overview of the current biological treatments and discuss their potential anti-asthmatic effects. DATA SOURCES: We reviewed articles in PubMed found using the search words "Asthma/therapy AND antibodies, monoclonal/therapeutic use AND cytokines." STUDY SELECTIONS: Only...... articles published in English since 2000 were considered. The search identified 29 studies; 8 additional studies were found by hand search, generating 37 studies. RESULTS: Of the 37 studies investigating biological treatments of asthma, 5 were on the effects of anti-IgE (omalizumab); 12 on anti-IL-5; 8...... TSLP, IL-9, and TNF-α lacked convincing effectiveness. CONCLUSION: Research on the biological treatment of asthma shows promising results. While anti-IgE (omalizumab) has been used in the treatment of asthma for some years, anti-IL-5 has recently been approved for use. The efficacy of results of other...

  6. Severe asthma: lessons learned from the National Heart, Lung, and Blood Institute Severe Asthma Research Program.

    Science.gov (United States)

    Jarjour, Nizar N; Erzurum, Serpil C; Bleecker, Eugene R; Calhoun, William J; Castro, Mario; Comhair, Suzy A A; Chung, Kian Fan; Curran-Everett, Douglas; Dweik, Raed A; Fain, Sean B; Fitzpatrick, Anne M; Gaston, Benjamin M; Israel, Elliot; Hastie, Annette; Hoffman, Eric A; Holguin, Fernando; Levy, Bruce D; Meyers, Deborah A; Moore, Wendy C; Peters, Stephen P; Sorkness, Ronald L; Teague, W Gerald; Wenzel, Sally E; Busse, William W

    2012-02-15

    The National Heart, Lung, and Blood Institute Severe Asthma Research Program (SARP) has characterized over the past 10 years 1,644 patients with asthma, including 583 individuals with severe asthma. SARP collaboration has led to a rapid recruitment of subjects and efficient sharing of samples among participating sites to conduct independent mechanistic investigations of severe asthma. Enrolled SARP subjects underwent detailed clinical, physiologic, genomic, and radiological evaluations. In addition, SARP investigators developed safe procedures for bronchoscopy in participants with asthma, including those with severe disease. SARP studies revealed that severe asthma is a heterogeneous disease with varying molecular, biochemical, and cellular inflammatory features and unique structure-function abnormalities. Priorities for future studies include recruitment of a larger number of subjects with severe asthma, including children, to allow further characterization of anatomic, physiologic, biochemical, and genetic factors related to severe disease in a longitudinal assessment to identify factors that modulate the natural history of severe asthma and provide mechanistic rationale for management strategies.

  7. Evaluation of quality of life according to asthma control and asthma severity in children and adolescents.

    Science.gov (United States)

    Matsunaga, Natasha Yumi; Ribeiro, Maria Angela Gonçalves de Oliveira; Saad, Ivete Alonso Bredda; Morcillo, André Moreno; Ribeiro, José Dirceu; Toro, Adyléia Aparecida Dalbo Contrera

    2015-01-01

    To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents. We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global Initiative for Asthma, respectively. The patients also completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validated for use in Brazil, in order to evaluate their quality of life. The mean age of the patients was 11.22 ± 2.91 years, with a median of 11.20 (7.00-17.60) years. We selected 100 patients, of whom 27, 33, and 40 were classified as having controlled asthma (CA), partially controlled asthma (PCA), and uncontrolled asthma (UA), respectively. As for asthma severity, 34, 19, and 47 were classified as having mild asthma (MiA), moderate asthma (MoA), and severe asthma (SA), respectively. The CA and the PCA groups, when compared with the NCA group, showed higher values for the overall PAQLQ score and all PAQLQ domains (activity limitation, symptoms, and emotional function; p Quality of life appears to be directly related to asthma control and asthma severity in children and adolescents, being better when asthma is well controlled and asthma severity is lower.

  8. The Role of Allergy in Severe Asthma

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    Kennedy, Joshua L.; Heymann, Peter W.; Platts-Mills, Thomas A. E.

    2012-01-01

    Summary The classification of asthma to identify forms which have different contributing causes is useful for all cases in which the disease requires regular treatment, but it is essential for the management of severe asthma. Many forms of the disease can occur, and complex mixtures are not uncommon; here we artificially separated the cases into four groups: i) inhalant allergy, ii) fungal sensitization with or without colonization (including ABPA); iii) severe sinusitis with or without aspirin-exacerbated respiratory disease (AERD), and iv) non-inflammatory cases, including those associated with severe obesity and vocal cord dysfunction (VCD). The reason for focusing on these groups is because they illustrate how much the specific management depends upon correct classification. Inhalant allergy can present as chronically severe asthma. However, severe attacks of asthma requiring hospital admission can occur in cases which are generally only mild or moderate. The best recognized and probably the most common cause of these acute episodes is acute infection with a rhinovirus. Recent evidence suggests that high titer IgE, particularly to dust mite, correlates to exacerbations of asthma related to rhinovirus infection. While it is well recognized that the fungus Aspergillus can colonize the lungs and cause severe disease, it is less well recognized that those cases may not have full criteria for diagnosis of ABPA or may involve other fungi. Identifying fungal cases is important, because treatment with imidazole antifungals can provide significant benefit. Taken together, specific treatment using allergen avoidance, immunotherapy, anti-IgE, or antifungal treatment is an important part of the successful management of severe asthma, and each of these requires correctly identifying specific sensitization. PMID:22515388

  9. Effect of asthma severity on symptom perception in childhood asthma

    Directory of Open Access Journals (Sweden)

    A.L.B. Cabral

    2002-03-01

    Full Text Available Individual ability to perceive airway obstruction varies substantially. The factors influencing the perception of asthma are probably numerous and not well established in children. The present study was designed to examine the influence of asthma severity, use of preventive medication, age and gender on the association between respiratory symptoms (RS and peak expiratory flow (PEF rates in asthmatic children. We followed 92 asthmatic children, aged 6 to 16 years, for five months. Symptom scores were recorded daily and PEF was measured twice a day. The correlations among variables at the within-person level over time were analyzed for each child and for the pooled data by multivariate analysis. After pooling the data, there was a significant (P<0.05 correlation between each symptom and PEF; 60% of the children were accurate perceivers (defined by a statistically significant correlation between symptoms and PEF across time for diurnal symptoms and 37% for nocturnal symptoms. The accuracy of perception was independent of asthma severity, age, gender or the use of preventive medication. Symptom perception is inaccurate in a substantial number of asthmatic children, independently of clinical severity, age, gender or use of preventive medication. It is not clear why some asthmatic patients are capable of accurately perceiving the severity of airway obstruction while others are not.

  10. Airway Microbiota in Severe Asthma and Relationship to Asthma Severity and Phenotypes.

    Directory of Open Access Journals (Sweden)

    Qingling Zhang

    Full Text Available The lower airways harbor a community of bacterial species which is altered in asthma.We examined whether the lower airway microbiota were related to measures of asthma severity.We prospectively recruited 26 severe asthma, 18 non-severe asthma and 12 healthy subjects. DNA was extracted from induced sputum and PCR amplification of the V3-V5 region of bacterial 16S rRNA gene was performed.We obtained 138,218 high quality sequences which were rarefied at 133 sequences/sample. Twenty OTUs had sequences ≥1% of total. There were marked differences in the distribution of Phyla between groups (P = 2.8x10-118. Bacteroidetes and Fusobacteria were reduced in non-severe and severe asthmatic groups. Proteobacteria were more common in non-severe asthmatics compared to controls (OR = 2.26; 95% CI = 1.94-2.64 and Firmicutes were increased in severe asthmatics compared to controls (OR = 2.15; 95%CI = 1.89-2.45. Streptococcal OTUs amongst the Firmicutes were associated with recent onset asthma, rhinosinusitis and sputum eosinophilia.Sputum microbiota in severe asthma differs from healthy controls and non-severe asthmatics, and is characterized by the presence of Streptococcus spp with eosinophilia. Whether these organisms are causative for the pathophysiology of asthma remains to be determined.

  11. Challenges in the management of severe allergic asthma in the elderly

    OpenAIRE

    Ozturk AB; Iliaz S

    2016-01-01

    Ayse Bilge Ozturk,1 Sinem Iliaz21Department of Allergy and Immunology, 2Department of Pulmonary Medicine, Koç University Hospital, Istanbul, TurkeyAbstract: Little is known about the features of asthma and allergy in the elderly. A significant number of elderly patients with asthma have uncontrolled and severe asthma. This review aims to provide an analysis of the literature on the assessment and phenotype of severe allergic asthma in the elderly. Gaps and pitfalls in diagnostic an...

  12. Drug therapies in severe asthma - the era of stratified medicine.

    Science.gov (United States)

    Hetherington, Kathy J; Heaney, Liam G

    2015-10-01

    Difficult-to-treat asthma affects up to 20% of patients with asthma and is associated with significant healthcare cost. It is an umbrella term that defines a heterogeneous clinical problem including incorrect diagnosis, comorbid conditions and treatment non-adherence; when these are effectively addressed, good symptom control is frequently achieved. However, in 3-5% of adults with difficult-to-treat asthma, the problem is severe disease that is unresponsive to currently available treatments. Current treatment guidelines advise the 'stepwise' increase of corticosteroids, but it is now recognised that many aspects of asthma are not corticosteroid responsive, and that this 'one size fits all' approach does not deliver clinical benefit in many patients and can also lead to side effects. The future of management of severe asthma will involve optimisation with currently available treatments, particularly corticosteroids, including addressing non-adherence and defining an 'optimised' corticosteroid dose, allied with the use of 'add-on' target-specific novel treatments. This review examines the current status of novel treatments and research efforts to identify novel targets in the era of stratified medicines in severe asthma. © Royal College of Physicians 2015. All rights reserved.

  13. Novel monoclonal treatments in severe asthma.

    Science.gov (United States)

    Meteran, Howraman; Meteran, Hanieh; Porsbjerg, Celeste; Backer, Vibeke

    2017-12-01

    To provide a general overview of the current biological treatments and discuss their potential anti-asthmatic effects. We reviewed articles in PubMed found using the search words "Asthma/therapy AND antibodies, monoclonal/therapeutic use AND cytokines." Only articles published in English since 2000 were considered. The search identified 29 studies; 8 additional studies were found by hand search, generating 37 studies. Of the 37 studies investigating biological treatments of asthma, 5 were on the effects of anti-IgE (omalizumab); 12 on anti-IL-5; 8 on anti-IL-13; 5 on anti-IL-4R-α; 3 on anti-IL-9; one on TNF-α; one on anti-IL-2R-α; one on TSLP (Thymic Stromal Lymphopoietin); and one on OX40L. Sample sizes ranged from 3 to 943 participants. Studies of therapies targeting IgE, IL-2, IL4R-α, IL-5, and IL-13 showed some efficacy, whereas those targeting TSLP, IL-9, and TNF-α lacked convincing effectiveness. Research on the biological treatment of asthma shows promising results. While anti-IgE (omalizumab) has been used in the treatment of asthma for some years, anti-IL-5 has recently been approved for use. The efficacy of results of other large studies with a longer duration is needed to draw a firm conclusion. Such studies should not only focus on clinical outcomes, but also consider asthma-related quality of life. Knowledge on the asthma phenotypes and identification of biomarkers associated with these will be useful for physicians considering the right treatment for the asthma patient.

  14. Severe asthma: emergency care patient driven solutions.

    Science.gov (United States)

    Newell, Karen; Corrigan, Chris; Punshon, Geoffrey; Leary, Alison

    2017-08-14

    Purpose Patients with severe asthma were choosing not to use the emergency department (ED) in extremis and were self-medicating when experiencing severe asthma, putting their lives at risk. This local issue reflected a nationwide situation. The purpose of this paper is to better understand the reasons behind patients' reluctance to attend ED and to consider practical solutions in a structured way. Design/methodology/approach Systems thinking (soft systems methodology) was used to examine the issues resulting in this reluctance to attend the ED. Once this tame (well-defined) problem was revealed, a potential solution was developed in co-production with patients. Findings Patients feared attending the ED and felt vulnerable while in the ED for several reasons. This appeared to be a well-defined and solvable problem. The solution proposed was an asthma patient passport (APP), which increased patient's confidence in their ability to communicate their needs while in severe distress. The APP decreases (from 12 to 5 steps) the work patients had to do to achieve care. The APP project is currently being evaluated. Practical implications The APP should be offered to all people with severe asthma. Originality/value By revisiting systems thinking and identifying problems, a solution was identified. Although methods such as soft systems methodology have limitations when used in wicked (difficult or impossible to resolve) problems, such methods still have merit in tame problems and were applicable in this case to fully understand the issues, and to design practical solutions.

  15. Trend in asthma severity in steroid naive asthmatic children in Benin ...

    African Journals Online (AJOL)

    Objective: To determine the trend in severity of asthma in steroid naive children, in an era when steroid use in the treatment of asthma was uncommon. Materials and Methods: Case notes of patients managed for asthma from 1985 to 1995 and age 5 - 16 years were retrieved and reviewed (these case notes are usually ...

  16. Asthma Exacerbation in Children: A Practical Review

    Directory of Open Access Journals (Sweden)

    Lin-Shien Fu

    2014-04-01

    Full Text Available Asthma is the most common chronic lower respiratory tract disease in childhood throughout the world. Despite advances in asthma management, acute exacerbations continue to be a major problem in patients and they result in a considerable burden on direct/indirect health care providers. A severe exacerbation occurring within 1 year is an independent risk factor. Respiratory tract viruses have emerged as the most frequent triggers of exacerbations in children. It is becoming increasingly clear that interactions may exist between viruses and other triggers, increasing the likelihood of an exacerbation. In this study, we provide an overview of current knowledge about asthma exacerbations, including its definition, impact on health care providers, and associated factors. Prevention management in intermittent asthma as well as intermittent wheeze in pre-school children and those with persistent asthma are discussed. Our review findings support the importance of controlling persistent asthma, as indicated in current guidelines. In addition, we found that early episodic intervention appeared to be crucial in preventing severe attacks and future exacerbations. Besides the use of medication, timely education after an exacerbation along with a comprehensive plan in follow up is also vitally important.

  17. Asthma and obesity: does weight loss improve asthma control? a systematic review

    Directory of Open Access Journals (Sweden)

    Juel CTB

    2012-06-01

    Full Text Available Caroline Trunk-Black Juel,1 Zarqa Ali,1 Lisbeth Nilas,2 Charlotte Suppli Ulrik11Respiratory Section, Internal Medicine Unit, 2Department of Obstetrics and Gynaecology, Hvidovre Hospital and University of Copenhagen, Hvidovre, DenmarkAim and methods: Obesity is a major health problem, and obesity is associated with a high incidence of asthma and poor asthma control. The aim of the present paper is to systematically review the current knowledge of the effect on overall asthma control of weight reduction in overweight and obese adults with asthma.Results: Weight loss in obese individuals with doctor-diagnosed asthma is associated with a 48%–100% remission of asthma symptoms and use of asthma medication. Published studies, furthermore, reveal that weight loss in obese asthmatics improves asthma control, and that especially surgically induced weight loss results in significant improvements in asthma severity, use of asthma medication, dyspnoea, exercise tolerance, and acute exacerbations, including hospitalizations due to asthma. Furthermore, weight loss in obese asthmatics is associated with improvements in level of lung function and airway responsiveness to inhaled methacholine, whereas no significant improvements have been observed in exhaled nitric oxide or other markers of eosinophilic airway inflammation.Conclusion: Overweight and obese adults with asthma experience a high symptomatic remission rate and significant improvements in asthma control, including objective measures of disease activity, after weight loss. Although these positive effects of weight loss on asthma-related health outcomes seem not to be accompanied by remission or improvements in markers of eosinophilic airway inflammation, it has potentially important implications for the future burden of asthma.Keywords: asthma, weight loss, diet, bariatric surgery, asthma control

  18. "Association between Asthma Severity and Obesity in Two Asthma Clinics in Tehran "

    OpenAIRE

    Sanaz Tavasoli; Hassan Heidarnazhad; Anooshirvan Kazemnejad; Sara Miri

    2005-01-01

    The prevalence of both obesity and asthma has increased in recent years. Thus we decided to investigate the relation between obesity and asthma severity. We undertook a cross-sectional study in outpatient asthma clinics of 2 tertiary hospitals in Tehran. Obesity was defined as a body mass index greater than 30. Asthma severity was defined by using the Guide for Asthma Management and Prevention 2004 guidelines, according to patients’ clinical and/or spirometerical parameters. Active cigare...

  19. Mild, Moderate, Severe Asthma: What Do Grades Mean?

    Science.gov (United States)

    ... Print Share Mild, Moderate, Severe Asthma: What Do Grades Mean? Page Content Article Body After confirming an asthma diagnosis, your pediatrician will grade the severity of your child’s condition. This grading ...

  20. Atopy, but not obesity is associated with asthma severity among children with persistent asthma.

    Science.gov (United States)

    Lu, Kim D; Phipatanakul, Wanda; Perzanowski, Matthew S; Balcer-Whaley, Susan; Matsui, Elizabeth C

    2016-12-01

    Obesity is associated with an increased risk of asthma in children. Atopic sensitization is a major risk factor for asthma including severe asthma in children. It is unclear if obesity is associated with worse asthma control or severity in children and how its effects compare to atopy. We sought to examine relationships of weight status and atopy to asthma control and severity among a population of predominantly low income, minority children and adolescents with persistent asthma. A cross-sectional analysis of 832 children and adolescents, age range 5-17 years, with persistent asthma was performed. Clinical assessments included asthma questionnaires of symptoms, asthma severity score, health care utilization and medication treatment step, lung function testing, and skin prick testing as well as measures of adiposity. Data were collected between December 2010 and August 2014 from Johns Hopkins Hospital in Baltimore, MD and Children's Hospital of Boston, MA. Obesity was not associated with worse asthma control or severity in this group of predominantly low income, minority children and adolescents with persistent asthma. However, a greater degree of atopy was associated with lower lung function, higher asthma severity score, and higher medication treatment step. Atopy may be a more important risk factor for asthma severity than obesity among low-income minority children and adolescents with persistent asthma living in Northeastern cities in the United States.

  1. Benralizumab: a unique IL-5 inhibitor for severe asthma

    Directory of Open Access Journals (Sweden)

    Tan LD

    2016-04-01

    Full Text Available Laren D Tan,1 Jennifer M Bratt,2 Dorottya Godor,3 Samuel Louie,2 Nicholas J Kenyon2 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA; 2Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA; 3School of Medicine, Semmelweis University, Budapest, Hungary Abstract: The presence of eosinophilic inflammation is a characteristic feature of chronic and acute inflammation in asthma. An estimated 5%–10% of the 300 million people worldwide who suffer from asthma have a severe form. Patients with eosinophilic airway inflammation represent approximately 40%–60% of this severe asthmatic population. This form of asthma is often uncontrolled, marked by refractoriness to standard therapy, and shows persistent airway eosinophilia despite glucocorticoid therapy. This paper reviews personalized novel therapies, more specifically benralizumab, a humanized anti-IL-5Rα antibody, while also being the first to provide an algorithm for potential candidates who may benefit from anti-IL-5Rα therapy. Keywords: asthma, eosinophils, asthma treatments, benralizumab, IL-5, IL-5Rα, MEDI-563

  2. Evaluation of quality of life according to asthma control and asthma severity in children and adolescents

    Science.gov (United States)

    Matsunaga, Natasha Yumi; Ribeiro, Maria Angela Gonçalves de Oliveira; Saad, Ivete Alonso Bredda; Morcillo, André Moreno; Ribeiro, José Dirceu; Toro, Adyléia Aparecida Dalbo Contrera

    2015-01-01

    ABSTRACT OBJECTIVE: To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents. METHODS: We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global Initiative for Asthma, respectively. The patients also completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validated for use in Brazil, in order to evaluate their quality of life. RESULTS: The mean age of the patients was 11.22 ± 2.91 years, with a median of 11.20 (7.00-17.60) years. We selected 100 patients, of whom 27, 33, and 40 were classified as having controlled asthma (CA), partially controlled asthma (PCA), and uncontrolled asthma (UA), respectively. As for asthma severity, 34, 19, and 47 were classified as having mild asthma (MiA), moderate asthma (MoA), and severe asthma (SA), respectively. The CA and the PCA groups, when compared with the NCA group, showed higher values for the overall PAQLQ score and all PAQLQ domains (activity limitation, symptoms, and emotional function; p < 0.001 for all). The MiA group showed higher scores for all of the PAQLQ components than did the MoA and SA groups. CONCLUSIONS: Quality of life appears to be directly related to asthma control and asthma severity in children and adolescents, being better when asthma is well controlled and asthma severity is lower. PMID:26785958

  3. Decline in asthma prevalence and severity in Israel over a 10-year period.

    Science.gov (United States)

    Cohen, Shlomo; Berkman, Neville; Avital, Avraham; Springer, Chaim; Kordoba, Levana; Haklai, Ziona; Eshel, Amram; Goldberg, Shmuel; Picard, Elie

    2015-01-01

    The prevalence of asthma has increased in western countries towards the end of the last century, but recently seems to have stabilized. To evaluate trends in the prevalence and severity of asthma that occurred in Israel over the past decade. The medical records of 17-year-old boys, eligible for national service, between 1999 and 2008 were reviewed. National annual hospitalization and death rates for asthma were extracted. Three hundred thousand medical records were reviewed. During the study period, lifetime asthma prevalence decreased from 9.7 to 8.1% (p = 0.002). The point prevalence of moderate-to-severe and mild persistent asthma decreased significantly from 0.88 and 3.41% to 0.36 and 2.44%, respectively, during this period. The prevalence of intermittent asthma and asthma in clinical remission for more than 3 years did not change significantly. The annual hospitalization rate for asthma decreased from 13.0 to 7.5 per 10,000 population (p < 0.0001), whilst the annual death rate due to asthma decreased between 1999 and 2008 from 2.1 to 1.4 per 100,000 population (p = 0.003). The prevalence of asthma in Israeli teenage boys decreased significantly over the last decade. In addition, asthma hospitalization and asthma-related death rates in the total population also decreased. © 2014 S. Karger AG, Basel.

  4. Age-Specific Characteristics of Inpatients with Severe Asthma Exacerbation

    Directory of Open Access Journals (Sweden)

    Kiyoshi Sekiya

    2013-01-01

    Conclusions: The characteristics of inpatients with severe asthma vary depending on age. We need to establish countermeasures for asthma exacerbation according to the characteristics of patients depending on age.

  5. Perceived Stress, Severity of Asthma, and Quality of Life in Young Adults with Asthma

    Directory of Open Access Journals (Sweden)

    Tomoaki Kimura

    2009-01-01

    Conclusions: A major variable related to the disease-specific quality of life was perceived stress, followed by the severity of asthma. Stress management of patients with asthma may improve their quality of life.

  6. [Association between obesity and asthma severity in children].

    Science.gov (United States)

    Alaníz-Flores, Angélica; Canseco-Raymundo, María del Rosario; Granados-Gómez, Andrea; Becerril-Ángeles, Martín

    2013-01-01

    The association of prevalence of obesity and asthma has increased significantly, this phenomenon seems multifactorial. Obesity is considered a risk factor for asthma. It has been reported positive association between obesity and allergic asthma. In Mexico there is no conclusive data about this issue. The study was conducted in patients from 4 to 14 years of age, with allergic asthma. A history and physical examination and BMI estimation were performed, as well as the classification of asthma severity. We included 244 patients diagnosed with childhood allergic asthma, Fifty two patients (21.31%, OR 3.6) showed some degree of obesity (above the 85 percentile), 15.1% were male and 6% were female. Morbid obesity was found in 40 patients (16.3%). Our study found an increased prevalence of obesity in children with asthma, with a predominance in male gender, and showed a high association between the severity of asthma and increased BMI.

  7. Association of obesity and severity of acute asthma exacerbations in Filipino children.

    Science.gov (United States)

    De Vera, Michelle Joy B; Gomez, Maria Celeste; Yao, Carlo Emmanuel

    2016-07-01

    Increased body mass index (BMI) may be a risk factor for the development and severity of asthma. However, the effect of obesity on asthma exacerbations is unclear. To examine the association of obesity and the severity of acute asthma exacerbations. A retrospective cohort of children aged 5 to 18 years who were seen in the emergency department and admitted for acute asthma exacerbation from 2009 to 2011 was reviewed. Weight and height data to compute the BMI were taken from the medical record review. The Centers for Disease Control and Prevention BMI-for-age growth charts for boys and girls aged 2 to 20 years were used to classify underweight, normal, overweight, and obese. Severity of asthma exacerbations into mild, moderate, or severe was determined using criteria by the Global Initiative for Asthma 2010. The χ(2) test of association or the Fisher exact probability test for small samples was used to determine the association between nutritional status and severity of asthma exacerbations. Of the 303 cases reviewed, most were boys with a mean (SD) age of 10 (3.8) years. The prevalence of overweight and obese children admitted for acute asthma exacerbation was 21% and 28%, respectively. No significant difference was found in the severity of asthma exacerbations, with 82.9% of the nonobese group and 86.8% of the overweight-obese group having moderate-to-severe exacerbation (likelihood ratio, 0.879; 95% CI, 0.42-0.41; P = .88). Our findings suggest that the severity of acute asthma exacerbations was not affected by increased BMI. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. Prognostic value of cluster analysis of severe asthma phenotypes.

    Science.gov (United States)

    Bourdin, Arnaud; Molinari, Nicolas; Vachier, Isabelle; Varrin, Muriel; Marin, Grégory; Gamez, Anne-Sophie; Paganin, Fabrice; Chanez, Pascal

    2014-11-01

    Cross-sectional severe asthma cluster analysis identified different phenotypes. We tested the hypothesis that these clusters will follow different courses. We aimed to identify which asthma outcomes are specific and coherently associated with these different phenotypes in a prospective longitudinal cohort. In a longitudinal cohort of 112 patients with severe asthma, the 5 Severe Asthma Research Program (SARP) clusters were identified by means of algorithm application. Because patients of the present cohort all had severe asthma compared with the SARP cohort, homemade clusters were identified and also tested. At the subsequent visit, we investigated several outcomes related to asthma control at 1 year (6-item Asthma Control Questionnaire [ACQ-6], lung function, and medication requirement) and then recorded the 3-year exacerbations rate and time to first exacerbation. The SARP algorithm discriminated the 5 clusters at entry for age, asthma duration, lung function, blood eosinophil measurement, ACQ-6 scores, and diabetes comorbidity. Four homemade clusters were mostly segregated by best ever achieved FEV1 values and discriminated the groups by a few clinical characteristics. Nonetheless, all these clusters shared similar asthma outcomes related to asthma control as follows. The ACQ-6 score did not change in any cluster. Exacerbation rate and time to first exacerbation were similar, as were treatment requirements. Severe asthma phenotypes identified by using a previously reported cluster analysis or newly homemade clusters do not behave differently concerning asthma control-related outcomes, which are used to assess the response to innovative therapies. This study demonstrates a potential limitation of the cluster analysis approach in the field of severe asthma. Copyright © 2014. Published by Elsevier Inc.

  9. Transcriptional regulation of inflammatory genes associated with severe asthma.

    Science.gov (United States)

    Clifford, Rachel L; Coward, William R; Knox, Alan J; John, Alison E

    2011-01-01

    The 10% of patients with the most severe asthma are responsible for a large part of healthcare expenditure and morbidity. Understanding the processes involved is key if new therapeutic approaches are to be developed. Evidence is accumulating that chronic diseases such as asthma are associated with temporal and spatial alterations in the pattern of inflammatory gene expression within the airways. Expression of these genes can be regulated by transcriptional, posttranscriptional, translational and epigenetic mechanisms. It is well established that binding of activated transcription factors to specific inducible gene promoter sites is tightly controlled by chromatin state as a result of histone modifications, particularly the balance between histone acetylation and deacetylation [1]. The interaction between transcription factors and the promoter is key to the diversification of gene expression in a time dependent manner leading to altered gene expression profiles. Alterations of the accessibility of transcription factors to the DNA can have residing effects upon gene transcription. This review will focus on the regulation of several groups of key genes which are involved in chronic airway inflammation and remodelling in asthma drawing mainly from our experience of studying these processes in airway smooth muscle cells. An overview is shown in figure 1.

  10. The level of diagnostic assessment in severe asthma

    DEFF Research Database (Denmark)

    von Bulow, Anna; Backer, Vibeke; Bodtger, Uffe

    2017-01-01

    .3%) patients fulfilled the criteria for having severe asthma. The diagnosis of asthma was confirmed objectively in 53/98 patients (54.1%). In total, 83.7% underwent at least one diagnostic test for asthma: reversibility test: 63.3%, PEF: 52% and bronchial challenge test: 21.4%. Among patients eligible...... for a bronchial challenge test (FEV1 ≥ 70%; negative PEF measurement/reversibility test), only 23.1% had such a test performed. Inhalation technique and adherence were assessed in 19.4 and 30.6% of patients, respectively. CONCLUSION: Among patients managed for severe asthma in a specialist setting, only half had...

  11. Bronchial Thermoplasty: A Novel Therapy for Severe Asthma

    Science.gov (United States)

    Sheshadri, Ajay; Castro, Mario; Chen, Alexander

    2014-01-01

    Synopsis This article presents an overview of bronchial thermoplasty, a novel treatment for severe asthma. Within, the authors discuss the rationale for bronchial thermoplasty in severe asthma, current clinical evidence for the use of this procedure, clinical recommendations, and future directions. PMID:23993815

  12. Intravenous magnesium sulfate therapy in severe asthma

    Directory of Open Access Journals (Sweden)

    Mohd. Al-Ajmi

    2007-01-01

    Full Text Available A 22-year-old female, known asthmatic since seven years, developed severe bronchospasm in the preop-erative period. Bronchospasm remained unresponsive to the inhaled beta-agonist plus anticholinergic, IV ami-nophylline and hydrocortisone but responded quickly with magnesium sulfate® ( PSI, KSA infusion 1.25gm in 100ml normal saline over 20 minutes and another 1.25 gm over next 30 minutes as the initial infusion showed improvement in her clinical symptoms. Within half an hour of administering the 1st infusion of magnesium sulfate (1.25 gm the respiratory rate started reducing, rhonchi became less, SpO 2 came upto 92% and re-mained always above 90%. Encouraged by this result IV magnesium sulfate 2.5 gm in 500 ml normal saline was infused over next 24 hours along with alternate salbutamol and ipratropium nebulization every 6 hourly. With this treatment regimen the patient became asymptomatic within next 24 hours with normal clinical parameters and FEV 1 value. Hence it may be concluded that IV magnesium sulfate can be considered for patients with acute severe asthma who do not respond to standard therapeutic medications.

  13. Asthma and oral health: a review.

    Science.gov (United States)

    Thomas, M S; Parolia, A; Kundabala, M; Vikram, M

    2010-06-01

    Asthma is a chronic inflammatory condition that causes the airways to constrict and produce excess mucus, making breathing difficult. It is characterized by the obstruction of airflow which is variable over a short period of time. This condition is reversible, either spontaneously or can be controlled with the help of drugs. Asthma medication comprises bronchodilators, corticosteroids and anticholinergic drugs. Most of these drugs are inhaled using various forms of inhalers or nebulizers. The effect of these drugs on oral health is the subject of debate among dental practitioners. Patients taking asthma medication may be at risk of dental caries, dental erosion, periodontal diseases and oral candidiasis. Hence, patients with bronchial asthma on medication should receive special prophylactic attention. This article reviews the correlation between asthma and oral health, and suggests various measures to counter possible oral health problems related to asthma.

  14. A study of asthma severity in adult twins

    DEFF Research Database (Denmark)

    Thomsen, Simon Francis; van der Sluis, Sophie; Kyvik, Kirsten Ohm

    2012-01-01

    component was also found for the severity of specific asthma symptoms; wheezing 12% (3%-22%), P = 0.007 and shortness of breath 17% (7%-27%), P = 0.0006, but not for chest tightness and cough. Asthma symptom severity correlated weakly with rhinitis severity as well as with objective markers of lung function......, airway inflammation, airway responsiveness and allergic sensitization. Conclusion: The individual variation in asthma symptom severity is to some degree influenced by genetic factors, but environmental factors explain the main part of the variation. The genetic architectures underlying the severity...

  15. The potential role of vitamin D in the link between obesity and asthma severity/control in children.

    Science.gov (United States)

    Vo, Phuong; Bair-Merritt, Megan; Camargo, Carlos A

    2015-06-01

    Childhood obesity and asthma are major public health problems. Obesity is not only associated with increased risk of incident asthma, but it may worsen asthma severity/control. Although the mechanisms linking obesity with asthma expression have not been completely elucidated, evidence suggests that increased frequency of acute respiratory infection (ARI) and decreased corticosteroid responsiveness may help to explain how obesity worsens asthma expression. In addition, obese individuals have low vitamin D status, and emerging evidence suggests vitamin D affects risk of ARI and corticosteroid responsiveness in individuals with asthma. In this review, we summarize the association between obesity and asthma severity/control in children and discuss ARI and corticosteroid responsiveness as potential mediators in the obesity-asthma pathway. We also discuss the potential role of vitamin D, including a brief summary of recent randomized controlled trials of vitamin D supplementation.

  16. DNA methylation levels associated with race and childhood asthma severity.

    Science.gov (United States)

    Chan, Marcia A; Ciaccio, Christina E; Gigliotti, Nicole M; Rezaiekhaligh, Mo; Siedlik, Jacob A; Kennedy, Kevin; Barnes, Charles S

    2017-10-01

    Asthma is a common chronic childhood disease worldwide. Socioeconomic status, genetic predisposition and environmental factors contribute to its incidence and severity. A disproportionate number of children with asthma are economically disadvantaged and live in substandard housing with potential indoor environmental exposures such as cockroaches, dust mites, rodents and molds. These exposures may manifest through epigenetic mechanisms that can lead to changes in relevant gene expression. We examined the association of global DNA methylation levels with socioeconomic status, asthma severity and race/ethnicity. We measured global DNA methylation in peripheral blood of children with asthma enrolled in the Kansas City Safe and Healthy Homes Program. Inclusion criteria included residing in the same home for a minimum of 4 days per week and total family income of less than 80% of the Kansas City median family income. DNA methylation levels were quantified by an immunoassay that assessed the percentage of 5-methylcytosine. Our results indicate that overall, African American children had higher levels of global DNA methylation than children of other races/ethnicities (p = 0.029). This difference was more pronounced when socioeconomic status and asthma severity were coupled with race/ethnicity (p = 0.042) where low-income, African American children with persistent asthma had significantly elevated methylation levels relative to other races/ethnicities in the same context (p = 0.006, Hedges g = 1.14). Our study demonstrates a significant interaction effect among global DNA methylation levels, asthma severity, race/ethnicity, and socioeconomic status.

  17. Asthma and Adolescents: Review of Strategies to Improve Control

    Science.gov (United States)

    Hennessy-Harstad, Ellen

    2013-01-01

    One of every 10 adolescents in the United States has asthma. Adolescents who lack asthma control are at increased risk for severe asthma episodes and death. The National Heart, Lung, and Blood Institute 2007 asthma guidelines and research studies indicated that school nurses are instrumental in assisting adolescents to monitor their asthma, learn…

  18. Bronchial thermoplasty for moderate or severe persistent asthma in adults.

    Science.gov (United States)

    Torrego, Alfons; Solà, Ivan; Munoz, Ana Maria; Roqué I Figuls, Marta; Yepes-Nuñez, Juan Jose; Alonso-Coello, Pablo; Plaza, Vicente

    2014-03-03

    Bronchial thermoplasty is a procedure that consists of the delivery of controlled radiofrequency-generated heat via a catheter inserted into the bronchial tree of the lungs through a flexible bronchoscope. It has been suggested that bronchial thermoplasty works by reducing airway smooth muscle, thereby reducing the ability of the smooth muscle to bronchoconstrict. This treatment could then reduce asthma symptoms and exacerbations, resulting in improved asthma control and quality of life. To determine the efficacy and safety of bronchial thermoplasty in adults with bronchial asthma. We searched the Cochrane Airways Group Specialised Register of Trials (CAGR) up to January 2014. We included randomised controlled clinical trials that compared bronchial thermoplasty versus any active control in adults with moderate or severe persistent asthma. Our primary outcomes were quality of life, asthma exacerbations and adverse events. Two review authors independently extracted data and assessed risk of bias. We included three trials (429 participants) with differences regarding their design (two trials compared bronchial thermoplasty vs medical management and the other compared bronchial thermoplasty vs a sham intervention) and participant characteristics; one of the studies included participants with more symptomatic asthma compared with the others.The pooled analysis showed improvement in quality of life at 12 months in participants who received bronchial thermoplasty that did not reach the threshold for clinical significance (3 trials, 429 participants; mean difference (MD) in Asthma Quality of Life Questionnaire (AQLQ) scores 0.28, 95% confidence interval (CI) 0.07 to 0.50; moderate-quality evidence). Measures of symptom control showed no significant differences (3 trials, 429 participants; MD in Asthma Control Questionnaire (ACQ) scores -0.15, 95% CI -0.40 to 0.10; moderate-quality evidence). The risk of bias for these outcomes was high because two of the studies did not

  19. Association between dietary habits and asthma severity in children.

    Science.gov (United States)

    Silveira, Denise Halpern; Zhang, Linjie; Prietsch, Silvio O M; Vecchi, Amilcare Angelo; Susin, Lulie Rosane Odeh

    2015-01-01

    To investigate association between dietary habits and asthma severity in children. Cross-sectional study. Two teaching hospitals in Brazil. Cases (n=268) were children (3-12yr) with persistent asthma and age-matched controls (n=126) were those with intermittent asthma. Dietary habits were determined based on food consumption in the past 12 months classified as frequent (≥3 times per week) or infrequent (never or 2Z-score of BMI-for-age; non-obese: ≤2Z-score of BMI-for-age. After adjusting for confounding factors, maternal smoking during pregnancy, preterm birth and obesity were significantly associated with persistent asthma, with adjusted ORs (95% CI) of 2.11 (1.08- 4.13), 2.61(1.07-6.35) and 2.89 (1.49-5.61), respectively. No significant association was observed between frequency of consumption of specific foods, food groups, or dietary pattern (pro- or contra-Mediterranean diet) and the severity of asthma. This study did not find a significant association between dietary habits and asthma severity in children. Maternal smoking during pregnancy, preterm birth and obesity were independent factors associated with persistent asthma.

  20. Application of the asthma phenotype algorithm from the Severe Asthma Research Program to an urban population.

    Directory of Open Access Journals (Sweden)

    Paru Patrawalla

    Full Text Available RATIONALE: Identification and characterization of asthma phenotypes are challenging due to disease complexity and heterogeneity. The Severe Asthma Research Program (SARP used unsupervised cluster analysis to define 5 phenotypically distinct asthma clusters that they replicated using 3 variables in a simplified algorithm. We evaluated whether this simplified SARP algorithm could be used in a separate and diverse urban asthma population to recreate these 5 phenotypic clusters. METHODS: The SARP simplified algorithm was applied to adults with asthma recruited to the New York University/Bellevue Asthma Registry (NYUBAR to classify patients into five groups. The clinical phenotypes were summarized and compared. RESULTS: Asthma subjects in NYUBAR (n = 471 were predominantly women (70% and Hispanic (57%, which were demographically different from the SARP population. The clinical phenotypes of the five groups generated by the simplified SARP algorithm were distinct across groups and distributed similarly to those described for the SARP population. Groups 1 and 2 (6 and 63%, respectively had predominantly childhood onset atopic asthma. Groups 4 and 5 (20% were older, with the longest duration of asthma, increased symptoms and exacerbations. Group 4 subjects were the most atopic and had the highest peripheral eosinophils. Group 3 (10% had the least atopy, but included older obese women with adult-onset asthma, and increased exacerbations. CONCLUSIONS: Application of the simplified SARP algorithm to the NYUBAR yielded groups that were phenotypically distinct and useful to characterize disease heterogeneity. Differences across NYUBAR groups support phenotypic variation and support the use of the simplified SARP algorithm for classification of asthma phenotypes in future prospective studies to investigate treatment and outcome differences between these distinct groups. TRIAL REGISTRATION: Clinicaltrials.gov NCT00212537.

  1. Severe exacerbations and decline in lung function in asthma

    DEFF Research Database (Denmark)

    O'Byrne, Paul M; Pedersen, Søren; Lamm, Carl Johan

    2009-01-01

    are associated with a persistent decline in lung function. METHODS: The START (inhaled steroid treatment as regular therapy in early asthma) study was a 3-year, randomized, double-blind study of 7,165 patients (5-66 yr) with persistent asthma for less than 2 years, to determine whether early intervention...... with low-dose inhaled budesonide prevents severe asthma-related events (exacerbations requiring hospitalization or emergency treatment) and decline in lung function. MEASUREMENTS AND MAIN RESULTS: There were 315 patients who experienced at least one severe asthma exacerbation, of which 305 were analyzable...... difference was seen in both children and in adults, but not in adolescents. In the budesonide group, the change in the post-bronchodilator FEV(1) % predicted in patients who did or did not experience a severe exacerbation was -2.48% and -1.72%, respectively (P = 0.57). The difference in magnitude...

  2. Tachykinin receptors antagonism for asthma: a systematic review

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    Couto Nuno

    2011-08-01

    Full Text Available Abstract Background Tachykinins substance P, neurokinin A and neurokinin B seem to account for asthma pathophysiology by mediating neurogenic inflammation and several aspects of lung mechanics. These neuropeptides act mainly by their receptors NK1, NK2 and NK3, respectively which may be targets for new asthma therapy. Methods This review systematically examines randomized controlled trials evaluating the effect of tachykinins receptors antagonism on asthma. Symptoms, airway inflammation, lung function and airway inflammation were considered as outcomes. We searched the Cochrane Airways Group Specialized Register of Asthma Trials, Cochrane Database of Systematic Reviews, MEDLINE/PubMed and EMBASE. The search is as current as June 2010. Quality rating of included studies followed the Cochrane Collaboration and GRADE Profiler approaches. However, data were not pooled together due to different measures among the studies. Results Our systematic review showed the potential of NK receptor antagonist to decrease airway responsiveness and to improve lung function. However, effects on airway inflammation and asthma symptoms were poorly or not described. Conclusion The limited available evidence suggests that tachykinin receptors antagonists may decrease airway responsiveness and improve lung function in patients with asthma. Further large randomized trials are still required.

  3. Inhaled furosemide is not effective in severe asthma in children

    OpenAIRE

    Matsumoto, Tomoaki; Muraoka, Norimasa; Ogawa, Masakatsu; Matsui, Mika; Tajima, Seiki; Miike, Teruhisa

    2000-01-01

    The purpose of the present study was to determine whether or not inhaled furosemide has any therapeutic benefit in acute asthma in children. Aerosolized furosemide (20 mg) was administered four times per day together with conventional asthma therapy for 2 days in five children with severe asthma exacerbation. The oxygen saturation with a pulse oximeter (SpO2), and the peak expiratory flow (PEF) were measured before and 10 min after furosemide inhalation. Although a little improvement in SpO2 ...

  4. From asthma severity to control: a shift in clinical practice

    DEFF Research Database (Denmark)

    Pedersen, Søren

    2009-01-01

    -treatment. Several validated asthma control assessment tools have been developed to facilitate correct assessment of the level of control in clinical practice. It is hoped that focusing on control will reduce the frequency of sub-optimal treatment in the primary care setting. Further validation of the best way......Variability is a characteristic feature of asthma, and the aim of asthma management is to eliminate or minimise disease variability. Controlled asthma shows little or no variability, and is achievable and sustainable in the majority of patients. New international guidelines recommend control...... involves the control of several outcomes. Its assessment should include components relevant to achievement of best possible clinical control and reduction of future risk of adverse outcomes. Focusing on a single or a few outcomes can lead to incorrect control assessment and increased risk of under...

  5. Determinants of asthma after severe respiratory syncytial virus bronchiolitis.

    Science.gov (United States)

    Bacharier, Leonard B; Cohen, Rebecca; Schweiger, Toni; Yin-Declue, Huiquing; Christie, Chandrika; Zheng, Jie; Schechtman, Kenneth B; Strunk, Robert C; Castro, Mario

    2012-07-01

    The development of asthma after respiratory syncytial virus (RSV) bronchiolitis has been demonstrated in case-control studies, although the determinants of post-RSV asthma remain undefined. We sought to evaluate the potential determinants of physician-diagnosed asthma after severe RSV bronchiolitis during infancy. We enrolled 206 children during an initial episode of severe RSV bronchiolitis at 12 months of age or less in a prospective cohort study and followed these children for up to 6 years. In a subset of 81 children, we analyzed CCL5 (RANTES) mRNA expression in upper airway epithelial cells. Forty-eight percent of children had physician-diagnosed asthma before the seventh birthday. Independent determinants significantly associated with increased risk for physician-diagnosed asthma by the seventh birthday included maternal asthma (odds ratio [OR], 5.2; 95% CI, 1.7-15.9; P = .004), exposure to high levels of dog allergen (OR, 3.2; 95% CI, 1.3-7.7; P = .012), aeroallergen sensitivity at age 3 years (OR, 10.7; 95% CI, 2.1-55.0; P = .005), recurrent wheezing during the first 3 years of life (OR, 7.3; 95% CI, 1.2-43.3; P = .028), and CCL5 expression in nasal epithelia during acute RSV infection (OR, 3.8; 95% CI, 1.2-2.4; P bronchiolitis have a subsequent asthma diagnosis. The presence of increased CCL5 levels in nasal epithelia at the time of bronchiolitis or the development of allergic sensitization by age 3 years are associated with increased likelihood of subsequent asthma. Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  6. Prevalence of obesity in asthma and its relations with asthma severity and control.

    Science.gov (United States)

    Forte, Gabriele Carra; Grutcki, Denis Maltz; Menegotto, Samuel Millán; Pereira, Rosemary Petrik; Dalcin, Paulo de Tarso Roth

    2013-01-01

    To determine the prevalence of obesity in asthmatic patients attending at an outpatient clinic, and to investigate its relationships with asthma severity and level of asthma control. In a cross-sectional study we recruited patients aged 11 years and older with confirmed asthma diagnosis from the outpatient asthma clinic of Hospital de Clínicas de Porto Alegre, Brazil. They underwent an evaluation by a general questionnaire, an asthma control questionnaire and by pulmonary function tests. Nutritional status was classified by body mass index (BMI). 272 patients were included in the study. Mean age was 51.1 ± 16.5 years and there were 206 (74.9%) female patients. Mean BMI was 27.5 ± 5.3kg/m(2), and 96 (35.3%) patients were classified as normal weight, 97 (35.7%) as overweight and 79 (29%) as obesity. There was a significant higher proportion of female than male patients (34.3% vs. 13.2%, p = 0.002) in the obesity group. There were no significant differences with respect to asthma control (p = 0.741) and severity classification (p = 0.506). The FEV1% predicted was significantly higher in the obese than in the non-obese group (73.7% vs. 67.2%, p = 0.037). Logistic regression analysis identified sex (OR = 3.84, p = 0.002) as an independent factor associated with obesity. This study showed a high prevalence of obesity in asthmatic patients. Obese and non-obese subjects were similar in regard to asthma severity and level of asthma control. Female sex was associated with obesity in this asthma population. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

  7. Corticosteroids in acute severe asthma: effectiveness of low doses.

    OpenAIRE

    Bowler, S D; Mitchell, C. A.; Armstrong, J. G.

    1992-01-01

    BACKGROUND: Although the need for corticosteroids in acute severe asthma is well established the appropriate dose is not known. METHODS: The response to intravenous hydrocortisone 50 mg (low dose), 100 mg (medium dose), and 500 mg (high dose), administered every six hours for 48 hours and followed by oral prednisone, was compared in patients with acute asthma in a double blind randomised study. After initial emergency treatment with bronchodilators subjects received oral theophylline or intra...

  8. Association between severe asthma and changes in the stomatognathic system

    Directory of Open Access Journals (Sweden)

    Mayra Carvalho-Oliveira

    Full Text Available ABSTRACT Objective: To describe orofacial muscle function in patients with severe asthma. Methods: This was a descriptive study comparing patients with severe controlled asthma (SCA and severe uncontrolled asthma (SUA. We selected 160 patients, who completed a sociodemographic questionnaire and the 6-item Asthma Control Questionnaire (ACQ-6, as well as undergoing evaluation of orofacial muscle function. Results: Of the 160 patients evaluated, 126 (78.8% and 34 (21.2% presented with SCA and SUA, respectively, as defined by the Global Initiative for Asthma criteria. Regardless of the level of asthma control, the most frequent changes found after evaluation of muscle function were difficulty in chewing, oronasal breathing pattern, below-average or poor dental arch condition, and difficulty in swallowing. When the sample was stratified by FEV1 (% of predicted, was significantly higher proportions of SUA group patients, compared with SCA group patients, showed habitual open-mouth chewing (24.8% vs. 7.7%; p < 0.02, difficulty in swallowing water (33.7% vs. 17.3%; p < 0.04, and voice problems (81.2% vs. 51.9%; p < 0.01. When the sample was stratified by ACQ-6 score, the proportion of patients showing difficulty in swallowing bread was significantly higher in the SUA group than in the SCA group (66.6% vs. 26.6%; p < 0.01. Conclusions: The prevalence of changes in the stomatognathic system appears to be high among adults with severe asthma, regardless of the level of asthma control. We found that some such changes were significantly more common in patients with SUA than in those with SCA.

  9. Epigenetics, asthma, and allergic diseases: a review of the latest advancements.

    Science.gov (United States)

    Lovinsky-Desir, Stephanie; Miller, Rachel L

    2012-06-01

    Environmental epigenetic regulation in asthma and allergic disease is an exciting area that has gained a great deal of scientific momentum in recent years. Environmental exposures, including prenatal maternal smoking, have been associated with asthma-related outcomes that may be explained by epigenetic regulation. In addition, several known allergy and asthma genes have been found to be susceptible to epigenetic regulation. We review the latest experimental and translational studies that have been published this past year in several areas, including 1) characterization of environmental asthma triggers that induce epigenetic changes, 2) characterization of allergic immune and regulatory pathways important to asthma that undergo epigenetic regulation, 3) evidence of active epigenetic regulation in asthma experimental models and the production of asthma biomarkers, 4) evidence of transmission of an asthma-related phenotype across multiple generations, and 5) "pharmaco-epigenetics." The field has certainly advanced significantly in the past year.

  10. Examining Profiles of Family Functioning in Pediatric Asthma: Longitudinal Associations With Child Adjustment and Asthma Severity.

    Science.gov (United States)

    Al G Hriwati, Nour; Winter, Marcia A; Everhart, Robin S

    2017-05-01

    Identify profiles of functioning in families of children with asthma and examine whether profile membership predicts subsequent child mental and physical well-being. Primary caregivers and children ( N  = 1,030) from the Childhood Asthma Management Program completed questionnaires assessing family functioning and child adaptation at five time points. Asthma severity was also assessed via spirometry. Latent profile analyses identified a four-profile solution as best fitting the data: cohesive, permissive, controlling/disengaged, and controlling/enmeshed families. Distal outcome analyses using Bolck-Croon-Hagenaars techniques suggested that children from families that were more cohesive had fewer internalizing and externalizing symptoms. These associations remained stable across time. Family profiles did not differ with regards to child asthma severity. Results highlight the importance of looking beyond the effects of distinct components of family functioning and instead using pattern-based approaches. Recommendations for incorporating screenings and services for families in pediatric care settings are provided.

  11. Stem cells in animal asthma models: a systematic review.

    Science.gov (United States)

    Srour, Nadim; Thébaud, Bernard

    2014-12-01

    Asthma control frequently falls short of the goals set in international guidelines. Treatment options for patients with poorly controlled asthma despite inhaled corticosteroids and long-acting β-agonists are limited, and new therapeutic options are needed. Stem cell therapy is promising for a variety of disorders but there has been no human clinical trial of stem cell therapy for asthma. We aimed to systematically review the literature regarding the potential benefits of stem cell therapy in animal models of asthma to determine whether a human trial is warranted. The MEDLINE and Embase databases were searched for original studies of stem cell therapy in animal asthma models. Nineteen studies were selected. They were found to be heterogeneous in their design. Mesenchymal stromal cells were used before sensitization with an allergen, before challenge with the allergen and after challenge, most frequently with ovalbumin, and mainly in BALB/c mice. Stem cell therapy resulted in a reduction of bronchoalveolar lavage fluid inflammation and eosinophilia as well as Th2 cytokines such as interleukin-4 and interleukin-5. Improvement in histopathology such as peribronchial and perivascular inflammation, epithelial thickness, goblet cell hyperplasia and smooth muscle layer thickening was universal. Several studies showed a reduction in airway hyper-responsiveness. Stem cell therapy decreases eosinophilic and Th2 inflammation and is effective in several phases of the allergic response in animal asthma models. Further study is warranted, up to human clinical trials. Copyright © 2014 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  12. From bedside to bench to clinic trials: identifying new treatments for severe asthma

    Directory of Open Access Journals (Sweden)

    Amarjit Mishra

    2013-07-01

    Full Text Available Asthmatics with a severe form of the disease are frequently refractory to standard medications such as inhaled corticosteroids, underlining the need for new treatments to prevent the occurrence of potentially life-threatening episodes. A major obstacle in the development of new treatments for severe asthma is the heterogeneous pathogenesis of the disease, which involves multiple mechanisms and cell types. Furthermore, new therapies might need to be targeted to subgroups of patients whose disease pathogenesis is mediated by a specific pathway. One approach to solving the challenge of developing new treatments for severe asthma is to use experimental mouse models of asthma to address clinically relevant questions regarding disease pathogenesis. The mechanistic insights gained from mouse studies can be translated back to the clinic as potential treatment approaches that require evaluation in clinical trials to validate their effectiveness and safety in human subjects. Here, we will review how mouse models have advanced our understanding of severe asthma pathogenesis. Mouse studies have helped us to uncover the underlying inflammatory mechanisms (mediated by multiple immune cell types that produce Th1, Th2 or Th17 cytokines and non-inflammatory pathways, in addition to shedding light on asthma that is associated with obesity or steroid unresponsiveness. We propose that the strategy of using mouse models to address clinically relevant questions remains an attractive and productive research approach for identifying mechanistic pathways that can be developed into novel treatments for severe asthma.

  13. ALX receptor ligands define a biochemical endotype for severe asthma

    Science.gov (United States)

    Ricklefs, Isabell; Barkas, Ioanna; Duvall, Melody G.; Grossman, Nicole L.; Israel, Elliot; Bleecker, Eugene R.; Castro, Mario; Erzurum, Serpil C.; Fahy, John V.; Gaston, Benjamin M.; Denlinger, Loren C.; Mauger, David T.; Wenzel, Sally E.; Comhair, Suzy A.; Coverstone, Andrea M.; Fajt, Merritt L.; Hastie, Annette T.; Johansson, Mats W.; Peters, Michael C.; Phillips, Brenda R.; Levy, Bruce D.

    2017-01-01

    BACKGROUND. In health, inflammation resolution is an active process governed by specialized proresolving mediators and receptors. ALX/FPR2 receptors (ALX) are targeted by both proresolving and proinflammatory ligands for opposing signaling events, suggesting pivotal roles for ALX in the fate of inflammatory responses. Here, we determined if ALX expression and ligands were linked to severe asthma (SA). METHODS. ALX expression and levels of proresolving ligands (lipoxin A4 [LXA4], 15-epi-LXA4, and annexin A1 [ANXA1]), and a proinflammatory ligand (serum amyloid A [SAA]) were measured in bronchoscopy samples collected in Severe Asthma Research Program-3 (SA [n = 69], non-SA [NSA, n = 51] or healthy donors [HDs, n = 47]). RESULTS. Bronchoalveolar lavage (BAL) fluid LXA4 and 15-epi-LXA4 were decreased and SAA was increased in SA relative to NSA. BAL macrophage ALX expression was increased in SA. Subjects with LXA4loSAAhi levels had increased BAL neutrophils, more asthma symptoms, lower lung function, increased relative risk for asthma exacerbation, sinusitis, and gastroesophageal reflux disease, and were assigned more frequently to SA clinical clusters. SAA and aliquots of LXA4loSAAhi BAL fluid induced IL-8 production by lung epithelial cells expressing ALX receptors, which was inhibited by coincubation with 15-epi-LXA4. CONCLUSIONS. Together, these findings have established an association between select ALX receptor ligands and asthma severity that define a potentially new biochemical endotype for asthma and support a pivotal functional role for ALX signaling in the fate of lung inflammation. TRIAL REGISTRATION. Severe Asthma Research Program-3 (SARP-3; ClinicalTrials.gov NCT01606826) FUNDING Sources. National Heart, Lung and Blood Institute, the NIH, and the German Society of Pediatric Pneumology. PMID:28724795

  14. Asthma

    Directory of Open Access Journals (Sweden)

    Kim Harold

    2011-11-01

    Full Text Available Abstract Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICSs represent the standard of care for the majority of patients. Combination ICS/long-acting beta2-agonists (LABA inhalers are preferred for most adults who fail to achieve control with ICS therapy. Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma, but should only be prescribed by physicians with appropriate training in allergy. Regular monitoring of asthma control, adherence to therapy and inhaler technique are also essential components of asthma management. This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma.

  15. Clinical usefulness of mepolizumab in severe eosinophilic asthma

    Directory of Open Access Journals (Sweden)

    Menzella F

    2016-06-01

    Full Text Available Francesco Menzella, Mirco Lusuardi, Gloria Montanari, Carla Galeone, Nicola Facciolongo, Luigi ZucchiDepartment of Cardio-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS – Arcispedale Santa Maria Nuova, Reggio Emilia, ItalyAbstract: Asthma is a chronic inflammatory disorder of the airways with variable clinical severity from very mild and occasional symptoms to recurrent critical exacerbations, at risk of fatal or near-fatal outcome, in a small percentage of patients. Within the different inflammatory cascades involved in asthma, eosinophils play a central role in the pathogenesis and largely influence disease severity. Interleukin-5 (IL-5 is the main cytokine controlling eosinophil activity and proliferation at the site of inflammation. Mepolizumab was the first biological humanized anti-IL-5 monoclonal antibody tested in randomized clinical trials on eosinophilic asthma and other eosinophilic diseases. On the basis of several positive clinical efficacy data, it has recently been approved by the US Food and Drug Administration for the treatment of severe eosinophilic asthma. Unfortunately, high costs are at present a critical issue. Future studies will probably help in the correct selection of a potential “responder phenotype”, allowing the prescription of this promising therapy to appropriate patients and best define cost-effectiveness issues.Keywords: asthma, mepolizumab, phenotype, IL-5, effectiveness, biomarkers

  16. Emergency presentation and management of acute severe asthma in children

    Directory of Open Access Journals (Sweden)

    Øymar Knut

    2009-09-01

    Full Text Available Abstract Acute severe asthma is one of the most common medical emergency situations in childhood, and physicians caring for acutely ill children are regularly faced with this condition. In this article we present a summary of the pathophysiology as well as guidelines for the treatment of acute severe asthma in children. The cornerstones of the management of acute asthma in children are rapid administration of oxygen, inhalations with bronchodilators and systemic corticosteroids. Inhaled bronchodilators may include selective b2-agonists, adrenaline and anticholinergics. Additional treatment in selected cases may involve intravenous administration of theophylline, b2-agonists and magnesium sulphate. Both non-invasive and invasive ventilation may be options when medical treatment fails to prevent respiratory failure. It is important that relevant treatment algorithms exist, applicable to all levels of the treatment chain and reflecting local considerations and circumstances.

  17. [Socioeconomic Costs of Asthma in the European Union, United States and Canada: A Systematic Review].

    Science.gov (United States)

    Puig-Junoy, Jaume; Pascual-Argenté, Natàlia

    2017-03-09

    Asthma is responsible for a large number of doctor and emergency visits due to exacerbations and inadequate control of the disease, which give rise to very high associated economic costs. The social cost of asthma comprises both the healthcare and non-healthcare costs. The purpose of this study was to analyse up-to-date estimates of the social cost of asthma, with special reference to the influence of level of severity and degree of control. A systematic review of original cost-of-illness studies of asthma published in English or Spanish between January 2004 and December 2014 and indexed in PubMed, IBECS or IME was conducted. 29 cost-of-illness studies of asthma were identified, 21 of which used the societal perspective. Only 10 studies estimated the incremental cost of asthma with a control group, and none of them refers to EU countries. Of these 10, only 4 were regarded as high-quality evidence, insofar as they combined a matched control with regression models. The annual incremental cost of asthma in adults ranged from €416 to €5,317. The incremental healthcare cost of asthma increased with level of severity, from €964 for intermittent asthma to €11,703 for severe persistent asthma in adults. In adults, the incremental non-healthcare cost of asthma ranged from €136 to €3,461. Selected studies in this review show great heterogeneity due to different population characteristics, study designs and valuation methods, which limits their comparability. However, it can be concluded that incremental healthcare costs of asthma, compared to people without asthma, exceeds seven hundred Euros (valued in 2013) in most of the reviwed estimation for several countries. This figure is greater for studies from the United States. The incremental cost per patient increases very rapidly with level of severity and decreases with asthma patient control.

  18. Exacerbations of asthma - A descriptive study of 425 severe exacerbations

    NARCIS (Netherlands)

    Tattersfield, AE; Postma, DS; Barnes, PJ; Svensson, K; Bauer, CA; O'Byrne, PM; Lofdahl, CG; Pauwels, RA; Ullman, A

    The identification, prevention, and prompt treatment of exacerbations are major objectives of asthma management. We looked at change in PEF, symptoms, and use of rescue p-agonists during the 425 severe exacerbations that occurred during a 12-mo parallel group study (FACET) in which low and high

  19. A systematic review of predictive models for asthma development in children.

    Science.gov (United States)

    Luo, Gang; Nkoy, Flory L; Stone, Bryan L; Schmick, Darell; Johnson, Michael D

    2015-11-28

    Asthma is the most common pediatric chronic disease affecting 9.6 % of American children. Delay in asthma diagnosis is prevalent, resulting in suboptimal asthma management. To help avoid delay in asthma diagnosis and advance asthma prevention research, researchers have proposed various models to predict asthma development in children. This paper reviews these models. A systematic review was conducted through searching in PubMed, EMBASE, CINAHL, Scopus, the Cochrane Library, the ACM Digital Library, IEEE Xplore, and OpenGrey up to June 3, 2015. The literature on predictive models for asthma development in children was retrieved, with search results limited to human subjects and children (birth to 18 years). Two independent reviewers screened the literature, performed data extraction, and assessed article quality. The literature search returned 13,101 references in total. After manual review, 32 of these references were determined to be relevant and are discussed in the paper. We identify several limitations of existing predictive models for asthma development in children, and provide preliminary thoughts on how to address these limitations. Existing predictive models for asthma development in children have inadequate accuracy. Efforts to improve these models' performance are needed, but are limited by a lack of a gold standard for asthma development in children.

  20. Mold sensitization is common amongst patients with severe asthma requiring multiple hospital admissions

    OpenAIRE

    Hopkinson Linda C; O'Driscoll B Ronan; Denning David W

    2005-01-01

    Abstract Background Multiple studies have linked fungal exposure to asthma, but the link to severe asthma is controversial. We studied the relationship between asthma severity and immediate type hypersensitivity to mold (fungal) and non-mold allergens in 181 asthmatic subjects. Methods We recruited asthma patients aged 16 to 60 years at a University hospital and a nearby General Practice. Patients were categorized according to the lifetime number of hospital admissions for asthma (82 never ad...

  1. Dupilumab in the management of moderate-to-severe asthma: the data so far

    Directory of Open Access Journals (Sweden)

    Barranco P

    2017-09-01

    Full Text Available Pilar Barranco,1 Elsa Phillips-Angles,2 Javier Dominguez-Ortega,1 Santiago Quirce1 1Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ, CIBER de Enfermedades Respiratorias (CIBERES, Madrid, Spain; 2Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ, Madrid, Spain Abstract: Severe asthma constitutes illness in a relatively small proportion of all patients with asthma, but it is a major public health problem – with considerable effect on morbidity, mortality, as well as a high burden on health care resources. Regardless of effective treatments being widely available and the existence of treatment guidelines, a large population of severe asthma cases remain uncontrolled. Achieving and maintaining asthma control in this group of patients is, therefore, of utmost importance. The recognition of distinct inflammatory phenotypes within this population has driven the development of targeted biological therapies – particularly, selective targeted monoclonal antibodies (mAbs. It is noteworthy that in approximately 50% of these patients, there is strong evidence of the pathogenic role of T helper type-2 (Th2 cytokines, such as interleukin (IL-4 and IL-13, orchestrating the eosinophilic and allergic inflammatory processes. Among the recently developed antiasthma biologic drugs, the mAb dupilumab is very promising given its ability to inhibit the biological effects of both IL-4 and IL-13. In this review, we focused on IL-4 and IL-13, as these interleukins are considered to play a key role in the pathophysiology of asthma, and on dupilumab, an anti-IL-4 receptor human mAb, as a forthcoming treatment for uncontrolled severe asthma in the near future. Keywords: dupilumab, asthma, interleukin-4, interleukin-13, monoclonal antibodies, treatment

  2. Traffic, diesel and asthma : a literature review

    OpenAIRE

    Schembri, Gabriel

    2007-01-01

    This article details the major pollutants from motor vehicle exhaust, mainly particulate matter, nitrogen dioxide and polycyclic aromatic hydrocarbons. The emphasis is on motor vehicle emissions from diesel powered engines, which have become a significant source of air pollution in urban areas. The impact of motor vehicle pollutants on respiratory health is explored, and the major studies relating asthma to high volume of traffic and proximity to major traffic arteries are reviewed.

  3. Airway Inflammation after Bronchial Thermoplasty for Severe Asthma.

    Science.gov (United States)

    Denner, Darcy R; Doeing, Diana C; Hogarth, D Kyle; Dugan, Karen; Naureckas, Edward T; White, Steven R

    2015-09-01

    Bronchial thermoplasty is an alternative treatment for patients with severe, uncontrolled asthma in which the airway smooth muscle is eliminated using radioablation. Although this emerging therapy shows promising outcomes, little is known about its effects on airway inflammation. We examined the presence of bronchoalveolar lavage cytokines and expression of smooth muscle actin in patients with severe asthma before and in the weeks after bronchial thermoplasty. Endobronchial biopsies and bronchoalveolar lavage samples from 11 patients with severe asthma were collected from the right lower lobe before and 3 and 6 weeks after initial bronchial thermoplasty. Samples were analyzed for cell proportions and cytokine concentrations in bronchoalveolar lavage and for the presence of α-SMA in endobronchial biopsies. α-SMA expression was decreased in endobronchial biopsies of 7 of 11 subjects by Week 6. In bronchoalveolar lavage fluid, both transforming growth factor-β1 and regulated upon activation, normal T-cell expressed and secreted (RANTES)/CCL5 were substantially decreased 3 and 6 weeks post bronchial thermoplasty in all patients. The cytokine tumor-necrosis-factor-related apoptosis-inducing ligand (TRAIL), which induces apoptosis in several cell types, was increased in concentration both 3 and 6 weeks post bronchial thermoplasty. Clinical improvement and reduction in α-SMA after bronchial thermoplasty in severe, uncontrolled asthma is associated with substantial changes in key mediators of inflammation. These data confirm the substantial elimination of airway smooth muscle post thermoplasty in the human asthmatic airway and represent the first characterization of significant changes in airway inflammation in the first weeks after thermoplasty.

  4. Serum decoy receptor 3 is a biomarker for disease severity in nonatopic asthma patients

    Directory of Open Access Journals (Sweden)

    Ming-Han Chen

    2017-01-01

    Conclusion: High serum DcR3 levels are associated with disease severity in nonatopic asthma patients, which suggests that DcR3 is a potential biomarker that can be used to predict the severity of nonatopic asthma.

  5. Short-term ozone exposure and asthma severity: Weight-of-evidence analysis.

    Science.gov (United States)

    Goodman, Julie E; Zu, Ke; Loftus, Christine T; Lynch, Heather N; Prueitt, Robyn L; Mohar, Isaac; Shubin, Sara Pacheco; Sax, Sonja N

    2018-01-01

    To determine whether evidence indicates that short-term exposure to ambient concentrations of ozone in the United States can affect asthma severity, we systematically reviewed published controlled human exposure, epidemiology, and animal toxicity studies. The strongest evidence for a potential causal relationship came from epidemiology studies reporting increased emergency department visits and hospital admissions for asthma following elevated ambient ozone concentrations. However, while controlled exposure studies reported lung function decrements and increased asthma symptoms following high ozone exposures 160-400 parts per billion [ppb]), epidemiology studies evaluating similar outcomes reported less consistent results. Animal studies showed changes in pulmonary function at high ozone concentrations (> 500ppb), although there is substantial uncertainty regarding the relevance of these animal models to human asthma. Taken together, the weight of evidence indicates that there is at least an equal likelihood that either explanation is true, i.e., the strength of the evidence for a causal relationship between short-term exposure to ambient ozone concentrations and asthma severity is "equipoise and above." Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Psychopathology in patients with severe asthma is associated with increased health care utilization

    NARCIS (Netherlands)

    ten Brinke, A.; Ouwerkerk, M. E.; Zwinderman, A. H.; Spinhoven, P.; Bel, E. H.

    2001-01-01

    Severe asthma accounts for the majority of health costs for this disease, which is mainly related to the treatment of failed control. Several psychosocial factors have been associated with poor asthma control, but the question remains whether psychiatric disorder in patients with severe asthma

  7. Is There a Relationship Between Asthma and Dental Caries? A Critical Review of the Literature

    National Research Council Canada - National Science Library

    Gerardo Maupomé; Jay D. Shulman; Carlo Eduardo Medina-Solis; Oyebola Ladeinde

    2010-01-01

    The authors conducted a critical review of the literature to ascertain the strength of the scientific and professional evidence supporting an association between dental caries and the experience and severity of asthma...

  8. Measures to reduce maintenance therapy with oral corticosteroid in adults with severe asthma

    DEFF Research Database (Denmark)

    Nguyen, Vivi Q; Ulrik, Charlotte S

    2016-01-01

    on the evidence for OCS-sparing strategies in adults with severe asthma. METHODS: A systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 21 studies (which comprised 3060 subjects) were included. Of the nonbiologic......), masitinib (78% reduction in OCS dose), mepolizumab (50%83% reduction in OCS dose), and omalizumab (30%64% of enrolled patients achieved a reduction in OCS dose, and one study reported a dose reduction of 45%). CONCLUSIONS: In adults with severe asthma, several corticosteroid-sparing interventions were shown...... to be effective in reducing systemic steroid exposure, not least in studies of add-on biologic therapy. However, based on the available studies, ciclesonide, based on the low potential for systemic effect, especially seems to be a good candidate for reducing steroid exposure in these patients before possible...

  9. Prevalence of uncontrolled severe persistent asthma in pneumology and allergy hospital units in Spain.

    Science.gov (United States)

    Quirce, S; Plaza, V; Picado, C; Vennera, M; Casafont, J

    2011-01-01

    Severe persistent asthma is often poorly controlled and its prevalence in pneumology and allergy hospital units in Spain is unknown. To determine the prevalence of uncontrolled severe persistent asthma in hospital units in Spain and to describe the clinical characteristics of this condition. An observational, cross-sectional study was conducted in 164 Spanish hospital pneumology and allergology units. A record was made of all patients with asthma and patients with uncontrolled severe asthma (diagnosed on the basis of clinical criteria) seen in these units over 6 months. Information on sociodemographic variables, clinical characteristics, pharmacological asthma treatment, skin prick testing, total serum immunoglobulin E (IgE) levels, pulmonary function (forced expiratory volume in the first second and forced vital capacity), asthma control (Asthma Control Questionnaire [ACQ]), and quality of life (Asthma Quality of Life Questionnaire) was collected. According to the clinicians' judgement, 1423 out of 36 649 asthma patients (3.9%, 95% confidence interval, 3.7%-4.1%]) had uncontrolled severe persistent asthma.These patients had a mean (SD) ACQ score of 3.8 (1.0); 55.8% had a positive skin prick test to common aeroallergens and 54.2% had high levels of total serum IgE.The agreement between the assessment of asthma control based on clinicians' criteria and according to the Global Initiative forAsthma (GINA) guidelines was moderate (63.2%, Kic = 0.337), with an underestimation of asthma severity by clinicians; 53.2% of the patients classified as having controlled moderate to severe asthma had uncontrolled severe persistent asthma according to GINA criteria. There is a low prevalence of uncontrolled severe persistent asthma in patients seen at hospital units in Spain according to clinical criteria, although it should be noted that level of asthma control is overestimated by clinicians.

  10. Asthma and obesity: does weight loss improve asthma control? a systematic review

    OpenAIRE

    Juel CTB; Ali Z; Nilas L; Ulrik CS

    2012-01-01

    Caroline Trunk-Black Juel,1 Zarqa Ali,1 Lisbeth Nilas,2 Charlotte Suppli Ulrik11Respiratory Section, Internal Medicine Unit, 2Department of Obstetrics and Gynaecology, Hvidovre Hospital and University of Copenhagen, Hvidovre, DenmarkAim and methods: Obesity is a major health problem, and obesity is associated with a high incidence of asthma and poor asthma control. The aim of the present paper is to systematically review the current knowledge of the effect on overall asthma control of weight ...

  11. Vitamin D as an adjunctive therapy in asthma. Part 2: A review of human studies.

    Science.gov (United States)

    Kerley, Conor P; Elnazir, Basil; Faul, John; Cormican, Liam

    2015-06-01

    Vitamin D deficiency (VDD) is highly prevalent worldwide, with adverse effects on bone health but also potentially other unfavorable consequences. VDD and asthma-incidence/severity share many common risk factors, including winter season, industrialization, poor diet, obesity, dark skin pigmentation, and high latitude. Multiple anatomical areas relevant to asthma contain both the enzyme responsible for producing activated vitamin D and the vitamin D receptor suggesting that activated vitamin D (1,25-dihydroxyvitamin D) may have important local effects at these sites. Emerging evidence suggests that VDD is associated with increased airway hyperresponsiveness, decreased pulmonary function, worse asthma control, and possibly decreased response to standard anti-asthma therapy. However the effect is inconsistent with preliminary evidence from different studies suggesting vitamin D is both beneficial and detrimental to asthma genesis and severity. Current evidence suggests that supplementation with moderate doses of vitamin D may be appropriate for maintenance of bone health in asthmatics, particularly steroid users. However emerging data from an increasing number of randomized, controlled, intervention studies of vitamin D supplementation in pediatric and adult asthma are becoming available and should help determine the importance, if any of vitamin D for asthma pathogenesis. The purpose of this second of a two-part review is to review the current human literature on vitamin D and asthma, discussing the possible consequences of VDD for asthma and the potential for vitamin D repletion as adjunct therapy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. A review of obesity and asthma across the life span.

    Science.gov (United States)

    Khalid, Faiza; Holguin, Fernando

    2018-02-08

    This literature review aims to compare obese-asthmatic adults and children, and to characterize differences and similarities between the two subgroups from epidemiological, demographical, phenotypical, and physiological perspectives. Literature search was conducted using Pubmed database with "obesity," "asthma," "epidemiology," "cluster analysis," "demography," "mechanics," and ''FeNO'' as search terms. Articles investigating epidemiological, demographic, phenotypical variation, and mechanical aspects of breathing specifically in obese asthmatics were identified. The studies were then divided according to age: children (18 years of age). Increase in asthma incidence and prevalence is observed in both obese-asthmatic children and adults. Asthma prevalence is greater in adult females regardless of ethnic background, and in men of African American and Hispanic ethnicities. Degree of weight gain and early onset of menarche appears to directly affect asthma severity in adolescent girls and females. Airway hyperresponsiveness and fractional exhaled nitric oxide do not have any positive correlation with high BMI in obese-asthmatic children and adults. Obesity also alters lung mechanics in asthmatics, but the impact is different for children and adults likely due to differential effect of obesity on central and peripheral airway. Existing literature suggests both similarities and differences in obese-asthmatic children and adults. The most pertinent differences are related to gender, ethnicity, and lung functions.

  13. Gene Expression Correlated with Severe Asthma Characteristics Reveals Heterogeneous Mechanisms of Severe Disease.

    Science.gov (United States)

    Modena, Brian D; Bleecker, Eugene R; Busse, William W; Erzurum, Serpil C; Gaston, Benjamin M; Jarjour, Nizar N; Meyers, Deborah A; Milosevic, Jadranka; Tedrow, John R; Wu, Wei; Kaminski, Naftali; Wenzel, Sally E

    2017-06-01

    Severe asthma (SA) is a heterogeneous disease with multiple molecular mechanisms. Gene expression studies of bronchial epithelial cells in individuals with asthma have provided biological insight and underscored possible mechanistic differences between individuals. Identify networks of genes reflective of underlying biological processes that define SA. Airway epithelial cell gene expression from 155 subjects with asthma and healthy control subjects in the Severe Asthma Research Program was analyzed by weighted gene coexpression network analysis to identify gene networks and profiles associated with SA and its specific characteristics (i.e., pulmonary function tests, quality of life scores, urgent healthcare use, and steroid use), which potentially identified underlying biological processes. A linear model analysis confirmed these findings while adjusting for potential confounders. Weighted gene coexpression network analysis constructed 64 gene network modules, including modules corresponding to T1 and T2 inflammation, neuronal function, cilia, epithelial growth, and repair mechanisms. Although no network selectively identified SA, genes in modules linked to epithelial growth and repair and neuronal function were markedly decreased in SA. Several hub genes of the epithelial growth and repair module were found located at the 17q12-21 locus, near a well-known asthma susceptibility locus. T2 genes increased with severity in those treated with corticosteroids but were also elevated in untreated, mild-to-moderate disease compared with healthy control subjects. T1 inflammation, especially when associated with increased T2 gene expression, was elevated in a subgroup of younger patients with SA. In this hypothesis-generating analysis, gene expression networks in relation to asthma severity provided potentially new insight into biological mechanisms associated with the development of SA and its phenotypes.

  14. The complexities of defining atopy in severe childhood asthma.

    Science.gov (United States)

    Frith, J; Fleming, L; Bossley, C; Ullmann, N; Bush, A

    2011-07-01

    Defining atopy in children with severe, therapy-resistant asthma is complex. There is currently no gold standard test; both skin prick testing (SPT) and allergen-specific IgE (sIgE) are used. Furthermore, atopy is increasingly considered to be a spectrum, not an all-or-none phenomenon. SPTs and sIgE cannot be used interchangeably, and if both tests are not performed, opportunities for intervention will be missed. Furthermore, the severity of atopy will be defined differently by the two tests. Cross-sectional study of 47 children with severe, therapy-resistant asthma, mean age 11.8 years, range 5.3-16.6 years, who underwent SPT, and measurement of total and sIgE as part of their clinical work-up. Overall, 42/47 (89%) were atopic (defined as either one positive SPT or sIgE). There was 98% concordance between the two tests in classifying atopy. When each allergen was considered individually, in 40/200 (20%), the SPT and sIgE results were discordant, most commonly in 25/200 (12.5%), the SPT was negative and the sIgE was positive. House dust mite and cat sensitization were more likely detected by sIgE, but dog sensitization by SPT. When atopy was quantified, the sum of sIgEs compared with the sum of SPT weal diameter showed a moderate correlation (r(2) =0.44, Patopy equally well; however, for individual allergens, concordance is poor, and when used to quantify atopy, SPTs and sIgE were only moderately correlated. In a clinical setting, if allergen avoidance is contemplated in children with severe, therapy-resistant asthma, both tests should be performed in order to detect sensitization. © 2011 Blackwell Publishing Ltd.

  15. Attendance for general practitioner asthma care by children with moderate to severe asthma in Auckland, New Zealand.

    Science.gov (United States)

    Buetow, Stephen; Richards, Deborah; Mitchell, Ed; Gribben, Barry; Adair, Vivienne; Coster, Gregor; Hight, Makere

    2004-11-01

    Attendance for general practitioner (GP) care of childhood asthma varies widely in New Zealand (NZ). There is little current research to account for the variations, although groups such as Māori and Pacific peoples have traditionally faced barriers to accessing GP care. This paper aims to describe and account for attendance levels for GP asthma care among 6-9 year-olds with moderate to severe asthma in Auckland, NZ. During 2002, randomly selected schools identified all 6-9 year-olds with possible breathing problems. Completion of a questionnaire by each parent/guardian indicated which children had moderate to severe asthma, and what characteristics influenced their access to GP asthma care. A multilevel, negative binomial regression model (NBRM) was fitted to account for the number of reported GP visits for asthma, with adjustment for clustering within schools. Twenty-six schools (89.7 percent) identified 931 children with possible breathing problems. Useable questionnaires were returned to schools by 455 children (48.9 percent). Results indicated 209 children with moderate to severe asthma, almost one in every three reportedly making 5 or more GP visits for asthma in the previous year. Māori, Pacific and Asian children were disproportionately represented among these 'high attendees'. Low attendees (0-2 visits) were mainly NZ Europeans. The NBRM (n=155) showed that expected visits were increased by perceived need, ill-health, asthma severity and, in particular, Māori and Pacific child ethnicity. It may be that Māori and Pacific children no longer face significant barriers to accessing GP asthma care. However, more likely is that barriers apply only to accessing routine, preventative care, leading to poor asthma control, exacerbations requiring acute care, and paradoxically an increase in GP visits. That barriers may increase total numbers of visits challenges the assumption, for all health systems, that access can be defined in terms of barriers that must be

  16. Expression of asthma susceptibility genes in bronchial epithelial cells and bronchial alveolar lavage in the Severe Asthma Research Program (SARP) cohort.

    Science.gov (United States)

    Li, Xingnan; Hawkins, Gregory A; Moore, Wendy C; Hastie, Annette T; Ampleford, Elizabeth J; Milosevic, Jadranka; Li, Huashi; Busse, William W; Erzurum, Serpil C; Kaminski, Naftali; Wenzel, Sally E; Bleecker, Eugene R; Meyers, Deborah A

    2016-10-01

    Genome-wide association studies (GWASs) have identified genes associated with asthma, however expression of these genes in asthma-relevant tissues has not been studied. This study tested expression and correlation between GWAS-identified asthma genes and asthma or asthma severity. Correlation analyses of expression levels of GWAS-identified asthma genes and asthma-related biomarkers were performed in cells from human bronchial epithelial biopsy (BEC, n = 107) and bronchial alveolar lavage (BAL, n = 94). Expression levels of asthma genes between BEC and BAL and with asthma or asthma severity were weakly correlated. The expression levels of IL18R1 were consistently higher in asthma than controls or in severe asthma than mild/moderate asthma in BEC and BAL (p asthma (P = 0.03). rs17772583 in RAD50 was significantly correlated with RAD50 expression in BAL and BEC (P = 7.4 × 10(-7) and 0.04) but was not associated with asthma. This is the first report studying the expression of GWAS-identified asthma genes in BEC and BAL. IL13, rather than RAD50, IL4, or IL5, is more likely to be the asthma susceptibility gene. Our study illustrates tissue-specific expression of asthma-related genes. Therefore, whenever possible, disease-relevant tissues should be used for transcription analysis.

  17. Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma.

    Science.gov (United States)

    Blaiss, Michael S; Castro, Mario; Chipps, Bradley E; Zitt, Myron; Panettieri, Reynold A; Foggs, Michael B

    2017-12-01

    Severe asthma poses significant disease-related and economic burdens in the United States. Challenges in practice include how to define "severe asthma" for a given patient, knowing which are the right tests to perform and when, and having a better understanding of a patient's asthma phenotype. Furthermore, current guidelines do not address a clear, practical approach to treatment that is based on a patient's asthma phenotype. To develop a consensus on the definition of severe asthma, the role of biomarkers and phenotyping severe asthma, and the use of newer biologic therapies and bronchial thermoplasty to help guide practicing clinicians. A roundtable meeting was convened with a panel of severe asthma experts to discuss areas in practice that are not adequately addressed by current guidelines, specifically phenotype-guided treatment. We describe a consensus on the definition of severe asthma, asthma phenotyping with the use of available biomarkers, and guiding principles for newer biologic therapies and bronchial thermoplasty. To optimize therapy and improve outcomes such as daily symptoms, quality of life, exacerbations, and hospitalizations, a clear picture of a patient's asthma phenotype is needed to guide therapy. Determining asthma phenotypes is the foundation of precision medicine for this persistent, often difficult-to-treat disease. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  18. Right ventricular function during acute exacerbation of severe equine asthma.

    Science.gov (United States)

    Decloedt, A; Borowicz, H; Slowikowska, M; Chiers, K; van Loon, G; Niedzwiedz, A

    2017-09-01

    Pulmonary hypertension has been described in horses with severe equine asthma, but its effect on the right ventricle has not been fully elucidated. To evaluate right ventricular structure and function after a 1-week period of pulmonary hypertension secondary to acute exacerbation of severe equine asthma. Prospective study. A clinical episode of severe equine asthma was induced experimentally in six susceptible horses. Examinations in remission and on day 7 of the clinical episode included a physical examination with clinical scoring, echocardiography, arterial blood gas measurements, venous blood sampling for cardiac biomarkers, intracardiac pressure measurements, right ventricular and right atrial myocardial biopsies, airway endoscopy and bronchoalveolar lavage. After 1 month of recovery, physical examination, echocardiography and cardiac biomarker analysis were repeated. Echocardiographic and pressure measurements were compared with those in 10 healthy control horses. All horses developed clinical signs of acute pulmonary obstruction. Right heart pressures increased significantly. Altered right ventricular function could be detected by tissue Doppler and speckle tracking echocardiography. Cardiac troponin concentrations did not increase significantly, but were highly elevated in one horse which exercised in the paddock prior to sampling. Focal neutrophil infiltration was present in two myocardial samples. Even in remission, asthmatic horses showed a thicker right ventricular wall, an increased left ventricular end-systolic eccentricity index at chordal level and decreased right ventricular longitudinal strain compared with controls. The induced clinical episode was rather mild and the number of horses was limited because of the invasive nature of the study. Pulmonary obstruction in asthmatic horses induces pulmonary hypertension with right ventricular structural and functional changes. © 2017 EVJ Ltd.

  19. Clinical experience with Omalizumab in a Portuguese severe asthma unit

    Directory of Open Access Journals (Sweden)

    S. Alfarroba

    2014-03-01

    Full Text Available Background: It is widely recognized that asthma control is not always possible in patients with very severe asthma despite available treatment. The aim of this study was to evaluate the efficacy of Omalizumab on asthma control as an add‐on therapy in patients from the “Severe Asthma Outpatient Service” of Pulido Valente Hospital in Lisbon, Portugal. Methods: A retrospective study was conducted to assess asthma control by the ACT score and by GINA classification, frequency and severity of exacerbations, medication use and pulmonary function in patients treated with Omalizumab. Clinical information was collected from medical records from the start of treatment and at 6‐, 12‐ and 24‐month follow‐ups. Results: 26 patients started the treatment with Omalizumab, and all (100% were classified by GINA with uncontrolled asthma prior to treatment. Mean ACT score was 11.5. All the patients had treatment with fixed‐dose ICS and LABA and 34.6% also had an anti‐cholinergic inhaler. 42.3% of patients were also treated with oral glucocorticosteroids for control. Patients reported an average of 1.8 moderate and 3.1 severe exacerbations/year. Statistical differences were found at 6‐month follow‐up in most end‐points: GINA score improved: 60.9% of patients with partially controlled asthma and only 39.1% with uncontrolled asthma (Wilcoxon 0.00; ACT score improved to 19.52 (Wilcoxon 0.00; mean FEV1 improved to 76.7% (Wilcoxon 0.025; the proportion of patients requiring oral glucocorticosteroid therapy reduced to 17.4% (Wilcoxon 0.014; and the number of moderate and severe exacerbations also decreased to 1.04 and 1.83 respectively (Wilcoxon 0.007; Wilcoxon 0.002 respectively. Conclusions: The current analysis shows evidence that omalizumab is successful in improving asthma control as an add‐on therapy GINA step 5 treatment. Resumo: Introdução: Está bem documentado que o controlo de asma nem

  20. Point-of-care blood eosinophil count in a severe asthma clinic setting.

    Science.gov (United States)

    Heffler, Enrico; Terranova, Giovanni; Chessari, Carlo; Frazzetto, Valentina; Crimi, Claudia; Fichera, Silvia; Picardi, Giuseppe; Nicolosi, Giuliana; Porto, Morena; Intravaia, Rossella; Crimi, Nunzio

    2017-07-01

    One of the main severe asthma phenotypes is severe eosinophilic or eosinophilic refractory asthma for which novel biologic agents are emerging as therapeutic options. In this context, blood eosinophil counts are one of the most reliable biomarkers. To evaluate the performance of a point-of-care peripheral blood counter in a patients with severe asthma. The blood eosinophil counts of 76 patients with severe asthma were evaluated by point-of-care and standard analyzers. A significant correlation between blood eosinophils assessed by the 2 devices was found (R2 = 0.854, P asthma and the ELEN index, a composite score useful to predict sputum eosinophilia. The results of our study contribute to the validation of a point-of-care device to assess blood eosinophils and open the possibility of using this device for the management of severe asthma management. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  1. Innovative treatments for severe refractory asthma: how to choose the right option for the right patient?

    Directory of Open Access Journals (Sweden)

    Menzella F

    2017-08-01

    Full Text Available Francesco Menzella,1 Carla Galeone,1 Francesca Bertolini,2 Claudia Castagnetti,1 Nicola Facciolongo1 1Department of Medical Specialties, Pneumology Unit, IRCCS- Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; 2Department of Animal Science, Iowa State University, Ames, IA, USA Abstract: The increasing understanding of the molecular biology and the etiopathogenetic mechanisms of asthma helps in identification of numerous phenotypes and endotypes, particularly for severe refractory asthma. For a decade, the only available biologic therapy that met the unmet needs of a specific group of patients with severe uncontrolled allergic asthma has been omalizumab. Recently, new biologic therapies with different mechanisms of action and targets have been approved for marketing, such as mepolizumab. Other promising drugs will be available in the coming years, such as reslizumab, benralizumab, dupilumab and lebrikizumab. Moreover, since 2010, bronchial thermoplasty has been successfully introduced for a limited number of patients. This is a nonpharmacologic endoscopic procedure which is considered a promising therapy, even though several aspects still need to be clarified. Despite the increasing availability of new therapies, one of the major problems of each treatment is still the identification of the most suitable patients. This sudden abundance of therapeutic options, sometimes partially overlapping with each other, increases the importance to identify new biomarkers useful to guide the clinician in selecting the most appropriate patients and treatments, without forgetting the drug-economic aspects seen in elevated direct cost of new therapies. The aim of this review is, therefore, to update the clinician on the state of the art of therapies available for refractory asthma and, above all, to give useful directions that will help understand the different choices that sometimes partially overlap and to dispel the possible doubts that still exist

  2. Economic analysis of the phase III MENSA study evaluating mepolizumab for severe asthma with eosinophilic phenotype.

    Science.gov (United States)

    Basu, Anirban; Dalal, Anand; Canonica, Giorgio Walter; Forshag, Mark; Yancey, Steven W; Nagar, Saurabh; Bell, Christopher F

    2017-04-01

    Severe eosinophilic asthma patients are at risk of exacerbations, which are associated with substantial costs. Mepolizumab lowers eosinophil levels and reduces exacerbation risk in severe eosinophilic asthma. We evaluated asthma-related exacerbation costs in mepolizumab-treated patients (versus placebo). A within-trial economic analysis of the Mepolizumab as Adjunctive Therapy in Patients with Severe Asthma (MENSA) trial. Objectives were to quantify the incremental: (1) medical costs of asthma-related exacerbation; (2) asthma-related exacerbation emergency department visit/hospitalization costs; and (3) asthma-related total healthcare resource utilization. Mean medical costs of asthma-related exacerbations at 8 months were $969, $852, and $1692 in the mepolizumab 75 mg intravenous (IV), mepolizumab 100 mg subcutaneous (SC), and placebo groups, respectively (p = 0.16). Mean medical costs from emergency department visits or hospitalizations due to asthma-related exacerbations were $901, $795, and $1557 in the mepolizumab 75 mg IV, mepolizumab 100 mg SC, and placebo groups (p = 0.020). Asthma-related healthcare resource utilization (all services) was lower for the mepolizumab groups versus placebo. Adding mepolizumab to standard-of-care treatment for severe eosinophilic asthma lowered asthma exacerbation-related medical costs/healthcare resource utilization; although the cost savings ranged from $723-$840 per patient, differences were not statistically significant.

  3. Animal Model of Asthma, Various Methods and Measured Parameters: A Methodological Review.

    Science.gov (United States)

    Kianmeher, Majid; Ghorani, Vahideh; Boskabady, Mohammad Hosein

    2016-12-01

    Asthma is a chronic inflammatory disease of the airway with extensive airway remodeling. The ethical issues associated with the studies in asthmatic patients, required development of animal model of asthma. Animal models of asthma can provide valuable information on several features of asthma pathogenesis and treatment. Although these models cannot carry out all clinical features, they are valuable to understand mechanisms of the disease and curative access. Related articles were searched in different databases from September 1994 to April 2016 using; animal model of asthma, animal sensitization, allergen-induced asthma in animals terms. Although there are several reviews on this topic, in the present article, induction of animal model of asthma in different animals, various methods used for this purpose, measured parameters and research purposes were reviewed, which will help investigators to use the appropriate animal, methods, and evaluating parameters depending on their study design. In this study various method used for induction of animal model of asthma in different animals and measured parameters were described, which will help investigators to use the appropriate animal, method and evaluating parameters depending on their study design.

  4. Asthma Status and Severity Affects Missed School Days

    Science.gov (United States)

    Moonie, Sheniz A.; Sterling, David A.; Figgs, Larry; Castro, Mario

    2006-01-01

    Excessive school absence disrupts learning and is a strong predictor of premature school dropout. School-aged children with asthma are absent more often compared to their healthy peers without asthma; yet, the causes are inadequately documented. We sought to determine the difference in mean absence days between children with and without asthma,…

  5. Predictors of asthma following severe respiratory syncytial virus (RSV) bronchiolitis in early childhood.

    Science.gov (United States)

    Lu, Susan; Hartert, Tina V; Everard, Mark L; Giezek, Hilde; Nelsen, Linda; Mehta, Anish; Patel, Hima; Knorr, Barbara; Reiss, Theodore F

    2016-12-01

    We sought to identify predictors of asthma development following severe early childhood RSV bronchiolitis. Different definitions of asthma were also compared. This longitudinal, observational study (N = 343) followed patients (severity score for RSV bronchiolitis, high respiratory rate, and asthma diagnosis before enrollment. Predictors of atopic disorders included allergic rhinitis before enrollment, a relative with asthma, and the plasma biomarkers IL-5, IL-16, and IL-18. Predictors of chronic asthma therapy use included asthma diagnosis before enrollment and geographic region (Europe and Africa). Only 42% of patients with asthma (primary definition) also met the asthma definition by physician diagnosis and chronic asthma therapy use. Among children with early RSV bronchiolitis, hereditary factors (i.e., having a relative with asthma) and RSV bronchiolitis severity were predictors of asthma and atopic disorders at 6 years of age. Of interest, there was poor agreement among the asthma definitions evaluated. Pediatr Pulmonol. 2016;51:1382-1392. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  6. Which functional parameters can help differentiate severe asthma from COPD?

    Directory of Open Access Journals (Sweden)

    Ricardo Marques Dias

    2010-03-01

    Full Text Available The aim of this study was to identify the respiratory function parameters that help in the accurate diagnosis of asthma and COPD. We studied 20 asthma and 30 COPD patients who underwent lung function tests including spirometry and plethysmography both with bronchodilator test and diffusion with carbon monoxide (DLCO. The tests were performed according to International Guidelines (ATS/ERS. The asthma patients were younger (mean age = 48 than those in the COPD group (mean age = 59 and this group also had more female patients (65% than the COPD group (40%. The results showed a more severe obstruction in the asthma group: FEV1/FVC = 59% versus 66% for COPD. There was also a greater bronchodilator response as shown by changes in absolute and percentage values for FEV1 in the asthma group. Average DLCO values were normal in the asthma group (103%P and lower in the COPD (69%. In plethysmography the asthma group had a higher residual volume (%P and a higher airway resistance. We concluded that many functional parameters were useful in distinguishing the asthma and COPD groups. In individual analysis, DLCO was the parameter which best aided in an accurate diagnosis in both groups, with a higher specificity for COPD. The bronchodilator response measured by changes in FEV1 showed a higher sensitivity for asthma. Thus, these two tests are highlighted in the differential diagnosis of obstructive diseases. Resumo: Com o objectivo de identificar parâmetros funcionais respiratórios que contribuam para o diagnóstico diferencial entre asma e DPOC, estudámos 20 asmáticos e 30 bronquíticos, com ou sem enfisema, com os exames usuais de função pulmonar: espirografia, pletismografia e DLCO, pré e pós-broncodilatação para os dois primeiros exames. Os grupos apresentam diferenças significativas na sua constituição. Os asmáticos são mais jovens, média de 48 anos, contra 59 anos no grupo com DPOC, e o

  7. Greater severity of new onset asthma in allergic subjects who smoke: a 10-year longitudinal study

    Directory of Open Access Journals (Sweden)

    Antic Tjana

    2011-01-01

    Full Text Available Abstract Background Little is known about the association between cigarette smoking and asthma severity. We assessed smoking as a determinant of disease severity and control in a cohort of clinic-referred allergic subjects who developed new onset asthma. Methods Allergic rhinitis subjects with no asthma (n = 371 were followed-up for 10 years and routinely examined for asthma diagnosis. In those who developed asthma (n = 152, clinical severity and levels of asthma control were determined. Among these subjects, 74 (48.7% were current smokers, 17 (11.2% former smokers, and 61 (40.1% never smokers. Results When comparing current or past smokers to never smokers they had a higher risk of severe asthma in the univariate analysis, which became non-significant in the multivariate analysis. On the other hand, the categories of pack-years were significantly related to severe asthma in a dose response relationship in both the univariate and multivariate analysis: compared to 0 pack years, those who smoked 1-10 pack-years had an OR(95% CI of 1.47(0.46-4.68, those who smoked 11-20 pack-years had an OR of 2.85(1.09-7.46 and those who smoked more than 20 pack-years had an OR of 5.59(1.44-21.67 to develop more severe asthma. Smokers with asthma were also more likely to have uncontrolled disease. A significant dose-response relationship was observed for pack-years and uncontrolled asthma. Compared to 0 pack years, those who smoked 1-10 pack-years had an OR of 5.51(1.73-17.54 and those who smoked more than 10 pack-years had an OR of 13.38(4.57-39.19 to have uncontrolled asthma. Conclusions The current findings support the hypothesis that cigarette smoking is an important predictor of asthma severity and poor asthma control.

  8. Obstructive Sleep Apnea Risk, Asthma Burden and Lower Airway Inflammation in Adults in the Severe Asthma Research Program (SARP) II

    Science.gov (United States)

    Teodorescu, Mihaela; Broytman, Oleg; Curran-Everett, Douglas; Sorkness, Ronald L.; Crisafi, Gina; Bleecker, Eugene R.; Erzurum, Serpil; Gaston, Benjamin M.; Wenzel, Sally E.; Jarjour, Nizar N.

    2015-01-01

    Background Obstructive sleep apnea (OSA) may worsen asthma, but large studies are lacking and the underlying mechanisms are unknown. Objective Determine the prevalence of OSA risk among patients with asthma of different severity compared to normal controls (NC), and among asthmatics, test the relationship of OSA risk with asthma burden and airway inflammation. Methods Subjects with severe (SA, n=94) and non-severe asthma (NSA, n=161), and NC (n=146) were recruited in an add-on sub-study, to the observational Severe Asthma Research Program (SARP) II; subjects completed sleep quality, sleepiness and OSA risk (Sleep Apnea scale of the Sleep Disorders Questionnaire [SA-SDQ]) questionnaires and clinical assessments. Sputum was induced in a subset of asthmatics. Results Relative to NC, despite similar sleep duration, the SA and NSA subjects had worse sleep quality, were sleepier and had higher SA-SDQ scores. Among asthmatics, higher SA-SDQ was associated with increased asthma symptoms, β-agonist use, health care utilization, and worse asthma quality of life. Significant association of SA-SDQ with sputum polymorphonuclear cells% was noted: each increase in SA-SDQ by its standard deviation (6.85 units) was associated with a rise in % sputum neutrophils of 7.78 (95 % CI 2.33-13.22, p = 0.0006), independent of obesity and other confounders. Conclusions OSA symptoms are more prevalent among asthmatics, in whom they are associated with higher disease burden. OSA risk is associated with a neutrophilic airway inflammation in asthma, suggesting that OSA may be an important contributor to the neutrophilic asthma. Further studies are necessary to confirm these findings and better understand the mechanistic underpinnings of this relationship. PMID:26004304

  9. Omalizumab Treatment Response in a Population With Severe Allergic Asthma and Overlapping COPD.

    Science.gov (United States)

    Maltby, Steven; Gibson, Peter G; Powell, Heather; McDonald, Vanessa M

    2017-01-01

    Asthma and COPD are common airway diseases. Individuals with overlapping asthma and COPD experience increased health impairment and severe disease exacerbations. Efficacious treatment options are required for this population. Omalizumab (anti-IgE) therapy is effective in patients with severe persistent asthma, but limited data are available on efficacy in populations with overlapping asthma and COPD. Data from the Australian Xolair Registry were used to compare treatment responses in individuals with asthma-COPD overlap with responses in patients with severe asthma alone. Participants were assessed at baseline and after 6 months of omalizumab treatment. We used several different definitions of asthma-COPD overlap. First, we compared participants with a previous physician diagnosis of COPD to participants with no COPD diagnosis. We then made comparisons based on baseline lung function, comparing participants with an FEV1 80% predicted after bronchodilator use. In the population with an FEV1asthma control and health-related quality of life in all populations assessed based on the Asthma Control Questionnaire and Asthma Quality of Life Questionnaire scores. Omalizumab treatment did not improve lung function (FEV1, FVC, or FEV1/FVC ratio) in populations that were enriched for asthma-COPD overlap (diagnosis of COPD or FEV1 asthma control and health-related quality of life in individuals with severe allergic asthma and overlapping COPD. These findings provide real-world efficacy data for this patient population and suggest that omalizumab is useful in the management of severe asthma with COPD overlap. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  10. A Review on the Role of Vitamin D in Asthma

    OpenAIRE

    Ali, Niloufer S.; Nanji, Kashmira

    2017-01-01

    Asthma, a major public health issue, is one of the most common diseases affecting millions of population globally. It is a chronic respiratory disease characterized by increased airway inflammation and hyper-responsiveness. Vitamin D is of particular interest in asthma due to its immunomodulatory effects. Serum 25-hydroxyvitamin D is found to be associated with a wide range of pulmonary diseases, including viral and bacterial respiratory infections, asthma, and cancer. Several researches have...

  11. Research on psychosocial aspects of asthma in the Arab world: a literature review.

    Science.gov (United States)

    Al-Khateeb, Anas J; Al Khateeb, Jamal M

    2015-01-01

    The importance of psychosocial factors in the management of bronchial asthma has long been recognized. This paper offers a review of research published in the English language related to psychosocial aspects of bronchial asthma in Arab countries. Several databases (PubMed, Science Direct, Springer Link, ERIC, and PsychInfo) were searched using the following keywords: bronchial asthma, Arab countries, Algiers, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine (West Bank, Gaza), Qatar, Saudi Arabia, Syria, Tunisia, Sudan, Somalia; United Arab Emirates, and Yemen. Thirty-two studies were conducted in 9 Arab countries. Almost all studies found were published in the last fourteen years with an apparent increasing rate in the last five years. In descending order, these studies addressed: knowledge of and attitudes toward asthma, quality of life, behavioral and emotional problems and factors related to academic achievement. The main results of the studies reviewed were: (a) physicians', school staff's, and parents' knowledge of and attitudes toward asthma were generally unsatisfactory, (b) in-service asthma education programs significantly impacted parent and staff knowledge and attitudes, and asthma management practices, (c) quality of life in children and adolescents was significantly adversely affected by asthma, (d) asthma was a common cause of school absenteeism, and had a significant negative impact on academic achievement of students, and (e) students with asthma had significantly higher rates of behavioral and emotional difficulties compared to students without asthma. The paper concludes with a discussion about the implications of these results and a call for further research in this area.

  12. Environmental and Personal Factors Related to Asthma Severity among Children: Hospital Based Study, Egypt

    Directory of Open Access Journals (Sweden)

    Omaima Ibrahim AboElkheir

    2016-09-01

    Full Text Available Background: Childhood asthma is a complex disorder in which many environmental and personal factors play a role. However, the contribution of these factors to asthma severity is poorly understood. This study aims to determine the relationship between environmental exposures, personal factors and asthma severity among asthmatic children. Methods: This cross-sectional hospital based study was conducted on 180 asthmatic children; they were divided into mild, moderate and severe asthma according to forced expiratory volume in first second. Environmental factors (indoor and outdoor, food allergy, history of other allergic diseases, family history of allergic disorders, time trend of attacks as well as asthma outcome were reported. Results: Children with severe asthma were younger than those with mild or moderate asthma. Severe asthma was significantly linked to family history of allergy, presence of co-morbid allergic diseases, fish, egg and milk allergy, as well as exposure to passive smoking (73.7% and poor housing conditions. Also, it was significantly linked to presence of unauthorized factories in residential area (31.6 %, p=0.001. As well as, contact with pets (42.1%. Children with severe asthma had more limitations of physical activities (73.7%, missed school days (81.5%, with poor school performance (p=0.04 than those with mild moderate or asthma. Conclusion: Severe asthma was linked to female gender and younger age, co-morbid allergic diseases, family history of atopy and food allergy. It was higher among children residing in places with unauthorized factories and living in substandard housing condition. Children with severe asthma had poor asthma outcome.

  13. Pathway discovery using transcriptomic profiles in adult-onset severe asthma

    DEFF Research Database (Denmark)

    Hekking, Pieter-Paul; Loza, Matt J; Pavlidis, Stelios

    2017-01-01

    in nasal brushings (5 signatures), sputum (3 signatures), and endobronchial brushings (6 signatures). Signatures associated with eosinophilic airway inflammation, mast cells, and group 3 innate lymphoid cells were more enriched in adult-onset severe asthma, whereas signatures associated with induced lung...... injury were less enriched in adult-onset severe asthma. CONCLUSIONS: Adult-onset severe asthma is characterized by inflammatory pathways involving eosinophils, mast cells, and group 3 innate lymphoid cells. These pathways could represent useful targets for the treatment of adult-onset severe asthma....

  14. Effectiveness of school-based family asthma educational programs in quality of life and asthma exacerbations in asthmatic children aged five to 18: a systematic review.

    Science.gov (United States)

    Walter, Helen; Sadeque-Iqbal, Fatema; Ulysse, Rose; Castillo, Doreen; Fitzpatrick, Aileen; Singleton, Joanne

    2016-11-01

    Asthma is a common, chronic, non-communicable respiratory disease that affects millions of children worldwide. Asthma exacerbations can range from mild to severe and can have an unfavorable impact on the quality of life of children and their caregivers. Asthma exacerbations often result in absenteeism from school or work, activity intolerance and emergency hospital visits. One strategy to address this health issue in an attempt to improve health outcomes is school-based asthma educational programs. A review of the literature revealed that previous systematic reviews have examined similar topics on the effectiveness of school-based asthma educational programs that have included collaborative efforts between parents and schools. No systematic reviews were found that examined the effectiveness of school-based asthma educational programs that exclusively included children and their caregivers. Research has not been systematically reviewed to determine the effectiveness of a school-based asthma educational program within a familial context. To identify the best available evidence on the effectiveness of school-based family asthma educational programs that exclusively included both children and caregivers on the quality of life and number of asthma exacerbations of children aged five to 18 years with a clinical diagnosis of asthma. Children aged five to 18 years of any gender, race or ethnicity with a clinical diagnosis of asthma and their caregivers. School-based family asthma educational programs. Randomized controlled trials. Quality of life and the number of asthma exacerbations measured by either missed days from school or work, and/or physical activity intolerance, and/or emergency hospital visits. The search strategy aimed to find both published and unpublished studies from inception of the database to August 21, 2015. Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity before inclusion in the review

  15. Body Height of Children with Bronchial Asthma of Various Severities

    Directory of Open Access Journals (Sweden)

    Tatiana I. Eliseeva

    2017-01-01

    Full Text Available Influence of bronchial asthma (BA severity on physical development in children patients was evaluated in comparison with healthy population. Materials and Methods. 1042 children and adolescents (768 boys with atopic BA were evaluated. All children underwent standard examination in a clinical setting, including anthropometry. The control group included 875 healthy children of a comparable age (423 boys. Results. The fraction of patients with the normal, lower, and increased height among the whole group of patients with BA is close to the corresponding values in the healthy population (χ2=3.32, p=0.65. The fraction of BA patients with the reduced physical development is increased monotonically and significantly when the BA severity increases: healthy group, 8.2% (72/875, BA intermittent, 4.2% (6/144, BA mild persistent 9% (47/520, BA moderate persistent, 11.7% (36/308, and BA severe persistent, 24.3% (17/70 (χ2=45.6, p=0,0009. Conclusion. The fraction of the children with the reduced height is increased monotonically and significantly in the groups of increasing BA severities. At the same time, the fraction of such children in groups of intermittent and mild persistent BA practically does not differ from the conditionally healthy peers.

  16. Asthma

    Science.gov (United States)

    ... babies. Poor asthma control increases the risk of preeclampsia, a condition in which a pregnant woman develops ... other conditions that can interfere with your asthma management. Watch for Signs That Your Asthma Is Getting ...

  17. Severe bronchial asthma in children: the role of clinical and anamnestic indices in diagnosis verification

    Directory of Open Access Journals (Sweden)

    Kolyubakina L.V.

    2016-03-01

    Full Text Available The paper presents comparative analysis of results of clinical and anamnestic examination of children depending on the asthma severity. Severe asthma in schoolchildren relative to moderate phenotype characterized by birth overweight, more burdened individual allergic history, highly infectious index, drug or combined (medication, food and household allergies, seasonal exacerbations (mainly from November to March, what associated with the trigger role of ARVI and meteorological factors, inadequate asthma control during standard basic therapy.

  18. Exposure to secondhand smoke and asthma severity among children in Connecticut.

    Directory of Open Access Journals (Sweden)

    Jessica P Hollenbach

    Full Text Available To determine whether secondhand smoke (SHS exposure is associated with greater asthma severity in children with physician-diagnosed asthma living in CT, and to examine whether area of residence, race/ethnicity or poverty moderate the association.A large childhood asthma database in CT (Easy Breathing was linked by participant zip code to census data to classify participants by area of residence. Multinomial logistic regression models, adjusted for enrollment date, sex, age, race/ethnicity, area of residence, insurance type, family history of asthma, eczema, and exposure to dogs, cats, gas stove, rodents and cockroaches were used to examine the association between self-reported exposure to SHS and clinician-determined asthma severity (mild, moderate, and severe persistent vs. intermittent asthma.Of the 30,163 children with asthma enrolled in Easy Breathing, between 6 months and 18 years old, living in 161 different towns in CT, exposure to SHS was associated with greater asthma severity (adjusted relative risk ratio (aRRR: 1.07 [1.00, 1.15] and aRRR: 1.11 [1.02, 1.22] for mild and moderate persistent asthma, respectively. The odds of Black and Puerto Rican/Hispanic children with asthma being exposed to SHS were twice that of Caucasian children. Though the odds of SHS exposure for publicly insured children with asthma were three times greater than the odds for privately insured children (OR: 3.02 [2.84,3,21], SHS exposure was associated with persistent asthma only among privately insured children (adjusted odds ratio (aOR: 1.23 [1.11,1.37].This is the first large-scale pragmatic study to demonstrate that children exposed to SHS in Connecticut have greater asthma severity, clinically determined using a systematic approach, and varies by insurance status.

  19. The effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to 18 years diagnosed with asthma: a systematic review protocol.

    Science.gov (United States)

    Walter, Helen; Sadeque-Iqbal, Fatema; Ulysse, Rose; Castillo, Doreen; Fitzpatrick, Aileen; Singleton, Joanne

    2015-10-01

    $655 million was spent on asthma for 2008-09.Asthma is a chronic respiratory disease that affects millions of people of all ethnicities, ages and genders worldwide. The pathophysiology of asthma is multifaceted, and is characterized by restriction of airflow into and out of the lungs, airway inflammation with increased mucus production, and bronchial hyper-reactivity caused by exposure to environmental irritants and chemicals, often referred to as triggers, which in some cases are modifiable. Asthma triggers include respiratory infections, weather changes, stress, excitement, exercise and other physical activities, allergic hypersensitivity reactions, food additives, animal dander, dust mites, cockroaches, outdoor and indoor pollutants, certain medications and cigarette smoke. Asthma is characterized by recurrent, episodic, reversible symptoms often referred to as asthma exacerbations, or asthma attacks. Asthma symptoms include coughing, shortness of breath, chest tightness and wheezing that most frequently occur at night or in the early morning. Asthma symptoms vary in severity and frequency in affected individuals, and can occur several times a day or week. Asthma symptoms may be mild, moderate, or severe, and are classified according to presenting symptoms and quantitative measurements of lung function using a peak expiratory flow meter (PEF), or of forced expiratory volume in one second (FEV1). Asthma symptoms can be so severe that, if left untreated, death can occur.Exacerbations of asthma symptoms often result in school and work absenteeism, activity intolerance and emergency hospital visits for asthma. Nocturnal asthma exacerbations frequently cause sleeplessness, which may result in daytime fatigue. Asthma symptoms can interfere and disrupt activities of daily life, and can have an unfavorable impact on the quality of life for people with the disease, including children and their caregivers. For this review, quality of life represents how well the asthmatic

  20. Asthma and recreational SCUBA diving: a systematic review.

    Science.gov (United States)

    Koehle, Michael; Lloyd-Smith, Rob; McKenzie, Don; Taunton, Jack

    2003-01-01

    Asthma has traditionally been a contraindication to recreational self-contained underwater breathing apparatus (SCUBA) diving, although large numbers of patients with asthma partake in diving. The purpose of this paper is to review all the research relevant to the issue of the safety of asthma in divers. MEDLINE and MDConsult were searched for papers between 1980-2002. Keywords used for the search were 'asthma', 'SCUBA' and 'diving'. Additional references were reviewed from the bibliographies of received articles.A total of fifteen studies were identified as relevant to the area. These included three surveys of divers with asthma, four case series and eight mechanistic investigations of the effect of diving on pulmonary function. The survey data showed a high prevalence of asthma among recreational SCUBA divers, similar to the prevalence of asthma among the general population. There was some weak evidence for an increase in rates of decompression illness among divers with asthma. In healthy participants, wet hyperbaric chamber and open-water diving led to a decrease in forced vital capacity, forced expired volume over 1.0 second and mid-expiratory flow rates. In participants with asymptomatic respiratory atopy, diving caused a decrease in airway conductivity.There is some indication that asthmatics may be at increased risk of pulmonary barotrauma, but more research is necessary. Decisions regarding diving participation among asthmatics must be made on an individual basis involving the patient through informed, shared decision making.

  1. Appropriate selection for omalizumab treatment in patients with severe asthma?

    DEFF Research Database (Denmark)

    Nygaard, Leo; Henriksen, Daniel Pilsgaard; Madsen, Hanne

    2017-01-01

    .3-11.1, p = 0.0005), respectively. Conclusion: Only 42% of the omalizumab-treated patients were appropriately selected according to current guidelines. Still, as omalizumab showed significant improvement in asthma control over time, it is important to keep this drug in mind as an add-on to asthma therapy...

  2. Serum Magnesium and Vitamin D Levels as Indicators of Asthma Severity.

    Science.gov (United States)

    Shaikh, Mohammed Nadeem; Malapati, Brahma Reddy; Gokani, Ruchi; Patel, Bhavita; Chatriwala, Mitul

    2016-01-01

    Background. Serum magnesium levels affect the concentration of circulating vitamin D in blood and subsequently it affects the immunity; thus it plays significant role in the pathogenesis of asthma. Asthma, in adults, is less studied and hypomagnesemia along with vitamin D deficiency and insufficiency is common in asthmatic individuals, which causes frequent asthma attacks, respiratory infections, severe exacerbations, and poor response to bronchodilators. Objective. To detect the magnitude of vitamin D insufficiency and deficiency and serum magnesium levels among asthmatic patients and to correlate them with the severity of asthma. Materials and Methods. This is a cross-sectional case-control study which includes 60 patients of chronic stable asthma and 60 healthy controls. After taking clinical history and systemic examination, pulmonary function test was done. Serum levels of magnesium, 25-hydroxycholecalciferol [25(OH)D], and calcium were measured in all the subjects. Results. Significant correlation was found between vitamin D deficiency, hypomagnesemia, and asthma severity. Serum calcium levels were unaffected by that. Conclusion. Vitamin D and serum magnesium deficiency are highly prevalent in patients with asthma. Increased asthma severity, frequency of attacks, and exacerbation are associated with lower levels of one or both. Serum 25(OH)D and magnesium levels may serve as important markers of asthma severity.

  3. Serum Magnesium and Vitamin D Levels as Indicators of Asthma Severity

    Directory of Open Access Journals (Sweden)

    Mohammed Nadeem Shaikh

    2016-01-01

    Full Text Available Background. Serum magnesium levels affect the concentration of circulating vitamin D in blood and subsequently it affects the immunity; thus it plays significant role in the pathogenesis of asthma. Asthma, in adults, is less studied and hypomagnesemia along with vitamin D deficiency and insufficiency is common in asthmatic individuals, which causes frequent asthma attacks, respiratory infections, severe exacerbations, and poor response to bronchodilators. Objective. To detect the magnitude of vitamin D insufficiency and deficiency and serum magnesium levels among asthmatic patients and to correlate them with the severity of asthma. Materials and Methods. This is a cross-sectional case-control study which includes 60 patients of chronic stable asthma and 60 healthy controls. After taking clinical history and systemic examination, pulmonary function test was done. Serum levels of magnesium, 25-hydroxycholecalciferol [25(OHD], and calcium were measured in all the subjects. Results. Significant correlation was found between vitamin D deficiency, hypomagnesemia, and asthma severity. Serum calcium levels were unaffected by that. Conclusion. Vitamin D and serum magnesium deficiency are highly prevalent in patients with asthma. Increased asthma severity, frequency of attacks, and exacerbation are associated with lower levels of one or both. Serum 25(OHD and magnesium levels may serve as important markers of asthma severity.

  4. Viruses and bacteria in acute asthma exacerbations - A GA(2) LEN-DARE* systematic review

    DEFF Research Database (Denmark)

    Papadopoulos, N G; Christodoulou, I; Rohde, G

    2011-01-01

    and bacteria in acute asthma exacerbations - A GA(2) LEN-DARE systematic review. Allergy 2010; DOI: 10.1111/j.1398-9995.2010.02505.x. ABSTRACT: A major part of the burden of asthma is caused by acute exacerbations. Exacerbations have been strongly and consistently associated with respiratory infections...... and sensitive methodologies. This systematic review summarizes current knowledge and developments in infection epidemiology of acute asthma in children and adults, describing the known impact for each individual agent and highlighting knowledge gaps. Among infectious agents, human rhinoviruses are the most...... prevalent in regard to asthma exacerbations. The newly identified type-C rhinoviruses may prove to be particularly relevant. Respiratory syncytial virus and metapneumovirus are important in infants, while influenza viruses seem to induce severe exacerbations mostly in adults. Other agents are relatively...

  5. Lower prevalence and greater severity of asthma in hot and dry climate.

    Science.gov (United States)

    Correia Junior, Marco Aurélio de Valois; Sarinho, Emanuel Sávio Cavalcanti; Rizzo, José Angelo; Sarinho, Silvia Wanick

    To estimate asthma prevalence, severity, and associated factors in adolescents who live in a low relative humidity environment. In this cross-sectional study, adolescents aged 13-14 years from the city of Petrolina located in the Brazilian semiarid region answered the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The possible explanatory variables of the study were gender, family income, mother's education, smokers in the household, parental history of asthma, personal history of allergic rhinitis or atopic dermatitis, and physical activity level. Poisson regression analysis was used to assess the association between asthma and the explanatory variables. A total of 1591 adolescents participated in the study, of whom 49.7% were male. The prevalence of active asthma, severe asthma, and physician-diagnosed asthma were 14.0%, 10.4%, and 17.8%, respectively. Adolescents with asthma missed more school days than their peers (33 vs. 22 days/year; p<0.03). Associated factors that remained significant after adjustment were history of asthma in parents (PR=2.65, p<0.001) and personal diagnosis of allergic rhinitis (PR=1.96, p<0.001) and/or atopic dermatitis (PR=2.18, p<0.001). Asthma prevalence in this low-humidity environment was lower, but more severe than those reported in other Brazilian cities. The dry climate might hamper disease control and this may have contributed to the higher school absenteeism observed. The association of asthma with allergic rhinitis and atopic dermatitis as well as a history of asthma in parents suggests that atopy is an important risk factor for asthma in this population. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  6. Are operating room nurses at higher risk of severe persistent asthma? The Nurses' Health Study.

    NARCIS (Netherlands)

    Moual, N. le; Varraso, R.; Zock, J.P.; Henneberger, P.; Speizer, F.E.; Kauffmann, F.; Camargo, C.A.

    2013-01-01

    Objective: To assess the associations between operating room (OR) nursing, a category of health care workers at high risk of exposure to various inhaled agents, and asthma severity/control among women with asthma. Methods: The level of severity/control in nurses with prevalent doctor-diagnosed

  7. Sputum neutrophil counts are associated with more severe asthma phenotypes using cluster analysis.

    Science.gov (United States)

    Moore, Wendy C; Hastie, Annette T; Li, Xingnan; Li, Huashi; Busse, William W; Jarjour, Nizar N; Wenzel, Sally E; Peters, Stephen P; Meyers, Deborah A; Bleecker, Eugene R

    2014-06-01

    Clinical cluster analysis from the Severe Asthma Research Program (SARP) identified 5 asthma subphenotypes that represent the severity spectrum of early-onset allergic asthma, late-onset severe asthma, and severe asthma with chronic obstructive pulmonary disease characteristics. Analysis of induced sputum from a subset of SARP subjects showed 4 sputum inflammatory cellular patterns. Subjects with concurrent increases in eosinophil (≥2%) and neutrophil (≥40%) percentages had characteristics of very severe asthma. To better understand interactions between inflammation and clinical subphenotypes, we integrated inflammatory cellular measures and clinical variables in a new cluster analysis. Participants in SARP who underwent sputum induction at 3 clinical sites were included in this analysis (n = 423). Fifteen variables, including clinical characteristics and blood and sputum inflammatory cell assessments, were selected using factor analysis for unsupervised cluster analysis. Four phenotypic clusters were identified. Cluster A (n = 132) and B (n = 127) subjects had mild-to-moderate early-onset allergic asthma with paucigranulocytic or eosinophilic sputum inflammatory cell patterns. In contrast, these inflammatory patterns were present in only 7% of cluster C (n = 117) and D (n = 47) subjects who had moderate-to-severe asthma with frequent health care use despite treatment with high doses of inhaled or oral corticosteroids and, in cluster D, reduced lung function. The majority of these subjects (>83%) had sputum neutrophilia either alone or with concurrent sputum eosinophilia. Baseline lung function and sputum neutrophil percentages were the most important variables determining cluster assignment. This multivariate approach identified 4 asthma subphenotypes representing the severity spectrum from mild-to-moderate allergic asthma with minimal or eosinophil-predominant sputum inflammation to moderate-to-severe asthma with neutrophil-predominant or mixed granulocytic

  8. Sputum neutrophils are associated with more severe asthma phenotypes using cluster analysis

    Science.gov (United States)

    Moore, Wendy C.; Hastie, Annette T.; Li, Xingnan; Li, Huashi; Busse, William W.; Jarjour, Nizar N.; Wenzel, Sally E.; Peters, Stephen P.; Meyers, Deborah A.; Bleecker, Eugene R.

    2013-01-01

    Background Clinical cluster analysis from the Severe Asthma Research Program (SARP) identified five asthma subphenotypes that represent the severity spectrum of early onset allergic asthma, late onset severe asthma and severe asthma with COPD characteristics. Analysis of induced sputum from a subset of SARP subjects showed four sputum inflammatory cellular patterns. Subjects with concurrent increases in eosinophils (≥2%) and neutrophils (≥40%) had characteristics of very severe asthma. Objective To better understand interactions between inflammation and clinical subphenotypes we integrated inflammatory cellular measures and clinical variables in a new cluster analysis. Methods Participants in SARP at three clinical sites who underwent sputum induction were included in this analysis (n=423). Fifteen variables including clinical characteristics and blood and sputum inflammatory cell assessments were selected by factor analysis for unsupervised cluster analysis. Results Four phenotypic clusters were identified. Cluster A (n=132) and B (n=127) subjects had mild-moderate early onset allergic asthma with paucigranulocytic or eosinophilic sputum inflammatory cell patterns. In contrast, these inflammatory patterns were present in only 7% of Cluster C (n=117) and D (n=47) subjects who had moderate-severe asthma with frequent health care utilization despite treatment with high doses of inhaled or oral corticosteroids, and in Cluster D, reduced lung function. The majority these subjects (>83%) had sputum neutrophilia either alone or with concurrent sputum eosinophilia. Baseline lung function and sputum neutrophils were the most important variables determining cluster assignment. Conclusion This multivariate approach identified four asthma subphenotypes representing the severity spectrum from mild-moderate allergic asthma with minimal or eosinophilic predominant sputum inflammation to moderate-severe asthma with neutrophilic predominant or mixed granulocytic inflammation

  9. Effects of vitamin D levels on asthma control and severity in pre-school children.

    Science.gov (United States)

    Turkeli, A; Ayaz, O; Uncu, A; Ozhan, B; Bas, V N; Tufan, A K; Yilmaz, O; Yuksel, H

    2016-01-01

    Prevalence of asthma and vitamin D deficiency has been increasing and leading to significant morbidities. This study aimed to compare the vitamin D levels in the pre-school children with asthma and in healthy controls and to assess the relationship between vitamin D levels and asthma clinical parameters and control. Vitamin D [25(OH)D3] levels were measured in 102 pre-school children, aged 1-4 years with asthma and 102 healthy controls in winter. The patients with asthma were grouped according to serum vitamin D levels as sufficient, insufficient and deficient. Asthma control was classified according to the Global Initiative for Asthma (GINA) guidelines and the Test for Respiratory and Asthma Control in Kids (TRACK) in 1-4 years-old children. Serum vitamin D levels were 22.64 (9.96) ng/ml in the asthma group and 32.11 (14.74) ng/ml in the control group (p = 0.001). Total number of exacerbations during the previous year were significantly lower in the vitamin D sufficient group, compared to the deficient and insufficient groups (p = 0.03). Frequency of patients with controlled asthma was higher in the sufficient group compared to the deficient and insufficient groups (p = 0.001 and p = 0.001, respectively). There was a positive correlation between serum vitamin D levels and asthma control. The frequency of vitamin D deficiency and insufficiency was higher in children with asthma, compared to the controls. Therefore, we suggest that lower levels of vitamin D are associated with poor asthma control and increased asthma severity.

  10. Association of Body Mass Index with Asthma Severity and Pulmonary Function among Asthmatic Children

    Directory of Open Access Journals (Sweden)

    Rasuol Nasiri Kalmarzi

    2016-09-01

    Full Text Available Background Asthma is a chronic inflammatory disease in respiratory system and obesity is another inflammatory disease which incidence rate is increasing. Although, many studies have been conducted on severity of asthma and its relationship with obesity, but different results have been obtained. This study aimed to determine a relationship between asthma severity, Body Mass Index (BMI and pulmonary function in Kurdistan province, Iran. Materials and Methods: In this cross sectional study 90 asthmatic patients referred to referral hospital in Kurdistan, North West of Iran, were selected by simple random method. BMI was calculated by dividing weight by height.Pulmonary Function Test (PFT and bronchial-stimulation-test were used for confirmation and investigation of asthma severity. Data were analyzed using SPSS-15 and Chi-square and spearman correlation coefficient tests. Results: Relationship between BMI and severity of asthma (mild, medium and severe was evaluated, there was a relationship and positive relationship between them (P

  11. Asthma

    Science.gov (United States)

    ... their experiences with clinical research. More Information Related Health Topics Cough How the Lungs Work Oxygen Therapy Pulmonary Function Tests Other Resources NHLBI Resources "Asthma Action Plan" "Asthma and Physical Activity in the School" "At-A-Glance: Asthma" "How Asthma-Friendly Is ...

  12. Psychopathology in patients with severe asthma is associated with increased health care utilization.

    Science.gov (United States)

    ten Brinke, A; Ouwerkerk, M E; Zwinderman, A H; Spinhoven, P; Bel, E H

    2001-04-01

    Severe asthma accounts for the majority of health costs for this disease, which is mainly related to the treatment of failed control. Several psychosocial factors have been associated with poor asthma control, but the question remains whether psychiatric disorder in patients with severe asthma predisposes for increased health care utilization. In the present study we compared outpatients with severe asthma with and without psychological dysfunctioning with respect to health care utilization. All patients used high dose inhaled corticosteroids and long-acting bronchodilators for more than 1 yr, and had difficult-to-control asthma, requiring one or more courses of corticosteroids during the past year or maintenance therapy with prednisone. Medical history was taken and health care utilization questionnaires were completed. The General Health Questionnaire (GHQ) was used to identify psychiatric cases (GHQ-12 score of > or = 6). There were no differences between the psychiatric cases (n = 21) and the noncases (n = 77) with respect to demographic and objective disease characteristics. However, the psychiatric cases had increased odds ratios (OR) for frequent visits to GP (OR = 5.9), frequent emergency visits (OR = 5.3), frequent exacerbations (OR = 12.4), and frequent hospitalizations (OR = 4.8) as compared with the nonpsychiatric patients. The present findings suggest that the morbidity and costs of asthma might be related to the level of psychological dysfunctioning in patients with severe asthma rather than to asthma severity per se, thereby identifying an area of potential intervention.

  13. Association between severe asthma and changes in the stomatognathic system

    National Research Council Canada - National Science Library

    Carvalho-Oliveira, Mayra; Salles, Cristina; Terse, Regina; D'Oliveira Júnior, Argemiro

    2016-01-01

    .... Regardless of the level of asthma control, the most frequent changes found after evaluation of muscle function were difficulty in chewing, oronasal breathing pattern, below-average or poor dental...

  14. The dark side of the moon: severe therapy-resistant asthma in children.

    Science.gov (United States)

    de Benedictis, F M; Carloni, I; Bush, A

    2012-06-01

    Problematic severe asthma is the term used to describe children whose asthma is not responsive to standard therapy with high-dose inhaled corticosteroids and additional controllers. These children need to be assessed by a step-wise systematic protocol in order to confirm the diagnosis, evaluate co-morbidities, assess the adherence to treatment, and finally evaluate the basic management. More than half of these children have "difficult-to-treat asthma", which improves if the basic management is correct. Children whose asthma remains uncontrolled despite resolution of any reversible factors are termed "severe therapy-resistant" asthmatics; for them, an individualised treatment plan is developed after a detailed and invasive protocol of investigation. Therapeutic options for these patients can be divided into medications used in lower doses for children with less severe asthma, and those used in other pediatric diseases but not for asthma. Most treatments are unlicensed and there is a lack of high-quality evidence. Children with recurrent severe exacerbations, in particular in the context of good baseline asthma control, are particularly difficult to treat, and there is no evidence on which therapeutic option to recommend. International collaborations, using standard protocols of investigation, are needed to better understand mechanisms of severe therapy-resistant asthma and to deliver evidence-based treatments in the future.

  15. Review of the management of childhood asthma in Tasmania.

    Science.gov (United States)

    Bereznicki, Bonnie J; Norton, Lucy C; Beggs, Sean A; Gee, Peter; Bereznicki, Luke R E

    2013-08-01

    To review the supply of medications to children with asthma and parent-reported management of childhood asthma in Tasmania and highlight evidence-practice gaps for future interventions. Participating pharmacies ran a software application that extracted data from dispensing records and helped to identify children with asthma. Parents of identified children were mailed a survey evaluating components of asthma management. Dispensing and survey data were analysed. A total of 939 children from 23 pharmacies were identified by the software and deemed eligible for inclusion. Surveys were received from 353 (37.6%) parents. In the past year, short-acting beta-2 agonists were supplied to 56.1% of the cohort, preventers to 76.5% (inhaled corticosteroids 52.3%; leukotriene receptor antagonists 31.3%; inhaled cromones 0.6%), long-acting beta-2 agonists (LABAs) to 25.7% and oral corticosteroids to 21.5%. Approximately half of the children receiving inhaled corticosteroids were concurrently receiving a LABA. Among children with indicators of inadequately controlled asthma, up to 73.7% of their parents reported that their asthma was adequately controlled, up to 38.2% did not possess an Asthma Action Plan, up to 36.8% were not regularly using a spacer and up to 22.8% had not received a preventer. These results indicate gaps in childhood asthma management, in particular, undersupply of preventers in high-risk patient groups, high supply of LABAs and insufficient spacer and asthma action plan usage. These areas should be targeted for interventions to improve childhood asthma management. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  16. Obesity and Asthma

    DEFF Research Database (Denmark)

    Juel, Caroline Trunk-Black; Ulrik, Charlotte Suppli

    2013-01-01

    Asthma is more prevalent in obese compared with normal weight subjects. Our aim has been to review current knowledge of the impact of obesity on asthma severity, asthma control, and response to therapy.Several studies have shown that overweight and obesity is associated with more severe asthma...... and impaired quality of life compared with normal weight individuals. Furthermore, obesity is associated with poorer asthma control, as assessed by asthma control questionnaires, limitations in daily activities, breathlessness and wheezing, use of rescue medication, unscheduled doctor visits, emergency...... department visits, and hospitalizations for acute asthma. Studies of the impact of a high body mass index (BMI) on response to asthma therapy have, however, revealed conflicting results. Most studies show that overweight and obesity is associated with less favorable response to asthma therapy with regard...

  17. Association of Serum Vitamin D with Asthma and Atopy in Childhood: Review of Epidemiological Observational Studies.

    Science.gov (United States)

    Kolokotroni, Ourania; Middleton, Nicos; Kouta, Christiana; Raftopoulos, Vasilios; Yiallouros, Panayiotis K

    2015-01-01

    During the last decades, vitamin D deficiency has re-emerged worldwide affecting not only population's bone health, but also several other conditions including asthma and allergies. Increasing number of published epidemiological studies in the last seven years have examined the role of vitamin D deficiency in childhood in several outcomes including asthma diagnosis, asthma disease severity, allergic sensitization and atopy. This review presents evidence on this association from a systematic search in the literature of all available observational studies and their limitations. A total of 33 studies were identified: 3 prospective, 16 case-control and 14 cross-sectional studies. Overall, most of the case-control studies tend to report that asthmatics have lower vitamin D levels/status as compared to healthy children, although most of these studies are mainly descriptive in nature and tend to provide only crude, unadjusted comparisons. Studies that investigated the association of vitamin D with the prevalence, development and/or severity of asthma gave mixed findings, with the exception of studies that focused on vitamin D and severity of asthma which suggest a positive association of vitamin D levels with better asthma control, reduced use of asthma medication, fewer asthma exacerbations and lower utilisation of health care facilities for urgent treatment. Insufficient evidence also exists for the association of inadequate vitamin D status with higher risk of atopic sensitization. The lack of adequate number of prospective studies, the variable definitions for case ascertainment, the wide age range of the participants, and commonly the inadequate control for confounders make inferences difficult. Future studies are needed with a prospective design and repeated measurements of vitamin D to provide critical information on the timing and dosage of future vitamin D supplementation interventions.

  18. Digital Asthma Self-Management Interventions: A Systematic Review

    OpenAIRE

    Morrison, Deborah; Wyke, Sally; Agur, Karolina; Cameron, Euan J; Docking, Robert I; MacKenzie, Alison M; McConnachie, Alex; Raghuvir, Vandana; Thomson, Neil C; Mair, Frances S.

    2014-01-01

    Background Many people with asthma tolerate symptoms and lifestyle limitations unnecessarily by not utilizing proven therapies. Better support for self-management is known to improve asthma control, and increasingly the Internet and other digital media are being used to deliver that support. Objective Our goal was to summarize current knowledge, evidenced through existing systematic reviews, of the effectiveness and implementation of digital self-management support for adults and children wit...

  19. Infection with Mycoplasma pneumoniae is not related to asthma control, asthma severity, and location of airway obstruction

    Science.gov (United States)

    Ansarin, Khalil; Abedi, Siavoush; Ghotaslou, Reza; Soroush, Mohammad Hossein; Ghabili, Kamyar; Chapman, Kenneth R

    2011-01-01

    Background Mycoplasma pneumoniae is an organism that reportedly has a strong relationship to asthma. However, asthma severity and location of airway obstruction have not been compared between asthmatic patients with and without evidence for remote mycoplasma infection. Objectives The aim of this research was to study the relationship between previous M. pneumoniae infections in asthmatic patients and presence of any predilection for the involvement of central or peripheral airways, the severity of the disease, and asthma control. Methods Sixty-two patients with asthma were assessed by a validated asthma control test (ACT). All patients underwent spirometry and lung volume studies by body plethysmography. The forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), total lung capacity (TLC), residual volume (RV), and functional residual capacity (FRC) were measured. An oropharyngeal swab was obtained for polymerase chain reaction analysis to detect the mycoplasma antigen. Moreover, blood samples were obtained to measure the titration of antimycoplasma immunoglobulin M (IgM) and IgG antibodies. The asthmatic patients with a positive IgG for mycoplasma and negative PCR and negative IgM antibody were considered to have remote history of mycoplasma infection. The relationship between the asthma control using ACT score and pulmonary function variables were compared in patients with and without evidence for remote mycoplasma infection. Results The incidence of postnasal drip was higher among the patients with asthma who had no evidence for remote mycoplasma infection (61.3% vs 32%, P = 0.035). The median ACT score was 16.5 (11–22) and 20 (13.75–24) in patients with and without remote M. pneumoniae infection, respectively (P > 0.05). In addition, the medians of the predicted values of the pulmonary function test parameters (FEV1, FEV1/FVC, FRC, FRC/TLC, RV/TLC, maximal mean expiratory flow 25%–75%, forced expiratory flow [FEF] 50%, and FEF 75%) and

  20. Asthma associated with the use of cocaine, heroin, and marijuana: A review of the evidence.

    Science.gov (United States)

    Self, Timothy H; Shah, Samarth P; March, Katherine L; Sands, Christopher W

    2017-09-01

    A review of the evidence was conducted regarding asthma associated with the use of cocaine, heroin, and marijuana. A search of the English literature was performed via PubMed/Medline and EMBASE using the search terms asthma AND cocaine, heroin, and marijuana. When pertinent articles were found, salient references in those articles were assessed. Due to the relatively small number of studies, we included all studies and cases. For several decades, case reports, retrospective studies, and laboratory investigations have demonstrated that inhalation of cocaine or heroin is associated with increased asthma symptoms and reduced pulmonary function. Smoking crack cocaine, nasal insufflation of cocaine or heroin, and smoking heroin increases the risk of emergency department visits and hospitalizations for asthma. Although frequent smoking of marijuana may cause symptoms of cough, sputum production, and wheezing in the general population, more studies are needed specifically in patients with asthma. Smoking marijuana with concomitant tobacco use is common and further worsens the respiratory symptoms. Use of cocaine and heroin in patients with asthma should be avoided. Pending further studies, it would be prudent for patients with asthma to avoid smoking marijuana. Clinicians need to be vigilant regarding use of these drugs in their patients with hyperreactive airway disease.

  1. Bronchial thermoplasty : Long-term safety and effectiveness in patients with severe persistent asthma

    NARCIS (Netherlands)

    Wechsler, Michael E.; Laviolette, Michel; Rubin, Adalberto S.; Fiterman, Jussara; Silva, Jose R. Lapa e; Shah, Pallav L.; Fiss, Elie; Olivenstein, Ronald; Thomson, Neil C.; Niven, Robert M.; Pavord, Ian D.; Simoff, Michael; Hales, Jeff B.; McEvoy, Charlene; Slebos, Dirk-Jan; Holmes, Mark; Phillips, Martin J.; Erzurum, Serpil C.; Hanania, Nicola A.; Sumino, Kaharu; Kraft, Monica; Cox, Gerard; Sterman, Daniel H.; Hogarth, Kyle; Kline, Joel N.; Mansur, Adel H.; Louie, Brian E.; Leeds, William M.; Barbers, Richard G.; Austin, John H. M.; Shargill, Narinder S.; Quiring, John; Armstrong, Brian; Castro, Mario

    2013-01-01

    Background: Bronchial thermoplasty (BT) has previously been shown to improve asthma control out to 2 years in patients with severe persistent asthma. Objective: We sought to assess the effectiveness and safety of BT in asthmatic patients 5 years after therapy. Methods: BT-treated subjects from the

  2. 25-Hydroxyvitamin D3-deficiency enhances oxidative stress and corticosteroid resistance in severe asthma exacerbation.

    Directory of Open Access Journals (Sweden)

    Nan Lan

    Full Text Available Oxidative stress plays a significant role in exacerbation of asthma. The role of vitamin D in oxidative stress and asthma exacerbation remains unclear. We aimed to determine the relationship between vitamin D status and oxidative stress in asthma exacerbation. Severe asthma exacerbation patients with 25-hydroxyvitamin D3-deficiency (V-D deficiency or 25-hydroxyvitamin D-sufficiency (V-D sufficiency were enrolled. Severe asthma exacerbation with V-D-deficiency showed lower forced expiratory volume in one second (FEV1 compared to that with V-D-sufficiency. V-D-deficiency intensified ROS release and DNA damage and increased TNF-α, OGG1 and NFκB expression and NFκB phosphorylation in severe asthma exacerbation. Supplemental vitamin D3 significantly increased the rates of FEV1 change and decreased ROS and DNA damage in V-D-deficiency. Vitamin D3 inhibited LPS-induced ROS and DNA damage and were associated with a decline in TNF-α and NFκB in epithelial cells. H2O2 reduces nuclear translocation of glucocorticoid receptors in airway epithelial cell lines. V-D pretreatment enhanced the dexamethasone-induced nuclear translocation of glucocorticoid receptors in airway epithelial cell lines and monocytes from 25-hydroxyvitamin D3-deficiency asthma patients. These findings indicate that V-D deficiency aggravates oxidative stress and DNA damage, suggesting a possible mechanism for corticosteroid resistance in severe asthma exacerbation.

  3. Trend in asthma severity in steroid naive asthmatic children in Benin ...

    African Journals Online (AJOL)

    2012-10-18

    Oct 18, 2012 ... Of all these, corticosteroids have been used worldwide for the treatment of both chronic asthma. Trend in asthma severity in steroid naive asthmatic children in Benin city, Nigeria. O Oviawe, WO Osarogiagbon. Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.

  4. Sputum transcriptomics reveal upregulation of IL-1 receptor family members in patients with severe asthma

    NARCIS (Netherlands)

    Rossios, Christos; Pavlidis, Stelios; Hoda, Uruj; Kuo, Chih-Hsi; Wiegman, Coen; Russell, Kirsty; Sun, Kai; Loza, Matthew J.; Baribaud, Frederic; Durham, Andrew L.; Ojo, Oluwaseun; Lutter, Rene; Rowe, Anthony; Bansal, Aruna; Auffray, Charles; Sousa, Ana; Corfield, Julie; Djukanovic, Ratko; Guo, Yike; Sterk, Peter J.; Chung, Kian Fan; Adcock, Ian M.

    2018-01-01

    Sputum analysis in asthmatic patients is used to define airway inflammatory processes and might guide therapy. We sought to determine differential gene and protein expression in sputum samples from patients with severe asthma (SA) compared with nonsmoking patients with mild/moderate asthma. Induced

  5. Elevation of serum soluble E-selectin and VCAM-1 in severe asthma

    Directory of Open Access Journals (Sweden)

    Agnes Hamzaoui

    2001-01-01

    Full Text Available Objective: To investigate the significance of circulating adhesion molecules associated with leucocyteendothelial cell interactions in asthma, serum levels of soluble E (sE-selectin, soluble P (sP-selectin, soluble L (sL-selectin, and soluble vascular cell adhesion molecule-1 (sVCAM-1 were measured in mild, moderate and severe asthma.

  6. Azithromycin for prevention of exacerbations in severe asthma (AZISAST): A multicentre randomised double-blind placebo-controlled trial

    NARCIS (Netherlands)

    G.G. Brusselle (Guy); C. VanderStichele (Christine); P. Jordens (Paul); R. Deman (René); H. Slabbynck (Hans); V. Ringoet (Veerle); G. Verleden (Geert); I.K. Demedts (Ingel); K.M.C. Verhamme (Katia); A. Delporte (Anja); B. Demeyere (Bénédicte); T. Claeys (Tine); J. Boelens (Jerina); E. Padalko (Elizaveta); J. Verschakelen (Johny); G. van Maele (Georges); E. Deschepper (Ellen); G.F. Joos (Guy)

    2013-01-01

    markdownabstract__Background:__ Patients with severe asthma are at increased risk of exacerbations and lower respiratory tract infections (LRTI). Severe asthma is heterogeneous, encompassing eosinophilic and non-eosinophilic (mainly neutrophilic) phenotypes. Patients with neutropilic airway diseases

  7. Asthma and chronic obstructive pulmonary disease overlap syndrome (ACOS): structured literature review and physician insights.

    Science.gov (United States)

    Ding, B; Enstone, A

    2016-01-01

    To understand the key characteristics of Asthma and Chronic Obstructive Pulmonary Disease Overlap Syndrome (ACOS) and to identify evidence gaps relating to the identification, treatment and management of ACOS patients. A structured literature review and 1-hour telephone interviews with specialist respiratory physicians were conducted (n=10; China, France, Germany, Japan and the USA). All 10 physicians used the term ACOS in clinical practice. ACOS was not clearly defined in the literature. Prevalence of ACOS among adult patients with COPD or asthma ranged from 12-55%. ACOS patients had severe disease, with increased exacerbations and hospitalisations compared to some asthma and COPD patients. ACOS represented a clinical challenge due to a lack of evidence-based guidelines distinguishing between asthma, COPD and ACOS. Published data quantifying ACOS costs were limited. There is a need for consensus evidence-based guidance to facilitate earlier diagnosis and to optimise the management of ACOS patients.

  8. Vitamin D as an adjunctive therapy in asthma. Part 2: A review of human studies.

    LENUS (Irish Health Repository)

    Kerley, Conor P

    2015-03-05

    Vitamin D deficiency (VDD) is highly prevalent worldwide, with adverse effects on bone health but also potentially other unfavorable consequences. VDD and asthma-incidence\\/severity share many common risk factors, including winter season, industrialization, poor diet, obesity, dark skin pigmentation, and high latitude. Multiple anatomical areas relevant to asthma contain both the enzyme responsible for producing activated vitamin D and the vitamin D receptor suggesting that activated vitamin D (1,25-dihydroxyvitamin D) may have important local effects at these sites. Emerging evidence suggests that VDD is associated with increased airway hyperresponsiveness, decreased pulmonary function, worse asthma control, and possibly decreased response to standard anti-asthma therapy. However the effect is inconsistent with preliminary evidence from different studies suggesting vitamin D is both beneficial and detrimental to asthma genesis and severity. Current evidence suggests that supplementation with moderate doses of vitamin D may be appropriate for maintenance of bone health in asthmatics, particularly steroid users. However emerging data from an increasing number of randomized, controlled, intervention studies of vitamin D supplementation in pediatric and adult asthma are becoming available and should help determine the importance, if any of vitamin D for asthma pathogenesis. The purpose of this second of a two-part review is to review the current human literature on vitamin D and asthma, discussing the possible consequences of VDD for asthma and the potential for vitamin D repletion as adjunct therapy.

  9. Investigation of asthma comorbidity in children with different severities of allergic rhinitis.

    Science.gov (United States)

    Dogru, Mahmut

    2016-05-01

    Allergic rhinitis (AR) and asthma comorbidity is widely seen. However, the effects of AR on asthma are more likely to be studied in the literature. To investigate the prevalence of asthma in children with AR who are followed-up and to evaluate the effect of asthma on the severity of AR. A total of 509 children with AR who were followed-up in the pediatric allergy-immunology department between January 2012 and December 2013 were enrolled in the study. Asthma and AR are diagnosed by using the Global Initiative for Asthma and the Allergic Rhinitis and its Impact on Asthma, respectively. The patients were categorized into two groups according to the presence of asthma. The two groups were compared according to sociodemographic characteristics, clinical features, and laboratory findings. Skin-prick test results, serum immunoglobulin E levels, and the percentage of eosinophils of the patients were evaluated. A total of 299 of the patients were boys (58.7%) the mean age was 7.2 ± 3.5 years (range, 1.5-18 years). Patients with moderate-severe persistent rhinitis (40.5% of all patients) were the most common rhinitis subgroup. Mild intermittent rhinitis was diagnosed in 17.7%, mild persistent rhinitis in 11.2%, and moderate-severe intermittent rhinitis in 30.6% of the patients. Two hundred seventy-one children with AR (53.2%) also had concomitant asthma. The patients were categorized into two groups: AR-asthma comorbidity group (group I) and AR-only group (group II). There was no significant difference between these two groups when compared with the sex, age, familial atopy, exposure to smoke, and severity of AR (p > 0.05). The duration of illness, immunoglobulin E levels, number of positive sensitivity, sensitivity to house-dust mites, sensitivity to cockroaches, and polysensitization were significantly higher in the AR-asthma comorbidity group (p < 0.05). This study showed that asthma comorbidity had no effect on the severity of AR. However, it was also shown that the

  10. Increased body mass index predicts severity of asthma symptoms but not objective asthma traits in a large sample of asthmatics

    DEFF Research Database (Denmark)

    Bildstrup, Line; Backer, Vibeke; Thomsen, Simon Francis

    2015-01-01

    AIM: To examine the relationship between body mass index (BMI) and different indicators of asthma severity in a large community-based sample of Danish adolescents and adults. METHODS: A total of 1186 subjects, 14-44 years of age, who in a screening questionnaire had reported a history of airway...

  11. Patient profiles and clinical utility of mepolizumab in severe eosinophilic asthma

    Directory of Open Access Journals (Sweden)

    Haldar P

    2017-06-01

    Full Text Available Pranabashis Haldar Respiratory Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester, UK Abstract: Mepolizumab (Nucala® is an effective and specific anti-eosinophil molecular therapy that has recently been approved as add-on therapy for the management of severe eosinophilic asthma by the US Food and Drug Administration (FDA, European Medicines Agency (EMA; European Union and more recently National Institute for Health and Care Excellence (NICE; UK. It is one of several molecular therapies in development for this indication and is illustrative of the strategic trajectory for pharmaceutical drug development taken over the past decade in several disease areas. Molecular therapies offer the prospect of improved specificity and effectiveness of biological effect. However, this necessitates a clear understanding of the underlying mechanistic pathways underpinning pathological processes, to inform drug development that yields novel more efficacious treatment options with a better clinical profile than existing agents. For the first time, utilization of molecular therapies in clinical trials is providing a novel in vivo model to characterize the association between specific pathways and clinical disease expression. It is increasingly recognized that asthma exhibits both clinical and pathological heterogeneity. It follows that a one-size-fits-all approach will not be appropriate and cost-effectiveness may only be achieved by identifying responder subgroups. This so-called personalized approach to therapy is being supported by the parallel development of companion biomarkers for clinical application. In this review, the author summarizes the clinical studies, their interpretation and the lessons learnt with mepolizumab that have informed our understanding of the approach to personalized molecular therapy in asthma. Keywords: IL-5, Nucala, exacerbations 

  12. Vitamin D deficiency and its impact on asthma severity in asthmatic children.

    Science.gov (United States)

    Esfandiar, Nasrin; Alaei, Fariba; Fallah, Shahrzad; Babaie, Delara; Sedghi, Niloofar

    2016-12-17

    Despite obtaining evidences on association between vitamin D and development of lung in fetus, little is known about vitamin D level and its impact on severity of asthma in children. The present study aimed to assess the relationship between the asthma severity and vitamin D deficiency in asthmatic children. This case-control study was conducted on 106 individuals including asthmatic (n = 53) and healthy children (n = 53) who referred to Mofid hospital in Tehran in 2013. The level of serum vitamin D in both groups was measured by radioimmunoassay method at the reference lab and was categorized as sufficient (> 30 ng/ml), insufficient (20 to 30 ng/ml), or deficient (asthma in patients group was classified as controlled, partially controlled, and uncontrolled. In the groups with and without asthma, the prevalence of vitamin D deficiency was 73.6 and 49.1%, and the prevalence of vitamin D insufficiency was 18.9 and 18.9%, while normal vitamin D level was revealed in 7.5 and 32.1%, respectively with a significant difference (p = 0.005). Using the multivariate logistic regression analysis, the presence of asthma was associated with reduced level of vitamin D (OR = 1.068, 95% CI: 1.027-1.110, P = 0.001). In this context, the risk for asthma in the children with vitamin D deficiency was 6.3 times of those with normal vitamin D level. Although the presence of asthma was strongly associated with reduced level of vitamin D in serum, neither severity of asthma nor control status of asthma were associated with vitamin D deficiency. The presence of vitamin D deficiency effectively predict increased risk for childhood asthma; however the severity or control status of this event may not be predicted by confirming vitamin D deficiency.

  13. Cohort Study of Severe Bronchiolitis during Infancy and Risk of Asthma by Age 5 Years.

    Science.gov (United States)

    Balekian, Diana S; Linnemann, Rachel W; Hasegawa, Kohei; Thadhani, Ravi; Camargo, Carlos A

    Severe bronchiolitis (ie, bronchiolitis requiring hospital admission) is thought to markedly increase asthma risk, with 30%-50% developing asthma by age 5 years. To date, studies of this association are small, and most are from outside the United States. The objective of this study was to investigate the association between severe bronchiolitis and risk of asthma in a US birth cohort. We studied a cohort nested within the Massachusetts General Hospital Obstetric Maternal Study (MOMS), a prospective cohort of pregnant women enrolled during 1998-2006. Children of mothers enrolled in MOMS were included in the analysis if they received care within our health system (n = 3653). Diagnoses and medications were extracted from the children's electronic health records; we also examined pregnancy and perinatal risk factors collected for the underlying pregnancy study. The birth cohort was 52% male, 49% white, and 105 infants (2.9%) had severe bronchiolitis. Overall, 421 children (11.5%) developed asthma by age 5 years. Among the children with severe bronchiolitis, 27.6% developed asthma by age 5 years. In multivariable logistic regression adjusting for 12 risk factors, severe bronchiolitis remained a strong risk factor for developing asthma by age 5 years (odds ratio 2.57; 95% confidence interval 1.61-4.09). In a large Boston birth cohort, the frequency of severe bronchiolitis and childhood asthma was similar to published data. Among children with severe bronchiolitis, the risk of developing asthma was lower than prior studies but still high (27.6%). This difference may be due to different study designs, populations, and outcome definitions studied. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  14. The Medical Home Model and Pediatric Asthma Symptom Severity: Evidence from a National Health Survey.

    Science.gov (United States)

    Rojanasarot, Sirikan; Carlson, Angeline M

    2017-08-14

    The objective was to investigate the association between receiving care under the medical home model and parental assessment of the severity of asthma symptoms. It was hypothesized that parents of children who received care under the medical home model reported less severe asthma symptoms compared with their counterparts, whose care did not meet the medical home criteria. Secondary analyses were conducted using cross-sectional data from the 2011-2012 National Survey of Children's Health. Children with asthma aged 0-17 years were included and classified as receiving care from the medical home if their care contained 5 components: a personal doctor, a usual source of sick care, family-centered care, no problems getting referrals, and effective care coordination. Ordinal logistic regression was used to examine the relationship between parent-rated severity of asthma symptoms (mild, moderate, and severe symptoms) and the medical home. Approximately 52% of 8229 children who reported having asthma received care from the medical home. Only 30.8% of children with severe asthma symptoms received care that met the medical home criteria, compared to 55.7% of children with mild symptoms. After accounting for confounding factors, obtaining care under the medical home model decreased the odds of parent-reported severe asthma symptoms by 31% (adjusted odds ratio 0.69; 95% CI, 0.56-0.85). Study results suggest that the medical home model can reduce parent-rated severity of asthma symptoms. The findings highlight the importance of providing medical home care to children with asthma to improve the outcomes that matter most to children and their families.

  15. Risk Factors Associated with Irreversible Airway Obstruction in Asthma: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Lanlan Zhang

    2016-01-01

    Full Text Available Irreversible airway obstruction (IAO is a subtype of asthma and relates to poorer prognosis in some asthma patients. However, the prevalence and risk factors for IAO are unknown. A systematic review regarding controlled clinical studies (cohort, case-control studies on IAO asthma in adult and/or children affected by asthma/early wheeze was performed. Eighteen papers were identified in this study. It was reported that the incidence of IAO at random effects or fixed effects in severe asthma and nonsevere asthma was 0.54 (95% CI: 0.45–0.62 and 0.16 (95% CI: 0.12–0.20, respectively. In IAO asthma, the pooled odds ratio (OR related to smoking exposure was 2.22 (95% CI: 1.82–2.73, the OR for male, smoking, and fractional exhaled nitric oxide (FENO was 2.22 (95% CI: 1.82–2.7, 1.79 (95% CI: 1.46–2.19, and 2.16 (95% CI: 1.05–4.43, respectively, suggesting these factors increase the risk of IAO. However, a decreased OR in IAO asthma was observed due to rhinitis (OR = 0.31, 95% CI: 0.24–0.40, atopy (OR = 0.584, 95% CI: 0.466–0.732, and atopic dermatitis (OR = 0.60, 95% CI: 0.42–0.85, indicating these factors are associated with reduced risk of IAO. IAO in asthma is associated with gender, smoking, FENO, rhinitis, atopy, and atopic dermatitis.

  16. ANTI-IGE THERAPY FOR SEVERE ASTHMA IN CHILDREN: TWO-YEAR TRIAL

    Directory of Open Access Journals (Sweden)

    T.Yu. Kulichenko

    2010-01-01

    Full Text Available The article summarizes a two-year experience of treating children and adolescents with severe uncontrolled atopic asthma using Omalizumab. This treatment facilitated to achieve full asthma control in 70% of patients and partial control in 30% of patients. Anti-Ig Etherapy contributes to reduce the frequency of asthma relapses 77%, and the number of those seeking emergency medical treatment, particularly no need for in-patient asthma care. Thanks to treatment, lung function parameters improve, particularly in children with low bronchial patency parameters even after administration of broncholytics. Thanks to treatment with omalizumab, the dosage of inhalant glucocorticosteroids is reduced 1.5 to 2.5 times in 75% patients. Treatment tolerance in all children is satisfactory, no serious adverse events associated with the medication or any system side effects are registered in patients. Anti-IgE therapy is a good alternative to use of high and ultra-high doses of inhalant glucocorticosteroids in children with severe atopic asthma. Key words: omalizumab, anti-IgE-antibodies, treatment-resistant asthma, atopic asthma, treatment, children, adolescents, asthma control. (Pediatric Pharmacology. – 2010; 7(3:57-65

  17. Cost-effectiveness analysis of a state funded programme for control of severe asthma

    Directory of Open Access Journals (Sweden)

    Loureiro Sebastião

    2007-05-01

    Full Text Available Abstract Background Asthma is one of the most common chronic diseases and a major economical burden to families and health systems. Whereas efficacy of current therapeutical options has been clearly established, cost-effectiveness analysis of public health interventions for asthma control are scarce. Methods 81 patients with severe asthma (12–75 years joining a programme in a reference clinic providing free asthma medication were asked retrospectively about costs and events in the previous 12 months. During 12 months after joining the programme, information on direct and indirect costs, asthma control by lung function, symptoms and quality of life were collected. The information obtained was used to estimate cost-effectiveness of the intervention as compared to usual public health asthma management. Sensitivity analysis was conducted. Results 64 patients concluded the study. During the 12-months follow-up within the programme, patients had 5 fewer days of hospitalization and 68 fewer visits to emergency/non scheduled medical visits per year, on average. Asthma control scores improved by 50% and quality of life by 74%. The annual saving in public resources was US$387 per patient. Family annual income increased US$512, and family costs were reduced by US$733. Conclusion A programme for control of severe asthma in a developing country can reduce morbidity, improve quality of life and save resources from the health system and patients families.

  18. Response to omalizumab in patients with severe allergic asthma

    DEFF Research Database (Denmark)

    Zierau, Louise; Walsted, Emil Schwarz; Thomsen, Simon Francis

    2017-01-01

    at a specialized outpatient asthma clinic were included. Change in GETE score, time to discontinuation of treatment and associated risk factors were analysed. RESULTS: As a result of omalizumab treatment, most patients improved in GETE score from poor/worsening to excellent. Women were treated for a median time...

  19. Sensitization to Ascaris lumbricoides and severity of childhood asthma in Costa Rica.

    Science.gov (United States)

    Hunninghake, Gary M; Soto-Quiros, Manuel E; Avila, Lydiana; Ly, Ngoc P; Liang, Catherine; Sylvia, Jody S; Klanderman, Barbara J; Silverman, Edwin K; Celedón, Juan C

    2007-03-01

    Little is known about sensitization (defined as a positive IgE) to helminths and disease severity in patients with asthma. To examine the relationship between sensitization (defined as a positive IgE) to Ascaris lumbricoides and measures of asthma morbidity and severity in a Costa Rican population with low prevalence of parasitic infection but high prevalence of parasitic exposure. Cross-sectional study of 439 children (ages 6 to 14 years) with asthma. Linear regression and logistic regression were used for the multivariate statistical analysis. After adjustment for parental education and other covariates, sensitization to Ascaris lumbricoides was associated with having at least 1 positive skin test to allergens (odds ratio, 5.15; 95% CI, 2.36-11.21; P < .001), increased total serum IgE and eosinophils in peripheral blood, reductions in FEV(1) and FEV(1)/forced vital capacity, increased airway responsiveness and bronchodilator responsiveness, and hospitalizations for asthma in the previous year (odds ratio, 3.08; 95% CI, 1.23-7.68; P = .02). Sensitization to Ascaris lumbricoides is associated with increased severity and morbidity of asthma among children in Costa Rica. This association is likely mediated by an increased degree of atopy among children with asthma who are sensitized to Ascaris. In areas with a low prevalence of helminthiasis such as Costa Rica, Ascaris sensitization may be an important marker of severe atopy and disease morbidity in children with asthma.

  20. Teenage use of GP care for moderate to severe asthma in Auckland, New Zealand.

    Science.gov (United States)

    Buetow, Stephen; Richards, Deborah; Mitchell, Ed A; Gribben, Barry; Adair, Vivienne; Coster, Gregor; Hight, Makere

    2005-07-15

    To describe and understand teenagers' frequency of attendance for General Practitioner (GP) care of moderate to severe asthma in the Auckland region. Ten Auckland schools identified 510 children aged 13-14 years with breathing problems, who were invited to complete a screening questionnaire. 271 children participated, of whom 114 had moderate to severe asthma. 39% of the 114 had made 0-1 GP visit for asthma, and 17% made 'greater than and equal to' 5 visits. Low attendees (0-1 visit) were disproportionately New Zealand European. High attendees ('greater than and equal to' 5 visits) tended to be Maori and/or Pacific Islanders. Half of the teenagers attended GP asthma care as often as it wanted, independently of ethnicity; 62% tell their parents when they cannot manage their asthma; and 29% must pay for GP care. Expected attendance was increased for Maori and Pacific students versus others by 77% (p=0002), and by asthma of increased severity (pNew Zealand Europeans) in this case, challenges whether such barriers persist, at least for acute care of moderate to severe asthma.

  1. Non invasive proportional assist ventilation in management of severe asthma exacerbation

    Directory of Open Access Journals (Sweden)

    Khaled Hussein

    2012-07-01

    Conclusion: NIV can relieve respiratory distress and improve gas exchange in the majority of patients with severe asthma exacerbation who are candidate for intubation after failure of conventional medical therapy.

  2. A systematic review of serious games in asthma education.

    Science.gov (United States)

    Drummond, David; Monnier, Delphine; Tesnière, Antoine; Hadchouel, Alice

    2017-05-01

    Serious games may be useful tools for asthma education. The objectives of this systematic review were to identify the available articles on serious games designed to educate patients and the general public about asthma and to assess their impact on patient's knowledge, behavior, and clinical outcomes related to asthma. PubMed, EMBASE, Cochrane Library, PsychInfo, and Web of Science were systematically searched from January 1980 to December 2015 for studies investigating serious games in asthma education. Two investigators independently assessed studies against inclusion criteria and rated those included on indicators of quality. Investigators extracted data on serious games' content and learning objectives, and on outcomes following Kirkpatrick classification. A total of 12 articles were found to be relevant, describing a total of 10 serious games. All serious games were directed toward children, with eight games for children with asthma and two for school-based intervention. The average Medical Education Research Study Quality Instrument score was 13.9 of 18, which is high. Most of the serious games were associated with high rates of satisfaction and improvement in children's knowledge. Seven studies evaluated the impact of serious games on clinical outcomes and found no significant difference relative to control groups. Although serious games designed for asthma education have evolved with advances in technology, results of their evaluation remained similar across studies, with clear improvements in knowledge but little or no change in behaviors and clinical outcomes. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma

    Directory of Open Access Journals (Sweden)

    Goh KJ

    2017-04-01

    Full Text Available Ken Junyang Goh,1 Anthony Chau Ang Yii,1,2 Therese Sophie Lapperre,1,2 Adrian KW Chan,1–3 Fook Tim Chew,4 Sanjay H Chotirmall,5,* Mariko Siyue Koh1–3,* 1Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 2Duke-National University of Singapore Medical School, 3Allergy Centre, Singapore General Hospital, 4Department of Biological Sciences, Faculty of Science, National University of Singapore, 5Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore *These authors contributed equally to this work Background: Severe asthma is a largely heterogeneous disease with varying phenotypic profiles. The relationship between specific allergen sensitization and asthma severity, particularly in Asia, remains unclear. We aim to study the prevalence of specific allergen sensitization patterns and investigate their association with outcomes in a severe asthma cohort in an Asian setting. Methods: We conducted a cross-sectional study of patients receiving step 4 or 5 Global Initiative for Asthma treatment. Univariate and multivariate analyses were performed to assess the association between sensitization to a specific identifiable allergen by skin prick test (SPT and uncontrolled asthma (defined in our study as the use of ≥2 steroid bursts or hospitalization in the past year, a history of near-fatal asthma or evidence of airflow obstruction on spirometry. Results: Two hundred and six severe asthma patients (mean age 45±17 years, 99 [48.1%] male were evaluated. Of them, 78.2% had a positive SPT to one or more allergens. The most common allergen to which patients were sensitized was house dust mites (Blomia tropicalis, Dermatophagoides pteronyssinus and Dermatophagoides farinae. Also, 11.7% were sensitized to Aspergillus species. On multivariate analysis, Aspergillus sensitization was associated with uncontrolled asthma (odds ratio 6.07, 95% confidence interval 1.80–20.51. In particular, Aspergillus

  4. Therapy with omalizumab for patients with severe allergic asthma improves asthma control and reduces overall healthcare costs.

    LENUS (Irish Health Repository)

    Costello, R W

    2012-02-01

    BACKGROUND: Patients with asthma who have persistent symptoms despite treatment with inhaled steroids and long-acting beta agonists are considered to have severe asthma. Omalizumab is a monoclonal antibody directed against IgE, which is used as an add-on treatment for patients who have severe persistent allergic asthma. AIMS: The aim of this study was to assess the clinical benefit and healthcare utilisation of patients who responded to omalizumab therapy and to establish an overall cost implication. METHODS: This was an observational retrospective cohort study designed to investigate the effect of omalizumab on exacerbations of asthma before and after 6 months of treatment in Irish patients. RESULTS: Centres who had treated patients with severe allergic asthma for the 6 months prior and post omalizumab treatment were audited with a standardised assessment tool. Sixty-three (32 male) patients were studied. In the 6 months prior to omalizumab 41 of 63 (66%) had been hospitalised, and this fell to 15 of 63 (24%), p < 0.0001 in the 6 months after treatment was started. Hospital admissions reduced from 2.4 +\\/- 0.41 to 0.8 +\\/- 0.37 and the mean number of bed days occupied was reduced from 16.6 +\\/- 2.94 to 5.3 +\\/- 2.57 days, p < 0.001. The number of oral corticosteroid doses used fell from 3.1 +\\/- 0.27 to 1.2 +\\/- 0.17, p < 0.001. The overall cost saving per omalizumab responder patients for 6 months was 834. CONCLUSIONS: Six months therapy with omalizumab reduced the number of bed days, the number of hospitalisations and the use of oral corticosteroids compared to the 6 months prior to commencement. Despite the cost of the additional therapy there were overall savings in health costs.

  5. Folate Deficiency, Atopy, and Severe Asthma Exacerbations in Puerto Rican Children.

    Science.gov (United States)

    Blatter, Joshua; Brehm, John M; Sordillo, Joanne; Forno, Erick; Boutaoui, Nadia; Acosta-Pérez, Edna; Alvarez, María; Colón-Semidey, Angel; Weiss, Scott T; Litonjua, Augusto A; Canino, Glorisa; Celedón, Juan C

    2016-02-01

    Little is known about folate and atopy or severe asthma exacerbations. We examined whether folate deficiency is associated with number of positive skin tests to allergens or severe asthma exacerbations in a high-risk population and further assessed whether such association is explained or modified by vitamin D status. Cross-sectional study of 582 children aged 6 to 14 years with (n = 304) and without (n = 278) asthma in San Juan, Puerto Rico. Folate deficiency was defined as plasma folate less than or equal to 20 ng/ml. Our outcomes were the number of positive skin tests to allergens (range, 0-15) in all children and (in children with asthma) one or more severe exacerbations in the previous year. Logistic and negative binomial regression models were used for the multivariate analysis. All multivariate models were adjusted for age, sex, household income, residential proximity to a major road, and (for atopy) case/control status; those for severe exacerbations were also adjusted for use of inhaled corticosteroids and vitamin D insufficiency (a plasma 25[OH]D atopy and 2.2 times increased odds of at least one severe asthma exacerbation (95% confidence interval for odds ratio, 1.1-4.6). Compared with children who had normal levels of both folate and vitamin D, those with both folate deficiency and vitamin D insufficiency had nearly eightfold increased odds of one or more severe asthma exacerbation (95% confidence interval for adjusted odds ratio, 2.7-21.6). Folate deficiency is associated with increased degree of atopy and severe asthma exacerbations in school-aged Puerto Ricans. Vitamin D insufficiency may further increase detrimental effects of folate deficiency on severe asthma exacerbations.

  6. Effectiveness of omalizumab in reducing corticosteroid burden in patients with moderate to severe persistent allergic asthma.

    Science.gov (United States)

    Karpel, Jill; Massanari, Marc; Geba, Gregory P; Kianifard, Farid; Inhaber, Neil; Zeldin, Robert K

    2010-12-01

    Asthma guidelines advocate maintaining asthma control while minimizing corticosteroid exposure. To assess the reduction in corticosteroid burden during long-term treatment and the corresponding impact of this reduction on asthma control, lung function, and inflammation in patients with moderate to severe allergic asthma. We conducted a pooled analysis (N = 1,071) of 2 similarly designed, randomized, double-blind, placebo-controlled omalizumab trials and their extension phases. Each study included a 16-week steroid-stable phase, a 12-week steroid-reduction phase, and a 24-week extension phase. Patients received subcutaneous omalizumab (minimum, 0.016 mg/kg/IU (IgE/mL) every 4 weeks) or placebo every 2 or 4 weeks. Outcomes included change from baseline in inhaled corticosteroid dose, number of oral corticosteroid bursts, and other clinical measures, including asthma exacerbations and change in asthma quality-of-life score (questionnaire), lung function, and eosinophil count. The median reduction from baseline in inhaled corticosteroid dose (beclomethasone dipropionate equivalent dose) by the completion of the extension phase was greater for the omalizumab group than for the placebo group (-420.0 vs -252.0 μg/d; P < .001). During that time, omalizumab-treated patients required fewer oral corticosteroid bursts overall for treatment of acute exacerbations (mean, 0.2 vs 0.3; relative risk, 0.56; 95% confidence interval, 0.41 to 0.76; P < .001) and demonstrated greater improvements in measures of asthma control. The addition of omalizumab to baseline therapy in patients 12 years or older with moderate to severe persistent allergic asthma resulted in a durable reduction in the overall steroid burden and improvement in other clinical measures of asthma control. Copyright © 2010 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  7. Mold sensitization is common amongst patients with severe asthma requiring multiple hospital admissions

    Directory of Open Access Journals (Sweden)

    Hopkinson Linda C

    2005-02-01

    Full Text Available Abstract Background Multiple studies have linked fungal exposure to asthma, but the link to severe asthma is controversial. We studied the relationship between asthma severity and immediate type hypersensitivity to mold (fungal and non-mold allergens in 181 asthmatic subjects. Methods We recruited asthma patients aged 16 to 60 years at a University hospital and a nearby General Practice. Patients were categorized according to the lifetime number of hospital admissions for asthma (82 never admitted, 53 one admission, 46 multiple admissions. All subjects had allergy skin prick tests performed for 5 mold allergens (Aspergillus, Alternaria, Cladosporium, Penicillium and Candida and 4 other common inhalant allergens (D. pteronyssinus, Grass Pollen, Cat and Dog. Results Skin reactivity to all allergens was commonest in the group with multiple admissions. This trend was strongest for mold allergens and dog allergen and weakest for D. pteronyssinus. 76% of patients with multiple admissions had at least one positive mold skin test compared with 16%-19% of other asthma patients; (Chi squared p Conclusion These findings support previous suggestions that mold sensitization may be associated with severe asthma attacks requiring hospital admission.

  8. Vitamin D insufficiency and severe asthma exacerbations in Puerto Rican children.

    Science.gov (United States)

    Brehm, John M; Acosta-Pérez, Edna; Klei, Lambertus; Roeder, Kathryn; Barmada, Michael; Boutaoui, Nadia; Forno, Erick; Kelly, Roxanne; Paul, Kathryn; Sylvia, Jody; Litonjua, Augusto A; Cabana, Michael; Alvarez, María; Colón-Semidey, Angel; Canino, Glorisa; Celedón, Juan C

    2012-07-15

    Vitamin D insufficiency (a serum 25(OH)D asthma exacerbations, but this could be explained by underlying racial ancestry or disease severity. Little is known about vitamin D and asthma in Puerto Ricans. To examine whether vitamin D insufficiency is associated with severe asthma exacerbations in Puerto Rican children, independently of racial ancestry, atopy, and time outdoors. A cross-sectional study was conducted of 560 children ages 6-14 years with (n = 287) and without (n = 273) asthma in San Juan, Puerto Rico. We measured plasma vitamin D and estimated the percentage of African racial ancestry among participants using genome-wide genotypic data. We tested whether vitamin D insufficiency is associated with severe asthma exacerbations, lung function, or atopy (greater than or equal to one positive IgE to allergens) using logistic or linear regression. Multivariate models were adjusted for African ancestry, time outdoors, atopy, and other covariates. Vitamin D insufficiency was common in children with (44%) and without (47%) asthma. In multivariate analyses, vitamin D insufficiency was associated with higher odds of greater than or equal to one severe asthma exacerbation in the prior year (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.5-4.9; P = 0.001) and atopy, and a lower FEV(1)/FVC in cases. After stratification by atopy, the magnitude of the association between vitamin D insufficiency and severe exacerbations was greater in nonatopic (OR, 6.2; 95% CI, 2-21.6; P = 0.002) than in atopic (OR, 2; 95% CI, 1-4.1; P = 0.04) cases. Vitamin D insufficiency is associated with severe asthma exacerbations in Puerto Rican children, independently of racial ancestry, atopy, or markers of disease severity or control.

  9. Effect of disease severity and pharmacotherapy of asthma on oral health in asthmatic children.

    Science.gov (United States)

    Bjerkeborn, K; Dahllöf, G; Hedlin, G; Lindell, M; Modéer, T

    1987-04-01

    Oral health was studied in a group of asthmatic children (n = 61). The children were divided in two groups, 5-10 and 11-18 yr of age. The individuals with asthma were further subgrouped with respect to the disease severity. Severe asthma was defined as more than 10 asthmatic attacks per year. This patient group had daily medication compared to children with moderate asthma (less than 10 asthmatic attacks/yr) who medicated temporarily. 55 age matched children from the same area made up the control group. All children were examined clinically and two bitewing radiographs were taken. The results showed no statistically significant differences concerning caries prevalence and gingival condition in asthmatic children compared to a healthy control group. The study shows that neither the asthma per se nor the disease severity affected the caries prevalence and gingival condition in asthmatic children.

  10. The Potential of Mobile Apps for Improving Asthma Self-Management: A Review of Publicly Available and Well-Adopted Asthma Apps

    Science.gov (United States)

    Tinschert, Peter; Jakob, Robert; Barata, Filipe; Kramer, Jan-Niklas

    2017-01-01

    number of functions and gamification components; highest correlation: r36=.80, Papp’s potential tends to be consistent across review frameworks. Conclusions Several apps were identified that performed consistently well across all applied review frameworks, thus indicating the potential mHealth apps offer for improving asthma self-management. However, many apps suffer from low quality. Therefore, app reviews should be considered as a decision support tool before deciding which app to integrate into a patient’s asthma self-management. Furthermore, several research-practice gaps were identified that app developers should consider addressing in future asthma apps. PMID:28768606

  11. Matrix Metalloproteinase-1 Activation Contributes to Airway Smooth Muscle Growth and Asthma Severity.

    Science.gov (United States)

    Naveed, Shams-Un-Nisa; Clements, Debbie; Jackson, David J; Philp, Christopher; Billington, Charlotte K; Soomro, Irshad; Reynolds, Catherine; Harrison, Timothy W; Johnston, Sebastian L; Shaw, Dominick E; Johnson, Simon R

    2017-04-15

    Matrix metalloproteinase-1 (MMP-1) and mast cells are present in the airways of people with asthma. To investigate whether MMP-1 could be activated by mast cells and increase asthma severity. Patients with stable asthma and healthy control subjects underwent spirometry, methacholine challenge, and bronchoscopy, and their airway smooth muscle cells were grown in culture. A second asthma group and control subjects had symptom scores, spirometry, and bronchoalveolar lavage before and after rhinovirus-induced asthma exacerbations. Extracellular matrix was prepared from decellularized airway smooth muscle cultures. MMP-1 protein and activity were assessed. Airway smooth muscle cells generated pro-MMP-1, which was proteolytically activated by mast cell tryptase. Airway smooth muscle treated with activated mast cell supernatants produced extracellular matrix, which enhanced subsequent airway smooth muscle growth by 1.5-fold (P asthma, airway pro-MMP-1 was 5.4-fold higher than control subjects (P = 0.002). Mast cell numbers were associated with airway smooth muscle proliferation and MMP-1 protein associated with bronchial hyperresponsiveness. During exacerbations, MMP-1 activity increased and was associated with fall in FEV1 and worsening asthma symptoms. MMP-1 is activated by mast cell tryptase resulting in a proproliferative extracellular matrix. In asthma, mast cells are associated with airway smooth muscle growth, MMP-1 levels are associated with bronchial hyperresponsiveness, and MMP-1 activation are associated with exacerbation severity. Our findings suggest that airway smooth muscle/mast cell interactions contribute to asthma severity by transiently increasing MMP activation, airway smooth muscle growth, and airway responsiveness.

  12. Family functioning and child asthma severity: A bio-behavioral approach.

    Science.gov (United States)

    Al Ghriwati, Nour; Winter, Marcia A; Everhart, Robin S; Fiese, Barbara H

    2017-12-01

    Family factors are directly associated with the psychosocial adjustment of children with chronic illnesses such as asthma (Kaugars, Klinnert, & Bender, 2004). Research indicates that negative family factors may also contribute to child disease severity via bio-behavioral mechanisms of effect. For instance, children from more conflicted families often experience greater internalizing symptoms that subsequently impact their asthma severity (Wood et al., 2006). These pathways have yet to be examined with a comprehensive focus on strength-based family factors. This study examined whether factors such as family cohesion, problem-solving abilities, and communication influence asthma severity via their effects on child depression and anxiety symptoms. Participants were 215 children (136 males and 79 females), ages 5 to 12 years old, and their families. Primary caregiver, child, and teacher ratings of child and family functioning in addition to objective measures of parent-child interactions and asthma severity were collected. Using structural equation modeling, the authors identified significant indirect associations between family factors and child asthma severity via child depressive symptoms; however, these associations were not present in models with child anxiety symptoms. Results suggest an indirect effect of family functioning on children's lung function, with differential roles of anxiety and depression in these pathways. This article also highlights the importance of incorporating multirater multimethod measures to understand children's experiences in pediatric asthma. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. The Influence of the Microbiome on Early-Life Severe Viral Lower Respiratory Infections and Asthma-Food for Thought?

    Science.gov (United States)

    Lynch, Jason P; Sikder, Md Al Amin; Curren, Bodie F; Werder, Rhiannon B; Simpson, Jennifer; Cuív, Páraic Ó; Dennis, Paul G; Everard, Mark L; Phipps, Simon

    2017-01-01

    Severe viral lower respiratory infections are a major cause of infant morbidity. In developing countries, respiratory syncytial virus (RSV)-bronchiolitis induces significant mortality, whereas in developed nations the disease represents a major risk factor for subsequent asthma. Susceptibility to severe RSV-bronchiolitis is governed by gene-environmental interactions that affect the host response to RSV infection. Emerging evidence suggests that the excessive inflammatory response and ensuing immunopathology, typically as a consequence of insufficient immunoregulation, leads to long-term changes in immune cells and structural cells that render the host susceptible to subsequent environmental incursions. Thus, the initial host response to RSV may represent a tipping point in the balance between long-term respiratory health or chronic disease (e.g., asthma). The composition and diversity of the microbiota, which in humans stabilizes in the first year of life, critically affects the development and function of the immune system. Hence, perturbations to the maternal and/or infant microbiota are likely to have a profound impact on the host response to RSV and susceptibility to childhood asthma. Here, we review recent insights describing the effects of the microbiota on immune system homeostasis and respiratory disease and discuss the environmental factors that promote microbial dysbiosis in infancy. Ultimately, this knowledge will be harnessed for the prevention and treatment of severe viral bronchiolitis as a strategy to prevent the onset and development of asthma.

  14. Literature review of gender differences in respiratory conditions: a focus on asthma and Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Cadeddu, Chiara; Capizzi, Silvio; Colombo, Delia; Nica, Mihaela; De Belvis, Antonio Giulio

    2016-01-01

    Gender differences are evident in many common health conditions, especially respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). The aim of this review was to identify published studies describing gender differences in asthma and COPD, in particular regarding pathophysiology, diagnosis and treatment, with a focus on Italian data. a literature review was performed from April to November 2015, using the PubMed scientific database and the following ??eywords: "gender differences" and "asthma" for the asthma review and "gender differences" and "COPD" for the COPD review. Gender differences in asthma are related to age groups. In the female population, asthma is generally more severe and disabling, and presents higher mortality rates with respect to same-age males. COPD prevalence is growing and is underestimated in women, because it tends to be diagnosed with difficulty and at a delayed stage. The same findings were observed when restricting the review to Italian data. Clinicians should collaborate to develop a more gender-oriented approach towards diagnosis and treatment of asthma and COPD. In Italy, this would also facilitate measures to improve compliance, particularly among women.

  15. Does periodontal infection have an effect on severe asthma in adults?

    Science.gov (United States)

    Gomes-Filho, Isaac Suzart; Soledade-Marques, Kaliane Rocha; Seixas da Cruz, Simone; de Santana Passos-Soares, Johelle; Trindade, Soraya Castro; Souza-Machado, Adelmir; Fischer Rubira-Bullen, Izabel Regina; de Moraes Marcílio Cerqueira, Eneida; Barreto, Maurício Lima; Costa de Santana, Teresinha; Freitas Coelho, Julita Maria

    2014-06-01

    The effect of periodontal infection on systemic diseases and conditions has been the subject of numerous studies worldwide. It is considered that periodontitis may influence the hyperinflammatory response in patients with severe asthma as a result of immuno-inflammatory changes. This study aims to evaluate the influence of periodontitis on severe asthma in adults. A case-control study was carried out, comprising 220 adult individuals: 113 diagnosed with asthma (case group) and 107 without asthma diagnosis (control group). The diagnosis of periodontitis was established after a full clinical examination using probing depth, clinical attachment level, and bleeding on probing. The diagnosis of severe asthma was based on the criteria recommended by the Global Initiative of Asthma (2012). Descriptive analyses of the variables were performed, followed by bivariate analyses, using the χ(2) test. Association measurements (odds ratio [OR]), with and without adjustment for potential confounders, were obtained. A significance level of 5% was used. The ORunadjusted for the main association was 4.38 (95% confidence interval [CI] = 2.47 to 7.75). In the logistic regression model, after adjusting for age, education level, osteoporosis, smoking habit, and body mass index, the ORadjusted was 4.82 (95% CI = 2.66 to 8.76), which was statistically significant. Individuals with periodontal infection showed, approximately, five times more likelihood to have bronchial inflammation than those without such periodontal tissue infection. The findings demonstrate the influence of periodontitis on severe asthma, given that the frequency of periodontitis is higher in individuals with severe asthma than in those without a diagnosis of bronchial inflammation.

  16. DOES VITAMIN D DEFICIENCY CONTRIBUTE TO THE SEVERITY OF ASTHMA IN CHILDREN AND ADULTS?

    Science.gov (United States)

    Ahmed, Syed Zaryab; Jaleel, Anila; Hameed, Kamran; Qazi, Salman; Suleman, Ahsan

    2015-01-01

    Role of vitamin D in the health of bones has been well established for over decades; It was known that its deficiency caused rickets in children and osteomalacia in adults. Later it was discovered that these can be corrected by giving vitamin D. Researchers discovered that vitamin D can be synthesized by exposure to sun. Hence it was also named "the sunshine vitamin". As time passed it was observed that low levels of vitamin D were associated with multiple diseases. This sparked the interest of the scientific community to further the research on vitamin D which led to the studies that started associating vitamin D with various diseases like cancers (prostate, colon and breast), autoimmune diseases (rheumatoid arthritis), infectious diseases (tuberculosis, hepatitis B, hepatitis C, HIV), cardiovascular diseases, mental illnesses (schizophrenia), diabetes mellitus (type 1, type 2 and gestational) and allergic conditions like asthma. With time, more studies were carried out relating levels of vitamin D to development of asthma, asthma exacerbations and risk factors leading to development of asthma like respiratory tract infections with positive associations. A number of studies were carried out which tried to explain the possible molecular mechanisms relating deficiency of vitamin D in pathogenesis of asthma. This review summarizes the role of vitamin D in development of asthma and probable mechanisms relating vitamin D to the pathogenesis of asthma.

  17. Acupuncture and asthma: a review of controlled trials

    NARCIS (Netherlands)

    Kleijnen, J.; ter Riet, G.; Knipschild, P.

    1991-01-01

    BACKGROUND: Published controlled trials of acupuncture in asthma have often contained a small number of subjects and the results are contradictory. Controlled trials have been reviewed to determine whether clearer conclusions could be obtained by assessing as many studies as possible according to

  18. Omalizumab therapy in severe asthma: experience from the Spanish registry--some new approaches.

    Science.gov (United States)

    Vennera, María Del Carmen; Pérez De Llano, Luis; Bardagí, Santiago; Ausin, Pilar; Sanjuas, Carles; González, Héctor; Gullón, José A; Martínez-Moragón, Eva; Carretero, José A; Vera, Elisabet; Medina, Juan F; Alvarez, Francisco J; Entrenas, Luis M; Padilla, Alicia; Irigaray, Rosa; Picado, César

    2012-05-01

    The efficacy of omalizumab in severe asthma has been widely demonstrated. The main objective of this study was to evaluate the efficacy and tolerability of omalizumab in a real-life setting in Spain, particularly in those patients with immunoglobulin E (IgE) levels out of range. Totally 266 uncontrolled severe asthma patients receiving high-dose inhaled corticosteroids (ICSs) plus long-acting β2-agonist (LABA) were recruited. Main efficacy outcomes were asthma exacerbation rate (AER), asthma control test (ACT), and global evaluation of treatment effectiveness (GETE). AER was reduced from 3.6 (3.6) in previous year to 0.67 (1.2) at 4 months (p 700 IU/ml. At follow-up, maintenance treatment with oral steroids was discontinued in a considerable number of patients: from 89 to 19 (p 700 IU/ml.

  19. Phenotypes determined by cluster analysis in severe or difficult-to-treat asthma.

    Science.gov (United States)

    Schatz, Michael; Hsu, Jin-Wen Y; Zeiger, Robert S; Chen, Wansu; Dorenbaum, Alejandro; Chipps, Bradley E; Haselkorn, Tmirah

    2014-06-01

    Asthma phenotyping can facilitate understanding of disease pathogenesis and potential targeted therapies. To further characterize the distinguishing features of phenotypic groups in difficult-to-treat asthma. Children ages 6-11 years (n = 518) and adolescents and adults ages ≥12 years (n = 3612) with severe or difficult-to-treat asthma from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study were evaluated in this post hoc cluster analysis. Analyzed variables included sex, race, atopy, age of asthma onset, smoking (adolescents and adults), passive smoke exposure (children), obesity, and aspirin sensitivity. Cluster analysis used the hierarchical clustering algorithm with the Ward minimum variance method. The results were compared among clusters by χ(2) analysis; variables with significant (P < .05) differences among clusters were considered as distinguishing feature candidates. Associations among clusters and asthma-related health outcomes were assessed in multivariable analyses by adjusting for socioeconomic status, environmental exposures, and intensity of therapy. Five clusters were identified in each age stratum. Sex, atopic status, and nonwhite race were distinguishing variables in both strata; passive smoke exposure was distinguishing in children and aspirin sensitivity in adolescents and adults. Clusters were not related to outcomes in children, but 2 adult and adolescent clusters distinguished by nonwhite race and aspirin sensitivity manifested poorer quality of life (P < .0001), and the aspirin-sensitive cluster experienced more frequent asthma exacerbations (P < .0001). Distinct phenotypes appear to exist in patients with severe or difficult-to-treat asthma, which is related to outcomes in adolescents and adults but not in children. The study of the therapeutic implications of these phenotypes is warranted. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights

  20. Efficacy of omalizumab in cat-allergic patients with moderate-to-severe persistent asthma.

    Science.gov (United States)

    Massanari, Marc; Kianifard, Farid; Zeldin, Robert K; Geba, Gregory P

    2009-01-01

    Cat allergen (Fel d 1) is a pervasive and common trigger of exacerbations in sensitized patients with IgE-mediated asthma. This study was designed to evaluate the effect on asthma-related outcome measures of adding omalizumab to current treatment in patients with moderate-to-severe persistent asthma and cat allergen sensitivity. A pooled analysis was conducted of two double-blind, placebo-controlled, 28-week pivotal U.S. registration trials. In all patients, asthma was inadequately controlled with moderate-high dose inhaled corticosteroids. Patients were randomized to receive subcutaneous omalizumab (minimum, 0.016 mg/kg per IgE IU/mL every 4 weeks) or matched placebo. The effects of omalizumab on asthma-related outcomes were assessed for patients with cat allergen sensitivity (n = 811), identified by positive skin-prick test. The mean number of asthma exacerbations requiring treatment with systemic steroid bursts in cat allergen-sensitive patients was lower in those receiving omalizumab versus placebo (0.6 versus 1.3, respectively; relative risk = 0.50, p < 0.001). Compared with placebo, omalizumab treatment led to significantly lower asthma symptom scores (least squares means (LSMs) treatment difference [95% confidence interval {CI}]: -0.57 [-0.77, -0.37]; p < 0.001), less rescue medication use (LSMs treatment difference [95% CI]: -0.75 puffs of rescue beta-agonist per day [-1.04, -0.46]; p < 0.001), and improvement in forced expiratory volume in 1 second (LSMs treatment difference [95% CI]: 100.84 mL [51.86, 149.81]; p < 0.001). Patient and investigator global evaluations of treatment effectiveness paralleled these outcomes. Omalizumab improved asthma control by reducing exacerbations and decreasing symptoms in cat-allergic patients with moderate-to-severe persistent IgE-mediated asthma.

  1. House dust mite control measures for asthma: systematic review

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C.; Johansen, Helle Krogh

    2008-01-01

    The major allergen in house dust comes from mites. We performed a systematic review of the randomized trials that had assessed the effects of reducing exposure to house dust mite antigens in the homes of people with mite-sensitive asthma, and had compared active interventions with placebo...... improved (relative risk 1.01, 95% CI 0.80-1.27), asthma symptom scores (standardized mean difference -0.04, 95% CI -0.15 to 0.07) or in medication usage (standardized mean difference -0.06, 95% CI -0.18 to 0.07). Chemical and physical methods aimed at reducing exposure to house dust mite allergens cannot...

  2. Is there a relationship between asthma and dental caries?: a critical review of the literature.

    Science.gov (United States)

    Maupomé, Gerardo; Shulman, Jay D; Medina-Solis, Carlo Eduardo; Ladeinde, Oyebola

    2010-09-01

    The authors conducted a critical review of the literature to ascertain the strength of the scientific and professional evidence supporting an association between dental caries and the experience and severity of asthma. In March 2010, the authors searched Medline (1976-2010) by using the Ovid Web Gateway for the terms "asthma" and ["dental caries" or "dental caries susceptibility"] appearing in studies of humans published in English. The authors eliminated conference proceedings and abstracts, opinion pieces and unpublished studies; they included case series, cross-sectional, case-control and cohort studies and clinical trials. The review yielded 27 studies described in 29 articles. The authors found that researchers have investigated the hypothesized relationship between asthma and caries by means of diverse strategies, often using asthma cases clustered in pools of patients seeking clinical care. The strongest methodological designs were more likely to reveal little support for a positive association. The authors found no strong evidence suggesting that a causal link exists. Future research incorporating better-defined covariates and longitudinal designs is needed. Asthma per se may not be a risk factor for caries. Patients who have extreme dryness of the mouth, whose use of nebulizers is persistent, whose consumption of carbohydrates is frequent, and who have used multiple medications or have used medications over the long term necessitate cautious dental health care.

  3. Effective education parameters for trigger remediation in underserved children with asthma: A systematic review.

    Science.gov (United States)

    Belice, Paula Jo; Becker, Ellen A

    2017-03-01

    The prevalence of asthma is highest in minority children living in urban areas. Pediatric asthma research has focused on self-management education and trigger remediation using a multi-trigger, multi-component educational intervention approach. The purpose of this systematic review was to identify common educational parameters of these proposed interventions. The review also sought to identify which clinical outcomes improved with multi-trigger, multi-component educational interventions. PubMed, SCOPUS and ProQuest Dissertations were searched between 2000 to 2014 using the following terms: asthma; urban population or poverty area; environmental remediation; health education; allergens or dust mites or cockroaches or mold or mice or rats. Studies were included if they met the following criteria: 1) participants were minority children identified as underserved; 2) there was a multi-trigger and multi-component intervention; 3) asthma severity was classified as persistent; and 4) asthma control was classified as not well controlled. A total of 531 articles were retrieved of which 17 met the inclusion criteria. The interventions lacked consistency in their explanation. Most studies were vague in reporting pedagogical methods and educational content. Few studies reported a theoretical framework to guide their approach. Over half the studies did not report a learning assessment nor health literacy of the caregiver or the child with asthma. Yet all of the findings demonstrated statistically significant results in some or all of their primary outcomes. Overall, the research lacked clarity in the approach to impact asthma outcomes and reduces the opportunity to substantiate the findings through replication.

  4. February 2015 pulmonary case of the month: severe asthma

    Directory of Open Access Journals (Sweden)

    Uppalapu S

    2015-02-01

    Full Text Available No abstract available. Article truncated at 150 words. History of present illness: A 50-year-old African-American woman with a history of asthma presented to the emergency department with a chief complaint of shortness of breath for 2 weeks. She reported some chest tightness, wheezing and dry cough. She denied fever, chills, myalgias or arthralgias at the time of admission. PMH, SH and FH: In addition to asthma, she has a past medical history of type 2 diabetes mellitus, hypertension, and multiple sclerosis. She admitted to social smoking but states she quit 6 to 7 months ago. She denies alcohol, recreational drug use, or a family history of early coronary artery disease, strokes or cancers. Medications: montelukast 10 mg daily; salmeterol/fluticasone 250/50 inhaled twice a day; albuterol inhaler as needed for shortness of breath; metformin 500 mg bid; dimethyl fumarate 240 mg bid; omega 3 fish oil; calcium carbonate 600 mg daily; naproxen 500 mg bid; lisinopril 10 mg daily ...

  5. Do eosinophil counts correlate differently with asthma severity by symptoms versus peak flow rate?

    Science.gov (United States)

    Koshak, E A; Alamoudi, O S

    1999-12-01

    Discrepancy in asthmatic assessment by symptoms and peak flow rate (PFR) is a frequent dilemma. Currently, total peripheral eosinophil count (TPEC) is under study for asthma evaluation. To explore the correlation between TPEC and asthma severity assessed by symptoms alone versus symptoms and PFR. Adults asthmatics were selected from the Asthma Clinic. Severity assessment was based on two methods: symptoms alone or symptoms and PFR. Expiratory PFR was recorded by a Wright peak flow meter. Severity levels included mild intermittent, mild persistent, moderate persistent, and severe persistent. Total peripheral eosinophil count was performed on a Celldyn-3500 counter. Data was analyzed for statistical significance. Sixty asthmatics aged 15 to 70 years (mean = 34 years), of which 68.3% were female, were studied. Severity levels differed between the two assessment methods in 45% of the cases and showed a predominance of the moderate persistent type. Total peripheral eosinophil count ranged between 22 and 2470 cells/mm3 (mean = 520 +/- SD = 393) and eosinophilia was found in 50% of the cases. Total peripheral eosinophil count showed a high positive correlation with increased asthma severity level assessed by history alone (r = 0.460, P < .001); more than by history and PFR (r = 0.328, P < .05). The discrepancy between symptoms and PFR is confirmed by these results. A reliable objective parameter in asthma assessment is a continuous challenge. This study advocates the possible supplementation of TPEC as another objective parameter that might help in selecting the appropriate severity level in asthmatics.

  6. Association Between Severe Vitamin D Deficiency, Lung Function and Asthma Control.

    Science.gov (United States)

    Beyhan-Sagmen, Seda; Baykan, Ozgur; Balcan, Baran; Ceyhan, Berrin

    2017-04-01

    To examine the relationship between severe vitamin D deficiency, asthma control, and pulmonary function in Turkish adults with asthma. One hundred six asthmatic patients underwent pulmonary function tests skin prick test, peripheral blood eosinophil counts, IgE, body mass index and vitamin D levels were determined. Patients were divided into 2 subgroups according to vitamin D levels (vitamin D level<10ng/ml and vitamin D level≥10 ng/ml). Asthma control tests were performed. The mean age of subgroup i (vitamin D level<10) was 37±10 and the mean age of subgroup ii (vitamin D level≥10ng/ml) was 34±8. Sixty-six percent of patients had severe vitamin D deficiency (vitamin D level<10 ng/ml). There was a significant trend towards lower absolute FEV 1 (L) values in patients with lower vitamin D levels (P=.001). Asthma control test scores were significantly low in the severe deficiency group than the other group (P=.02). There were a greater number of patients with uncontrolled asthma (asthma control test scores<20) in the severe vitamin D deficiency group (P=.040). Patients with severe vitamin D deficiency had a higher usage of inhaled corticosteroids than the group without severe vitamin D deficiency (P=.015). There was a significant trend towards lower absolute FEV 1 (L) (P=.005, r=.272) values in patients with lower vitamin D levels. Vitamin D levels were inversely related with body mass index (P=.046). The incidence of severe vitamin D deficiency was high in adult Turkish asthmatics. In addition, lower vitamin D levels were associated with poor asthma control and decreased pulmonary function. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Beta2 adrenergic receptor (ADRβ2) haplotype pair (2/4) is associated with severe asthma.

    Science.gov (United States)

    Chung, Li Ping; Baltic, Svetlana; Ferreira, Manuel; Temple, Suzanna; Waterer, Grant; Thompson, Philip J

    2014-01-01

    β2 adrenergic receptor (ADRβ2) polymorphisms including ADRβ2+46G>A have been reported to cause adverse outcomes in mild asthmatics. The extent to which ADRβ2 polymorphisms and in particular their haplotypes contribute to severe asthma is unknown. To determine the association of ADRβ2 polymorphisms and haplotypes with asthma severity. Caucasians (n = 2979) were genotyped for 11 ADRβ2 polymorphisms. The cohort (mean age 39.6, 60% female) included 2296 non-asthmatics, 386 mild asthmatics, 172 moderate asthmatics and 125 severe asthmatics. Haplotype frequency and haplotype pair for each subject was determined using the PHASE algorithm. The three asthmatic cohorts were comparable in age and gender but were distinguishable from each other in terms of symptoms, spirometry, medication use and health care utilisation (p haplotypes were identified and no association was found with asthma diagnosis or severity per se. Haplotype pair 2/4 was associated with asthma severity (Trend Test, OR 1.42, p = 0.0008) but not with asthma per se. Prevalence of haplotype pair 2/2 appeared to decrease with asthma severity (Trend Test, OR 0.78, p = 0.067). Two new haplotypes were identified, occurring exclusively in asthmatics at a frequency of ≥ 1%. In addition, a positive association between carriage of ADRβ2 +523*C and increased risk of atopy was discovered. ADRβ2 haplotype pair 2/4 is associated with severe asthma and is consistent with findings of poor bronchodilator response in mild asthmatics who are also haplotype 2/4.

  8. Multidisciplinary treatment in children with problematic severe asthma: A prospective evaluation.

    Science.gov (United States)

    Verkleij, Marieke; Beelen, Anita; van Ewijk, Bart E; Geenen, Rinie

    2017-05-01

    For children with problematic severe asthma, achieving adequate control of asthma is difficult. The aim of this prospective observational study was to evaluate the effects of intensive multidisciplinary inpatient treatment on multiple outcome variables in children with problematic severe asthma. Participants were 89 children with problematic severe asthma (mean age 13.6 ± 2.5 years) treated in tertiary care clinics at high altitude (Switzerland) or sea level (Netherlands) and their parents (85 mothers, 55 fathers). The primary outcome variable was the Childhood Asthma Control Test (C-ACT). Other outcome variables were forced expiratory volume in 1 sec (FEV1 ), fractional concentration of exhaled nitric oxide (FeNO), quality of life [PAQLQ(S)], children's coping (UCL-A), parents' report of behavioral problems (CBCL), and parenting stress (PSI/NOSI). Evaluations were taken pre-treatment, post-treatment, and 3-6 months follow-up. Median [P25;P75] treatment duration 74 [56;80] days; Median follow-up interval 131 [103;177] days. The percentages of children showing controlled asthma (C-ACT) were 18% (pre-treatment), 69% (post-treatment), and 44% (follow-up). The vast majority of the children (80%) showed an improvement on C-ACT with 4% showing a deterioration. On C-ACT, FeNO, quality of life, and behavioral problems, improvements at post-treatment were highly significant. Improvements generally remained at a functional level at follow-up. Children's coping and parenting stress in parents did not change. The improvement in asthma control and other outcome variables suggests that multidisciplinary inpatient treatment is an effective approach for a heterogeneous group of children with asthma that remained uncontrolled in secondary care. Pediatr Pulmonol. 2017;52:588-597. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  9. Unsupervised phenotyping of Severe Asthma Research Program participants using expanded lung data.

    Science.gov (United States)

    Wu, Wei; Bleecker, Eugene; Moore, Wendy; Busse, William W; Castro, Mario; Chung, Kian Fan; Calhoun, William J; Erzurum, Serpil; Gaston, Benjamin; Israel, Elliot; Curran-Everett, Douglas; Wenzel, Sally E

    2014-05-01

    Previous studies have identified asthma phenotypes based on small numbers of clinical, physiologic, or inflammatory characteristics. However, no studies have used a wide range of variables using machine learning approaches. We sought to identify subphenotypes of asthma by using blood, bronchoscopic, exhaled nitric oxide, and clinical data from the Severe Asthma Research Program with unsupervised clustering and then characterize them by using supervised learning approaches. Unsupervised clustering approaches were applied to 112 clinical, physiologic, and inflammatory variables from 378 subjects. Variable selection and supervised learning techniques were used to select relevant and nonredundant variables and address their predictive values, as well as the predictive value of the full variable set. Ten variable clusters and 6 subject clusters were identified, which differed and overlapped with previous clusters. Patients with traditionally defined severe asthma were distributed through subject clusters 3 to 6. Cluster 4 identified patients with early-onset allergic asthma with low lung function and eosinophilic inflammation. Patients with later-onset, mostly severe asthma with nasal polyps and eosinophilia characterized cluster 5. Cluster 6 asthmatic patients manifested persistent inflammation in blood and bronchoalveolar lavage fluid and exacerbations despite high systemic corticosteroid use and side effects. Age of asthma onset, quality of life, symptoms, medications, and health care use were some of the 51 nonredundant variables distinguishing subject clusters. These 51 variables classified test cases with 88% accuracy compared with 93% accuracy with all 112 variables. The unsupervised machine learning approaches used here provide unique insights into disease, confirming other approaches while revealing novel additional phenotypes. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  10. Patient and physician evaluation of the severity of acute asthma exacerbations

    Directory of Open Access Journals (Sweden)

    Atta J.A.

    2004-01-01

    Full Text Available We studied the ability of patients not experienced in the use of peak expiratory flow meters to assess the severity of their asthma exacerbations and compared it to the assessment of experienced clinicians. We also evaluated which data of physical examination and medical history are used by physicians to subjectively evaluate the severity of asthma attacks. Fifty-seven adult patients (15 men and 42 women, with a mean (± SD age of 37.3 ± 14.5 years and 24.0 ± 17.9 years of asthma symptoms with asthma exacerbations were evaluated in a University Hospital Emergency Department. Patients and physicians independently evaluated the severity of the asthma attack using a linear scale. Patient score, physician score and forced expiratory volume at the first second (FEV1 were correlated with history and physical examination variables, and were also considered as dependent variables in multiple linear regression models. FEV1 correlated significantly with the physician score (rho = 0.42, P = 0.001, but not with patient score (rho = 0.03; P = 0.77. Use of neck accessory muscles, expiratory time and wheezing intensity were the explanatory variables in the FEV1 regression model and were also present in the physician score model. We conclude that physicians evaluate asthma exacerbation severity better than patients and that physician's scoring of asthma severity correlated significantly with objective measures of airway obstruction (FEV1. Some variables (the use of neck accessory muscles, expiratory time and wheezing intensity persisted as explanatory variables in physician score and FEV1 regression models, and should be emphasized in medical schools and emergency settings.

  11. Patient and physician evaluation of the severity of acute asthma exacerbations

    Directory of Open Access Journals (Sweden)

    J.A. Atta

    2004-09-01

    Full Text Available We studied the ability of patients not experienced in the use of peak expiratory flow meters to assess the severity of their asthma exacerbations and compared it to the assessment of experienced clinicians. We also evaluated which data of physical examination and medical history are used by physicians to subjectively evaluate the severity of asthma attacks. Fifty-seven adult patients (15 men and 42 women, with a mean (± SD age of 37.3 ± 14.5 years and 24.0 ± 17.9 years of asthma symptoms with asthma exacerbations were evaluated in a University Hospital Emergency Department. Patients and physicians independently evaluated the severity of the asthma attack using a linear scale. Patient score, physician score and forced expiratory volume at the first second (FEV1 were correlated with history and physical examination variables, and were also considered as dependent variables in multiple linear regression models. FEV1 correlated significantly with the physician score (rho = 0.42, P = 0.001, but not with patient score (rho = 0.03; P = 0.77. Use of neck accessory muscles, expiratory time and wheezing intensity were the explanatory variables in the FEV1 regression model and were also present in the physician score model. We conclude that physicians evaluate asthma exacerbation severity better than patients and that physician's scoring of asthma severity correlated significantly with objective measures of airway obstruction (FEV1. Some variables (the use of neck accessory muscles, expiratory time and wheezing intensity persisted as explanatory variables in physician score and FEV1 regression models, and should be emphasized in medical schools and emergency settings.

  12. Effectiveness of bronchial thermoplasty in patients with severe refractory asthma: Clinical and histopathologic correlations.

    Science.gov (United States)

    Pretolani, Marina; Bergqvist, Anders; Thabut, Gabriel; Dombret, Marie-Christine; Knapp, Dominique; Hamidi, Fatima; Alavoine, Loubna; Taillé, Camille; Chanez, Pascal; Erjefält, Jonas S; Aubier, Michel

    2017-04-01

    The effectiveness of bronchial thermoplasty (BT) has been reported in patients with severe asthma, yet its effect on different bronchial structures remains unknown. We sought to examine the effect of BT on bronchial structures and to explore the association with clinical outcome in patients with severe refractory asthma. Bronchial biopsy specimens (n = 300) were collected from 15 patients with severe uncontrolled asthma before and 3 months after BT. Immunostained sections were assessed for airway smooth muscle (ASM) area, subepithelial basement membrane thickness, nerve fibers, and epithelial neuroendocrine cells. Histopathologic findings were correlated with clinical parameters. BT significantly improved asthma control and quality of life at both 3 and 12 months and decreased the numbers of severe exacerbations and the dose of oral corticosteroids. At 3 months, this clinical benefit was accompanied by a reduction in ASM area (median values before and after BT, respectively: 19.7% [25th-75th interquartile range (IQR), 15.9% to 22.4%] and 5.3% [25th-75th IQR], 3.5% to 10.1%, P Asthma Control Test scores, numbers of exacerbations, and visits to the emergency department (all P ≤ .02) 3 and 12 months after BT. BT is a treatment option in patients with severe therapy-refractory asthma that downregulates selectively structural abnormalities involved in airway narrowing and bronchial reactivity, particularly ASM, neuroendocrine epithelial cells, and bronchial nerve endings. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  13. The effectiveness of the treatment of severe exercise-induced asthma in schoolchildren

    Directory of Open Access Journals (Sweden)

    M.N. Garas

    2017-03-01

    Full Text Available Background. Bronchial asthma is one of the most common chronic multifactorial diseases of the lungs. At least 10–12 % of patients with bronchial asthma are suffering from a severe form of the disease. One aspect of inadequate severe asthma control is its phenotypic heterogeneity, interest of experts increases to the problem of exercise-induced asthma. The purpose of the study was to increase efficiency of treatment for severe exercise-induced asthma in schoolchildren based on the analysis of the attack dynamics and to achieve disease control according to main inflammatometric and spirometric indices. Materials and methods. We examined 46 children with severe persistent bronchial asthma, in particular, 15 schoolchildren suffering from severe exercise-induced asthma, the second clinical group (comparison one consisted of 31 children suffering from severe type of the disease, with no signs of exercise-induced bronchoconstriction. Basic therapy effectiveness was determined prospectively by assessing the disease control using AST-test with an interval of 3 months. The severity of bronchial obstruction syndrome in patients on admission to hospital during exacerbation was assessed by score scale. Airway hyperresponsiveness was evaluated according to the results of bronchoprovocation with histamine. Results. Children of I clinical group had more significant manifestations of bronchial obstruction during the week of inpatient treatment than the comparison group of patients, including significantly more severe manifestations of bronchial obstruction were verified on 1st and 7th day of hospitalization. Due to the analysis of basic therapy effectiveness, only a quarter of I clinical group patients and a larger part of schoolchildren in comparison group achieved the partial control after a 3-month course of anti-inflammatory treatment. Eosinophilic inflammation was observed in most children with severe exercise-induced asthma (60.1 % and in 47.2 % of

  14. Utilization and Costs of Severe Uncontrolled Asthma in a Managed-Care Setting.

    Science.gov (United States)

    Zeiger, Robert S; Schatz, Michael; Dalal, Anand A; Qian, Lei; Chen, Wansu; Ngor, Eunice W; Suruki, Robert Y; Kawatkar, Aniket A

    2016-01-01

    Clinical and economic burden of patients with severe uncontrolled asthma (SUA) in a real-world managed-care setting required further documentation. The objective of this study was to determine the characteristics, clinical, and economic burden of SUA in a managed-care setting. This observational study identified patients with persistent asthma aged 12 years or more (N = 25,935) using the International Classification of Diseases, 9th Revision asthma codes and Healthcare Effectiveness Data and Information Set administrative criteria. An SUA subgroup was identified when all of the following 3 criteria were met in 2012: (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β2-agonist; and (3) 3 or more dispensed non-ICS controllers. Health care utilization and direct costs (all-cause and asthma-related) in 2013 were compared between SUA and non-SUA subgroups using multivariable regression. Compared with the non-SUA subgroup (N = 25,350, 97.7%), the SUA subgroup (N = 585, 2.3%) at baseline was significantly older and had more comorbidities, asthma specialist care, controller medication dispensed, and asthma exacerbations. During follow-up, patients with SUA exhibited significantly more asthma exacerbations and short-acting β2-agonist use, and higher all-cause and asthma-related costs than patients with non-SUA. The adjusted asthma-related average direct cost per patient at follow-up was significantly higher for SUA (mean ± SE) ($2325 ± $75) than non-SUA ($1261 ± $9) with an incremental cost of $1056 (95% CI, $907-$1205). Asthma drugs accounted for the major difference (incremental cost of $848/patient; 95% CI, $737-$959). Increases and disparities in health care utilization and direct cost by SUA status suggest that patients with SUA require more intensive therapy, greater attention to adherence and comorbidities, more specialist care, and, possibly

  15. Factors associated with severe uncontrolled asthma and the perception of control by physicians and patients.

    Science.gov (United States)

    Vennera, María del Carmen; Picado, César; Herráez, Lys; Galera, Jordi; Casafont, Jordi

    2014-09-01

    Despite current treatments, more than half of patients with asthma are not controlled. The objective was to evaluate the correlation between control perceived by patients and physicians, compared with control evaluated according to criteria of the Spanish Guidelines for Asthma Management (GEMA), and to investigate the factors associated with that control. Multicenter, cross-sectional, observational study including 343 patients with severe persistent asthma according to GEMA criteria seen in the Department of Pulmonology and Allergology. The correlation between asthma control perceived by the patient, the physician and according to clinical judgment based on the GEMA criteria was calculated, and a multivariate analysis was used to determine variables related to the perception of asthma control. According to GEMA criteria, only 10.2% of patients were well controlled, 27.7% had partial control and 62.1% were poorly controlled. Both the physicians and the patients overestimated control: 75.8% and 59.3% of patients had controlled asthma according to the patient and the physician, respectively, and were not controlled according to GEMA (P<.0001). Patients with uncontrolled asthma according GEMA had higher body mass index (P=.006) and physical inactivity (P=.016). Factors associated with a perceived lack of control by both physicians and patients were: nocturnal awakenings (≥ 1 day/week), frequent use of rescue medication (≥ 5 days/week) and significant limitation in activities. Discrepant factors between physicians and patients were dyspnea and emergency room visits (patients only), FEV1 ≤ 80% and a poorer understanding of the disease by the patient (physicians only). Only 10% of patients with severe asthma evaluated in this study are controlled according to GEMA criteria. Patients and physicians overestimate control and the overestimation by patients is greater. Physical inactivity and obesity are associated with a lack of control according to GEMA. Copyright

  16. The Potential of Mobile Apps for Improving Asthma Self-Management: A Review of Publicly Available and Well-Adopted Asthma Apps.

    Science.gov (United States)

    Tinschert, Peter; Jakob, Robert; Barata, Filipe; Kramer, Jan-Niklas; Kowatsch, Tobias

    2017-08-02

    components; highest correlation: r36=.80, Pmanagement. However, many apps suffer from low quality. Therefore, app reviews should be considered as a decision support tool before deciding which app to integrate into a patient's asthma self-management. Furthermore, several research-practice gaps were identified that app developers should consider addressing in future asthma apps.

  17. Therapy with omalizumab for patients with severe allergic asthma improves asthma control and reduces overall healthcare costs.

    LENUS (Irish Health Repository)

    Costello, R W

    2011-05-11

    BACKGROUND: Patients with asthma who have persistent symptoms despite treatment with inhaled steroids and long-acting beta agonists are considered to have severe asthma. Omalizumab is a monoclonal antibody directed against IgE, which is used as an add-on treatment for patients who have severe persistent allergic asthma. AIMS: The aim of this study was to assess the clinical benefit and healthcare utilisation of patients who responded to omalizumab therapy and to establish an overall cost implication. METHODS: This was an observational retrospective cohort study designed to investigate the effect of omalizumab on exacerbations of asthma before and after 6 months of treatment in Irish patients. RESULTS: Centres who had treated patients with severe allergic asthma for the 6 months prior and post omalizumab treatment were audited with a standardised assessment tool. Sixty-three (32 male) patients were studied. In the 6 months prior to omalizumab 41 of 63 (66%) had been hospitalised, and this fell to 15 of 63 (24%), p < 0.0001 in the 6 months after treatment was started. Hospital admissions reduced from 2.4 ± 0.41 to 0.8 ± 0.37 and the mean number of bed days occupied was reduced from 16.6 ± 2.94 to 5.3 ± 2.57 days, p < 0.001. The number of oral corticosteroid doses used fell from 3.1 ± 0.27 to 1.2 ± 0.17, p < 0.001. The overall cost saving per omalizumab responder patients for 6 months was 834. CONCLUSIONS: Six months therapy with omalizumab reduced the number of bed days, the number of hospitalisations and the use of oral corticosteroids compared to the 6 months prior to commencement. Despite the cost of the additional therapy there were overall savings in health costs.

  18. Characterization of pharmacists' interventions in asthma management: A systematic review.

    Science.gov (United States)

    Crespo-Gonzalez, Carmen; Fernandez-Llimos, Fernando; Rotta, Inajara; Correr, Cassyano J; Benrimoj, Shalom I; Garcia-Cardenas, Victoria

    2018-02-10

    Pharmacists have adopted an active role in asthma management. This review aimed to analyze the intervention dose, understood as the "amount of program delivered," and core components of the intervention provided by pharmacists in asthma management. A literature search was conducted in December 2016 using PubMed. A 2-stage approach was used. At the first stage, systematic reviews of pharmacists' interventions in asthma management were identified. At the second stage, primary studies included in the systematic reviews were selected. The DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) was used for data extraction. In addition GINA (Global Initiative for Asthma) guidelines were used as a reference to classify the interventions' core components. Thirty-one studies were included. In most of the studies, the pharmacist-patient intervention occurred at the community pharmacy setting (n = 22). The most common core components used in pharmacists' interventions were the provision of drug information and patient counseling (n = 27). Pharmacists' interventions frequently were targeted at assessing and improving the use of patient's inhaler technique (n = 27). Educational materials and written action plans were the materials most commonly used in the interventions (n = 20). The duration (n = 13) and the frequency (n = 16) of the intervention were the most frequent information about the intervention dose measure reported. Pharmacists' interventions in asthma management are complex. Structured educational programs and patient counseling appear to be the most frequent core components of pharmacists' interventions. Interventions were focused on providing information about the condition and on inhaler technique assessment and training. However, most studies failed to report the intervention dose sufficiently to be reproduced. The reporting of this indicator is crucial to ensure the reproducibility of the interventions assessed and their

  19. Herbal medicine for adults with asthma: A systematic review.

    Science.gov (United States)

    Shergis, Johannah L; Wu, Lei; Zhang, Anthony L; Guo, Xinfeng; Lu, Chuanjian; Xue, Charlie C

    2016-08-01

    Many people with asthma use herbal medicines to help reduce symptoms and improve asthma control. To update the systematic review and meta-analysis of randomised controlled trials of herbal medicine for adult asthma. Nine English and Chinese databases were searched (PubMed, Embase, CINAHL, CENTRAL, AMED, CBM, CNKI, CQVIP, Wanfang). Herbal medicines combined with routine pharmacotherapies compared with the same pharmacotherapies alone or placebo. Cochrane Risk of Bias Tool and GRADE Summary of Findings tables were used to evaluate methodological quality. Twenty-nine (29) studies involving 3,001 participants were included. Herbal interventions used multi-ingredients such as licorice root, crow-dipper, astragali, and angelica. Compared with routine pharmacotherapies alone, herbal medicines as add-on therapy improved lung function (FEV1: MD 7.81%, 95% CI 5.79, 9.83, I(2) = 63%; PEFR: MD 65.14 L/min, 95% CI 58.87, 71.41, I(2) = 21%); asthma control (MD 2.47 points, 95% CI 1.64, 3.29, I(2) = 55%); reduced salbutamol usage (MD -1.14 puffs/day, 95% CI -2.20, -0.09, I(2) = 92%); and reduced acute asthma exacerbations over one year (MD -1.20, 95% CI -1.82, -0.58, one study). Compared with placebo plus pharmacotherapies herbal medicines as add-on therapy improved lung function (FEV1: MD 15.83%, 95% CI 13.54, 18.12 and PEFR: MD 55.20 L/min, 95% CI 33.41, 76.99). Other outcomes were not reported in these placebo studies. Included studies were low to moderate quality. Adverse events were rare. Herbal medicines combined with routine pharmacotherapies improved asthma outcomes greater than pharmacotherapies alone. Included studies did not blind participants therefore more studies that address such weaknesses are warranted.

  20. Obesity-associated severe asthma represents a distinct clinical phenotype: analysis of the British Thoracic Society Difficult Asthma Registry Patient cohort according to BMI.

    Science.gov (United States)

    Gibeon, David; Batuwita, Kannangara; Osmond, Michelle; Heaney, Liam G; Brightling, Chris E; Niven, Rob; Mansur, Adel; Chaudhuri, Rekha; Bucknall, Christine E; Rowe, Anthony; Guo, Yike; Bhavsar, Pankaj K; Chung, Kian Fan; Menzies-Gow, Andrew

    2013-02-01

    Obesity has emerged as a risk factor for the development of asthma and it may also influence asthma control and airway inflammation. However, the role of obesity in severe asthma remains unclear. Thus, our objective was to explore the association between obesity (defied by BMI) and severe asthma. Data from the British Thoracic Society Difficult Asthma Registry were used to compare patient demographics, disease characteristics, and health-care utilization among three BMI categories (normal weight: 18.5-24.99; overweight: 25-29.99; obese: 30) in a well-characterized group of adults with severe asthma. The study population consisted of 666 patients with severe asthma; the group had a median BMI of 29.8 (interquartile range, 22.5-34.0). The obese group exhibited greater asthma medication requirements in terms of maintenance corticosteroid therapy (48.9% vs 40.4% and 34.5% in the overweight and normal-weight groups, respectively), steroid burst therapy, and short-acting b 2 -agonist use per day. Significant differences were seen with gastroesophageal reflux disease (53.9% vs 48.1% and 39.7% in the overweight and normal weight groups, respectively) and proton pump inhibitor use. Bone density scores were higher in the obese group, while pulmonary function testing revealed a reduced FVC and elevated carbon monoxide transfer coefficient. Serum IgE levels decreased with increasing BMI and the obese group was more likely to report eczema, but less likely to have a history of nasal polyps. Patients with severe asthma display particular characteristics according to BMI that support the view that obesity-associated severe asthma may represent a distinct clinical phenotype.

  1. Predictors of frequent exacerbations in (ex)smoking and never smoking adults with severe asthma.

    Science.gov (United States)

    Westerhof, Guus A; de Groot, Jantina C; Amelink, Marijke; de Nijs, Selma B; Ten Brinke, Anneke; Weersink, Els J; Bel, Elisabeth H

    2016-09-01

    Persistent eosinophilic airway inflammation is an important driver for asthma exacerbations in non-smokers with asthma. Whether eosinophilic inflammation is also a predictor of asthma exacerbations in (ex)smokers is not known. The aim was to investigate factors associated with frequent exacerbations in never smokers and (ex)smokers with asthma. (Ex)smoking (n = 83) and never smoking (n = 70) patients with uncontrolled asthma despite high dose asthma medication (GINA treatment step 4-5) were selected from a cohort of 571 adult-onset asthma patients. Clinical, functional and inflammatory parameters were used in multivariate logistic regression analyses to identify factors associated with frequent exacerbations (≥3 oral corticosteroid (OCS) bursts in the previous year). Frequent exacerbations in (ex)smokers were independently associated with ICS dose (OR 1.2, 95%CI: 1.1-1.3) and blood neutrophil count (OR 1.5, 95%CI: 1.2-2.1). In never smokers frequent exacerbations were independently associated with blood eosinophil count (OR 18.9, 95%CI: 1.8-202.1). This study shows that never smoking and (ex)smoking patients with severe asthma have different predictors of frequent exacerbations: higher blood neutrophils in (ex)smokers versus higher blood eosinophils in never smokers. This suggests that different types of systemic background inflammation play a role in the aetiology of exacerbations in these patients. Netherlands Trial Register: NTR2217, NTR1846 and NTR1838. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Comparison of nebulized epinephrine and terbutaline in patients with acute severe asthma: a controlled trial.

    Science.gov (United States)

    Adoun, Michèle; Frat, Jean-Pierre; Doré, Pierre; Rouffineau, Jean; Godet, Cendrine; Robert, René

    2004-06-01

    To compare the efficacy and tolerability of nebulized adrenaline and terbutaline in acute severe asthma. Prospective pilot randomized double-blind cross-over trial. Emergency department of a university hospital. Thirty-eight patients admitted with severe acute asthma. Each patient received adrenaline (3 mg) and terbutaline (5 mg) nebulizations over 20 min in randomized order. Additional treatment comprised methylprednisolone, intravenous hydration, and oxygen. The efficacy and tolerability of the two drugs were evaluated at the end of each nebulization as well as potential synergistic effects. Eighteen patients received adrenaline first, and 20 received terbutaline first. Peak expiratory flow (PEF) improved significantly in both groups after the first nebulization (from 157 L/min +/- 111 L/min to 199 L/min +/- 134 L/min with adrenaline, P nebulization. No adverse effects were observed. Adrenaline nebulization was as effective and as well tolerated as terbutaline in acute severe asthma. No synergistic effect between terbutaline and adrenaline was observed.

  3. Vitamin D as an adjunctive therapy in asthma. Part 1: A review of potential mechanisms.

    LENUS (Irish Health Repository)

    Kerley, Conor P

    2015-02-27

    Vitamin D deficiency (VDD) is highly prevlalent worldwide. The classical role for vitamin D is to regulate calcium absorption form the gastrointestinal tract and influence bone health. Recently vitamin D receptors and vitamin D metabolic enzymes have been discovered in numerous sites systemically supporting diverse extra-skeletal roles of vitamin D, for example in asthmatic disease. Further, VDD and asthma share several common risk factors including high latitude, winter season, industrialization, poor diet, obesity, and dark skin pigmentation. Vitamin D has been demonstrated to possess potent immunomodulatory effects, including effects on T cells and B cells as well as increasing production of antimicrobial peptides (e.g. cathelicidin). This immunomodulation may lead to asthma specific clinical benefits in terms of decreased bacterial\\/viral infections, altered airway smooth muscle-remodeling and -function as well as modulation of response to standard anti-asthma therapy (e.g. glucocorticoids and immunotherapy). Thus, vitamin D and its deficiency have a number of biological effects that are potentially important in altering the course of disease pathogenesis and severity in asthma. The purpose of this first of a two-part review is to review potential mechanisms whereby altering vitamin D status may influence asthmatic disease.

  4. A review of barriers to effective asthma management in Puerto Ricans: cultural, healthcare system and pharmacogenomic issues.

    Science.gov (United States)

    Alicea-Alvarez, Norma; Swanson-Biearman, Brenda; Kelsen, Steven G

    2014-02-01

    Among the Hispanic community, Puerto Ricans have the highest prevalence of asthma and manifest the worst outcomes. The expected growth of the Hispanic population in the USA in the next several decades make elimination of disparate care in Puerto Rican asthmatics a matter of national importance. The purpose of this review of the literature (ROL) is to examine a variety of health system, genetic and cultural barriers in the Puerto Rican community which have created disparities in asthma care and outcomes among adult and pediatric Hispanic populations. In addition, this ROL describes several culturally sensitive, community-based educational interventions which can be used as a framework for future projects to improved asthma outcomes. Databases searched included Medline, PubMED, EBSCOhost, PsycINFO, CINAHL, Google Scholar and ERIC. Papers published in English from January 1990 to January 2012 were reviewed. Health system policies, insurer compensation patterns, clinician attitudes and cultural values/folk remedies in the Puerto Rican community represent barriers to effective asthma management, the use of controller medication and the implementation of educational interventions. In addition, genetic factors involving the beta-2 adrenergic receptor gene, which impair the response to albuterol, appear to contribute to poorer outcomes in Puerto Rican asthmatics. In contrast, several comprehensive, community-based, culturally sensitive educational interventions such as Controlling Asthma in American Cities Project (CAACP), the Racial and Ethnic Approach to Community Health in the US Program and Healthy Hoops programs (REACH) have been described. We believe that culturally sensitive community-based asthma education programs can serve as models for programs targeted toward Puerto Ricans to help decrease asthma morbidity. Moreover, greater sensitivity to Puerto Rican mores and folk remedies on the part of healthcare providers may improve the patient-clinician rapport and

  5. Pooled Sequencing of Candidate Genes Implicates Rare Variants in the Development of Asthma Following Severe RSV Bronchiolitis in Infancy.

    Directory of Open Access Journals (Sweden)

    Dara G Torgerson

    Full Text Available Severe infection with respiratory syncytial virus (RSV during infancy is strongly associated with the development of asthma. To identify genetic variation that contributes to asthma following severe RSV bronchiolitis during infancy, we sequenced the coding exons of 131 asthma candidate genes in 182 European and African American children with severe RSV bronchiolitis in infancy using anonymous pools for variant discovery, and then directly genotyped a set of 190 nonsynonymous variants. Association testing was performed for physician-diagnosed asthma before the 7th birthday (asthma using genotypes from 6,500 individuals from the Exome Sequencing Project (ESP as controls to gain statistical power. In addition, among patients with severe RSV bronchiolitis during infancy, we examined genetic associations with asthma, active asthma, persistent wheeze, and bronchial hyperreactivity (methacholine PC20 at age 6 years. We identified four rare nonsynonymous variants that were significantly associated with asthma following severe RSV bronchiolitis, including single variants in ADRB2, FLG and NCAM1 in European Americans (p = 4.6x10-4, 1.9x10-13 and 5.0x10-5, respectively, and NOS1 in African Americans (p = 2.3x10-11. One of the variants was a highly functional nonsynonymous variant in ADRB2 (rs1800888, which was also nominally associated with asthma (p = 0.027 and active asthma (p = 0.013 among European Americans with severe RSV bronchiolitis without including the ESP. Our results suggest that rare nonsynonymous variants contribute to the development of asthma following severe RSV bronchiolitis in infancy, notably in ADRB2. Additional studies are required to explore the role of rare variants in the etiology of asthma and asthma-related traits following severe RSV bronchiolitis.

  6. The national review of asthma deaths: what did we learn and what needs to change?

    Science.gov (United States)

    2015-01-01

    Key points The 2014 UK National Review of Asthma Deaths identified potentially preventable factors in two-thirds of the medical records of cases scrutinised 45% of people who died from asthma did not call for or receive medical assistance in their final fatal attack Overall asthma management, acute and chronic, in primary and secondary care was judged to be good in less than one-fifth of those who died There was a failure by doctors and nurses to identify and act on risk factors for asthma attacks and asthma death The rationale for diagnosing asthma was not evident in a considerable number of cases, and there were inaccuracies related to the completion of medical certificates of the cause of death in over half of the cases considered for the UK National Review of Asthma Deaths Educational aims To increase awareness of some of the findings of the recent UK National Review of Asthma Deaths and previous similar studies To emphasise the need for accurate diagnosis of asthma, and of the requirements for completion of medical certificates of the cause of death To consider areas for improving asthma care and prevention of attacks and avoidable deaths Summary Despite the development and publication of evidence-based asthma guidelines nearly three decades ago, potentially preventable factors are repeatedly identified in studies of the care provided for patients who die from asthma. The UK National Review of Asthma Deaths (NRAD), a confidential enquiry, was no exception: major preventable factors were identified in two-thirds of asthma deaths. Most of these factors, such as inappropriate prescription and failure to provide patients with personal asthma action plans (PAAPs), could possibly have been prevented had asthma guidelines been implemented. NRAD involved in-depth scrutiny by clinicians of the asthma care for 276 people who were classified with asthma as the underlying cause of death in real-life. A striking finding was that a third of these patients did not actually

  7. The relationship between the severity of asthma and comorbidites with anxiety and depressive disorders

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    Valença Alexandre M

    2006-01-01

    Full Text Available OBJECTIVE: There is evidence that asthma is associated with increased frequency of psychiatric symptoms and mental disorders. Our aim was to assess the frequency of anxiety and depressive disorders in a sample of asthmatic outpatients and observe if there is any relationship between this comorbidity and the severity of asthma. METHOD: Sixty-two consecutive patients of two outpatient asthma clinics located in university hospitals were evaluated. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview 4.4 Version. RESULTS: Twenty-seven patients (43.5% met criteria for at least one psychiatric diagnosis. The most frequent diagnoses were major depression (24%, generalized anxiety disorder (20.9% and panic disorder/agoraphobia spectrum disorders (17.7%. We found no significant differences in the prevalence of anxiety disorders and depression between the groups with mild/moderate and severe asthma. Despite the high frequency of depression and anxiety disorders, only 4 (6.5% patients were under psychiatric treatment and 13 (20.9% patients were taking benzodiazepines. Twelve of 15 (80% patients who reported present use of psychotropic medication were not under psychiatric treatment at the moment of the study. CONCLUSIONS: Our results support the high morbidity of anxiety and depressive disorders in asthmatic patients, independent of the severity of asthma.

  8. Detrimental effects of environmental tobacco smoke in relation to asthma severity.

    Science.gov (United States)

    Comhair, Suzy A A; Gaston, Benjamin M; Ricci, Kristin S; Hammel, Jeffrey; Dweik, Raed A; Teague, W Gerald; Meyers, Deborah; Ampleford, Elizabeth J; Bleecker, Eugene R; Busse, William W; Calhoun, William J; Castro, Mario; Chung, Kian Fan; Curran-Everett, Douglas; Israel, Elliot; Jarjour, W Nizar; Moore, Wendy; Peters, Stephen P; Wenzel, Sally; Hazen, Stanley L; Erzurum, Serpil C

    2011-05-04

    Environmental tobacco smoke (ETS) has adverse effects on the health of asthmatics, however the harmful consequences of ETS in relation to asthma severity are unknown. In a multicenter study of severe asthma, we assessed the impact of ETS exposure on morbidity, health care utilization and lung functions; and activity of systemic superoxide dismutase (SOD), a potential oxidative target of ETS that is negatively associated with asthma severity. From 2002-2006, 654 asthmatics (non-severe 366, severe 288) were enrolled, among whom 109 non-severe and 67 severe asthmatics were routinely exposed to ETS as ascertained by history and validated by urine cotinine levels. ETS-exposure was associated with lower quality of life scores; greater rescue inhaler use; lower lung function; greater bronchodilator responsiveness; and greater risk for emergency room visits, hospitalization and intensive care unit admission. ETS-exposure was associated with lower levels of serum SOD activity, particularly in asthmatic women of African heritage. ETS-exposure of asthmatic individuals is associated with worse lung function, higher acuity of exacerbations, more health care utilization, and greater bronchial hyperreactivity. The association of diminished systemic SOD activity to ETS exposure provides for the first time a specific oxidant mechanism by which ETS may adversely affect patients with asthma.

  9. Efficacy of acupuncture in children with asthma: a systematic review.

    Science.gov (United States)

    Liu, Chi Feng; Chien, Li Wei

    2015-07-07

    We performed a systematic review of the efficacy of various types of acupuncture in the treatment of asthma in children. We searched the MEDLINE, Embase, and Cochrane Library databases up to October 20, 2014. Randomized controlled trials (RCTs) of children and adolescents (acupuncture (traditional and laser) vs. control, with one showing significant improvement in asthma-specific anxiety level, but no significant differences in other lung function parameters or quality of life. Another RCT reported significant benefits of laser acupuncture on lung function parameters but did not describe or report statistical analyses. One crossover RCT showed significant improvements in response to both acupuncture and placebo acupuncture, with better improvements with acupuncture compared to placebo acupuncture (forced exhaled volume in 1 s [FEV1], PEF). Two additional crossover RCTs showed no significant differences between single sessions of laser acupuncture and placebo acupuncture on baseline, postacupuncture, and postinduced bronchoconstriction values (% predicted FEV1, maximum expiratory flow). A recent study showed a significant effect of acupuncture paired with acupressure on medication use and symptoms in preschool-age children. Methodologic and reporting variability remains an issue. However, the results suggest that acupuncture may have a beneficial effect on PEF or PEF variability in children with asthma. The efficacy of acupuncture on other outcome measures is unclear. Large-scale RCTs are needed to further assess the efficacy of acupuncture in the treatment of asthma in children.

  10. Bronchial Thermoplasty – Long Term Safety and Effectiveness in Severe Persistent Asthma

    Science.gov (United States)

    Wechsler, Michael E.; Laviolette, Michel; Rubin, Adalberto S.; Fiterman, Jussara; Lapa e Silva, Jose R.; Shah, Pallav L.; Fiss, Elie; Olivenstein, Ronald; Thomson, Neil C.; Niven, Robert M.; Pavord, Ian D.; Simoff, Michael; Hales, Jeff B.; McEvoy, Charlene; Slebos, Dirk-Jan; Holmes, Mark; Phillips, Martin J.; Erzurum, Serpil C.; Hanania, Nicola A.; Sumino, Kaharu; Kraft, Monica; Cox, Gerard; Sterman, Daniel H.; Hogarth, Kyle; Kline, Joel N.; Mansur, Adel H.; Louie, Brian E.; Leeds, William M.; Barbers, Richard G.; Austin, John H.M.; Shargill, Narinder S.; Quiring, John; Armstrong, Brian; Castro, Mario

    2014-01-01

    Background Bronchial thermoplasty (BT) has previously been shown to improve asthma control out to 2 years in patients with severe persistent asthma. Objective To assess effectiveness and safety of BT in asthma patients 5 years post therapy. Methods BT-treated subjects from the Asthma Intervention Research 2 (AIR2) Trial (ClinicalTrials.gov NCT01350414) were evaluated annually for 5 years to assess long-term safety of BT and durability of treatment effect. Outcomes assessed post-BT included severe exacerbations, adverse events, healthcare utilization, spirometry data, and high resolution computed tomography (HRCT) scans. Results 162/190 BT-treated subjects (85.3%) from the AIR2 Trial completed 5 years of follow-up. The proportion of subjects experiencing severe exacerbations and Emergency Room visits, and the rates of events in each of years 1 to 5 remained low and were less than those observed in the 12 months prior to BT treatment (average 5 year reduction in proportions: 44% for exacerbations and 78% for ER visits). Respiratory adverse events and respiratory-related hospitalizations remained unchanged in Years 2 through 5 as compared to the first year after BT. Pre-BD FEV1 values remained stable between years 1 and 5 after BT, despite a 17% reduction in average daily inhaled corticosteroid dose. HRCT scans from baseline to 5 years after BT showed no structural abnormalities that could be attributed to BT. Conclusions These data demonstrate the 5-year durability of the benefits of BT with regard to both asthma control (based on maintained reduction in severe exacerbations and ER visits for respiratory symptoms) and safety. BT has become an important addition to our treatment armamentarium and should be considered for patients with severe persistent asthma who remain symptomatic despite taking ICS (inhaled corticosteroids) and LABA (long-acting-β2-agonists). PMID:23998657

  11. Skin Test Reactivity to Indoor Allergens Correlates with Asthma Severity in Jeddah, Saudi Arabia

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    Koshak Emad A

    2006-03-01

    Full Text Available Abstract Background There is increased emphasis on the role of indoor allergens in asthma. Objective To examine the spectrum of skin test reactivity (sensitization to indoor allergens and its correlation with asthma severity in Jeddah, Saudi Arabia. Methods Asthmatic patients referred to the allergy clinic at King Abdulaziz University Hospital (KAUH in Jeddah were studied. Measures of clinical severity were adopted from national and international asthma guidelines. The degree of sensitization was assessed by the wheal size (positive ≥ 3 mm from standard skin-prick tests for the following common indoor inhalant allergens: house dust mites (Dermatophagoides pteronyssinus [Dp] and Dermatophagoides farinae [Df], cat, and cockroach. Results Skin test results from 113 of 151 (74.8% asthmatic patients were positive for one or more allergens. The patients' ages ranged between 9 and 63 years (mean, 30 ± 13 years, and females constituted 65.5%. The predominant asthma severity level was moderate persistent (55.8%, followed by mild persistent (33.6%. The prevalences of sensitization to indoor allergens were as follows: Dp, 87% (3-25 mm [mean, 7 mm]; Df, 84% (3-20 mm [mean, 7 mm]; cat, 44% (3-15 mm [mean, 6 mm]; and cockroach, 33% (3-12 mm [mean, 4 mm]. Higher asthma severity levels were significantly correlated with the number of allergens with positive sensitization (R = 0.3, p Dp [degrees of freedom {df} = 16, p Df [df = 17, p df = 10, p df = 8, p Conclusions Immunoglobulin E-mediated skin test reactivity to indoor allergens, particularly to house dust mites, was common in asthmatic patients from Jeddah at KAUH. Increased sensitization was associated with higher levels of asthma severity, which is compatible with the literature. This emphasizes the importance of identifying sensitization to relevant indoor allergens in the clinical evaluation of asthmatic persons.

  12. The Severity-Dependent Relationship of Infant Bronchiolitis on the Risk and Morbidity of Early Childhood Asthma

    Science.gov (United States)

    Carroll, Kecia N.; Wu, Pingsheng; Gebretsadik, Tebeb; Griffin, Marie R.; Dupont, William D.; Mitchel, Edward F.; Hartert, Tina V.

    2009-01-01

    Background Infants hospitalized for bronchiolitis have a high rate of early childhood asthma. It is not known whether bronchiolitis severity correlates with the risk of early childhood asthma or with asthma-specific morbidity. Objectives To determine whether a dose-response relationship exists between severity of infant bronchiolitis and both the odds of developing early childhood asthma and asthma-specific morbidity. Methods We conducted a population-based retrospective birth cohort study of term, healthy infants born 1995-2000 and enrolled in a statewide Medicaid program. We defined bronchiolitis severity by categorizing infants into mutually exclusive groups based on most advanced level of healthcare for bronchiolitis. Healthcare visits, asthma-specific medications, and demographics were identified entirely from Medicaid and linked vital records files. Asthma was ascertained between 4-5.5 years, and one-year asthma morbidity (hospitalization, emergency department visit, or oral corticosteroid course) was determined between 4.5-5.5 years, among children with prevalent asthma. Results Among 90,341 children, 18% had an infant bronchiolitis visit, and these infants contributed to 31% of early childhood asthma diagnoses. Relative to children with no infant bronchiolitis visit, the adjusted odds ratios for asthma were 1.86 [95% confidence intervals 1.74-1.99], 2.41 (2.21-2.62) and 2.82 (2.61-3.03) in the Outpatient, Emergency Department, and Hospitalization groups respectively. Children hospitalized with bronchiolitis during infancy had increased early childhood asthma morbidity compared with children with no bronchiolitis visit. Conclusion To our knowledge, this is the first study to demonstrate the dose-response relationship between severity of infant bronchiolitis and the increased odds of both developing early childhood asthma and experiencing asthma-specific morbidity. PMID:19361850

  13. Prevalence and severity of self-reported asthma in young adults, 1976-2004

    DEFF Research Database (Denmark)

    Browatzki, A; Ulrik, Charlotte Suppli; Lange, P

    2009-01-01

    ) subjects answered a questionnaire, and had their height, weight, forced expiratory volume in 1 s (FEV1) and forced vital capacity measured. The prevalence of self-reported asthma was 1.5, 4.7 and 6.9%, respectively, in the three surveys (pincreasing prevalence of asthma was observed in both...... to increase over the last three decades among young Danish adults, and the observed increase in severity seems, at least partly, to be related to the increase in prevalence of obesity.......The aim of the present study was to describe the prevalence and severity of asthma in young Danish adults over three decades. Males and females aged 20-35 yrs were sampled from the population of Copenhagen for the three surveys (1976-1978, 1991-1993 and 2001-2004). A total of 3,285 (46% male...

  14. Acute asthma severity identification of expert system flow in emergency department

    Science.gov (United States)

    Sharif, Nurul Atikah Mohd; Ahmad, Norazura; Ahmad, Nazihah; Desa, Wan Laailatul Hanim Mat

    2017-11-01

    Integration of computerized system in healthcare management help in smoothening the documentation of patient records, highly accesses of knowledge and clinical practices guideline, and advice on decision making. Exploit the advancement of artificial intelligent such as fuzzy logic and rule-based reasoning may improve the management of emergency department in terms of uncertainty condition and medical practices adherence towards clinical guideline. This paper presenting details of the emergency department flow for acute asthma severity identification with the embedding of acute asthma severity identification expert system (AASIES). Currently, AASIES is still in preliminary stage of system validation. However, the implementation of AASIES in asthma bay management is hope can reduce the usage of paper for manual documentation and be a pioneer for the development of a more complex decision support system to smoothen the ED management and more systematic.

  15. Pear shaped spacer nebuhaler compared with nebulised solution for terbutaline administration in acute severe asthma.

    Science.gov (United States)

    Beasley, C R; O'Donnell, T V

    1985-10-09

    The efficacy of terbutaline (1 mg) administered from pressurised aerosol through a nebuhaler was compared in a crossover trial with terbutaline (4 mg) as nebulised solution in 20 patients with acute severe asthma. The improvements following the nebuhaler, which did not require an electrical or pressure source, were worthwhile. In contrast to earlier experience in stable asthma, the increases in FEV1 (p = 0.04) and VC (p = 0.05) at 20 minutes were greater following the higher dose as nebuliser solution than following nebuhaler use. Nebuhaler technique requires individual attention since some patients with the severe asthma breathed out through the nebuhaler reservoir due to failure to close the one-way valve.

  16. Depressive symptomatology, quality of life and disease control among individuals with well-characterized severe asthma.

    Science.gov (United States)

    Yonas, Michael A; Marsland, Anna L; Emeremni, Chetachi A; Moore, Charity G; Holguin, Fernando; Wenzel, Sally

    2013-10-01

    A thorough examination of the relationship of asthma severity and control with symptoms of depression is needed to identify groups of asthmatics at high risk for poor disease control outcomes. This study examines the relationship of symptoms of depression with severity and control in a well-characterized cohort of asthmatics and healthy controls. Depressive symptoms and quality of life were assessed using the Beck Depression Inventory. Disease control was measured by a composite index incorporating symptoms, activity limitation and rescue medication use. Individuals with asthma (n = 91) reported more symptoms of depression than controls (n = 36; p control (p control was associated with more depressive symptoms in severe (r = 0.46, p = 0.002) but not in not severe (r = 0.13, p = 0.40) asthmatics. The relationship of symptoms of depression among severe asthmatics was attenuated by disease control. Exploratory analyses identified specific disease symptom characteristics, as opposed to exacerbations, as associated with symptoms of depression. Among individuals with severe asthma, increased symptom burden is positively associated with risk for co-morbid depression. These findings point to a need for regular mood disorder screenings and treatment referrals among this group. Further research is warranted to examine whether treatment of comorbid depression improves treatment adherence and asthma-related quality of life.

  17. Correlation between CCL26 production by human bronchial epithelial cells and airway eosinophils: Involvement in patients with severe eosinophilic asthma.

    Science.gov (United States)

    Larose, Marie-Chantal; Chakir, Jamila; Archambault, Anne-Sophie; Joubert, Philippe; Provost, Véronique; Laviolette, Michel; Flamand, Nicolas

    2015-10-01

    High pulmonary eosinophil counts are associated with asthma symptoms and severity. Bronchial epithelial cells (BECs) produce CC chemokines, notably CCL26 (eotaxin-3), which recruits and activates eosinophils from asthmatic patients. This suggests that CCL26 production by BECs might be involved in persistent eosinophilia in patients with severe asthma despite treatment with high corticosteroid doses. We sought to determine whether CCL26 levels correlate with eosinophilia and asthma severity. Human CC chemokine expression was assessed by means of quantitative PCR or a quantitative PCR array in vehicle- or IL-13-treated BECs. CCL26 was quantitated by means of ELISA. Immunohistochemistry analyses of CCL26 and major basic protein were done on bronchial biopsy specimens. IL-13 selectively induced CCL26 expression by BECs. This increase was time-dependent and more prominent in BECs from patients with severe eosinophilic asthma. CCL26 levels measured in supernatants of IL-13-stimulated BECs also increased with asthma severity as follows: patients with severe eosinophilic asthma > patients with mild asthma ≈ healthy subjects. Immunohistochemistry analyses of bronchial biopsy specimens confirmed increased levels of CCL26 in the epithelium of patients with mild and those with severe eosinophilic asthma. Tissue eosinophil counts did not correlate with CCL26 staining. However, sputum CCL26 levels significantly correlated with sputum eosinophil counts (P asthma severity. They also suggest a role for CCL26 in the sustained inflammation observed in patients with severe eosinophilic asthma and reveal CCL26 as a potential target for treating patients with eosinophilic asthma that are refractory to classic therapies. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  18. Adding omalizumab to the therapy of adolescents with persistent uncontrolled moderate--severe allergic asthma.

    Science.gov (United States)

    Massanari, M; Milgrom, H; Pollard, S; Maykut, R J; Kianifard, Farid; Fowler-Taylor, A; Geba, G P; Zeldin, R K

    2009-10-01

    This study aimed to evaluate the effectiveness of omalizumab among adolescents with moderate-severe allergic asthma inadequately controlled with inhaled corticosteroids. Data from patients 12 to 17 years of age were pooled from 5 placebo-controlled registration trials of omalizumab. Impact on asthma control was assessed by need for rescue bursts of oral corticosteroids, lung function, symptom scores, and unscheduled office visits. In adolescents (n = 146), addition of omalizumab decreased mean number of rescue bursts (0.3 vs 0.9) versus placebo; relative risk 0.47 (95% confidence interval [CI], 0.22-0.99; P = .047). At study conclusion, mean forced expiratory volume in 1 second increased 268 mL (13.8%) in omalizumab-treated subjects versus 98 mL (5.5%) for placebo (least squares mean treatment difference 146 mL [95% CI, 19.4-272.6; P = .024]). Omalizumab significantly improved asthma symptom scores and reduced unscheduled office visits. Omalizumab added to baseline therapy improves measures of asthma control in adolescents with persistent moderate-severe allergic asthma.

  19. Assessing the relationship between obesity and asthma in adolescent patients: a review

    OpenAIRE

    Ross KR; Hart MA

    2013-01-01

    Kristie R Ross, Meeghan A HartDepartment of Pediatrics, Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, OH, USAAbstract: The parallel rise in the prevalence of obesity and asthma over the last several decades has led to an extensive line of investigation into the relationship between these two conditions. This review will discuss evidence from laboratory-based studies, observational clinical studies, and clinical trials that su...

  20. Obstructive Sleep Apnoea Modulates Airway Inflammation and Remodelling in Severe Asthma.

    Directory of Open Access Journals (Sweden)

    Camille Taillé

    Full Text Available Obstructive sleep apnoea (OSA is frequently observed in severe asthma but the causal link between the 2 diseases remains hypothetical. The role of OSA-related systemic and airway neutrophilic inflammation in asthma bronchial inflammation or remodelling has been rarely investigated. The aim of this study was to compare hallmarks of inflammation in induced sputum and features of airway remodelling in bronchial biopsies from adult patients with severe asthma with and without OSA.An overnight polygraphy was performed in 55 patients referred for difficult-to-treat asthma, who complained of nocturnal respiratory symptoms, poor sleep quality or fatigue. We compared sputum analysis, reticular basement membrane (RBM thickness, smooth muscle area, vascular density and inflammatory cell infiltration in bronchial biopsies.In total, 27/55 patients (49% had OSA diagnosed by overnight polygraphy. Despite a moderate increase in apnoea-hypopnoea index (AHI; 14.2 ± 1.6 event/h [5-35], the proportion of sputum neutrophils was higher and that of macrophages lower in OSA than non-OSA patients, with higher levels of interleukin 8 and matrix metalloproteinase 9. The RBM was significantly thinner in OSA than non-OSA patients (5.8 ± 0.4 vs. 7.8 ± 0.4 μm, p<0.05. RBM thickness and OSA severity assessed by the AHI were negatively correlated (rho = -0.65, p<0.05. OSA and non-OSA patients did not differ in age, sex, BMI, lung function, asthma control findings or treatment.Mild OSA in patients with severe asthma is associated with increased proportion of neutrophils in sputum and changes in airway remodelling.

  1. Long-term effects of biofeedback-induced facial relaxation on measures of asthma severity in children.

    Science.gov (United States)

    Kotses, H; Harver, A; Segreto, J; Glaus, K D; Creer, T L; Young, G A

    1991-03-01

    We studied the effects of electromyographic biofeedback on measures of asthma severity in children. Fifteen children received biofeedback training to reduce facial tension, and 14 children, who served as controls, received biofeedback training to maintain facial tension at a stable level. Assignment to experimental condition was random. As a result of training, electromyographic levels decreased in children trained in facial relaxation and remained fairly constant in children trained in facial tension stability. Biofeedback training was augmented for children in both groups by having them practice their facial exercises at home. Each child's condition was followed for a five-month period subsequent to biofeedback training. Throughout the experiment, the following measures of asthma severity were monitored: lung function, self-rated asthma severity, medication usage, and frequency of asthma attacks. In addition, standardized measures of attitudes toward asthma, self-concept, and chronic anxiety were recorded at regular intervals. As compared to the facial stability subjects, the facial relaxation subjects exhibited higher pulmonary scores, more positive attitudes toward asthma, and lower chronic anxiety during the follow-up period. Subjects in the two groups, however, did not differ on self-rated asthma severity, medication usage, frequency of asthma attacks, or self-concept. Based on the improvements we observed in pulmonary, attitude, and anxiety measures, we concluded that biofeedback training for facial relaxation contributes to the self-control of asthma and would be a valuable addition to asthma self-management programs.

  2. State of the evidence on acute asthma management in children: a critical appraisal of systematic reviews

    NARCIS (Netherlands)

    Boluyt, Nicole; van der Lee, Johanna H.; Moyer, Virginia A.; Brand, Paul L. P.; Offringa, Martin

    2007-01-01

    OBJECTIVE: Our goal was to evaluate clinical, methodologic, and reporting aspects of systematic reviews on the management of acute asthma in children. METHODS: We undertook a systematic review of systematic reviews on acute asthma management in children. We identified eligible reviews by searching

  3. Mannose binding lectin (MBL levels predict lung function decline in severe asthma

    Directory of Open Access Journals (Sweden)

    Ilonka. H. van Veen

    2006-12-01

    Full Text Available There is increasing evidence that activation of the complement system in asthma contributes to ongoing inflammation, tissue damage and airway remodeling. Mannose binding lectin (MBL is a pattern recognition molecule that serves as the key mediator of the lectin pathway of complement activation. MBL levels are genetically determined and vary widely amongst individuals. In the present study we hypothesized that high MBL levels in asthma are associated with increased loss of lung function over time, as a consequence of inflammatory tissue damage. We measured serum MBL levels by ELISA in 68 patients with severe asthma and prospectively determined the change in post-bronchodilator (pb FEV1 over a mean period of 5.7 years. The relationship between MBL and change in pbFEV1 (FEV1 was analysed using (multiple regression analysis and corrected for possible confounders (age, sex, age of onset, asthma duration, and pbFEV1. The median (range MBL level was 332 (10.8-3587 ng·ml–1. MBL was significantly associated with FEV1 (p<0.04. Patients with a high MBL level (332 ng·ml–1 had an increased risk of lung function decline compared to those with low MBL levels (OR (CI: 3.16 (1.14-8.79, p = 0.027; the excess decline being 42 ml·yr–1 (p = 0.01. We conclude that a high MBL level is associated with an increased decline in lung function in patients with severe asthma. MBL might provide a clue towards better understanding of the pathophysiology of ongoing inflammation and subsequent decline in lung function of patients with severe asthma.

  4. Effects of β2-adrenergic receptor polymorphisms on asthma severity ...

    African Journals Online (AJOL)

    Background: Several polymorphisms of the β2-adrenergic receptor (ADRB2) gene have been identified. There is mounting evidence that these polymorphisms are associated with significant variability in response to bronchodilator therapy and thus in severity and duration of asthmatic symptoms. Objectives: to assess the ...

  5. Beneficial effect of omeprazole in a patient with severe bronchial asthma and gastro-oesophageal reflux

    NARCIS (Netherlands)

    Depla, A. C.; Bartelsman, J. F.; Roos, C. M.; Tytgat, G. N.; Jansen, H. M.

    1988-01-01

    A 25-yr-old man suffered from severe nocturnal asthma, which was shown to be provoked by pathological gastro-oesophageal reflux. A dramatic, immediate improvement of his pulmonary condition was achieved by treatment with omeprazole after failure of other therapeutic measures, including high doses of

  6. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort

    DEFF Research Database (Denmark)

    Shaw, Dominick E; Sousa, Ana R; Fowler, Stephen J

    2015-01-01

    U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe ast...

  7. Serum YKL-40 and assessment of severity of bronchial asthma in ...

    African Journals Online (AJOL)

    EL-HAKIM

    bronchial asthma severity, compared to clinical assessment and the related pulmonary function tests. METHODS. This is a cross-sectional observational study. Study population: Thirty known asthmatic children were enrolled from Pulmonology Clinic of Children's Hospital,. Ain Shams University from October 2008 till May.

  8. Effects of secondhand smoke exposure on asthma morbidity and health care utilization in children: a systematic review and meta-analysis.

    Science.gov (United States)

    Wang, Zhen; May, Sara M; Charoenlap, Suvanee; Pyle, Regan; Ott, Nancy L; Mohammed, Khaled; Joshi, Avni Y

    2015-11-01

    Secondhand smoke (SHS) exposure can trigger asthma exacerbations in children. Different studies have linked increased asthma symptoms, health care use, and deaths in children exposed to SHS, but the risk has not been quantified uniformly across studies. To perform a systematic review and meta-analysis to evaluate and quantify asthma severity and health care use from SHS exposure in children. A systematic review was undertaken to assess the association between asthma severity and SHS in children. Inclusion criteria included studies that evaluated children with SHS exposure and reported outcomes of interest with asthma severity including exacerbations. Random effect models were used to combine the outcomes of interest (hospitalization, emergency department or urgent care visits, severe asthma symptoms, wheeze symptoms, and pulmonary function test results) from the included studies. A total of 1,945 studies were identified and 25 studies met the inclusion criteria. Children with asthma and SHS exposure were twice as likely to be hospitalized for asthma (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.20-2.86, P = .01) than children with asthma but without SHS exposure. SHS exposure also was significantly associated with emergency department or urgent care visits (OR 1.66, 95% CI 1.02-2.69, P = 0.04), wheeze symptoms (OR 1.32, 95% CI 1.24, 1.41, P < .001), and lower ratio of forced expiratory volume in 1 second to forced vital capacity (OR -3.34, 95% CI -5.35 to -1.33, P = .001). Children with asthma and SHS exposure are nearly twice as likely to be hospitalized with asthma exacerbation and are more likely to have lower pulmonary function test results. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  9. The burden of severe asthma in childhood and adolescence

    DEFF Research Database (Denmark)

    Fleming, Louise; Murray, Clare; Bansal, Aruna T

    2015-01-01

    preschoolers with mild/moderate wheeze in a cross-sectional study. Despite high-dose treatment, the severe cohorts had more severe exacerbations compared with the mild/moderate ones (annual medians: school-aged 3.0 versus 1.1, preschool 3.9 versus 1.8; p... of these children, integrating clinical data with high-dimensional biomarkers, may help to improve and tailor their clinical management....

  10. A randomized, double-blind, placebo-controlled study of tumor necrosis factor-alpha blockade in severe persistent asthma

    NARCIS (Netherlands)

    Wenzel, Sally E.; Barnes, Peter J.; Bleecker, Eugene R.; Bousquet, Jean; Busse, William; Dahlén, Sven-Erik; Holgate, Stephen T.; Meyers, Deborah A.; Rabe, Klaus F.; Antczak, Adam; Baker, James; Horvath, Ildiko; Mark, Zsuzsanna; Bernstein, David; Kerwin, Edward; Schlenker-Herceg, Rozsa; Lo, Kim Hung; Watt, Rosemary; Barnathan, Elliot S.; Chanez, Pascal; Chanez, P.; Tunon-de-Lara, M.; Antczak, A.; Pierzchala, W.; Bukowczan, Z.; Trawinska, E.; Baker, J.; Wenzel, S. E.; Katial, R.; Bernstein, D.; Kerwin, E.; Bensch, G.; Castro, M.; Noonan, M.; Nayak, A.; Chupp, G.; Kline, J.; Busse, W.; Kavuru, M. S.; Lang, D.; Wolfe, R.; Baughman, R.; Korenblat, P.; Mansfield, L.; Bleecker, E.; Lisberg, E.; Liu, M.; Panettieri, R.; Spangenthal, S.; Blumberg, M.; Elkayam, D.; Noth, I.; Ramsdell, J.; Smith, C.; Horvath, I.; Mark, Z.; Bartfai, Z.; Vinkler, I.; Szima, B.; Janaskova, T.; Reiterer, P.; Kornmann, O.; Gillissen, A.; Kanniess, F.; Kunkel, G.; Zetterstrom, O.; Dahlen, B.; Howarth, P.; Thomson, N.; Fabbri, L.; Gjomarkaj, M.; Centanni, S.; Joos, G.; Rabe, K. F.; Bel, E. H.

    2009-01-01

    RATIONALE: The treatment effect of golimumab, a human monoclonal antibody against tumor necrosis factor (TNF)-alpha, in severe persistent asthma is unknown. OBJECTIVES: To assess the safety and efficacy of golimumab in a large population of patients with uncontrolled, severe persistent asthma.

  11. Prevalence, severity and determinants of asthma in Danish five-year-olds

    DEFF Research Database (Denmark)

    Hermann, Christian; De Fine Olivarius, Niels; Høst, Arne

    2006-01-01

    BACKGROUND: The prevalence of asthma and wheeze is increasing. AIM: To study the annual and cumulative prevalence of asthma and wheeze in 5-y-old Danish children. METHODS: We obtained data on 3052 (82.0% of eligible) Danish children by a postal parental questionnaire including ISAAC questions reg....... The majority of children with current wheeze had an early onset, and severe early symptoms tended to persist. Used with consideration, the label "childhood bronchitis" seems purposeful........9% of the children. Current wheeze was associated with male gender (OR 1.63, 95% CI 1.35-1.96), low parental post-primary education (OR 1.29, 95% CI 1.02-1.63 for or =3 y) and current maternal smoking (OR 1.69, 95% CI 1.39-2.04). "Severe current wheeze" was recognized as asthma in six and childhood...... regarding respiratory symptoms and our own questions on sociodemography and tobacco exposure. RESULTS: "Wheeze ever" was reported in 38.3%, "doctor-diagnosed asthma ever" in 10.5%, "childhood bronchitis ever" in 30.0%, "current wheeze" (severe" (>3 episodes) in 3...

  12. Prevalence and severity of asthma, rhinitis, and eczema in Singapore schoolchildren.

    Science.gov (United States)

    Goh, D Y; Chew, F T; Quek, S C; Lee, B W

    1996-02-01

    This study was part of an international effort to evaluate the epidemiology of asthma and allergic diseases around the world. The aim was to assess the prevalence and severity of these disorders in Singapore schoolchildren. The international study of asthma and allergies in childhood (ISAAC) written questionnaire was administered to 6238 schoolchildren. The respondents were parents of a 6-7 year cohort (n = 2030), and schoolchildren aged 12-15 years (n = 4208). The overall cumulative and 12 month prevalence of wheezing were 22% and 12%, respectively. The prevalence of doctor diagnosed asthma was 20%. Rhinitis was reported by 44% and chronic rashes by 12%. Multiple logistic regression analysis showed that a higher prevalence of wheezing and rhinitis was associated with males, and subjects of higher socioeconomic status (based on type of housing and total family income). More severe asthma related symptoms were present in Malays and Indians than in the Chinese. Allergic disorders are common in Singapore and prevalence is comparable to some populations in the West. Demographic and socioeconomic factors appear to influence the prevalence and severity of these disorders.

  13. Asthma and obesity

    DEFF Research Database (Denmark)

    Ulrik, Charlotte S

    2016-01-01

    PURPOSE OF REVIEW: Obesity has significant negative impact on asthma control and risk of exacerbations. The purpose of this review is to discuss recent studies evaluating the effects of weight reduction on asthma control in obese adults. RECENT FINDINGS: Clinical studies have shown that weight...... reduction in obese patients is associated with improvements in symptoms, use of controller medication, and asthma-related quality of life together with a reduction in the risk for severe exacerbations. Furthermore, several studies have also revealed improvements in lung function and airway responsiveness...... reduction in obese adults with asthma leads to an overall improvement in asthma control, including airway hyperresponsiveness and inflammation. Weight reduction should be a cornerstone in the management of obese patients with asthma....

  14. Incidence and long-term outcome of severe asthma-COPD overlap compared to asthma and COPD alone

    DEFF Research Database (Denmark)

    Baarnes, Camilla Boslev; Andersen, Zorana Jovanovic; Tjønneland, Anne

    2017-01-01

    in the Danish Diet, Cancer, and Health cohort (1993-1997) were followed in the National Patients Registry for admissions for asthma (DJ45-46) and COPD (DJ40-44) and vital status. Asthma-COPD overlap was defined as at least one hospital admission for asthma and one for COPD (different time points), and incident...... asthma-COPD overlap as at least one of the diagnoses occurring after enrollment into the Diet, Cancer, and Health cohort. RESULTS: A total of 1,845 (3.2%) and 4,037 (7.1%) participants had admissions for asthma and COPD, respectively, with 662 (1.2%) participants with asthma-COPD overlap. Incidence rate...... of asthma-COPD overlap per 1,000 person-years was higher in women (0.73) than in men (0.54) (Pperson-years) compared with COPD (23.1, P

  15. Job strain and the risk of severe asthma exacerbations

    DEFF Research Database (Denmark)

    Heikkilä, K; Madsen, I E H; Nyberg, S T

    2014-01-01

    in working-age European men and women. METHODS: We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe...

  16. Effect of vitamin D supplementation on moderate to severe bronchial asthma.

    Science.gov (United States)

    Yadav, Madhu; Mittal, Kundan

    2014-07-01

    To define the therapeutic role of vitamin D in children with moderate to severe bronchial asthma as an adjunct to standard treatment. Hundred asthmatic children of either sex, attending the respiratory and asthma clinic were enroled in the study. Diagnosis was made on the basis of history and clinical examination. Randomization was done using sealed opaque envelop method. In addition to the treatment as per GINA guidelines, one group received oral vitamin D3 (Cholecalciferol) 60,000 IU per month for 6 mo and the other group received placebo powder in the form of glucose sachet with a double blinded design. Monthly follow up of every patient was done and during every visit change in severity, level of control, Peak expiratory flow rate (PEFR), steroid dosage, number of exacerbations and number of emergency visits were assessed. Monthly doses of 60,000 IU vitamin D significantly reduced the number of exacerbations as compared to placebo (p = 0.011). PEFR significantly increased in the treatment group (p = 0.000). Monthly doses of vitamin D significantly reduced the requirement of steroids (p = 0.013) and emergency visits (p = 0.015). Control of asthma was achieved earlier in patients who received monthly vitamin D. Vitamin D significantly reduced the level of severity of asthma patients over 6 mo of treatment (p = 0.016). Vitamin D has a definite role in the management of moderate to severe persistent bronchial asthma as an adjunct to standard treatment.

  17. Airway inflammation and illness severity in response to experimental rhinovirus infection in asthma.

    Science.gov (United States)

    Zhu, Jie; Message, Simon D; Qiu, Yusheng; Mallia, Patrick; Kebadze, Tatiana; Contoli, Marco; Ward, Christine K; Barnathan, Elliot S; Mascelli, Mary Ann; Kon, Onn M; Papi, Alberto; Stanciu, Luminita A; Jeffery, Peter K; Johnston, Sebastian L

    2014-06-01

    The nature of bronchial mucosal inflammation and its physiologic and clinical significance in rhinovirus-induced asthma exacerbations is unclear. We investigated bronchial mucosal inflammatory response and its association with physiologic and clinical outcomes in an experimental model of rhinovirus-induced asthma exacerbations. We used immunohistochemistry methods to detect phenotypes of inflammatory cells infiltrating the bronchial mucosa before and after experimental rhinovirus infection in 10 subjects with asthma and 15 normal subjects. Compared with baseline, rhinovirus infection significantly increased the number of epithelial (P = .005) and subepithelial (P = .017) neutrophils in subjects with asthma only and subepithelial CD68+ macrophages in both subjects with asthma (P = .009) and normal subjects (P = .018) but more so in those with asthma (P = .021). Numbers of CD45+, CD68+, and CD20+ cells; neutrophils; and eosinophils at day 4 postinfection were positively associated with virus load (r = 0.50-0.72, P = .016-0.03). At acute infection in subjects with asthma, CD4+ cells correlated with chest symptom scores (r = 0.69, P = .029), the fall in the 10% fall in FEV1 (PC10) correlated with neutrophils (r = -0.89, P = .029), the PC10 correlated inversely with CD4+ (r = -0.67, P = .023) and CD8+ cells (r = -0.65, P = .03), the 20% fall in FEV1 was inversely associated with CD20+ cells (r = -0.65, P = .03), and higher epithelial CD8+ cell counts were significantly associated with a greater maximum fall in FEV1 (r = -0.72, P = .03), whereas higher subepithelial mast cell counts were significantly associated with a lower maximum percent fall in peak expiratory flow (r = 0.8, P = .024). In subjects with asthma, rhinovirus infection induces bronchial mucosal neutrophilia and more severe monocyte/macrophage infiltration than in normal subjects. Airway neutrophils, eosinophils, and T and B lymphocytes during infection are related to virus load and physiologic and

  18. Changes in rates and severity of compensation claims for asthma due to diisocyanates: a possible effect of medical surveillance measures.

    Science.gov (United States)

    Tarlo, S M; Liss, G M; Yeung, K S

    2002-01-01

    A medical surveillance programme was introduced into Ontario for workers exposed to diisocyanates in 1983, but no mandated surveillance programme is in effect in this province for other occupational respiratory sensitisers. This study assesses changes in incidence and severity of compensated claims for occupational asthma (OA) due to diisocyanates compared with other causes, which have occurred since the introduction of this surveillance programme. New claims for OA compensated by the Ontario Workers' Compensation Board (WCB) between 1980 and 1993 were retrospectively reviewed. Linkage was made between these data and an Ontario Ministry of Health database to assess hospital admissions for asthma from the date of onset of OA until the end of 1996. Numbers of claims for OA induced by diisocyanates ranged from 9-15/year in 1980-83, increased up to 55-58 claims/year in 1988-90, then fell to 19-20 claims/year by 1992-93. By contrast yearly numbers of claims for OA due to other causes increased up to 1985-87 then remained relatively stable. Duration of symptoms for OA induced by diisocyanates was shorter than for other claims and there were fewer hospital admissions among those with OA induced by diisocyanates than among those with OA induced by other causes. Occupational asthma from all causes was diagnosed earlier in claims for 1987-93 compared with 1980-86, and indicators of severity of asthma were also milder in accepted claims during 1987-93 than in earlier claims. Although engineering and industrial hygiene measures may have contributed to these changes, our findings are also consistent with a beneficial contribution from the medical surveillance programme for workers exposed to diisocyanates.

  19. Patient's adherence in asthma.

    Science.gov (United States)

    Gillisen, Adrian

    2007-11-01

    Nonadherence in asthma treatment results in increasing mortality, morbidity, and it is associated with increasing treatment costs. In asthma, adherence rates are often below 50%. Understanding of the needs and behaviors of asthma patients as well as treatment barriers to comply with asthma guidelines is important in developing programs to promote adherence. This article presents information on common types of nonadherence in asthma patients, the causes, and it reviews the literature on interventions to overcome these factors to maximize adherence rates. Although several interventions are effective in improving medication adherence in asthma, only few significantly enhance adherence rates and clinical outcomes of these patients. An improvement in treatment adherence is a complex task, requiring asthma self-management, education programs coupled with educational reinforcements, simplifying treatment planes and applications forms. Good communications skills among clinicians and patient education are also central for improving adherence. Methods to overcoming physician barriers ensure consistency in implementing guideline recommendations in practice.

  20. Body composition in severe refractory asthma: comparison with COPD patients and healthy smokers.

    Directory of Open Access Journals (Sweden)

    Markos Minas

    Full Text Available BACKGROUND: Body composition is an important parameter for patients with chronic obstructive pulmonary disease (COPD whereas the association between asthma and obesity is not fully understood. The impact of severe refractory asthma (SRA on fat free mass (FFM has not been investigated. METHODOLOGY AND PRINCIPAL FINDINGS: 213 subjects (70 healthy smokers, 71 COPD patients and 72 asthma patients without significant comorbidities were included in the study. In all patients, body composition assessment (using bioelectrical impendance analysis, skinfold and anthropometric measurements and spirometry were performed. Differences in fat free mass index (FFMI between groups were assessed and determinants of FFMI in asthma were evaluated. Patients with SRA had lower values of FFMI compared to patients with mild-to-moderate asthma [18.0(17.3-18.3-19.5(18.4-21.5, p<0.001], despite the fact that they were more obese. The levels of FFMI in SRA were lower than those of GOLD stage I-III COPD and comparable to those of stage IV COPD patients [18.0(17.3-18.3-18.8(17.8-20.1, p = ns]. These differences were present even after proper adjustments for sex, age, smoking status, daily dose of inhaled corticosteroids (ICS and daily use of oral corticosteroids (OCS. In multivariate analysis, independent predictors of FFMI in asthmatic patients were age, use of OCS and the presence of SRA, but not smoking, sex or cumulative dose of ICS used. CONCLUSIONS AND SIGNIFICANCE: SRA is related to the presence of low FFMI that is comparable to that of GOLD stage IV COPD. The impact of this observation on asthma mechanisms and outcomes should be further investigated in large prospective studies.

  1. Relationship between serum vitamin D, disease severity, and airway remodeling in children with asthma.

    Science.gov (United States)

    Gupta, Atul; Sjoukes, Alies; Richards, David; Banya, Winston; Hawrylowicz, Catherine; Bush, Andrew; Saglani, Sejal

    2011-12-15

    Little is known about vitamin D status and its effect on asthma pathophysiology in children with severe, therapy-resistant asthma (STRA). Relationships between serum vitamin D, lung function, and pathology were investigated in pediatric STRA. Serum 25-hydroxyvitamin D [25(OH)D(3)] was measured in 86 children (mean age, 11.7 yr): 36 with STRA, 26 with moderate asthma (MA), and 24 without asthma (control subjects). Relationships between 25(OH)D(3), the asthma control test (ACT), spirometry, corticosteroid use, and exacerbations were assessed. Twenty-two of 36 children with STRA underwent fiberoptic bronchoscopy, bronchoalveolar lavage, and endobronchial biopsy with assessment of airway inflammation and remodeling. 25(OH)D(3) levels (median [IQR]) were significantly lower in STRA (28 [22-38] nmol/L) than in MA (42.5 [29-63] nmol/L) and control subjects (56.5 [45-67] nmol/L) (P , P , P = 0.002) in all subjects. 25(OH)D(3) levels were positively associated with ACT (r = 0.6, P , and inversely associated with exacerbations (r = -0.6, P , P = 0.001) in MA and STRA. Airway smooth muscle (ASM) mass, but not epithelial shedding or reticular basement membrane thickness, was inversely related to 25(OH)D(3) levels (r = -0.6, P = 0.008). There was a positive correlation between ASM mass and bronchodilator reversibility (r = 0.6, P = 0.009) and an inverse correlation between ASM mass and ACT (r = -0.7, P asthma control and lung function. The link between vitamin D, airway structure, and function suggests vitamin D supplementation may be useful in pediatric STRA.

  2. Association of food allergy with asthma severity and atopic diseases in Jewish and Arab adolescents.

    Science.gov (United States)

    Graif, Yael; German, Larissa; Livne, Irit; Shohat, Tamy

    2012-10-01

      To investigate the prevalence of reported food allergy and its association with atopic diseases and asthma severity among Jewish and Arab adolescents.   The self-report questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) was administered to adolescents aged 13-14 years from randomly selected junior high schools in Israel. Questions regarding food allergy were added.   A total of 11 171 questionnaires were available for analysis. Food allergy was reported by 3.6% of participants: 1.9% milk, 0.6% egg, 0.6% peanut and 0.4% sesame. On multivariate analysis, food allergy was strongly associated with current asthma (OR, 2.5; 95% CI, 1.8-3.3), atopic eczema (OR, 3.2; 95% CI, 2.4-4.3) and allergic rhinitis (OR, 2.4; 95% CI, 1.8-3.1). Arabs were significantly more allergic to peanut (OR, 2.5; 95% CI, 1.5-4.1), egg (OR, 3.5; 95% CI, 2.1-5.9) and sesame (OR, 2.3; 95% CI, 1.2-4.5) than Jews, and less allergic to milk (OR, 0.6; 95% CI, 0.4-0.9). Asthmatic subjects with food allergy had significantly more parameters of severe asthma than those without food allergy (p foods differs between Jews and Arabs. Asthmatic adolescents with food allergy report more severe asthma than those without food allergy. © 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.

  3. Chlamydia pneumoniae, and mycoplasma pneumoniae: Are they related to severe asthma in childhood?

    Science.gov (United States)

    Iramain, Ricardo; De Jesús, Raùl; Spitters, Cristopher; Jara, Alfredo; Jimenez, Jimmy; Bogado, Norma; Cardozo, Laura

    2016-08-01

    Mycoplasma pneumoniae and Chlamydia pneumoniae are frequent agents of acute respiratory diseases and they have been recognized as infectious triggers of asthma. To determine the frequency of these triggers and their relationship to severe asthma. 82 patients were enrolled in a prospective cross-sectional study from January 2007 to March 2013 and they were divided into three study groups: Group 1: 27 children with severe asthma, Group 2: 29 children with stable asthma and Group 3: 26 children which was the control group. Serological tests included IgG and IgM for both C. pneumoniae and M. pneumoniae. Average age ± SD was 10.9 ± 2.5 for Group 1; 10.1 ± 2.9 for Group 2 and 9.9± 1.9 for Group 3 (p = 0.4). M. pneumoniae IgM was observed in 6/27 (22.2%) in Group 1, 2/29 (6.9%) in Group 2 and 0/26 in the Control Group (p = 0,01). C.pneumoniae IgM was present in 7/26 (26.9%) in Group 1, 2/29 (6.9%) in Group 2 and 0/26 in Group 3 (p = 0.005). No significant difference was observed between Group 2 and Group 3. M. pneumoniae IgG was observed in 7/27 (25.9%) in Group 1, 4/29 (13.7%) in Group 2 and 0/26 in the Control Group (p pneumoniae IgG was present in 8/26 (30.7%) in Group 1, 5/29 (17.2%) in Group 2 and 0/26 in Group 3 (p pneumoniae and C. pneumoniae may play a role in the development of severe asthma.

  4. Incidence and long-term outcome of severe asthma-COPD overlap compared to asthma and COPD alone

    DEFF Research Database (Denmark)

    Baarnes, Camilla Boslev; Andersen, Zorana Jovanovic; Tjønneland, Anne

    2017-01-01

    in the Danish Diet, Cancer, and Health cohort (1993-1997) were followed in the National Patients Registry for admissions for asthma (DJ45-46) and COPD (DJ40-44) and vital status. Asthma-COPD overlap was defined as at least one hospital admission for asthma and one for COPD (different time points), and incident...... asthma-COPD overlap as at least one of the diagnoses occurring after enrollment into the Diet, Cancer, and Health cohort. RESULTS: A total of 1,845 (3.2%) and 4,037 (7.1%) participants had admissions for asthma and COPD, respectively, with 662 (1.2%) participants with asthma-COPD overlap. Incidence rate...

  5. [The degree of asthma severity in children and the level of maternal anxiety and depression].

    Science.gov (United States)

    Witkowska-Płusa, Urszula

    2015-02-01

    Care for sick children most often falls to mothers, which may affect their mental state, causing the states of depression and anxiety. The aim of this study was to determine the relationship between the severity of asthma in children and the level of anxiety and depression in mothers, taking into account the importance of the material status of the family, the educational level of the mothers, the presence of critical events, as well as the coexistence of allergic diseases in other family members. The study included 60 mothers of children with bronchial asthma. Age of mothers in the investigated families was on average 37.28 +/- 6.24 years, and most had a high school education (55.0%) or higher (28.3%). 16.7% of mothers and 8.3% fathers suffered from asthma. 13.3% of mothers of children with asthma were brought child alone. To assess the level of anxiety the inventory for measuring state and trait anxiety (STAI - State Trait Anxiety Inventory) developed by Spielberger, Gorsuch'a and Lushene'a was applied. To determine the changes in depressive the Beck Depression Inventory (BDI - Beck Depression Inventory questionnaire) was used. The Student's t test was included for two independent populations and a comparison of the results obtained in the questionnaire for diagnosing the level of anxiety and depression. For other parameters the correlation coefficient r-Pearson rank and Kendall's tau were performed. Mothers of children with moderate asthma compared to mothers of children with mild asthma had higher levels of anxiety (both state and properties), and also a slightly higher level of depression. Maternal age was connected positively and moderately strongly with the number held by children (r = 0.380; p = 0.003) and age of a child with asthma (r = 0.613, p = 0.0005). The duration of the child's disease was associated positively and moderately strongly with the level of state anxiety mother (X-1) (r = 0.345; p = 0.007) and a bit less and also positively with the

  6. Nebulized magnesium for moderate and severe pediatric asthma: A randomized trial.

    Science.gov (United States)

    Alansari, Khalid; Ahmed, Wessam; Davidson, Bruce L; Alamri, Mohamed; Zakaria, Ibrahim; Alrifaai, Mahomud

    2015-12-01

    Intravenous magnesium sulfate, a rescue therapy added to bronchodilator and systemic steroid therapy for moderate and severe asthma, is uncommonly administered. We hypothesized that nebulized magnesium would confer benefit without undue risk. Patients aged 2 to 14 y with moderate and severe asthma (PRAM severity score ≥ 4) admitted to infirmary/observation unit care were randomized double-blind on admission to receive 800 mg nebulized magnesium or normal saline placebo after all received intensive therapy with combined nebulized albuterol-ipratropium and intravenous methylprednisolone. Time to medical readiness for discharge was the primary outcome; sample size was chosen to detect a 15% absolute improvement. Improvement over time in PRAM severity score and other secondary outcomes were compared for the overall group and severe asthma subset. One hundred and ninety-one magnesium sulfates and 174 placebo patients met criteria for analysis. The groups were similar with mean baseline PRAM scores >7. Blinded active therapy significantly increased blood magnesium level 2 hr post-treatment completion compared to placebo, 0.85 vs 0.82 mmol/L, P = 0.001. There were no important adverse effects. Accelerated failure time analysis showed a non-significantly shortened time to medical readiness for discharge of 14% favoring the magnesium sulfate group, OR = 1.14, 95% CI 0.93 to 1.40, P = 0.20. Mean times until readiness for discharge were 14.7 hr [SD 9.7] versus 15.6 hr [SD 11.3] for the investigational and placebo groups, respectively, P = 0.41. Adding nebulized magnesium to combined nebulized bronchodilator and systemic steroid therapy failed to significantly shorten time to discharge of pediatric patients with moderate or severe asthma. © 2015 Wiley Periodicals, Inc.

  7. Digital asthma self-management interventions: a systematic review.

    Science.gov (United States)

    Morrison, Deborah; Wyke, Sally; Agur, Karolina; Cameron, Euan J; Docking, Robert I; Mackenzie, Alison M; McConnachie, Alex; Raghuvir, Vandana; Thomson, Neil C; Mair, Frances S

    2014-02-18

    Many people with asthma tolerate symptoms and lifestyle limitations unnecessarily by not utilizing proven therapies. Better support for self-management is known to improve asthma control, and increasingly the Internet and other digital media are being used to deliver that support. Our goal was to summarize current knowledge, evidenced through existing systematic reviews, of the effectiveness and implementation of digital self-management support for adults and children with asthma and to examine what features help or hinder the use of these programs. A comprehensive search strategy combined 3 facets of search terms: (1) online technology, (2) asthma, and (3) self-management/behavior change/patient experience. We undertook searches of 14 databases, and reference and citation searching. We included qualitative and quantitative systematic reviews about online or computerized interventions facilitating self-management. Title, abstract, full paper screening, and quality appraisal were performed by two researchers independently. Data extraction was undertaken using standardized forms. A total of 3810 unique papers were identified. Twenty-nine systematic reviews met inclusion criteria: the majority were from the United States (n=12), the rest from United Kingdom (n=6), Canada (n=3), Portugal (n=2), and Australia, France, Spain, Norway, Taiwan, and Greece (1 each). Only 10 systematic reviews fulfilled pre-determined quality standards, describing 19 clinical trials. Interventions were heterogeneous: duration of interventions ranging from single use, to 24-hour access for 12 months, and incorporating varying degrees of health professional involvement. Dropout rates ranged from 5-23%. Four RCTs were aimed at adults (overall range 3-65 years). Participants were inadequately described: socioeconomic status 0/19, ethnicity 6/19, and gender 15/19. No qualitative systematic reviews were included. Meta-analysis was not attempted due to heterogeneity and inadequate information

  8. Effects of Age and Disease Severity on Systemic Corticosteroid Responses in Asthma.

    Science.gov (United States)

    Phipatanakul, Wanda; Mauger, David T; Sorkness, Ronald L; Gaffin, Jonathan M; Holguin, Fernando; Woodruff, Prescott G; Ly, Ngoc P; Bacharier, Leonard B; Bhakta, Nirav R; Moore, Wendy C; Bleecker, Eugene R; Hastie, Annette T; Meyers, Deborah A; Castro, Mario; Fahy, John V; Fitzpatrick, Anne M; Gaston, Benjamin M; Jarjour, Nizar N; Levy, Bruce D; Peters, Stephen P; Teague, W Gerald; Fajt, Merritt; Wenzel, Sally E; Erzurum, Serpil C; Israel, Elliot

    2017-06-01

    Phenotypic distinctions between severe asthma (SA) and nonsevere asthma (NONSA) may be confounded by differential adherence or incorrect use of corticosteroids. To determine if there are persistent phenotypic distinctions between SA (as defined by 2014 American Thoracic Society/European Respiratory Society guidelines) and NONSA after intramuscular triamcinolone acetonide (TA), and to identify predictors of a corticosteroid response in these populations. A total of 526 adults age 18 years and older (315 SA) and 188 children age 6 to less than 18 years (107 SA) in the NHLBI Severe Asthma Research Program III were characterized before and 3 weeks after TA. The primary outcome for corticosteroid response was defined as greater than or equal to 10-point improvement in percent predicted FEV1. Adult asthma groups exhibited a small but significant mean FEV1% predicted improvement after TA (SA group mean difference, 3.4%; 95% confidence interval, 2.2-4.7%; P = 0.001), whereas children did not. Adult SA continued to manifest lower FEV1 and worse asthma control as compared with NONSA after TA. In children, after TA only prebronchodilator FEV1 distinguished SA from NONSA. A total of 21% of adults with SA and 20% of children with SA achieved greater than or equal to 10% improvement after TA. Baseline bronchodilator response and fractional exhaled nitric oxide had good sensitivity and specificity for predicting response in all groups except children with NONSA. One in five patients with SA exhibit greater than or equal to 10% improvement in FEV1 with parenteral corticosteroid. Those likely to respond had greater bronchodilator responsiveness and fractional exhaled nitric oxide levels. In adults, differences in airflow obstruction and symptoms between SA and NONSA persist after parenteral corticosteroids, suggesting a component of corticosteroid nonresponsive pathobiology in adults with SA that may differ in children. Clinical trial registered with www.clinicaltrials.gov (NCT

  9. CYTOLOGICAL AND MORPHOMETRIC ESTIMATE OF THE INFLAMMATION AMONG THE CHILDREN, SUFFERING FROM MODERATELY SEVERE BRONCHIAL ASTHMA

    Directory of Open Access Journals (Sweden)

    T.R. Dulina

    2007-01-01

    Full Text Available The search for the new noninvasive and information methods to estimate the intensity of the inflammatory processes during the bronchial asthma is an important task for the modern medicine, pediatrics, in particular. We have examined 20 children, suffering from moderately severe bronchial asthma in remission. patients underwent the induction of the sputum by means of nail hypertonic solution, bronchoscopic examination along with the sampling of the lavage fluid and bronchial biopsy, cytometry of the induced sputum and bronchoalveolar lavage fluid, morphometric examination of the biopsy samples of bronchi walls, determination of the nitric oxide contents in the expired air. We revealed high self descriptiveness of the cytological characteristics of the induced sputum. High percentage of neutrophiles and eosinophiles in the induced sputum disclosed during remission of the bronchial asthma, as well as thickness increase of the basilemma, ratio distortion of the ciliated and cyathiform cells in the favor of the latter, especially along with the high nitric oxide contents in the expired air indicate the continuous persistence in the allergic respiratory inflammation.Key words: induced sputum, bronchial asthma, children.

  10. Vitamin C and asthma in children: modification of the effect by age, exposure to dampness and the severity of asthma

    Directory of Open Access Journals (Sweden)

    Hemilä Harri

    2011-08-01

    Full Text Available Abstract Background We previously found a significant benefit of vitamin C supplementation in asthmatic children. Purpose To test whether the effect of vitamin C on asthma is heterogeneous over the participant population. Methods Egyptian asthmatic children between 7 and 10 years of age (n = 60 were included in the cross-over trial. They were administered 0.2 grams per day of vitamin C and placebo for separate 6-week periods. The variation in the vitamin C effect on two clinically relevant outcomes was analyzed: the childhood asthma control test (C-ACT, which measures the severity of asthma symptoms (the scale ranges from 0 to 27 points, 1. We used linear modeling to examine the variation of the vitamin C effect in the subgroups. Results The effect of vitamin C on the C-ACT was significantly modified by age and baseline C-ACT levels. In the children aged 7.0-8.2 years with a baseline C-ACT of 18 to 19 points, vitamin C increased the C-ACT score by 4.2 points (95% CI: 3.3-5.3; whereas in the children aged 8.3-10 years who had a baseline C-ACT of 14 to 15 points, vitamin C increased the C-ACT score by only 1.3 points (95% CI: 0.1-2.5. The effect of vitamin C on the FEV1 levels was significantly modified by age and exposure to dampness. In the children aged 7.0-8.2 years with no exposure to dampness, vitamin C increased the FEV1 level by 37% (95% CI: 34-40%, whereas in the children aged 8.3-10 years with exposure to dampness or mold in their bedroom more than one year prior to the study, vitamin C increased the FEV1 level by only 21% (95% CI: 18-25%. Conclusions We found strong evidence that the effect of vitamin C on asthmatic children is heterogeneous. Further research is needed to confirm our findings and identify the groups of children who would receive the greatest benefit from vitamin C supplementation.

  11. A genome-wide association study identifies CDHR3 as a susceptibility locus for early childhood asthma with severe exacerbations

    DEFF Research Database (Denmark)

    Bønnelykke, Klaus; Sleiman, Patrick; Nielsen, Kasper

    2014-01-01

    Asthma exacerbations are among the most frequent causes of hospitalization during childhood, but the underlying mechanisms are poorly understood. We performed a genome-wide association study of a specific asthma phenotype characterized by recurrent, severe exacerbations occurring between 2 and 6 ...

  12. A genome-wide association study identifies CDHR3 as a susceptibility locus for early childhood asthma with severe exacerbations

    NARCIS (Netherlands)

    Bonnelykke, Klaus; Sleiman, Patrick; Nielsen, Kasper; Kreiner-Moller, Eskil; Mercader, Josep M.; Belgrave, Danielle; den Dekker, Herman T.; Husby, Anders; Sevelsted, Astrid; Faura Tellez, Grissel; Mortensen, Li Juel; Paternoster, Lavinia; Flaaten, Richard; Molgaard, Anne; Smart, David E.; Thomsen, Philip F.; Rasmussen, Morten A.; Bonas-Guarch, Silvia; Holst, Claus; Nohr, Ellen A.; Yadav, Rachita; March, Michael E.; Blicher, Thomas; Lackie, Peter M.; Jaddoe, Vincent W. V.; Simpson, Angela; Holloway, John W.; Duijts, Liesbeth; Custovic, Adnan; Davies, Donna E.; Torrents, David; Gupta, Ramneek; Hollegaard, Mads V.; Hougaard, David M.; Hakonarson, Hakon; Bisgaard, Hans

    Asthma exacerbations are among the most frequent causes of hospitalization during childhood, but the underlying mechanisms are poorly understood. We performed a genome-wide association study of a specific asthma phenotype characterized by recurrent, severe exacerbations occurring between 2 and 6

  13. Characteristics and severity of asthma in children with and without atopic conditions: A cross-sectional study

    NARCIS (Netherlands)

    Arabkhazaeli, Ali; Vijverberg, Susanne J. H.; van Erp, Francine C.; Raaijmakers, Jan A. M.; van der Ent, Cornelis K.; Maitland van der Zee, Anke H.

    2015-01-01

    Background: Childhood allergic diseases have a major impact on a child's quality of life, as well as that of their parents. We studied the coexistence of reported allergies in children who use asthma medication. Additionally, we tested the hypothesis that asthma severity is greater among children

  14. Prevalence and severity of allergic rhinitis in house dust mite-allergic patients with bronchial asthma or atopic dermatitis

    NARCIS (Netherlands)

    Terreehorst, I.; Oosting, A. J.; Tempels-Pavlica, Z.; de Monchy, J. G. R.; Bruijnzeel-Koomen, C. A. F. M.; Hak, E.; van Wijk, R. Gerth

    2002-01-01

    BACKGROUND: Allergic rhinitis, asthma and atopic dermatitis are closely associated. Although population-based studies report a high prevalence of rhinitis among asthma patients, less is known of the association between rhinitis and atopic dermatitis and the severity of concomitant rhinitis.

  15. Prevalence and severity of allergic rhinitis in house dust mite-allergic patients with bronchial asthma or atopic dermatitis

    NARCIS (Netherlands)

    Terreehorst, [No Value; Oosting, AJ; Tempels-Pavlica, Z; de Monchy, JGR; Bruijnzeel-Koomen, CAFM; Hak, E; van Wijk, R.

    Background Allergic rhinitis, asthma and atopic dermatitis are closely associated. Although population-based studies report a high prevalence of rhinitis among asthma patients, less is known of the association between rhinitis and atopic dermatitis and the severity of concomitant rhinitis.

  16. Association of pediatric asthma severity with exposure to common household dust allergens

    Energy Technology Data Exchange (ETDEWEB)

    Gent, Janneane F., E-mail: janneane.gent@yale.edu [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States); Belanger, Kathleen [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States); Triche, Elizabeth W. [Brown University, Department of Community Health/Epidemiology, Providence, RI (United States); Bracken, Michael B. [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States); Beckett, William S. [Mount Auburn Hospital, Department of Internal Medicine, Cambridge, MA (United States); Leaderer, Brian P. [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States)

    2009-08-15

    Background: Reducing exposure to household dust inhalant allergens has been proposed as one strategy to reduce asthma. Objective: To examine the dose-response relationships and health impact of five common household dust allergens on disease severity, quantified using both symptom frequency and medication use, in atopic and non-atopic asthmatic children. Methods: Asthmatic children (N=300) aged 4-12 years were followed for 1 year. Household dust samples from two indoor locations were analyzed for allergens including dust mite (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1), cockroach (Bla g 1). Daily symptoms and medication use were collected in monthly telephone interviews. Annual disease severity was examined in models including allergens, specific IgE sensitivity and adjusted for age, gender, atopy, ethnicity, and mother's education. Results: Der p 1 house dust mite allergen concentration of 2.0 {mu}g/g or more from the main room and the child's bed was related to increased asthma severity independent of allergic status (respectively, OR 2.93, 95% CI 1.37, 6.30 for 2.0-10.0 {mu}g/g and OR 2.55 95% CI 1.13, 5.73 for {>=}10.0 {mu}g/g). Higher pet allergen levels were associated with greater asthma severity, but only for those sensitized (cat OR 2.41 95% CI 1.19, 4.89; dog OR 2.06 95% CI 1.01, 4.22). Conclusion: Higher levels of Der p 1 and pet allergens were associated with asthma severity, but Der p 1 remained an independent risk factor after accounting for pet allergens and regardless of Der p 1 specific IgE status.

  17. A proof-of-concept, randomized, controlled trial of omalizumab in patients with severe, difficult-to-control, nonatopic asthma.

    Science.gov (United States)

    Garcia, Gilles; Magnan, Antoine; Chiron, Raphaël; Contin-Bordes, Cécile; Berger, Patrick; Taillé, Camille; Devouassoux, Gilles; de Blay, Frédéric; Couderc, Louis-Jean; Didier, Alain; O'Callaghan, Dermot S; Girodet, Pierre-Olivier; Bourdeix, Isabelle; Le Gros, Vincent; Humbert, Marc

    2013-08-01

    While up to 50% of patients with severe asthma have no evidence of allergy, IgE has been linked to asthma, irrespective of atopic status. Omalizumab, an anti-IgE monoclonal antibody, is reported to significantly benefit a subset of patients with severe, persistent, allergic asthma. Therefore, we investigated whether omalizumab has biologic and clinical effects in patients with refractory nonatopic asthma. Forty-one adult patients who, despite daily treatment with or without maintenance oral corticosteroids, had severe, nonatopic, refractory asthma according to GINA (Global Initiative for Asthma) step 4, were randomized to receive omalizumab or placebo in a 1:1 ratio. The primary end point was the change in expression of high-affinity IgE receptor (FcεRI) on blood basophils and plasmacytoid dendritic cells (pDC2) after 16 weeks. The impact of omalizumab on lung function and clinical variables was also examined. Compared with placebo, omalizumab resulted in a statistically significant reduction in FcεRI expression on basophils and pDC2 (P < .001). The omalizumab group also showed an overall increase in FEV1 compared with baseline (+250 mL, P = .032; +9.9%, P = .029). A trend toward improvement in global evaluation of treatment effectiveness and asthma exacerbation rate was also observed. Omalizumab negatively regulates FcεRI expression in patients with severe nonatopic asthma, as it does in severe atopic asthma. Omalizumab may have a therapeutic role in severe nonatopic asthma. Nonetheless, our preliminary findings support further investigation to better assess the clinical efficacy of omalizumab. ClinicalTrials.gov; No.: NCT01007149; URL: www.clinicaltrials.gov and European Clinical Trials Database, EudraCT; No.: 2009-010937-38; URL: https://www.clinicaltrialsregister.eu.

  18. Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma.

    Science.gov (United States)

    Leversha, A M; Campanella, S G; Aickin, R P; Asher, M I

    2000-04-01

    To compare the costs and effectiveness of albuterol by metered dose inhaler (MDI) and spacer versus nebulizer in young children with moderate and severe acute asthma. Randomized, double-blind, placebo-controlled trial in an emergency department at a children's hospital. The participants were children 1 to 4 years of age with moderate to severe acute asthma. Patients assigned to the spacer group received albuterol (600 microg) by MDI by spacer (AeroChamber) followed by placebo by nebulizer (n = 30). The nebulizer group received placebo MDI by spacer followed by 2.5 mg albuterol by nebulizer (n = 30). Treatments were repeated at 20-minute intervals until the patient was judged to need no further doses of bronchodilator, or a total of 6 treatments. Clinical score, heart rate, respiratory rate, auscultatory findings, and oxygen saturation were recorded at baseline, after each treatment, and 60 minutes after the last treatment. Baseline characteristics and asthma severity were similar for the treatment groups. The spacer was as effective as the nebulizer for clinical score, respiratory rate, and oxygen saturation but produced a greater reduction in wheezing (P =.03). Heart rate increased to a greater degree in the nebulizer group (11.0/min vs 0.17/min for spacer, P vs 60% in the nebulizer group, P =.04, adjusted for sex). No differences were seen in rates of tremor or hyperactivity. The mean cost of each emergency department presentation was NZ$825 for the spacer group and NZ$1282 for the nebulizer group (P =.03); 86% of children and 85% of parents preferred the spacer. The MDI and spacer combination was a cost-effective alternative to a nebulizer in the delivery of albuterol to young children with moderate and severe acute asthma.

  19. Plasma antibodies against heat shock protein 70 correlate with the incidence and severity of asthma in a Chinese population

    Directory of Open Access Journals (Sweden)

    Wei Qingyi

    2005-02-01

    Full Text Available Abstract Background The heat shock proteins (Hsps are induced by stresses such as allergic factors and inflammatory responses in bronchi epithelial cells and therefore may be detectable in patients with asthma. However, the etiologic link between anti-Hsps and asthma (its severity and related inflammatory responses such as interleukin-4 and immunoglobulin E has not been established. We determined whether antibodies against Hsp60 and Hsp70 were present in patients with asthma and evaluated their associations with risk and severity of asthma. Methods We determined the levels of anti-Hsp60 and anti-Hsp70 by immunoblot and their associations with risk and symptom severity of asthma in 95 patients with asthma and 99 matched non-symptomatic controls using multivariate logistic regression analysis. Results Compared to the controls, asthma patients were more likely to have detectable anti-Hsp60 (17.2% vs 5.1% and anti-Hsp70 (33.7% vs 8.1% (p ≤ 0.001. In particular, the presence of anti-Hsp70 was associated with a greater than 2 fold risk for asthma (adjusted OR = 2.21; 95% CI = 1.35~3.59. Furthermore, both anti-Hsp60 and anti-Hsp70 levels were positively correlated with symptom severity (p Conclusions These data suggest that anti-Hsp60 and especially anti-Hsp70 correlate with the attacks and severity of asthma. The underlying molecular mechanisms linking antibodies to heat shock proteins and asthma remain to be investigated.

  20. Low-dose budesonide treatment reduces severe asthma-related events in patients with infrequent asthma symptoms at baseline

    DEFF Research Database (Denmark)

    Reddel, H. K.; Busse, W. W.; Pedersen, Søren

    2015-01-01

    symptoms, evidence is lacking for the benefit of ICS and safety of bronchodilator-only treatment. We investigated asthma outcomes by baseline symptom frequency in a post-hoc analysis of the multinational inhaled Steroid Treatment As Regular Therapy in early asthma (START) study.2 METHODS: Patients aged 4......-66 years with recent-onset mild asthma (11 years] or 200 mug [patients aged 2 symptom days/week; further divided into 0-1, >1-2 symptom days/week). RESULTS: Overall, 7138 patients were included (budesonide, n=3577; placebo, n=3561). At baseline, symptom frequency was 0-1 symptom days/week for 2184 (30......RATIONALE: Inhaled corticosteroids (ICS) are highly effective in low doses for reducing asthma-related exacerbation risk and mortality. Previously, ICS treatment was recommended for patients with 'persistent' asthma, defined by symptoms >2 days/week.1 However, for patients with less frequent...

  1. Impurity profile of bronchodilators used in asthma: A critical review.

    Science.gov (United States)

    Prajapati, Krunal J; Kothari, Charmy

    2017-08-29

    Asthma is defined as a heterogeneous disease usually characterized by chronic airway inflammation (GINA 2016) affecting almost 334 million people worldwide (Global asthma report 2014). Treatment of asthma with a long-acting bronchodilator is important because it reduces the symptoms that occur at night or in the early morning and it is very effective to use as a long term control medication for asthma by preventing asthmatic symptoms. The main objective of this review is to describe the impurity profile and force degradation studies for three major classes of bronchodilators namely β2-adrenoceptor agonists, muscarinic receptor antagonists and xanthine. Unidentified and potential toxic impurities are hazardous to health, so in order to increase the safety of drug therapy; impurities should be identified and determined by selective analytical methods. Different conditions for degradations like hydrolytic (acidic, basic and neutral), oxidative, photolytic and thermolytic have been discussed in detail for bronchodilators. Furthermore, it is discussed with the name along with number of impurities and degradants present in different matrices including its clinical implication. The name as well as structures of all the observed impurities in different bronchodilators is included, which can aid in impurity profiling. Various analytical methods, including Chromatographic techniques like TLC; HPTLC; HPLC; GC, Spectroscopic techniques like UV; IR; NMR; MS and hyphenated techniques like GC-MS; LC-MS; CE-MS; SFC-MS; LC-NMR; CE-NMR; LC-FTIR has been used for the identification and quantification of impurities. A general scheme has been presented for the impurity profiling. Nineteen articles, six patents and fifteen drugs are included in this review. In that, majority (7) of papers are based on HPLC-UV, 5 papers are based on LC-MS, 2 papers are based on LC-MS-NMR, 1 paper is based on LC-NMR, 1 paper is based on GC-MS-NMR, 1 paper is based on GC-UV and 1 paper is based on TLC

  2. Relevance of Allergy in Adult Asthma

    Science.gov (United States)

    Mathur, Sameer K.; Viswanathan, Ravi K.

    2014-01-01

    Recent studies on asthma have demonstrated multiple phenotypes of asthma, based on the clinical characteristics of the disease. With the current interest in personalized medicine, the question arises whether the presence of allergic sensitization has any relevance for these phenotypes and the management of asthma. This review will examine the current knowledge of asthma phenotypes and the impact of atopy on asthma diagnosis and severity in adults. In addition, this review will address whether therapies targeted at the atopic axis help improve asthma outcomes, including lung function indices and exacerbations. PMID:24643812

  3. Obesity and asthma: a coincidence or a causal relationship? A systematic review.

    Science.gov (United States)

    Ali, Zarqa; Ulrik, Charlotte Suppli

    2013-09-01

    Epidemiological data has established increasing adiposity as a risk factor for incident asthma. However, the mechanisms underlying the association between obesity and asthma are incompletely understood. In the present paper, we review current knowledge of possible mechanisms mediating the observed association between obesity and asthma. Systematic literature review. Obesity and asthma share some etiological factors, such as a common genetic predisposition and effects of in utero conditions, and may also have common predisposing factors such as physical activity and diet. Obesity results in important changes in the mechanical properties of the respiratory system which could explain the occurrence of asthma. However, there are also plausible biological mechanisms whereby obesity could be expected to either cause or worsen asthma. These include co-morbidities such as gastro-oesophageal reflux, complications from sleep-disordered breathing, breathing at low lung volumes, chronic systemic inflammation, and endocrine factors, including adipokines and reproductive hormones. Obesity related asthma is in general not associated with eosinophilic airway inflammation, and adipokines are likely to play important roles in the inflammatory pathogenesis of asthma in obese individuals. The association between obesity and asthma is not straightforward, and further knowledge is clearly needed, as understanding the underlying mechanisms may lead to new therapeutic options for this high-risk part of the asthma population. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Montelukast for prevention and treatment of asthma exacerbations in adults: Systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Hong Ping; Jia, Chun E; Lv, Yan; Gibson, Peter Gerard; Wang, Gang

    2014-01-01

    It has proven efficacy in reducing asthma exacerbations, but the effect size of montelukast (a leukotriene receptor antagonist) for varied severity of asthma exacerbations is not systematically assessed. This study was designed to systematically explore the evidence for montelukast, as first-line or add-on therapy, in preventing and treating asthma exacerbations in adult patients with asthma. Randomized controlled trials were searched in PubMed, CENTRAL, Web of Science, Embase, and OVID up to March 2013, where montelukast prevented or treated asthma exacerbations in adults. Primary outcomes were the number of patients experiencing exacerbations in chronic asthma and hospitalizations in acute asthma. Odds ratio (OR) with 95% confidence intervals (CI), risk difference, and number needed to treat (NNT) were calculated and pooled. Adverse events were also assessed in chronic asthma. Twenty trials for chronic asthma and six for acute asthma were identified. In comparison with placebo, adults with chronic asthma receiving montelukast had significantly reduced number of exacerbations (OR = 0.60 and 95% CI, 0.49, 0.74; NNT = 17 and 95% CI, 12, 29). However, montelukast was inferior to inhaled corticosteroids (ICSs) (OR = 1.63; 95% CI, 1.29, 2.0) and ICS plus long-acting beta2-agonist (LABA; OR = 3.94; 95% CI, 1.64, 9.48) as the first-line therapies and LABA (OR = 1.22; 95% CI, 1.05, 1.42) as the add-on therapies in reducing asthma exacerbations. In acute asthma, montelukast could statistically improve peak expiratory flow percent predicted (p = 0.008) and reduce systemic corticosteroid intake (p = 0.005). Montelukast had low risk in hoarseness and insomnia. Our meta-analysis suggests that montelukast significantly reduces mild, moderate, and part of severe exacerbations in chronic mild to moderate asthma, but it has inferior efficacy to ICS or ICS plus LABA.

  5. A systematic review of economic evaluations of therapy in asthma

    Directory of Open Access Journals (Sweden)

    Katayoun Bahadori

    2010-08-01

    Full Text Available Katayoun Bahadori1, Bradley S Quon2, Mary M Doyle-Waters1, Carlo Marra3, J Mark FitzGerald21Centre for Clinical Epidemiology and Evaluation (C2E2, 2Department of Medicine, Respiratory Division, 3Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, CanadaBackground: Asthma’s cost-effectiveness is a major consideration in the evaluation of its treatment options. Our objective was to perform a systematic review of the cost-effectiveness of asthma medications.Methods: We performed a systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, OHE-HEED, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessments Database, NHS Economic Evaluation Database, and Web of Science and reviewed references from key articles between 1990 and Jan 2008.Results: A total of 49 RCTs met the inclusion criteria. Maintenance therapy with inhaled corticosteroids was found to be very cost-effective and in uncontrolled asthmatics patients currently being treated with ICS, the combination of an ICS/LABA represents a safe, cost-effective treatment. The simplified strategy using budesonide and formoterol for maintenance and reliever therapy was also found to be as cost-effective as salmeterol/fluticasone plus salbutamol. Omalizumab was found to be cost-effective. An important caveat with regard to the published literature is the relatively high proportion of economic evaluations which are funded by the manufacturers of specific drug treatments.Conclusion: Future studies should be completed independent of industry support and ensure that the comparator arms within studies should include dosages of drugs that are equivalent.Keywords: asthma, medication, cost-effectiveness, cost of illness, economic costs

  6. Effect of relaxation-breathing training on anxiety and asthma signs/symptoms of children with moderate-to-severe asthma: a randomized controlled trial.

    Science.gov (United States)

    Chiang, Li-Chi; Ma, Wei-Fen; Huang, Jing-Long; Tseng, Li-Feng; Hsueh, Kai-Chung

    2009-08-01

    Emotional stress triggers and exacerbates asthma in children. Reducing anxiety in adults by relaxation-breathing techniques has been shown in clinical trials to produce good asthma outcomes. However, more evidence is needed on using this intervention with asthmatic children. To evaluate the effectiveness of combined self-management and relaxation-breathing training for children with moderate-to-severe asthma compared to self-management-only training. Two-group experimental design. Pediatric outpatient clinic of a medical center in central Taiwan. Participants were 48 children, ages 6-14 years, with moderate-to-severe asthma and their parents. Participants were randomly assigned to an experimental or comparison group and matched by gender, age, and asthma severity. Both groups participated in an asthma self-management program. Children in the experimental group were also given 30 min of training in a relaxation-breathing technique and a CD for home practice. Data on anxiety levels, self-perceived health status, asthma signs/symptoms, peak expiratory flow rate, and medication use were collected at baseline and at the end of the 12-week intervention. Effects of group, time, and group-time interaction were analyzed using the Mixed Model in SPSS (12.0). Anxiety (especially state anxiety) was significantly lower for children in the experimental group than in the comparison group. Differences in the other four physiological variables were also noted between pre- and post-intervention, but these changes did not differ significantly between groups. A combination of self-management and relaxation-breathing training can reduce anxiety, thus improving asthmatic children's health. These results can serve as an evidence base for psychological nursing practice with asthmatic children.

  7. Automated chart review utilizing natural language processing algorithm for asthma predictive index.

    Science.gov (United States)

    Kaur, Harsheen; Sohn, Sunghwan; Wi, Chung-Il; Ryu, Euijung; Park, Miguel A; Bachman, Kay; Kita, Hirohito; Croghan, Ivana; Castro-Rodriguez, Jose A; Voge, Gretchen A; Liu, Hongfang; Juhn, Young J

    2018-02-13

    Thus far, no algorithms have been developed to automatically extract patients who meet Asthma Predictive Index (API) criteria from the Electronic health records (EHR) yet. Our objective is to develop and validate a natural language processing (NLP) algorithm to identify patients that meet API criteria. This is a cross-sectional study nested in a birth cohort study in Olmsted County, MN. Asthma status ascertained by manual chart review based on API criteria served as gold standard. NLP-API was developed on a training cohort (n = 87) and validated on a test cohort (n = 427). Criterion validity was measured by sensitivity, specificity, positive predictive value and negative predictive value of the NLP algorithm against manual chart review for asthma status. Construct validity was determined by associations of asthma status defined by NLP-API with known risk factors for asthma. Among the eligible 427 subjects of the test cohort, 48% were males and 74% were White. Median age was 5.3 years (interquartile range 3.6-6.8). 35 (8%) had a history of asthma by NLP-API vs. 36 (8%) by abstractor with 31 by both approaches. NLP-API predicted asthma status with sensitivity 86%, specificity 98%, positive predictive value 88%, negative predictive value 98%. Asthma status by both NLP and manual chart review were significantly associated with the known asthma risk factors, such as history of allergic rhinitis, eczema, family history of asthma, and maternal history of smoking during pregnancy (p value NLP-API and abstractor, and the effect sizes were similar between the reviews with 4.4 vs 4.2 respectively. NLP-API was able to ascertain asthma status in children mining from EHR and has a potential to enhance asthma care and research through population management and large-scale studies when identifying children who meet API criteria.

  8. Innate lymphoid cells and asthma.

    Science.gov (United States)

    Yu, Sanhong; Kim, Hye Young; Chang, Ya-Jen; DeKruyff, Rosemarie H; Umetsu, Dale T

    2014-04-01

    Asthma is a complex and heterogeneous disease with several phenotypes, including an allergic asthma phenotype characterized by TH2 cytokine production and associated with allergen sensitization and adaptive immunity. Asthma also includes nonallergic asthma phenotypes, such as asthma associated with exposure to air pollution, infection, or obesity, that require innate rather than adaptive immunity. These innate pathways that lead to asthma involve macrophages, neutrophils, natural killer T cells, and innate lymphoid cells, newly described cell types that produce a variety of cytokines, including IL-5 and IL-13. We review the recent data regarding innate lymphoid cells and their role in asthma. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  9. Models of chronic disease management in primary care for patients with mild-to-moderate asthma or COPD: a narrative review.

    Science.gov (United States)

    Cranston, Josephine M; Crockett, Alan J; Moss, John R; Pegram, Robert W; Stocks, Nigel P

    2008-04-21

    To review the literature for any promising strategies for the primary care management of mild-to-moderate asthma and chronic obstructive pulmonary disease (COPD) in adults. Using "MeSH" terms for COPD, asthma and primary health care, we conducted an extensive literature search for relevant meta-analyses, systematic reviews, narrative reviews, reports and individual studies. Grey literature was also included. We chose a narrative review approach because of substantial heterogeneity of study designs in the literature. 1119 articles of potential relevance were retained, of which 246 were included in our review. There was insufficient evidence to determine whether general practitioners with a special interest (GPwSI) in respiratory care improved the diagnosis and management of mild-to-moderate COPD. An asthma service involving GPwSI increased respiratory drug costs but reduced the costs for less specific drugs. No clear benefit has been shown for practice nurse-run asthma clinics in primary care compared with usual care in altering asthma morbidity, quality of life, lung function or medication use. Evidence to determine the effectiveness of practice nurse-run COPD clinics could not be found. Self-management education, GP review and action plans may produce short-term benefits for asthma patients, particularly those with moderate-to-severe disease, but the evidence for a similar approach to patients with mild-to-moderate COPD is equivocal. There has been poor uptake of respiratory clinical guidelines relevant to primary care - partly because most guidelines are based on moderate-to-severe disease. Spirometry programs in primary care are useful for differential diagnosis of asthma and COPD. Spirometry may alter the management of mild asthma, but there is a lack of evidence that it alters the management of COPD in primary care. The role of primary health care in management of mild-to-moderate asthma and COPD requires further investigation using randomised controlled

  10. Combination Therapy in Asthma: A Review | Saleh | Nigerian ...

    African Journals Online (AJOL)

    Background: Asthma can be defined as a chronic inflammatory disease of the airways that is reversible either spontaneously or by treatment. Despite the exponential increase in asthma research, the prevalence of asthma is on the increase, especially in children and young adults in the western societies. Inhaled therapies

  11. Adolescent and caregivers' experiences of electronic adherence assessment in paediatric problematic severe asthma.

    Science.gov (United States)

    Stewart, Amy C; Gannon, Kenneth N; Beresford, Fran; Fleming, Louise

    2018-01-01

    This study explored the experiences of adolescents and their caregivers regarding adherence to inhaled corticosteroids which are assessed through an electronic monitoring device (EMD). These devices are increasingly being used for assessing medication adherence, yet there is little information about patient's experience of these tools. Semi-structured interviews were conducted with eight adolescents with severe asthma, aged 11-15 years, who were electronically monitored as part of their care, along with their caregivers. Interviews were analysed using thematic analysis. Three themes were identified: 'they were trying to help me get better', 'checking up and catching out' and 'who is responsible?' The themes highlighted differences in priorities between participant groups, the impact of monitoring on the healthcare relationship and the dilemma of transferring responsibility for asthma management to adolescents. The findings suggest it is important for healthcare professionals to engage with patient's preferences and priorities when introducing EMDs.

  12. Computed tomography assessment of airways throughout bronchial tree demonstrates airway narrowing in severe asthma.

    Science.gov (United States)

    Brillet, Pierre-Yves; Debray, Marie-Pierre; Golmard, Jean-Louis; Ould Hmeidi, Yahya; Fetita, Catalin; Taillé, Camille; Aubier, Michel; Grenier, Philippe A

    2015-06-01

    To analyze airway dimensions throughout the bronchial tree in severe asthmatic patients using multidetector row computed tomography (MDCT) focusing on airway narrowing. Thirty-two patients with severe asthma underwent automated (BronCare software) analysis of their right lung bronchi, with counts of airways >3 mm long arising from the main bronchi (airway count) and bronchial dimension quantification at segmental and subsegmental levels (lumen area [LA], wall area [WA], and WA%). Focal bronchial stenosis was defined as >50% narrowing of maximal LA on contiguous cross-sectional slices. Severe asthmatics were compared to 13 nonsevere asthmatic patients and nonasthmatic (pooled) subjects (Wilcoxon rank tests, then stepwise logistic regression). Finally, cluster analysis of severe asthmatic patients and stepwise logistic regression identified specific imaging subgroups. The most significant differences between severe asthmatic patients and the pooled subjects were bronchial stenosis (subsegmental and all bronchi: P bronchial stenosis: P = .009). Airway count was as discriminant as forced expiratory volume in 1 second/forced vital capacity (P = .01) to identify patients in each cluster, with both variables being correlated (r = 0.59, P = .005). Severe asthma-associated morphologic changes were characterized by focal bronchial stenoses and diffuse airway narrowing; the latter was associated with airflow obstruction. WA%, dependent on airway caliber, is the best parameter to identify severe asthmatic patients from pooled subjects. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

  13. Assessing the value of mepolizumab for severe eosinophilic asthma: a cost-effectiveness analysis.

    Science.gov (United States)

    Whittington, Melanie D; McQueen, R Brett; Ollendorf, Daniel A; Tice, Jeffrey A; Chapman, Richard H; Pearson, Steven D; Campbell, Jonathan D

    2017-02-01

    Adding mepolizumab to standard treatment with inhaled corticosteroids and controller medications could decrease asthma exacerbations and use of long-term oral steroids in patients with severe disease and increased eosinophils; however, mepolizumab is costly and its cost effectiveness is unknown. To estimate the cost effectiveness of mepolizumab. A Markov model was used to determine the incremental cost per quality-adjusted life year (QALY) gained for mepolizumab plus standard of care (SoC) and for SoC alone. The population, adults with severe eosinophilic asthma, was modeled for a lifetime time horizon. A responder scenario analysis was conducted to determine the cost effectiveness for a cohort able to achieve and maintain asthma control. Over a lifetime treatment horizon, 23.96 exacerbations were averted per patient receiving mepolizumab plus SoC. Avoidance of exacerbations and decrease in long-term oral steroid use resulted in more than $18,000 in cost offsets among those receiving mepolizumab, but treatment costs increased by more than $600,000. Treatment with mepolizumab plus SoC vs SoC alone resulted in a cost-effectiveness estimate of $386,000 per QALY. To achieve cost effectiveness of approximately $150,000 per QALY, mepolizumab would require a more than 60% price discount. At current pricing, treating a responder cohort yielded cost-effectiveness estimates near $160,000 per QALY. The estimated cost effectiveness of mepolizumab exceeds value thresholds. Achieving these thresholds would require significant discounts from the current list price. Alternatively, treatment limited to responders improves the cost effectiveness toward, but remains still slightly above, these thresholds. Payers interested in improving the efficiency of health care resources should consider negotiations of the mepolizumab price and ways to predict and assess the response to mepolizumab. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All

  14. Comparison of Rapid Bronchodilatory Effects of Salmeterol and Formoterol in Patients with Moderate to Severe Asthma

    Directory of Open Access Journals (Sweden)

    Ebrahim Salehifar

    2015-10-01

    Full Text Available Backgrounds: All of Long-acting β2-agonists are beneficial in maintenance treatment of asthma but their use in relieving acute asthma attacks is not well known. The aim of this study was to compare rapid bronchodilatory effects of Salmeterol and Formoterol in patient with moderate to severe asthma.Methods: It was a randomized, double blind, cross-over study on 60 patients with moderate to severe asthma. Patients randomly received 50 micrograms of salmeterol or 18 micrograms of formoterol  and  after  one-week  washed  out  period  exchanged  their  medications. All  patients undergone spirometry for four times (before receiving the drugs, as well as 3, 30 and 60 minutes after drug inhalation and Forced Expiratory Volume in 1 second (FEV1, Forced Vital Capacity (FVC, FVC percentage predicted value, FEV1/FVC, Peak Expiratory Flow Rate (PEFR and PEFR percentage predicted value were measured.Results: Both medications could significantly increase FEV1/FVC and PEFR at 3, 30 and 60 minutes after inhalation (P<0.001 compared to baseline.Three minutes after inhalation of salmeterol and formoterol, FEV1 increased by 8.7% and 12.2% respectively. Formoterol was associated with more increase in the amounts of FEV1 compared to Salmeterol.Conclusion: This study showed that fromoterol has a more rapid onset of bronchodilating action compared with salmeterol at 3 minutes after inhalation. Both agents had significant increases in FEV1/FVC and PEFR compared to baseline with no significant differences between two drugs.

  15. Effects of Fruit and Vegetable Consumption on Risk of Asthma, Wheezing and Immune Responses: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Hosseini, Banafshe; Berthon, Bronwyn S; Wark, Peter; Wood, Lisa G

    2017-03-29

    Abstract: Evidence suggests that reduced intake of fruit and vegetables may play a critical role in the development of asthma and allergies. The present review aimed to summarize the evidence for the association between fruit and vegetable intake, risk of asthma/wheeze and immune responses. Databases including PubMed, Cochrane, CINAHL and EMBASE were searched up to June 2016. Studies that investigated the effects of fruit and vegetable intake on risk of asthma/wheeze and immune responses were considered eligible (n = 58). Studies used cross-sectional (n = 30), cohort (n = 13), case-control (n = 8) and experimental (n = 7) designs. Most of the studies (n = 30) reported beneficial associations of fruit and vegetable consumption with risk of asthma and/or respiratory function, while eight studies found no significant relationship. Some studies (n = 20) reported mixed results, as they found a negative association between fruit only or vegetable only, and asthma. In addition, the meta-analyses in both adults and children showed inverse associations between fruit intake and risk of prevalent wheeze and asthma severity (p vegetable intake was negatively associated with risk of prevalent asthma (p fruit and vegetable intake in asthma, with n = 6 showing a protective effect against either systemic or airway inflammation. Fruit and vegetable consumption appears to be protective against asthma.

  16. Effects of Fruit and Vegetable Consumption on Risk of Asthma, Wheezing and Immune Responses: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Banafshe Hosseini

    2017-03-01

    Full Text Available Abstract: Evidence suggests that reduced intake of fruit and vegetables may play a critical role in the development of asthma and allergies. The present review aimed to summarize the evidence for the association between fruit and vegetable intake, risk of asthma/wheeze and immune responses. Databases including PubMed, Cochrane, CINAHL and EMBASE were searched up to June 2016. Studies that investigated the effects of fruit and vegetable intake on risk of asthma/wheeze and immune responses were considered eligible (n = 58. Studies used cross-sectional (n = 30, cohort (n = 13, case-control (n = 8 and experimental (n = 7 designs. Most of the studies (n = 30 reported beneficial associations of fruit and vegetable consumption with risk of asthma and/or respiratory function, while eight studies found no significant relationship. Some studies (n = 20 reported mixed results, as they found a negative association between fruit only or vegetable only, and asthma. In addition, the meta-analyses in both adults and children showed inverse associations between fruit intake and risk of prevalent wheeze and asthma severity (p < 0.05. Likewise, vegetable intake was negatively associated with risk of prevalent asthma (p < 0.05. Seven studies examined immune responses in relation to fruit and vegetable intake in asthma, with n = 6 showing a protective effect against either systemic or airway inflammation. Fruit and vegetable consumption appears to be protective against asthma.

  17. The respiratory microbiome in bronchial mucosa and secretions from severe IgE-mediated asthma patients.

    Science.gov (United States)

    Millares, Laura; Bermudo, Guadalupe; Pérez-Brocal, Vicente; Domingo, Christian; Garcia-Nuñez, Marian; Pomares, Xavier; Moya, Andrés; Monsó, Eduard

    2017-01-19

    The bronchial microbiome in chronic lung diseases presents an abnormal pattern, but its microbial composition and regional differences in severe asthma have not been sufficiently addressed. The aim of the study was to describe the bacterial community in bronchial mucosa and secretions of patients with severe chronic asthma chronically treated with corticosteroids in addition to usual care according to Global Initiative for Asthma. Bacterial community composition was obtained by 16S rRNA gene amplification and sequencing, and functional capabilities through PICRUSt. Thirteen patients with severe asthma were included and provided 11 bronchial biopsies (BB) and 12 bronchial aspirates (BA) suitable for sequence analyses. Bacteroidetes, Firmicutes, Proteobacteria and Actinobacteria showed relative abundances (RAs) over 5% in BB, a cutoff that was reached by Streptococcus and Prevotella at genus level. Legionella genus attained a median RA of 2.7 (interquartile range 1.1-4.7) in BB samples. In BA a higher RA of Fusobacteria was found, when compared with BB [8.7 (5.9-11.4) vs 4.2 (0.8-7.5), p = 0.037], while the RA of Proteobacteria was lower in BA [4.3 (3.7-6.5) vs 17.1 (11.2-33.4), p = 0.005]. RA of the Legionella genus was also significantly lower in BA [0.004 (0.001-0.02) vs. 2.7 (1.1-4.7), p = 0.005]. Beta-diversity analysis confirmed the differences between the microbial communities in BA and BB (R2 = 0.20, p = 0.001, Adonis test), and functional analysis revealed also statistically significant differences between both types of sample on Metabolism, Cellular processes, Human diseases, Organismal systems and Genetic information processing pathways. The microbiota in the bronchial mucosa of severe asthma has a specific pattern that is not accurately represented in bronchial secretions, which must be considered a different niche of bacteria growth.

  18. Impaired Nuclear Translocation of the Glucocorticoid Receptor in Corticosteroid-Insensitive Airway Smooth Muscle in Severe Asthma

    OpenAIRE

    Chang, P-J; Michaeloudes, C; Zhu, J; Shaikh, N.; Baker, J.; Chung, KF; Bhavsar, PK

    2015-01-01

    Rationale: Patients with severe asthma (SA) are less responsive to the beneficial effects of corticosteroid (CS) therapy, and relative CS insensitivity has been shown in airway smooth muscle cells (ASMC) from patients with SA.

  19. Prevalence of asthma and severity of allergic rhinitis comparing 2 perennial allergens: house dust mites and Parietaria judaica pollen.

    Science.gov (United States)

    Sala-Cunill, A; Bartra, J; Dalmau, G; Tella, R; Botey, E; Raga, E; Valero, A

    2013-01-01

    Allergic rhinitis (AR) is an increasingly prevalent worldwide disease that has a considerable impact on quality of life and health care costs. Asthma and AR may be part of the same disease, with AR leading to an increased risk of asthma. To assess the prevalence of asthma in patients with AR due to house dust mites (HDMs) or Parietaria judaica and analyze the characteristics of asthma and AR in each group. Cross-sectional, multicenter study with recording of demographic and clinical characteristics. All patients had AR confirmed by symptoms and a positive skin prick test to HDMs or P judaica. They were classified according to the severity and frequency ofAR following the Allergic Rhinitis and its Impact on Asthma (ARIA) and modified ARIA criteria and according to the severity of asthma following the Global Initiative for Asthma criteria. We studied 395 patients (226 in the HDM group and 169 in the Pjudaica group) with a mean (SD) age of 43 (15.3) years. Using the modified ARIA criteria, we detected more severe and persistent AR in the P judaica group than in the HDM group (44.5% vs 24.8%, P < .001). Nevertheless, there were no statistically significant differences between the groups in terms of the severity or prevalence (50% in HDM vs 47.9% in P judaica, P = .685) of asthma. AR due to P judaica pollen, which behaves like a perennial allergen, is associated with the same prevalence of asthma and with more severe rhinitis than AR due to HDMs.

  20. Tobaksrygning og asthma

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Lange, Peter

    2002-01-01

    Cigarette smoking is a well-known health hazard, probably not least for patients suffering from asthma. This review gives a short overview of the effects of passive and active smoking on the inception and outcome with of longitudinal changes in the lung function and mortality of patients...... with asthma. Substantial evidence suggests that smoking affects asthma adversely. Exposure to environmental tobacco smoke, especially maternal smoking in children, may be a significant risk factor for asthma. Such exposure in patients with established asthma is not only associated with more severe symptoms......, but also with a poorer quality of life, reduced lung function, and increased utilisation of health care including hospital admissions. Active smoking does not appear to be a significant risk factor for asthma, but is associated with a worse outcome with regard to both longitudinal changes in lung function...

  1. Cleaning and asthma: A systematic review and approach for effective safety assessment.

    Science.gov (United States)

    Vincent, Melissa J; Parker, Ann; Maier, Andrew

    2017-11-01

    Research indicates a correlative relationship between asthma and use of consumer cleaning products. We conduct a systematic review of epidemiological literature on persons who use or are exposed to cleaning products, both in occupational and domestic settings, and risk of asthma or asthma-like symptoms to improve understanding of the causal relationship between exposure and asthma. A scoring method for assessing study reliability is presented. Although research indicates an association between asthma and the use of cleaning products, no study robustly investigates exposure to cleaning products or ingredients along with asthma risk. This limits determination of causal relationships between asthma and specific products or ingredients in chemical safety assessment. These limitations, and a lack of robust animal models for toxicological assessment of asthma, create the need for a weight-of-evidence (WoE) approach to examine an ingredient or product's asthmatic potential. This proposed WoE method organizes diverse lines of data (i.e., asthma, sensitization, and irritation information) through a systematic, hierarchical framework that provides qualitatively categorized conclusions using hazard bands to predict a specific product or ingredient's potential for asthma induction. This work provides a method for prioritizing chemicals as a first step for quantitative and scenario-specific safety assessments based on their potential for inducing asthmatic effects. Acetic acid is used as a case study to test this framework. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  2. Prevalence and Severity of Asthma, Rhinitis, and Atopic Eczema in 13- to 14-Year-Old Schoolchildren from Southern Brazil

    Directory of Open Access Journals (Sweden)

    Neto Arnaldo

    2006-03-01

    Full Text Available Abstract The objective of this study was to investigate the prevalence and severity of asthma, rhinitis, and atopic eczema in schoolchildren from southern Brazil. A cross-sectional study was carried out with the International Study of Asthma and Allergies in Childhood phase III written questionnaire. The questionnaire was self-applied by 2,948 randomly selected schoolchildren aged 13 to 14 years. The lifetime prevalence rates of symptoms were as follows: wheezing, 40.8%; rhinitis, 40.7%; eczema, 13.6%; self-reported asthma, 14.6%; rhinitis, 31.4%; eczema, 13.4%. Rhinitis was reported by 55% of adolescents with current asthma (60% females vs 46.9% males. Girls 13 to 14 years of age had higher prevalence rates of asthma, rhinitis, and eczema than boys had. Atopic eczema was reported by 42.7% of girls and 31.4% of boys with asthma. The prevalence rates were statistically significant for symptoms of asthma, rhinitis, and atopic eczema in females. However, there were no statistically significant differences between the sexes in regard to reported asthma and bronchospasm induced by exercise.

  3. Impaired fibrinolysis and lower levels of plasma α2-macroglobulin are associated with an increased risk of severe asthma exacerbations.

    Science.gov (United States)

    Bazan-Socha, Stanislawa; Mastalerz, Lucyna; Cybulska, Agnieszka; Zareba, Lech; Kremers, Romy; Zabczyk, Michal; Pulka, Grazyna; Iwaniec, Teresa; Bazan, Jan G; Hemker, Coenraad; Undas, Anetta

    2017-09-08

    Recently we have reported that asthma is associated with enhanced plasma thrombin formation, impaired fibrinolysis and platelet activation. In the present study we investigated whether described prothrombotic blood alterations might predispose to thromboembolic events or asthma exacerbations. In 164 adult asthmatics we assessed clinical events during 3-year follow-up and analyzed their associations with measured at baseline prothrombotic blood parameters. Data were obtained from 157 (95.7%) of the asthma patients. We documented 198 severe asthma exacerbations (64/year), which occurred in 53 subjects (34%). These patients were older (p = 0.004), had worse asthma control (p = 0.02) and lower spirometry values (p = 0.01), at baseline. Interestingly, this subgroup had longer clot lysis time (CLT), as well as lower α2-macroglobulin (p = 0.038 and p = 0.04, respectively, after adjustment for potential confounders). Increased CLT and lower α2-macroglobulin were demonstrated as independent predictors of asthma exacerbation in multiple regression model. Moreover, we documented two episodes of deep vein thrombosis (1.3%), and eight acute coronary syndromes (5.1%). Patients who experienced thromboembolic events (n = 10, 6.4%, 2.1%/year) had lower α2-macroglobulin (p = 0.04), without differences in efficiency of fibrinolysis and thrombin generation. Impaired fibrinolysis and lower levels of α2-macroglobulin might predispose to a higher rate of asthma exacerbations, suggesting new links between disturbed hemostasis and asthma.

  4. OMALIZUMAB-BASED TREATMENT OF TEENAGERS, SUFFERING FROM SEVERE ATOPIC BRONCHIAL ASTHMA

    Directory of Open Access Journals (Sweden)

    T.V. Kulichenko

    2008-01-01

    Full Text Available Omalizumab, a medicine of the recombinant humanized mono clonal antibodies to Ige, is applied in russia among teenagers throughout a year. it is prescribed to patients with severe persistent incontrolled by iks atopic bronchial asthma (BA. The article generalizes the experience of omalizumab application among teenagers and highlights the first findings in respect of its efficiency and safety. 6 month long omalizumab based treatment contributes to the reduction in the recurrence of the clinically significant BA exacerbations by 65% and the frequency of because hospitalizations by 78%. Against the background of the ongoing treatment, the indices of the bronchial passability get better; the need in the bronchial spasmolytics falls down; BA control improves. Most children have a chance to sizably reduce the dose of the inhalant glucocorticosteroids against the omalizumab based treatment. The authors pointed out to the reduced symptoms of the allergic rhinitis, grass pollen allergy, food allergy among teenagers, who have been receiving the ant Ige therapy for a long time. They also noted the satisfactory profile of omalizumab safety.Key words: omalizumab, ant Ige antibodies, bronchial asthma, treatment, children, teenagers, bronchial asthma control.

  5. Genetic polymorphisms of the beta-2 adrenergic receptor in Israelis with severe asthma compared to non-asthmatic Israelis.

    Science.gov (United States)

    Shachor, Joshua; Chana, Ziv; Varsano, Shabtai; Erlich, Tamar; Goldman, Elizabeth; Dror, Yigal; Yakovy, Ilana; Navon, Ruth

    2003-11-01

    It has been argued that arginine replacement in locus 16 (Arg16) of beta 2 adrenergic receptor with glycin (Gly16) increases asthma severity, while glutamin replacement in locus 27 (Gln27) with glutamic acid (Glu27) decreases it. In addition, ethnic dependency of these polymorphisms has been described, but few studies investigated its relation to asthma severity in a non-anglosaxic population. To investigate non-anglosaxic ethnic influences on beta 2AR polymorphisms and its correlations to asthma severity. Sixty-six Israeli Jewish and Arab asthmatics who had near-fatal asthma and/or severe nocturnal asthma and/or steroid-dependency were investigated for genetic polymorphisms of beta 2AR and compared to matched controls. The Jewish patients included both Ashkenazi (of European origin) and non-Ashkenazi (originating from the Middle East or North Africa). The results were compared with those of ethnically matched 113 non-asthmatic Israelis and non-asthmatic Anglo-Saxons described in the literature. We found no significant genetic differences between the asthmatics and their controls or between the various ethnic groups of our population. However, the prevalence of Glu27 was significantly lower in non-asthmatic Israelis compared to non-asthmatic Anglo-Saxons. The genetic distribution of beta 2AR polymorphisms in severe Israeli asthmatics is not different from that of non-asthmatic Israelis and therefore its clinical impact on asthma is probably minimal.

  6. Sahaja yoga in the management of moderate to severe asthma: a randomised controlled trial.

    Science.gov (United States)

    Manocha, R; Marks, G B; Kenchington, P; Peters, D; Salome, C M

    2002-02-01

    to establish whether elements of this intervention may be clinically valuable in patients with severe asthma.

  7. Influence of degree of specific allergic sensitivity on severity of rhinitis and asthma in Chinese allergic patients

    Directory of Open Access Journals (Sweden)

    Zhao Changqing

    2011-07-01

    Full Text Available Abstract Background The association between sensitizations and severity of allergic diseases is controversial. Objective This study was to investigate the association between severity of asthma and rhinitis and degree of specific allergic sensitization in allergic patients in China. Method A cross-sectional survey was performed in 6304 patients with asthma and/or rhinitis from 4 regions of China. Patients completed a standardized questionnaire documenting their respiratory and allergic symptoms, their impact on sleep, daily activities, school and work. They also underwent skin prick tests with 13 common aeroallergens. Among the recruited subjects, 2268 provided blood samples for serum measurement of specific IgE (sIgE against 16 common aeroallergens. Results Significantly higher percentage of patients with moderate-severe intermittent rhinitis were sensitized to outdoor allergens while percentage of patients sensitized to indoor allergens was increased with increasing severity of asthma. Moderate-severe intermittent rhinitis was associated with the skin wheal size and the level of sIgE to Artemisia vulgaris and Ambrosia artemisifolia (p Dermatophagoides (D. pteronyssinus and D. farinae (p Conclusions Artemisia vulgaris and Ambrosia artemisifolia sensitizations are associated with the severity of intermittent rhinitis and D. pteronyssinus and D. farinae sensitizations are associated with increasing severity of asthma in China. Increase in number of allergens the patients are sensitized to may also increase the severity of rhinitis and asthma.

  8. [Metered-dose inhaler with spacer vs nebulization for severe and potentially severe acute asthma treatment in the pediatric emergency department].

    Science.gov (United States)

    Sannier, N; Timsit, S; Cojocaru, B; Leis, A; Wille, C; Garel, D; Bocquet, N; Chéron, G

    2006-03-01

    To compare treatment with beta 2 agonist delivered either by a spacer device or a nebulizer in children with severe or potentially severe acute asthma. In this randomized trial, children 4 to 15 years, cared for in the emergency department for severe or potentially severe acute asthma, received 6 times either nebulizations of salbutamol (0.15mg/kg) or puffs of a beta 2 agonist (salbutamol 50 microg/kg or terbutaline 125 microg/kg). The primary outcome was the hospitalization rate. Secondary outcomes included percentage improvement in Bishop score, in PEF, SaO(2), respiratory and heart rates, side effects, length of stay and relapses 10 and 30 days later. Groups did not differ for baseline data. There were no significant differences between the 2 groups (nebulizer N=40, spacer N=39) for baseline characteristics before emergency department consultation except for length of acute asthma in the spacer group. Clinical evolution after treatment, hospitalization rate, relapse were similar including the more severe subgroup. In the spacer group, tachycardia was less frequent (Pvs 108+/-13 min, Pmetered-dose inhaler with spacer is an effective alternative to nebulizers for the treatment of children with severe or potentially severe acute asthma in the emergency department. Time gained can be used for asthma education.

  9. Fractional exhaled nitric oxide for the management of asthma in adults: a systematic review.

    Science.gov (United States)

    Essat, Munira; Harnan, Sue; Gomersall, Tim; Tappenden, Paul; Wong, Ruth; Pavord, Ian; Lawson, Rod; Everard, Mark L

    2016-03-01

    The aim of this review was to evaluate the clinical effectiveness of fractional exhaled nitric oxide (FeNO) measured in a clinical setting for the management of asthma in adults.13 electronic databases were searched and studies were selected against predefined inclusion criteria. Quality assessment was conducted using QUADAS-2. Class effect meta-analyses were performed.Six studies were included. Despite high levels of heterogeneity in multiple study characteristics, exploratory class effect meta-analyses were conducted. Four studies reported a wider definition of exacerbation rates (major or severe exacerbation) with a pooled rate ratio of 0.80 (95% CI 0.63-1.02). Two studies reported rates of severe exacerbations (requiring oral corticosteroid use) with a pooled rate ratio of 0.89 (95% CI 0.43-1.72). Inhaled corticosteroid use was reported by four studies, with a pooled standardised mean difference of -0.24 (95% CI -0.56-0.07). No statistically significant differences for health-related quality of life or asthma control were found.FeNO guided management showed no statistically significant benefit in terms of severe exacerbations or inhaled corticosteroid use, but showed a statistically significant reduction in exacerbations of any severity. However, further research is warranted to clearly define which management protocols (including cut-off points) offer best efficacy and which patient groups would benefit the most. Copyright ©ERS 2016.

  10. Mold-sensitivity in children with moderate-severe asthma is associated with HLA-DR and HLA-DQ.

    Science.gov (United States)

    Knutsen, A P; Vijay, H M; Kumar, V; Kariuki, B; Santiago, L A; Graff, R; Wofford, J D; Shah, M R

    2010-11-01

    Several epidemiologic studies in the United States and Europe have linked Alternaria sensitivity to both persistence and severity of asthma. In this study, we examined T cell responses and HLA class II alleles in children with moderate-severe asthma. Ninety-six children with moderate-severe asthma were compared to 90 children with mild asthma. HLA class II genotyping was performed to determine HLA allelic frequencies. Th1/Th2 Alternaria-specific T cell cytokine responses were determined by the use of Alternaria-stimulated cultures. HLA class II restriction was examined by inhibition of Alternaria-stimulated lymphoproliferative responses with blocking anti-HLA class II monoclonal antibodies. Children with moderate-severe asthma had significantly increased sensitivities to Aspergillus fumigatus; sensitivities to Alternaria were similar in both moderate-severe and mild asthmatics. The frequency of HLA-DRB1*13 alleles were increased in mold-sensitive moderate-severe asthmatic children. HLA-DRB1*03 tended to be increased in mold-sensitive moderate-severe asthmatics. The frequency of HLA-DQB1*03 alleles was significantly decreased in mold and Alternaria-sensitive moderate-severe asthma. HLA class II blocking monoclonal antibodies demonstrated HLA-DR restriction. Alternaria-stimulated IL-5 and IL-13 synthesis was significantly increased in moderate-severe asthmatics. IL-5 and IL-13 synthesis was significantly increased in Alternaria-stimulated lymphocyte cultures of HLA-DQB1*03- asthmatics compared to HLA-DQB1*03+ asthmatics. In children with Alternaria-sensitive moderate-severe asthma, there was increased Th2 sensitivity to Alternaria stimulation. This was associated with HLA-DR restriction and with increased frequency of HLA-DRB1*13 and HLA-DRB1*03. There was decreased frequency of HLA-DQB1*03 in Alternaria-sensitive moderate-severe asthma, suggesting HLA-DQB1*03 may be protective of the development of Alternaria-sensitive severe asthma. © 2010 John Wiley & Sons A/S.

  11. Noninvasive assessment of asthma severity using pulse oximeter plethysmograph estimate of pulsus paradoxus physiology

    Directory of Open Access Journals (Sweden)

    Jenkins Cathy A

    2010-03-01

    Full Text Available Abstract Background Pulsus paradoxus estimated by dynamic change in area under the oximeter plethysmograph waveform (PEP might provide a measure of acute asthma severity. Our primary objective was to determine how well PEP correlates with forced expiratory volume in 1-second (%FEV1 (criterion validity and change of %FEV1 (responsiveness during treatment in pediatric patients with acute asthma exacerbations. Methods We prospectively studied subjects 5 to 17 years of age with asthma exacerbations. PEP, %FEV1, airway resistance and accessory muscle use were recorded at baseline and at 2 and 4 hours after initiation of corticosteroid and bronchodilator treatments. Statistical associations were tested with Pearson or Spearman rank correlations, logistic regression using generalized estimating equations, or Wilcoxon rank sum tests. Results We studied 219 subjects (median age 9 years; male 62%; African-American 56%. Correlation of PEP with %FEV1 demonstrated criterion validity (r = - 0.44, 95% confidence interval [CI], - 0.56 to - 0.30 and responsiveness at 2 hours (r = - 0.31, 95% CI, - 0.50 to - 0.09 and 4 hours (r = - 0.38, 95% CI, - 0.62 to - 0.07. PEP also correlated with airway resistance at baseline (r = 0.28 for ages 5 to 10; r = 0.45 for ages 10 to 17, but not with change over time. PEP was associated with accessory muscle use (OR 1.16, 95% CI, 1.11 to 1.21, P Conclusions PEP demonstrates criterion validity and responsiveness in correlations with %FEV1. PEP correlates with airway resistance at baseline and is associated with accessory muscle use at baseline and at 2 and 4 hours after initiation of treatment. Incorporation of this technology into contemporary pulse oximeters may provide clinicians improved parameters with which to make clinical assessments of asthma severity and response to treatment, particularly in patients who cannot perform spirometry because of young age or severity of illness. It might also allow for earlier recognition

  12. A systematic review of adverse drug events associated with administration of common asthma medications in children

    Science.gov (United States)

    Johnson, David W.; Sperou, Arissa J.; Crotts, Jennifer; Saude, Erik; Hartling, Lisa; Stang, Antonia

    2017-01-01

    Objective To systematically review the literature and determine frequencies of adverse drug events (ADE) associated with pediatric asthma medications. Methods Following PRISMA guidelines, we systematically searched six bibliographic databases between January 1991 and January 2017. Study eligibility, data extraction and quality assessment were independently completed and verified by two reviewers. We included randomized control trials (RCT), case-control, cohort, or quasi-experimental studies where the primary objective was identifying ADE in children 1 month– 18 years old exposed to commercial asthma medications. The primary outcome was ADE frequency. Findings Our search identified 14,540 citations. 46 studies were included: 24 RCT, 15 cohort, 4 RCT pooled analyses, 1 case-control, 1 open-label trial and 1 quasi-experimental study. Studies examined the following drug classes: inhaled corticosteroids (ICS) (n = 24), short-acting beta-agonists (n = 10), long-acting beta-agonists (LABA) (n = 3), ICS + LABA (n = 3), Leukotriene Receptor Antagonists (n = 3) and others (n = 3). 29 studies occurred in North America, and 29 were industry funded. We report a detailed index of 406 ADE descriptions and frequencies organized by drug class. The majority of data focuses on ICS, with 174 ADE affecting 13 organ systems including adrenal and growth suppression. We observed serious ADE, although they were rare, with frequency ranging between 0.9–6% per drug. There were no confirmed deaths, except for 13 potential deaths in a LABA study including combined adult and pediatric participants. We identified substantial methodological concerns, particularly with identifying ADE and determining severity. No studies utilized available standardized causality, severity or preventability assessments. Conclusion The majority of studies focus on ICS, with adrenal and growth suppression described. Serious ADE are relatively uncommon, with no confirmed pediatric deaths. We identify substantial

  13. Dietary pattern and asthma: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Lv N

    2014-08-01

    Full Text Available Nan Lv,1 Lan Xiao,1 Jun Ma1,2 1Palo Alto Medical Foundation Research Institute, 2Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA Background: The literature on the relationship between diet and asthma has largely focused on individual nutrients, with conflicting results. People consume a combination of foods from various groups that form a dietary pattern. Studying the role of dietary patterns in asthma is an emerging area of research. The purpose of this study was to systematically review dietary patterns and asthma outcomes in adults and children, to review maternal diet and child asthma, and to conduct a meta-analysis on the association between asthma prevalence and dietary patterns in adults. Methods: We searched Medline, Scopus, and ISI Web of Knowledge up to January 2014. Two researchers independently reviewed studies meeting the inclusion criteria using the American Dietetic Association quality criteria. A linear mixed model was used to derive the pooled effect size (95% confidence interval for each of three dietary pattern categories (healthy, unhealthy, and neutral. Results: Thirty-one studies were identified (16 cross-sectional, one case-control, 13 cohort, and one randomized controlled trial, including 12 in adults, 13 in children, five in pregnant woman–child pairs, and one in both children and pregnant woman–child pairs. Six of the 12 adult studies reported significant associations between dietary patterns and asthma outcomes (eg, ever asthma and forced expiratory volume in one second. Seven of ten studies examining the Mediterranean diet showed protective effects on child asthma and/or wheeze. Four of the six studies in mother-child pairs showed that maternal dietary patterns during pregnancy were not associated with child asthma or wheeze. The meta-analysis including six adult studies, the primary outcome of which was the prevalence of current or ever asthma, showed no association with healthy

  14. The association between ambient temperature and childhood asthma: a systematic review

    Science.gov (United States)

    Xu, Zhiwei; Crooks, James Lewis; Davies, Janet Mary; Khan, Al Fazal; Hu, Wenbiao; Tong, Shilu

    2017-10-01

    The objectives of this study are to review available information on the association between ambient temperature and childhood asthma, and to elucidate the possible underlying mechanisms of this relationship. A systematic review was conducted based on the papers retrieved from four databases, including PubMed, ProQuest, ScienceDirect, and Scopus. Papers examining the association of absolute temperature or temperature variation with childhood asthma published from 1 January 2000 to 31 December 2016 were included. Thirteen papers have quantified the effect of absolute temperature on childhood asthma, and six papers have examined the effect of intra- or inter-day temperature variation on childhood asthma. All studies were conducted in urban areas. Aeroallergen sensitizations were only considered in the analyses of one study. Discrepancy existed in the significance of the relationship between absolute temperature and childhood asthma, and also in the shape of this relationship (i.e. linear or non-linear) and whether temperature effects were lagged. Increasing evidence is suggesting non-linear relationship between absolute temperature and childhood asthma. Future research should investigate the burden of childhood asthma specifically attributable to extreme temperatures and temperature variation using advanced statistical approach, particularly in rural areas, after properly considering aeroallergens and air pollution. Projecting future burden of childhood asthma under climate change scenarios is also warranted.

  15. Herbal Medicine Cordyceps sinensis Improves Health-Related Quality of Life in Moderate-to-Severe Asthma

    Directory of Open Access Journals (Sweden)

    Ningqun Wang

    2016-01-01

    Full Text Available Moderate-to-severe asthma has a substantial impact on the health-related quality of life (HR-QOL of the patients. Cordyceps sinensis is a traditional Chinese medicine that is evaluated clinically for the treatment of many diseases, such as chronic allograft nephropathy, diabetic kidney disease, and lung fibrosis. In order to investigate the effects of Cordyceps sinensis on patients with moderate-to-severe persistent asthma, 120 subjects were randomized to receive Corbin capsule containing Cordyceps sinensis for 3 months (treatment group, n=60, whereas the control group (n=60 did not receive treatment with Corbin capsule. Inhaled corticosteroid and as-needed β-agonists were used in the treatment of both groups. HR-QOL was measured with the Juniper’s Asthma Quality of Life Questionnaire (AQLQ. The incidence of asthma exacerbation, pulmonary function testing, and serum measurements of inflammatory mediators were also evaluated. The results showed that the treatment group indicated a significant increase in AQLQ scores and lung function compared with the control group. The expression levels of the inflammation markers IgE, ICAM-1, IL-4, and MMP-9 in the serum were decreased and IgG increased in the treatment group compared with the control group. Therefore, the conclusion was reached that a formulation of Cordyceps sinensis improved the HR-QOL, asthma symptoms, lung function, and inflammatory profile of the patients with moderate-to-severe asthma. This trial is registered with ChiCTR-IPC-16008730.

  16. Vitamin D and asthma: current perspectives.

    Science.gov (United States)

    Jiao, Junfang; Castro, Mario

    2015-08-01

    To review the current evidence on the relationship between vitamin D and asthma. The rising morbidity and tremendous socioeconomic burden of asthma have prompted efforts to seek modifiable environmental and nutritional factors that contribute to the asthma epidemic. The association between low levels of vitamin D and asthma has been supported by many, but not all observational and epidemiologic studies. Recently, several controlled clinical trials have been undertaken to explore the effect of vitamin D supplementation on asthma control and respiratory tract infections. While some trials support the beneficial role of vitamin D supplementation in reducing asthma severity in children, several trials have found no beneficial role in adults. Given the high prevalence of vitamin D insufficiency in children and adults worldwide and recent randomized controlled trials of vitamin D in asthma, supplementation with vitamin D cannot be recommended as adjunctive therapy for asthma.

  17. Coexistence of asthma and polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Zierau, Louise; Gade, Elisabeth Juul; Lindenberg, Svend

    2016-01-01

    Asthma may be associated with polycystic ovary syndrome (PCOS), and possibly patients with PCOS have a more severe type of asthma. The purpose of this systematic literature review is to summarize evidence of a coexistense of PCOS and asthma using the available literature. The search was completed...... on 01.01.2016. English language articles were retrieved using the search terms 'Asthma' AND 'PCOS', 'Asthma' AND 'systemic inflammation', 'Asthma' AND 'metabolic syndrome', 'asthma' AND 'gynaecology', 'PCOS' AND 'systemic inflammation', 'PCOS' AND 'metabolic syndrome', 'PCOS' AND 'allergy'. Five papers...... meeting prespecified search criteria were found of which two were registry studies of relevance. The current literature supports a coexistense of PCOS and asthma and gives us an indication of the causes for the possible link between PCOS and asthma. Further research in the area must be conducted...

  18. Aerobic training decreases bronchial hyperresponsiveness and systemic inflammation in patients with moderate or severe asthma: a randomised controlled trial.

    Science.gov (United States)

    França-Pinto, Andrezza; Mendes, Felipe A R; de Carvalho-Pinto, Regina Maria; Agondi, Rosana Câmara; Cukier, Alberto; Stelmach, Rafael; Saraiva-Romanholo, Beatriz M; Kalil, Jorge; Martins, Milton A; Giavina-Bianchi, Pedro; Carvalho, Celso R F

    2015-08-01

    The benefits of aerobic training for the main features of asthma, such as bronchial hyperresponsiveness (BHR) and inflammation, are poorly understood. We investigated the effects of aerobic training on BHR (primary outcome), serum inflammatory cytokines (secondary outcome), clinical control and asthma quality of life (Asthma Quality of Life Questionnaire (AQLQ)) (tertiary outcomes). Fifty-eight patients were randomly assigned to either the control group (CG) or the aerobic training group (TG). Patients in the CG (educational programme+breathing exercises (sham)) and the TG (same as the CG+aerobic training) were followed for 3 months. BHR, serum cytokine, clinical control, AQLQ, induced sputum and fractional exhaled nitric oxide (FeNO) were evaluated before and after the intervention. After 12 weeks, 43 patients (21 CG/22 TG) completed the study and were analysed. The TG improved in BHR by 1 doubling dose (dd) (95% CI 0.3 to 1.7 dd), and they experienced reduced interleukin 6 (IL-6) and monocyte chemoattractant protein 1 (MCP-1) and improved AQLQ and asthma exacerbation (pAsthma Control Questionnaire 7 (ACQ-7; p>0.05). A within-group difference was found in the ACQ-6 for patients with non-well-controlled asthma and in sputum eosinophil and FeNO in patients in the TG who had worse airway inflammation. Aerobic training reduced BHR and serum proinflammatory cytokines and improved quality of life and asthma exacerbation in patients with moderate or severe asthma. These results suggest that adding exercise as an adjunct therapy to pharmacological treatment could improve the main features of asthma. NCT02033122. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Vitamin D and asthma in children: A systematic review and meta-analysis of observational studies

    Directory of Open Access Journals (Sweden)

    Kana Ram Jat

    2017-01-01

    Full Text Available There is growing literature suggesting a link between Vitamin D deficiency and asthma in children, but systematic reviews are lacking. The aim of this study is to evaluate the prevalence of Vitamin D deficiency in asthmatic children and to assess the correlations of Vitamin D levels with asthma incidence, asthma control, and lung functions. PubMed, EMBASE, and Cochrane Library were searched for observational studies on asthma and Vitamin D. Two authors independently extracted data. Meta-analysis was performed using the Review Manager Software. A total of 23 (11 case–control, 5 cohort, and 7 cross-sectional studies enrolling 13,160 participants were included in the review. Overall, Vitamin D deficiency and insufficiency were prevalent in 28.5% and 26.7% children with asthma, respectively. The mean 25-hydroxyvitamin D (25(OHD levels (10 studies were significantly lower in asthmatic children as compared to nonasthmatic children with a mean difference of −9.41 (95% confidence interval [CI] −16.57, −2.25. The odds ratio of Vitamin D deficiency (eight case–control studies was significantly higher among asthmatic children as compared to nonasthmatic children (odds ratio 3.41; 95% CI 2.04, 5.69. Correlations between Vitamin D levels and incidence of asthma, lung functions, and control of asthma had mixed results. To conclude, asthmatic children had lower 25(OHD levels as compared to nonasthmatic children, but the correlations between 25(OHD and asthma incidence, asthma control, and lung functions were varied. Well-designed randomized controlled trials are required to determine if children with asthma can benefit from Vitamin D supplementation.

  20. Vitamin D and asthma in children: A systematic review and meta-analysis of observational studies.

    Science.gov (United States)

    Jat, Kana Ram; Khairwa, Anju

    2017-01-01

    There is growing literature suggesting a link between Vitamin D deficiency and asthma in children, but systematic reviews are lacking. The aim of this study is to evaluate the prevalence of Vitamin D deficiency in asthmatic children and to assess the correlations of Vitamin D levels with asthma incidence, asthma control, and lung functions. PubMed, EMBASE, and Cochrane Library were searched for observational studies on asthma and Vitamin D. Two authors independently extracted data. Meta-analysis was performed using the Review Manager Software. A total of 23 (11 case-control, 5 cohort, and 7 cross-sectional) studies enrolling 13,160 participants were included in the review. Overall, Vitamin D deficiency and insufficiency were prevalent in 28.5% and 26.7% children with asthma, respectively. The mean 25-hydroxyvitamin D (25(OH)D) levels (10 studies) were significantly lower in asthmatic children as compared to nonasthmatic children with a mean difference of -9.41 (95% confidence interval [CI] -16.57, -2.25). The odds ratio of Vitamin D deficiency (eight case-control studies) was significantly higher among asthmatic children as compared to nonasthmatic children (odds ratio 3.41; 95% CI 2.04, 5.69). Correlations between Vitamin D levels and incidence of asthma, lung functions, and control of asthma had mixed results. To conclude, asthmatic children had lower 25(OH)D levels as compared to nonasthmatic children, but the correlations between 25(OH)D and asthma incidence, asthma control, and lung functions were varied. Well-designed randomized controlled trials are required to determine if children with asthma can benefit from Vitamin D supplementation.

  1. A review of epidemiological studies of asthma in Ghana | Amoah ...

    African Journals Online (AJOL)

    Context/Background: The last few decades have witnessed a rise in the global prevalence of asthma with a number of risk factors being linked to this increase. Although there is insufficient data on the prevalence of asthma in Ghana, a few studies conducted in this country have shed light on the disease aetiology and ...

  2. Adiponectin in Asthma and Obesity: Protective Agent or Risk Factor for More Severe Disease?

    Science.gov (United States)

    de Lima Azambuja, Renato; da Costa Santos Azambuja, Layla Salomao Eulalio; Costa, Cláudia; Rufino, Rogério

    2015-10-01

    The relationship between asthma and obesity is well established, although the pathophysiological mechanisms linking both diseases remain unknown. Adiponectin is a hormone secreted by adipose cells, plays a role in the modulation of inflammation and may be the key linking these two types of inflammation. We conducted a cross-sectional study with asthma with different body mass indices (BMI); the patients were classified as eutrophic, overweight, or obese. We assessed disease control using the GINA consensus, and the levels of adiponectin, C-reactive protein (CRP) and interleukin 33 (IL-33) in each of the patients. We evaluated 75 of the 96 patients eligible for the study, including 25 in each BMI group. The CRP levels were significantly higher in the obese patients compared with both the eutrophic (p = 0.01) and the overweight (p = 0.03) patients. The mean adiponectin level was 21.82 ± 9.93 mg/L for the eutrophic asthmatics, which is a level that was significantly higher than in the overweight (15.31 ± 6.27 mg/L, p = 0.0140) and the obese (16.69 ± 11.45 mg/L, p = 0.0287) patients. The patients with higher adiponectin levels exhibited smaller FEV1 (p = 0.02) and lower FVC (p = 0.003). The IL-33 levels were not different between the groups. Adiponectin does not protect against the development of inflammation in the setting of asthma and may in fact exacerbate the disease via its anti-TH1 inflammatory effects, allowing for increased TH2 differentiation and a more severe allergic response.

  3. A phase II placebo-controlled study of tralokinumab in moderate-to-severe asthma.

    Science.gov (United States)

    Piper, Edward; Brightling, Christopher; Niven, Robert; Oh, Chad; Faggioni, Raffaella; Poon, Kwai; She, Dewei; Kell, Chris; May, Richard D; Geba, Gregory P; Molfino, Nestor A

    2013-02-01

    Pre-clinical data demonstrate a pivotal role for interleukin (IL)-13 in the development and maintenance of asthma. This study assessed the effects of tralokinumab, an investigational human IL-13-neutralising immunoglobulin G4 monoclonal antibody, in adults with moderate-to-severe uncontrolled asthma despite controller therapies. 194 subjects were randomised to receive tralokinumab (150, 300 or 600 mg) or placebo subcutaneously every 2 weeks. Primary end-point was change from baseline in mean Asthma Control Questionnaire score (ACQ-6; ACQ mean of six individual item scores) at week 13 comparing placebo and combined tralokinumab dose groups. Secondary end-points included pre-bronchodilator lung function, rescue β(2)-agonist use and safety. Numerical end-points are reported as mean±sd. At week 13, change from baseline in ACQ-6 was -0.76±1.04 for tralokinumab versus -0.61±0.90 for placebo (p=0.375). Increases from baseline in forced expiratory volume in 1 s (FEV(1)) were 0.21±0.38 L versus 0.06±0.48 L (p=0.072), with a dose-response observed across the tralokinumab doses tested. β(2)-agonist use (puffs per day) was decreased for tralokinumab -0.68±1.45 versus placebo -0.10±1.49 (p=0.020). The increase in FEV(1) following tralokinumab treatment remained evident 12 weeks after the final dose. Safety profile was acceptable with no serious adverse events related to tralokinumab. No improvement in ACQ-6 was observed, although tralokinumab treatment was associated with improved lung function.

  4. Association of stem cell factor gene expression with severity and atopic state in patients with bronchial asthma.

    Science.gov (United States)

    Tayel, Safaa I; El-Hefnway, Sally M; Abd El Gayed, Eman M; Abdelaal, Gehan A

    2017-01-18

    Bronchial asthma is a chronic inflammatory and remodeling disorder of the airways, in which many cells, cellular elements, and cytokines play important roles. Stem cell factor (SCF) may contribute to the inflammatory changes occurring in asthma. We aimed to show the expression of SCF gene in patients with asthma as a means of diagnosis and its association with severity and atopic state in these patients. This study was carried out on 80 subjects, 50 asthmatic patients and 30 age and gender matched healthy control persons. They were subjected to full history taking, general and local chest examination, spirometric measurements (pre and post broncodilators) using a spirometer, serum IgE, and real time PCR for assessment of SCF mRNA expression. This study showed significant difference between the studied groups regarding pulmonary function tests (P bronchial asthma.

  5. Surfactant protein B polymorphisms are associated with severe respiratory syncytial virus infection, but not with asthma

    Directory of Open Access Journals (Sweden)

    Heinzmann Andrea

    2007-05-01

    Full Text Available Abstract Background Surfactant proteins (SP are important for the innate host defence and essential for a physiological lung function. Several linkage and association studies have investigated the genes coding for different surfactant proteins in the context of pulmonary diseases such as chronic obstructive pulmonary disease or respiratory distress syndrome of preterm infants. In this study we tested whether SP-B was in association with two further pulmonary diseases in children, i. e. severe infections caused by respiratory syncytial virus and bronchial asthma. Methods We chose to study five polymorphisms in SP-B: rs2077079 in the promoter region; rs1130866 leading to the amino acid exchange T131I; rs2040349 in intron 8; rs3024801 leading to L176F and rs3024809 resulting in R272H. Statistical analyses made use of the Armitage's trend test for single polymorphisms and FAMHAP and FASTEHPLUS for haplotype analyses. Results The polymorphisms rs3024801 and rs3024809 were not present in our study populations. The three other polymorphisms were common and in tight linkage disequilibrium with each other. They did not show association with bronchial asthma or severe RSV infection in the analyses of single polymorphisms. However, haplotypes analyses revealed association of SP-B with severe RSV infection (p = 0.034. Conclusion Thus our results indicate a possible involvement of SP-B in the genetic predisposition to severe RSV infections in the German population. In order to determine which of the three polymorphisms constituting the haplotypes is responsible for the association, further case control studies on large populations are necessary. Furthermore, functional analysis need to be conducted.

  6. Linking obesity and asthma.

    Science.gov (United States)

    Sutherland, E Rand

    2014-04-01

    A growing body of literature suggests that obesity has a significant impact on asthma risk, phenotype, and prognosis. Epidemiological studies have clearly demonstrated that asthma is more likely to occur in obese patients, and health status is impaired in obese individuals with asthma, with obese asthmatics experiencing more symptoms, worse quality of life, increased healthcare use, and increased asthma severity. However, obesity has well-described effects on lung function and mechanics that can lead to symptoms of dyspnea without causing the pathophysiologic changes of asthma. Adding to the challenges of evaluating this association, some studies have failed to demonstrate a robust relationship between obesity and traditional biomarkers of airway inflammation in adult asthmatics, leading to the conclusion that obesity does not necessarily worsen airway inflammation in asthma. In this regard, emerging data suggest that nonatopic mechanisms may be relevant in obese asthmatics, and that these mechanisms may have a direct impact on the response of obese asthmatics to asthma therapies, most notably inhaled glucocorticoids. This article will review selected aspects of the contributions of obesity-related airway and systemic inflammation to asthma, with a focus on the impact of obesity as a modifier of risk, prognosis, and therapeutic response in asthma. © 2014 New York Academy of Sciences.

  7. Association between Western diet pattern and adult asthma: a focused review.

    Science.gov (United States)

    Brigham, Emily P; Kolahdooz, Fariba; Hansel, Nadia; Breysse, Patrick N; Davis, Meghan; Sharma, Sangita; Matsui, Elizabeth C; Diette, Gregory; McCormack, Meredith C

    2015-04-01

    Radical changes in diet have paralleled the increase in asthma with shifts toward a "Western" diet pattern, characterized by the high intake of processed meats and refined grains, high-fat dairy products, and sugary desserts and drinks. Because diet represents a modifiable risk factor in numerous chronic diseases, the authors examined the association between consumption of a Western diet pattern and asthma incidence, prevalence, and morbidity in adults. PubMed, Cochrane, Web of Science, and Scopus were searched for peer-reviewed publications published from January 1980 to April 2014. Studies retrieved for inclusion assessed dietary patterns representative of a Western diet and asthma incidence, prevalence, respiratory symptoms, and lung function. Ten observational studies conducted in North American, European, and Asian countries, ranging from 153 to more than 70,000 individuals, did not provide evidence to support an association between a Western dietary pattern and asthma incidence and prevalence. Five of these studies also investigated asthma morbidity, with variable findings. Current evidence does not support an association between a Western diet and incident or prevalent adult asthma but does suggest a possible link between a Western diet pattern and adult asthma morbidity. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. Asthma interventions in primary schools--a review.

    Science.gov (United States)

    Al Aloola, Noha A; Naik-Panvelkar, Pradnya; Nissen, Lisa; Saini, Bandana

    2014-10-01

    To explore, in depth, the literature for evidence supporting asthma interventions delivered within primary schools and to identify any "gaps" in this research area. A literature search using electronic search engines (i.e. Medline, PubMed, Education Resources Information Center (ERIC), International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Informit) and the search terms "asthma", "asthma intervention" and "school-based asthma education program" (and derivatives of these keywords) was conducted. Twenty-three articles met the inclusion criteria; of these eight were Randomised Controlled Trials. There was much variety in the type, content, delivery and outcome measures in these 23 studies. The most common intervention type was asthma education delivery. Most studies demonstrated improvement in clinical and humanistic markers, for example, asthma symptoms medication use (decrease in reliever medication use or decrease in the need for rescue oral steroid), inhaler use technique and spacer use competency, lung function and quality of life. Relatively few studies explored the effect of the intervention on academic outcomes. Most studies did not report on the sustainability or cost effectiveness of the intervention tested. Another drawback in the literature was the lack of details about the intervention and inconsistency in instruments selected for measuring outcomes. School-based asthma interventions regardless of their heterogeneity have positive clinical, humanistic, health economical and academic outcomes.

  9. Serum levels of adiponectin and leptin in asthmatic patients and its relation with asthma severity, lung function and BMI.

    Science.gov (United States)

    Nasiri Kalmarzi, R; Ataee, P; Mansori, M; Moradi, G; Ahmadi, S; Kaviani, Z; Khalafi, B; Kooti, W

    Asthma is one of the diseases which has a high prevalence in developed and developing countries. The relationship between asthma and obesity has always been focused by researchers. In this field, adipokines, especially adiponectin and leptin have highly attended by the scientist. The aim of this study was to determine the serum level of adiponectin, leptin and the leptin/adiponectin ratio in asthmatic patients and its relationship with disease severity, lung function and BMI (body mass index). In this cross-sectional study, 90 asthmatic women admitted to the tertiary referral hospital in Kurdistan province - Iran, were examined. First, BMI was measured and then pulmonary function tests were performed in all asthmatics patient. Forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), and FEV1/FVC, were measured. At the end, blood samples were collected and serum level of adiponectin and leptin were measured by ELISA method. Serum leptin and leptin/adiponectin levels correlated positively with asthma severity and BMI (p=0.0001), but there was no correlation between adiponectin level with asthma severity and BMI (p>0.05), also serum leptin and leptin/adiponectin levels inversely correlated with FEV1 and FVC in patient (p=0.0001). Asthma is linked with obesity, and there is an association between asthma severity and BMI with serum leptin and leptin/adiponectin levels, but our results do not support a significant role of adiponectin in obesity or asthma. Copyright © 2016 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

  10. Comorbidities in severe asthma: frequency of rhinitis, nasal polyposis, gastroesophageal reflux disease, vocal cord dysfunction and bronchiectasis

    Directory of Open Access Journals (Sweden)

    Carla Bisaccioni

    2009-01-01

    Full Text Available OBJECTIVES: Severe asthma is found in approximately 10% of patients with asthma. Some factors associated with worse asthma control include rhinitis, gastroesophageal reflux disease, vocal cord dysfunction (VCD, nasal polyposis and bronchiectasis. Therefore, we evaluated the prevalence of these illnesses in patients with severe asthma. METHODS: We conducted a retrospective analysis of data obtained from electronic medical records of patients with severe asthma between January 2006 and June 2008. Symptoms of rhinitis and gastroesophageal reflux disease were evaluated as well as intolerance to nonsteroidal anti-inflammatory drugs. We evaluated the results of esophagogastroduodenoscopy, videolaryngoscopy and CT scans of the chest in order to confirm gastroesophageal reflux disease, nasal polyposis, vocal cord dysfunction and bronchiectasis. RESULTS: We evaluated 245 patients. Rhinitis symptoms were present in 224 patients (91.4%; 18 (7.3% had intolerance to nonsteroidal anti-inflammatory drugs, and 8 (3.3% had nasal polyposis. Symptoms of gastroesophageal reflux disease were reported for 173 (70.6% patients, although the diagnosis of gastroesophageal reflux disease was confirmed based on esophagogastroduodenoscopy or laryngoscopy findings in just 58 (33.6% patients. Vocal cord dysfunction was suspected in 16 (6.5% and confirmed through laryngoscopy in 4 (1.6%. The patient records provided CT scans of the chest for 105 patients, and 26 (24.8% showed bronchiectasis. DISCUSSION: Rhinitis and gastroesophageal reflux disease were the most common comorbidities observed, in addition to bronchiectasis. Therefore, in patients with severe asthma, associated diseases should be investigated as the cause of respiratory symptoms and uncontrolled asthma.

  11. The relationship between asthma and suicidal behaviours: a systematic literature review.

    Science.gov (United States)

    Barker, Emma; Kõlves, Kairi; De Leo, Diego

    2015-07-01

    Asthma is a highly prevalent chronic condition worldwide, and is particularly common in younger people compared to other chronic conditions. Asthma can result in a number of symptoms that are detrimental to the quality of life of sufferers. The aim of the present systematic literature review was to analyse the existing literature on the relationship between asthma and fatal and nonfatal suicidal behaviours. Articles were retrieved from Scopus, PubMed, ProQuest and Web of Knowledge. We searched for the terms (suicid* OR self-harm) AND (asthma* OR "bronchial hyperreactivity") published in English-language peer-reviewed journals between 1990 and December 2014. Original research papers providing empirical evidence about the potential link between asthma and suicidal behaviours were included. The initial search identified 746 articles. Specific limiting criteria reduced the number of articles to the 19 articles that were finally included in the systematic review. The review found a potential link between asthma and suicide mortality, ideation and attempts across the age groups. Limitations of the review include the restriction to English-language papers published within the chosen time period, the limited number of papers involving suicide mortality, and the fact that the majority of papers originated from the USA. Copyright ©ERS 2015.

  12. Near-fatal asthma in the elderly.

    Science.gov (United States)

    Arjona, Nydia

    2015-01-01

    Asthma affects the elderly as often as other age groups; however, it more often becomes fatal in the elderly. Unfortunately, asthma is often unmanaged or underdiagnosed in the older population. It is important for health care providers to recognize risk factors in the elderly and properly treat them before asthma becomes fatal. This article describes near-fatal asthma and identifies risk factors specifically for the elderly. Symptoms of asthma are reviewed as well as assessments and diagnostic tests to identify asthma severity and complications. Proper management needs to be urgently initiated to prevent worsening respiratory distress; this includes fast-acting drug treatments appropriate for elderly patients. Decompensated acute respiratory failure, secondary to severe asthma, requires the skills of an experienced anesthesiologist because these patients may rapidly deteriorate during induction and intubation. Ventilator management must include strategies to prevent worsening hyperinflation of the lungs. Elderly asthma patients have a higher mortality risk related to ventilator complications and other comorbidities.

  13. Nasal IL-17F is related to bronchial IL-17F/neutrophilia and exacerbations in stable atopic severe asthma

    NARCIS (Netherlands)

    Sorbello, V; Ciprandi, G; Di Stefano, A; Massaglia, G M; Favatà, G; Conticello, S; Malerba, M; Folkerts, G; Profita, M; Rolla, G; Ricciardolo, F L M

    Severe asthma (SA) is associated with neutrophil recruitment and T helper (TH )17 chemokine overexpression in bronchial biopsies. We aimed to evaluate IL-17A and IL-17F expression in nasal/bronchial lamina propria of atopic mild-to-severe asthmatics and controls in relation to neutrophilia and

  14. Prevalence, risk factors and severity of asthma symptoms in children of Kermanshah, IRAN: ISAAC phase I, II.

    Science.gov (United States)

    Zobeiri, Mehdi

    2011-01-01

    asthma is more common here, more prevalent in girls than boys and is higher in 13-14 years old than 6-7 years old but sever asthma is much less common. The results may be due to better diagnosis and better control of disease.

  15. Vitamin C and common cold-induced asthma: a systematic review and statistical analysis.

    Science.gov (United States)

    Hemilä, Harri

    2013-11-26

    Asthma exacerbations are often induced by the common cold, which, in turn, can be alleviated by vitamin C. To investigate whether vitamin C administration influences common cold-induced asthma. Systematic review and statistical analysis of the identified trials. Medline, Scopus and Cochrane Central were searched for studies that give information on the effects of vitamin C on common cold-induced asthma. All clinically relevant outcomes related to asthma were included in this review. The estimates of vitamin C effect and their confidence intervals [CI] were calculated for the included studies. Three studies that were relevant for examining the role of vitamin C on common cold-induced asthma were identified. The three studies had a total of 79 participants. Two studies were randomized double-blind placebo-controlled trials. A study in Nigeria on asthmatics whose asthma attacks were precipitated by respiratory infections found that 1 g/day vitamin C decreased the occurrence of asthma attacks by 78% (95% CI: 19% to 94%). A cross-over study in former East-Germany on patients who had infection-related asthma found that 5 g/day vitamin C decreased the proportion of participants who had bronchial hypersensitivity to histamine by 52 percentage points (95% CI: 25 to 71). The third study did not use a placebo. Administration of a single dose of 1 gram of vitamin C to Italian non-asthmatic common cold patients increased the provocative concentration of histamine (PC20) 3.2-fold (95% CI: 2.0 to 5.1), but the vitamin C effect was significantly less when the same participants did not suffer from the common cold. The three reviewed studies differed substantially in their methods, settings and outcomes. Each of them found benefits from the administration of vitamin C; either against asthma attacks or against bronchial hypersensitivity, the latter of which is a characteristic of asthma. Given the evidence suggesting that vitamin C alleviates common cold symptoms and the findings

  16. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... among Children Asthma-related Missed School Days among Children aged 5–17 Years Asthma Severity among Adults with Current Asthma Asthma Severity among Children with Current Asthma Overuse of quick-relief medication ...

  17. Prevalence of Symptoms of Severe Asthma and Allergies in Irish School Children: An ISAAC Protocol Study, 1995–2007

    Directory of Open Access Journals (Sweden)

    Jean Holohan

    2011-08-01

    Full Text Available Childhood asthma is a recurring health burden and symptoms of severe asthma in children are also emerging as a health and economic issue. This study examined changing patterns in symptoms of severe asthma and allergies (ever eczema and hay fever, using the Irish International Study of Asthma and Allergies in Childhood (ISAAC protocol. ISAAC is a cross-sectional self-administered questionnaire survey of randomly selected representative post-primary schools. Children aged 13–14 years were studied: 2,670 (in 1995, 2,273 (in 1998, 2,892 (in 2002–2003, and 2,805 (in 2007. Generalized linear modelling using Poisson distribution was employed to compute adjusted prevalence ratios (PR. A 39% significant increase in symptoms of severe asthma was estimated in 2007 relative to the baseline year 1995 (adjusted PR: 1.39 [95% CI: 1.14–1.69] increasing from 12% in 1995 to 15.3% in 2007. Opposite trends were observed for allergies, showing a decline in 2007, with an initial rise. The potential explanations for such a complex disease pattern whose aetiological hypothesis is still evolving are speculative. Changing environmental factors may be a factor, for instance, an improvement in both outdoor and indoor air quality further reinforcing the hygiene hypothesis but obesity as a disease modifier must also be considered.

  18. Effect of diaphragmatic breathing exercise on quality of life in subjects with asthma: A systematic review.

    Science.gov (United States)

    Prem, Venkatesan; Sahoo, Ramesh Chandra; Adhikari, Prabha

    2013-05-01

    The aim of this systematic review was to determine if diaphragmatic breathing exercise improves quality of life (QoL) in asthma. Electronic databases were searched for randomized controlled trials (RCTs). Data were extracted and risk of bias was assessed by two independent reviewers. Three RCTs were eligible for inclusion (254 subjects). Two studies compared diaphragmatic breathing exercise to asthma education, and one compared with asthma medication. Meta-analysis was not possible due to clinical heterogeneity of the studies. All three studies had a low risk of bias. All studies reported short-term effects, and long-term effects of breathing exercise on asthma quality life. There is a moderate evidence of improvement in QoL following diaphragmatic breathing both in short-term and long-term basis.

  19. Do United States’ Teachers Know and Adhere to the National Guidelines on Asthma Management in the Classroom? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Yudilyn Jaramillo

    2015-01-01

    Full Text Available Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms “asthma management,” “teacher(s,” “school teacher,” and “public school.” The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US. From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools.

  20. Do United States' teachers know and adhere to the national guidelines on asthma management in the classroom? A systematic review.

    Science.gov (United States)

    Jaramillo, Yudilyn; Reznik, Marina

    2015-01-01

    Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI) has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms "asthma management," "teacher(s)," "school teacher," and "public school." The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US). From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools.

  1. Vitamin D Supplementation for Childhood Asthma: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Bruno D Riverin

    Full Text Available There is growing evidence that vitamin D plays a role in the pathogenesis of asthma but it is unclear whether supplementation during childhood may improve asthma outcomes.The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of vitamin D supplementation as a treatment or adjunct treatment for asthma.We searched MEDLINE, Embase, CENTRAL, and CINAHL through July 2014.We included RCTs that evaluated vitamin D supplementation in children versus active control or placebo for asthma.One reviewer extracted data and one reviewer verified data accuracy. We qualitatively summarized the main results of efficacy and safety and meta-analyzed data on comparable outcomes across studies. We used GRADE for strength of evidence.Main planned outcomes measures were ED visits and hospitalizations. As secondary outcomes, we examined measures of asthma control, including frequency of asthma exacerbations, asthma symptom scores, measures of lung function, β2-agonist use and daily steroid use, adverse events and 25-hydroxyvitamin D levels.Eight RCTs (one parallel, one crossover design comprising 573 children aged 3 to 18 years were included. One study (moderate-quality, n = 100 reported significantly less ED visits for children treated with vitamin D. No other studies examined the primary outcome (ED visits and hospitalizations. There was a reduced risk of asthma exacerbations in children receiving vitamin D (low-quality; RR 0.41, 95% CI 0.27 to 0.63, 3 studies, n = 378. There was no significant effect for asthma symptom scores and lung function. The serum 25(OHD level was higher in the vitamin D group at the end of the intervention (low-quality; MD 19.66 nmol/L, 95% CI 5.96 nmol/L to 33.37 nmol/L, 5 studies, n = 167.We identified a high degree of clinical diversity (interventions and outcomes and methodological heterogeneity (sample size and risk of bias in included trials.Randomized controlled trials provide some low

  2. Vitamin D Supplementation for Childhood Asthma: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Riverin, Bruno D; Maguire, Jonathon L; Li, Patricia

    2015-01-01

    There is growing evidence that vitamin D plays a role in the pathogenesis of asthma but it is unclear whether supplementation during childhood may improve asthma outcomes. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of vitamin D supplementation as a treatment or adjunct treatment for asthma. We searched MEDLINE, Embase, CENTRAL, and CINAHL through July 2014. We included RCTs that evaluated vitamin D supplementation in children versus active control or placebo for asthma. One reviewer extracted data and one reviewer verified data accuracy. We qualitatively summarized the main results of efficacy and safety and meta-analyzed data on comparable outcomes across studies. We used GRADE for strength of evidence. Main planned outcomes measures were ED visits and hospitalizations. As secondary outcomes, we examined measures of asthma control, including frequency of asthma exacerbations, asthma symptom scores, measures of lung function, β2-agonist use and daily steroid use, adverse events and 25-hydroxyvitamin D levels. Eight RCTs (one parallel, one crossover design) comprising 573 children aged 3 to 18 years were included. One study (moderate-quality, n = 100) reported significantly less ED visits for children treated with vitamin D. No other studies examined the primary outcome (ED visits and hospitalizations). There was a reduced risk of asthma exacerbations in children receiving vitamin D (low-quality; RR 0.41, 95% CI 0.27 to 0.63, 3 studies, n = 378). There was no significant effect for asthma symptom scores and lung function. The serum 25(OH)D level was higher in the vitamin D group at the end of the intervention (low-quality; MD 19.66 nmol/L, 95% CI 5.96 nmol/L to 33.37 nmol/L, 5 studies, n = 167). We identified a high degree of clinical diversity (interventions and outcomes) and methodological heterogeneity (sample size and risk of bias) in included trials. Randomized controlled trials provide some low

  3. Effect of outdoor air pollution on asthma exacerbations in children and adults: Systematic review and multilevel meta-analysis.

    Science.gov (United States)

    Orellano, Pablo; Quaranta, Nancy; Reynoso, Julieta; Balbi, Brenda; Vasquez, Julia

    2017-01-01

    Several observational studies have suggested that outdoor air pollution may induce or aggravate asthma. However, epidemiological results are inconclusive due to the presence of numerous moderators which influence this association. The goal of this study was to assess the relationship between outdoor air pollutants and moderate or severe asthma exacerbations in children and adults through a systematic review and multilevel meta-analysis. We searched studies published in English on PubMed, Scopus, and Google Scholar between January 2000 and October 2016. Studies following a case-crossover design with records of emergency departments and/or hospital admissions as a surrogate of moderate or severe asthma exacerbations were selected. A multilevel meta-analysis was employed, taking into account the potential clustering effects within studies examining more than one lag. Odds ratios (ORs) and 95% confidence intervals were estimated. A subgroup analysis in children aged 0 to 18 years and a sensitivity analysis based on the quality of the included studies as defined in the Newcastle-Ottawa Scale were performed. Publication bias was evaluated through visual inspection of funnel plots and by a complementary search of grey literature. (Prospero Registration number CRD42015032323). Database searches retrieved 208 records, and finally 22 studies were selected for quantitative analysis. All pollutants except SO2 and PM10 showed a significant association with asthma exacerbations (NO2: 1.024; 95% CI: 1.005,1.043, SO2: 1.039; 95% CI: 0.988,1.094), PM10: 1.024; 95% CI: 0.995,1.053, PM2.5: 1.028; 95% CI: 1.009,1.047, CO: 1.045; 95% CI: 1.005,1.086, O3: 1.032; 95% CI: 1.005,1.060. In children, the association was significant for NO2, SO2 and PM2.5. This meta-analysis provides evidence of the association between selected air pollutants and asthma exacerbations for different lags.

  4. Severe eczema in infancy can predict asthma development. A prospective study to the age of 10 years.

    Directory of Open Access Journals (Sweden)

    Marie Ekbäck

    Full Text Available BACKGROUND: Children with atopic eczema in infancy often develop allergic rhinoconjunctivitis and asthma, but the term "atopic march" has been questioned as the relations between atopic disorders seem more complicated than one condition progressing into another. OBJECTIVE: In this prospective multicenter study we followed children with eczema from infancy to the age of 10 years focusing on sensitization to allergens, severity of eczema and development of allergic airway symptoms at 4.5 and 10 years of age. METHODS: On inclusion, 123 children were examined. Hanifin-Rajka criteria and SCORAD index were used to describe the eczema. Episodes of wheezing were registered, skin prick tests and IgE tests were conducted and questionnaires were filled out. Procedures were repeated at 4.5 and 10 years of age with additional examinations for ARC and asthma. RESULTS: 94 out of 123 completed the entire study. High SCORAD points on inclusion were correlated with the risk of developing ARC, (B = 9.86, P = 0.01 and asthma, (B = 10.17, P = 0.01. For infants with eczema and wheezing at the first visit, the OR for developing asthma was 4.05(P = 0.01. ARC at 4.5 years of age resulted in an OR of 11.28(P = 0.00 for asthma development at 10 years. CONCLUSION: This study indicates that infant eczema with high SCORAD points is associated with an increased risk of asthma at 10 years of age. Children with eczema and wheezing episodes during infancy are more likely to develop asthma than are infants with eczema alone. Eczema in infancy combined with early onset of ARC seems to indicate a more severe allergic disease, which often leads to asthma development. The progression from eczema in infancy to ARC at an early age and asthma later in childhood shown in this study supports the relevance of the term "atopic march", at least in more severe allergic disease.

  5. Features of Severe Bronchial Asthma Phenotypes in School-Age Children Predisposed to Overweigh

    Directory of Open Access Journals (Sweden)

    L.A. Ivanova

    2015-11-01

    Full Text Available One of the aspects of inadequate control of severe bronchial asthma (BA is its phenotypic heterogeneity. Although the relationship between obesity and BA is certain, the mechanism of this phenotype of the disease is poorly understood. The objective of the study was to improve the efficiency of basic treatment for severe BA in school-age children predisposed to overweight based on an analysis of indicators of control, inflammatometry and spirometric characteristics. In a pulmonary department of regional clinical hospital (Chernivtsi, there were examined 18 children predisposed to overweight, whose body mass index exceeded the limits of 95% confidence interval (21.7 kg/m2 (I clinical group. Control group consisted of 39 patients with severe BA, who are not predisposed to overweight. It is proved that a predisposition to overweight in children with severe persistent BA adversely affect the indicators of achieving disease control. The lower efficacy of basic treatment in children predisposed to overweight is established that is due to a significantly greater share of school-age children with neutrophilic nature of bronchia inflammation in this group and airway hypersensitivity to histamine.

  6. Spirometry in Asthma Care: A Review of the Trends and Challenges in Pediatric Practice

    Science.gov (United States)

    Ayuk, Adaeze C; Uwaezuoke, Samuel N; Ndukwu, Chizalu I; Ndu, Ikenna K; Iloh, Kenechukwu K; Okoli, Chinyere V

    2017-01-01

    Background: Given the rising incidence of noncommunicable diseases (NCDs) globally, especially bronchial asthma, there is the need to reduce the associated morbidity and mortality by adopting an objective means of diagnosis and monitoring. Aim: This article aims to review the trends and challenges in the use of spirometry for managing childhood bronchial asthma especially in developing countries. Methods: We conducted a literature search of published data on the use of spirometry for the diagnosis of childhood bronchial asthma with special emphasis resource-poor countries. Results: Guidelines for the diagnosis and treatment of childhood asthma recommend the use of spirometry, but this is currently underused in both tertiary and primary care settings especially in developing countries. Lack of spirometers and proper training in their use and interpretation of findings as well as a dearth of asthma guidelines remains core to the underuse of spirometry in managing children with asthma. Targeting education of health care staff was, however, observed to improve its utility, and practical implementable strategies are highlighted. Conclusions: Spirometry is not frequently used for asthma diagnosis in pediatric practice especially in resource-poor countries where the NCD burden is higher. Strategies to overcome the obstacles are implementable and can make a difference in reducing the burden of NCD. PMID:28781518

  7. Spirometry in Asthma Care: A Review of the Trends and Challenges in Pediatric Practice

    Directory of Open Access Journals (Sweden)

    Adaeze C Ayuk

    2017-07-01

    Full Text Available Background: Given the rising incidence of noncommunicable diseases (NCDs globally, especially bronchial asthma, there is the need to reduce the associated morbidity and mortality by adopting an objective means of diagnosis and monitoring. Aim: This article aims to review the trends and challenges in the use of spirometry for managing childhood bronchial asthma especially in developing countries. Methods: We conducted a literature search of published data on the use of spirometry for the diagnosis of childhood bronchial asthma with special emphasis resource-poor countries. Results: Guidelines for the diagnosis and treatment of childhood asthma recommend the use of spirometry, but this is currently underused in both tertiary and primary care settings especially in developing countries. Lack of spirometers and proper training in their use and interpretation of findings as well as a dearth of asthma guidelines remains core to the underuse of spirometry in managing children with asthma. Targeting education of health care staff was, however, observed to improve its utility, and practical implementable strategies are highlighted. Conclusions: Spirometry is not frequently used for asthma diagnosis in pediatric practice especially in resource-poor countries where the NCD burden is higher. Strategies to overcome the obstacles are implementable and can make a difference in reducing the burden of NCD.

  8. Rhinoviruses, Allergic Inflammation, and Asthma

    Science.gov (United States)

    Gavala, Monica; Bertics, Paul J.; Gern, James E.

    2011-01-01

    Summary Viral infections affect wheezing and asthma in children and adults of all ages. In infancy, wheezing illnesses are usually viral in origin, and children with more severe wheezing episodes are more likely to develop recurrent episodes of asthma and to develop asthma later in childhood. Children who develop allergen-specific immunoglobulin E (allergic sensitization), and those who wheeze with rhinoviruses (HRV) are at especially high risk for asthma. In older children and adults, HRV infections generally cause relatively mild respiratory illnesses and yet contribute to acute and potentially severe exacerbations in patients with asthma. These findings underline the importance of understanding the synergistic nature of allergic sensitization and infections with HRV in infants relative to the onset of asthma and in children and adults with respect to exacerbations of asthma. This review discusses clinical and experimental evidence of virus/allergen interactions and evaluates theories which relate immunologic responses to respiratory viruses and allergens to the pathogenesis and disease activity of asthma. Greater understanding of the relationship between viral respiratory infections, allergic inflammation, and asthma is likely to suggest new strategies for the prevention and treatment of asthma. PMID:21682739

  9. Noninvasive ventilation for acute exacerbations of asthma: A systematic review of the literature.

    Science.gov (United States)

    Green, Elyce; Jain, Paras; Bernoth, Maree

    2017-11-01

    Asthma is a chronic disease characterised by reversible airway obstruction caused by bronchospasm, mucous and oedema. People with asthma commonly experience acute exacerbations of their disease requiring hospitalisation and subsequent utilisation of economic and healthcare resources. Noninvasive ventilation has been suggested as a treatment for acute exacerbations of asthma due to its ability to provide airway stenting, optimal oxygen delivery and decreased work of breathing. This paper is a systematic review of the available published research focused on the use of noninvasive ventilation for the treatment of acute exacerbations of asthma to determine if this treatment provides better outcomes for patients compared to standard medical therapy. Database searches were conducted using EBSCOhost, MEDLINE and PubMed. Search terms used were combinations of 'noninvasive ventilation', 'BiPAP', 'CPAP', 'wheez*' and 'asthma'. Articles were included if they were research papers focused on adult patients with asthma and a treatment of noninvasive ventilation, and were published in full text in English. Included articles were reviewed using the National Health and Medical Research Council (Australia) evidence hierarchy and quality appraisal tools. There were 492 articles identified from the database searches. After application of inclusion/exclusion criteria 13 articles were included in the systematic review. Studies varied significantly in design, endpoints and outcomes. There was a trend in better outcomes for patients with acute asthma who were treated with noninvasive ventilation compared to standard medical therapy, however, the variability of the studies meant that no conclusive recommendations could be made. More research is required before noninvasive ventilation can be conclusively recommended for the treatment of acute exacerbations of asthma. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  10. Clinical characteristics of children and adolescents with severe therapy-resistant asthma in Brazil

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    Andrea Mendonça Rodrigues

    2015-08-01

    Full Text Available AbstractObjective: To describe the clinical characteristics, lung function, radiological findings, and the inflammatory cell profile in induced sputum in children and adolescents with severe therapy-resistant asthma (STRA treated at a referral center in southern Brazil.Methods: We retrospectively analyzed children and adolescents (3-18 years of age with uncontrolled STRA treated with high-dose inhaled corticosteroids and long-acting β2 agonists. We prospectively collected data on disease control, lung function, skin test reactivity to allergens, the inflammatory cell profile in induced sputum, chest CT findings, and esophageal pH monitoring results.Results: We analyzed 21 patients (mean age, 9.2 ± 2.98 years. Of those, 18 (86% were atopic. Most had uncontrolled asthma and near-normal baseline lung function. In 4 and 7, induced sputum was found to be eosinophilic and neutrophilic, respectively; the inflammatory cell profile in induced sputum having changed in 67% of those in whom induced sputum analysis was repeated. Of the 8 patients receiving treatment with omalizumab (an anti-IgE antibody, 7 (87.5% showed significant improvement in quality of life, as well as significant reductions in the numbers of exacerbations and hospitalizations.Conclusions: Children with STRA present with near-normal lung function and a variable airway inflammatory pattern during clinical follow-up, showing a significant clinical response to omalizumab. In children, STRA differs from that seen in adults, further studies being required in order to gain a better understanding of the disease mechanisms.

  11. Asthma mortality in the Danish child population

    DEFF Research Database (Denmark)

    Jørgensen, Inger Merete; Jensen, V B; Bülow, S

    2003-01-01

    Child death due to asthma is a rare and potentially preventable event. We investigated possible risk factors for death due to asthma in children and adolescents, as a step towards preventing or minimizing asthma death in this age group, and improving asthma management and care. We reviewed all 108...... cases of asthma death in 1-19-year-olds in Denmark, 1973-1994. Copies of death certificates, hospital records, information from general practitioners, and autopsy records were obtained. The information was assessed with particular reference to: features and duration of asthma before death; severity...... of asthma; time and place of death; long-term and ongoing medical treatment; quality of medical care; circumstances of final illness; and medical treatment during the final episode of asthma. Age groups of 1-4 years, 5-14 years, and 15-19 years were analyzed separately and in aggregate. Death occurred...

  12. Clinical characteristics of the asthma-COPD overlap syndrome--a systematic review

    DEFF Research Database (Denmark)

    Nielsen, Mia; Bårnes, Camilla Boslev; Ulrik, Charlotte Suppli

    2015-01-01

    is described clinically as persistent airflow limitation combined with features of both asthma and COPD. The aim of this paper is, therefore, to review the currently available literature focusing on symptoms and clinical characteristics of patients regarded as having ACOS. METHODS: Based on the preferred......BACKGROUND AND OBJECTIVE: In recent years, the so-called asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) has received much attention, not least because elderly individuals may present characteristics suggesting a diagnosis of both asthma and COPD. At present, ACOS...... reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic literature review was performed. RESULTS: A total of 11 studies met the inclusion criteria for the present review. All studies dealing with dyspnea (self-reported or assessed by the Medical Research Council dyspnea...

  13. Roflumilast combined with montelukast versus montelukast alone as add-on treatment in patients with moderate-to-severe asthma.

    Science.gov (United States)

    Bateman, Eric D; Goehring, Udo-Michael; Richard, Frank; Watz, Henrik

    2016-07-01

    Roflumilast, a selective phosphodiesterase 4 inhibitor, has been shown to provide modest improvements in lung function in patients with mild-to-moderate asthma, but its efficacy in patients with moderate-to-severe asthma has not been assessed. We hypothesized that this drug might provide benefit if combined with montelukast, a leukotriene receptor antagonist, in patients whose symptoms are uncontrolled by inhaled corticosteroids and long-acting β-agonists. We sought to examine the efficacy, safety, and mode of action of the addition of roflumilast and montelukast versus montelukast alone in patients with moderate-to-severe asthma. In a phase 2, randomized, double-blind, placebo-controlled, multiple-dose, 2-sequence, crossover study, 64 patients were randomized to receive 500 μg of roflumilast plus montelukast followed by placebo plus 10 mg of montelukast (sequence AB) or placebo plus 10 mg of montelukast followed by 500 μg of roflumilast plus 10 mg of montelukast (sequence BA). All patients had a diagnosis of bronchial asthma inadequately controlled by at least a medium-dose inhaled corticosteroid plus a long-acting β-agonist. The analysis of FEV1 change from baseline to week 4 showed a statistically significant and clinically meaningful treatment difference of 100 mL for roflumilast plus montelukast versus placebo plus montelukast. Also, improvements in patient-reported outcomes and a reduction in urinary leukotriene E4 levels were observed during roflumilast plus montelukast treatment compared with placebo plus montelukast treatment. Adverse events were consistent with the known safety profile of roflumilast. The combination of roflumilast with montelukast compared with montelukast alone improved lung function and asthma control in patients with moderate-to-severe asthma and deserves further study for this indication. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Effect of obesity and metabolic syndrome on severity, quality of life, sleep quality and inflammatory markers in patients of asthma in India.

    Science.gov (United States)

    Singh, Mandeep; Gupta, Nitesh; Kumar, Raj

    2016-01-01

    The study aimed to compare the effect of obesity with and without metabolic syndrome on asthma severity, quality of life, sleep quality, sleep disordered breathing and inflammatory markers as compared to non-obese asthma patients. 60 asthma patients recruited for the study were divided equally into non-obese (NOA), obese without metabolic syndrome (OANMS) and obese with metabolic syndrome (OAMS) groups. Study cohorts were assessed for severity of asthma, quality of life and quality of sleep using questionnaires and inflammatory markers (FENO, hs-CRP, IL-5, IL-6 and leptin). Institutional ethical committee approved the study. The results suggests OAMS patients may be a subtype of asthmatics having significantly severe asthma (p obese asthmatics especially with metabolic syndrome represent a subtype of asthmatic population. Hence, the treatment of metabolic syndrome may be necessary in addition to asthma to achieve optimal control.

  15. Increase in prevalence and severity of asthma in young adults in Copenhagen

    DEFF Research Database (Denmark)

    Hansen, Ejvind Frausing; Rappeport, Y; Vestbo, Jørgen

    2000-01-01

    BACKGROUND: It is the general impression that the prevalence of asthma has increased during recent decades. A study was undertaken to investigate asthma prevalence, respiratory symptoms, and lung function in young adults in the City of Copenhagen 15 years apart. METHODS: Men and women aged 20-35 ...

  16. Relationship between Vitamin D, Inflammation and Lung Function In Patients with Severe Uncontrolled Asthma

    Directory of Open Access Journals (Sweden)

    Elena Janeva-Jovanovska

    2017-11-01

    CONCLUSION: Because there are little studies about the link between vitamin D and asthma, further research to clarify the mechanism how vitamin D control the activity of CD4+ T cells and the related Th2-type cytokines in the parthenogenesis of asthma.

  17. Self-hypnosis for anxiety associated with severe asthma: a case report

    Directory of Open Access Journals (Sweden)

    Anbar Ran D

    2003-07-01

    Full Text Available Abstract Background Management of asthma can be complicated by both medical and psychiatric conditions, such as gastroesophageal reflux, chronic sinusitis, and anxiety. When symptoms of asthma are interpreted without regard to such conditions treatment may yield a suboptimal outcome. For example, anxiety-associated dyspnea, tachypnea, and chest tightness can be mistakenly interpreted as resulting from an exacerbation of asthma. Medical treatment directed only for asthma may thus lead to overuse of asthma medications and increased hospitalizations. Case Presentation The described case illustrates how a systemic steroid-dependent patient with asthma benefited from receiving care from a pediatric pulmonologist who also was well versed in the diagnosis and treatment of anxiety. By using self-hypnosis, the patient was able to reduce her dependence on bronchodilators. Following modification of her medical therapy under supervision of the pulmonologist, and regular use of hypnosis, the patient ultimately was weaned off her systemic steroid therapy. Conclusions This report emphasizes that anxiety must be considered as a comorbid condition in the treatment of asthma. Self-hypnosis can be a useful skill in the treatment of a patient with anxiety and asthma.

  18. Use of medicinal herbs by patients with severe asthma managed at a Referral Center

    Directory of Open Access Journals (Sweden)

    Tacila Pires Mega

    2011-09-01

    Full Text Available Asthma is a chronic inflammatory disease of the airways that may lead to limitations in regular activities, to hospitalizations and a decrease in quality of life. Adherence to drug treatment is crucial for control of the disease. The use of medicinal herbs can reduce adherence to prescriptions, as the medication may be replaced by infusions or herbal products. The objective of this study was to evaluate the frequency of use of traditional herbal medicine among severe asthmatics in Salvador. Information on use of homemade remedies was obtained through application of a questionnaire during patient visits to a referral center. We also collected data on economic and social aspects as well as disease control. One hundred and forty-four (91,1% out of one hundred and fifty-eight patients evaluated used herbal medicines, but only 26.5% attributed improvement of asthma symptoms to this alternative treatment and only 8 had substituted a prescribed medication by herbal medicines. There was a trend towards lower adherence to prescription drug treatment in this group of patients. Despite the high frequency of use of medicinal herbs in our sample, there was no improvement in the asthma treatment in this population compared to non-users. Adherence to conventional drug treatment was satisfactory and there was neither reduction in asthma control nor increase in hospitalizations among the users of medicinal plants.A asma é uma enfermidade inflamatória crônica das vias aéreas que pode resultar em limitações nas atividades diárias, internações e prejuízo da qualidade de vida. A adesão ao tratamento medicamentoso é fundamental para o controle da doença. O uso de plantas medicinais pode reduzir a adesão ao tratamento prescrito, à medida que os medicamentos são substituídos por chás ou ervas. O objetivo deste estudo foi avaliar a frequência de uso de plantas medicinais entre asmáticos graves em Salvador. As informações sobre uso de rem

  19. Changes in rates and severity of compensation claims for asthma due to diisocyanates: a possible effect of medical surveillance measures

    OpenAIRE

    Tarlo, S; Liss, G.; Yeung, K.

    2002-01-01

    Objectives: A medical surveillance programme was introduced into Ontario for workers exposed to diisocyanates in 1983, but no mandated surveillance programme is in effect in this province for other occupational respiratory sensitisers. This study assesses changes in incidence and severity of compensated claims for occupational asthma (OA) due to diisocyanates compared with other causes, which have occurred since the introduction of this surveillance programme.

  20. Identifying patients at risk for severe exacerbations of asthma: development and external validation of a multivariable prediction model

    NARCIS (Netherlands)

    Loymans, Rik J. B.; Honkoop, Persijn J.; Termeer, Evelien H.; Snoeck-Stroband, Jiska B.; Assendelft, Willem J. J.; Schermer, Tjard R. J.; Chung, Kian Fan; Sousa, Ana R.; Sterk, Peter J.; Reddel, Helen K.; Sont, Jacob K.; ter Riet, Gerben

    2016-01-01

    Preventing exacerbations of asthma is a major goal in current guidelines. We aimed to develop a prediction model enabling practitioners to identify patients at risk of severe exacerbations who could potentially benefit from a change in management. We used data from a 12-month primary care pragmatic

  1. Identifying patients at risk for severe exacerbations of asthma: development and external validation of a multivariable prediction model

    NARCIS (Netherlands)

    Loymans, R.J.; Honkoop, P.J.; Termeer, E.H.; Snoeck-Stroband, J.B.; Assendelft, W.J.J.; Schermer, T.R.J.; Chung, K.F.; Sousa, A.R.; Sterk, P.J.; Reddel, H.K.; Sont, J.K.; Riet, G. Ter

    2016-01-01

    BACKGROUND: Preventing exacerbations of asthma is a major goal in current guidelines. We aimed to develop a prediction model enabling practitioners to identify patients at risk of severe exacerbations who could potentially benefit from a change in management. METHODS: We used data from a 12-month

  2. Evaluation of the Correlation Between Body Mass Index and the Severity of Asthma in Recently Diagnosed Patients

    Directory of Open Access Journals (Sweden)

    Davood Attaran

    2011-06-01

    Full Text Available Introduction: Asthma and obesity are among diseases that cause several problems and impair quality of life.  The concurrence of these diseases, changes in the respiratory physiology, changes associated with obesity and limited activity associated with asthma may cause an interaction between the two conditions. Materials and Methods: We studied the epidemiologic characteristics of all recently diagnosed cases of asthma with no previous treatment who visited the Respiratory Diseases Clinic of the Ghaem Hospital from 2004 to 2007, their Body Mass Indexes (BMI were calculated and then spirometry was performed in all cases. Results: We studied 232 cases with the mean age of 38.96±12.94 years and the mean BMI of 27.05±4.92. Cough and exertional dyspnea were the most common clinical symptoms. In spirometric evaluations, the mean maximum mid-expiratory flow (MMEF increased with weight, which was not, however, insignificant. FVC in obese patients was significantly less than in normal weight cases. A significant correlation was not also seen between BMI and FEV1 (r=-0.023, P=0.729. Conclusion: Except for FVC which had a significant correlation with BMI, other studied indices yielded no significant results, which calls for more extensive studies with larger populations. Considering the fact that mild asthma is less common in obese patients, better weight control in asthmatic patients can promote their quality of life and make asthma management more effective.

  3. Phthalate esters and childhood asthma: A systematic review and congener-specific meta-analysis.

    Science.gov (United States)

    Li, Ming-Chieh; Chen, Chi-Hsien; Guo, Yue Leon

    2017-10-01

    Exposure to phthalate esters (PAEs) has been associated with childhood asthma, but the congener-specific effects of PAEs on childhood asthma were unclear. We aimed to systematically review and meta-analyze observational studies on the associations between specific effects of PAEs and the risk of childhood asthma. Relevant studies were identified by searching three databases up to October 20, 2016. The reference lists of the retrieved articles were also reviewed. We included observational studies that reported risk estimates with 95% confidence intervals (CIs) for the associations between phthalate exposure and the risk of childhood asthma. Fixed-effects models were generally applied to calculate pooled risk estimates. When heterogeneity was present, random-effects models were applied. A total of nine studies featuring 43 data points were included in our final meta-analyses. Results indicated that the benzyl butyl phthalate (BBzP) exposure had a significant association with the risk of childhood asthma. The Odd Ratios (ORs) were from 1.39 to 1.41 for different combination strategies. Subgroup analyses by different exposure period or samples used showed that prenatal exposure to BBzP had a stronger association with the risk of childhood asthma (OR = 1.38, 95% CI = 1.09-1.75), compared to those with postnatal exposure. Besides, the association was evident when the phthalate exposure was measured from dust samples. The OR for the associations between di-2-ethylhexyl phthalate (DEHP) in dust and childhood asthma was 2.71 (95% CI = 1.39-5.28), and 2.08 (95% CI = 1.10-3.92) for BBzP. Our study suggested a positive association between DEHP and BBzP exposure and childhood asthma. Future studies are warranted to identify the underlying mechanisms of the association. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. A systematic review of the association between obesity and asthma in children

    Science.gov (United States)

    Liu, Pei-Ching; Kieckhefer, Gail M.; Gau, Bih-Shya

    2013-01-01

    Aims To provide a comprehensive integration of contemporary studies focusing on the relationship between obesity and asthma in paediatric populations. Background The simultaneous increase in asthma and obesity prevalence has been widely discussed over the past twenty years. Although studies have discovered a positive correlation between the two, evidence-based findings are needed to develop nursing interventions. Data Sources An electronic database search was conducted for studies published between January 1966 - May 2011. Additional articles were identified through the reference lists of reviewed papers. Review Methods A quantitative systematic review was undertaken to aggregate evidence regarding the association between obesity and asthma in children. Inclusion/exclusion criteria and quality appraisal were applied to ensure research primarily designed to study the relationship between obesity and asthma in children was included. Results The majority of studies support a positive association between obesity and asthma in children. Among correlates recognized as important effect modifiers, gender was the most prominent, with obese girls more likely to have asthma diagnoses than obese boys. Scrutinization of covariates in selected studies revealed that most related to children's demographic characteristics and were inconsistent across the studies. Conclusions This review was designed to integrate contemporary scientific findings on the association between obesity and asthma by including a large number of studies with variant research designs. To identify high-risk groups and develop nursing interventions to help children affected by both epidemics, more interdisciplinary and well-designed investigations focusing on an expanded spectrum of correlates including demographic and behavioural factors are warranted. PMID:23560878

  5. Systematic meta-review of supported self-management for asthma: a healthcare perspective.

    Science.gov (United States)

    Pinnock, Hilary; Parke, Hannah L; Panagioti, Maria; Daines, Luke; Pearce, Gemma; Epiphaniou, Eleni; Bower, Peter; Sheikh, Aziz; Griffiths, Chris J; Taylor, Stephanie J C

    2017-03-17

    Supported self-management has been recommended by asthma guidelines for three decades; improving current suboptimal implementation will require commitment from professionals, patients and healthcare organisations. The Practical Systematic Review of Self-Management Support (PRISMS) meta-review and Reducing Care Utilisation through Self-management Interventions (RECURSIVE) health economic review were commissioned to provide a systematic overview of supported self-management to inform implementation. We sought to investigate if supported asthma self-management reduces use of healthcare resources and improves asthma control; for which target groups it works; and which components and contextual factors contribute to effectiveness. Finally, we investigated the costs to healthcare services of providing supported self-management. We undertook a meta-review (systematic overview) of systematic reviews updated with randomised controlled trials (RCTs) published since the review search dates, and health economic meta-analysis of RCTs. Twelve electronic databases were searched in 2012 (updated in 2015; pre-publication update January 2017) for systematic reviews reporting RCTs (and update RCTs) evaluating supported asthma self-management. We assessed the quality of included studies and undertook a meta-analysis and narrative synthesis. A total of 27 systematic reviews (n = 244 RCTs) and 13 update RCTs revealed that supported self-management can reduce hospitalisations, accident and emergency attendances and unscheduled consultations, and improve markers of control and quality of life for people with asthma across a range of cultural, demographic and healthcare settings. Core components are patient education, provision of an action plan and regular professional review. Self-management is most effective when delivered in the context of proactive long-term condition management. The total cost (n = 24 RCTs) of providing self-management support is offset by a reduction in

  6. Tobaksrygning og asthma

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Lange, Peter

    2002-01-01

    Cigarette smoking is a well-known health hazard, probably not least for patients suffering from asthma. This review gives a short overview of the effects of passive and active smoking on the inception and outcome with of longitudinal changes in the lung function and mortality of patients with ast......Cigarette smoking is a well-known health hazard, probably not least for patients suffering from asthma. This review gives a short overview of the effects of passive and active smoking on the inception and outcome with of longitudinal changes in the lung function and mortality of patients...... with asthma. Substantial evidence suggests that smoking affects asthma adversely. Exposure to environmental tobacco smoke, especially maternal smoking in children, may be a significant risk factor for asthma. Such exposure in patients with established asthma is not only associated with more severe symptoms......, but also with a poorer quality of life, reduced lung function, and increased utilisation of health care including hospital admissions. Active smoking does not appear to be a significant risk factor for asthma, but is associated with a worse outcome with regard to both longitudinal changes in lung function...

  7. Influence of chronic azithromycin treatment on the composition of the oropharyngeal microbial community in patients with severe asthma.

    Science.gov (United States)

    Lopes Dos Santos Santiago, Guido; Brusselle, Guy; Dauwe, Kenny; Deschaght, Pieter; Verhofstede, Chris; Vaneechoutte, Dries; Deschepper, Ellen; Jordens, Paul; Joos, Guy; Vaneechoutte, Mario

    2017-05-10

    This study of the oropharyngeal microbiome complements the previously published AZIthromycin in Severe ASThma (AZISAST) clinical trial, where the use of azithromycin was assessed in subjects with exacerbation-prone severe asthma. Here, we determined the composition of the oropharyngeal microbial community by means of deep sequencing of the amplified 16S rRNA gene in oropharyngeal swabs from patients with exacerbation-prone severe asthma, at baseline and during and after 6 months treatment with azithromycin or placebo. A total of 1429 OTUs were observed, of which only 59 were represented by more than 0.02% of the reads. Firmicutes, Bacteroidetes, Fusobacteria, Proteobacteria and Actinobacteria were the most abundant phyla and Streptococcus and Prevotella were the most abundant genera in all the samples. Thirteen species only accounted for two thirds of the reads and two species only, i.e. Prevotella melaninogenica and Streptococcus mitis/pneumoniae, accounted for one fourth of the reads. We found that the overall composition of the oropharyngeal microbiome in patients with severe asthma is comparable to that of the healthy population, confirming the results of previous studies. Long term treatment (6 months) with azithromycin increased the species Streptococcus salivarius approximately 5-fold and decreased the species Leptotrichia wadei approximately 5-fold. This was confirmed by Boruta feature selection, which also indicated a significant decrease of L. buccalis/L. hofstadtii and of Fusobacterium nucleatum. Four of the 8 treated patients regained their initial microbial composition within one month after cessation of treatment. Despite large diversity of the oropharyngeal microbiome, only a few species predominate. We confirm the absence of significant differences between the oropharyngeal microbiomes of people with and without severe asthma. Possibly, long term azithromycin treatment may have long term effects on the composition of the oropharygeal microbiome in

  8. Impact of an integrated disease management program in reducing exacerbations in patients with severe asthma and COPD.

    Science.gov (United States)

    Jain, Vipul V; Allison, Richard; Beck, Sandra J; Jain, Ratnali; Mills, Paul K; McCurley, James W; Van Gundy, Karl P; Peterson, Michael W

    2014-12-01

    Conflicting data exists on the effectiveness of integrated programs in reducing recurrent exacerbations and hospitalizations in patients with Asthma and chronic obstructive lung disease (COPD). We developed a Pulmonologist-led Chronic Lung Disease Program (CLDP) for patients with severe asthma and COPD and analyzed its impact on healthcare utilization and predictors of its effectiveness. CLDP elements included clinical evaluation, onsite pulmonary function testing, health education, and self-management action plan along with close scheduled and on-demand follow-up. Patients with ≥2 asthma or COPD exacerbations requiring emergency room visit or hospitalization within the prior year were enrolled, and followed for respiratory related ER visits (RER) and hospitalizations (RHA) over the year (357 ± 43 days) after CLDP interventions. A total of 106 patients were enrolled, and 104 patients were subject to analyses. During the year of follow-up after CLDP enrollment, there was a significant decrease in mean RER (0.56 ± 1.48 versus 2.62 ± 2.81, p logistic regression analysis revealed lack of spirometry utilization as an independent risk factor for severe exacerbations. A Pulmonologist-led disease management program integrating key elements of care is cost effective and significantly decreases severe exacerbations. Integrated programs should be encouraged for care of frequent exacerbators of asthma and COPD. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... please visit this page: About CDC.gov . Asthma Learn How to Control Asthma Asthma and Severe Weather ... Working on Asthma Follow @CDCasthma on Twitter to learn more about helping people with asthma live healthier ...

  10. Fenótipos clínicos de asma grave Clinical phenotypes of severe asthma

    Directory of Open Access Journals (Sweden)

    Roseliane de Souza Araújo Alves

    2008-09-01

    Full Text Available OBJETIVO: Estabelecer os fenótipos clínicos em portadores de asma grave. MÉTODOS: Foram estudados, retrospectivamente, 111 pacientes em um ambulatório especializado. Os pacientes foram avaliados e acompanhados de maneira sistemática, estabelecendo-se ao final do acompanhamento a adesão e o controle ou não da doença por dados clínicos e funcionais. A resistência ao tratamento foi definida como o não preenchimento, ao final do acompanhamento, por pelo menos seis meses, dos critérios de controle de asma, apesar do uso correto e adesão à medicação. Os fenótipos foram determinados por análise fatorial e comparados por testes diversos. RESULTADOS: Ao final, 88 pacientes foram considerados aderentes e 23 não aderentes. Por análise fatorial do grupo aderente, quatro fenótipos foram determinados: o fenótipo 1 (28 pacientes, formado pelos pacientes resistentes ao tratamento, com maior freqüência de sintomas noturnos, maior número de exacerbações e uso mais freqüente de broncodilatador de resgate; o fenótipo 2 (48 pacientes, formado pelos pacientes com obstrução persistente, com menores valores de relação volume expiratório forçado no primeiro segundo/capacidade vital forçada na avaliação inicial, idade mais avançada e maior tempo de doença; o fenótipo 3 (42 pacientes, representa os pacientes com rinossinusite alérgica, sendo constituído de não fumantes com obstrução predominantemente reversível; e o fenótipo 4 (15 pacientes, formado por casos com história de intolerância à aspirina associado à asma quase fatal. CONCLUSÕES: Um número significativo de portadores de ama grave não adere ao tratamento. Muitos pacientes com asma grave têm obstrução irreversível, mas o fenótipo clínico mais relevante é constituído pelos pacientes resistentes ao tratamento habitual.OBJECTIVE: To characterize clinical phenotypes of severe asthma. METHODS: A total of 111 patients were retrospectively evaluated at a

  11. Smoking, longer disease duration and absence of rhinosinusitis are related to fixed airway obstruction in Koreans with severe asthma: findings from the COREA study

    Directory of Open Access Journals (Sweden)

    Moon Hee-Bom

    2011-01-01

    Full Text Available Abstract Background The clinical manifestations of severe asthma are heterogeneous. Some individuals with severe asthma develop irreversible fixed airway obstruction, which is associated with poor outcomes. We therefore investigated the factors associated with fixed airway obstruction in Korean patients with severe asthma. Methods Severe asthma patients from a Korean adult asthma cohort were divided into two groups according to the results of serial pulmonary function tests. One group had fixed airway obstruction (FAO [forced expiratory volume in 1 second (FEV1/forced vital capacity (FVC ratio Results Multivariate analysis showed that longer duration of disease, greater amount of cigarette smoking and absence of rhinosinusitis were significantly related to the development of FAO in severe asthmatics. Other parameters, including atopic status, pattern of airway inflammatory cells in induced sputum, and frequency of asthma exacerbations did not differ between the FAO and RAO groups. Conclusion Severe asthma patients with longer disease duration and the absence of rhinosinusitis are more likely to develop FAO. This study also demonstrates the importance of quitting smoking in order to prevent irreversible airway obstruction. Further investigation is required to determine the mechanism by which these factors can modify the disease course in Korean patients with severe asthma.

  12. The relationship between serum levels of vitamin D with asthma and its symptom severity: A case-control study.

    Science.gov (United States)

    Nasiri Kalmarzi, Rasoul; Zamani, A; Fathallahpour, A; Ghaderi, E; Rahehagh, Ramesh; Kooti, W

    Asthma is a heterogeneous disease characterised by chronic inflammatory airways, and is affected by several immunological factors. One of the most discussed and researched hypotheses is the relationship between vitamin D serum levels with asthma. This study aimed to investigate the relationship between vitamin D serum levels with asthma and pulmonary functions in children in Kurdistan province, Iran. In this case-control study, 120 children ranging from 6 to 18 years were referred in summer for investigation. Participants were divided into two groups: asthma group, N=60; and control group, N=60. After serum separation, samples were analysed using vitamin D ELISA kit. Additionally, pulmonary function test and serum IgE levels were measured in both groups. Data were analysed using Chi-square test and multiple regression analysis in SPSS15. No difference was shown between the groups in terms of gender composition (male: 57.5; female: 42.5) (P>0.05). Average Vitamin D serum level in the case group (17.98±8.68) was less than in control group (22.35±6.26) (Pasthma (17.77±6.41) and the control group (24.9±3.18) was statistically significant (P, FVC, and FEV1/FVC. Multiple regression analysis showed a reverse relationship between vitamin D levels with IgE serum levels; this remained after adjustment for potential confounders (e.g. age, sex, BMI, FEV1, and FVC). The results showed that serum levels of vitamin D in asthma patients were less than in healthy people, and also reduced lung function in these patients. So, the serum levels of vitamin D in asthma patients must be checked continuously. Copyright © 2016 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

  13. Nasal IL-17F is related to bronchial IL-17F/neutrophilia and exacerbations in stable atopic severe asthma.

    Science.gov (United States)

    Sorbello, V; Ciprandi, G; Di Stefano, A; Massaglia, G M; Favatà, G; Conticello, S; Malerba, M; Folkerts, G; Profita, M; Rolla, G; Ricciardolo, F L M

    2015-02-01

    Severe asthma (SA) is associated with neutrophil recruitment and T helper (TH )17 chemokine overexpression in bronchial biopsies. We aimed to evaluate IL-17A and IL-17F expression in nasal/bronchial lamina propria of atopic mild-to-severe asthmatics and controls in relation to neutrophilia and asthma exacerbations. Cryostat sections of nasal/bronchial biopsies obtained from 14 SA and 14 mild asthma (MA) stable atopic patients with rhinitis, and seven healthy controls were analyzed by immunohistochemistry for neutrophils, IL-17A and IL-17F expression. Atopic SA showed an increase in asthma exacerbations number, IL-17F and IL-17A expression in nasal/bronchial lamina propria compared to MA and controls, and a higher expression of bronchial neutrophils in SA compared to MA and controls. In all asthmatics, significant relationships were found between bronchial IL-17F and neutrophils/FEV1 , nasal IL-17F and bronchial neutrophil/IL-17 markers and between the latter and exacerbations, suggesting that nasal IL-17F might be informative on bronchial IL17-driven neutrophilia in atopic SA. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Smoke exposure as a risk factor for asthma in childhood: a review of current evidence.

    Science.gov (United States)

    Ferrante, Giuliana; Antona, Roberta; Malizia, Velia; Montalbano, Laura; Corsello, Giovanni; La Grutta, Stefania

    2014-01-01

    Asthma is a common chronic multifactorial disease that affects >300 million people worldwide. Outdoor and indoor pollution exposure has been associated with respiratory health effects in adults and children. Smoking still represents a huge public health problem and millions of children suffer the detrimental effects of passive smoke exposure. This study was designed to review the current evidences on exposure to passive smoke as a risk factor for asthma onset in childhood. A review of the most recent studies on this topic was undertaken to provide evidence about the magnitude of the effect of passive smoking on the risk of incidence of asthma in children. The effects of passive smoking are different depending on individual and environmental factors. Environmental tobacco smoke (ETS) is one of the most important indoor air pollutants and can interact with other air pollutants in eliciting respiratory outcomes during childhood. The increased risk of respiratory outcomes in children exposed to prenatal and early postnatal passive smoke might be caused by an adverse effect on both the immune system and the structural and functional development of the lung; this may explain the subsequent increased risk of incident asthma. The magnitude of the exposure is quite difficult to precisely quantify because it is significantly influenced by the child's daily activities. Because exposure to ETS is a likely cause for asthma onset in childhood, there is a strong need to prevent infants and children from breathing air contaminated with tobacco smoke.

  15. Oral health and habits in children with asthma related to severity and duration of condition.

    Science.gov (United States)

    Eloot, A K; Vanobbergen, J N; De Baets, F; Martens, L C

    2004-12-01

    This study was designed to examine the oral health status of asthmatic children and to compare the oral health condition and habits of different groups of asthmatic children. 140 asthmatic children were involved in the present study. Of those, 30 were younger than 7 years of age, 73 were between 7 and 12, 37 were older than 12. Dental caries was scored according to the guidelines of the BASCD. No radiographs were taken. The gingival health and the amount of plaque were assessed using the bleeding index described by Mühleman and Son [1971] and the plaque index of Silness and Löe [1964] respectively. To differentiate between the asthmatic children three explanatory variables were used: the time the asthmatic symptoms had lasted, the exposure time to the medication and the severity of the asthmatic condition. Finally the parents and children were asked to fill in a questionnaire referring to oral health habits. The mean dmft was 1.99 (SD+/-2.74) and the mean DMFT was 1.10 (SD+/-1.98). Non-parametric correlation and multiple logistic regression analyses showed no significant difference between the caries (dmft/s, DMFT/S), the gingival health (bleeding index) and plaque indices and the three explanatory variables. The impact of possible compensatory factors as oral hygiene and dietary habits was of no significant importance. This analysis revealed that neither the period (of the disease and the medication) nor the severity of the asthma had a significant influence on the risk of caries and gingivitis in asthmatic children. No reported oral health and dietary habits could explain this lack of correlation.

  16. Asthma and rhinitis in cleaning workers: a systematic review of epidemiological studies.

    NARCIS (Netherlands)

    Folletti, I.; Zock, J.P.; Moscato, G.; Siracusa, A.

    2014-01-01

    Objective: This article presents a systematic review of epidemiological studies linking cleaning work and risk of asthma and rhinitis. Methods: Published reports were identified from PubMed covering the years from 1976 through June 30, 2012. In total, we identified 24 papers for inclusion in the

  17. Budesonide : An Updated Review of its Pharmacological Properties, and Therapeutic Efficacy in Asthma and Rhinitis.

    Science.gov (United States)

    Brogden, Rex N; McTavish, Donna

    1992-09-01

    Inhaled budesonide is now well established in the management of adult and childhood asthma, and when nebulised, shows considerable promise in recurrent wheezing and in severe asthma in infants. Studies conducted since the drug was previously reviewed in the Journal in 1984 have confirmed the comparable efficacy of equal doses of budesonide and beclomethasone dipropionate, the ability of budesonide to reduce oral maintenance corticosteroid requirements, and demonstrated its potential as first-line treatment of mild to moderate asthma. Recent studies have established the usefulness and good tolerability of intranasal budesonide in the treatment of seasonal allergic and perennial rhinitis where the drug is more effective than disodium cromoglycate and at least as effective as beclomethasone dipropionate. After up to 10 years of treatment with inhaled budesonide there is no evidence that the drug damages the tracheobronchial lining or the nasal mucosa. Inhaled corticosteroids continue to play an important role in the treatment of asthma with an increasing focus on their role as first-line therapy, and widespread clinical experience has shown budesonide is an effective and well tolerated member of this class which should be considered where inhaled or intranasal administration of a corticosteroid is indicated. Budesonide has a high ratio of topical to systemic activity compared with reference corticosteroids such as beclomethasone dipropionate. In healthy volunteers, high doses of budesonide cause less depression of plasma cortisol urinary free cortisol excretion than equal dosages of beclomethasone dipropionate. The dosage of inhaled budesonide required to suppress fasting plasma cortisol levels in adults varies considerably between individuals. The adrenal suppressive effect of high dosages of inhaled corticosteroids may be reduced by mouth rinsing and use of a large volume spacer device which reduces oropharyngeal deposition and the amount swallowed. Several studies

  18. Diagnosis and definition of severe refractory asthma: an international consensus statement from the Innovative Medicine Initiative (IMI)

    OpenAIRE

    Bel, E. H.; Sousa, A; Fleming, L.; Bush, A; Chung, K F; Versnel, J; Wagener, A.H.; S.S. Wagers; P. J. Sterk; Compton, C. H.

    2011-01-01

    Patients with severe refractory asthma pose a major healthcare problem. Over the last decade it has become increasingly clear that, for the development of new targeted therapies, there is an urgent need for further characterisation and classification of these patients. The Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED) consortium is a pan-European public-private collaboration funded by the European Commission Innovative Medicines Initiative of the European ...

  19. Exposure to bisphenol A and the development of asthma: A systematic review of cohort studies.

    Science.gov (United States)

    Xie, Ming-Yu; Ni, Hong; Zhao, De-Sheng; Wen, Li-Ying; Li, Ke-Sheng; Yang, Hui-Hui; Wang, Shu-Si; Zhang, Heng; Su, Hong

    2016-10-01

    There is conflicting evidence about the association between bisphenol A (BPA) exposure and childhood asthma risk. We aimed to review the epidemiological literature on the relationship between prenatal or postnatal exposure to BPA and the risk of childhood asthma/wheeze. The PubMed database was systematically searched, and additional studies were found by searching reference lists of relevant articles. Six studies fulfilled the eligibility criteria. Three studies found that prenatal BPA exposure is associated with an increased risk of childhood wheeze, while another study reported a reduced risk of wheeze. Regarding the postnatal BPA exposure, three studies demonstrated an increased risk of childhood asthma/wheeze. The mean prenatal BPA was associated with the risk of childhood wheeze/asthma. Besides, the influence of BPA exposure during the second trimester of pregnancy on the prevalence of childhood wheeze was marked. Further studies are urgently needed to explore the underlying mechanism about adverse effect of BPA exposure on childhood wheeze/asthma. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Causes of death in patients with asthma and asthma-chronic obstructive pulmonary disease overlap syndrome.

    Science.gov (United States)

    Harada, Tomoya; Yamasaki, Akira; Fukushima, Takehito; Hashimoto, Kiyoshi; Takata, Miki; Kodani, Masahiro; Okazaki, Ryota; Takeda, Kenichi; Watanabe, Masanari; Kurai, Jun; Shimizu, Eiji

    2015-01-01

    The administration of inhaled corticosteroids and worldwide usage of several asthma guidelines have improved asthma mortality. Elderly patients with asthma show high mortality rates, and may have several comorbidities, including overlap with chronic obstructive pulmonary disease (COPD). Among patients showing asthma overlapped with COPD (asthma-COPD overlap syndrome; ACOS), mortality is worse than for asthma alone. Therefore, we investigated comorbidities, malignancies, and causes of death in patients with asthma and ACOS. This was a retrospective study. From January 2000 to March 2012, 650 patients were followed up at Tottori University Hospital. Medical records were reviewed to collect data regarding patient characteristics and comorbidities, and causes of death were recorded for patients who died during the study period. Eighty-seven patients died during the study period. The most frequent cause of death was malignancy. The proportion of malignant disease was 21.7% in all patients, 19.4% in patients with asthma alone, and 32.4% in patients with ACOS. One patient died from an asthma attack during this period. The most frequent cause of death in patients with asthma and ACOS was malignant disease. It is necessary to control not only asthma but also comorbidities in patients with asthma, especially in those with ACOS.

  1. A phase III randomized controlled trial of tiotropium add-on therapy in children with severe symptomatic asthma.

    Science.gov (United States)

    Szefler, Stanley J; Murphy, Kevin; Harper, Thomas; Boner, Attilio; Laki, István; Engel, Michael; El Azzi, Georges; Moroni-Zentgraf, Petra; Finnigan, Helen; Hamelmann, Eckard

    2017-11-01

    Studies in adults and adolescents have demonstrated that tiotropium is efficacious as an add-on therapy to inhaled corticosteroids (ICSs) with or without other maintenance therapies in patients with moderate or severe symptomatic asthma. We sought to assess the efficacy and safety of once-daily tiotropium Respimat add-on therapy to high-dose ICS with 1 or more controller medications, or medium-dose ICS with 2 or more controller medications, in the first phase III trial of tiotropium in children with severe symptomatic asthma. In this 12-week, double-blind, placebo-controlled, parallel-group trial, 401 participants aged 6 to 11 years were randomized to receive once-daily tiotropium 5 μg (2 puffs of 2.5 μg) or 2.5 μg (2 puffs of 1.25 μg), or placebo (2 puffs), administered through the Respimat device as add-on to background therapy. Compared with placebo, tiotropium 5 μg, but not 2.5 μg, add-on therapy improved the primary end point, peak FEV 1 within 3 hours after dosing (5 μg, 139 mL [95% CI, 75-203; P add-on therapy to ICS with other maintenance therapies in children with severe symptomatic asthma. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  2. Astragalus polysaccharide modulates ER stress response in an OVA-LPS induced murine model of severe asthma.

    Science.gov (United States)

    Lu, Yuan; Xing, Qiong-Qiong; Xu, Jian-Ya; Ding, Dou; Zhao, Xia

    2016-12-01

    Endoplasmic reticulum (ER) stress has been recently revealed to play a pivotal role in the pathogenesis of severe asthma. Astragalus polysaccharide (APS), a major bioactive component from Astragalus membranaceus, exerts immunomodulatory and anti-inflammatory effects and has been shown to suppress ER stress in chronic diseases such as type-2 diabetes. However, the pharmaceutical application of APS in the treatment of severe asthma is unknown. The results obtained here indicate that APS significantly attenuates eosinophils and neutrophil-dominant airway inflammation by reducing the mRNA levels of Cxcl5, Il8, and chemokine (C-C motif) ligand 20 (Ccl20) and the protein levels of IL13RA and IL17RA. APS also inhibits the activation of unfolded protein response by decreasing the levels of ER stress markers such as C/EBP homologous protein (CHOP), which was associated with a reduction of PERK phosphorylation. Moreover, APS substantially blocks the nuclear translocation of ATF6 and NF-κB p65. Interestingly, we observed that APS markedly suppresses mucus hypersecretion by decreasing the levels of mucin (MUC) 5AC and MUC5B, which might be due to inhibition of goblet cells differentiation by suppressing the expression of IRE1β-correlated genes. In summary, APS can have potential pharmaceutical application in treatment of severe asthma. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Spirometry and PRAM severity score changes during pediatric acute asthma exacerbation treatment in a pediatric emergency department.

    Science.gov (United States)

    Arnold, Donald H; Gebretsadik, Tebeb; Hartert, Tina V

    2013-03-01

    To examine the time-dependent changes of spirometry (percent-predicted forced expiratory volume in 1 second [%FEV(1)]) and the Pediatric Respiratory Assessment Measure (PRAM) during the treatment of acute asthma exacerbations. We conducted a prospective study of participants aged 5-17 years with acute asthma exacerbations managed in a Pediatric Emergency Department. %FEV(1) and the PRAM were recorded pretreatment and at 2 and 4 hours. We examined responses at 2 and 4 hours following treatment and assessed whether the changes of %FEV(1) and of the PRAM differed during the first and the second 2-hour treatment periods. Among 503 participants, median [interquartile range, IQR] age was 8.8 [6.9, 11.4], 61% were male, and 63% were African-American. There was significant mean change of %FEV(1) during the first (+15.4%; 95% CI 13.7 to 17.1; p spirometry does not. This suggests that spirometry and clinical severity scores do not have similar trajectories and that clinical severity scores may be more sensitive to clinical change of acute asthma severity than spirometry.

  4. The Effects of Self-Management Education for School-Age Children on Asthma Morbidity: A Systematic Review

    Science.gov (United States)

    Ahmad, Emily; Grimes, Deanna E.

    2011-01-01

    The effects of asthma self-management education for school-age children on number of school days missed, emergency department visits and hospital admissions were evaluated through a systematic review of the published research. A total of 9 studies on asthma education programs that were conducted in schools by school nurses and health educators and…

  5. Neighborhood-Level Factors Related to Asthma in Children Living in Urban Areas: An Integrative Literature Review

    Science.gov (United States)

    DePriest, Kelli; Butz, Arlene

    2017-01-01

    Asthma disproportionately affects children who are non-White and of low socioeconomic status. One innovative approach to address these health disparities is to investigate the child's neighborhood environment and factors influencing asthma symptoms. The purpose of this integrative review is to critique research investigating the relationships…

  6. Asthma management in New York City schools: A classroom teacher perspective.

    Science.gov (United States)

    Cain, Agnieszka; Reznik, Marina

    2016-09-01

    Classroom teachers play an important role in facilitating asthma management in school but little is known about their perspectives around asthma management. We examined the perspectives of classroom teachers around barriers to school asthma management. We conducted key informant interviews with 21 inner-city classroom teachers from 3rd to 5th grades in 10 Bronx, New York elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and independently coded for common themes. We used thematic and content review to analyze interview data. Seven themes representing teachers' perspectives on in-school asthma management emerged: (1) the problematic process of identifying students with asthma; (2) poor familiarity with the city health department's asthma initiative and poor general knowledge of school policies on asthma management; (3) lack of competency in managing an acute asthma attack in the classroom and poor recognition of symptoms of an asthma attack; (4) lack of confidence in dealing with a hypothetical asthma attack in the classroom; (5) lack of quick access to asthma medication in school; (6) limited communication between school staff; and (7) enthusiasm about learning more about asthma management. Our results revealed several barriers contributing to suboptimal in-school asthma management: ineffective ways of identifying students with asthma, lack of teacher knowledge of guidelines on asthma management, lack of comfort in managing students' asthma, inadequate access to asthma medication in school, and limited communication between school staff. These issues should be considered in the design of interventions to improve in-school asthma management.

  7. Lactic Acidosis in Asthma: Report of Two Cases and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Suma Prakash

    2002-01-01

    Full Text Available Lactic acidosis is commonly associated with states of hypoxia and decreased tissue perfusion. Elevated lactic acid levels have also been observed in individuals who are not septic and who are normotensive, but who have received systemic adrenergic agonist therapy. This report presents two patients with acute asthma treated with very large doses of aerosolized and systemic salbutamol, who developed lactic acidosis despite normal systemic hemodynamics and adequate oxygenation. Lactic acidosis was clinically important because it contributed to respiratory failure in one patient, and complicated the assessment and management of acute, severe asthma in the other patient.

  8. Sahaja yoga in the management of moderate to severe asthma: a randomised controlled trial

    OpenAIRE

    Manocha, R; Marks, G; Kenchington, P; Peters, D.; Salome, C

    2002-01-01

    Background: Sahaja Yoga is a traditional system of meditation based on yogic principles which may be used for therapeutic purposes. A study was undertaken to assess the effectiveness of this therapy as an adjunctive tool in the management of asthma in adult patients who remained symptomatic on moderate to high doses of inhaled steroids.

  9. Serum YKL-40 and assessment of severity of bronchial asthma in ...

    African Journals Online (AJOL)

    Background: Serum and lung tissue levels of a chitinase-like protein YKL-40 have recently been found to be increased in patients with bronchial asthma. Furthermore, serum YKL-40 levels correlated positively with thickening of the lung sub-epithelial basement membrane, frequency of rescue inhaler use, and deterioration ...

  10. Experience from a group of adolescents with severe allergy asthma treatment with omalizumab

    DEFF Research Database (Denmark)

    Hofbauer, Anne Marie Bro; Agertoft, Lone

    2016-01-01

    UNLABELLED: Theme: Complex health care and chronic disease management. BACKGROUND: Evidence supports that group educational interventions improve self-perception, self-confidence and attack management in asthma care. AIM: To evaluate education and structured dialogue in enhancing knowledge and in...

  11. Asthma and obesity

    DEFF Research Database (Denmark)

    Juel, Caroline Trunk-Black; Ali, Zarqa; Nilas, Lisbeth

    2012-01-01

    Obesity is a major health problem, and obesity is associated with a high incidence of asthma and poor asthma control. The aim of the present paper is to systematically review the current knowledge of the effect on overall asthma control of weight reduction in overweight and obese adults with asthma....

  12. Asthma-chronic obstructive pulmonary disease overlap syndrome – Literature review and contributions towards a Portuguese consensus

    Directory of Open Access Journals (Sweden)

    D. Araújo

    2017-03-01

    Full Text Available Introduction: Phenotypic overlap between the two main chronic airway pulmonary diseases, asthma and chronic obstructive pulmonary disease (COPD, has been the subject of debate for decades, and recently the nomenclature of asthma-COPD overlap syndrome (ACOS was adopted for this condition. The definition of this entity in the literature is, however, very heterogeneous, it is therefore important to define how it applies to Portugal. Methods: A literature review of ACOS was made in a first phase resulting in the drawing up of a document that was later submitted for discussion among a panel of chronic lung diseases experts, resulting in reflexions about diagnosis, treatment and clinical guidance for ACOS patients. Results: There was a consensus among the experts that the diagnosis of ACOS should be considered in the concomitant presence of: clinical manifestations characteristic of both asthma and COPD, persistent airway obstruction (post-bronchodilator FEV1/FVC 300 eosinophils/μL or >5% of leukocytes and previous history of atopy should also be considered. The recommended first line pharmacological treatment in these patients is the ICS/LABA association; if symptomatic control is not achieved or in case of clinical severity, triple therapy with ICS/LABA/LAMA may be used. An effective control of the exposure to risk factors, vaccination, respiratory rehabilitation and treatment of comorbidities is also important. Conclusions: The creation of initial guidelines on ACOS, which can be applied in the Portuguese context, has an important role in the generation of a broad nationwide consensus. This will give, in the near future, a far better clinical, functional and epidemiological characterization of ACOS patients, with the ultimate goal of achieving better therapeutic guidance. Keywords: Asthma, Chronic obstructive pulmonary disease, Overlap syndrome, Portuguese consensus

  13. Effect of outdoor air pollution on asthma exacerbations in children and adults: Systematic review and multilevel meta-analysis

    Science.gov (United States)

    Quaranta, Nancy; Reynoso, Julieta; Balbi, Brenda; Vasquez, Julia

    2017-01-01

    Background Several observational studies have suggested that outdoor air pollution may induce or aggravate asthma. However, epidemiological results are inconclusive due to the presence of numerous moderators which influence this association. The goal of this study was to assess the relationship between outdoor air pollutants and moderate or severe asthma exacerbations in children and adults through a systematic review and multilevel meta-analysis. Material and methods We searched studies published in English on PubMed, Scopus, and Google Scholar between January 2000 and October 2016. Studies following a case-crossover design with records of emergency departments and/or hospital admissions as a surrogate of moderate or severe asthma exacerbations were selected. A multilevel meta-analysis was employed, taking into account the potential clustering effects within studies examining more than one lag. Odds ratios (ORs) and 95% confidence intervals were estimated. A subgroup analysis in children aged 0 to 18 years and a sensitivity analysis based on the quality of the included studies as defined in the Newcastle-Ottawa Scale were performed. Publication bias was evaluated through visual inspection of funnel plots and by a complementary search of grey literature. (Prospero Registration number CRD42015032323). Results Database searches retrieved 208 records, and finally 22 studies were selected for quantitative analysis. All pollutants except SO2 and PM10 showed a significant association with asthma exacerbations (NO2: 1.024; 95% CI: 1.005,1.043, SO2: 1.039; 95% CI: 0.988,1.094), PM10: 1.024; 95% CI: 0.995,1.053, PM2.5: 1.028; 95% CI: 1.009,1.047, CO: 1.045; 95% CI: 1.005,1.086, O3: 1.032; 95% CI: 1.005,1.060. In children, the association was significant for NO2, SO2 and PM2.5. Conclusion This meta-analysis provides evidence of the association between selected air pollutants and asthma exacerbations for different lags. PMID:28319180

  14. Effect of outdoor air pollution on asthma exacerbations in children and adults: Systematic review and multilevel meta-analysis.

    Directory of Open Access Journals (Sweden)

    Pablo Orellano

    Full Text Available Several observational studies have suggested that outdoor air pollution may induce or aggravate asthma. However, epidemiological results are inconclusive due to the presence of numerous moderators which influence this association. The goal of this study was to assess the relationship between outdoor air pollutants and moderate or severe asthma exacerbations in children and adults through a systematic review and multilevel meta-analysis.We searched studies published in English on PubMed, Scopus, and Google Scholar between January 2000 and October 2016. Studies following a case-crossover design with records of emergency departments and/or hospital admissions as a surrogate of moderate or severe asthma exacerbations were selected. A multilevel meta-analysis was employed, taking into account the potential clustering effects within studies examining more than one lag. Odds ratios (ORs and 95% confidence intervals were estimated. A subgroup analysis in children aged 0 to 18 years and a sensitivity analysis based on the quality of the included studies as defined in the Newcastle-Ottawa Scale were performed. Publication bias was evaluated through visual inspection of funnel plots and by a complementary search of grey literature. (Prospero Registration number CRD42015032323.Database searches retrieved 208 records, and finally 22 studies were selected for quantitative analysis. All pollutants except SO2 and PM10 showed a significant association with asthma exacerbations (NO2: 1.024; 95% CI: 1.005,1.043, SO2: 1.039; 95% CI: 0.988,1.094, PM10: 1.024; 95% CI: 0.995,1.053, PM2.5: 1.028; 95% CI: 1.009,1.047, CO: 1.045; 95% CI: 1.005,1.086, O3: 1.032; 95% CI: 1.005,1.060. In children, the association was significant for NO2, SO2 and PM2.5.This meta-analysis provides evidence of the association between selected air pollutants and asthma exacerbations for different lags.

  15. Mitochondrial Dysfunction in Metabolic Syndrome and Asthma

    Directory of Open Access Journals (Sweden)

    Ulaganathan Mabalirajan

    2013-01-01

    Full Text Available Though severe or refractory asthma merely affects less than 10% of asthma population, it consumes significant health resources and contributes significant morbidity and mortality. Severe asthma does not fell in the routine definition of asthma and requires alternative treatment strategies. It has been observed that asthma severity increases with higher body mass index. The obese-asthmatics, in general, have the features of metabolic syndrome and are progressively causing a significant burden for both developed and developing countries thanks to the westernization of the world. As most of the features of metabolic syndrome seem to be originated from central obesity, the underlying mechanisms for metabolic syndrome could help us to understand the pathobiology of obese-asthma condition. While mitochondrial dysfunction is the common factor for most of the risk factors of metabolic syndrome, such as central obesity, dyslipidemia, hypertension, insulin resistance, and type 2 diabetes, the involvement of mitochondria in obese-asthma pathogenesis seems to be important as mitochondrial dysfunction has recently been shown to be involved in airway epithelial injury and asthma pathogenesis. This review discusses current understanding of the overlapping features between metabolic syndrome and asthma in relation to mitochondrial structural and functional alterations with an aim to uncover mechanisms for obese-asthma.

  16. Distribuição da gravidade da asma na infância Distribution of severity of asthma in childhood

    Directory of Open Access Journals (Sweden)

    Silvia de Magalhães Simões

    2010-10-01

    Full Text Available OBJETIVO: Estimar a distribuição dos padrões de gravidade da asma em uma amostra populacional de crianças em Salvador (BA. MÉTODOS: Questionário epidemiológico (International Study of Asthma and Allergies in Childhood - ISAAC foi aplicado juntamente com questionário elaborado com base em critérios de gravidade adotados na prática clínica (Global Initiative for Asthma - GINA em 417 crianças de 5 a 12 anos com sintomas de asma nos últimos 12 meses. Com base nas questões do ISAAC, as crianças foram classificadas em asma grave e não grave. De acordo com os critérios clínicos da GINA, quatro categorias de gravidade foram criadas: intermitente, persistente leve, persistente moderada e grave. RESULTADOS: Noventa crianças (22,3% apresentaram indicadores de gravidade segundo o ISAAC. Com base nos critérios da GINA, havia 143 crianças com asma intermitente, 160 com asma leve persistente, 51 com asma moderada e 43 com asma grave. A concordância entre os dois questionários foi de 81,3%, com índice kappa de 0,5. CONCLUSÕES: A maioria das crianças asmáticas em Salvador possui asma persistente. Há bom nível de concordância na identificação da asma grave, entre a classificação epidemiológica e a clínica.OBJECTIVE: To estimate the distribution of asthma severity in a population-based sample of children from Salvador, Brazil. METHODS: An epidemiologically oriented questionnaire (International Study of Asthma and Allergies in Childhood, ISAAC and a questionnaire based on criteria used in clinical practice (The Global Initiative for Asthma, GINA were administered simultaneously to 417 children aged 5 to 12 years who reported symptoms of asthma in the past 12 months. According to the ISAAC instrument, children were classified into severe and non-severe asthma, whereas GINA clinical criteria produced four categories of severity: intermittent, mild persistent, moderate persistent and severe asthma. RESULTS: Ninety children reported

  17. Effectiveness of Telemedicine for Controlling Asthma Symptoms: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Zhao, Jie; Zhai, Yun-Kai; Zhu, Wei-Jun; Sun, Dong-Xu

    2015-06-01

    The effectiveness of telemedicine for the management of chronic diseases is unclear. This study examined the effectiveness of telemedicine in relieving asthma symptoms. A systematic review of the Medline, Cochrane, EMBASE, and Google Scholar databases was conducted until December 31, 2013 using the following key words: "asthma," "telemedicine," "telehealth," "e-health," "mobile health," "Internet," "telecommunication," "telemanagement," "remote," and "short message service." Inclusion criteria were randomized controlled trial, a diagnosis of asthma, the majority of the patients were ≥18 years of age, and intervention involved any format of telemedicine. A meta-analysis of eligible studies was conducted with the primary outcome being change of asthma symptoms. Of 813 articles identified, 11 were included in the qualitative synthesis, and 6 were included in the meta-analysis. Among the 11 studies, there were 1,460 patients in the intervention groups and 1,349 in the control groups, and the total numbers of participants ranged from 12 to 481 in the intervention groups and from 12 to 487 in the control groups. The mean age of patients ranged in the intervention groups from 34.4 to 54.6 years and in the control groups from 30.7 to 56.4 years. The treatment duration ranged from 0.5 to 12 months. The meta-analysis of six eligible studies revealed no significant difference in asthma symptom score change between the telemedicine and control groups (pooled Hedges's g=0.34, 95% confidence interval=-0.05 to 0.74, Z=1.69, p=0.090). Telemedicine interventions do not appear to improve asthma function scores, but other benefits may be present.

  18. Psychological aspects in asthma: do psychological factors affect asthma management?

    OpenAIRE

    Baiardini, Ilaria; Sicuro, Francesca; Balbi, Francesco; Canonica, Giorgio Walter; Braido, Fulvio

    2015-01-01

    Despite the regular treatment with inhaled corticosteroids (ICS) or ICS plus long-acting beta2-agonists, permits to control de majority of asthmatics, a significant proportion of patients does not respond to this treatment. This review was aimed to explore the role of psychological factors associated to the unsuccessful fulfilment of optimal levels of asthma control, especially in patients suffering from severe asthma. The results of a Medline search were 5510 articles addressed to different ...

  19. Job strain and the risk of severe asthma exacerbations: a meta-analysis of individual-participant data from 100 000 European men and women.

    Science.gov (United States)

    Heikkilä, K; Madsen, I E H; Nyberg, S T; Fransson, E I; Westerlund, H; Westerholm, P J M; Virtanen, M; Vahtera, J; Väänänen, A; Theorell, T; Suominen, S B; Shipley, M J; Salo, P; Rugulies, R; Pentti, J; Pejtersen, J H; Oksanen, T; Nordin, M; Nielsen, M L; Kouvonen, A; Koskinen, A; Koskenvuo, M; Knutsson, A; Ferrie, J E; Dragano, N; Burr, H; Borritz, M; Bjorner, J B; Alfredsson, L; Batty, G D; Singh-Manoux, A; Kivimäki, M

    2014-06-01

    Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women. We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses. During a median follow-up of 10 years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19). Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death. © 2014 The Authors. Allergy Published by John Wiley & Sons Ltd.

  20. Allergen immunotherapy for the treatment of allergic rhinitis and/or asthma: an umbrella review.

    Science.gov (United States)

    Elliott, Jesse; Kelly, Shannon E; Johnston, Amy; Skidmore, Becky; Gomes, Tara; Wells, George A

    2017-05-10

    Allergic rhinitis and asthma are important public health concerns, yet there is no consensus about the benefits and harms of allergen-specific immunotherapy to treat these conditions. We performed an umbrella review of systematic reviews summarizing the current evidence for the benefits and harms of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). We searched MEDLINE, Embase, the Cochrane Library and the grey literature from Jan. 1, 2010 to Nov. 20, 2016 for systematic reviews of randomized controlled trials or prospectively controlled studies involving children or adults with allergic rhinitis or asthma. Outcomes were summarized narratively (benefits: total combined symptom-medication score, symptom score, medication score, disease-specific quality of life, adherence; harms: anaphylaxis, death, local and systemic reactions). Twenty-three systematic reviews were included. SCIT and SLIT were more effective than placebo for most outcomes. SCIT was better than SLIT at improving medication and symptom scores, with no differences in quality of life; however, data were limited for this comparison. Anaphylaxis and death were infrequently reported. Few reviews assessed benefits or harms among children. Allergen immunotherapy appears to be effective among patients with allergic rhinitis and asthma. The safety of allergen immunotherapy is not conclusively established, although death and anaphylaxis appear to be rare. PROSPERO no.: CRD42015024590. Copyright 2017, Joule Inc. or its licensors.

  1. Is influenza vaccination in asthma helpful?

    Science.gov (United States)

    Bueving, Herman J; Thomas, Siep; Wouden, Johannes C van der

    2005-02-01

    Influenza infections are frequently involved in asthma exacerbations. During influenza epidemics substantial excess morbidity due to respiratory tract complications is reported in all age categories as well as excess mortality among the elderly. Vaccines are available for protection against influenza. Worldwide, vaccination is advised and considered a quality point for asthma care. However, the protective effect of influenza vaccination in patients with asthma is still disputed. In order to establish the current state of affairs we reviewed the recent literature on the protective effect of influenza vaccination and its usefulness in patients with asthma. Several studies were found addressing influenza and the protective aspects of vaccination. They discussed the incidence, the adverse effects of vaccination, the coverage of influenza vaccination among patients with asthma and the effectiveness of the vaccine. Influenza vaccination can safely be used in patients with asthma. Allegations that vaccination could provoke asthma exacerbations are convincingly invalidated by previous and recent research. Although patients with asthma are one of the major target groups for immunization, vaccine coverage in all age categories remains low. So far, no unequivocal beneficial effect of influenza vaccination in patients with asthma was found in observational and experimental studies in the sense of reduction of asthma exacerbations and other complications. Recent studies confirm these negative findings. More long-term randomized, placebo-controlled studies, focusing on influenza- proven illness in patients with asthma, are needed to address the question of how helpful influenza vaccination is in these patients.

  2. A Comparison of a Budesonide-Based and a Beclomethasone/Prednisolone-Based Management Strategy for the Treatment of Severe Asthma in General Practice

    OpenAIRE

    Govindaraj Mohan; Kevin A. MacLusky; Clifford C. Godley; Pamela L. Todd

    1999-01-01

    Objective: Patients with severe asthma often require short courses of oral corticosteroids in addition to their daily inhaled steroid to maintain adequate lung function. The objective of this study was to compare two management strategies for the treatment of severe asthma. A budesonide-based management strategy and a beclomethasone/prednisolone-based management strategy were compared for efficacy and tolerability. Design and Setting: 50 patients were randomised into this 24-week, open, paral...

  3. Effect of outdoor fungus concentrations on symptom severity of children with asthma and/or rhinitis monosensitized to molds.

    Science.gov (United States)

    Inal, Ayfer; Karakoc, Gulbin Bingol; Altintas, Derya Ufuk; Pinar, Munevver; Ceter, Talip; Yilmaz, Mustafa; Kendirli, Seval Guneser

    2008-03-01

    Although the relationship between asthma severity and exposure to airborne fungi has been well studied, little is known about the contribution of outdoor molds to the symptoms of children monosensitized to molds. In this study, we aimed to investigate the effect of outdoor mold spore concentrations on daily asthma and/or rhinitis scores in children monosensitized to molds. Nineteen children with asthma and/or rhinitis sensitized only to molds recorded their daily symptoms and PEF values to the diaries, from February 2005 to January 2006. Additionally, mold spores were measured daily using a Burkard 7-day recording volumetric spore trap in city atmosphere and compared with meteorological data. Total number of mold spores in atmosphere was found to be 352,867 spore/m3 during the study period. Cladosporium (53%) was the most common encountered outdoor fungi, followed by Altemaria (29%) and 1-septate Ascospore (3%). Outdoor fungi concentrations were significantly correlated with mean monthly rhinitis score (r = 0.877, p molds.

  4. The effect of various breathing exercises (pranayama in patients with bronchial asthma of mild to moderate severity

    Directory of Open Access Journals (Sweden)

    Saxena Tarun

    2009-01-01

    Full Text Available Background/Aim: The incidence of bronchial asthma is on increase. Chemotherapy is helpful during early course of the disease, but later on morbidity and mortality increases. The efficacy of yoga therapy though appreciated is yet to be defined and modified. Aim: To study the effect of breathing exercises ( pranayama in patients with bronchial asthma of mild to moderate severity. Materials and Methods: Fifty cases of bronchial asthma (Forced Expiratory Volume in one second (FEV1 > 70% were studied for 12 weeks. Patients were allocated to two groups: group A and group B (control group. Patients in group A were treated with breathing exercises (deep breathing, Brahmari , and Omkara , etc. for 20 minutes twice daily for a period of 12 weeks. Patients were trained to perform Omkara at high pitch (forceful with prolonged exhalation as compared to normal Omkara . Group B was treated with meditation for 20 minutes twice daily for a period of 12 weeks. Subjective assessment, FEV1%, and Peak Expiratory Flow Rate (PEFR were done in each case initially and after 12 weeks. Results: After 12 weeks, group A subjects had significant improvement in symptoms, FEV1, and PEFR as compared to group B subjects. Conclusion: Breathing exercises ( pranayama , mainly expiratory exercises, improved lung function subjectively and objectively and should be regular part of therapy.

  5. The Effect of Combined Therapy ICS/LABA and ICS/LABA plus Montelukast in Patients with Uncontrolled Severe Persistent Asthma Based on the Serum IL-13 and FEV1

    Directory of Open Access Journals (Sweden)

    Elena Jovanovska Janeva

    2015-05-01

    CONCLUSION: Treatment with ICS/LABA plus Montelukast proved superior compared to therapy of ICS/LABA in patients with uncontrolled severe persistent asthma and allows achievement of well controlled of asthma with subjective clinical improvement.

  6. Efficacy and safety of subcutaneous omalizumab vs placebo as add-on therapy to corticosteroids for children and adults with asthma: a systematic review.

    Science.gov (United States)

    Rodrigo, Gustavo J; Neffen, Hugo; Castro-Rodriguez, José A

    2011-01-01

    Omalizumab is a humanized monoclonal anti-IgE for the treatment of severe allergic asthma. Because omalizumab targets an immune system molecule, there has been particular interest in the drug's safety. To establish the efficacy and safety of subcutaneous omalizumab as add-on therapy to corticosteroids, a systematic review of placebo-controlled studies was performed. Primary outcomes were reduction of steroid use and asthma exacerbations. Secondary outcome measures included lung function, rescue medication use, asthma symptoms, health-related quality of life, and adverse effects. Eight trials (3,429 participants) fulfilled the selection criteria. At the end of the steroid-reduction phase, patients taking omalizumab were more likely to be able to withdraw from corticosteroids completely compared with those taking placebo (relative risk [RR] = 1.80; 95% CI, 1.42-2.28; P = .00001). Omalizumab patients showed a decreased risk of asthma exacerbations at the end of the stable (RR = 0.57; 95% CI, 0.48-0.66; P = .0001) and adjustable-steroid phases (RR = 0.55; 95% CI, 0.47-0.64; P = .0001); post-hoc analysis suggests this effect was independent of duration of treatment, age, severity of asthma, and risk of bias. The frequency of serious adverse effects was similar in the omalizumab (3.8%) and placebo (5.3%) groups. However, injection site reactions were more frequent in the omalizumab patients (19.9% vs 13.2%). There were no indications of increased risk of hypersensitivity reactions, cardiovascular effects, or malignant neoplasms. Data indicate that the efficacy of add-on omalizumab in patients with moderate-to-severe allergic asthma is accompanied by an acceptable safety profile.

  7. Validation of asthma recording in electronic health records: a systematic review

    Directory of Open Access Journals (Sweden)

    Nissen F

    2017-12-01

    Full Text Available Francis Nissen,1 Jennifer K Quint,2 Samantha Wilkinson,1 Hana Mullerova,3 Liam Smeeth,1 Ian J Douglas1 1Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; 2National Heart and Lung Institute, Imperial College, London, UK; 3RWD & Epidemiology, GSK R&D, Uxbridge, UK Objective: To describe the methods used to validate asthma diagnoses in electronic health records and summarize the results of the validation studies. Background: Electronic health records are increasingly being used for research on asthma to inform health services and health policy. Validation of the recording of asthma diagnoses in electronic health records is essential to use these databases for credible epidemiological asthma research.Methods: We searched EMBASE and MEDLINE databases for studies that validated asthma diagnoses detected in electronic health records up to October 2016. Two reviewers independently assessed the full text against the predetermined inclusion criteria. Key data including author, year, data source, case definitions, reference standard, and validation statistics (including sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV] were summarized in two tables.Results: Thirteen studies met the inclusion criteria. Most studies demonstrated a high validity using at least one case definition (PPV >80%. Ten studies used a manual validation as the reference standard; each had at least one case definition with a PPV of at least 63%, up to 100%. We also found two studies using a second independent database to validate asthma diagnoses. The PPVs of the best performing case definitions ranged from 46% to 58%. We found one study which used a questionnaire as the reference standard to validate a database case definition; the PPV of the case definition algorithm in this study was 89%. Conclusion: Attaining high PPVs (>80% is possible using each of the discussed validation

  8. A Pharmaco-Economic Analyzis of Treating Severe Uncontrolled Child Asthma with Omalizumab — Actual Russian Clinical Practice Data

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    A. S. Kolbin

    2016-01-01

    Full Text Available Background: Omalizumab is the first and yet the only biopreparation for asthma which combines high efficiency and high cost. The clinical-economic expediency of using omalizumab in asthmatic children has not been previously studied in Russia.Objective: Our aim was to evaluate the clinical and economic expediency of using omalizumab as additive treatment (to basic or supporting therapy in children with severe uncontrolled atopic asthma under the Russian economic conditions.Methods: We conducted a mathematical simulation of asthma treatment in children with an increased frequency of hospitalization (9 times per year with an average monthly omalizumab requirement of 558 mg. The model is based on the Markov chain. The model includes direct and non-direct costs. The planning horizons were 2 and 5 years. We analyzed the efficiency and utility of the costs and their influence on the budget. The stability of received data is proven by sensitivity analyzis.Results: Over a 5-year planning horizon the cost of an additional year of quality life (due to using omalizumab was 1,259,185 roubles, while the “society’s solvency” is 1 341 308 roubles (cost utility analizis. It takes 39,820 rubles to prevent one hospitalization with omalizumab over a 5-year planning horizon (cost efficiency analizis, which is comparable to the cost of hospitalization (43,141 rubles. Total costs for treating 100 children with asthma, 7 of which would be treated with omalizumab, were equal to the amount of money which is enough to treat 105 children without omalizumab (analysis of budgetary influence.Conclusion: The analyses of cost efficiency and utility have shown that the strategy of using omalizumab together with standard treatment is economically expedient. Budgetary influence analysis has not detected a significant burden on the budget.

  9. Local adverse effects associated with the use of inhaled corticosteroids in patients with moderate or severe asthma

    Directory of Open Access Journals (Sweden)

    Charleston Ribeiro Pinto

    2013-06-01

    Full Text Available OBJECTIVE: To describe and characterize local adverse effects (in the oral cavity, pharynx, and larynx associated with the use of inhaled corticosteroids (ICSs in patients with moderate or severe asthma. METHODS: This was a cross-sectional study involving a convenience sample of 200 asthma patients followed in the Department of Pharmaceutical Care of the Bahia State Asthma and Allergic Rhinitis Control Program Referral Center, located in the city of Salvador, Brazil. The patients were ≥ 18 years of age and had been using ICSs regularly for at least 6 months. Local adverse effects (irritation, pain, dry throat, throat clearing, hoarseness, reduced vocal intensity, loss of voice, sensation of thirst, cough during ICS use, altered sense of taste, and presence of oral candidiasis were assessed using a 30-day recall questionnaire. RESULTS: Of the 200 patients studied, 159 (79.5% were women. The mean age was 50.7 ± 14.4 years. In this sample, 55 patients (27.5% were using high doses of ICS, with a median treatment duration of 38 months. Regarding the symptoms, 163 patients (81.5% reported at least one adverse effect, and 131 (65.5% had a daily perception of at least one symptom. Vocal and pharyngeal symptoms were identified in 57 (28.5% and 154 (77.0% of the patients, respectively. The most commonly reported adverse effects were dry throat, throat clearing, sensation of thirst, and hoarseness. CONCLUSIONS: Self-reported adverse effects related to ICS use were common among the asthma patients evaluated here.

  10. Home-based respiratory rehabilitation in adult patients with moderate or severe persistent asthma.

    Science.gov (United States)

    Renolleau-Courtois, Delphine; Lamouroux-Delay, Aurore; Delpierre, Stéphane; Badier, Monique; Lagier-Tessonnier, Françoise; Palot, Alain; Gouitaa, Marion; Tummino, Céline; Charpin, Denis; Molinari, Nicolas; Chanez, Pascal

    2014-06-01

    We assessed retrospectively the feasibility of a home-based respiratory rehabilitation (RR) program for asthmatics under optimal pharmacological treatment, as this type of care can reduce costs and offer a more patient-friendly approach for subjects with persistent asthma. Fifty-two patients with persistent asthma were recruited to the RR program (20 males, 32 females, 54 ± 11 (SD) years, forced expiratory volume in one second 71 ± 33% of predicted mean value, BMI 29.9 ± 7.9 kg/m(2)). This two-month protocol comprised education sessions, respiratory physiotherapy and an exercise training program at home and in groups supervised by an adapted physical activity instructor. Thirty-nine patients completed the whole RR program, i.e. 25% dropout. The dropout rate was significantly higher with respect to younger patients in employment. The number of exacerbations decreased significantly during the year following the program, regardless of whether the patients had dropped out (p asthma. Both functional and physiologic indices improved during the follow-up period.

  11. Volatile organic compounds and risk of asthma and allergy: a systematic review

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    Ulugbek B. Nurmatov

    2015-03-01

    Full Text Available Volatile organic compounds (VOCs are ubiquitous domestic pollutants. Their role in asthma/allergy development and exacerbations is uncertain. This systematic review investigated whether domestic VOC exposure increases the risk of developing and/or exacerbating asthma and allergic disorders. We systematically searched 11 databases and three trial repositories, and contacted an international panel of experts to identify published and unpublished experimental and epidemiological studies. 8455 potentially relevant studies were identified; 852 papers were removed after de-duplication, leaving 7603 unique papers that were screened. Of these, 278 were reviewed in detail and 53 satisfied the inclusion criteria. Critical appraisal of the included studies indicated an overall lack of high-quality evidence and substantial risk of bias in this body of knowledge. Aromatics (i.e. benzenes, toluenes and xylenes and formaldehyde were the main VOC classes studied, both in relation to the development and exacerbations of asthma and allergy. Approximately equal numbers of studies reported that exposure increased risks and that exposure was not associated with any detrimental effects. The available evidence implicating domestic VOC exposure in the risk of developing and/or exacerbating asthma and allergy is of poor quality and inconsistent. Prospective, preferably experimental studies, investigating the impact of reducing/eliminating exposure to VOC, are now needed in order to generate a more definitive evidence base to inform policy and clinical deliberations in relation to the management of the now substantial sections of the population who are either at risk of developing asthma/allergy or living with established disease.

  12. Association of IL-4RA single nucleotide polymorphisms, HLA-DR and HLA-DQ in children with Alternaria-sensitive moderate-severe asthma

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    Santiago Luis A

    2010-03-01

    Full Text Available Abstract Background Asthma afflicts 6% to 8% of the United States population, and severe asthma represents approximately 10% of asthmatic patients. Several epidemiologic studies in the United States and Europe have linked Alternaria sensitivity to both persistence and severity of asthma. In order to begin to understand genetic risk factors underlying Alternaria sensitivity and asthma, in these studies we examined T cell responses to Alternaria antigens, HLA Class II restriction and HLA-DQ protection in children with severe asthma. Methods Sixty children with Alternaria-sensitive moderate-severe asthma were compared to 49 children with Alternaria-sensitive mild asthma. We examined HLA-DR and HLA-DQ frequencies in Alternaria-sensitive asthmatic by HLA typing. To determine ratios of Th1/Th2 Alternaria-specific T-cells, cultures were stimulated in media alone, Alternaria alternata extract and Alt a1. Sensitivity to IL-4 stimulation was measured by up-regulation of CD23 on B cells. Results Children with Alternaria-sensitive moderate-severe asthma trended to have increased sensitivities to Cladosporium (46% versus 35%, to Aspergillus (43% versus 28%, and significantly increased sensitivities to trees (78% versus 57% and to weeds (68% versus 48%. The IL-4RA ile75val polymorphism was significantly increased in Alternaria-sensitive moderate-severe asthmatics, 83% (0.627 allele frequency compared to Alternaria-sensitive mild asthmatics, 57% (0.388 allele frequency. This was associated with increased sensitivity to IL-4 stimulation measured by significantly increased IL-4 stimulated CD23 expression on CD19+ and CD86+CD19+ B cells of Alternaria-sensitive moderate-severe asthmatics. IL-5 and IL-13 synthesis was significantly increased in Alternaria-sensitive moderate-severe asthmatics compared to mild asthmatics to Alternaria extract and Alt a1 stimulation. The frequency of HLA-DQB1*03 allele was significantly decreased in Alternaria-sensitive moderate-severe

  13. Pregnancy-associated plasma protein-A (PAPP-A) levels in patients with severe allergic asthma are reduced by omalizumab.

    Science.gov (United States)

    Bulut, Ismet; Ozseker, Zeynep F; Coskun, Abdurrahman; Serteser, Mustafa; Unsal, Ibrahim

    2017-12-06

    Remodeling is a crucial feature of severe asthma and may be associated with activation of the allergic cascade by immunoglobulin E (IgE). Omalizumab, an anti-IgE monoclonal antibody, effectively targets the severe allergic asthma phenotype. Pregnancy-associated plasma protein-A (PAPP-A) is an insulin-like growth factor binding protein-4 (IGFBP-4) protease, increasing local insulin-like growth factor (IGF)-1 concentrations, which in turn initiating a cascade involved in the regulation of cell growth, differentiation, and proliferation in various tissues. In the present study, we evaluated the effects of omalizumab on serum PAPP-A, IGFBP-4, and IGF-1 levels in subjects with severe allergic asthma. We studied 36 asthmatic subjects and 36 healthy controls. An ultrasensitive enzyme-linked immunosorbent assay (ELISA) kit was used to measure serum PAPP-A levels, and routine commercial ELISA kits were employed to assess serum levels of IGF-1, IGFBP-4 in control subjects and asthmatic subjects before therapy (baseline) and after six months of omalizumab therapy in patients with severe asthma. Compared to control subjects, serum PAPP-A and IGFB-4 levels were significantly higher in asthmatic subjects (both p values 0.05). In asthma subjects, 6-month omalizumab treatment significantly decreased the serum PAPP-A (p PAPP-A level may be a useful biomarker for predicting airway remodeling in patients with severe asthma receiving omalizumab, and may also reflect the response to treatment.

  14. Management of an acute asthma attack.

    Science.gov (United States)

    Barnard, Amanda

    2005-07-01

    Despite a more proactive approach to asthma management, which includes an increased range of drugs, wide dissemination of guidelines, and the use of asthma action plans, an acute severe asthma attack is one of the most common emergencies a general practitioner will encounter. This article discusses the management of an acute asthma attack in the general practice setting. Assessment of severity is vital and can be ascertained quite quickly with a brief history and rapid physical examination. It is important to remember that wheeze is an unreliable indicator of the severity of attack and may be absent in severe asthma. The cornerstones of treatment are oxygen and inhaled beta 2 agonists. Beta 2 agonists can be given continuously in severe life threatening asthma. Early administration of systemic steroids is important. Patients discharged to home after treatment of an asthma attack require close follow up including beta 2 agonists for symptom control, review of medications including a consideration of a short course of oral steroids, a written asthma action plan and detailed advice about what to do in case of deterioration in the next 24 hours. They should be reviewed in 24-48 hours.

  15. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... page: About CDC.gov . Asthma Learn How to Control Asthma Asthma and Severe Weather Brochures Facts Triggers Indoors In the Workplace Outdoors Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, ...

  16. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Learn How to Control Asthma Asthma and Severe Weather Brochures Facts Triggers Indoors In the Workplace Outdoors ... CDC Publications on Asthma National Asthma Control Program America Breathing Easier Guide for State Programs Interventions Community ...

  17. Importance of mold allergy in asthma.

    Science.gov (United States)

    Portnoy, Jay M; Barnes, Charles S; Kennedy, Kevin

    2008-03-01

    Fungal exposure is hypothesized (controversially) to contribute to asthma development and to trigger symptoms in patients with asthma. The ubiquity of environmental fungal exposure makes a careful review of evidence essential. Evidence that exposure to high concentrations of fungal spores, antigens, or metabolites is associated with asthma development is limited. However, because mechanisms of asthma genesis are poorly understood, so too are the mechanisms of this potential association. This association is not proof of causality. Stronger evidence supports the hypothesis that fungal exposure triggers symptoms in asthmatic individuals. Proposed mechanisms have been tested and correlations between exposure and symptoms demonstrated. Though some correlations remain speculative, controlled studies could test such hypotheses. Because asthma is common and fungal exposure is ubiquitous, it is surprising that asthmatics don't have more symptoms when exposed to fungi. Fortunately, symptoms are dose dependent, creating an opportunity to develop clinically effective interventions. Given the right guidance, even patients with severe asthma can create healthy indoor environments.

  18. MicroRNA-21 drives severe, steroid-insensitive experimental asthma by amplifying phosphoinositide 3-kinase?mediated suppression of histone deacetylase 2

    OpenAIRE

    Kim, RY; Horvat, JC; Pinkerton, JW; Starkey, MR; Essilfie, AT; Mayall, JR; Nair, PM; Hansbro, NG; Jones, B; Haw, TJ; Sunkara, KP; Nguyen, TH; Jarnicki, AG; Keely, S; Mattes, J

    2016-01-01

    BACKGROUND: Severe steroid-insensitive asthma is a substantial clinical problem. Effective treatments are urgently required, however, their development is hampered by a lack of understanding of the mechanisms of disease pathogenesis. Steroid-insensitive asthma is associated with respiratory tract infections and noneosinophilic endotypes, including neutrophilic forms of disease. However, steroid-insensitive patients with eosinophil-enriched inflammation have also been described. The?mechanisms...

  19. Effect of Disease Severity in Asthma and Chronic Obstructive Pulmonary Disease on Inhaler-Specific Inhalation Profiles Through the ELLIPTA? Dry Powder Inhaler

    OpenAIRE

    Prime, David; de Backer, Wilfried; Hamilton, Melanie; Cahn, Anthony; Preece, Andrew; Kelleher, Dennis; Baines, Amanda; Moore, Alison; Brealey, Noushin; Moynihan, Jackie

    2015-01-01

    Abstract Background: Two studies were undertaken to characterize the maximal effort inhalation profiles of healthy subjects and patients with asthma or chronic obstructive pulmonary disease (COPD) through a moderate-resistance dry powder inhaler (DPI). Correlations between inhaler-specific inhalation characteristics and inhaler-independent lung function parameters were investigated. Methods: Healthy subjects (n?=?15), patients with mild, moderate, or severe asthma (n?=?45), and patients with ...

  20. Comparison of six-minute walk test in children with moderate/severe asthma with reference values for healthy children

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    Lívia Barboza de Andrade

    2014-06-01

    Full Text Available OBJECTIVE: to compare physical performance and cardiorespiratory responses in the six-minute walk test (6MWT in asthmatic children with reference values for healthy children in the same age group, and to correlate them with intervening variables. METHODS: this was a cross-sectional, prospective study that evaluated children with moderate/severe asthma, aged between 6 and 16 years, in outpatient follow-up. Demographic and spirometric test data were collected. All patients answered the pediatric asthma quality of life (QoL questionnaire (PAQLQ and level of basal physical activity. The 6MWT was performed, following the American Thoracic Society recommendations. Comparison of means was performed using Student's t-test and Pearson's correlation to analyze the 6MWT with study variables. The significance level was set at 5%. RESULTS: 40 children with moderate or severe asthma were included, 52.5% males, 70% with normal weight and sedentary. Mean age was 11.3 ± 2.1 years, mean height was 1.5 ± 0.1 m, and mean weight was 40.8 ± 12.6 Kg. The mean distance walked in the 6MWT was significantly lower, corresponding to 71.9% ± 19.7% of predicted values; sedentary children had the worst values. The difference between the distance walked on the test and the predicted values showed positive correlation with age (r = 0.373, p = 0.018 and negative correlation with cardiac rate at the end of the test (r = -0.518, p < 0.001. Regarding QoL assessment, the values in the question about physical activity limitations showed the worst scores, with a negative correlation with walked distance difference (r = -0.311, p = 0.051. CONCLUSIONS: asthmatic children's performance in the 6MWT evaluated through distance walked is significantly lower than the predicted values for healthy children of the same age, and is directly influenced by sedentary life style.

  1. Coagulopathy after severe pediatric trauma: A review

    Science.gov (United States)

    Russell, Robert T.; Lisco, Steven J.; Kerby, Jeffrey D.; Pittet, Jean-François

    2014-01-01

    Trauma remains the leading cause of morbidity and mortality in the United States among children from the age 1 year to 21 years old. The most common cause of lethality in pediatric trauma is traumatic brain injury (TBI). Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy (TIC) include hypothermia, acidosis, hemodilution and consumption of coagulation factors secondary to local activation of the coagulation system following severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of TIC that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma. PMID:24569507

  2. [Epigenetics, environment and asthma].

    Science.gov (United States)

    Rico-Rosillo, Guadalupe; Vega-Robledo, Gloria Bertha; Silva-García, Raúl; Oliva-Rico, Diego

    2014-01-01

    Asthma is a chronic inflammatory disease of the respiratory tract with a complex genetic background influenced by the exposition to a series of environmental factors. Genetic studies can only elucidate part of the heritability and susceptibility of asthma and even though several diseases have an evident genetic etiology, only a fraction of the genes involved in their pathogenicity have been identified. The epigenetic regulation of the latter is a fact one should bear in mind in order to explain the major triggers of diseases whose understanding is complicated, such as allergies and asthma. External stimulus such as nourishment, stress, physical activity, atmospheric pollution, tobacco smoking and alcohol drinking can induce either gene silencing or gene expression. In this regard, epigenetics can explain how these environmental factors influence our genetic inheritance. There is growing evidence that backs-up the fact that DNA methylation, histone post-translational modification and microRNA expression are influenced by the environment. This helps explaining how several of the risk factors mentioned contribute to the development and inheritance of asthma. In this review, different environmental factors and their relation with the main epigenetic regulatory mechanisms will be analyzed, as well as their possible role in the development of asthma.

  3. Asthma and obesity: is weight reduction the key to achieve asthma control?

    Science.gov (United States)

    Ulrik, Charlotte S

    2016-01-01

    Obesity has significant negative impact on asthma control and risk of exacerbations. The purpose of this review is to discuss recent studies evaluating the effects of weight reduction on asthma control in obese adults. Clinical studies have shown that weight reduction in obese patients is associated with improvements in symptoms, use of controller medication, and asthma-related quality of life together with a reduction in the risk for severe exacerbations. Furthermore, several studies have also revealed improvements in lung function and airway responsiveness, and more recently it has been shown that weight reduction following bariatric surgery has positive impact on small airway function, systemic inflammation and bronchial inflammation in this group of patients, which may explain the observed improvements in symptom control and lung function. Weight reduction in obese adults with asthma leads to an overall improvement in asthma control, including airway hyperresponsiveness and inflammation. Weight reduction should be a cornerstone in the management of obese patients with asthma.

  4. Distinguishing adult-onset asthma from COPD: a review and a new approach

    Directory of Open Access Journals (Sweden)

    Abramson MJ

    2014-09-01

    Full Text Available Michael J Abramson,1 Jennifer L Perret,2,3 Shyamali C Dharmage,2 Vanessa M McDonald,4 Christine F McDonald3 1School of Public Health and Preventive Medicine, Monash University, 2Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia; 3Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia; 4Priority Research Centre for Asthma and Respiratory Disease, University of Newcastle, Newcastle, Australia Abstract: Adult-onset asthma and chronic obstructive pulmonary disease (COPD are major public health burdens. This review presents a comprehensive synopsis of their epidemiology, pathophysiology, and clinical presentations; describes how they can be distinguished; and considers both established and proposed new approaches to their management. Both adult-onset asthma and COPD are complex diseases arising from gene–environment interactions. Early life exposures such as childhood infections, smoke, obesity, and allergy influence adult-onset asthma. While the established environmental risk factors for COPD are adult tobacco and biomass smoke, there is emerging evidence that some childhood exposures such as maternal smoking and infections may cause COPD. Asthma has been characterized predominantly by Type 2 helper T cell (Th2 cytokine-mediated eosinophilic airway inflammation associated with airway hyperresponsiveness. In established COPD, the inflammatory cell infiltrate in small airways comprises predominantly neutrophils and cytotoxic T cells (CD8 positive lymphocytes. Parenchymal destruction (emphysema in COPD is associated with loss of lung tissue elasticity, and small airways collapse during exhalation. The precise definition of chronic airflow limitation is affected by age; a fixed cut-off of forced expiratory volume in 1 second/forced vital capacity leads to overdiagnosis of COPD in the elderly. Traditional approaches to distinguishing between asthma and COPD have highlighted age of onset

  5. The impact of prenatal exposure to air pollution on childhood wheezing and asthma: A systematic review.

    Science.gov (United States)

    Hehua, Zhang; Qing, Chang; Shanyan, Gao; Qijun, Wu; Yuhong, Zhao

    2017-11-01

    There has been no clear consensus about whether prenatal exposure to air pollution contributes to the development of wheezing and asthma in children. We conducted a systematic review to analyze the association between exposure to different pollutants during pregnancy and the development of childhood wheezing and asthma. We systematically reviewed epidemiological studies published through June 6, 2017 available in the MEDLINE and Web of Science databases. We included studies that examined the association between prenatal exposure to any air pollutants except tobacco smoke and the incidence or prevalence of "wheezing" or "asthma" from birth to 14 years of age. We extracted key characteristics of each included study using a template of predefined data items. We used the Critical Appraisal Skills Programme checklists to assess the validity of each included study. We conducted overall and subgroup meta-analyses for each summary exposure-outcome association. Pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated by using a random effects model. Eighteen studies met our eligibility criteria. There was notable variability in exposure assessment methods. The overall random effects risk estimates (95% CI) of different pollutants were 1.04 (0.94-1.15) aromatic hydrocarbons (PAH), 1.04 (1.01-1.07) NO2, 1.4 (0.97-2.03) PM2.5 for childhood wheeze and 1.07 (1.01-1.14) NO2, 1 (0.97-1.03) PM2.5, 1.02 (0.98-1.07) SO2, 1.08 (1.05-1.12) PM10 for childhood asthma. Minimal heterogeneity was seen for PAH and SO2, while some heterogeneity was observed for PM10, PM2.5 and NO2. The overall and subgroup risk estimates from the meta-analyses showed statistically significant associations between prenatal exposures to NO2, SO2, and PM10 and the risk of wheezing and asthma development in childhood. There is insufficient evidence to show an effect of prenatal exposure to BC, CO, and O3 on childhood wheezing and asthma. Further studies are needed to examine the individual

  6. The effectiveness of physiotherapy in patients with asthma: a systematic review of the literature.

    Science.gov (United States)

    Bruurs, Marjolein L J; van der Giessen, Lianne J; Moed, Heleen

    2013-04-01

    Since the introduction of medical therapy for asthma the interest in non-medical treatments deteriorated. Physiotherapy could have beneficial effects in asthmatics. This review investigates the effectiveness of physiotherapy in the treatment of patients with asthma. A review was performed on the terms breathing exercises (BE), inspiratory muscle training (IMT), physical training (PhT) and airway clearance (AC) in patients with asthma. The search resulted in 237 potentially relevant articles, after exclusion 23 articles remained. BE (n = 9) may improve disease specific quality of life (QoL), reduce symptoms, hyperventilation, anxiety and depression, lower respiratory rate and medication use. IMT (n = 3) can improve inspiratory pressure and may reduce medication use and symptoms. PhT (n = 12) can reduce symptoms, improve QoL and improve cardiopulmonary endurance and fitness. In conclusion, physiotherapy may improve QoL, cardiopulmonary fitness and inspiratory pressure and reduce symptoms and medication use. Further studies, investigating combinations of techniques, are needed to confirm these findings. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Dexmedetomidine facilitates induction of noninvasive positive pressure ventilation for acute respiratory failure in patients with severe asthma.

    Science.gov (United States)

    Takasaki, Yasushi; Kido, Takanori; Semba, Kazunori

    2009-01-01

    Noninvasive positive pressure ventilation (NPPV) has been reported to be effective for acute respiratory failure in patients with severe asthma. Although NPPV requires less sedative than invasive mechanical ventilation, agitated patients with severe asthma should be given the minimum sedation necessary to facilitate the induction of NPPV. Two asthmatic patients (a 65-year-old man and a 32-year-old woman) separately presented to the intensive care unit with exacerbating respiratory failure. We initiated NPPV using bilevel positive airway pressure (PAP) ventilation. The ventilation was initially set as an inspiratory PAP of 15 cmH(2)O and an expiratory PAP of 4 cmH2O. Because they seemed too agitated to tolerate the mask ventilation, dexmedetomidine was administered intravenously, at 3 microg x kg(-1) x h(-1) [DOSAGE ERROR CORRECTED] for 10 min, followed by a continuous infusion at 0.2-0.6 mircog x kg(-1) x h(-1) [DOSAGE ERROR CORRECTED]. One hour after the institution of NPPV, the patients were well cooperative with the mask ventilation and the respiratory symptoms had markedly improved. While the Ramsay sedation scale was maintained at 2 or 3 during the continuous dexmedetomidine infusion, we successfully weaned the patients from NPPV by reducing the inspiratory PAP. Dexmedetomidine helped the agitated patients cooperate with mask ventilation without inducing respiratory depression. We conclude that dexmedetomidine may be a valuable sedative to facilitate the induction of NPPV.

  8. MicroRNA-19a enhances proliferation of bronchial epithelial cells by targeting TGFβR2 gene in severe asthma.

    Science.gov (United States)

    Haj-Salem, I; Fakhfakh, R; Bérubé, J-C; Jacques, E; Plante, S; Simard, M J; Bossé, Y; Chakir, J

    2015-02-01

    Allergic asthma is characterized by inflammation and airway remodeling. Bronchial epithelium is considered a key player in coordinating airway wall remodeling. In mild asthma, the epithelium is damaged and fails to proliferate and to repair, whereas in severe asthma, the epithelium is highly proliferative and thicker. This may be due to different regulatory mechanisms. The purpose of our study was to determine the role of miRNAs in regulating proliferation of bronchial epithelial cells obtained from severe asthmatic subjects in comparison with cells obtained from mild asthmatics and healthy controls. Human bronchial epithelial cells (BEC) were isolated by bronchoscopy from bronchial biopsies of healthy donors and patients with mild and severe asthma. MiRNA expression was evaluated using the TaqMan low-density arrays and qRT-PCR. Transfection studies of bronchial epithelial cells were performed to determine the target genes. Cell proliferation was evaluated by BrdU incorporation test. MiR-19a was upregulated in epithelia of severe asthmatic subjects compared with cells from mild asthmatics and healthy controls. Functional studies based on luciferase reporter and Western blot assays suggest that miR-19a enhances cell proliferation of BEC in severe asthma through targeting TGF-β receptor 2 mRNA. Moreover, repressed expression of miR-19a increased SMAD3 phosphorylation through TGF-β receptor 2 signaling and abrogated BEC proliferation. Our study uncovers a new regulatory pathway involving miR-19a that is critical to the severe phenotype of asthma and indicates that downregulating miR-19a expression could be explored as a potential new therapy to modulate epithelium repair in asthma. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Staphylococcal superantigen-specific IgE antibodies: degree of sensitization and association with severity of asthma.

    Science.gov (United States)

    Elabras, José; Mello, Fernanda Carvalho de Queiroz; Lupi, Omar; Bica, Blanca Elena Rios Gomes; Papi, José Angelo de Souza; França, Alfeu Tavares

    2016-01-01

    To determine the presence of staphylococcal superantigen-specific IgE antibodies and degree of IgE-mediated sensitization, as well as whether or not those are associated with the severity of asthma in adult patients. This was a cross-sectional study involving outpatients with asthma under treatment at a tertiary care university hospital in the city of Rio de Janeiro, Brazil. Consecutive patients were divided into two groups according to the severity of asthma based on the Global Initiative for Asthma criteria: mild asthma (MA), comprising patients with mild intermittent or persistent asthma; and moderate or severe asthma (MSA). We determined the serum levels of staphylococcal toxin-specific IgE antibodies, comparing the results and performing a statistical analysis. The study included 142 patients: 72 in the MA group (median age = 46 years; 59 females) and 70 in the MSA group (median age = 56 years; 60 females). In the sample as a whole, 62 patients (43.7%) presented positive results for staphylococcal toxin-specific IgE antibodies: staphylococcal enterotoxin A (SEA), in 29 (20.4%); SEB, in 35 (24.6%); SEC, in 33 (23.2%); and toxic shock syndrome toxin (TSST), in 45 (31.7%). The mean serum levels of IgE antibodies to SEA, SEB, SEC, and TSST were 0.96 U/L, 1.09 U/L, 1.21 U/L, and 1.18 U/L, respectively. There were no statistically significant differences between the two groups in terms of the qualitative or quantitative results. Serum IgE antibodies to SEA, SEB, SEC, and TSST were detected in 43.7% of the patients in our sample. However, neither the qualitative nor quantitative results showed a statistically significant association with the clinical severity of asthma. Determinar a presença de anticorpos IgE específicos para superantígenos estafilocócicos e o grau de sensibilização mediada por esses, assim como se esses estão associados à gravidade da asma em pacientes adultos. Estudo transversal incluindo asmáticos adultos em acompanhamento ambulatorial em

  10. Role of Obesity in Asthma: Mechanisms and Management Strategies.

    Science.gov (United States)

    Scott, Hayley A; Wood, Lisa G; Gibson, Peter G

    2017-08-01

    Obesity is a commonly reported comorbidity in asthma, particularly in severe asthma. Obese asthmatics are highly symptomatic with a poor quality of life, despite using high-dose inhaled corticosteroids. While the clinical manifestations have been documented, the aetiologies of obese-asthma remain unclear. Several potential mechanisms have been proposed, including poor diet quality, physical inactivity and consequent accrual of excess adipose tissue. Each of these factors independently activates inflammatory pathways, potentially exerting effects in the airways. Because the origins of obesity are multifactorial, it is now believed there are multiple obese-asthma phenotypes, with varied aetiologies and clinical consequences. In this review, we will describe the clinical implications of obesity in people with asthma, our current understanding of the mechanisms driving this association and describe recently proposed obese-asthma phenotypes. We will then discuss how asthma management is complicated by obesity, and provide graded recommendations for the management of obesity in this population.

  11. Vitamin D and asthma-life after VIDA?

    Science.gov (United States)

    Brehm, John M

    2014-09-01

    The vitamin D hypothesis postulates that lower vitamin D levels are causally associated with increased asthma risk and asthma severity. Multiple epidemiological studies have shown an inverse relationship between circulating vitamin D levels (in the form of 25-hydroxy vitamin D) and asthma severity and control and lung function. However, in the recently published vitamin D and asthma (VIDA) study, vitamin D supplementation failed to show an improvement in asthma control in adults. This article reviews the current epidemiological and trial evidence for vitamin D and asthma and explores some of the possible alternative explanations for previous findings (including "reverse causation" and the importance of studying children and adults). We also address some of the unique challenges of conducting vitamin D trials and potential ways to address them. Finally, I will argue for further clinical trials of vitamin D in asthma, especially in children, using knowledge gained from the VIDA trial.

  12. Preclinical development of CAT-354, an IL-13 neutralizing antibody, for the treatment of severe uncontrolled asthma

    Science.gov (United States)

    May, RD; Monk, PD; Cohen, ES; Manuel, D; Dempsey, F; Davis, NHE; Dodd, AJ; Corkill, DJ; Woods, J; Joberty-Candotti, C; Conroy, LA; Koentgen, F; Martin, EC; Wilson, R; Brennan, N; Powell, J; Anderson, IK

    2012-01-01

    BACKGROUND AND PURPOSE IL-13 is a pleiotropic Th2 cytokine considered likely to play a pivotal role in asthma. Here we describe the preclinical in vitro and in vivo characterization of CAT-354, an IL-13-neutralizing IgG4 monoclonal antibody (mAb), currently in clinical development. EXPERIMENTAL APPROACH In vitro the potency, specificity and species selectivity of CAT-354 was assayed in TF-1 cells, human umbilical vein endothelial cells and HDLM-2 cells. The ability of CAT-354 to modulate disease-relevant mechanisms was tested in human cells measuring bronchial smooth muscle calcium flux induced by histamine, eotaxin generation by normal lung fibroblasts, CD23 upregulation in peripheral blood mononuclear cells and IgE production by B cells. In vivo CAT-354 was tested on human IL-13-induced air pouch inflammation in mice, ovalbumin-sensitization and challenge in IL-13 humanized mice and antigen challenge in cynomolgus monkeys. KEY RESULTS CAT-354 has a 165 pM affinity for human IL-13 and functionally neutralized human, human variant associated with asthma and atopy (R130Q) and cynomolgus monkey, but not mouse, IL-13. CAT-354 did not neutralize human IL-4. In vitro CAT-354 functionally inhibited IL-13-induced eotaxin production, an analogue of smooth muscle airways hyperresponsiveness, CD23 upregulation and IgE production. In vivo in humanized mouse and cynomolgus monkey antigen challenge models CAT-354 inhibited airways hyperresponsiveness and bronchoalveolar lavage eosinophilia. CONCLUSIONS AND IMPLICATIONS CAT-354 is a potent and selective IL-13-neutralizing IgG4 mAb. The preclinical data presented here support the trialling of this mAb in patients with moderate to severe uncontrolled asthma. PMID:21895629

  13. Preclinical development of CAT-354, an IL-13 neutralizing antibody, for the treatment of severe uncontrolled asthma.

    Science.gov (United States)

    May, R D; Monk, P D; Cohen, E S; Manuel, D; Dempsey, F; Davis, N H E; Dodd, A J; Corkill, D J; Woods, J; Joberty-Candotti, C; Conroy, L A; Koentgen, F; Martin, E C; Wilson, R; Brennan, N; Powell, J; Anderson, I K

    2012-05-01

    IL-13 is a pleiotropic Th2 cytokine considered likely to play a pivotal role in asthma. Here we describe the preclinical in vitro and in vivo characterization of CAT-354, an IL-13-neutralizing IgG4 monoclonal antibody (mAb), currently in clinical development. In vitro the potency, specificity and species selectivity of CAT-354 was assayed in TF-1 cells, human umbilical vein endothelial cells and HDLM-2 cells. The ability of CAT-354 to modulate disease-relevant mechanisms was tested in human cells measuring bronchial smooth muscle calcium flux induced by histamine, eotaxin generation by normal lung fibroblasts, CD23 upregulation in peripheral blood mononuclear cells and IgE production by B cells. In vivo CAT-354 was tested on human IL-13-induced air pouch inflammation in mice, ovalbumin-sensitization and challenge in IL-13 humanized mice and antigen challenge in cynomolgus monkeys. CAT-354 has a 165 pM affinity for human IL-13 and functionally neutralized human, human variant associated with asthma and atopy (R130Q) and cynomolgus monkey, but not mouse, IL-13. CAT-354 did not neutralize human IL-4. In vitro CAT-354 functionally inhibited IL-13-induced eotaxin production, an analogue of smooth muscle airways hyperresponsiveness, CD23 upregulation and IgE production. In vivo in humanized mouse and cynomolgus monkey antigen challenge models CAT-354 inhibited airways hyperresponsiveness and bronchoalveolar lavage eosinophilia. CAT-354 is a potent and selective IL-13-neutralizing IgG4 mAb. The preclinical data presented here support the trialling of this mAb in patients with moderate to severe uncontrolled asthma. © 2011 MedImmune Ltd. British Journal of Pharmacology © 2011 The British Pharmacological Society.

  14. Shiitake mushroom (Lentinus edodes): a poorly known allergen in Western countries responsible for severe work-related asthma.

    Science.gov (United States)

    Pravettoni, Valerio; Primavesi, Laura; Piantanida, Marta

    2014-10-01

    The aim of this study was to investigate the IgE-mediated pathogenesis of severe asthma presented by a patient only after handling shiitake (Lentinus edodes) mushrooms (SM). Skin tests were performed using in-house extracts from mushrooms that the patient usually handled, i.e., shiitake, porcini, oyster and black fungus mushroom varieties. Specific IgE to champignons and various molds were determined. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) immunoblotting was performed to detect IgE-binding components. Four negative controls were included in the study. Skin prick tests performed with in-house mushroom extracts from varieties other than shiitake were completely negative, in contrast to the positive test obtained for shiitake mushrooms. Serum specific IgE levels for common molds and champignons were all negative. SDS-PAGE revealed many protein bands in the four mushroom extracts. Immunoblotting using the patient's serum showed allergenic bands at about 15 and 24 kDa exclusively for SM that were not shared with negative controls. Another faint band was detectable at approximately 37 kDa for SM and porcini varieties. Here, we present the first European case of SM-induced occupational asthma, a disease more frequently occurring in Asia. Asthma attacks stopped when the patient avoided contact with shiitake mushrooms. No skin reactions and no IgE-binding proteins by immunoblotting were detectable with the other mushrooms tested. The positive skin test with shiitake mushrooms and IgE-binding components in the shiitake extract confirmed the IgE-mediated etiology of the reaction.

  15. Shiitake mushroom (Lentinus edodes: A poorly known allergen in Western countries responsible for severe work-related asthma

    Directory of Open Access Journals (Sweden)

    Valerio Pravettoni

    2014-10-01

    Full Text Available Objectives: The aim of this study was to investigate the IgE-mediated pathogenesis of severe asthma presented by a patient only after handling shiitake (Lentinus edodes mushrooms (SM. Material and Methods: Skin tests were performed using in-house extracts from mushrooms that the patient usually handled, i.e., shiitake, porcini, oyster and black fungus mushroom varieties. Specific IgE to champignons and various molds were determined. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE immunoblotting was performed to detect IgE-binding components. Four negative controls were included in the study. Results: Skin prick tests performed with in-house mushroom extracts from varieties other than shiitake were completely negative, in contrast to the positive test obtained for shiitake mushrooms. Serum specific IgE levels for common molds and champignons were all negative. SDS-PAGE revealed many protein bands in the four mushroom extracts. Immunoblotting using the patient’s serum showed allergenic bands at about 15 and 24 kDa exclusively for SM that were not shared with negative controls. Another faint band was detectable at approximately 37 kDa for SM and porcini varieties. Conclusions: Here, we present the first European case of SM-induced occupational asthma, a disease more frequently occurring in Asia. Asthma attacks stopped when the patient avoided contact with shiitake mushrooms. No skin reactions and no IgE-binding proteins by immunoblotting were detectable with the other mushrooms tested. The positive skin test with shiitake mushrooms and IgE-binding components in the shiitake extract confirmed the IgE-mediated etiology of the reaction.

  16. Emerging interleukin receptor antagonists for the treatment of asthma.

    Science.gov (United States)

    Al Efraij, Khalid; FitzGerald, J Mark

    2017-09-01

    Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. Most patients with asthma can be well-controlled with inhaled corticosteroids and, if necessary, the addition of a long-acting beta agonist. Despite these therapies, 5% to 10% of patients with asthma have severe, uncontrolled asthma. Selecting patients based on peripheral eosinophil counts and a history of exacerbations has led to significant decreases in exacerbations and an improvement in asthma control with medications that target IL-4, IL-5 and IL-13/. Areas covered: This review will cover the definition of severe asthma, existing treatment options, biomarkers, and the emerging role of interleukin antagonists in the treatment of severe asthma. Expert opinion: IL antagonists are novel drugs targeting important inflammatory cytokines in asthma. Anti-IL-5 drugs provide the most promise as they have obtained regulatory approval and are available for use. Anti-IL-4 drug results are also promising. There is, however, uncertainty regarding the success of anti-IL-13 drugs development at this point. An ongoing focus of research is to significantly increase our understanding of the biology of asthma, and in particular severe asthma, making more and better targeted therapies. There may also be potential in the future to use these new drugs earlier in the development of asthma, as disease-modifying interventions that might be associated with remission or even cure.

  17. Indoor air pollution and asthma in children.

    Science.gov (United States)

    Breysse, Patrick N; Diette, Gregory B; Matsui, Elizabeth C; Butz, Arlene M; Hansel, Nadia N; McCormack, Meredith C

    2010-05-01

    The purpose of this article is to review indoor air pollution factors that can modify asthma severity, particularly in inner-city environments. While there is a large literature linking ambient air pollution and asthma morbidity, less is known about the impact of indoor air pollution on asthma. Concentrating on the indoor environments is particularly important for children, since they can spend as much as 90% of their time indoors. This review focuses on studies conducted by the Johns Hopkins Center for Childhood Asthma in the Urban Environment as well as other relevant epidemiologic studies. Analysis of exposure outcome relationships in the published literature demonstrates the importance of evaluating indoor home environmental air pollution sources as risk factors for asthma morbidity. Important indoor air pollution determinants of asthma morbidity in urban environments include particulate matter (particularly the coarse fraction), nitrogen dioxide, and airborne mouse allergen exposure. Avoidance of harmful environmental exposures is a key component of national and international guideline recommendations for management of asthma. This literature suggests that modifying the indoor environment to reduce particulate matter, NO(2), and mouse allergen may be an important asthma management strategy. More research documenting effectiveness of interventions to reduce those exposures and improve asthma outcomes is needed.

  18. Phase-contrast computed tomography for quantification of structural changes in lungs of asthma mouse models of different severity

    Energy Technology Data Exchange (ETDEWEB)

    Dullin, Christian, E-mail: christian.dullin@med.uni-goettingen.de [University Medical Center Goettingen, Robert Koch Strasse 40, Goettingen, Lower Saxony 37075 (Germany); Larsson, Emanuel [Elettra-Sincrotrone Trieste, Strada Statale 14, km 163,5 in AREA Science Park, Basovizza (Trieste) 34149 (Italy); University of Trieste, Trieste (Italy); Linkoeping University, SE-581 83 Linkoeping (Sweden); Tromba, Giuliana [Elettra-Sincrotrone Trieste, Strada Statale 14, km 163,5 in AREA Science Park, Basovizza (Trieste) 34149 (Italy); Markus, Andrea M. [University Medical Center Goettingen, Robert Koch Strasse 40, Goettingen, Lower Saxony 37075 (Germany); Alves, Frauke [University Medical Center Goettingen, Robert Koch Strasse 40, Goettingen, Lower Saxony 37075 (Germany); University Medical Center Goettingen, Robert Koch Strasse 40, Goettingen, Lower Saxony 37075 (Germany); Max Planck Institut for Experimental Medicine, Hermann-Rein-Strasse 3, Goettingen, Lower Saxony 37075 (Germany)

    2015-06-17

    Synchrotron inline phase-contrast computed tomography in combination with single-distance phase retrieval enables quantification of morphological alterations in lungs of mice with mild and severe experimental allergic airways disease in comparison with healthy controls. Lung imaging in mouse disease models is crucial for the assessment of the severity of airway disease but remains challenging due to the small size and the high porosity of the organ. Synchrotron inline free-propagation phase-contrast computed tomography (CT) with its intrinsic high soft-tissue contrast provides the necessary sensitivity and spatial resolution to analyse the mouse lung structure in great detail. Here, this technique has been applied in combination with single-distance phase retrieval to quantify alterations of the lung structure in experimental asthma mouse models of different severity. In order to mimic an in vivo situation as close as possible, the lungs were inflated with air at a constant physiological pressure. Entire mice were embedded in agarose gel and imaged using inline free-propagation phase-contrast CT at the SYRMEP beamline (Synchrotron Light Source, ‘Elettra’, Trieste, Italy). The quantification of the obtained phase-contrast CT data sets revealed an increasing lung soft-tissue content in mice correlating with the degree of the severity of experimental allergic airways disease. In this way, it was possible to successfully discriminate between healthy controls and mice with either mild or severe allergic airway disease. It is believed that this approach may have the potential to evaluate the efficacy of novel therapeutic strategies that target airway remodelling processes in asthma.

  19. Prevalence and severity of asthma and related symptoms in 6- to 7-year-old schoolchildren of Rio de Janeiro using of the ISAAC questionnaire by telephone survey.

    Science.gov (United States)

    Valle, Solange Oliveira Rodrigues; Kuschnir, Fabio Chigres; Solé, Dirceu; e Silva, Martha Andrade Vilela; da Silva, Rosanna Iozzi; Caetano, Silvana; Carneiro, Alcides José de Carvalho; dos Santos, Lucia Helena; de Carvalho, Marina Maria Baltazar; da Cunha, Antonio Jose Ledo Alves

    2014-04-01

    To evaluate the prevalence and severity of asthma and its association with sex in 6- to 7-year-old schoolchildren from the city of Rio de Janeiro (RJ), obtained by a telephone survey. A cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) Written Questionnaire for Asthma adapted and validated by telephone interviews was conducted. The random sample was recruited systematically, without replacement, taking into account the proportion of school classes and students in each regional coordination of the Municipal Secretariat of Education, which supplied the students' telephone numbers. The data were collected by a polling company from May to July 2010. Prevalence ratios (PRs) and 95% confidence intervals (95% CI) were compared using the difference in proportions test suitable for large samples to analyze the association between asthma and sex. In total, 3216 interviews from parents/caregivers of children were analyzed; 51.4% of the children were males. Mothers were the primary respondents (71.9%). The prevalence rates of "wheezing ever" and "wheezing in the last 12 months" were 52.2% and 20.9%, respectively, and were significantly higher among boys (PR: 1.10, 95% CI: 1.03-1.18 and PR: 1.27, 95% CI: 1.10-1.45). The same pattern was observed for "asthma ever" (PR: 1.44, 95% CI: 1.12-1.85) and for "severe asthma" (PR: 1.42, 95% CI: 1.11-1.82). The prevalence of asthma was high among RJ's students. Most of the indicators of the disease were more prevalent among boys. Our results were similar to those observed in other Brazilian and international centers using the traditional ISAAC protocol. The use of this method can be an alternative for epidemiological studies of childhood asthma especially in areas where the telephone coverage is high.

  20. Fluticasone-formoterol: a systematic review of its potential role in the treatment of asthma

    Directory of Open Access Journals (Sweden)

    Prosser TR

    2015-06-01

    Full Text Available Theresa R Prosser, Suzanne G Bollmeier St Louis College of Pharmacy, St Louis, MO, USA Background: The purpose of this systematic review is to summarize and evaluate the available published data regarding the efficacy and safety of a combination product containing fluticasone propionate/formoterol (FP-F in order to establish its potential role compared with other inhaled combination corticosteroid/long-acting beta2 receptor agonists for the maintenance treatment of asthma.Methods: A PubMed and EMBASE search was conducted using the terms “fluticasone propionate”, “formoterol fumarate”, “Flutiform®”, and “asthma” in July 2014 to identify trials using this combination specifically for the treatment of asthma. Additional information was gathered from references cited in the identified publications, the package insert, and the ClinicalTrials.gov registry. All randomized controlled clinical trials for humans in asthma were evaluated for inclusion. Data from animal trials, clinical trials for chronic obstructive pulmonary disease, and non-English sources were excluded.Results: Seven short-term safety and efficacy trials of FP-F compared with its individual components and two comparison trials of FP-F versus other combination products were identified. Generally, the incidence of drug-related adverse events was low and consistent with previously reported drug class-related adverse events (ie, pharyngitis, dysphonia, and headache. The combination of FP-F was shown to be noninferior to fluticasone propionate/salmeterol for improving predose forced expiratory volume at one second (FEV1 and 2 hours post dose FEV1. FP-F was also noninferior to budesonide/formoterol in improving predose FEV1. Other clinical endpoints, including various symptom scores, asthma control, quality of life, and subjects’ assessment of the medications were not significantly different.Conclusion: Poor asthma control is common. The data from short-term studies

  1. A systematic review of fractional exhaled nitric oxide in the routine management of childhood asthma.

    Science.gov (United States)

    Gomersal, Tim; Harnan, Sue; Essat, Munira; Tappenden, Paul; Wong, Ruth; Lawson, Rod; Pavord, Ian; Everard, Mark Lloyd

    2016-03-01

    Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of eosinophilic inflammation which may be used to guide the management of asthma in childhood. To synthesise the available evidence on the efficacy of FeNO-guided management of childhood asthma. Databases including MEDLINE and the Cochrane Library were searched, and randomised controlled trials (RCTs) comparing FeNO-guided management with any other monitoring strategy were included. Study quality was assessed using the Cochrane risk of bias tool for RCTs, and a number of outcomes were examined, including: exacerbations, medication use, quality of life, adverse events, and other markers of asthma control. Meta-analyses were planned if multiple studies with suitable heterogeneity were available. However, due to wide variations in study characteristics, meta-analysis was not possible. Seven RCTs were identified. There was some evidence that FeNO-guided monitoring results in improved asthma control during the first year of management, although few results attained statistical significance. The impact on severe exacerbations was unclear. Similarly, the impact on use of anti-asthmatic drugs was unclear, and appears to depend on the step up/down protocols, and the clinical characteristics of patients. The potential benefit of FeNO monitoring is equivocal. Trends toward reduced exacerbation and increased medication use were seen, but typically failed to reach statistical significance. There are a number of issues that complicate data interpretation, including differences in the likely severity of included cohorts and variations in treatment algorithms. Further work is needed to systematically explore the impact of these parameters. © 2016 Wiley Periodicals, Inc.

  2. Recent advances in the epidemiologic investigation of risk factors for asthma: a review of the 2011 literature.

    Science.gov (United States)

    Antó, Josep M

    2012-06-01

    The present review aims to identify and summarize epidemiologic investigations published during 2011 on the environmental risk factors for asthma. Potentially eligible papers were identified by a MEDLINE search. In total, 1,130 items were retrieved. Based on a broad definition of environment, the following topics were included: obesity, diet, vitamin D, air pollution, farming environment, and social factors. Some of the more relevant contributions included evidence that 1) obesity precedes asthma, 2) fruit consumption is longitudinally associated with a lower risk of asthma and atopy, 3) a comprehensive statewide smoking ban was followed by a reduction in hospital admissions for asthma, 4) asthma is one of the diseases showing the largest burdens due to environmental tobacco smoke, 5) traffic-related urban air pollution is associated with bronchial inflammation as measured by fractional exhaled nitric oxide and uncontrolled asthma, 6) aeroallergens and desert dust may contribute to the short-term effects of air pollution and asthma, and 7) maternal exposure to air pollution before and during pregnancy may alter the immune competence in offspring.

  3. Cluster analysis and characterization of response to mepolizumab. A step closer to personalized medicine for patients with severe asthma.

    Science.gov (United States)

    Ortega, Hector; Li, Hao; Suruki, Robert; Albers, Frank; Gordon, David; Yancey, Steven

    2014-09-01

    Detailed characterization of asthma phenotypes is essential for identification of responder populations to allow directed personalized medical intervention. The aim of this study was to identify distinctive patient characteristics within subgroups of a well-characterized severe asthma population at risk for exacerbations and to determine the treatment response within each subgroup. A supervised cluster analysis with recursive partitioning approach was applied to data from the Dose Ranging Efficacy And safety with Mepolizumab (DREAM) study to identify characteristics that maximized the differences across subgroups. Exacerbation rate ratios were calculated for each cluster comparing mepolizumab versus placebo. Three predictors were identified in four primary clusters: blood eosinophils, airway reversibility, and body mass index. The reduction in exacerbations was significantly greater in patients who received mepolizumab (clusters 2, 3, and 4) with raised eosinophils (responder population). Cluster 2 with low airway reversibility (mean, 11%) had a 53% reduction in exacerbations. These patients more frequently reported sinusitis and nasal polyposis. Those with higher airway reversibility (mean, 28%) were further split by body mass index. The nonobese versus obese (clusters 3 and 4) had a 35 and 67% reduction in exacerbations, respectively. Cluster 4 also had patients with more comorbidities, including hypertension, weight gain, and anxiety. Using supervised cluster analysis helped identify specific patient characteristics related to disease and therapeutic response. Patients with eosinophilic inflammation received significant therapeutic benefit with mepolizumab, and responses differed within clusters. Clinical trial registered with www.clinicaltrials.gov (NCT01000506).

  4. Massage Therapy in Children with Asthma: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Wu, Ji; Yang, Xi-Wen; Zhang, Ming

    2017-01-01

    To systematically evaluate the efficacy of massage, a traditional treatment method of traditional Chinese medicine on children with asthma. Literatures from 5 databases using the date ranging from 1 January, 1990, to 13 December, 2016, were reviewed, which were all randomized controlled trials evaluating the efficacy on children with asthma and effect on lung function mainly by massage therapy. 14 researches with 1299 patients were included in the meta-analysis. Compared with control group, a better efficacy was found in treatment group, which focused on massage therapy. Compared with control group, there was remarkable increase on FEV1 as well as PEF in treatment group. All studies have shown that massage therapy has a significantly positive effect on children with asthma, improves the pulmonary function parameters of large airway, reduces the plasma concentrations of PAF and prostaglandin, and increases the levels of PAF-AH and DP1; therefore, it greatly improves pulmonary function. However, the limited research designs of included studies lead to high risk of bias. More randomized controlled trials with better methodological quality are needed to further confirm the effectiveness of massage.

  5. Massage Therapy in Children with Asthma: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Ji Wu

    2017-01-01

    Full Text Available Objective. To systematically evaluate the efficacy of massage, a traditional treatment method of traditional Chinese medicine on children with asthma. Methods. Literatures from 5 databases using the date ranging from 1 January, 1990, to 13 December, 2016, were reviewed, which were all randomized controlled trials evaluating the efficacy on children with asthma and effect on lung function mainly by massage therapy. Results. 14 researches with 1299 patients were included in the meta-analysis. Compared with control group, a better efficacy was found in treatment group, which focused on massage therapy. Compared with control group, there was remarkable increase on FEV1 as well as PEF in treatment group. Conclusion. All studies have shown that massage therapy has a significantly positive effect on children with asthma, improves the pulmonary function parameters of large airway, reduces the plasma concentrations of PAF and prostaglandin, and increases the levels of PAF-AH and DP1; therefore, it greatly improves pulmonary function. However, the limited research designs of included studies lead to high risk of bias. More randomized controlled trials with better methodological quality are needed to further confirm the effectiveness of massage.

  6. [Systematic literature review on interventions in rehabilitation for children and adolescents with asthma bronchiale].

    Science.gov (United States)

    Ahnert, J; Löffler, S; Müller, J; Vogel, H

    2010-06-01

    Relevant data bases were used to collect and evaluate guidelines, meta-analyses, and reviews as well as primary studies dealing with asthma therapy for children and adolescents. Treatment approaches whose effectiveness with regard to bronchial asthma was empirically verified (i. e., evidence-based) were identified (medical and diagnostic procedures as well as drug trials were excluded from the analysis). 152 methodically sound studies referring to asthma treatment of children and adolescents were selected. Strong evidence was found for patient education, parent education, exercise therapy, inhalation, and tobacco withdrawal. Nutritional counseling and avoidance of allergens showed limited evidence. Psychotherapy, relaxation techniques, breathing exercises, climate therapy, clinical social work (social and legal counseling services, vocational reintegration counseling, aftercare) and integration counseling showed inconsistent evidence. No evidence was found for alternative medicine. Challenges regarding the development of treatment standards for children and adolescent rehabilitation are highlighted; these refer to limitations in report quality in some of the studies, the validity of treatments for comorbid conditions, a lack of differentiation for different age groups, and transferability of outpatient or international study results to inpatient rehabilitation. Georg Thieme Verlag KG Stuttgart New York.

  7. Psychopathology in difficult asthma

    NARCIS (Netherlands)

    Prins, L.C.; van Son, M.J.M.; Keimpema, A.R.; van Ranst, D; Pommer, A; Meijer, J.W.; Pop, V.J.M.

    2015-01-01

    OBJECTIVE: Within the asthma population, difficult asthma (DA) is a severe condition in which patients present with frequent exacerbations, hospitalizations and emergency room visits. The identification and treatment of psychopathology is included in the management of DA. Psychopathology is supposed

  8. Fluticasone furoate/vilanterol: a review of its use in patients with asthma.

    Science.gov (United States)

    Syed, Yahiya Y

    2015-03-01

    Fluticasone furoate/vilanterol (Relvar(®)) is a once-daily, fixed combination of an inhaled corticosteroid (ICS) and a long-acting β2-adrenoreceptor agonist (LABA), delivered via a dry powder inhaler (Ellipta(®)). It is approved for the treatment of asthma in the EU and Japan, and is the first once-daily ICS/LABA to be available for this indication. Fluticasone furoate is an enhanced-affinity glucocorticoid receptor agonist, with potent anti-inflammatory activity. Vilanterol produces rapid and prolonged bronchodilation. In phase III trials in adolescents and adults with various levels of asthma uncontrolled on ICS and/or ICS/LABA, fluticasone furoate/vilanterol 100/25 or 200/25 µg once daily (approved dosages in the EU) significantly improved pulmonary function compared with placebo or equivalent dosages of fluticasone furoate alone (in some trials) or fluticasone propionate. In similar trials, fluticasone furoate/vilanterol 100/25 µg once daily was as effective as fluticasone propionate/salmeterol 250/50 µg twice daily in improving pulmonary function and significantly reduced the risk of severe asthma exacerbation relative to fluticasone furoate alone. In clinical trials, fluticasone furoate/vilanterol was generally well tolerated with fewer than 15 % of patients experiencing treatment-related adverse events, the most common of which were oral/oropharyngeal candidiasis, dysphonia, extrasystoles and cough. The tolerability profile of fluticasone furoate/vilanterol was generally similar to that of fluticasone propionate/salmeterol. Thus, fluticasone furoate/vilanterol is an effective and generally well tolerated ICS/LABA option for the treatment of uncontrolled asthma.

  9. A systematic review of the effectiveness of patient-centred care on emergency room visits, hospitalizations, unscheduled sick clinic visits, and missed school days for children with asthma.

    Science.gov (United States)

    Barnes, Cheryl; Cauvin, Eugene; Duran-Kim, Meral; Montalbano, Lisa; Londrigan, Marie

    2012-01-01

    Childhood asthma is a major clinical concern worldwide, associated with increased levels of morbidity and missed school days, placing a heavy strain on healthcare systems in terms of both financial cost and hospital usage. The utilization of suitable therapy, written treatment plans, and patient education have been the focus of many interventional strategies to improve outcomes. The objective of this systematic review was to identify, appraise, and synthesize the best available evidence to determine the effectiveness of patient-centred care on emergency room visits, hospitalizations, unscheduled primary care provider visits, and missed school days in the management of children with asthma. The review considered studies that included children from newborn to seventeen years of age with a clinical diagnosis of asthma who were being treated in an outpatient healthcare setting, regardless of severity, previous treatments, co-morbidities, and ethnic or socioeconomic backgrounds.The review considered studies that evaluated the effects of the patient-centred care model in the management of children with asthma.This review considered studies that included the following outcome measures: emergency room (ER) visit rates, hospital admission rates, unscheduled primary care provider visit rates, and number of missed school days per year associated with asthma symptoms.The review considered any randomized controlled trials (RCTs) and quasi-experimental clinical controlled trials (CCTs). The search strategy examined both published and unpublished studies from 1970 to present that were written in the English language. The databases searched included: Medline, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Academic Search Premier, PsycINFO, Healthsource Nursing/Academic edition, and PubMed. A grey literature search was performed. Papers that met the inclusion criteria were assessed by two independent reviewers for methodological validity prior to

  10. Mobile Technology Interventions for Asthma Self-Management: Systematic Review and Meta-Analysis

    Science.gov (United States)

    Schüz, Benjamin; Walters, Julia; Walters, E Haydn

    2017-01-01

    Background Mobile technology interventions (MTI) are becoming increasingly popular in the management of chronic health behaviors. Most MTI allow individuals to monitor medication use, record symptoms, or store and activate disease-management action plans. Therefore, MTI may have the potential to improve low adherence to medication and action plans for individuals with asthma, which is associated with poor clinical outcomes. Objective A systematic review and meta-analysis were conducted to evaluate the efficacy of MTI on clinical outcomes as well as adherence in individuals with asthma. As the use of evidence-based behavior change techniques (BCT) has been shown to improve intervention effects, we also conducted exploratory analyses to determine the role of BCT and engagement with MTI as moderators of MTI efficacy. Methods We searched electronic databases for randomized controlled trials up until June 2016. Random effect models were used to assess the effect of MTI on clinical outcomes as well as adherence to preventer medication or symptom monitoring. Mixed effects models assessed whether the features of the MTI (ie, use of BCT) and how often a person engaged with MTI moderated the effects of MTI. Results The literature search located 11 studies meeting the inclusion criteria, with 9 providing satisfactory data for meta-analysis. Compared with standard treatment, MTI had moderate to large effect sizes (Hedges g) on medication adherence and clinical outcomes. MTI had no additional effects on adherence or clinical outcomes when compared with paper-based monitoring. No moderator effects were found, and the number of studies was small. A narrative review of the two studies, which are not included in the meta-analysis, found similar results. Conclusions This review indicated the efficacy of MTI for self-management in individuals with asthma and also indicated that MTI appears to be as efficacious as paper-based monitoring. This review also suggested a need for robust

  11. A systematic review of associations between environmental exposures and development of asthma in children aged up to 9 years.

    Science.gov (United States)

    Dick, S; Friend, A; Dynes, K; AlKandari, F; Doust, E; Cowie, H; Ayres, J G; Turner, S W

    2014-11-24

    Childhood asthma is a complex condition where many environmental factors are implicated in causation. The aim of this study was to complete a systematic review of the literature describing associations between environmental exposures and the development of asthma in young children. A systematic review of the literature up to November 2013 was conducted using key words agreed by the research team. Abstracts were screened and potentially eligible papers reviewed. Papers describing associations between exposures and exacerbation of pre-existing asthma were not included. Papers were placed into the following predefined categories: secondhand smoke (SHS), inhaled chemicals, damp housing/mould, inhaled allergens, air pollution, domestic combustion, dietary exposures, respiratory virus infection and medications. Children aged up to 9 years. Diagnosed asthma and wheeze. 14,691 abstracts were identified, 207 papers reviewed and 135 included in the present review of which 15 were systematic reviews, 6 were meta-analyses and 14 were intervention studies. There was consistent evidence linking exposures to SHS, inhaled chemicals, mould, ambient air pollutants, some deficiencies in maternal diet and respiratory viruses to an increased risk for asthma (OR typically increased by 1.5-2.0). There was less consistent evidence linking exposures to pets, breast feeding and infant dietary exposures to asthma risk, and although there were consistent associations between exposures to antibiotics and paracetamol in early life, these associations might reflect reverse causation. There was good evidence that exposures to house dust mites (in isolation) was not associated with asthma risk. Evidence from observational and intervention studies suggest that interactions between exposures were important to asthma causation, where the effect size was typically 1.5-3.0. There are many publications reporting associations between environmental exposures and modest changes in risk for asthma in young

  12. Treatment of acute severe asthma with inhaled albuterol delivered via jet nebulizer, metered dose inhaler with spacer, or dry powder.

    Science.gov (United States)

    Raimondi, A C; Schottlender, J; Lombardi, D; Molfino, N A

    1997-07-01

    Despite the increasing use of dry powder formulations in the ambulatory setting, there is a paucity of information on the efficacy of this therapeutic modality to treat acute severe asthma. In addition, studies that compared wet nebulization vs metered dose inhalers formulated with chlorofluorocarbon (CFCMDI) attached to holding chambers have yielded discrepant results. Thus, it is unclear which of the three delivery systems would elicit a superior bronchodilator response, particularly in patients with life-threatening asthma. In a prospective, randomized open design, we studied the response to inhaled albuterol (salbutamol) in 27 adult asthmatics presenting to the emergency department (ED) with an FEV1 nebulizer (Puritan-Bennett Raindrop; Lawrenceville, Ga) impelled with oxygen (O2) at 8 L/min; group B, baseline FEV1 of 0.6 (0.15) L, received albuterol, 400 microg, via a CFCMDI attached to a 145-mL valved aerosol holding chamber (Aerochamber; Trudell Medical; London, ON); and group C, baseline FEV1 of 0.6 (0.17) L, received albuterol powder, 400 microg, by another means (Rotahaler; Glaxo; Research Triangle Park, NC). All groups received the respective treatments on arrival in the ED, every 30 min during the first 2 h, and then hourly until the sixth hour. Clinical parameters and FEV1 were recorded on ED admission and 15 min after each dose of albuterol. At the time of ED admission, all patients also received continuous O2 and one dose of I.V. steroids (dexamethasone, 8 mg). The total dose of inhaled albuterol administered during the 6-h treatment was 45 mg of nebulized solution in group A and 3,600 microg of albuterol aerosol and dry powder in groups B and C, respectively. No significant differences were found in the population demographics, baseline FEV1, and arterial blood gas values on air. FEV1 improved significantly in all patients after the 6 h of treatment. The 6-h area under the curve FEV1 improved similarly with the three delivery methods despite

  13. The Potential for Emerging Microbiome-Mediated Therapeutics in Asthma.

    Science.gov (United States)

    Ozturk, Ayse Bilge; Turturice, Benjamin Arthur; Perkins, David L; Finn, Patricia W

    2017-08-10

    In terms of immune regulating functions, analysis of the microbiome has led the development of therapeutic strategies that may be applicable to asthma management. This review summarizes the current literature on the gut and lung microbiota in asthma pathogenesis with a focus on the roles of innate molecules and new microbiome-mediated therapeutics. Recent clinical and basic studies to date have identified several possible therapeutics that can target innate immunity and the microbiota in asthma. Some of these drugs have shown beneficial effects in the treatment of certain asthma phenotypes and for protection against asthma during early life. Current clinical evidence does not support the use of these therapies for effective treatment of asthma. The integration of the data regarding microbiota with technologic advances, such as next generation sequencing and omics offers promise. Combining comprehensive bioinformatics, new molecules and approaches may shape future asthma treatment.

  14. Obesity and asthma

    DEFF Research Database (Denmark)

    Ali, Zarqa; Ulrik, Charlotte Suppli

    2013-01-01

    Epidemiological data has established increasing adiposity as a risk factor for incident asthma. However, the mechanisms underlying the association between obesity and asthma are incompletely understood. In the present paper, we review current knowledge of possible mechanisms mediating the observed...... association between obesity and asthma....

  15. Clinical phenotypes of asthma

    NARCIS (Netherlands)

    Bel, Elisabeth H.

    2004-01-01

    PURPOSE OF REVIEW: Asthma is a phenotypically heterogeneous disorder and, over the years, many different clinical subtypes of asthma have been described. A precise definition of asthma phenotypes is now becoming more and more important, not only for a better understanding of pathophysiologic

  16. Evaluation of the use of Swedish integrated electronic health records and register health care data as support clinical trials in severe asthma: the PACEHR study.

    Science.gov (United States)

    Franzén, Stefan; Janson, Christer; Larsson, Kjell; Petzold, Max; Olsson, Urban; Magnusson, Gunnar; Telg, Gunilla; Colice, Gene; Johansson, Gunnar; Sundgren, Mats

    2016-11-15

    In the development of new drugs for severe asthma, it is a challenge from an ethical point of view to randomize severe asthma patients to placebo, and to obtain long-term safety data due to discontinuations. The aim of this study was to evaluate the feasibility of using electronic health record (EHR) data to create a real-world reference population of uncontrolled asthmatic patients to supplement the concurrent control/placebo group in long-term studies of asthma. EHR data from 36 primary care centres and a University hospital in Sweden were linked to Swedish mandatory health registers (2005-2013), creating a population covering 33 890 asthma patients, including data on co-morbidities, risk factors and laboratory/respiratory measurements. A severe asthma EHR reference cohort was established. We used logistic regression to estimate the propensity score (probability) of each RCT or EHR patient existing in the EHR cohort given their covariates. We created an EHR-derived reference cohort of 240 patients, matching the placebo group (N = 151) in an RCT of severe asthma. The exacerbation rate during follow-up in the EHR study population was 1.24 (weighted) compared to 0.9 in the RCT placebo group. Patients in the EHR cohort were of similar age as in the RCT placebo group, 50.6 years versus 50.1 years; had slightly higher body mass index 27.0 kg/m2 versus 27.3 kg/m2; and consisted of 40% versus 34% males. The results indicate that EHRs provide an opportunity to supplement the control group in RCTs of severe diseases.

  17. Long-term outcomes of bronchial thermoplasty in subjects with severe asthma: a comparison of 3-year follow-up results from two prospective multicentre studies

    Science.gov (United States)

    Laviolette, Michel; Cohn, Lauren; McEvoy, Charlene; Bansal, Sandeep; Shifren, Adrian; Khatri, Sumita; Grubb, G. Mark; McMullen, Edmund; Strauven, Racho; Kline, Joel N.

    2017-01-01

    Bronchial thermoplasty is an endoscopic therapy for severe asthma. The previously reported, randomised sham-controlled AIR2 (Asthma Intervention Research 2) trial showed a significant reduction in severe asthma exacerbations, emergency department visits and hospitalisations after bronchial thermoplasty. More “real-world” clinical outcome data is needed. This article compares outcomes in bronchial thermoplasty subjects with 3 years of follow-up from the ongoing, post-market PAS2 (Post-FDA Approval Clinical Trial Evaluating Bronchial Thermoplasty in Severe Persistent Asthma) study with those from the AIR2 trial. 279 subjects were treated with bronchial thermoplasty in the PAS2 study. We compared the first 190 PAS2 subjects with the 190 bronchial thermoplasty-treated subjects in the AIR2 trial at 3 years of follow-up. The PAS2 subjects were older (mean age 45.9 versus 40.7 years) and more obese (mean body mass index 32.5 versus 29.3 kg·m−2) and took higher doses of inhaled corticosteroids (mean dose 2301 versus 1961 μg·day−1). More PAS2 subjects had experienced severe exacerbations (74% versus 52%) and hospitalisations (15.3% versus 4.2%) in the 12 months prior to bronchial thermoplasty. At year 3 after bronchial thermoplasty, the percentage of PAS2 subjects with severe exacerbations, emergency department visits and hospitalisations significantly decreased by 45%, 55% and 40%, respectively, echoing the AIR2 results. The PAS2 study demonstrates similar improvements in asthma control after bronchial thermoplasty compared with the AIR2 trial despite enrolling subjects who may have had poorer asthma control. PMID:28860266

  18. An analysis of the utilisation and expenditure of medicines dispensed for the management of severe asthma.

    LENUS (Irish Health Repository)

    McGowan, B

    2009-03-01

    There are approximately 6,300 people in Ireland with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) and with a fast growing elderly population the incidence of COPD is likely to increase. This study examines the prescribing patterns of medicines dispensed for the management Asthma\\/COPD in patients over the age of 35 years using the HSE-Primary Care Reimbursement Services (PCRS) prescribing databases. The HSE-PCRS pharmacy claims data, which covers all those over 70 years of age and means tested for those less than 70 years, was analysed for the years 2005\\/2006. Approximately 26,548 (17.9%) of patients who were prescribed a respiratory drug received inhaled short-acting beta2 agonists in combination with a regular standard-dose inhaled corticosteroid. A further 5,044 (3.4%) were also prescribed a regular inhaled long-acting beta2 agonist (salmeterol or formoterol). A total of 2506 patients (6.2%) on combination therapy were co-prescribed four different anti-asthmatic treatments inclusive of oral prednisolone. A small proportion of the patients prescribed a respiratory drug were co-prescribed nicotine replacement therapy (n = 5177, 3.5%). In total there were 9,728 (6.2%) patients prescribed a mucolytic drug in combination with a respiratory drug and the rate of co-prescribing with antibiotics was 22%. COPD is a debilitating disease that is primarily caused by smoking and is therefore largely preventable. The HSE-PCRS pharmacy claims data is a valuable tool for helping to assess the burden of this disease in the Irish context.

  19. Asthma and lung cancer, after accounting for co-occurring respiratory diseases and allergic conditions: a systematic review protocol.

    Science.gov (United States)

    Denholm, Rachel; Crellin, Elizabeth; Arvind, Ashwini; Quint, Jennifer

    2017-01-16

    Asthma is one of the most frequently diagnosed respiratory diseases in the UK, and commonly co-occurs with other respiratory and allergic diseases, such as chronic obstructive pulmonary disease (COPD) and atopic dermatitis. Previous studies have shown an increased risk of lung cancer related to asthma, but the evidence is mixed when accounting for co-occurring respiratory diseases and allergic conditions. A systematic review of published data that investigate the relationship between asthma and lung cancer, accounting for co-occurring respiratory and allergic diseases, will be conducted to investigate the independent association of asthma with lung cancer. A systematic review will be conducted, and include original reports of cohort, cross-sectional and case-control studies of the association of asthma with lung cancer after accounting for co-occurring respiratory diseases. Articles published up to June 2016 will be included, and their selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A standardised data extraction form will be developed and pretested, and descriptive analyses will be used to summarise the available literature. If appropriate, pooled effect estimates of the association between asthma and lung cancer, given adjustment for a specific co-occurring condition will be estimated using random effects models. Potential sources of heterogeneity and between study heterogeneity will also be investigated. The study will be a review of published data and does not require ethical approval. Results will be disseminated through a peer-reviewed publication. International Prospective Register for Systematic Reviews (PROSPERO) number CRD42016043341. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  20. Endobronchial amyloidosis mimicking bronchial asthma: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Kang Hyun-Wook

    2016-01-01

    Full Text Available Among two tracheobronchial forms (local and diffuse and two parenchymal forms (nodular and alveolar septal that were reported in previous literature, localized endobronchial amyloidosis is an uncommon disease of unknown cause. Bronchial amyloid deposits can occur as focal nodules or multifocal infiltration of the submucosa. We report the case of a 47-year-old man who had complained of dyspnea and wheezing for 1 month and who had been treated for severe asthma at another hospital. Endobronchial amyloidosis was confirmed by histological examination of the bronchial biopsies.

  1. A review of ibuprofen and acetaminophen use in febrile children and the occurrence of asthma-related symptoms.

    Science.gov (United States)

    Kanabar, Dipak; Dale, Stephen; Rawat, Mariyam

    2007-12-01

    Although many studies have investigated the safety and tolerability of ibuprofen or acetaminophen (paracetamol) use in children, few have specifically examined the association of ibuprofen or acetaminophen and the occurrence of asthma in pediatric populations. The primary objective of this literature review was to ascertain whether ibuprofen use exacerbates the symptoms of asthma or asthma-related adverse events in febrile children, and how it compares with acetaminophen use. The secondary objective was to develop an algorithm that allows for the consideration of ibuprofen treatment in children by health care professionals. Twelve electronic databases (MEDLINE, EMBASE, Cochrane Database, DARE, British Nursing Index, CBIB, Derwent Drug File, International Pharmaceutical Abstracts, Pharm-Line, CINAHL, PASCAL, SCZZ-SciSearch) were searched from their year of inception to June 2007, to identify English-language articles pertaining to ibuprofen or acetaminophen use in the asthmatic pediatric population. The following search terms were used: asthma, child, pediatric, pediatrics, ibuprofen, Nurofen, Brufen, Motrin, Advil, propionic acid, paracetamol, and acetaminophen. Of 472 articles retrieved, 3 were relevant for the development of the algorithm. Two were subanalyses of a major randomized controlled trial (RCT), the Boston University Fever Study. Therefore, some overlap should be noted. The third article was another RCT. Other studies and review articles identified were used for the discussion. Findings from the literature analysis indicated that the use of ibuprofen in the pediatric population does not exacerbate asthma morbidity. Two of the studies demonstrated that ibuprofen was associated with a lower risk for asthma morbidity in febrile children with or without asthma compared with acetaminophen. In one study, ibuprofen use was associated with a lower relative risk for hospitalization (0.63) and outpatient visits (0.56) for asthma compared with acetaminophen. In

  2. Advances in asthma in 2016: Designing individualized approaches to management.

    Science.gov (United States)

    Anderson, William C; Apter, Andrea J; Dutmer, Cullen M; Searing, Daniel A; Szefler, Stanley J

    2017-09-01

    In this year's Advances in Asthma review, we discuss viral infections in asthmatic patients and potential therapeutic agents, the microbiome, novel genetic associations with asthma, air quality and climate effects on asthma, exposures during development and long-term sequelae of childhood asthma, patient-centered outcomes research, and precision medicine. In addition, we discuss application of biomarkers to precision medicine and new information on asthma medications. New evidence indicates that rhinovirus-triggered asthma exacerbations become more severe as the degree of sensitization to dust mite and mouse increase. The 2 biggest drivers of asthma severity are an allergy pathway starting with allergic sensitization and an environmental tobacco smoke pathway. In addition, allergic sensitization and blood eosinophils can be used to select medications for management of early asthma in young children. These current findings, among others covered in this review, represent significant steps toward addressing rapidly advancing areas of knowledge that have implications for asthma management. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  3. Mechanisms of Asthma in Obesity. Pleiotropic Aspects of Obesity Produce Distinct Asthma Phenotypes.

    Science.gov (United States)

    Dixon, Anne E; Poynter, Matthew E

    2016-05-01

    The majority of patients with severe or difficult-to-control asthma in the United States are obese. Epidemiological studies have clearly established that obese patients tend to have worse asthma control and increased hospitalizations and do not respond to standard controller therapy as well as lean patients with asthma. Less clear are the mechanistic underpinnings for the striking clinical differences between lean and obese patients with asthma. Because obesity is principally a disorder of metabolism and energy regulation, processes fundamental to the function of every cell and system within the body, it is not surprising that it affects the respiratory system; it is perhaps surprising that it has taken so long to appreciate how dysfunctional metabolism and energy regulation lead to severe airway disease. Although early investigations focused on identifying a common factor in obesity that could promote airway disease, an appreciation has emerged that the asthma of obesity is a manifestation of multiple anomalies related to obesity affecting all the different pathways that cause asthma, and likely also to de novo airway dysfunction. Consequently, all the phenotypes of asthma currently recognized in lean patients (which are profoundly modified by obesity), as well as those unique to one's obesity endotype, likely contribute to obese asthma in a particular individual. This perspective reviews what we have learned from clinical studies and animal models about the phenotypes of asthma in obesity, which show how specific aspects of obesity and altered metabolism might lead to de novo airway disease and profoundly modify existing airway disease.

  4. Indoor allergen exposure and asthma outcomes

    Science.gov (United States)

    Sheehan, William J.; Phipatanakul, Wanda

    2016-01-01

    Purpose of review The aim of the present review is to discuss updates on research regarding the relationship between indoor allergen exposure and childhood asthma with a focus on clinical effects, locations of exposure, and novel treatments. Recent findings Recent data continue to demonstrate that early life sensitization to indoor allergens is a predictor of asthma development later in life. Furthermore, avoidance of exposure to these allergens continues to be important especially given that the vast majority of children with asthma are sensitized to at least one indoor allergen. New research suggests that mouse allergen, more so than cockroach allergen, may be the most relevant urban allergen. Recent evidence reminds us that children are exposed to clinically important levels of indoor allergens in locations away from their home, such as schools and daycare centers. Exposure to increased levels of indoor mold in childhood has been associated with asthma development and exacerbation of current asthma; however, emerging evidence suggests that early exposure to higher fungal diversity may actually be protective for asthma development. Novel treatments have been developed that target TH2 pathways thus decreasing asthmatic responses to allergens. These therapies show promise for the treatment of severe allergic asthma refractory to avoidance strategies and standard therapies. Summary Understanding the relationship between indoor allergens and asthma outcomes is a constantly evolving study of timing, location, and amount of exposure. PMID:27653703

  5. Recent advances in understanding and managing asthma [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Su-Ling Loo

    2016-08-01

    Full Text Available This review highlights the important articles published in the area of asthma research from January 2015 to July 2016. In basic science, significant advances have been made in understanding the link between the innate immune response and type II acquired immune responses in asthma and the role of the airway epithelium. Novel information continues to emerge with regard to the pathogenesis and heterogeneity of severe asthma. There have been important translational clinical trials in the areas of childhood asthma, treatment of allergy to improve asthma outcomes, and improving drug delivery to optimize the management of asthma. In addition, there are increasing data concerning the application of biological agents to the management of severe asthma. This body of work discusses the most notable advances in the understanding and management of asthma.

  6. Sudden death in young persons with uncontrolled asthma--a nationwide cohort study in Denmark

    DEFF Research Database (Denmark)

    Gullach, Anders Juul; Risgaard, Bjarke; Lynge, Thomas Hadberg

    2015-01-01

    BACKGROUND: Asthma is a common chronic disease among young adults, and several studies have reported increased mortality rates in patients with asthma